General description:

Premature ejaculation (PE) means 'coming too quickly' is also known as early discharge or quick discharge , early fall, Shighra-patan, rapid ejaculation, rapid climax, premature climax, or early ejaculation) affects 25%-40% of the men.

Premature ejaculation is also defined as the occurrence of ejaculation prior to the wishes of both sexual partners.

Premature ejaculation is one of the most frequent, of sexual disorders in the male and is characterized by sudden ejaculation of the semen, just prior to or immediately after vaginal penetration during intercourse (before one wishes or before he could satisfy the female partner).

It's one of the commonest of all sexual problems. Recently, a survey done of several thousand males, shows that 50 per cent of them 'often' or 'sometimes' had this trouble.

It's commoner in younger men. Men generally get better control as they grow older.

However, various surveys showed that many middle-aged men still have this problem.

This problem makes people unhappy and frustrated and in severe cases PE can threaten or even ruin a marriage - simply because it spoils the sex lives of both partners. Sometimes, the condition is so bad that the man cannot even manage to have intercourse because he invariably ejaculates before he can get into the vagina.

This can be devastating for a man's self-confidence. And it can be hugely frustrating and annoying for his partner, too especially if she wants to get pregnant. One of the major contributor towards this problem is wrong or misadventerous sex practices during early days.

Anxiety too plays a part in many cases of PE. If you're nervous, you're likely to come too quickly. That's why many males have discovered for themselves that a small amount of alcohol eases their nerves and makes them less likely to climax prematurely. But alcohol is not recommend as a treatment !

An estimated 30%-70% of males experience premature ejaculation. The National Health and Social Life Survey (NHSLS) indicates Dr.Kumar’s edit PE 2 approximately 10% to 30% people of all age group suffer with quick semen discharge.

However, various surveys have shown that many men do not report premature ejaculation to their physician, possibly because of embarrassment or a feeling that no treatment is available for the problem.

Premature ejaculation may alter self-esteem, may cause marital dysfunction/divorce, and may be a factor in depression, with its obvious consequences.

This is a very frustrating disorders of male sexual function in which man feels totally helpless. This leads to bitterness in husbands & wife relationships. His pleasure is often decreased by the abrupt early discharge.

When a man is, ejaculating fast, the woman will probably be left unsatisfied. Her frustration will only increase the negative pattern.

As he concentrates on controlling his ejaculation, this concentration may begin to get in the way of maintaining the erection. This then can bring about the loss of erection. After some time this may even completely inhibit the erection from occurring. Often a problem that might begin with premature ejaculation gets joined to a problem of impotence, and then both issue have to be dealt with.

After a time the couple will begin to withdraw from each other, not wanting to enter an experience that is going to end up frustrating them. The man doubts his masculinity, and the wife later experiences a lessening of confidence in her, along with anger toward her partner.

To clarify, a male may reach climax after 8 / 10 minutes of sexual intercourse, but this is not premature ejaculation if his partner regularly climaxes in 5 minutes and both are satisfied with the timing.

Another male might delay his ejaculation for a maximum of 15 minutes, yet he may consider this premature if his partner, even with foreplay, requires 20 minutes of stimulation before reaching climax.

The organ systems directly affected by premature ejaculation include the male reproductive tract (i.e., penis, prostate, seminal vesicles, testicles, and their appendages), the portions of the central and peripheral nervous system controlling the male reproductive tract.

If the premature ejaculation occurs so early that it happens before commencement of sexual intercourse and the couple is attempting pregnancy, then pregnancy is impossible to achieve unless artificial insemination is used.

The genes of a male who ejaculates rapidly (but not so rapidly that ejaculation occurs before intromission) would be more likely to be passed on to succeeding generations.

Premature ejaculation is of two types:

Primary premature ejaculation :- Primary premature ejaculation applies to individuals who have had the condition since they became capable of functioning sexually.
Secondary premature ejaculation means that the condition began in an individual who previously experienced an acceptable level of ejaculatory control, and, for unknown reasons, he began experiencing premature ejaculation later in life.
If the patient has ED that began after the premature ejaculation, then treatment of both conditions may be required.

With regard to premature ejaculation, some type of performance anxiety is often a major factor. Performance pressure (ie, fear of failure to satisfy the partner) can arise from various events. ED is a common precipitating event. If the male is afraid his erection will not last, because of either actual instances of previous ED or imagined failure of his erection, this may precipitate premature ejaculation. The patient may have used the phrase, "Honey, you excited me so much I just could not hold back."

Science of mechanism of ejaculation:

The physical process of ejaculation requires two sequential actions: emission and expulsion.

The emission phase is the first phase. It involves deposition of seminal fluid from the ampullary vas deferens, seminal vesicles, and prostate gland into the posterior urethra. The second phase is the expulsion phase. It involves closure of bladder neck, followed by the rhythmic contractions of the urethra by pelvic-perineal and bulbospongiosus muscle, and intermittent relaxation of external urethral sphincters.

Sympathetic motor neurons control the emission phase of ejaculation reflex, and expulsion phase is executed by somatic and autonomic motor neurons. These motor neurons are located in the thoracolumbar and lumbosacral spinal cord.

Causes of Premature Ejaculation:

Premature ejaculation can be caused by physical or psychological factors. Sometimes, if a man becomes depressed he may experience this issue. Stopping premature ejaculation depends largely on determining why it is happening in the first place.

Thus premature ejaculation causes a man to focus more and more on his own sexual response pattern, thus getting away from the freedom and naturalness of allowing the response to occur by itself. As he concentrates on controlling his ejaculation, this concentration may begin to get in the way of maintaining the erection. This then can bring about the loss of erection. After some time this may even completely inhibit the erection from occurring. Often a problem that might begin with premature ejaculation gets joined to a problem of impotence, and then both issue have to be dealt with.

After a time the couple will begin to withdraw from each other, not wanting to enter an experience that is going to end up frustrating them. The man doubts his masculinity, and the wife later experiences a lessening of confidence in her, along with anger toward her partner.

Possible psychological and environmental factors:

There are number of possible causes of premature ejaculation.
(These causes are diagnosed by detailed history and a thorough physical check-up).

In addition to a general medical history, the history should include details about prior relationships in which premature ejaculation was not a problem.
Does he have an impotence problem? If he has erectile dysfunction (ED), did is begin after the premature ejaculation or before?
Is the patient experiencing premature ejaculation with self-stimulation or just with coitus?
What is the time required for the female partner to reach climax? Can she reach climax with intercourse, or does she require direct clitoral stimulation (oral or manual) to be able to climax?
Was premature ejaculation always a problem or did it start after an initial time frame when coitus was satisfactory to both partners?
1. Hormone disorder.
2. Urogenital Infections.
3. Neurogenic causes.
4. Increased penile sensitivity to touch.
5. Sex Centre disorder i.e. hyper excitability of sex centre.
6. Psychogenic i.e. psychiatric illness.

In following section we'll discuss these causes in detail:

1. Hormone disorder:
In recent studies it have been seen that many hormone disorder directly causes premature ejaculation. Additionally hormone disorder may cause other sexual dysfunction, which may secondarily cause early discharge. These hormones are important for normal control on your ejaculation. Testosterone is thought to play a role in the ejaculatory reflex. Higher testosterone (free and total) levels have been demonstrated in men with premature ejaculation than in men without premature ejaculation. Many men with premature ejaculation have been shown to have low serum levels of prolactin.

2. Urogenital Infections:
Any infection of urethra, prostate, epidididymis, seminal vesicle, Orchitis, epididimo-orchitis etc. Leads to irritability of sacro-coccigeal nerves, which govern the function of all these sex organs. This irritability leads to lowers threshold for ejaculation. Thus infections are one of the significant causes of early orgasm.

3. Neurogenic causes:
Among nervous system disorder, any disorder involving sex centre area in brain as multiple sclerosis, hyper-excitable focus or any organic lesion will lead to very fast semen discharge. Any lesion of conus medullaris of spinal cord leads to premature ejaculation.

4. Increased penile sensitivity to touch:
There is excess of certain neurotransmitters in the penile skin which makes it highly erogenous at time of sexual excitation leading to reaching peak of excitation & climax fast. In various studies it has been found that bulbo-cvernous reflex is hyperactive.

5. Sex Centre disorder:
There are certain conditions in which sex centre, which is situated in brain, becomes hyper excitable so that peak of orgasmic threshold reaches very quickly, which occurs due to various reasons. Sex centre is a part of brain, which is situated in hippocampal part of forebrain. It controls the time taken for orgasm i.e. ejaculatory discharge during sexual activity.

In early orgasm disorders the sex centre is extremely sensitive to sexual stimulation so that sex centre reaches peak of excitation within few moments after penetration in vagina so that the orgasmic threshold reaches within seconds of sexual intercourse or even before coitus.

Sex centre also controls the other component of sex cycle namely desire & erection. Thus beside premature ejaculation, patient may also suffer with low desire or erectile dysfunction.

6. Psychogenic:
Psychological factors commonly contribute to premature ejaculation. While men sometimes underestimate the relationship between sexual performance and emotional well-being, premature ejaculation can be caused by temporary depression, stress over financial matters, unrealistic expectations about performance, a history of sexual repression, or an overall lack of confidence, many psychiatric illnesses as anxiety, anxiety neurosis, schizophrenia, Performance Anxity leads to early climax.

Deficiency of neuro-transmitters as serotonin & others have been found to be one of the significant causes of early semen fall.

Research published in an andrology journal showed that semen from men with premature ejaculation contained significantly less acid phosphatase and alpha-glucosidase than did the semen of controls. These researchers concluded that these may reflect dysfunction of the prostate and epididymis, possibly contributing to premature ejaculation.

According to Dr. A. Kumar – who heads the Kayakalp International Sex & Health Clinic, Mumbai, India ---

I have found from my 23 years of experience that those males who have less sperm counts in their semen (like oligospernia & Azoospermia) suffers from premature ejaculation.

Diagnosis of Cause:

We take detail history:

Detailed general & systemic examination.
Investigation & Diagnostic tests.
Complete Male Hormone Profile tests.
Biochemistry tests.
Urine is tested for pus cells.
Scrotum, epididydmus, prostate is examined for infection.
Semen is examined for pus & semen culture sensitivity.
Ultrasonography of scrotum & prostate may be required.

Treatment

Treatment may involve the clinician simply explaining why premature ejaculation occurs, assuring the person or couple that it is a normal part of the male sexual response, and providing techniques that may assist the man in learning to delay ejaculation.

Such techniques (Sex Therapy) may include :

1. The "stop and start" method:
This involves sexual stimulation until the man recognizes that he is about to ejaculate, the stimulation is then stopped for about thirty seconds and then may be resumed. The sequence is repeated until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs.

2. The "squeeze" method popularized by Masters & Johnson:
This involves sexual stimulation until the man recognizes that he is about to ejaculate, at that point, the man or his partner gently squeezes the end of the penis (where the glans meets the shaft) for several seconds whilst withholding further sexual stimulation for about 30 seconds, and then resuming stimulation. The sequence may be repeated by the person or couple until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs.

Stopping premature ejaculation is a major goal of any man who suffers from it. It can be one of the most embarrassing and frustrating sexual problems that a man can deal with, and there is a lot of advice out there about how to put it to an end. Men who find themselves grappling with this issue are likely to try practically anything to make it stop. Men may try many different techniques in order to stop premature ejaculation; they range from medication to therapy to specific methods in bed. Trying many different things is the best idea, though.

There are dozens of different hints and tips for stopping premature ejaculation; in some cases, sexual therapy is the best method. Other men find that the best way to stop premature ejaculation is by trying medication.

3. Kegel exercise:
First published in 1948 by Dr. Arnold Kegel, a pelvic floor exercise, more commonly called a Kegel exercise, consists of repeatedly contracting and relaxing the muscles that form part of the pelvic floor. Exercises are usually done to reduce premature ejaculatory occurrences in men, as well as to increase the size and intensity of erections.

The aim of Kegel exercises is to improve muscle tone by strengthening the pubococcygeus (PC) muscles of the pelvic floor.

Kegel exercises can help men achieve stronger erections, maintain healthy hips, and gain greater control over ejaculation.

PC muscles control the flow of semen and urine, the firmness of your penis during erection and the shooting power of your ejaculation. The great thing about Kegel exercises for men is that you can do them anywhere, anytime -- and nobody will know the difference.

You will be able to have better sex by being able to better control your orgasms and ejaculations, and last for longer.

4. Delay Creams And Gels:
One of the most common treatments for stopping premature ejaculation are topical creams, gels and other ointments. These products usually work to numb up a man's penis, making it less sensitive and prolonging sexual encounters and some men claim that they are the most effective means of stopping premature ejaculation. However, other men have little success with them. As mentioned previously, stopping premature ejaculation differs from man to man; trying out different kinds of creams and gels is just another way of trying to achieve success against this embarrassing problem.

5. Some men try to distract themselves by thinking non-sexual thoughts (such as naming baseball players and records) to avoid getting excited too fast.

In Korea and other areas of the Far East, SS cream (a combination of 9 ingredients, mainly herbal; SS stands for Super Secret) has been shown to desensitize the penis, decrease the vibratory threshold, and help men with premature ejaculation to significantly delay their ejaculatory response.

Unfortunately, SS Cream is not yet approved by the US Food and Drug Administration (FDA).

6. Using of Condoms:
Using one or two condom during intercourse also delay the ejaculation time, as the condom reduces the touch sensation.

Some therapists advise young men to masturbate (or have their partner stimulate them rapidly to climax) 1-2 hours before sexual relations are planned.

7. Oral Medicines:
After the finding out the cause of premature ejaculation. Various drugs to treat sex centre & other causes are prescribed along with sex therapy.

Hormone pills are given when hormone disorder are found.
Medicines to cure the urogenital infections when infection as the cause is confirmed.
In recent years, Doctors are trying to treat premature ejaculation with antidepressant drugs. That may seem a little odd, but the reason is that certain antidepressants are well known for the side-effect of delaying male climax. For most men, that side effect is unwanted. But for guys with premature ejaculation, it's quite desirable.
8. Surgical Care:
No recommended surgical treatment exists for premature ejaculation.

MALE INFERTILITY IS EQUALLY RESPONSIBLE FOR HAVING NO CHILDREN !

In our Indian society, the objective of marriage is propagation, having children to carry forward the family name. The name & achievements of a childless person are forgotten with his or her Death. Childless couples do not get due respect in the society. They are considered to be handicapped. They have to bear the taunts from people. Sometimes the taunts become so unbearable that the women commit suicide or have extra marital affairs to have children because it is the woman who is held responsible for having no children. Some times, pressurized by the family members, the husbands give divorce to the wives.

Q - Dr. A Kumar, please tell us the real meaning of infertility.
A - If you are married and you want a child. You are having intercourse regularly, without using any contraceptives (condom, copper T or contraceptive pills). After doing all this, if the wife does not conceive for A YEAR, it is called infertility.

Q - The woman is held responsible for having no Children, is it a fact?
A - No. Not at all. The fact is, in 30 % cases, the man is at fault for having no children. In 30 % cases, the woman is at fault. In 30 % cases, both the man and woman are at fault and in remaining 10 % cases, the reason is unknown. For having a healthy baby, the outer and inner sex organs of the man and woman need to be normal. Any disease or abnormality in these organs will make it difficult to conceive.

Q - What are the reasons of male infertility?
A - When the man is at fault for not having a baby, there is some problem in his semen. Normally, when the sperms in the semen are not normal, the man cannot have a baby. There may be no sperms at all (Azoospermia) or the number of sperms may be very small (Oligospermia) or the sperms may be less mobile (Nil Motility -Asthenospermia). In some cases, the Quantity of semen is very small because sufficient semen is not produced in the testes. In some cases, Antisperm antibodies are found in the semen.

In some cases, The Laboratory reports show that the sperm count and sperm mobility is Normal. But still there is problem in conceiving. In such cases, the sperms are very weak. They die before reaching the egg or cannot break the outer layer (cover) of the egg. This condition is also deterrent for conceiving.

Apart from semen related problems, surgery around penis, vericocele, (painful and swollen testicles), hydrocele (increased size of and hanging testicles), some diseases like Syphilis, Gonorrhea, Mumps, T.B. etc..

Apart from these reasons, there are other reasons too, responsible for male infertility. These are Low sex power, Erectile Dysfunction, Premature Ejaculation etc. Sometimes, the man cannot have sexual intercourse. These are the main reasons of male infertility. When proper intercourse is not possible, conception is also not possible.

The reasons for female infertility are obstructions or swelling in the fallopian tubes, problems in the uterus, acidic discharge from the vagina, surgery around vagina, STD, inconsistent periods, underdeveloped uterus, ovulation problems etc.

Q - What would you like to tell the Childless couples?
A - Most of the couples resort to the means like worshipping gods, pooja-paath, mantra-tantra, black magic etc. This is nothing but waste of time, energy and money. Many years after the marriage, they come to the doctor. I would like to urge them that they should not waste time and money in these things and visit good sexologist / Gyaenecologist / Infertility Specialist in time so they can find the exact reason of male or female infertility and treat it accordingly. Sometimes wasting time may make the disease Incurable.

Retrograde ejaculation or Dry Orgasm

Retrograde ejaculation refers to the entry of semen into the bladder instead of going out through the urethra during ejaculation.

Retrograde ejaculation is not life threatening but is one cause of male infertility.

Retrograde ejaculation may cause a couple to experience problems, including infertility, as most sperm fail to enter the partner's vagina, lowering the chances of conception. To induce pregnancy, the male's urine may be centrifuged and the isolated sperm injected directly into the woman.

Taoists and Indian Yogis and some fields of alternative medicine recommend and teach deliberate retrograde ejaculation as a way of "conserving the body's energy". One manner of achieving this is by applying pressure to the perineum during orgasm. It was believed that doing this caused the sperm to travel into the head and nourish the brain, or that energy is conserved physically by keeping the sperm (and thereby, the "intelligence" that created it) in the body.

Although you still reach sexual climax,

Retrograde ejaculation doesn't 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 signs and symptoms include:


During a male orgasm, sperm is released from each of the testicles. From each testicle, sperm then travels through a tube called the vas deferens. The vas deferens leads into the prostate, where sperm mixes with semen. The muscle at the opening of the bladder (bladder neck) tightens to prevent semen from entering the bladder as it passes into 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 your body through the penis.

Causes

• Retrograde ejaculation is a common side effect of medications, such as tamsulosin, that are used to relax the muscles of the urinary tract, treating conditions such as benign prostatic hyperplasia. By relaxing the bladder sphincter muscle, the likelihood of retrograde ejaculation is increased.
The medications that mostly cause it are antidepressant and antipsychotic medication; patients experiencing this phenomenon tend to quit the medications.
• Retrograde ejaculation may be caused by prior prostate or urethral surgery, diabetes, some medications, including some drugs used to treat hypertension (high blood pressure) and some mood-altering drugs. The main reason is that the bladder neck does not close off so semen goes backwards into the bladder rather than forward out of the penis.
The condition is relatively uncommon and may occur either partially or completely. The presence of semen in the bladder is harmless. It mixes with the urine and leaves the body with normal urination. Men with diabetes and those who have had genitourinary tract surgery are at increased risk of developing the condition.
• Retrograde ejaculation can be caused by medications, health conditions or surgeries that affect the nerves or muscles that control the bladder opening.
Several conditions can cause problems with the muscle that closes the bladder during ejaculation. These include:

Surgery such as 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
A dry orgasm is the primary sign of retrograde ejaculation. But dry orgasm — the ejaculation of little or no semen — can also be caused by other conditions, including:

Surgical removal of the prostate (prostatectomy)
Surgical removal of the bladder (cystectomy)
Radiation therapy to treat cancer in the pelvic area

Risk factors

You're at increased risk of retrograde ejaculation if:

You have diabetes or multiple sclerosis
You've had prostate or bladder surgery
You take certain drugs for high blood pressure or a mood disorder
You had a spinal cord injury

Causes of Retrograde Ejaculation

The following medical conditions are some of the possible causes of Retrograde Ejaculation. There are likely to be other possible causes, so ask your doctor about your symptoms.

• Previous surgery to the prostate
• Diabetes mellitus
• Multiple sclerosis
• Blood pressure medication
• Abdominal, pelvic or genital surgery (see Abdominal symptoms)
• Antidepressant drugs
• Previous radiation for treatment of prostate cancer

Symptoms

• Little or no semen discharged from the urethra during the male sexual climax (during ejaculation)
• Possible infertility
• Cloudy urine after sexual climax

Exams and Tests

A urinalysis performed on a urine specimen that is obtained shortly after ejaculation will reveal a large amount of sperm in the urine.

Treatment

Medications do not help retrograde ejaculation if there has been permanent damage to the prostate or the testes from radiation. Medications also do not help if prostate surgery has resulted in damage to the muscles or nerves. Medications only work if there has been mild nerve damage caused by diabetes, multiple sclerosis or mild spinal cord injury.

If retrograde ejaculation is caused by drugs, your doctor may recommend that you stop taking such drug. This can make the problem go away.
Retrograde ejaculation caused by diabetes or after genitourinary tract surgery may be treated with epinephrine-like drugs (such as pseudoephedrine or imipramine).

If retrograde ejaculation is caused by medications, discontinuation of the medication often restores normal ejaculation. If retrograde ejaculation is caused by surgery or diabetes, it is often not correctable.

Maintaining good blood sugar control may help prevent this condition in men who have diabetes. Avoiding drugs that cause retrograde ejaculation will also prevent this condition.

Medications used to treat retrograde ejaculation include

• Tricyclic antidepressants.
• Antihistamines.
• Decongestants..

These medications tighten the bladder neck muscles and prevent semen from going backwards into the bladder. However, the medications do have many side effects and they have to be taken at least 1–2 hours prior to sexual intercourse.

A hydrocele is a fluid-filled sac surrounding a testicle that results in swelling of the scrotum, the loose bag of skin underneath the penis. Older boys and adult men can develop a hydrocele due to inflammation or injury within the scrotum.

A hydrocele usually isn't painful. Typically not harmful, a hydrocele may not need any treatment. However, if you have scrotal swelling, see your doctor to rule out other causes.

They are common in newborns, but most hydroceles disappear without treatment within the first year of life. However, if your baby's hydrocele doesn't disappear after a year or if it enlarges, you should make another appointment for your child's doctor to examine the hydrocele again.

Symptoms

Usually the only indication of a hydrocele is a painless swelling of one or both testicles. Adult men with a hydrocele may experience discomfort from the heaviness of a swollen scrotum. Sometimes, the swollen testicle may be smaller in the morning and larger later in the day.

See your doctor if you experience scrotal swelling. It's important to rule out other possible causes for the swelling. Sometimes a hydrocele is associated with an inguinal hernia, in which a weak point in the abdominal wall allows a loop of intestine to extend into the scrotum and which may require treatment.

Causes

In older males, a hydrocele can develop as a result of inflammation or injury within the scrotum. Inflammation may be the result of infection of the small coiled tube at the back of each testicle (epididymitis) or of the testicle.

A hydrocele typically isn't dangerous and usually doesn't affect fertility. However, it may be associated with an underlying testicular condition that may cause serious complications:

• Infection or tumor. Either may reduce sperm production or function.
• Inguinal hernia. A loop of intestine could become trapped in the weak point in the abdominal wall (strangulated), a life-threatening condition.

Get immediate medical treatment if you develops sudden, severe scrotal pain or swelling, especially within several hours of an injury to the scrotum. These signs and symptoms can occur with a number of conditions, including hydrocele. These signs and symptoms may also be caused by a condition called testicular torsion. Testicular torsion is an emergency medical condition that occurs when a testicle becomes so twisted that blood flow is blocked. The testicle can only be saved if this condition is treated within hours of when symptoms began.

If you have painless scrotal swelling, meet your doctor.

Tests and diagnosis

Your doctor will do a physical exam. The exam may reveal an enlarged scrotum that isn't tender to the touch. Pressure to the abdomen or scrotum may enlarge or shrink the fluid-filled sac, which may indicate an associated inguinal hernia.

Because the fluid in a hydrocele usually is clear, the doctor may shine a light through the scrotum (transillumination). With a hydrocele, the light will outline the testicle, indicating that clear fluid surrounds it.

If your doctor suspects your hydrocele is caused by inflammation, blood and urine tests may help determine whether you have an infection, such as epididymitis.

The fluid surrounding the testicle may keep the testicle from being felt. In that case, you may need an ultrasound imaging test, can rule out a hernia, testicular tumor or other cause of scrotal swelling.

Treatments and drugs

For adult males as well, hydroceles often go away on their own within six months. A hydrocele requires treatment only if it gets large enough to cause discomfort or disfigurement. Then it may need to be removed.

Treatment approaches include:

• Surgical excision (hydrocelectomy). Removal of a hydrocele may be performed on an outpatient basis using general or spinal anesthesia. The surgeon may make an incision in the scrotum or lower abdomen to remove the hydrocele. If a hydrocele is discovered during surgery to repair an inguinal hernia, your doctor may remove it even if it's causing you no discomfort.

A hydrocelectomy may require you to have a drainage tube and wear a bulky dressing over the site of the incision for a few days after surgery. Also, you may be advised to wear a scrotal support for a time after surgery. Ice packs applied to the scrotal area after surgery may help reduce swelling. Surgical risks include blood clots, infection or injury to the scrotum.

• Needle aspiration. Another option is to remove the fluid in the scrotum with a needle. The injection of a thickening or hardening (sclerosing) drug after the aspiration may help prevent the fluid from reaccumulating. Aspiration and injection may be an option for men who have risk factors that make surgery more dangerous. Risks of this procedure include infection and scrotal pain.
Sometimes, a hydrocele may recur after treatment.

Gonorrhea (also gonorrhoea) is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae (also called Gonococcus, which is often abbreviated as "GC" by clinicians).

In both men and women if gonorrhea is left untreated, it may spread throughout the body, affecting joints and even heart valves.

Signs and symptoms

The infection is transmitted from one person to another through vaginal, oral, or anal sexual relations.

The incubation period is 2 to 30 days with most symptoms occurring between 4–6 days after being infected. A small number of people may be asymptomatic for a lifetime.

In males, symptoms include a yellowish discharge from the penis, associated with painful, and sometimes frequent, urination. Symptoms can develop from two to thirty days after infection. A few percent of infected men have no symptoms. The infection may move into the prostate, seminal vesicles, and epididymis, causing pain and fever. Untreated, gonorrhea can lead to sterility.

Men may complain of pain on urinating and thick, copious, urethral pus discharge (also known as gleet) is the most common presentation. Examination may show a reddened external urethral meatus. Ascending infection may involve the epididymis, testicles, or prostate gland, causing symptoms such as scrotal pain or swelling.

Women may complain of vaginal discharge, difficulty urinating (dysuria), projectile urination, off-cycle menstrual bleeding, or bleeding after sexual intercourse.

The cervix may appear anywhere from normal to the extreme of marked cervical inflammation with pus. Early symptoms may include a discharge from the vagina, discomfort in the lower abdomen, irritation of the genitals, pain or burning during urination and abnormal bleeding. Symptoms, which may indicate development of pelvic inflammatory disease (PID), include cramps and pain, bleeding between menstrual periods, vomiting, or fever.

Women who leave these symptoms untreated may develop severe complications. The infection will usually spread to the uterus, fallopian tubes, and ovaries, causing Pelvic Inflammatory Disease (PID).

Infection of the urethra (urethritis) causes little dysuria or pus.

The combination of urethritis and cervicitis on examination strongly supports a gonorrhea diagnosis, as both sites are infected in most gonorrhea patients. Gonorrhea infection can also be present as septic arthritis.

An infected mother may transmit gonorrhea to her newborn during childbirth, a condition known as ophthalmia neonatorum.

Treatment

There are many Antibiotics that may be used to treat gonorrhea.

It is important to refer all sexual partners to be checked for gonorrhea to prevent spread of the disease and to prevent the patient from becoming re-infected with gonorrhea. Patients should also be offered screening for other sexually transmitted infections. In areas where co-infection with chlamydia is common, doctors may prescribe a combination of antibiotics.

The patient must be rechecked by throat swab 72 hours or more after being given treatment, and then retreated if the throat swab is still positive.

In men, inflammation of the epididymis (epididymitis); prostate gland (prostatitis) and urethral structure (urethritis) can result from untreated gonorrhea

History

The exact time of onset of gonorrhea as prevalent disease or epidemic cannot be accurately determined from the historical record.

It has been suggested that mercury was used as a treatment for gonorrhea.

Silver nitrate was one of the widely used drugs in the 19th century. The silver-based treatment was used until the first antibiotics came into use in the 1940s.