Symptoms that may need assessment
- Difficulty achieving or maintaining an erection
- Early or delayed ejaculation
- Difficulty conceiving after a year of trying
- An abnormal semen analysis report
- Swelling, heaviness or a 'bag of worms' feeling in the scrotum — varicocele
- A painless scrotal swelling — hydrocele
- Reduced libido, low energy or other hormonal symptoms
- Sudden severe testicular pain — an emergency, see below
How it is assessed
Assessment begins with a full history including general health, medication, smoking and alcohol, and a physical examination. Investigations may include a semen analysis reported to WHO parameters, hormone profile, blood sugar and lipids, a scrotal Doppler ultrasound, and a penile Doppler in selected cases. Erectile difficulty in particular can be an early marker of cardiovascular disease and diabetes, so those are actively checked rather than ignored.
How it is treated
Treatment depends on what is found: control of diabetes and blood pressure, review of medicines that may be responsible, lifestyle changes that genuinely make a difference, medication where it is indicated, hormone treatment where a deficiency is proven, and surgical correction of a varicocele or hydrocele. Where fertility treatment beyond andrology is needed, an onward referral is arranged.