My Penis Stuff

Why It Is Used

An antiandrogen is often added to luteinizing hormone-releasing hormone (LH-RH) agonist therapy to prevent a rise in testosterone at the beginning of LH-RH agonist therapy. (The rise in testosterone can cause a tumor flare with bone pain, urinary blockage, or other symptoms of rapid cancer growth. But this growth does shrink over time.)

Antiandrogens can be used along with surgery to remove the testicles (orchiectomy).

Antiandrogens are often used in combination with other hormone therapy to block the supply of testosterone. This is done to slow the growth of advanced prostate cancer and ease severe bone pain caused by the spread of cancer to the bones.

How Well It Works

Antiandrogen therapy is not an effective treatment for advanced prostate cancer by itself. But it does help other treatments work better.

Antiandrogen treatment after surgery to remove the prostate (radical prostatectomy) can slow the growth of cancer near the prostate and can increase survival.

Antiandrogen treatment for 2 to 3 years after radiation therapy increases survival for some men who have advanced prostate cancer.

Side Effects

Side effects from antiandrogen treatment may include:

• Nausea.
• Breast enlargement (gynecomastia).
• Diarrhea.
• Low red blood cell count (anemia).
• Decreased sex drive.
• Erection problems.
• Liver problems. Some cases of serious liver problems have been reported.

Long-term treatment with antiandrogens may cause osteoporosis, which causes bones to become brittle and break more easily. Your doctor may prescribe a bisphosphonate medicine. Zoledronic acid is specifically designed for people who are receiving treatment for metastatic cancer. In a clinical trial of men with metastatic prostate cancer, men who took zoledronic acid experienced far fewer bone fractures and less bone pain than those who did not take the drug.¹ For more information on prevention of and medication for bone thinning, see the topic Osteoporosis.

Why It Is Used

These medicines often are used by men who have moderate and bothersome symptoms of prostate enlargement and who want more than home treatment for their symptoms.

How Well It Works

Many men find a 4- to 6-point reduction in their American Urological Association (AUA) symptom index scores. Most men find this a significant improvement in their symptoms. Symptoms generally improve in 2 to 3 weeks.

Using a combination of an alpha-blocker with a 5-alpha reductase inhibitor may help your symptoms more than either medicine alone.

Side Effects

Side effects vary with the medicine and the individual. Common minor side effects of alpha-blockers include:

• Weakness or fatigue.
• Lightheadedness, dizziness, or fainting when you stand up suddenly after sitting or lying down. This may occur if your blood pressure becomes low when you stand up suddenly (postural or orthostatic hypotension).
• Headaches and nasal congestion.

Medicines used to treat erection problems, such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis), may make these side effects worse.

Alpha-blockers may cause ejaculation of semen into the bladder (retrograde ejaculation) instead of out through the penis. This is not harmful.

These side effects go away when the medicine is stopped.

Why It Is Used

These medications may be used to treat symptoms of chronic prostatitis/pelvic pain syndrome, noninflammatory, a type of prostatitis, when muscle tightness and spasms are suspected to be the cause of symptoms and pain. Muscle tightness and spasms may force urine into the prostate, causing irritation that leads to prostatitis.

These medicines are approved by the U.S. Food and Drug Administration (FDA) for treating symptoms of benign prostatic hyperplasia (BPH), which may be caused by muscle spasms in the bladder neck or in the prostate. Although these medicines have not been approved by the FDA for the treatment of prostatitis, your doctor may prescribe one of these medicines to treat your prostatitis.

How Well It Works

Most men who take alpha-blockers for prostatitis have fewer symptoms, but it takes awhile for the medicine to give results. Alpha-blockers work best in men who haven’t already tried many different kinds of medicines for prostatitis and who have moderate to severe symptoms.

Side Effects

Alpha-blockers can reduce blood pressure to less than normal. This can result in lightheadedness, especially when you stand up abruptly after sitting or lying down (postural hypotension).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Why It Is Used

5-alpha reductase inhibitors are not recommended for men with BPH symptoms without a noticeably enlarged prostate. 5-alpha reductase inhibitors may be prescribed for men who have bothersome, moderate symptoms of BPH.

How Well It Works

Most men who use 5-alpha reductase inhibitors report about a 3-point decrease in their American Urologic Association (AUA) symptom index. This change represents a noticeable improvement in symptoms. 5-alpha reductase inhibitors also decrease the risk of complications, such as being unable to urinate (urinary retention), and make it less likely that you will need surgery.

It may take up to 6 to 12 months before symptom improvement is noticeable.

Early studies indicate that dutasteride is as effective as finasteride in reducing BPH symptoms. But no direct comparisons of treatment with dutasteride versus finasteride have yet been made.

Using a combination of an alpha-blocker with a 5-alpha reductase inhibitor may help your symptoms more than either medicine alone.

Side Effects

5-alpha reductase inhibitors appear to be very safe and well tolerated. Side effects found in the first year of use included:

• Decreased sex drive.
• Increased ejaculatory dysfunction (such as a smaller amount of semen ejaculated).
• Difficulty getting an erection.
• Breast tenderness or enlargement.

One large study reported that after 1 year of treatment, finasteride resulted in the same level of decreased sex drive and inability to get an erection as a placebo. In the same study, the risk for ejaculatory dysfunction was higher with finasteride.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

How To Prepare

Blood or urine tests

You do not need to do anything before having a blood or urine test.

Nocturnal penile tumescence (NPT) test

Do not take any medicines that cause an erection, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), before the test.

Do not drink alcohol or take sleeping pills for 2 days before you have a nocturnal penile tumescence (NPT) test. The alcohol and the pills can change your deep (REM) sleep time, which can affect nocturnal erections.

Intracavernosal injection test

If you are having an intracavernosal injection test, tell your doctor if you:

• Are allergic to any medicine.
• Have any bleeding problems or are taking blood-thinning medicine, such as aspirin or warfarin (Coumadin).
• Have ever had an erection lasting more than 4 hours (priapism).

Doppler ultrasound

You may be asked to avoid products that contain nicotine (cigarettes, chewing tobacco) for 30 minutes to 2 hours before the test.

How It Is Done

Nocturnal penile tumescence (NPT) test

It is helpful if you wear briefs-type underwear (not boxer shorts) with a fly front when you are ready for bed. Put your penis through the fly front and keep your pubic hair inside the underwear out of the way. Put the device around your penis. After you put the device on , carefully put your penis inside your underwear.

The types of devices you can use include:

• Snap gauge. A snap gauge is a ringlike device made up of plastic films that fit around the penis. The films break at certain pressures. A snap gauge will break during an erection. It can also tell how firm the penis became during the erection. This test is usually done 2 or 3 nights in a row.
• Electronic devices. Electronic devices measure changes in the fullness of the penis. The devices have one or more elastic loops that fit around the penis. These are hooked to a small unit that records changes as the loops are stretched. These devices are expensive and may mean you need to stay overnight at a sleep study laboratory.

Intracavernosal injection test

The intracavernosal injection test is generally done by a urologist in the office or clinic. For the test, you will need to take off all of your clothes below the waist, and you will be given a cloth or paper gown to use.

While you sit or stand, your penis will be cleaned with a special soap. Then, your doctor will inject a medicine into the base of your penis with a small needle. After the medicine is injected, your doctor may massage the penis for a few seconds to help spread the medicine in the penis. Some doctors may use a band that is gently tightened around the base of the penis for 5 minutes after the medicine is given to make sure an erection occurs.

A low dose of the medicine is used at first. If the low dose does not cause an erection, then a larger dose may be used. An erection should occur within 5 to 10 minutes after the medicine is given.

The medicine may also be given in a thin tablet that is put in the urethra.

After the medicine is given, you may be asked to watch sexually stimulating movies or to massage your penis to cause an erection. Your doctor will measure how rigid and how long the erection lasts. After the test, your doctor may inject a second medicine to make sure your erection goes away.

Doppler ultrasound

The Doppler ultrasound test is done by a urologist or ultrasound technician.

You will lie down on an examination table. Your doctor may need to inject a medicine or use a soft band around the penis to cause an erection to see blood flow through the vessels.

How It Feels

Nocturnal penile tumescence (NPT) test

A nocturnal penile tumescence (NPT) test does not cause any discomfort, but you may feel embarrassed about doing the test. Remember that it is important to find the cause of your inability to have an erection and you do not need to feel embarrassed about the test.

Intracavernosal injection test

During the intracavernosal injection test, you will feel a sharp, stinging pain at the base of your penis from the needle. If you feel a burning or aching pain during the erection, tell your doctor immediately.

Doppler ultrasound

The ultrasound does not cause any pain. If you get a medicine or device during the test to cause an erection, you may feel embarrassed and the shot may hurt.

Risks

There is very little chance of problems from having blood drawn from a vein for blood tests. You may get a small bruise at the site. You can keep pressure on the site for several minutes after the blood test to prevent bruising.

There are no problems from collecting a urine sample.

Nocturnal penile tumescence (NPT) test

There are no problems from having the nocturnal penile tumescence (NPT) test.

Intracavernosal injection test

The intracavernosal injection test has a small chance of causing:

• Bleeding at the injection site.
• Bruising or swelling around the injection site.
• An erection that lasts for 4 or more hours. This condition, called priapism, is a rare side effect of some medicines used for this test. If priapism occurs, it usually can be reversed using another medicine.

Doppler ultrasound

There are no problems from an ultrasound test. If a device is used to cause an erection, you may have some mild discomfort. If a shot of medicine is used, you have the same chance for problems as the intracavernosal injection test.

Results

Tests for erection problems can help find a cause for a man’s problem in having or maintaining an erection (erectile dysfunction or impotence).

Tests for erection problems may include blood tests for testosterone, luteinizing hormone, prolactin, and thyroid hormone. A urine test, complete blood count, blood sugar level and cholesterol and triglyceride levels may also be done.

Nocturnal penile tumescence (NPT) test

An erection has likely occurred if:

• One or more films on the snap gauge have broken.
• The electronic device has recorded an increase in penis size.

An erection has likely not occurred if:

• None of the films on the snap gauge have broken.
• The electronic device has not recorded an increase in penis size.

The test is more accurate if repeat tests show the same results.

Intracavernosal injection test

An erection caused by intracavernosal injection is usually measured on a scale of 0 to 4, with a full erection measuring a 4.

• If the test causes an erection with a value of 3 or 4, it is likely that your erection problems do not have a physical cause.
• If the test causes an erection with a value of 0 to 2, your erection problems may have a physical cause.

Doppler ultrasound

The ultrasound can show if you have blood flow problems as the cause of your erection problems.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

• Anxiety or pain while having the intracavernosal injection test.
• Sleep problems or the use of sleeping pills.
• The use of tobacco, alcohol, or illegal drugs.

What To Think About

• For more information on the lab tests done for erection problems, see the medical tests Urine Test, Complete Blood Count (CBC), Blood Glucose, Cholesterol and Triglycerides Tests, Testosterone, Prolactin, and Thyroid Hormone Tests.
• Your doctor may do a digital rectal examination to check your prostate gland. For more information, see the medical test Digital Rectal Examination (DRE).
• Doppler ultrasound may not be widely available. For more information, see the medical test Doppler Ultrasound.
• Occasional erection problems are normal. If you are usually able to have and maintain a full erection, tests are usually not needed. Your erection problem may be from stress or anxiety or relationship problems.
• Psychological tests may be recommended if no physical cause is found for your erection problem. You may want to see a counselor who specializes in sexual problems.
• An angiogram may be recommended if initial tests cannot find a cause for your erection problems. An angiogram is an X-ray test that takes pictures of the blood flow in an artery. For more information, see the medical test Angiogram. Experts are not sure how useful the angiogram test is because treatment to repair the blood vessels of the penis will be a choice for only a few men with this specific problem.
• Dorsal nerve conduction test, evoked potential studies, and penile biothesiometry are extensive neurologic tests to check the nerve supply to the penis. These nervous system tests are not generally done or are not widely available.

Why It Is Done

Testicular ultrasound is done to:

• Evaluate a mass or pain in the testicles.
• Identify and monitor infection or inflammation of the testicles or epididymis.
• Identify twisting of the spermatic cord cutting off blood supply to the testicles (testicular torsion).
• Monitor for recurrence of testicular cancer.
• Locate an undescended testicle.
• Identify fluid in the scrotum (hydrocele), fluid in the epididymis (spermatocele), blood in the scrotum (hematocele), or pus in the scrotum (pyocele).
• Guide a biopsy needle for testicular biopsy when testing for infertility.
• Evaluate an injury to the genital area.

How To Prepare

No special preparation is needed for a testicular ultrasound.

If you are having a biopsy or another test during the ultrasound, you may need to sign a consent form.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will indicate.

How It Is Done

A testicular ultrasound is usually done by an ultrasound technologist. It is done in an ultrasound room in a doctor’s office or hospital.

You will need to remove all your clothes from the waist down and put on a gown before the test. You will be asked to lie on your back on a padded examination table. Folded towels will be used to cover the penis and lift the scrotum. A gel (such as K-Y Jelly) will be spread on your scrotum for the transducer. The transducer is pressed against your skin and moved across your scrotum many times.

You will need to lie very still during the ultrasound scan. You may be asked to take a breath and hold it for several seconds during the scanning. Testicular ultrasound takes about 20 minutes.

When the test is finished, the gel is removed from your skin. You may be asked to wait until the radiologist has reviewed the information. The radiologist may want to do additional ultrasound views.

How It Feels

The gel may feel cold when it is applied to your scrotum unless it is first warmed to body temperature. You will feel light pressure from the transducer as it passes over your scrotum. If the ultrasound test is being done to determine the extent of damage from a recent injury or to investigate testicular pain, the slight pressure of the transducer may be somewhat painful. You will not hear the sound waves.

If a biopsy is done during the ultrasound, you may experience slight discomfort when the sample is obtained.

Risks

There are no known risks associated with a testicular ultrasound test.

Results

A testicular ultrasound (sonogram) is a test that uses reflected sound waves to produce a picture of the testicles and scrotum.

What Affects the Test

Factors that can interfere with your test or the accuracy of the results include:

• Not being able to remain still during the test.
• Having an open sore or wound in the area that needs to be viewed.

What To Think About

• Testicular ultrasound is usually done to evaluate a mass or pain in the testicles for possible cancer. Young men with a testicular mass or pain should be evaluated immediately by a doctor. Testicular cancer is the most common cancer in young men.
• With testicular ultrasound, your doctor can usually tell the difference between a fluid-filled cyst, a solid lump, or another type of mass.
  • A fluid-filled mass that has a symmetrical shape and does not have particles floating in it is likely to be a cyst.
  • A mass that does not have fluid, one that has fluid with floating particles (atypical cyst), or one that is larger than expected needs further evaluation. Often a follow-up ultrasound is done in 6 to 8 weeks to allow time for the mass to go away on its own.
  • If a solid lump or an atypical cyst is present and a testicular ultrasound cannot determine whether it is cancer, a biopsy may be recommended.

Why It Is Done

A testicular scan is done to:

• Determine the cause of a painful, swollen testicle.
• Assess the damage to the testicles caused by an injury.
• Assess the flow of blood within the testicles.

How To Prepare

No special preparation is needed for a testicular scan.

You may be asked to sign a consent form before the test. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will indicate.

How It Is Done

A testicular scan is usually done by a nuclear medicine technologist. The scan pictures are usually interpreted by a radiologist or nuclear medicine specialist.

You will need to remove any jewelry that might interfere with the scan. You may need to take off all or most of your clothes, but you will be given a cloth or paper covering to use during the test.

The technologist cleans the site on your arm where the radioactive tracer will be injected. A small amount of the radioactive tracer is then injected.

You will lie on your back on a table and your penis will be taped to your abdomen to prevent it from interfering with the scan. A sling or towel may be used to support the testicles under the scanner. After the radioactive tracer is injected, the camera will scan for radiation released by the tracer and produce pictures of the tracer in your testicles. Two scans are done about 15 minutes apart. You need to lie very still during each scan to avoid blurring the pictures. The camera does not produce any radiation, so you are not exposed to any additional radiation while the scan is being done.

A testicular scan takes about 45 minutes.

How It Feels

You may feel nothing at all from the needle puncture when the tracer is injected, or you may feel a brief sting or pinch as the needle goes through the skin. Otherwise, a testicular scan is usually painless. You may find it uncomfortable to remain still during the scan, especially if your testicles are sore. Ask for a pillow or blanket to make yourself as comfortable as possible before the scan begins.

Risks

Allergic reactions to the radioactive tracer are rare. Most of the tracer will be eliminated from your body (through your urine or stool) within a day, so be sure to promptly flush the toilet and thoroughly wash your hands with soap and water. The amount of radiation is so small that it is not a risk for people to come in contact with you following the test.

Occasionally, some soreness or swelling may develop at the injection site. These symptoms can usually be relieved by applying moist, warm compresses to your arm.

There is always a very slight risk of damage to cells or tissue from being exposed to any radiation, including the low level of radiation released by the radioactive tracer used for this test.

Results

A testicular scan uses a camera to take pictures of the testicles after a radioactive tracer accumulates in testicular tissues (nuclear medicine test). The results of a testicular scan are usually available within 2 days. In an emergency, results can be available within an hour.

What Affects the Test

The results of a testicular scan may not be accurate if you cannot remain still during the test.

What To Think About

• Testicular ultrasound has largely replaced testicular scans to investigate possible testicular torsion or tumors in the testicles.
• Abnormal results from a testicular scan may be further investigated by other tests, such as a testicular biopsy, an ultrasound test, or X-ray tests.
• If a testicular scan is done for a young boy, a parent can accompany him while the test is being done.

Why It Is Done

Testicular examination

A testicular examination may detect the causes of pain, inflammation, swelling, congenital abnormalities (such as an absent or undescended testicle), and lumps or masses in the testicles.

Testicular self-examination (TSE)

Testicular self-examination (TSE) is done to familiarize a man with the normal size, shape, and weight of his testicles and the area around the scrotum. This allows him to detect any changes from normal.

How To Prepare

No special preparation is needed before a testicular examination by your health professional. However, for comfort, you should empty your bladder ahead of time. You will be asked to undress and put on a hospital gown.

Testicular self-examination (TSE) is painless and takes only a minute. It is best performed after a bath or shower, when the scrotal muscles are warm and relaxed.

How It Is Done

Testicular examination

The examination may be done initially while you are lying down, then repeated while standing. Your health professional will inspect your abdomen, groin, and genital area (penis, scrotum, testicles). The scrotum and both testicles will be felt (palpated) for their size, weight, texture, and consistency and for physical signs of swelling, lumps, or masses. The absence of one testicle usually indicates an undescended testicle. Shrinking (atrophy) of one or both testicles will also be noted.

If a mass is found in a testicle, your health professional will place a strong light behind the testicle to determine whether light can pass through it (called transillumination). A testicular tumor is too solid for light to pass through it. Also, a testicle with a tumor generally appears heavier than a normal testicle. A palpable mass or swelling caused by a hydrocele will allow light to pass through it. A hydrocele feels like water in a thin plastic bag. The other testicle also will be felt and examined to make sure it does not contain any lumps, masses, or other abnormalities.

Your health professional will also feel the lymph nodes in your groin and along your inner thigh for signs of enlargement.

Testicular self-examination (TSE)

TSE is best performed after a bath or shower, when the scrotal muscles are warm and relaxed. If you do the exam at another time, remove your underwear so that your genitals are exposed. See a picture of testicular self-examination.

Stand and place your right leg on an elevated surface about chair height. Then gently feel your scrotal sac until you locate the right testicle. Roll the testicle gently but firmly between your thumb and fingers of both hands, carefully exploring the surface for lumps. The skin over the testicle moves freely, making it easy to feel the entire surface of the testicle. Repeat the procedure for the other side, lifting your left leg and examining your left testicle. Feel the entire surface of both testicles.

How It Feels

A testicular examination by your health professional may cause mild discomfort if your testicles are painful, swollen, or inflamed. Whenever the genital area is touched, there is a possibility your body will react, and you may have an erection. This is a normal response that your health professional is aware of and you do not need to feel embarrassed.

Generally, there is no pain or discomfort associated with a testicular self-examination (TSE) unless a testicle is swollen or tender. A cancerous lump usually is firm to the touch and usually is not tender or painful when pressed.

Risks

There are no risks associated with a testicular examination or testicular self-examination (TSE).

Results

Testicular examination and testicular self-examination (TSE) are two different methods to detect lumps or abnormalities of the testicles.

If you cannot feel both testicles in your baby’s scrotum (descended), talk to his doctor.

What Affects the Test

There are no factors that interfere with a testicular examination or testicular self-examination (TSE).

What To Think About

• Undescended testicles may be a risk factor for testicular cancer. Parents should check their children or have them checked by a health professional to be sure that both testicles have descended properly before puberty.
• Expert recommendations on testicular examinations:
  • The American Cancer Society recommends that all men between the ages of 15 and 40 have a testicular examination as part of a regular physical examination by their health professional. However, ACS does not recommend regular self-examinations for men who do not have risk factors for testicular cancer.
  • The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for testicular cancer in teen and adult men who have no symptoms of cancer. The USPSTF recommends that men who have an increased risk of developing testicular cancer talk to their health professional about regular screening.