译者：从小就生活在“医生圈”的我，居然不认识任何泌尿科医生。也许，这是因为我“健康”？（显然不是！）在听说一位美女决定成为泌尿科医生后，我的朋友们都傻眼了。也许，这篇文章可以帮助大家了解一些基本常识。

神奇的泌尿科医生

以下是你可能需要找泌尿科医生解决的三个健康问题。

詹西·邓恩（NYT）

发布于 2023 年 1 月 27 日

更新于 2023 年 2 月 2 日

泌尿科医生经常处理由身体功能引起的两种非常私密的健康问题：小便和性（功能）。 正因为如此，“大多数泌尿科医生倾向于说话简洁且幽默，因为我们知道这些问题对我们的患者来说是个难（开口的话）题，”加州大学圣地亚哥分校健康中心的泌尿科医生、该大学医学院泌尿外科玛丽亚·乌洛科 (Maria Uloko) 助理教授说。

根据我的经验（作为一名患者和健康记者），泌尿科医生会很乐意讨论我们这些外行人往往回避的话题：勃起问题、撒尿太多、撒尿太少、性交疼痛、性高潮减少或不存在、泌尿道感染，这样的例子不胜枚举。

华盛顿特区郊外的泌尿科医生和性健康专家雷切尔·鲁宾 (Rachel Rubin) 表示，许多人不会向医生透露这些问题，即使这些问题正在影响他们的日常生活； 他们只是学会忍受。 “他们会告诉自己，‘好吧，这只是因为我老了。 忍着吧，”鲁宾医生说。但是，“如果这些问题困扰你并且对你很重要，那就是需要医疗解决方案的医疗问题。”

泌尿科医生的工作有两个部分。 “有一些严重的疾病，比如癌症，”西北大学范伯格医学院泌尿学纳尔逊·贝内特（Nelson Bennett）教授说，他专门研究男性性功能。“但我们的日常工作中，有很大一部分基本上都是为了提高生活质量。 我告诉我的病人，没有人因为不勃起而死亡，但他们仍然生活在痛苦中。” 所有这些可能就是为什么看过泌尿科医生（包括我自己）的人，有时会说（看病）结果改变了他们的生活（质量）。

以下是你可能需要找泌尿科医生解决的三个健康问题。

勃起问题

如果你患有勃起功能障碍，鲁宾医生说：“不要感到尴尬。 你的朋友也一样（会有这个问题）。” 据美国泌尿外科协会称，美国有多达 3000 万男性患有勃起功能障碍。

贝内特医生说，几乎所有勃起问题都有不同的治疗方案，包括口服药物、注射药物、手术、和认知行为疗法。

尽管在直接面向消费者的网站上偷偷订购伟哥等药物可能很诱人， Bennett 医生在2021 年的一项研究中发现，这种做法正在急剧增加；但他表示，有几个理由（病人）需要去看专家。 “我们实际上可以开始找出你出现问题的原因，而不是仅仅通过服用药物来掩盖问题，”他说。 有些药物也会影响勃起，例如抗抑郁药；它可能会导致性高潮延迟或完全消失。 他说，泌尿科医生可以对这些进行筛查。

更重要的是，勃起问题可能是未来心脏问题的征兆。 阴茎动脉直径为 1 毫米，比直径 3 毫米的心脏动脉细多了。 鲁宾医生说：“因此，如果你首先堵塞了（1 毫米的）小管道，那么你可能会在第一次心脏病发作之前出现勃起功能障碍。”

“这些（小管道堵塞）是你需要开始关注的，”贝内特医生说，“因为我们知道勃起问题比心血管问题早大约 10 年出现。”

痛苦的性生活

对于老年女性来说，性交疼痛是更年期泌尿生殖系统综合症（genitourinary syndrome of menopause, or G.S.M.）的一个主要症状。这个术语在 2014 年取代了令人沮丧的短语，即“外阴阴道萎缩”。 在围绝经期及以后，随着雌激素在女性体内减少，外阴、阴道、和尿道的组织变得干燥、柔软、且更加敏感。 鲁宾医生说，这个过程可能会导致反复尿路感染和尿失禁，性生活可能会变得令人痛苦；这让许多女性感到惊讶。根据 2019 年的一项评论，该疾病（即G.S.M.）可能会影响多达一半的绝经后女性，并且“如果不治疗，不太可能得到改善”。

鲁宾医生说，已证明对 G.S.M. 等病症有效的治疗方法是插入 DHEA（一种模仿激素、润滑剂和保湿剂的类固醇）； 服用ospemifene，一种经美国联邦药物管理局批准用于治疗 G.S.M. 的口服药； 阴道扩张器； 和低剂量局部阴道雌激素。

“在鸡尾酒会或儿童生日聚会时，我都会推荐阴道激素，”鲁宾医生说。 （但是，你首先需要与自己的医生讨论这些治疗方法。）

鲁宾医生补充说，盆底（肌肉康复）疗法（Pelvic floor therapy）是另一种选择。 “盆底治疗师会帮助你修复你的（盆底）肌肉，就像你在膝关节置换术后需要进行康复一样。” 她补充说，你不必永远这样做康复。 “康复治疗师会教你如何优化你骨盆附近的肌肉，然后让你自己回家去练习。”（And you don’t have to do it forever, she added. “Physical therapists are there to optimize your pelvis and send you out the door.”）

然后是 DIY方法（即自己解决问题）：2023 年的一项审查发现，振动器（vibrators）被认为是治疗外阴疼痛的“一种公认的方式”。 “我认为医生应该开振动器处方，这是一种健康辅助工具，就像眼镜或助听器一样，”鲁宾医生补充道。 “我们越将它标准化，并在检查室对患者进行有关（使用）它的教育，效果就越好。”

膀胱问题

你可能知道，膀胱控制的丧失会影响女性一生中各个荷尔蒙阶段——怀孕、产后、和更年期——但“男性也受到尿失禁的困扰，”贝内特（Bennett）医生说。 根据美国泌尿外科协会的数据，四分之一到三分之一的美国人患有尿失禁。

尿失禁主要有两种类型：“压力性尿失禁”，即咳嗽、打喷嚏、或运动等活动引起的突然漏尿；“紧急性尿失禁”，即强烈而立即的小便冲动，让你疯狂冲向卫生间。

Bennett 医生说，一些男性患者会因为前列腺问题而每晚上厕所 10 次，从而导致睡眠不足。

尿失禁的一些治疗方法包括药物治疗，女性则使用阴道雌激素，但泌尿科医生还教患者凯格尔运动（Kegel exercises）、使用电刺激和盆底康复疗法。 （男性也有骨盆底。）

乌洛科医生说，泌尿科医生“是真正受人尊敬的水管工。 我们知道如何修复泄漏。”

译者附注：

凯格尔练习（骨盆肌肉强化练习； 骨盆底练习）

凯格尔运动可以帮助增强子宫、膀胱、和肠道（大肠）下面的肌肉。 它们可以帮助有漏尿或大便控制问题的男、女性。

患有大脑和神经疾病的人也可能存在漏尿或大便控制问题。

凯格尔练习可以在坐着或躺着的任何时候进行。 你可以在吃饭、坐在办公桌前、开车、休息或看电视时进行这些练习。

如何找对骨盆底肌肉

凯格尔运动就像假装你要小便，然后忍住。 你放松并收紧控制尿流的肌肉。 找到合适的肌肉来收紧很重要。

下次你必须小便时，开始小便，然后停止。 感觉阴道（女性）、膀胱或肛门的肌肉收紧并向上移动。 这些是骨盆底肌肉。 如果你感觉它们收紧，那么你就完成了正确的练习。 你的大腿、臀部肌肉和腹部应该保持放松。

如何进行凯格尔练习

一旦你知道了运动的感觉，就可以每天进行 3 次凯格尔练习：

• 确保膀胱排空，然后坐下或躺下。

• 收紧骨盆底肌肉。 握紧并数 3 ～5 秒。

• 放松肌肉并数3 ～5 秒。

• 重复10 次，每天3 次（早上、下午和晚上）。

进行这些练习时，深呼吸并放松身体。 确保腹部、大腿、臀部或胸部肌肉没有收紧。

4 ～ 6 周后，你应该会感觉好一些，症状也会减少。 继续练习，但不要增加练习次数。 过度使用可能会导致排尿或排便时用力。

一些注意事项：

• 一旦你学会了如何进行这些练习，请勿在小便时进行凯格尔练习（一个月不能超过两次“小便时进行凯格尔练习”）。 排尿时进行凯格尔练习不好：随着时间的推移，会削弱盆底肌肉或对膀胱和肾脏造成损害。

• 对于女性，凯格尔运动不正确或用力过大可能会导致阴道肌肉过度收紧。 这可能会导致性交时疼痛。

• 如果停止进行这些练习，失禁会复发。 一旦你开始这样做练习，你可能需要在余生中都这样做练习。

• 你开始进行这些练习后，可能需要几个月的时间才能减轻你的失禁。

（https://medlineplus.gov/ency/ Patientinstructions/000141.htm）

The Life-Changing Magic of a Urologist

Here are three issues you may want to address with a professional.

By Jancee Dunn

Published Jan. 27, 2023

Updated Feb. 2, 2023

Urologists often deal with health problems that arise from two very intimate functions: peeing and sex. Because of this, “most urologists tend to have a lot of brevity and a bit of humor, because we know these are hard topics for our patients,” said Maria Uloko, a urologist at UC San Diego Health and assistant professor of urology at the University of California, San Diego School of Medicine.

In my experience (as both a patient and a health journalist), urologists will happily discuss the subjects that some of us laypeople tend to avoid: erectile problems, peeing too much, peeing too little, painful sex, dwindling or nonexistent orgasms, urinary tract infections and the list goes on.

Rachel Rubin, a urologist and sexual health specialist based outside Washington, D.C., said many people don’t share these issues with their doctor even if they are ongoing; they simply learn to live with discomfort. “They’ll tell themselves, ‘Well, that’s just aging. Suck it up,’” Dr. Rubin said. But, “if it bothers you and it matters to you, then it’s a medical problem with medical solutions.”

There are two parts of a urologist’s job. “There’s the serious illness stuff, like cancers,” said Nelson Bennett, a professor of urology at Northwestern University Feinberg School of Medicine, who specializes in male sexual function. “But there’s a big chunk of our practice that is basically quality of life. I tell my patients that no one dies of not having an erection, but they’re still suffering.” All of this may be why people who have seen a urologist (present company included) sometimes say the results are life altering.

Here are three issues you may want to address with a professional.

Erection problems

If you have erectile dysfunction, Dr. Rubin said: “Don’t be embarrassed. So do your friends.” Erectile dysfunction affects as many as 30 million men in the United States, according to the American Urological Association.

There are treatment options for almost every erectile problem, including oral medications, injectable medications, surgery and cognitive behavioral therapy, Dr. Bennett said.

Although it can be tempting to furtively order medications such as Viagra on direct-to-consumer websites, a practice that Dr. Bennett found, in a 2021 study, is dramatically increasing, he said there are several reasons to see a specialist instead. “We can actually begin to figure out why you’re having the problem, as opposed to just taking medication to cover it up,” he said. Some medications can also affect erections, such as antidepressants, which can cause orgasms to be delayed, or vanish altogether. And a urologist can screen for those, he said.

What’s more, erection problems can be a sign of heart problemsdown the road. Penis arteries, which are one millimeter in diameter, are very small, compared with heart arteries, which are 3 millimeters. “So if you’re clogging your small pipes first, you may have erectile dysfunction before you have your first heart attack,” Dr. Rubin said.

“Those are the guys you need to start looking at,” said Dr. Bennett, “because we know that erectile issues will predate cardiovascular issues by about 10 years.”

Painful sex

For older women, painful sex is a leading sign of genitourinary syndrome of menopause, or G.S.M., a term that in 2014 replaced the dispiriting phrase “vulvovaginal atrophy.” During perimenopause and beyond, as estrogen leaves a woman’s body, the tissues in the vulva, vagina and urinary tract become dryer, less supple and more sensitive. This process can cause recurrent urinary tract infections and incontinence, and sex can become excruciating, which takes many women by surprise, Dr. Rubin said. G.S.M. may affect up to half of postmenopausal women, according to a 2019 review, and is “unlikely to improve without treatment.”

What has been shown to work for conditions like G.S.M., Dr. Rubin said, are treatments like inserts with DHEA, a steroid that mimics hormones, lubricants and moisturizers; ospemifene, an oral medication that is approved by the Federal Drug Administration to treat G.S.M.; vaginal dilators; and low-dose topical vaginal estrogen.

“There’s not a cocktail party or children’s birthday party where I don’t recommend vaginal hormones,” Dr. Rubin said. (It is important, however, that you discuss any of these treatments with your own doctor first.)

Pelvic floor therapy is another option, Dr. Rubin added. “Pelvic floor therapists rehab your muscles, just like you would do rehab after a knee replacement.” And you don’t have to do it forever, she added. “Physical therapists are there to optimize your pelvis and send you out the door.”

Then there’s the D.I.Y. approach: a 2023 review found that vibrators were considered “an accepted modality” to treat vulvar pain. “I think doctors should be prescribing vibrators, which are health aids, just like eyeglasses or hearing aids,” Dr. Rubin added. “The more we normalize them and educate patients in exam rooms about them, the better.”

Bladder issues

You may know that bladder control loss afflicts women at various hormonal stages in their lives — pregnancy, after giving birth and during menopause — but “men are plagued by urinary incontinence, too,” Dr. Bennett said. A quarter to a third of Americans have incontinence, according to the American Urological Association.

There are two main types: “stress incontinence,” which means sudden leaking brought on by activities like coughing, sneezing or exercise, and “urgency incontinence,” a strong and immediate urge to pee, which sends you on a mad dash to the bathroom.

Some male patients will visit the bathroom 10 times a night because of a prostate issue, which leads to sleep deprivation, Dr. Bennett said.

Some treatments for urinary incontinence include medication, and for women, vaginal estrogen, but urologists also teach patients Kegel exercises, use electrical stimulation and employ pelvic floor physical therapy. (Men have a pelvic floor, too.)

Urologists, Dr. Uloko said, “are really glorified plumbers. We know how to fix the leaks.”

On Kegel exercises

Pelvic muscle strengthening exercises; Pelvic floor exercises

Kegel exercises can help make the muscles under the uterus, bladder, and bowel (large intestine) stronger. They can help both men and women who have problems with urine leakage or bowel control. 

People who have brain and nerve disorders may also have problems with urine leakage or bowel control.

Kegel exercises can be done any time you are sitting or lying down. You can do them when you are eating, sitting at your desk, driving, and when you are resting or watching television.

How to Find the Right Muscles 

A Kegel exercise is like pretending you have to urinate and then holding it. You relax and tighten the muscles that control urine flow. It is important to find the right muscles to tighten.

Next time you have to urinate, start to go and then stop. Feel the muscles in your vagina (for women), bladder, or anus get tight and move up. These are the pelvic floor muscles. If you feel them tighten, you have done the exercise right. Your thighs, buttock muscles, and abdomen should remain relaxed.

How to do Kegel Exercises 

Once you know what the movement feels like, do Kegel exercises 3 times a day:

• Make sure your bladder is empty, then sit or lie down.

• Tighten your pelvic floor muscles. Hold tight and count 3 to 5 seconds.

• Relax the muscles and count 3 to 5 seconds.

• Repeat 10 times, 3 times a day (morning, afternoon, and night). 

Breathe deeply and relax your body when you are doing these exercises. Make sure you are not tightening your stomach, thigh, buttock, or chest muscles.

After 4 to 6 weeks, you should feel better and have fewer symptoms. Keep doing the exercises, but do not increase how many you do. Overdoing it can lead to straining when you urinate or move your bowels.

Some notes of caution:

• Once you learn how to do them, do not practice Kegel exercises at the same time you are urinating more than twice a month. Doing the exercises while you are urinating can weaken your pelvic floor muscles over time or cause damage to bladder and kidneys.

• In women, doing Kegel exercises incorrectly or with too much force may cause vaginal muscles to tighten too much. This can cause pain during sexual intercourse.

• Incontinence will return if you stop doing these exercises. Once you start doing them, you may need to do them for the rest of your life.

• It may take several months for your incontinence to lessen once you start doing these exercises.

（https://medlineplus.gov/ency/patientinstructions/000141.htm）