Scott Webb (Host): There are many questions or concerns that men may be reluctant to discuss with their doctors. So, we hope that today's podcast on men's health and penis health specifically will ease that burden and answer a whole bunch of questions. And here to answer my questions today is Xelenia Depeña. She's the Medical Director, Valley Medical Group Primary and Walk-in Care, Dumont, and a board-certified family medicine physician.

Host: Welcome to Conversations like No Other, presented by Valley Health System in Ridgewood, New Jersey. Our podcast goes beyond broad everyday health topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about penis health, and we're going to get to ED and some other things as well. Initially here though, is it true that you can fracture your penis? Like, is that a thing? And if so, what happens? How does it heal and so on?

Dr. Xelenia Depeña: Yes, a patient can fracture their penis. That's possible. And usually, what it would present like is with pain or a popping sound some patients describe. So when something like that happens, you definitely want to go to the emergency room. That's actually an emergency visit. So, it's going to be treated in one of two ways. If it's something minor, it may just require some stitches. If it's something very severe, then a surgeon would have to intervene and then the healing time on that can play out differently depending on what the treatment was. So, some men will be able to get back into like their sexual activity in like three to four weeks if they have a minor injury. But if they do have a surgical intervention, they might have a little bit more time to heal, and that would definitely be managed by the surgeon.

The long term of it is the patient may have a change in their anatomy of the actual penis. They may have like a deviation. They can experience pain with sexual intercourse or with erections. They can also have a complication of erectile dysfunction or priapism, which is the opposite, meaning that they will have an erection for prolonged periods of time. They can also have other things that might be more anatomy changes, such as a fistula or strictures, which can affect the way that they urinate. So, it is serious and it is something that does require medical attention. So if that was to happen again, the recommendation would be to go straight to the emergency room for that.

Host: Yeah, wondering, I've done some podcasts on Peyronie's. I'm not sure, maybe it's a tomayto-tomahto how it's pronounced. But I know that men having curved penises, that's a real thing. But does that mean that there's a fracture or could it be from something like Peyronie's or something else?

Dr. Xelenia Depeña: Right. That's a good question, because it actually can be normal. Some men, their anatomy just may be that they have a curved penis, that's normal. However, there is, like you mentioned, Peyronie's disease, which is actually a medical condition and this can be a result from injury or infections or inflammation. And what'll happen is the person will build up scar tissue in the tissue of the penis, and this is what causes the problem with the Peyronie's disease, right? So, that's not normal because they've actually had some type of pathology happening, which causes this issue. But again, it can be normal, but also abnormal if there's like a history of in infection or inflammation. And some of it can be related to recurrent injuries, right? So, this could be like sports injuries, it could be injuries during sexual intercourse or infections, recurrent infections, things like that build up like this fibrous scar tissue.

Host: Yeah, it was very much sort of preached to us when I was a kid to wear our athletic supporters and cups especially. But I know that my son, who's 20 now, his generation, they often did not wear their cups. And so, you're talking about injuries, which are very real and can happen and can be painful and be serious. As I mentioned before we got rolling here, we were going to cover a whole bunch of topics related to men's health. So, what does it mean if it hurts to ejaculate or if we have blood in the ejaculate? What might that be a sign of?

Dr. Xelenia Depeña: Great. Yeah. This is an excellent question because this can happen to anyone, right? And so, a lot of times where the painful ejaculation will come from is that perhaps they might have some type of infection, inflammation, cancer, right? So as a physician, those are my top three things that I'm thinking about. So, the patient would have to come in and we'd have to evaluate them. We'll check the urine. We'll do some imaging. We check for sexually transmitted diseases, which can be the most common cause, right? Like, you know, as a clinician I have to think cancer, but we always work it up, right? We figure out what's going on, what are the common causes and what are the causes that can, you know, harm the patient. So, we'll have to check the prostate, the bladder, the urethra, all the genital, as well as the kidney and the bladder system because everything is connected.

Host: Right. It's all connected, yeah.

Dr. Xelenia Depeña: So, that would require an evaluation, not in the emergency room necessarily. That is something you could see your primary care doctor or mid-level provider. But people may go to the emergency, right? Because that's scary. Anytime you see blood in the ejaculate or urine or in the toilet, you know, that might prompt people to go to the emergency room, so that's okay. But it is something that we would see in the primary setting as well.

Host: Yeah. Right. Some people may just go right to the ED, others may wait, you know, let's say over the weekend and see their doctor on Monday if they can. And wondering, should a man be concerned, let's say they're uncircumcised, should they be concerned about any particular conditions? You know, when the foreskin can't be retracted from the penis head, is that a sign that there's something they should be concerned about?

Dr. Xelenia Depeña: So, the issue with uncircumcised penises is the risk for infections, and that's really more based on the patient's hygiene, right? So, you know, if the parents choose not to circumcise their young son, they're basically teaching them from a very young age how to retract the foreskin, how to clean it out properly, and continuing this through life. There's no hard fast rule that, you know, circumcised is better versus uncircumcised. It is a conversation that you want to have when parents are deciding that with their sons. Because what will occur is if they are not having the best of hygiene, they can have infections. So like yeast infection or STDs, things like that can sometimes be harbored in that area because it's almost like a pocket, right? So, that would be the education piece that you give to parents. So, they can go either way. If they decide to not circumcise, then it's always that education piece for parents so that they're informed and then they teach the child, and the child will continue into adulthood to practice that good hygiene, so their risk of infection is reduced.

Host: Yeah, good hygiene for sure. And we were talking earlier about blood in the ejaculate, but what about rash or discharges? Are those also things that we should be concerned about? And again, is it an ED thing or could it wait until we get to the office?

Dr. Xelenia Depeña: Always abnormal. So, anytime there's a rash or there's a bump or there's a discharge from the penis, it has to be something that has to be looked at by somebody because things present the same. And when I mention things, it's like serious sexually transmitted diseases, so we have herpes, we have syphilis, we have HIV, gonorrhea, chlamydia. These are all sexually transmitted infections that can look similar, present the same. So, the patient would need a workup and that can again be done in your primary care doctor's or mid-level provider's office. You can go to the ER, you can go for anything really, right? Like if you have an emergency, something's strange on body, sure. But, you know, if you have that connection with your primary care doctor or provider, like sure. You know, that's something we probably work up the most. I would say that's a very common visit that we have because that's very abnormal for people, right? Like if they see something coming out when they're ejaculating or urinating, these are, you know, going to be concerning, that will bring people to the office.

Host: Yeah, definitely. And you mentioned urination there, so let's talk about that, blood in the urine or when it burns to urinate.

Dr. Xelenia Depeña: Yeah. Great question too. So, blood in the urine is abnormal until it's worked up. And so, what does that mean? That means that the patient should come in, see their primary care provider because it can be at the kidney level, it can be a bladder issue, it can be a penis or prostate issue. So, this requires an evaluation. Again, it can be an infection, it can be inflammation, or it can even be cancer. And in addition to that, there can also be patients that just have blood in their urine normally all the time, and it's nothing, right? But the only way that we'll know that it's nothing is with them being evaluated. So, that would be some blood work, some urine analysis. It'll be also imaging if we need it. So, it does require us to work it up and make sure that it's not anything that's fatal or, you know, that has to be treated in the moment, like an infection.

Host: And it's good that we have experts like yourself because I didn't even know that it could be normal. Like what's normal for one person may not be normal for someone else. So, I didn't even know that blood in the urine might not be a big thing. So, it is great to have your expertise. And I remember, doctor, when I used to see those commercials for those magic pills, like I think they were blue, the magic blue pills. What does it mean if a man has an erection that persists that just won't go away and doesn't end? Whether it's related to the magic pills or not, what does that mean? Is that a problem?

Dr. Xelenia Depeña: It can be a problem. What you're referring to is called priapism, so when a man has a persistent erection. And it could be a couple different causes, a lot of the things that we've already talked about, you know, history of recurrent infections and inflammation; being uncircumcised, so the skin can just be there and it's causing these structural issues. So, releasing the erection might be a little bit more difficult. Also, it could be medication-induced. As you mentioned, we have a lot of, medications in the market now, Viagra, Cialis. And a lot of times we do find that patients are taking non-prescribed pills. And so, you know, maybe a buddy or something lent you a pill and then you didn't really know the side effects of it. And so, yes, that would require the patient to go to the ER to correct. We do treat it with a medication called phenylephrine, and what it'll do is release the blood from the area so that the erection can be terminated.

Host: Yeah. Yeah. I like the way you put that, unprescribed pills that are available on the internet.

Dr. Xelenia Depeña: To add to that also, Scott, there's other things which might not be known to like our younger crowd. So, drug use such as marijuana and cocaine also are good causes of priapism. And anyone that has sickle cell disease, we see that as well; traumas to the spinal cord; and then, carbon monoxide poisoning, which, you know, is very relevant to us here who live in the winter states.

Host: Yeah, for sure. Is it possible, doctor, for our penis to swell but not be related to an erection? Is that a thing?

Dr. Xelenia Depeña: Yes. So, sometimes it could just be blood, right? Blood flow, a blood clot. Again, going back to infection, going back to circulation issue, inflammation, it's possible. So again, this would be something abnormal. So again, something that the patient would have to come and be evaluated for.

Host: So, I have a loaded question for you because I'm sure that it could be mental, physical, a multitude of factors that could be causing it. But doctor, what causes ED? What causes erectile dysfunction?

Dr. Xelenia Depeña: So, great question because a very common issue that we have in our male population. So, there's a lot of causes of erectile dysfunction. And it really starts from just looking at the patient as a whole, right? So when I have a patient that comes in and they're mentioning that they have erectile dysfunction, one of the first things, because it is the most common cause is any type of stress, fatigues, psychological issues that the patient may be having or marital or relationship discord. Those are usually the number one things that we find in patients.

However, when we dig further, and we have, let's say an older patient, perhaps maybe like 45 or 50s presenting with erectile dysfunction, we have to look at a little bit of a wider scope as far as medications that they take because there are a lot of medications that cause erectile dysfunction. There's a lot of medical conditions that cause erectile dysfunction. So, some of those being type 2 diabetes, hypertension, high cholesterol to name the top three, in addition to weight changes, right? So, some men, they might gain a lot of weight over time, and this could be like maybe over a 20-year period, they might go up 10, 15 pounds in their lifetime, and those things can contribute as well to erectile dysfunctions. Smoking, alcohol use. So, it is a loaded question because it does really require a very good physical and history for a patient to identify what are the modifiable risk factors and non-modifiable risk factors for this patient and what they can change in their lifestyle to help avoid the erectile dysfunction and as well as getting their medical conditions under control if they're not, which, you know, that would be the part where I would step in.

And then, also getting our specialty involved, right? So, a lot of times when patients have these type of presentations. We do want urology involved because that is the specialist for men, specifically prostate, penis, you know, genital care. So, we'd plug them in there as well, so that they have that, you know, well-rounded workup as far as like what could be the causes. And then, whatever causes there are, we fix that and then we try to see how that goes for the patient. And then, we can introduce medications to help if maybe there's some permanent changes that we can't really fix with controlling diabetes or high blood pressure or, you know, because a lot of men unfortunately think it's their age, but that's not necessarily true. I've had patients that are in their 70s and still going strong, don't have any complaints.

Scott Webb (Host): Right.

Dr. Xelenia Depeña: You know, their desire doesn't change either in patients. And it's important to really talk about sexual health, especially with aging populations because just because you get older doesn't mean that your desire goes down. It may be that your biology is changing. And so, that's where we want to, again, have this open and candid, talk with patients about their sexual health because it's a part of life and it's a natural part of our lives. And patients are very embarrassed to talk about these things. And bringing it up as the doctor or the provider is crucial to get this conversation out. Because it might be that, you know, couples come in and maybe the wife is complaining about it and the husband's ashamed to talk about it, or vice versa, maybe the husband's like, "You know, I want to make sure I'm taking care of my wife or my partner or whatever." And so, you know, it's a very intimate and private conversation, but we have a lot of information about it. In the medical field, we know how to address it and so we definitely want to promote talking about it and making sure that patients are enjoying good quality of life.

Host: Yeah. You said earlier how everything's sort of connected, which sort of means our brains and our libidos, if you will, are connected to all of this. Should a man be concerned if there's a sudden change in desire or how they're ejaculating?

Dr. Xelenia Depeña: Yes. So going back to, you know, talking to the patient and, you know, when I see patients in the clinic, we always screen them actually for depression, right? So, depression is very common in especially older men. It's not as talked about, but we definitely have to screen for it, because of the fact that we know by the data that patients are being affected by this. So, this could be one of the psychological factors for men having less libido, again, any discordant relationships. And we look at that as a way to open up the bigger conversation of is there something physically wrong with the patient or is it something that we have to address from the mental health perspective? And you have all sorts of patients that walk through the door, right? Like, I have patients that their sexual desire ended at 30 and they're good.

Host: They're fine, just fine. Right. Yeah.

Dr. Xelenia Depeña: Yeah, I have patients that are 72 and, you know, even going further into-- which is a little out of my scope of practice, but I've had patients in the past where they have a penile implant, right? So, we even have surgical interventions for patients who still want to enjoy a healthy sex life.

Host: Sure. Well, you are a wealth of information, doctor. We've covered so much territory today. I just want to finish up by asking what's HPV? What does that mean exactly? And what are the recommendations for vaccinations?

Dr. Xelenia Depeña: Great. Now, this is up my alley because primary care, right?

Host: Okay. Yeah.

Dr. Xelenia Depeña: So, HPV stands for human papilloma virus. This is a sexually transmitted infection that is a virus, one of the most common ones that we have. So because we know it's so common, there's been this initiative by, you know, all the institutions that be that create and promote vaccination for population of health to start vaccinating children, right? So, the reason we vaccinate is because HPV can have permanent or not symptoms such as genital warts, which can be very shocking to patients because the warts can be very unsightly. So, it can really affect like their mental health and their sexual health. So, they can suffer from that aspect of it. Or they can have no symptoms or they can even have different forms of cancer that HPV can cause such as oral cancer, head and neck cancer, genital cancers. So, these are different things that we try to in the pediatric population prevent. And the way that we prevent is with the vaccination.

So, the medical community has come to the conclusion to start vaccinating as young as 11 and 12 for both boys and girls in order to help prevent any type of manifestation of like cancer or warts or anything else that HPV can cause. And usually, you know, we try to do this before patients are sexually active. But it doesn't mean that they can't get it if they've already become sexually active. The idea is to vaccinate early so that when they're adults, they're not suffering the consequences, you know, when they might really be more having a sexual health experience.

Host: Yeah. I remember when I would take my kids for their shots and vaccinations. The first time I heard that one of the shots was HPV, I sort of raised an eyebrow and I thought, "Well, that's interesting." But then, I sort of connected the dots and I thought, well, sure. If you vaccinate children, then they hopefully don't get HPV and don't suffer the way many adults do because they came up in an era when we weren't vaccinating or they, you know, opted not for the vaccination. So, as I said, doctor, a wealth of information today, so helpful, so educational. Thanks so much. You stay well.

Dr. Xelenia Depeña: Thank you so much, Scott.

Host: And for more information about primary care services at Valley, please visit valleyhealth.com/primarycare. And if you found this podcast helpful, please share on your socials and check out our entire podcast library for topics of interest to you. And thanks for listening to Conversations Like No Other presented by Valley Health System in Ridgewood, New Jersey. For more information on today's topic or to be connected with today's guest, please call 201-291-6090 or email valleypodcast@valleyhealth.com. I'm Scott Webb. Stay well.