Men's Health Problems: Penile and Testicular Disorders & Sexually Transmitted Infections

This set of flashcards focuses on vocabulary related to men's health problems, specifically penile and testicular disorders, as well as sexually transmitted infections (STIs). Each card provides key terms and their definitions to aid in understanding and preparing for exams.

What is Erectile Dysfunction?

Failure to consistently maintain a sufficiently rigid erect penis for satisfactory sexual activity.

What is the pathophysiology of Erectile Dysfunction?

Involves impaired blood flow into the penis (arterial insufficiency), impaired veno-occlusion (venous leakage), neurological issues (nerve damage), hormonal imbalances (e.g., low testosterone), or psychogenic factors (stress, anxiety, depression).

What are common clinical presentations of Erectile Dysfunction?

Difficulty achieving an erection, difficulty maintaining an erection during intercourse, or a reduction in erectile rigidity. It may also include a decrease in libido or self-esteem.

How is Erectile Dysfunction diagnosed?

Based on patient history (sexual, medical, psychosocial), physical examination, and laboratory tests (e.g., testosterone levels, glucose, lipid panel). Further specialized tests like nocturnal penile tumescence, vascular studies, or a penile Doppler ultrasound may be used.

How is Erectile Dysfunction managed?

1. Lifestyle Modifications: Diet, exercise, smoking cessation, alcohol reduction.2. Oral Medications: Phosphodiesterase-5 (PDE5) inhibitors (e.g., sildenafil, tadalafil).3. Vasoactive Therapy: Intracavernosal injections (e.g., alprostadil) or urethral suppositories.4. Vacuum Erection Devices.5. Penile Implants (Prostheses).6. Psychological Counseling (for psychogenic causes).7. Hormone Therapy (e.g., testosterone replacement for hypogonadism).

What are Androgens?

Hormones that play a crucial role in male traits and reproductive activity, essential for the development and maintenance of male sexual characteristics and function.

What is Detumescence?

The physiological process of subsiding of erectile tissue; the penis returning to its flaccid state, typically following ejaculation or cessation of sexual stimulation.

What is Priapism?

A painful condition of prolonged erection not associated with sexual desire or stimulation, typically lasting more than 4 hours. It is considered a urological emergency.

What is the pathophysiology of Priapism?

1. Ischemic Priapism (Low-Flow): The most common type, caused by impaired venous outflow from the penis, leading to venous stasis, hypoxia, and acidosis within the corpora cavernosa. This can result in penile fibrosis and permanent ED.2. Non-Ischemic Priapism (High-Flow): Less common, caused by unregulated arterial inflow into the penis, often due to a fistula between a cavernosal artery and corpus cavernosum, usually following trauma.

What are the clinical presentations of Priapism?

A sustained, often painful, erection lasting longer than 4 hours.

• Ischemic Priapism: Rigid, fully erect penis, typically painful, with little to no arterial inflow.

• Non-Ischemic Priapism: Less rigid, often not painful, with normal or increased arterial inflow.

How is Priapism diagnosed?

Through clinical history and physical examination. Differentiating between ischemic and non-ischemic types is crucial:

• Cavernosal blood gas analysis: For ischemic priapism, it will show low pO2, high pCO2, and low pH.

• Penile Doppler ultrasound: Used to assess blood flow and identify potential fistulas in non-ischemic priapism.

How is Priapism managed?

• Ischemic Priapism: A urological emergency requiring immediate intervention.- Aspiration and Irrigation: Removal of blood from the corpora cavernosa.

  • Intracavernosal injection of sympathomimetics: Such as phenylephrine, to promote detumescence.

  • Surgical Shunt: If medical management fails, to create a pathway for blood outflow.

• Non-Ischemic Priapism: Less urgent.- Observation: Can resolve spontaneously.

  • Selective Arterial Embolization: To close the fistula.

What is Hypogonadism?

Decreased or absent secretion of testosterone from the gonads (testes), leading to abnormally low testosterone levels.

What is the pathophysiology of Hypogonadism?

1. Primary Hypogonadism: Testicular failure (e.g., Klinefelter syndrome, mumps orchitis, chemotherapy, trauma), resulting in low testosterone and elevated gonadotropins (LH, FSH).2. Secondary Hypogonadism: Pituitary or hypothalamic dysfunction (e.g., pituitary adenoma, Kallmann syndrome), leading to low testosterone and low or normal gonadotropins.

What are the clinical presentations of Hypogonadism?

1. In adults: Decreased libido, erectile dysfunction, decreased muscle mass, increased body fat, fatigue, depression, reduced body hair, and osteoporosis.2. In pre-pubertal males: Delayed or incomplete puberty, small testes, underdeveloped secondary sexual characteristics.

How is Hypogonadism diagnosed?

Measurement of serum total testosterone levels, typically confirmed with repeat morning samples. Further tests include LH (Luteinizing Hormone), FSH (Follicle-Stimulating Hormone), prolactin, and sometimes imaging (e.g., pituitary MRI) to identify the cause.

How is Hypogonadism managed?

1. Testosterone Replacement Therapy (TRT): Available in various forms (injections, gels, patches, pellets) to restore testosterone levels and alleviate symptoms. Not suitable for those desiring fertility.2. For fertility: Human Chorionic Gonadotropin (hCG) or other gonadotropin therapies may be used to stimulate testicular function.3. Address underlying cause: E.g., removal of a pituitary tumor.

What is Microphallus (Micropenis)?

A condition in which the stretched penile length is abnormally small relative to average size for age, typically at least 2.5 standard deviations below the mean.

What is the pathophysiology of Microphallus?

Often due to hypothalamic-pituitary axis dysfunction during fetal development, leading to insufficient androgen stimulation. It can be associated with hypogonadism (primary or secondary) or panhypopituitarism. Genetic abnormalities can also play a role.

How is Microphallus diagnosed?

Primarily by physical measurement of stretched penile length shortly after birth or during childhood, comparing it to age-matched norms. Hormonal evaluation may be performed to identify underlying endocrine causes.

How is Microphallus managed?

1. Hormonal Therapy: If diagnosed in infancy, a short course of testosterone therapy may be attempted to promote penile growth. The effectiveness decreases after puberty.2. Surgical Intervention: Rarely considered, and generally not effective for significant length increase.

What is Peyronie’s Disease?

A condition characterized by the formation of fibrous scar tissue (plaque) inside the tunica albuginea of the penis, causing curved, painful erections, penile shortening, and sometimes erectile dysfunction.

What is the pathophysiology of Peyronie’s Disease?

The exact cause is unknown, but it's believed to involve repeated penile trauma (e.g., during intercourse) leading to localized inflammation, impaired healing, and subsequent collagen deposition and fibrosis within the tunica albuginea. Genetic predisposition and autoimmune factors may also contribute.

What are the clinical presentations of Peyronie’s Disease?

• Penile curvature: The most common symptom, making intercourse difficult or impossible.

• Painful erections: Especially during the acute inflammatory phase.

• Palpable plaque: A firm lump or band can often be felt under the skin of the penis.

• Penile shortening or narrowing.

• Erectile Dysfunction.

How is Peyronie’s Disease diagnosed?

Primarily by physical examination, where a palpable plaque and curvature are noted. A dynamic ultrasound (after injection of a vasoactive agent) can visualize the plaque, assess calcification, and evaluate blood flow.

How is Peyronie’s Disease managed?

Management depends on the disease phase (acute vs. chronic) and severity.

• Acute Phase (Painful, progressing curvature):- Oral Medications: Pentoxifylline, Vitamin E (efficacy debated).

  • Intralesional Injections: Collagenase Clostridium histolyticum (Xiaflex) for specific curvatures, verapamil, interferon alpha-2b.

  • Traction Devices.

• Chronic Phase (Stable curvature, pain resolved):- Surgery: Plication procedures (Nesbit procedure), grafting procedures (for severe deformities with good erectile function), or penile prosthesis implantation (if significant ED is present).

What is Prehn’s Sign?

A clinical sign suggesting epididymitis when relief of scrotal pain is observed with manual elevation of the scrotum. (Note: Its reliability is debated and absence does not rule out testicular torsion).

What is a Hydrocele?

A condition where there is a collection of serous fluid in the tunica vaginalis, the sac surrounding the testicle, resulting in scrotal swelling.

What is the pathophysiology of a Hydrocele?

1. Congenital Hydrocele: Failure of the processus vaginalis to close during development, allowing peritoneal fluid to flow into the scrotum (communicating hydrocele).2. Acquired Hydrocele: Can result from inflammation (epididymitis, orchitis), trauma, infection, or tumors, leading to an imbalance in fluid secretion and absorption by the tunica vaginalis (non-communicating hydrocele).

What are the clinical presentations of a Hydrocele?

Often a painless scrotal swelling, which may fluctuate in size (communicating hydrocele). The scrotum usually feels soft and smooth. Can cause discomfort or a feeling of heaviness if large.

How is a Hydrocele diagnosed?

Physical examination noting a non-tender, smooth, and soft scrotal mass. Transillumination (shining a light through the scrotum, which illuminates the fluid-filled sac) is often positive. Scrotal ultrasound confirms the diagnosis and rules out other causes of swelling.

How is a Hydrocele managed?

1. Observation: Small, asymptomatic hydroceles often resolve spontaneously, especially in infants.2. Surgical Repair (Hydrocelectomy): Indicated for large, symptomatic, or persistent hydroceles, involving excision or eversion of the tunica vaginalis. Aspiration alone is generally discouraged due to high recurrence rates and infection risk.

What is a Varicocele?

An abnormal dilation (varicosity) of the pampiniform plexus, the network of veins within the spermatic cord, often described as a 'bag of worms.' It is a common cause of male infertility.

What is the pathophysiology of a Varicocele?

Primarily due to incompetent or absent valves in the internal spermatic vein, leading to retrograde blood flow and venous pooling around the testis. This increases scrotal temperature and causes oxidative stress, impairing spermatogenesis. Most commonly occurs on the left side due to anatomical reasons (left spermatic vein drains into the left renal vein at a perpendicular angle).

What are the clinical presentations of a Varicocele?

• Often asymptomatic.
• 'Bag of worms' sensation/appearance in the scrotum, especially when standing or with Valsalva maneuver.
• Dull ache or heaviness in the testicle, worsening with prolonged standing.
• Infertility (due to impaired sperm production) or testicular atrophy.

How is a Varicocele diagnosed?

Physical examination (palpation of the 'bag of worms' feeling, especially with Valsalva maneuver). Scrotal Doppler ultrasound confirms the diagnosis by showing dilated veins with reflux, particularly during Valsalva maneuver.

How is a Varicocele managed?

1. Observation: For asymptomatic varicoceles not affecting fertility.2. Surgical Repair (Varicocelectomy): Indicated for significant pain, testicular atrophy, or male infertility in the presence of an abnormal semen analysis. Techniques include open surgical ligation, laparoscopic ligation, or percutaneous embolization.

What is Testicular Torsion?

A urological emergency where the spermatic cord (which contains blood vessels, nerves, and the vas deferens) becomes twisted, cutting off the blood supply to the ipsilateral testicle.

What is the pathophysiology of Testicular Torsion?

The twisting of the spermatic cord leads to venous obstruction initially, then arterial obstruction, resulting in ischemia (lack of blood flow) and potentially infarction (tissue death) of the testicle if not promptly corrected. It often occurs in males with a 'bell-clapper' deformity, an anatomical variation that allows the testicle to rotate freely within the tunica vaginalis.

What are the clinical presentations of Testicular Torsion?

• Sudden onset of severe scrotal or inguinal pain, often radiating to the lower abdomen.
• Nausea and vomiting.
• High-riding testicle (testicle appears elevated in the scrotum).
• Absent cremasteric reflex (lack of testicular elevation when the inner thigh is stroked).
• Scrotal swelling, erythema, and tenderness.

How is Testicular Torsion diagnosed?

Primarily a clinical diagnosis based on history and physical examination. Scrotal Doppler ultrasound is the key diagnostic tool to confirm the absence of blood flow to the affected testicle. Time is critical, so surgical exploration should not be delayed if torsion is strongly suspected.

How is Testicular Torsion managed?

Urological Emergency: Time-sensitive, with surgical intervention needed within hours for testicular viability.

• Manual Detorsion: An attempt to untwist the testicle manually, sometimes performed acutely but always followed by surgical exploration.
• Surgical Exploration and Detorsion: The definitive treatment. The testicle is untwisted, and then both testicles are typically fixed to the scrotal wall (orchiopexy) to prevent future torsion.
• Orchiectomy: If the testicle is non-viable (infarcted) due to prolonged ischemia, it must be surgically removed.

What is Gynecomastia?

Benign enlargement of glandular breast tissue in males, resulting from an imbalance between estrogen and androgen action at the breast tissue level.

What is the pathophysiology of Gynecomastia?

Usually due to an elevated estrogen-to-androgen ratio. This can occur from:

• Increased estrogen production: Liver disease, tumors (adrenal, testicular, lung).
• Decreased androgen production: Hypogonadism (primary or secondary), renal failure.
• Increased peripheral aromatization of an drogens to estrogens: Obesity, aging.
• Medications: Spironolactone, cimetidine, ketoconazole, anabolic steroids, certain antiandrogens.
• Physiological: Neonatal, pubertal, and senescent (elderly) gynecomastia.

What are the clinical presentations of Gynecomastia?

Palpable, often tender, subareolar breast tissue enlargement, usually bilateral but can be unilateral. Typically, it feels firm and rubbery, distinct from diffuse fatty tissue (pseudogynecomastia).

How is Gynecomastia diagnosed?

Clinical examination for palpable glandular tissue. Differentiating from pseudogynecomastia. Diagnostic work-up includes hormone levels (testosterone, estradiol, LH, FSH, prolactin), liver and kidney function tests, and sometimes imaging (mammography, ultrasound) to rule out breast cancer or identify underlying causes.

How is Gynecomastia managed?

1. Observation: Physiological gynecomastia (e.g., puberty) often resolves spontaneously.2. Address underlying cause: Discontinue causative medications, treat liver/kidney disease, manage hormonal imbalances.3. Pharmacological Therapy: Tamoxifen or raloxifene (selective estrogen receptor modulators) may be used for painful or persistent gynecomastia.4. Surgery (Mastectomy): For severe, persistent, or symptomatic cases, or for cosmetic reasons.

What is Chlamydia?

A common sexually transmitted infection (STI) caused by the bacterium Chlamydia trachomatis. It can lead to various complications, including epididymitis in males.

What is the pathophysiology of Chlamydia?

C. trachomatis is an obligate intracellular bacterium that infects columnar epithelial cells. The infection elicits an inflammatory response. In males, the infection can ascend from the urethra to the epididymis, causing inflammation.

What are the clinical presentations of Chlamydia in males?

Often asymptomatic. If symptoms occur, they can include:

• Urethritis: Dysuria (painful urination), clear or mucopurulent urethral discharge.

• Epididymitis: Unilateral scrotal pain, swelling, tenderness, fever.

• Proctitis: Rectal pain, discharge, or bleeding (in men who have sex with men).

How is Chlamydia diagnosed?

Nucleic Acid Amplification Tests (NAATs) are the gold standard, performed on urine samples or swabs (urethral, rectal, pharyngeal).

How is Chlamydia managed?

1. Antibiotics: Azithromycin (single dose) or Doxycycline (7 days).2. Partner notification and treatment: To prevent re-infection and further spread.3. Abstinence: Until both partners are treated and symptoms resolve (typically 7 days after single-dose therapy or completion of 7-day course).

What is Epididymitis?

Inflammation of the epididymis, a coiled tube located at the back of the testicle that stores and carries sperm. It is often caused by bacterial infection.

What is the pathophysiology of Epididymitis?

Infection, most commonly bacterial, ascends from the urethra or bladder. In sexually active men, Chlamydia trachomatis and Neisseria gonorrhoeae are common culprits. In older men or those with urinary tract abnormalities, coliform bacteria (e.g., E. coli) are often responsible. The infection leads to inflammation, pain, and swelling of the epididymis.

What are the clinical presentations of Epididymitis?

• Gradual onset of unilateral scrotal pain, swelling, and tenderness in the epididymis.

• May be accompanied by fever, dysuria (painful urination), or urethral discharge.

• Prehn's sign (relief of scrotal pain with manual elevation of the scrotum) may be present, though its reliability is debated.

• The testicle's position is usually normal, which helps differentiate it from testicular torsion.

How is Epididymitis diagnosed?

Diagnosis is primarily based on clinical history and physical examination, revealing a tender, swollen epididymis. Further diagnostic steps include:

• Urinalysis and urine culture: To identify bacterial infection.

• STI testing (NAATs): For Chlamydia trachomatis and Neisseria gonorrhoeae in sexually active individuals.

• Scrotal ultrasound: To confirm inflammation, assess blood flow to differentiate from testicular torsion, and rule out complications like abscess or tumor.

How is Epididymitis managed?

Management typically involves:

1. Antibiotics: Chosen based on the suspected etiology.

   • For suspected STI (e.g., in sexually active men <35 years): Ceftriaxone (single IM dose) plus Doxycycline (oral for 7-10 days).

   • For suspected enteric organisms (e.g., in men >35 years or with urinary abnormalities): Fluoroquinolones (e.g., levofloxacin) or Trimethoprim-sulfamethoxazole (oral for 10-14 days).

2. Supportive care: Rest, scrotal elevation, ice packs, and NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) for pain and inflammation.

3. Partner treatment: For STI-related epididymitis to prevent re-infection and further spread.

What is Ceftriaxone?

A broad-spectrum cephalosporin antibiotic commonly administered intravenously or intramuscularly for bacterial infections, including those related to sexually transmitted infections (e.g., gonorrhea, and often co-administered with doxycycline for suspected chlamydia/gonorrhea infections).

What is Sperm Banking?

The process of collecting, cryopreserving (freezing), and storing sperm for future use. It is often recommended for men undergoing treatments that may impair fertility (e.g., chemotherapy, radiation, orchiectomy) or for those considering vasectomy.

What is Human Chorionic Gonadotropin (hCG) in the context of male reproductive health?

A hormone that, in males, can be used as a tumor marker for certain germ cell tumors (e.g., testicular cancer). It can also be administered to stimulate Leydig cells in the testes to produce testosterone, useful in some cases of secondary hypogonadism for fertility preservation.

What is Orchiectomy?

Surgical removal of one or both testicles. It is a common treatment for testicular cancer, severe testicular trauma, or in cases of hormonal therapy for prostate cancer.

What is a Radical Orchiectomy?

A specific surgical procedure to remove an entire testicle, its associated epididymis, and the entire spermatic cord up to the internal inguinal ring, typically performed for the diagnosis and treatment of suspected testicular cancer.

What is Bacillus Calmette-Guérin (BCG) therapy?

An intravesical immunotherapy for bladder cancer, where a weakened form of Mycobacterium bovis is instilled into the bladder to stimulate an immune response against cancer cells. A rare but serious complication can be granulomatous epididymitis.

What is Ejaculation?

The reflex expulsion of semen from the male reproductive tract through the urethra, typically occurring concurrently with orgasm. It involves two phases: emission (sperm and fluid move into the urethra) and expulsion.

What is Vasoactive Therapy for Erectile Dysfunction?

Treatment for erectile dysfunction that involves the use of drugs (e.g., alprostadil) to directly increase blood flow to the penis by relaxing the smooth muscles of the corpora cavernosa, thereby facilitating an erection.

What is Human Immunodeficiency Virus (HIV)?

A viral infection that attacks the immune system, leading to acquired immunodeficiency syndrome (AIDS) if left untreated. It is often screened for in sexually active individuals due to its transmission route, and can indirectly impact male reproductive health through systemic effects or opportunistic infections.