Ever wondered why your pee stream isn't straight? You're not alone! In this AMA, Dr. Rena Malik dives into the surprising reasons ...

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Why Your Pee Stream Isn’t Straight - Circumcision Pros &amp; Cons | AMA

welcome back to ask me anything this is our episode where we answer our subscriber questions Our member questions if you're interested in becoming a member so your question can be answered make sure to check us out at supercast ral.com so you can ask your questions get early access to our podcast episodes as well as transcripts from the podcast without further Ado let's get to it all right first question let me just say upfront I am not asking this for any philosophical or religious reasons I'm a 45-year old man and uncircumcised I do wonder if there are any benefits to me getting a circumcision for medical reasons what are perks of getting one and what are some negatives so circumcision is a surgical removal of four skin on the penis sometimes it's done for religious purposes sometimes it's done for personal preference reasons but ultimately as an adult what are the reasons that men undergo circumcision so there's a few one can be if you're getting recurrent episodes of balanitis or infection under the for skin that you know you're struggling with so that often can be a sign that getting a circumcision would alleviate that problem and you wouldn't have further risk of infections that's one two is if you're getting fimosis so fimosis is where you're unable to retract the foreskin now this is not inherently dangerous but over time if you're unable to retract the foreskin you can't see underneath it there's also a increased sort of smma formation inflammation those those sorts of things which can put you at a slightly higher risk for something like penal cancer now penal cancer is very very rare but ultimately it is something that we want you to be able to look at your glands and the TIY of your penis and make sure there's no signs of changes or abnormalities on the penis and so when you have fimosis that can limit your ability to do that also sometimes when you have fimosis it can be painful because the penis can have pain when getting erect particularly if you find yourself being in the camp of Growers you might know notice that it's actually uncomfortable because your glands is stuck behind the foreskin and it makes getting an erection a bit painful and for those reasons you may want to get a circumcision another condition that might put you make you consider a circumcision is something called lyan sclerosis this is a skin condition that results in changes of the skin to leave the sort of whitish patches on the skin that make it sort of sometimes it's painful sometimes it may make it look anesthetically pleasing sometimes it can cause difficulty with urination if it's on the tip of the penis but what it involves the for skin sometimes doing a circumcision can be Curative or at least improve the condition altogether so there are reasons to do it in terms of General reasons people do it as a whole is it can reduce the risk of STI particularly HIV and so that's another reason that sometimes people consider getting a circumcision now in terms of benefits of a circumcision benefits are basically you're alleviating those issues I talked about right so you're going to have an EAS you're not going to have to worry about retracting your foreskin you're going to be able to see under your foreskin you're at lower risk for both balanitis and sexually transmitted infections and for some people when they're having pain with sex they actually find that their sex life is significantly better after getting a circumcision because they're no longer dealing with this pain in terms of risks what people really worry about is what is going to change my sexual experience and it's going to particularly change my sensation now after you get a circumcision as an adult for the first you know 1 to 3 months you are going to have changes in sensation right because you've had four skin covering the head of your penis for your entire life and now all of a sudden we've removed that and your your glands or your head of your penis is exposed to your boxers or your underwear and so people will feel hyp sensitive during that first healing period that usually improves over time they've done some large trials looking at adults who've undergone circumcision and compared their sexual function before and after circumcision and what they found was that there was really no significant difference in sensation in ejaculation in erectile function in the presence of premature ejaculation any of those things there was really no significant difference and so that's really reassuring in saying hey we're looking at this large population of people and we're not seeing a difference now I want to be thoughtful because there are people who really do feel like they're sensation changes or they've had changes in in F sexual function after circumcision and that is a totally valid and real experience so the risk is that yeah could you have an experience that's not typical yes absolutely could you have hypers sensitivity that persists potentially but really the biggest thing that I see is that people are a little bit dissatisfied with the way their penis looks you get very used to looking at your penis a certain way and when you get a circumcision it drastically changes the way your penis looks particularly if you have a lot of for skin and so that can lead to dissatisfaction so ultimately I recommend getting one if you have any of those conditions and if you've really seriously thought about the risks and benefits while it is a pretty straightforward procedure and the risk of having a side you know an injury or an UNT complication is very low it is still a procedure and even if the risks are low if something happens to you it happens to you and your experience is valid and important so bottom line if you want a circumcision for any of the reasons I've talked about it's absolutely indicated if you want one for you know cosmetic reasons that's also fine but again just be well informed talk to your physician make sure you understand what your experience is going to be like after the circumcision and how it's going to take place one last thing a lot of times we'll do this with patients awake in the office because we can numb the penis quite well and you don't have to undergo anesthesia so that's another important thing to talk with your doctor about if they do that in the office or if they take you to a surgery center and what your preference might be so talk to your doctor about that talk to your doctor about what to expect after the circumcision and you know their personal experience during circumcision and how they handle it and make sure you're fully informed before you proceed with any surgery all right next question when I was in my 20s I would get turned on by my boyfriend and it felt like a rain shower was in my pants that's how it turned on I would get exclamation point But now that I'm a 50-year-old happily married woman I'm noticing the plumbing isn't the same I still love my husband to death but my downstairs doesn't do the same rain shower like it used to sometimes I feel guilty because quote is my body saying I am not attracted to my man end quote what can I do to improve this or can I expect it to turn into a desert down there when I get into my 60s great question so one I think you know it is very normal experience for a lot of women to experience changes in lubrication after menopause now menopause average age is 51 and that means that half the people will hit menopause before 51 and half people will have menopause after 51 and so what happens during menopause and how do you define it first that is not having a period for 12 months so the absence of menstruation for 12 months equals menopause but that doesn't mean your symptoms just start around then they can start as early as four years four to seven years before menopause and then they will continue particularly when it comes to what we call the genitor urinary syndrome of menopause so what is that right that includes this dryness that this person is experiencing so when you undergo menopause what happens is your estrogen drops very very low and so what that means is that you no longer have estrogen activating The receptors in your vulva and vagina and that leads to a decrease in lubrication it also leads to shrinkage of the labia manur or the inner lips of the vulva it also leads to sort of sometimes shortening of the urethra it may also cause changes in the clitoral hood or the covering of the clitoris as well as the clitoris itself and importantly here the lining or the skin of the vagina changes it becomes more thin potentially more Frable and it makes less lubrication and the cause of this is hormonal and so this can happen very very commonly and the thing about it is unlike hot flashes which last for up to 10 years during menopause and then go away this doesn't happen with these symptoms for lack of of estrogen the genital urinary syndrome of menopause continues throughout your as you age and sometimes can get worse and so sometimes what you'll see is that you're fine you're fine all of a sudden you're noticing some dryness you can also notice that you're developing recurrent urinary tract infections and this can be very easily treated all of these things can be very easily treated with vaginal estrogen which is very safe and effective vaginal estrogen is essentially using topical hormonal cream depository or ring in the vagina that creates more estrogen in those tissues only a very tiny amount gets systemically absorbed into the bloodstream so most of it just stays local in those tissues and it can help reduce that discomfort if you're having pain with sex it can help increase lubrication and it can help with just generally keeping the health and nourishing those tissues over time it is very very safe it is very effective there's very few contraindications to vaginal estrogen really only if you've have active breast cancer is vaginal estrogen contraindicated otherwise if you've had breast cancer in the past or you've had blood clots or any other issues that you might be concerned about vaginal estrogen is completely safe and effective so that's one way and the other thing I want to point out here is that while menopause is a very well understood time of low estrogen there are other times in life where you might notice that you have less estrogen one being if you're lactating so you just had a baby and you might be breastfeeding sometimes with certain medications that can mess with your hormonal milu and cause decrease estrogen and so the amount of lubrication you make is not always indicative of how aroused you are how turned on you are with your partner so I want you to be reassured and reassure your partners and all the men who are listening that if your partner's going through an time of low estrogen and their lubricant is less that doesn't mean that they don't like you it just means that they they are having a hormonal change right and that can be treated the other thing is obviously use lubricant I can't say this enough lubricant should be used by everyone it is safe makes sex more fun more pleasurable and I've made videos about lubricant I'll make sure to link those in the description in the show notes so you can check those out but essentially try them you will find that it will enhance your sexual experience and make things more fun so no fear you may you uh might be going through some menopause but um if you still love your husband that's a good thing next question what's the difference between a you UTI and prostatitis I a dude and I always thought only women get UTI um my older brother has prostatitis and he had to have catheters put in him but I had to go to the ER recently and I thought it was going to be prostatitis too cuz it hurt when I tried to pee but the nurse practitioner said it was a UTI is there a difference between a UTI and prostatitis like this this question of a men getting a UTI for for some reason there's a myth out there that men can't get UTI I've seen this in other comments so what do you what do you say What's the difference between UTI and prostatitis and what are they yeah absolutely so prostatitis is defined as the inflammation of the prostate right and so you can have infections that arise from the prostate which is acute or chronic bacterial prostatitis but you can also have nonbacterial causes of prostatitis now now what is prostatitis right it is a discomfort or pain that is attributed to the prostate which is in the pelvis that lasts for some period of time now when it's acute it's very acute onset it's usually with high fevers pain sometimes difficulty urinating and usually during that time you'll need antibiotics when you have chronic proost bacterial prostatitis that is usually lasting for about 6 weeks or more and that is again when you have these symptoms you might not have fevers but when you're when we do an evaluation we find that there is signs of bacterial infection and then UTI urinary tract infection is an infection arising from the urinary tract so the source can be the bladder the kidneys most commonly the kidney stones or bladder issues or incomplete emptying of the bladder which happens to men a lot and I'll explain but basically there're two different sources of infection sometimes but they can be somewhat similar in how they present so Force simplicity s let's just talk about bacterial prostatitis versus UTI so bacterial prostatitis is when you have bacterial infection of the prostate now this is typically figured out because either you have very clear signs and symptoms of prostatitis like an acute bacterial prostatitis and we treat you without a prostate exam because we don't want to examine the prostate and cause that bacteria to then translocate or get into the blood stream and cause you to get very very sick and so those are very sort of typical signs and symptoms that we see and we treat you for the the prostatitis now if you have chronic bacterial prostatitis and a UTI and you can't tell most of the times we'll examine you with a prostate exam often times if your prostate is tender meaning when we do the prostate exam it hurts that likely that it is prostatitis we also can do sort of a post prostate massage urine collection to see if we find any bacteria in the urine but a UTI would be just collecting urine and assessing for a urinary tract infection now the UTI is typically present with simp symptoms of bladder pain pain with urination going more urgently going more frequently sometimes you might have pain in the kidneys or flank pain sometimes you can get fevers things like that when you have prostatitis it's typically pain in the pelvic region that's the symptom that you're having most often pain in the pelvic region sometimes it can cause pain with urination sometimes not but it's mostly pain in the pelvic region men can get UTI so as I mentioned before why do men get U the most common reason is because are not emptying their bladder completely and that's because of an enlarged prostate now if you're new to this podcast or this channel I have talked about BPH or enlarg prostate so many times and I will share a bunch of videos where I've talked about BPH so you can learn more about it but essentially an enlarg prostate is very very common if you look at 80-year-olds 80% of them will have an enlarged prostate and when you have an enlarged prostate it essentially decreases the flow of urine out from your bladder and sometimes makes it more difficult to empty now when you have urine sitting in the bladder that doesn't empty that becomes food for bacteria which puts you at higher risk for UTI and so in those cases we treat the UTI both UTI and bacterial prostis are treated with antibiotics but then we essentially want to investigate what's going on is this caused by incomplete emptying or might there be something else like a kidney stone and so we do an investigation and if we find that it's from an enlarged prostate then we try to treat that issue or help you empty your bladder better so you stop having UTI but to answer your question UTI are not just for women men get them too they get them less commonly because they have a longer urethra than women but they do get them in these circumstances where maybe they're not emptying their bladder completely or if they have neurologic conditions that they may need to catheterize or other issues like that all right next question I can't seem to pee straight anymore I can't even remember when this started but when I used to have a nice dream with decent name now I just have p and it goes all over the place even if I hold a penis in the direction of the toilet I don't think I had any kind of injury cuz I have no symptoms like pain but the stream is wacky all right well let's see what what to do for this wacky stream wacky stream so this is more common than you'll realize and there's a few reasons so one you said injury he mentioned injury in his question stem so sometimes you can get what's called a urethral stricture or narrowing now now this can happen due to some sort of injury or if you've had a procedure Urologic procedure and you had some scarring in the urethra sometimes that can be a cause if you've had a sexually transmitted infection for a long period of time that wasn't treated you can develop urinary strictures and so if you develop a Ural strcture it's essentially like think about you're using a hose when the hose is wide open the stream from the hose is straight but when you put your thumb on it because there's a stricture right that's basically a stricture the stream goes all over the place so very similarly if you have anything blocking the flow of urine it will cause your stream to go wacky and so in this case it it's probably not a eral strcture but you do want that's on the differential mean that's one of the things that could cause it it can also be caused by an enlarged prostate and so when you have an enlarged prostate that blocks the flow of urine which can cause sort of a wacky stream the other thing is sometimes if you have just recently ejaculated you can have some leftover remnant semen in the urethra or the P tube and that can function the same way it can cause turbulence when the urine flows making the stream go wacky now it's not dangerous right it's not dangerous if your stream is wacky it's just more of a nuisance so if you but if you are bothered by it absolutely see your urologist so we can assess and evaluate which of these things might be causing your stream to go arai and we can address them and hopefully help your urine stream improve thank you guys for joining us on today's episode of the AMA if you want to hear the rest of this episode make sure to sign up for our premium membership at renam malik. supercast docomo here because we love being able to give you educational content and this is a great way to support and we appreciate you so much and as always we're going to take care of yourself because you're worth it

Dr.

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