Erectile Dysfunction
Erectile dysfunction (inability to achieve or maintain erection sufficient for penetration) is an extremely private complaint of patients. It poses a huge psychological trauma on the patient as well as his spouse. Treatment of erectile dysfunction is possible. A detailed evaluation of the patient’s medical history and the associated circumstances during which the problem started is required. ED may have a psychological cause or an organic reason. Most of the cases of ED have an underlying psychological reason, like acute stress at home or work, relationship problems, misconception about masturbation etc. These patients present with a more sudden onset complaints and a history of psychological stress can be elicited. Nighttime erections or erections during masturbations are present. Treatment in these cases involve both medical management as well as psychological treatment (either counselling or medications) and improvement is expected in majority.
A less common and more worrisome type of ED is due to an organic cause, of which cardiovascular cause is the most important. ED can provide an important window in patients to screen for underlying heart or peripheral vascular disease and in these cases treatment of these latter conditions take a priority. In these patients, ED can provide a golden opportunity to screen patients of such life threatening heart conditions. Improvement in the underlying cause in cases of organic ED helps in resolution of the ED itself as well.
Things you can do to reduce the risk of ED –
Maintain a healthy and active lifestyle
Do regular aerobic exercise (30 min/day, 5 days/week)
Maintain a healthy mental state (meditation/yoga)
Seek treatment for life and relationship stressors (don’t stigmatize the visit to a psychologist/psychiatrist, if needed)
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Male Infertility
Half of all couples presenting with infertility are found to have a problem with the male partner. It is a common misconception that infertility is due to problem with the female partner only. In our society, men are often not investigated as a cause of infertility and this leads to under-evaluation and under-treatment of this condition. There are many reasons for male infertility, some of which are treatable by surgery, some with lifestyle changes or medications and some for which assisted reproductive methods are required (such as IVF) to achieve pregnancy. Common causes include hormonal abnormalities, obstruction in the male reproductive tract, abnormality in the testes or unknown causes. During evaluation, the doctor will examine your testes to detect any abnormalities and you will be prescribed blood tests and semen analysis (two samples, each after abstinence for 1-3 days) to identify the cause. With the current assisted reproductive techniques, pregnancy is now possible in many patients with male factor infertility and normal female partner.
Things you can do to help improve your fertility –
Avoid smoking and alcohol intake
Maintain a healthy and active lifestyle
Maintain a normal weight (both under-nutrition and obesity are harmful)
Avoid excessive mental stress (meditation and yoga are beneficial to reduce stress)
Avoid excessively tight underwear
Avoid excessively long hot water baths (>30 min/session)
Avoid prolonged placement of laptops on the lap
Testicular Pain and Varicocele
Many patients, mostly young adults, present with complaints of heaviness and discomfort in the groin extending to one or both of the testicles. Some of these patients are found to have varicoceles as well. Some patients are found to have varicoceles on evaluation for infertility. Chronic testicular pain (chronic orchalgia) and varicoceles are troubling problems for the patients. However, it is important to understand that they are not life threatening and do not increase the risk for developing any serious condition in the future. Many patients demand surgery for varicoceles detected on ultrasound, but not clinically apparent. It is important that these patients are counselled properly and given a trial of conservative management before doing any surgical intervention. Surgery for varicocele has limited indications which your doctor will discuss with you and the step for surgery in these cases should be taken after a shared decision making process. Supportive management such as scrotal support and patient education can provide significant relief in majority of the patients.
Testicular Infections and Torsion
Testicular Infection
Testicular infections (epidydimo-orchitis) is a common condition encountered by the urologist. Patients usually present with gradually worsening pain and swelling in the testis, with or without urinary burning or fever. There might occasionally be pus formation in the testis as well. In most cases, you will require antibiotics, along with painkillers and other supportive treatment for the infection. The pain responds quickly to treatment, although the swelling may take a longer time to subside. An assessment for the cause for the infection will be done as well as these infections can either be sexually transmitted in some cases, or due to associated urological conditions in other. In cases there is pus in the testis and the testis is suspected to be non-viable on investigations, surgery may be required to remove the dead testis and the pus, without which improvement is unlikely.
Testicular Torsion
Testicular torsion is a surgical emergency and is often confused with epidydimo-orchitis. Torsion most commonly presents in adolescent males with sudden onset testicular pain and swelling. In these cases, it is imperative that the patient presents to the urologist as the earliest as with prompt surgical management (usually within a window of 6 hours from onset), the testis might be saved. However, many times the patients lose this opportunity due to delay in seeking treatment or getting second opinions and the testis becomes non-salvageable. In these cases, the testis needs to be removed. During surgery, the other testis is also fixed into position so that it doesn’t run the risk of torsion in the future and the fertility of the patient is preserved.
Testicular Cancer
Testicular cancer is a relatively uncommon condition and it usually affects young men. The most important fact you should know about testicular cancer is that with proper and rigorous treatment, the outcome of patients is excellent, with cure possible in many patients. This condition usually presents with increase in the size of the testis .The patient can often feel a change in the testicular feeling with loss of testicular sensation and heaviness in the affected testis. It is common for patients to delay treatment due to embarrassment. However, if the patient presents early, complete cure is possible with just removal of the testis. Therefore, it is very important to seek treatment with a urologist in case of above complaints. People with undescended testis should be aware that their risk of developing a testicular tumor are higher and they should seek treatment for their undescended testis with a urologist. Along with surgery, treatment of testicular tumor may also involve chemotherapy and radiation therapy. However, with regular follow up and aggressive treatment, the outcomes are excellent for these patients.
Phimosis and Paraphimosis
Phimosis
Phimosis is a condition in which the patient is unable to retract the foreskin over the penis. In some cases, it could be mild and cause problems only during erections. However, in severe cases the skin is unable to be retracted even in relaxed state of the penis, which can lead to build up of dead skin and bacteria beneath the skin, leading to repeated infections of the area (called balanoposthitis). This condition can also lead to problems with urinary stream if severe and can rarely predispose to cancer of the penis. The treatment for this condition is circumcision, in which the doctor removes the tight foreskin of the penis and exposes the urinary opening, so that the above problems are cured. Utmost care is taken to give the best cosmetic appearance to the penis. Circumcision does not lead to problems with erection or orgasm and does not affect the fertility of the patient.
Paraphimosis
In this condition, the foreskin of the penis, after being retracted forcefully (on purpose or accidentally) is unable to come back to the original position. This is a medical emergency as it can damage the blood supply to the tip of the penis, if not treated. The patient usually presents with painful and retracted foreskin. In the emergency situation, the doctor may be able to put back the skin by various non-surgical methods. However, a patient who has had even a single such episode should get circumcision done to prevent future episodes. In rare cases, emergency circumcision is also required.
Penile Cancer
Cancer of the penis is a relatively uncommon condition, usually affecting older patients. It usually presents with a swelling or lump over the penis, usually affecting the tip of the penis. It might also present as hardness below the foreskin and may occasionally cause problem with urination. Patients with this condition often delay seeking treatment for their condition due to embarrassment. This often leads to disease advancement and poor outcome for the patients. In very early stages, penile cancer can be treated by non-surgical methods, like radiation and lasers to save the penis. However, in our country the patients most present in more advanced stages and often require partial or complete removal of the penis. Depending on the biopsy report after the penile surgery, patients might require further surgery of the groin, chemotherapy or radiation. In early stages the disease outcome is good, however, with advancing stages the prognosis becomes poorer.
Things you can do to reduce your risk of developing penile cancer –
Maintain regular hygiene of the penile region and glans (after retracting the foreskin during bath)
Avoid unprotected sex, avoid multiple partners (prevent STDs and HIV)
Stop smoking