MALE GENITOURINARY SYMPTOMS - Medwords.com.au

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MALE GENITOURINARY SYMPTOMS in a matter of months. The results of treatment are good if commenced early in the course of the disease, but advanced disease may be incurable. CYSTITIS Cystitis is an infection of the urinary bladder that usually occurs in women, with less than 10% occurring in men because the longer length of their urethra (the tube leading from the bladder to the outside). A bacterial infection can enter the bladder by coming up the urethra from outside the body, or through the bloodstream to the kidneys and then the bladder. Entry from the outside is far more common, and often due to irritation of the urethra with sex. Slackness of the muscle ring that controls the release of urine from the bladder can also allow bacteria to enter the bladder. This damage may be caused by childbirth or prolapse of the womb, and may eventually cause incontinence with a cough or laugh. The symptoms include burning pain on passing urine, pain in the pelvis, the desire to pass urine very frequently and blood may be seen in the urine. The infection may spread up the ureters to the kidneys to cause acute pyelonephritis. The urine can be cultured to identify the responsible bacteria and correct antibiotic. Further investigations such as X-rays and ultrasound scans of the bladder and kidneys may be performed, to exclude more serious causes of recurrent cystitis. Appropriate antibiotic tablets for a week or two, and urinary alkalinisers (in the form of a powder that makes a fizzy drink) result in a rapid cure in most patients. Drinking extra fluid will help wash the infection out of the bladder, while passing urine immediately after sex sometimes prevents infections. Commercial urinary alkalinisers or cranberry juice may be used regularly to prevent cystitis in women who have this problem regularly. EPIDIDYMO-ORCHITIS Epididymo-orchitis is a bacterial or viral infection of the testicle and epididymis. The sperm produced in a testicle passes into a dense network of fine tubes that forms a lump on the back of the testicle called the epididymis. These join up to form the sperm tube (vas deferens) that takes the sperm to the penis. Epididymoorchitis is an infection of both the epididymis and testicle. Orchitis is an infection of the testicle alone, but the infection is almost invariably present in both places. Men with a bacterial epididymo-orchitis are acutely uncomfortable, have a painful swollen testicle, and a fever. Occasionally an abscess will form, which must be surgically drained. A painful testicle can also be caused by torsion of the testis, which is a surgical emergency requiring immediate treatment. Any boy or man, particularly in the teenage years or early twenties, who develops a painful testicle, must see a doctor immediately - day or night. Blood tests may show the presence of infection in the body, and treatment involves appropriate antibiotics, aspirin or paracetamol for pain relief, ice may be applied to the scrotum, and a supportive bandage or jockstrap worn. If the infection is caused by a virus such as mumps, there is no effective treatment available. With the correct treatment, bacterial epididymo-orchitis resolves in a couple of days, and usually does not cause any problems with fertility or masculinity. In cases of viral infection there may be problems with fertility in later life. GONORRHOEA Gonorrhoea (“clap”) is a common sexually transmitted bacterial infection caused by the bacterium Neisseria gonorrhoeae, which can only be caught by having sex with a person who already has the disease. It has an incubation period of three to seven days after contact. Some degree of protection can be obtained by using a condom. 8
MALE GENITOURINARY SYMPTOMS The symptoms vary significantly between men and women. In women there may be minimal symptoms with a mild attack, but when symptoms do occur they include a foul discharge from the vagina, pain on passing urine, pain in the lower abdomen, passing urine frequently, tender lymph nodes in the groin, and fever. If left untreated the infection can involve the uterus and Fallopian tubes to cause salpingitis and pelvic inflammatory disease, which can result in infertility and persistent pelvic pain. Babies born to mothers with the infection can develop gonococcal conjunctivitis (eye infection). In men symptoms are usually obvious with a yellow milky discharge from the penis, pain on passing urine and, in advanced cases, inflamed lymph nodes in the groin. If left untreated the prostate can become infected, which can cause scarring of the urine tube (urethra), permanent difficulty in passing urine and reduced fertility. With anal intercourse, a rectal infection with gonorrhoea can develop and cause an anal discharge, mild diarrhoea, rectal discomfort and pain on passing faeces. Oral sex can lead to the development of a gonococcal throat infection. Gonorrhoea may also enter the bloodstream and cause septicaemia. An unusual complication is gonococcal arthritis, which causes pain in the knees, ankles and wrists. Other rarer complications include infections of the heart, brain and tendons. The diagnosis is confirmed by examining a swab from the urethra, vagina or anus under a microscope, and culturing the bacteria on a nutrient substance. There are no blood tests available to diagnose gonorrhoea. Other sexually transmitted diseases should also be tested for when gonorrhoea is diagnosed, as they may be contracted at the same time. For this reason, blood tests are often ordered when treating anyone with any form of venereal disease. Gonorrhoea has been readily treated with a course of penicillin until recently, but many strains are now resistant to penicillin and more potent antibiotics (eg. spectinomycin) are required. All sexual contacts of the infected person need to be notified as they may be carriers of the disease and unaware of the presence of the infection. After treatment, a follow-up swab is important to ensure that the infection has been adequately treated. The appropriate antibiotics can cure more than 95% of gonorrhoea cases. IMPOTENCE - PSYCHOGENIC Impotence is the inability of a man to obtain a firm erection of the penis when sexually stimulated. It is a very common problem, and something that every man experiences at some time, particularly in middle age and older. The process of erection sometimes mystifies women. It is one over which the man has no direct control, as it is a local reflex in the pelvis triggered by sexual excitement. A man even has difficulty in detecting if his penis is erect unless it is touched or seen. The penis contains two sausage shaped sponge filled tubes (corpora cavernosa) that fill with blood under pressure when a muscular ring closes off the drainage veins behind the base of the penis. A wide range of diseases may cause impotence, and these must be excluded by appropriate investigations before a psychological cause is diagnosed, or impotence treatment is given. If a cause is found, that should be specifically treated to resolve the problem. Only if no particular cause can be diagnosed should the various impotence treatments available be used. A lot of impotence is caused by a psychological feedback mechanism. For one of the reasons listed below, a man may fail to develop an erection when attempting sex. He feels embarrassed and ashamed about this, particularly if it is with a new partner. The next time he tries to have sex he will be anxious as to whether he will be able to perform. This anxiety makes him concentrate on trying to get an erection, which is an almost certain way in which to prevent an erection. After two failures, the anxiety increases, which further decreases the chance of success at subsequent attempts. It requires the patient understanding of the man’s partner and the continuing advice of a doctor, to overcome this erection failure cycle. Common causes of impotence include the overuse of alcohol (which increases the desire, while reducing the ability), stress and anxiety in any aspect of life, difficult circumstances (eg. lack of privacy), heavy smoking, illegal drugs (eg. marijuana, heroin) and medications (eg. those used to lower blood pressure and improve depression, sedatives, cimetidine, clofibrate, digoxin). Other possible causes of impotence include depression, pituitary gland disease (gland in the brain which controls all other glands including the testes), testicular diseases or injury, poorly controlled diabetes mellitus (sugar diabetes), high levels of cholesterol may cause hardening of the arteries (atherosclerosis) and make it difficult for the blood to get into the penis and cancer of the prostate gland may interfere with the normal nerve and blood vessel reflexes that allow an erection. Rare causes of impotence include Peyronie disease (a replacement of the blood filled sacs by fibrous scar tissue), a “fracture” of the erect penis, multiple sclerosis, paraplegia and quadriplegia, lead poisoning, Klinefelter syndrome) and Fröhlich syndrome. Psychological factors may be overcome by not planning sex, but relaxing and waiting until the right circumstances occur spontaneously. Mutual heavy petting and erotic stimulation, but without the expectation of sex, sexual toys, pornography and vacuum pumps to create an erection may be used. Once spontaneous erections 9
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