Hernia and erectile dysfunction

Erectile dysfunction after your hernia surgery

So you’re going in for a hernia operation, and you’re afraid it’ll ruin your performance in bed.

We can’t promise you that nothing will go wrong, but we can tell you it’s not likely. Hernia repairs aren’t supposed to involve any of your sexual equipment and the possible complications that could indirectly affect your lovemaking tend not to last. Hernias and hernia repairs vary a lot, and so do the guys who have them, so actual data is hard to crunch about this. However, a very thorough study in Europe broke down the risk for common hernia repair recently, and you’ll be glad to know it’s pretty good news: overall, there’s only about a 5% chance of anything going wrong in your surgery, and ‘going wrong’ doesn’t usually mean anything very lasting. The truth is, hernias are not considered extremely serious these days, and there’s no real reason you shouldn’t recover after your repair and be the same guy you always were. In fact you might even perform better than you’re doing now in the bedroom, if your hernia’s been bad enough to get in the way.

To explain more, let’s talk through what a hernia is (there’s more than one kind), what the options are for fixing them (these get better all the time), and where trouble brews, if it brews (and what happens next).

Here’s what a hernia is…

The word refers to any kind of rupture, where something pushes through something else, perhaps through a tear or a weak spot. Herniation, wherever it is, typically looks like a bulge that shouldn’t be there. It’s a kind of injury, sometimes a complication of an earlier injury. There are lots of places where this can happen. One’s along your upper stomach and diaphragm. That’s called a hiatal hernia. You can get an umbilical one at your belly button. Incisional ones push through old scars. General abdominal ones are the ventral kind. Femoral hernias are in your outer groin, and inguinal ones are in your inner groin.

The inguinal kind is probably the one you’re worried about if you’re reading this article. It’s the one that makes a lump in your groin or enlarges your scrotum, so it’s the one that seems dangerously close to your sexual equipment. It’s also the kind of groin hernia that men usually get – about 97% of the time. They’re really common. Worldwide, there are about 20 million inguinal hernia repairs done every year.

Here’s how repair works…

Not everybody gets these fixed, sometimes hernias don’t cause any problems and not every surgeon bothers with them.

To fix them, it used to be that surgeons would open a flap and suture up the torn tissue, like any other injury. They still do it this way for babies, smaller hernias, hernias that are complicated, or if there’s infection. Your author had this done once, and it was no big deal.

These days, however, most hernias are repaired with a surgical mesh, because that kind of repair is less likely to fail. It can be a permanent synthetic mesh, designed to stay forever, or, more usually, an animal-derived mesh, that absorbs and disappears by the time your body’s healed up and strong enough to hold together by itself.

They don’t have to open a flap to do this nowadays, either. Some surgeons prefer laparoscopic ‘keyhole’ surgery instead. You can talk to your surgeon about which is better for you. Suture and mesh are both possible with flap or keyhole.

Inguinal repair is actually so slick and so routine now, that it’s often done under local anesthesia, in an outpatient setting. You’re home watching football the same day.

If there’s any trouble…

When complications happen (and remember, some hernias are more complex than others), they’re usually lingering pain, infection, repair failure, tissue that sticks together, intestinal blockage, bleeding, fluid build-up, or accidental perforations in surrounding structures. But these things are not common. Only a few percent of people ever need to go back to their doctor, and their numbers are dwindling, mostly because better meshes are on the market now. The problem used to be that meshes shrank, or patients’ bodies rejected them as foreign matter.

But notice what’s not on the list of complications. Normal inguinal surgery has nothing to do with the parts of your anatomy that you use in sex.

There can be outright accidents, where there’s injury of the spermatic cord or its components, or very occasionally nerve damage, that can reduce genital sensitivity, and that doesn’t typically reverse itself. So it’s not absolutely impossible that you’d have trouble getting and sustaining erections after an inguinal hernia repair. But you’d have to be really unlucky for that to happen.

The happy ending…

In other words, complications that affect your love life are not what you should associate with routine inguinal hernia surgery. Normally there won’t be any complications, and, if there are, they’re probably reversible. Here’s the way one important study on the subject summarises your risk:

Guys do better in bed after their surgery than they were doing before, because the hernia itself had been causing problems. If they didn’t feel like sex right after, it’s because (reasonably enough) they were sore. Mesh repair itself had no effect at all on sexual performance, and in this study there were no complications. This study, the authors point out, is exactly in line with other studies. Even in men who have had repeat operations, and who have been examined for possible effects on serious things, like testicular arterial flow, it’s all been good.

So, it’s not absolutely impossible that something can go wrong and interfere with your love life. But it isn’t likely. Hernia repair, by its nature, just isn’t supposed to have any negative effects on your sexual activity. Rest up, like you would after any surgery, or any injury for that matter, and you should be up and about again pretty soon.

Feature Image, stock photo, posed by model: iStock/Svetikd

Sexual Dysfunction and Hernias: Separating the Facts From the Bull

Think you’ll have to live with sexual dysfunction after a diagnosis of an inguinal (groin) hernia? Think again. Although people can experience temporary sexual dysfunction because of pain and pelvic floor spasms, the condition is rare.

“As far as we know, there haven’t really been any good studies … to quantify the sexual dysfunction that you get with hernias,” says Shirwin Towfigh, MD, surgeon and president of Beverly Hills Hernia Center in California, adding that there is no link between male sexual organs and hernias. “The nerves are totally different. The anatomy is actually separate.”

A hernia occurs when part of an organ protrudes through an abnormal opening in an abnormal way. An inguinal (groin) hernia occurs when part of the intestine bulges through a weak spot in the abdominal wall at the inguinal canal, which is the passageway through the abdominal wall near the groin, according to an article published by Harvard Medical School. About 1 in 4 men develop an inguinal hernia in their lifetime and about 1 in 7 will have a hernia that will need surgery, says Dr. Towfigh.

RELATED: The Ultimate Guide to Healthy Sex

How Can Hernias Affect Your Sex Life?

Hernias are mainly asymptomatic. The majority of people don’t have pain from their hernia. Instead, they might have discomfort, a dull ache, or no noticeable symptoms except for the bulging from the hernia itself. But people who do experience pain are more likely to experience sexual problems, says Towfigh.

A study published in the International Journal of Urology, which included 210 men and 14 women, revealed that 23.2 percent of patients complained about preoperative sexual dysfunction, and 16 percent of patients complained about postoperative sexual dysfunctions.

“They may have pain with orgasm, pain with erection, or they may not be able to achieve or maintain an erection,” says Towfigh, adding that hernia removal surgery normally fixes these problems.

Inguinal hernia operations are the most common surgery for hernias. “Surgery by an experienced and dedicated hernia surgeon is the safest way to repair a hernia, and using a flat mesh implant, minimally invasively or open by Lichtenstein technique, is still the most accepted way to perform this procedure,” says Brian P. Jacob, MD, an expert hernia surgeon at Hernia Repair in New York City.

Does Inguinal Hernia Repair Cause Sexual Dysfunction?

Although hernias do not appear to have a direct link to sexual dysfunction, pain after surgery may cause sexual dysfunction in some patients, but it is a complicated issue, says Towfigh. According to the Cleveland Clinic, pain after surgery may be associated with the mesh used in hernia repair. The body may recognize the mesh as a foreign object, causing inflammation or irritation. Chronic pain may also result from a nerve being caught in the mesh. In this case, patients my opt for mesh removal, nerve ablation, or anesthetic injections to relieve the pain.

“Specifically, sometimes the cremaster muscles or the spermatic cord can become adherent to scar tissue or a mesh implant and therefore potentially be indirectly related to sexual dysfunction complaints,” says Dr. Jacob.

“I believe that it is very important to teach the patient who is complaining of sexual dysfunction that it is unlikely for sexual dysfunction and inguinal hernia repair to be directly related unless there is a significant problem with the location of the mesh after its implant.”

A study published in June 2016 in the Central European Journal of Urology found that having an inguinal hernia and undergoing hernia surgery may impact sexual activity. This study also revealed that implanted mesh can lead to long-term tissue induration, which can impact sexual function. Another study, published in March 2018 in the journal Frontiers of Surgery, found that sexual dysfunction due to groin pain after hernia surgery is surprisingly common. There is still limited research on this topic, says Towfigh.

“I recognize that, in rare cases, the two (hernia repair surgery and sexual dysfunction) may be related, and therefore it is important to separate out the cases where they are potentially related from the majority where the two are not related. For the cases where sexual dysfunction is not related to the hernia repair, we must send these patients to physicians who specialize in sexual dysfunction,” says Jacob.

How Soon Can I Resume Sexual Activity After Surgery?

The Hernia Surgery center in Los Angeles advises patients to discuss sexual intercourse with their doctor, as hernia repair recovery times may vary.

The good news is that they are no medical or physical restrictions on activity after surgery, but patients should let pain be their guide, as sex may be uncomfortable at first, according to the Cleveland Medical Center. So if it is painful, give it some more time.

Bruising and swelling of the scrotum and the base of the penis and the testicles can also occur in some patients after open or laparoscopic surgery, but these symptoms should gradually fade on their own, according to the Society of American Gastrointestinal and Endoscopic Surgeons.

Sexual dysfunction common after men’s hernia surgery

(Reuters Health) – – Many men experience sexual dysfunction or pain during sexual activity after groin surgery to repair a hernia, a research review suggests.

The authors analyzed data from 12 previous studies with a total of 4,884 patients. They focused on men who had what’s known as an inguinal hernia, when soft tissue in the intestine bulges through the abdominal wall into the groin.

Overall, 5.3% of men developed sexual dysfunction after surgeries to repair inguinal hernias and 9% of men developed pain during sexual activity.

“At least temporary sexual dysfunction and pain with sexual activity are not very common but also not very rare as outcomes of inguinal hernia repair in men,” said Dr. David Soybel of the Pennsylvania State University College of Medicine in Hershey, the study’s senior author.

“Hernia surgeons and patients should find ways to discuss sexual health openly and frankly, as part of the pre-operative evaluation and as part of the follow-up after repair,” Soybel said by email.

With minimally-invasive procedures, 7.8% of patients developed sexual dysfunction and 7.4% had painful sexual activity afterwards. With more invasive “open” operations, 3.7% of patients had sexual dysfunction and 12.5% had painful sexual activity.

These differences, however, were too small to rule out the possibility that they were due to chance, according to the report in the Journal of the American College of Surgeons.

Among the subset of men who had open procedures, 1.9% of those who had general anesthesia developed sexual dysfunction compared with 6.2% who had local anesthesia. All of the studies that looked at painful sexual activity included only procedures using general anesthesia.

While the results suggest that men should discuss sexual side effects of surgery with their doctors, it’s possible that some patients had sexual dysfunction or painful sexual activity as a result of the hernia and not the procedures to repair them, Soybel said.

“Such symptoms may be caused by the presence of a groin hernia that is causing pain, because of its being trapped in the hernia, or pressure on structures that are important in sexual function, such as the vas deferens or the blood vessels and nerves that supply the testicle,” Soybel said.

“After repair, the same structures may become tethered or trapped in the scar that forms around the repair,” Soybel added. “In both open and laparoscopic repairs, nerves that provide sensation to the skin of the groin, scrotum and penis are in the operative field, and may be at risk for trapping (causing pain) or interruption (causing numbness), which can interfere with sensations that are part of the experience of sexual intercourse.”

The analysis wasn’t designed to determine how hernias or surgery to repair them might directly cause sexual health problems.

“We know that sexual dysfunction is a known possible complication following inguinal hernia repair,” said Dr. Kristoffer Andresen of the department of surgery at Herlev Hospital in Denmark.

“The current study adds to the body of growing literature describing this complication,” Andresen, who wasn’t involved in the study, said by email. “Furthermore, the study highlights the need for including this outcome in shared decision-making with patients as well as in future studies of inguinal hernia repair.”

SOURCE: bit.ly/2YIAN1c Journal of the American College of Surgeons, online November 13, 2019.

Our Standards:The Thomson Reuters Trust Principles.

There is one particular type of hernia, called an inguinal or groin hernia, that often causes a significant amount of concern from men about whether or not it will affect their sexual function. Most of this concern is based on the location of the hernia, which is of course is the same location that will require surgery to repair the hernia.

Fact or Fiction?

The chance of an inguinal hernia causing any sort of sexual dysfunction issue is extremely low. An inguinal hernia is named by the site at which it typically protrudes from, which is the inguinal canal. Despite being near the reproductive organs, this canal possesses its own separate nerves, which are the only ones likely to be affected by an inguinal hernia or its repair surgery.

Some temporary impairment of sexual function could follow an inguinal hernia repair surgery. This is due to the fact that it can be difficult or even painful to use the pelvic floor muscles that have been affected by the hernia.

It is much more likely for men to experience problems with their sexual health if they do not properly treat an inguinal hernia. These hernias can make both an erection and an orgasm quite painful. The further that these hernias progress and the more severe they become, the more likely the patient is to experience sexual dysfunction problems.

Inguinal Hernia Repair

If an individual experiences sexual health complications as a result of an inguinal hernia, they can usually relieve these painful symptoms by undergoing a hernia repair surgery.

In very rare instances, hernia surgery can potentially compromise the blood flow to the testis. However, this is not a problem unless both testes are affected, as a single testis is able to provide more than enough testosterone.

It is also important to speak with your doctor about when you will be able to return to regular sexual activity after your hernia repair surgery. These periods of time will vary from patient to patient, but will often last at least a few weeks until their pain has subsided.

Contact the hernia experts of Michigan Hernia Surgery today to schedule a consultation to discuss your inguinal hernia and potential treatment options!

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The Relevance of Sexual Dysfunction Related to Groin Pain After Inguinal Hernia Repair – The SexIHQ Short Form Questionnaire Assessment

FIGURE 2

Figure 2. SexIHQ Questionnaire on pain during sexual activity.

The Swedish Hernia Register (SHR)

The SHR is a validated voluntary nationwide prospective register that covers more than 95% of all groin hernia repairs performed in Sweden. Patients enter the register at their primary operation. Complications occurring within 30 days are reported. A recurrent operation is recorded as a new entry. All inhabitants in Sweden have a unique personal identity number, which enables follow-up of patients having subsequent hernia surgery performed anywhere in Sweden. External review of data in the SHR is conducted annually.

Data retrieved in 2010 from the SHR included: age; body mass index (BMI); status according to the American Society of Anesthesiologists (ASA); hernia type; hernia size according to the European Hernia Society classification (12); mesh weight, (heavy-weight: over 50 g/m2, light-weight: less than 50 g/m2); permanent fixation or non-permanent/no fixation, intraoperative complications; operation time (skin to skin); in-hospital or day-care surgery; and postoperative complications within 30 days (hematoma, infection, urinary retention requiring indwelling catheter, severe pain, reoperation, and unspecified complications).

Inguinal Pain Questionnaire (IPQ)

IPQ is a validated questionnaire and includes 19 questions regarding different pain modalities (11, 13). Questions 2, 11, 12, 14, 16, and 19 were regarded as relevant for this study. Question 2 Pain past week was graded on a 7-level scale from No pain to Pain that could not be ignored; prompt medical advice sought. The definition of pain was grades 3–7; pain that could not be ignored, but did not interfere with every day activities and worse. Grade 1–2; No pain and Pain present that could easily be ignored was defined as no pain.

The Short Form-36 (SF-36)

The SF-36 for measurement of health-related quality-of-life (HRQL), licensed by the HRQL-group (www.hrql.se) at Gothenburg University, was used. The subscales and composite scores (physical and mental) were calculated according to the SF-36 manual (14). Norm-based scores were calculated using the Swedish age- and gender-specific means and standard deviations. The norm data have a mean of 50 and a SD of 10. A 5-point difference corresponds to an effect size of 0.5 SD and can be regarded as a medium size clinically important difference (15).

Statistical Analysis

The IBM SPSS Statistics Software version 22 was used for all statistical analyses. Continuous variables were analyzed using the Student t-test, and categorical variables with Pearson χ2 test or Fisher’s exact test. A p-value of less than 0.05 was regarded as significant. Risk factors were selected prior to analysis and entered simultaneously, while odds ratios (OR) were evaluated using binary logistic regression.

Results

Included patients are reported in a flowchart in Figure 1. 87% of patients (675/776) answered the questionnaire whereof 80% (538/675) met the inclusion criteria and remained for analysis. The follow-up time was 33 (SD 15) months; NPS-patients 33 (SD 15) months, and PS-patients 34 (SD 15) months (p < 0.692). The characteristics of the patients are shown in Table 1. Operations were unilateral in 45% and bilateral in 55%.

TABLE 1

Table 1. Patient characteristics.

Pain During Sexual Activity

Operative and postoperative data are shown in Table 2. There were no differences between the NPS and PS groups regarding mesh-weight, fixation, uni- or bilateral operation, intraoperative complications, operation time, and hospital stay. Heavy-weight meshes were used in 66% of patients without difference between the NPS and the PS groups (p < 0.364). Immediate severe postoperative pain was seen in 0.6% (3 patients), all in the NPS group. Postoperative complications were reported in a total of 6.5%. Within the NPS 6% reported any complication, and in in the PS group 18% (p < 0.005). Postoperative infection was reported in 0.6% (3 patients), all in the NPS group. No reoperation within 30 days was reported.

TABLE 2

Table 2. Operative and postoperative data.

Results on SexIHQ are reported in Table 3. The option “Always having pain during sexual activity” was reported by 1.5% of the patients, “severe pain” (VAS ≥ 7) by 0.7%, “severe erectile dysfunction” (VAS ≥ 7) by 0.7%, “severe ejaculatory dysfunction” (VAS ≥ 7) by 1.5% and “depression due to sexual dysfunction” by 3.5%. The proportion of patients having “Pain at sexual activity” (PS) did not change over time, Figure 3.

FIGURE 3

Figure 3. Proportion of patients with sexual dysfunction due to pain in relation to the length of follow-up. Error bars represents 95% confidence intervals.

TABLE 3

Table 3. SexIHQ results (n = 44).

SF-36

All subscales for SF-36 were slightly above the norm in NPS patients, Figure 4. In PS patients, all SF-36 scales were significantly lower compared to the norm, except for Physical Function (PF), Role Physical (RP), and Role Emotional (RE).

FIGURE 4

Figure 4. SF-36 shown with norm based scores for eight subscales and two composite scores for patients without (n = 494) and with (n = 44) pain during sexual activity (mean 50, SD 10). PF, Physical Function; RP, Role Physical; BP, Bodily Pain; GH, General Health; VI, Vitality; SF, Social Function; RE, Role Emotional; MH, Mental Health; and PCS, Physical Composite Score; MCS, Mental Composite Score. Error bars represents 95% confidence intervals.

Risk Factor Analysis

Risk factor analysis for sexual dysfunction related to pain is presented in Figure 5. A postoperative complication was the only independent risk factor for sexual dysfunction due to pain in a multivariable model: OR 4.89 (95% CI 1.92–12.43; p < 0.001).

FIGURE 5

Figure 5. Risk factor analysis for sexual dysfunction related to pain.

Discussion

This study is based on the Swedish National Hernia Register, introducing the SexIHQ questionnaire specifically addressing impairment of sexual function related to pain after inguinal hernia repair with TEP. Long-term sexual impairment after groin hernia operation was present in one out of twelve patients and did not seem to attenuate over time. Quality-of-life was considerably reduced in afflicted patients.

A relatively short questionnaire, specifically investigating genital pain and sexual dysfunction in hernia patients was developed by Aasvang et al. (1). This protocol was further developed and used in a more detailed protocol (7). We enhanced these ideas with the purpose of making a more specific questionnaire, the SexIHQ, which only assesses impairment of sexual function caused by pain after surgical repair. The debilitating effect of pain on both erectile and ejaculatory function, as well as psychological problems (e.g., depression), seemed relevant to include as a dimension in the quality-of-life concept. This is supported by the decreased dimensions of SF-36 in both physical and mental domains. To assess sexual dysfunction, visual analogue scales and tick-boxes were used in this 8-question 1-page questionnaire, which was created for implementation in large cohort studies (e.g., register-based). The goal was to approach only patients having sexual impairment after hernia repair. For this reason, the questionnaire starts with two questions discriminating sexually active from sexually inactive patients, defining sexually active patients as having pain during sexual activity versus those without. This method limits the number of patients needed to be addressed with more specific questions on sexual issues, hopefully increasing the response rate in large cohorts.

A limitation of this study is the lack of preoperative data. These data are not available in most register-based studies today. Even if all questions focus on the relation between “pain in the groin” and sexual function, it could still be difficult for the patient to differentiate between postoperative groin pain and other conditions as a cause for the impairment of sexual function. In a recently published RCT (Lichtenstein versus the Onstep technique), 28% of patients reported pain during sexual activity preoperatively, but reduced to 11% postoperatively (5). In another study on TAPP, the corresponding values were 23 and 10% (4). Our results, in a national cohort of patients operated on by several different surgeons at different educational levels, experienced 8.2% of pain during sexual activity. Among these patients 6.1% (33/44) reported sexual dysfunction; this indicates that the TEP repair may be a competitive technique in this perspective.

Including patients from a national register has its advantages. All levels of experience and varying techniques used by operating surgeons are included, resulting in high external validity. Three studies on this subject were published from the Danish national hernia register (1, 4, 7).

A register-based questionnaire study of 1,172 patients operated on by TAPP during a 10 year period had a response rate of 68% (7). We achieved a response rate of 86% in patients operated on during a 5 year period, which is regarded as excellent. One explanation might be that our questionnaire was limited to very few questions, whereas only pain-afflicted patients (8%) were requested to answer them.

The only risk factor for impairment of sexual function was a postoperative complication. Preoperative pain has also been demonstrated to be a risk factor for postoperative pain (4). We were unable to evaluate this finding as no preoperative pain status is recorded in the SHR.

Conclusion

We present a short form questionnaire for cohorts that assesses sexual dysfunction related to chronic postoperative pain in a national cohort of TEP-operated men. Care should be taken to prevent complications, thereby reducing the risk of sexual dysfunction. Patients should be preoperatively informed about the risk of pain, and also about the risk of sexual dysfunction after groin hernia surgery.

Ethics Statement

The trial was approved by the Regional Ethics Review Board at Lund University (634/2008) and registered at www.ClinicalTrials.gov (ID: NCT02419950). A written consent was signed by all participating patients in accordance with the Declaration of Helsinki.

Author Contributions

NG has been engaged in all the parts of the study including planning, sending all questionnaires, creating the data platform, analyzing data, performing statistical calculations, preparing tables, figures and the manuscript. PR has been engaged in all the parts of the study, preparing the data base platform, double-checking all statistical calculations, preparing the manuscript, tables and figures, and revising the manuscript. UP been engaged in all the parts of the study, analyzing data and preparing the manuscript. AM, being the principle investigator of the project, has been engaged in all the parts of the study, project planning, applications, data analysis, interpretation of data and preparing the manuscript.

Funding

The authors are grateful for valuable statistical advice from biostatistician Jan-Åke Nilsson, Lund University, Department of Clinical Sciences. Unrestricted funding from Lund University; ALF Region Skåne Research and Development Funds; Anders Borgström Fellowship; and Helge B Wulff Foundation.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Conditions That Affect Male Sexual Function

An Overview of Conditions Affecting Male Sexual Function

According to the National Institute of Health, male sexual desire disorder affects around three percent of the population, and erectile dysfunction affects as many as five percent of adult men. Also, three percent of males have hypoactive sexual desire, and approximately four percent of men suffer with ejaculatory disorders. A man must have normal spermatogenesis to impregnate a woman. Also, he must be able to transmit the sperm into the woman’s vagina. Without a normal erection or problems with spermatogenesis, this cannot occur. Male sexual functioning disorders include ejaculation disorders, undescended or mispositioned testicles, benign prostatic hyperplasia, inguinal hernia, and erectile dysfunction. Any sexual function problem that prevents sexual activity or the sexual response cycle can alter fertility. Fortunately, most causes of male sexual dysfunction are treatable.

Ejaculation Disorders

There are three types of ejaculation disorders: premature ejaculation, inhibited ejaculation, and retrograde ejaculation. Premature ejaculation occurs before or soon after vaginal penetration. With inhibited ejaculation, the ejaculatory process is slow to occur. Retrograde ejaculation occurs when the ejaculate is forced back into the bladder rather than exiting via the urethra and end of the penis.

Incidence, Prevalence, and Causes

Some cases of premature and inhibited ejaculation are caused by a lack of attraction to the sex partner, or from psychological factors. Premature ejaculation is the most common type of sexual dysfunction in men, and it is due to nervousness and performance anxiety. Also, many medications and drugs affect ejaculation, such as antidepressants, alcohol, and opiates. Retrograde ejaculation is common in men who suffer from diabetic neuropathy, where there is substantial nerve damage.

Signs and Symptoms

Ejaculation disorders are diagnosed based on subjective complaint. When the man experiences difficulties with ejaculation, the doctor can identify the type of sexual dysfunction based on the patient’s description of the problem.

Treatment

For premature ejaculation, treatment involves self-help techniques and couples therapy. Certain techniques used include use of a thick condom to decrease sensation, masturbating an hour before sexual activity, and taking deep breaths during intercourse. Also, certain medications can help with delaying ejaculation, such as selective serotonin reuptake inhibitors (SSRIs). With inhibited ejaculation, the physical causes must be treated.

Undescended or Mispositioned Testicles

Undescended or mispositioned testicles are two of the most common congenital testicular conditions that affect male sexual function. The testes normally descend into the scrotum from the abdomen before birth, but sometimes this does not occur. If the testicles are malpositioned, they could sit in the inguinal canal, pelvis, abdomen, or high scrotum.

Undescended or mispositioned testicles occur in approximately four percent of all full-term infants, and it is more common for premature infants. Many cases of this condition resolve by the first year of life, but many times the condition is not recognized, resulting in infertility due to endocrine understimulation and high body temperature. Also, men with undescended or mispositioned testicles are at a greater risk for developing testicular cancer.

There are no real signs or symptoms of malpositioned and undescended testicles for male infants and toddlers. Older men do experience infertility, however. The diagnosis of this condition is made by clinical inspection of a qualified physician and by testicular ultrasound.

The treatment for mispositioned and undescended testicles involves surgery. This is usually done when the infant is around one year old. Some cases of rectractile testes descend without surgery.

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is the condition where the prostate gland enlarges. This disorder can cause trouble with urination and frequent lower urinary tract infections. In addition to compromised urethral outlet function, many men also have difficulty with structural functioning.

Health experts estimate that as many as 50 percent of all men in their 50s have BPH, and by the age of 80, as many as 90 percent will develop this condition. Androgens are male sex hormones that are needed for normal growth and function of the prostate gland. While they do not directly cause BPH, an imbalance between two forms of androgens contributes to prostatic enlargement. Also, a defect in substances that regulate the prostate gland can produce inflammation, further worsening the condition. Risk factors for BPH include physical inactivity, use of over-the-counter cold medications, diet pills, obesity, and smoking.

Men with benign prostatic hypertrophy have troublesome symptoms, including a decline in urine stream force, nighttime urination, feelings that the bladder is not emptying, and urinary retention. BPH is diagnosed by a digital rectal examination. Several laboratory tests to assess the prostate include the serum prostate specific antigen (PSA), urinalysis, urine culture, chemistry panels, and BUN and creatinine levels. To accurately diagnose this condition, the doctor may order voiding tests, such as an urodynamic study or uroflowmetry test.

BPH is often difficult to treat. In order to slow the growth of the prostate gland and relax the prostate muscles, alpha 1-adrenergic blockers are used. These include medications such as doxazosin (Cardura), tamsulosin (Flomax), and terazosin (Hytrin). Additionally certain 5-alpha reductase inhibitors are used to inhibit the conversion of testosterone to DHT (Avodart, for example).

Inguinal Hernia

Abdominal hernias are protrusions of the abdominal contents through the abdomen wall. Over half of these hernias are indirect inguinal hernias, which present in the inguinal canal. The majority of these hernias is congenital and only become symptomatic when trauma or chronic cough occurs.

A direct inguinal hernia is one that does not pass through the inguinal canal, yet enters the canal. An indirect inguinal hernia enters the canal and remains there or descends farther into the scrotum. In the U.S. alone, over 700,000 inguinal hernia repairs are done each year. Health experts estimate that 25 percent of men have an inguinal hernia during their lifetime.

The symptoms and signs of an inguinal hernia include groin tenderness, bowel obstruction, a visible bulge, and pain. The doctor can tell if someone has an inguinal hernia by inspecting the inguinal canal via the scrotum. To confirm this condition, ultrasound is often necessary.

Many men with inguinal hernias require surgery, which is done by laproscopic method or conventional measures. This surgery is especially necessary when there is a risk for necrosis (tissue death).

Erectile dysfunction (ED) is defined as the inability to achieve and/or maintain and erection that is sufficient for sexual activity. ED occurs from a complex multifactorial cause, involving physical, environmental, social, and psychological factors.

The known physical causes of ED include advancing age, diminished testosterone levels, cardiovascular disorders, and endocrine conditions. Common psychological causes include fatigue, depression, low self-esteem, performance anxiety, and stress.Risk factors for this condition include heart disease, hypertension, diabetes, cigarette smoking, spinal cord injuries, stroke, congenital defects, and renal failure. This disorder is quite common, affecting as many as 15 million men over the age of 18 years.

To diagnose ED, the doctor must conduct a detailed history and physical examination. The main symptom is inability to obtain an erection or maintain one. Laboratory tests to assess this condition include thyroid, hormone, and prolactin levels. To determine vascular problems, a dynamic infusion cavernosometry test is done.

In order for the doctor to treat this condition, the underlying cause must first be identified. Psychological issues must be addressed with medications, counseling, and behavioral modification. If serum testosterone levels are low, supplementation is often necessary. Alternative therapies include penile prosthesis, surgery, vacuum erection devices, and injections.

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