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Reproductive Health Concerns in Males

 

Testicular pain

What are the common causes of pain in the scrotal region (loose bag of skin that holds testis)?

Besides concerned about the sexual function and fertility issues, men may have other problems related to reproductive system like swelling and pain in scrotal region or other problems related to testis or penis. Pain in scrotal region may be due to a problem in testis or other structures around/behind, testis, groin or lower abdomen. Severe testicle pain that comes on quickly can be a sign of testicular torsion. This condition requires immediate treatment. Other conditions include:

  • Hydrocele (swelling of the scrotum)
  • Inguinal hernia
  • Kidney stones
  • Mumps
  • Retractile testicle (a testicle that pulls up inside the groin — this condition occurs in young boys)
  • Testicle injury or blow to the testicles

  • The common causes of pain may be:
  • Infections (epididymitis or orchitis).
  • Injury.
  • Testicular torsion.
  • Varicocele.
  • Testicular cancer.

 

What should be done in case of painful abscesses in scrotum with burning sensation during urination?

One must consult the doctor at the earliest. It may be a sign of sexually transmitted infection.

 

What are the common causes of pain in the testicular region?

The common causes of pain may be:

  • (i) Injury.
  • (ii) Testicular torsion.
  • (iii) Testicular cancer.

 

When should you consult a doctor for the pain in the testicular region?

Testicular pain should be considered serious if it shows these features and must be shown to a doctor urgently: Sudden, severe testicle pain, testicle pain accompanied by nausea, fever, chills, blood in the urine, or burning sensation while passing urine, mild testicle pain lasting longer than a few days and a lump or swelling in or around a testicle

 

What is testicular torsion?

Testicular torsion is a condition in which the testes gets twisted on its supporting cord known as spermatic cord as a result of which blood supply to the testes gets cut off. As a result the wall of the scrotum becomes bluish to purple colour and very painful. This is a medical emergency and must be reported immediately

 

 

Hydrocele

What are the common reasons for enlargement of the testes on one side?

If you notice enlargement of the testes on one side, you must immediately show a surgeon. Some of the common causes can be because of infections, a hydrocele, or because of a tumour of the testes.

 

What is a hydrocele?

A varicocele often produces no signs or symptoms. Rarely, it may cause pain. The pain may:

  • Vary from dull discomfort — a feeling of heaviness — to sharp
  • Increase with sitting, standing or physical exertion, especially over long periods
  • Worsen over the course of a day
  • Be relieved when you lie on your back With time, varicoceles may enlarge and become more noticeable
  •  

When to see a doctor for a varicocele?

Because a varicocele usually causes no symptoms, it's often discovered during a fertility evaluation or a routine physical exam. However, if you experience pain or swellings in your scrotum or you discover a mass on your scrotum, contact your doctor. A number of conditions can cause a scrotal mass or testicular pain, some of which require immediate treatment.

 

 

Hydrocele

What are the common reasons for enlargement of the testes on one side?

If you notice enlargement of the testes on one side, you must immediately show a surgeon. Some of the common causes can be because of infections, a hydrocele, or because of a tumour of the testes.

 

What is a hydrocele?

A hydrocele is a fluid-filled sac surrounding a testicle that results in swelling of the scrotum, the loose bag of skin underneath the penis. Up to 10 percent of male infants have a hydrocele at birth, but most hydroceles disappear without treatment within the first year of life. Additionally, adult men can develop a hydrocele due to inflammation or injury within the scrotum. Hydroceles usually aren't painful. Typically not harmful, hydroceles may require no treatment, especially if they are small in size. However, if you have scrotal swelling, see your doctor to rule out other causes, such as testicular cancer or other conditions

 

What are the symptoms of a hydrocele?

Usually the only symptom of a hydrocele is a painless swelling of one or both testicles. Adult men with a hydrocele may experience discomfort from the heaviness of a swollen scrotum. See your doctor if you experience scrotal swelling. It's important to rule out other possible causes for the swelling, such as a tumor. Sometimes a hydrocele is associated with an inguinal hernia, in which a weak point in the abdominal wall allows a loop of intestine to extend into the scrotum and which may require treatment. If your baby has scrotal swelling, make an appointment with your baby's doctor. If the doctor determines that the cause of the swelling is a hydrocele, it will typically disappear on its own. However, if your baby's hydrocele doesn't disappear after a year or if it enlarges, you should have it re-evaluated.

 

What are the common causes of a hydrocele?

In older males, a hydrocele can develop as a result of inflammation or injury within the scrotum. Inflammation may be the result of infection of the small coiled tube at the back of each testicle (epididymitis) or of the testicle. In India, filariasis is a common cause of hydrocele in parts of eastern UP, Bihar and the coastal states of peninsular India. Hydroceles can also occur secondary to infections of the testes and epididymis, tuberculosis, cancer of the testes, and also injury to the scrotum. In a large number of cases, the cause may not be evident.

 

Does a hydrocele require treatment?

If there is a suspicion of a hydrocele, you should show a surgeon. He may ask for an ultrasound of the scrotum to rule out an underlying tumor of the testes. If there is an underlying treatable cause (filariasis, infection, tuberculosis), then it should be treated. If the hydrocele is small, it may not require surgical treatment. If large and giving rise to discomfort, it will require treatment by surgery.

 

Undescended testes

My son does not have a testis on one side. Is it normal? What is this?

He is having a condition called undescended testes (absent testes) on one side. An undescended testis is a testicle that hasn't moved into its proper position in the bag of skin hanging behind the penis (scrotum) prior to the birth of the baby boy. About 2 to 5 percent of baby boys are born with one or two undescended testes. An undescended testis is more common among baby boys born prematurely, or before 37 weeks. It's rare for boys to have two undescended testes. For most boys born with one or two undescended testes, the problem corrects itself within the first few months of life. If your infant has an undescended testis that doesn't correct itself, surgery can usually be used to relocate it into the scrotum.

 

When do I have to see a doctor for this condition?

An undescended testis is typically detected when your baby is examined shortly after birth. If your son has an undescended testis, ask the doctor about the problem. If the testes haven‘t moved into the scrotum by the time your son is 4 months old, the problem probably won't correct itself. Treating undescended testes when your son is still a baby may lower the risk of complications later in life, such as infertility and testicular cancer. Older boys — from infants to preadolescent boys — who have normally descended testes at birth may appear to be "missing" a testis later. This condition may indicate a retractile testis, which moves back and forth between the scrotum and the groin and may be easily guided by hand into the scrotum during a physical examination. If you notice any changes in your son's genitals or are concerned about his development, talk to your doctor.

 

What is the treatment of undescended testes?

The goal of treatment is to move the undescended testes to its proper location in the scrotum. Early treatment may lower the risk of complications of an undescended testis, such as the risk of infertility and testicular cancer.An undescended testis is usually corrected with surgery. The surgeon carefully manipulates the testes into the scrotum and stitches it into place. When your son has surgery will depend on number factors, such as your son's health and how difficult the procedure might be. Your surgeon will likely recommend doing the surgery after your son is 3 to 6 months old and before he is 15 months old. Early surgical treatment appears to lower the risk of later complications. In some cases, the testes may be poorly developed, abnormal or dead tissue. The surgeon will remove this testicular tissue. If your son also has an inguinal hernia associated with the undescended testes, the hernia is repaired during the surgery.

 

When should surgery be done for correcting undescended testes?

The time of surgery depends on number factors. It is usually done when baby is 3 to 6 months old and before he is 15 months old. In some cases, the testes may be poorly developed, abnormal or dead tissue. The surgeon will remove this testicular tissue. If there is an inguinal hernia associated with the undescended testes, the hernia (growth in the groin) is repaired during the surgery.

 

Hernia

What is hernia?

A hernia is an opening or weakness in the muscular structure of the wall of the abdomen. This defect causes a bulging of the abdominal wall. This bulging is usually more noticeable when the abdominal muscles are tightened, thereby increasing the pressure in the abdomen. Any activities that increase intra-abdominal pressure can worsen a hernia; examples of such activities are lifting, coughing, or even straining to have a bowel movement.

 

How hernia is treated?

A hernia repair requires surgery. There are several different procedures that can be used for fixing any specific type of hernia. In a standard repair, following appropriate anesthesia and sterilization of the surgical site, an incision is made over the area of the hernia and carried down carefully through the sequential tissue layers. The goal is to separate away all the normal tissue and define the margins of the hole or weakness. Once this has been achieved, the hole is then closed, usually by suture and plastic mesh. There are different ways by which a hernia is repaired. More and more of hernia repairs are now being done using laparoscopic techniques.

 

Phimosis

Is it abnormal if the foreskin does not cover head of the penis?

No, it is normal and natural. It may be present since childhood or may occur in adults also.

 

The skin over the tip of the penis cannot be pulled back. Is it normal? Can it cause problems? Does it require treatment

Any condition where the foreskin (prepuce) of the penis cannot be retracted or pulled backward is called phimosis. Most infants are born with a foreskin that cannot be retracted and the prepuce may be tight until after puberty. A fully retractable foreskin occurs in 50% of ten year olds, 90% of 16 year olds and 98 to 99% of 18 year olds. Phimosis can be caused by failure of foreskin to loosen during growth, infections of the tip of the penis (glans), deformities caused by trauma and diseases of the genitals. Phimosis is usually a painless condition. Infection may result from an inability to carry out effective cleaning of the area in which case swelling, redness and discharge may all be present making the area tender and painful. A very tight foreskin can cause problems during intercourse, urination. It has been suggested that any radical or surgical treatments for phimosis should not be done until after puberty, or unless there is obstruction to the flow of urine. After attaining puberty, if the foreskin is still tight and there problems intercourse or urination, or frequent infection of the glans, then a minor surgical procedure may be required to correct this problem.

 

When the foreskin (prepuce) is pulled back while cleaning or during intercourse, then it does not come back easily and causes pain and swelling of the glans. What is to be done?

An inability to pull back the foreskin into position over the head of the penis can cause pain, swelling of the head of the penis and the foreskin. This condition is called paraphimosis. It may cause restricted blood flow, causing the head of the penis to become dark purple in colour. If this occur, emergency treatment is required.

 

Can Phimosis cause problems?

Phimosis is usually a painless condition. Infection may result from an inability to carry out effective cleaning of the area in which case swelling, redness and discharge may all be present making the area tender and painful. A very tight foreskin can cause problems during intercourse, urination.

 

Does Phimosis require treatment?

It has been suggested that any radical or surgical treatments for phimosis should not be done until after puberty, or unless there is obstruction to the flow of urine. After attaining puberty, if the foreskin is still tight and there is problems in intercourse or urination, or frequent infection of the glans (tip of penis), then a minor surgical procedure may be required to correct this problem.

 

Circumcisions

What is circumcision?

Boys are born with a hood of skin, called the foreskin, covering the head (also called the glans) of the penis. In circumcision, the foreskin is surgically removed, exposing the end of the penis.

 

Who should undergo circumcision?

Any new born male child can undergo circumcision. Routine circumcision is usually performed during the first 10 days (often within the first 48 hours), in the hospital. The doctor should prepare you by telling you about the procedure he or she will use and the possible risks. Circumcision after the newborn period can be a more complicated procedure and usually requires general anaesthesia.

 

Is circumcision a good practice?

Parents who choose circumcision often do so based on religious beliefs, concerns about hygiene, or cultural or social reasons, such as the wish to have their son look like other men in the family. Studies have shown that circumcision lowers the risk of many diseases. HIV rates among those not circumcised are two to eight times higher than in those groups which practice circumcision. Circumcision is a good practice if performed by an expert and done under hygienic conditions.

 

Does circumcision leads to improved sexual health?

Some people claim that circumcision either lessens or heightens the sensitivity of the tip of the penis, decreasing or increasing sexual pleasure later in life. But neither of these subjective findings has been proved.

 

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