A common problem

Dear Dr. G,

I have consulted a doctor regarding left testicular pain (near the epididymis). After taking antibiotics for one month, the pain has gone. 

The doctor informed me this was due to an infection and the overall structure of the testicle is not affected.

Sadly, after 1 year of consultation of urologist, the pain has recurred at same location. 

Can you please advise me regarding the matter? Can this be caused by non-hygiene practice?
 
Thanks,
Ong

Dear Ong,

I am terribly sorry to learn your testicles are causing you such problems one year after you had it resolved. Please be assures you are not alone. In a typical week, I see three to five patients who are facing the similar issues like you. The vast majority of the problem is not caused by poor hygiene. 

Testicle pain can be acute or chronic in nature. Acute testicular pain is usually intense and sudden onset. The most serious of all is a condition called testicular torsion. This is a relatively common medical condition affecting 1 in 4000 men before the age of 25 years old. Testicular torsion is most prevalent amongst adolescent males and exceedingly rare for men above 40 years old. Imagine the testicle is position like a “bell’s clapper” in the scrotal sac, and with a “twist of misfortune”, the testicle rotates in the horizontal axis. This will result in deprivation of the blood supply and pain of excruciating proportion. Although the description you gave is not consistent with acute torsion, however, there is still a small possibility of intermittent may be the source of you pain. In medical terminology, we commonly term this as “Bell’s Clapper Deformity of the Scrotum”

For testicular pain to be classified as chronic, men have to experience pain for at least three months duration (Yes!!  Three agonizing months). The etiology the chronicity may be associated with prolonged infection such as epididymitis, orchitis or prostatitis. In some cases, inflammatory changes occur even in the absence of pathogens. Since your last treatment was successfully resolved with antibiotics, I would urge you to have the tests to rule out the presence of sexually transmitted infections (STI), such as chlamydia or gonorrhea. Such infection may be chronically resulting in damage to the patency and integrity of spermatogenesis.

Of course, there is also a possibility you pain may be completely unrelated to the condition in the previous year. One of the common causes of chronic testicular discomfort is varicocele. Essentially, this is a medical condition characterized by dilated group of veins accumulated near the epididymis, just like the varicose veins that affect the lower limbs. I suggest you get yourself scan and establish the real etiology before the commencement of treatment.

Sadly, twenty five percent of patients with chronic testicular pain will have no identifiable cause. The symptoms often persist for many months or even years. Under these circumstances, the doctors can only prescribe various medications such as Non Steroidal Anti-inflammatory (NSAISD’s) or other painkillers, and let nature takes its course.

So, be prepared and be patience. It might be a long drag!

Regards

Dr.G


Hi Dr. G,

Good day. I would like to ask you a few questions about PE.

I just read The Star Online about your Q&Es about the PE, towards the end of Sept 2013.

I have this problem too. I'm a 28-year-old man. Not married and no kid. Got a steady girl friend for five years but broke up recently. But I still want to ask the below:

I would like to know when you say men have ejaculation latency period of 5-8 minutes. What does that mean? Is this partner, positional and mood dependent?

As of my case, I developed a technique of increasing the interval of foreplay. In addition to that, I often reduce the rate of intercourse to prevent premature ejaculation. Despite such strategies, I still ejaculate less than 2-5 minutes. 

I would like to know whether it is normal?

Please advise me. Thanks. 

A very curious man

Dear Very Curious man,

Thank you so much for your email, and I appreciate you reading the previous articles. Thank goodness for online newspaper that makes news clippings the thing of the past, and retrieval of archive articles is so easy and may benefit many others.

I am sorry to hear that you have broken off with your partner after a five-year relationship. I certainly hope the issue of sexual performance is not the main contributory factor. Many of us underestimate the negative impact of Premature Ejaculation (PE) on a relationship. Recent studies had highlighted men with PE suffer from significant adverse psychosocial impact compared with men with Erectile Dysfunction (ED). These include low self-esteem/ confidence, difficulties in inter-personal relationship and poor quality of life satisfaction. In many instances, the delay in seeking treatment often resulted in irreversible damage in relationship.

With regards to the interval of intercourse, many men indeed get so hung up about the timing, and become a bit obsessive about their performance. In reality, it is impossible to predict how long one last in the act of intimacy. All these are estimates. In fact, I recently participated in a study asking participating men to outline their own interval of intercourse; how long is the average and what would be the ideal in various Asia Pacific countries. The men from countries that have high self-confidence (guess which one?) clearly think their performance is above average, and vice versa. The interesting fact is when ask to estimate what is the timing for the act, most men would double the interval that is commonly published in scientific journals to be normal.

In the scientific community, we assess the interval of Intercourse by a method called IELT (Intra-Vaginal Ejaculation Latency Time). This is simply for the partner to get a stopwatch activated from the moment of penetration and terminate the timing upon completion. As you can image, such assessment is grossly unnatural and cumbersome. Needless to say, the compliance and accuracy of the timing are often imprecise (to say the least). But that is the best assessment we have! 

A few clinicians in Netherland and other countries had studied the IELT in normal couples and reported it to be 5-8 minutes (Waldinger and Patrick). This has become the benchmark we work with. The same researchers also assess the IELT of men who “self-reported” having the problems of PE. Nearly 90% of these men actually do have the IELT of around 1 minute. As a result, the International Society of Sexual Medicine (ISSM) has included in the definition the interval of around 1 minute, to be diagnosed as having PE.

Indeed the ability of sexual performance in different individuals is situational and partners dependent. The sufferers of PE do constantly trying to develop better control to prevent early ejaculation. Some would slow down act of intimacy and other will prolonged the foreplay. The sex therapist would advice couples to “start and stop” the act of love making of even thinking of unpleasant thoughts to prevent PE. Like what you have discovered, the vast majority of sufferers find these behavioral techniques work up to a point, but highly undesirable as it takes the “love” out of lovemaking.

My advice is to go and see your doctor. Get the diagnosis establish and perhaps the pills may reignite the flames of passion in your love life?

Regards

Dr. G


Dear Dr. G,

My wife had a fall hitting her left forehead on the kitchen floor about 3 months ago. A CT scan and MRI showed no skull fracture and no blood clot in the brain. 

However, she is now experiencing occasional 'prickly' pain on the left side of her head. The doctor said there is nerve injury causing her head pain. 

My question is whether the damaged nerves can repair themselves; and if they do, how long will it take? 

Thank you, Doctor. 
Nervous

Dear Nervous,

Thank you for your two emails. I assure you that I have received them safe and sound. 

Truthfully, I am a bit nervous myself answering your question. The organs I specialize in are normally below the waistline, therefore answering the question regarding the brain and the nerves may be challenging. However, as I often get mistaken as “Neurologist” rather than “Urologist” over dinner parties, I have done enough background work to be able to handle simple head injury questions. However, I am in no way even remotely pretending to be as clever as the “Brain doctors”.

I am sorry to learn that you wife took a tumble and hit her forehead three months ago and continue to get occasional prickly pain the left side of the head. I am pleased to learn the MRI scan had been normal.

What she is experiencing indeed sounds like the “post concussion syndrome”. Post concussion syndrome is a collection of symptoms that minor head injury victims develop after a concussion. The commonest symptoms are headache, dizziness and nausea. The vast majority of the symptoms may resolve within three months of the event, sadly some may persist for half a year and rarely beyond a year. Since the condition is mostly self-limiting, treatment is often unnecessary. In patients with the impairment of the quality of life, symptomatic relieve with medications may be warranted.

The exact cause of post concussion syndrome is largely unknown. One theory is the slight damage of the nerve cells in the brain is undergoing repair that induces the symptoms. Others believe that post concussion syndrome develop because of the psychological or emotional reaction to the initial head injury.

So, Dr. G’s advice is to look after her, support her and get into the kitchen of yours and stop her from having another tumble.

Regards

Dr. G

PS. Don’t forget. Go a see the Neurologist (Real Brain Doctor) and not Urologist