Common Male Genitourinary Issues

Men’s health concerns often arise in visits centered around other issues. A discussion about lipid levels can quickly become a discussion about erectile dysfunction. Topics such as pelvic pain, urinary symptoms, fertility, and prostate health may be sensitive, private, or culturally taboo, making it difficult for patients to raise them as chief concerns. These issues affect quality of life and long-term health, and we want to be able to handle them when they do come up.

This edition of FP Essentials offers accessible, practicerelevant frameworks for approaching men’s health problems that are sometimes complex. Chronic pelvic pain syndrome, for example, is often multifactorial and requires attention to physical, psychological, interpersonal, and social contributors. The authors recommend useful in-office tools to guide history taking and monitor treatment effectiveness. Decisions around prostate cancer screening truly require individualized counseling. This edition provides information about navigating multiple and sometimes conflicting guidelines while assessing individualized risk and preferences.

Section One reviews chronic prostatitis/chronic pelvic pain syndrome, with an emphasis on a structured evaluation and an interdisciplinary approach to management when symptoms do not fit neatly into a single diagnosis. Section Two focuses on benign prostatic hyperplasia and overactive bladder, addressing lower urinary tract symptoms from initial evaluation through assessment of treatment effectiveness. Section Three covers family planning in men, including contraception counseling and infertility evaluation. Section Four examines prostate cancer, with attention to screening recommendations, risk stratification, and the approach to shared decision-making, as well as risk-tailored treatment options.

I suspect many readers will recognize these concerns and the difficulty that some men have with bringing them up. This edition also makes clear the potential benefit to addressing these concerns. I hope you find this edition of FP Essentials useful in your practice.

Kate Rowland, MD, MS, FAAFP, Associate Medical Editor
Vice Chair of Education and Associate Professor
Department of Family and Preventive Medicine
Rush University, Chicago, Illinois

Gretchen Irwin, MD, MBA, is a professor and chair of the Department of Family and Community Medicine at the University of Kansas School of Medicine-Wichita. She has served in multiple educational roles including as the clerkship director for the required third-year family medicine clerkship; program director for the University of Kansas School of Medicine-Wichita Family Medicine Residency at Wesley Medical Center; and associate dean for graduate medical education and ACGME (Accreditation Council for Graduate Medical Education) Designated Institutional Official for the University of Kansas School of Medicine-Wichita. Dr. Irwin has presented at national conferences and authored more than 15 publications related to men’s health.

Joseph Jenkins Saffold, MD, is an associate professor in the Department of Family and Community Medicine at the University of Kansas School of Medicine-Wichita. He teaches residents full time at the university’s Family Medicine Residency at Wesley Medical Center. He has served as the medical student liaison and education committee chair for the residency program. Dr. Saffold has presented at regional conferences and currently is a member of the Kansas Academy of Family Physicians board of directors.

Author disclosure: No relevant financial relationships.