Andrology and Venerology

Andrology and Venerology

Male infertility

About 10-15% of couples are infertile. This means they cannot conceive a child, despite having had frequent, unprotected sex for a year or more. Almost 50% of the time the cause is male.

Male infertility is due to low sperm production, abnormal sperm function, or obstructions that prevent sperm release. Illness, injury, chronic health problems, lifestyle, and other factors can influence male infertility.


The main sign of male infertility is the inability to conceive a child. There may be no other obvious signs or symptoms. In some cases, however, the signs and symptoms are caused by underlying problems, such as an inherited disorder, a hormonal imbalance, dilation of the veins around the testicle, or a condition that obstructs the passage of sperm.

Although most men with male infertility do not notice symptoms (except the inability to conceive), signs and symptoms associated with male infertility may include:

  • Problems with sexual function, such as difficulty ejaculating or ejaculating small amounts of fluid, reduced sex drive, or problems maintaining erection (erectile dysfunction).
  • Pain, swelling, or a lump in the testicle area.
  • Recurrent respiratory infections.
  • Inability to smell.
  • Abnormal breast growth (gynecomastia).
  • Decreased facial or body hair, or other signs of chromosomal or hormonal abnormalities.
  • Lower than normal sperm count (less than 15 million sperm per milliliter of semen or a total sperm count less than 39 million per ejaculation).

Medical causes

Male fertility problems can be due to various health problems and medical treatments. These include:

  • Varicocele. It is a dilation of the veins that drain the testicle. It is the most common reversible cause of male infertility. Although the exact reason varicoceles cause infertility is unknown, it may be related to abnormal testicular temperature regulation. Varicoceles produce a decrease in sperm quality. Treatment of varicoceles can improve sperm count and function, and could potentially improve outcomes when assisted reproductive techniques, such as in vitro fertilization, are used.
  • Infection. Some infections can interfere with sperm production or health, or cause scarring that blocks sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis), and some sexually transmitted infections, such as gonorrhea or HIV. Although some infections can cause permanent testicular damage, sperm can be retrieved more often.
  • Ejaculation problems. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging from the tip of the penis. Various health conditions can lead to retrograde ejaculation, including diabetes, spinal injuries, medications, and bladder, prostate, or urethra surgery. Some men with spinal cord injuries or certain diseases cannot ejaculate semen, even though they still produce sperm. Often, in these cases it is still possible to retrieve sperm for use in assisted reproduction techniques.
  • Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and try to eliminate them.
  • Tumors. Cancer and nonmalignant tumors can directly affect the male genital organs through glands that release hormones associated with reproduction, such as the pituitary gland, or from unknown causes. In some cases, surgery, radiation, or chemotherapy to treat tumors can affect male fertility.
  • Undescended testicles. In some men, one or both testicles do not descend from the abdomen into the sac that normally contains the testicles (scrotum) during fetal development. Decreased fertility is more likely in men who had this disorder.
  • Hormonal imbalances. Infertility may be due to disorders of the testicles or an abnormality that affects the hormonal systems, such as the hypothalamus, pituitary gland, and adrenal and thyroid glands. Low testosterone levels (male hypogonadism) and other hormonal problems have several underlying causes.
  • Defects of the tubules that carry sperm. Various tubes carry sperm. These can be blocked due to various causes, for example, inadvertent injury during surgery, previous infections, trauma or abnormal development, such as cystic fibrosis or similar inherited disorders. Blockage can occur at any level: inside the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts, or in the urethra.
  • Chromosomal defects. Inherited disorders, such as Klinefelter syndrome, in which a man is born with two X chromosomes and one Y chromosome (instead of one X and one Y), cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility are cystic fibrosis, Kallmann syndrome, and Kartagener syndrome.
  • Problems with sexual intercourse. They can be problems maintaining or maintaining an erection sufficient for sexual intercourse (erectile dysfunction), premature ejaculation, painful sexual intercourse, anatomical abnormalities such as having a penile curvature or an opening of the urethra under the penis (hypospadias), or psychological or relationship problems that interfere with sexual intercourse.
  • Celiac disease. Celiac disease, a digestive disorder caused by gluten sensitivity, can lead to male infertility. Fertility may improve after implementing a gluten-free diet.
  • Some medicines. Testosterone replacement therapy, long-term anabolic steroid use, cancer drugs (chemotherapy), certain antifungal drugs, some ulcer medications, and other medications can affect sperm production and decrease male fertility.
  • Previous surgeries. Certain surgeries can prevent you from having sperm in ejaculation, including vasectomy, bilateral inguinal hernia repairs, scrotal or testicle surgeries, prostate surgeries (benign and malignant), and major abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, surgery can be performed to reverse this blockage or retrieve sperm directly from the epididymis and testicles.

Environmental causes

Excessive exposure to certain environmental elements, such as heat, toxins, and chemicals, can reduce sperm production or function. Specific causes include:

  • Industrial chemicals. Long-term exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, paint materials, and lead can contribute to decreased sperm count.
  • Exposure to heavy metals. Exposure to lead or other heavy metals can also cause infertility.
  • Radiation or x-rays. Radiation exposure can reduce sperm production, although it will often return to normal in the long run. With high doses of radiation, sperm production can decrease permanently.
  • Excessive heat in the testicles. High temperatures affect sperm production and function. Although studies are limited and inconclusive, frequent use of saunas or hot tubs can temporarily affect sperm count. Sitting for extended periods, wearing tight clothing, or working with a laptop on your legs for long periods can also increase the temperature of the scrotum and slightly reduce sperm production.

Health, lifestyle and other causes

Other causes of male infertility include:

  • Drug use. Anabolic steroids used to stimulate muscle strength and growth can cause the testicles to contract and decrease sperm production. Also, cocaine or marijuana use can temporarily reduce the number and quality of sperm.
  • Consumption of alcoholic beverages. Alcohol consumption can lead to a decrease in testosterone levels, can cause erectile dysfunction, and decrease sperm production. Liver disease caused by excessive alcohol consumption can also cause fertility problems.
  • Smoking tobacco. Men who smoke are more likely to have a low sperm count compared to those who don’t smoke. It is possible that passive smoking also affects male fertility.
  • Emotional stress. Stress can interfere with the hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect sperm count.
  • Depression. Research shows that the chances of getting pregnant can decrease if the male partner has severe depression. In addition, depression in men can cause sexual dysfunction due to reduced libido, erectile dysfunction, or delayed or inhibited ejaculation.
  • Weight. Obesity can impair fertility in several ways, causing sperm to directly impact themselves and causing hormonal changes that reduce male fertility.


A detailed medical history and thorough physical examination is the mainstay for the initial diagnosis of infertility.

Several tests are indicated to diagnose male infertility:

The spermogram measures the number of sperm per milliliter of semen, their motility, vitality and whether abnormal forms are identified.

Semen culture rules out infections in the genital organs that should be fixed.

Testicular ultrasound It measures the volume and anatomy of the testicles and epididymis. Abnormal volume and various anatomical alterations may be related to many causes of infertility.

Blood tests tell us if there is any hemametric or organic factor that may be influencing infertility.

The hormonal profile It measures the levels of testosterone and pituitary hormones. If any of these hormones are altered, it can indicate that there is a condition that must be corrected to recover fertility.

The karyotype is a chromosomal study that rules out genetic alterations linked to infertility.


At Uros Associats we establish therapies practically from the first consultation. We prescribe medications that help improve sperm count and motility; we provide guidance on certain lifestyle changes that may benefit the recovery of fertility; If there is erectile dysfunction or premature ejaculation, we initiate specific treatments for each of these conditions. For infections in the seminal tract we indicate specific antibiotics. As for the most complex pathologies, such as obstructions of the seminal ducts or genetic syndromes linked to infertility, we collaborate in assisted reproduction therapies, most of them surgical, minimally invasive.


There are many types of male infertility that cannot be prevented. However, you can avoid some of the known causes of male infertility. For example:

  • Don’t smoke.
  • Limit or eliminate alcohol consumption.
  • Don’t use drugs.
  • Maintain a healthy weight.
  • Avoid factors by which the testicles can be exposed to heat for a long time.
  • Reduces stress.
  • Avoid exposure to pesticides, heavy metals and other toxins.

Erectile dysfunction

Erectile dysfunction (impotence) is the inability to get an erection or maintain it firmly enough to have sexual intercourse.

Although more than half of men at some point in their lives have had erection problems occasionally, not constituting a source of concern, it can become a serious inconvenience if it is frequent or constant. Established erectile dysfunction can produce a lot of stress, instability in relationships, lack of confidence and self-esteem problems. Erectile dysfunction, in addition, can be an incipient sign of some other underlying disease, which should be diagnosed.

The symptoms of erectile dysfunction are:

  • Constant problems getting and/or maintaining an erection
  • Decreased libido (sex drive)


Male sexual arousal is a complex process involving the brain, hormones, emotions, nerves, muscles, and blood vessels. Erectile dysfunction can be the result of a problem with any of these factors. Similarly, stress and mental health concerns can lead to erectile dysfunction or make it worse.

Sometimes erectile dysfunction is due to a combination of physical and psychological issues. For example, a minor physical illness that slows your sexual response can make you anxious about maintaining an erection. This anxiety can lead to or worsen erectile dysfunction.

Some of the physical and psychological causes that can generate erectile dysfunction are:

  • Heart disease
  • Atherosclerosis
  • High cholesterol level
  • High blood pressure
  • Diabetes
  • Obesity
  • Metabolic syndrome: condition involving increased blood pressure, high insulin levels, body fat around the waist, and high cholesterol levels
  • Parkinson’s disease
  • Multiple sclerosis
  • Some medications, including many used for high blood pressure
  • Smoking
  • Peyronie’s disease: scar tissue inside the penis
  • Alcohol and other substance abuse
  • Sleep disorders
  • Treatments for prostate cancer or an enlarged prostate
  • Surgeries or injuries affecting the pelvic area or spinal cord
  • Depression, anxiety or stress, relationship or mental health problems

Risk factors

Some risk factors for erectile dysfunction are:

  • Diabetes mellitus
  • High blood pressure
  • Smoking
  • Overweight or obesity
  • Some medical treatments, such as those of the prostate, chemotherapy, blood pressure medications, antidepressants, antihistamines, analgesics.
  • Trauma to the pelvis, spine or diseases that cause spinal degeneration and/or peripheral nerves.
  • Alcohol and drug use.

As a man ages, the sexual response slows, but this is not necessarily considered erectile dysfunction; Therefore, age itself should not be taken as a risk factor.


A healthy life, avoiding the aforementioned toxins, taking care of weight, performing moderate physical exercise and following a regular medical check-up, is the fundamental pillar to maintain good erectile function throughout life.


To diagnose erectile dysfunction, in Uros Associats we collect the patient’s medical history in detail, a complete urological physical examination is performed and blood tests are indicated that inform us about the general hematimetric, lipid and hormonal condition. In certain cases, imaging tests, such as penile ultrasound, will be required. Most of the time invasive or expensive tests are not needed.


Treatment of erectile dysfunction is usually multimodal. Key lifestyle changes are proposed (weight reduction, physical exercise, smoking cessation), safe medicines adapted to the patient’s preferences are prescribed (orally or injectable) and their progress or deterioration in the field of sexuality is closely monitored. If the drugs prove not to be enough, the penile prosthesis will be offered: an implantable device that is voluntarily activated in the corpora cavernosa of the penis and that is usually the definitive solution to erectile dysfunction. The prosthesis is, in most cases, a safe option for patients in whom it is indicated, allowing the person to have satisfactory sexual intercourse. This device does not affect sexual sensations and does not prevent orgasm or ejaculation.

Premature ejaculation

Premature ejaculation is diagnosed when in a persistent way, ejaculation and orgasm occur before or as soon as they penetrate and this occurs against the will of the male. For us to talk about premature ejaculation, this problem must appear in a frequent way, and cause problems to one or both members of the couple.

It is called primary premature ejaculation, when this problem occurs from the first sexual intercourse and acquired when it appears later.

It is a very frequent problem. It affects approximately 30% of men and is underdiagnosed by fear or embarrassment to consult the doctor.


Premature ejaculation can produce:

  • loss of self-esteem.
  • anxiety in the male and his partner.
  • poor satisfaction with their sex life.
  • Low level of partner satisfaction.


To diagnose premature ejaculation, a good medical history and physical examination are almost always sufficient.


Although many cases of premature ejaculation resolve on their own over time, persistent cases can benefit from various sexual re-education techniques and pelvic floor exercises. These techniques teach delaying orgasm. Kegel exercises strengthen the pelvic floor and improve control of the ejaculatory reflex.

Some medications may be used to delay ejaculation. Some are topical (usually anesthetic and applied to the glans), and others are oral.

In Uros Associats we have an excellent andrological service, specialized in treating all cases of premature ejaculation. Multimodal therapy is the preferred weapon of our unit, which guarantees the control of almost all cases.

Peyronie’s disease or penile curvature

Peyronie’s disease is a noncancerous condition that results from fibrous scar tissue forming on the penis and causing curved and painful erections. Penises vary in shape and size, and having a curved erection is not necessarily a cause for concern. But Peyronie’s disease causes significant curvature or pain in some men or their partners.

This can prevent you from having sex or can make it harder to get an erection. In many men, Peyronie’s disease also causes stress and anxiety. Penis shortening is another common concern.

This disease sometimes goes away on its own but in others it will remain and/or get worse. Treatment can prevent it from getting worse or even improve symptoms. Even if you’ve had the condition for some time, treatment can help improve bothersome symptoms, such as pain, curvature, and shortening of the penis.


Signs and symptoms of Peyronie’s disease may come on suddenly or develop progressively. Include:

  • Scar tissue. Scar tissue affects the corpora cavernosa and can be felt under the skin; It can be small or very extensive and affect one or several areas of the penis at a time.
  • A significant curvature of the penis. The penis may curve upwards, curve downwards, or bend to one side.
  • Erection problems. Peyronie’s disease can cause problems achieving or maintaining an erection.
  • Shortening of the penis. The penis may shorten as a result of La Peyronie’s disease.
  • Pain. You may feel pain in your penis, with or without erection.
  • Other deformities of the penis. In some men with Peyronie’s disease, the erect penis may have a narrowing, indentations, or even an hourglass appearance, with a tight, narrow band around the shaft of the penis.

The curvature and shortening of the penis associated with the disease could get progressively worse. However, at some point the condition stabilizes, usually after about three to 12 months.

Pain during erections usually improves within a year or two, but scar tissue, penile shortening, and curvature often remain. In some men, both the curvature and pain associated with Peyronie’s disease improve without treatment.


The cause is not fully known, although common causes have been established in about half of the cases.

Repeated injuries to the penis during sexual intercourse, physical exercises, pelvic or transurethral surgeries or an accident with impact on the penis can lead to improper healing of the injured part (in this case the penis) and therefore a formation of scar tissue in the form of a nodule. The scar produces an abnormal curvature of the erect penis. The tightness of this scar nodule during an erection produces pain and a disfigured appearance.

Heredity may play a role in cases of Peyronie’s disease. The condition is more common if the patient has first-degree relatives who have had the disease.

Connective tissue disorders, such as Dupuytren’s contracture on the palms of the hands or soles of the feet, and some diseases that can compromise wound healing, such as diabetes mellitus, have also been linked.

Age, without a doubt, contributes as well. The disease is more common in males 50-60 years of age.


A medical history and physical examination are critical to the diagnosis of Peyronie’s disease. Patients are also asked to take selfies of the erect penis from various angles, to establish the severity of the curvature.


The Andrology unit of Uros Associats has extensive expertise in the management of Peyronie’s disease. Not all cases require treatment, only those in which the condition compromises the erection, causes pain to the patient or his partner or prevents penetration into a sexual intercourse. In many cases, fibrous plaque is required to stabilize before targeted treatment can be carried out.

There are several therapies available, from drug treatments, injection of substances that degrade scar connective tissue within plaque or penile remodeling surgeries. The choice of therapy will depend on the time of evolution of the disease, the extent of the plaque, the degree of curvature of the penis and the initial length of the limb. The therapies are agreed in detail with the patient.

Penile fracture

Penile fracture occurs if trauma occurs with the erect penis. It consists of the partial rupture of the tunica albuginea, which is the fibrous lining of the corpora cavernosa. Most often it happens during sexual intercourse, in which the penis accidentally bends sharply. It is a painful injury, manifested with a sudden sound described as a click, loss of erection and the appearance of a bruise on the penis, around the fracture.

Risk factors

Although rare, penile fracture can occur in certain cases:

  • Very vigorous sexual intercourse.
  • Certain sexual positions, in which the penis is more susceptible to colliding sharply with the pelvis of the partner and therefore to injury.
  • Anal sex.
  • Aggressive masturbatory practices.
  • Use of some sex toys.


Medical history and physical examination is usually sufficient to diagnose penile fracture. In some cases, penile ultrasound or magnetic resonance imaging of the penis may be indicated. These tests help locate the fracture, measure its extent and rule out the involvement of other structures, such as the urethra.


Penile fracture is an emergency. If not treated immediately it can produce permanent deformations of the penis or permanent erectile dysfunction. Surgical exploration is, with few exceptions, the standard indication. It consists of stripping the penis, locating the lesion and repairing it with stitches. The outlook will depend on many factors, including adherence to postoperative care indicated after repair.

Men’s sexually transmitted diseases

Sexually transmitted diseases (STDs), or sexually transmitted infections (STIs), are usually acquired through sexual contact. The organisms (bacteria, viruses, or parasites) that cause sexually transmitted diseases can be passed from one person to another through blood, semen, or vaginal fluids and other body fluids.

Sometimes these infections can be transmitted nonsexually, such as from mother to child during pregnancy or childbirth, or through blood transfusions or shared needles.

Sexually transmitted diseases do not always have symptoms. It’s possible to get sexually transmitted diseases from people who seem perfectly healthy and don’t even know they have an infection.

Signs and symptoms

These diseases can have very flowery symptoms or be completely asymptomatic. Signs and symptoms that may indicate a sexually transmitted infection include:

  • Sores or bumps on the genitals or oral or rectal area
  • Pain or burning when urinating
  • Discharge from the penis
  • Unusual or strange-smelling vaginal or urethral discharge
  • Unusual vaginal bleeding
  • Pain during sex
  • Pain and swelling of the lymph nodes, particularly in the groin, although sometimes more widespread
  • Pain in the lower abdomen
  • Fever
  • Rash on the trunk, hands, or feet

Signs and symptoms may appear a few days after exposure, or it may take years before you have any noticeable problems, depending on the germ causing you.


STDs can be caused by bacteria, parasites, or viruses:

  • Bacteria (gonorrhea, syphilis, chlamydia)
  • Parasites (trichomoniasis)
  • Virus (human papillomavirus, genital herpes, HIV, hepatitis A, hepatitis B, hepatitis C)

Risk factors

Factors that may increase the risk of STDs include:

  • Having unprotected sex. Vaginal or anal penetration of an infected partner if a latex condom is not used greatly increases the risk of contracting a sexually transmitted infection. Inappropriate or inconsistent use of condoms can also increase the risk. In oral sex, infections can also be transmitted if done without a latex condom or dental dam.
  • Having sexual contact with several partners. If you have sexual contact with more people, the greater your risk will be.
  • Having a history of sexually transmitted infections. Having a sexually transmitted infection makes it easier for another sexually transmitted infection to take hold.
  • Alcohol abuse or drug use.
  • Drug injection. Needle sharing transmits many serious infections, including HIV, hepatitis B, and hepatitis C.
  • Being young. Half of sexually transmitted infections occur in people between 15 and 24 years of age.


Possible complications include:

  • Pelvic pain
  • Pregnancy complications
  • Eye inflammation
  • Arthritis
  • Pelvic inflammatory disease
  • Sterility
  • Cardiopathy
  • Certain cancers, such as cervical, penile, and rectal cancer, associated with the human papillomavirus


To prevent STDs, it would be most appropriate to:

  • Vaccination. Getting vaccinated early, before sexual exposure, is also effective in preventing certain types of STDs. There are vaccines to prevent human papillomavirus, hepatitis A and hepatitis B.
  • Use condoms and dental dams consistently and correctly. Use a new latex condom or dental dam for every sexual act, whether oral, vaginal, or anal. Never use an oil-based lubricant, such as petroleum jelly, with a latex condom or dental dam. Condoms made from natural membranes are not recommended because they are not as effective in preventing STIs. Keep in mind that while condoms reduce the risk of exposure to most sexually transmitted infections, they provide less protection for some sexually transmitted infections such as human papillomavirus or herpes. Non-barrier methods of birth control, such as birth control pills (oral contraceptives) or intrauterine devices (IUDs), do not protect against sexually transmitted infections.
  • There is evidence that male circumcision can help reduce a man’s risk of getting HIV from an infected woman (heterosexual transmission) by up to 60%. Male circumcision can also help prevent transmission of genital human papillomavirus and genital herpes.


A medical history and physical exam are critical to the diagnosis of virtually all STDs. In addition, a complete disease testing panel is indicated (because many of these infections are contracted concomitantly). Tests can be blood, genital smear, seminal fluid analysis, or skin lesion biopsy.

At Uros Associats we keep the patient informed at all times of their diagnosis process, clarifying any doubts that may arise and guaranteeing confidentiality. The fear of being diagnosed with an STD should never prevent the patient from approaching one of our specialists.


Treatment of STIs depends on the disease or diseases being diagnosed. In many cases it is enough to comply with an antibiotic scheme and then perform clinical controls to cure the infection. In other cases, as in many viral infections, treatment may be non-curative, so we focus on solving the symptoms until the patient develops sufficient autoimmunity against the aggressor. In diseases with a more serious prognosis, such as HIV and hepatitis B or C, we refer the patient to infectious disease specialists to establish strict treatment and control, and thus avoid serious complications in the medium or long term.