| MALE REPRODUCTIVE SYSTEM | | | | 10/24/2014 |

Contents

Vasectomy 3 BPH – Benign Prostatic Hyperplasia 4 ED – Erectile Dysfunction 6 Andropause 7 Gynecomastia 8 PSA Testing 9 Peyronie’s Disease 10 Diphallia 12 Cryptorchidism 13 Orchiopexy 14 Prostate Cancer 15 STD’s 17 a) Chlamydia 17 b) Gonorrhea 18 c) Syphilis 19 d) Herpes Genitalis 20 Paternity Test 21 Viagra (sildenafil) 22 Circumcision 23

Vasectomy

* A vasectomy is the surgical procedure performed on men in which the vas deferens (the tubes that carry the sperm from the testicles to the seminal vesicles) are cut, ties or cauterized.

* The semen no longer contains sperm after the tubes are cut, so conception cannot occur. The testicles continue to produce sperm, but they die and are absorbed by the body.

* There are 4 types of vasectomies: * Traditional vasectomy – the doctor will make an incision on the scrotum, allowing access to the vas deferens, which will then be cut. * No-scalpel vasectomy – the doctor cut the vas deferens via a small hole on the scrotum. * Clip vasectomy – small clamps are used to block the vas deferens instead of severing it. * Laser vasectomy – the vase deferens are cut and cauterized with a surgical laser

* The vasectomy procedure prevents the release of sperm when a man ejaculates. The man will still produce semen, but will be sperm free.

* Vasectomies may be reversed, however, this procedure should be considered permanent as there is no guarantee of successful reversal.

* Following the procedure, ice packs are often applied to the scrotum to reduce swelling and decrease pain and the wearing of a scrotal supporter for 3-4 days.

* Mild over-the-counter medications such as aspirin or acetaminophen should be able to control any discomfort.

* A semen specimen will be examined and found to be free of sperm after at least a month from the procedure before the male can rely on the vasectomy for birth control

* Vasectomies are more than 99% effective assuming that there is no sperm in the semen.

* It takes approximately 3 months (10-20 ejaculations) after a vasectomy

BPH – Benign Prostatic Hyperplasia

* BPH is the enlargement of the prostate gland.

* BPH happens to almost all men as they get older. As the prostate gland grows, it can press on the urethra and cause urination and bladder problems.

* It is not cancer, and it does not raise the risk for prostate cancer.

* The cause of BPH is unknown.

* Men who have had their testicles removed at a young age (for example, as a result of testicular cancer) do not develop BPH.

* If the testicles are removed after a man develops BPH, the prostate will begin to shrink in size.

* Less than half of all men with BPH have symptoms of the disease. Symptoms may include: * Inability to urinate * Incontinence * Needing to urinate 2 or more times in a night * Painful urination * Blood in the urine * Straining to urinate * Scanty urination stream

* To determine BPH, the doctor will ask the patient about his medical history and do a rectal exam to feel the prostate gland. Other tests might be recommended as well: * Prostate-specific antigen (PSA) blood test to screen for prostate cancer * Urine flow rate * Urinalysis or Urine culture to check for infection

* Self-care and medications can be used to treat mild cases of BPH. * Avoiding alcohol and caffeine * Regular exercise * Reduced stress * Alpha 1-blockers - relaxes the muscles of the bladder neck and prostate, allowing for easier urination * Finasteride and dutasteride – lowers to hormones produced by the prostate, reducing the size of the gland

* Prostate surgery may be recommended if you have: * Incontinence * Frequent blood in the urine * Inability to fully empty the bladder * Recurrent urinary tract infections * Decreasing kidney function * Bladder stones

BPH – Benign Prostatic Hyperplasia (con’t)

* The surgical procedure is usually based on the severity of your symptoms and the size and shape of your prostate gland: * Transurethral resection of the prostate (TURP) – TURP is performed by inserting a scope through the penis and removing the prostate piece by piece. * Prostatectomy - An incision is made through the abdomen or perineum (the area behind the scrotum). Only the inner part of the prostate gland is removed.

* Men who have had BPH for long time with slowly worsening symptom may develop: * Sudden inability to urinate * Urinary tract infections * Urinary stones * Damage to the kidneys * Blood in the urine

* BPH may come back over time even after having surgery.

ED – Erectile Dysfunction

* Erectile dysfunction or impotence occurs when a man can no longer get or keep an erection firm during sexual activities.

* Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these.

* Sometimes a combination of physical and psychological issues causes erectile dysfunction.

* In most cases, erectile dysfunction is caused by something physical. Common causes include: * Heart disease * High cholesterol * High blood pressure * Obesity * Diabetes * Low testosterone levels * Smoking * Drinking and other substance abuse * Treatments for prostate cancer

* Psychological causes may include: * Depression, anxiety or other mental health conditions * Stress * Relationship problems due to stress, poor communication

* Subsequent complications from erectile dysfunction can consist of: * An unsatisfactory sex life * Stress or anxiety * Embarrassment or low self-esteem * Marital or relationship problems * The inability to get your partner pregnant

* Many options exist in the treating of erectile dysfunction: * Oral medications – Viagra, Cialis and Levitra (all working the same way) to enhance the effect of nitric oxide, a natural chemical your body produces that relaxes muscles in the penis, increasing the blood flow and allowing for an erection during sexual activities.

Andropause

* Andropause, also known as male menopause, is the group of symptoms, including fatigue and decrease libido, experienced by some middle-aged men.

* Unlike menopause in women, where the hormone production stops completely, testosterone levels decline in men at a slower pace.

* The testes, unlike the ovaries, do not run out of the substance it needs to make testosterone.

* A healthy man may be able to make sperm well into his 80s or later.

* Although symptoms may vary from person to person, common symptoms of men going through andropause include: * Low sex drive. * Difficulties getting erections or erections that are not as strong as usual. * Lack of energy. * Depression. * Irritability and mood swings. * Loss of strength or muscle mass. * Increased body fat. * Hot flashes.

* To diagnose andropause, the doctor will order a series of blood tests, which may include the measuring of testosterone levels.

* If testosterone levels are low, the doctor may recommend testosterone replacement therapy to relieve symptoms, which can be administered a number of ways: * Oral tablets * Injections * Transdermal patches * Gels

* But there are potential risks and side effects: * Fluid retention * Breast enlargement * Increased risks of blood clots * Decrease in testicular size * Mood swings, aggression * Prostate growth * Problems with fertility

Gynecomastia

* Gynecomastia is the swelling or enlargement of the breast tissue in males, caused by an imbalance of hormones of estrogen and testosterone, affecting one or both breasts

* Newborns, boys going through puberty and older men can develop gynecomastia as hormone levels change. * Gynecomastia in infants – more than half of male infants are born with enlarged breasts due to the effects of their mother's estrogen. The swollen breast tissue goes away, generally within the first few weeks. * Gynecomastia during puberty – caused by hormone changes during puberty * Gynecomastia in men – the occurrence of gynecomastia peaks again between the ages of 50 and 80. At least 1 in 4 men in this age group are affected.

* Medications can also cause gynecomastia: * Anti-androgens – used to treat prostate enlargement * Anabolic steroids * AIDS medications * Cancer treatments * Ulcer medications

* There are several health conditions that can also cause gynecomastia by affecting the normal balance of hormones : * Hypogonadism * Hyperthyroidism * Kidney failure * Malnutrition

* There are no medical complications due to gynecomastia, mostly psychological and emotional because of appearance.

* There are two gynecomastia surgery options available to men: * Liposuction – surgery that removes breast fat, but not the breast gland tissue itself. * Mastectomy – surgery that removes the breast gland tissue.

PSA Testing

* PSA testing stands for prostate-specific antigen testing. It is a test to measure the blood levels of PSA levels in the blood.

* Prostate-specific antigen is a protein produced in the prostate gland. The higher the PSA levels, the more likely it is that the man has prostate cancer.

* The blood test is sent for analysis and results are usually reported as nanograms of PSA per millilitre (ng/mL).

* The most common cause of PSA elevation includes benign prostatic hyperplasia (BPH) and prostatitis (inflammation of the prostate).

* PSA elevation can also occur with prostate manipulation such as ejaculation, prostate examination, urinary retention or catheter placement and prostate biopsy.

* It is normally recommended for men to get yearly PSA screening beginning at the age of 50, but for men who are at higher risk of prostate cancer, including African American men and men whose father or brother had prostate cancer, screening should at age 40 or 45.

* If the levels are high, the doctor will recommend a prostate biopsy.

* The PSA test may give false-positive or false-negative results. A false-positive test result occurs when a man’s PSA level is elevated but no cancer is actually present. A false-positive test result may create anxiety for a man and his family and lead to additional medical procedures, such as a prostate biopsy, that can be harmful. Possible side effects of biopsies include serious infections, pain, and bleeding.

* Most men with an elevated PSA level turn out not to have prostate cancer. Only about 25% of men who have a prostate biopsy due to an elevated PSA level actually have prostate cancer.

Peyronie’s Disease

* Peyronie's disease is the development of fibrous scar tissue inside the penis that causes curved, painful erections.

* A plaque, or hard lump, forms on the penis. The plaque often begins as a localized area of irritation and swelling or inflammation and can develop into a hardened scar. The scarring reduces the elasticity of the penis in the area affected.

* Peyronie's disease can occur in a mild form that heals without treatment in 6 -18 months. In these cases, the problem does not progress past the inflammation phase.

* In severe cases, the disease can be permanent. The hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection.

* Peyronie's disease can cause general pain as well as painful erections. It also can cause emotional distress, and affect a man's desire and ability to function during sex.

* The exact cause of Peyronie's disease is unknown. For men who suffer with Peyronie’s disease for a short period of time, the likely cause is some kind of trauma (hitting or bending) that causes bleeding inside the penis.

* For the severe cases that might require surgery, the causes can be from the following possibilities: * Vasculitis – Inflammation of blood or lymphatic vessels. This inflammation can lead to the formation of scar tissue. * Connective tissue disorders – these conditions generally cause a thickening or hardening of the connective tissue. * Heredity – some studies suggest that a man who has a relative with Peyronie's disease is at greater risk for developing the disease

* There are two ways in which Peyronie's disease can be treated – surgery or non-surgical treatment.

* Because the plaque of Peyronie's disease often shrinks or disappears without treatment, most doctors suggest waiting one to two years or longer before attempting to correct it with surgery.

* There are two surgical techniques used to treat Peyronie's disease: * One method involves the removal of the plaque, followed by the placement of a patch of skin or artificial material. This method can involve partial loss of erectile function, especially rigidity. * The second technique, the surgeon removes or pinches the tissue from the side of the penis opposite the plaque, which cancels out the bending effect. This method, known as the Nesbit procedure, causes a shortening of the erect penis.

* Penile implants can also be used in cases where Peyronie's disease has affected the man's ability to achieve or maintain an erection.

Peyronie’s Disease (con’t)

* The non-surgical treatment for Peyronie's disease involves injecting medication directly into the plaque in an attempt to soften the affected tissue, decrease the pain, and correct the curvature of the penis.

Diphallia

* Diphallia, also known as Penile Duplications, is a congenital anomaly (birth defect) in which an infant male has two penises.

* This congenital anomaly occurs when two genital tubercles develop and as a result, the penis may be partially or completely duplicated.

* The two penises can either be symmetrical or asymmetrical.

* The two penises usually lay side by side or the penises will be on top of the other.

* They may be of equal size or one may be significantly smaller than the other.

* They may also function normally, being able urinate independently as well as simultaneously. They are usually capable of having erection and ejaculation.

* Diphallia is not a hereditary disorder, but an extremely rare disorder. First described in 1609 by Johannes Jacob Wecker.

* Since then only 100 cases of diphallia has been reported. On average, around 1 in every 5.5 million men will be affected by this disorder.

* There is no cure for diphallia. Surgical amputation may be the only option, but may not always be possible if both of the penises are fully developed or in cases where the penises are complicatedly connected to other organs of the body.

Cryptorchidism

* Cryptorchidism is a condition in which one or both testicles have failed to descend from the abdomen into the scrotum.

* Cryptorchidism is the most common genital abnormality in boys, affecting approximately 30% of baby boys born prematurely and about 4% born full-term.

* The testicles will move down on their own by the sixth month in roughly half the babies born with cryptorshidism.

* If descent doesn't happen by then, it's important to get treatment because testicles that remain undescended may be damaged, which could affect fertility later or lead to other medical problems.

* Doctors usually diagnose cryptorchidism during a physical exam at birth or at a checkup shortly after.

* Some boys may have the condition known as retractile testes. This is a normal condition in which the testes are in the scrotum but on occasion, temporarily retract or pull back up into the groin.

* If the baby’s testicles have not descended on their own, the doctor will recommend surgery.

* This surgery is an orchiopexy, in which a small incision is made in the groin and the testicles are brought down and fixed into place in the scrotum.

* It is important to treat cryptorchidism for several reason: * The higher temperature of the body may inhibit the normal development of the testicle, which could impair normal production of sperm in the undescended testicle in the future, which could lead to infertility. * The undescended testicle is at a greater risk to form a tumor * The undescended testicle may be more vulnerable to injury or testicular torsion.

* It is recommended that all boys who have had undescended testicles undergo follow-up evaluations by an urologist for years after their corrective surgeries.

Orchiopexy

* Orchiopexy is a surgery to move an undescended testicle (cryptorchidism) into the scrotum and permanently fix it there.

* An orchiopexy is normally an out-patient operation.

Prostate Cancer

* Prostate cancer is a form of cancer that begins in the gland cells of the prostate, which is only found in males.

* Approximately 1 in 7 men will be diagnosed with prostate cancer during his lifetime.

* Prostate cancer occurs mainly in older men. Roughly 6 in 10 cases are diagnosed in men aged 65 or older, and it is rare before age 40. The average age at the time of diagnosis is about 66.

* Prostate cancer is the second leading cause of cancer death in men, behind lung cancer. About 1 in 36 men will die of prostate cancer.

* There are no warning signs of early prostate cancer. Once a tumour causes the prostate gland to swell, or once cancer spreads beyond the prostate, the following symptoms may happen: * A frequent need to urinate, especially at night. * Difficulty starting or stopping a stream of urine * A weak or interrupted urinary stream * Leaking of urine when laughing or coughing * Inability to urinate standing up * A painful or burning sensation during urination or ejaculation * Blood in urine or semen

* If prostate cancer is presumed, the doctor will order one or some of the following tests: * Digital rectal exam * Prostate-specific antigen (PSA Testing) * Transrectal ultrasound * MRI of the prostate using a rectal probe * CT scan of the abdomen and pelvis, looking for prostate cancer metastasis on other organs * MRI of the skeleton to look for metastasis to bones * Surgery to examine the lymph nodes in the pelvis for any prostate cancer spread

* Doctors use the TNM system of prostate cancer stages (tumour, nodes and metastasis) * T for tumour – describes the size of the tumour * N for nodes – describes whether the cancer has spread to the lymph nodes and to what extent * M for metastasis – if the cancer has spread to another system in the body

* There are 4 stages of prostate cancer: * Stage I – the cancer is found only in the prostate gland * Stage II – the tumour has grown in the prostate gland, but has not yet spread beyond it * Stage III – the cancer has spread to just beyond the prostate gland * Stage IV – the cancer has now spread or metastasized beyond the prostate to other tissues. Usually spreading to the lymph nodes, the liver, bones or the lungs.

Prostate Cancer (con’t)

* There are many alternative treatments and drug therapy the doctor could recommend, depending on the stage of the prostate cancer: * Hormone Therapy to stop the man’s body from producing testosterone * Medications that stop your body from producing testosterone. * Medications that block testosterone from reaching cancer cells. * Radiation Therapy using high-powered energy to kill cancer cells. * Radiation that comes from outside of your body (external beam radiation) * Radiation placed inside your body (brachytherapy). * Surgery by removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes. * By making an incision in the abdomen. * By making an incision between the anus and scrotum * Laparoscopic prostatectomy. * Cryosurgery involving freezing the tissue to kill the cancer cells. * Chemotherapy, using drugs to kill rapidly growing cancer cells

STD’s

a) Chlamydia

* Chlamydia is a sexually transmitted disease. Causing an infection in the urethra of the male * It is the most common treatable sexually transmitted disease, especially in men and women under the age of 25.

* People who are sexually active and those who have multiple partners are at a higher risk of infection

* Some of the symptoms a man will begin to have are as follows: * Difficulty with urination * Painful urination * Burning sensation during urination * Discharge from the penis * Redness, swelling, itching of the opening of the urethra at tip of the penis * Swelling and tenderness of the testicles

* In men, if chlamydia is not treated, it can result in a condition called epididymitis. If epididymitis is not treated, it can lead to sterility.

* Treatment for chlamydia is through antibiotics. Both sexual partners must be treated for both gonorrhea and chlamydia to prevent passing the infections back and forth.

STD’s

b) Gonorrhea

* Gonorrhea is one of the most common sexually transmitted diseases, one of the biggest threats to sexually active individuals (including homosexual and bi-sexual).

* Gonorrhea has different symptoms depending on which part of the body has been infected.

* It can take up to four weeks from the time of infected to when symptoms begin to show.

* About 10% of men who have gonorrhea show no symptoms at all. For the other 90%, the symptoms of gonorrhea in men are very noticeable.

* Symptoms include: * Discomfort in the penis * A thick white, yellow or green discharge from the tip of the penis * Pain or burning sensation when urinating

* If gonorrhea is left untreated, the infection can spread to the glands near the urethra, the prostate, seminal vesicles, testes and bladder. This may lead to: * Rectal or urethral abscesses * Painfully swollen testicles * Difficulty urinating

* Treatment for gonorrhea is simple. There are a number of antibiotics that can successfully cure gonorrhea.

STD’s

c) Syphilis

* Syphilis is a sexually transmitted infection (STI) that is caused by bacteria. It is easily transmitted during sexual activity.

* Over 80% of the cases of syphilis have been among gay and bisexual men.

* There are three different stages after infection, with different symptoms at each stage: * Primary Stage - About three weeks after sex with someone who has syphilis, a painless sore or chancre will develop. The sore may go away, but the infection remains * Secondary Stage - 4 to 10 weeks after the chancre appears, a red rash on the chest, palms, genitals, or the soles of feet might develop. Muscle and joint pain may also happen. Again, these symptoms may go away, but the infection still remains and can still be transmitted. * Late or Tertiary Stage – There can be a long period with no symptoms. However, the bacteria still lives within the body and can cause serious damage to the heart, brain and bones. It may take 10 to 30 years for the damage to be seen.

* If it’s caught early, syphilis can be easily treated with antibiotics, usually by injections. A series of blood tests after treatment will confirm that the treatment worked. It’s important to get these follow up blood tests. The treatment for syphilis is free.

STD’s

d) Herpes Genitalis

* Herpes Genitalis is a common, highly infectious sexually transmitted disease.

* Caused by a virus, infecting the genital areas.

* Genital herpes is extremely widespread, largely because it is so contagious. Carriers can transmit the disease without having any symptoms of an active infection.

* The highest rates of infection are seen among the poor, those with less education, those using cocaine, and those with many sexual partners.

* In men, genital herpes sores or lesions usually appear on or around the penis.

* Ulcers or blisters may also be found anywhere around the genitals and in and around the anus.

* Other symptoms can also develop: * Fever * Muscle aches * Headaches (may be severe) * Painful urination * Swollen and tender lymph nodes in the groin.

* There is no cure for this disease, but the symptoms can be managed with medications.

Paternity Test

* A paternity test is a medical test, typically a blood test, to determine whether a man may be the father of a particular child.

* The test compares the DNA of the alleged father and of the child or children to determine if their DNA matches at 50% (children inherit 50% of their DNA from each parent).

* If the DNA from the alleged father does not match the DNA from the child, the alleged father is excluded as the biological father. This is reported as 0% probability of paternity.

* When the DNA does match, then the alleged father is concluded to be the biological father of the child, typically at a minimum probability of paternity of 99.95% or higher.

Viagra (sildenafil)

* Viagra is a brand name for Sildenafil citrate. * It is used to treat erectile dysfunction or impotence in men. * Viagra should not be taken if the man has the following medical conditions: * Heart disease or coronary artery disease * A recent history of a heart attack, stroke, or congestive heart failure * High or low blood pressure * Liver or kidney disease * A blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia * Hemophilia * Stomach ulcers * Peyronie's disease * Have been told to not have sexual intercourse for health reasons * If an erection lasts for more than 4 hours, emergency medical treatment is advised, as a prolonged erection or priapism can cause damage to the penis. * Some of the common side effects while taking Viagra may include: * Redness in the face, neck or chest * Headache * Upset stomach * Diarrhea * For most patients, the recommended dose is 50 mg taken, as needed, approximately 1 hour before sexual activity. However, VIAGRA may be taken anywhere from 30 minutes to 4 hours before sexual activity.

Circumcision

* Circumcision is the surgical removal of the foreskin, a small flap of skin that covers the tip of the penis.

* Hieroglyphs from before 2300 BCE show that the procedure was practiced in ancient Egypt.

* Globally, about 30 % of men worldwide, or roughly 670 million, are circumcised, most as infants, making it the most common infant surgery in the world.

* A medical circumcision is performed, most often in a hospital, in the first few days of life on full-term infants unless health concerns prevent it. The procedure is as follows: * The penis and surrounding areas will be cleaned * Local anesthetic will be administered * The doctor will use a special ring called a Plastibell or clamp to separate the foreskin from the penis and then remove it * Afterward, the penis is covered with an antibiotic ointment and covered loosely with gauze. * The whole procedure should take less than 10 minutes

Circumcision (con’t)

* The Jewish ritual circumcision, called a bris, signifies a religious covenant and must take place as part of a religious ceremony on the child’s eighth day of life, unless health concerns prevent it.

* The bris is performed by a mohel, or ritual circumciser, trained in both the procedure and Jewish law.

* It may be done at home or in a synagogue or social hall, in the presence of family and friends.

* A mohel’s technique is different from a surgeon’s - Clamps are forbidden, instead a butterfly-shaped shield protects the glans while the mohel removes the foreskin with a sharp scalpel.