Ask the experts

Do varicoceles need to be repaired?

Varicoceles may form if blood flow in the scrotum is weak. Blood could collect in the veins or flow backward with poor blood flow from the testicles. Swollen lymph nodes or a rare mass could cause blood to collect.

There are no drugs to treat or prevent varicocele. Pain relievers (such as acetaminophen or ibuprofen) or ice may help with pain. Wearing tighter fitting underwear may also help. Surgery is an effective treatment option to potentially improve fertility. For this, a small cut is made in the lower groin. The veins that produce the varicocele are found and tied off to stop blood flow. Improvements in semen parameters are seen in up to 70% of patients undergoing surgery. Embolization (briefly blocking the veins) is a non-surgical treatment option. For this, a catheter is used to place a tiny coil and/or embolic fluid in the nearby blood vessel. This diverts blood from a swollen varicocele. This technique is often utilized if recurrence of varicoceles is seen after surgery.

Most men who have varicoceles don’t have problems with it. The general rule is: if you feel no pain, don’t worry. However, if you feel a pain or a lump on your scrotum, it’s a good idea to ask your doctor or urologist about it.

Dr. David Shin, a urologist at Hackensack University Medical Center, focuses on medical and surgical treatments for male infertility and sexual dysfunction.

Does a low sex drive mean I have a hormone imbalance?

A low sex drive can have many causes. In some cases, reduced hormone levels are the cause.

Older women may have a low sex drive due to menopause when the female hormone estrogen reaches lower levels and causes low sexual desire. Other menopausal symptoms, such as poor vaginal lubrication, can lead to painful intercourse. Low estrogen can cause hot flashes. These menopausal symptoms may add to a woman’s lower desire for sex.

Testosterone is a hormone that fuels a man’s sex drive. Testosterone levels begin to decline after age 30. When they reach a low level, a man may begin to lose the desire for sex and his erections may not work as well anymore.

A low sex drive is not always due to hormone imbalances. In both men and women, low sex drive can also be caused by certain chronic illnesses. Some of these may include:

  • Diabetes – changes in blood sugar can cause fatigue, which can lead to lower sexual desire. Obesity in diabetes may lead to a change of testosterone to estrogen in men and cause lower sexual desire.
  • Cancer – fatigue due to cancer, cancer pain or cancer treatments, such as radiation, surgery and chemotherapy, can lower a person’s desire for sex.
  • Parkinson’s Disease – challenges with movement and lower levels of the neurotransmitter Dopamine can lower sexual desire.
  • Mental health conditions, such as depression and anxiety can also cause lower sexual desire.

Other parts of life can also lower a person’s desire for sex. These can be the stress of daily life, coping with money problems or job loss, recent loss of a loved one, or an ongoing need to manage a chronic illness or a life after an injury.

If you have a low sex drive, start by talking to your primary care doctor or nurse, or to a mental health expert to help you learn more. Your doctor can help you come up with a treatment plan or refer you to a specialist to talk about further options.

Dr. Daniela Wittmann is an Associate Professor of Urology at the University of Michigan. She is also certified as a sex therapist and a sex therapy supervisor by the American Association of Sexuality Educators, Counselors and Therapists. She conducts clinical care and research at Michigan Medicine.

Should I be concerned if I have blood in my semen?

Finding blood in your semen can be concerning. It’s not something to ignore, but it doesn’t usually signal a serious health problem. For instance, a single episode of blood in your semen is not usually a sign of cancer. However, it may be caused by a condition that requires treatment.

Blood in semen can occur at any age, but is most common in men ages 30 to 40.

Common causes include:

  • Blood leaking from a small blood vessel that bursts during ejaculation.
  • Trauma from a recent vasectomy.
  • Trauma from a recent prostate biopsy.
  • An infection in the urinary tract or prostate. If you have an infection, you may also have other symptoms such as painful urination.
  • Sexually transmitted infection.
  • Inflammation in the prostate. This is called prostatitis. This can cause blood in the semen and urine, painful urination, painful sex or a feeling of fullness or swelling in the rectum or genital area.

If you see blood in your semen, speak with your doctor. You’ll be asked about when you first noticed the blood and how often you’ve seen it in your semen. You’ll have a physical exam to check the prostate and genitals. Your doctor may order tests such as a urine test to check for infections.

In many cases, a man with blood in his semen won’t need treatment, especially if he is under 40 and does not have risk factors for serious health issues. If the blood is caused by an infection or inflammation, the doctor may prescribe antibiotics.

If you are over 40 or have certain risk factors such as a history of cancer or bleeding disorders, your doctor may order more tests to rule out a more serious cause of the blood.

Dr. Amarnath Rambhatla, a urologist at Henry Ford Hospital, focuses on male infertility, low testosterone, sexual dysfunction, Peyronie’s disease, vasectomy and vasectomy reversal.  |  WINTER 2021-2022  |  UROLOGYHEALTH extra