Summer 2019 Newsletter

July 25, 2019

As Men's Health Month draws to a close, I'd like to


For far too many doctors and lay persons, Men's Health has been equated to Prostate Cancer and "T levels". How would women feel if Women's Health only conjured breasts being smashed for an annual mammogram?

Men, like women, are (to borrow a description from the late Peter Drucker) four dimensional creatures. They have a physical, mental, emotional and spiritual facet. However, men are less likely to have regular physical examinations and are even less likely to have the opportunities to explore and address their psychosocial well-being. In addition to the obvious differences between our hormones and genitals, conditions affecting our cardiovascular systems, brains, muscles, and bones are also different... Men's health addresses a man's physical and mental well-being within the context of what it means to be a male in his family, society, and culture.

So let us begin by preparing an environment which allows men to accept compassion and which gives them permission to take better care of themselves. From their heads to their toes: Let's help them take better care of their skin, their teeth, and their muscles. Let's help them obtain the sleep that has been stolen away. Let's educate them about their metabolism and the maelstrom of weight gain and its impact on blood pressure, kidney stone formation, infertility, testosterone, cholesterol, heart disease and cancer. Let's give them permission to be sensitive and to work on their relationships.

Let's stop scaring them and capitalizing on their fear!


The Texas Urological Society meeting was held in San Francisco June 27-29. Guest speakers from the Bay Area included Dr. Jennifer Hah (Stanford), Dr. Jeannette Potts (Vista Urology), and Dr. Sanjay Reddy (UCSF).

Dr. Potts' lecture can be summarized as:

Can You Handle the Truth...About Men With Pelvic Pain?
(The truth will set you free - but first it will piss you off. — Gloria Steinem)

Truth #1: This is NOT prostatitis!
Truth #2: It is often non-urological - and there is usually more than one diagnosis.
Truth #3: PT is the new cipro - it is prescribed with the same disregard as cipro - no diagnosis, no evidence, and no follow-up.
Truth #4: Patients need doctors.
Truth #5: Functional Somatic Syndromes/Central Sensitization is very common in these patients. FSS/CSS is extremely costly.
Truth #6: When we are dismissive of our patients, we are complicit in this cost.
Truth #7: All patients deserve a physical exam - even if they had a normal imaging study in the past!

There are no short cuts!


The 49th ICS Annual Meeting is taking place on September 3-6, 2019, in Gothenburg, Sweden. This meeting brings together the most renowned experts in the research and treatment of LUTS, incontinence and pelvic floor disorders. Both Drs. Payne and Potts have speaking commitments and workshops at this meeting:

  • (September 3) Drs. Payne and Potts are faculty for a workshop entitled "Rethinking Pelvic Pain". Dr. Potts has an intriguing presentation about Truths vs. Myths in pelvic pain.
  • (September 4) Dr. Potts will be speaking about Chronic Pelvic Pain in Men in a workshop focused on "The Evidence Base for Physiotherapy".
  • (September 5) Dr. Payne is a speaker at a Roundtable Discussion on Ulcerative Interstitial Cystitis.
  • (September 6) Dr. Payne is moderating a Workshop entitled "Female Genital Mutilation/Cutting: the role of the ICS".

It's sure to be a busy week!


Interleading is a version of tango dance involving the sharing or switching of the lead. The switch is subtle, even playful. The follower gives her partner cues, and gradually influences direction and speed...ultimately directing the dance - without force nor coercion. This should not be confused with back leading, in which, typically a follower or woman, forces her partner to follow her lead. The implication in back leading is that she must control the dance, because he doesn't know what he is doing. It is rude and demeaning. Indeed, it is a huge "no-no" in tango.

Interleading celebrates the strength of the traditional leader, in his ability to briefly and intermittently relinquish his role. It also celebrates sensitivity, not strength, on the part of the follower, who must be keenly aware of his footing and balance, in order to assume the lead. If done thoughtfully, it conjures trust rather than emasculation.

This lesson from the dance floor was particularly special to me as a woman who specializes in men's health. It is a metaphor for the process of shared decision-making that comes with screening tests, laboratory studies, and diagnostic procedures. It is the process of informed consent... Understanding first, what he is bringing with him to the dance floor, and second, respecting his axis. For when I assume the lead, as his physician, he will be better informed, respected, and less frightened.