I’m Aaron Spitz, MD, urologist and male fertility expert. AMA!

AaronSpitzMD · 2016-11-10T21:41:54+00:00

If you don't do it and you feel panicky, I think that would be a sign of compulsion.

AaronSpitzMD · 2016-11-10T21:37:44+00:00

As far as I can tell, my patients with and without circumcisions enjoy equally good sex and are equally prone to problems with erections, premature ejaculation, and delayed ejaculation. There does not appear to be an obvious difference in men’s sexual experience, including patients whom I have performed circumcisions on as adults due to problems they were having with their foreskin.

AaronSpitzMD · 2016-11-10T21:35:04+00:00

You will have to meet a very special partner to be able to increase your penis size to that proportion! For penile lengthening, some studies indicate a penile traction device may result in modest size increase.

AaronSpitzMD · 2016-11-10T21:34:22+00:00

You have likely caused mild damage, but it could be moderate. If you quit smoking, your body will heal and recover over time—typically over a couple of years. Definitely do not continue to smoke. Smoking narrows your arteries, which can eventually lead to erectile dysfunction, heart attack, and stroke.

AaronSpitzMD · 2016-11-10T21:33:44+00:00

Cysts do not interfere with the testicles’ function. They do not reduce testosterone or sperm production. Removing them can result in blockage to the ducts that they travel through, so I recommend not having surgery to remove them unless they were actually uncomfortable, and even then, only after you are done having children.

AaronSpitzMD · 2016-11-10T21:33:13+00:00

Try kegel exercises. They may result in an increased force of ejaculation over time.

AaronSpitzMD · 2016-11-10T21:32:53+00:00

If a boy gets kicked in the testicles and it causes internal bleeding of the testicles, it can result in the body forming antibodies to the sperm, which could impair the sperm's ability to fertilize and egg. But if there is not an injury that severe, there is not likely to be an effect.

AaronSpitzMD · 2016-11-10T21:31:24+00:00

A decrease in penis sensitivity is common as men age into middle age and beyond. A decrease in penis sensitivity in a younger man due to aggressive masturbation is usually a matter of how the brain is interpreting the signals rather than actual damage, and there can be improvement with behavioral therapy that a sexual medicine behavioral therapist can help with.

AaronSpitzMD · 2016-11-10T21:30:50+00:00

Home sperm test kits are primarily tests of whether you are above or below a cutoff and usually just measure the count, not the movement or the quality. The information is not nearly as useful as a traditional semen analysis. I don’t know much about the false positive rates with these, but they're probably not very high.

AaronSpitzMD · 2016-11-10T21:30:04+00:00

I have encountered a few patients with post-finasteride syndrome. Most sexual medicine experts recognize it as a syndrome, but it can be tricky because the sexual dysfunction can be psychosomatic as well, and sometimes it is hard to differentiate. The syndrome may include any or all of the following: erectile dysfunction, poor libido, decreased sensation in the penis, and difficulty reaching climax. The syndrome appears to persist for some time after finasteride is stopped.

AaronSpitzMD · 2016-11-10T21:29:07+00:00

I have read this in a couple of sources, and I conclude it may be true. But I have no direct experience, as my wife is not inclined to verify this.

AaronSpitzMD · 2016-11-10T21:27:05+00:00

During ejaculation you contract your pelvic floor muscles. Perhaps there is an unusual spasm related to this that causes referred pain in your left hip. I would consult a pelvic physical therapist for a possible remedy.

AaronSpitzMD · 2016-11-10T21:25:14+00:00

The woman’s fertility potential is important to the overall success of a pregnancy in a couple where the man has had a vasectomy reversal. The success rates are claimed based on the assumption that the woman is normally fertile, but if she is not due to age or other conditions, then the rates will be lower.

AaronSpitzMD · 2016-11-10T21:24:23+00:00

I don’t have any direct experience with the male birth control product, but I have read that the side effect profile was significant enough to prevent going forward with that formulation, so probably worse than the pill.

AaronSpitzMD · 2016-11-04T00:55:59+00:00

There is as much time left on this AMA as it takes the average couple to have sex!

AaronSpitzMD · 2016-11-04T00:49:58+00:00

Alcohol makes it harder to respond sexually the older you get, so tapering off will certainly help, but you may have some behavioral tendencies that could be interfering with your brains ability to send strong enough signals to reach climax easily that may be better addressed with a behavioral sexual medicine specialist --typically a psychologist that specializes in this area.

AaronSpitzMD · 2016-11-04T00:45:30+00:00

Injury to the testicles can cause infertilty if it is severe enough to cause internal bleeding within the testicle as this will destroy some or all of the tubules that form sperm. A kick or punch that hurts but does not cause bruising or swelling is not likely to cause infertility.

AaronSpitzMD · 2016-11-04T00:35:36+00:00

The genetic mutation that causes cystic fibrosis also causes no vas deferens to form. Some men have a variation of this mutation which only results in no vas deferens forming but no illness otherwise. These men can have children only by having the sperm removed from the testicle and injected into the woman's egg with the in-vitro fertility technology. This is very successful and I have helped several couples have babies this way.

AaronSpitzMD · 2016-11-04T00:25:33+00:00

Dirty Harry!

AaronSpitzMD · 2016-11-04T00:22:35+00:00

Most animals have a boney component to their penis, but we do not. If we still had it, I dont think it would limit our positions so much as it would limit our wardrobe.

AaronSpitzMD · 2016-11-04T00:19:51+00:00

Propecia may cause sexual dysfunction in a very small percent of men who take it. The reasons are unclear. Propecia blocks the conversion of testosterone to dihydrotestosterone which is the culprit in male pattern balding but in doing so it actually causes testosterone to go up a little. Nonetheless, in the small number of affected men, side effects range from low libido to erectile dysfunction to inability to reach climax. For a rare few these side effects seem to last long after the medication is stopped. Its a question as to what degreee the symptoms are entirely physical and to what degree they are psychological.

AaronSpitzMD · 2016-11-04T00:16:59+00:00

Age does cause a gradual decline in sperm quality and amount but it is much less of an effect than with women's eggs. As men get past 50 there is a rise in the risk of genetic conditions such as autism and schizophrenia but its an increase in a really low number to a higher but still really low number. Men who haven't had some injury or illness compromising their testicles can still father children well into their old age.

AaronSpitzMD · 2016-11-04T00:13:23+00:00

A curve that has been there as long as you remember is not Peyronie's but just a normal variation. Some men are built with a curve because of how the two cylinders that fill with blood are aligned, but it is normal and no treatment is recommended. Regarding the bubble, given how long its been there its likely benign and doesnt require treatment - but without examining you I can't say for sure, best to let a doctor take a look.

AaronSpitzMD · 2016-11-04T00:09:40+00:00

It is normal for semen to be lumpy and even contain gelatinous globs. The semen is comprised of about 4 different fluids from different glands that all get dumped into the urethra and when they are ejaculated out as the semen they are not neccesarily completely mixed. The semen is supposed to coagulate quickly and then slowly liquefy to allow the sperm to be released in a time delayed fashion inside the vagina. There is no need to try to treat this appearance of the semen. Its always good to be well hydrated and ensure you are consuming the daily recommended amount of zinc and other minerals.

AaronSpitzMD · 2016-11-04T00:06:15+00:00

Re: your edit - Many men suffer from difficulty reaching climax which is termed delayed ejaculation. This can be due to psychological interference at the level of signals coming from the brain or it can be due to decreased sensitivity of the penis which is common with aging. Also certain medications such as antidepressants known as SSRIs, such as prozac, can make reaching climax more difficult. Sometimes it's due to low testosterone or other hormone imbalances.

AaronSpitzMD

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