General health

Dr Marcus Gleave on Male Problems "Downstairs"


Some men are reluctant to come and see their doctor, particularly if the problem is ‘downstairs’.

Here’s a brief summary of some of these (treatable) problems:

Erectile dysfunction/impotence

Happens to almost every man at some point. Common causes are alcohol, stress, tiredness and relationship problems.

If it only happens occasionally it is not something to worry about, but if it is worsening or happening increasingly frequently, it is important to see your doctor. General measures to improve erections and sexual function include reducing alcohol, stopping smoking, losing weight and taking more exercise.In addition there are effective treatments that can be prescribed, the most well known being sildenafil or ‘viagra’.

When you see your doctor for treatment we will also try to determine the likely cause of the problem – it may be psychological in which case you can be referred to a specialist. Erection problems may be due to restricted blood flow to the area, which may require your doctor checking things like your blood pressure and cholesterol. Treatment of these can help with erections as well as being important for your cardiovascular health.

I would advise any man worried about this to come and see us – all of our doctors manage patients with this problem routinely, it is incredibly common and we can offer you really effective treatment.

Premature ejaculation

Also common, especially in younger men or at the start of a new relationship. If it happens to you don’t worry, there are a lot of non-medical strategies that can help, such as masturbating an hour beforehand, using a thicker condom or stopping for breaks during sex.

If the problem isn’t resolving go and speak to your doctor, they may recommend psychological therapy, or there are several medicines that can be helpful.


A lot of men are vaguely worried about their prostate, and most have no idea where it is or what it does! Your prostate is a gland that sits just below the bladder and is wrapped around the urethra – the tube that we pee through. The prostates function is to produce fluid that makes up part of ejaculate.

The prostate is about the size of a walnut, and it often swells a bit as we get older, particularly as men pass 50. Symptoms of an enlarged prostate include more frequent urination – often noticeable at night – difficulty getting going/stopped and a weaker flow.

Men who develop these symptoms should see their doctor for assessment, in most cases the cause is age related swelling which may be managed by watchful waiting, medication or, sometimes, surgery. Your doctor will discuss further testing with you in order to rule out other causes such as prostate cancer.

Overactive bladder

This is common in men and often missed as we tend to rush to blame the poor old prostate for everything! Symptoms of OAB include needing to urinate more frequently (generally passing small volumes), urgency –‘ when you need to go you need to go’ and sometimes leakage of urine if unable to access a bathroom in time. Adjusting the quantity that we drink, reducing alcohol and caffeine, and performing pelvic floor exercises can all be helpful.

Your doctor can exclude other causes such as a urine infection and then talk you through the other management options. These include simple bladder retraining exercises and medications. A few patients require referral to a specialist for more advanced tests and treatments.

I hope you have found this useful! If you have any questions comment below.

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