chapter 26

Alterations of the Male Reproductive System

Sexual Maturity

  • Occurs during puberty

  • Development of secondary sex characteristics

  • Rapid growth and reproductive capability

Alterations of Sexual Maturation

Delayed Puberty

  • Secondary sex characteristics not present by age 14

  • 95% due to hormonal delays affecting the HPG axis

  • 5% related to disruption of the HPG axis due to chronic conditions

  • Treatment: Exogenous sex steroid administration

Precocious Puberty

  • Occurs before age 9

  • Forms:

    • Central: GnRH-dependent, HPG axis functioning prematurely

    • Peripheral: GnRH-independent, sex hormones produced without gonadotropin stimulation

  • Treatment: Address underlying causes, appropriate hormones, weight management.

Disorders of the Male Reproductive System

Urethral Disorders

  • Urethritis: Inflammation, often due to STIs; symptoms include dysuria and discharge; treated with antibiotics.

  • Urethral Strictures: Narrowing due to scarring; symptoms include urinary obstruction; treated surgically.

Disorders of the Penis

  • Phimosis: Tight foreskin; treated via circumcision.

  • Paraphimosis: Foreskin cannot be returned to its position; medical emergency requiring surgery.

  • Peyronie's Disease: Fibrous tissue causing penile curvature; treatment involves medications or surgery.

  • Priapism: Prolonged, painful erection; considered a medical emergency; treatment varies from ice packs to surgical intervention.

Disorders of the Scrotum and Testes

  • Varicocele: Dilation of veins in the spermatic cord; treatment may involve surgical ligation.

  • Hydrocele: Fluid collection in the scrotum; may require aspiration or surgery if symptomatic.

  • Spermatocele: Benign cysts of the epididymis; generally not requiring treatment.

  • Cryptorchidism: Undescended testes; can lead to infertility and cancer; treated with hormones or surgery.

  • Torsion: Twisting of the testis; surgical emergency to prevent necrosis.

  • Orchitis: Infection/inflammation; managed with rest, scrotal support, and antibiotics.

  • Testicular Cancer: Common in young men; treatable via surgery, radiation, and/or chemotherapy.

Disorders of the Prostate Gland

  • Benign Prostatic Hyperplasia (BPH): Enlargement causing urinary issues; treatment includes medication and surgery.

  • Prostatitis: Inflammation, acute or chronic; treated with antibiotics and supportive care.

  • Prostate Cancer: Frequently diagnosed, asymptomatic until late; linked to dietary and genetic factors; treatment varies based on stage and type.

Male Sexual Dysfunction

  • Caused by various factors including physical, psychological, or iatrogenic causes; can manifest as erectile dysfunction.

  • Treatment includes identifying underlying issues, medication, and potential surgical options.

Impairment of Sperm Production and Quality

  • Requires FSH, LH, testosterone; factors affecting spermatogenesis include hormonal disruptions, trauma, and infections.

  • Hormonal and environmental factors can negatively impact sperm quality and motility.

Disorders of the Male Breast

  • Gynecomastia: Hormonal imbalance causing breast tissue overdevelopment; requires identification of underlying causes and monitoring.

  • Male Breast Cancer: Rare, usually manages by hormone therapy and surgical intervention; more common after age 60.