How Testicular Cancer Impacts Sex for Men

I recently had a young man in my practice who had been treated for cancer of the testicles. He had several sexual issues now that his cancer treatment was winding down. Here is some information that may be of help to anyone else facing this medical condition.

Testicular cancer tends to strike at a younger age than most other cancers - usually in men between the ages of 17 and 34 years. My client was 30.

Cancer of the testicles can be a particularly devastating diagnosis if it is bilateral (on both sides) since many men attempt to start families around this age. It can significantly lower sperm counts and quality even before the treatment begins. So sperm banking is an important topic to discuss with one's physician.

The risk of getting testicular cancer is greater for men whose testes descended from their lower pelvis into their scrotum after age six or never descended at all. It occurs in approximately 4 of every 100,000 men.

Cancer of the testes is highly curable if it is discovered early. Early detection is possible if a man examines his testicles about once a month. To do this: roll each testicle between the thumb (placed on the top side) and the index and middle fingers (placed on the underside).

Any hard lump should be examined immediately by a physician. A lump may turn out to be a boil or a cyst, both of which are much less serious. As with any cancer, delayed treatment increases the risk of it spreading to other parts of the body. Partners can rest assured that cancer cannot be transmitted through sexual activity and if radiation therapy is being used, they will not be contaminated.

Treatment usually involves surgical removal of the diseased testicle. If physiologically possible, intercourse and/or other sexual activities may be resumed about six weeks after surgery. But sexual functioning may be affected. There may be interference with ejaculation and the ability to reach orgasm. Men may experience "dry orgasms" due to surgery in which the semen goes into the bladder rather than through the urethra and out of body. It is then excreted when a man urinates later.

Usually if there is a remaining testicle, it can produce enough male hormones to maintain masculine traits and typical male bodily functions. If testosterone levels are decreased, hormone replacement therapy can begin after the treatment is finished. For cosmetic enhancement, a saline implant that resembles the removed testis can be surgically placed in the scrotum to create the usual appearance of the scrotum.

So, even though the rate of testicular cancer is fairly low, the minute it takes to do a self-examination is a small price to pay, especially if you're the one in 25,000 who develops it, discovers it, and has it treated.

Related Topics:

• WebMD Video: Testicular Cancer
• Preventing Testicular Cancer

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Testicle Movements - And What They Mean

Recently a client commented to me that she noticed that her lover's testicles move around at different times - sometimes high, sometimes low. She wondered what caused this. And, is it a sign of sexual turn-on?

If you have ever had the chance to go skinny-dipping in cold water with a man, you may have noticed that his testicles do raise and lower. When they come into contact with cold water (or any cold temperature) they snug up to the base of the penis.

The testicles hang in a sack of fleshy skin called the scrotum. They are outside the body, but inside the scrotum, because the temperature of the core of the body is too warm for them. The testicles have two main functions to perform: manufacturing sperm and manufacturing testosterone. This outside-the-body location creates the optimal temperature for testicular functioning - about 94 degrees F.

Therefore, one of the main reasons you might see testicles moving around relates to temperature. The cremaster muscle is responsible for the movement. It expands and contracts according to temperature - moving them further from the body when it's warm and closer to the body when it's cold. (In really cold lakes, they can't seem to get close enough!)

Another reason for testicle movement does have to do with sexual arousal. In the 1960's, Masters and Johnson observed that the testicles elevate just before ejaculation and actually make direct contact with the body. They found that in about 85% of men the right testicle rises before the left one.

Masters and Johnson stated that this movement is very important and that at least partial elevation must occur in order to have what they called a full ejaculation. Sometimes older men will have varying testicular movement and report that there is less pleasurable pressure associated with their ejaculation when their testicles elevate only slightly. Younger men can also have the experience of less pressure when they ejaculate involuntarily and before arousal has reached its peak.

During arousal the testicles also increase in size due to vasocongestion, the accumulation of blood in the pelvis that occurs during arousal. The skin of the scrotum thickens and the testicles increase in size usually by approximately 50% at the height of arousal. However, Masters and Johnson found that if sexual excitement is sustained long enough, the testicles could almost double in size, returning to normal size after orgasm. They also found that this increase in size tends to taper off as men age.

So, the answer to the question about arousal is a qualified "yes." Some people watch their partner's scrotal elevation as a sign of how close he is to reaching orgasm. This is more easily done during oral and manual stimulation. Men looking to "last longer," can also notice this aspect of their arousal to determine where they are relative to orgasm.

I mention these movements since they are quite common. If and when they happen, enjoy them as aspects of arousal. If not, no problem, many people have very satisfying sex without all these ups and downs.

Related Topics:

• WebMD Video: What Men Need to Know About Testicular Cancer
• Testicular Examination and Testicular Self-Examination (TSE)

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Phimosis: The Ins and Outs of a Difficult Foreskin

Yesterday I was talking with a female colleague whose brother just had an adult circumcision due to phimosis. He was sad about the change in his sensation and frustrated that he could not choose another path to solving his problem. Unfortunately, his case (which developed in adulthood -- a rare phenomenon) did not respond to some nonsurgical approaches.

What is phimosis, you might be wondering? It is the inability to retract the adult or late-adolescent foreskin of the penis because the opening is too small or adhesions (abnormal tissue attachments) have formed.

Before listing treatment approaches, it is useful to know how the foreskin functions. It is normal for the foreskin to adhere to the glans (head) of the penis at birth. It is attached with a membrane called synechia which is similar to the membrane that attaches finger nails to the nail bed. In fact, only about 4% of male babies are born with retractable foreskins. Normal bathing of the penis with water and mild soap are generally sufficient to cleanse the penis of newborn males and children.

Many people view this normal condition in children as phimosis and mistakenly attempt to force the foreskin back. This can cause harm and lead to the formation of lesions and the condition called acquired phimosis. The synechia is made up of specialized cells that will totally disappear in all but a few cases by age 17.

When puppies and kittens are born with their eyes shut, we allow nature to take its course rather than forcing their eyelids open. Foreskins develop similarly. In fact, foreskins and eyelids have a great deal in common in the protective function they serve. In cases of injuries during World War II (where some soldiers' eyelids were destroyed by fiery explosions) the foreskins of these men were used to surgically form new eyelids for them.

In some cases, medical attention will be needed to deal with this tissue to finish what nature did not. My colleague's brother was not one of those individuals, but before a man opts for adult circumcision he should try some gradual approaches first.

Here are the instructions: Try stretching the foreskin with fingers. Do this either in a bath or while using lubrication when the penis is flaccid (unaroused). If there is enough opening to insert the tips of the smallest finger on each hand, do so and gently stretch the opening outward. If that is not yet possible, lightly pinch the foreskin between the thumbs and index fingers at the opening and stretch it from the outside. Over time (possibly weeks or a few months) there may be enough improvement to allow the foreskin to retract sufficiently over the glans of the penis.

One can also consider minor surgical approaches. The first involves creating a slit in the foreskin when it will not stretch sufficiently. Some people do not find this solution aesthetically pleasing. Second, some plastic surgery techniques are being developed to expand the opening of the foreskin without removing it entirely. Ask physicians for information about these surgical options.

If a man wishes, of course, he may decide to have a complete circumcision, that is, the removal of the entire foreskin. While circumcision is performed on nearly 50 percent of newborn American males, in most other countries around the world it is fairly rare. I was quite happy to read recent data that indicated that California, my home state, had a circumcision rate of 21% in 2004, the most recent year for which we have data. A billboard in Florida succinctly summarized my feelings about the circumcision of newborns: a foreskin is not a birth defect.

If a man's foreskin will not retract, it may be uncomfortable to have a full erection no matter whether his sexual partner is a woman, a man or is stimulating himself. So, regardless of one's desires or plans regarding a sexual partner, in order to have the option of a full sexual life, I recommend that a man patiently and steadfastly tackle this problem before opting for circumcision.

Related Topics:

• WebMD Video: Circumcision - Pros and Cons
• Circumcision: New Weapon Against AIDS?

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