Men’s Urological Health: The Things We Don’t Talk About Enough

From weak streams to testicular lumps: why noticing changes matters.

I know what you’re thinking:

“Georgie, you’re not a guy — how can you talk about men’s health?!”

Fair point. I confirm I do not have XY chromosomes.

But urinary health isn’t something that belongs to one sex, one diagnosis or one particular type of patient.

And Oui was never meant to be a place where I only talk about the parts of urology that I have personally experienced.

If we’re serious about making bladder, bowel and urological health easier to talk about, then that has to include men’s health too.

Because men have bladders.

Men get UTIs.

Men live with continence problems.

Men experience urinary retention, kidney stones, prostate problems, testicular conditions and sexual dysfunction.

And men can be just as reluctant — sometimes spectacularly reluctant — to tell somebody when something has changed.

So no, I cannot tell you what it feels like to have a prostate.

I can, however, read the evidence, listen to the people who do, and help make the conversation a little less awkward.

And really, that is rather the point of Oui.

There are certain parts of men's health that people will discuss quite happily.

Blood pressure.

Cholesterol.

Back pain.

Football injuries.

Then somebody mentions urine flow, erections, testicles or the prostate and suddenly the conversation becomes considerably quieter.

That silence matters.

Urological problems are common, and many are treatable. Some are inconvenient.

Some significantly affect quality of life. And some changes need investigating because they can occasionally signal something more serious.

The challenge is that embarrassment can make it very easy to wait.

And wait.

And gradually get used to symptoms.

Until something that initially felt slightly awkward has quietly become part of everyday life.

So perhaps we should start with something very simple:

if something about the way you wee, your genitals or your sexual function has changed, you are allowed to talk about it.

In fact, it may be important that you do.

First: urology is about much more than the prostate

When people hear men's urological health, the prostate tends to dominate the conversation.

The prostate is important.

But men's urological health is much broader than that.

It includes the kidneys, bladder, ureters, urethra and male reproductive organs, and symptoms can involve everything from urinary flow to testicular changes and sexual function.

That means things worth noticing can include:

• needing to wee more frequently;

• struggling to start;

• a weaker urinary stream;

• getting up repeatedly during the night;

• urgency or leakage;

• blood in the urine;

• difficulty emptying the bladder;

• genital or urinary pain;

• erectile problems;

• and changes to the testicles.

One symptom can have many possible causes.

That is why symptoms are clues, not diagnoses.

“My stream isn't what it used to be”

Changes in urinary flow are common in men, particularly as they get older.

Healthcare professionals often group these under the rather glamorous title lower urinary tract symptoms, or LUTS.

NICE guidance on LUTS in men covers symptoms associated with storing urine, passing urine and what happens immediately afterwards. These can include hesitancy, a weak or intermittent stream, straining, urgency, increased frequency, getting up during the night and dribbling after urination.

One possible explanation is benign prostate enlargement.

The prostate sits below the bladder and surrounds part of the urethra — the tube through which urine leaves the body. As the prostate gets larger, it can place pressure on the urethra and affect urinary flow.

The important word here is:

benign.

An enlarged prostate is not the same thing as prostate cancer.

The NHS describes benign prostate enlargement as common, particularly in men over 50, and symptoms can include difficulty starting to urinate, a weak or stop-start stream, feeling unable to empty the bladder completely, dribbling afterwards and needing to wee more often or urgently. King Charles III of the United Kingdom has spoken publically about experiencing benign prostate enlargement to encourage normalising the topic in conversation.

But that does not mean urinary changes should automatically be dismissed as ageing.

There are several possible explanations for male urinary symptoms.

The sensible question isn't:

“Is this definitely my prostate?”

It is:

“Something has changed. Is it worth finding out why?”

The prostate: small gland, enormous publicity department

The prostate is a small gland beneath the bladder.

It produces fluid that contributes to semen, and its location means changes in the gland can affect the nearby urethra.

It also seems to have developed an extraordinary ability to become the prime suspect whenever a man experiences anything remotely urinary.

Weak stream?

Prostate.

Getting up at night?

Prostate.

Urgency?

Probably prostate.

Sometimes it is.

Sometimes it isn't.

And that distinction matters.

One particularly important point is that prostate cancer often causes no symptoms at first.

The NHS explains that prostate cancer commonly begins in the outer part of the gland, meaning it may not press on the urethra and cause urinary symptoms until it has grown or spread.

So two things can be true at once:

urinary symptoms do not automatically mean prostate cancer;

and

having no urinary symptoms does not automatically rule prostate cancer out.

Who is at greater risk of prostate cancer?

Risk is not identical for everybody.

Age is important.

Family history matters.

Genetics can matter too.

The NHS advises that people with certain inherited genetic changes, including a faulty BRCA2 gene, can have an increased risk of prostate cancer. It also asks about family histories of prostate, breast, ovarian and pancreatic cancers when assessing prostate-cancer risk.

Black men are also known to have a higher lifetime risk of developing prostate cancer than men from some other ethnic groups.

This isn't about turning ordinary urinary symptoms into a cancer scare.

It is about understanding your own level of risk and having an informed conversation when appropriate.

And then there is the PSA test

PSA stands for prostate-specific antigen.

It is measured with a blood test and can help identify whether something may be affecting the prostate.

But PSA is not a simple yes-or-no cancer test.

The NHS is very clear about this: a raised PSA can occur for reasons other than cancer, including benign prostate enlargement, and a PSA result cannot by itself tell somebody whether they have prostate cancer.

If a result is raised, further investigation may be needed.

The NHS also recommends discussing the potential benefits and limitations of PSA testing before deciding whether it is appropriate.

In other words:

PSA is useful information. It is not a crystal ball.

Blood in your wee is different

There is one urinary change that deserves particularly clear advice.

Blood in your urine should be checked.

The NHS advises seeing a GP if you think there is blood in your urine rather than trying to diagnose the cause yourself. Possible explanations can include urinary infection, kidney stones and prostate problems, but blood can come from anywhere in the urinary tract.

It may look pink, red or dark brown.

And it does not need to hurt.

This is important because people can be tempted to think:

It only happened once.

There wasn't very much.

I feel fine.

But visible blood in the urine deserves medical assessment.

That does not mean blood in your urine equals cancer.

It means it is a symptom worth investigating.

This is exactly the kind of symptom where embarrassment should not win.

Nobody working in urology is going to think:

Good heavens. Urine.

They talk about it all day.

Men get UTIs too

UTIs are often spoken about as though they belong exclusively to women's health.

They don't.

Men can develop urinary tract infections too.

Current NHS advice recommends urgent GP or NHS 111 assessment when somebody with suspected UTI symptoms is male. The same guidance highlights warning signs such as fever or shivering, pain in the back beneath the ribs, blood in the urine, rapidly worsening symptoms and feeling seriously unwell.

UTI symptoms can include burning or pain when urinating, needing to urinate more often or urgently, cloudy or smelly urine and lower abdominal discomfort.

And infections involving the upper urinary tract can become serious.

So no: a UTI isn't automatically “a women's problem”.

And then there are testicles

Testicular health tends to receive less everyday attention than prostate health.

Yet this is one part of the body where becoming familiar with your own normal can be particularly useful.

The NHS recommends checking the testicles regularly — around once a month — so that changes are easier to notice. Things to look or feel for include a new lump or swelling, a change in size, weight or shape, heaviness or hardness, persistent discomfort, or anything that simply feels different from usual.

One testicle may naturally be slightly larger or hang lower than the other.

That can be entirely normal.

What matters is change.

And once again, noticing a change does not mean somebody has testicular cancer.

The NHS emphasises that these symptoms are common and can be caused by several different conditions. But they should still be assessed, because if a change is caused by cancer, earlier diagnosis can make treatment easier.

If it has changed:

get it checked.

Knowing your normal matters

One of the least dramatic pieces of health advice may also be one of the most useful:

know what is normal for you.

That applies to urinary frequency.

Your stream.

Whether you usually get up during the night.

Your testicles.

Sexual function.

You do not need to conduct a daily inspection with a clipboard.

But being familiar with your own body makes it easier to notice a genuine change.

For the testicles specifically, the NHS advises checking during or just after a warm bath or shower, when the scrotal skin is relaxed.

The point is not to become anxious about every variation.

It is simply to notice when something is different from your normal.

We should probably talk about erections too

Erectile dysfunction is very common.

And it can be extraordinarily difficult to discuss because erections are tangled up with ideas about masculinity, confidence, relationships and ageing.

Occasional difficulty getting or maintaining an erection happens to many men.

Stress.

Tiredness.

Alcohol.

Medication.

Life, generally.

The NHS says occasional erection problems are usually nothing to worry about. But if the problem keeps happening, it is worth speaking to a GP.

Persistent erectile dysfunction can be associated with physical conditions including high blood pressure, high cholesterol and diabetes, as well as hormonal problems, medication effects and psychological factors.

And importantly:

erectile dysfunction isn't a character flaw.

It isn't evidence that somebody is less masculine.

It is a health symptom.

Like any other persistent change, it deserves the possibility of assessment and treatment.

Urological treatment can affect sexual health too

Urinary and sexual health are not neatly separated systems.

They share anatomy, nerves, blood supply and enormous psychological significance.

Treatment for prostate disease can affect sexual function, and urinary problems can affect confidence, relationships and intimacy.

Those consequences matter.

Surviving disease matters enormously.

So does living afterwards.

Good urological care therefore isn't only concerned with whether treatment technically worked.

Quality of life matters too.

Getting up at night isn't always “just getting older”

There is a medical word for waking during the night to urinate:

nocturia.

It becomes more common with age.

But common does not mean trivial.

Repeated night-time urination interrupts sleep.

And nocturia can occur as part of several different urinary problems, including benign prostate enlargement. The NHS lists needing to get up during the night among the common symptoms of an enlarged prostate, while NICE includes nocturia among lower urinary tract symptoms in men.

The useful question isn't simply:

How many times do you get up?

It is:

Why are you getting up?

“But it's embarrassing”

Sometimes it is.

There is no point pretending otherwise.

Talking about urine flow, dribbling, erections or testicular changes is more intimate than discussing a sore shoulder.

But embarrassment has an unfortunate habit of turning temporary silence into prolonged suffering.

Someone may start organising their life around toilets.

Accepting broken sleep.

Avoiding sex.

Putting up with leakage.

Avoiding journeys.

Assuming deterioration is simply inevitable.

All without asking whether anything could be done.

The NHS explicitly tells people with symptoms of an enlarged prostate not to be embarrassed because GPs are accustomed to discussing urinary problems.

Sometimes the most useful medical intervention begins with a sentence somebody really does not want to say:

“I've noticed something has changed.”

What happens if you actually tell somebody?

Usually, something far less dramatic than imagination suggests.

For urinary symptoms, a healthcare professional may ask about:

how often you urinate;

whether you experience urgency;

how strong your stream is;

whether you feel completely empty afterwards;

whether you get up during the night;

whether there is pain or blood;

your medication;

your wider health;

and how much the symptoms are affecting everyday life.

NICE guidance recommends a structured initial assessment for men with lower urinary tract symptoms, including a medical history, review of medications, physical examination and urine testing. Depending on the circumstances, further assessment may include tools such as urinary-frequency records, flow measurement or assessment of residual urine.

For suspected prostate problems, the NHS also describes assessment that can include discussion of symptoms, examination and PSA testing where appropriate.

It is healthcare.

Not an audition.

There is no score for how impressively your bladder performs.

And please don't suffer because you assume nothing can be done

The treatment depends entirely on what is causing the problem.

For benign prostate enlargement, for example, options can range from lifestyle measures and medication through to procedures or surgery, depending on symptom severity and individual circumstances.

Erectile dysfunction also has treatments.

Urinary infections can be treated.

Many lower urinary tract symptoms can be investigated and managed.

Not everybody needs an intervention.

But everybody deserves the opportunity to understand what is happening.

Perhaps the bigger problem is silence

There is a strange contradiction in men's health.

We are perfectly capable of making jokes about ageing prostates, weak streams and getting up three times in the night.

But humour can sometimes become a socially acceptable substitute for actually talking about symptoms.

And there is a difference between:

“We're all getting old, mate.”

and:

“This has changed. Should I get it checked?”

One dismisses the symptom.

The other starts a conversation.

Men's urological health doesn't need to be frightening.

It doesn't need every urinary symptom turned into a cancer scare.

And it certainly doesn't need shame.

It needs something much simpler.

Know what is normal for you.

Notice when something changes.

Understand that symptoms can have many possible causes.

And be willing to say the embarrassing thing out loud.

Because whether it is:

a weaker urinary stream,

blood in the urine,

a testicular change,

persistent erectile problems,

leakage,

pain,

or simply something that doesn't feel right — you don't need to diagnose it yourself.

You just need to start the conversation.

Oui. Together, we can.

A note from Oui

Oui exists to raise awareness, share reliable information and make urinary health easier to discuss. It does not provide individual medical advice or diagnosis.

Many urinary, genital and sexual symptoms have several possible explanations. Having one of the symptoms discussed here does not mean you have cancer or another serious condition.

But if something has changed, is persistent or worries you, speak to an appropriate healthcare professional.

And one message is worth repeating:

Blood in your urine should be checked. 

If in doubt, get it checked out.

References & Further Reading

NICE. Lower urinary tract symptoms in men: management (CG97). Guidance covering assessment and management of male LUTS, including storage, voiding and post-micturition symptoms. NICE — Lower urinary tract symptoms in men

NHS. Enlarged prostate. Information on benign prostate enlargement, symptoms, assessment and treatment. NHS — Enlarged prostate

NHS. Symptoms of prostate cancer. Covers early presentation, urinary symptoms, risk assessment and referral. NHS — Prostate cancer symptoms

NHS. PSA test. Explains what PSA testing can and cannot tell you and how raised results may be investigated. NHS — PSA test

NHS. Blood in urine. Covers haematuria, possible causes and when to seek assessment. NHS — Blood in urine

NHS. Urinary tract infections (UTIs). Includes symptoms, treatment and circumstances where urgent GP or NHS 111 assessment is advised. NHS — Urinary tract infections

NHS. How to check your testicles. Guidance on becoming familiar with what is normal and recognising changes. NHS — How to check your testicles

NHS. Symptoms of testicular cancer. Covers lumps, swelling, changes in size and other symptoms that should be assessed. NHS — Testicular cancer symptoms

NHS. Erectile dysfunction. Covers common causes, when to seek help and treatment. NHS — Erectile dysfunction