Infertility & Sexual Health Conditions
Azoospermia
Azoospermia is the absence of sperm in ejaculate, which makes conceiving a child through sexual intercourse impossible. The causes can be broken down into either obstructive or non-obstructive causes. Depending on the cause of the blockage, the solution can be a simple procedure or a microsurgical reconstruction. Non-obstructive azoospermia is a problem with producing sperm and is more difficult to treat. It can be caused by chemical exposure, radiation, chemotherapy, and genetic disorders.
Treatment Options
- Hormonal treatment — Taking certain types of hormones, such as clomiphene or HCG can stimulate sperm production.
- Microsurgical reconstruction — A blockage of the vas deferens, which carries sperm from the testicles to the urethra, can either be treated with microsurgical reconstruction (typically an outpatient procedure) or IVF.
Buried Penis
A buried penis is a condition that results from a variety of factors, including obesity and/or diabetes. A buried penis is a penis of average size, but one that is hidden under the skin of the abdomen, thigh, or scrotum.
It’s frequently confused for simple phimosis, which happens when the foreskin is too tight to be pulled back over the head, or the glans, of the penis.
If left untreated, a buried penis can become worse and require extensive surgical treatment.
Common Symptoms
- Difficulty having sex
- Problems urinating
- Skin inflammation of the penis
- Skin irritation
- Urinary tract infections
Treatment Options
Different treatment options are available depending on the underlying cause of the buried penis, including medication and surgery.
Dyspareunia/Ejaculatory Duct Obstruction
Ejaculatory duct obstruction is a blockage in one or both ejaculatory ducts that carry ejaculate. This condition can exist from birth, or it can develop later in a man’s life.
Common Symptoms
- Change in semen consistency and makeup
- Pelvic pain, especially following ejaculation
- Significant reduction in semen
Treatment Options
Your Mount Sinai urologist often treats ejaculatory duct obstruction with transurethral resection, also called TURED. It’s an outpatient treatment that your urologist performs endoscopically using robotic instruments to remove all or part of the urethra.
Epididymitis
Epididymitis is inflammation of the epididymis, which is the tube connecting the testicle with the vas deferens, which carries sperm. Infection is the most common cause of epididymitis and usually starts in the urethra or bladder.
Common Symptoms
- Fever and chills
- Lump in the testicle
- Pain
- Painful ejaculation
Treatment Options
Mount Sinai urologists typically treat epididymis with antibiotics. However, patients need a thorough evaluation and diagnosis before a physician can recommend treatment.
Erectile Dysfunction
Erectile dysfunction, or ED, is a common condition affecting many men as they age. It is defined as the inability to have a satisfactory erection that lasts long enough for sexual intercourse. In order to be considered ED, it needs to happen most of the time a man wants to get an erection. Some patients don’t care about this aspect of their life and prefer not to seek treatment, while others are significantly distressed by even small changes in their sexual performance.
When evaluating a patient for erectile dysfunction, the first thing our Mount Sinai urologists will do is characterize the erectile dysfunction. Contrary to popular belief, not all ED cases are the same. Some men only have ED during certain situations, others have it all the time. Some only have ED after starting a certain medication, or after a surgery. All of these situations are different and may need to be treated differently.
Common Symptoms
- Reduced sexual desire
- Trouble getting an erection
- Trouble keeping an erection
Treatment Options
IPP (Penile Prosthesis)
An inflatable penile prosthesis is an implantable device to treat Erectile Dysfunction (ED) or Peyronie’s Disease. Patients either go home the same day or the next day. Risks include bleeding or infection, erosion of the device out of the implanted space, and device failure.
Oral ED Medications
Oral medications in pill form are the most common treatment for ED, and most patients have no problem taking these medications. The most common side effects are headaches and flushing of the skin. Rarely, patients will complain about vision changes, dizziness, upset stomach, or back pain.
Penile Implant
Penile implants are different than inflatable prostheses and require expert surgical skill, particularly in complicated cases. During surgery, a surgeon will make an incision below the head or base of the penis, or in the lower abdomen. The surgeon stretches the spongy tissue of the penis and places the implant cylinders inside the penis. Severe curvature (Peyronie’s Disease), previous injury, or priapism (prolonged erections with severe scarring) may make a case more complicated. Most men are able to resume sexual activities and strenuous exercise one month to six weeks after surgery.
Infertility
Infertility (or sterility) refers to an individual’s inability to conceive a child. This male health issue is mainly associated with the production or delivery of sperms to the female ovary.
Common Infertility Causes
In men, the most common cause of infertility is a disorder of the sperm such as underdeveloped sperm, abnormally developed sperm, or a low sperm count. In addition, dilated scrotal veins called varicoceles, ejaculatory problems, hormones, medications, or genetic conditions may cause this condition.
Treatment Options
The infertility treatment depends on the underlying cause of infertility, which your physician diagnoses after conducting various tests. Treatments include:
- Assisted reproductive techniques like IVF or Intracytoplasmic Sperm Injection (ICSI)
- Medication
- Surgical treatments
Genital Pain (Testicle Pain and Prostatitis)
When a man has an uncomfortable sensation in his genital region lasting more than three months, and that pain is not attributable to an obvious tumor or infection, we use this generic term.
Treatment Options
It may take a few visits with your Mount Sinai urologist to determine the cause of your genital pain and to determine optimal treatment. It may not be possible to completely resolve pain, but for most patients, we are able to control the discomfort to allow for quality of life and continuation of routine.
Low Sperm Count (Oligospermia)
Oligospermia is a condition where men have a low sperm count. This sperm count decreases the possibility of a man conceiving a child.
Common Symptoms
- Inability to conceive a child
Treatment Options
- Hormonal therapies — If someone has low testosterone or high estrogen, medications such as Clomid or Anastrozole can improve sperm counts. Additionally, they may help patients if they are symptomatic from their low testosterone.
- Varicocele ligation (varicocelectomy) — This surgery removes enlarged veins and restores proper blood flow to the reproductive organs.
Low Testosterone
Testosterone is a hormone produced in men. Hormones are chemicals produced in the body to regulate the activity of various organ systems. In the case of testosterone, it is used to regulate the development of male sexual characteristics and reproduction.
Common Symptoms
- Decrease in energy
- Decrease in sex drive or libido
- Mild depression and anxiety
Treatment Options
At Mount Sinai, our urologists help men with low testosterone by delivering the hormone to their bodies in different formats. The most common is a gel, applied every day in the morning. There are also injections that are self-administered every one to two weeks, an injection given in the office every 10 weeks, and, lastly, a small implantable pellet that is placed in the office every four to six months.
Peyronie’s Disease
Peyronie’s Disease (penile curvature or bent penis) is a condition where the penis becomes curved during erections. It is commonly associated with erectile dysfunction. This curvature can be quite severe, even greater than 90 degrees, making intercourse impossible.
Common Symptoms
- Curvature of the penis
- Pain
- Restrictions during erection
Treatment Options
Incision and Grafting
The doctors at Mount Sinai Medical Center are among the few practitioners who perform incision and grafting procedures in South Florida. These procedures are more complicated than standard procedures for Peyronie’s Disease and will restore length to the penis. However, they have a significantly longer healing time than other procedures.
Incision and grafting procedures involve incising, or removing, a small part of the flat scar tissue created by the bent penis and inserting a graft in its place. Some length can be restored. This procedure requires six months until the desired outcome is reached, and while this procedure is associated with penile numbness, this usually dissipates.
Inflatable Penile Prosthesis
Penile Prosthesis, or implant, is a good option for patients who have significant erectile dysfunction (ED) and Peyronie’s Disease. It is either used alone, or in combination with other treatments (depending on the severity of the plaque, or scar tissue, and curvature).
Tunica Albuginea Plication (TAP)
Tunica Albuginea Plication (TAP) has become the most popular surgical treatment for Peyronie’s due to its rapid healing time and minimal side effects. This procedure entails balancing length to make the penis functional and straight. The stretched penile length does not change, but because the long side is shortened, the penis may visually appear slightly shorter. Due to the location of the surgery, injury to nerves and loss of erectile function is rare. Complications are rare, but include penile fracture, hematoma, prolonged pain, and infection.
Xiaflex
Xiaflex is used in disorders of abnormal scar formation such as Peyronie’s Disease. It is a relatively new procedure that has been shown in trials to improve curvature by about 30% in many patients.
Phimosis
Phimosis is a congenital abnormality of the foreskin covering the head of the penis. It causes the penis to contract and prevents it from retracting over its head. This can interfere with the flow of urine.
Common Symptoms
- Appearance of a white ring, which looks like scar tissue
- Infection of urinary tract
- Pain in the foreskin
- Pain when your penis erects during sex
- Pain while urinating
Treatment Options
Treatment depends on the severity of phimosis. A physician may recommend:
- Application of steroid cream
- Partial or full circumcision
- Surgery
Testicular Pain
Testicular pain is pain or discomfort in one or both of the testicles. If you experience pain in the testicles that radiates up to the abdomen, you should immediately consult your physician.
Common Causes
- Injury
- Infection
- Inflammation or a “twisting” of the testicles called testicular torsion
Treatment Options
Your physician investigates the underlying cause of testicular pain to recommend the most suitable treatment, which may include:
- Medications
- Microsurgical denervation of the spermatic cord
- Spermatic cord block
- Surgery for testicular torsion
Varicocele
A varicocele is a varicose vein of the testicle, which typically occurs on the left side. These are similar to varicose veins that appear on people’s legs. Varicose veins are veins with faulty valves that allow for stagnation or pooling of blood in the vein. This can cause the vein to become enlarged.
Common Symptoms
- Dull, recurring pain in the scrotum
- Lump in the testicles
- Swelling in the scrotum
- Visibly enlarged or twisted veins in the scrotum
Treatment Options
- Laparoscopic varicocelectomy — Varicocele surgery is performed in the hospital, but as an outpatient procedure, which means the man can go home the same day. There is one small incision that is 2 centimeters in size located approximately one to two centimeters above the scrotum.
- Microsurgical varicocelectomy — In this procedure, abnormal veins are tied right above the scrotum with the aid of an operating microscope.
- Varicocele ligation — This procedure requires a small, 2-3 centimeter incision, just above the scrotum on the affected side.