Andrology mainly addresses issues related to male reproductive and sexual health. The scope of the chapter; male infertility (infertility), erection problems, sexual arousal, penile structure/shape disorders, sexual function problems, disorders of the testicles, ejaculation disorders, and orgasm problems, erectile dysfunction (erection problems), sexually transmitted diseases, varicocele (forming of varicosis in the testicles), prostate diseases, aging in the male, the testis-related diseases such as many health problems premature ejaculation included.
MALE INFERTILITY (INFERTILITY)
What causes infertility?
Married couples, without any method of birth control, despite the fact that they have a regular relationship for 1 year, can not have children is considered infertility. 10-15 percent of married couples go to a doctor because of infertility. When the causes are examined in these couples, it is understood that more than 50 percent of the problems are caused by men. Hormonal Disorders, Drugs, diseases that occur in the reproductive organs, varicocele, affecting sperm production, undescended testes, chemicals, testicular infections, any health problem, such as mumps, migrated the old surgery, due to cancer treatment, chemotherapy, and radiation therapy, sexually transmitted diseases, are the leading causes of male infertility. Diseases can affect sperm production.
“Semen analysis”, which couples who cannot have children at the end of a year with regular and unprotected sex, will perform after 3 to 5 days of sexual abstinence, is the first study that will allow them to detect the problem in men and ensure that couples receive the most appropriate treatment for infertility treatment without unnecessary time and economic loss. In the treatment of infertility, the factors that lead to the problem should be determined first and treatment for the cause should be planned. In some cases, assisted reproductive techniques are applied.
“Erection difficulty/impotence” is defined as the inability to maintain the hardness of the penis required for sexual intercourse, or even if there is stiffness. Erection problems can be of psychological origin due to environmental factors such as family problems, adaptation problems, economic problems, working conditions, workload and stress, as well as develop due to another underlying health problem in a large proportion of patients. Cardiovascular diseases, diabetes, smoking and alcohol use, nervous system diseases, some drugs used are among the most important causes of erection difficulties. It is the most important point to know that the erection problem is a treatable disease and not to avoid going to the doctor. There are a wide range of successful treatment alternatives, ranging from oral medications to erection problems, local needle injections to the penis, shock wave application or penile prosthesis called penile prosthesis. The basis of erection treatment is based on the identification of the underlying problem that may cause the problem.
“Libido”, controlled in men through the hormone testosterone, forms the basis of the sex drive. Apart from Hormonal factors, environmental factors and psychological factors also affect sexual desire. In addition, sexual trauma, infections such as mumps, excess iron in the blood, kidney-liver problems, diabetes, thyroid problems can also reduce testosterone production. On the other hand, a change in testosterone to estrogen in adipose tissue with weight gain, as well as a decrease in the number of cells that release testosterone with aging, and a change in the effectiveness of testosterone can lead to a decrease in sexual desire and a loss of sexual performance along with it. It is extremely important to first get a detailed history of these people and look at their testosterone level.
DISORDERS OF THE STRUCTURE OF THE PENIS
Congenital penile curvature and small penis are the most common structural disorders.
Micropenis; perhaps one of the most disturbing questions in men’s heads is whether the penis size is normal. Penis smallness is a condition called micro penis. Penis size varies from society to society and depending on the physiological structure of the person. It is calculated by measuring the distance from the abdominal area to the end point in the penis, which is stretched by holding it from the end. The average penis length of an adult male is 13.5±1 cm. Penis length is associated with body structure, but may vary depending on genetic and hormonal reasons.
Curvature of the Penis: this is a condition in which the penis curves in any direction and this is the size that will prevent sexual intercourse. Penile curvature from birth is called “congenital penile kurvatur”. It may need to be surgically corrected.
Another problem that occurs in old age is “Peyronie’s disease”. This problem, which begins with pain during hardening, is a condition of calcification in the layers of the penis. In this disease, which occurs in two periods as acute and chronic, drug therapy is applied in the painful acute period. During the chronic period, the pain disappears and curvature/disfigurement develops in the penis. During this period, surgical treatments are applied.
Although ejaculation, which gives sexual pleasure, is used as a synonym for orgasm in men, orgasm can occur without ejaculation or ejaculation without orgasm.Juno is a sexual pleasure. Premature Ejaculation, lack of ejaculation, inward or backward ejaculation, late ejaculation, such as different ejaculation problems can be seen. In the treatment of ejaculation, the factors that lead to the problem should be determined first and treatment for the cause should be planned.
Premature ejaculation is the most common ejaculation problem. During sexual intercourse, a man’s semen arrives before 1 minute or during the time before his partner reaches orgasm, and this continues for more than 50 percent of sexual relationships is called “premature ejaculation”. In some men, this problem begins in the first relationship and can last for life. In some men, it can occur due to some health problems that occur over time (prostate disease, infections, psychological factors, diabetes, thyroid disease). Elimination of active factors in this group of patients will ensure the elimination of the problem. Although some people also have normal relationship time, they have a psychological obsession with premature ejaculation. Many different alternatives are used in the treatment of premature ejaculation, such as sex therapies, psychological behavior therapies and drug therapy.
SEXUALLY TRANSMITTED DISEASES
Sexually transmitted diseases are a common condition in the young active age group of reproductive age. If infections are not treated, they are the cause of infertility in the future with factors such as blockage of the sperm channels, the presence of chronic infection. Although skin lesions cause poor appearance in men, they are among the first causes of cervical cancer in women. Those with a lesion called a wart should be checked with their partner.
Varicocele, which occurs in about 30-40 percent of those who apply to the doctor with infertility problem, is the varicose veins in the balls that drain the blood in the testicles. Impaired testicular temperature affects testicular function and disrupts sperm and testosterone production by accumulating toxic substances in contaminated blood in the testicle and disrupting testicular blood flow. As a result of long standing, there may be an increase in pain. Varicocele diagnosis can be made by physical examination. In the necessary cases, it is recommended to treat it by connecting enlarged vessels performed by micro-surgery.
In men, with age, disorders due to the growth of the prostate occur due to hormonal and various factors. Frequent urination, night urination, difficulty urinating, scattered urination, feeling the need for a toilet again after urination are problems that occur due to the growth of the prostate gland. In both cases, the same complaints occur, but the differential diagnosis is provided by examination and blood tests (PSA level measurement). Prostate enlargement also plays a role in the development of erection/impotence in men.
For benign prostate enlargement, different methods are available, from medication to closed operations. Currently, it is not possible for sexual dysfunction to occur in surgeries performed due to benign prostatic enlargement. However, in these people, due to the deterioration of the normal anatomical structure between the bladder and urinary tract, semen during sexual intercourse comes not from the outside, but into the bladder. In some men, lack of semen flow can lead to the feeling that masculinity has disappeared and psychologically lead to erection problems. Detailed explanation of this condition to patients before surgery will lead to easier adaptation of patients after surgery.
In operations for prostate cancer, the situation is different. In these patients, sexual dysfunction may be more common because it is removed in the surrounding tissue. Rehabilitation of penile tissue with the use of nerve protection surgeries or erection drugs at an early stage after surgery are the methods used in treatment. Some people perceive this as a deficiency and may experience psychological sexual dysfunction. Again, these people who cannot have children can resort to IVF or sperm freezing methods, since the sperm channels are connected and removed after cancer surgery, as the continuation of semen cannot be achieved.
AILMENTS SEEN IN AGING MEN