Male Reproductive Diseases

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CONGENITAL MALFORMATION CRYPTORCHIDISM Definition

Undescended testicle (cryptorchidism) is a testicle that hasn't moved into its proper position in the bag of skin hanging below the penis (scrotum) before birth. Usually just one testicle is affected, but sometimes both testicles are undescended. Cryptorchidism (derived from the Greek kryptos, meaning hidden and orchis, meaning testicle) is the absence of one or both testes from the scrotum. It is the most common birth defect regarding male genitalia. Cryptorchidism is distinct from monorchism the condition of having only one testicle. A testis absent from the normal scrotal position can be: 1. found anywhere along the "path of descent" from high in the posterior (retroperitoneal) abdomen, just below the kidney, to the inguinal ring; 2. found in the inguinal canal; 3. ectopic, that is, found to have "wandered" from that path, usually outside the inguinal canal and sometimes even under the skin of the thigh, the perineum, the opposite scrotum, or the femoral canal; 4. found to be undeveloped (hypoplastic) or severely abnormal (dysgenetic); 5. found to have vanished (also see anorchia).
Causes
The exact cause of an undescended testicle isn't known. A combination of genetics, maternal health and other environmental factors might disrupt the hormones, physical changes and nerve activity that influence the development of the testicles.
Risk factors

Low birth weight Premature birth Family history of undescended testicle or other problems of genital development Conditions of the fetus that can restrict growth, such as Down syndrome or an abdominal wall defect Alcohol use by the mother during pregnancy Cigarette smoking by the mother or exposure to secondhand smoke Obesity in the mother Diabetes in the mother type 1 diabetes, type 2 diabetes or gestational diabetes Parents' exposure to some pesticides
Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.
Symptoms

Not seeing or feeling a testicle in the scrotum is the main sign of an undescended testicle. Testicles form in the abdomen during fetal development. During the last couple of months of normal fetal development, the testicles gradually descend from the abdomen through a tube-like passageway in the groin (inguinal canal) into the scrotum. With an undescended testicle, that process stops or is delayed.
Complications
Testicular cancer. Testicular cancer usually begins in the cells in the testicle that produce immature sperm. What causes these cells to develop into cancer is unknown. Men who've had an undescended testicle have an increased risk of testicular cancer. The risk is greater for undescended testicles located in the abdomen than in the groin. Surgically correcting an undescended testicle might decrease, but not eliminate, the risk of future testicular cancer. Fertility problems. Low sperm counts, poor sperm quality and decreased fertility are more likely to occur among men who've had an undescended testicle. A decrease in cells in the testicle that produce sperm has been found as early as 1 year old.
Other complications related to the abnormal location of the undescended testicle include:
Testicular torsion. Testicular torsion is the twisting of the spermatic cord, which contains blood vessels, nerves and the tube that carries semen from the testicle to the penis. This painful condition cuts off blood to the testicle. If not treated promptly, it might result in the loss of the testicle. Testicular torsion occurs 10 times more often in undescended testicles than in normal testicles. Trauma. If a testicle is located in the groin, it might be damaged from pressure against the pubic bone. Inguinal hernia. If the opening between the abdomen and the inguinal canal is too loose, a portion of the intestines can push into the groin.
Tests and diagnosis

History collection Physical examination Laparoscopy. A small tube containing a camera is inserted through a small incision in abdomen. Laparoscopy is done to locate an intra-abdominal testicle. laparoscopy may show no testicle present, or a small remnant of nonfunctioning testicular tissue that is then removed. Open surgery. Direct exploration of the abdomen or groin through a larger incision may be necessary in some cases.
Treatments and drugs

The goal of treatment is to move the undescended testicle to its proper location in the scrotum. Early treatment (before 1 year of age) might lower the risk of complications of an undescended testicle, such as infertility and testicular cancer.
Surgery
orchiopexy An undescended testicle is usually corrected with surgery. The surgeon carefully manipulates the testicle into the scrotum and stitches it into place . This procedure can be done either with a laparoscope or with open surgery. Surgery is recommend within 3 to 6 months old age and before the baby is 12 months old. Early surgical treatment appears to lower the risk of later complications. If an inguinal hernia associated with the undescended testicle, the hernia is repaired during the surgery. After surgery, the surgeon will monitor the testicle to see that it continues to develop, function properly and stay in place. Monitoring might include:

Physical exam Ultrasound exam of the scrotum Tests of hormone levels
Hormone treatment Hormone treatment involves the injection of human chorionic gonadotropin (HCG). This hormone could cause the testicle to move to son's scrotum. Hormone treatment is not usually recommended because it is much less effective than surgery. Other treatments If one or both testicles either missing or didn't survive after surgery might consider saline testicular prostheses for the scrotum that can be implanted during late childhood or adolescence. These prostheses give the scrotum a normal appearance. Lifestyle and home remedies Even after corrective surgery, it's important to check the condition of the testicles to ensure they develop normally. Check the position of his testicles regularly during diaper changes and baths. Self-examination of testicles will be an important skill for early detection of possible tumors.
HYPOSPADIAS
Definition Hypospadias (hi-poe-SPAY-dee-us) is a condition in which the opening of the urethra is on the underside of the penis, instead of at the tip. The urethra is the tube through which urine drains from bladder and exits body. Causes Hypospadias is present at birth (congenital). The exact reason this defect occurs is unknown. Sometimes hypospadias is inherited. As the penis develops in a male fetus, certain hormones stimulate the formation of the urethra and foreskin. Hypospadias results when a malfunction occurs in the action of these hormones, causing the urethra to develop abnormally. Risk factors This condition is more common in infants with a family history of hypospadias. increased risk of hypospadias in infant males born to women of an advanced age those who used in vitro fertilization (IVF) to conceive. The connection to IVF may be due to the mother's exposure to progesterone, a natural hormone, or to progestin, a synthetic form of progesterone, administered during the IVF process. Symptoms

Opening of the urethra at a location other than the tip of the penis Downward curve of the penis (chordee) Hooded appearance of the penis because only the top half of the penis is covered by foreskin
Other symptoms include:

Abnormal spraying of urine Having to sit down to urinate Malformed foreskin that makes the penis look "hooded"
Complications If hypospadias is not treated, a child may have problems learning to use a toilet properly. During adulthood, untreated hypospadias can cause difficulty in achieving an erection. Signs and tests
A physical examination can diagnose this condition. Imaging tests may be needed to look for other congenital defects. Treatments and drugs Treatment involves surgery to reposition the urethral opening and, if necessary, straighten the shaft of the penis. During surgery, a pediatric urology surgeon uses tissue grafts from the foreskin or from the inside of the mouth to reconstruct the urinary channel in the proper position, correcting the hypospadias. The surgery usually takes from 90 minutes to three hours and is done while the child is unconscious (general anesthesia). Rarely, the repair may require two or more surgeries. When surgery is performed Surgery is best done at an early age usually between ages 4 months and 12 months. Generally, the earlier the surgery is done, the less traumatic it is for the child. But the procedure can be completed at any age and even into adulthood. Infants should not be circumcised before the procedure because the foreskin tissue may be needed for the surgery. Complications of surgery In most cases, surgical repair results in a penis with normal or near-normal function and appearance and no future problems. However, in a small number of cases, a hole (fistula) or scarring may develop along the underside of the penis where the new urinary channel was created. This can result in urine leakage and require an additional surgery for repair.
Epispadias
An epispadias is a rare type of malformation of the penis in which the urethra ends in an opening on the upper aspect (the dorsum) of the penis Causes Epispadias is an uncommon and partial form of a spectrum of failures of abdominal and pelvic fusion in the first months of embryogenesis known as the exstrophy - epispadias complex. While epispadias is inherent in all cases of exstrophy it can also, much less frequently, appear in isolation as the least severe form of the complex spectrum. It occurs as a result of defective migration of the genital tubercle primordii to the cloacal membrane, and so malformation of the genital tubercle, at about the 5th week of gestation In women Women can also have this type of congenital malformation. Epispadias of the female may occur when the urethra develops too far anteriorly, exiting in the clitoris or even more forward. For females, this may not cause difficulty in urination but may cause problems with sexual satisfaction. Frequently, the clitoris is bifurcated at the site of urethral exit, and therefore clitoral
sensation is less intense during sexual intercourse due to frequent stimulation during urination. However, with proper stimulation, using either manual or positional techniques, clitoral orgasm is definitely possible Treatment The main treatment for isolated epispadias is a comprehensive surgical repair of the genitourinary area usually during the first 7 years of life, including reconstruction of the urethra, closure of the penile shaft and mobilisation of the corpora. The most popular and successful technique is known as the modified CantwellRansley approach. In recent decades however increasing success has been achieved with the complete penile disassembly technique despite its association with greater and more serious risk of damage
Prostatitis
Prostatitis is defined as the inflammation of the prostate gland. Prostatitis is swelling and inflammation of the prostate gland, a walnut-sized gland located directly below the bladder in men. The prostate gland produces fluid (semen) that nourishes and transports sperm. Prostatitis often causes painful or difficult urination. Other symptoms of prostatitis include pain in the groin, pelvic area or genitals, and sometimes, flu-like symptoms.
Causes Acute bacterial prostatitis is often caused by common strains of bacteria. The infection may start when bacteria carried in urine leaks into prostate. Chronic bacterial prostatitis may be the result of small amounts of bacteria that aren't eliminated with antibiotics because they "hide" in the prostate. Some men with chronic prostatitis have pain but no evidence of an inflamed prostate. In most cases of prostatitis, the cause is never identified. Causes other than bacterial infection can include:

An immune system disorder A nervous system disorder Injury to the prostate or prostate area
Risk factors

Being a ng or middle-aged man Having a past episode of prostatitis

Having an infection in the bladder or the tube that transports semen and urine to the penis (urethra) Having a pelvic trauma, such as injury from bicycling or horseback riding Not drinking enough fluids (dehydration) Using a urinary catheter, a tube inserted into the urethra to drain the bladder Having unprotected sexual intercourse Having HIV/AIDS Being under psychological stress Having certain inherited traits particular genes may make some men more susceptible to prostatitis
Classification Prostatitis is classified into acute, chronic, asymptomatic inflammatory prostatitis, and chronic pelvic pain syndrome. Meares/Stamey (Old) Acute prostatitis is a bacterial infection of the prostate Acute bacterial Acute prostatitis gland that requires urgent medical treatment. prostatitis Chronic bacterial prostatitis is a relatively rare Chronic bacterial Chronic bacterial condition that usually presents as intermittent urinary prostatitis prostatitis tract infections. Inflammatory Nonbacterial Chronic prostatitis/chronic pelvic pain syndrome, CP/CPPS prostatitis accounting for 90%-95% of prostatitis diagnoses, used Noninflammatory to be known as chronic nonbacterial prostatitis. Prostatodynia CP/CPPS Asymptomatic inflammatory prostatitis patients have Asymptomatic no history of genitourinary pain complaints, but inflammatory leukocytosis is noted, usually during evaluation for (none) prostatitis other conditions. Between 6-19% of men have pus cells in their semen but no symptoms. Type Description Symptoms Prostatitis symptoms vary depending on the cause. They may include:

Pain or burning sensation when urinating (dysuria) Difficulty urinating, such as dribbling or hesitant urination Frequent urination, particularly at night (nocturia) Urgent need to urinate Pain in the abdomen, groin or lower back Pain in the area between the scrotum and rectum (perineum) Pain or discomfort of the penis or testicles Painful orgasms (ejaculations) Flu-like symptoms (with bacterial prostatitis)
Based on symptoms and laboratory tests, doctor may conclude that have one of the following types of prostatitis:
Acute bacterial prostatitis. This type of prostatitis may cause flu-like symptoms associated with the sudden onset of infection, such as fever, chills, nausea and vomiting. It can usually be treated with antibiotics. Chronic bacterial prostatitis. This is bacterial prostatitis that lasts for at least three months due to recurring or difficult-to-treat infections. Urinary tract infections are common with this type of prostatitis. Between bouts of infection, chronic bacterial prostatitis may not cause symptoms or may cause minor symptoms that become severe when infection flares up. Chronic prostatitis not caused by bacteria. This condition is often referred to as chronic abacterial prostatitis or chronic pelvic pain syndrome. It lasts for at least three months. Most cases of prostatitis fall into this category. For some men, symptoms remain about the same over time. For others, the symptoms go through cycles of being more and less severe. Symptoms sometimes improve over time without treatment. Prostatitis that doesn't cause symptoms. This type of prostatitis is called asymptomatic inflammatory prostatitis, and it doesn't cause any symptoms that notice. It's found only by chance when 're undergoing tests for other conditions. It doesn't require treatment.
Complications

Bacterial infection of the blood (bacteremia) Inflammation of the coiled tube attached to the back of the testicle (epididymitis) Pus-filled cavity in the prostate (prostatic abscess) Abnormalities in semen and infertility (this can occur with chronic prostatitis)
Tests and diagnosis

Medical history and symptoms. Physical examination. doctor will examine abdomen and genitals and will likely preform a digital rectal examination (DRE). During a digital rectal exam, doctor will gently insert a lubricated, gloved finger into rectum. doctor will be able to feel the surface of the prostate and judge whether it is enlarged, tender or inflamed. Blood culture. This test is used to see whether there are signs of infection in blood. Urine and semen test. to examine samples of urine or semen for signs of infection. In some cases take a series of samples before, during and after massaging prostate with a lubricated, gloved finger. Examination with a viewing scope (cystoscopy). use an instrument called a cystoscope to examine the urethra and bladder. A cystoscope is a small tube with a light and magnifying lens or camera that's inserted through the urethra and into the bladder. This test is used to rule out other conditions that could be causing symptoms. Bladder tests (urodynamic tests). these tests are used to check how well the patient can empty bladder. This can help to understand how much prostatitis is affecting ability to urinate.

Prostatitis treatments vary depending on the underlying cause. They can include:
Antibiotics. This is the most commonly prescribed treatment for prostatitis. The choice of medication on the type of bacteria that may be causing infection. If have severe symptoms, may need intravenous (IV) antibiotics. Take oral antibiotics for four to six weeks, but may need longer treatment for chronic or recurring prostatitis. Alpha blockers. These medications help relax the bladder neck and the muscle fibers where prostate joins bladder. This treatment may lessen symptoms, such as painful urination. Examples include tamsulosin (Flomax), terazosin (Hytrin), alfuzosin (Uroxatral) and doxazosin (Cardura). Common side effects include headaches and a decrease in blood pressure.
Pain relievers. Pain medications such as aspirin or ibuprofen (Advil, Motrin, others) may make more comfortable. Overusing these medications can cause problems. Prostate massage. This is done by physician using a lubricated, gloved finger a procedure similar to a digital rectal exam. It may provide some symptom relief Other treatments. Other potential treatments for prostatitis are being studied. These treatments include heat therapy with a microwave device and drugs based on certain plant extracts.
Lifestyle and home remedies

Soak in a warm bath (sitz bath). Limit or avoid alcohol, caffeine, and spicy or acidic foods. Sit on a pillow or inflatable cushion to ease pressure on the prostate. Avoid bicycling, or wear padded shorts and adjust bicycle to relieve pressure on prostate.
Alternative medicine
Biofeedback. This is a method for teaching to use thoughts to control body. A biofeedback specialist uses signals from monitoring equipment to teach to control certain body functions and responses, including relaxing muscles. Acupuncture. This type of treatment involves the insertion of very thin needles through skin, to various depths at certain points on body Herbal remedies and supplements. Some herbal treatments for prostatitis include cernilton (rye grass), quercetin (a chemical found in green tea, onions and other plants) and extract of the saw palmetto plant. Prostate supplements combine minerals and vitamins, particularly zinc, selenium and vitamins E and D.
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Orchitis
Orchitis (or-KIE-tis) is an inflammation of one or both testicles, most commonly associated with the virus that causes mumps. Causes and types Bacterial orchitis Most often, bacterial orchitis is the result of epididymitis, an inflammation of the coiled tube that connects the vas deferens and the testicle. The vas deferens carries sperm from testicles. When inflammation in the epididymis spreads to the testicle, the resulting condition is known as epididymo-orchitis. Epididymitis usually is caused by an infection of the urethra or bladder that spreads to the epididymis. Often the cause of the infection is a sexually transmitted infection (STI), particularly gonorrhea or chlamydia. Other causes of infection may be related to having been born with abnormalities in urinary tract or having had a catheter or medical instruments inserted into penis. Viral orchitis Most cases of viral orchitis are the result of the mumps virus. About one-third of males who contract the mumps after puberty develop orchitis during their course of the mumps, usually four to seven days after onset. Risk factors

Not being immunized against mumps Having recurring urinary tract infections Having surgery that involves the genitals or urinary tract, because of the risk of infection Being born with an abnormality in the urinary tract (congenital)
High-risk sexual behaviors that can lead to STIs also put at risk of sexually transmitted orchitis. They include having:

Multiple sexual partners Sex with a partner who has an STI Sex without a condom A personal history of an STI
Other causes of orchitis usually are bacterial, including sexually transmitted infections (STIs), such as gonorrhea or chlamydia.
Bacterial orchitis often results from epididymitis, an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm.
Symptoms
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Swelling in one or both testicles Pain ranging from mild to severe Discomfort when sitting Tenderness in one or both testicles, which may last for weeks Nausea Fever Discharge from penis
The terms "testicle pain" and "groin pain" are sometimes used interchangeably. But groin pain occurs in the fold of skin between the thigh and abdomen not in the testicle. The causes of groin pain are different from the causes of testicle pain. Complications

Testicular atrophy. Orchitis may eventually cause the affected testicle to shrink. Scrotal abscess. The infected tissue fills with pus. Repeated epididymitis. Orchitis can lead to recurrent episodes of epididymitis. Infertility. In a small number of cases, orchitis may cause infertility; however, if orchitis affects only one testicle, infertility is less likely.
Tests and diagnosis

Health history collection A physical exam. A physical exam may reveal enlarged lymph nodes in groin and an enlarged testicle on the affected side; both may be tender to the touch. doctor also may do a rectal examination to check for prostate enlargement or tenderness. STI screening. This involves obtaining a sample of discharge from urethra. doctor may insert a narrow swab into the end of penis to obtain the sample, which will be viewed under a microscope or cultured to check for gonorrhea and chlamydia. Urinalysis. A sample of urine, collected either at home first thing in the morning or at doctor's office, is analyzed in a lab for abnormalities in appearance, concentration or content. Ultrasound imaging. This test, which uses high-frequency sound waves to create precise images of structures inside body, may be used to rule out twisting of the spermatic cord (testicular torsion). Ultrasound with color Doppler can determine if the blood flow to testicle is reduced or increased, which helps confirm the diagnosis of orchitis. Nuclear scan of the testicles. Also used to rule out testicular torsion, this test involves injecting tiny amounts of radioactive material into bloodstream. Special cameras can then detect areas in testicles that receive less blood flow, indicating torsion, or more blood flow, confirming the diagnosis of orchitis.
Treating bacterial orchitis In addition to steps to relieve discomfort, such as resting and applying ice packs, bacterial orchitis and epididymo-orchitis require antibiotic treatment. If the cause of the infection is an STI, sexual partner also needs treatment.
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Antibiotic drugs most commonly used to treat bacterial orchitis include ceftriaxone (Rocephin), ciprofloxacin (Cipro), doxycycline (Vibramycin, Doryx), azithromycin (Zithromax), and trimethoprim and sulfamethoxazole combined (Bactrim, Septra). Treating viral orchitis If doctor has determined that a bacterial infection isn't the cause of orchitis, won't need antibiotic treatment. Instead, treatment for viral orchitis, the type associated with mumps, is aimed at relieving symptoms. doctor may prescribe pain medication, nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others) recommend bed rest, elevating scrotum and applying cold packs.

Rest in bed. Lie down so that scrotum is elevated. Apply cold packs to scrotum as tolerated. Avoid lifting heavy objects.
Prevention

Practicing safer sex, such as having just one sex partner and using a condom, helps protect against STIs, which helps prevent STI-related bacterial orchitis. Getting immunized against mumps is best protection against viral, mumps-related orchitis. The vaccine is recommended for children older than 1 year, with a booster shot recommended when child is between 4 and 6 years old.
Testicular cancer
Definition Testicular cancer occurs in the testicles (testes), which are located inside the scrotum, a loose bag of skin underneath the penis. The testicles produce male sex hormones and sperm for reproduction. Causes It's not clear what causes testicular cancer in most cases. Nearly all testicular cancers begin in the germ cells the cells in the testicles that produce immature sperm. What causes germ cells to become abnormal and develop into cancer isn't known. Risk factors
An undescended testicle (cryptorchidism). The testes form in the abdominal area during fetal development and usually descend into the scrotum before birth. Men who
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have a testicle that never descended are at greater risk of testicular cancer in either testicle than are men whose testicles descended normally. The risk remains even if the testicle has been surgically relocated to the scrotum. Still, the majority of men who develop testicular cancer don't have a history of undescended testicles. Abnormal testicle development. Conditions that cause testicles to develop abnormally, such as Klinefelter's syndrome, may increase risk of testicular cancer. Family history. If family members have had testicular cancer, may have an increased risk. Age. Testicular cancer affects teens and nger men, particularly those between ages 15 and 34. However, it can occur at any age. Race. Testicular cancer is more common in white men than in black men.
There are two types of testicular cancer:
Seminoma. Seminoma tumors occur in all age groups, but if an older man develops testicular cancer, it is more likely to be seminoma. Seminomas, in general, aren't as aggressive as nonseminomas and are particularly sensitive to radiation therapy. Nonseminoma. Nonseminoma tumors tend to develop earlier in life and grow and spread rapidly. Several different types of nonseminoma tumors exist, including choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumor. Nonseminomas are sensitive to radiation therapy, but not as sensitive as seminomas are. Chemotherapy is often very effective for nonseminomas, even if the cancer has spread.
Sometimes both types of cancer are present in a tumor. In that case, the cancer is treated as though it is nonseminoma. Staging the cancer Stage I. Cancer is limited to the testicle.

Stage II. Cancer has spread to the lymph nodes in the abdomen. Stage III. Cancer has spread to other parts of the body. Testicular cancer most commonly spreads to the lungs, liver, bones and brain.
Symptoms

A lump or enlargement in either testicle A feeling of heaviness in the scrotum A dull ache in the abdomen or groin A sudden collection of fluid in the scrotum Pain or discomfort in a testicle or the scrotum Enlargement or tenderness of the breasts
Cancer usually affects only one testicle. Tests and diagnosis health history and physical examination
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Most men discover testicular cancer themselves, either unintentionally or while doing a testicular self-examination to check for lumps. In other cases, doctor may detect a lump during a routine physical exam. Ultrasound. A testicular ultrasound test uses sound waves to create an image of the scrotum and testicles. During an ultrasound lie on back with legs spread. doctor then applies a clear gel to scrotum. A hand-held probe is moved over scrotum to make the ultrasound image. An ultrasound test can help doctor determine the nature of any testicular lumps, such as if the lumps are solid or fluid filled. Ultrasound also tells doctor whether lumps are inside or outside of the testicle. doctor uses this information to determine whether a lump is likely to be testicular cancer.
Blood tests. doctor may order tests to determine the levels of tumor markers in blood. Tumor markers are substances that occur normally in blood, but the levels of these substances may be elevated in certain situations, including testicular cancer. A high level of a tumor marker in blood doesn't mean have cancer, but it may help doctor in determining diagnosis. Surgery to remove a testicle (radical inguinal orchiectomy). If it's determined that the lump on testicle may be cancerous, surgery to remove the testicle may be recommended. removed testicle will be analyzed in a laboratory to determine if the lump is cancerous and, if so, what type of cancer. Computerized tomography (CT). CT scans take a series of X-ray images of abdomen. doctor uses CT scans to look for signs of cancer in abdominal lymph nodes. Blood tests. Blood tests to look for elevated tumor markers can help doctor understand whether cancer likely remains in body after testicle is removed
Treatments and drugs The options for treating testicular cancer depend on several factors, including the type and stage of cancer, overall health, and own preferences. Treatment options may include: Surgery
Radical inguinal orchiectomy Surgery to remove testicleis the primary treatment for nearly all stages and types of testicular cancer. To remove testicle, surgeon makes an incision in groin and extracts the entire testicle through the opening. A prosthetic, salinefilled testicle can be inserted if choose. Retroperitoneal lymph node dissection may also have surgery to remove the lymph nodes in groin (Sometimes this is done at the same time as surgery to remove testicle. In other cases it can be done later. The lymph nodes are removed through a large incision in abdomen. surgeon takes care to avoid severing nerves surrounding the lymph nodes, but in some cases severing the nerves may be unavoidable. Severed nerves can cause difficulty with ejaculation, but won't prevent from having an erection.
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Radiation therapy Radiation therapy is a treatment option that's frequently used in people who have the seminoma type of testicular cancer. Radiation therapy is also used in certain situations in people who have the nonseminoma type of testicular cancer. Radiation therapy uses highpowered energy beams, such as X-rays, to kill cancer cells. During radiation therapy, 're positioned on a table and a large machine moves around , aiming the energy beams at precise points on body. Side effects may include fatigue, as well as skin redness and irritation in abdominal and groin areas. Chemotherapy Chemotherapy treatment uses drugs to kill cancer cells. Chemotherapy drugs travel throughout body to kill cancer cells that may have migrated from the original tumor. doctor might recommend chemotherapy after surgery. Chemotherapy may be used before or after lymph node removal. Side effects of chemotherapy depend on the drugs being used.. Common side effects include fatigue, nausea, hair loss, infertility and an increased risk of infection. There are medications and treatments available that reduce some of the side effects of chemotherapy.
Prevention There's no way to prevent testicular cancer. Some doctors recommend regular testicle selfexaminations to identify testicular cancer at its earliest stage. If choose to do a testicular self-examination, a good time to examine testicles is after a warm bath or shower. The heat from the water relaxes scrotum, making it easier for to find anything unusual. To do this examination, follow these steps:

Stand in front of a mirror. Look for any swelling on the skin of the scrotum. Examine each testicle with both hands. Place the index and middle fingers under the testicle while placing thumbs on the top. Gently roll the testicle between the thumbs and the fingers. Remember that the testicles are usually smooth, oval shaped and somewhat firm. It's normal for one testicle to be slightly larger than the other. Also, the cord leading upward from the top of the testicle (epididymis) is a normal part of the scrotum. By regularly performing this exam, can become more familiar with testicles and aware of any changes that might be of concern.
Benign prostatic hyperplasia
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Benign prostatic hyperplasia (BPH), also called benign enlargement of the prostate (BEP), adenofibromyomatous hyperplasia and benign prostatic hypertrophy (technically incorrect usage), is an increase in size of the prostate. BPH involves hyperplasia of prostatic stromal and epithelial cells, resulting in the formation of large, fairly discrete nodules in the periurethral region of the prostate. When sufficiently large, the nodules compress the urethral canal to cause partial, or sometimes virtually complete, urinary tract obstruction by the urethra, which interferes with the normal flow of urine. It leads to symptoms of urinary hesitancy, frequent urination, increased risk of urinary tract infections, urinary retention, or contribute to or cause insomnia. Although prostate specific antigen levels may be elevated in these patients because of increased organ volume and inflammation due to Causes The exact cause is not known. Risk factors The main risk factors for prostate gland enlargement include:
Aging. Prostate gland enlargement rarely causes signs and symptoms in men nger than 40. By 55, about 1 in 4 men have some signs and symptoms. By 75, about half of men report some symptoms. Family history. Having a blood relative such as a father or brother with prostate problems means 're more likely to have problems as well.
urinary tract infections, BPH does not lead to cancer or increase the risk of cancer. Signs and symptoms Benign prostatic hyperplasia symptoms are classified as storage or voiding. Storage symptoms include urinary frequency, urgency (compelling need to void that cannot be deferred), urgency incontinence, and voiding at night (nocturia).
Voiding symptoms include urinary stream hesitancy (needing to wait for the stream to begin), intermittency (when the stream starts and stops intermittently), straining to void, and dribbling. Pain and dysuria are usually not present.
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Weak urine stream Difficulty starting urination Stopping and starting while urinating Dribbling at the end of urination Frequent or urgent need to urinate Increased frequency of urination at night (nocturia) Straining while urinating Not being able to completely empty the bladder Urinary tract infection Formation of stones in the bladder Reduced kidney function
Tests and diagnosis An initial evaluation for enlarged prostate will likely include:
Detailed questions about symptoms. doctor will want to know about other health problems may have, what medications 're taking and whether there's a history of prostate problems in family. doctor may have complete a questionnaire such as the American Urological Association (AUA) Symptom Index for BPH. Digital rectal exam. This exam can allow doctor to check prostate by inserting a finger into rectum. With this simple test, doctor can determine whether prostate is enlarged and check for signs of prostate cancer. Neurological exam. This is a brief evaluation of mental functioning and nervous system. It can help identify causes of urinary problems other than enlarged prostate. What this exam involves will depend on specific condition. Urine test (urinalysis). Analyzing a sample of urine in the laboratory can help rule out an infection or other conditions that can cause similar symptoms.
doctor may use additional tests to rule out other problems and help confirm enlarged prostate is causing urinary symptoms. These can include:
Prostate-specific antigen (PSA) blood test. It's normal for prostate gland to produce PSA, which helps liquefy semen. When have an enlarged prostate, PSA levels increase. However, PSA levels can also be elevated due to prostate cancer, recent tests, surgery or infection (prostatitis). Urinary flow test. This test measures the strength and amount of urine flow. urinate into a receptacle attached to a special machine. The results of this test over time help determine if condition is getting better or worse.
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Postvoid residual volume test. This test measures whether can empty bladder completely. This is often done by using an ultrasound test to measure urine left in bladder. Or, it may be done by inserting a tube (catheter) into bladder after urinate. Transrectal ultrasound. An ultrasound test provides measurements of prostate and also reveals the particular anatomy of prostate. With this procedure, an ultrasound probe about the size and shape of a large cigar is inserted into rectum. Ultrasound waves bouncing off prostate create an image of prostate gland. Prostate biopsy. With this procedure, a transrectal ultrasound guides needles used to take tissue samples of the prostate. Examining tissues from a biopsy under a microscope can be help diagnose or rule out prostate cancer. Urodynamic studies and pressure flow studies. With these procedures, a catheter is threaded through urethra into bladder. Water (or less commonly air) is slowly injected into bladder. This allows doctor to measure bladder pressures and to determine how well bladder muscles are working. Cystoscopy. Also called urethrocystoscopy, this procedure allows doctor to see inside urethra and bladder. After receive a local anesthetic, a lighted flexible telescope (cystoscope) is inserted into urethra to look for signs of problems. Intravenous pyelogram or CT urogram. These tests can help detect urinary tract stones, tumors or blockages above the bladder. First, dye is injected into a vein, and Xrays or CT scans are taken of kidneys, bladder and the tubes that connect kidneys to bladder (ureters). The dye helps outline the drainage systems of the kidneys.
Complications
Acute urinary retention. Acute urinary retention is a sudden, painful inability to urinate. This may occur after 've taken an over-the-counter decongestant medication for allergies or a cold. When are unable to urinate at all, doctor may thread a tube (catheter) through urethra into bladder. Or, doctor may put in a suprapubic tube a catheter that drains bladder through the lower abdomen. The type of catheter need will depend on particular circumstances. Some men with an enlarged prostate require surgery or other procedures to relieve urinary retention. Urinary tract infections (UTIs). Some men with an enlarged prostate end up having surgery to remove part of the prostate to prevent frequent urinary tract infections. Bladder stones. These are mineral deposits that can cause infection, bladder irritation, blood in the urine and obstruction of urine flow and are generally caused by the inability to completely empty the bladder. Bladder damage. This occurs when the bladder hasn't emptied completely over a long period of time. The muscular wall of the bladder stretches and weakens and no longer contracts properly. Often, symptoms of bladder damage improve after prostate surgery or other treatment, but not always.
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Kidney damage. This is caused by high pressure in the bladder due to urinary retention. This high pressure can directly damage the kidneys or allow bladder infections to reach the kidneys. When an enlarged prostate causes obstruction of the kidneys, a condition called hydronephrosis a swelling of the urine-collecting structures in one or both kidneys may result.
Treatments and drugs Lifestyle Lifestyle alterations to address the symptoms of BPH include decreasing fluid intake before bedtime moderating the consumption of alcohol and caffeine-containing products, and following a timed voiding schedule.
Medications Medications are the most common treatment for moderate symptoms of prostate enlargement. Medications used to relieve symptoms of enlarged prostate include:
Alpha blockers. These medications relax bladder neck muscles and muscle fibers in the prostate itself and make it easier to urinate. These medications include terazosin, doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral) and silodosin (Rapaflo). Alpha blockers work quickly. Within a day or two, 'll probably have increased urinary flow and need to urinate less often. These may cause a harmless condition called retrograde ejaculation semen going back into the bladder rather than out the tip of the penis. 5 alpha reductase inhibitors. These medications shrink prostate by preventing hormonal changes that cause prostate growth. They include finasteride (Proscar) and dutasteride (Avodart). They generally work best for very enlarged prostates. It may be several weeks or even months before notice improvement. While 're taking them, these medications may cause sexual side effects including impotence (erectile dysfunction), decreased sexual desire or retrograde ejaculation. Combination drug therapy. Taking an alpha blocker and a 5 alpha reductase inhibitor at the same time is generally more effective than taking just one or the other by itself. Tadalafil (Cialis). This medication, from a class of drugs called phosphodiesterase inhibitors, is often used to treat impotence (erectile dysfunction). It also can be used as a treatment for prostate enlargement. Tadalafil can't be used in combination with alpha blockers. It also can't be taken with medications called nitrates, such as nitroglycerin.
Surgery
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Transurethral resection of the prostate (TURP) TURP has been a common procedure for enlarged prostate for many years, and it is the surgery with which other treatments are compared. With TURP, a surgeon places a special lighted scope (resectoscope) into urethra and uses small cutting tools to remove all but the outer part of the prostate (prostate resection). TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. Following TURP, there is risk of bleeding and infection, and may temporarily require a catheter to drain bladder after the procedure. 'll be able to do only light activity until 're healed. Transurethral incision of the prostate (TUIP or TIP) This surgery is an option if have a moderately enlarged or small prostate gland, especially if have health problems that make other surgeries too risky. Like TURP, TUIP involves special instruments that are inserted through the urethra. But instead of removing prostate tissue, the surgeon makes one or two small cuts in the prostate gland to open up a channel in the urethra making it easier for urine to pass through. Open prostatectomy This type of surgery is generally done if have a very large prostate, bladder damage or other complicating factors, such as bladder stones. It's called open because the surgeon makes an incision in lower abdomen to reach the prostate. Open prostatectomy is the most effective treatment for men with severe prostate enlargement, but it has a high risk of side effects and complications. It generally requires a short stay in the hospital and is associated with a higher risk of needing a blood transfusion. Minimally invasive surgery Minimally invasive treatments are less likely to cause blood loss during surgery and require a shorter, if any, hospital stay. These treatments also typically require less pain medication. Laser surgery Laser surgeries (also called laser therapies) use high-energy lasers to destroy or remove overgrown prostate tissue. Laser surgeries generally relieve symptoms right away and have a lower risk of side effects than does TURP. Some laser surgeries can be used in men who shouldn't have other prostate procedures because they take blood-thinning medications. Laser surgery can be done with different types of lasers and in different ways.
Ablative procedures (including vaporization) remove prostate tissue pressing on the urethra by burning it away, easing urine flow. Ablative procedures may cause irritating urinary symptoms after surgery and may need to be repeated at some point. Enucleative procedures are similar to open prostatectomy, but with fewer risks. These procedures generally remove all the prostate tissue blocking urine flow and prevent
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regrowth of tissue. One benefit of enucleative procedures over ablative procedures is that removed prostate tissue can be examined for prostate cancer and other conditions. Types of laser surgery include:

Holmium laser ablation of the prostate (HoLAP) Visual laser ablation of the prostate (VLAP) Holmium laser enucleation of the prostate (HoLEP) Photoselective vaporization of the prostate (PVP)
Transurethral microwave thermotherapy (TUMT) With this procedure, doctor inserts a special electrode through urethra into prostate area. Microwave energy from the electrode generates heat and destroys the inner portion of the enlarged prostate gland causing it to shrink and ease urine flow. This surgery has a lower risk of complications than does TURP, but is generally only used on small prostates in special circumstances, because re-treatment may be necessary. Transurethral needle ablation (TUNA) With this outpatient procedure, a lighted scope (cystoscope) is passed into urethra. doctor uses the scope to place needles into prostate gland. When the needles are in place, radio waves pass through them, heating and destroying excess prostate tissue that's blocking urine flow. TUNA basically scars the prostate tissue, which causes it to shrink and open up, easing urine flow. This type of surgery may be a good choice if bleed easily or have certain other health problems. Like TUMT, TUNA may only partially relieve symptoms and it may take some time before notice results. The risk of erectile dysfunction with the procedure is very low. Prostatic stents A prostatic stent is a tiny metal or plastic device that's inserted into urethra to keep it open. Tissue grows over the metallic stent to hold it in place. The plastic stent needs to be changed every four to six weeks but keeps from having to undergo any surgical procedure. In most cases, doctors don't consider stents a viable long-term treatment because they can cause side effects including painful urination or frequent urinary tract infections. The metal stents can be difficult to remove and are used only in special circumstances, such as for someone who can't have surgery. Sometimes, plastic stents may be used temporarily before surgery to make sure 'll be able to urinate after surgery.
Prostate cancer
Definition Prostate cancer is cancer that occurs in a man's prostate a small walnut-shaped gland that produces the seminal fluid that nourishes and transports sperm.
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Prostate cancer is one of the most common types of cancer in men. Prostate cancer usually grows slowly and initially remains confined to the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly. Causes It's not clear what causes prostate cancer. prostate cancer begins when some cells in prostate become abnormal. Mutations in the abnormal cells' DNA cause the cells to grow and divide more rapidly than normal cells do. The abnormal cells continue living, when other cells would die. The accumulating abnormal cells form a tumor that can grow to invade nearby tissue. Some abnormal cells can break off and spread (metastasize) to other parts of the body. Risk factors

Older age. The risk of prostate cancer increases with age. Prostate cancer is most common in men older than 65. Being black. Black men have a greater risk of prostate cancer than do men of other races. In black men, prostate cancer is also more likely to be aggressive or advanced. It's not clear why this is. Family history of prostate or breast cancer. If men in family have had prostate cancer, risk may be increased. Also, if have a family history of the BRCA1 or BRCA2 gene mutation or a very strong history of women with breast cancer, risk for prostate cancer may be higher. Obesity. Obese men diagnosed with prostate cancer may be more likely to have advanced disease that's more difficult to treat
The prostate cancer stages are:

Stage I. This stage signifies very early cancer that's confined to a small area of the prostate. When viewed under a microscope, the cancer cells aren't considered aggressive. Stage II. Cancer at this stage may still be small but may be considered aggressive when cancer cells are viewed under the microscope. Or cancer that is stage II may be larger and may have grown to involve both sides of the prostate gland. Stage III. The cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
Stage IV. The cancer has grown to invade nearby organs, such as the bladder, or spread to lymph nodes, bones, lungs or other organs. Symptoms Prostate cancer may not cause signs or symptoms in its early stages. Prostate cancer that is more advanced may cause signs and symptoms such as:
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Trouble urinating Decreased force in the stream of urine Blood in the urine Blood in the semen General pain in the lower back, hips or thighs Discomfort in the pelvic area Bone pain Erectile dysfunction
Complications
Cancer that spreads (metastasizes). Prostate cancer can spread to nearby organs, such as bladder, or travel through bloodstream or lymphatic system to bones or other organs. Prostate cancer that spreads to the bones can cause pain and broken bones. Once prostate cancer has spread to other areas of the body, it may still respond to treatment and may be controlled, but it can no longer be cured. Incontinence. Both prostate cancer and its treatment can cause urinary incontinence. Treatment for incontinence depends on the type have, how severe it is and the likelihood it will improve over time. Treatment options may include medications, catheters and surgery. Erectile dysfunction. Erectile dysfunction can be a result of prostate cancer or its treatment, including surgery, radiation or hormone treatments. Medications, vacuum devices that assist in achieving erection and surgery are available to treat erectile dysfunction.
Tests and diagnosis
Digital rectal exam (DRE). During a DRE, doctor inserts a gloved, lubricated finger into rectum to examine prostate, which is adjacent to the rectum. If doctor finds any abnormalities in the texture, shape or size of gland, may need more tests. Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in arm and analyzed for PSA, a substance that's naturally produced by prostate gland. It's normal for a small amount of PSA to be in bloodstream. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer. Ultrasound. If other tests raise concerns, doctor may use transrectal ultrasound to further evaluate prostate. A small probe, about the size and shape of a cigar, is inserted into rectum. The probe uses sound waves to make a picture of prostate gland. Collecting a sample of prostate tissue. If initial test results suggest prostate cancer, doctor may recommend a procedure to collect a sample of cells from prostate (prostate biopsy). Prostate biopsy is often done using a thin needle that's inserted into the prostate to collect tissue. The tissue sample is analyzed in a lab to determine whether cancer cells are present.
Determining how far the cancer has spread Once a prostate cancer diagnosis has been made, doctor works to determine the extent (stage) of
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the cancer. If doctor suspects cancer may have spread beyond prostate, imaging tests such as these may be recommended:

Bone scan Ultrasound Computerized tomography (CT) scan Magnetic resonance imaging (MRI) Positron emission tomography (PET) scan
Treatments and drugs Radiation therapy Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy can be delivered in two ways:
Radiation that comes from outside of body (external beam radiation). During external beam radiation therapy, lie on a table while a machine moves around body, directing high-powered energy beams to prostate cancer. typically undergo external beam radiation treatments five days a week for several weeks. External beam radiation uses X-rays or protons to deliver the radiation. Radiation placed inside body (brachytherapy). Brachytherapy involves placing many rice-sized radioactive seeds in prostate tissue. The radioactive seeds deliver a low dose of radiation over a long period of time. doctor implants the radioactive seeds in prostate using a needle guided by ultrasound images. The implanted seeds eventually stop giving off radiation and don't need to be removed.
Side effects of radiation therapy can include painful urination, frequent urination and urgent urination, as well as rectal symptoms, such as loose stools or pain when passing stools. Erectile dysfunction can also occur. Hormone therapy Hormone therapy is treatment to stop body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of hormones may cause cancer cells to die or to grow more slowly. Hormone therapy options include:
Medications that stop body from producing testosterone. Medications known as luteinizing hormone-releasing hormone (LH-RH) agonists prevent the testicles from receiving messages to make testosterone. Drugs typically used in this type of hormone therapy include leuprolide (Lupron, Eligard), goserelin (Zoladex), triptorelin (Trelstar) and histrelin (Vantas). Medications that block testosterone from reaching cancer cells. Medications known as anti-androgens prevent testosterone from reaching cancer cells. Examples include bicalutamide (Casodex), flutamide, and nilutamide (Nilandron). These drugs typically are given along with an LH-RH agonist or given before taking an LH-RH agonist.
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Chemotherapy Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in arm, in pill form or both.
Chemotherapy may be a treatment option for men with prostate cancer that has spread to distant areas of their bodies. Chemotherapy may also be an option for cancers that don't respond to hormone therapy. Multiple new chemotherapy drugs have recently been approved for treatment of progressive, metastatic prostate cancer.
Immunotherapy A form of immunotherapy (Provenge) has been developed to treat advanced, recurrent prostate cancer. This treatment takes some of own immune cells, genetically engineers them to fight prostate cancer, then injects the cells back into body through a vein. Some men do respond to this therapy with some improvement in their cancer, but the treatment is very expensive and requires multiple visits for the treatment. Surgery to remove the testicles (orchiectomy). Removing testicles reduces testosterone levels in body. The effectiveness of orchiectomy in lowering testosterone levels is similar to that of hormone therapy medications, but orchiectomy may lower testosterone levels more quickly. Hormone therapy is used in men with advanced prostate cancer to shrink the cancer and slow the growth of tumors. In men with early-stage prostate cancer, hormone therapy may be used to shrink tumors before radiation therapy. This can make it more likely that radiation therapy will be successful. Hormone therapy is sometimes used after surgery or radiation therapy to slow the growth of any cancer cells left behind. Side effects of hormone therapy may include erectile dysfunction, hot flashes, loss of bone mass, reduced sex drive and weight gain. Surgery to remove the prostate Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes. Ways the radical prostatectomy procedure can be performed include:
Using a robot to assist with surgery. During robotic laparoscopic surgery, the instruments are attached to a mechanical device (robot) and inserted into abdomen through small incisions. The surgeon sits at a console and uses hand controls to guide the robot to move the instruments. Using a robot during laparoscopic surgery may allow the surgeon to make more precise movements with surgical tools than is possible with traditional laparoscopic surgery. Making an incision in abdomen. During retropubic surgery, the prostate gland is taken out through an incision in lower abdomen. Compared with other types of prostate surgery, retropubic prostate surgery may carry a lower risk of nerve damage, which can lead to problems with bladder control and erections.
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Making an incision between anus and scrotum. Perineal surgery involves making an incision between anus and scrotum in order to access prostate. The perineal approach to surgery may allow for quicker recovery times, but this technique makes removing the nearby lymph nodes and avoiding nerve damage more difficult. Laparoscopic prostatectomy. During a laparoscopic radical prostatectomy, the doctor performs surgery through small incisions in the abdomen with the assistance of a long, slender tube with a small camera on the end (laparoscope). This type of surgery is not commonly performed for prostate cancer in the U.S. anymore.
Freezing prostate tissue Cryosurgery or cryoablation involves freezing tissue to kill cancer cells. During cryosurgery for prostate cancer, small needles are inserted in the prostate using ultrasound images as guidance. A very cold gas is placed in the needles, which causes the surrounding tissue to freeze. A second gas is then placed in the needles to reheat the tissue. The cycles of freezing and thawing kill the cancer cells and some surrounding healthy tissue. Heating prostate tissue using ultrasound High-intensity focused ultrasound treatment uses powerful sound waves to heat prostate tissue, causing cancer cells to die. High-intensity focused ultrasound is done by inserting a small probe in rectum. The probe focuses ultrasound energy at precise points in prostate. High-intensity focused ultrasound treatments are currently only available in clinical trials in the U.S.
Sexual dysfunction
Sexual dysfunction or sexual malfunction is difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including physical pleasure, desire, preference, arousal or orgasm. Sexual dysfunctions can have a profound impact on an individual's perceived quality of sexual life. Categories
Sexual desire disorders

Hypoactive sexual desire disorder Sexual desire disorders or decreased libido are characterised by a lack or absence for some period of time of sexual desire or libido for sexual activity or of sexual fantasies. The condition ranges from a general lack of sexual desire to a lack of sexual desire for the current partner. The condition may have started after a period of normal sexual functioning or the person may always have had no/low sexual desire. Causes Decrease in the production of normal estrogen in women or testosterone in both men and women. Other causes may be aging, fatigue, pregnancy, medications (such as the SSRIs) Psychiatric conditions, such as depression and anxiety.
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Sexual arousal disorders

Sexual arousal disorders were previously known as frigidity in women and impotence in men, though these have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction, and frigidity has been replaced with a number of terms describing specific problems with, for example, desire or arousal.
Erectile dysfunction
Erectile dysfunction or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. Causes Damage to the nervi erigentes which prevents or delays erection, or diabetes as well as cardiovascular disease, which simply decreases blood flow to the tissue in the penis, many of which are medically reversible. Psychological or physical. Psychological erectile dysfunction can often be helped by almost anything that the patient believes in; there is a very strong placebo effect. Physical damage is much more severe. One leading physical cause of ED is continual or severe damage taken to the nervi erigentes. These nerves course beside the prostate arising from the sacral plexus and can be damaged in prostatic and colo-rectal surgeries.
Premature ejaculation
Premature ejaculation is when ejaculation occurs before the partner achieves orgasm, or a mutually satisfactory length of time has passed during intercourse. There is no correct length of time for intercourse to last, but generally, premature ejaculation is thought to occur when ejaculation occurs in under 2 minutes from the time of the insertion of the penis. For a diagnosis, the patient must have a chronic history of premature ejaculation, poor ejaculatory control, and the problem must cause feelings of dissatisfaction as well as distress the patient, the partner or both.
Orgasm disorders
Anorgasmia Orgasm disorders are persistent delays or absence of orgasm following a normal sexual excitement phase. CAUSES The disorder can have physical, psychological, or pharmacological origins. SSRI antidepressants.
Sexual pain disorders

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Sexual pain disorders affect women almost exclusively and are also known as dyspareunia (painful intercourse) or vaginismus (an involuntary spasm of the muscles of the vaginal wall that interferes with intercourse). Causes insufficient lubrication (vaginal dryness) in women. Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by menopause, pregnancy, or breast-feeding. Irritation from contraceptive creams and foams can also cause dryness, as can fear and anxiety about sex. Another female sexual pain disorder is called vulvodynia or vulvar vestibulitis. In this condition, women experience burning pain during sex which seems to be related to problems with the skin in the vulvar and vaginal areas. The cause is unknown. Causes General There are many factors which may result in a person experiencing a sexual dysfunction. These may result from emotional or physical causes. 1. Emotional factors include interpersonal or psychological problems, which can be the result of depression, sexual fears or guilt, past sexual trauma, sexual disorders, among others. 2. Physical factors that can lead to sexual dysfunctions include the use of drugs, such as alcohol, nicotine, narcotics, stimulants, antihypertensives, antihistamines, and some psychotherapeutic drugs 3. Physiological change that affects the reproductive systempremenstrual syndrome, pregnancy, postpartum, menopausecan have an adverse effect on libido. Injuries to the back may also impact sexual activity, as would problems with an enlarged prostate gland, problems with blood supply, nerve damage (as in spinal cord injuries). 4. Disease, such as diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis may also impact on the activity, as would failure of various organ systems (such as the heart and lungs), endocrine disorders (thyroid, pituitary, or adrenal gland problems), hormonal deficiencies (low testosterone, other androgens, or estrogen) and some birth defects. 5. Hormonal. Lower estrogen levels after menopause may lead to changes in genital tissues and sexual responsiveness. The folds of skin that cover genital area (labia) become thinner, exposing more of the clitoris. This increased exposure sometimes reduces the sensitivity of the clitoris. Risk factors

Depression or anxiety Heart and blood vessel disease Neurological conditions, such as spinal cord injury or multiple sclerosis
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Liver or kidney failure Certain medications, such as antidepressants or high blood pressure medications Emotional or psychological stress, especially with regard to relationship with partner A history of sexual abuse
Other sexual problems

Sexual dissatisfaction (non-specific) Lack of sexual desire Anorgasmia Impotence Sexually transmitted diseases Delay or absence of ejaculation, despite adequate stimulation Inability to control timing of ejaculation Inability to relax vaginal muscles enough to allow intercourse Inadequate vaginal lubrication preceding and during intercourse Burning pain on the vulva or in the vagina with contact to those areas Unhappiness or confusion related to sexual orientation Transsexual and transgender people may have sexual problems (before or after surgery), though actually being transgendered or transsexual is not a sexual problem in itself. Persistent sexual arousal syndrome Post SSRI Sexual Dysfunction Sexual addiction Hypersexuality All forms of Female genital cutting
Symptoms Female sexual dysfunction can happen at any age. Sexual problems often develop when hormones are in flux for example, after having a baby or during menopause. Sexual concerns may also occur with major illness, such as cancer, diabetes, or heart and blood vessel (cardiovascular) disease. problems might be classified as female sexual dysfunction if experience one or more of the following and 're distressed about it:

desire to have sex is low or absent. can't maintain arousal during sexual activity, or don't become aroused despite a desire to have sex. can't experience an orgasm. have pain during sexual contact.
Tests and diagnosis
Discuss sexual and medical history. might be uneasy talking with doctor about such personal matters, but sexuality is a key part of well-being. The more forthcoming can
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be about sexual history and current problems, the better chances of finding an effective approach to treating them. Perform a pelvic exam. During the exam, doctor checks for physical changes that affect sexual enjoyment, such as thinning of genital tissues, decreased skin elasticity, scarring or pain.
Treatment for males Marriage counseling sessions are recommended in this situation. Lifestyle changes such as discontinuing smoking, drug or alcohol abuse can also help in some types of erectile dysfunction. Treatment for females A vacuum device is the only approved medical device for arousal and orgasm disorders Many patients with female sexual dysfunction are often also referred to a counselor or therapist for psychosocial counseling. Treating female sexual dysfunction linked to a hormonal cause might include:
Estrogen therapy. Localized estrogen therapy comes in the form of a vaginal ring, cream or tablet. This therapy benefits sexual function by improving vaginal tone and elasticity, increasing vaginal blood flow and enhancing lubrication. Androgen therapy. Androgens include male hormones, such as testosterone. Testosterone plays a role in healthy sexual function in women as well as men, although women have much lower amounts of testosterone. Androgen therapy for sexual dysfunction is controversial, however. Some studies show a benefit for women who have low testosterone levels and develop sexual dysfunction; other studies show little or no benefit. Tibolone. Tibolone is a synthetic steroid drug currently used in Europe and Australia for treatment of postmenopausal osteoporosis. In one randomized trial, postmenopausal women taking the drug experienced an improvement in overall sexual function and a reduction in personal distress compared with postmenopausal women taking estrogen, but the effect was small. Due to concerns over increased risk of breast cancer and stroke in women taking tibolone, the drug isn't approved by the Food and Drug Administration for use in the U.S. Phosphodiesterase inhibitors. This group of medications has proved successful in treating erectile dysfunction in men, but the drugs don't work nearly as well in treating female sexual dysfunction. Studies looking into the effectiveness of these drugs in women show inconsistent results. One drug, sildenafil (Viagra), may prove beneficial for some women who experience sexual dysfunction as a result of taking selective serotonin reuptake inhibitors (SSRIs), a class of drugs used to treat depression. However, don't take sildenafil if use nitroglycerin for angina a type of chest pain caused by reduced blood flow to the heart.
Hormone replacement therapy

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Hormone replacement therapy (HRT) has the ability to improve a woman's sexual satisfaction Estrogens are responsible for the maintenance of collagen, elastic fibers, and vasoculature of the urogenital tract, all of which are important in maintaining vaginal structure and functional integrity; they are also important for maintaining vaginal pH and moisture levels, both of which aid in keeping the tissues lubricated and protected Nonmedical treatment for female sexual dysfunction To treat sexual dysfunction, doctor might recommend that start with nonmedical strategies:
Talk and listen. Open, honest communication with partner makes a world of difference in sexual satisfaction. Even if 're not used to talking about likes and dislikes, learning to do so and providing feedback in a nonthreatening way sets the stage for greater intimacy. Practice healthy lifestyle habits. Go easy on alcohol drinking too much can blunt sexual responsiveness. Stop smoking smoking restricts blood flow to sexual organs, decreasing sexual arousal. Be physically active regular physical activity can increase stamina and elevate mood, enhancing romantic feelings. Learn ways to decrease stress so can focus on and enjoy sexual experience. Seek counseling. Talk with a counselor or therapist who specializes in sexual and relationship problems. Therapy often includes education about how to optimize body's sexual response, ways to enhance intimacy with partner, and recommendations for reading materials or couples exercises. Use a lubricant. A vaginal lubricant may be helpful during intercourse if experience vaginal dryness or pain during sex. Try a device. Arousal improves with stimulation of the clitoris. Use a vibrator to provide clitoral stimulation. Although some women find clitoral vacuum suction devices helpful for enhancing sexual arousal, those devices can be cumbersome.

Avoid excessive alcohol. Drinking too much blunts sexual responsiveness. Don't smoke. Cigarette smoking restricts blood flow throughout body. Less blood reaches sexual organs, which means could experience decreased sexual arousal and orgasmic response. Be physically active. Regular aerobic exercise increases stamina, improves body image and elevates mood. This can help feel more romantic, more often. Make time for leisure and relaxation. Learn ways to decrease stress, and allow self to relax amid the stresses of daily life. Being relaxed can enhance ability to focus on sexual experiences and may help attain more satisfying arousal and orgasm.
Mindfulness. This type of meditation is based on being mindful, or having an increased awareness and acceptance of living in the present moment. focus on what experience during meditation, such as the flow of breath. can observe thoughts and emotions but let them pass without judgment. Some research shows that mindfulness practiced during the course of group therapy improved many aspects of sexual response and reduced personal distress in women with desire and arousal disorders.
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Acupuncture. Acupuncture involves the insertion of extremely thin needles into skin at strategic points on body. Acupuncture may have positive effects on women with sexual pain disorders. Another possible therapy is acupuncture to improve libido in women with low desire, although this area has yet to be rigorously studied. Yoga. During yoga, perform a series of postures and controlled breathing exercises to promote a more flexible body and a calm mind. Certain subsets of yoga aim to channel the body's sexual energy and improve sexual functioning. Very little data exist on the benefits of yoga on sexual functioning. However, the practice of yoga is associated with improved psychological well-being and overall health.
INFERTILITY
It is defined as a couples inability to achieve a pregnancy after at least a one year of regular unprotected intercourse. Types Primary infertility It refers to a couple who has never had a child. Secondary infertility It means that at least one conception has occurred, but currently the couple cannot achieve a pregnancy. Etiology Male causes Sperm abnormalities Oligospermia Asthenospermia Teratospermia Low sperm level Retrograde ejaculation Structural abnormalities Anorchia Cryptochidism Hypospadias Tube blockage Syringomyelia
Genetic factors Damaged DNA Defective acrosome
Autoimmunity Secretions of antibodies against the sperms
Medications
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Inherited disorders like Klinefelter syndrome Polycystic kidney disease Cystic fibrosis
Corticosteroids Methotrexate Phenytoin Ca channel blockers
Medical conditions STDs Mycoplasm Severe injury Diabetes Cushing syndrome Chronic anaemia Liver or kidney failure Thyroid disease Varicoceles Ejaculatory duct obstruction Impotence
Environmental and life style causes Free radicals Exposure to Estrogen like chemicals Hydrocarbons Bicycling Radiotherapy Smoking Malnutrition, Obesity Narcotics Testicular overheating Emotional stress Sexual issue
Hormonal factors Hypogonadism Testosterone deficiency
Infections Mumps Glandular infections HIV infections prostatitis
Female causes Ovarian and ovulation factors polycystic ovarian syndrome Anovulation Inadequate corpus luteum Uterine factors Uterine fibroid Uterine polyps Congenital malformations of uterus
Vaginal factors Vaginismus Vaginal obstruction
Cervical factors Cervical stenosis Antisperm antibodies Non-receptive cervical mucus
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Tubal factors Tubal obstruction Endometriosis Pelvic adhesions Pelvic inflammatory disease Tubal occlusion and dysfunction
Other causes Prolonged use of contraceptives Sexually transmitted diseases Inadequate body fat Lack of proper growth and development
Diagnostic evaluations History collection Duration of infertility since marriage or any previous fertility events. Frequency and timing of intercourse. Sexual history (before and after marriage), any sexually transmitted diseases. Working conditions; exposure to toxins, chemicals or radiation. History of any medication and allergies. Childhood medical problems, injuries and illness. Any history of chronic medical conditions like diabetes, tuberculosis, infections and any history of previous surgery. Family history of reproductive problems.
Physical examination of female reproductive system A thorough gynecologic examination should include an evaluation of hair distribution, clitoris size, Bartholin glands, labia majora and minora, and any condylomata acuminatum or other lesions that could indicate the existence of venereal disease. The inspection of the vaginal mucosa may indicate a deficiency of estrogens or the presence of infection. The evaluation of the cervix should include a Papanicolaou test and cultures for gonorrhea, chlamydia, Ureaplasma urealyticum,and Mycoplasma hominis. Bimanual examination should be performed to establish the direction of the cervix and the size and position of the uterus to exclude the presence of uterine fibroids, adnexal masses, tenderness, or pelvic nodules indicative of infection or endometriosis.
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Physical examination of male reproductive system A physical examination of scrotum and testes for detection of undescended testes, varicoceles, absence of vas deference, cyst, size and texture of testes. Penis may be examined for the warts, discharge from the urinary tract and altered location of urethral opening. Routine records of blood pressure, pulse rate, and temperature. Measure height and weight to calculate the body mass index Attention should be directed to congenital abnormalities of the genital tract (eg, hypospadias, cryptorchid, congenital absence of the vas deferens). Testicular size, urethral stenosis, and presence of varicocele are also determined. A history of previous inguinal hernia repair can indicate an accidental ligation of the spermatic artery. Diagnostic tests for males 1.)Semen analysis This is a very important test for the male infertility. Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating semen into a clean container. A laboratory analyzes semen specimen for quantity, color, and presence of infections or blood, approximate number of total sperm cells, sperm motility/forward progression. This is the most common type of fertility testing. Semen deficiencies are often labeled as follows: Normal Values for SA Volume 2.0 ml or more Sperm Concentration 20 million/ml or more Motility 50% forward progression 25% rapid progression Viscosity Liquification in 30-60 min Abnormal Values for SA Oligospermia or Oligozoospermia decreased number of spermatozoa in semen Aspermia - complete lack of semen Hypospermia - reduced seminal volume Azoospermia - absence of sperm cells in semen
Morphology 30% or more normal Teratospermia - increase in sperm with abnormal morphology forms
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pH 7.2-7.8 WBC Fewer than 1 million
Asthenozoospermia - reduced sperm motility Abnormal volume Retrograde ejaculation Infection Ejaculatory failure
2. semen function test
Hamster test
Human zona penetration test
Acrosome reaction test
Computer aided sperm motility analysis
Hamster test in this test the hamster eggs (after removing their covering) are used to observe the penetration of human sperms into the eggs. Fertilization of eggs less than 5-20% indicates the infertility. Human zona penetration test in this the dead human eggs are removed from the ovaries and used to observe the penetration of human zona by the sample of sperm which indicates whether the sperm can penetrate the outer covering of an egg. Acrosome reaction test it is used to test the ability of the sperms enzyme rich covering to dissolve. Computer aided sperm motility analysis to detect the motility of sperms to penetrate the eggs. 3.)Hormone testing. Testosterone level FSH (spermatogenesis- Sertoli cells) LH (testosterone- Leydig cells 4.) Transrectal and scrotal ultrasound.
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Ultrasound can help to look for evidence of conditions such as retrograde ejaculation and ejaculatory duct obstructionlar, testicular cancer.
5.) Post ejaculatory urine examination
It helps to detect the retrograde ejaculation and infections.
6.) Antisperm antibodies blood tests for antisperm antibodies are conducted in case of reversed vasectomy, clumping of sperms during semen analysis, injury to testes.
7.) Testicle biopsy
For detecting obstruction in transportation system if sperm if the sperm count is low when the production of sperms is normal. Biopsies of both testes or different regions give accurate results. They requires incisions under anaesthesia. Epididymis should be carefully detected.
Tests for women 1.)Post coital test a microscopic examination of cervical mucus within 2-24 hours of intercourse is done to detect the presence or absence of live sperms; cervical mucus should be cultured for the presence of infection if no live sperm is observed.
2.)Hysterosalpingography. This test evaluates the condition of uterus and fallopian tubes. Fluid is injected into uterus, and an X-ray is taken to determine if the cavity is normal and ensure the fluid progresses through fallopian tubes. Blockage or problems often can be located and may be corrected with surgery. 3.)Laparoscopy. Performed under general anesthesia, this procedure involves making a small incision (8 to 10 millimeters) beneath navel and inserting a thin viewing device to examine fallopian tubes, ovaries and uterus. The most common problems identified by laparoscopy are
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endometriosis and scarring. It also can detect blockages or irregularities of the fallopian tubes and uterus. Laparoscopy generally is done on an outpatient basis.
4.)Hormone testing. Hormone tests may be done to check levels of ovulatory hormones as well as thyroid and pituitary hormones. 5.)Ovarian reserve testing. Testing may be done to determine the potential effectiveness of the eggs after ovulation. This approach often begins with hormone testing early in a woman's menstrual cycle. 6.)Genetic testing. Genetic testing may be done to determine whether there's a genetic defect causing infertility. 7.)Pelvic ultrasound. Pelvic ultrasound may be done to look for uterine or fallopian tube disease. Endometrial biopsy, to verify ovulation and inspect the lining of the uterus. 8.)Pap smear test PHARMACOLOGICAL TREATMENT Anovulation 1.)Clomiphene citrate an anti-estrogen drug designed as a fertility medicine for women, is controversial. Vitamin E helps counter oxidative stress, which is associated with sperm DNA damage and reduced sperm motility. A hormone-antioxidant combination may improve sperm count and motility. Clomiphene citrate (Clomid): This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth. Antiestrogen Combines and blocks estrogen receptors at the hypothalamus and pituitary causing a negative feedback Increases FSH production stimulates the ovary to make follicles
2.)Follicle-stimulating hormone or FSH (Gonal-F, Follistim): FSH works much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.
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3.)Gonadotropin-releasing hormone (Gn-RH) analog: These medicines are often used for women who don't ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray. Adverse effects Hyperstimulation of the ovaries Multiple gestation Fetal wastage 4.)Metformin (Glucophage):this medicine for women who have insulin resistance and/or PCOS. Citrate or FSH is taken with the combination of metformin. This medicine is usually taken by mouth. 5.)Bromocriptine (Parlodel): This medicine is used for women with ovulation problems due to high levels of prolactin. Prolactin is a hormone that causes milk production. Many fertility drugs increase a woman's chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.
ASSISTED REPRODUCTIVE TECHNOLOGIES (ART) is a group of different methods used to help infertile couples. ART works by removing eggs from a woman's body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman's body. 1.)Intrauterine insemination (IUI) It is an infertility treatment that is often called artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI. IUI is often used to treat: Mild male factor infertility Women who have problems with their cervical mucus Couples with unexplained infertility
2.)In vitro fertilization (IVF)

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It means fertilization outside of the body. IVF is the most effective ART used when a woman's fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman's uterus. 3.)Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer It is similar to IVF. Fertilization occurs in the laboratory. Then the very ng embryo is transferred to the fallopian tube instead of the uterus. 4.)Gamete intrafallopian transfer (GIFT) It involves transferring eggs and sperm into the woman's fallopian tube. So fertilization occurs in the woman's body. Few practices offer GIFT as an option. 5.)Intracytoplasmic sperm injection (ICSI) It is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube. 6.)Surrogacy Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner. After birth, the surrogate will give up the baby for adoption by the parents. 7.)Gestational Carrier Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn't become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilized by the man's sperm and the embryo is placed inside the carrier's uterus. The carrier will not be related to the baby and gives him or her to the parents at birth. 8.)Alternatives Donor oocyte Patients with poor ovarian reserve have a rather low chance of overcoming infertility; yet, some of them, along with patients with premature menopause and patients with physiologic
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menopause, are interested in having a child. The only alternative for these patients is adoption or an oocyte donation Donor oocyte is the counterpart of donor sperm. The source of the oocyte can be anonymous or known (ie, nger relative, designated donor). Ideally, the donor should be aged 21-30 years, although the age can extend to 35 years. The donor undergoes ovulation induction according to the standard IVF protocol. Meanwhile, the recipient takes increasing doses of estrogens to synchronize her endometrium in preparation for a fresh embryo transfer. This technique is similar to the one described under Frozen embryo transfer Because oocyte cryopreservation is still in a preliminary stage of development, only fresh oocytes without quarantine are used. However, the donor must be screened for numerous transmissible diseases (eg, HIV, syphilis, hepatitis, gonorrhea, chlamydia) according to FDA regulations, and a complete physical and gynecological evaluation is performed. The donor patient also undergoes a psychological evaluation. The recipient patient also has a psychological evaluation. The oocyte recipient and her partner are required to have the same kinds of screening tests as the oocyte donor. The legal aspects of the procedure and future offspring must be discussed. A thorough consent form must be signed by all parties involved 9.)Donor sperm Men who cannot produce sperm or women who do not have a partner and wish to become pregnant may opt for donor sperm. Many opt to use sperm banks, which require strict and rigorous infectious testing. The sperm donor may choose to be known or anonymous. After deposition, the samples are frozen and quarantined for at least 6 months. Once repeat infectious testing is confirmed to be negative, the sample is available for selection and intrauterine insemination or IVF is performed in sync with the patient's cycle. 10.)Donor embryo Donor embryo is the earliest form of adoption. As stated in the embryo cryopreservation consent form, the couple must sign an advance directive regarding embryo ownership and disposition. Those directives should include statements regarding (1) embryo donation to another couple, (2) donation of the embryos for research, or (3) disposition of the embryos after thawing.
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Donor embryo is one option the patient can choose; therefore, those embryos can be donated according to the IVF program policy. Embryo donation programs must follow the regulations established for tissue donors, which require that all screening tests must be performed before embryo cryopreservation, with the tests being repeated at least 6 months later. The same screening tests are required for the recipient couple. Anatomic Abnormalities Surgical treatments Lysis of adhesions Septoplasty Tuboplasty Myomectomy
Surgery may be performed laparoscopically, hysteroscopically. If the fallopian tubes are beyond repair one must consider in vitro fertilization. Treatment for males Treating retrograde ejaculation and failure of emission Various methods are used to treat these conditions caused by surgery, severe disease, spinal cord injury. 1.)Phosphodiesterase-5(PDE-5) inhibitors are oral medications that are used to treat erectile dysfunction. PDE-5 is an enzyme found in the trabecular smooth muscles that inactivates the cGMP, the nucleotide that causes cavernosal relaxation necessary for the erection. By blocking the inhibition of PDE-5, it facilitates the corporeal smooth muscle relaxation in response to sexual stimulation. It is taken 1 hour before sexual activity. 2.)Alpha-adrenergic agonists Pseudoephedrine, stimulates the muscle contraction and help ejaculation. 3.)Electrovibration
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This technique is often beneficial if drugs are not effective, particularly with complete failure of emission. These methods can help in sperm collection for intrauterine insemination or ART. In case of retrograde ejaculation, sodium bicarbonate is typically used to reduce the acidity of the urine to prepare sperm for IVF. Urine sample is taken after ejaculation and sperm are separated by washing techniques. 4.)Varicocelectomy It is the surgical correction of varicocele. In this procedure tying off the swollen and twisted veins through the inguinal retroperitoneal approach. 5.)Orichopexy In this surgery the undescended testes are bring into the scrotum. 6.)Sperm extraction vasal aspiration In this a small scrotal incision is given under anesthesia and syringe is inserted into the vas deferens to suction the leaky sperm into the nourished fluid. The sperms also brought by the general massage of the epididymis and vas deferens. The aspirated sperms are prepared for the intrauterine insemination. Indications Congenital and acquired obstructions of ductal system General guidelines for the couple 1.)Timing and monitoring the sexual activity Male hormone levels are higher in morning. Sexual activity in males are highest in October, conception rate is also higher in this month. Sperm count are higher in winter season than in the summer. Monitoring of basal body temperature is used to determine the time of ovulation as it rises and falls according to the hormone fluctuations. Excellent screening tool for ovulation. Temperature drops at the time of menses. Rises two days after the lutenizing hormone (LH) surge. Ovum released one day prior to the first rise. Temperature elevation of more than 16 days suggests pregnancy. Monitoring reproductive hormonal level Serum Progesterone
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Progesterone starts rising with the LH surge drawn between day 21-24 Mid-luteal phase >10 ng/ml suggests ovulation Adjusting sexual activity some studies shows that having intercourse daily and several times a day before and during ovulation period improves the fertility rate. Athough frequent sexual activity decreases the sperm count per ejaculation, a regular semen supply increases the chances of fertilization. 2.)changes in life style Exercise moderately. Regular exercise is important. Avoid weight extremes. Being overweight or underweight can affect hormone production and cause infertility. So control the diet and do regularly exercise. Avoid alcohol, tobacco and street drugs. These substances may impair ability to conceive and have a healthy pregnancy. Don't drink alcohol or smoke tobacco. Avoid illegal drugs such as marijuana and cocaine. These also decrease the sperm production. Limit caffeine. Women trying to get pregnant may want to limit caffeine intake. Limit medications. Reducing stress it may improves the sperm quality. Wear loose cloths
3.)Dietary modifications Diet should be rich in fruits, vegetables and wholr grains Animal fat should be avoided, use monosaturated oils. Use fish and fish oils. Take higher amount of antioxidant vitamins C, E and beta- carotene. Daily supplementation of zinc 66mg and folic acid 5 mg increase the sperm count but does not improves the quality of sperms. 4.) psychological support
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Gynecomastia
Gynecomastia is the benign enlargement of breast tissue in males.
Classification
The spectrum of gynecomastia severity has been categorized into a grading system:[26]

Grade I: Minor enlargement, no skin excess Grade II: Moderate enlargement, no skin excess Grade III: Moderate enlargement, skin excess Grade IV: Marked enlargement, skin excess
Causes Gynecomastia is triggered by a decrease in the amount of the hormone testosterone compared with estrogen. The cause of this decrease can be conditions that block the effects of or reduce testosterone or a condition that increases estrogen level. Several things can upset the hormone balance, including the following. Natural hormone changes The hormones testosterone and estrogen control the development and maintenance of sex characteristics in both men and women. Testosterone controls male traits, such as muscle mass and body hair. Estrogen controls female traits, including the growth of breasts. Most people think of estrogen as an exclusively female hormone, but men also produce it though normally in small quantities. But male estrogen levels that are too high or are out of balance with testosterone levels can cause gynecomastia.
Gynecomastia in infants. More than half of male infants are born with enlarged breasts due to the effects of their mother's estrogen. Generally, the swollen breast tissue goes away within two to three weeks after birth. Gynecomastia during puberty. Gynecomastia caused by hormone changes during puberty is relatively common. In most cases, the swollen breast tissue will go away without treatment within six months to two years. Gynecomastia in men. The prevalence of gynecomastia peaks again between the ages of 50 and 80. At least one in four men are affected during this time.
Medications A number of medications can cause gynecomastia. These include:

Anti-androgens used to treat prostate enlargement or cancer and some other conditions. Examples include flutamide, finasteride (Proscar) and spironolactone (Aldactone). Anabolic steroids and androgens. AIDS medications. Gynecomastia can develop in HIV-positive men who are receiving a treatment regimen called highly active antiretroviral therapy (HAART). Efavirenz
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(Sustiva) is more commonly associated with gynecomastia than are other HIV medications. Anti-anxiety medications, such as diazepam (Valium). Tricyclic antidepressants. Antibiotics. Ulcer medications, such as cimetidine. Cancer treatment (chemotherapy). Heart medications, such as digoxin (Lanoxin) and calcium channel blockers.
Street drugs and alcohol Substances that can cause gynecomastia include:

Alcohol Amphetamines Marijuana Heroin Methadone
Health conditions Several health conditions can cause gynecomastia by affecting the normal balance of hormones. These include:
Hypogonadism. Any of the conditions that interfere with normal testosterone production, such as Klinefelter syndrome or pituitary insufficiency, can be associated with gynecomastia. Aging. Hormone changes that occur with normal aging can cause gynecomastia, especially in men who are overweight. Tumors. Some tumors, such as those involving the testes, adrenal glands or pituitary gland, can produce hormones that alter the male-female hormone balance. Hyperthyroidism. In this condition, the thyroid gland produces too much of the hormone thyroxine. Kidney failure. About half the people being treated with regular hemodialysis experience gynecomastia due to hormonal changes. Liver failure and cirrhosis. Hormonal fluctuations related to liver problems as well as medications taken for cirrhosis are associated with gynecomastia. Malnutrition and starvation. When body is deprived of adequate nutrition, testosterone levels drop, but estrogen levels remain constant, causing a hormonal imbalance. Gynecomastia can also occur once normal nutrition resumes.
Herbal products Plant oils, such as tea tree or lavender, used in shampoos, soaps or lotions have been associated with gynecomastia. This is probably due to their weak estrogenic activity. Risk factors

Adolescence Older age

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Use of anabolic steroids or androgens to enhance athletic performance Certain health conditions, including liver and kidney disease, thyroid disease, hormonally active tumors, and Klinefelter syndrome
Complications
Although there are few physical complications associated with gynecomastia, having this condition can cause psychological or emotional problems caused by appearance.
Tests and diagnosis physical examination that may include careful evaluation of breast tissue, abdomen and genitals. Initial tests to determine the cause of gynecomastia may include: Blood tests Mammograms may need further testing depending on initial test results, including: Chest X-rays Computerized tomography (CT) scans Magnetic resonance imaging (MRI) scans Testicular ultrasounds Tissue biopsies Treatments and drugs Medications Medications used to treat breast cancer and other conditions, such as tamoxifen and raloxifene, may be helpful for some men with gynecomastia. Although these medications are approved by the Food and Drug Administration, they have not been approved specifically for this use. Surgery to remove excess breast tissue If still have significant bothersome breast enlargement despite initial treatment or observation, doctor may advise surgery. Two types of surgery are used to treat gynecomastia:

Liposuction. This surgery removes breast fat, but not the breast gland tissue itself. Mastectomy. This type of surgery removes the breast gland tissue. The surgery is often done on an endoscopic basis, meaning only small incisions are used. This less invasive type of surgery involves less recovery time.
Prevention

Don't use illegal drugs. Examples include steroids and androgens, amphetamines, heroin, and marijuana. Avoid alcohol. Don't drink alcohol, or drink very little. Review medications. If 're taking medication known to cause gynecomastia, ask doctor if there are other choices.
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Limit beverages in the evening. Don't drink anything for an hour or two before bedtime to help avoid wake-up trips to the bathroom at night. Don't drink too much caffeine or alcohol. These can increase urine production, irritate bladder and worsen symptoms. If take water pills (diuretics), talk to doctor. Maybe a lower dose, taking them only in the morning, or a milder diuretic or change in the time take medication will help ease urinary symptoms. Don't stop taking diuretics without first talking to doctor. Limit decongestants or antihistamines. These drugs tighten the band of muscles around urethra that control urine flow, which makes it harder to urinate. Go when feel the urge. Try to urinate when first feel the urge. Waiting too long to urinate may overstretch the bladder muscle and cause damage. Schedule bathroom visits. Try to urinate at regular times to "retrain" the bladder. This can be done every four to six hours during the day and can be especially useful if have severe frequency and urgency. Stay active. Inactivity causes to retain urine. Even a small amount of exercise can help reduce urinary problems caused by an enlarged prostate. Urinate and then urinate again a few moments later. This is known as double voiding. Keep warm. Colder temperatures can cause urine retention and increase urgency to urinate.
Male breast cancer

Male breast cancer is a relatively rare cancer in men that originates from the breast. As it presents a similar pathology as female breast cancer. Male breast cancer is cancer that forms in the breast tissue of men. Though breast cancer is most commonly thought of as a woman's disease, male breast cancer does occur. The stages of male breast cancer are:

Stage I. The tumor is no more than 2 centimeters (cm) in diameter (3/4 inch) and hasn't spread to the lymph nodes. Stage II. The tumor may be up to 5 cm (about 2 inches) in diameter and may have spread to nearby lymph nodes. Or the tumor may be larger than 5 cm and no cancer cells are found in the lymph nodes. Stage III. The tumor may be larger than 5 cm (about 2 inches) in diameter and may involve several nearby lymph nodes. Lymph nodes above the collarbone may also contain cancer cells. Stage IV. Cancer at this stage has spread beyond the breast to distant areas, such as the bone, brain, liver or lungs.
Types of breast cancer diagnosed in men include:
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Cancer that begins in the milk ducts. Ductal carcinoma is the most common type of male breast cancer. Nearly all male breast cancers begin in the milk ducts. Cancer that begins in the milk-producing glands. Lobular carcinoma is rare in men because men have few lobules in their breast tissue. Cancer that spreads to the nipple. In some cases, breast cancer can form in the milk ducts and spread to the nipple, causing crusty, scaly skin around the nipple. This is called Paget's disease of the nipple.
Causes It's not clear what causes male breast cancer breast cancer occurs when some breast cells begin growing abnormally. These cells divide more rapidly than healthy cells do. The accumulating cells form a tumor that may spread (metastasize) to nearby tissue, to the lymph nodes or to other parts of the body. Inherited genes that increase breast cancer risk Some men inherit mutated genes from their parents that increase the risk of breast cancer. Mutations in one of several genes, especially a gene called BRCA2, put at greater risk of developing breast and prostate cancers. The normal function of these genes is to help prevent cancer by making proteins that keep cells from growing abnormally. But if they have a mutation, the genes aren't as effective at protecting from cancer. Risk factors

Older age. Breast cancer is most common in men ages 60 to 70. Exposure to estrogen. If take estrogen-related drugs, such as those used as part of a sexchange procedure, risk of breast cancer is increased. Estrogen drugs may also be used in hormone therapy for prostate cancer. Family history of breast cancer. If have a close family member with breast cancer, have a greater chance of developing the disease. Klinefelter's syndrome. This genetic syndrome occurs when a boy is born with more than one copy of the X chromosome. Klinefelter's syndrome causes abnormal development of the testicles. As a result, men with this syndrome produce lower levels of certain male hormones (androgens) and more female hormones (estrogens). Liver disease. If have liver disease, such as cirrhosis of the liver, male hormones may be reduced and female hormones may be increased. This can increase risk of breast cancer. Obesity. Obesity may be a risk factor for breast cancer in men because it increases the number of fat cells in the body. Fat cells convert androgens into estrogen, which may increase the amount of estrogen in body and, therefore, risk of breast cancer. Radiation exposure. If 've received radiation treatments to chest, such as those used to treat cancers in the chest, 're more likely to develop breast cancer later in life.
Symptoms

A painless lump or thickening in breast tissue Changes to the skin covering breast, such as dimpling, puckering, redness or scaling
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Changes to nipple, such as redness or scaling, or a nipple that begins to turn inward Discharge from nipple
Tests and diagnosis Diagnosing male breast cancer If breast cancer is suspected, doctor may conduct a number of diagnostic tests and procedures such as:
Clinical breast exam. During this exam, doctor uses his or her fingertips to examine breasts and the areas around armpits and collarbone for lumps or other changes. doctor assesses how large the lumps are, how they feel, and how close they are to skin and muscles. Mammogram. A mammogram is an X-ray of breast tissue. To assess breast tissue, breast will be pressed flat as much as possible. During a mammogram, stand in front of a machine with shirt off. Two flat plastic plates come together to compress breast tissue. A radiology technician takes the X-rays. The compression of the mammogram can be uncomfortable. Ask the technician what to expect and speak up if 're feeling pain. Ultrasound. Ultrasound uses sound waves to create pictures of a suspicious breast mass. doctor may recommend an ultrasound in certain situations. Using a needle to remove cells for testing. A biopsy procedure involves removing a sample of suspicious tissue for laboratory testing. A breast biopsy is commonly done by inserting a needle into the breast lump and drawing cells or tissue from the area. When analyzed in a laboratory, tissue sample reveals whether have breast cancer and, if so, what type of breast cancer have.
Treatments and drugs Surgery The goal of surgery is to remove the tumor and surrounding breast tissue. Surgical procedures used to treat male breast cancer include:
Surgery to remove breast tissue and surrounding lymph nodes. Most men with breast cancer undergo a modified radical mastectomy. In this procedure, a surgeon removes all of breast tissue, including the nipple and areola, and some underarm (axillary) lymph nodes. lymph nodes are tested to see if they contain cancer cells. Removing lymph nodes increases risk of serious arm swelling (lymphedema). Surgery to remove one lymph node for testing. During a sentinel lymph node biopsy, doctor identifies the lymph node most likely to be the first place cancer cells would spread. That lymph node is removed and tested for cancer cells. If no cancer cells are found in that lymph node, there is a good chance that breast cancer hasn't spread beyond breast tissue.
Radiation therapy Radiation therapy uses high-energy beams, such as X-rays, to kill cancer cells. During radiation therapy for male breast cancer, radiation comes from a large machine that moves around body, directing the energy beams to precise points on chest.
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In male breast cancer, radiation therapy may be used to eliminate any remaining cancer cells in the breast, chest muscles or armpit after surgery. Chemotherapy Chemotherapy uses drugs to kill cancer cells. Chemotherapy treatment often involves receiving two or more drugs in different combinations. These may be administered through a vein in arm (intravenously), in pill form or by both methods.
Chemotherapeutic and hormonal options in male breast cancer

Chemotherapeutic options include:

Cyclophosphamide plus methotrexate plus fluorouracil (CMF). Cyclophosphamide plus doxorubicin plus fluorouracil (CAF). Trastuzumab (monoclonal antibody therapy).
Hormonal options include:

Orchiectomy Gonadotropin hormone releasing hormone agonist (GNRH agonist) with or without total androgen blockage (anti-androgen Tamoxifen for estrogen receptorpositive patients. Progesterone Aromatase inhibitors.
Hormone therapy Some breast cancers rely on hormones for fuel. If doctor determines that cancer uses hormones to help it grow, may be offered hormone therapy. Most men with male breast cancer have hormone-sensitive tumors. Hormone therapy for male breast cancer often involves the medication tamoxifen, which is also used in women. Other hormone therapy medications used in women with breast cancer haven't been shown to be effective in men.
Creative activities. Creative activities such as art, dance and music may help feel less distressed. Some cancer centers have specially trained professionals who can guide through these activities. Exercise. Gentle exercise may help boost mood and make feel better. If haven't been exercising regularly, ask doctor if it's OK. Start slow and work way up to more exercise on more days of the week. Meditation. Meditation is a quiet activity that helps clear mind of distracting thoughts. can meditate on own or receive guidance from an instructor. Prayer. Many people find strength from a power greater than themselves. pray on own or can meet with a chaplain or other religious person who can pray with . Relaxation exercises. Relaxation exercises help refocus mind and help relax. Relaxation exercises include guided imagery and progressive muscle relaxation. do relaxation exercises on own, with an instructor or by listening to a recording that guides through the exercises.
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INTEGUMENTARY SYSTEM Dermatitis

Dermatitis is an inflammation of the skin. Causes and types

Atopic dermatitis (eczema). This condition often occurs with allergies and frequently occurs in families in which members have asthma, hay fever or eczema. Contact dermatitis. This condition results from direct contact with one of many irritants or allergens such as poison ivy; jewelry containing nickel; and certain cleaning products, perfumes and cosmetics. Seborrheic dermatitis. This condition is common in people with oily skin or hair, and it may come and go depending on the season. It's likely that hereditary factors play a role in this condition.
Risk factors
Age. Dermatitis can occur at any age, but atopic dermatitis (eczema) usually begins in infancyAllergies and asthma. People who have a personal or family history of hay fever or asthma are more likely to develop atopic dermatitis. Occupation. Jobs that put you in contact with certain metals, solvents or cleaning supplies increase risk of contact dermatitis.
Symptoms Each type of dermatitis may look a little different and may tend to occur on different parts of body. The most common types of dermatitis include:
Atopic dermatitis (eczema). Usually beginning in infancy, this red, itchy rash most commonly occurs where the skin flexes inside the elbows, behind the knees and the front of the neck. When scratched, the rash can leak fluid and crust over. Contact dermatitis. This rash occurs on areas of the body that have come into contact with substances that either irritate the skin or cause an allergic reaction, such as poison ivy. The rash may burn, sting or itch. Blisters may develop. Seborrheic dermatitis. This condition causes a red rash with yellowish and somewhat "oily" scales, usually on the scalp and sometimes on the face, especially around the ears and nose. It's a common cause of dandruff. In infants, this disorder is known as cradle cap.
Complications
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Scratching the itchy rash associated with dermatitis can cause open sores, which may become infected. These skin infections can spread and may, very rarely, become lifethreatening.
Tests and diagnosis
Patch testing In the case of contact dermatitis, patch testing is done on skin to see which substances inflame skin. In this test, applies small amounts of various substances to skin under an adhesive covering. During return visits over the next several days, examines skin to see had a reaction to any of the substances. This type of testing is most useful for determining if you have specific contact allergies.

Dermatitis treatment varies, depending on the cause. Using corticosteroid creams, applying wet compresses and avoiding irritants are the cornerstones of most dermatitis treatment plans. Light therapy, which involves exposing skin to controlled amounts of natural or artificial light, also may be used in some cases.
Lifestyle and home remedies These steps can help you manage dermatitis:
Use nonprescription anti-itch products. Over-the-counter hydrocortisone cream or calamine lotion can temporarily relieve itching. Oral antihistamines, such as diphenhydramine (Benadryl, others), may be helpful if itching is severe. Apply cool, wet compresses. Covering the affected area with bandages and dressings can help protect skin and prevent scratching. Take a comfortably cool bath. Sprinkle bath water with baking soda, uncooked oatmeal or colloidal oatmeal a finely ground oatmeal that's made for the bathtub. Avoid scratching. Cover the itchy area with a dressing, if you can't keep from scratching it. Trim nails and wear gloves at night. Wear cotton clothing. Smooth-textured cotton clothing can help you avoid irritating the affected area. Choose mild laundry detergent. Because clothes, sheets and towels touch skin, choose mild laundry products that are unscented. Avoid fabric softeners.
Prevention
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Avoiding dry skin may be one factor in helping you prevent future bouts of dermatitis. These tips can help you minimize the drying effects of bathing on skin:
Bathe less frequently. Most people who are prone to dermatitis don't need to bathe daily. Try going a day or two without a shower or bath. When you do bathe, limit self to 15 to 20 minutes, and use warm, rather than hot, water. Use only mild soaps. Choose mild soaps that clean without excessively removing natural oils. Deodorant and antibacterial soaps may be more drying to skin. Use soap only on face, underarms, genital areas, hands and feet. Dry self carefully. Whisk water off skin with the palms of hands. Gently pat skin dry with a towel after bathing. Moisturize skin. While skin is still damp, seal in moisture with an oil or cream. Pay special attention to legs, arms, back and the sides of body.
Acne vulgaris
Definition

Acne vulgaris is a common skin disorder Chronic disease of sebaceous follicle, primarily affecting face, chest, and back Onset typically occurs at puberty because of increased sebum production triggered by increased androgen levels, but may persist throughout adulthood Inflammation is due in part to over-proliferation of Propionibacterium acnes, an anaerobic Gram-positive organism that resides in follicles Classified on basis of type of lesions (comedonal noninflammatory vs inflammatory) and number of lesions present
Key points

Use acne morphology to distinguish between noninflammatory and inflammatory forms Base therapy on the type of acne present, the distribution, and the severity Use combination therapy when needed Give the patient hope, and keep titrating and adjusting medications until good results are achieved Know when to use or refer for isotretinoin treatment
Causes Common causes

Increased androgen production Overactivity/hyperresponsiveness of sebaceous glands in response to androgens

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Colonization of Propionibacterium acnes, which metabolizes sebum to free fatty acid, leading to inflammatory lesions
Rare causes Industrial exposure to halogenated hydrocarbons. Serious causes

Adrenal hyperplasia Polycystic ovarian syndrome
Contributory or predisposing factors

Adolescence Hair greases or oil-based cosmetics Sports equipment such as helmet straps rubbing and occluding skin Medications with iodine (found in some cough medicines) Some prescription drugs: lithium, isoniazid, phenytoin, corticosteroids, anabolic steroids, and oral contraceptives with high androgenic activity Chemotherapeutic agents that act on epidermal growth factor receptors Excessive milk intake, especially skim milk, in teenagers
Cardinal features

Disease of pilosebaceous unit (sebaceous follicle), primarily affecting face, chest, and back Onset typically occurs at puberty because of increased sebum production triggered by increased androgen levels. Virtually all adolescents will be affected to varying degrees Comedonal lesions are caused by obstruction of the pilosebaceous unit Follicular disruption then leads to inflammatory lesions (papules, pustules) Scarring may result Treatment is based on type of lesions and number of lesions present
Medical Care Treatment should be directed toward the known pathogenic factors involved in acne. These include follicular hyperproliferation, excess sebum, P acnes, and inflammation. The grade and severity of the acne help in determining which of the following treatments, alone or in combination, is most appropriate. When a topical or systemic antibiotic is used, it should be used in conjunction with benzoyl peroxide to reduce the emergence of resistance.
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Topical treatments Topical retinoids are comedolytic and anti-inflammatory. They normalize follicular hyperproliferation and hyperkeratinization. Topical retinoids reduce the numbers of microcomedones, comedones, and inflammatory lesions. They may be used alone or in combination with other acne medications. The most commonly prescribed topical retinoids for acne vulgaris include adapalene, tazarotene, and tretinoin. These retinoids should be applied once daily to clean, dry skin, but they may need to be applied less frequently if irritation occurs. Skin irritation with peeling and redness may be associated with the early use of topical retinoids and typically resolves within the first few weeks of use. Instruct patients about sun protection. The use of mild, nonirritating cleansers and noncomedogenic moisturizers may help reduce this irritation. Alternate-day dosing may be used if irritation persists. Topical retinoids thin the stratum corneum, and they have been associated with sun sensitivity. Topical antibiotics are mainly used for their role against Propionibacterium acnes. They may also have anti-inflammatory properties. Commonly prescribed topical antibiotics for acne vulgaris include clindamycin (or less commonly erythromycin) alone or in combination with benzoyl peroxide. Clindamycin is available in a variety of topical agents. They may be applied once or twice a day. Gels and solutions may be more irritating than creams or lotions. Clindamycin has maintained better efficacy than erythromycin, which is infrequently used. Benzoyl peroxide products are also effective against P acnes, and no bacterial resistance Systemic treatments Systemic antibiotics are a mainstay in the treatment of acne vulgaris. These agents have anti-inflammatory properties, and they are effective against P acnes. The tetracycline group of antibiotics is commonly prescribed for acne. The more lipophilic antibiotics, such as doxycycline and minocycline, are generally more effective than tetracycline. Other antibiotics, including trimethoprim alone or in combination with sulfamethoxazole, and azithromycin, reportedly are helpful.
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Hormonal therapies Oral contraceptives increase sex hormonebinding globulin, resulting in an overall decrease in circulating free testosterone. Combination birth control pills have shown efficacy in the treatment of acne vulgaris. Spironolactone may also be used in the treatment of acne vulgaris. Spironolactone binds the androgen receptor and reduces androgen production. Adverse effects include dizziness, breast tenderness, and dysmenorrhea. Isotretinoin therapy should be initiated at a dose of 0.5 mg/kg/d for 4 weeks and increased as tolerated until a cumulative dose of 120-150 mg/kg is achieved. Coadministration with steroids at the onset of therapy may be useful in severe cases to prevent initial worsening. Some patients may respond to doses lower than the standard recommendation dosages. A lower dose (0.25-0.4 mg/kg/d) may be as effective as the higher dose given for the same time period and with greater patient satisfaction. Isotretinoin is a teratogen, and pregnancy must be avoided. Surgical Care Procedural treatments include manual extraction of comedones and intralesional steroid injections. Additionally, some patients may benefit from superficial peels that use glycolic or salicylic acid. Phototherapy using red light or blue light and photodynamic therapy are being assessed as potential treatments for acne. The usefulness of some fractional laser treatments in the management of acne is also being evaluated.
Atopic dermatitis (eczema)

Atopic dermatitis (eczema) is an itchy inflammation of skin. It's a long-lasting (chronic) condition that may be accompanied by asthma or hay fever. Eczema may affect any area of skin, but it typically appears on arms and behind knees. It tends to flare periodically and then subside. The cause of atopic dermatitis is unknown, but it may result from a combination of inherited tendencies for sensitive skin and malfunction in the body's immune system.
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Causes The exact cause of atopic dermatitis (eczema) is unknown, but it's likely due to a combination of dry, irritable skin with a malfunction in the body's immune system. Stress and other emotional disorders can worsen atopic dermatitis, but they don't cause it. Most experts believe atopic dermatitis has a genetic basis. It has been thought to be connected to asthma and hay fever Factors that worsen atopic dermatitis

Long, hot baths or showers Dry skin Stress Sweating Rapid changes in temperature Low humidity Solvents, cleaners, soaps or detergents Wool or man-made fabrics or clothing Dust or sand Cigarette smoke Living in cities where pollution is high Certain foods, such as eggs, milk, fish, soy or wheat
Infantile eczema When atopic dermatitis occurs in infants, it's called infantile eczema. This condition may continue into childhood and adolescence. Infantile eczema often involves an oozing, crusting rash, mainly on the skin of the face and scalp, but it can occur anywhere. After infancy, the rash becomes dryer and tends to be red to brown-gray in color. In adolescence, the skin may be scaly or thickened and easily irritated. The intense itching may continue. Symptoms

Red to brownish-gray colored patches Itching, which may be severe, especially at night Small, raised bumps, which may leak fluid and crust over when scratched Thickened, cracked or scaly skin Raw, sensitive skin from scratching
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Though the patches can occur anywhere, they most often appear on the hands and feet, in the front of the bend of the elbow, behind the knees, and on the ankles, wrists, face, neck and upper chest. Atopic dermatitis can also affect the skin around the eyes, including eyelids. Scratching can cause redness and swelling around the eyes. Atopic dermatitis most often begins in childhood before age 5 and may persist into adulthood. For some, it flares periodically and then subsides for a time, even up to several years. Itching may be severe, and scratching the rash can make it even itchier and cause more inflammation. Once the skin barrier is broken, the skin can become infected by bacteria, especially Staphylococcus aureus, which commonly live on the skin. Breaking this itch-scratch cycle can be challenging. Complications
Neurodermatitis. Prolonged itching and scratching may increase the intensity of the itch, possibly leading to neurodermatitis (lichen simplex chronicus). Neurodermatitis is a condition in which an area of skin that's frequently scratched becomes thick and leathery. The patches can be raw, red or darker than the rest of skin. Persistent scratching can also lead to permanent scars or changes in skin color. Skin infections. Sometimes, scratching can break the skin and cause open sores and fissures that can become infected, a process called impetiginization. A milder form of infection is impetigo, usually due to staphylococcal infection. Having atopic dermatitis predisposes you to this infection. Eye complications. Severe atopic dermatitis can also cause eye complications, which may lead to permanent eye damage. When these complications occur, itching in and around the eyelids becomes severe. Signs and symptoms of eye complications also include eye watering and inflammation of the eyelid (blepharitis) and the lining of the eyelid (conjunctivitis). If you suspect complications with eyes, see promptly.
Tests and diagnosis
There is no test to definitively diagnose atopic dermatitis (eczema). Instead, it's typically diagnosed based on an examination of skin and a review of medical history.
Treatments and drugs Aims to reduce inflammation, relieve itching and prevent future flare-ups.
Medications
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Corticosteroid creams or ointments. may recommend prescription corticosteroid creams or ointments to ease scaling and relieve itching. Some low-potency corticosteroid creams are available without a prescription, but you should always talk to before using any topical corticosteroid. Side effects of long-term or repeated use can include skin irritation or discoloration, thinning of the skin, infections, and stretch marks on the skin. Antibiotics. You may need antibiotics if you have a bacterial skin infection or an open sore or fissure caused by scratching. may recommend taking antibiotics for a short time to treat an infection or for longer periods of time to reduce bacteria on skin and to prevent recurrent infections. Oral antihistamines. If itching is severe, oral antihistamines may help. Diphenhydramine (Benadryl, others) can make you sleepy and may be helpful at bedtime. If skin cracks open, may prescribe mildly astringent wet dressings to prevent infection. Oral or injected corticosteroids. For more severe cases, may prescribe oral corticosteroids, such as prednisone, or an intramuscular injection of corticosteroids to reduce inflammation and to control symptoms. These medications are effective, but can't be used long term because of potential serious side effects, which include cataracts, loss of bone mineral (osteoporosis), muscle weakness, decreased resistance to infection, high blood pressure and thinning of the skin. Immunomodulators. A class of medications called immunomodulators, such as tacrolimus (Protopic) and pimecrolimus (Elidel), affect the immune system and may help maintain normal skin texture and reduce flares of atopic dermatitis. This prescriptiononly medication is approved for children older than 2 and for adults. Due to possible concerns about the effect of these medications on the immune system when used for prolonged periods, the Food and Drug Administration recommends that Elidel and Protopic be used only when other treatments have failed or if someone can't tolerate other treatments.
Light therapy (phototherapy) As the name suggests, this treatment uses natural or artificial light. The simplest and easiest form of phototherapy involves exposing skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light including the more recently available narrow band ultraviolet B (NBUVB) either alone or with medications. Though effective, long-term light therapy has many harmful effects, including premature skin aging and an increased risk of skin cancer. For these reasons, it's important to consult before using light exposure as treatment for atopic dermatitis. can advise you of possible advantages and disadvantages of light exposure in specific situation.
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Infantile eczema Treatment for infantile eczema includes identifying and avoiding skin irritations, avoiding extreme temperatures, and lubricating babys skin with bath oils, lotions, creams or ointments. See baby's doctor if these measures don't improve the rash or if the rash looks infected. baby may need a prescription medication to control his or her symptoms or to treat the infection. may recommend an oral antihistamine to help lessen the itch and to cause drowsiness, which may be helpful for nighttime itching and discomfort. Lifestyle and home remedies To help reduce itching and soothe inflamed skin, try these self-care measures:
Try to identify and avoid triggers that worsen the inflammation. Rapid changes of temperature, sweating and stress can worsen the condition. Avoid direct contact with wool products, such as rugs, bedding and clothes, as well as harsh soaps and detergents. Apply an anti-itch cream or calamine lotion to the affected area. A nonprescription hydrocortisone cream, containing at least 1 percent hydrocortisone, can temporarily relieve the itch. A nonprescription oral antihistamine, such as diphenhydramine (Benadryl, others), may be helpful if itching is severe. Avoid scratching whenever possible. Cover the itchy area if you can't keep from scratching it. Trim nails and wear gloves at night. Apply cool, wet compresses. Covering the affected area with bandages and dressings can help protect the skin and prevent scratching. Take a warm bath. Sprinkle the bath water with baking soda, uncooked oatmeal or colloidal oatmeal a finely ground oatmeal that is made for the bathtub (Aveeno, others). Or, add 1/2 cup (118 milliliters) of bleach to a U.S. standard-sized bathtub (40 gallons; 151 liters) filled to the overflow drainage holes with warm water. The diluted bleach bath is thought to kill bacteria that grow on the skin. Choose mild soaps without dyes or perfumes. Be sure to rinse the soap completely off body. Moisturize skin. Use an oil or cream to seal in moisture while skin is still damp from a bath or shower. Pay special attention to legs, arms, back and the sides of body. If skin is already dry, consider using a lubricating cream. Use a humidifier. Hot, dry indoor air can parch sensitive skin and worsen itching and flaking. A portable home humidifier or one attached to furnace adds moisture to the air inside home. Portable humidifiers come in many varieties. And be sure to keep humidifier clean to prevent the growth of bacteria and fungi. Wear cool, smooth-textured cotton clothing. Avoid clothing that's rough, tight, scratchy or made from wool. This will help you avoid irritation. Also, wear appropriate clothing in hot weather or during exercise to prevent excessive sweating.
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Prevention Avoiding dry skin may be one factor in helping to prevent future bouts of dermatitis. These tips can help you minimize the drying effects of bathing on skin:
Bathe less frequently. Try going a day or two without a shower or bath. When you do bathe, limit self to 15 to 20 minutes, and use warm, rather than hot, water. Using a bath oil also may be helpful. Use only certain soaps or synthetic detergents. Choose mild soaps that clean without excessively removing natural oils. Deodorant and antibacterial soaps may be more drying to skin. Use soap only on face, underarms, genital areas, hands and feet. Use clear water elsewhere. Dry self carefully. Brush skin rapidly with the palms of hands, or gently pat skin dry with a soft towel after bathing. Moisturize skin. Moisturizers provide a seal over skin to keep water from escaping. Thicker moisturizers work best, such as over-the-counter brands Cetaphil, Vanicream and Eucerin. You may also want to use cosmetics that contain moisturizers. If skin is extremely dry, you may want to apply an oil, such as baby oil, while skin is still moist. Oil has more staying power than moisturizers do and prevents the evaporation of water from the surface of skin
Psoriasis
Classification Psoriasis may be classified into nonpustular and pustular types as follows Nonpustular
Psoriasis vulgaris (chronic stationary psoriasis, plaque-like psoriasis) is the most common form of psoriasis. It affects 80% to 90% of people with psoriasis. Plaque psoriasis typically appears as raised areas of inflamed skin covered with silvery white scaly skin. These areas are called plaques. Psoriatic erythroderma (erythrodermic psoriasis) involves the widespread inflammation and exfoliation of the skin over most of the body surface. It may be accompanied by severe itching, swelling and pain. It is often the result of an exacerbation of unstable plaque psoriasis, particularly following the abrupt withdrawal of systemic treatment. This form of psoriasis can be fatal, as the extreme inflammation and exfoliation disrupt the body's ability to regulate temperature and for the skin to perform barrier functions.[15]
Pustular
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Pustular psoriasis appears as raised bumps that are filled with noninfectious pus (pustules). The skin under and surrounding the pustules is red and tender. Pustular psoriasis can be localised, commonly to the hands and feet (palmoplantar pustulosis), or generalised with widespread patches occurring randomly on any part of the body. Types include:

Generalized pustular psoriasis (pustular psoriasis of von Zumbusch) Pustulosis palmaris et plantaris (persistent palmoplantar pustulosis, pustular psoriasis of the Barber type, pustular psoriasis of the extremities) Annular pustular psoriasis Acrodermatitis continua Impetigo herpetiformis
Other Additional types of psoriasis include:

Drug-induced psoriasis Inverse psoriasis appears as smooth inflamed patches of skin. It occurs in skin folds, particularly around the genitals (between the thigh and groin), the armpits, under an overweight abdomen (panniculus), and under the breasts (inframammary fold). It is aggravated by friction and sweat, and is vulnerable to fungal infections. Napkin psoriasis Seborrheic-like psoriasis
Guttate psoriasis is characterized by numerous small, scaly, red or pink, teardrop-shaped lesions. These numerous spots of psoriasis appear over large areas of the body, primarily the trunk, but also the limbs and scalp. Guttate psoriasis is often preceded by a streptococcal infection, typically streptococcal pharyngitis. The reverse is not true. Nail psoriasis produces a variety of changes in the appearance of finger and toe nails. These changes include discolouring under the nail plate, pitting of the nails, lines going across the nails, thickening of the skin under the nail, and the loosening (onycholysis) and crumbling of the nail. Psoriatic arthritis involves joint and connective tissue inflammation. Psoriatic arthritis can affect any joint, but is most common in the joints of the fingers and toes. This can result in a sausage-shaped swelling of the fingers and toes known as dactylitis. Psoriatic arthritis can also affect the hips, knees and spine (spondylitis).
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Psoriasis triggers Psoriasis typically starts or worsens because of a trigger that you may be able to identify and avoid. Factors that may trigger psoriasis include:

Infections, such as strep throat or thrush Injury to the skin, such as a cut or scrape, bug bite, or a severe sunburn Stress Cold weather Smoking Heavy alcohol consumption Certain medications including lithium, which is prescribed for bipolar disorder; high blood pressure medications such as beta blockers; antimalarial drugs; and iodides
Risk factors
Family history. Perhaps the most significant risk factor for psoriasis is having a family history of the disease. About 40 percent of people with psoriasis have a family member with the disease, although this may be an underestimate. Viral and bacterial infections. People with HIV are more likely to develop psoriasis than people with healthy immune systems are. Children and young adults with recurring infections, particularly strep throat, also may be at increased risk. Stress. Because stress can impact immune system, high stress levels may increase risk of psoriasis. Obesity. Excess weight increases risk of inverse psoriasis. In addition, plaques associated with all types of psoriasis often develop in skin creases and folds. Smoking. Smoking tobacco not only increases risk of psoriasis but also may increase the severity of the disease. Smoking may also play a role in the initial development of the disease.
Symptoms Psoriasis signs and symptoms can vary from person to person but may include one or more of the following:

Red patches of skin covered with silvery scales Small scaling spots (commonly seen in children) Dry, cracked skin that may bleed Itching, burning or soreness Thickened, pitted or ridged nails Swollen and stiff joints
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Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas. Mild cases of psoriasis may be a nuisance; more-severe cases can be painful, disfiguring and disabling. Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission. In most cases, however, the disease eventually returns. Complications

Thickened skin and bacterial skin infections caused by scratching in an attempt to relieve severe itching Fluid and electrolyte imbalance in the case of severe pustular psoriasis Low self-esteem Depression Stress Anxiety Social isolation
Tests and diagnosis

Physical exam and medical history. usually can diagnose psoriasis by taking medical history and examining skin, scalp and nails. Skin biopsy. Rarely, may take a small sample of skin (biopsy) that's examined under a microscope to determine the exact type of psoriasis and to rule out other disorders. A skin biopsy is usually done in a doctor's office using a local anesthetic.
Treatments and drugs Psoriasis treatments aim to:

Interrupt the cycle that causes an increased production of skin cells, thereby reducing inflammation and plaque formation. Remove scales and smooth the skin, which is particularly true of topical treatments that you apply to skin.
Psoriasis treatments can be divided into three main types: topical treatments, light therapy and systemic medications. Topical treatments Used alone, creams and ointments that you apply to skin can effectively treat mild to moderate
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psoriasis. When the disease is more severe, creams are likely to be combined with oral medications or light therapy. Topical psoriasis treatments include:
Topical corticosteroids. These powerful anti-inflammatory drugs are the most frequently prescribed medications for treating mild to moderate psoriasis. They slow cell turnover by suppressing the immune system, which reduces inflammation and relieves associated itching. Medicated foams and scalp solutions are available to treat psoriasis patches on the scalp. Long-term use or overuse of strong corticosteroids can cause thinning of the skin and resistance to the treatment's benefits. To minimize side effects and to increase effectiveness, topical corticosteroids are generally used on active outbreaks until they're under control. Vitamin D analogues. These synthetic forms of vitamin D slow down the growth of skin cells. Calcipotriene (Dovonex) is a prescription cream or solution containing a vitamin D analogue that may be used alone to treat mild to moderate psoriasis or in combination with other topical medications or phototherapy. This treatment can irritate the skin. Calcitriol (Rocaltrol) is expensive, but may be equally effective and possibly less irritating than calcipotriene. Anthralin. This medication is believed to normalize DNA activity in skin cells. Anthralin (Dritho-Scalp) can also remove scale, making the skin smoother. However, anthralin can irritate skin, and it stains virtually anything it touches, including skin, clothing, countertops and bedding. For that reason doctors often recommend shortcontact treatment allowing the cream to stay on skin for a brief time before washing it off. Anthralin is sometimes used in combination with ultraviolet light. Topical retinoids. These are commonly used to treat acne and sun-damaged skin, but tazarotene (Tazorac, Avage) was developed specifically for the treatment of psoriasis. Like other vitamin A derivatives, it normalizes DNA activity in skin cells and may decrease inflammation. The most common side effect is skin irritation. It may also increase sensitivity to sunlight, so sunscreen should be applied while using the medication. Although the risk of birth defects is far lower for topical retinoids than for oral retinoids, needs to know if you're pregnant or intend to become pregnant if you're using tazarotene. Calcineurin inhibitors. Currently, calcineurin inhibitors tacrolimus (Prograf) and pimecrolimus (Elidel) are approved only for the treatment of atopic dermatitis, but studies have shown them to be effective at times in the treatment of psoriasis. Calcineurin inhibitors are thought to disrupt the activation of T cells, which in turn reduces inflammation and plaque buildup. The most common side effect is skin irritation. Calcineurin inhibitors are not recommended for long-term or continuous use because of a potential increased risk of skin cancer and lymphoma. Calcineurin inhibitors are used only with 's input and approval. They may be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are too irritating or may cause harmful effects.
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Salicylic acid. Available over-the-counter (nonprescription) and by prescription, salicylic acid promotes sloughing of dead skin cells and reduces scaling. Sometimes it's combined with other medications, such as topical corticosteroids or coal tar, to increase its effectiveness. Salicylic acid is available in medicated shampoos and scalp solutions to treat scalp psoriasis. Coal tar. A thick, black byproduct of the manufacture of petroleum products and coal, coal tar is probably the oldest treatment for psoriasis. It reduces scaling, itching and inflammation. Exactly how it works isn't known. Coal tar has few known side effects, but it's messy, stains clothing and bedding, and has a strong odor. Coal tar is available in over-the-counter shampoos, creams and oils. It's also available in higher concentrations by prescription. Moisturizers. By themselves, moisturizing creams won't heal psoriasis, but they can reduce itching and scaling and can help combat the dryness that results from other therapies. Moisturizers in an ointment base are usually more effective than are lighter creams and lotions.
Light therapy (phototherapy) As the name suggests, this psoriasis treatment uses natural or artificial ultraviolet light. The simplest and easiest form of phototherapy involves exposing skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light either alone or in combination with medications.
Sunlight. Ultraviolet (UV) light is a wavelength of light in a range too short for the human eye to see. When exposed to UV rays in sunlight or artificial light, the activated T cells in the skin die. This slows skin cell turnover and reduces scaling and inflammation. Brief, daily exposures to small amounts of sunlight may improve psoriasis, but intense sun exposure can worsen symptoms and cause skin damage. Before beginning a sunlight regimen, ask about the safest way to use natural sunlight for psoriasis treatment. UVB phototherapy. Controlled doses of UVB light from an artificial light source may improve mild to moderate psoriasis symptoms. UVB phototherapy, also called broadband UVB, can be used to treat single patches, widespread psoriasis and psoriasis that resists topical treatments. Short-term side effects may include redness, itching and dry skin. Using a moisturizer may help decrease these side effects. Narrowband UVB therapy. A newer type of psoriasis treatment, narrowband UVB therapy may be more effective than broadband UVB treatment. It's usually administered two or three times a week until the skin improves, then maintenance may require only weekly sessions. Narrowband UVB therapy may cause more severe and longer lasting burns, however. Goeckerman therapy. Some doctors combine UVB treatment and coal tar treatment, which is known as Goeckerman treatment. The two therapies together are more effective than either alone because coal tar makes skin more receptive to UVB light. Once
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requiring a three-week hospital stay, a modification of the original treatment can be performed in a doctor's office. Another method, the Ingram regimen, combines UVB therapy with a coal tar bath and an anthralin-salicylic acid paste that's left on skin for several hours or overnight. Photochemotherapy, or psoralen plus ultraviolet A (PUVA). Photochemotherapy involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure. This more aggressive treatment consistently improves skin and is often used for more-severe cases of psoriasis. PUVA involves two or three treatments a week for a prescribed number of weeks. Short-term side effects include nausea, headache, burning and itching. Long-term side effects include dry and wrinkled skin, freckles, and increased risk of skin cancer, including melanoma, the most serious form of skin cancer. Excimer laser. This form of light therapy, used for mild to moderate psoriasis, treats only the involved skin. A controlled beam of UVB light of a specific wavelength is directed to the psoriasis plaques to control scaling and inflammation. Healthy skin surrounding the patches isn't harmed. Excimer laser therapy requires fewer sessions than does traditional phototherapy because more powerful UVB light is used. Side effects can include redness and blistering. Pulsed dye laser. Similar to the excimer laser, the pulsed dye laser uses a different form of light to destroy the tiny blood vessels that contribute to psoriasis plaques. Side effects can include bruising for up to 10 days after treatment. There is a slight risk of scarring. Combination light therapy. Combining UV light with other treatments such as retinoids frequently improves phototherapy's effectiveness. Combination therapies are often used after other phototherapy options are ineffective.
Oral or injected medications Retinoids. Related to vitamin A, this group of drugs may reduce the production of skin cells if you have severe psoriasis that doesn't respond to other therapies. Signs and symptoms usually return once therapy is discontinued, however. Side effects may include dryness of the skin and mucous membranes, itching, and hair loss. And because retinoids such as acitretin (Soriatane) can cause severe birth defects, women must avoid pregnancy for at least three years after taking the medication. Methotrexate. Taken orally, methotrexate helps psoriasis by decreasing the production of skin cells and suppressing inflammation. It may also slow the progression of psoriatic arthritis in some people. Methotrexate is generally well tolerated in low doses, but may cause upset stomach, loss of appetite and fatigue. When used for long periods it can cause a number of serious side effects, including severe liver damage and decreased production of red and white blood cells and platelets.
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Cyclosporine. Cyclosporine suppresses the immune system and is similar to methotrexate in effectiveness. Like other immunosuppressant drugs, cyclosporine increases risk of infection and other health problems, including cancer. Cyclosporine also makes you more susceptible to kidney problems and high blood pressure the risk increases with higher dosages and long-term therapy. Hydroxyurea. This medication isn't as effective as cyclosporine or methotrexate, but unlike the stronger drugs it can be combined with phototherapy. Possible side effects include a decrease in red blood cells (anemia) and a decrease in white blood cells and platelets. It should not be taken by women who are pregnant or planning to become pregnant. Immunomodulator drugs (biologics). Several immunomodulator drugs are approved for the treatment of moderate to severe psoriasis. They include alefacept (Amevive), etanercept (Enbrel), infliximab (Remicade) and ustekinumab (Stelara). These drugs are given by intravenous infusion, intramuscular injection or subcutaneous injection and are usually used for people who have failed to respond to traditional therapy or who have associated psoriatic arthritis. Biologics work by blocking interactions between certain immune system cells and particular inflammatory pathways. Although they're derived from natural sources rather than chemical ones, they must be used with caution because they have strong effects on the immune system and may permit life-threatening infections. In particular, people taking these treatments must be screened for tuberculosis. Thioguanine. Nearly as effective as methotrexate and cyclosporine, this drug has fewer side effects. However, this drug is more likely to cause anemia, and women who are pregnant or planning to become pregnant must avoid it because it may cause birth defects.
Lifestyle and home remedies Although self-help measures won't cure psoriasis, they may help improve the appearance and feel of damaged skin. These measures may benefit you:
Take daily baths. Bathing daily helps remove scales and calm inflamed skin. Add bath oil, colloidal oatmeal, Epsom salts or Dead Sea salts to the water and soak for at least 15 minutes. Avoid hot water and harsh soaps, which can worsen symptoms; use lukewarm water and mild soaps that have added oils and fats. Use moisturizer. Blot skin after bathing, then immediately apply a heavy, ointmentbased moisturizer while skin is still moist. For very dry skin, oils may be preferable they have more staying power than creams or lotions do and are more effective at preventing water from evaporating from skin. During cold, dry weather, you may need to apply a moisturizer several times a day.
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Cover the affected areas overnight. To help improve redness and scaling, apply an ointment-based moisturizer to skin and wrap with plastic wrap overnight. In the morning, remove the covering and wash away the scales with a bath or a shower. Expose skin to small amounts of sunlight. A controlled amount of sunlight can significantly improve lesions, but too much sun can trigger or worsen outbreaks and increase the risk of skin cancer. If you sunbathe, it's best to try short sessions three or more times a week. Keep a record of when and how long you're in the sun to help avoid overexposure. And be sure to protect healthy skin with a broad-spectrum sunscreen with an SPF of at least 15. Apply sunscreen generously, and reapply every two hours or more often if you're swimming or perspiring. Before beginning any sunbathing program, ask about the best way to use natural sunlight to treat skin. Apply medicated cream or ointment. Apply an over-the-counter cream or ointment containing hydrocortisone or salicylic acid to reduce itching and scaling. If you have scalp psoriasis, try a medicated shampoo that contains coal tar. For best results, follow label directions. Avoid psoriasis triggers, if possible. Find out what triggers, if any, worsen psoriasis and take steps to prevent or avoid them. Infections, injuries to skin, stress, smoking and intense sun exposure can all worsen psoriasis. Avoid drinking alcohol. Alcohol consumption may decrease the effectiveness of some psoriasis treatments. Eat a healthy diet. Although there's no evidence that certain foods will either improve or aggravate psoriasis, it's important to eat a healthy diet, particularly when you have a chronic disease. A healthy diet includes eating a variety fruits and vegetables of all colors and whole grains. If you eat meat, focus on lean cuts and fish. If you think certain foods make symptoms better or worse, keep a food diary to see what effect different foods have.
Aloe vera. Taken from the leaves of the aloe vera plant, aloe extract cream may reduce redness, scaling, itching and inflammation. You may need to use the cream several times a day for a month or more to see any improvements in skin. Fish oil. Omega-3 fatty acids found in fish oil supplements may reduce inflammation associated with psoriasis, although results from studies are mixed. Taking 3 grams or less of fish oil daily is generally recognized as safe, and you may find it beneficial.
Melanoma
Melanoma, the most serious type of skin cancer, develops in the cells (melanocytes) that produce melanin the pigment that gives skin its color. Melanoma can also form in eyes and, rarely, in internal organs, such as intestines.
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The exact cause of all melanomas isn't clear, but exposure to ultraviolet (UV) radiation from sunlight or tanning lamps and beds increases risk of developing melanoma. Limiting exposure to UV radiation can help reduce risk of melanoma. The risk of melanoma seems to be increasing in people under 40, especially women. Knowing the warning signs of skin cancer can help ensure that cancerous changes are detected and treated before the cancer has spread. Melanoma stages
Determine the thickness. The thickness of a melanoma is determined by carefully examining the melanoma under a microscope and measuring it with a special tool (micrometer). The thickness of a melanoma helps doctors decide on a treatment plan. In general, the thicker the tumor, the more serious the disease. See if the melanoma has spread. To determine whether melanoma has spread to nearby lymph nodes, surgeon may use a procedure known as a sentinel node biopsy. During a sentinel node biopsy, a dye is injected in the area where melanoma was removed. The dye flows to the nearby lymph nodes. The first lymph nodes to take up the dye are removed and tested for cancer cells. If these first lymph nodes (sentinel lymph nodes) are cancer-free, there's a good chance that the melanoma has not spread beyond the area where it was first discovered. Cancer can still recur or spread, even if the sentinel lymph nodes are free of cancer.
Risk factors
Fair skin. Having less pigment (melanin) in skin means you have less protection from damaging UV radiation. If you have blond or red hair, light-colored eyes, and freckle or sunburn easily, you're more likely to develop melanoma than is someone with a darker complexion. But melanoma can develop in people with darker complexions, including Hispanics and blacks. A history of sunburn. One or more severe, blistering sunburns can increase risk of melanoma as an adult. Excessive ultraviolet (UV) light exposure. Exposure to UV radiation, which comes from the sun and from tanning beds, can increase the risk of skin cancer, including melanoma. Living closer to the equator or at a higher elevation. People living closer to the earth's equator, where the sun's rays are more direct, experience higher amounts of UV radiation than do those living in higher latitudes. In addition, if you live at a high elevation, you're exposed to more UV radiation. Having many moles or unusual moles. Having more than 50 ordinary moles on body indicates an increased risk of melanoma. Also, having an unusual type of mole increases
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the risk of melanoma. Known medically as dysplastic nevi, these tend to be larger than normal moles and have irregular borders and a mixture of colors. A family history of melanoma. If a close relative, such as a parent, child or sibling, has had melanoma, you have a greater chance of developing it, too. Weakened immune system. People with weakened immune systems have an increased risk of skin cancer. This includes people who have HIV/AIDS and those who have undergone organ transplants.
Symptoms The first melanoma signs and symptoms often are:

A change in an existing mole The development of a new pigmented or unusual-looking growth on skin
Melanoma doesn't always begin as a mole. It can also occur on otherwise normal-appearing skin. Normal moles Normal moles are generally a uniform color, such as tan, brown or black, with a distinct border separating the mole from surrounding skin. They're oval or round and usually smaller than 1/4 inch (about 6 millimeters) in diameter the size of a pencil eraser. Most people have between 10 and 45 moles. Many of these develop by age 40, although moles may change in appearance over time some may even disappear with age. Unusual moles that may indicate melanoma To help you identify characteristics of unusual moles that may indicate melanomas or other skin cancers, think of the letters A-B-C-D-E:

A is for asymmetrical shape. Look for moles with irregular shapes, such as two very different-looking halves. B is for irregular border. Look for moles with irregular, notched or scalloped borders characteristics of melanomas. C is for changes in color. Look for growths that have many colors or an uneven distribution of color. D is for diameter. Look for new growth in a mole larger than 1/4 inch (about 6 millimeters). E is for evolving. Look for changes over time, such as a mole that grows in size or that changes color or shape. Moles may also evolve to develop new signs and symptoms, such as new itchinss or bleeding.
Other suspicious changes in a mole may include:

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Scaliness Itching Spreading of pigment from the mole into the surrounding skin Oozing or bleeding
Cancerous (malignant) moles vary greatly in appearance. Some may show all of the changes listed above, while others may have only one or two unusual characteristics. Hidden melanomas Melanomas can also develop in areas of body that have little or no exposure to the sun, such as the spaces between toes and on palms, soles, scalp or genitals. These are sometimes referred to as hidden melanomas, because they occur in places most people wouldn't think to check. When melanoma occurs in people with darker skin, it's more likely to occur in a hidden area. Hidden melanomas include:
Melanoma under a nail. Subungual melanoma is a rare form that occurs under a nail and can affect the hands or the feet. It's more common in blacks and in other people with darker skin pigment. The first indication of a subungual melanoma is usually a brown or black discoloration that's often mistaken for a bruise. Melanoma in the mouth, digestive tract, urinary tract or vagina. Mucosal melanoma develops in the mucous membrane that lines the nose, mouth, esophagus, anus, urinary tract and vagina. Mucosal melanomas are especially difficult to detect because they can easily be mistaken for other, far more common conditions. Melanoma in the eye. Eye melanoma, also called ocular melanoma, occurs in the uvea the layer beneath the white of the eye (sclera). An eye melanoma may cause vision changes and may be diagnosed during an eye exam.
Tests and diagnosis Skin cancer screening

Skin exams by a trained professional. During a skin exam, conducts a head-to-toe inspection of skin. Skin exams you do at home. A self-exam may help you learn the moles, freckles and other skin marks that are normal for you so that you can notice any changes. It's best to do this standing in front of a full-length mirror while using a hand-held mirror to inspect hard-to-see areas. Be sure to check the fronts, backs and sides of arms and legs. In addition, check groin, scalp, fingernails, soles of feet and spaces between toes.
Diagnosing melanoma
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Punch biopsy. During a punch biopsy, uses a tool with a circular blade. The blade is pressed into the skin around a suspicious mole and a round piece of skin is removed. Excisional biopsy. In this procedure, the entire mole or growth is removed along with a small border of normal-appearing skin. Incisional biopsy. With an incisional biopsy, only the most irregular part of a mole or growth is taken for laboratory analysis.
Treatments and drugs Treating early-stage melanomas Treatment for early-stage melanomas usually includes surgery to remove the melanoma. A very thin melanoma may be removed entirely during the biopsy and require no further treatment. Otherwise, surgeon will remove the cancer as well as a small border of normal skin and a layer of tissue beneath the skin. For people with early-stage melanomas, this may be the only treatment needed. Treating melanomas that have spread beyond the skin If melanoma has spread beyond the skin, treatment options may include:
Surgery to remove affected lymph nodes. If melanoma has spread to nearby lymph nodes, surgeon may remove the affected nodes. Additional treatments before or after surgery may also be recommended. Chemotherapy. Chemotherapy uses drugs to destroy cancer cells. Chemotherapy can be given intravenously, in pill form or both so that it travels throughout body. Or hemotherapy can be given in a vein in arm or leg in a procedure called isolated limb perfusion. During this procedure, blood in arm or leg isn't allowed to travel to other areas of body for a short time so that the chemotherapy drugs travel directly to the area around the melanoma and don't affect other parts of body. Radiation therapy. This treatment uses high-powered energy beams, such as X-rays, to kill cancer cells. It's sometimes used to help relieve symptoms of melanoma that has spread to another organ. Fatigue is a common side effect of radiation therapy, but energy usually returns once the treatment is complete. Biological therapy. Biological therapy boosts immune system to help body fight cancer. These treatments are made of substances produced by the body or similar substances produced in a laboratory. Biological therapies used to treat melanoma include interferon and interleukin-2. Side effects of these treatments are similar to those of the flu, including chills, fatigue, fever, headache and muscle aches. Ipilimumab (Yervoy) is another drug that uses immune system to fight melanoma. Ipilimumab is used to treat advanced melanoma that has spread beyond its original location. Targeted therapy. Targeted therapy uses medications designed to target specific vulnerabilities in cancer cells. Vemurafenib (Zelboraf) is a targeted therapy approved to
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treat advanced melanoma that can't be treated with surgery or melanoma that has spread through the body. Vemurafenib only treats melanoma that has a certain genetic mutation. Prevention
Avoid midday sun. Avoid the sun when its rays are the strongest. For most places, this is between about 10 a.m. and 4 p.m. Because the sun's rays are strongest during this period, try to schedule outdoor activities for other times of the day, even in winter or when the sky is cloudy. You absorb UV radiation year-round, and clouds offer little protection from damaging rays. Wear sunscreen year-round. Use a broad-spectrum sunscreen with an SPF of at least 15. Apply sunscreen generously, and reapply every two hours or more often if you're swimming or perspiring. Use a generous amount of sunscreen on all exposed skin, including lips, the tips of ears, and the backs of hands and neck. Wear protective clothing. Sunscreens don't provide complete protection from UV rays, so wear tightly woven clothing that covers arms and legs and a broad-brimmed hat, which provides more protection than a baseball cap or visor does. Some companies also sell photoprotective clothing. dermatologist can recommend an appropriate brand. Don't forget sunglasses. Look for those that block both types of UV radiation UVA and UVB rays. Avoid tanning beds. Tanning beds emit UV radiation, which can increase the risk of skin cancer. Become familiar with skin so you'll notice changes. Examine skin so that you become familiar with what skin normally looks like. This way, you may be more likely to notice any skin changes. With the help of mirrors, check face, neck, ears and scalp. Examine chest and trunk and the tops and undersides of arms and hands. Examine both the front and back of legs and feet, including the soles and the spaces between toes. Also check genital area and between buttocks.
Itchy skin (pruritus)

Definition Itchy skin is an uncomfortable, irritating sensation that can make scratching irresistible. It seems simple. Also known as pruritus (proo-RIE-tus), itchy skin may be the result of a rash or another condition, such as psoriasis or dermatitis. Causes
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Dry skin Itchy skin that isn't accompanied by other obvious skin changes, such as a rash, is most often caused by dry skin (xerosis). Dry skin usually results from environmental factors that you can influence. These include hot or cold weather with low humidity levels, long-term use of air conditioning or central heating, and washing or bathing too much. Other possible causes Other conditions such as skin disorders, internal diseases, allergies and drug reactions can also cause itchy skin.
Skin conditions and rashes. Many skin conditions cause itchy skin, including eczema (dermatitis), psoriasis, scabies, lice, chickenpox, hives and dermatographism. In these cases, the itching usually affects specific areas and is accompanied by other signs, such as red, irritated skin or bumps and blisters. Internal diseases. These include liver disease, malabsorption of wheat (celiac disease), kidney failure, iron deficiency anemia, thyroid problems and cancers, including leukemia and lymphoma. In these cases, the itching usually affects the whole body, rather than one specific area. The skin may look otherwise normal except for the repeatedly scratched areas. Nerve disorders. Conditions that affect the nervous system such as multiple sclerosis, diabetes mellitus, pinched nerves and shingles (herpes zoster) can cause itching. Irritation and allergic reactions. Wool, chemicals, soaps and other substances can irritate the skin and cause itching. Sometimes the substance causes an allergic reaction, such as in the case of poison ivy or cosmetics. Food allergies also may cause itchy skin reactions. Drugs. Reactions to drugs, such as antibiotics, antifungal drugs or narcotic pain medications, can cause widespread rashes and itching. Pregnancy. Some women experience itchy skin during pregnancy, especially on the abdomen, thighs, breasts and arms. Also, itchy skin conditions, such as dermatitis, can worsen during pregnancy.
Symptoms Itchy skin may occur in small areas, such as on an arm or leg. Or whole body may feel itchy. Itchy skin can occur without any other noticeable changes on the skin. Or it may be associated with:

Redness Bumps, spots or blisters Dry, cracked skin Leathery or scaly texture to the skin
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Sometimes itchiness lasts a long time and can be intense. As you rub or scratch the area, it gets itchier. And the more it itches, the more you scratch. Breaking this itch-scratch cycle can be challenging. Complications
Prolonged itching and scratching may increase the intensity of the itch, possibly leading to neurodermatitis (lichen simplex chronicus). Neurodermatitis is a condition in which an area of skin that's frequently scratched becomes thick and leathery. The patches can be raw, red or darker than the rest of skin. Persistent scratching can also lead to a bacterial skin infection and permanent scars or changes in skin color.
Tests and diagnosis
Physical exam and other tests is likely to first conduct a physical exam to see if a cause for itching can be determined.

Blood test. A complete blood count can provide evidence of an internal condition causing itch, such as iron deficiency. Chemistry profile. This test is used to determine if you have a liver or kidney disorder, which could cause itchy skin. Thyroid function test. Thyroid abnormalities, such as hyperthyroidism, may cause itching. Chest x-rays. Signs of underlying disease that are associated with itchy skin, such as enlarged lymph nodes, can be seen by using radiography.
Medications
Corticosteroid creams. Applied topically, these may control itching. may recommend applying the medicated cream to affected areas, then covering these areas with damp cotton material that has been soaked in water or other solutions. The moisture in the wet dressings helps the skin absorb the cream. Oral antihistamines. These include oral antihistamines for allergies or hives and corticosteroid creams for itching from skin inflammation.
Treating the underlying disease If an internal disease is found, whether it's kidney disease, iron deficiency or a thyroid problem, treating that disease often relieves the itch. Other itch-relief methods also may be recommended.
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Light therapy (phototherapy) Phototherapy involves exposing skin to certain wavelengths of ultraviolet light. Multiple sessions are usually scheduled until the itching is under control. Short-term relief Although many types of itching respond well to treatment, relief may not be immediate. However, a number of creams and ointments are specifically designed to relieve itch. These include short-term use of:

Topical anesthetics such as lidocaine or benzocaine Ointments and lotions such as menthol, camphor or calamine
Benzocaine has been linked to a rare but serious, sometimes deadly, condition that decreases the amount of oxygen that the blood can carry. Don't use benzocaine in children younger than age 2 without supervision from a health care professional, as this age group has been the most affected. If you're an adult, never use more than the recommended dose of benzocaine and conider talking with . Although these anti-itch products may immediately soothe itch, treatment of the underlying cause is most important for long-term relief. Lifestyle and home remedies

Use a high-quality moisturizing cream on skin. Apply this cream at least once or twice daily, concentrating on the areas where itching is most severe. Apply an anti-itch cream or lotion to the affected area. A nonprescription hydrocortisone cream, containing at least 1 percent hydrocortisone, can temporarily relieve the itch. A nonprescription oral antihistamine, such as diphenhydramine (Benadryl, others), may be helpful if itching is severe. Avoid scratching whenever possible. Cover the itchy area if you can't keep from scratching it. Trim nails and wear gloves at night. Apply cool, wet compresses. Covering the affected area with bandages and dressings can help protect the skin and prevent scratching. Take a comfortably cool bath. Sprinkle the bath water with baking soda, uncooked oatmeal or colloidal oatmeal a finely ground oatmeal that is made for the bathtub(Aveeno, others). Wear smooth-textured cotton clothing. This will help you avoid irritation. Choose mild soaps without dyes or perfumes. Be sure to rinse the soap completely off body. And after washing, apply a moisturizer to protect skin. Use a mild, unscented laundry detergent when washing clothes, towels and bedding. Try using the extra-rinse cycle on washing machine.
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Avoid substances that irritate skin or that cause an allergic reaction. These can include nickel, jewelry, perfume, cleaning products and cosmetics.
Alopecia
Definition Hair loss (alopecia) can affect just scalp or entire body. It can be the result of heredity, certain medications or an underlying medical condition. Anyone men, women and children can experience hair loss. Baldness typically refers to excessive hair loss from scalp. Symptoms
Gradual thinning on top of head. This is the most common type of hair loss, affecting both men and women. In men, hair often begins to recede from the forehead in a line that resembles the letter M. Women typically retain a line of hair at the forehead but experience a broadening of the part in their hair. Circular or patchy bald spots. Some people experience smooth bald spots, often about an inch (2.6 centimeters) across. This type of hair loss usually affects just the scalp, but it sometimes also occurs in beards or eyebrows. In some cases, skin may become itchy or painful before the hair falls out. Sudden loosening of hair. A physical or emotional shock can cause hair to loosen. Handfuls of hair may come out when combing or washing hair or even after gentle tugging. This type of hair loss usually causes overall hair thinning and not bald patches. Full-body hair loss. Some conditions and medical treatments, such as chemotherapy for cancer, can result in the loss of hair all over body. The hair usually grows back after treatment ends.
Causes Most people normally shed 50 to 100 hairs a day. But with about 100,000 hairs in the scalp, this amount of hair loss shouldn't cause noticeable thinning of the scalp hair. As people age, hair tends to gradually thin. Other causes of hair loss include hormonal factors, medical conditions and medications. Hormonal factors The most common cause of hair loss is a hereditary condition called male-pattern baldness or female-pattern baldness. In genetically susceptible people, certain sex hormones trigger a
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particular pattern of permanent hair loss. Most common in men, this type of hair thinning can begin as early as puberty. Hormonal changes and imbalances can also cause temporary hair loss. This could be due to pregnancy, childbirth, discontinuation of birth control pills or the onset of menopause. Medical conditions A variety of medical conditions can cause hair loss, including:

Thyroid problems. The thyroid gland helps regulate hormone levels in body. If the gland isn't working properly, hair loss may result. Alopecia areata. This disease occurs when the body's immune system attacks hair follicles causing smooth, roundish patches of hair loss. Scalp infections. Infections, such as ringworm, can invade the hair and skin of scalp, leading to hair loss. Once infections are treated, hair generally grows back. Other skin disorders. Diseases that can cause scarring, such as lichen planus and some types of lupus, can result in permanent hair loss where the scars occur.
Medications Hair loss can be caused by drugs used to treat:

Cancer Arthritis Depression Heart problems High blood pressure
Other causes of hair loss Hair loss can also result from:
A physical or emotional shock. Many people experience a general thinning of hair several months after a physical or emotional shock. Examples include sudden or excessive weight loss, a high fever, or a death in the family. Hair-pulling disorder. This mental illness causes people to have an irresistible urge to pull out their hair, whether it's from the scalp, their eyebrows or other areas of the body. Hair pulling from the scalp often leaves patchy bald spots on the head. Certain hairstyles. Traction hair loss can occur if the hair is pulled too tightly into hairstyles such as pigtails or cornrows.
Risk factors
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Family history. risk of hair loss increases if relatives on either side of family have experienced hair loss. Heredity also affects the age at which you begin to lose hair and the developmental speed, pattern and extent of baldness. Hair treatments. Overuse or improper use of hair-coloring products, hair straighteners and permanent waves can leave hair brittle and prone to breaking off at the scalp. Excessive hairstyling or hairstyles that pull hair too tightly cause traction alopecia. Poor nutrition. hair may thin out if you skimp on good dietary sources of iron and protein, such as red meat, nonfat dairy products and iron-fortified cereal. Hair loss related to poor nutrition often accompanies eating disorders and crash dieting.
Tests and diagnosis
A complete medical history, family history and physical examination can help in a diagnosis. The pattern and rate of hair loss, the appearance of nearby hairs, and accompanying symptoms are considered when making the diagnosis. Lab tests may perform blood tests to determine if you have a medical condition that causes hair loss, such as thyroid disease, diabetes or lupus. Biopsies and samples During a pull test, several dozen hairs are gently pulled to see how many come out. This helps determine the stage of the shedding process. Scraping samples taken from the skin or from a few hairs plucked from the scalp can help verify whether an infection is causing hair loss. When a diagnosis is difficult to confirm, may perform a punch biopsy. During this test, the doctor uses a circular tool to remove a small section of skin's deeper layers.
Treatments and drugs Minoxidil (Rogaine). Minoxidil is an over-the-counter liquid or foam that you rub into scalp twice daily to grow hair and to prevent further loss. Some people experience some hair regrowth or a slower rate of hair loss or both. It may take 12 weeks for new hair to start growing. Minoxidil is available in a 2 percent solution and in a 5 percent solution. Side effects can include scalp irritation and occasionally unwanted hair growth on the adjacent skin of the forehead or face. Finasteride (Propecia). This prescription medication to treat male-pattern baldness is taken daily in pill form. Many men taking finasteride experience a slowing of hair loss, and some may show some new hair growth. Rare side effects of finasteride include diminished sex drive and sexual function.
Surgery In the most common type of permanent hair loss, only the top of the head is affected. Surgical procedures can make the most of the hair you have left.
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Hair transplants. This type of procedure removes tiny plugs of skin, each containing a few hairs, from the back or sides of scalp. The plugs are then implanted into the bald sections of scalp. Several transplant sessions may be needed, as hereditary hair loss progresses with time. Scalp reduction. This procedure surgically removes some of the bald skin on head. After hairless scalp is removed, the space is closed with hair-covered scalp. Doctors can also fold hair-bearing skin over an area of bald skin in a scalp reduction technique called a flap.
Surgical procedures to treat baldness are expensive and can be painful. Possible risks include infection and scarring. Wigs and hairpieces can be used to cover either permanent or temporary hair loss. Quality, natural-looking wigs and hairpieces are available. Lifestyle and home remedies These tips may help you avoid preventable types of hair loss:

Eat a nutritionally balanced diet. Avoid tight hairstyles, such as braids, buns or ponytails. Avoid compulsively twisting, rubbing or pulling hairs.

Male Reproductive Diseases

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CONGENITAL MALFORMATION CRYPTORCHIDISM Definition

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

Tests and diagnosis

Treatments and drugs

Physical exam Ultrasound exam of the scrotum Tests of hormone levels

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

Other symptoms include:

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

Being a ng or middle-aged man Having a past episode of prostatitis

Tests and diagnosis

Treatments and drugs

Lifestyle and home remedies

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

Tests and diagnosis

Treatments and drugs

Lifestyle and home remedies

There are two types of testicular cancer:

Benign prostatic hyperplasia

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

The prostate cancer stages are:

Tests and diagnosis

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

Sexual desire disorders

Sexual arousal disorders

Sexual pain disorders

Other sexual problems

Tests and diagnosis

Hormone replacement therapy

Lifestyle and home remedies

Genetic factors Damaged DNA Defective acrosome

Autoimmunity Secretions of antibodies against the sperms

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

Corticosteroids Methotrexate Phenytoin Ca channel blockers

Hormonal factors Hypogonadism Testosterone deficiency

Infections Mumps Glandular infections HIV infections prostatitis

Vaginal factors Vaginismus Vaginal obstruction

Cervical factors Cervical stenosis Antisperm antibodies Non-receptive cervical mucus

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

pH 7.2-7.8 WBC Fewer than 1 million

2. semen function test

Human zona penetration test

Acrosome reaction test

Computer aided sperm motility analysis

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

5.) Post ejaculatory urine examination

It helps to detect the retrograde ejaculation and infections.

7.) Testicle biopsy

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

2.)In vitro fertilization (IVF)

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.

Medications A number of medications can cause gynecomastia. These include:

Alcohol Amphetamines Marijuana Heroin Methadone

Adolescence Older age

Lifestyle and home remedies

Male breast cancer

Types of breast cancer diagnosed in men include:

Prepared by Ms. Kawaljit Kaur Kang, Lecturer, M.Sc. Med. Surg.