andrological visit

Understanding the Process: How Does a Andrological Visit Happen

Visiting an andrologist can be an intimidating experience, especially if you’re unsure about what to expect. however, understanding the process can alleviate any anxiety you may have. in this article, we’ll guide you through the typical steps of an andrological visit, from scheduling to follow-up..

Scheduling the Appointment

The first step in the process is scheduling your appointment. You can do this by calling the andrology clinic or using their online booking system. Make sure to mention any specific concerns you have to allow the clinic to allocate sufficient time for your visit.

Completion of Medical History Form

Upon arrival at the clinic, you will be provided with a medical history form to complete. This form includes questions about your medical history, previous surgeries, any medications you are currently taking, and any symptoms you may be experiencing. Be thorough and honest when filling out the form to help your andrologist get a complete picture of your health.

Consultation with the Andrologist

Once you have completed the form, you will be called in for a consultation with the andrologist. During this initial discussion, you will have the opportunity to discuss your concerns and ask any questions you may have. The andrologist will be attentive and will provide valuable insights and recommendations based on your specific situation.

Physical Examination

Following the consultation, the andrologist may conduct a physical examination to further assess your condition. This examination could involve assessing the external genitalia, checking for any physical abnormalities, and evaluating your overall health. It is important to remember that these examinations are routine and conducted in a professional and respectful manner.

Diagnostic Tests

Based on the initial consultation and the physical examination, the andrologist may recommend diagnostic tests to gather more information about your condition. These tests could include blood work, semen analysis, or ultrasounds, depending on your specific situation. The andrologist will explain the purpose of each test and any preparation needed.

Discussion of Test Results and Treatment Plan

Once the test results are available, you will have a follow-up appointment with the andrologist. During this visit, the andrologist will discuss the test results in detail and provide a comprehensive explanation of your diagnosis. They will then propose a treatment plan tailored to your specific needs and discuss any considerations or potential risks associated with the recommended treatment.

Follow-Up and Continued Care

After starting the treatment, regular follow-up appointments will be scheduled to assess your progress and make any necessary adjustments to ensure the best outcome. The andrologist will monitor your response to treatment and address any concerns or questions you may have throughout the process. Open communication and adherence to the recommended treatment plan are crucial for a successful outcome.

In Conclusion

Understanding the process of an andrological visit can help alleviate any apprehension you may have. By providing a step-by-step breakdown of the typical visit, we hope you feel more prepared and empowered to take control of your health. Remember, an andrologist is there to provide expert care, answer your questions, and support you on your journey to optimal health.

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Basic diagnostics in andrology

Affiliation.

• 1 Clinic and Polyclinic for Dermatology, Venereology and Allergology, University Hospital Leipzig AöR and Leipzig Medical School of the University of Leipzig, Germany.
• PMID: 23957479
• DOI: 10.1111/ddg.12177

Basic andrological diagnosis consists of taking the patient's medical history and the couple's history as well as performing a physical examination including genital ultrasound, spermiogram, and hormonal analysis. If needed, a testicular biopsy and genetic testing may also be performed. Recent studies have shown the effect of lifestyle factors on male fertility. Thus, the patient history and clinical/andrological examinations have been broadened to include information on metabolic disorders like obesity and diabetes mellitus. The biggest changes occurred with the publication of the fifth edition of the WHO laboratory manual in 2010 and the introduction of a section on semen analysis in the German Medical Association guidelines (RiliBÄK). The reference values for almost all spermiogram parameters were adapted in an evidence-based approach using worldwide prospective population studies. For central parameters such as sperm motility and morphology, the assessment criteria were changed. New independent markers such as sperm DNA fragmentation rate are now routinely used in clinical diagnosis. For German andrological laboratories, there are now mandatory quality assurance measures for semen analysis (in the German "Rili-BÄK" guidelines). These include duplicate testing of all standard semen parameters and inter-laboratory comparison at regular intervals.

© The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin.

• Andrology / methods*
• Erectile Dysfunction / diagnosis*
• Infertility, Male / diagnosis*
• Medical History Taking / methods*
• Physical Examination / methods*
• Semen Analysis / methods*

• Medical Reports

• The andrological examination

WHO IS THE ANDROLOGIST SPECIALIST?

The andrologist is the specialist who deals with typical male health problems and can be considered the counterpart of the gynaecologist in the field of female health. The andrology specialist can be either an endocrinologist , in which case he/she deals more with the medical aspects of andrology, or a urologist, in which case he/she deals more with the surgical aspects of the branch.

WHY AN ANDROLOGICAL EXAMINATION?

The andrological examination is a common specialist examination , assessing male health in its totality and complexity, while focusing specifically on the male genital and reproductive system. The andrologist's focus is on disorders of the male genital system, both pertaining to dysfunctions and malformations, including infections, tumours and other conditions.

WHEN IS AN ANDROLOGICAL EXAMINATION NECESSARY?

An andrological examination should certainly be carried out whenever there is suspicion of pathologies of the male genital and reproductive system to verify their actual existence and to undertake any specific treatment.

However, on the other hand, an andrological examination should also be scheduled routinely, even without specific pathologies, at different stages of a male's life.

WHY IS IT IMPORTANT?

An andrological check in childhood allows to ascertain the normal development of the external genitalia , in particular the size and conformation of the penis as well as the regular position of the testicles in the scrotal sac and their palpatory integrity in relation to the prepubertal period.

A second important moment of evaluation is the pubertal development period to verify the correct start of the pubertal process and its completion with the achievement of a typical adult testicular volume. In this age group it is also important to meet with the andrologist for education on the testicular self-examination, an easy to perform, completely painless procedure that allows the early identification of any irregularities of the scrotal organs, including testicular lumps.

Moreover, the interview with the andrologist can be useful to answer the questions of the teenager who often does not know whom to ask about genitals and sexuality and who often turns to his peers or to the web, perhaps collecting inaccurate and misleading information. The andrologist will also teach/recommend any virtuous behaviour he or she should adopt in their approach to sexual life to avoid contracting sexually transmitted diseases potentially harmful to the genital health and future fertility.

Andrological evaluation is certainly also useful in adulthood and old age for the assessment of risks related to these specific ages or in relation to fertility in the young adult male. The andrologist can, once again, recommend correct behaviour to promote/preserve male health and counteract risk factors (smoking, obesity, abuse of anabolic substances, drug abuse, excessive alcohol consumption, and so on).

WHAT PATHOLOGIES AND PROBLEMS DOES THE ANDROLOGIST DIAGNOSE?

As mentioned above, the andrologist deals with male health in its complexity and comprehensiveness. In particular, the andrologist will diagnose, treat and monitor the following male health conditions over time:

• alterations in genital and/or pubertal development;
• shortness of the frenulum;
• erectile dysfunction;
• sexual desire disorders;
• ejaculation disorders (early or late);
• preputial phimosis/paraphimosis;
• "plastic 'penile induratio' or La Peyronie's disease;
• infections of the male genital organs;
• male infertility;
• prostatic hypertrophy;
• testicular infections/inflammations;
• infection/inflammation of the epididymis;
• micropenis;
• curved penis;
• prostatitis;
• testicular tumours;
• varicocele.

HOW DOES THE ANDROLOGICAL EXAMINATION TAKE PLACE?

The andrological examination is carried out according to the normal procedures of a specialist examination.

The first part of the examination, or anamnesis, consists of an interview with the patient in order to find out the reason for the visit and to acquire valuable data on his or her previous history, with particular attention to concomitant pathologies, his family history, his lifestyle habits, any current therapies, and his sexual health.

This is followed by the physical examination, which consists of the classic medical examination in which the general info is assessed, including weight, height, waist circumference, any malformations and also the degree of virilisation, with reference to specific tables.

The andrologist will then focus on an objective examination of the genitals assessing the size, shape and development of the penis, testicles, epididymis and vas deferens. In some cases, according to the andrologist's judgement and more frequently as the patient gets older, the prostate gland may also need to be evaluated by digital rectal examination. This manoeuvre, which lasts only a few seconds, does not cause pain but only a slight sensation of discomfort which is easily tolerated.

The examination then continues with a review of any blood or instrumental tests brought to the patient's attention. If the patient has not undergone any in-depth diagnostic tests, or if the andrologist considers it useful to request specific diagnostic tests or additional investigations to those already performed, he will prescribe them.

The andrologist may also request, as part of a multidisciplinary assessment, the evaluation of other specialists (e.g., dietician, cardiologist, geneticist, urologist, endocrinologist, diabetologist, paediatrician, psychosexologist, surgeon, and so on).

The examination will end with the report by the specialist and any therapeutic prescriptions that are explained to the patient.

REPRODUCTIVE AND PUBERTAL DEVELOPMENT DISORDERS AT AUXOLOGICO

The Auxologico Reproductive and Pubertal Development Disorders Centre has a highly specialised team that can accommodate and satisfy all diagnostic and therapeutic requests relating to pathologies of pubertal development, sexual health and reproduction in both males and females.

UROLOGY AND ANDROLOGY AT AUXOLOGICO

The clinical and surgical activities of Urology and Andrology at Auxologico aim to offer the best diagnostic and therapeutic standards of urological and andrological diseases with the creation of programmes dedicated to individual and specific clinical conditions and patient pathologies.

Outpatient activities are carried out at all Auxologico sites, where all the diagnostic imaging equipment (traditional radiology, magnetic resonance imaging, CT scans and ultrasound scans) needed for the correct diagnostic assessment is also available. 

And there is also, unique for Italy, a Urogenetics Service dedicated to the prevention of prostate cancer in individuals with a family history of this disease.  Finally, innovative diagnostic tests are performed, such as RM fusion prostate biopsy and the examination of circulating tumour cells in the blood. 

The Uro technologies Centre also carries out surgery using advanced, minimally invasive technologies and procedures, which have unquestionable advantages such as reducing invasiveness and pain, shortening convalescence times, and guaranteeing superior results to traditional surgery. 

Surgery is carried out at the Capitanio Hospita l , in the centre of Milan, with an attentive assistance of patients in the pre- and post-operative phases and dedicated rehabilitation programmes. 

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Varicocele is a disorder characterized by an alteration of the venous testicular circulation that involves damage to the testicular function.

It is a very common disease that affects approximately 15 to 20% of males. This disorder bears great social significance because of its frequency and also for the consequences it incurs: it is the leading cause of infertility, not only for men, but also for the entire couple (putting together the causes of male and female infertility).

In this situation, the varicocele is treated only after analyzing the symptoms in details, starting from the general information, the initial symptoms, signs of recognition, relationship with the couple’s infertility, possible effects of varicocele on the declination of testosterone hormones and on the erection disorders and the surgical methods for varicocele. Antegrade Scrotal Sclerotherapy and Microsurgical Ligation are described in details, using photos of the actual conduct of surgical operations. The point is explained with the help of guidelines, international bibliographical references and personal studies of Dr. Maio recently published in national and international conferences.

The testicular or spermatic veins have a long course upwards, up to the vicinity of the kidneys and are provided with one-way valve mechanisms that prevent the blood, little by little as it reaches to stagnate at the bottom around the testicle. If there are any predisposing conditions (like absence of valves, course, and/or abnormal outlet of the veins, multiplicity or increased length of the same in young long-limbed persons), one can determine a reflux (reverse flow) within the venous system. Anatomical Diversity facilitates the formation of varicocele on the left; it rarely manifests itself on the right, it is bilateral by approx 15%. 

The wearing out of the veins involves a pooling of blood around the testicle, an increase in temperature and a slowdown in metabolisms of the gonad itself, which in the long run, causes irreversible changes resulting in the possible impairment of fertility. 

The treatment of varicocele is the interruption of the reflux. There are several surgical methods of refluxing veins ligation at the sub-groin level, groin level or further up in retroperitoneum (the latter also laparoscopically), each with its own advantages and disadvantages. However, unfortunately, with any type of treatment, failures are also possible. For this reason, in the past 15 years there have been developed sclerotherapy techniques which have the advantage of being less invasive, executable under local anesthesia and, thus, in Day Hospital. These methods have been perfected by us and integrated with each other according to the need, in order to customize the treatment to obtain the best results with minimal invasiveness.

The varicocele is a major cause of male infertility and appears at the onset of puberty. It is a very common situation, since about 15-20% of all the children aged 14-15 years and above are the potent carriers.

Having a varicocele does not necessarily mean to be undergoing surgery.   About 60% of all Varicoceles which are highlighted at school screenings are not so important as to undergo treatment, at least during adolescence.

Since the incidences of varicocele is very high, exceeding that of male infertility (there are many men with varicocele who have children), and since the age of 18 is not justified to perform the examination of the seminal fluid (Sperm analysis) to evaluate fertility, just those cases where some major forms have been developed are treated during adolescence and are therefore more at risk of developing future infertility. The rest are monitored in time and treated just in case the condition worsens.

F.A.Q. Varicocele

How can you realize that you have varicocele.

Cases of Varicoceles bearing particular relevance are visible and palpable like in the case of varicose veins of the legs. As in this case, the situation becomes much more evident if one stands-up. By palpating funiculars structures, over the testicle while standing and by exercising an abdominal contraction (like when you blow or you go against the body), the expansion in the volume of these veins becomes evident. This is the expression of reflux in the spermatic vein system which is more evident in the standing position and during the abdominal contraction. The subjective relief of a situation of this kind is, almost always, an expression of the presence of a varicocele. It is not, however, quite the contrary, since in the most modest forms it may also escape in a medical examination, so much that, in case of suspicion, pain or infertility, further investigations are recommended like the Doppler or eco-color- doppler.

As for those where action is required, please note that currently we have alternative methods to the classic surgery which are equally valid, but much less invasive, treatable under local anesthesia wherein the patient gets discharged after a few hours only.

What constitutes of an andrological visit?

It is a simple examination of the genital apparatus that is typically performed either by standing or by lying down and lasts for a few minutes only without any hint of pain. Many kids refuse to pay the andrological visit, because they do not experience any trouble and the problem at the time does not interest them or merely because they feel embarrassed. It must be stressed that, at least in youngsters, the symptoms such as pain in the testicle, feeling of heaviness or discomfort associated with the Varicoceles are quite rare and the discovery of this disorder usually happens during a visit to a general physician, a sports doctor or during a a called-up visit. At least 90% of young people suffering from Varicoceles were examined with the disease during the school screening, while they were completely unaware of carrying the disease. Moreover, we must remember that the testicle has two functions: one is to produce hormones ( Testosterone ) which serve for the purpose of sexual development and sexual desire, the other is to produce spermatozoa ( spermatogenesis ), the cells necessary for fertilization of women. The alterations that occur in the Varicoceles are mainly concerned with the spermatogenesis. This means that a man can be superpowerful in terms of performance in sex, but quite unaware, he may have reduced reproductive capacity. Finally, it should be added that if the shame could be considered as a normal expression among the teenagers, the same attitude is also expected from other as well. In both the cases, making an andrological visit proves to be useful to clear any doubts or concerns about their genital apparatus. In fact, if Varicoceles is one of the most frequently encountered andrological problem, visits to the medical experts during adolescence gives accurate information on the changes of the genital apparatus during the development of puberty.

Andrologist

Andrology is the branch of medicine that studies the man and can be considered the male counterpart to gynecology .

What does an andrologist do?

An andrologist deals with male health problems , focusing mainly on disorders of the reproductive tract, from dysfunctions through infections, tumors, and other diseases.

What diseases are treated by an andrologist?

Among the diseases and disorders most often treated by an andrologist include erectile dysfunction , premature ejaculation , genital infections , male infertility , frenulum breve , phimosis foreskin , curved penis , peyronie , testicular tumors , and prostatic hypertrophy .

What are the procedures used by an andrologist?

In addition to collecting the medical history of the patient, an andrologist performs a physical examination , assessing not only the male genitalia but the whole body. Typically the doctor will inspect the penis and testicles by touch, and also examine the base of the penis where blood flows in the vessels, the nerve reflexes and their sensitivity. The specialist may also perform a prostate examination depending on the patient. After the visit an andrologist may prescribe further tests such as blood tests with hormonal assays, urinalysis, urine culture, semen examination, doppler ultrasound of the testicles or penis, transrectal ultrasound of the prostate, testing of drug-induced erections, and nocturnal penile tumescence (NPT). The doctor can prescribe drugs if needed to treat the case, or address the problem with a surgical procedure .

When should a patient visit an andrologist ?

A visit to an andrologist is recommended when the patient is experiencing symptoms such as itching or pain in the genitals , redness or spots , swellings of the testicles , bending or shortening of the penis , breast enlargement or any indication of a prostate problem . An andrologist can also help in cases of genital trauma , and when the patient is unable to conceive a child. It is recommended to conduct a visit every year after the age of 15 .

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Basic and Clinical Andrology is an open access journal within the domain of andrology, covering all aspects of male reproductive and sexual health in humans and animal models. The journal aims to bring to light the various clinical advancements and research developments in andrology from the international community. 

Basic and Clinical Andrology is a continuation of the French journal Andrologie and is the official journal of the French Society of Andrology (SALF). As an open-access journal, Basic and Clinical Andrology can ensure wide distribution and increased visibility of authors’ work. 

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ANDROLOGICAL VISIT

Have you ever done an andrological visit?

It looks like a medical difficult term, actually it is a simple and painless check done by a specialist in the prevention and diagnosis of male genital diseases, which if ignored, may impair fertility.

The first andrological visit consists of a collection of information on past and current health status of the patient, his sex life and about any symptoms. Later, during the examination, the specialist analyzes the urogenital system by palpation of penis, glands and testicles. He also assesses the genital nerve reflexes and verify if there are inflammation (infections typically cause secretions, redness, sores or rashes).

Get an andrological visit if you have these symptoms:

• if there is a important delay in pubertal development , in the body modifications typical of adolescence (hair, height, genitals);
• if genitals are too small for your age;
• if you have noticed some breast increase ;
• if you have noticed abnormal penis (curvature), difficulties in the sliding of the skin that covers it, or the opening of the foreskin to release the glans ( phimosis );
• If you think you have a varicocele (enlarged vein in the scrotum that is the “bag” that contains testicles);
• if a testicle or both are not descended into scrotum. In this case must be “lowered” surgically to prevent infertility.

Regardless of these symptoms, remember that all adolescents should get andrological visit , especially if you have sex. Physician can also give tips on contraception and how to avoid sexually transmitted infections .

If you are afraid and/or ashamed to talk about such private and intimate topics note that all doctors are bound by professional secre t .

WHO – Department of Reproductive Health and Research (RHR)

http://www.who.int/reproductivehealth/topics/en/

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Resolution of erectile dysfunction after an andrological visit in a selected population of patients affected by psychogenic erectile dysfunction

Giorgio cavallini.

Gynepro-Medical Group, Andrological Section, via Tranquillo Cremona 8, 40137 Bologna, Italy

The aim of this study was to ascertain whether some patients with psychogenic erectile dysfunction (PED) who chose psychotherapy spontaneously improved their sexual function immediately after diagnosis. Two hundred eighty-five patients with PED were retrospectively studied. Complete resolution of PED was analyzed regarding age, primary or secondary PED, marital status, domestic status, prevailing attitude of the female partner to the dysfunction, duration of their partnership, social status, duration of PED, International Index of Erectile Function score, and prevailing attitude of the patient after a diagnosis of PED. The data were analyzed using post-hoc tests. PED was resolved in 32.3% of the patients immediately after diagnosis. These patients were older, more frequently affected by secondary ED, more frequently living with their partner, and more frequently resigned or happy with the diagnosis of PED than the patients who did not resolve their PED. A nonchalant or cooperative female attitude to PED improved the possibility of PED resolution. The other variables did not influence PED resolution. Our data showed that a clear-cut diagnosis of psychogenic erectile deficiency and some psychosocial factors were critical for the management of some patients with PED.

INTRODUCTION

Psychogenic erectile dysfunction (PED) has been defined as the persistent inability (generated by psychological issues) of attaining and maintaining an erection which is sufficient to allow satisfactory sexual intercourse. 1 Treatment approaches to PED have included different types of psychological therapy and/or phosphodiesterase-5 inhibitor (PDE5i) administration. 2 , 3 We noted that several patients with PED improved their sexual function without any treatment immediately after diagnosis. The only paper found regarding this topic was published by Vickers et al . in 1993 and only involved 18 PED patients. 4 While our study involved 285 patients, the findings could be regarded as more significant.

MATERIALS AND METHODS

This was a retrospective study involving 3026 patients with erectile dysfunction (ED). It began on January 2, 2012 (when all ED patients began to routinely undergo dynamic duplex of the penile arteries in our department) and ended on December 30, 2014.

The followings were determined for each patient: anamnesis, objective examination, basal and dynamic duplex evaluation of the intracavernous alprostadil injection in cavernosal arteries of the penis (i.e., after a 10 injection), and measurement of the body mass index (BMI) (weight in kg height −2 in m), blood pressure, blood count, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), blood sugar, total and fractionated cholesterol, triglycerides, electrophoretic analysis of plasma proteins, follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), total T (tT), bioavailable T (bT), albumin, sex hormone-binding globulin (SHBG), total prostate-specific antigen (PSA), free PSA (when PSA >4 ng ml −1 ), fasting glucose and glycated hemoglobin, and urine analysis. 1 As it has been indicated, the normal peak systolic velocity (PSV) should be >35 cm s −1 . 5

Each patient and his partner separately participated in three semistructured sexological interviews (SSIs), and the International Index of Erectile Function-15 (IIEF-15) questionnaire was administered 6 in the course of each SSI. As a general rule, the author assured the patients and their partners that they were completely free to express their feelings/attitudes in the course of each session of SSI without any opinion/criticism/preconception from the part of the author.

The first SSI took place in the course of diagnostic procedure for PED. The aim of this SSI was to identify personality traits (i.e., difficulties in personal relationships, anxiety, depression, etc.) or stressful events (financial problems, couple crisis, etc.) capable of constituting risk factors for PED; the presence of coexisting sexual disorders (premature/prolonged ejaculation, dysmotphobias, etc.) and sexological history were also assessed. 2 Factors capable of increasing performance anxiety related to PED (planning sexual intercourse, comfortable conditions for sexual intercourse, etc.) 2 were also investigated. The patient and partner attitudes/feelings with regard to undiagnosed ED were studied in the course of SSI. The attitudes/feelings were investigated using the Relationship Quality Interview (RQI), a semistructured, behaviorally anchored individual interview. 7 At the end of SSI, the Author invited the patients and their partners to define their attitudes/feelings with regard to undiagnosed ED using one word.

The second round of SSIs took place when the patients and their partners returned to the outpatient clinic to undergo their first psychological interview, i.e., 1–2 weeks after the diagnosis of PED (see below). This round attempted to verify the PED resolution and the presence or the absence of ED, and collected the patient and partner attitudes regarding the diagnosis of PED. We collected the attitudes of the patients with regard to the diagnosis using RQI. The patients were invited to define their attitudes/feelings with regard to the diagnosis of PED using one word. The patients were invited to define their performance anxiety related to sexual intercourse as increased, diminished, or unchanged after the diagnosis of PED.

The third round of SSIs took place 10-12 weeks after the diagnosis of PED. Only patients who resolved their PED immediately after the diagnosis and their partners had third SSI session. This round of SSI was aimed at ascertaining whether erectile ability was still present.

Selection of the patients

The exclusion criteria were established a posteriori to obtain the population as homogeneous and as free as possible from any confounding data:

• Absence of a stable heterosexual relationship (stable relationship >1 year) (275 cases)
• Prostatic abnormalities at digital rectal examination and/or PSA >4 ng ml −1 (50 cases)
• Occasional finding of Peyronie's disease (210 cases)
• Any previous treatment for ED (452 cases)
• Peak systolic velocity (PSV) of the cavernosal arteries <35 cm s −1 after intracavernosal injection of Alprostadil 10 mg (139 cases)
• Any hormonal abnormality (69 cases)
• Any risk factors for developing ED: diabetes, hypertension, obesity, smoking or alcohol habit, drug consumption, age >50 years, metabolic syndrome, and dyslipidemia associated (639 cases) or not (101 cases) with PSV of the cavernosal arteries <35 cm s −1 after intracavernosal injection of Alprostadil 10 mg
• Situational/occasional ED (i.e., ED present only in certain circumstances/cases) (473 cases)
• Disagreement between male and female partners regarding the presence of ED (150 cases)
• Patients with PED who chose PDE5i as a therapy (see Discussion section) (195 cases: 137 did not trust psychology as a therapy for ED; 58 stated that they had no time for psychotherapy)
• Patients who refused the diagnosis of PED (35 cases)
• Patients who dropped out for unknown reasons (118 cases)
• Patients who began psychotherapy despite PED resolution after diagnosis (15 cases).

The diagnosis of PED was reached on the basis of clinical history, the first SSI, a negative objective examination, any hormonal abnormality, any risk factors for developing ED and a PSV of the cavernosal arteries <35 cm s −1 after intracavernosal injection of Alprostadil 10 mg. 1 , 2 , 5 The absence of any organic cause of ED and the diagnosis of PED were fully explained to the patients and their partners.

The patients were invited to choose between PDE5i administration, or a psychological interview and subsequent psychological therapy. The patients who chose psychotherapy were instructed to return to the outpatient clinic 1–2 weeks after the diagnosis to have their first psychological interview. This paper dealt with 285 PED patients who chose psychological therapy for their dysfunction: 104 were afraid of drugs, 133 expressed the will to resolve the psychological problem generating the PED, and 58 stated that their partner strongly disagreed with PDE5i administration. Complete resolution of ED was intended as intercourse defined by the patients and their partners as fully satisfactory and an IIEF-15 score >28. 6

Main outcome measures and statistical analysis

This paper dealt with 92 PED patients who completely resolved their ED immediately after diagnosis, and 193 PED patients who did not resolve their ED. The mean time course for complete resolution ± standard deviation was 3 ± 2 days.

Complete resolution of the PED was analyzed as a function of the following variables: primary or secondary PED, marital status (married, widowed, divorced, or involved in a stable relationship), domestic status (living or not living with the partner), prevailing attitude of the female partner to ED (aggressiveness, resignation, frustration, nonchalance, and cooperation), duration of partnership with the present partner, social status (laborer, artisan, office worker, graduate, businessman, or university student), age (in years), duration of ED (in months), and IIEF score of 15 and prevailing attitude of the patients after the diagnosis of PED (happiness due to the absence of any physical alteration, anger/frustration due to likely personal “fragility” and/or presumptive long/complicated psychological therapy, resignation regarding an unwanted diagnosis, and fear of poorly controllable/uncontrollable disease [PED]). Patient and partner attitudes were identified with SSIs and were grouped a posteriori. This research paper used post-hoc tests, i.e., the Bonferroni correction of values of the Chi-square test and the analysis of variance. 5

Table 1 presents the distribution of patients between the patients who resolved their ED completely after the diagnosis of PED and those who did not as regards the above mentioned variables. The patients who resolved their ED immediately after diagnosis were older, more frequently affected by secondary ED, more frequently living with their partner, and more frequently resigned or happy with the diagnosis of PED than the patients who did not resolve their PED after diagnosis. A nonchalant or cooperative female attitude to PED was more frequent in those couples who resolved PED immediately after diagnosis than in couples who did not resolve the PED. On the other hand, no difference occurred between patients who resolved and patients who did not resolve their PED after diagnosis in terms of marital status ( P = 0.320), IIEF-15 score ( P = 0.239), duration of PED ( P = 0.135), duration of partnership ( P = 0.342), and social status ( P = 0.311).

Clinical and demographic differences between the patients who completely resolved their PED immediately after diagnosis and patients who needed additional therapy: Age, primary or secondary PED, marital status, domestic status, social status, age, duration of ED and IIEF-15 score, prominent feeling after the diagnosis of PED, prevailing attitude of the female partner to PED, and duration of partnership with the present partner

DISCUSSION AND CONCLUSIONS

Approximately 1/3 of the patients with PED who chose to be treated with psychotherapy completely resolved their ED after diagnosis. Resolution was related to patient and partner attitudes and cohabitation. As a result of SSIs, the following data were collected. The patients who did not live with their partners stated that their sexual intercourse needed to be programmed in terms of when, where, and how long and that they felt the planning produced anxiety. This was not the case when the couples cohabitated. The patients stated that the nonchalant and cooperative attitude of their partners reduced their performance anxiety whereas frustration, resignation, and aggressiveness of their partners increased their performance anxiety. In addition, the patients who were happy or resigned after the diagnosis of PED stated that their anxiety was reduced after this diagnosis whereas the patients who were angry, frustrated, or fearful after the diagnosis stated that their performance anxiety increased after the diagnosis of PED. It should be postulated that conditions and/or feelings capable of reducing the anxiety might be associated with PED resolution.

Patients who resolved their PED immediately after diagnosis were older and more frequently affected by secondary PED than those who did not resolve their PED; the reasons are still unknown. The duration of PED, partnership, marital status, the IIEF-15 score, and the social status of the patients did not play a role in PED resolution. The reasons are unknown in this case as well. It is likely that a prospective study might be useful in resolving these obscure points, at least in part.

Our data confirmed the results of the paper published by Vickers et al . in 1993 in which 18 patients with psychogenic ED were examined. Of 14 patients with secondary psychogenic ED, 10 (71%) experienced remission after the diagnosis of psychogenic ED. Three patients noted spontaneous remission during the initial evaluation and another three experienced remissions within 3 months of completion of the evaluation and reassurance that they had normal erectile capacity. 4

This paper only dealt with patients who agreed to treat their PED psychologically since it is difficult to check PDE5i assumption after a medical prescription. In any case, the retrospective analysis of the files of the patients affected by PED revealed that 25/195 patients who chose to use PD5i stated that they had their PED improved immediately after diagnosis in the absence of the use of any of the drugs prescribed. Despite the fact that these data cannot be used for this study, they corroborate the hypothesis that a diagnosis of PED might improve sexual potency “ per se .” We established the exclusion criteria a posteriori to be able to study patients independently of any risk factor for organic ED and/or of any organic cause of ED to avoid any confounding data.

We also agree that duplex dynamic examination of the penile arteries in young patients with no risk factor for ED might be dangerous due to the possibility of prolonged erections and/or priapism; 1 , 5 however, there has been a great deal of speculation that vascular ED in young men may be due to subclinical perineal trauma in the absence of any risk factors. 8 In addition, several Italian medical internet sites ( www.medicitalia.it and www.dica33.i ) have strongly popularized penile dynamic duplex examination; thus, a number of patients insisted on undergoing dynamic duplex of the penile arteries, even though they were informed about the absence of any risk factor for arterial disease and that penile dynamic duplex might cause priapism or prolonged erection. 1 , 5 Thus, it was felt that a medical visit and diagnosis would not be fully believable for any patient regarding the absence of any vascular problem without a dynamic duplex examination of the penis and its arteries.

Regression is common among subjects with self-reported ED (regarding 25% of cases) over a period of several years. 9 Martin et al . 11 described the incidence of spontaneous remission and biopsychosocial predictors of ED and low sexual desire (SD) in 827 patients with 35-80 years of age at baseline who were examined clinically 5 years apart. ED remission was more frequent in the absence of risk factors for organic ED and in the presence of factors recognized as capable of lowering anxiety, such as living with their partner, thus confirming our data.

The main bias of this study is that the hypothesis that the spontaneous remission of PED which occurred in this study might have occurred even in the absence of a diagnosis of PED, as was the case in the patients studied by Travison et al . 10 and Martin et al . 10 However, the patients studied by Travison et al . and Martin et al . had ED remission over a period of several years while our patients had PED remission immediately after diagnosis, mainly when reassuring factors or attitudes were present. These data have allowed us to hypothesize that a diagnosis of PED played some roles in PED remission.

This was a retrospective study; thus, it was difficult to try to obtain a reliable control population. In fact, the patients’ curiosity and their right to be informed regarding their diagnosis made it impossible to obtain a suitable control population, namely patients affected by PED undergoing the investigations and assessments as listed in the Materials and Methods section of this manuscript but receiving no explanation of the diagnosis. In any case, we believe that this potential bias does not substantially modify the take-home message of this paper. In fact, our data strongly indicated that the role of the physician in patient management is critical for the achievement of sexual health; this fact is especially important in an era, such as this one, where the Internet and the industrial pressure to sell PDE5i tend to relegate physicians to a secondary role.

AUTHOR CONTRIBUTIONS

GC is the sole author of this manuscript: he visited all the patients, reviewed their files, performed statistical analysis, and wrote and reviewed the paper.

COMPETING INTERESTS

The author declares no competing interests.

Scope and Goals of Andrology

• First Online: 27 October 2023

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• Eberhard Nieschlag 5 &
• Hermann M. Behre 6  

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Andrology encompasses all areas of medicine and science dealing with the reproductive functions of the male under physiological and pathological conditions. It focuses on infertility and hypogonadism, as well as on sexual aspects, including erectile dysfunction, male senescence (the aging male) and male contraception. In this chapter infertility is treated as one of the main areas of andrology, with a special emphasis on diagnosis and therapy of the male in the context of the infertile couple. The chapter deals with the possibilities of male contraception as the complementary aspect of reproduction.

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Nieschlag, E., Behre, H.M. (2023). Scope and Goals of Andrology. In: Nieschlag, E., Behre, H.M., Kliesch, S., Nieschlag, S. (eds) Andrology. Springer, Cham. https://doi.org/10.1007/978-3-031-31574-9_1

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