Hi guys welcome back to my channel, this is Dr. Rena Malik, urologist and pelvic surgeon. On
today's video, I'm going to be responding to your comments, thank you all so much for being a part
of this community asking questions and being engaged because I wouldn't be here without you
guys and I'm so grateful to each and every one of you. For those of you who are new here, I'm a
board-certified urologist who makes video content on urologic education, bladder health, sexual
health, and much much more. If you like what you see make sure you subscribe and share this
channel with your friends also if you want another opportunity to ask questions and get them answered
I am changing the format of my email newsletter, I'm going to be sending out a weekly newsletter
where I answer one or two of the top questions for my last video of the week and that email will show
up in your inbox once a week where you can get answers to the top questions that you guys all ask
so if you're interested in being a part of that please hit the link in the description down below
and sign up the first question i got from cesar garcia asks about the possible side
effects of viagra being an erection that lasts four hours long is that possible well first of
all a erection that lasts longer than four hours is called a priapism and a priapism can be in two
different types it can be an ischemic priapism where the erection is causing a lack of blood
flow to the penis and that's the more common kind of priapism that we see due to things like
taking injections for erectile dysfunction or other medications or there are non-ischemic
priapisms and non-ischemic priapism is actually called a high flow priapism so there's actually
blood flowing in and out of the penis and there's less risk of injury to the penis in the long term
so when you have an ischemic priapism what you'll notice is that you'll have significant pain and a
very firmly erect penis and this erection is not related to sexual interest or stimulation
and that ischemic priapism will be less rigid so it won't be necessarily a very firm erection and
it won't be painful but if you are a person who develops an erection lasting longer than four
hours you must go to an emergency room to figure out if you have an ischemic priapism
because an ischemic priapism is a surgical emergency meaning that it needs to be treated
first we'll try medical options and procedural options and if those don't work we then take you
to the operating room because during this time if you have an ischemic priapism you are causing
damage to the tissues of your penis and if this lasts for longer than 24 hours it's very likely
that you will not have erections or normal erections after this is completed because you've
lost so much blood flow to the penis but to the question about having it after taking viagra it's
actually a very rare event with these medications in fact it only occurs in point one to point seven
percent of people who've taken a medication for erections whether that's sildenafil tildallophil
vardenafil avanafil any of the medications which you may more commonly know as viagra
cialis levitra and so on these are extremely rare as long as you're taking them with the prescribed
instructions given to you by your doctor in fact they did a study looking at medication-induced
priapism and in fact medications for erections like pde5 inhibitors or sildenafil viagra etc
were third most common more common than that or two times more common than that were things
like trazadone which is a sleep medication or an antidepressant and 2.6 times more likely than that
or things like antipsychotics which are used for a number of psychological disorders like bipolar
disorders including clozapine olanzapine risperidone and others bottom line these
medications for erections are very very safe especially if they're taken as prescribed
so the next question is is it really true that a person who is circumcised lasts longer while
having sex than those who are not well so i've done a study before on the benefits and risks of
having a circumcision so make sure you check that out but specifically to answer your question does
it help with what we call premature ejaculation or ejaculating before you're ready for it to happen
and they've done a couple of meta analyses on circumcision they looked at 36 studies with 19 000
men who were circumcised and about 20 000 men who were not and they looked at things like sensation
sensitivity premature ejaculation erections and satisfaction and of all those studies they found
five that looked at premature ejaculation and they had about 7 600 men who were circumcised compared
to about 6 300 men who were uncircumcised and what they found was that there was no significant
difference in the rate of premature ejaculation it was about 24 in the circumcision group and 31
in the uncircumcised group and that was not significantly different in those groups and in all
the other areas they looked at including sexual function sensation pleasure they really found no
difference between those men who got circumcised and those who did not they also found in these
studies that there were people who got circumcised as an adult these were not all people who were
circumcised as an infant who had no comparison these were people who actually went on and got
circumcised as adults is retrograde ejaculation a temporary side effect of this medication which is
an alpha blocker so alpha blockers are medications that are used for people who have an enlarged
prostate if you want to learn more about enlarged prostate i've made a video a complete guide to an
enlarged prostate so please check that one out but essentially alpha blockers work by relaxing the
prostate smooth muscle to allow the urine from the bladder to flow better however because they cause
this relaxation they also cause relaxation in a few other structures including the bladder neck
the vas deferens and the seminal vesicles because of this they can cause ejaculatory
problems and what do i mean by that well they can cause things like decreased volume of ejaculation
they can also cause things like an ejaculation meaning that you're not having any ejaculate or
retrograde ejaculation and what that is is because the bladder neck is relaxed when the
semen is emitted through the ejaculatory duct into the prostate and the urethra it actually
flows backwards into the bladder rather than going forwards out when you reach climax however
the prevalence of ejaculatory dysfunction is different for different medications so tamsilosin
the medication which we give very often also known as phlomax for an enlarged prostate has a three to
eleven percent rate of ejaculatory dysfunction silidosin has an average rate of ejaculatory
dysfunction about twenty percent so what can you do if you're experiencing that yes it is temporary
which is great there have been studies looking specifically at tamsulosin and they found that
reducing the dose or doing it every other day can help with restoring ejaculatory dysfunction up to
90 percent of men and if you are on silidosin you can consider switching to tamsilos or alphazosin
which is another alpha blocker that have lower rates of ejaculatory dysfunction so the next
question is by janie bird which asks if a male urinates on a pregnancy test and the result is
positive do they have prostate cancer well that's not true but there is a cancer to be worried about
if a man has a positive pregnancy test and that is testicular cancer testicular cancer
is relatively uncommon about 1 in every 250 men in the united states developed testicular cancer
in the united states last year also of the about 9 000 new testes cancers that were diagnosed only
about 440 of them resulted in death so testicular cancer fortunately is very very treatable however
let's get back to the question how would it make you p-positive on a pregnancy test well in order
to understand that you need to understand the different types of testicular cancers there are
two major types that are the most common there's things called seminomas or non-seminomatous germ
cell tumors within that non-seminomidous germ cell tumors there are different types of tumors
and one of those is called choriocarcinoma this specific type of tumor has these specific
cells called sinchotrophoblasts which make something called human chorionic gonadotropin
and that's exactly what a pregnancy test tests it looks for the presence of hcg and so if a
man has this very rare type of testicular cancer which is less than one percent of all testicular
cancers they could see a positive pregnancy test however this is extremely rare what i recommend
for all men specifically if you're between the ages of 20 and 40 is to do a testicular self
exam when you're in the shower hold the testicle steady with one hand and using the other hand
palpate all the way around the testicle feel the epididymis which is on the back and lateral side
of the testicle and feel what a normal testicle feels like and feel the other side do it every
month so if you notice any sort of lumps or bumps make sure you don't delay and see your primary
care doctor or urologist right away the number one way that people present with testicular cancer is
having a painless mass a lot of times people will even notice it after having some sort of
trauma to the testes and they just assume that it's from the trauma itself but unfortunately
sometimes we do diagnose testicular cancer so make sure you examine yourself monthly and if
you feel something come in get an exam and get an ultrasound it's very simple very straightforward
and it could save your life all right thank you guys so much for watching make sure you
sign up for my email list down below if you want to be on the email where i answer your questions
thank you guys so much and always remember to take care of yourself because you're worth it