Ovarian cysts

Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary. The ovaries are two organs — each about the size and shape of an almond — located on each side of your uterus. Eggs (ova) develop and mature in the ovaries and are released in monthly cycles during your childbearing years.

Many women have ovarian cysts at some time during their lives. Most ovarian cysts present little or no discomfort and are harmless. The majority of ovarian cysts disappear without treatment within a few months.

However, ovarian cysts — especially those that have ruptured — sometimes produce serious symptoms. The best way to protect your health is to know the symptoms and types of ovarian cysts that may signal a more significant problem, and to schedule regular pelvic examinations.

Signs and symptoms

You can't depend on symptoms alone to tell you if you have an ovarian cyst. In fact, you'll likely have no symptoms at all. Or if you do, the symptoms may be similar to those of other conditions, such as endometriosis, pelvic inflammatory disease, ectopic pregnancy or ovarian cancer. Even appendicitis and diverticulitis can produce signs and symptoms that mimic a ruptured ovarian cyst.

Still, it's important to be watchful of any symptoms or changes in your body and to know which symptoms are serious. If you have an ovarian cyst, you may experience the following signs and symptoms:

Menstrual irregularities
Pelvic pain — a constant or intermittent dull ache that may radiate to your lower back and thighs

Pelvic pain shortly before your period begins or just before it ends
Pelvic pain during intercourse (dyspareunia)
Pain during bowel movements or pressure on your bowels
Nausea, vomiting or breast tenderness similar to that experienced during pregnancy
Fullness or heaviness in your abdomen
Pressure on your rectum or bladder — difficulty emptying your bladder completely

The signs and symptoms that signal the need for immediate medical attention include:

Sudden, severe abdominal or pelvic pain
Pain accompanied by fever or vomiting

Causes

Your ovaries normally grow cyst-like structures called follicles each month. Follicles produce the hormones estrogen and progesterone and release an egg when you ovulate.

Sometimes a normal monthly follicle just keeps growing. When that happens, it becomes known as a functional cyst. This means it started during the normal function of your menstrual cycle. There are two types of functional cysts:

Follicular cyst. Around the midpoint of your menstrual cycle, your brain's pituitary gland releases a surge of luteinizing hormone (LH), which signals the follicle holding your egg to release it. When everything goes according to plan, your egg bursts out of its follicle and begins its journey down the fallopian tube in search of fertilization.

A follicular cyst begins when the LH surge doesn't occur. The result is a follicle that doesn't rupture or release its egg. Instead it grows and turns into a cyst. Follicular cysts are usually harmless, rarely cause pain and often disappear on their own within two or three menstrual cycles.

Corpus luteum cyst. When LH does surge and your egg is released, the ruptured follicle begins producing large quantities of estrogen and progesterone in preparation for conception. This changed follicle is now called the corpus luteum. Sometimes, however, the escape opening of the egg seals off and fluid accumulates inside the follicle, causing the corpus luteum to expand into a cyst.

Although this cyst usually disappears on its own in a few weeks, it can grow to almost 4 inches in diameter and has the potential to bleed into itself or twist the ovary, causing pelvic or abdominal pain. If it fills with blood, the cyst may rupture, causing internal bleeding and sudden, sharp pain. The fertility drug clomiphene citrate (Clomid, Serophene), which is used to induce ovulation, increases the risk of a corpus luteum cyst developing after ovulation. These cysts don't prevent or threaten a resulting pregnancy.

When to seek medical advice

If you experience severe or spasmodic pain in your lower abdomen, accompanied by fever and vomiting, see your doctor. These signs and symptoms — or those of shock such as cold, clammy skin, rapid breathing, and lightheadedness or weakness — indicate an emergency and require immediate medical attention.

Screening and diagnosis

A cyst on your ovary may be found during a pelvic exam. If a cyst is suspected, doctors often advise further testing to determine its type and whether you need treatment.

Typically, doctors address several questions to determine a diagnosis and to aid in management decisions:

Shape. Is your cyst irregularly shaped?
Size. What size is it?
Composition. Is it filled with fluid, solid or mixed? Fluid-filled cysts aren't likely to be cancerous. Those that are solid or mixed — filled with fluid and solid — may require further evaluation to determine if cancer is present.

To identify the type of cyst, your doctor may perform the following procedures:

Pregnancy test. A positive pregnancy test may suggest that your cyst is a corpus luteum cyst, which can develop when the ruptured follicle that released your egg reseals and fills with fluid.

Pelvic ultrasound. In this painless procedure, a wand-like device (transducer) is used to send and receive high-frequency sound waves (ultrasound). The transducer can be moved over your abdomen and inside your vagina, creating an image of your uterus and ovaries on a video screen. This image can then be photographed and analyzed by your doctor to confirm the presence of a cyst, help identify its location and determine whether it's solid, filled with fluid or mixed.

Laparoscopy. Using a laparoscope — a slim, lighted instrument inserted into your abdomen through a small incision — your doctor can see your ovaries and remove the ovarian cyst.

CA 125 blood test. Blood levels of a protein called cancer antigen 125 (CA 125) often are elevated in women with ovarian cancer. If you develop an ovarian cyst that is partially solid and you are at high risk of ovarian cancer, your doctor may test the level of CA 125 in your blood to determine whether your cyst could be cancerous. Elevated CA 125 levels can also occur in noncancerous conditions, such as endometriosis, uterine fibroids and pelvic inflammatory disease.

Complications

A large ovarian cyst can cause abdominal discomfort. If a large cyst presses on your bladder, you may need to urinate more frequently because its capacity is reduced.

Some women develop less common types of cysts that may not produce symptoms, but that your doctor may find during a pelvic examination. Cystic ovarian masses that develop after menopause may be cancerous (malignant). These factors make regular pelvic examinations important.

The following types of cysts are much less common than functional cysts:

Dermoid cysts. These cysts may contain tissue such as hair, skin or teeth because they form from cells that produce human eggs. They are rarely cancerous, but they can become large and cause painful twisting of your ovary.

Endometriomas. These cysts develop as a result of endometriosis, a condition in which uterine cells grow outside your uterus. Some of that tissue may attach to your ovary and form a growth.

Cystadenomas. These cysts develop from ovarian tissue and may be filled with a watery liquid or a mucous material. They can become large — 12 inches or more in diameter — and cause twisting of your ovary.

Treatment

Treatment depends on your age, the type and size of your cyst, and your symptoms. Your doctor may suggest:

Watchful waiting. You can wait and be re-examined in one to three months if you're in your reproductive years, you have no symptoms and an ultrasound shows you have a simple, fluid-filled cyst. Your doctor will likely recommend that you get follow-up pelvic ultrasounds at periodic intervals to see if your cyst has changed in size.

Watchful waiting, including regular monitoring with ultrasound, is also a common treatment option recommended for postmenopausal women if a cyst is filled with fluid and is less than 2 centimeters in diameter.

Birth control pills. Your doctor may recommend birth control pills to reduce the chance of new cysts developing in future menstrual cycles. Oral contraceptives offer the added benefit of significantly reducing your risk of ovarian cancer — the risk decreases the longer you take birth control pills.

Surgery. Your doctor may suggest removal of a cyst if it is large, doesn't look like a functional cyst, is growing or persists through two or three menstrual cycles. Cysts that cause pain or other symptoms may be removed.

Some cysts can be removed without removing the ovary in a procedure known as a cystectomy. Your doctor may also suggest removing the affected ovary and leaving the other intact in a procedure known as oophorectomy. Both procedures may allow you to maintain your fertility if you're still in your childbearing years. Leaving at least one ovary intact also has the benefit of maintaining a source of estrogen production.

If a cystic mass is cancerous, however, your doctor will advise a hysterectomy to remove both ovaries and your uterus. After menopause, the risk of a newly found cystic ovarian mass being cancerous increases. As a result, doctors more commonly recommend surgery when a cystic mass develops on the ovaries after menopause.

Prevention

Although there's no definite way to prevent the growth of ovarian cysts, regular pelvic examinations are a way to help ensure that changes in your ovaries are diagnosed as early as possible. In addition, be alert to changes in your monthly cycle, including symptoms that may accompany menstruation that aren't typical for you or that persist over more than a few cycles. Be sure to talk with your doctor about any concerns relating to menstruation.

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is a general term that refers to infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus) and other reproductive organs. It is a common and serious complication of some sexually transmitted diseases (STDs), especially chlamydia and gonorrhea. PID can damage the fallopian tubes and tissues in and near the uterus and ovaries. Untreated PID can lead to serious consequences including infertility, ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere outside of the womb), abscess formation, and chronic pelvic pain.

How Common is PID?

Each year in the United States, it is estimated that more than 1 million women experience an episode of acute PID. More than 100,000 women become infertile each year as a result of PID, and a large proportion of the ectopic pregnancies occurring every year are due to the consequences of PID. Annually more than 150 women die from PID or its complications.


How Do Women get PID?

PID occurs when bacteria move upward from a woman's vagina or cervix (opening to the uterus) into her reproductive organs. Many different organisms can cause PID, but many cases are associated with gonorrhea and chlamydia, two very common bacterial STDs. A prior episode of PID increases the risk of another episode because the reproductive organs may be damaged during the initial bout of infection.

Sexually active women in their childbearing years are most at risk, and those under age 25 are more likely to develop PID than those older than 25. This is because the cervix of teenage girls and young women is not fully matured, increasing their susceptibilty to the STDs that are linked to PID.

The more sex partners a woman has, the greater her risk of developing PID. Also, a woman whose partner has more than one sex partner is at greater risk of developing PID, because of the potential for more exposure to infectious agents.

Women who douche may have a higher risk of developing PID compared with women who do not douche. Research has shown that douching changes the vaginal flora (organisms that live in the vagina) in harmful ways, and can force bacteria into the upper reproductive organs from the vagina.

Women who have an intrauterine device (IUD) inserted may have a slightly increased risk of PID near the time of insertion compared with women using other contraceptives or no contraceptive at all. However, this risk is greatly reduced if a woman is tested and, if necessary, treated for STDs before an IUD is inserted.

What are the Symptoms of PID?

Symptoms of PID vary from none to severe. When PID is caused by chlamydial infection, a woman may experience mild symptoms or no symptoms at all, while serious damage is being done to her reproductive organs. Because of vague symptoms, PID goes unrecognized by women and their health care providers about two thirds of the time. Women who have symptoms of PID most commonly have lower abdominal pain. Other signs and symptoms include fever, unusual vaginal discharge that may have a foul odor, painful intercourse, painful urination, irregular menstrual bleeding, and pain in the right upper abdomen (rare).

What are the Complications of PID?

Prompt and appropriate treatment can help prevent complications of PID. Without treatment, PID can cause permanent damage to the female reproductive organs. Infection-causing bacteria can silently invade the fallopian tubes, causing normal tissue to turn into scar tissue. This scar tissue blocks or interrupts the normal movement of eggs into the uterus. If the fallopian tubes are totally blocked by scar tissue, sperm cannot fertilize an egg, and the woman becomes infertile. Infertility also can occur if the fallopian tubes are partially blocked or even slightly damaged. About one in eight women with PID becomes infertile, and if a woman has multiple episodes of PID, her chances of becoming infertile increase.

In addition, a partially blocked or slightly damaged fallopian tube may cause a fertilized egg to remain in the fallopian tube. If this fertilized egg begins to grow in the tube as if it were in the uterus, it is called an ectopic pregnancy. As it grows, an ectopic pregnancy can rupture the fallopian tube causing severe pain, internal bleeding, and even death.

Scarring in the fallopian tubes and other pelvic structures can also cause chronic pelvic pain (pain that lasts for months or even years). Women with repeated episodes of PID are more likely to suffer infertility, ectopic pregnancy, or chronic pelvic pain.

How is PID Diagnosed?

PID is difficult to diagnose because the symptoms are often subtle and mild. Many episodes of PID go undetected because the woman or her health care provider fails to recognize the implications of mild or nonspecific symptoms. Because there are no precise tests for PID, a diagnosis is usually based on clinical findings. If symptoms such as lower abdominal pain are present, a health care provider should perform a physical examination to determine the nature and location of the pain and check for fever, abnormal vaginal or cervical discharge, and for evidence of gonorrheal or chlamydial infection. If the findings suggest PID, treatment is necessary.

The health care provider may also order tests to identify the infection-causing organism (e.g., chlamydial or gonorrheal infection) or to distinguish between PID and other problems with similar symptoms. A pelvic ultrasound is a helpful procedure for diagnosing PID. An ultrasound can view the pelvic area to see whether the fallopian tubes are enlarged or whether an abscess is present. In some cases, a laparoscopy may be necessary to confirm the diagnosis. A laparoscopy is a minor surgical procedure in which a thin, flexible tube with a lighted end (laparoscope) is inserted through a small incision in the lower abdomen. This procedure enables the doctor to view the internal pelvic organs and to take specimens for laboratory studies, if needed.

What is the treatment for PID?

PID can be cured with several types of antibiotics. A health care provider will determine and prescribe the best therapy. However, antibiotic treatment does not reverse any damage that has already occurred to the reproductive organs. If a woman has pelvic pain and other symptoms of PID, it is critical that she seek care immediately. Prompt antibiotic treatment can prevent severe damage to reproductive organs. The longer a woman delays treatment for PID, the more likely she is to become infertile or to have a future ectopic pregnancy because of damage to the fallopian tubes.

Because of the difficulty in identifying organisms infecting the internal reproductive organs and because more than one organism may be responsible for an episode of PID, PID is usually treated with at least two antibiotics that are effective against a wide range of infectious agents. These antibiotics can be given by mouth or by injection. The symptoms may go away before the infection is cured. Even if symptoms go away, the woman should finish taking all of the prescribed medicine. This will help prevent the infection from returning. Women being treated for PID should be re-evaluated by their health care provider two to three days after starting treatment to be sure the antibiotics are working to cure the infection. In addition, a woman's sex partner(s) should be treated to decrease the risk of re-infection, even if the partner(s) has no symptoms. Although sex partners may have no symptoms, they may still be infected with the organisms that can cause PID.

Hospitalization to treat PID may be recommended if the woman (1) is severely ill (e.g., nausea, vomiting, and high fever); (2) is pregnant; (3) does not respond to or cannot take oral medication and needs intravenous antibiotics; or (4) has an abscess in the fallopian tube or ovary (tubo-ovarian abscess). If symptoms continue or if an abscess does not go away, surgery may be needed. Complications of PID, such as chronic pelvic pain and scarring are difficult to treat, but sometimes they improve with surgery.

How can PID be Prevented?

STD (mainly untreated Chlamydia or gonorrhea) is the main preventable cause of PID. Women can protect themselves from PID by taking action to prevent STDs or by getting early treatment if they do get an STD.

The surest way to avoid transmission of STDs is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of chlamydia and gonorrhea.

CDC recommends yearly chlamydia testing of all sexually active women age 25 or younger and of older women with risk factors for chlamydial infections (those who have a new sex partner or multiple sex partners). An appropriate sexual risk assessment by a health care provider should always be conducted and may indicate more frequent screening for some women.

Any genital symptoms such as an unusual sore, discharge with odor, burning during urination, or bleeding between menstrual cycles could mean an STD infection. If a woman has any of these symptoms, she should stop having sex and consult a health care provider immediately. Treating STDs early can prevent PID. Women who are told they have an STD and are treated for it should notify all of their recent sex partners so they can see a health care provider and be evaluated for STDs. Sexual activity should not resume until all sex partners have been examined and, if necessary, treated.

Adapted from: Centers for Disease Control and Prevention

Women Reproductive Disorders - Ovaries Diseases - Premature Ovarian Failure

Also called: POF, Primary ovarian insufficiency
Premature ovarian failure (POF) is when a woman's ovaries stop working before she is 40. POF used to be called premature menopause. However, POF is not the same as menopause. Some women with POF still have occasional periods. Premature menopause is when periods stop before age of 40. This can be natural or caused by surgery, chemotherapy or radiation.

Missed periods are usually the first sign of POF. Later symptoms may be similar to those of natural menopause.

Most women with POF cannot get pregnant naturally. Fertility treatments help a few women; others use donor eggs to have children. There is no treatment that will restore normal ovarian function. However, many health care providers suggest taking hormones until age 50.

The term premature ovarian failure describes a stop in the normal functioning of the ovaries in a woman younger than age 40. Some people also use the term primary ovarian insufficiency to describe this condition. It is also known as hypergonadotropic hypogonadism.
Health care providers used to call this condition premature menopause, but premature ovarian failure is actually much different than menopause.

In menopause, a woman will likely never have another menstrual period again; women with premature ovarian failure are much more likely to get periods, even if they come irregularly.

A woman in menopause has virtually no chance of getting pregnant; a woman with premature ovarian failure has a greatly reduced chance of getting pregnant, but pregnancy is still possible.

What are the symptoms of premature ovarian failure?
The most common first symptom of premature ovarian failure is skipping or having irregular periods.
Some women with premature ovarian failure also have other symptoms, similar to those of women going through natural menopause. These may include:


Hot flashes and night sweats
Irritability, poor concentration
Decreased interest in sex or pain during sex
Drying of the vagina
Infertility

Premature ovarian failure also puts women at risk for some other health conditions, some of them serious, including:


Osteoporosis – loss of bone strength and bone density. Getting enough calcium, vitamin D, and weight-bearing physical activity can help reduce this risk.
Low thyroid function – affects metabolism and can cause very low energy. Replacing the thyroid hormone can treat the problem.

Addison’s disease – an autoimmune disorder in which the body has trouble handling physical stress, such an injury or illness, because of problems with the adrenal glands. About 3.2 percent of women with premature ovarian failure also have Addison’s disease. Addison’s can be dangerous for women who don’t know they have it. This condition can’t be prevented, but can be managed with help from your health care provider.

Heart disease – estrogen replacement therapy, along with keeping a healthy body weight and getting regular, moderate, physical activity, can help reduce this risk.
Also, it is important to know that people who are carriers for the gene for Fragile X syndrome, or who have the premutation for the condition, are more likely than other people to get premature ovarian failure. If you are a Fragile X carrier or have a premutation, it is important to get tested for premature ovarian failure.

Are there treatments for the symptoms of premature ovarian failure?

There is no proven treatment to make a woman’s ovaries work normally again. However, there are treatments that can help some of the symptoms of premature ovarian failure.

Estrogen replacement therapy (ERT), also called hormone replacement therapy (HRT) gives women the estrogen and other hormones their bodies are not making. HRT can help women have regular periods and lower their risk for osteoporosis.
Current research is looking into giving women the hormone testosterone to help

How is premature ovarian failure diagnosed?

Because one of the most common signs of premature ovarian failure is irregular periods, women should pay close attention to their menstrual cycles and tell their health care provider about any changes.

If your health care provider thinks you may have premature ovarian failure, he or she may do a blood test to measure the level of a hormone called follicle stimulating hormone that is normally present in the body. This test will help determine whether the ovaries are working properly or not.

What causes premature ovarian failure?

Researchers know that in women in premature ovarian failure something happens to stop the normal functioning of the ovaries; but in most cases, the exact cause is not clear.

Most research focuses on a problem with the follicles in the ovaries. Follicles in the ovaries start out as microscopic seeds. These seeds mature into eggs, which travel to the uterus for fertilization. Follicles also release the hormone estrogen, which is important for a woman’s overall health and bone health.

Most women have enough follicles to last until menopause. However, this may not be the case in women with premature ovarian failure.

Women with premature ovarian failure may fall into one of two groups:

A woman with follicle depletion has no follicles left in her ovaries and there is no way to make more.

A woman with follicle dysfunction may have follicles in her ovaries, but they are not working properly.

About 10 percent to 20 percent of women with premature ovarian failure have a family history of the condition. This finding suggests that some cases of premature ovarian failure can be genetic. However, genetics is not the only cause of premature ovarian failure.

How does premature ovarian failure affect fertility?

Women with premature ovarian failure are unlikely to get pregnant because their ovaries do not work correctly. At this time there is no proven treatment to improve a woman’s ability to have a baby naturally if she has premature ovarian failure.
However, between 5 percent and 10 percent of women with premature ovarian failure become pregnant without fertility treatment. There is also a type of fertility treatment, known as egg donation, which may be an option for women with premature ovarian failure.

Adapted from: National Institute of Child Health and Human Development

Penile Cancer

The penis contains several types of tissue, including skin, nerves, smooth muscle, and blood vessels. Running through the inside of the penis is a thin tube called the urethra. Urine and semen come out through the urethra. The head of the penis is called the glans. At birth, the glans is covered by a piece of skin called the foreskin, or prepuce. The foreskin is often removed in infant boys in an operation called circumcision.

Inside the penis are 3 chambers that contain a soft, spongy network of blood vessels. Two of these cylinder-shaped chambers, known as the corpora cavernosa, lie on either side of the upper part of the penis. The third lies below them and is known as the corpus spongiosum. This chamber widens at its end to form the glans. The corpus spongiosum surrounds the urethra, a tube that carries urine from the bladder through the penis. The opening at the end of the urethra is called the meatus.

When a man gets an erection, nerves signal to his body to store blood in the vessels inside the corpora cavernosa and corpus spongiosum. As the blood fills the chamber, the spongy tissue expands, causing the penis to elongate and stiffen. After ejaculation, the blood flows back into the body, and it becomes soft again.

Semen consists of fluid produced by 2 small sacs near the bladder and prostate (the seminal vesicles) and by the prostate gland. It contains sperm cells that were made in the testicles. This fluid is produced and stored in the seminal vesicles. During ejaculation, semen from the seminal vesicles passes into the urethra and out the tip of the penis.

Cancers of the Penis

Each of the tissues in the penis contains several types of cells. Different types of penile cancer (cancer of the penis) can develop in each kind of cell. The differences are important because they determine the seriousness of the cancer and the type of treatment needed.

Epidermoid carcinoma: Penile cancer develops in the skin of the penis. About 95% of penile cancers develop from flat skin cells called squamous cells. Penile tumors tend to grow slowly. If they are found at an early stage, these tumors can usually be cured. Squamous cell penile cancers can develop anywhere on the penis but most develop on the foreskin (in men who have not been circumcised) or on the glans.

Verrucous carcinoma is an uncommon form of squamous cell cancer that can occur on the male or female genitals, skin, mouth, larynx, and anus. Verrucous carcinoma of the genitals is sometimes also called a Buschke-Lowenstein tumor. It looks a lot like a benign (noncancerous) genital wart (see the section "Benign and Precancerous Conditions" for more information). These low-grade cancers can spread deeply into surrounding tissue, but they rarely spread to other parts of the body.

Adenocarcinoma, a very rare type of penile cancer, can develop from sweat glands in the skin of the penis. Paget disease of the penis is a condition in which adenocarcinoma cells are found in the penile skin. The cancer cells at first spread within the skin, but they may eventually invade underneath the skin and spread to lymph nodes. Paget disease can affect skin anywhere in the body but most often affects skin of the perianal area (tissues of or around the anus), vulva, and the breasts. (This condition should not be confused with Paget disease of the bone, an entirely different disease also named after Dr. James Paget.)

The earliest stage of squamous cell cancer of the penis (or any other organ) is called squamous cell carcinoma in situ (CIS). Penile CIS is contained entirely within the skin of the penis and has not yet spread to deeper tissues of the penis. Depending on the exact location of a CIS of the penis, doctors may give additional names to the disease. CIS of the glans is sometimes called erythroplasia of Queyrat. The same condition when found on the shaft of the penis (or skin of other parts of the body) is called Bowen disease.

Melanomas: About 2% of penile cancers develop from pigment-producing skin cells called melanocytes. Cancers of these cells are called melanoma. These cancers are more dangerous because they grow and spread more rapidly. Melanomas usually develop from sun-exposed areas of skin. Although sun exposure is an important risk factor for melanoma, a few of these cancers can develop on the penis or other areas not likely to become sunburned.

Basal cell penile cancer: Basal cell cancers represent less than 2% of penile cancers. They are slow-growing tumors that rarely spread to other parts of the body.

Sarcomas: The remaining 1% of penile cancers are sarcomas, cancers that develop from the blood vessels, smooth muscle, and other connective tissue cells of the penis.

Benign and Precancerous Conditions

Sometimes abnormal benign (not cancerous) growths develop on the penis. Some of these benign growths may eventually evolve into invasive cancer if they are not treated. These precancerous conditions can resemble warts or irritated patches of skin. Like penile cancer, they usually develop on the glans or on the foreskin, but they can also occur along the shaft of the penis.

Condylomas are wart-like growths that resemble tiny cauliflowers. Some are so small that they are apparent only when the skin is viewed under a magnifying lens. Others may be as large as an inch or more in diameter.

Squamous cell cancer of the penis usually forms slowly over many years, and it is usually preceded by precancerous changes that may last for several years. The medical term for this precancerous condition is penile intraepithelial neoplasia, or dysplasia. "Intraepithelial" means that the precancerous cells are confined to the epithelium (surface layer of the penile skin).

Adapted from: American Cancer Society

Urethral Stricture

Urethral stricture is an abnormal narrowing of the urethra (the tube that releases urine from the body).

Causes

Urethral stricture may be caused by inflammation or scar tissue from surgery, disease, or injury. It may also be caused by external pressure from an enlarging tumor near the urethra, although this is rare.

Increased risk is associated with men who have a history of sexually transmitted disease (STD), repeated episodes of urethritis, or benign prostatic hyperplasia (BPH). There is also increased risk of urethral stricture after an injury or trauma to the pelvic region. Any instrument inserted into the urethra (such as a catheter or cystoscope) increases the chance of developing urethral strictures.

Congenital (present at birth) pediatric strictures are rare, as are true strictures in women.

Symptoms

Dysuria (painful urination)
Difficulty urinating
Slow urine stream (may develop suddenly or gradually)
Spraying of urine stream
Decreased urine output
Increased urinary frequency or urgency
Incontinence
Blood in the semen
Pelvic pain
Lower abdominal pain
Bloody or dark urine
Discharge from the urethra
Swelling of the penis
Urinary retention

Exams and Tests

A physical examination may reveal the following:

Decreased urinary stream
Enlarged or tender lymph nodes in the inguinal (groin) areas
Redness or swelling of the penis
Urethral discharge
Enlarged or tender prostate
Distended bladder
Hardness (induration) on the under surface of the penis
Sometimes the exam reveals no abnormalities.

Tests include the following:

Urinary flow rate may be measured
Post-void residual (PVR) measurement
Urinalysis
Urine culture (if evidence of infection)
Tests for chlamydia and gonorrhea
Cystoscopy to confirm diagnosis
A retrograde urethrogram to confirm diagnosis

Treatment

Placement of a suprapubic catheter, which allows the bladder to drain through the abdomen, may be necessary to alleviate acute problems such as urinary retention.

Dilation of the urethra may be attempted by inserting a thin instrument to stretch the urethra under local anesthesia. If urethral dilation is not possible, surgery may be necessary to correct the condition. Surgical options vary depending on the location and the length of the stricture.

Cystoscopic visual urethrotomy may be all that is needed for small stricture. A urethral stent may be inserted thru the cystoscope.

An open urethroplasty may be performed for longer stricture by removing the diseased portion or replacing it with other tissue. The results vary depending on the size and location of urethroplasty, the number of prior therapies, and the experience of the surgeon.

There are no drug treatments currently available for this disease. If all else fails, a urinary diversion -- appendicovesicostomy (Mitrofanoff procedure) -- may be performed to allow the patient to perform self-catheterization of the bladder through the abdominal wall.

Outlook (Prognosis)

Treatment usually results in an excellent outcome. However, repeated therapies may be needed to remove the scar tissue.

Possible Complications

Urethral stricture may totally block urine flow, causing acute urinary retention, a condition that must be alleviated quickly.

When to Contact a Medical Professional

Call your health care provider if symptoms of urethral stricture occur.

Prevention

Practicing safer-sex behaviors may decrease the risk of contracting sexually transmitted diseases and subsequent urethral stricture.

Early treatment of urethral stricture may prevent complications such as kidney or bladder infection or injury

Adapted from: U.S. National Library of Medicine

Retrograde ejaculation

Retrograde ejaculation is when semen goes into the bladder rather than out of your penis during orgasm. Although you still reach sexual climax, you may ejaculate very little or no semen (dry orgasm). Retrograde ejaculation isn't harmful, but it can cause fertility problems.

Retrograde ejaculation can be caused by medications, health conditions or surgeries that affect the nerves or muscle that control the bladder opening. If retrograde ejaculation is caused by a medication, stopping the medication may be effective. For retrograde ejaculation due to a health condition or as a result of surgery, treatment with medications may restore normal ejaculation and fertility.

Signs and symptoms

Retrograde ejaculation does not affect your ability to get an erection or have an orgasm — but when you climax, semen goes into your bladder instead of coming out of your penis. Retrograde ejaculation can cause:

Dry orgasms or orgasms in which you ejaculate very little semen out of your penis
Urine that is cloudy after orgasm because it contains semen
Male infertility

Causes

Normally during ejaculation, sperm from the testicles is carried through a tube called the vas deferens until it mixes with fluid from the semen glands and prostate. The muscle at the opening of the bladder (bladder neck) should contract or tighten to prevent the semen from entering the bladder as it passes through the tube inside the penis (urethra). This is the same muscle that holds urine in your bladder until you urinate. With retrograde ejaculation, the bladder neck muscles don't tighten properly. As a result, sperm can enter the bladder instead of being ejected out of the penis.

Several conditions can cause problems with the muscle that closes the bladder during ejaculation. These include:

Surgery such as retroperitoneal lymph node dissection, bladder neck surgery or prostate surgery
Side effect of certain medications used to treat high blood pressure, prostate enlargement and mood disorders
Nerve damage caused by a medical condition such as diabetes, multiple sclerosis or a spinal cord injury

Risk factors

You're at increased risk of retrograde ejaculation if:

You have diabetes, especially if you have diabetic nerve damage
You have had prostate or bladder surgery
You take certain medications for high blood pressure or a mood disorder
You sustained a spinal cord injury

When to seek medical advice

If you ejaculate very little or no semen when you have an orgasm, see a doctor. You may have retrograde ejaculation. This condition is not harmful and only requires treatment if you are attempting to father a child. However, dry orgasm, or orgasm with little semen, can also be an early symptom of an underlying medical condition that requires treatment.

Screening and diagnosis

To diagnose retrograde ejaculation, your doctor will look for sperm in your urine with a microscope after you ejaculate.

If you have a dry orgasm, but your doctor doesn't find semen in your bladder, you may have a problem with semen production. This can be caused by damage to the prostate or semen-producing glands as a result of surgery or radiation treatment for cancer in the pelvic area.

Complications

Retrograde ejaculation is not harmful. The only complication is difficulty getting your partner pregnant. Some men with retrograde ejaculation may find orgasm less pleasurable.

Treatment

Retrograde ejaculation typically doesn't require treatment unless it interferes with fertility. In such cases, treatment depends on the underlying cause. If retrograde ejaculation is the side effect of a certain medication, it may improve when that medication is stopped or changed.

Retrograde ejaculation can sometimes be reversed with medications that are primarily used to treat other conditions, including:

Imipramine, a tricyclic antidepressant

Chlorpheniramine and brompheniramine, antihistamines sometimes used treat cold symptoms

Ephedrine, pseudoephedrine and phenylephrine, used in some decongestant medications

These medications help keep the bladder neck muscle closed during ejaculation. While they're often effective treatment for retrograde ejaculation, all of these medications can also cause numerous side effects. Some of the side effects are minor, but others can be more serious.

Before prescribing medications, your doctor will want to know about any other medications you're currently taking. Some medications used to treat retrograde ejaculation can cause serious reactions when combined with other medications. Your doctor will also want to know about any health problems you may have. Some of these medications can increase blood pressure and heart rate, which can be dangerous in men who have high blood pressure or heart disease.

If medications are not effective and you're attempting to father a child, doctors may be able to artificially inseminate your partner with sperm recovered from your bladder after you ejaculate.

Prevention

If you need to have surgery that may affect the bladder neck muscle, such as prostate or bladder surgery, or if you have a spinal injury, there's little you can do to prevent retrograde ejaculation. However, there are things you can do to prevent retrograde ejaculation caused by nerve damage from diabetes or the use of certain medications.

If you have diabetes, work with your doctor to keep your blood sugar under control.
If you're taking medications for high blood pressure or a mood disorder, ask your doctor if they may cause retrograde ejaculation. You may be able to take another medication instead, or change doses.

Adapted from: Mayo foundation for Medical Education and Research

Priapism

Priapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation. The condition develops when blood in the penis becomes trapped and unable to drain. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction.

It can occur in all age groups, including newborns. However, it usually affects men between the ages of 5 to 10 years and 20 to 50 years.

There are two categories of priapism: low-flow and high-flow.

Low flow: This type of priapism is the result of blood being trapped in the erection chambers. It often occurs without a known cause in men who are otherwise healthy, but also affects men with sickle-cell disease, leukemia (cancer of the blood) or malaria.

High flow: High flow priapism is more rare than low-flow and usually less painful. It is the result of a ruptured artery from an injury to the penis or the perineum (area between the scrotum and anus), which prevents blood in the penis from circulating normally.

What causes priapism?

Sickle cell anemia: Some adult cases of priapism are the result of sickle-cell disease and approximately 42% of all adults with sickle-cell will eventually develop priapism.

Medications: A common cause of priapism is the use and/or misuse of medications. Drug-related priapism includes drugs such as Desyrel used to treat depression or Thorazine, used to treat certain mental illnesses. For people who have erectile dysfunction, injection therapy medications to treat the condition may also cause priapism.

Other causes of priapism include:

Trauma to the spinal cord or to the genital area
Black widow spider bites
Carbon monoxide poisoning
Illicit drug use, such as marijuana and cocaine
In rare cases, priapism may be related to cancers that can affect the penis and prevent the outflow of blood.

How is priapism diagnosed?

If you experience priapism, it is important that you seek medical care immediately. Tell your doctor:

The length of time you have had the erection
How long your erection usually lasts
Any medication or drugs, legal or illegal, which you have used. Be honest with your doctor, illegal drug use is particularly relevant since both marijuana and cocaine have been linked to priapism.
Whether or not priapism followed trauma to that area of the body.

Your doctor will review your medical history and perform a thorough physical examination to determine the cause of priapism. This will include checking the rectum and the abdomen for evidence of unusual growths or abnormalities that may indicate the presence of cancer.

After the physical exam is complete, the doctor will take a blood-gas measurement of the blood from the penis. During this test, a small needle is placed in the penis, some of the blood is drawn and then it is sent to a lab for analysis. This provides a clue as to how long the condition has been present and how much damage has occurred.

How is priapism treated?

The goal of all treatment is to make the erection go away and preserve future erectile function. If a person receives treatment within four to six hours, the erection can almost always be reduced with medication. If the erection has lasted less than four hours, decongestant medications, which may act to decease blood flow to the penis, may be very helpful. Other treatment options include:

Ice packs: Ice applied to the penis and perineum may reduce swelling.

Surgical ligation: Used in cases where an artery has been ruptured, the doctor will ligate (tie off) the artery that is causing the priapism in order to restore normal blood flow.

Intracavernous injection: Used for low-flow priapism, during this treatment drugs known as alpha-agonists are injected into the penis that cause the veins to narrow reducing blood flow to the penis causing the swelling to subside.

Surgical shunt: Also used for low-flow priapism, a shunt is a passageway that is surgically inserted into the penis to divert the blood flow and allow circulation to return to normal.

Aspiration: After numbing the penis, doctors will insert a needle and drain blood from the penis to reduce pressure and swelling.

If you suspect that you are experiencing priapism, you should not attempt to treat it yourself. Instead seek emergency as soon as possible.

What is the outlook for people with priapism?

As long as treatment is prompt, the outlook for most people is very good. However, the longer medical attention is delayed, the greater the risk of permanent erectile dysfunction

Peyronie’s Disease

Peyronie’s disease, a condition of uncertain cause, is characterized by a plaque, or hard lump, that forms on the penis. The plaque develops on the upper or lower side of the penis in layers containing erectile tissue. It begins as a localized inflammation and can develop into a hardened scar.

Cases of Peyronie’s disease range from mild to severe. Symptoms may develop slowly or appear overnight. In severe cases, the hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection. In many cases, the pain decreases over time, but the bend in the penis may remain a problem, making sexual intercourse difficult. The sexual problems that result can disrupt a couple’s physical and emotional relationship and lead to lowered self-esteem in the man. In a small percentage of patients with the milder form of the disease, inflammation may resolve without causing significant pain or permanent bending.

The plaque itself is benign, or noncancerous. A plaque on the top of the shaft (most common) causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. At times, pain, bending, and emotional distress prohibit sexual intercourse.

One study found Peyronie’s disease in 1 percent of men. Although the disease occurs mostly in middle age, younger and older men can develop it. About 30 percent of men with Peyronie’s disease develop fibrosis (hardened cells) in other elastic tissues of the body, such as on the hand or foot. A common example is a condition known as Dupuytren’s contracture of the hand. In some cases, men who are related by blood tend to develop Peyronie’s disease, which suggests that genetic factors might make a man vulnerable to the disease.

Men with Peyronie’s disease usually seek medical attention because of painful erections and difficulty with intercourse. Since the cause of the disease and its development are not well understood, doctors treat the disease empirically; that is, they prescribe and continue methods that seem to help. The goal of therapy is to keep the Peyronie’s patient sexually active. Providing education about the disease and its course often is all that is required. No strong evidence shows that any treatment other than surgery is effective. Experts usually recommend surgery only in long-term cases in which the disease is stabilized and the deformity prevents intercourse.

A French surgeon, François de la Peyronie, first described Peyronie’s disease in 1743. The problem was noted in print as early as 1687. Early writers classified it as a form of impotence, now called erectile dysfunction (ED). Peyronie’s disease can be associated with ED; however, experts now recognize ED as only one factor associated with the disease—a factor that is not always present.
A cross-section of the penis (left) displays the internal cavity that runs the length of the penis and is divided into two chambers (corpora cavernosa) by a vertical connecting tissue known as a septum. It is believed that, during trauma such as bending, bleeding might occur at a point of attachment of the septum to tissue lining the chamber wall (center). The bleeding results in a hard scar, which is characteristic of Peyronie’s disease. The scar reduces flexiblility on one side of the penis during erection, leading to curvative (right).

Course of the Disease

Many researchers believe the plaque of Peyronie’s disease develops following trauma (hitting or bending) that causes localized bleeding inside the penis. Two chambers known as the corpora cavernosa run the length of the penis. The inner-surface membrane of the chambers is a sheath of elastic fibers. A connecting tissue, called a septum, runs between the two chambers and attaches at the top and bottom.

If the penis is abnormally bumped or bent, an area where the septum attaches to the elastic fibers may stretch beyond a limit, injuring the lining of the erectile chamber and, for example, rupturing small blood vessels. As a result of aging, diminished elasticity near the point of attachment of the septum might increase the chances of injury.

The damaged area might heal slowly or abnormally for two reasons: repeated trauma and a minimal amount of blood flow in the sheath-like fibers. In cases that heal within about a year, the plaque does not advance beyond an initial inflammatory phase. In cases that persist for years, the plaque undergoes fibrosis, or formation of tough fibrous tissue, and even calcification, or formation of calcium deposits.

While trauma might explain acute cases of Peyronie’s disease, it does not explain why most cases develop slowly and with no apparent traumatic event. It also does not explain why some cases disappear quickly or why similar conditions such as Dupuytren’s contracture do not seem to result from severe trauma.

Some researchers theorize that Peyronie’s disease may be an autoimmune disorder.

Diagnosis and Evaluation

Doctors can usually diagnose Peyronie’s disease based on a physical examination. The plaque is visible and palpable whether the penis is flaccid or erect. Full evaluation, however, may require examination during erection to determine the severity of the curvature. The erection may be induced by injecting medicine into the penis or through self-stimulation. Some patients may eliminate the need to induce an erection in the doctor’s office by taking a digital or Polaroid picture in the home. The examination may include an ultrasound scan of the penis to pinpoint the location and extent of the plaque and evaluate blood flow throughout the penis.

Treatment

Because the course of Peyronie’s disease is different in each patient and because some patients experience improvement without treatment, medical experts suggest waiting 1 to 2 years or longer before attempting to correct it surgically. During that wait, patients often are willing to undergo treatments whose effectiveness has not been proven.

Experimental Treatments
Some researchers have given vitamin E orally to men with Peyronie’s disease in small-scale studies and have reported improvements. Yet, no controlled studies have established the effectiveness of vitamin E therapy. Similar inconclusive success has been attributed to oral application of para-aminobenzoate, a substance belonging to the family of B-complex molecules.

Researchers have injected chemical agents such as verapamil, collagenase, steroids, calcium channel blockers, and interferon alpha-2b directly into the plaques. These interventions are still considered unproven because studies included small numbers of patients and lacked adequate control groups. Steroids, such as cortisone, have produced unwanted side effects, such as the atrophy or death of healthy tissues. Another intervention involves iontophoresis, the use of a painless current of electricity to deliver verapamil or some other agent under the skin into the plaque.

Radiation therapy, in which high-energy rays are aimed at the plaque, has also been used. Like some of the chemical treatments, radiation appears to reduce pain, but it has no effect at all on the plaque itself and can cause unwelcome side effects. Although the variety of agents and methods used points to the lack of a proven treatment, new insights into the wound healing process may one day yield more effective therapies.

Surgery
Peyronie’s disease has been treated surgically with some success. The two most common surgical procedures are removal or expansion of the plaque followed by placement of a patch of skin or artificial material, and removal or pinching of tissue from the side of the penis opposite the plaque, which cancels out the bending effect. The first method can involve partial loss of erectile function, especially rigidity. The second method, known as the Nesbit procedure, causes a shortening of the erect penis.

Some men choose to receive an implanted device that increases rigidity of the penis. In some cases, an implant alone will straighten the penis adequately. In other cases, implantation is combined with a technique of incisions and grafting or plication (pinching or folding the skin) if the implant alone does not straighten the penis.

Most types of surgery produce positive results. But because complications can occur, and because many of the phenomena associated with Peyronie’s disease (for example, shortening of the penis) are not corrected by surgery, most doctors prefer to perform surgery only on the small number of men with curvature so severe that it prevents sexual intercourse

Adapted from: National Institute of Diabetes and Digestive and Kidney Diseases

Paraphimosis, Penile Trauma

PARAPHIMOSIS

Paraphimosis (say: "para-fim-oh-sus") is a serious condition that can happen only in men and boys who haven't been circumcised. Paraphimosis means the foreskin is stuck behind the head of the penis and can't be pulled back down into a normal position.
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What causes paraphimosis?

Uncircumcised men sometimes pull the foreskin back during sex, when they go to the bathroom or when they clean their penises. Doctors and nurses might pull the foreskin back when they examine the penis or put in a catheter.

Sometimes you, a doctor or a nurse might forget to pull the foreskin back down. If the foreskin is left behind the head of the penis too long, your penis might swell so much that the foreskin is trapped behind it.

What can I do to avoid getting paraphimosis?

After having sex, going to the bathroom or cleaning yourself, be sure to pull the foreskin back down to its natural position.
Never leave the foreskin behind the head of your penis for any longer than you need to.

If a catheter is put into your bladder, check afterward to be sure that the foreskin is covering the head of your penis.
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What happens if I get paraphimosis?

Paraphimosis usually causes pain in your penis, but not always. You might get an infection in your penis. You might not be able to go to the bathroom at all. If you can't pull your foreskin over the head of your penis, you need to call your doctor right away.

The first thing your doctor will do is treat the swelling. This can be done by pressing your penis with a hand or by wrapping your penis in a tight bandage. After the swelling has gone away, your doctor should be able to pull the foreskin back down. If the foreskin remains stuck, your doctor might need to make a small cut in the trapped foreskin to loosen it.

Adapted from: American Academy of Family Physicians

PENILE TRAUMA

While the penis is one of the least injured organs, it is not risk-free. What can put it at risk? And how is it repaired? The following information should tell you when it is imperative to see your doctor about problems.

How does the penis normally function?

The two main functions of the penis are urinary and reproductive. Inside the penis there are three tubes. One is called the urethra. It is hollow and allows urine to flow from the bladder through the hole in the prostate through the penis and to the outside. The two other tubes are called the corpora cavernosa. The three tubes are wrapped together by a very tough fibrous sheath called the tunica albuginea. The corpora cavernosa are spongy tubes that are soft until filled with blood during an erection. At the time of sexual activity the erection of the penis allows it to be inserted into the woman's vagina. In this situation, the urethra acts as a channel for semen to be ejaculated into the vagina. The penis facilitates conception and pregnancy and also serves as a source of sexual pleasure for the man and his partner.

What are the causes and symptoms of penile injury?

The penis is much less frequently injured than other parts of the body such as the abdomen, legs, arms and head. However, it can be wounded as a result of various injuries, including automobile accidents, gunshot wounds, burns sexual activity and, in the case of mental disturbance, self-mutilation.

Perhaps the most common injury to the penis occurs during sexual activity. In the flaccid state, injury to the penis is rare because of the mobility and flexibility of the organ. During an erection, arterial blood flow causes the penis to be come rigid thus placing it at higher risk for injury. Although there is no bone in the penis, urologists frequently refer to the injury as a penile "fracture." During vigorous thrusting, the erect penis may accidentally slip out of the vagina. Due to the fast action, the penis strikes the outside of the woman instead of being reinserted into the vagina. The penis may then bend sharply despite the erection. A typical sign of this problem is a sharp pain in the penis joined by a "popping" sound. The pain and sound are produced by a rupture of the tunica albuginea, which is stretched tightly during the time of an erection. The pain may last for a short time or it may continue. The penis develops a collection of blood under the skin called a hematoma, which can distort the appearance of the penis (eggplant deformity). The injury is usually limited to one or both of the corpora cavernosa and, on rare occasions, the urethra.

The penis can also be injured by tearing the suspensory ligament, the structure that supports the organ at its base. Attached to the pelvic bone, this ligament can rip if an erect penis is pushed down suddenly causing pain and bleeding.

Further injuries can occur if a man places a rubber tube or other instrument around the base of the penis that is too tight or on for too long. Cutting off the blood supply, it can produce a wound known as a strangulation lesion. Also, if an object is inserted into the urethra, both it and/or the penis can be injured.

How are injuries to the penis treated?

If a person sustains a penile injury, a urologist will take a thorough medical history and complete a physical examination along with blood and urine tests. The focus of any initial examination is to define the injury and assess the damage to the penis. Given that information, the doctor may call for other tests including a retrograde urethrogram if he/she thinks the urethra is involved. This test is performed by injecting a liquid radio contrast solution through the opening at the top of the penis and then taking X-rays. If the X-ray shows any leakage outside the urethra, it may indicate damage to that part of the urinary tract.

Additional imaging techniques might include an ultrasound of the penis, MRI or a special test called a cavernosogram. In the latter test, a thin hypodermic needle is inserted into one area of the penis before a radio contrast solution is injected and X-rays taken.

If the injury is amputation of the penis, the amputated portion should be wrapped in gauze soaked in sterile saline solution and placed in a plastic bag. The plastic bag should then be put into a second bag or cooler with an ice water slush. If reattachment of the penis is possible, the lower temperature produced by the slush will increase the likelihood of successful reattachment. Penile reattachment even after 16 hours has been reported to be successful.

Historically, treatment for a penis fractured during sexual activity was non-surgical management (e.g., cold compresses, pressure dressings, penile splinting and anti-inflammatory medications). Today, the treatment of choice will probably be for the individual to undergo surgery since it has the best long-term results by lowering complication rates often linked to non-surgical approaches. The most common surgical technique is to "deglove" the penis by making a cut around the shaft near the glans penis and peeling back the skin to the base to examine the inner surface. The surgeon will then evacuate any hematoma that helps to make examination of any tears in the tunica albuginea easier. If tears exist, they are repaired before the skin is sewn back into position. A Foley catheter may be placed through the penile urethra into the bladder to drain urine and allow the penis to heal. With the entire penis bandaged, the patient will probably remain in the hospital for one or two days, and go home with or without the catheter. They may be given antibiotics and pain medication and will probably be asked to make a followup office visit with their doctor.

For massive injuries to the penis, major reconstruction is frequently possible by urologists experienced with this difficult surgery. How closely the reconstructed penis can return to normal urinary or sexual function varies greatly.

What can be expected after treatment for injuries to the penis?

Most cases of fractured penis caused by sexual activity and most other minor penile injuries will heal without problems. However, complications can and do occur. Possible complications include: infection, erectile dysfunction due to blockage of the nerve or blood supply to the penis, priapism in which the penis becomes erect and stays erect to the point of pain, fistula formation in which urine may leak out of the urethra and through the skin of the penis to the outside, curvature (chordee) of the penis after the injury has healed or major loss of skin, portion of the urethra or corpora cavernosum. Failure for the return of sufficient sexual function is dependent upon the degree of injury to the arteries, nerves and corpora cavernosum and whether the patient was experiencing erectile dysfunction just prior to the injury.

Frequently asked questions:

How frequent are penile injuries?

Unfortunately, doctors have not been able to gather meaningful statistics as to how many penile injuries actually occur in the United States.

How does a Foley catheter work?

Ever since E.B. Foley, a Minneapolis urologist, first introduced the catheter bearing his name; doctors have had an effective way to efficiently and continuously drain the urinary tract. Held in place by its own configuration — primarily with a sterile liquid-filled balloon — the Foley can be inserted simply by passing the rubber tubing through the urethra into the bladder. It remains there until the penis is healed.

How do I prevent penile injury?

Penile injuries related to sexual intercourse can be prevented in most cases if your partner is simply aware of the possibility. If your penis is erect and inadvertently slips from the vagina of your partner, stop the thrusting immediately. For other injuries, caution on the job, especially near machinery, defensive driving and gun safety are obvious precautions for the other types of injuries.

Adapted from: American Urological Association

Male Yeast Infection

Male yeast infection is widely misunderstood and is a much overlooked disease today. This report explains their causes, symptoms, and natural treatments without drugs and unwanted side effects. Recent advances have made it possible to eliminate yeast from the body by treating the cause and not just the very uncomfortable effects and symptoms...

Most men will go through life never knowing that they have a candida or fungal infection because it is extremely difficult to detect since men are built different than women. Women will get a vaginal infection and this is the clue that things are amiss in their body. Whereas men will have absolutely no idea they may have a male yeast infection until it creates other problems with their health.

Usually, men are informed by their significant other that she has a yeast infection, so the chances are he has it too. Most doctors will prescribe an anti-fungal and suggest that the man takes it also, other wise he will give it back to her.

This is very true and worse, I am afraid, especially if she has a vaginal infection. During sex, the males urethra is exposed and vulnerable to a male yeast infection from an infected female. The yeast can travel up the urethral canal and settle in the prostate gland.

Now you may not have problems for years but prostate cancer and prostate problems are affecting almost every male at some point in their life. Think about it, boys and young girls do not get reproductive yeast infections as near as often as adults, do they? Boys also do not have prostate problems or girls ever need a hysterectomy. This obviously shows me that sex is an additional cause of infections.

Yeast is used to raise bread in cooking. Isn't it possible that it can swell a prostate gland?

Men who drink beer have been known to have skin yeast on their penis. They are usually totally unaware they have a male yeast infection due to the outside temperature of the skin being about 77 degrees keeping the infection dormant. But the vaginal canal, being a very inviting place for yeast to grow, can activate the infection in the woman. Before the female notices symptoms, she can give it right back to the male, and it can travel up the urethral canal settling in the prostate. It then literally becomes a ticking time bomb.

In some cases, male yeast infections will be noticeable as a penile yeast infection that has dry cracked skin although the infection can occur most anywhere on the skin. When the man has an erection, this skin can crack and be extremely painful.


How Do Men Get A Male Yeast Infection?
All the causes of male yeast infection are the same for any other fungus infection including sex. Most often the good bacteria to yeast ratio in your digestive system becomes unbalanced, allowing the yeast fungi to thrive and spread to other parts of the body.

Male and yeast infection in boys most common causes are antibiotics, alcohol, beer, sex, wheat products, corn products, peanuts, barley, and a weakened immune system.

These common food products are universally contaminated with molds. We all unknowingly eat them thinking they are perfectly safe, but they are not in most cases since they are usually contaminated with molds and fungus. The powerful effect of molds in the body and modern medicine is best illustrated in the following paragraphs.

Take for instance Penicillin, discovered in 1928 by Dr. Fleming as he was running an experiment with mold from bread(wheat product). He took some of this mold and added it to his dish of live bacteria. What he noticed was that the mold completely cleared out the bacteria. The fungus killed the bacteria just as it does in your digestive system when you take antibiotics.

Think back how many times in your life you went to the doctor for a chest cold, or what ever it may have been, and you were prescribed an antibiotic. You took it, the cold cleared up and you thought everything was ok. What you didn't know is the antibiotic killed your good bacteria, also. Not all of it, since we have in a normal healthy human digestive system about 70 trillion beneficial bacteria, but you killed some allowing the male yeast infection to spread throughout your body. You have a cold beer every now and then, you killed some more. Male yeast infection thrives on beer and helps it grow due to the yeast being used in its production. You eat food unknowingly that contains molds, you killed some more. You eat sugar-laden foods, which feed the infection allowing it to grow and spread. This goes on until the fungus takes a good hold in your digestive system and becomes systemic. Piercing the lining of the intestine and spreading throughout the body. There have been cases of yeast encasing people's hearts and causing it to shut down.

The bottom line is you have let your immune system get worn down by the constant introduction of molds to your body. That is when you begin to experience some of the symptoms...


Common Male Yeast Infection Symptoms
Here are some of the more common symptoms you may experience with a male yeast infection. For more symptoms please see Symptom page link to the left.

Men and boys most commonly experience digestive problems and all the related problems as the number one symptom.

The more common symptoms of male yeast infection are constipation, bad breath, bloating, indigestion, frequent intestinal gas, frequent diarrhea, very loose stools, sexual dysfunction, irratibility and mood swings, fatigue or lack of energy, memory loss, jock itch, dry itchy flaky skin, athletes feet, and prostate problems.

You may also develop a craving for sweets, pastas, chips, etc. Any of the foods that feed the male yeast infection since the parasite demands to be fed, and you will more than likely feed it, until you realize you have it, and do something about it.


The Male Yeast Infection Simple Home Test
There is a simple test to see if you have a male yeast infection. The very first thing when you wake up in the morning, before you even get out of bed, spit twice into the glass of water that you left on your nightstand from the night before. Now over the course of the next 15 minutes watch the glass of water. If your spit just kind of dissolves and dissipates in the water, you do not have an infection.


If on the other hand it becomes cloudy, with strings, sinks to the bottom, looks like spider webs, you more than likely have it. If there is sediment in the bottom of the glass after 30 minutes or so then you have parasites also and will have to deal with them first. It will be very noticeable, so don't worry about being unsure if you have it or not. In most cases, you will be able to tell in the first 5 minutes.


The Male Yeast Infection on The Penis or Other Genital Skin Areas

You can use Lotrimin that can be obtained at a pharmacy or Gentian Violet , which is a natural and safe alternative. One word of warning; Gentain Violet will stain your clothes purple. People have reported that spraying your clothes with hair spray or Zout stain remover before washing takes the stains out.

Another very good male yeast infection product, or for any other yeast infection of the skin, that is applied directly on the skin is Aceium. It has been found to work for skin yeast when nothing else will, including the high powered prescription creams.

Other herbs for male yeast infections that you can use are Nutribiotic Liquid Grapefruit Seed Extract and Oregamax diluted in water so it does not burn the skin. Nutiva Organic Coconut Oil can also be used directly on the penal yeast infection.

If your male yeast infection does not respond you probably have herpes and what you are looking at is herpes sores, not yeast.

You cannot get rid of herpes but you can easily keep it under control. Herpes is a virus and like any other virus travels from cell to cell by secretion of an enzyme that digests a hole in the cell wall. Once inside the virus wines and dines and alters the genetic code of the cell. It then digests a way out and enters the cell next to the infected cell by the same process.

By taking things that strengthen the cell wall the virus will be able to enter the cell but it is much harder for it to do so. However, a strong cell will not let the virus get out and spread to the next cell. The immune system then has the time to target the bad cell and removes it from the body.

Cell walls are made out of 60% collagen, 35% fats, and 5% is various other common minerals. Collagen is primarily made out of vitamin c, l-lysine, and l-proline. So if you supplement with these things on a daily basis your herpes infection will not be become active. You can get a pre-made formula called Vitamin C with Bioflavonoids, Querticin, Green Tea, L-lysine and L-Proline if it is more convenient to take it that way. I suggest 24 capsules a day in the beginning then 8 to 12 capsules a day for maintenance.

Or you can get these items separately with impeccable quality in mind as Vitamin C Powder, L-lysine, and L-proline here. Separate doses would be 1 tsp V-C, 1500mgs L-lysine, and 1500mgs L-proline. Double the two aminos in the beginning then drop down for maintenance.

Intestinal or systemic male yeast infection is treated in much the same way as all other fungal infections.

Adapted from: yeastinfectionadvisor

Inflammation of the Penis, Hidden penis

Inflammation of the Penis

Balanitis is inflammation of the glans penis (the cone-shaped end of the penis). Posthitis is inflammation of the foreskin. Commonly, a yeast or bacterial infection beneath the foreskin causes posthitis. Inflammation of both the glans penis and the foreskin (balanoposthitis) can also develop. The inflammation causes pain, itching, redness, and swelling and can ultimately lead to a narrowing (stricture) of the urethra. Men who develop balanoposthitis have an increased chance of later developing balanitis xerotica obliterans, phimosis, paraphimosis, and cancer.

In balanitis xerotica obliterans, chronic inflammation causes the skin near the tip of the penis to harden and turn white. The opening of the urethra is often surrounded by this hard white skin, which eventually blocks the flow of urine and semen. Antibacterial or anti-inflammatory creams may relieve the inflammation, but often the urethra must be reopened surgically.

In phimosis, the foreskin is tight and cannot be retracted over the glans penis. This condition is normal in a newborn or young child and usually resolves without treatment by puberty. In older men, phimosis may result from prolonged irritation or recurring balanoposthitis. The tightened foreskin can interfere with urination and sexual activity and may increase the risk of urinary tract infections. The usual treatment is circumcision.

In paraphimosis, the retracted foreskin cannot be pulled forward to cover the glans penis. The condition most commonly develops after a medical professional retracts the foreskin as part of a medical procedure or if someone pulls back the foreskin to clean the penis of a child and forgets to pull it back forward. The glans penis swells, increasing pressure around the trapped foreskin. The increasing pressure eventually prevents blood from reaching the penis, which could result in the destruction of penile tissue if the foreskin is not pulled back forward. Circumcision or slitting the foreskin relieves paraphimosis.

Erythroplasia of Queyrat usually occurs in uncircumcised men. It produces a discrete, reddish, velvety area on the penis, usually on or at the base of the glans penis. The cause may be long-standing irritation of the penis under the foreskin. While not cancer itself, erythroplasia of Queyrat can become cancerous if left untreated. Removal of a tissue sample for examination under a microscope (biopsy) confirms the diagnosis. Erythroplasia of Queyrat is treated with a cream containing the drug fluorouracil

Hidden penis

Hidden penis refers to a penis that is normal in size but appears very small because part of it is concealed. This condition may also be called concealed penis or buried penis.

Hidden penis is an abnormality that's present at birth (congenital). Causes may include:

Congenital fat pad. Some males are born with excessive fat in the lower abdomen just above the penis, which hides the penis.

Poor skin fixation to the shaft of the penis. Sometimes the penile skin isn't adequately attached to the base or shaft of the penis. When this occurs, the penis isn't fixed in its normal position outside of the body.

Tight foreskin covering the head of the penis (phimosis). The penis becomes trapped in the foreskin, becoming partially hidden.

A doctor can often make a diagnosis of hidden penis on physical examination. In cases where abdominal fat is the cause, hidden penis may improve in the first few years of life as the lower abdomen loses fat and the penis increases in size. In other cases, treatment may include surgical repair.

Obesity may also cause concealment of the penis. The lower abdomen may become so large that it hangs low and covers the penis. The penis may also appear to shrink with age due to decreased muscle tone in the lower abdominal muscles and increased fat in the lower abdomen. Such cases of "hidden" penis can be reversed with weight loss and strengthening of the abdominal muscles.

Hypospadias

Hypospadias is a common birth defect of the penis. Usually, the urethral opening (the opening of the tube that carries urine out of the penis) appears at the very tip of the head (or glans) of the penis. In hypospadias, the opening can appear anywhere on the underside of the penis. In a mild case of hypospadias, the opening may be just below the head of the penis (coronal). In more severe cases of hypospadias, the opening can be anywhere from the middle of the underside of the penis (mid-shaft) to below the place where the penis and scrotum meet (perineal). Frequently there is a downward curving of the penis called chordee. This curvature may be more pronounced when the penis is erect. The foreskin is also incomplete and has the appearance of a dorsal hood (skin covering only the top and sides of the head of the penis).

How often does hypospadias occur?
This is a relatively common condition that occurs in approximately one out of every 300 male births. Most cases of hypospadias (approximately 90%) are of the milder type.

What causes hypospadias?

The urethra (tube that caries urine) is formed between the 6th and 14th week of pregnancy. There is evidence that in some cases a lack of male hormone produced by the fetus may cause the urethra to stop growing before it reaches its full length. However, in most cases no cause is identified. Hypospadias is not usually caused by anything the parents did or did not do during pregnancy. (In rare cases, progesterone taken by the mother early in pregnancy may cause hypospadias.)

How will this affect my child?

In mild cases, there is little effect from hypospadias. In more severe cases, because the unusually placed opening of the hole will force urine to spray downwards, a boy will find it difficult or even impossible to urinate from a standing position. If chordee is involved, an adult male may have difficulty with sexual functioning due to the curvature of the penis. Unless the hypospadias is very severe, the hypospadias should not affect a man’s fertility. The hypospadias does not affect the ability to hold and release urine, nor will it result in more urinary infections. However, the appearance of the foreskin can be a source of embarrassment or self-consciousness.

Treatment: What can be done?

In mild cases, surgery is optional, based on an evaluation of the urinary stream, the straightness of erections and the way it looks. In moderate to severe cases, surgery is almost always recommended to establish normal function. The goal of surgery is first to straighten out any curvature of the penis and second to remake the part of the urethra that didn’t form. Except for the most severe cases, hypospadias can be corrected in one operation as an outpatient. Depending on the severity of the problem, a second more minor procedure may be needed about 6 months later in 5 to 25% of cases to correct a small leak or a narrowing.

What is this type of surgery like?

There are several surgeries that are available to correct this anomaly. The choice of surgery is based on multiple factors, including the position of the urethral opening, the appearance of the glans, the severity of the chordee, the surgeon’s preference, etc. The penis needs to be straight during erection. This is done primarily by releasing fibrous bands on the underside of the penis (ventral aspect). Sometimes this is not sufficient and more elaborate surgery is needed. Once the penis is straight, the urethra may need to be lengthened. The foreskin can be used for this purpose. The foreskin is also used to recover the ventral skin defect (on the underside of the penis). The need for urine drainage and stenting (inserting a catheter) as well as the length of time of this drainage depends upon the techniques used and the severity of the hypospadias.

When will my son be scheduled for this surgery?

Surgical correction is best done when anesthesia is safe and the penis is large enough. Most surgeons will recommend performing the procedure at an early age so that a child will not have a memory of the experience. Generally this is when the child is between 6 and18 months. Frequently, the surgery can be done as outpatient procedure, which means that your son will not have to stay overnight at the hospital. The alternative is to wait until the child is old enough to make his own informed decision about surgery. However, the risks of complications related to the surgery are higher in adults than children.

How long will the surgery take?

The length of the surgery depends on how curved the penis is and exactly where and how low the opening is on the penis. Most operations take between 1 and 3 hours.

How will hypospadias affect my son in the future?

If your son has his hypospadias repaired surgically, it is likely that the penis will function normally. He will be able to urinate from a standing position and will be able to engage in normal and comfortable intercourse. Recent research studies find that surgically corrected hypospadias should not be considered as a risk factor for poor psychosocial adaptation in childhood. However, repeated genital surgeries may slightly increase the risk of emotional problems.

Studies of boys who had surgery for hypospadias repair show no differences in the average ages at which various sexual milestones (such as kissing, necking and sexual intercourse) were reached as compared to boys without hypospadias repair. However, the condition or its surgical repair may be associated with greater self-consciousness and dissatisfaction with the appearance of the penis. This observation, together with the knowledge that boys and men with hypospadias are sometimes unwilling to seek advice on their own when they experience difficulties, suggests that combining surgical management with psychological counseling might be helpful. This applies mainly to the more severe forms of hypospadias. For older children, the availability of a mental health professional who is introduced to the child during the period of surgery and follow-up may lessen the perceived stigma associated with seeking out counseling when it would be useful.


Adapted from: MAGIC Foundation

Male Reproductive System Disorders -Penile Disorders

Problems with the penis can cause pain and affect a man's sexual function and fertility. Penis disorders include

Erectile dysfunction - inability to get or keep an erection
Priapism - a painful erection that does not go away
Peyronie's disease - bending of the penis during an erection due to a hard lump called a plaque
Balanitis - inflammation of the skin covering the head of the penis, most often in men and boys who have not been circumcised
Penile cancer - a rare form of cancer, highly curable when caught early
And many others.

ERECTILE DYSFUNCTION

Erectile dysfunction (ED) affects the lives of many middle-aged men and their partners to one degree or another. The term erectile dysfunction covers a range of disorders, but usually refers to the inability to obtain an adequate erection for satisfactory sexual activity.

Although erectile dysfunction, formerly called impotence, is more common in men older than 65, it can occur at any age. An occasional episode of erectile dysfunction happens to most men and is normal. As men age, it's also normal to experience changes in erectile function. Erections may take longer to develop, may not be as rigid or may require more direct stimulation to be achieved. Men may also notice that orgasms are less intense, the volume of ejaculate is reduced and recovery time increases between erections.

When erectile dysfunction proves to be a pattern or a persistent problem, it can interfere with a man's self-image as well as his and his partner's sexual life. Erectile dysfunction may also be a sign of a physical or emotional problem that requires treatment.

Erectile dysfunction was once a taboo subject, but more men are seeking help. Doctors are gaining a better understanding of what causes erectile dysfunction and are finding new and better treatments.

Signs and symptoms

Patterns of erectile dysfunction include:

Occasional inability to obtain a full erection
Inability to maintain an erection throughout intercourse
Complete inability to achieve an erection

Causes

The penis contains two cylindrical, sponge-like structures that run along its length, parallel to the tube that carries semen and urine (urethra). When a man becomes sexually aroused, nerve impulses cause the blood flow to the cylinders to increase about seven times the normal amount. This sudden influx of blood expands the sponge-like structures and produces an erection by straightening and stiffening the penis. Continued sexual arousal or excitation maintains the higher rate of blood flow, keeping the erection firm. After ejaculation, or when the sexual excitation passes, the excess blood drains out of the spongy tissue, and the penis returns to its nonerect size and shape.

Specific steps take place to produce and sustain an erection:

Arousal. The first step is sexual arousal, which men obtain from the senses of sight, touch, hearing and smell, and from thoughts.

Nervous system response. The brain communicates the sexual excitation to the body's nervous system, which activates increased blood flow to the penis.

Blood vessel response. A relaxing action occurs in the blood vessels that supply the penis, allowing more blood to flow into the shafts that produce the erection.

If something affects any of these factors or the delicate balance among them, erectile dysfunction can result.

Nonphysical causes
Nonphysical causes may account for impotence. They may include:

Psychological problems. The most common nonphysical causes are stress, anxiety and fatigue. Impotence is also an occasional side effect of psychological problems such as depression.

Negative feelings. Feelings that you express toward your sexual partner — or that are expressed by your sexual partner — such as resentment, hostility or lack of interest also can be a factor in erectile dysfunction.

Physical causes
Physical causes account for many cases of erectile dysfunction and may include:

Nerve damage from longstanding diabetes (diabetic neuropathy)
Cardiovascular disorders affecting the blood supply to the pelvis
Certain prescription medications
Operations for cancer of the prostate
Fractures that injure the spinal cord
Multiple sclerosis
Hormonal disorders
Alcoholism and other forms of drug abuse

In fact, erectile dysfunction may be one of the first signs of an underlying medical problem.

The physical and nonphysical causes of erectile dysfunction commonly interact. For instance, a minor physical problem that slows sexual response may cause anxiety about attaining an erection. Then the anxiety can worsen your erectile dysfunction.

Risk factors

A wide variety of physical and emotional risk factors can contribute to erectile dysfunction. They include:

Physical diseases and disorders. Chronic diseases of the lungs, liver, kidneys, heart, nerves, arteries or veins can lead to impotence. So can endocrine system disorders, particularly diabetes. The accumulation of deposits (plaques) in your arteries (atherosclerosis) also can prevent adequate blood from entering the penis. And in some men, erectile dysfunction may be caused by low levels of the hormone testosterone (male hypogonadism).

Surgery or trauma. Damage to the nerves that control erections can cause erectile dysfunction. It may result from an injury to the pelvic area or spinal cord. Surgery to treat bladder, rectal or prostate cancer also can result in erectile dysfunction. Prolonged bicycle riding also can cause a temporary problem.

Medications. A wide range of drugs — including antidepressants, antihistamines and medications to treat high blood pressure, pain and prostate cancer — can cause erectile dysfunction by interfering with nerve impulses or blood flow to the penis. Tranquilizers and sleeping aids also may pose a problem.

Substance abuse. Chronic use of alcohol, marijuana or other drugs often causes erectile dysfunction and decreased sexual drive. Excessive tobacco use also can damage penile arteries.

Stress, anxiety or depression. Psychological conditions also contribute to some cases of erectile dysfunction.

When to seek medical advice

It's normal to experience erectile dysfunction on occasion. But if erectile dysfunction lasts longer than two months or is a recurring problem, see your doctor for a physical exam or for a referral to a doctor who specializes in erectile problems. Your own doctor or a specialist can help you determine the underlying cause or causes of erectile dysfunction and then help you find the right type of treatment.

Although you might view erectile dysfunction as a personal or embarrassing problem, it's important to seek treatment. In many cases, erectile dysfunction can be successfully treated. Also, see your doctor if the therapy or medication prescribed to treat erectile dysfunction isn't working for you. Don't try to combine medications or therapies on your own or deviate from prescribed doses.

Screening and diagnosis

Your doctor will want to ask questions about how and when your condition developed, the medications you take and any other physical conditions you may have. Your doctor will also want to discuss recent physical or emotional changes.

If your doctor suspects that physical causes are involved, he or she will likely want to take blood tests to check your level of male hormones and for other potential medical problems, such as diabetes. Your doctor may also want to try eliminating or replacing certain prescription drugs you're taking one at a time to see whether any are responsible for erectile dysfunction.

More specialized tests may include:

Ultrasonography. This test can determine the adequacy of arterial circulation in your genital organs. Ultrasonography involves using a wand-like device (transducer) held over the blood vessels that supply the penis. The transducer emits sound waves that pass through body tissues and reflect back, producing an image to let your doctor see if your blood flow is impaired. The test often is done before and after injection of medication to see if there's an improvement in blood flow.

Neurologic evaluation. Your doctor usually assesses possible nerve damage by conducting a physical examination to test for normal touch sensation in your genital area.

Cavernosometry and cavernosography. Cavernosometry is a test that measures penile vascular pressure. Cavernosography involves injecting a dye into your blood vessels to permit your doctor to view any possible abnormalities in blood flow into and out of your penis.

If your doctor suspects that mainly nonphysical causes are to blame, he or she may ask whether you obtain erections during masturbation, with a partner or while you sleep. Most men experience many erections, without remembering them, during sleep. A simple test that involves wrapping a special perforated tape around your penis before going to sleep can confirm whether you have nocturnal erections. If the tape is separated in the morning, your penis was erect at some time during the night. Tests of this type confirm that there is not a physical abnormality causing erectile dysfunction, and that the cause is likely psychological.

Treatment

A wide variety of options exist for treating erectile dysfunction. They include everything from medications and simple mechanical devices to surgery and psychological counseling. The cause and severity of your condition are important factors in determining the best treatment or combination of treatments for you. You and your doctor may also want to consider how much money you're willing to spend and the personal preferences of you and your partner. If erectile dysfunction is the result of a medical condition, the cost of treatment may be covered by insurance.

Oral medications
Oral medications available to treat ED include:

Sildenafil (Viagra)
Tadalafil (Cialis)
Vardenafil (Levitra)

The Food and Drug Administration (FDA) approved Viagra in 1998, and it became the first oral medication for erectile dysfunction on the market. Since then, Levitra and Cialis have been approved, providing more options for oral therapy.

Viagra, Levitra and Cialis work in much the same way. Chemically known as phosphodiesterase inhibitors, these drugs enhance the effects of nitric oxide, a chemical messenger that relaxes smooth muscles in the penis. This increases the amount of blood and allows a natural sequence to occur — an erection in response to sexual stimulation. These medications don't automatically produce an erection. Instead they allow an erection to occur after physical and psychological stimulation. Many men experience improvement in erectile function after taking these medications regardless of the cause of their impotence.

These medications share many similarities, but they have differences as well. They vary in dosage, duration of effectiveness and possible side effects. Other distinctions — for example, which drug is best for certain types of men — aren't yet known. No study has directly compared these three medications.

Not all men benefit
Although these medications can help many people, not all men can or should take them to treat erectile dysfunction. If you've had a heart attack, stroke or life-threatening heart rhythm during the last six months, don't take these medications. If you've been told that sexual activity could trigger a cardiac event, discuss other options with your doctor. In addition, don't take Viagra, Levitra or Cialis with nitrate medications, such as the heart drugs nitroglycerin (Nitro-Bid, others), isosorbide mononitrate (Imdur) and isosorbide dinitrate (Isordil). The combination of these medications, which work to widen (dilate) blood vessels, can cause dizziness, low blood pressure, and circulation and heart problems.

Don't expect these medications to fix your impotence immediately. Dosages may need adjusting. Or you may need to alter when you take the medication. Before taking any medication, make sure to discuss with your doctor its potential benefits and side effects.

Prostaglandin E (alprostadil)
Two treatments involve using a drug called alprostadil (al-PROS-tuh-dil). Alprostadil is a synthetic version of the hormone prostaglandin E. The hormone helps relax smooth muscle tissue in the penis, which enhances the blood flow needed for an erection. There are two ways to use alprostadil:

Needle-injection therapy. With this method, you use a fine needle to inject alprostadil (Caverject, Edex) into the base or side of your penis. This generally produces an erection in five to 20 minutes that lasts about an hour. Because the injection goes directly into the spongy cylinders that fill with blood, alprostadil is an effective treatment for many men. And because the needle used is so fine, pain from the injection site is usually minor. Other side effects may include bleeding from the injection, prolonged erection and formation of fibrous tissue at the injection site. The cost per injection can be expensive. Injecting a mixture of alprostadil and other prescribed drugs may be a less expensive and more effective option. These other drugs may include papaverine and phentolamine (Regitine).

Self-administered intraurethral therapy. This method's trade name is Medicated Urethral System for Erection (MUSE). It involves using a disposable applicator to insert a tiny suppository, about half the size of a grain of rice, into the tip of your penis. The suppository, placed about two inches into your urethra, is absorbed by erectile tissue in your penis, increasing the blood flow that causes an erection. Although needles aren't involved, you may still find this method painful or uncomfortable. Side effects may include pain, minor bleeding in the urethra, dizziness and formation of fibrous tissue.

Hormone replacement therapy
For the small number of men who have testosterone deficiency, testosterone replacement therapy may be an option.

Vacuum devices
This treatment involves the use of an external vacuum and one or more rubber bands (tension rings). To begin you place a hollow plastic tube, available by prescription, over your penis. You then use a hand pump to create a vacuum in the tube and pull blood into the penis. Once you achieve an adequate erection, you slip a tension ring around the base of your penis to maintain the erection. You then remove the vacuum device. The erection typically lasts long enough for a couple to have adequate sexual relations. You remove the tension ring after intercourse.

Vascular surgery
This treatment is usually reserved for men whose blood flow has been blocked by an injury to the penis or pelvic area. Surgery may also be used to correct erectile dysfunction caused by vascular blockages. The goal of this treatment is to correct a blockage of blood flow to the penis so that erections can occur naturally. But the long-term success of this surgery is unclear.

Penile implants
This treatment involves surgically placing a device into the two sides of the penis, allowing erection to occur as often and for as long as desired. These implants consist of either an inflatable device or semirigid rods made from silicone or polyurethane. This treatment is often expensive and is usually not recommended until other methods have been considered or tried first. As with any surgery, there is a small risk of complications such as infection.

Psychological counseling
If stress, anxiety or depression is the cause of your erectile dysfunction, your doctor may suggest that you, or you and your partner, visit a psychologist or psychiatrist with experience in treating sexual problems.

Prevention

Although most men experience episodes of erectile dysfunction from time to time, you can take these steps to decrease the likelihood of occurrences:

Limit or avoid the use of alcohol and other similar drugs.
Stop smoking.
Exercise regularly.
Reduce stress.
Get enough sleep.
Deal with anxiety or depression.
See your doctor for regular checkups and medical screening tests.

Coping skills

Whether the cause is physical factors or psychological factors or a combination of both, erectile dysfunction can become a source of mental and emotional stress for a man — and his partner. If you experience erectile dysfunction only on occasion, try not to assume that you have a permanent problem or to expect it to happen again during your next sexual encounter. Don't view one episode of erectile dysfunction as a lasting comment on your health, virility or masculinity.

In addition, if you experience occasional or persistent erectile dysfunction, remember your sexual partner. Your partner may see your inability to have an erection as a sign of diminished sexual desire. Your reassurance that this is not the case can be helpful in this situation.

To appropriately treat erectile dysfunction and strengthen your relationship with your partner, try to communicate openly and honestly about your condition. Couples may also want to seek counseling to confront any concerns they may have about erectile dysfunction and to learn how to discuss their feelings. Try to maintain this communication throughout the diagnosis and treatment process. In fact, treatment is often more successful if couples work together as a team

Adapted from: Mayo Foundation for Medical Education and Research