American Medical Association Family Medical Guide - American Medical Association [551]
Orchitis
Orchitis is inflammation of one or both testicles that usually results from the viral infection mumps (see page 440) but also can result from an injury or a bacterial infection in the prostate gland or epididymis. This rare condition can permanently damage one or both testicles and, in some cases, can result in infertility.
Symptoms and Diagnosis
Orchitis causes pain, swelling, and a feeling of heaviness in the scrotum. You also may have a fever and nausea. In some cases, symptoms include discharge from the penis, pain during urination, pain during sexual intercourse or ejaculation, or blood in the semen.
To diagnose orchitis, a doctor will perform a manual examination of the affected testicle and will probably recommend an ultrasound scan (see page 111) of the scrotum. He or she will order blood and urine tests to help determine the cause of the infection.
Treatment
In many cases, orchitis can be treated successfully by limiting activity, placing an ice pack on the affected testicle, and wearing an athletic supporter. For pain, doctors usually recommend over-the-counter pain relievers. If orchitis results from a bacterial infection, a doctor will prescribe an antibiotic or an antibacterial drug.
Hypogonadism
Hypogonadism, or testosterone deficiency, is a disorder in which the testicles fail to produce the male sex hormone testosterone, which stimulates sexual development. There are two main types of hypogonadism: primary and secondary. Primary hypogonadism, also known as primary testicular failure, arises from an abnormality in the testicles. Secondary hypogonadism signals a defect in the pituitary gland, a small structure at the base of the brain that secretes a variety of different hormones, which regulate many processes in the body.
When the pituitary gland does not send hormones to the testicles, the testicles cannot produce testosterone. Hypogonadism affects about 1 in 500 men and boys.
Primary hypogonadism can be caused by a number of factors, including:
• A genetic disorder such as Klinefelter syndrome (see page 957), in which an extra X chromosome causes abnormal testicle development
• Absence of testicles at birth
• Undescended testicles
• Hemochromatosis (see page 961), an inherited disorder that causes iron to build up in the blood
• Injury to the testicles
• Hernia surgery
• Chemotherapy or radiation therapy for cancer
• Inflammatory diseases such as sarcoidosis (see page 929)
• Mumps contracted during adolescence or in adulthood
• Normal aging
The possible causes of secondary hypogonadism include disorders that affect the functioning of the pituitary gland, severe head injury, or taking some medications.
Symptoms
The symptoms produced by hypogonadism vary depending on the age at which the disorder occurs. If it occurs during fetal development, too little testosterone is produced, resulting in a condition in which the infant’s genitals are not fully developed and his or her gender cannot be determined. During puberty, hypogonadism can cause such symptoms as slowed growth, underdeveloped muscle mass, small penis and testicles, and scant growth of body hair. Other signs during puberty include breast enlargement, disproportionately long arms and legs, and failure of the voice to deepen.
Men who develop hypogonadism can have scant beard and body hair growth, testicles that are smaller or less firm than normal, and enlarged breasts. They may also have increased body fat and decreased muscle mass and bone density, erection problems, and infertility from an inability to produce sperm. The lowered testosterone levels can also produce symptoms similar to those of menopause in women, including hot flashes, a reduced sex drive, and mood swings.
Diagnosis
If your son has signs of hypogonadism, take him to a doctor for an evaluation because early detection can prevent delayed puberty (see page 449). Early diagnosis and treatment in adulthood can help prevent osteoporosis.
If you have signs of hypogonadism, your doctor will ask about your physical symptoms,