American Medical Association Family Medical Guide - American Medical Association [552]
Treatment
The treatment for hypogonadism depends on its cause. Disorders of the testicles are treated with testosterone injected into a muscle, delivered in a skin patch, or rubbed onto the abdomen in a gel. For pituitary disorders, doctors give pituitary hormones to stimulate sperm production. A growth or tumor in the pituitary gland may require medication or surgical removal. If you are interested in restoring your fertility, your doctor may refer you to a doctor who specializes in treating infertility.
Fluid Accumulation in the Scrotum
For a number of reasons, various types of fluid can accumulate in the scrotum. A hydrocele is an accumulation of the watery lubricating fluid that is normally found in the membrane that covers the testicles. This condition develops when the membrane produces excess fluid or when the body does not reabsorb fluid normally. A hematocele is a collection of blood around the testicle that may result after injury to or rupture of a testicle. A spermatocele is a cyst filled with dead sperm cells that develops next to the epididymis. A varicocele is a mass of varicose (swollen) veins in the spermatic cord that can develop when the valves in the veins are not working properly, causing the veins to stretch and bulge. An untreated varicocele can sometimes cause infertility. Although any of these accumulations of fluid can increase in size, they are usually harmless and do not necessarily require treatment. However, any mass or persistent swelling in the scrotum needs to be evaluated by a doctor.
Symptoms
Fluid accumulations in the scrotum usually produce a mass on one side of the scrotum. The mass may be soft or firm and may or may not be painful. Some men experience a heavy, dragging feeling in the scrotum. Although a large mass can cause pressure and discomfort in the scrotum, it does not affect a man’s ability to achieve and maintain an erection.
Spermatocele
A spermatocele is a cyst filled with dead sperm cells that arises from the epididymis and usually causes a painless swelling in the upper back portion of one or both testicles. Although spermatoceles may grow large enough to cause pressure and discomfort in the scrotum, they are usually harmless.
Hydrocele
A hydrocele is usually a soft, painless swelling around a testicle that develops when excess fluid accumulates between the testicle and its membrane covering. If a large hydrocele is causing discomfort, a doctor will probably recommend outpatient surgery to open the membrane around the testicle to prevent fluid from reaccumulating. Alternatively, the doctor may administer a local anesthetic and drain the fluid from the scrotum with a needle and syringe.
Diagnosis
To diagnose fluid accumulation in the scrotum, a doctor will perform a physical examination during which he or she may use a strong light source to pass light through the scrotum. If the light passes through the mass, the mass is probably a hydrocele. If the light does not pass through the mass, it could be a hematocele or a varicocele. A spermatocele may light up under a strong light source in a darkened room. To confirm the diagnosis, the doctor will order an ultrasound scan (see page 111) of the scrotum or a biopsy (in which a sample of cells is removed from the mass and examined under a microscope).
Treatment
If an accumulation of fluid in the scrotum is not growing and is not causing discomfort, treatment may not be necessary. However, your doctor may ask you to watch for any increased swelling. If