Dr. Stephen G. Bennett, MD

Medication can relieve mild to moderate symptoms of BPH, such as frequent urination, incomplete bladder emptying, a weak urine stream, and straining while urinating. However, other forms of treatment may be more appropriate if an individual has pain with urination, frequent urinary tract infections, or is unable to urinate. The size of the prostate and the severity of their symptoms will determine the type of treatment they need. If the prostate is not very large, doctors will likely recommend a transurethral procedure. This minimally invasive technique involves the insertion of a scope into the urethra. The most common transurethral procedures for BPH are:

• Transurethral incision of the prostate or TUIP, where the surgeon uses the scope to make small cuts in the area of the prostate that meets the bladder. These cuts will open up the pathway for urine and allow it to flow with more ease.
• Transurethral needle ablation or TUNA, where needles are inserted through the scope and into the prostate. The needles use radiofrequency waves to destroy excess prostate tissue.
• Laser prostate ablation, where lasers pass through the scope to melt away the part of the prostate causing urine blockage.
• Transurethral resection of the prostate or TURP, where the inside of the prostate is trimmed and removed one tiny piece at a time using the scope.

If the prostate is too big for a transurethral procedure, an individual may need a simple prostatectomy, which can be done in one of three ways: laparoscopic, robotic, or open. During a laparoscopic simple prostatectomy, a surgeon makes several small incisions on the belly. Then they insert a long tube with a camera into one of the cuts and surgical instruments into the others. Using the camera to see inside the belly, they carefully removes the enlarged part of the prostate. Robotic simple prostatectomy uses the same techniques as the laparoscopic method, but the surgery is done with the help of a robot. For men with very large prostates, open simple prostatectomy may be the best treatment option. This surgery differs from the other approaches in that it requires a much larger incision.

Most transurethral treatments for BPH, like TUIP, TUNA, and laser prostate ablation, are done in the doctor's office or outpatient surgery center. TURP and simple prostatectomy, however, need to be performed in the hospital and require an average stay of one to three days. Patients should wait a week before doing any strenuous activities after a TUIP, TUNA, or laser prostate ablation, and about four to six weeks after a TURP or simple prostatectomy. Although these treatments improve BPH symptoms for most patients, it is important to be aware of the risks involved, such as urine control issues, tightening of the urethra, and erectile dysfunction.

During the procedure, the surgeon inserts the laparoscope, which contains a light and camera that allows the surgeon to see what is happening inside the body. Then tiny tools are placed through the small openings and used to perform the surgery.

The most common laparoscopic surgery is gallbladder removal, but laparoscopic surgery may also be used for the removal of a kidney or appendix, to treat certain cysts and tumors, for bariatric surgery, for some GERD treatments, or for hernia repairs, among others.

Because laparoscopic surgery only uses a few tiny incisions, the scars are minimal and recovery is easier than with open surgery.

Sexual intimacy disorders are those that cause problems with the act of sexual intercourse, such as erectile dysfunction or vulvodynia. Erectile dysfunction, the inability to get or maintain an erection hard enough for sexual intercourse, is extremely common. It affects fully half of men over 40 to some degree. It is treated with medications, devices, or surgery. Vulvodynia, burning pain in the vulva that can be made worse with sexal activity, has no known cause. It is treated with oral or topical medications.

Sexually transmitted diseases, including HIV/AIDS, herpes, gonorrhea, and chlamydia, are bacterial or viral infections that are contagious in the bodily fluids exchanged during sexual contact. Barrier methods of contraception, such as condoms, help prevent the spread of STDs. HIV is a virus that can be caught from an infected person's sexual fluids or blood. When the virus infects the body, it interferes with the immune system and causes the disease known as AIDS. There is no cure, but anti-viral medications can help people with AIDS live a long and healthy life. Herpes is also a virus found in sexual fluids, called HSV-2. It causes blisters that come and go on the genitals. There is no cure for herpes, but anti-virals can minimize outbreaks. Gonorrhea and chlamydia are both bacterial infections. They are extremely common and often have no symptoms. The most common signs of an infection are burning pain and discharge. Gonorrhea and chlamydia can be treated with medications.

Reproductive health refers to both contraception and infertility treatment. Contraceptives prevent and plan the timing of pregnancy. Some, such as a vasectomy or tubal ligation, are extremely effective at preventing pregnancy. Others, such as spermicides, are less reliable. Popular contraceptives include condoms, birth control pills, IUDs, and diaphragms. On the other side of reproductive health, infertility is the inability to carry a pregnancy to term after one year of trying. It can be due to problems in either the man or the woman, and both genders are affected equally. In total, about 15% of the population suffer from infertility. Infertility treatments include medications and surgery.

Gay and transgender people have a few specific health care needs that may sometimes fall under the sexual health umbrella. First, many LGBT people still face discrimination from healthcare providers, so providing supportive and appropriate care is an issue. Because of social attitudes surrounding sexual orientation and gender identity, many gay and transgender people struggle with their identities. Rates of depression, substance abuse, and suicide are all higher in this group. Providing mental health support and counseling to those in transition is critical. Finally, transgender patients who are undergoing gender affirmation require sensitive medical health care, including surgical and hormonal treatment.

Sexual violence can be defined as any unwanted or non-consensual sexual activity. It ranges from sexual harassment to touching to rape. It affects women more than men and is widespread: 1 in 4 women report being victims of sexual violence at the hands of a partner, and as many as 1 in 3 girls report their first sexual contact as being violent. Sexual violence has lasting physical and emotional consequences for victims, but educating both girls and boys can prevent violence. Care for those who have endured sexual violence includes counseling and mental health support, medical care, and legal support.

Sexuality is more than a reproductive requirement -- it is a form of expression and identity. Sexual health blends all these aspects of experience together and helps people lead sexually fulfilling lives.