Category: Andrologist

Urologist, Andrologist

Curvature of penis (Peyronie’s disease)

Dr Varinder Attri

What is Peyronie’s disease ?

Peyronie’s disease is the fibrous scar tissue of the penis which forms as a result of prior trauma to the outer layer of erectile body tissue. This leads to the bend or curvature of the penis. Short Frenulum (Tight Frenulum, Frenulum Breve)

What are the symptoms of Peyronie disease ?

The common symptoms includes curvature of the penis on erection (upward/downward or lateral direction), difficulty getting or maintaining erection (erectile dysfunction), pain while erection, feeling of lump in the penis, shortening of penis etc. Erectile dysfunction – causes, diagnosis and treatment

What is the cause of Peyronie disease ?

The exact etiology of this condition is not known. It is the repeated prior trauma by sexual acts, accident, athletic activities etc. to the penis which leads to formation of fibrous scar after healing. This leads to bending or curvature of penis.

How this condition is diagnosed ?

Peyronie’s disease is typically diagnosed with examining the scar tissue on palpation. The degree of curvature or bending is assessed on erection. Patient can self report with pics taken at home with penis in erect state or it can be assessed at hospital setting with intracavernous injection.

What is the treatment of peyronie disease ?

There are various oral and intralesional therapies available for this conditions though the therapeutic value of each is limited. Various oral agents include tamoxifen, pentoxyphylline, Vitamin E etc. Intralesional agents are injected into the scar tissue and helps loosening the scar and its size. Various intralesional agents which are commonly used are Collagenase injection (not available in India), verapamil injection, triamcinolone etc. Despite these therapies, there are large number of patients which need surgical treatment, whic include simple plication (placing suture to the opposite side of bending), partial or complete incision or excision of scar tissue followed by grafting. Penile implant is often required in patients undergoing excision of scar tissue with grafting.

Whom to meet if suffering from peyronie disease ?

You should meet your andrologist for management of peyronie disease.

Book your appointment @drvarinderattriurologist.bussiness.site

Urologist, Andrologist

Erectile dysfunction – causes, diagnosis and treatment

Dr Varinder Attri

What is erectile dysfunction?

Erectile dysfunction or otherwise called impotence, is the inability of achieving or maintaining hard enough erection of penis, that is required for sexual act. Persons with erectile dysfunction have either looseness of erection or have complete lack of erection. Read how it is different from premature ejaculation Premature ejaculation- causes, diagnosis and treatment

What are the causes of erectile dysfunction?

There are numerous causes of erectile dysfunction. It can be broadly divided into – Organic and non-organic causes. Organic causes are those where there is some underlying cause which leads to erectile dysfunction and non organic causes include those where no underlying cause is found.

Organic causes – Uncontrolled long term diabetes or hypertension, heart diseases, low testosterone levels, obesity, hypothyroidism, certain blood pressure medications, hyperlipidemia, prostate enlargement, chronic kidney disease, peyronie’s disease etc.

Non-organic causes- These includes stress, anxiety, relationship problems, depression etc.

Erectile dysfunction can be caused by any one of above factors or these factors can be present together in some patients. ED patients usually also suffer from premature ejaculation.

How to diagnose erectile dysfunction?

History and examination is most important parameter in diagnosis of ED. It include detailed questionnaire pertaining to erection After history, if required doctor may order few investigations in search of underlying causes leading to erectile dysfunction. Blood tests to check for diabetes, kidney disease, hypothyroidism, hypogonadism (Testosterone and Testosterone deficiency syndrome), PSA (PSA testing) etc are done. Doctor may do oral phosphodiesterase test after giving either sildenafil or tadalafil orally and checking the erection achieved. Sometimes your doctor may order penile doppler ultrasound after applying injection in penis to check penile vessels and hardness of penis.

What are the treatment options for ED?

There are various treatment options for ED. The underlying cause need to be addressed along with the ED treatment.

Psychological counselling- Psychological counselling is done in patients with anxiety, stress or depression or patients having relationship tension.

Oral therapy – There are multiple drugs in market which are used for ED such as Sildenafil, tadalafil, avenafil etc which are usually prescribed by andrologist for ED treatment.

Intra penile injections- Sometimes doctor may prescribe you with intra-penile injection (also called Intracavernous injection). These injection therapy is more beneficial in patients which are primarily having psychogenic erectile dysfunction with failed response to oral therapy.

Vacuum erection device – These devices help in achieving erection with the help of pump action. These can be particularly useful for elderly people or patients in whom other therapies are contraindicated.

Penile prosthesis (Penile implant) – Penile implant placement is the last resort for patients with erectile dysfunction who do not respond to oral or intra cavernous injections. There are variety of penile prosthesis in market (malleable, 2 piece, 3 piece implant). These implants are placed if patient has failed other therapies mentioned above. After implant surgery, the ED patient usually have high satisfaction rate.

Which doctor to meet for treatment of ED?

You should meet your nearby andrologist for treatment of erectile dysfunction.

Andrologist, Urologist

Painful ejaculation or painful orgasm- causes, diagnosis and treatment

Dr Varinder Attri

What is painful ejaculation or painful orgasm ?

Pain before onset of ejaculation or during ejaculation is termed as painful ejaculation. It can be dull or sharp pain and can involve the scrotum, penis root or shaft or perineal region. Pain can persist for few minutes to hours and person can have pain with urination also.

What are the causes of painful ejaculation ?

Various reason for painful ejaculation include – Prostatitis (infection/inflammation of the prostate), urinary tract infection, history of prostate surgery, sexually transmitted infections (STDs), use of medications such as antidepressants, prostate cancer, ejaculatory duct calculi etc. are the most common causes of painful ejaculation.

How to diagnose this condition and its causes ?

Painful ejaculation diagnosis is based on history provided by the patient. Causes leading to painful ejaculation can be assessed with the physical examination including digital rectal examination to palpate the prostate for any infection, urine examination with microscopy and culture, urethral discharge (if any), Trans rectal ultrasound (TRUS), serum PSA test. Additional tests are usually advised based on these initial tests.

What is the treatment for painful ejaculation ?

Treatment depends on the underlying cause. When it is caused by infection with either prostatitis or sexually transmitted infection, treatment is prescribing antibiotics to the patient along with analgesics. When its secondary to prostate surgery, it usually subside with time. Treatment for prostatic duct or ejaculatory duct calculi need endoscopic surgery for ejaculatory duct resection. Change of medicines for antidepressant induced painful ejaculation may be necessary. When painful ejaculation occurs due to prostate cancer, its treatment is done after more elaborate investigations and depending upon stage, type, patients age etc.

Whom to consult if you are having symptoms of painful ejaculation ?

Meet your local Urologist or Andrologist for best treatment.

Andrologist, Urologist

Guide to chronic prostatitis: symptoms, diagnosis and treatment

Dr Varinder Attri

What is prostate gland ?

Prostate is a walnut sized reproductive gland present below the bladder in all men. Urethra (urinary passage) passes through it. Its function is to provide nutrition to the sperms.

What is prostatitis ?

Prostatitis means that you have inflammation of your prostate gland. Prostatitis can present in short time duration with fever/chills (acute prostatitis) or can have persistent course (chronic prostatitis) and can have either infective or non-infective etiology.

What is meant by chronic prostatitis ?

Chronic prostatitis is the persistence of inflammation in the prostate for more than three months. It can be either infectious or non – infectious. Majority of patients have non infectious cause of chronic prostatitis and only 1 in 10 diagnosed having bacterial cause of infection. Read more about urinary tract infection at Urinary tract infection (UTI)

What are the symptoms of chronic prostatitis ?

Symptoms of chronic prostatitis are variable and include – Burning micturition (painful urination), pain in the penis, scrotum or suprapubic region, difficulty in initiating urinary stream, frequent urge of passing urine, poor urinary stream, sensation of having residual urine in bladder after passing urine, dribbling at the end of passing urine, pain while ejaculation or during orgasm etc. These symptoms may be very subtle in few patients but can be very annoying and bothersome in others, interfering in daily activities, work and sexual life. (Know the symptoms of enlarged prostate at BPH (Enlarged prostate) Symptoms)

How to make a diagnose of chronic prostatitis ?

Diagnosis of chronic prostatitis is made after detailed history and work up of the patient. Workup includes physical examination with digital rectal examination (DRE) to palpate the prostate and rule out any acute infection and laboratory tests such as urine examination and imaging with ultrasound to look for source of infection. EPS (Expressed prostatic secretions) which are drops of urethral discharge obtained after DRE and initial urine sample after DRE helps in ruling out any bacterial infection within prostate. Occasionally doctor may advice cystoscopy to look at urethra, prostate and bladder for any pathology. Read how to diagnose BPH at Prostate enlargement diagnosis

What is the treatment of chronic prostatitis ?

Lifestyle changes

Use of heating pad or sitz bath (soaking lower body half in warm water), limiting caffeinated products such as cold drinks, tea, coffee, cutting down alcohol intake, avoid spicy and acidic food, avoiding large amount of fluid intake at a time, avoid prolonged sitting, daily brisk walk for atleast 15 minutes, pelvic relaxation exercises etc helps in improving symptoms.

Medical treatment

  1. Alpha blocker – This medicine relax the bladder neck and prostate muscle fibers and helps in easing pain or voiding symptoms associated with chronic prostatitis.
  2. Antibiotics – Role of antibiotics are controversial when urine examination tests are normal, but use of antibiotics for 2-3 weeks (Doxycycline, fluoroquinolones) are often prescribed for any subclinical infection harboring in the prostate.
  3. Analgesics and Anti-inflammatory drugs – Painkillers and anti-inflammatory drugs (NSAIDs) helps reducing inflammation and reduces pain. Other neuropathic painkillers such as pregabalin helps in few patients.
  4. Muscle relaxants – These drugs helps in relaxing spasm of pelvic floor muscles.
  5. Prostatic massage – Prostatic massage helps reducing inflammation and reduces the symptoms of chronic prostatitis.

What is the prognosis of chronic prostatitis ?

Chronic prostatitis is poorly understood entity and its association with infection is subtle. Hence, this disease is very difficult to cure with many men do not respond to the therapy . Nonetheless, several potentially effective treatments are available. Your urologist may be able to help out in alleviation of symptoms associated with this disease.

Does chronic prostatitis increase the risk of prostate cancer ?

There is no evidence that chronic prostatitis increases the risk of developing prostate cancer. Read more about prostate cancer and its diagnosis at Prostate cancer

Andrologist, Urologist

Premature ejaculation- causes, diagnosis and treatment

Dr Varinder Attri

What is premature ejaculation ?

Premature ejaculation is defined when a man ejaculates sooner during sexual intercourse than he would like to. Nearly one third male experience this problem at some point of time. Premature ejaculation is diagnosed by a doctor when a male presents with complaints such as –

  • Always or nearly always ejaculate within one minute of penetration
  • Are unable to delay ejaculation during intercourse all or nearly all of the time
  • Feel distressed and frustrated, and tendency to avoid sexual intimacy therefore

What is the presentation of premature ejaculation ?

Premature ejaculation can be either of two types – Primary (Lifelong) and Secondary (Acquired). When a male presents with history of premature ejaculation nearly all of the times during sexual acts since the start of his first sexual encounter, it is called as primary type. Secondary type or acquired premature ejaculation is the one where a man who did not had ejaculation problems to begin with, start having early ejaculation now. Read how premature ejaculation is different from erectile dysfunction Erectile dysfunction – causes, diagnosis and treatment

What are the causes of premature ejaculation ?

Premature ejaculation can be broadly divided into – Psychological causes and organic causes.

Psychological causes – Various factors such as poor body image, depression, previous sexual experiences, sexual abuse etc can lead on to the premature ejaculation.

Organic causes – Erectile dysfunction, anxiety disorder, hypogonadism (Testosterone and Testosterone deficiency syndrome), abnormal hormone levels etc.

How the diagnosis of premature ejaculation made ?

The diagnosis of premature ejaculation is made on the patient’s history. Repeated or very often episodes of very early ejaculation which cannot be delayed or postpone by the person, points towards premature ejaculation. There is high chances of patient with premature ejaculation who is also suffering from erectile dysfunction and hence the evaluation of such disorder is also done.

What is the treatment for premature ejaculation ?

There are various methods to treat premature ejaculation, and often either one or combination of these used for the any patient.

  • Pelvic floor muscle exercises – Kegal exercises where the pelvic floor muscles are tightened and to hold it in contraction for three seconds, and then relax for three seconds. This is tried a few times in a sequence. Kegel exercises can be done while sitting, standing or walking.
  • Squeeze technique – In this method, the sexual activity is started as usual till the level of stimulation and at the peak of stimulation before the ejaculation, the sexual activity is stopped and either partner or male himself squeeze the penis till the urge to ejaculate goes off and then subsequently sexual activity can be resumed. This process can then be repeated again.
  • Use of condoms – Condom application leads to decrease in sensation and helps delaying ejaculation therefore.
  • Topical anesthetics – Anesthetic creams and sprays that contain a numbing agent, such as benzocaine, lidocaine or prilocaine, are sometimes used to treat premature ejaculation. These products are applied to the penis 10 to 15 minutes before sex to reduce sensation and help delay ejaculation. Side effect include that some men report temporary loss of sensitivity and decreased sexual pleasure.
  • Medications – Many oral medications are used to delay the ejaculations. These medicines include SSRI (escitalopram, paroxetine, fluoxetine, dapoxetine), Tricyclic antidepressant (Clomipramine), tramadol, phosphodiesterase inhibitors (sildenafil, tadalafil). Use of SSRI and clomipramine may take few days to show its effect completely.

Whom to consult if someone suffering from premature ejaculation ?

You should consult your nearby andrologist if you or your partner suffering from premature ejaculation.