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Prostatitis is swelling or infection of the prostate gland. It often hurts. The prostate gland sits just below a man’s bladder and makes part of the fluid for semen. In young men, the prostate is about the size of a walnut. It usually grows larger as you grow older.

There are several types of prostatitis. They vary based on how long a man has had the problem and what kind of symptoms he has.

What causes prostatitis?

Sometimes prostatitis is caused by bacteria, but often the cause is not known.

What are the symptoms?

Symptoms of long-term (chronic) prostatitis are often mild and start slowly over weeks or months. They may include:

• An urge to urinate often. But you may pass only small amounts of urine.
• A burning pain when you urinate.
• A problem starting the urine stream, urinating in waves rather than in a steady stream, urine flow that is weaker than normal, and dribbling after urinating.
• Waking up at night to urinate often.
• A feeling of not completely emptying your bladder.
• Pain in your lower back, in the area between the testicles and anus, in the lower belly or upper thighs, or above the pubic area. Pain may be worse during a bowel movement.
• Some pain during or after ejaculation.
• Pain in the tip of your penis.

Symptoms of acute prostatitis are the same, but they start suddenly and are severe. They may also include a fever and chills.

Some men may have no symptoms.

How is prostatitis diagnosed?

A doctor can often tell if you have prostatitis by asking about your symptoms and past health. He or she will also do a physical exam, including a digital rectal exam. In this test, the doctor puts a gloved, lubricated finger in your rectum to feel your prostate. You may also need blood and urine tests to find out which type of prostatitis you have or to look for another cause of your problems.

How is it treated?

Prostatitis caused by bacteria is treated with antibiotics and self-care. If it is not caused by bacteria, it usually gets better with home treatment.

Home treatment includes drinking plenty of fluids and getting lots of rest. Taking over-the-counter pain relievers can also help.

Your doctor may prescribe medicine to control pain and reduce swelling. He or she may also prescribe medicine to soften your stool and relax your bladder muscles.

Surgery is rarely used to treat prostatitis.

• Prostate cancer is common among men older than 65. Most cases are treatable because they are found with screening tests before the cancer has spread to other parts of the body. Most men do not die from it.
• The most common way to check for prostate cancer is to have a digital rectal exam and a prostate-specific antigen (PSA) blood test. A higher level of PSA may mean prostate cancer, but it could also mean an enlargement or infection of the prostate.
• Experts disagree on whether regular PSA testing is right for all men. Testing could lead to cancer treatment that can cause other health problems, especially loss of bladder control and not being able to have an erection. The decision to have a PSA test for prostate cancer depends on your doctor’s opinion and your preferences.
• Because other problems can also cause your PSA to be high, your doctor may do a biopsy to figure out the cause. A biopsy means your doctor takes a sample of tissue from your prostate gland and sends the sample to a lab for testing.
• Choosing treatment for prostate cancer can be confusing. You and your doctor may decide to treat your cancer with surgery or radiation. Or, if the cancer has not spread, you may be able to wait and watch to see what happens. During watchful waiting, you will have regular checkups with your doctor to see if your cancer has changed.

What is prostate cancer?

Prostate cancer is the abnormal growth of cells in a man’s prostate gland. The prostate sits just below the bladder. It makes part of the fluid for semen. In young men, the prostate is about the size of a walnut. It usually grows larger as you grow older.

Prostate cancer is common in men older than 65. It usually grows slowly and can take years to grow large enough to cause any problems. Most cases are treatable, because they are found with screening tests before the cancer has spread to other parts of the body. Although most men may die with prostate cancer, most men do not die from it.

Experts don’t know what causes prostate cancer, but they believe that your age, family history (genetics), and race affect your chances of getting it. Eating a high-fat diet may also play a part.

What are the symptoms?

Prostate cancer usually does not cause symptoms in its early stages. Most men don’t know they have it until it is found during a regular medical exam.

When problems are noticed, they are most often problems with urinating. But these same symptoms can also be caused by an enlarged prostate (benign prostatic hyperplasia). An enlarged prostate is common in older men.

See your doctor for a checkup if:

• You have trouble starting your urine stream.
• You have a weaker-than-normal urine stream.
• You cannot urinate at all.
• You have to urinate often.
• You feel like your bladder is not emptying completely when you urinate.
• You have to get up at night to urinate.
• You have pain or burning when you urinate.
• You have blood in your urine.
• You have a deep pain in your lower back, belly, hip, or pelvis.

How is prostate cancer diagnosed?

The most common way to check for prostate cancer is to have a digital rectal exam, in which the doctor puts a gloved, lubricated finger in your rectum to feel your prostate, and a prostate-specific antigen (PSA) blood test. A higher level of PSA may mean that you have prostate cancer, but it could also mean that you have an enlargement or infection of the prostate.

If your PSA is high, or if your doctor finds anything in the rectal exam, he or she may do a biopsy to figure out the cause. A biopsy means your doctor takes a sample of tissue from your prostate gland and sends it to a lab for testing.

Because many men have regular checkups, about 9 out of 10 prostate cancers are found in the early stages. The 5-year survival rate is almost 100%. The 5-year survival rate shows the percentage of men still alive 5 years or longer after diagnosis. It’s important to remember that everyone’s case is different, and these numbers may not show what will happen in your case.

Should you have regular tests for prostate cancer?

It is important to have regular health checkups, including a digital rectal exam. But experts disagree on whether regular PSA testing is right for all men. Testing could lead to cancer treatment that can cause other health problems, especially loss of bladder control and not being able to have an erection.

Talk with your doctor about the reasons for and against having a PSA test for prostate cancer. The decision to have a PSA test depends on your doctor’s opinion and your preferences.

How is prostate cancer treated?

Your treatment will depend on what kind of cancer cells you have, how far they have spread, your age and general health, and your preferences.

You and your doctor may decide to treat your cancer with surgery, radiation, hormone therapy, or a combination. Or, if the cancer has not spread and you are around age 70 or older, you may be able to wait and watch to see what happens. During watchful waiting, you will have regular checkups with your doctor to see if your cancer has changed.

Choosing treatment for prostate cancer can be confusing. Talk with your doctor to choose the treatment that is best for you.

How can treatment affect your quality of life?

Both surgery and radiation can cause urinary incontinence (not being able to control urination) or impotence (not being able to have an erection).

Nerves that help a man have an erection are right next to the prostate. Surgery to remove the cancer may damage them. Many times a special form of surgery, called nerve-sparing surgery, can be used to try to avoid damaging the nerves. But if the cancer has spread to the nerves, they may have to be removed during surgery.

These same nerves can also be damaged by the X-rays that are used in radiation therapy.

Drugs and mechanical aids may help men who are impotent because of treatment. Many men recover their ability to have an erection several months or years after surgery.

What is premature ejaculation?

Premature ejaculation is uncontrolled ejaculation either before or shortly after sexual penetration, with minimal sexual stimulation and before the person wishes. It may result in an unsatisfactory sexual experience for both partners. This can increase the anxiety that may contribute to the problem. Premature ejaculation is one of the most common forms of male sexual dysfunction and has probably affected every man at some point in his life.

What causes premature ejaculation?

Most cases of premature ejaculation do not have a clear cause. With sexual experience and age, men often learn to delay orgasm. Premature ejaculation may occur with a new partner, only in certain sexual situations, or if it has been a long time since the last ejaculation. Psychological factors such as anxiety, guilt, or depression can cause premature ejaculation. In some cases, premature ejaculation may be related to an underlying medical cause such as hormonal problems, injury, or a side effect of certain medicines.

What are the symptoms?

The main symptom of premature ejaculation is an uncontrolled ejaculation either before or shortly after intercourse begins. Ejaculation occurs before the person wishes it, with minimal sexual stimulation.

How is premature ejaculation diagnosed?

Your health professional will discuss your medical and sexual history with you and conduct a thorough physical examination. Your doctor may want to talk to your partner as well. Because premature ejaculation can have many causes, your health professional may order laboratory tests to rule out any underlying medical problem.

How is it treated?

In many cases, premature ejaculation resolves on its own over time without the need for medical treatment. Practicing relaxation techniques or using distraction methods may help you delay ejaculation. For some men, stopping or cutting down on the use of alcohol, tobacco, or illegal drugs may improve their ability to control ejaculation.

Your health professional may recommend that you and your partner practice specific techniques to help delay ejaculation. These techniques may involve identifying and controlling the sensations that lead up to ejaculation and communicating to slow or stop stimulation. Other options include using a condom to reduce sensation to the penis or trying a different position (such as lying on your back) during intercourse. Counseling or behavioral therapy may help reduce anxiety related to premature ejaculation.

Certain antidepressant medicines called selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), are sometimes used to treat premature ejaculation. These medicines are used because a side effect of SSRIs is inhibited orgasm, which helps delay ejaculation. The use of SSRIs for the treatment of premature ejaculation is not related to depression and is considered an “off-label” use.

Surgery to move an undescended testicle into the scrotum is called orchiopexy or orchidopexy. It is usually performed on infants and young boys who are between 6 months and 15 months old. In most cases, a pediatric surgeon or a specialist who treats urinary problems in children (pediatric urologist) performs the surgery.

Orchiopexy may also be done on older boys and, rarely, on teens and adult men who have undescended testicles. Untreated undescended testicles are usually removed in adult men and teens who have gone through puberty because of the increased risk of testicular cancer.

Depending on the location of the testicle, one or two small incisions are made in the scrotum, the groin, or the abdomen to allow the surgeon to reach the testicle and move it to the scrotum. Sometimes another surgical method called laparoscopy is used to move undescended testicles when they are located high in the inguinal canal or in the abdomen. In both types of orchiopexy, general anesthesia is used.

Usually only one surgery is needed. But in some cases where the testicles are located in the abdomen, orchiopexy may require two separate operations that are done several months apart. Sometimes an undescended testicle is surgically removed from the body and reimplanted in the scrotum (testicular autotransplantation), and the surrounding tissues and blood vessels are reattached.

What To Expect After Surgery

Orchiopexy can be done as an outpatient procedure or with a short hospital stay. The surgery for testicles that are located just above the scrotum and for testicles that are low in the inguinal canal is usually much simpler than for testicles that are higher up in the canal or in the abdomen. Uncomplicated orchiopexy surgery can often be done on an outpatient basis, meaning the child goes home the same day.

For at least 2 weeks after surgery, boys should avoid games, sports, rough play, bike riding, and other activities where there is a risk of an injury to the genitals.

The doctor will perform a follow-up exam usually within 2 to 3 months after the operation.

Why It Is Done

Orchiopexy is done to place an undescended testicle in its normal position in the scrotum.

• Placing undescended testicles in the scrotum may help prevent infertility.
• Treatment does not appear to reduce the risk of developing testicular cancer, but it makes it easier to find cancer if it develops.
• Surgery can boost a boy’s self-esteem. An empty or partially empty scrotum can make a boy feel bad about himself and his body, especially during the teen years.

How Well It Works

Usually, the outcome of orchiopexy is good, and the testicle is moved into the scrotum. But success rates vary by where the testicle is located at the time the surgery is done. Success rates are:

• About 92% for testicles that are located just above the scrotum (prescrotal).
• About 80% to 90% for testicles that are located in the inguinal canal.
• About 74% for testicles that are located in the abdomen.

Risks

Possible complications for orchiopexy include:

• Infection.
• Bleeding or blood clots in the scrotum.
• Damage to the vas deferens and the blood supply to the testicle. Without an adequate blood supply, the testicle may shrink (atrophy).
• The testicle(s) moving out of the scrotum again (reascend) after surgery and requiring further treatment. This rarely happens.

What To Think About

Orchiopexy is considered a safe and reliable procedure that has relatively few risks. It is best to choose a surgeon and hospital staff who have training and experience in this procedure and in the special needs of children.

In some cases, the testicle is removed from the body entirely and then reimplanted in the scrotum (testicular autotransplantation). This procedure requires reattaching surrounding tissue and blood vessels. Sometimes the surgeon uses the blood vessels that supply the vas deferens to also supply the testicle in its new location. Talk with a doctor if you have had surgery for an undescended testicle and are now considering a vasectomy. During a vasectomy, the vas deferens is cut, and this could affect blood flow to a reimplanted testicle.

Some doctors recommend a testicular biopsy during orchiopexy if the undescended testicle is in the abdomen or if the child has genital defects, such as hypospadias, or a genetic disorder. In this test, a small sample of tissue is taken from the testicles and then examined for signs of cancer.

Orchiectomy is the removal of the testicles, a man’s main source of testosterone, which prostate cancer usually needs to continue growing.

What To Expect After Surgery

Orchiectomy can be done as an outpatient procedure or with a short hospital stay. Regular activities are usually resumed within 1 to 2 weeks, and a full recovery can be expected within 2 to 4 weeks.

Why It Is Done

Orchiectomy may help relieve symptoms, prevent complications, and prolong survival for advanced prostate cancer. Radiation treatment is sometimes needed as well.

How Well It Works

Orchiectomy often causes the tumor to shrink and relieves bone pain.

This surgery does not cure prostate cancer, although it may prolong survival.

Risks

Orchiectomy causes sudden hormone changes in the body. Side effects from hormone changes include:

• Sterility.
• Loss of sexual interest.
• Erection problems.
• Hot flashes.
• Larger breasts (gynecomastia).
• Weight gain.
• Loss of muscle mass.
• Thin or brittle bones (osteoporosis)

What To Think About

Removing the testicles has the same effect as hormone treatment. Some men may prefer surgery over hormone therapy, which involves taking pills daily or having injections every 1 to 4 months. And orchiectomy costs less overall. But a benefit of hormone therapy is that you can stop taking the hormone drugs, while an orchiectomy is permanent.

Some men choose to have reconstructive surgery after an orchiectomy, in which the surgeon replaces the testicles with artificial testicles.

Klinefelter syndrome is a genetic disorder that affects males. Klinefelter syndrome occurs when a boy is born with one or more extra X chromosomes. Most males have one Y and one X chromosome. Having extra X chromosomes can cause a male to have some physical traits unusual for males.

Many men with an extra X chromosome are not aware that they have it, and they lead normal lives. Males with Klinefelter syndrome may be described as XXY males or males with XXY syndrome. Klinefelter syndrome occurs in about 1 in 1,000 males.

What causes Klinefelter syndrome?

The presence of an extra X chromosome in males most often occurs when cells split unevenly to produce eggs. But it can also occur when cells split unevenly to produce sperm.

What are the symptoms?

Many men with Klinefelter syndrome do not have obvious symptoms. Others have sparse body hair, enlarged breasts, and wide hips. In almost all men the testicles remain small. In some men the penis does not reach adult size. Their voice may not be as deep. They usually cannot father children, but they can have a normal sex life.

Some boys with Klinefelter syndrome have language and learning problems.

How is Klinefelter syndrome diagnosed?

Klinefelter syndrome usually is not diagnosed until around ages 11 to 12, when boys often begin puberty. At this point, the boy’s testicles fail to grow normally and you may start to notice other symptoms.

To find out if your son has Klinefelter syndrome, your doctor will ask questions about his past health, do a physical exam, and order a chromosome test called a karyotype.

How is it treated?

Males with Klinefelter syndrome can be given testosterone, a hormone needed for sexual development. If treatment is started around the age of puberty, it can help a boy have more normal body development.

Speech therapy and educational support can help boys who have language or learning problems.