How Penile Disorders Affect Function and Fertility
There are many disorders of the penis and scrotum that can affect fertility. These include phimosis, paraphimosis, Peyronie's disease, uretheral stricture, epispadias, hypospadias, and genital injuries. Most of the male reproductive system is outside of the pelvis and abdomen. Congenital penile or scrotal anomalies can affect genitalia development and signify underlying malformations. The penis is one of the external reproductive structures. It has three parts: the root (attaches to the wall of the abdomen), the body (also called shaft), and the glans penis (the cone-shaped end or head). The skin of the penis is elastic and loose in order to accommodate changes in the penis size with erection. The penis expels semen from the urinary meatus, the opening at the end of the glans. Disorders of the penis can not only affect sexual function but they can also alter fertility.
Phimosis and Paraphimosis
Phimosis is the condition where the foreskin of the penis is constricted at the opening or meatus. This prevents retraction or makes it difficult. Phimosis is often congenital, but it can also result from local trauma, inflammation, or infection. Paraphimosis is the disorder where tight foreskin cannot be returned to normal position once retracted. Paraphimosis occurs from sexual intercourse, rigorous cleaning, catheterization, or masturbation.
Approximately 10 percent of males have phimosis by the age of three years. However, only around two percent of males have nonretractible foreskins by the age of 16 years. With both paraphimosis and phimosis, the man has tenderness, redness, and swelling of the penis. Treatment of paraphimosis is manual reduction, or use of an elastic wrap. For severe cases, surgery is necessary. Phimosis is treated by control of infection, adequate genital hygiene, and circumcision.
Peyronie's disease is a disorder where fibrous plaques form in the penis near the middle of the shaft. This condition is more common among middle-aged or older men. The exact cause of Peyronie's disease is not known, but health experts think it is caused by an abnormal reaction to penile trauma. The rate of Peyronie's disease is estimated at around two percent of the general population.
The main symptom of Peyronie's disease is pain, which can last for up to 18 months during the acute phase. The doctor diagnoses this condition by physical examination and medical history. Most men with Peyronie's disease have an abnormal penile curvature with erection. Treatment of this condition involves medications such as colchicine, para-aminobenzoic acid, and vitamin E. When conventional treatment fails, surgical intervention is needed.
A urethral stricture is blockage or narrowing of the urethra, causing difficult passage of urine and semen. Most cases of urethral stricture occur from trauma. Urethral strictures can also occur from an enlarged or nodular prostate gland or from catheterization. Male urethral stricture disease occurs at a rate of approximately one percent and accounts for more than 5,000 inpatient visits annually.
The symptoms of this condition include spraying of urine during urination, urethral discharge, a decreased urine stream, and bladder infection. The doctor must perform either a cystoscopy or urethrography to diagnose a urethral stricture. Treatment of the condition involves surgery to either reconstruct the urethra or dilate it.
Epispadias and Hypospadias
Epispadias is defined as an abnormal urethral opening on the top of the penile shaft just under the bladder or on the middle region. With hypospadias, the urinary opening forms on the lower area of the penis. Both of these conditions are congenital, and diagnosis is made by clinical inspection. Treatment of epispadias involves staged surgeries to reconstruct the bladder and urethra. As for hypospadias, the penis must be reconstructed during surgery.
The incidence of hypospadias is around one per 275 live births. Epispadias is not as common, with an incidence of approximately one per 100,000 live births. The prognosis of these conditions depends on the extent of the defect. Most male infants with minor epispadias can father children. However, many men with extensive epispadias and hypospadias are unable to conceive children.
Penile and Scrotal Injuries
Injury to the penis and/or scrotum is common. Scrotal injuries can result from infections, burns, traumatic force, or gunshot wounds. Penile injuries often occur from animal bites, zipper mishaps, battlefield trauma, and amputations. When the testicles are injured, bleeding and hematoma could occur. To treat these conditions, emergency medical care is needed, and surgery is often necessary.
Cuts to the penis are common, do not typically cause infertility, and usually heal quickly if kept clean. With urethral injuries, infertility is more likely. A fracture of the penis occurs with excessive bending of an erect penile shaft. This occurs during vigorous intercourse and results in a tear to the corpus cavernosum (one of two tube-like structures in the penis that hold blood). This is an emergency situation and can lead to permanent erectile dysfunction.
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