6.4 – Male Reproductive Diseases, Disorders and Diagnostic Testing

Erectile Dysfunction Disorder (EDD)

Erectile dysfunction (ED) is a condition in which a male has difficulty either initiating or maintaining an erection. The combined prevalence of minimal, moderate, and complete ED is approximately 40% in men at age 40 and reaches nearly 70% by 70 years of age. In addition to aging, ED is associated with diabetes, vascular disease, psychiatric disorders, prostate disorders, the use of some drugs such as certain antidepressants, and problems with the testes resulting in low testosterone concentrations. These physical and emotional conditions can lead to disruptions in the vasodilation pathway and result in an inability to achieve an erection (Betts, et al., 2013).

Cancer

Prostate Cancer

According to the Centers for Disease Control and Prevention (CDC), prostate cancer is the second most common cancer occurring in men. However, some forms of prostate cancer grow very slowly and may not require treatment. In contrast, aggressive forms of prostate cancer involve metastasis to organs like the lungs and brain. There is no link between Benign Prostatic Hyperplasia and prostate cancer, but the symptoms are similar. Prostate cancer is detected by medical history, a blood test, and a digital rectal exam that allows physicians to palpate the prostate and check for unusual masses. If a mass is detected, the cancer diagnosis is confirmed by biopsy of the cells (Betts, et al., 2013).

Testicular Cancer

Testicular cancer begins in the testicle or testis. It is most often found in men age 15 to 44 years, although it can be diagnosed at any age (Canadian Cancer Society, 2020). Testicular cancer is rare and treatable when diagnosed early. Common signs and symptoms include a painless lump in the testicle, swelling, a heavy feeling in the scrotum or abdomen, amongst others. Sometimes, testicular cancer is found during infertility testing. An orchiectomy is the most common procedure for diagnosing and treating testicular cancer (Canadian Cancer Society, 2020). To learn more about testicular cancer, diagnosis, and treatments, please go to the Canadian Cancer Society’s web page on testicular cancer [New Tab].

Sexually Transmitted Infections (STIs)

The terms for sexually transmitted infections (STI) and sexuality transmitted diseases (STD) are often used interchangeably. Sexuality transmitted disease (STD) implies the disease was acquired through sexual transmission. A disease is a disorder of structure or function in a human, which produces specific signs or symptoms. A disease must be managed, as with the case of human immunodeficiency virus (which can also be acquired through the transmission of other bodily fluids; thus not solely sexual transmission). The treatment may include antiretrovirals or anti-virals (Urology Care Foundation, 2019).

Chlamydia (CT)

Chlamydia is one of the most common sexually transmitted infections (STIs) caused by bacteria that infect the cervix, urethra, and other reproductive organs. Chlamydia is easy to treat and can be cured. Many people with chlamydia do not have any symptoms and unknowingly pass the infection to their sexual partner(s). If symptoms develop, they usually appear two to six weeks after sexual contact with an infected person. Males may have penial discharge and itching around the urethra. The urethra is the opening in the penis. Males may also experience dysuria, polyuria, urethral pain and urethritis (Ontario Agency for Health Protection and Promotion, 2019; Region of Peel, 2007).

Chlamydia spreads through unprotected oral, anal or vaginal sex with an infected person. Chlamydia can be spread to the eyes via the hands with direct contact of infected fluids. Until a patient finishes their treatment, they continue to have the infection and can continue to pass it to others. Chlamydia is treated with antibiotic pills. If the patient has epididymitis, they may need to be hospitalized and be treated with intravenous (IV) antibiotics. All sexual partners within the past 60 days should be examined, treated, and informed that having no symptoms does not mean there is no infection (Ontario Agency for Health Protection and Promotion, 2019; Region of Peel, 2007).

Gonorrhea (Gonococcus) – (GC)

Gonorrhea is a sexually transmitted infection (STI) caused by bacteria that infects the cervix, urethra, and other reproductive organs. Infections can also infect the throat and anus. Gonorrhea can be treated and cured. Many people infected with gonorrhea have no symptoms and can unknowingly pass the infection on to their sexual partner(s). If symptoms develop, they may appear two to seven days after sexual contact with an infected person. Symptoms vary depending on which part of the body is infected. Males may have yellowish-white discharge from the penis. They may also have dysuria, polyuria, testicular pain and testitis. Gonorrhea infection from oral sex may lead to sore throat and swollen glands. Gonorrhea infection from anal sex may cause itchiness and discharge from the anus. Gonorrhea is spread through unprotected oral, vaginal or anal sex with an infected person. Until the patient finishes their treatment, they continue to have the infection and can pass it to others (Ontario Agency for Health Protection and Promotion, 2019a; Region of Peel, 2007).

Gonorrhea is treated with oral antibiotics in combination with an intramuscular (IM) injection. It is important that one completes the treatment and abstain from unprotected sexual activity for at least seven days following treatment. If the patient develops epididymitis, the patient may need to go to a hospital and be treated with intravenous antibiotics. All sexual partners within the past 60 days should be examined, treated, and informed that having no symptoms does not mean there is no infection (Ontario Agency for Health Protection and Promotion, 2019a; Region of Peel, 2007).

Reportable Diseases

Both chlamydia and gonorrhea are reportable diseases to the Ministry of Health and Long Term Care. Therefore, the local health department will be calling the doctor’s office or patient to ensure correct treatment was received and sexual partners have been followed up with testing and treatment (Ontario Agency for Health Protection and Promotion, 2019a; Region of Peel, 2007). To learn more about STIs and STDs such as chlamydia and gonorrhea, please go to the Public Health Ontario website [New Tab].

Human Papillomavirus- HPV

HPV is another common sexually transmitted infection (STI). Both males and females can be infected with HPV. Around three quarters of sexually active individuals have been exposed to HPV during their lifetime. There are over 100 strains of HPV and some strains of HPV can cause visible genital warts. The warts are usually painless but may be itchy, uncomfortable, and hard to treat. Some strains of HPV cause genital, anal, throat, and cervical cancers. HPV spreads through sexual activity and skin-to-skin contact in the genital area with an infected person. Since some people are asymptomatic, they don’t know they have the virus and consequently pass the virus to their sexual partners. Treatments are available for genital warts but there is no cure for HPV (York Region Health Connect, n.d.). To learn more about HPV symptoms, treatments, and prognosis, visit the CDC Fact Sheet on HPV [PDF].

HPV Vaccine

A vaccine called Gardasil® 9 is available for 9 HPV strains. This vaccine assists the immune system in protecting the body against infections and diseases caused by HPV (York Region Health Connection, n.d.). To learn more about Gardasil® 9 treatments, please visit the Gardasil® 9 website [New Tab].

Herpes Simplex Virus (HSV)

Genital herpes is a sexually transmitted infection (STI) that is caused by a virus called herpes simplex virus (HSV). There are two types of herpes simplex viruses:

• Type 1- oral herpes or cold sores (HSV-1)
• Type 2- genital herpes (HSV-2)

These viruses are very similar and either type can cause genital herpes or cold sores. Symptoms might include dysuria, enlarged glands, myalgia, arthralgia and fever. Once a patient is infected with HSV, the virus remains in their body even after the symptoms are gone and can cause recurring outbreaks. When the virus becomes active again, the symptoms return but are usually less painful and heal faster. Recurring outbreaks vary from person-to-person, however they can be triggered by emotional or physical stress, exposure to sunlight, hormonal changes, poor nutrition, sexual intercourse, lack of sleep or a low immune system.

Herpes is spread through direct contact with the sores or blisters of an infected person. Contact (and transfer of the virus) can occur from genitals-to-genitals, mouth-to-genitals or mouth-to-mouth. Herpes can also be passed to the anal area. Herpes spreads easily during sexual contact while symptoms are present, or just before an outbreak of symptoms. An infected person may spread herpes even when they have no symptoms; this is called asymptomatic shedding. One can spread the herpes virus to other parts of their body after touching the sores, which is referred to as autoinoculation. The fingers, eyes, and other body areas can accidentally become infected in this way. Hand washing after touching sores and blisters is recommended to prevent spreading the virus.

There is no cure for herpes. Antiviral pills help to reduce symptoms and speed the healing of blisters or sores and are prescribed by a doctor. Treatment of symptoms may be managed with medication for pain, bath salts, cold compresses, and urinating in water may help to relieve discomfort. Keep the infected area clean and dry, wear cotton underwear and loose clothing to reduce discomfort. All sexual partner(s) should be informed. The only way to reduce the risk, of transmission of herpes is to avoid direct contact with the sores and to use condoms. Condoms will reduce but not eliminate risk as the virus can be present and shed from the skin in the genital area (Ontario Ministry of Health and Long-Term Care, 2015).

To learn more about the symptoms, complications, treatments and prognosis of HSV, please visit the Mayo Clinic’s page on Genital Herpes [New Tab] website or Public Health Ontario’s Testing Index [New Tab].

Medical Specialties and Procedures related to the Male Reproductive System

Vasectomy

No-Scalpel Vasectomy (NSV)

An alternative to a traditional vasectomy is the no-scalpel vasectomy (NSV). This is a minimally invasive procedure and an added benefit is that the recovery time is shorter. All vasectomies are completed by a urologist (Gentle Procedures Clinic, n.d.). To learn more about the NSV procedure, visit No-Scalpel Vasectomy Procedure Info [New Tab] by the Gentle Procedures Clinic in Toronto, Ontario.

Urology

Urology is a surgical subspecialty in which the surgeon has additional training in the treatments of diseases and disorders of the male and female urogenital systems (Canadian Medical Association, 2018). To learn more about urology and the training involved to become a urologist, visit the Canadian Medical Association’s Urology Profile [New Tab].

Attribution

Except where otherwise noted, this chapter is adapted from “Male Reproductive System” in Building a Medical Terminology Foundation by Kimberlee Carter and Marie Rutherford licensed under CC BY 4.0. / A derivative of Betts et al., which can be accessed for free from Anatomy and Physiology (OpenStax). Adaptations: dividing Male Reproductive System chapter content into sub-chapters.