Sex education: Start discussions early

It's never too early to start talking to your children about sexual matters. Openness, even with young children, will show that sex is an acceptable topic of conversation. Teach your child that you are available to discuss sexual issues, and establish a comfort level — for both of you — with the topic.

Don't feel like you have to include everything in one big discussion. Instead, talk about questions and behaviors as they occur.

Toddlers explore themselves

Between the ages of 18 months to 3 years, children begin to learn about their own bodies. Teach your child the proper names for sex organs. Otherwise, he or she might get the idea that something is wrong with these parts of the body.

It's normal for a child to explore his or her body and to do what feels good. Self-stimulation is one way a child's natural sexual curiosity is manifested. Boys typically pull at their penis, and girls rub their external genitalia.

The concept of privacy

This may be a good time to teach your child about privacy. Masturbation is a normal, but private, activity. If your child suddenly starts masturbating in the middle of a play group, try to distract him or her. If that fails, take your child aside for a reminder about the importance of privacy.

Sometimes, frequent masturbation can indicate a problem in the child's life. Perhaps he or she is under a lot of stress, or isn't receiving enough attention at home. It can even be a sign of sexual abuse. Teach your child that the parts of the body covered by a bathing suit are private, and that no one should be allowed to touch them without permission.

Curiosity about others

By the age of 3 or 4, children are ready to know that boys and girls have different genitals. To satisfy their normal curiosity about each other's sex organs, children may play "doctor" or matter-of-factly take turns examining each other. This exploration is far removed from adult sexual activity, and it's harmless when only young children are involved. As a family matter, however, you may want to set limits on such exploration, discouraging it if you see it going on.

At this age, many children ask the dreaded question: "Where do babies come from?" Try to give a simple and direct response, such as: "Babies grow in a special place inside the mother." As your child matures, you can add more details.

Segregation of the sexes

Between the ages of 5 and 7, children become more aware of their gender. Boys may tend to associate only with boys, and girls only with girls. In fact, they may even say they hate children of the opposite sex.

At this age, questions about sex will become more complex, as your child tries to understand the connection between sexuality and making babies. He or she may turn to friends for some of these answers.

Because children can pick up faulty information about sex and reproduction, it may be best to ask what your child knows about a particular topic before you start explaining it.

Preteen angst

Children between the ages of 8 and 12 worry a lot about whether they are "normal." Penis size and breast size figure heavily in these worries. Children of the same age mature at wildly different rates. Reassure your child that he or she is well within the normal range of development.

What kids should know before they reach puberty

The American Academy of Pediatrics recommends that before they reach puberty, children should have a basic understanding of:

* The names and functions of male and female sex organs
* What happens during puberty and what the physical changes of puberty mean — movement into young womanhood or young manhood
* The nature and purpose of the menstrual cycle
* What sexual intercourse is and how females become pregnant
* How to prevent pregnancy
* Same-sex relationships
* Masturbation
* Activities that spread sexually transmitted diseases (STDs), in particular AIDS
* Your expectations and values

Be honest, open and matter-of-fact

Talking about sexual matters with your child can make you both feel uncomfortable and embarrassed. Let your child guide the talk with his or her questions. Don't giggle or laugh, even if the question is cute. Try not to appear overly embarrassed or serious.

If you have been open with your child's questions since the beginning, it is more likely that your child will come to you with his or her questions in the future. The best place for your child to learn about relationships, love, commitment and respect is from you.
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Orchitis

Introduction

If you're an adult male, you may have heard that getting mumps may affect your fertility. The reason is viral orchitis, an inflammation of one or both testicles, most commonly associated with the virus that causes mumps. About one-third of males who contract mumps after puberty develop orchitis.



Fortunately, infertility as a result of mumps-related orchitis is rare. And in those countries where use of the mumps vaccine is widespread, such as in the United States, your risk of contracting mumps is small.

Other causes of orchitis usually are bacterial, including sexually transmitted diseases (STDs). The best way to prevent orchitis is to prevent mumps and to avoid behaviors that may result in STDs.


Signs and symptoms

The signs and symptoms of orchitis usually have an abrupt onset. They may include:

Testicular swelling on one or both sides
Pain ranging from mild to severe
Tenderness in one or both testicles
Nausea and vomiting
Fever
Discharge from penis
Prostate enlargement and tenderness
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. Causes of groin pain are different from causes of testicle pain.


Causes

A number of bacterial and viral organisms can lead to orchitis.

Bacterial orchitis
Most often, bacterial orchitis is the result of epididymitis, an inflammation of the coiled tube (epididymis) that connects the vas deferens and the testicle. The vas deferens carries sperm from your testicles. When inflammation in the epididymis spreads to the testicle, the resulting condition is known as epididymo-orchitis. Bacterial orchitis is rare without epididymitis.

Epididymitis usually is caused by an infection of the urethra or bladder that spreads to the epididymis. Often the cause of the infection is an STD, particularly gonorrhea or chlamydia. The highest incidence of sexually transmitted epididymo-orchitis occurs in men ages 19 to 35. Non-sexually transmitted forms of the infection may be related to anatomical abnormalities in the urinary tract or having had a catheter or medical instruments inserted into the penis.

Viral orchitis
Most cases of viral orchitis are the result of mumps. About one-third of males who contract the mumps after puberty develop orchitis during the course of the mumps, usually four to six days after onset. The mumps virus can spread from the salivary glands to other parts of the body, including the testicles.


Risk factors

Several factors may contribute to developing orchitis. For non-sexually transmitted orchitis, they include:

Not being immunized against mumps
Being older than 45
Recurring urinary tract infections
Surgery that involves the genitals or urinary tract, because of the risk of infection
Malformations in the urinary tract present at birth (congenital)
High-risk sexual behaviors that can lead to STDs also put you at risk of sexually transmitted orchitis. They include having:

Multiple sexual partners
Sex with a partner who has an STD
Sex without a condom
A personal history of an STD

When to seek medical advice

If you experience pain or swelling in your scrotum, especially if the pain comes on suddenly, contact your doctor. A number of conditions can cause testicular pain, and some of the conditions require immediate treatment. One such condition involves twisting of the spermatic cord (testicular torsion), which may cause pain similar to that caused by orchitis. Your doctor can administer diagnostic tests to determine which condition is causing your pain.


Screening and diagnosis

Your doctor will conduct a physical exam, which may reveal enlarged lymph nodes in your groin and an enlarged testicle on the affected side; both may be tender to the touch. Your doctor also may do a rectal examination to check for prostate enlargement or tenderness and order blood and urine tests to check for infection and other abnormalities.

Other tests your doctor might order to determine the presence of an STD and to rule out the possibility of testicular torsion, which requires immediate treatment, include:

STD screening. This involves obtaining a sample of discharge from your urethra. Your doctor may insert a narrow swab into the end of your penis to obtain the sample, which will be viewed under a microscope to check for gonorrhea and chlamydia.
Ultrasound imaging. This test, which uses high-frequency sound waves to create precise images of structures inside your body, may be used to rule out twisting of the spermatic cord (testicular torsion) and determine increased blood flow to your testicle, which helps confirm the diagnosis of orchitis.
Nuclear scan of the testicles. Also used to rule out testicular torsion, this test involves injecting trace amounts of radioactive material into your bloodstream. Special cameras then can detect areas in your testicles that receive less blood flow, indicating torsion, or more blood flow, confirming the diagnosis of orchitis.

Complications

Orchitis may cause the affected testicle to shrink (atrophy). It also can cause scrotal abscess, in which the infected tissue fills with pus, or lead to recurrent episodes of epididymitis. In rare cases, orchitis can impair fertility; however, if orchitis affects only one testicle, sterility is rare.


Treatment

Treatment depends on the cause of orchitis.

Treating viral orchitis
Treatment for viral orchitis, the type associated with mumps, is aimed at relieving symptoms. Your doctor may prescribe pain medication, nonsteroidal anti-inflammatory drugs, such as ibuprofen (Motrin, Advil, others) or naproxen (Aleve, Anaprox, others) and recommend bed rest, elevating your scrotum and applying cold packs.

In addition to measures to relieve discomfort, bacterial orchitis and epididymo-orchitis require antibiotic treatment. If the cause of the infection is an STD, your sexual partner also may need treatment.

Treating bacterial orchitis
Antibiotic drugs most commonly used to treat bacterial orchitis include ceftriaxone (Ceftin), ciprofloxacin (Cipro), doxycycline (Vibramycin, Doryx), azithromycin (Zithromax), and trimethoprim and sulfamethoxazole combined (Bactrim, Septra). Make sure your doctor is aware of any other medications you're taking or any allergies you have. This information, as well as whether your infection is sexually transmitted and what type of STD you have, will help your doctor select the best treatment.

Be sure to take the entire course of antibiotics recommended by your doctor. Even if your symptoms clear up sooner, complete the course to ensure that the infection has been eradicated.


Prevention

Getting immunized against mumps is your best protection against viral, mumps-related orchitis. Having sex with just one partner and using a condom helps protect against STDs.


Self-care

To ease your discomfort, try these suggestions:

Rest in bed.
Lie down so that your scrotum is elevated.
Apply cold packs to your scrotum as tolerated.

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Hydrocele

Introduction

A hydrocele is a fluid-filled sac that surrounds a testicle, causing swelling of the scrotum. About one in 10 male infants has a hydrocele at birth, but most hydroceles disappear without treatment within the first year of life. Additionally, men — usually older than 40 — can develop a hydrocele due to inflammation or injury within the scrotum.



Hydroceles usually aren't painful. Typically not harmful, hydroceles may require no treatment. However, if you have scrotal swelling, see your doctor to rule out other causes, such as testicular cancer or other conditions.


Signs and symptoms

Usually the only indication of a hydrocele is a painless swelling of one or both testicles.


Causes

For baby boys, a hydrocele can develop in the womb a few weeks before birth. At about the eighth month of gestation, the testicles descend from the developing baby's abdominal cavity into the scrotum. A sac (processus vaginalis) accompanies each testicle, allowing fluid to surround them.

In most cases, the sac closes and the fluid is absorbed. However, if the fluid remains after the sac closes, the condition is known as a noncommunicating hydrocele. Because the sac is closed, fluid can't flow back into the abdomen. Usually the fluid gets absorbed within a year.

In some cases, however, the sac remains open. With this condition, known as communicating hydrocele, the sac can change size or, if the scrotal sac is compressed, fluid can flow back into the abdomen.

In older males, a hydrocele can develop as a result of inflammation or injury within the scrotum. Inflammation may be the result of infection of the small coiled tube at the back of each testicle (epididymitis) or of the testicle (orchitis).


Risk factors

Most hydroceles are present at birth (congenital). For a secondary hydrocele, which usually affects men 40 or older, risk factors include:

Scrotal injury
Infection
Radiation therapy

When to seek medical advice

See your doctor if you experience scrotal swelling. It's important to rule out other possible causes for the swelling, such as a tumor. Often a hydrocele is associated with an inguinal hernia, in which a weak point in the abdominal wall allows a loop of intestine to extend into the scrotum and which may require treatment.


Screening and diagnosis

An infant's hydrocele typically disappears on its own. However, if your baby's hydrocele doesn't disappear after a year or if it enlarges, you may need to have it evaluated.

Screening and diagnosis entails a physical exam, which may reveal an enlarged scrotum that isn't tender to the touch. Pressure to the abdomen or scrotum may enlarge or shrink the fluid-filled sac, which may indicate an associated inguinal hernia.

Because the fluid in a hydrocele usually is clear, your doctor may shine a light through the scrotum (transillumination). With a hydrocele, the light will outline the testicle, indicating that clear fluid surrounds it. However, transillumination cannot confirm the diagnosis because it also may indicate other conditions, such as hernia.

If your doctor suspects your hydrocele is caused by inflammation, blood and urine tests may help determine whether you have an infection such as epididymitis.

The fluid surrounding the testicle may keep the testicle from being felt. In that case, further study may be needed. Possible tests include:

Ultrasound imaging. This test, which uses high-frequency sound waves to create images of structures inside your body, may be used to rule out a testicular tumor or other cause of scrotal swelling.
Abdominal X-ray. A basic X-ray uses electromagnetic radiation to make images of your bones, teeth and internal organs. An X-ray may distinguish a hydrocele from an inguinal hernia .

Complications

A hydrocele typically isn't dangerous and doesn't cause infertility. However, it may be associated with an underlying testicular condition that may cause serious complications:

Infection or tumor. Either may impair sperm production or function.
Inguinal hernia. A loop of intestine could become trapped in the weak point in the abdominal wall (strangulated), a life-threatening condition.

Treatment

For baby boys, hydroceles typically disappear on their own within a year. If a hydrocele doesn't disappear after a year or if it continues to enlarge, it may need to be surgically removed.

For adult males as well, hydroceles often go away on their own. A hydrocele requires treatment only if it gets large enough to cause discomfort or disfigurement. Then it may need to be removed.

Treatment approaches include:

Surgical excision (hydrocelectomy). Removal of a hydrocele may be performed on an outpatient basis using general or spinal anesthesia. The surgeon may make an incision in the scrotum or lower abdomen to remove the hydrocele. If a hydrocele is discovered during surgery to repair an inguinal hernia, your doctor may remove it even if it's causing you no discomfort.

A hydrocelectomy may require you to have a drainage tube and wear a bulky dressing over the site of the incision for a few days after surgery. Also, you may be advised to wear a scrotal support for a time after surgery. Ice packs applied to the scrotal area during the first 24 hours after surgery may help reduce swelling. Surgical risks include blood clots, infection or injury to the scrotum.

Needle aspiration. Another option is to remove the fluid in the scrotum with a needle. This treatment isn't widely used because it's common for the fluid to return. The injection of a thickening or hardening (sclerosing) drug after the aspiration may help prevent the fluid from reaccumulating. Aspiration and injection may be an option for men who have risk factors that make surgery more dangerous. Risks of this procedure include infection and scrotal pain.
Sometimes, a hydrocele may recur after treatment.


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Epididymitis

Introduction

Epididymitis is inflammation of the small coiled tube (epididymis) at the back of the testicle. The result is pain and swelling in the loose bag of skin underneath the penis (scrotum). Epididymitis most commonly affects men between the ages of 19 and 35.



The epididymis connects the testicle with the vas deferens, the tube that carries sperm. In most cases, the cause of the inflammation is a bacterial infection that spreads from your bladder or the tube that drains urine from your bladder (urethra).

For heterosexual men older than 40 and for homosexual men, the most common cause of the infection is a urinary tract infection that spreads to the epididymis. For young heterosexual men, the most common cause is a sexually transmitted disease (STD); for them, the best way to prevent epididymitis is to avoid behaviors that may result in STDs.


Signs and symptoms

The signs and symptoms of epididymitis may include:

Testicular swelling on one or both sides
Scrotal pain ranging from mild to severe
Tenderness in one or both testicles
Tenderness in the groin, felt in the fold of the skin between your thigh and abdomen
Painful urination
Painful intercourse or ejaculation
Fever
Discharge from penis
Blood in the semen
Epididymitis may be acute or chronic.

Acute

Signs and symptoms usually come on over a day or two.
They tend to be severe.
They usually clear up with treatment.
Chronic

This form may result from several episodes of untreated acute epididymitis.
If the chronic form occurs on its own, the cause generally is unknown.
Symptoms tend to come on gradually.
Treatment may improve symptoms but not clear them up completely.

Causes

A number of bacterial organisms can lead to epididymitis. Often the cause of the infection is an STD, particularly gonorrhea, chlamydia or both. Children, older men and homosexual men are more likely to have non-sexually-transmitted forms of the infection.

Urinary tract infections may spread to the epididymis. For men older than 40 who have a history of urinary tract infections or prostate infections, the spread of bacteria from the infected site is the most common cause of epididymitis. In those instances, bacteria may travel up the vas deferens to the epididymis. Other causes may be related to anatomical abnormalities in the urinary tract or having had a catheter or surgical instruments inserted into the penis, which can introduce bacteria into the genital-urinary tract.


Risk factors

High-risk sexual behaviors put you at risk of sexually transmitted epididymitis. They include:

Multiple sex partners
Sex with a partner who has an STD
Sex without a condom
Personal history of an STD
For older men, having chronic urinary tract infections or prostate infections increases the risk of developing epididymitis. Also, having an enlarged prostate that obstructs bladder function and causes urine to remain in the bladder puts you at higher risk of bladder infections, which increases the risk of epididymitis. Surgery of the urinary tract or having a catheter in place also increases risk.


When to seek medical advice

If you experience pain or swelling in your scrotum, contact your doctor. A number of conditions can cause testicular pain, and some of the conditions require immediate treatment. Your doctor can determine which condition is causing your pain.


Screening and diagnosis

Your doctor will conduct a physical exam, which may reveal enlarged lymph nodes in your groin and an enlarged testicle on the affected side, both of which may be tender to the touch. Your doctor also may do a rectal examination to check for prostate enlargement or tenderness and order blood and urine tests to check for infection and other abnormalities.

Other tests your doctor might order include:

STD screening. This involves obtaining a sample of discharge from your urethra. Your doctor may insert a narrow swab into the end of your penis to obtain the sample, which is then tested for the presence of bacteria or other infectious organisms. The results can be used to select the most effective antibiotic for treatment.
Ultrasound imaging. Your doctor may use this test, which uses high-frequency sound waves to create precise images of structures inside your body, to ensure there isn't another reason for your symptoms. The main conditions to be ruled out are twisting of the spermatic cord (testicular torsion), which inhibits blood flow to the testes, and testicular tumor. If the ultrasound shows increased blood flow to your testicle, it supports a diagnosis of epididymitis.
Nuclear scan of the testicles. Also used to rule out testicular torsion, this test involves injecting trace amounts of radioactive material into your bloodstream. Special cameras then can detect areas in your testicles that receive less blood flow, indicating torsion, or more blood flow, supporting the diagnosis of epididymitis.

Complications

Epididymitis may eventually cause

Shrinkage of the affected testicle (atrophy)
Scrotal abscess, the infected tissue fills with pus
Chronic epididymitis, which can occur when untreated acute epididymitis leads to recurrent episodes
Impaired fertility (rare)
If the condition spreads from your epididymis to your testicle, the resulting condition is known as epididymo-orchitis. Signs, symptoms and treatment options are basically the same as they are for epididymitis.


Treatment

Treatment for epididymitis is with antibiotic medications. Drugs most commonly used to treat epididymitis include ceftriaxone (Ceftin), ciprofloxacin (Cipro), doxycycline (Doryx, Vibramycin), azithromycin (Zithromax), and trimethoprim and sulfamethoxazole combined (Bactrim, Septra). Make sure your doctor is aware of any other medications you're taking or any allergies you have. This information, as well as determining what type of infection you have, will help your doctor select the best treatment.

Be sure to take the entire course of antibiotics prescribed by your doctor, even though you may get relief from your symptoms in two to three days after you start treatment. If you're not feeling better in that time, contact your doctor. When you've finished your medication, it's a good idea to return to your doctor for a follow-up visit to be sure that the infection has cleared up.


Prevention

Safer sexual practices, such as monogamous sex and condom use, help protect against STDs. If you have recurrent urninary tract infections or other risk factors for epididymitis, your doctor may discuss with you other ways to prevent recurrent episodes of epididymitis.


Self-care

Having epididymitis usually means you're experiencing considerable pain and discomfort. To ease your symptoms, try these suggestions:

Rest in bed. Depending on the severity of your discomfort, you may want to stay in bed one or two days.
Elevate your scrotum. While lying down, place a folded towel under your scrotum.
Wear an athletic supporter. A supporter provides better support than boxers do for the scrotum.
Apply cold packs to your scrotum. Wrap the pack in a thin towel and remove the cold pack every 30 minutes or so to avoid damaging your skin.

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