Andrological examination

What is an andrological examination.

An andrological examination is a critical step to rule out, diagnose, or monitor a disorder of andrological nature . In addition to patients with known chronic andrological problems, in agreement with a urologist, patients must undergo periodic inspections to monitor their condition. The doctor can diagnose whether symptoms such as feeling discomfort in the genital area, specific testicular discomfort, realization that the testes are asymmetric, and in case of change of texture and sensitivity of the testicles are of andrological nature. 

What is the purpose of an andrological examination?

An andrological examination is useful to prevent, diagnose, monitor, and determine treatments for major andrologic diseases like erectile dysfunction, premature ejaculation, varicocele, phimosis and short frenulum. This type of visit can also be used to monitor the possible evolution of a previously diagnosed disease.

How is an andrological examination carried out?

At the first stage of the examination the specialist collects information on the history and lifestyle of the patient, asking questions about nutrition, smoking, alcohol consumption, physical activity and lifestyle, pathologies, other cases in the family of andrological diseases, medication intake, and course of love life. The specialist will then continue by carefully examining the shape, size, and appearance of the testes and penis, by feeling. If the patient also has urological disorders or is older than 50 years, the examination usually includes a rectal examination to evaluate the health of the prostate and to rule out the presence of venous anal diseases such as hemorrhoids. The specialist may ask for blood tests such as blood glucose, lipid profile, hepatorenal function, dosage of various hormones, and dosage of free radicals in order to have a clearer picture about the presence of any abnormalities.

Are there any guidelines for preparation?

There are no standards of preparation . It is good, however, that the patient brings any tests carried out at the request of their own doctor, all previous tests already carried out involving an andrological problem, any recent blood tests, even if performed for other reasons, and a note of the name of any medications taken daily.

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What does andrologist do? When should I see an andrologist?

andrological visit

The answer could be obvious: because you have a problem or to try to prevent any problems due to human aging. When should I see an andrologist is a question that we dealt with, in part, in the article who is the Andrologist. Today we want to deal with the topic trying to explain what andrologist does and when I should see an andrologist .

Understanding the importance of the Andrological examination for men would be useful and very important for all men and women. Unfortunately in UK there are many people who show reticence to this type of control and the reason is mainly due to the fact that while women are used to meeting the gynecologist every year since childhood, the male generally does not go to the Andrologist except when it is strictly necessary, that is, in times of need.

Basically there is no male health culture, which if it were set from an early age, in terms of prevention and education of one's body, would benefit future men by drastically reducing the problems.

A fear born of a prejudice

Why do you go to the Andrologist

The lack of knowledge of who the Andrologist is, what he does and above all what an Andrological visit involves creates fear and anxiety. The only image that the candidate for the visit can see is the physical examination or the prostate check.

Men are notoriously bad patients, compared to women, they often avoid going to the doctor or skip the directions they are advised. However, they also die five years earlier than women and live more years in poor health, with higher suicide rates. While efforts are being made to create awareness campaigns to make sure men go to the doctor, resilience is strong.

Experts say cultural and social barriers have led generations of men to view health disorders as a sign of weakness. Researchers say men are conditioned from an early age to avoid sharing emotions, feelings or stress.

"Men are connected to an idea of ​​masculinity for which we do not talk about problems with others, and if there is a problem it resolves itself!

Women have a much stronger record when it comes to regular care, because they are typically followed by pediatricians, then by the gynecologist and later by general practitioners. Men may not see another doctor after the pediatrician!

10 reasons to see an Andrologist

urologist London

There are several reasons why men should consult with an Andrologist. We will indicate below a series of symptoms, if you recognize any that ails you, it is advisable to book a visit to the specialist. An Andrologist can correctly identify and diagnose the problem, determine the severity level, and provide treatment options. ATTENTION to remember: prevention is everything! The sooner a potential health problem is detected, the better the chances of treating it before it develops into something serious.

1) Erectile dysfunction: this is certainly an uncomfortable topic to deal with, but the Andrologist is the best person to talk to. Erectile dysfunction (ED), is the inability to reach or maintain an erect penis, affects sexual performance and intimacy, but can also reveal complications such as vascular disease, hypertension and kidney failure. While many men find it embarrassing to talk about this problem, it is important to evaluate and treat all underlying conditions as soon as possible.

2) Testicular Pain, Lumps, or Masses: When testicular pain is persistent and does not go away within two weeks, it's time to see a Urologist. Any masses, indurations or lumps on the testicles should be examined by a specialist. This is to prevent or rule out any possibility of testicular cancer. Fortunately, when diagnosed early, cancer found in the testicles is one of the most treatable cancers.

3) Abnormal prostate exam: Men over the age of 40 to 50 are advised to have an annual exam by the same doctor if possible. In this way, any changes can be monitored more closely and early diagnosis of prostate cancer is more likely. If small nodules or irregularities are detected

If this is not the case, a Urologist / Andrologist should be consulted to determine any potentially serious problems. Remember: when caught early, prostate cancer has a high cure rate.

4) Difficulty urinating: this is a disorder that can compromise the quality of life of those who suffer from it. It is generally caused by an enlarged prostate and is a common symptom of aging. Fortunately, this condition can be treated with medication to relieve symptoms or the prostate can be treated to help urinate.

5) Painful urination: Infections can occur in any part of the urinary tract, often caused by bacteria. A specialist can determine the cause of this infection and recommend targeted treatment.

6) Frequent urination or desire to urinate often: it is time to see a Urologist / Andrologist if incontinence (urine leakage) starts suddenly or if it interferes with your lifestyle. Urinary incontinence is quite common and can usually be successfully managed or treated.

7) An elevated level or a change in the level of prostate specific antigen (PSA): The PSA test is often used as a method to detect early stage prostate cancer. Typically, a very low level of PSA is found in the bloodstream. When there is a change or a higher level of PSA in the blood, a urologist can determine the cause.

8) Kidney abnormality: If your doctor finds anything unusual on X-rays, you should see a Urologist.

9) Infertility: 25% of infertility problems can be directly related to a male problem. If your partner is being evaluated, you should get a simultaneous evaluation from a Urologist.

10) Blood in the urine: This is a serious sign that needs immediate advice from a urologist, as it could be an early warning sign of bladder or kidney cancer. The intermittent presence of blood in the urine should also be reported to the doctor because it requires immediate attention. The examination by a Urologist includes urine tests, an X-ray or CT scan and a cystoscopy (using optical fibers to see inside the bladder).

11) Premature ejaculation

Conclusions

T he Andrologist is a Urologist or an Endocrinologist s pecialized in the treatment of conditions relating to sexual dysfunction and fertility in males. As andrologists possess more experience in the male reproductive system, they are generally the most appropriate professionals to consult for patients with infertility and sexual dysfunction.

This specialization also treats different types of pathologies and interfaces with other specialists when there are health conditions such as: heart disease, hypertension or kidney failure; which can impair sexual function. They can also intervene in the context of in vitro fertilization, when reproductive or sexual ability is compromised, or perform vasectomies when reproductive capacity is no longer desired.

Dr. Fabio Castiglione is a Urologist and Andrologist in London . He is Director of the HolisticAndrology Clinic . At his centers, a therapeutic approach is used based on the most recent clinical studies, on the guidelines of international scientific societies of sexual medicine and on the extensive clinical experience of Dr. Castiglione.

HolisticAndrology, urology clinic in London , has always been at the forefront to improve the quality of life for all people suffering from Impotence. If you are interested and want more information, do not hesitate to contact us.

Contact HolisticAndrology , andrology clinic in London (tel. +44 (0) 7830398165) to book an andrological consultation with dr. Fabio Castiglione, Urologist London .

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(AN-DROL’-UH-JEE) Andrology is the study of the male reproductive system, including sexual health. In common usage, andrology pertains to men as gynecology pertains to women.

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  • 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?

The andrological examination

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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andrological visit

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.

video

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.

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  • v.13(1); Jan-Feb 2019

The Risk of Psychiatric Morbidity and Course of Distress in Males Undergoing Infertility Evaluation Is Affected by Their Factor of Infertility

Katarzyna warchol-biedermann.

1 The Department of Clinical Psychology, Poznan University of Medical Sciences, Poznan, Poland

This panel study aimed to explore the effects of male, female, mixed or idiopathic factor of infertility on the course of clinical distress and possible psychiatric morbidity in involuntarily childless males undergoing fertility evaluation for the first time. A sample of 255 males completed the General Health Questionnaire-28 (GHQ-28) (a) at the baseline, before their initial fertility evaluation (T 1 ); (b) before their second andrological appointment 2–3 months after diagnostic disclosure (T 2 ); and (c) before subsequent treatment-related /follow-up appointments (T 3 , T 4 ) to be screened for clinically significant distress and risk for psychiatric morbidity. Then they were dichotomized as non-cases and cases. The timing of psychological testing was strictly related to andrological appointments and medical procedures. The research demonstrated that the baseline prevalence of clinical distress and psychiatric morbidity in all the subgroups was similar to reference values, but then significantly surged after the diagnostic disclosure, particularly in male and mixed factor respondents. However, the percentage of clinically distressed mixed or idiopathic factor of infertility respondents remained stable after diagnostic disclosure and during the entire follow-up. The prevalence of clinically significant distress and risk for psychiatric morbidity in the male factor of infertility, female factor of infertility, and mixed factor subgroups decreased during the follow-up but remained higher than at the baseline. The study identifies that the course of distress and risk of psychiatric morbidity of males is significantly affected by their factor of infertility and changes across the pathway of treatment-related /follow-up appointments.

It is estimated that 10%–20% of all couples experience difficulties conceiving ( Agarwal, Mulgund, Hamada, & Chyatte, 2015 ; Boivin, Bunting, Collins, & Nygren, 2007 ). Studies have reported that unwanted childlessness affects psychological status and well-being of couples who are unable to achieve pregnancy. Investigations also indicated that males and females experiencing unintended childlessness differ in their attitudes or psychological reactions to their fertility problems ( Cui, 2010 ; Culley, Hudson, & Lohan, 2013 ; Dooley, Dineen, Sarma, & Nolan, 2014 ; Dooley, Norman, & Sarma, 2011 ; National Institute for Health and Clinical Excellence, 2013 ; Schaller, Griesinger, & Banz-Jansen, 2016 ; Schick, Rösner, Toth, Strowitzki, & Wischmann, 2016 ; Wischmann & Thorn, 2013 ). The research on the influence of involuntary childlessness or infertility treatment on men’s psychological health is limited, but studies indicate infertile males may manifest symptoms of elevated distress, anxiety, and depression ( Fisher & Hammarberg, 2012 ; Holley et al., 2015 ; Yang et al., 2017 ).

The studies so far have not sufficiently considered the fact that patients’ experiences take place on a timeline of events, when patients face life circumstances, which may notably affect their psychological distress or their risk of developing symptoms of depression. In this context, it is noteworthy that a couple is usually referred for infertility evaluation after they have unsuccessfully tried to conceive for a year ( National Institute for Health and Clinical Excellence, 2013 ). As time goes by, both partners grow increasingly concerned about their inability to conceive, so they come to a decision to undergo fertility testing. The results of the testing usually identify the partner who is responsible for the reproductive failure so far, that is, the couple’s inability to achieve pregnancy can be attributed to the male partner (male factor), to the female partner (female factor), or to both partners (mixed factor), or the causes of unwanted childlessness remain unexplained (idiopathic/unexplained infertility factor). Studies indicate the diagnosis of infertility can affect the couple’s relationship. Both partners may experience decreased sexual satisfaction, lower self-esteem, and increased anxiety ( Peterson et al., 2012 ). However, the outcomes of the fertility workup may be particularly burdensome to the partner with poor results of testing ( Fisher & Hammarberg, 2012 ; Wischmann & Thorn, 2013 ). Diagnostic testing is followed by necessary treatment for individuals who need it or follow-up visits for the healthy ones. The final stage is often marked by the couple’s decision to start adoption procedures or to undergo assisted reproductive technology (ART) treatment ( Fisher & Hammarberg, 2012 ). Considering the sequence of events related to the diagnosis and treatment, one may suppose that the research on the influence of unwanted childlessness on distress and mental health status of males (a) while seeking initial infertility testing; (b) while learning of their role in previous reproductive failure; and (c) during subsequent treatment-related or checkup testing appointments may expand the knowledge on the impact of unintended childlessness on male psychological distress and risk of psychiatric morbidity. In this respect, it would be valuable to investigate the role of the so-called male, female, mixed, or idiopathic infertility factors, which not only cause failure to conceive but may also stigmatize the spouses ( Fisher & Hammarberg, 2012 ; Wischmann & Thorn, 2013 ).

The impact of the sequence of events related to infertility testing, obtaining the diagnosis, and necessary treatment on distress reactions and prevalence of mental health symptoms such as depression in males from infertile couples remains an underresearched area, which should be clarified for several reasons. Male factor of unwanted childlessness is involved in up to half of all infertility cases, so males are often treated for infertility ( Brugh & Lipshultz, 2004 ). Psychological distress may indirectly influence the results of infertility therapy by exerting negative effects on semen quality via action on the neuroendocrine system ( Hanna & Gough, 2015 ; Nordkap et al., 2016 ). Increased psychological strain and compromised well-being may affect patient adherence to medical regimes and may cause discontinuation of infertility treatment despite a favorable prognosis and ability to cover the costs of treatment ( Gameiro, Boivin, Peronace, & Verhaak, 2012 ). Infertility specialists and other health-care providers involved in diagnostic procedures or treatment of unwanted childlessness should understand how an unfulfilled wish for a child affects male mental health status to prevent or counteract its negative effects. Assessment of male psychological reaction to infertility diagnosis and treatment and its determinants is essential for preparation of accurate prevention and support programs ( Frederiksen, et al., 2015 ; Schmidt, Sobotka, Bentzen, Nyboe Andersen, & ESHRE Reproduction and Society Task Force, 2012 ; Wischmann, Scherg, Strowitzki, & Verres, 2009 ).

The goal of this study was to assess the level of distress and the risk of stress-related psychiatric disorders such as depression in males with unwanted childlessness who sought the help of a fertility doctor for the first time. In the current study it was hypothesized that the distress and risk of common mental health disorders would increase after the diagnostic disclosure and then decrease during the follow-up.

Male distress and risk of psychiatric morbidity were suspected to be affected by male, female, mixed, or idiopathic factors of infertility.

Materials and Methods

Participants.

Two hundred and fifty-five males without a history of previous or present physical (cardiac or other) disease and psychiatric treatment who sought fertility evaluation for the first time were recruited from a convenience sample of males who decided to be examined at an andrological outpatient clinic in Poznan, Poland.

Participant Recruitment

Subjects were approached by infertility staff at the reception desk or in the waiting room of the clinic. Of the 255 respondents who initially enrolled, some individuals were lost during follow-up, that is, they completed the questionnaires less than four times. One respondent returned an incomplete questionnaire, four respondents withdrew from the study, and 65 of them withdrew from treatment. Respondents withdrew from treatment and from the study because (a) respondent’s spouse became pregnant; (b) the couple decided to start ART procedure; or (c) they believed their chance of successful fertility treatment success was poor. The statistical analysis could not determine any significant association between (male, female, mixed, or unexplained) factor of infertility and respondent dropout. Two hundred and fifty-three respondents completed the testing twice, 215 respondents completed the testing three times, and 185 of them completed the testing four times. Two subjects who initially enrolled were excluded from the sample because they had previously been diagnosed with azoospermia. Respondents’ medical history including the information on their female partner’s health status and psychiatric history was gathered during the first andrological visit and then updated at the follow-up appointments. Respondents attended the andrological visit along with their spouses. Two hundred and forty-eight out of 255 (97.2%) respondents’ partners had already undergone fertility examination and knew their fertility status at the baseline. The spouses who failed to provide the results of their fertility examination at the first andrological appointment were routinely asked to undergo their evaluation and provide the results of their fertility examination for diagnostic reasons. The data were collected in a way that guaranteed respondents’ anonymity.

Design of the Study

This panel study included the baseline evaluation (T 1 ) and the three subsequent psychological evaluations (T 2 , T 3 , T 4 ), which were 2–3 months apart. The assessments were carried out on the day when respondents provided a semen sample for fertility evaluation, 1 day before their andrological appointment. The timing of psychological testing was strictly related to andrological visits and to medical procedures, that is, respondents completed the tests (a) before their initial fertility testing (T 1 ); (b) before the second andrological visit, 2–3 months after they had learned of their role in previous reproductive failure when their emotional response to the diagnosis stabilized (T 2 ); and (c) before the third and the fourth treatment-related or checkup testing appointments (T 3 , T 4 ). This strategy not only maximized follow-up response rate but also made it possible to observe the effect of the sequence of events related to the effect of diagnostic disclosure and treatment-related/follow-up andrological appointments on the course of distress and the risk of psychiatric morbidity of unintentionally childless males. As the baseline assessment took place 1 day before the first andrological appointment, the respondents were not informed of their fertility status and they obtained information about the results of their initial fertility evaluation during the first doctor’s visit on the next day.

Along with a sociodemographic questionnaire to be completed only once at the baseline, all participants individually filled up the Polish version of the General Health Questionnaire-28 (GHQ-28). The GHQ-28 is a self-administered screening tool commonly used in medical settings to detect individuals who manifest symptoms of elevated emotional distress and are likely to have or be at risk of developing mood disorders such as depression, which frequently leads to social and occupational disability or suicide ( Overholser, Braden, & Dieter, 2012 ; Seo et al., 2017 ; Yang et al., 2015 ). Respondents used a 4-point Likert scale to describe changes in their mood/behavior over the past 4 weeks. The traditional (binary) method of calculating the GHQ score was employed, where answers Not at all and No more than usual scored 0, while the answers Rather more than usual and Much more than usual scored 1. In the present study the GHQ was evaluated with the use of a commonly accepted cutoff point indicating elevated levels of psychological distress and an increased risk of stress-related mood disorders such as depression. Additionally, individuals with scores below or above the cutoff point were dichotomized as non-cases and cases (individuals characterized by clinically significant distress levels who are at risk of psychiatric morbidity), respectively. Since GHQ-28 is used to assess self-reported alterations in a subject’s mental status and not lifelong personal characteristics, it was considered to be particularly well suited for the purpose of the current study, which focuses on the impact of obtaining one’s infertility diagnosis and treatment over time. GHQ-28 is characterized by high test–retest reliability (.78–.9), high internal consistency, and excellent intrarater/interrater reliability (Cronbach’s α .9–.95) and correlates well with the Hospital Depression and Anxiety Scale (HADS). Similarly, the Cronbach’s α of the Polish version of the questionnaire reached the value of .934 ( Goldberg & Blackwell, 1970 ; Goldberg & Williams, 1988 ; Makowska, Merecz, 2001 ; Merecz-Kot & Andysz, 2014 ; Richard, Lussier, Gagnon, & Lamarche, 2004 ).

Then in order to explore how diagnostic disclosure and treatment-related or follow-up andrological appointments affected respondents’ risk of psychiatric morbidity, respondents were divided into defined respondent subgroups based on their specific subtype of infertility.

Respondents with male factor of infertility, respondents with female factor of infertility, respondents with mixed factor of infertility, and respondents with unexplained (idiopathic) factor of infertility were compared using appropriate non-parametric statistical tests (χ 2 test, χ 2 test with Yates’s correction for continuity, Fisher’s exact test) with significance level set at <.05. The results of each subgroup were also referred to the outcomes of a separate GHQ-28 testing in a nationwide randomly selected sample of individuals. The sample included individuals 19–65 years old who had no history of previous or present chronic disease or psychiatric treatment ( Merecz-Kot & Andysz, 2014 ). The statistical analysis was performed with the use of Statistica 13.1 ( Statsoft, 2013 ).

Ethical Approval

All subjects were informed about the purpose and importance of the study and assured of their anonymity and confidentiality, and they voluntarily gave their verbal consent to participate. Subjects’ consent was not recorded to maintain their anonymity. The investigator also made sure subjects knew they could stop the testing at any moment. The study proposal was approved by the bioethical committee of our university (Approval No: 920/14), which ensures ethical procedures in data collection and analysis.

Characteristics of the sample

The investigation included 255 male participants, who were 22–51 years old with a mean age of 30.24 ± 4.29. They were married and, except for one respondent who had a child from a previous relationship, childless. Their spouses were 21–42 years old with a mean age of 28.42 ± 3.7. Their waiting time to conception (length of time the couple have been trying to conceive) ranged from 8 to 24 months ( M = 14.53 ± 3.17; median value (Me) = 14), while the duration of their current marriage ranged from 1 to 11 months ( M = 2.16 ± 1.02). Detailed sociodemographics are presented in Table 1 .

Detailed Baseline Sociodemographic Characteristics of Study Participants.

Note. n = the number of respondents within a given category.

The prevalence of clinically significant distress and psychiatric morbidity across the timeline of treatment-related/follow-up andrological appointments

Statistical analysis indicated that the estimated prevalence of clinically significant distress and psychiatric morbidity in the sample amounted to 10.9% at the baseline (baseline assessment; T 1 ). Next, after diagnostic disclosure (second assessment; T 2 ), the percentage of significantly distressed individuals in the sample significantly increased and reached 45.8% (Fisher’s exact test, p value < .00). There were no significant changes at the third assessment (44.6% at T 3 ), but then at the fourth assessment, a significant decrease in the analyzed percentage was observed (25.9% at T 4 ; Fisher’s exact test, p value = .00). The comparison demonstrated that the observed baseline proportion of significantly distressed individuals (10.9%) was lower than the reference value of 12% (the corresponding proportion of significantly distressed individuals in a nationally representative sample of occupationally active individuals aged 19–65 years; Merecz-Kot & Andysz, 2014 ), but the difference did not reach statistical significance. However, after diagnostic disclosure (at T 2 ), the proportion of significantly distressed individuals in the sample significantly exceeded reference value (χ 2 , p = .00). These differences remained significant at the third and at the fourth assessment (T 3 and T 4 ; χ 2 , p values = .00 and = . 00, respectively).

The impact of diagnostic disclosure on respondents’ distress and mental health status

Of the 255 respondents who enrolled, there were 76 respondents with the male factor of infertility and 80 with the female factor of infertility; 78 respondents came from couples with mixed infertility factor, while 21 were diagnosed with idiopathic (unexplained) infertility factor.

The investigation of the association between respondents’ infertility factor and their distress and risk of psychiatric morbidity has shown that the prevalence of clinically significant distress in the subgroup of respondents with the male factor of unwanted childlessness, which reached 9.2% at the baseline (T 1 ) significantly increased after diagnostic disclosure and reached 59.2% at T 2 ( p value = .00). At the third and at the fourth assessment (49.2% at T 3 and 34.6% at T 4 ), statistically significant changes in the percentage of significantly distressed male factor of infertility respondents could not be determined. The analysis has also shown that the baseline proportion of male factor of infertility respondents was lower than the corresponding reference value of 12% ( Merecz-Kot & Andysz, 2014 ), but statistical differences could not be determined. After diagnostic disclosure (T 2 ), the proportion of significantly distressed individuals with the male factor significantly exceeded the reference value (χ 2 , p value = .00). These differences persisted at T 3 and T 4 , (χ 2 , p values = .00 and = .00, respectively).

Next, the analysis indicated that the percentage of significantly distressed respondents with female infertility factor amounted to 13.7% at the baseline and increased to 21.5% at T 2 . Although significant changes in the prevalence of clinically significant distress in this subgroup could not be indicated after diagnostic disclosure, a significant increase in the percentage of significantly distressed female factor of infertility individuals was observed at the third assessment (42.6% at T 3 ; p value = .04). Finally, at the fourth assessment before the fourth andrological appointment, significant changes in the percentage of clinically distressed female factor of infertility respondents could not be observed (34.4% at T 4 ). The analysis has also shown that the baseline proportion of abnormally distressed female factor of infertility respondents at risk for psychiatric morbidity (13.7%) was greater than the reference value, but the statistical differences were insignificant ( Merecz-Kot & Andysz, 2014 ). At the second assessment (T 2 ), the percentage of significantly distressed female factor of infertility respondents was significantly greater than the reference value (χ 2 , p value = .04). These statistically significant differences continued at T 3 and T 4 (χ 2 , p values < .00 and < .00, respectively).

The assessment of the subgroup with the mixed infertility factor showed the percentage of respondents with clinically significant distress and elevated risk for psychiatric morbidity in this subgroup amounted to 11.5% at baseline (T 1 ) but significantly increased at the second visit, after diagnostic disclosure (67.5% at T 2 ; Fisher’s exact test, p value = .04). At the third assessment before the third andrological visit, the percentage of distressed individuals with mixed infertility factor has not significantly changed (50.7% at T 3 ). At the final assessment before the fourth andrological appointment, the analyzed percentage significantly dropped (16.3% at T 4 ; p value = .00). The analysis has also demonstrated that the baseline (T 1 ) prevalence of clinically significant distress in the subgroup of respondents with mixed factor of involuntary childlessness (11.5%) was lower than the reference value (12%), but the statistical differences were insignificant ( Merecz-Kot & Andysz, 2014 ). At the second assessment (T 2 ), after diagnostic disclosure, the percentage of distressed individuals with the mixed factor was significantly greater than the reference value (χ 2 , p value = .00). These statistically significant differences persisted at the third visit (T 3 ;, χ 2 , p value = .00). At the fourth visit (T 4 ), the proportion of significantly distressed individuals with the mixed factor (16.7% and 12%, respectively) still exceeded the reference value, but the differences were statistically insignificant ( p value > .05).

The evaluation of the course of distress in the subgroup with idiopathic (unexplained or unknown) infertility factor revealed that the percentage of significantly distressed respondents in this subgroup amounted to 4.7% at the baseline. That proportion has not significantly changed throughout the entire follow-up observation (9.5% at T 2 , 15.7% at T 3 , and 0% at T 4 ; see Figure1 for details).

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The numbers and percentages of respondents at risk for psychiatric morbidity at various stages of the procedure.

To add, statistical analysis was performed to explore statistical differences in the prevalence of clinically significant distress and risk of psychiatric morbidity between subgroups with male, female, mixed, or idiopathic infertility factor at the baseline and at subsequent psychological assessment before andrological appointments. Here, statistically significant differences could not be determined at the baseline assessment (T 1 ), before the diagnostic disclosure. However, at the second assessment (T 2 ) the prevalence of clinically significant distress was significantly higher in the male factor of infertility respondents than in female factor of infertility respondents ( p value = .00) or the mixed or idiopathic factor of infertility subgroup ( p value = .01). Distress was also markedly more prevalent in the subgroup with the mixed factor than in the female factor of infertility respondents ( p value = .00) or subjects with mixed or idiopathic factor of infertility ( p value = .00). Then, these differences persisted at the third and the fourth assessment (T 3 and T 4 ), as the analysis has not determined any significant statistical differences associated with respondent’s factor of infertility (χ 2 , the results are significant at p < .05).

Unwanted childlessness may have adverse consequences for male psychological status and well-being. An unfulfilled child wish has been associated with elevated anxiety, low self-esteem, mood disturbances, or depression in males ( Fisher & Hammarberg, 2012 ; Holley et al., 2015 ; Schick et al., 2016 ; Wischmann & Thorn, 2013 ; Yang et al., 2017 ). The outcomes of the studies were largely determined by the time of the diagnosis, duration of infertility, the length of time the couple had been pursuing medical therapy, or the type of treatment (e.g., respondents were examined prior to making a decision to undergo or while undergoing ART treatment).

This investigation focused on the course of male distress at different stages of fertility experience including fertility workup, diagnostic disclosure, treatment process, and repeated treatment-related or follow-up visits. The timing of psychological testing was strictly related to andrological visits, that is, respondents completed the tests (a) before their initial fertility testing; (b) before the second visit, 2–3 months after they had learned of their role in previous reproductive failure when their emotional response to the diagnosis stabilized; and (c) before the third and the fourth treatment-related or checkup testing appointments. This research design eliminated the effect of a direct emotional response to the diagnostic disclosure and information about the patient’s health status because the respondent’s emotional reaction could stabilize during the time interval between andrological appointments.

The analysis demonstrated that 10.9% respondents had high levels of distress and were at risk for psychiatric morbidity at baseline, before they learned of their andrological diagnosis. These results are similar to the corresponding proportion of significantly distressed individuals in a nationally representative sample of occupationally active individuals aged 19–65 years, which was used as a reference value in the study ( Merecz-Kot & Andysz, 2014 ). In contrast, the analysis has shown that after diagnostic disclosure, the percentage of respondents who were significantly distressed and at risk for psychiatric morbidity markedly exceeded the corresponding baseline percentage or reference values. Learning of the diagnosis led to a marked surge, which was followed by a drop in the percentage of significantly distressed individuals. However, the proportion of significantly distressed individuals at follow-up was significantly greater than the baseline percentage.

The study also aimed to analyze whether the occurrence of clinically significant distress was associated with the learning of one’s biological role in reproductive failure. Respondents were divided into four defined subgroups: respondents with the male factor of infertility, respondents with the female factor of infertility, respondents with the mixed factor of infertility, and respondents with the idiopathic factor of infertility. The analysis of the stress outcomes after diagnostic disclosure revealed a statistically significant increase in the prevalence of clinically significant distress in the subgroups of respondents with the male and mixed infertility factor ( p values = .00), while lower proportions of significantly distressed patients were observed in the subgroups with the female and with the idiopathic infertility factor. One may note that at the second assessment, after the diagnostic disclosure, the analyzed percentage of distressed males with male and mixed infertility factors significantly exceeded not only their respective baseline values but also markedly differed from the corresponding percentages of distressed males in the couples with the female and idiopathic infertility factors. These data confirm the conclusions of other studies indicating that males with the male factor of unwanted childlessness may experience elevated distress when they receive their diagnoses (( Fisher & Hammarberg, 2012 ; Gameiro et al., 2012 ; Hanna & Gough, 2015 ; Holter, Anderheim, Bergh, & Möller, 2007 ; Kumbak et al., 2010 ; Martins et al., 2016 ; Pook & Krause, 2005 ; Schmidt et al., 2012 ; Wischmann et al., 2009 ; Wischmann & Thorn, 2013 ; Wincze, 2015 ).

There are investigations of psychological effects of diagnostic disclosure of the male infertility factor, which generated discordant results, for example, Kumbak et al.’s (2010) study of Turkish males could not find any significant differences in measures of anxiety, anger, or depression that could be attributed to respondents’ factor of infertility.

Holter’s team ( 2007 ) reported that subjects reacted to their infertility experiences similarly, regardless of their diagnostic category. They also demonstrated that the male factor of infertility did not adversely affect their respondent’s well-being or outlook on life.

Pook and Krause (2005) , who explored the course of infertility distress in a group of males who twice visited an andrological clinic for workups, demonstrated distress was associated with an interaction of factors such as a recent treatment failure and duration of treatment of ≥17 months. These authors could not indicate that subjects’ distress was directly or indirectly associated with the diagnosis of the male fertility factor.

The aforementioned studies used different designs, for example, the respondents were assessed before starting or while undergoing their ART treatment. In this observation psychological tests were carried out after a considerable period of time since the last visit so the respondent’s psychological status and distress levels could stabilize and reach a plateau. A question may arise about the reasons for the differences between subgroups of respondents with various infertility factors. It may be suggested that during diagnostic evaluation, male patients are affected by a number of factors such as an unfulfilled child wish and the effect of the ability to father a child on their self-esteem or sense of manliness ( Fisher & Hammarberg, 2012 ). It may be concluded that the ability to father a child goes beyond a biomedical problem because in all cultures male fertility is associated with masculinity, so male factor infertility can be perceived as stigmatizing. Other psychological agents influencing males undergoing fertility evaluation may include guilty feelings or feelings of inadequacy that may arise, wife’s reaction, perceived social support, keeping hope in fertility treatments, the subject’s coping skills, or self-efficacy ( Boivin & Gameiro, 2015 ; Culley et al., 2013 ; Hanna and Gough, 2015 ; Kumbak et al., 2010 ; Marci et al., 2012 ; Navid, Mohammadi, Vesali, Mohajeri & Omani Samani, 2017 ; Song, Kim, Yoon, Hong, & Shim, 2016 ; Sylvest, Christensen, Hammarberg, Schmidt, 2014 ; Volgsten & Schmidt, 2017 ; Volgsten, Svanberg, & Olsson, 2010 ; Wischmann & Thorn, 2013 ).

In the current study the proportion of distressed respondents with mixed infertility factor significantly increased at the second visit but then at the fourth visit the percentage of distressed respondents significantly dropped ( p value = .00). In this context, it is noteworthy that both males with the mixed factor and males with the male factor of unwanted childlessness suffer from impaired fertility. However, males with the mixed factor share a similar health problem with their wives. Consequently, they may be more likely to receive their wife’s support and may experience less guilty feelings over not being able to conceive. Social support and acceptance may have advantageously affected coping skills of some participants of the study, so they were ready to reconcile with their circumstances and move forward. At the fourth visit (T 4 ) these males had already been in treatment for some time and knew their medical problem was challenging because both partners needed treatment ( Kumbak et al., 2010 ; Marci et al., 2012 ; Martins et al., 2016 ; Sylvest et al., 2014 ; Wincze, 2015 ).

This study revealed that the percentage of female factor of infertility respondents with an increased risk for psychiatric morbidity and clinically significant distress remained stable between T 1 and T 2 , but then it rose significantly at T 3 ( p value < .046). This finding can be related to the fact that the majority of female factor of infertility respondents asked for fertility evaluation because their wife had already been in treatment. It may be suggested that at the time of the third assessment they had realized their chances of having a biological baby were dwindling. That might have resulted in their deteriorated well-being. Publications maintain that males in couples with female infertility factor pursuing medical treatment display distress due to forced timing of sexual activity, psychological pressure to conceive, or because they worry about the side effects of treatment. In the present study, however, the subjects manifested a marked rise in stress levels after they had already been in treatment for some time ( Marci et al., 2012 ; Schaller et al., 2016 ; Song et al., 2016 ).

The investigation demonstrated that the subgroup of respondents with idiopathic (unexplained) infertility factor was characterized by a stable percentage of distressed individuals, which remained well below reference values during the entire follow-up time. This problem was also analyzed in investigations of males undergoing ART treatment; for example, Navid and colleagues (2017) observed that males with unexplained fertility factor who were undergoing ART treatment were more satisfied with their life than other unintentionally childless male respondents. On the contrary, Volgsten and colleagues (2017) indicated the unexplained infertility factor was an independent determinant for depression in undesirably childless males in couples undergoing in vitro fertilization procedures. Another study by Volgsten et al. (2010) indicated that 3 years after undergoing unsuccessful in vitro fertilization treatment, individuals with unexplained infertility suffered from compromised well-being and were frustrated over not knowing the causes of their inability to conceive. Unexplained infertility was also difficult to understand, accept, and deal with. The inconsistency in the study findings may be, in part, related to the fact that the respondents of the Volgsten et al. (2010) study were investigated at various stages of their infertility experience. Consequently, they differed in the ability to keep hope in treatment effects and to cope with an uncertain diagnosis. Individuals participating in the current study, in turn, were characterized by a relatively short waiting time to conception, so they could have believed the problem was minor and only temporary. Still, psychological implications of unexplained infertility should be further explored in order to improve the understanding of patients’ difficulties in dealing with the diagnosis and treatment ( Boivin & Gameiro, 2015 ).

Of further interest were changes in the prevalence of clinically significant distress during the follow-up. Here, the analysis demonstrated the percentage of respondents with high levels of distress and an increased risk for psychiatric morbidity decreased in the final stage of the testing. The decrease was most prominent in the subgroup of respondents with the mixed factor but it was the least prominent in respondents with male factor of infertility. The decrease may by associated with factors. These factors may include patients’ adjustment to the diagnosis of infertility, their readiness to make decisions about initiating in vitro fertilization treatment, or finding alternative ways to fulfill parenthood goals (e.g., the decision to start adoption procedures). However, the observed mechanisms seem to be diverse and appear to be related to the diagnostic category of unwanted childlessness. Adequate support directed at helping individuals who are treated for unwanted childlessness may be very helpful. The support interventions should consider the diagnostic category of infertility and its effect on patient’s distress and psychological strain. Infertility treatment specialists or other health-care professionals should be provided education training programs to help them understand how learning of one’s role in inability to conceive influences distress and risk of psychiatric morbidity. Infertility staff should integrate the knowledge into practice so that they will be able to provide adequate emotional support to males treated for unwanted childlessness.

The present study has some limitations that should be considered while interpreting the results. First, respondents came from a single setting and covered the costs of andrological procedures at the clinic. Second, it is acknowledged that the questionnaires were retrospective and self-administered. Third, respondents’ stress outcomes could have been affected by other factors such as age or their religious background. However, the longitudinal nature of the study provides valuable indicators for physicians, counselors, and other professionals working with males with unintended childlessness.

The study implies that male course of distress and risk of psychiatric morbidity is significantly affected by the factor of infertility and changes across the pathway of treatment-related/follow-up andrological appointments. The risk for psychiatric morbidity significantly surges after the diagnostic disclosure, particularly if male or mixed factor of infertility is diagnosed; then it decreases but remains significantly elevated during the follow-up.

Acknowledgments

The author thanks the infertility staff of the andrological outpatient clinic for their kind and unconditional support in gathering the data for this study. The author would also like to acknowledge and thank the participants who generously shared their time and answered the questionnaires.

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

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andrological visit

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/

Post correlati

Contraception, tips for intimate hygiene, drugs and sexuality.

andrological visit

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

Affiliation.

  • 1 Gynepro-Medical Group, Andrological Section, via Tranquillo Cremona 8, 40137 Bologna, Italy.
  • PMID: 26806083
  • PMCID: PMC5312222
  • DOI: 10.4103/1008-682X.172646

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.

  • Attitude to Health
  • Erectile Dysfunction / diagnosis
  • Erectile Dysfunction / physiopathology*
  • Erectile Dysfunction / therapy
  • Middle Aged
  • Psychotherapy
  • Recovery of Function*
  • Referral and Consultation*
  • Remission, Spontaneous
  • Retrospective Studies
  • Sexual Dysfunctions, Psychological / diagnosis
  • Sexual Dysfunctions, Psychological / physiopathology*
  • Sexual Dysfunctions, Psychological / therapy
  • Sexual Partners / psychology
  • Young Adult

IMAGES

  1. The andrological examination

    andrological visit

  2. Andrology

    andrological visit

  3. Andrological and urological appointment

    andrological visit

  4. Andrologist And Men’s Health: What To Expect From An Appointment

    andrological visit

  5. Best Andrology Hospital

    andrological visit

  6. Andrology

    andrological visit

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COMMENTS

  1. Andrological examination

    An andrological examination is useful to prevent, diagnose, monitor, and determine treatments for major andrologic diseases like erectile dysfunction, premature ejaculation, varicocele, phimosis and short frenulum. This type of visit can also be used to monitor the possible evolution of a previously diagnosed disease.

  2. What does andrologist do? When should I see an andrologist?

    The lack of knowledge of who the Andrologist is, what he does and above all what an Andrological visit involves creates fear and anxiety. The only image that the candidate for the visit can see is the physical examination or the prostate check. Men are notoriously bad patients, compared to women, they often avoid going to the doctor or skip the ...

  3. Anamnesis and Physical Examination

    Anamnesis, i.e., the medical history, and physical examination are essential in every branch of medicine, including andrology. Regardless of the reason that leads a patient to the andrological visit, the first step must be the complete and comprehensive collection of information which will serve to guide the specialist for a diagnosis and, therefore, a therapy.

  4. PDF Anamnesis and Physical Examination

    leads a patient to the andrological visit, the first step must be the complete and comprehensive collection of information which will serve to guide the specialist for a diagnosis and, therefore, a therapy. An accurate andrological examination includes inspection and palpation of the entire genital area. However, they may

  5. Twenty‐year experience with macro‐area school screening for

    Subjects aged between 11 and 14 years underwent andrological visit. During the study period, three main andrological screenings were performed into our macro‐area. The distribution of cohorts was different among the screenings. Among andrological diseases, varicocele diagnosis increased especially in the last 10 years.

  6. Home Page

    What is Andrology? (AN-DROL'-UH-JEE) Andrology is the study of the male reproductive system, including sexual health. In common usage, andrology pertains to men as gynecology pertains to women.

  7. The andrological examination

    The andrological examination. 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 ...

  8. Who Is the Surgical Patient?

    The andrological patient requires a tailored clinical, surgical, and psychosexological approach. Patient and family experience feelings of vulnerability, insecurity, and anguish about the future. ... One who appears alongside him, in the best case scenario, is right there from the first andrological visit. A clinical partnership for one patient ...

  9. Erectile Dysfunction after Allogeneic Hematopoietic Stem Cell

    The andrological visit included testicular measure, penis and genital skin inspection, and penile ultrasound and elastosonography. Free testosterone (FT), inhibin B, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, thyroid stimulating hormone (TSH), free triiodothyronine 3 (FT3), FT4, cortisol, and adrenocorticotropic ...

  10. Anamnesis and Physical Examination

    Regardless of the reason that leads a patient to the andrological visit, the first step must be the complete and comprehensive collection of information which will serve to guide the specialist ...

  11. The Etiology of Infertility Affects Fertility Quality of Life of Males

    The timing of psychological testing was strictly related to andrological visits and to medical procedures, that is, respondents completed the tests (1) before their first fertility testing (T 1) at the baseline, before a diagnostic disclosure; (2) before the second andrological visit, 2-3 months after the diagnostic disclosure when their ...

  12. Male Sexual Pain and Chronic Prostatitis: A New Point of Vision

    The first type that occurs quite frequently experiences pain when touched above the testicles and can persist for a lifetime. Normally, this disorder is discovered during an urological or andrological visit for other motives. The pain is normally described as pain or discomfort by palpation of the testicles.

  13. Minimally Invasive Varicocele ♂️ Antonini Urology

    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 ...

  14. The Etiology of Infertility Affects Fertility Quality of Life of Males

    the andrological visit along with their spouses. Two hun-dred and forty-eight (97.2%) spouses had already under-gone fertility examination and knew their fertility status at the baseline. The remaining seven spouses were rou-tinely asked to undergo their evaluation and provide the results of their fertility examination for diagnostic rea-sons.

  15. Resolution of erectile dysfunction after an andrological visit in a

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

  16. The Risk of Psychiatric Morbidity and Course of Distress in Males

    Respondents attended the andrological visit along with their spouses. Two hundred and forty-eight out of 255 (97.2%) respondents' partners had already undergone fertility examination and knew their fertility status at the baseline. The spouses who failed to provide the results of their fertility examination at the first andrological ...

  17. Semen analysis in "urology-naïve" patients: a chance of uroandrological

    Role of andrological visit in psychogenic ED is been described in literature [17] Among our patients, 6 males had the opportunity to discuss their sexual issues (mild erectile dysfunction related to anxiety pattern) for the first time with a qualified figure, finally setting aside their embarrassment. In this case, no pharmacological treatment ...

  18. ANDROLOGICAL VISIT » ChiediloQui.it

    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 ...

  19. Resolution of erectile dysfunction after an andrological visit in a

    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 PE …

  20. The Risk of Psychiatric Morbidity and Course of Distress in Males

    andrological visit and then updated at the follow-up appointments. Respondents attended the andrological visit along with their spouses. Two hundred and forty-eight out of 255 (97.2%) respondents' partners had already undergone fertility examination and knew their fertility status at the baseline. The spouses who failed to provide

  21. The Risk of Psychiatric Morbidity and Course of Distress in Males

    At the third assessment before the third andrological visit, the percentage of distressed individuals with mixed infertility factor has not significantly changed (50.7% at T 3). At the final assessment before the fourth andrological appointment, the analyzed percentage significantly dropped (16.3% at T 4; p value = .00).