Urological and Sexual Health IE - Q4 2023

Urological and Sexual Health Q4 2023 | A promotional supplement distributed on behalf of Mediaplanet, which takes sole responsibility for its content

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To end AIDS, let communities lead and power progress

Unapologetic and candid: the power of words in smashing sexual health stigma

Human immunodeficiency virus (HIV) transmission rates are now beginning to fall in Ireland compared to 2019 levels.

Sexual health has a long history of stigma and shame, in part because of how we do — and don’t — talk about it.

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ccess to treatment for people living with HIV in Ireland is increasing. This treatment enables people living with HIV to have long lives and prevents onward transmission. Around the world too, while the job is not yet done, the HIV response has secured remarkable gains.

Tackling stigma and facing HIV with pride Crucial to progress has been tackling stigma. Stigma keeps people away from prevention, testing and treatment. Tackling stigma saves lives and transforms people’s quality of life. I’m proud to be part of a growing movement highlighting that people living with HIV can not only survive, but we can also thrive.

This medical condition is no reason to be ashamed. As I have found, the experience of living with HIV doesn’t make you unlovable, it is just one extra thing that someone is going to love about you and you’re going to love about yourself. We are tackling the epidemic of silence. The momentum is palpable in Irish society and globally.

For the AIDS response to succeed, let communities lead.

Supporting communities for HIV breakthroughs Communities of people living with HIV, and those at risk of HIV, are powering progress.

All these achievements take our time, our expertise and our energy. That is why it is so vital that communities are fully supported; we require more than just being granted a seat at the table; we need authorities to enable us to lead — and we need to be resourced for the work that we do. The most important lesson is this: for the AIDS

Robbie Lawlor launched this year’s UNAIDS World AIDS Day report, together with the Executive Director of UNAIDS Winnie Byanyima at an event in the UK: Let Communities Lead in the fight to end AIDS | UNAIDS

Robbie Lawlor Community activist and Co-Founder of Access to Medicines Ireland

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believe in advocating for loud, unapologetic and candid use of language to empower men and women.

The normalisation of sexual health can reduce the stigma associated with it and encourage individuals to embrace it as an integral aspect of overall health and wellness.

Impact of sexual health language and words When it comes to discussing our sexual health, the silence is deafening. A lack of education about our vulvas, vaginas and penises has led to a generation that is confused, embarrassed and unsure of their bodies. The impact of this ‘hush hush’ culture is having devastating health consequences; for instance, 35% of women report not attending routine cervical screenings, asserting embarrassment as their main reason.

Barriers to breaking the silence This silence is catalysed by advertisement laws, which have made it nearly impossible to discuss sexual health online. The word ‘vulva’ sits among 40 others that lead to shadow-banned content across social media, which means the content — including the word — is likely to reach fewer people. This doubles the chances that those looking for answers may resort to pornography for information, which is often unreal, unfair or misleading.

There has been positive progress with the likes of the Centre for Intimacy Justice and others campaigning for change to social media policies. Following such activity, last year, Meta announced changes to its sexual health policies. However, several brands are still reporting shadow banning for content specifically surrounding women’s sexual health.

Influencing change in sexual health stigma There is clearly a way to go in undoing the stigma around sexual health. For healthcare providers, the priority should be to ensure patients feel safe, confident and empowered to discuss any sexual health issues they may face.

For governments, it is to ensure all young people have access to accurate, comprehensive and informative sexual health education. For you and me, it might be as simple as starting to talk about our experience with our sexual health. Let’s call

Rebecca Baldwin Portfolio Director, Women’s Health Innovation Series

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Urinary incontinence treatment and management options beyond pads People who suffer symptoms of urinary incontinence are encouraged to seek out a range of approaches that could help ease their condition.

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rinary incontinence can be effectively treated, rather than simply managed with incontinence products and pads.

Lifestyle changes, physiotherapy, medical interventions and surgical devices are options that can make a significant difference.

James Forde Consultant Urologist

WRITTEN BY Mark Nicholls

Types of urinary incontinence James Forde, consultant urologist at Beaumont Hospital and Blackrock Clinic in Dublin, says urinary incontinence is a common problem, affecting men and women, with two main types: (1) stress incontinence, where people experience a loss of urine during exertion; and (2) urge incontinence, which is involuntary leakage of urine and associated with an overactive bladder.

Overactive bladder factors Studies have shown that it affects about 12% of the population; around 350,000 people over the age of 40 in Ireland have overactive bladder symptoms. Forde, who has a specialist interest in voiding dysfunction says: “Overactive bladder is a condition where people experience urinary urgency, which is a compelling need to pass urine and is associated with increased urinary frequency when you void more frequently than normal.

“A lot of patients suffer in silence or are embarrassed and do not like to tell anyone about it. Nocturia, waking up during the night to go to the toilet, is also associated with urinary incontinence.”

Spread paid for by Medtronic

Conservative incontinence management Forde underlines the importance of raising awareness and urges people to talk to their GP or healthcare professional if they suspect a problem. “They may rule out conditions that are making incontinence worse — such as infections or other medical conditions — and, from there, recommend conservative management options that can improve everyday quality of life,” he adds.

Conservative options for an overactive bladder can be as basic as patients detailing their fluid history — such as if they consume a lot of caffeinated drinks, which can be bladder irritants — or physio such as pelvic floor exercises to train their bladder and reduce overactive and urinary incontinence symptoms.

“We ensure patients maximise all conservative options prior to starting them on medication because, in certain cases, conservative management can be more effective than medication,” Forde continues.

Surgical interventions for incontinence For those not improving with medication, surgical options such as botulinum toxin (botox) injections into the bladder can be effective at slowing down bladder activity.

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1 A variety of therapies are available to treat incontinence.

Quality of life can be restored with the right medical treatment.

Up to 80% of patients report a significant improvement with botox. Though, there can be side effects with some patients (around 10%) having trouble emptying their bladder or developing a urinary tract infection.

Another type of surgical treatment that has increased in popularity is sacral neural modulation, developed by companies such as Medtronic, for overactive bladder patients with urge incontinence.

Forde explains: “That involves inserting leads through the lower back, which produce an electrical current that helps modulate or slow down the activity of the bladder and can be a very effective technique. About 70% of patients see an improvement.” The treatment is a longlasting solution, aided by prolonged battery.

Seek advice to get effective treatment In cases of stress incontinence, there are also various procedures and surgical interventions that can help. These also start with conservative management techniques and physiotherapy.

Forde’s overarching message to people who have, or fear they have, urinary incontinence issues is that they should not be embarrassed to seek advice and treatment. “There are lots of treatment options available, including very successful conservative management techniques that we build on to try and improve patients’ quality of life,” he says.

With well-established guidelines and pathways with suitable, safe and effective treatments, there are a range of options — beyond continence materials and pads — that can effectively address urinary incontinence.

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A journey to better health 5

If you've noticed changes to how you think and feel that concern you, talk to your GP about them.

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In the first instance, they may recommend changes to what you eat and drink. Other lifestyle changes may be encouraged, including: weight loss and stopping smoking. You may also be directed to other information sources e.g. the CONfidence app.

3 If the conservative efforts above do not work for you, then you must return to your doctor to find an alternative treatment. This might include incontinence medicine.

4 Your GP may refer you to a specialised team for further tests and treatment options.

Continue to maintain a healthy lifestyle. Treatment options include: • Supervised pelvic floor muscle-training / physiotherapy • PTNS: stimulation of a nerve in the lower leg • Alternative incontinence medicine • Sacral neuromodulation: pacemaker for bladder/bowel

There are other options available and you may be able to discuss these with your hospital.

• For Faecal incontinence: f anal irrigation (washout), a colostomy • For stress incontinence: slings made out of a surgical mesh that restore the normal anatomy of the bladder • For overactive bladder symptoms: botox injections every few months

6 Continue to seek help from your doctor if you have still not found the right treatment for you.

How life-changing bowel incontinence treatment ended my 25 years of suffering Bowel incontinence, also known as faecal incontinence, is an inability to control one’s bowel movements.

However, effective solutions now exist.

Patient Story Medtronic

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hroughout early life, I was misdiagnosed with ‘diarrhoea predominant IBS,’ and I lived with this diagnosis for 25 years. I would have catastrophic episodes of incontinence. It only got worse.

It was only when I went to a specialist hospital, that I got the help I needed. However, even with the wonderful care I had, there was no attention to looking after the psychological effects.

I had the Interstim II fitted and had that for seven years.

Unfortunately, it ran out of battery just as the pandemic hit. I was back to square one for nine months and had to go back to adult nappies. It was very emotionally distressing.

Psychological impacts of bowel incontinence Every time I lose control of my environment, the panic attacks would begin; the adrenaline would flow; gut motility When I was finally would increase. I would have no control over my bowel functions. It’s willing to talk about it, More advanced solution to bowel life-altering, and people suffer from it incontinence I felt liberated. It affects When I finally had the operation, for years because no one wants to talk about it.

I opted for the latest rechargeable your social life; sexual When I was finally willing to talk about microdevice (InterStim Micro). It life; mental health — it, I felt liberated. It affects your social allowed me to get full-body MRI scans, life; sexual life; mental health — every and the battery lasts up to 15 years. It every element of life. element of life. The panic attacks could can completely stop bowel urges. be severe. That doesn’t disappear as The previous one gave me more time. soon as you put in the SNS (sacral nerve stimulator).

This second one gave me control. This treatment gave me back my life. Currently, there is a new recharge-free battery Journey of seeking help for incontinence: ups and downs available. I’m pleased to know there are options I can I have had two stimulator devices (also known as sacral choose from when it comes time for a battery replacement. nerve stimulation) fitted. Before that, I had seen several More patients and healthcare providers should be more GPs and three good gastroenterologists, but they didn’t aware of the success of finding the right treatment. seem aware of the life-changing treatment available.

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Scan the QR code for much more information about all forms of incontinence.

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Low testosterone in men: who is at risk and how to handle it Late-onset testosterone deficiency (TD) is a deficiency of testosterone in men as they age. It is a hormone disorder in men, like others such as type 2 diabetes.

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estosterone deficiency can lead to a range of signs and symptoms that can significantly affect quality of life. TD is also a risk factor (meaning, it can put you at a higher risk) for type 2 diabetes and osteoporosis, among other conditions.

Testosterone deficiency risk factors and characteristics It is important to note that if you have some pre-existing conditions or risk factors for disease, your risk for low testosterone is higher. Some of the most common conditions associated with low testosterone are obesity and type 2 diabetes. Certain medications and illicit drug use can also lower testosterone. As a result, it is important to make sensible lifestyle choices to reduce your exposure to these risk factors.

The testosterone molecule acts on receptors called androgen receptors that are all over the body. These receptors are responsible for developing and maintaining male characteristics as well as regulating mood, and they also play a role in metabolism and sexual function.

Signs and symptoms of testosterone deficiency The three most common signs or symptoms relating to low testosterone are low libido or sex drive; loss of early morning erections; and erectile dysfunction. These symptoms rarely travel alone, and below are the other common associated symptoms with testosterone deficiency.

Physical: Fatigue; loss of muscle tissue; increased weight around the midsection.

Psychological: Increased anxiety; lower mood; loss of concentration.

Typically, a middle-aged man may present with low mood or increased anxiety. On further questioning, he may reveal a history of reduced libido or the inability to maintain erections. Sometimes, we accept these things as ‘I’m just getting on,’ and as a result — without prompting — it may never have crossed his mind to mention such symptoms or ask for help.

If you have any of these signs and symptoms which are suggestive of low testosterone, please speak to your GP who may be able to help you, and visit testosteronedeficiency.ie for more information on the condition.

Dr Emmett Byrne, GP with A Special Interest in Men’s Health, Dublin

Paid for by Besins Find out more at besinshealthcare.ie

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Why the first step to erectile dysfunction treatment is talking about it Professor Eamonn Rogers Chair, EAU Patient Office

Patient-physician communication is the foundation of erectile dysfunction treatment. Yet, the public is barely aware that there is a conversation to be had.

Find out more: urologyweek.org/ content/uploads/PressRelease_ED_2020.pdf

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rectile dysfunction (ED) is a condition Erectile dysfunction and patient engagement that over half of men over the age of 40 The lack of awareness around ED is a key example experience, though only a minority can of the importance of patient engagement in the even define what it is. This alone should treatment process. ED has a tremendous qualityraise alarm bells, but the cause behind this lack of of-life impact on patients, leading to greater knowledge is not surprising. reported stress and anxiety, but the taboos and Many find the topic of erectile dysfunction stigma around ED lead men to avoid seeking help. to be a taboo subject and avoid speaking about Less than a third of patients spoke to their partners it when relevant. This lack of attention, and about their struggles with ED, and a quarter never thus awareness, leads to spoke to anyone at all, including worse symptoms and longer a doctor. periods of suffering than if Less than a third of those experiencing EDs were Awareness and communication are patients spoke to their key to treating ED empowered to speak to a doctor.

Engaging patients with partners about their Awareness of ED found to be educational tools and direct struggles with ED, and communication are key to alarmingly low In a 2020 pan-European study of a quarter never spoke breaking through the taboos over 1,000 individuals, only half surrounding men’s sexual health. to anyone at all, of respondents could correctly If patients don’t know that they identify the definition of erectile aren’t alone, don’t know that including a doctor. dysfunction. Research found their symptoms are the result of that 52% of men aged 40–70 a medical condition and don’t experience ED, making this lack of awareness a know that treatments are available to them, why cause for concern. would they communicate their struggles?

Furthermore, respondents did not know how Physicians need to proactively communicate with common the condition is, greatly underestimating their patients about ED. We, as a society, need to its prevalence. This lack of knowledge and patient break down the taboos around ED; and men need communication further contributes to the isolation easy access to educational tools to inform them people may feel when struggling with ED. The about such conditions and treatments. reality is: ED is treatable for most patients, and yet, one in four respondents had never heard of any of the listed treatments for ED.

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Prostate cancer treatment can be very invasive and can leave patients with lifelong residual issues.

Why prostate cancer care pathways must prioritise sexual function Support groups play a critical role for prostate cancer patients dealing with sexual function challenges post-surgery or radiation therapy, as emphasised by clinicians and patient advocates.

S Associate Professor David Galvin Consultant Urologist, Mater Misericordiae and St Vincent’s University hospitals, University College Dublin. Principal Investigator IPCOR and PRAISE-U

Martin Sweeney Prostate cancer patient and patient advocate WRITTEN BY Mark Nicholls

urgery or radiation therapy can have a lifelong impact on urinary, bowel and sexual function, but clinicians and patient advocates stress that there is support available to help men address this and improve their quality of life after having prostate cancer.

Prostate study on sexual impact In Ireland, the Irish Prostate Cancer Outcomes Research Programme (IPCOR), funded by Movember, assessed the quality of life impact on men with prostate cancer. It compiled a database of nearly 900 men from 16 hospitals, gathering information on the effects of diagnosis and treatment on sexual, urinary and bowel function.

Principal investigator David Galvin says the study found that less than 10% encountered long-term difficulties with urinary or bowel function, but men reported a massive impact on sexual function.

Professor Galvin, Consultant Urologist and Associate Professor at Mater Misericordiae and St Vincent’s University hospitals, University College Dublin, says: “When a man cannot perform sexually, it has negative consequences on every aspect of his life and his relationships, confidence and selfesteem. It can impact on his state of mind as well.”

Support groups in recovery process Professor Galvin underlines the

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importance of support groups in helping men and their partners adjust to the changes. “It is about making sure men have access to that support — and having it delivered at a timely point in their recovery and in a manner in which they would find appropriate and helpful,” he adds.

“This is not only for them but also their partner, whether they are heterosexual or homosexual couples, to help men enjoy intimacy and sex in ways that can be fulfilling.”

He says there needs to be consistency of advice, support and education of healthcare staff in the sexual function area.

Movember — a charity focusing on prostate cancer, testicular cancer, mental health and suicide prevention — has produced Clinical Guidelines for Sexual Health and Prostate Cancer. This evidencebased framework aids clinicians in assessing and managing sexual side effects of prostate cancer therapies — fostering shared decision-making among clinicians, patients and partners.

Patient advocate: post-treatment challenges Prostate cancer patient advocate Martin Sweeney was 49 when he was diagnosed in 2015.

He warns that failure to appropriately address the issues men face after having treatment can affect mental health. External support is valuable, but he cites concern about insufficient professionally trained

support in Ireland outside the treatment pathway.

He adds: “Prostate cancer treatment can be very invasive and can leave patients with lifelong residual issues.

With sexual function, it is important men can explore ways of having intimate time with their partner.”

Support groups and the topic of quality of life and sexual recovery should be integral and central to the care pathways, insists Sweeney.

“However, not every health professional is aware of the need to bring these issues up. Normalising the narrative is the most important thing, and men should understand that they should not suffer in silence.”

Treatment options and further research Sweeney points to treatments such as Viagra and similar medication, penile injections or implants to improve sexual function as well as peer support and counselling. He also underlines the role of spouses and partners in the process.

IPCOR2, funded by Movember, is about to begin with patient partners included in the study process.

Further research will see a biobank established to look for new targets to treat prostate cancer.

Professor Galvin is also working on a pilot prostate screening project for Ireland — similar to bowel, breast and cervical screening programmes — while additional advice is available through ARC Cancer Support Centres.

Paid for by IPCOR and Movember

Scan the QR code for Movember’s Guidelines for Sexual Health and Prostate Cancer:

Scan the QR code to access ARC Cancer Support Network:

Scan the QR code to read the IPCOR Annual Report 2018

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Access to free consent education based on 10 years of Irish research Recent Irish surveys reveal that many college students report experiencing harassment and sexual assault.

Yet, there’s also a prevalent positive attitude toward consent.

H Rebecca Connolly Sexual Violence and Harassment Prevention and Response Programme Coordinator, University of Galway

Paid for by Active * Consent and The University of Galway

ow do positive attitudes towards consent exist alongside traumatising sexual harassment experiences? To improve college-based education on consent, The Active* Consent programme is leading the way in Ireland.

• About 90% of workshop participants would recommend it to a friend while 91% learned something useful.

• Workshops led to improvements in self-reported consent management skills, knowledge and confidence that peers consider consent important.

Findings on sexual violence and consent in students • The Active* Consent 2020 national survey of Higher Education students, conducted with the Union of Students in Ireland, indicated that 4 in 10 (42%) female first-year students (and one in five males) experienced unwanted sexual touching within six months of starting college.

• A majority of female college students surveyed agreed they had experienced sexual harassment in the past four years.

• In secondary school pupils, most participants agreed that a smile was enough non-verbal consent for intimacy, such as oral sex.

• Up to one-third of transition-year male pupils surveyed agreed with incorrect rape myth beliefs.

• Despite this, over 80% of young people surveyed say it’s important to talk about consent.

Sustainable consent education and support for young people requires an equal focus on institutional ownership and staff capacity. Over 1,500 staff have trained as consent workshop facilitators since 2016. We partner with Galway Rape Crisis Centre to provide 12-hour First Point of Contact training.

Changing culture: partnership, youth engagement, staff support Empowering students nationwide to shape a safer campus, The Active* Champion programme — launched at the University of Galway — provides comprehensive consent training. Rooted in 10 years of research, it promotes a sex-positive perspective and inclusivity.

Student Champions, from diverse backgrounds, contribute to a supportive environment where no one is judged for their sex choices.

• Last year, over 22,000 first-year students participated in consent workshops.

Pádraig MacNeela Active* Consent Programme Co-Lead, Head of School of Psychology, University of Galway

Consent literacy: consent is for everyone Consent is ongoing, mutual and freely given (OMFG).

Consent is for everyone — all relationships, genders and sexual orientations — and each type of intimacy. Young people in Ireland must reach the four signposts for consent literacy: • Knowledge: accurate information on consent attitudes and behaviours; how alcohol and drugs affect consent; digital intimacy; laws on consent and sexual assault.

• Communication skills: verbal and nonverbal behaviour; what helps or hinders consent; how to talk about consent.

• Confidence: seeking support for themselves or their peers, whether from school, college or a professional service.

• Challenge: being part of the change in our culture that recognises and responds to non-consenting attitudes or actions.

The programme also offers resources for consent awareness, education and training.

The Active* Consent programme draws on expertise from psychology, health promotion, theatre, psychotherapy and social media.

For resources and support, visit consenthub.ie

Student health services help mitigate rising sexually transmitted infections The Irish student population (estimated at 350,000 people) bear a disproportionate burden of sexually transmitted infections (STIs), with 40% of all STIs notified occurring in the under-25 age group.

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lthough STIs are usually easy to treat, some cause serious health issues. Chlamydia, the most common STI, can be asymptomatic in 50–80% of cases. The asymptomatic nature of many STIs means young people often do not seek treatment.

Caroline Kennedy-Crawford Student Health Nurse, Atlantic Technological University, Sligo (ISHA President)

Helping students prevent STIs The Irish Student Health Association (ISHA) find students often do not have the skills or experience to negotiate safe sexual health practices. Students transitioning into adulthood may mean they are at an experimental stage in their sexual encounters.

Equally, not all students are sexually active and shouldn’t feel pressured into having sex. Importantly, students should be educated to protect themselves from STIs. They must ensure that sexual encounters are safe, consensual and enjoyable.

Access to condoms for protection Studies have found that 47% of Irish students reported inconsistent condom use. Despite awareness of the consequences of STIs, young people often ignore safe sex guidance — placing them at risk. Among the most effective public health tools to prevent STIs are condoms.

In 2015, the HSE Sexual Health and Crisis Pregnancy Programme (SHCPP) set up the National Condom Distribution Service (NCDS) to supply free condoms to target elevated-risk populations, including Irish Higher Education.

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Student health services offer advice and STI screening Student health services provide an ideal setting to promote safe sex practices (including consent) and STI screening. Testing is essential for identifying STIs and limiting transmission. Students often hesitate to seek help, but methods used today are straightforward, so there’s little to worry about in terms of the testing experience.

Students will receive education from student health professionals, which is non-judgmental, confidential and supportive. Student health professionals have extensive training in managing sexual health needs. Most institutions offer free or subsidised care. Free, at-home testing through SH:24 is available for students who are not comfortable attending the health centre in person, and it’s available in every county in Ireland.

Initiatives promoting sexual health practices Sex education is normalised through Higher Education health promotion campaigns, such as SHAG (Sexual Health Awareness and Guidance) events. The key messages are: use condoms correctly every time you have sex (oral, anal, vaginal) and get tested regularly, particularly with new/multiple partners.

Staff in student health centres will empower young people with the tools to make safe and informed decisions, which should continue throughout their lifetime.

Dr Robert Scully Medical Director, Student Health Services, Maynooth University (ISHA Vice President)

The Irish Student Health Association (ISHA) represents healthcare professionals working in third-level student health centres across Ireland. For free, 24-hour home testing, visit sh24.ie

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