As a urologist, Ryan Berglund, MD, regularly fields difficult — and often embarrassing — questions from his patients and from callers on a local radio show on Friday evenings.
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Here are the 10 most common urology-related questions he gets and his answers to each.
1. Is it normal to feel something in my testicles or scrotum?
There are a lot of normal structures outside the testicle in the scrotum.
Some abnormal things:
- Something that feels like a bag of worms in your scrotum, particularly on the left side, is a collection of abnormally large blood vessels called varicocele. This can lead to infertility and decreased testicle size.
- Hydrocele is fluid collected around the testicle.
- Spermatocele is excess fluid or a cyst in the epididymis.
- The varicocele, spermatocele and hydrocele are abnormal, but most people don’t do anything about them.
If you feel an actual lump inside the testicle, there is a concern of testicular cancer.
A man should examine his testicles once a month in the shower, supporting the testicle with one hand and feeling with the other hand. If you feel a hardness or irregularity inside the testicle, it’s important to contact your doctor.
2. Can a man break his penis?
Yes. There is no bone in the penis, but it has a very strong layer around it called the tunica albuginea that allows for rigidity during an erection.
A penile fracture occurs when that fibrous connective tissue “breaks” during intercourse.
When the erectile bodies fill with blood at high pressure, this strong layer keeps the blood inside and allows for an erection. When it breaks, that layer tears and you bleed through it.
There’s usually a very loud, painful snap followed by detumescence (the erection subsides). The result is bruising and swelling, and it is a surgical emergency.
3. What does normal semen look like? When should I worry?
Normal semen is thick and white, but it can have different consistencies.
- Blood in the semen, if it’s persistent, is a condition called hematospermia, and may relate to a prostate problem.
- If you have a foul-smelling ejaculate with pain, have your doctor check for infection.
4. I am a young man and cannot get an erection. Is that normal?
The risk of having severe erectile dysfunction under the age of 50 is less than 5 percent, so it’s worthwhile to chat with your primary physician if you encounter that problem.
Erectile dysfunction at a young age may relate to:
- A past trauma
- A vascular problem
- A disease that affects the nerves or blood vessels, such as diabetes or hypertension.
Some prescription drugs, illegal drugs, and smoking can also cause erectile dysfunction.
5. What is the normal range of penis size? Can you make it larger?
The normal range is about 3.5 to 7.5 inches, with the average about 5.5 inches. For a normal-sized penis, there’s no safe way to make it larger.
6. My penis has acne. Is that a concern? What spots on my penis or scrotum are abnormal?
People can get infections or irritation of the hair follicles on the penis, and that is not unusual. But if you notice the following, see your doctor:
- Something that looks like an ulcer or a breakdown of the skin with a weeping wound
- Something that looks like a head of cauliflower — probably a wart
- Something that starts out as a red area but expands and drains pus — can signal a more serious infection
7. Can I give my wife a urinary tract infection or can she transmit one to me? Can I get a sexually transmitted disease from a toilet seat?
In general, we don’t consider urinary tract infections (UTIs) as sexually transmitted diseases (STDs). There are some STDs, though, that can cause symptoms similar to a UTI. A standard e coli UTI — the most common type — is not sexually transmitted, as e coli is a ubiquitous bacteria in that area.
Women who are prone to UTIs may get one after intercourse, but it doesn’t mean that her partner is carrying an STD.
No, the woman cannot transmit a UTI to you.
While it is feasible to contract an infection from an unclean toilet seat, this would be an unusual mode of transmission.
8. Should I or shouldn’t I be circumcised?
The use of circumcision for medical or health reasons continues to be debated. This is a very personal decision that no doctor can make on behalf of his patient.
According to the American Academy of Pediatrics (AAP), the overall health benefits outweigh the risks. However, AAP does not recommend routine circumcision for newborn males. The procedure might be recommended in older boys and men to treat phimosis (the inability to retract the foreskin) or to treat an infection of the penis.
9. My penis curves. Should I or can I fix it?
That’s Peyronie’s disease, and curvatures up to about 30 degrees don’t cause any functional problems.
Curvatures greater than 30 degrees may affect intercourse. To fix this problem:
- A doctor can inject a collagenase drug into the scar tissue that causes the curvature.
- A doctor can do a surgical excision of the scar tissue with a graft or a penile prosthesis.
- A doctor can perform a plication, or surgical unbending of the penis.
10. It takes me a long time to pee and takes a while to start. Should I be worried?
Most urinary problems from the prostate are benign prostatic hyperplasia (BPH). Medications can help in some cases, but if problems are so severe that the patient is unable to empty his bladder, there are surgical interventions.
Some people worry that this symptom could signal prostate cancer, but most urinary problems are not related. Those problems that are, show up at a very late phase of advanced disease.