Movember, Men's Health Month: The Urological Checks Men Should Have

November is known around the world as men’s health awareness month. In this movement, known as Movember, men grow a moustache for a month to draw attention to prostate cancer, testicular cancer and men’s mental health. Men tend to put off health checks more often than women. In this article we give a simple summary of which urological checks are worth discussing at which age.

What is Movember, and why is men’s health discussed in November?

Movember is a blend of the words “moustache” and “November”. Started by a small group in the early 2000s, the movement has since spread to many countries. Its aim is to encourage men to look after their health before symptoms appear and not to put off seeing a doctor.

Early detection matters a great deal in urology: early-stage prostate cancer often causes no symptoms, and testicular cancer usually starts as a painless lump. Simple checks can help these problems be picked up early.

How should young men examine their testicles?

Testicular cancer is a rare cancer, but it is the most common solid-organ cancer in men aged 15–35, and when it is caught early the treatment options are highly effective. For this reason, young men are advised to examine their testicles themselves once a month:

1. Examine yourself after a warm shower, when the skin of the scrotum is relaxed.
2. Gently roll each testicle in turn between your thumb and fingers.
3. The soft, cord-like structure at the back of the testicle (the epididymis) is normal; do not mistake it for a lump.
4. Check for hardness, a lump you can feel, a difference in size, a feeling of heaviness or new swelling.

A slight difference in size between the two testicles is normal. What matters is a newly appearing change. If you notice such a change, see a urologist within a few weeks. For details, see the testicular cancer page and our article on the causes of testicular pain. Sudden, severe testicular pain, on the other hand, is an emergency.

What should men planning to have children bear in mind?

A male factor plays a role in around half of the cases in which a pregnancy does not occur. If there is no pregnancy after a year of regular intercourse (after six months if the female partner is over 35), assessment should begin in both partners together. For the man, the first step is usually an examination and a semen analysis.

The following may call for an earlier assessment:

• A history of an undescended testicle in childhood
• A feeling of heaviness in the scrotum, especially one that increases on standing, or twisted veins (this may be a varicocele)
• Having had mumps after puberty
• Planned cancer treatment (sperm freezing should be discussed before treatment)

You can find out how to read a semen analysis in our article on semen analysis results, and the most common questions in our male infertility article.

Why can erection problems be a sign of heart health?

Erection problems (erectile dysfunction) are not just a matter of sexual life. The blood vessels in the penis are narrower than the ones supplying the heart and can be affected earlier by hardening of the arteries. For this reason, erection problems can appear several years before cardiovascular disease.

Especially with erection problems that start after the age of 40, the assessment should not stop at recommending medication. Blood pressure, blood sugar, cholesterol, weight and smoking are reviewed and, if necessary, the assessment is carried out together with cardiology. This approach helps protect both sexual health and general health. For treatment options, see the erectile dysfunction page.

At what age should the PSA test be discussed?

PSA is a blood test used in the early detection of prostate cancer. However, not every raised PSA means cancer, and in some men it can lead to the detection of small tumours that would never have caused a problem. For this reason, the European Association of Urology (EAU) guidelines recommend a shared decision-making approach in which the benefits and limitations of the test are discussed.

According to the guidelines, the groups in whom a PSA test should be discussed are:

• Men aged 50 and over
• Men whose father or brother has had prostate cancer: from the age of 45
• Men of African descent: from the age of 45
• Men carrying a BRCA2 gene change: from the age of 40

How often the test is repeated depends on the first PSA value. We explain in detail how the result is interpreted in our article on what a raised PSA means. For general information about prostate cancer, see the prostate cancer page.

Which urinary symptoms need checking?

The prostate starts to grow after the age of 40, and urinary symptoms become more common with age. The following symptoms should not be dismissed as “just a natural part of getting older”:

• A weaker urine flow, or a flow that stops and starts
• Difficulty starting to pass urine, or needing to strain
• A feeling of not emptying the bladder completely
• Passing urine frequently during the day or getting up often at night to urinate
• A sudden urge to pass urine that cannot be put off

You can assess the severity of your symptoms yourself before your appointment with the IPSS prostate score test. Visible blood in the urine, on the other hand, should always be investigated at any age, especially in smokers. For more on this, see our article on the causes of blood in the urine.

Which urological checks are recommended at which age?

Ages 20–40

• Monthly testicular self-examination
• Protection against sexually transmitted infections, and testing if there is any suspicion
• Early assessment if there are problems trying to have children

Ages 40–50

• If there are erection problems, addressing them together with a general health assessment
• Monitoring of blood pressure, blood sugar and cholesterol
• If prostate cancer runs in the family, a discussion about PSA from the age of 45

Age 50 and over

• A shared decision about the PSA test
• Assessment of urine flow, getting up at night to urinate and urinary incontinence
• Seeing a doctor without delay if blood appears in the urine

Why is men’s mental health part of this month?

Men’s mental health is also an important strand of the Movember movement. Anxiety, depression and stress can be closely intertwined with problems with sexual desire, erection and ejaculation. Men’s difficulty in talking about emotional problems can lead to both mental and physical health problems being noticed late. Getting support from a mental health professional when needed is a natural part of treatment.

When should you see a urologist?

A newly noticed hardness or swelling in a testicle, blood in the urine, a weaker urine flow, getting up often at night to urinate, erection problems, no pregnancy after a year of trying, or having reached the age of 50 (45 if there is a family history) are all good reasons to see a urologist. Bringing your previous test results with you makes the assessment easier.

Op. Dr. Mücahit Kabar sees patients in Bursa (Nilüfer), Turkey, at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) and Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). Appointments are booked through the hospitals’ online booking pages or appointment lines. Consultations are held in English or Turkish and are confidential; the hospitals’ international patient departments can arrange interpreters for other languages. If you are travelling from abroad, you can send your questions and previous test results by WhatsApp to +90 541 622 54 82 before your visit. See the contact and appointment information for details.