FAQ's

Frequently asked questions from patients like you

Penis enlargement

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How many centimetres are usually gained in thickness with penis thickening?

It depends on each patient, their particular conditions and as far as the surgeon can go, but speaking in a range where the technique does not involve a high risk, we speak of between 1 and 2 cm in diameter at most. Going beyond these figures increases the risk.

I have heard that with this intervention the thickness gained is in a state of flaccidity. Is this true?

You can't say that you don't notice anything at all when is erected, but we can say that you really notice it when is in resting state. You have to think that if the patient's erection is of medium or large size, once the penis gains length the transferred fat is distributed evenly. Therefore, those people are seeking a thicker erection.

What about the glans? Can this area of the penis also be thickened?

If the techniques of penis thickening have to be treated cautiously and always going to Centers that have a lot of experience, the techniques of glans thickening on the other hand we totally discourage them. They are based on the controlled inoculation of synthetic material into the glans, which can lead to a number of problems. The volume of the glans is indeed increased, but it rarely leads to a natural and satisfactory aesthetic result. As an added counter-indication, it numbs the nerve endings in this important area of the penis.

I underwent an operation to increase the thickness of my penis and I am not happy. What can I do?

There is no simple and general answer, since each case is a world and an operation of this type badly performed can generate a multitude of unique and special problems. The ideal would be to go to a center specializing in reconstructive phalloplasty as is our case and thoroughly review which have been the errors of planning or execution to assess whether they can be retouched and improved (something very rare, the truth) or if as usual we choose to return (for health and safety) to the state prior to surgery.

Penile curvature

How frequent can Peyronie's disease be among men? What is its prevalence?

Although deformities of the penis are common, they are rarely pathological. However, it is estimated that between one and three per cent of all men of reproductive age have Peyronie's disease.

There are groups of men with a greater predisposition to the disease such as those over 70 years of age (6.5 per cent have Peyronie's curvature) or those with prostate pathologies (8.4 per cent).

Prevalence studies of Peyronie's disease are often difficult to document given the scarce information of clinical interest provided by the relatively few patients who seek medical help.

Can homoeopathy correct Peyronie's disease?

The homoeopathic treatments for Peyronie's disease (such as fluoric calcarea, causticum, chelidonium compose and tuberculinum) are not clear even among homoeopaths themselves and furthermore, they have not been documented and scientifically evidenced enough to be considered effective and safe. In our opinion, it is best to turn to a qualified urologist/andrologist for any deformity or discomfort in the penis.

Are vacuum pumps beneficial for Peyronie's?

The popular penis vacuum pumps can be dangerous if the patient has Peyronie's disease because the exaggerated increase in blood volume in the corpora cavernosa could cause pain and encourage the fibrotic process to advance and grow. 

It is best not to use this type of device if you suffer from any morphological alteration of the penis without medical supervision.

What action does verapamil have on Peyronie's curvature? Can it be useful in treatment?

Creams or ointments with verapamil can stimulate the synthesis of enzymes such as endogenous (i.e. produced by the same organism) collagenase at the place of application. 

Remember that collagenase is a catalytic enzyme that destroys excess collagen fibres. Applying a drug of this type increases enzyme synthesis and decreases the fibrous scar that directly or indirectly produces penile curvature.

Is it true that Peyronie's disease can be cured with herbs and home remedies? Is it safe to perform them?

Hundreds of thousands of home techniques can be found on the Internet to treat diseases like Peyronie's with herbal remedies and substances obtained from them. 

However, these remedies have not been scientifically proven based on accepted parameters of safety and trust, so it is not recommended performing them. The consequences could be worse than the current state of the disease.

Erection Problems

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Can you have sex after receiving shock waves?
There is not the slightest inconvenience for the man who undergoes shock wave therapy for erectile dysfunction, to have to take sexual abstinence because the treatment is non-invasive and does not generate inflammatory effects of any kind. Sex life can continue without problems.
Is shock wave treatment painful? Could it leave me any negative after-effects?

This treatment is totally painless, so much so that it does not require the patient to receive anaesthetics or painkillers. The risks of complications are very small and are not a major concern. 

However, the patient must be monitored by the physician throughout the treatment.

How soon can I see the positive effects of the treatment?
It is estimated that improvement in erectile function may be evident within three to five months after the start of treatment. This time may vary from patient to patient. If you do not perceive any positive effect, most probably the mistake has been made by your doctor, who will have indicated it without taking into account the type of erectile dysfunction you present.
Can I take sildenafil (Viagra®) after receiving ED shock waves?
Yes. In fact, shock wave therapy increases the effectiveness of shock waves according to certain scientific studies. No contraindications or adverse effects have been reported.

Penis prosthesis

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Si soy una persona que practica mucho ciclismo ¿La prótesis de pene es recomendable?

Sí, no hay ningún inconveniente con las prótesis de pene y prácticamente ningún deporte, incluido el ciclismo. Si se recomienda evitar los deportes de alto riesgo de contacto como el karate, que puedan recibir algunas patadas o traumatismos severos que pudiera condicionar la rotura de algún componente de la prótesis.

Realmente el apoyo del sillín de bicicleta es recomendable que sea lo más ancho posible y que no haya un apoyo en ninguno de los componentes, pero la prótesis normalmente va alejada de los sitios de apoyo del asiento de la bicicleta.

¿Cuánto dura un implante de pene o una prótesis hidráulica en tu experiencia?

Los implantes de prótesis de pene están garantizados de por vida. Tenemos experiencia con pacientes de más de 25 o 30 años sin problema alguno en los componentes de la prótesis.

¿De qué tamaño queda el pene con la prótesis?

El tamaño del pene no se verá afectado por la prótesis. En todo caso es posible que gane algo de tamaño si es el deseo del paciente. Las prótesis actuales expanden y son capaces de rellenar completamente el cuerpo cavernoso y siempre intentamos, en andomedic, maximizar el tamaño y mejorar el tamaño con el que se termina con respecto a con el que se empieza la intervención. El tamaño del pene va a quedar igual a como estaba o mejor.

¿A qué se debe que hay tantos testimonios en internet que comentan que con la implantación de la prótesis de pene les ha quedado un menor tamaño?

Hay varios factores que pueden condicionar una disminución o la sensación de pérdida de tamaño.

Uno de los factores es que el paciente recuerda cuando tenía erecciones y su miembro era de tamaño superior y luego después de un tiempo sin sufrir erecciones sufre una atrofia y eso es difícilmente recuperable.

Una buena medida es medirse el pene estirado al máximo, en la parte de arriba estirado, antes de colocarse un implante. Ese tamaño de estiramiento máximo va a ser, aproximadamente, el tamaño que va a tener después de la prótesis.

¿Cómo se puede evitar el problema del glande frio a la hora de implantar o la prótesis de pene?

El glande frio viene sobre todo producido por una falta de excitación, la erección del glande se produce sobre todo cuando hay una buena excitación sexual.

En ocasiones, aunque es raro que ocurra, se puede manifestar aún incluso a pesar de tener buena excitación. En esos casos algún tratamiento con inhibidores, o algún tratamiento con alprostadilo en crema a nivel del glande o la uretra, pueden beneficiar la aparición, o sea pueden evitar que aparezca el glande frio, pero no es durante la intervención, ni antes.

Prostate

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Can laser surgery be used to treat prostate cancer?

Although much less common than open surgery with a scalpel, lasers can also be used to surgically treat this disease. However, surgeons and urologists are faced with a problem: the cancer is often poorly located within the prostate, complicating its resection by means of a transurethral laser.

Can i have sex after prostate surgery?

Doctors advise against having sex for at least two weeks after prostate surgery because ejaculation could be painful, hemorrhagic (hemospermia) and slow the healing process of the urethra.

How long does the surgery take?

This type of surgery is usually quite fast compared to traditional techniques. It rarely exceeds two or three hours of surgery (added to the 24 or 48 hours of hospital recovery).

STD (Venereal Diseases)

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What are the most serious complications?
If infection with herpes simplex virus type 2 is not adequately treated for a very long time, or if the person has an immunosuppressive disease (such as HIV), life-threatening complications can occur. Among the most common complications are aseptic meningitis and neonatal herpes.
Is neonatal hsv-2 infection preventable?

It's somewhat difficult to prevent a newborn child with an infected mother from getting the disease.

In any case, within prenatal care there are tests for this infection because of the great risks to the life of the newborn.

If the pregnant woman develops symptoms similar to genital herpes (or has suffered it before) is recommended cesarean delivery, to prevent the newborn has direct contact with the female genital organs.

In addition, this group of patients (pregnant women) can receive treatment with antiviral drugs from the 36th week of gestation.

Before this period, there is a risk of fetal damage.

If i am infected, can i have sex?

That is not recommended. However, the treating physician will be responsible for giving specific instructions for the patient to have sex with a decreased risk of transmissibility.

Vasectomy and Vasovasostomy

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Is vasectomy a safe method?

Vasectomy is one of the most effective surgical methods of contraception, with a failure rate of less than 1% - about 4 men in 1000 would remain fertile even several months after the vasectomy.

Technical failures could occur with inexperienced surgeons and result in failure due to gradual reconnection of the vas, formation of a new channel, lack of identification and cutting of the vas, for this reason, it is important to complete the seminogram checks to verify the effectiveness of the operation.

Is it a painful procedure?

It is a procedure where local anaesthesia is used and in some cases, general anaesthesia is required, some surgical and post-operative discomfort can be felt, then inflammation and areas of hematoma can be observed, with slight pain, for which non-steroidal analgesics are indicated to help control all these effects.

Will a vasectomy affect my sexual activity?

The post-vasectomy patient's sex life is completely normal and will not be affected at all. His erections, orgasms and ejaculations will continue as usual. His sexual desire will remain the same as before the operation.

The amount of semen after the operation is only reduced by 5% and retains its usual characteristics. Only with the use of a microscope is it possible to visualize the absence of sperm in the seminal fluid.

What can I do if I regret it and want to reverse the operation?

Although vasectomy is considered an irreversible technique, there is currently the possibility of reversing it, through the vasovasostomy technique, recanalization of the vas deferens is achieved.

The success of this procedure will depend primarily on the quality and quantity of sperm (for conception by natural means) and the technique used in the initial operation, the greater the number of vas deferens that was resected, the less successful the recanalization can be.

It is often said that the time elapsed from the vasectomy also contributes, a time greater than 10 years is also associated with fewer probabilities of success, something that in our long experience in the operating room has not happened.

Does vasectomy protect me from sexual diseases?

Vasectomy does not offer any protection against sexually transmitted diseases, so it is recommended to take other measures such as the use of condoms, reducing or avoiding multiple sexual partners and in more extreme cases, sexual abstinence.

How much does it cost to get a vasectomy?
The price varies depending on the hospital centre where the procedure is performed and the medical fees, however, the cost (all-inclusive) in our office in Seville is approximately 1000 euros.
Will a vasectomy affect my male hormones?

Vasectomy does not affect any male sexual characteristics, as the release of male hormones produced in the testicles continues to occur normally and in the usual amount. These hormones are released directly into the bloodstream and are not interrupted by the cutting of the vas deferens.

Therefore, it is a myth that vasectomy causes erection problems, female traits in men, and that it sharpens the tone of voice.

Are there long-term complications after a vasectomy?

There is no increased risk of prostate or testicular cancer in patients after vasectomy. Nor is heart disease or atherosclerosis associated with this procedure, which is why the World Health Organization considers vasectomy very safe and without long-term complications.

What happens to the sperm after a vasectomy?

Testicular cells continue to produce sperm, but they are naturally reabsorbed by the body, just as when a man has days without ejaculating. This is a normal process and has no complications.

Laparadoscopic surgery for prostate

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What are the risks and possible complications?

Since minimally invasive laparoscopic methods are used, the risks and probability of post-intervention complications are very small. However, among the complications that may occur are:

Blood in the urine (hematuria).

Infections, especially urinary tract (UTI).

Post-surgical pain, what e is treated with pain relievers.

Hematomas at the sites near the laparoscopy holes.

According to the European Association of Urology, it is estimated that almost 9 percent of men who undergo this procedure develop urinary incontinence because some nerve bundles that control the bladder sphincter muscle are likely to be cut during the removal of the prostate. , which relaxes during urination. It is difficult to predict how likely you are to cause urinary incontinence before surgery.

How long is it possible to have a completely normal urinary function?

Men who undergo laparoscopic prostatectomies again enjoy a completely normal and voluntary urinary function, without discomfort or signs of obstruction, about three months after surgery.

It must be taken into account the significant percentage of patients who, due to prostate disorders (such as benign prostatic hyperplasia or malignant gland tumors) lost the ability to urinate calmly, so three months is longer than positive to regain this function.

What other self-care can be taken at home after surgery?

After the surgery, the doctor will give specific instructions on the care of the operation site to speed up the healing and recovery process. More specifically, of the incisions that were made in the skin and, for this, the care is as follows:

• Place sterile adhesive, especially for these cases, on the incision site for about 10 days to two weeks after the intervention. This will help each incision stay as dry, clean, and protected as possible from clothing rubbing.

• Avoid taking aspirin to treat pain, in that case, it is possible to take over-the-counter pain relievers such as acetaminophen.

• It is normal for the skin near the incision sites to change color and become a little bluish or dark. This is completely normal and will go away on its own after a couple of days.

• When to drive a car again is a frequent question among men undergoing this surgery and the truth is that there is no set time, but in most patients they can do it again in about 10 to 14 days. All this depends on the doctor's instructions.

Could erectile dysfunction develop from such a surgery?

Erectile dysfunction (ED) represents the most important and most prevalent risk that is run when performing a radical prostatectomy, regardless of its surgical modality. Obviously, doctors are very careful when removing the prostate and leaving the bundle of nerves that supply the penis and genital structures intact. However, the anatomy indicates that there is a close relationship between the gland and these nerves, so when removing it, it also takes some nerves with it, reducing the sensitivity of the area and the erectile response of the corpora cavernosa. However, all is not lost. If male sexual impotence, erectile dysfunction or weak erections occur, other therapeutic methods can be used to maintain the active sexual life of patients.

These therapeutic methods include:

Phosphodiesterase 5 inhibitor drugs, better known as retardants of the sildenafil, taladafil or vardenafil type. Generally orally, in tablets.

Intracavernous injections of vasodilator drugs, with excellent results in the short and medium term.

Suction or vacuum pumps.

Penile implants.

The European Association of Urology speaks of a 40.9 percent risk of developing ED after a radical prostatectomy intervention.

Can I have problems with fertile function after undergoing surgery?

No, because the prostate that will eventually be removed does not have the function of producing sperm (this occurs in the testicles, inside the scrotum).

After surgery, ejaculations will be slightly less abundant (because the prostate produces some semen) but the ability to fertilize remains intact unless there are problems with the testicles.

In which cases should I call the doctor?

If you are in the recovery period and notice the following symptoms, it is important to call your doctor or go for a consultation:

Fever over 40 ° C.

If the pain is very strong or does not go away with the indicated painkillers.

Difficulty urinating or blood in the urine.

Dizziness and vertigo.

Is it necessary to use a urinary catheter to urinate after the intervention? How long should it be in place?

Yes, it is necessary to use a catheter or bladder catheter for some time after (a couple of days) laparoscopic radical prostatectomy surgery because it is necessary to give the urethral tissues an opportunity to reconnect and heal.

Which patient is a candidate for to have laparoscopic prostate surgery?

Any male patient diagnosed with localized prostate cancer without metastasis may be a candidate for laparoscopic radical prostatectomy.

However, each case must be treated and evaluated individually since in rare cases, a tumor not so well located within the prostate glandular tissue can be approached by laparoscopic methods.

Can you have sex after laparoscopic prostate surgery?

Doctors recommend absolute sexual abstinence for one month after such an intervention. This withdrawal includes penetrative sex, masturbation, and ejaculation (ejaculation may be painful or bloody).

If I develop erectile dysfunction from laparoscopic prostatectomy, what can I do?

Developing minor erectile problems after a potentially life-threatening organ has been removed is somewhat minor. In fact, it is rare with this technique and men continue to enjoy active and fulfilling sex lives.

In many other cases, erectile dysfunction was already an underlying problem. That is, it was already present before surgery (especially in obese, diabetic, hypertensive or very old patients).

Among the alternatives to treat erectile dysfunction are:

• Phosphodiesterase 5 inhibitor drugs such as sildenafil, taladafil or vardenafil that favor the relaxation of the blood vessels that go to the penis and therefore, the erection mechanisms are enhanced.

• Intracavernous injections of alprostadil, a drug with a vasodilator effect that infiltrates the base of the corpora cavernosa of the penis and has a long-lasting effect.

• Vacuum pumps, suction devices into which the penis is inserted in a flaccid state to induce an erection.

• Penile implant surgery, a definitive and surgical solution to the problem.

Laser prostate surgery

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Can laser surgery be used to treat prostate cancer?

Although much less common than open surgery with a scalpel, lasers can also be used to surgically treat this disease. However, surgeons and urologists are faced with a problem: the cancer is often poorly located within the prostate, complicating its resection by means of a transurethral laser.

Can i have sex after prostate surgery?

Doctors advise against having sex for at least two weeks after prostate surgery because ejaculation could be painful, hemorrhagic (hemospermia) and slow the healing process of the urethra.

How long does the surgery take?

This type of surgery is usually quite fast compared to traditional techniques. It rarely exceeds two or three hours of surgery (added to the 24 or 48 hours of hospital recovery).

Priapism

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When do i know it's time to see a doctor?

If you consider that an erection has lasted longer than it should (more than a couple of hours, at most three hours if you have taken a drug against impotence), becomes painful or persists even in the absence of sexual stimuli, you must suspect a problem of priapism and it is vitally important that you attend the emergency room as soon as possible so that health professionals confirm the diagnosis and give the most appropriate treatment for the case.

This is no time to waste on shameful thoughts (will they laugh at me when I seek help?) or home remedies on the Internet that could worsen your state of health and endanger the integrity of your penis. We're talking about something serious.

What are the most serious complications of priapism?

In the worst case scenario, priapism could cause almost irreparable damage to the tissues of the penis and adjacent structures (such as the scrotum or testicles). Lack of blood supply (leading to lack of oxygen and other nutrients, accumulation of waste substances such as carbon dioxide or lactic acid) can lead to cell death and gangrene.

In this case, treatment consists of amputation of the penis. Fortunately, for this to happen, priapism should last more than 24 hours, more than enough time to seek medical help.

Can priapism be a manifestation of a sexually transmitted infection?

Not directly. Certain sexually transmitted infections (STIs), such as syphilis, human papillomavirus or certain fungi, can swell the delicate mucous membranes of the penis (glans or foreskin), making it easy to confuse them with priapism, especially when there is a lack of knowledge about the clinical manifestations of these pathologies. Indirectly, they could predispose the area to blood imbalances.

Can i develop penile cancer if i have suffered from priapism?

In theory, there is no clear relationship between priapism and the onset of penile cancer (which in itself has a cause that is difficult to determine).

However, severe priapism (accompanied by signs of tissue necrosis) can predispose the cells of the penis to alter its normal processes, so there must be continuous monitoring to assess that everything is progressing well.

Caverjet (injectable Aprostadilo)

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I have read that you need a prescription to buy at the Caverject pharmacy, is this true?

You should not use Caverject without the supervision of a specialist. Any doctor can do this, although it is the specialist in Urology, Andrology or Sexual Medicine who has the most experience to prescribe it. Like any other drug, we advise against trying to search unauthorized websites or the black market (milanuncios, wallapop, vivu or even the Deep Web) because you could be the victim of a forgery (we have seen very realistic ones) that could bring unpredictable consequences to your health. Not to mention, of course, economic scams that make you believe that you are going to receive a package for which you have paid that never arrives.

How long does a packaged product last, without being used?

As long as the package has not been opened and the storage conditions have been adequate (the usual ones in most medicines), the expiry date itself is the one that marks this line from which it should not be used. Once it has been opened and "prepared" it should be used immediately (less than an hour).

If I don't have or can't find the Caverject solvent serum, can I use water?
In no case can you use any other substance than the one provided, you must follow the instructions to the letter for safety.
With a low dose of 10 mcg, I had a prolonged erection and discomfort. Should I lower the dose even further?

If you find yourself in this case, perhaps your dysfunction case is not excessively serious, so rather than lowering the dose, with the help of a specialist overseeing the entire process, you could simply change the type of medication to one less invasive than the injection.

How long do I have to wait between injections?

The ideal is to space the application in 24 hours, although it can be used earlier, but its effects can be noticeably reduced (and it is not advisable to increase the dose without medical supervision).

Can caverject be used for erectile dysfunctions caused by Peyronie?

It is expressly contraindicated in the leaflet given by the manufacturer "if you suffer from an anatomical deformation of the penis, such as angulation, cavernous fibrosis or Peyronie's disease".

Penis thickening

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How many centimetres are usually gained in thickness with penis thickening?

It depends on each patient, their particular conditions and as far as the surgeon can go, but speaking in a range where the technique does not involve a high risk, we speak of between 1 and 2 cm in diameter at most. Going beyond these figures increases the risk.

I have heard that with this intervention the thickness gained is in a state of flaccidity. Is this true?

You can't say that you don't notice anything at all when is erected, but we can say that you really notice it when is in resting state. You have to think that if the patient's erection is of medium or large size, once the penis gains length the transferred fat is distributed evenly. Therefore, those people are seeking a thicker erection.

What about the glans? Can this area of the penis also be thickened?

If the techniques of penis thickening have to be treated cautiously and always going to Centers that have a lot of experience, the techniques of glans thickening on the other hand we totally discourage them. They are based on the controlled inoculation of synthetic material into the glans, which can lead to a number of problems. The volume of the glans is indeed increased, but it rarely leads to a natural and satisfactory aesthetic result. As an added counter-indication, it numbs the nerve endings in this important area of the penis.

I underwent an operation to increase the thickness of my penis and I am not happy. What can I do?

There is no simple and general answer, since each case is a world and an operation of this type badly performed can generate a multitude of unique and special problems. The ideal would be to go to a center specializing in reconstructive phalloplasty as is our case and thoroughly review which have been the errors of planning or execution to assess whether they can be retouched and improved (something very rare, the truth) or if as usual we choose to return (for health and safety) to the state prior to surgery.

HPV

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Can they come back?

Relapses are frequent, especially in the first three months of treatment. Approximately 20-50% of patients will have a relapse. It is important to inform the patient that this does not mean the treatment has failed, and that sometimes, more than one treatment session will be needed to eradicate the warts. Follow-ups should be conducted every 3 months.

VIH – SIDA

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Can there be complications?

Many are the complications of HIV-AIDS because the immune system is weakened in such a way that almost any common infection can have fatal outcomes.

The most frequent complications include pneumonia, fungal lung infections, candidiasis in the mouth, esophagus and trachea, cervical cancer (in women), cytomegalovirus retinitis (resulting in total vision loss), Kaposi's sarcoma (a variant of skin cancer), non-Hodgkin's lymphoma (a type of leukemia), tuberculosis, salmonellosis, toxoplasmosis, among many other infectious diseases and psychological disorders.

What causes aids and how does the virus work?

AIDS (the sexual disease par excellence) is produced by a virus, the Human Immunodeficiency Virus or HIV.

This virus invades the body tissues, travelling through the bloodstream. However, it has a special predilection for CD4+ T lymphocytes, the cells in charge of identifying pathogenic microorganisms (such as bacteria, fungi or other viruses) and causing their death, keeping infections at bay.

When HIV invades these cells, the body's level of defence against new infections falls and a systemic weakening occurs.

Any normally neutralised infection (such as influenza, for example) can evolve to potentially dangerous levels.

When does hiv become aids?

According to careful observations in HIV patients, AIDS (or its associated signs and symptoms) begins to take place when the cell load of CD4+ T lymphocytes falls below 200 per micro-litre of blood.

This is in most cases. However, this phenomenon can be different from person to person, especially if they have

Tricomoniasis

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Can there be complications?

Although rare, complications from trichomoniasis can occur in patients with special conditions. For example, in gestational women, the disease could advance the time of labour from weeks to months, most likely due to the weakening of the vaginal mucosa and the constant immune reaction in that area, which activates pro-inflammatory substances such as cytokines.

In turn, this disease has been shown to increase the risk of contracting HIV and other sexually transmitted infections.

In men, urethritis and prostatitis caused by infection with trichomonas vaginalis are highly likely to become malignant over time, increasing the risk of developing prostate cancer.

What patients are most at risk for complications?

Patients at higher risk of complications from initial infection with trichomonas vaginalis are those whose immune systems have been weakened by more chronic conditions. For example, seropositive patients (HIV), patients with systemic lupus erythematosus (SLE), inadequately controlled diabetics, morbidly obese, sex workers, or patients with cancer and antineoplastic treatments (chemotherapy), as the latter decrease the body's immune response.

For a couple of weeks i have had mucous secretions through the urethra, do i suffer from trichomoniasis?

The causes of mucous secretions from the urethra are quite extensive, ranging from vaginal infections by bacteria to increased cervical mucus during ovulation. Only through specific tests (such as microscopic observation, test strips for trichomonas vaginalis or PCR) a case of real trichomoniasis can be confirmed to start treatment. However, this vaginal discharge has a particular characteristic, an unpleasant or infrequent odour.

Sifilis

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Risk factors

Having an "unbalanced" sex life, with very frequent partner changes or a high number of unprotected sexual intercourse without latex condoms can increase the chance of getting syphilis in the future.

The existence of other sexually transmitted infections (such as HIV) is also often a recurrent history of syphilis.

How to prevent it?
The correct and regular use of latex condoms is an important way to reduce the incidence of this disease, especially among the young population, the most affected. Also, avoiding unhygienic sexual practices or having sex with overly promiscuous people helps prevent the infection from spreading.
If i am infected, can i have sex?
Although doctors recommend reducing the frequency of sexual relations, provided that the patient is in medical control, constant check-ups and also protects him or herself and their only partner with the use of latex condoms when having sexual encounters, there are no drawbacks to maintaining an active and responsible sexual life.

Genital herpes

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What are the most serious complications?
If infection with herpes simplex virus type 2 is not adequately treated for a very long time, or if the person has an immunosuppressive disease (such as HIV), life-threatening complications can occur. Among the most common complications are aseptic meningitis and neonatal herpes.
Is neonatal hsv-2 infection preventable?

It's somewhat difficult to prevent a newborn child with an infected mother from getting the disease.

In any case, within prenatal care there are tests for this infection because of the great risks to the life of the newborn.

If the pregnant woman develops symptoms similar to genital herpes (or has suffered it before) is recommended cesarean delivery, to prevent the newborn has direct contact with the female genital organs.

In addition, this group of patients (pregnant women) can receive treatment with antiviral drugs from the 36th week of gestation.

Before this period, there is a risk of fetal damage.

If i am infected, can i have sex?

That is not recommended. However, the treating physician will be responsible for giving specific instructions for the patient to have sex with a decreased risk of transmissibility.

Gonorrhoea

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Can there be complications?

Complications from this bacteria are rare but can occur as a result of bacteremia (the passage of bacteria into the bloodstream), where there may be invasion of other tissues.

As a result, there may be skin infections (in the form of painful pustules that bleed) or joint inflammation (infectious arthritis), which is common in the knee or ankle and causes a lot of pain when trying to bend or extend the limbs.

Inflammation of the meninges surrounding the brain and spinal cord (meningitis) or heart infection (endocarditis) may also occur.

Gonococcal sepsis can be life-threatening, although it's rare in civilized countries.

What is ocular gonorrhoea and how is it treated?

Ocular gonorrhoea occurs in adults by self-inoculation (touching the eyelids with contaminated hands and fingers, with purulent secretions from the genitals) or, in children during birth.

This condition usually occurs as inflammation and redness of the eyelids and the presence of pus, but can be complicated when the bacteria reaches the cornea.

Treatment includes eye washing and antibiotics.

What is neonatal gonorrhoea and how is it treated?

During birth, a mother with gonorrhoea can transmit the disease to the child, causing neonatal conjunctivitis and other associated eye discomforts, just like adults.

The treatment of neonatal conjunctivitis for neisseria gonorrhoeae is the application of antibiotics (such as gentamicin) in drops.

Chlamydia

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What are the most common complications?

The two most serious complications in chlamydia patients are ocular trachoma and lymphogranuloma venereum. Ocular trachoma usually occurs by auto-inoculation from the genitals. The treatment corresponds to the administration of intravenous or oral antibiotics and instillations of ophthalmic solutions. It can lead to partial or total blindness if it does not receive intensive treatment.

Lymphogranuloma venereum (or LGV) occurs when bacteria invade the lymphatic pathways of the body and cause the formation of blisters, which manifest as ulcerative inflammations in the lymphatic pathways. It causes a lot of pain and in some cases, surgical removal is required. The treatment of LGV involves the administration of antibiotics.

Candidiasis

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Can there be serious complications?

If the disease is not properly treated and the proliferation of fungi persists and increases with time, candidiasis may become chronic, resulting in excessive spread of the yeast to areas as distal as the palms of the hands or the nail folds of the feet (mucocutaneous candidiasis).

When does a mucocutaneous candidiasis become invasive and how is it treated?

This transformation of the initial clinical condition occurs in people with extremely weak immune systems, such as patients with HIV, uncontrolled diabetes or those receiving immunosuppressive treatments (cancer chemotherapy, steroids, anti-rejection of transplanted organs drugs, etc.).

What are the differences between candidemia and invasive candidiasis?

Invasive candidiasis is when the initial infection (in external genitalia, for example) spreads to sites as diverse as the kidneys, brain, eyes, or delicate heart valves. It occurs in people with very weakened immune systems or hospitalized patients.

However, candidemia is a severe septicemic state in which the yeast reaches the bloodstream and can reach almost any tissue or organ of the body. It usually follows medical procedures such as the implantation of inguinal venous catheters.

Candidemia always precedes invasive candidiasis.

Maldescended Testicles

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Is there a remedy or solution other than surgery? Massages? Physiotherapy? Medications and hormones?

Unfortunately, it is not so simple. Entering the operating room is the necessary solution for the restoration of testicular normality. There is no other method. As we have seen above, hormonal treatment is often complementary and prior to surgery, but not a substitute for it. Of course, you should not manually manipulate the area with massages or physiotherapy, since it would not only achieve nothing but could be harmful as well.

My baby has a testicle that appears and disappears from his scrotum. Does he have a maldescended testicle?

If it presents that variable behavior, it is very likely a retractile testicle, not a maldescended testicle. As we discussed earlier on this page, retractile testicles don’t require surgery, but observation and patience, because it is a condition that tends to solve by itself when the male is approaching puberty.

Dr. Pedro Lopez Pereira, a renowned urologist who has treated hundreds of children in his long experience at the Hospital La Paz in the Community of Madrid is the head of our Pediatric Unit and he performs all the interventions in addition to following up the results.

Hypospadias

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My son was operated in another clinic and the result has not been satisfactory. Does he have the option of a second operation?

Some cases of hypospadias may reappear a few months after being operated on, with the appearance of fistulas usually the main setback. It is possible to re-intervene with a good prognosis in most of such cases, but we must always assess the patient's condition carefully because each new intervention adds instability in the tissues of the affected area. You can only enter the operating room again after a substantial period of time and the reasons why the previous one was not successful must be well analyzed. This explains why the knowledge and analytical capacity of an experienced team such as ours are basic aspects to be taken into account by the parents. In other words, it is a surgery that must be performed by a medical team of proven ability.

Is this pathology covered by Social Security or is it usually done in the field of private medicine?

In Spain, all the cases usually have public medical coverage by the state or regional service. However, there are many parents who prefer to go to private medical centers (whether they have medical insurance or not) regardless of the price. This choice which often involves a cost on the family finances is usually guided by two main reasons. The first is the freedom to choose the professional doctor and the second is to shorten the waiting periods which are sometimes quite lengthy. Both are important issues to take into account since the successful correction of hypospadias depends a lot on the expertise and experience of the surgeon, and it is a condition that needs to be addressed with some urgency i.e. in the first months of the child's life (before 15 months).

Does the intervention have repercussions on the development (size, length or thickness) of my child's penis in the future? And is there any impact on erection, ejaculation, orgasm or fertility?

After a well planned and executed intervention, the resulting phalloplasty leaves the penis of the child without any present or future sexual or urinary problems. So, it is perfectly prepared for its development at puberty without any type of sequela. This further highlights the importance of choosing the surgical team since it is a very sensitive operation that could end up with setbacks in the future if not executed perfectly.

I had mild hypospadias. Is it hereditary? Can it be passed genetically to my future children?
Indeed, there is a certain predisposition for family genetic inheritance. This does not mean that in 100% of cases it is guaranteed that their offspring will have this anomaly, but there is a chance of them having it. Dr. Pedro Lopez Pereira, renowned urologist who has treated hundreds of patients in his long experience at the Hospital Universitario La Paz in the Community of Madrid is the head of our Pediatric Unit and the person who performs all interventions and follows up with the results.

Phimosis

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How do I know if I or my child have phimosis?

If you have a child who is about two or three years old (maybe a few years older or younger) and you notice that he feels discomfort when urinating, has a swollen glans area, or has difficulty retracting the foreskin, your child may have phimosis. These symptoms may become visible even in the teenage years.

Or, you are the one who has trouble having sex (you feel pain during intercourse), you suffer from recurrent urinary infections or you simply find it hard to uncover the head of the penis, you are one of the few cases of phimosis that persist into adulthood.

In any case, the best thing to do is to go to a specialist doctor, according to the age (a paediatrician for your child or a urologist/andrologist for you).

Does phimosis affect fertility?

You can rest assured for the sake of your baby's future that there is no direct association between the presence of phimosis and fertility problems; in theory, a problem with the male external genitalia (phimosis) should not impair the process of spermatogenesis (where sperm is produced), within the testicles.

However, in a very indirect way, absolute phimosis could make normal ejaculation, and therefore, eventual fertilization, more difficult in one way or another.

Is there a suitable age for this?

Until now, specialists maintain the consensus that surgical interventions and non-surgical treatments aimed at reducing or eliminating phimosis problems have a higher success rate in paediatric patients. Also, the passage of years (for example, in persistent phimosis in adulthood) could aggravate the fusion of the foreskin with the glans, making treatment more difficult.

It is important to rule out this type of health problem at an early age so that treatment is timely and has a higher level of effectiveness.

Does phimosis affect the size of the penis?
There is no direct relationship between the size of the penis and the presence of phimosis, however, having a short, slightly retractable or very narrow foreskin could reduce the length by a couple of centimetres. It often happens that after phimosis surgery (or with the use of topical steroids), the penis may present a slight and apparent increase in size. Although extremely rare, we have also had cases opposite to our Seville practice: after an operation, the penis is shortened by a few centimetres and the existing tension in the erection shows that the stitches have been placed in the wrong (unnatural) place which must be corrected by phalloplasty (mainly by means of small grafts which reduce the tension in the tissues). This type of case is already closer to medical malpractice, and as we say is very unusual.
How long does the post-operative period last and when can the patient live a normal life?

The recovery period of circumcision (and other surgical interventions to treat phimosis) is usually, at most, about 10 days. That is, the time it takes for the wound to heal and absorb (fall out) the stitches.

During this period of time, it is advisable not to do intense physical activity (such as running or cycling) or have intercourse to prevent the wound from opening up again and the need of repeating the process (not to mention that it would be very painful).

Can you have sex while having phimosis?

You can have sex as long as you know your body well and the limits you can go to, otherwise, you could injure your foreskin or glans.

Many men with untreated phimosis have an active sex life without problems. Adequate lubrication is essential when having sex, and maybe even more so in this case.

Is phimosis the same as a short frenulum?

No, a short frenulum is a condition that occurs when the frenulum, a band of tissue that connects the ventral portion of the foreskin to the glans, is short or inelastic in length and for that reason, it is difficult to retract the foreskin.

In many cases, a short frenulum can be accompanied by phimosis aggravating the latter. The most commonly used treatment corresponds to surgical intervention: ventral slit or subincision.

Is it recommended to perform circumcision for balanitis or balanoposthitis?

Balanitis (inflammation of the glans) and balanoposthitis (inflammation of the glans and foreskin) are conditions that in most cases have infectious causes, i.e. produced by fungi or bacteria. These inflammatory diseases of the glans (and foreskin) can also be caused by trauma or injury.

Treatment is therefore usually ointment/cream or oral antibiotic.

A circumcision (surgical removal of the foreskin) would, therefore, have no relevant effect on the treatment of balanitis or balanoposthitis caused by infections. Unless this surgery can reduce the compression of these anatomical structures produced by a narrow foreskin, typical of the most chronic cases of these diseases.

Why perform it in a private medical centre instead of a Social Security centre?

The advantages of carrying out this type of surgery in private medical centres as opposed to public health centres are the short times for carrying out the treatment (around 24/48 hours, whereas in Social Security centres it could take weeks or months to begin) and the quality of the treatment, not only from a medical point of view but also from an aesthetic point of view, especially in cases where surgery is required.

Also, in a private medical centre they will be able to provide you with more personalised, confidential attention, adapted to your needs.

Does a partial circumcision have advantages over a total one? When is each one of them indicated?

A circumcision is partial when the foreskin is not cut completely, leaving a small portion covering the glans, or total when the entire foreskin is removed, leaving the glans completely exposed.

However, total circumcision is considered better than partial circumcision because there is less risk of developing a fibrotic ring around the glans over time.

Whatever the case may be, there are clinical and aesthetic criteria aimed at choosing the best option on an individual basis, as each case is particular and must be treated in consultation with the depth and care it deserves.

Epididymitis, orchitis and orchiepididymitis

Can this disease have complications related to fertility or reproduction?

Yes. If the infection is prolonged and not properly treated, reproductive damage may occur. It could also leave sequelae in terms of the size, shape or appearance of the testicle due to abnormal development or the extended lack of blood flow.

What is chronic epididymitis? How is it different from the common condition?
While common epididymitis (as well as orchitis or orchiepididymitis) usually has a favorable prognosis because the patient responds favorably to the antibiotics provided. We understand that chronic epididymitis has more chances of reappearing again and again or lasts over a prolonged period of time. These cases (more common in adults) are more sensitive and should be treated more keenly so that the causes of recurrence can be found and dealt with in a different plane.
Can you have sex or ejaculate while the infection is being treated?

In a more acute phase of the infection, it is most likely for the patient not have a full erection or sexual desire due to pain and discomfort. Once the treatment begins and the inflammation and discomfort go away, masturbation or sexual intercourse can resume, although with some caution and care. There are some sexual positions more appropriate than others since they minimize friction in the scrotal area. Do not be afraid or embarrassed to consult with your urologist, we are on your side.

Dr. Pedro Lopez Pereira, a renowned urologist who has treated hundreds of children in his long experience at the Hospital La Paz in the Community of Madrid is the head of our Pediatric Unit and he performs all the interventions in addition to following up the results.

Hydrocele

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Can a hydrocele affect fertility?

Hydrocele has not been associated as a direct cause of infertility nor does it usually drastically affect the male's reproductive capacity.

However, it is important to bear in mind that in cases of large hydroceles and stress, the blood supply and testicular tissue may be compromised. In addition, there may be cases where the hydrocele is associated with testicular infections, factors that directly influence fertility and the possibility of pregnancy.

Are varicocele, spermatocele and hydrocele the same thing?
They are three testicular pathologies but they refer to totally different conditions. When we talk about varicocele, it is the dilation and tortuosity of the testicular veins and it is generally associated with a diminished reproductive capacity, the spermatocele, also called spermatic cyst, and is a cystic formation that usually contains liquid and sperm cells, is benign and forms in the epididymis. Finally, the hydrocele is the accumulation of liquid between the parietal and visceral layer of the tunica albuginea, associated with a defect in the peritoneal vaginal canal, which may or may not be in communication with the abdominal cavity. Despite being three different entities, they share similar symptoms and signs, such as a feeling of testicular heaviness, increased volume or testicular asymmetry and slight pain or discomfort in the scrotal region.
What are the warning signs after a hydrocelectomy?
After a hydrocelectomy, you should follow the post-operative care and assist your physician with any of these symptoms:
  • Swelling and redness of the scrotal area with progressive enlargement.
  • Sensitivity alterations or inflammation around the incision.
  • Bleeding or suppuration from the surgical wound.
  • Fever above 38 ºC.
  • Pain that does not subside with the recommended analgesics.
  • Persistent vomiting.
Does the presence of hydrocele represent any vital danger?

Presenting hydrocele does not represent any danger to the individual who suffers it, or to his testicles. However, this condition may be associated with testicular tumours and infections, inguinal hernias and testicular torsion, for this reason, a review with the medical specialist is necessary to evaluate the conditions of the disease and its association with other pathologies.

Emergency medical care should also be sought in cases where the scrotum suddenly increases in size, becomes tight and begins to be very painful.

Why does hydrocele occur in newborns and infants?

During the intrauterine development of men, the testicles descend through the peritoneal vaginal canal from the abdomen into the scrotum. This process is surrounded by a sac called tunica vaginalis, which has fluid inside it; normally this membrane closes before birth and the fluid is reabsorbed. In many cases, the tunic closes but the liquid is not reabsorbed forming a non-communicating hydrocele. In other cases, the tunic does not close and the liquid can pass freely from the abdominal cavity into the scrotum, forming a communicating hydrocele and with the possibility of an inguinal hernia.

Prostate problems

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Can you have sex while having a prostate condition?

In acute prostate inflammations or in cases of terminal prostate cancer, total abstinence from sexual relations is recommended because constant compression of the prostate could aggravate the patient's clinical condition.

In any case, the urologist will be in charge of determining if there is any risk of increasing the inflammation of the gland with sexual relations.

Can a child develop inflammation of the prostate?

Yes, it could be possible. Although rare and isolated, cases of prostatitis and benign prostatic hyperplasia can occur in boys even before they have reached sexual maturity.

These cases usually have a high genetic component. The clinical management of the diseases is the same as in adult men.

How can prostate cancer be prevented?
The greatest predisposition to prostate cancer comes from genetic factors but with certain healthy lifestyle habits, the risk of the disease can be considerably reduced. Some tips for preventing prostate cancer are:
  • Maintain a balanced diet, low in fat and highly processed or fried foods. High in vegetables and lean meats.
  • Avoid sedentary lifestyles.
  • Engage in moderate physical exercise, at least three times per week (this helps to maintain, among other things, proper blood testosterone levels).
  • Avoid smoking and alcoholism.
  • Perform medical and urological checkups once a year for men over 40 years of age. Tests should include blood tests (to measure prostate antigen levels) and digital rectal exam.
What complications could result from bacterial prostatitis?
If bacterial prostatitis is not adequately treated, it can get out of control and lead to major, life-threatening problems. The most common complications of prostatitis are:
  • Prostatic abscesses, in which a sac of pus and dead cell material originates inside the prostate, increasing the inflammation of the gland and complicating its treatment. It causes pain and is considered a urological emergency.
  • The passage of bacteria into the blood (bacteremia) can lead to sepsis and septic shock.
  • Passing of bacteria into the testicles, epididymis and scrotum.
Can medicines for prostate hyperplasia treatment cause erectile dysfunction?

The answer is yes, although in low proportion. Medicines to treat enlarged prostate are drugs that minimise the number of androgen receptors, partially desensitising the gland and therefore causing less hyperplasia. It creates more problems, for example, with regard to ejaculation. Something we deal with in other sections of our website such as retrograde ejaculation and delayed ejaculation.

The decrease in androgen receptors (mainly for testosterone) can occur not only in the prostate but in other body tissues, especially the central nervous system, lowering the body's response to this hormone and thus, the effects it produces. Sexual desire may be diminished, as well as the erectile response of the penis and ejaculation.

It should be noted that these drugs do not interact negatively with retardant medications (such as sildenafil, tadalafil or vardenafil), so they may be used to treat erection problems while treating the prostate.

Moles, Spots and Genital Warts

Can moles be removed with pharmacy medications or do home remedies work as I have read online?

There are countless home remedies available on the Internet for removing moles, ranging from astringent and lightening creams to vegetable poultices. However, virtually none of these treatments have been tested or supported by relevant medical studies to measure their effectiveness and safety.

Removing a mole (or a melanocytic nevus) involves completely destroying a large group of melanocytic cells that are clustered together and located under the skin. For this reason, a home or drug treatment is unlikely to eliminate it completely and forever.

What are the risks of trying to remove a wart by ripping it off?

There are certain popular techniques for wart removal. These range from cutting out the entire lesion with a razor blade (at home) to tying the base of the wart with a strand of hair until the wart falls off on its own.

These techniques can be potentially dangerous because removing a skin element such as a wart without medical supervision and proper antiseptic care can carry a high risk of infection.

In addition, warts are skin lesions of varying sizes that protrude from the skin. They are incredibly vascularized and can bleed profusely if they are cut. Their removal must be done in a hospital and by qualified personnel to prevent bleeding or infection.

Is recovery after laser removal of moles, warts or spots on the genitals painful or uncomfortable?

In the days following a laser mole, wart or blemish removal treatment, the patient should watch for a number of normal skin reactions. For example, there is a slight peeling of the skin above the skin lesion, itching, and signs of irritation.

These discomforts are usually well-tolerated and disappear completely on their own after a couple of weeks.

How can I tell if a mole (or a nevus) is malignant or benign? When should I see a dermatologist?
In almost 95 per cent of cases, moles (also called melanocytic nevi) are benign skin lesions, which means that they are completely safe, asymptomatic, and do not pose a risk of becoming malignant. However, in other cases, moles can become malignant and produce more serious and delicate problems. Evaluating whether a mole has become malignant or not is the job of the dermatologist. They will carefully examine the lesion, review the patient's medical history, and obtain a small sample of tissue to take to a laboratory for biopsy. If the result is positive, a treatment plan is drawn up that is appropriate to the patient's needs. However, a benign mole can become malignant and modify some of its characteristics such as:
  • Size (they get bigger).
  • Colour (they change to darker colours or degrade rapidly).
  • Texture (some grow so large that they become palpable).
  • Contour (some tend to become irregularly contoured and grow without an apparent pattern).
In other cases, moles may itch, hurt, ooze pus, or bleed. This is a clear indication of a neoplasia process.

Female Incontinence

What else can UI cause?

UI also causes the obvious discomfort resulting from leaks, embarrassment, and withdrawal in patients. Many who suffer from it keep silent, and the lack of information sometimes only aggravates the problem. Nowadays, thanks to web portals such as ours, many people find answers to the most common questions they usually ask in our Seville office once they make the decision to obtain treatment.

Do "normal" pads work for urine loss?
They are hardly adequate; you need another type of material that has a different (faster) absorption capacity for the menstrual flow.
Does eating worsen or improve on the symptoms?

Eating does not help to eradicate the problem, but can mitigate its symptoms and prevent them from worsening. Avoid excess sugar, alcohol and spicy foods and eat a balanced and varied diet.

If I drink less water, will I have less leakage problems?

No, and be careful. Common sense can lead us to think that if we drink less, we will have less need to urinate, but urine that is unbalanced by drinking little water can be very irritating to the bladder and increase the symptoms instead.

Can incontinence caused by a Neurogenic Bladder be cured?

This type of incontinence occurs in patients who have some type of disease/nerve injury presenting many associated pathologies (urinary tract infections, renal deterioration, etc). They require special and individualized care, which depends on the type of neurogenic bladder they develop. The study, treatment and follow-up of these patients must be specialized and intensive, with a continuous and personal doctor-patient relationship. It is complex to cure or eliminate completely. However, through Urodynamic Studies, which involve teaching these patients certain routines such as self-catheterization, and specialized surgeries, it is possible to obtain a better quality of life, while reducing complications and hospital admissions.

What are those beneficial (routine) exercises?

There are very extended routines like the classic Kegel exercises or the newest and most recommended hypopressive gymnastics.

How do I know if urine leakage is not indicating a major health problem?

You should check everything to be reassured, of course. That is why it is ideal that you seek help from a professional (urologist).

How do I know the type of UI I’m suffering from?

You can compare your case with the different types we have described above. However, it’s always ideal for you to seek help from a professional to assess everything in depth as earlier mentioned.

Male hypogonadism

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Can male hypogonadism trigger erectile dysfunction?

Yes, this is because prolonged drops in testosterone also affect negatively sex-related emotional responses. As the libido decreases, it becomes more difficult to achieve and maintain effective penile erections that allow for a full sex life.

What is female hypogonadism? How is it diagnosed and treated?

Female hypogonadism refers to a hormonal disorder of the ovaries to produce estrogens and progestogens, the quintessential female sex hormones.

In addition to altering menstrual cycles and decreasing the ability to ovulate (and therefore have children), hypogonadism also has effects on other systems. It promotes the early onset of menopause.

It is diagnosed with physical examinations and laboratory tests, to measure the blood levels of these ovarian hormones and those of the Hypothalamic–pituitary axis.

Treatment consists of hormone replacement therapy, similar to men's but with estrogens and progestogens. It is generally performed with doses that vary according to the passage of days to stimulate or simulate the hormonal changes typical of the menstrual cycle.

Does hypergonadism exist? What is it and how does it manifest itself?

Much less frequent than hypogonadism, hypergonadism refers to the endocrine pathology in which the body of a man or woman secretes high amounts of sexual hormones per day, testosterone in men and estrogens and progestogens in women.

The most obvious clinical manifestations are alterations in body development, changes in behaviour and sleep patterns. There may also be problems with having children.

Male hypergonadism is associated with prostate cancer. <span">Its treatment involves the administration of drugs that decrease the body's response to testosterone. That is, they make some tissues (such as the testicles) less sensitive to testosterone.

Vasectomy

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Is vasectomy a safe method?

Vasectomy is one of the most effective surgical methods of contraception, with a failure rate of less than 1% - about 4 men in 1000 would remain fertile even several months after the vasectomy.

Technical failures could occur with inexperienced surgeons and result in failure due to gradual reconnection of the vas, formation of a new channel, lack of identification and cutting of the vas, for this reason, it is important to complete the seminogram checks to verify the effectiveness of the operation.

Is it a painful procedure?

It is a procedure where local anaesthesia is used and in some cases, general anaesthesia is required, some surgical and post-operative discomfort can be felt, then inflammation and areas of hematoma can be observed, with slight pain, for which non-steroidal analgesics are indicated to help control all these effects.

Will a vasectomy affect my sexual activity?

The post-vasectomy patient's sex life is completely normal and will not be affected at all. His erections, orgasms and ejaculations will continue as usual. His sexual desire will remain the same as before the operation.

The amount of semen after the operation is only reduced by 5% and retains its usual characteristics. Only with the use of a microscope is it possible to visualize the absence of sperm in the seminal fluid.

What can I do if I regret it and want to reverse the operation?

Although vasectomy is considered an irreversible technique, there is currently the possibility of reversing it, through the vasovasostomy technique, recanalization of the vas deferens is achieved.

The success of this procedure will depend primarily on the quality and quantity of sperm (for conception by natural means) and the technique used in the initial operation, the greater the number of vas deferens that was resected, the less successful the recanalization can be.

It is often said that the time elapsed from the vasectomy also contributes, a time greater than 10 years is also associated with fewer probabilities of success, something that in our long experience in the operating room has not happened.

Does vasectomy protect me from sexual diseases?

Vasectomy does not offer any protection against sexually transmitted diseases, so it is recommended to take other measures such as the use of condoms, reducing or avoiding multiple sexual partners and in more extreme cases, sexual abstinence.

How much does it cost to get a vasectomy?
The price varies depending on the hospital centre where the procedure is performed and the medical fees, however, the cost (all-inclusive) in our office in Seville is approximately 1000 euros.
Will a vasectomy affect my male hormones?

Vasectomy does not affect any male sexual characteristics, as the release of male hormones produced in the testicles continues to occur normally and in the usual amount. These hormones are released directly into the bloodstream and are not interrupted by the cutting of the vas deferens.

Therefore, it is a myth that vasectomy causes erection problems, female traits in men, and that it sharpens the tone of voice.

Are there long-term complications after a vasectomy?

There is no increased risk of prostate or testicular cancer in patients after vasectomy. Nor is heart disease or atherosclerosis associated with this procedure, which is why the World Health Organization considers vasectomy very safe and without long-term complications.

What happens to the sperm after a vasectomy?

Testicular cells continue to produce sperm, but they are naturally reabsorbed by the body, just as when a man has days without ejaculating. This is a normal process and has no complications.

Shock Waves

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Can you have sex after receiving shock waves?
There is not the slightest inconvenience for the man who undergoes shock wave therapy for erectile dysfunction, to have to take sexual abstinence because the treatment is non-invasive and does not generate inflammatory effects of any kind. Sex life can continue without problems.
Is shock wave treatment painful? Could it leave me any negative after-effects?

This treatment is totally painless, so much so that it does not require the patient to receive anaesthetics or painkillers. The risks of complications are very small and are not a major concern. 

However, the patient must be monitored by the physician throughout the treatment.

How soon can I see the positive effects of the treatment?
It is estimated that improvement in erectile function may be evident within three to five months after the start of treatment. This time may vary from patient to patient. If you do not perceive any positive effect, most probably the mistake has been made by your doctor, who will have indicated it without taking into account the type of erectile dysfunction you present.
Can I take sildenafil (Viagra®) after receiving ED shock waves?
Yes. In fact, shock wave therapy increases the effectiveness of shock waves according to certain scientific studies. No contraindications or adverse effects have been reported.

Venous Leak

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Are there cases in which it occurs in combination with other problems that affect erection or sexuality?

If several symptoms appear in the same patient, this does not necessarily mean they are related. For example, if there’s Venous Leakage with Premature Ejaculation or Infertility, it is very likely that there is no relationship between them. However, if you have an acquired curve (Peyronie), the connection should be studied since there is probably a direct relationship due to a structural problem in the penile anatomy. Here is another example that may be related; in addition to the vascular problems typical of this disease, a significant number of patients present with anxiety problems related to sex because they are men who experience much frustration from their sexual relations.

What’s the price? How much does the entire treatment cost?

We know that people who come to our website ask for a specific figure to get a quick idea about the cost, but unfortunately, like is the case with other treatments, it is difficult to provide this because first, you have to diagnose the extent of the problem for each case. At the Andromedi Clinic, we believe that giving a budget that does not work for everyone equally (which can increase or decrease with the medical discoveries we make during consultation) is something that, besides being unethical, can frustrate the people concerned.

With treatments like vasectomy, where all patients receive very similar care, we can give an almost definitive figure. But in this case, each patient is different since there are multiple variables that affect a clear answer about "how much it costs". We believe that medical practice, including the important economic point, should be something more human, more personal, with greater patience and dedication.

You can request for an individualized quote without any obligations through the contact area of our website, through the e-mail or telephone 648 862 033 (with prefix +34 for international calls). We will be happy to help you find the best way to carry it out.

Is it covered by Social Security? Is there any health insurance at the Andromedi clinic?

Currently, this treatment is mainly offered in the private sector, since Spanish Social Security covers only certain cases and especially in certain Autonomous Communities. We advise that you request information locally to see if you can benefit from that coverage.

As for medical insurance at our Clinic in Seville, we do not work with any of them because our center is 100% independent.

I've seen adverts about using low-intensity shock waves to treat this ailment. Do shock waves really work?

Generally, venous leakage patients don’t have the ideal profile to receive shock wave treatment. The best solution for this condition is specific surgical intervention. It might not be harmful and could end up helping to increase the erectile capacity, although this treatment is not for this pathology.

Lack of Sexual Desire

Are home or natural remedies effective?

In many pharmacies or on the Internet you can find a large number of natural remedies that promise to improve performance and increase sexual appetite in both men and women.

Many of these products come in oral form and others to be applied directly to the external genitals in the form of creams, lotions and ointments.

However, over 95 per cent of these natural products are not approved by health agencies such as the U.S. FDA or the Ministry of Health of the Kingdom of Spain, so it is difficult to guarantee their safety and effectiveness.

Many home remedies that help "increase libido" can produce side effects, cause allergies, or interact with other medications. 

The general recommendation is to go to a qualified health care professional for him to indicate medications of reliable use. Self-medication is a practice that can seriously jeopardize a patient's health.

What attitude can I take towards a lack of sexual desire? How can I start to fight the low sexual desire?
According to many centres of sexology and human sexual psychology, not all diseases can be cured with medicines or complex procedures such as surgeries, many of them, as the decrease of desire for sexual intimacy, can find a solution in small actions such as:
  • Practice meditation. This will help to relax the body and calm the mind, which will be helpful in releasing tension and feeling more confident in one's abilities.
  • Exercising will improve blood circulation, strengthen muscles and help the brain release tranquillizing substances, among many other positive effects.
  • Eating properly with a balanced diet full of vegetables and fruits. This helps to improve the body's physical condition and chemistry.
  • Leave behind bad habits and addictions such as alcohol, smoking or sedentary life.
  • Thinking of new and interesting ways to improve your sex life or make it more dynamic. Communication is a vital asset. Talking with the partner and discussing the concerns and positive aspects of the relationship is one of the most fundamental factors in treating low sexual desire. This is key to avoiding divorces or separations where, interestingly, sexuality is one of the most important causes.
I am a man and I feel my libido dropping. Can I improve or increase my sex drive by taking Viagra®?

When the sexual desire is low or not as intense as in the past, the known retardants or vasodilators can hardly increase the libido because they help to maintain and achieve the erection itself, they do not encourage or promote the necessary sexual stimuli to make the penis more rigid and bigger.

In fact, most men with low libido have normal and even very good erectile function. What exists is an emotional problem (almost always) to feel pleasure and get an erection.

How can I prepare myself before I go to the doctor's office?
It is recommended that each patient who seeks professional help to try to solve their problem of low sexual desire, should come to us already having several aspects clear to facilitate the diagnosis. These aspects can be:
  • Since when do I feel my sexual interest has diminished? When was the last time in my life that I perceived as the most sexually active?
  • How's the relationship? Is it stable or are there frequent conflicts? How is the couple's communication? Am I sexually attracted to my partner?
  • What are our sexual habits as a couple? Do we always do the same or, on the contrary, do we seek to innovate? Is it interesting what we do in sex? How many times do we make love in a month or a week.
  • Do I feel like I care about my physical and mental health? What healthy habits do I do to feel vitalized? Am I overworking? How's my diet? Do I exercise?
  • Have I taken any medication? What have they been and how long have I been taking them? Do I remember why the doctor prescribed them?
  • Have I felt weaker than before? How is the quality of my erections if I am a man? Do I feel vaginal pain during penetration or am I close to menopause if I am a woman?
What can I do to lower my stress or anxiety levels?
The diseases of the 21st century are said to be stress and anxiety given the fast pace of life today and the amount of work pressure that people are under. All of this can cause physical discomfort and general debilitation with negative repercussions on sexual desire, a totally biological element and a sign of physical, mental and emotional well-being. Dealing with stress and anxiety can be a complex task since the causes that produce them can be very broad, but in general, there are techniques and habits that can help, such as:
  • Practising sports or physical activity (running, dancing, cycling, walking).
  • Resting properly, more than six hours a day, but less than eight.
  • Eating properly.
  • Meditate.
  • Cultivating healthy social relationships and keeping hobbies present.
  • If you're in a relationship, it's up to both of you to care for it and keep the flame of passion alive despite the circumstances.

Premature ejaculation

I've read that premature ejaculation is incurable, and can only be controlled. Is this true?

To say that premature ejaculation has a definitive cure would be quite inaccurate, not only because it usually results from multiple causes (which must be treated individually) but also because the experience is usually as subjective as it is difficult to explain.

There are cases of men with premature ejaculation who do not present with significant problems when performing sexually, mainly because they know how to "compensate" the short coitus durations with satisfactory foreplay or manual stimulation of other erogenous zones.

Controlled premature ejaculation makes a smooth sex life possible while allowing the opportunity for medical treatments to take effect. Is this a total cure? Well, looking only at the present and not in the future where some regression or a stage of relapse could occur, it heals and can be considered a cure.  

Is There Something Similar In Women?

The various stages of sex in women are different from what men experience. Orgasms in females are usually less intense but more durable compared to the male orgasm (which ends in ejaculation).

"Female ejaculation" is an extremely rare sexual phenomenon, even though it can occur. In such cases, the ejaculation occurs towards the end of orgasm, suddenly decreasing sexual desire.

Very few cases have been reported of female ejaculation occurring so abruptly that it leads to low sexual performance. That said, psychotherapy may help to delay orgasms in women as is the case in men.

Is There A Relationship Between Erectile Dysfunction And Premature Ejaculation?

Erectile dysfunction doesn’t necessarily appear with premature ejaculation, although the anxiety and worry from one could lead to the other. The prevalence of this "combined" condition is usually very low, with the treatment even more complex and profound, includingsexual psychotherapy in combination with drugs that delay ejaculattion.

Why Do I Have Premature Ejaculation During Sexual Relationships, But Not When I Masturbate?

When this happens, the premature ejaculation is most likely caused by emotional irregularities like inferiority complex, problems related to other people, or feelings of guilt.

In such cases, the psychotherapist specialized in human sexology can provide you with the tools needed to overcome the specific problems (learn to think and feel) and reach an optimal state of mental health.

Could Premature Ejaculation be a Temporary problem which occurs sporadically?

At certain points in time, episodes of premature ejaculation may occur and then disappear during other sexual encounters.

For the specialist tasked with treating such cases, it is often very difficult to determine (or check) whether the premature ejaculation responds to a specific factor or is a subjective experience of the patient. For instance, when the expectations of the sexual relationship in time and quality do not correspond to the actual performance.

A complete medical examination, ranging from the patient's lifestyles, to the level of sexual performance should provide sufficient understanding about the actuality and extent of the problem.

Peyronie’s Disease

How frequent can Peyronie's disease be among men? What is its prevalence?

Although deformities of the penis are common, they are rarely pathological. However, it is estimated that between one and three per cent of all men of reproductive age have Peyronie's disease.

There are groups of men with a greater predisposition to the disease such as those over 70 years of age (6.5 per cent have Peyronie's curvature) or those with prostate pathologies (8.4 per cent).

Prevalence studies of Peyronie's disease are often difficult to document given the scarce information of clinical interest provided by the relatively few patients who seek medical help.

Can homoeopathy correct Peyronie's disease?

The homoeopathic treatments for Peyronie's disease (such as fluoric calcarea, causticum, chelidonium compose and tuberculinum) are not clear even among homoeopaths themselves and furthermore, they have not been documented and scientifically evidenced enough to be considered effective and safe. In our opinion, it is best to turn to a qualified urologist/andrologist for any deformity or discomfort in the penis.

Are vacuum pumps beneficial for Peyronie's?

The popular penis vacuum pumps can be dangerous if the patient has Peyronie's disease because the exaggerated increase in blood volume in the corpora cavernosa could cause pain and encourage the fibrotic process to advance and grow. 

It is best not to use this type of device if you suffer from any morphological alteration of the penis without medical supervision.

What action does verapamil have on Peyronie's curvature? Can it be useful in treatment?

Creams or ointments with verapamil can stimulate the synthesis of enzymes such as endogenous (i.e. produced by the same organism) collagenase at the place of application. 

Remember that collagenase is a catalytic enzyme that destroys excess collagen fibres. Applying a drug of this type increases enzyme synthesis and decreases the fibrous scar that directly or indirectly produces penile curvature.

Is it true that Peyronie's disease can be cured with herbs and home remedies? Is it safe to perform them?

Hundreds of thousands of home techniques can be found on the Internet to treat diseases like Peyronie's with herbal remedies and substances obtained from them. 

However, these remedies have not been scientifically proven based on accepted parameters of safety and trust, so it is not recommended performing them. The consequences could be worse than the current state of the disease.

Vesicoureteral Reflux

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What is hydronephrosis?

Hydronephrosis is a disease of the kidneys in which there is dilation of the collecting system caused by poor urinary elimination.

This problem can be caused by mechanical causes (such as an obstruction in the urinary tract, vesicoureteral reflux, kidney stones...) or by physiological causes (infections of the urinary tract) that produce in the long run, compression and atrophy of the renal parenchyma, becoming less functional.

Hydronephrosis must be treated medically to prevent it from progressing to chronic renal failure.

Is there any indication in terms of food or drink that I should know about to help my child?

There is no proper diet for children (or patients in general) with vesicoureteral reflux, however, a diet with high water consumption will help maintain a hypoosmotic urine production, which will keep many of the urinary tract infections at bay.

It is also advisable to reduce consumption of coffee and soft drinks because they can irritate the walls of the urinary tract and cause discomfort when urinating.

Is it hereditary? Could your siblings have it? What about your future children?

Observations made to pediatric patients with VUR have shown that there is a clear relationship between the family or genetic factor and the appearance of the disease, for example, the incidence among siblings has a probability of 27 per cent and the incidence between parents and children is 36 per cent.

However, these factors may warn the obstetrician or pediatric physician from initiating monitoring of the disease and the most appropriate treatments.

It is estimated that between one and three per cent of children suffer from some type of primary vesicoureteral reflux (VUR), many of which do not even show signs of the disease.

What are the chances that my child's VUR can be fixed without surgery?

It is common to see a favourable progression of the disease to a natural solution, i.e., correction of the valve problem without the need for medical treatment (including medication).

However, more than half of the cases of vesicoureteral reflux of grade III or higher have a surgical solution, since the anatomical defect is too big to be repaired by itself.

So if my child was born with vesicoureteral reflux, they will no longer be able to have a normal life?

Although it is known that vesicoureteral reflux can have devastating long-term consequences if it is not treated in time, the life of children with this congenital problem can be normal as long as medical check-ups and other indications are fully complied with.

Varicocele

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¿El varicocele predispone al cáncer testicular?

No hay estudios que demuestren que la presencia de varicocele contribuya como causa directa en el cáncer testicular, sin embargo, las dos condiciones pueden coexistir en un individuo

¿Qué resultados puedo esperar luego de una varicocelectomía?
Cuando la varicocelectomía se realiza en paciente joven, con un abordaje quirúrgico adecuado y un equipo médico-quirúrgico óptimo se pueden observar resultados muy favorables, como:
  • Mejora la calidad del semen en el 50-70% de los casos operados.
  • Hay una gran tasa de embarazos después de la operación, oscila entre un 30 y un 60%, por lo general el embarazo se logra luego de 8 meses al año de la varicocelectomía.
  • Se detiene el deterioro de la función y el tejido testicular además hay mejoría en los niveles de testosterona.
  • Puede revertirse la disminución del tamaño del testículo si se realiza al momento de hacer el diagnóstico. En la mayoría de los adolescentes y jóvenes, tras la cirugía del varicocele el testículo aumenta de tamaño.
¿Cómo es la recuperación y los cuidados postoperatorios que se deben tener?

Es una operación de corta duración, aproximadamente menos de una hora, el tiempo de hospitalización es por lo general son 24 horas, para evaluar la presencia de complicaciones inmediatas.

Se pueden retomar las actividades diarias luego de las 48- 72 horas, siempre y cuando la persona no tenga una rutina que implique grandes esfuerzos físicos,
Se recomienda realizar ejercicio físico leve y retomar la actividad sexual posterior a las 3 semanas de operado, luego de que el cirujano haya comprobado que la herida quirúrgica está cicatrizando bien y que no se desarrolló ningún tipo de complicaciones.

Dentro de los cuidados, es muy importante realizar limpieza de la herida quirúrgica con soluciones antisépticas, cambiando los vendajes diariamente. Para la inflamación y molestias que se puede presentar en los testículos, se recomienda el uso de analgésicos antiinflamatorios recetados por el médico tratante y colocación de frío local.

¿Hay relación entre el varicocele y la infertilidad?

Se ha demostrado que la presencia de varicocele influye directamente en la fertilidad del hombre, las cifras nos muestran que un 30 a 40% de los hombres que presentan infertilidad poseen esta patología. 

El varicocele genera mayor estrés oxidativo y alteraciones en la carga genética de los espermatozoides, producto del reflujo venoso y la elevación de la temperatura escrotal que lleva a la disfunción testicular.

¿Un hombre que presente varicocele puede generar un embarazo natural?

Esto va a depender del grado de varicocele que presente el hombre, si este padece de un grado leve, de corta tiempo de evolución el cual no ha afectado su calidad espermática sin problemas podrá lograr el embarazo de la pareja.
Es importante tener en cuenta que mientras mayor sea el grado y el tiempo de evolución de la enfermedad, se verá mucho más comprometida la fertilidad del individuo.

¿El varicocele puede disminuir la libido?
No hay una causa directa para que los hombres que padecen de varicocele tengan disminución del deseo sexual, sin embargo, en las formas graves de la enfermedad hay descenso de los niveles de testosterona, lo que podría originar la disminución de la libido, en casos severos podría ser un motivo de impotencia sexual.
¿Se pueden tener relaciones sexuales si se tiene varicocele?
Si, en caso de que el dolor o malestar en los testículos no represente un problema para llevar a cabo el acto sexual.

Others

What else can UI cause?

UI also causes the obvious discomfort resulting from leaks, embarrassment, and withdrawal in patients. Many who suffer from it keep silent, and the lack of information sometimes only aggravates the problem. Nowadays, thanks to web portals such as ours, many people find answers to the most common questions they usually ask in our Seville office once they make the decision to obtain treatment.

Do "normal" pads work for urine loss?
They are hardly adequate; you need another type of material that has a different (faster) absorption capacity for the menstrual flow.
Does eating worsen or improve on the symptoms?

Eating does not help to eradicate the problem, but can mitigate its symptoms and prevent them from worsening. Avoid excess sugar, alcohol and spicy foods and eat a balanced and varied diet.

If I drink less water, will I have less leakage problems?

No, and be careful. Common sense can lead us to think that if we drink less, we will have less need to urinate, but urine that is unbalanced by drinking little water can be very irritating to the bladder and increase the symptoms instead.

Can incontinence caused by a Neurogenic Bladder be cured?

This type of incontinence occurs in patients who have some type of disease/nerve injury presenting many associated pathologies (urinary tract infections, renal deterioration, etc). They require special and individualized care, which depends on the type of neurogenic bladder they develop. The study, treatment and follow-up of these patients must be specialized and intensive, with a continuous and personal doctor-patient relationship. It is complex to cure or eliminate completely. However, through Urodynamic Studies, which involve teaching these patients certain routines such as self-catheterization, and specialized surgeries, it is possible to obtain a better quality of life, while reducing complications and hospital admissions.

What are those beneficial (routine) exercises?

There are very extended routines like the classic Kegel exercises or the newest and most recommended hypopressive gymnastics.

How do I know if urine leakage is not indicating a major health problem?

You should check everything to be reassured, of course. That is why it is ideal that you seek help from a professional (urologist).

How do I know the type of UI I’m suffering from?

You can compare your case with the different types we have described above. However, it’s always ideal for you to seek help from a professional to assess everything in depth as earlier mentioned.

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