My Penis Stuff

What is epididymitis?

The epididymis is a long, tightly coiled tube that lies above and behind each testicle. It collects and stores maturing sperm made by the testicles prior to ejaculation. Inflammation and infection of the epididymis is called epididymitis.

What causes epididymitis?

The causes of epididymitis vary depending on your age and behavior. In children it is most commonly associated with urinary tract infections. In young, sexually active men it is often associated with sexually transmitted disease, and in older men with enlargement of the prostate gland. Bacterial infections, possibly spread from the rectal area or following a urological procedure, may cause epididymitis. Also, an injury to the groin may cause epididymitis.

What are the symptoms?

Pain, tenderness, and swelling in the scrotum (epididymides or testicles) that gradually get worse are the most common symptoms of epididymitis. Other symptoms may include fever and chills, frequent or painful urination, or a discharge from the penis.

How is epididymitis diagnosed?

Epididymitis is diagnosed using a physical examination and a medical history. A culture of discharge from the penis is done to check for a bacterial infection, such as a sexually transmitted disease, and a urinalysis and urine culture are done to check for a urinary tract infection. You may also have a blood test to check for an elevated white cell count and an ultrasound or nuclear medicine test to make sure that you do not have torsion of the testicle, an emergency condition that causes loss of blood flow to the testicles and requires urgent surgical treatment. These tests are also used to make sure that you do not have a tumor.

How is it treated?

Antibiotics are used to treat epididymitis. Supportive measures, such as bed rest with elevation of the hips and anti-inflammatory medicines (such as ibuprofen or ketoprofen), may help relieve discomfort caused by epididymitis.

If you have symptoms of epididymitis, reduce the risk of spreading a possible infection to your partner by avoiding sexual intercourse until you can be examined by your health professional. It is important for sex partners to be evaluated and treated for a possible infection.

Everyone gets angry from time to time. Anger and arguments are normal parts of healthy relationships. But anger that leads to threats, hitting, or hurting someone is not normal or healthy. This is a form of abuse. Physical, verbal, or sexual abuse is not okay in any relationship. When it occurs between spouses, partners, or in a dating relationship, it is called domestic abuse or domestic violence.

Domestic abuse is also called intimate partner abuse. It is not the same as an occasional argument. It is a pattern of abuse used by one person to control another. Abuse includes:

• Hitting, pushing, shaking, slapping, kicking, pinching, and burning or threats to hurt you, your children, or pets. Drugging you with medicine, tying you up, and physical punishment of any kind also are kinds of abuse.
• Controlling behavior, such as limiting contact with your family or friends, or limiting you access to money.
• Not trusting you or spying on you, such as repeatedly calling or checking up on you for no good reason.
• Name-calling, insults, threats, or putting you down in front of others.
• Forcing you to have sex or do other sexual acts. This can range from unwanted touching to rape, sodomy, forced nudity, forcing you to watch pornography, or forcing you to act out pornography. Preventing you from using birth control or protecting yourself from sexually transmitted diseases (STDs) is also abuse.

Domestic abuse is a common form of violence and is a major problem. About 25% of women and 8% of men in the United States have been physically or sexually abused by a partner. It can happen to anyone, at any age, no matter what race or religion they are, no matter what their level of education is or how much money they make.

• Teens may experience dating abuse.
• Older adults can be targets of both domestic abuse and elder abuse.
• Men can be abused in relationships.

Abuse can cause lasting health problems and emotional pain. You are more likely to have long-term health problems if you have an abusive partner. Women who are sexually abused by their partners have more sexually transmitted diseases and unwanted pregnancies.

During pregnancy, abuse can cause problems such as poor weight gain, infections, and bleeding. It may increase your baby’s chance of low birth weight, premature birth, and death.

Abusers often blame the victim for the abuse. They may say “you made me do it.” This is not true. Every person is responsible for his or her actions. They may say they are sorry and tell you it will never happen, even though it already has.

Once abuse starts, it usually gets worse if steps are not taken to stop it. If you are in an abusive relationship, ask for help. This may be hard, but know you are not alone. Your family, friends, fellow church members, employer, doctor, or your local YMCA, YWCA, police department, hospital, or clinic can help you. The National Domestic Violence Hotline can help you find resources in your area. Call toll-free: 1-800-799-7233.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

Emergencies

Do you have any of the following symptoms that require emergency treatment? Call 911 or other emergency services immediately.

• You think you are in immediate physical danger.
• You or someone else has just been physically or sexually abused.
• You have been physically hurt and do not have someone who can safely take you to emergency care.

Symptoms to Watch For

It is important to watch for signs of intimate partner abuse. If your partner has any of the following behaviors, the National Domestic Violence Hotline can help you find resources in your area. Call the hotline toll-free: 1-800-799-7233.

• Calls you names or tells you that you are crazy
• Criticizes things you do and say, or criticizes how you look
• Blames you for the abuse he or she commits
• Limits where you can go, what you can do, and who you can talk to
• Unexpectedly checks up on you at your workplace, home, school, or elsewhere
• Apologizes for abusive behavior and tells you it will never happen again, even though it already has

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home Treatment

Once abuse starts, it usually gets worse if steps are not taken to stop it. If you are in an abusive relationship, ask for help. This may be hard, but know you are not alone. Help is available. The National Domestic Violence Hotline can help you find resources in your area. Call toll-free: 1-800-799-7233.

If you feel threatened, it is very important to develop a plan for dealing with a threatening situation. If your partner has threatened to harm you or your child, seek help.

• Anytime you are in danger, call 911 .
• If you do not have a safe place to stay, tell a friend, a religious counselor, or your doctor. Do not feel that you have to hide what is happening.
• Have a plan for how to leave your house, where to go, and where to stay in case you need to get out quickly (safety plan). Do not tell your partner about your plan. For help in developing your plan, call:
  • The National Domestic Violence Hotline toll-free at 1-800-799-7233. They can help you find resources in your area.
  • Your local YMCA, YWCA, police department, hospital, or clinic for the local crisis line for names of shelters and safe homes near you.
• Teach your children how to call for help in an emergency.
• Be alert to warning signs, such as threats or drinking. This can help you avoid danger.
• If you can, make sure that there are no guns or other weapons in your home.
• If you are working, contact your human resources department or employee assistance program to find out what help is available to you.
• If you are seeing a counselor, be sure to go to all appointments.

If you are no longer living with a violent partner, contact the police to obtain a restraining order if your abuser continues to pursue you, threaten you, or act violently toward you.

If you know someone who may be abused

Here are some things you can do to help a friend or family member.

• Let your friend know you are willing to listen whenever she or he wants to talk. Don’t confront your friend if she or he is not ready to talk. Encourage your friend to talk with her or his health professional, human resources manager, and supervisor to see what resources might be available.
• Tell your friend that the abuse is not her or his fault and that no one deserves to be abused. Remind your friend that domestic violence is against the law and that help is available. Be understanding if she or he is unable to leave. She or he knows the situation best and when it is safest to leave.
• If your friend has children, gently point out that you are concerned that the violence is affecting them. Many people do not understand that their children are being harmed until someone else talks about this concern.
• Encourage and help your friend develop a safety plan. This plan will help keep your friend and her or his children safe during a violent incident, when preparing to leave, and after leaving.

The most important step is to help your friend contact local domestic violence groups. There are programs across the country that provide options for safety, legal support, support, and needed information and services. To find the nearest program:

• Call the National Domestic Violence Hotline at 1-800-799-7233.
• See the National Coalition Against Domestic Violence’s Web site at http://www.ncadv.org/resources/state.htm.

The most dangerous time for your friend may be when she or he is leaving the abusive relationship, so any advice about leaving must be informed and practical.

Symptoms to Watch For During Home Treatment

If problems from domestic abuse become more frequent or severe, use the Check Your Symptoms section to determine if and when you need to see your doctor.

Prevention

To prevent violence

• Be alert to warning signs, such as threats or drunkenness, so that you can avoid a dangerous situation. If you cannot predict when violence may occur, have a safety plan for use in an emergency.
• If you are no longer living with a violent partner, contact the police to obtain a restraining order if your abuser continues to pursue you, threaten you, or act violently toward you.
• Learn how to recognize signs of teen relationship abuse in your teen.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment

If you have made an appointment with your doctor, you may be able to get the most from your visit by being prepared to answer the following questions:

• Have you ever been emotionally or physically abused by your partner or someone important to you?
• Have you been hit, slapped, kicked, or otherwise physically hurt by someone?
• Has anyone forced you to have sexual activities?
• Has anyone threatened you?
• Are you afraid of your partner or anyone else?
• Has the abuse increased recently?
• What kind of injuries has the abuse caused?
• Have you thought of committing suicide?
• Has the abuser threatened violence against your children? Is he or she violent toward your children?
• Has the abuser hurt a pet or destroyed things that belong to you?
• Does the abuser control most or all your activities every day?
• Has the abuser ever been treated for a mental health problem?
• Has the abuser threatened or tried to commit suicide?
• Does the abuse happen when the abuser is drunk?
• Does the abuser use legal or illegal drugs? Does the abuse happen when the abuser is “high”?
• Does the abuser have access to guns or other violent weapons?
• Do you have any risk factors that increase your chances for domestic violence?

Treatment Overview

Catheters used to manage urinary incontinence include:

• Standard catheter. This is a thin, flexible, hollow tube that is inserted through the urethra into the bladder and allows the urine to drain out. The standard catheter is used for intermittent self-catheterization.
• Indwelling Foley catheter. This type of catheter, which remains in place continuously, has a balloon on the end that is inflated with sterile water after the end is inside the bladder. The inflated balloon prevents the catheter from slipping out. Urinary tract infections are more likely to occur with long-term use of an indwelling catheter than with intermittent self-catheterization. For more information, see the topic Care for an Indwelling Urinary Catheter.
• Condom catheter or Texas catheter. This is a special condom that fits over the penis and is attached to a tube that collects urine. Condom catheters are only for short-term use, because long-term use increases the risk of urinary tract infections, damage to the penis from friction with the condom, and urethral blockage.

What To Expect After Treatment

Catheterization may cause some discomfort during the procedure. A condom or Texas catheter does not cause much discomfort, because it is not inserted into the urethra, but indwelling catheters may cause some discomfort while in place.

Why It Is Done

Catheters can be used to treat severe incontinence that cannot be managed with medicines or surgery.

How Well It Works

Catheters do not cure incontinence but rather allow you or a caregiver to manage incontinence.

These devices are effective. But some men find catheters uncomfortable or painful and stop using them.

Risks

Using a catheter increases your risk for:

• Urinary tract infection.
• Damage to the urethra.
• Damage to the skin of the penis.

What To Think About

The use of catheters can be under your control and can be designed to fit into your lifestyle.

Topic Overview

Male babies who are not circumcised have a greater chance of urinary tract infections in the first year of life than babies who have been circumcised. Keeping your young son’s penis clean may help prevent these infections and other problems.

Retracting the foreskin for cleaning

Do not force the foreskin back over the tip of the penis. Initially, a baby’s foreskin may be difficult to pull back over the tip of the penis. After the first few years of life (though it may take somewhat longer), the foreskin will gradually become more retractable. By the time a boy is 3 or 4, his foreskin is usually fully retractable. Up to this time, wash or instruct your son to wash the outside of the penis with soap and water. Pushing your son’s foreskin back too early can cause scar tissue formation and damage.

When the foreskin is easy to retract, clean under it regularly. To clean under the foreskin, gently push it as far as possible toward the body. Carefully wash the entire area with soap and water. When the area is cleaned and rinsed, replace the foreskin over the head of the penis.

A boy as young as 3 or 4 can be taught to clean under his foreskin as a normal part of his hygiene. Before puberty, occasional cleaning is recommended. When a boy reaches puberty, he needs to clean under his foreskin daily.

If your son’s foreskin does not fully retract by the time he reaches puberty, call your doctor for advice.

Treatment Overview

Several types of behavioral methods are used for treating urinary incontinence: bladder training, habit training, biofeedback, and pelvic muscle exercises. Men who have incontinence due to physical or mental limitations (functional incontinence) can try timed voiding and prompted voiding.

Bladder training

Bladder training (also called bladder retraining) is used to treat urge incontinence. Bladder training attempts to increase how long you can wait before having to urinate. A health professional will teach a person about the structure of the lower urinary tract and the causes of incontinence.

A voiding schedule is first established. Then you are trained to resist the first urge to urinate and refrain from urinating until the scheduled time. The intervals between scheduled bathroom visits are increased until you can refrain from urinating for several hours.

Biofeedback

Biofeedback is a technique for learning to control a body function that is not normally under conscious control, such as skin temperature, muscle tension, heart rate, or blood pressure.

Men with incontinence are taught bladder-sphincter biofeedback methods along with pelvic floor exercises. These techniques record bladder, rectal sphincter, and abdominal pressures as well as electrical activity. As the information is recorded, it is displayed for you. By watching the information, you learn to relax your bladder and abdominal muscles and contract your pelvic floor muscles based on the information displayed.

Learning biofeedback requires practice in a lab or other setting under the guidance of a trained therapist. Home biofeedback units also are available.

Timed voiding

Timed voiding is also called habit training. It is used to treat urge incontinence. It sets a schedule for urinating (voiding) that is determined by your personal habits and does not attempt to increase how long you can wait before having to urinate or to teach you to resist the urge to urinate.

Prompted voiding

Prompted voiding requires a caregiver to prompt the incontinent person to urinate. The goal is to decrease the chance of accidents by making the person aware of the need to urinate periodically. Prompted voiding usually is used in combination with timed voiding for people who are unaware of their bodily functions, such as people who have dementia.

What To Expect After Treatment

See the How Well It Works section below.

Why It Is Done

Behavioral methods may be used to treat urge incontinence.

How Well It Works

Bladder training

• The initial response rates to bladder training are moderate.
• Most people who use bladder training have fewer symptoms of incontinence. Some people completely eliminate their incontinence.

Biofeedback

Biofeedback has been successful in treating men who have urge incontinence following removal of their prostate gland.

Timed voiding

Timed voiding reduced the frequency of incontinence accidents in the majority of the people who used this method.

Prompted voiding

People who use prompted voiding generally have 1 to 2 fewer incontinence accidents per day.

Risks

There are no risks associated with this treatment.

What To Think About

Behavioral methods require a high level of motivation.

Prompted voiding requires a committed caregiver to be successful.

Surgery Overview

An artificial sphincter is a device made of silicone rubber that is used to treat urinary incontinence.

An artificial sphincter has an inflatable cuff that fits around the urethra close to the point where it joins the bladder. A balloon regulates the pressure of the cuff, and a bulb controls inflation and deflation of the cuff. The balloon is surgically placed within the pelvic area, and the control pump is placed in the scrotum.

The cuff is inflated to keep urine from leaking. When urination is desired, the cuff is deflated, allowing urine to drain out.

What To Expect After Surgery

Because these procedures involve abdominal surgery, hospitalization is required.

You will most likely be able to leave the hospital the day after having the surgery.

Why It Is Done

Installation of an artificial sphincter may be done for:

• Urinary incontinence caused by the removal of the prostate.
• Severe continual leakage of urine from the urethra.
• Severe urinary incontinence for which other methods of treatment have failed.

How Well It Works

Artificial sphincter placement is the most reliable treatment for men who have incontinence after prostate removal for cancer.

In cases of severe stress incontinence and persistent leakage, implantation of an artificial sphincter has been successful in relieving incontinence in up to 90% of men.

Risks

Complications with this type of surgery include needing another surgery, or revision, in 27% of cases, in which 5% reported erosion of the part of the urethra surrounded by the artificial sphincter and 3% developed infections.

What To Think About

Because complications may occur, this is a treatment method that generally is reserved for people for whom all other treatment options have failed. Some people may prefer to manage their symptoms with absorbent pads and changes in habits rather than have this surgery.

Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor’s recommendation.

Key points in making your decision

Radiation therapy and surgery are both used successfully to treat localized prostate cancer. The decision between surgery and radiation often is based on balancing the benefits with the possible side effects of each treatment option, including its effects on sexual activity, bladder control, and other aspects of your quality of life.

• If one of your biggest concerns is that prostate cancer might come back after treatment, you may want to have a radical prostatectomy. Your doctor will be able to evaluate your cancer more accurately by looking at it during surgery and taking tissue samples that can be tested. This information will help your doctor decide how likely it is that your cancer will return.
• If the possibility of having bladder problems and erection problems is a major concern, you may want to consider radiation therapy because these problems are less common with radiation than with surgery.

Treatment choices are different for prostate cancer that is more advanced (has grown or spread outside the prostate gland). For more information, see the topic Prostate Cancer, Advanced or Metastatic.

Medical Information

What is localized prostate cancer?

Prostate cancer is the abnormal growth of cells in the tissues of the prostate gland. Localized prostate cancer is cancer than has not spread beyond the prostate gland.

Prostate cancer is the most common cancer in men. Most men who get it are older than 65. If your father, brother, or son has had prostate cancer, you have a higher-than-average risk for developing the disease.

Unlike many other cancers, prostate cancer is usually slow-growing. Most men will die with prostate cancer but not of prostate cancer.

African-American men have higher rates of both prostate cancer and deaths caused by prostate cancer.

Early prostate cancer usually does not cause symptoms. When prostate cancer is diagnosed early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate. As prostate cancer grows or spreads, symptoms may develop, including urinary problems (such as blood in the urine) and bone pain.

Prostate cancer that has grown through the prostate is called advanced prostate cancer, and treatment choices are different for that stage of cancer. For more information, see the topic Prostate Cancer, Advanced or Metastatic.

What are the treatment choices for localized prostate cancer?

Localized prostate cancer may be treated with radiation therapy, surgery, or drugs. You may also choose to watch and wait.

• Watchful waiting, also called surveillance or observation, means you are being monitored closely by your doctor, but you are not receiving active treatment such as surgery or radiation therapy as long as symptoms do not occur or get worse.
• Radical prostatectomy is an operation to remove the entire prostate as well as any nearby tissue that may contain cancer. It may be done as open surgery, by making a large incision, or as laparoscopic surgery, by making several very small incisions in the belly and using a tiny camera and special instruments to remove the prostate. Sometimes lymph nodes in the area also are removed so they can be checked for signs of cancer.
• Radiation therapy uses X-rays and other types of radiation to kill the cancer cells. This may be done with:
  • External-beam radiation, in which a machine aims high-energy rays at the cancer.
  • Brachytherapy, in which tiny pellets of radioactive material are injected directly into or near the cancer.
  • A combination of external radiation and brachytherapy.

If you are young and in good health or if your prostate cancer is fast-growing (higher-grade), your doctor probably will recommend surgery and/or radiation therapy to remove or destroy the cancer. Even though prostate cancer is usually slow-growing, it may eventually spread and cause symptoms and may threaten your life.

Age is not a reason to not have surgery or other treatment. But if you are around 70 or older, it is important to consider other medical conditions you may have, such as heart disease, as you make your treatment decisions.

When is prostatectomy used to treat prostate cancer?

Radical prostatectomy is most often recommended when a man is in good general health and has a life expectancy of at least another 10 years. In addition, there should be an expectation that the cancer can be entirely removed. If testing suggests that the cancer may have spread outside the prostate, or if you have other health problems that may add to the risks of major surgery, prostatectomy usually is not recommended.

Radical prostatectomy generally is effective in treating cancer that has not spread beyond the prostate gland. In follow-up PSA tests done in the years after prostatectomy, most men show no evidence of cancer.

Laparoscopic radical prostatectomy sometimes is used instead of open prostatectomy, which requires a larger cut in the belly.

A few surgeons do robotic-assisted laparoscopic radical prostatectomy. The surgeon controls the arms that hold the surgery tools and laparoscope. There are reports that it helps the surgeon see very well and work with less error.

When is radiation therapy used to treat prostate cancer?

Radiation therapy is most effective in treating cancers that have not spread outside the prostate. It may be used alone or combined with hormonal treatment. Rarely, it is used with surgery. Radiation therapy works as well as surgery for the treatment of early-stage localized prostate cancer.

What are the risks of prostatectomy?

A radical prostatectomy is a surgical procedure and carries all the risks of any major surgery, including heart attack, pulmonary embolism, bleeding, infection, and reactions to anesthesia or medications.

In addition, prostatectomy may cause bladder problems and erection problems. Increasingly, this surgery is done in a way that helps preserve the nerves that control erections. Most men who have nerve-sparing prostatectomies will regain the ability to have an erection within 4 to 6 months after surgery. It takes some men up to 2 years to regain full function.

More than 30% of men who have a radical prostatectomy develop bladder problems, ranging from a need to wear pads to occasional dribbling during stressful activities. Between 2% and 5% still have severe problems 6 months after having a prostatectomy. After 1 year, 92% no longer have problems.

Other possible complications include scar tissue that may narrow the outlet to your bladder and injury to the rectum or the ureters.

Evidence shows that the side effects of prostate surgery are lessened when the prostatectomy is done by a surgeon who is very experienced in this particular operation.⁷

What are the risks of radiation therapy?

About half of men who have external radiation develop erection problems within 5 years of treatment. Erection problems following radiation therapy increase over time.

Most other side effects generally go away when treatment is finished. In some cases, however, they may become chronic. Other side effects include:⁴

• An irritated rectum and an urgent need to pass a stool. This is called proctitis.
• An inflamed bladder and urination problems. This is called cystitis.
• An inflamed intestine and diarrhea. This is called enteritis.
• Being unable to have an erection. This is called impotence.
• Being unable to control urination. This is called incontinence.
• Painful urination. This is called dysuria.

Follow-up treatment

Any type of treatment for prostate cancer will need to be followed by regular checkups. Your follow-up care probably will include physical exams, prostate-specific antigen (PSA) tests to monitor PSA levels and measure the speed of any changes, digital rectal exams, and biopsies as needed to examine suspicious tissue.

Your Information

This discussion focuses your choice between:

• Having radiation therapy.
• Having a radical prostatectomy.

The decision about whether to have surgery or radiation treatment takes into account your personal feelings and the medical facts.

Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor’s recommendation.

Key points in making your decision

Birth control methods allow a woman or a couple to choose whether or when to have a child. Consider the following when making your decision:

• Permanence. If you are certain that you don’t want children (or more children), you might consider a permanent method of birth control, such as female tubal ligation or implants or male vasectomy.
• Effectiveness. Consider how important it is to you to avoid pregnancy, and then look at how well each method works. Hormonal implants and injections (Depo-Provera) and the hormonal and copper IUDs are the most effective. Birth control pills (both estrogen-progestin and progestin-only), patches, and rings are highly (but slightly less) effective. Barrier methods such as condoms, diaphragms, and spermicides are only moderately effective. See a reliability table for details on each method.
• Convenience. Some methods require more effort than others. Do a reality check by asking yourself how likely you are to use the method consistently. Answer whether you are willing to interrupt lovemaking, to abstain from sex during certain times of the month, or to remember to take a pill every day.
• Sexually transmitted disease protection. The most highly effective hormonal and IUD methods do not protect you from sexually transmitted diseases (STDs). Condoms are the only dependable protection you have from STDs. But condoms alone are not a highly effective birth control method. To avoid both STD infection and pregnancy, be sure to combine a condom with a more effective birth control method.
• Health risks. If you have health risks, some birth control methods may not be right for you. For example, combined (estrogen and progestin) birth control methods are not recommended for women older than 35 who smoke. Other conditions that may limit your choices of birth control include having migraines, heart disease, high blood pressure, blood clots, or diabetes.
• Return to fertility. If you plan to have children within the next year or two, you may want to avoid the Depo-Provera (progestin-only) shot, which can stop your monthly periods and delay your return to fertility.¹ Taking estrogen-progestin for a long time can also make your periods stop. You might not start periods again for several months after you stop taking hormones. But it isn’t permanent. You will start ovulating and having your periods, and your fertility should get back to normal.
• Other benefits. Some birth control methods have beneficial side effects. Combination hormonal methods (estrogen and progestin) can improve acne. Both combination and progestin-only methods reduce menstrual cramping and flow. In fact, with the Lybrel combination pill, the Depo-Provera shot, or the Mirena IUD, your period may stop altogether.

Medical Information

What are the different methods of birth control?

Sterilization is a surgical procedure done for men or women who decide that they do not want to have any or more children. Sterilization is one of the most effective forms of birth control. Sterilization is intended to be permanent, and while you can try to reverse it with another surgery, reversal is not always successful. Methods include:

• Tubal ligation or implants. The fallopian tubes, which carry the eggs from the ovaries to the uterus, are tied, cut, or blocked. A new type of procedure, using a device (called Essure) to block the fallopian tubes, is done without an incision and on an outpatient basis.
• Vasectomy. In this minor procedure, the vas deferens, the tube that carries sperm from the testicles to the seminal fluid (semen), from each testicle is cut and blocked so that sperm are no longer present in the semen.

Hormonal methods are very effective means of birth control. Hormonal methods use two basic formulas:

• Combination hormonal methods contain both estrogen and progestin (synthetic progesterone). Combination methods include pills, skin patches, and rings.
• Progestin-only hormonal methods include pills (also called the “mini-pill”) and injections (Depo-Provera). Progestin-only methods are an option for women who cannot take estrogen.

Compare the:

• Advantages and disadvantages of combination hormonal methods with progestin-only pills, patches, and rings.
• Advantages and disadvantages of the progestin-only (Depo-Provera) shot.

An intrauterine device (IUD) is a small device that is placed in your uterus to prevent pregnancy. IUDs usually contain copper (Copper T 380-A) or a hormone (the Mirena IUD, which releases a progestin called levonorgestrel). IUDs can provide birth control for 5 to 10 years.

Barrier methods include the diaphragm, cervical cap, Lea’s Shield, male condom, female condom, spermicidal foam, sponges, and film. Barrier methods prevent sperm from entering the uterus and reaching the egg. Typically, barrier methods are not highly effective, but they generally have fewer side effects than hormonal methods or IUDs. Spermicides and condoms should be used together or along with another method to increase their effectiveness. Barrier methods can interrupt lovemaking because they must be used every time you have sex. (A diaphragm, cap, or shield can be put in a few hours beforehand, if you can plan ahead.)

Fertility awareness, or natural family planning, requires that a couple chart the time during a woman’s menstrual cycle that she is most likely to become pregnant and avoid intercourse or use a barrier method during that time. Fertility awareness is not a highly effective method of preventing pregnancy.

If you are at risk of getting or spreading a sexually transmitted disease (such as genital herpes, chlamydia, and AIDS), use a condom. To most effectively prevent pregnancy, combine a condom with a highly effective birth control method.

How effective are birth control methods?

Hormonal implants, injections (Depo-Provera), and the hormonal and copper IUDs are very highly successful methods of birth control. These methods are 97% to 99.9% effective. That means fewer than 1 to 3 women out of 100 women who are using these methods will become pregnant during the first year of use.

Birth control pills (both combination and progestin-only) have a high success rate of 92%. But if taken properly (every day or at the same time every day), birth control pills can be highly successful. The hormonal skin patch and vaginal ring are thought to be about as effective as birth control pills, but how well they actually work has not been well studied.

Barrier methods, such as the diaphragm or condom, are moderately successful at preventing pregnancy. The diaphragm and cervical cap are 84% effective for women who have not had children or who have had a cesarean section. Women who have delivered children vaginally have lower rates of success with diaphragms and cervical caps. They are more effective when used consistently and fitted correctly, although not all women are able to achieve this.

Doctors often recommend that you use spermicides and condoms together or along with another method to increase their effectiveness. The male condom is 85% effective. The female condom is 79% effective. Spermicide is 71% effective. In real numbers, this means that of women who use male condoms alone for birth control each time they have sex, 15 out of 100 will become pregnant in the first year of use. Consider carefully whether this risk is acceptable to you.

Using fertility awareness takes organization, good record keeping, close observation of your body changes, and cooperation from your partner. Even when practiced carefully and consistently, fertility awareness is not a reliable method of birth control. Of women who use fertility awareness for birth control, 20 to 25 out of 100 will become pregnant in the first year of use.

Consider how comfortable you feel about using a particular method of birth control. If you are not comfortable or will not consistently use a birth control method for any reason, that method may not be effective. A reality check for birth control methods can help you determine which method is right for you.

Patch warnings

• The patch delivers more estrogen than the low-dose birth control pills do. Some research has found that women using the patch are more likely to get dangerous blood clots in the legs and lungs. The risk may be higher if you smoke or have certain health problems. The U.S. Food and Drug Administration (FDA) suggests that you talk to your doctor about your risks before using the patch.
• Direct sunlight or high heat can increase, then lower, the amount of hormone released from a patch. This can give you a big dose at the time and leave less hormone for the patch to release later in the week. This increases your risk of pregnancy. Avoid direct sunlight on the hormone patch. Also avoid using a tanning bed, heating pad, electric blanket, hot tub, or sauna while you are using a hormone patch.

What are health risks that may affect my choices?

Some health conditions may limit your choice of birth control methods. Discuss appropriate methods of birth control with your health professional if you:

• Have a chronic illness, such as diabetes or heart disease.
• Have a history of cardiovascular problems, such as high blood pressure (hypertension), stroke, high cholesterol, or blood clots.
• Have a history of nervous system problems, such as seizures or headaches.
• Have a history of migraines.
• Smoke cigarettes.
• Have a history of cancer.
• Use prescription medications. Certain antibiotics, antiretrovirals, and anticonvulsants, as well as St. John’s wort, make certain hormonal birth control less effective.²
• Have low bone density (osteoporosis) in your personal or family history.
• Are overweight. The pill and the patch may not work as well if you are overweight (body mass index greater than 30).

Bone thinning. Using Depo-Provera for 2 or more years can cause bone loss, which may not be fully reversible after stopping the medication and can lead to osteoporosis in later life. This concern may be greatest during the teen years, when young women should be building bone mass. Depo-Provera use is not recommended to be used for longer than 2 years unless you are protecting your bones with daily calcium and regular weight-bearing exercise, such as walking or running. Talk to your doctor about your risks if you have been using Depo-Provera for longer than 2 years.

Sexually transmitted disease. If a sexually transmitted disease is present at the time an IUD is inserted, a woman is at increased risk for pelvic inflammatory disease (PID) in the 20 days after insertion. Pelvic inflammatory disease can lead to infertility.⁷ This is why a test for STDs is important before inserting an IUD.

Will some temporary birth control methods prevent me from having children when I want them?

Consider how soon, if ever, you would like to become pregnant. Except for sterilization methods, which permanently prevent pregnancy, all currently available birth control methods allow you to become pregnant again, although some may cause a delay.

Depo-Provera. For some women, it may take 3 to 18 months to get pregnant after the last Depo-Provera (a progestin-only hormonal method) shot.

The estrogen-progestin pill. If you take monthly cycles of birth control hormones for a long time, your periods might stop. You might not start periods again for several months after you stop taking hormones. But it isn’t permanent. You will start ovulating and having your periods, and your fertility should get back to normal. Since it is common to ovulate before your first period comes back, it is possible to get pregnant sooner than you expect. So if you aren’t in a rush to get pregnant, use some form of birth control after you stop birth control hormones.

What can I do if I have unprotected sex?

Emergency contraception is a backup method for unprotected intercourse. This would be when you have not used a birth control method or have reason to believe that your method has not protected you as it should. For example, you could use emergency contraception if the condom breaks during sex.

Your Information

One method may work better than others for a woman or for a couple. You may use more than one method at a time, especially if you need sexually transmitted disease protection and highly effective birth control. And birth control needs change over time. Consider the information below as you make your decision.

You or someone you know may have been diagnosed as having a type of prostatitis, a common and painful disease of the prostate gland and its surrounding structures. The following has been designed to answer your questions about prostatitis.

What is the prostate?

The prostate is a part of the male reproductive system, is about the same size and shape of a walnut and weighs about an ounce. It is located below the bladder and in front of the rectum and surrounds the urethra, the tube-like structure that carries urine from the bladder out through the penis. The main function of the prostate is to produce ejaculatory fluid.

What are the different types of prostatitis and their causes?

Acute bacterial prostatitis is the least common type of prostatitis and is always caused by bacterial infection. It is usually easy to diagnose because of the typical symptoms and signs. It is a severe urinary tract infection associated often with fevers and chills, and a visit to a doctor or hospital is required. Acute bacterial prostatitis can affect any age group but commonly occurs in older and middle-aged men. Another type that is caused by bacterial infection is chronic bacterial prostatitis which is characterized by recurrent urinary tract infections in men. When symptoms do appear, they are generally less severe than acute bacterial prostatitis and rarely have fever, but often recur. This condition can also affect any age group but is most common in young and middle-aged men.

Nonbacterial prostatitis and prostatodynia, now properly referred to as chronic pelvic pain syndrome, are the most common types of prostatitis. The exact cause of these non-bacterial prostatitis conditions is not known, but may be due to persistent infection, inflammation and/or pelvic muscle spasm. Inflammation in the prostate can also occur without symptoms.

What causes prostatitis?

The bacteria that cause acute and chronic bacterial prostatitis get into the prostate from the urethra by backward flow of infected urine into the prostate ducts. Bacterial prostatitis is not contagious and is not considered to be a sexually transmitted disease. A sexual partner cannot catch this infection.

Certain conditions or medical procedures increase the risk of contracting bacterial prostatitis. There is a higher risk if the man has recently had a catheter or other instrument inserted into his urethra, an abnormality of his urinary tract or a recent bladder infection.

Chronic prostatitis/chronic pelvic pain syndrome may be caused by atypical organisms such as chlamydia, mycoplasma (which may be transmitted by sexual contact) ureaplasma or may also be due to a chemical or immunologic reaction to an initial injury, The nerves and muscles in the pelvis may cause pain in the area, either as a response to the prostate infection or inflammation or as an isolated problem itself.

What are the symptoms of prostatitis?

The symptoms of the various prostatitis syndromes depends upon the category.

In acute bacterial prostatitis, the symptoms are severe and sudden and may cause the patient to seek emergency medical care. Chills, fever, severe burning during urination and the inability to completely empty the bladder are common.

In chronic bacterial prostatitis, the symptoms are similar but do not produce fever. They include: burning during urination; urinary frequency, especially at night; perineal, testicular, bladder and low back pain; and painful ejaculation. The condition can be episodic, with flare-ups and remissions, associated with infection, treatment and subsequent recurrence.

The symptoms of chronic prostatitis/chronic pelvic pain syndrome include difficult and sometimes painful urination, discomfort or pain in the perineum, bladder, testicles and penis as well as difficult and painful ejaculation. In some cases, these symptoms can be indistinguishable from those described above for chronic bacterial prostatitis.

How is prostatitis diagnosed?

The correct diagnosis is very important because the treatment is different for the different types of prostatitis syndromes. In addition, it is extremely important to make sure that the symptoms are not caused by other conditions such as urethritis, cystitis, an enlarged prostate or cancer. To help make an accurate diagnosis, several types of examinations are useful.

To examine the prostate gland, the physician will perform a digital rectal examination (DRE). This is a simple examination in which the doctor will pass a lubricated, gloved finger into the rectum. Because the prostate is located just in front of the rectum, it can be easily pressed. The physician will be able to determine whether the prostate is enlarged or tender. Lumps or firm areas can suggest the presence of prostate cancer. The physician will also assess the degree of pain or discomfort the patient experiences as he presses the muscles and ligaments of the pelvic floor and perineum. If a man has prostatitis, this examination may produce momentary pain or discomfort but it causes neither damage nor significant prolonged pain.

If the physician requires a closer look at the prostate gland or decides that a biopsy is necessary, he may order a transrectal ultrasound, which allows him to visualize the prostate gland. If you are at risk for cancer, your physician will consider ordering a PSA test. During a prostate infection however, the PSA can be falsely elevated.

If your physician suspects that you have prostatitis or one of the other prostate problems, he may refer you to a urologist, a doctor who specializes in diseases of the urinary tract and male reproductive system, to confirm the diagnosis.

The urologist will repeat some of the examinations already performed by the first physician. The urologist will also assess the degree of pain or discomfort the patient experiences as he presses the prostate. The urologist may analyze various urine specimens as well as a specimen of prostatic fluid obtained by massaging the prostate gland during the DRE. The various urine specimens and prostatic fluid will be analyzed for signs of inflammation and infection. These samples may help the urologist determine whether your problem is inflammation or infection and whether the problem is in the urethra, bladder or prostate.

Other tests the urologist may consider employing include cystoscopy in which a small telescope is passed through the urethra into the bladder permitting examination of the urethra, prostate and bladder. The urologist may also order urine flow studies, which help measure the strength of your urine flow and any obstruction caused by the prostate, urethra or pelvic muscles.

How should prostatitis be treated?

Your treatment depends on the type of prostatitis you have.

If acute bacterial prostatitis is diagnosed, the patient will need to take antibiotics for a minimum of 14 days. Sometimes, this means being admitted to the hospital and being given intravenous antibiotics. A catheter is sometimes required if the patient has difficulty urinating. Almost all acute infections can be cured with this treatment. Frequently, the antibiotics will be continued for as long as four weeks.

If chronic bacterial prostatitis is diagnosed, the patient will require antibiotics for a longer period of time, usually four to 12 weeks. About 75 percent of all cases of chronic bacterial prostatitis clear up with this treatment. Sometimes the symptoms recur and antibiotic therapy is again required. For cases that do not respond to this treatment, long-term, low dose antibiotic therapy may be recommended to relieve the symptoms. Other medications (such as those used for nonbacterial prostatitis) or other treatments (e.g., prostate massage therapy) may also be used in difficult cases. In some rare cases, surgery on either the urethra or prostate may be recommended. There must be a specific anatomic problem, such as scar tissue in the urethra, for any surgery aimed at improving prostatitis to be effective.

The patient may not need antibiotics, if they are diagnosed with chronic pelvic pain syndrome. Frequently, physicians have difficulty trying to decide whether a patient has bacterial or nonbacterial prostatitis. This is because of the difficulties in obtaining a specimen and, sometimes, previous antibiotic therapy obscures the diagnosis. An organism that responds to antibiotics, but is difficult to diagnose may also cause chronic pelvic pain syndrome. For these reasons, antibiotics may be prescribed, at least initially, even when a definitive diagnosis of bacterial prostatitis has not been made with the appropriate tests. Your response to the antibiotic therapy will decide whether or not it should be continued. Many patients without a true infection may feel better during antibiotic therapy because many antibiotics have direct anti-inflammatory effects. Depending on your symptoms you may receive one of a variety of other treatments. These may consist of alpha-blockers, anti-inflammatory drugs, muscle relaxants, plant extracts (quercetin and/or bee pollen) and repetitive prostatic massage (to drain the prostate ducts).

Various heat therapies, biofeedback and relaxation exercises may alleviate some of the symptoms. You may be advised to discontinue some foods (e.g. spicy) and drinks (e.g. caffeinated, acidic) and avoid circumstances (e.g. bicycle riding) that exacerbate the problem. Once a correct diagnosis has been made, one of the best therapies may be that of reassurance that the patient does not have a life threatening condition.

Treatment for aysmptomatic prostatatic inflammation is usually not required.

Why do physicians have trouble diagnosing prostatitis?

The diagnosis of the various types of prostatitis can be very difficult and sometimes quite frustrating for the patient and his physician. The symptoms are variable and there is much overlap in symptoms between the various types of prostatitis. Once the patient has been treated with antibiotics, it can be difficult to differentiate a bacterial prostatitis from chronic pelvic pain syndrome.

How will prostatitis affect a patient?

Prostatitis is an extremely frustrating disease for both the patient and his physician. It can seriously affect a patient’s quality of life. The correct diagnosis of the prostatitis problem is difficult and it cannot always be cured. However, prostatitis is a treatable disease and one can usually get relief from major symptoms by following the recommended treatment.

Why are some patients not cured after they have been diagnosed with prostatitis?

Most cases of acute bacterial prostatitis respond completely to therapy. Unfortunately, the treatment for the chronic prostatitis syndrome is far from perfect. Patients with chronic bacterial prostatitis can have persistence of their infectious problem despite antibiotic use. This is because of the difficulty antibiotics have in penetrating the prostate gland to completely kill all the bacteria deep within the prostatic ducts. Repetitive or frequent prostate massages or use of alpha blockers may be helpful in these cases. The patients who have had chronic bacterial prostatitis and have been cured are susceptible to recurrences. Many patients with chronic prostatitis/chronic pelvic pain syndrome fail therapy. The physician may employ a multi-modal approach to therapy (more than one treatment at a time). Patients may find that they have to learn to live, and cope with their symptoms while the inflammation hopefully “burns itself out.”

What are some of the most important facts about prostatitis?

• Correct diagnosis is the key to the management of prostatitis.
• Prostatitis cannot always be cured but can be managed.
• Treatment should be followed even if symptoms have improved.
• Patients with prostatitis are not at higher risk for developing prostate cancer.
• There is no reason to discontinue normal sexual relations unless they are uncomfortable, usually during an acute phase.
• One can live a reasonably normal life with prostatitis.

When is surgical treatment suggested as a form of treatment?

When medical therapy fails, surgery is required to remove the obstructing tissue. Surgery is almost always recommended for men who are unable to urinate, have kidney damage, frequent urinary tract infections, significant urethral bleeding or stones in the bladder.

What are the different surgical treatments available?

Removal of the prostate can be accomplished in several different ways. The location of the enlargement within the prostate and the patient’s general health will help the urologist determine which of the three following procedures to use.

Transurethral resection of the prostate (TURP): Transurethral resection is the most common surgery for BPH. In the United States, approximately 200,000 people have TURPs performed each year. After the patient receives anesthesia, the surgeon inserts an instrument called a resectoscope through the tip of the penis into the urethra. The resectoscope contains a light, valves for controlling irrigating fluid and an electrical loop that cuts tissue and seals blood vessels. With this instrument, obstructive prostate tissue is removed one piece at a time. The removed tissue pieces are carried by the irrigating fluid into the bladder and then flushed out and sent to a pathologist for examination under a microscope. At the end of the procedure, a catheter is placed in the bladder through the penis. The bladder is continuously irrigated with fluid through the catheter in order to monitor bleeding and prevent blood from clotting and obstructing the catheter. Since there are no surgical incisions with this procedure, patients normally stay in the hospital only one to two days. Depending on surgeon preference, the catheter may be removed while the patient is still in the hospital or the patient may be sent home with the catheter in place, attached to a leg bag for convenience and removed several days later as an outpatient procedure.

Transurethral incision of the prostate (TUIP): Transurethral incision is used for men with smaller prostate glands who suffer from significant obstructive symptoms. Instead of cutting and removing tissue to relieve the obstructed bladder, this procedure widens the urethra by making several small cuts in the bladder neck where the urethra joins the bladder and in the prostate itself. This reduces the pressure of the prostate on the urethra and makes urination easier. Patients normally stay in the hospital one to three days. A catheter is left in the bladder for one to three days after surgery.

Open prostatectomy: When a transurethral procedure cannot be done, open surgery may be required. Open prostatectomy for BPH is also performed for a prostate that is too large to remove through the penis. Other reasons for choosing an open prostatectomy include patients with large bladder diverticula, with large bladder stones and who cannot physically tolerate having their legs placed in stirrups for TURP/TUIP surgery.

An incision is made in the abdominal wall from below the belly button to the pubic bone. The prostate gland can then be removed in its entirety through either an incision in the fibrous capsule surrounding the prostate (retropubic prostatectomy) or through an incision made in the bladder (suprapubic prostatectomy). Postoperative pain is mild to moderate. Patients usually stay in the hospital for several days and go home with a urinary catheter. In some cases a second catheter draining the bladder through the lower abdominal wall is used.

What can be expected after treatment?

Postoperatively, patients typically experience significant improvement in their symptoms (table 1). As with any operative procedure, complications do exist. Some occur in the early postoperative period (table 2) while others may occur many years later (table 3).

Table 1: Overall improvement in patient symptoms

Table 2: Immediate post-operative complications

Table 3: Late post-operative complications

Will surgery for BPH affect my ability to enjoy sex?

Most urologists say that even though it takes a while for sexual function to return fully, most men are able to enjoy sex again. Most experts agree that if you were able to maintain an erection shortly before surgery, you will probably be able to do so after surgery. Most men find little or no difference in the sensation of orgasm although they may find themselves suffering from retrograde ejaculation.

Is BPH a rare condition?

No, it is very common. It will affect approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.

Does BPH lead to prostate cancer?

No, BPH is not cancer and cannot lead to cancer, although both conditions can exist together. There are usually no symptoms during the early stages of prostate cancer, so yearly physical examinations and PSA testing are highly recommended.