MALE
GENITAL PROBLEMS
These are some of the problems we deal with:
Phimosis
Phimosis is the narrowing of the foreskin. It can happen at any age.
Treatment is usually surgical (circumcision) although it can sometimes improve with corticosteroid creams. The surgery consists of cutting the entire narrow foreskin and applying a series of stitches at that level.
Penile Incurvation
The incurvation of the penis either has always been present or occurs from a given moment. A hard plaque is usually palpated at the level of the corpora cavernosa. Urological evaluation and examination is important.
Oral treatments are often ineffective, so the definitive treatment is usually surgery.
Varicocele
They are varicose veins in the testicle. It usually manifests as a “lump” above the testicle, generally the left one. It can cause pain in the testicle and on other occasions can cause alterations in the semen that make it difficult to have children. The exploration along with the realization of a testicular Doppler ultrasound are basic in its diagnosis.
When asymptomatic, they are not usually treated.If treatment is required, it is by radiological embolization or surgery.
Epididymal cysts/spermatic cord cysts
They are usually liquid collections next to the testicle. It is important to rule out a testicular tumor.
The treatment, if they are large, is surgical.
Hydrocele
It is a collection of fluid around the testicle. It manifests as an enlargement of the hemiscrotal on that side. It is important to differentiate it from a testicular tumor. The diagnosis is made by examination and testicular ultrasound.
When they are large in size, treatment is surgical.
Balanitis
It consists of inflammation of the foreskin. The most frequent cause is fungal infection. The foreskin appears inflamed with reddened lesions and secretion of a whitish material.
It usually responds well to treatment with antifungal creams.
MALE
SEXUAL PROBLEMS
Impotence
What are the causes?
There are two types of causes:
- Organic (vascular, neuronal, hormonal, penile lesions or due to pharmacological treatments).
- Psychogenic (depression, performance anxiety, relationship problems, psychosocial problems, etc.)
There is usually a combination of psychogenic and organic factors. It may happen that erectile dysfunction is the first symptom of diseases that have not yet been diagnosed: diabetes, hypertension, high cholesterol or depression.
Initially, a complete analytical study including testosterone, cholesterol and glucose, among others, is necessary.
1. LIFESTYLE MODIFICATIONS:
- Stop smoking
- Limiting or avoiding alcohol consumption
- Healthy diet
- Regular physical exercise
2. PELVIC FLOOR STRENGTHENING EXERCISES
3. ADJUST CONCOMITANT TREATMENTS IF ANY:
- Antihypertensives
- Antidepressants
- Oral drugs (the treatment of choice): sildenafil, vardenafil, tadalafil, avanafil. All of them are effective and well tolerated. Contraindicated if taking nitrates or recent cardiovascular event or if you have an eye disease called retinitis pigmentosa. Some men may experience headaches and reddening of the face when taking them. It is important to note two things: it must be taken 20-30 minutes before sexual intercourse and there must be sexual arousal for it to work.
- Low energy shock waves
- Treatment with alprostadil: intracavernous (injection into the penis), intraurethral or cream.
- Vacuum systems
- Penile prosthesis
Premature ejaculation
How can I delay my ejaculation?
- Psychological therapy
- Pharmacological treatments: oral (dapoxetine) and anesthetic creams.
SEXUALLY TRANSMITTED
DISEASES (STD)
Urethral discharge (urethritis)
How does this manifest ?
Fluid discharge from the urethra more or less whitish or burning in the urethra.
What usually causes it?
Chlamydia and gonococcus are the most frequent causes.
Others: ureaplasma, mycoplasma, trichomonas.
What do I have to do?
A correct diagnosis by PCR of the urethral fluid is necessary and antibiotics (ceftriazone, doxycycline, azithromycin) should be taken.
- Avoid sexual contact until 7 days after completion of treatment, and until all sexual partners have been properly treated.
- In case of gonococcal/chlamydia infection, concurrent testing for chlamydia/gonocococcus respectively, syphilis and HIV is recommended.
- A new appointment is recommended in three weeks to check for resolution of symptoms.
- When to test for cure at 3-6 weeks post treatment:
- Symptoms persist.
- Not treated with regimen of choice.
- Isolation of M. genitalium (requires treatment with a long regimen, high resistance to macrolides).
- Doubtful compliance with treatment.
- It is advisable to perform a control test at three months due to high reinfection rates, not before >2 weeks after the end of treatment..
The patient’s sexual partners in the previous 2 months should be evaluated and treated with the same regimen as the patient, advising sexual abstinence until completion of treatment and disappearance of symptoms.
Genital Ulcer
How do they manifest?
Ulcerated lesion on genitals
What is usually the cause?
Herpes simplex virus (multiple, painful and preceded by vesicles)
Syphilis (single and non-painful
What do I have to do?
A correct diagnosis by PCR of the ulcer secretion and receive antiretroviral treatment or penicillin.
What precautions should I take?
Avoid sexual contact until the ulcer is resolved and treat the partner.
Genital Warts
How do they manifest?
They are raised, pedunculated, non-painful lesions.
What is usually the cause?
Human Papilloma Virus (HPV) 6 and 11
What should I do?
It should be treated with a topical treatment
Human papillomavirus
Are HPV infections common?
It primarily affects young, sexually active men and women. It is estimated that >80% of sexually active people will become infected with HPV at some time in their lives. We can carry HPV and not show any symptoms.
How many types of HPV are there?
There are many types of HPV. There are some with high oncogenic risk: 16,18,31,33,35,45,52 and 58 which are mainly associated with cancer of the cervix, anus and penis. Other HPV types are of low oncogenic risk: 6 and 11 which are responsible for most genital warts.
What happens if I get HPV?
Most HPV infections occur asymptomatically and are transient, with more than 80% clearing within two years. With multiple sexual contacts there may be an overlap between clearance and reinfection, leading to chronification of the infection.
How do I know if I am a carrier of HPV?
Currently, genital PCR can be performed by swabbing the genital mucosa.
If I am found to be a carrier of HPV, what should I do?
Currently, HPV screening is rarely performed in males because there is no effective treatment. The use of vaccines in males is controversial.