20.3 Male-Specific Disorders of the Reproductive Tract

Erectile Dysfunction

One of the most common disorders of the male reproductive system is erectile dysfunction. Erectile dysfunction, also referred to as “impotence,” is a condition in which the man cannot maintain a full erection of the penis for sexual intercourse Mayo Clinic, 2022a). This condition affects nearly 30 million men in the United States and may cause distressing feelings such as guilt, rejection, shame, and frustration (CDC, 2022). These feelings tend to negatively affect intimate relationships, with both the patient and their partner expressing sexual dissatisfaction. Erectile dysfunction can be caused by many different conditions, including

• benign prostatic hyperplasia (BPH)
• diabetes
• heart disease
• hyperlipidemia
• hypertension
• low testosterone levels
• medications (e.g., antidepressants, antihypertensives)
• neurological disorders (e.g., Parkinson’s disease, multiple sclerosis)
• obesity
• penile trauma
• psychological disorders (e.g., depression, anxiety, stress)
• substance misuse

Testicular Disorders

There are two main disorders of the male reproductive system that affect the testicles: testicular cancer and testicular torsion. Testicular cancer is rare, affecting only 1 of every 250 male individuals in the United States (American Cancer Society, 2023b). This cancer is typically diagnosed in men in their 20s or 30s, but there have been some cases diagnosed in children and older men. Risk factors for the development of testicular cancer include

• cryptorchidism (undescended testicle)
• family or personal history of testicular cancer
• human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) infection
• marijuana use

The condition testicular torsion occurs when the spermatic cord, the supplier of blood to the testicles, becomes twisted (Figure 20.9). This is a medical emergency and, without immediate intervention, could result in irreversible damage to the testicles and infertility (Mayo Clinic, 2022b). This condition may occur spontaneously, most often in young male individuals between the ages of 12 and 18 years, or because of physical trauma to the testicles. Without treatment, the testicle tissue may die, resulting in infertility.

Figure 20.9 Testicular torsion occurs when the spermatic cord becomes twisted, resulting in reduced blood flow to the testicle. (credit: modification of work from Anatomy and Physiology 2e. attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Recognizing and Analyzing Cues

Clinical manifestations associated with disorders of the male reproductive tract vary depending on the specific condition. Common clinical manifestations associated with testicular cancer, testicular torsion, and ED are listed in Table 20.4.

Diagnostics

There are not many diagnostic tests available for most disorders of the male reproductive system. For example, for ED, a diagnosis is made based on the symptoms reported to the provider by the patient. The provider may order blood tests after a diagnosis is made, but this is mostly to determine if there might be an underlying medical cause of ED, not to diagnose ED itself. Additionally, sometimes an ultrasound of the penis is performed to determine if there might be a physical blood flow issue that is not allowing a full erection to occur. Most patients diagnosed with ED are also screened for psychological disorders, such as anxiety or depression, that may be contributing to the condition.

When a patient presents with symptoms that indicate the possibility of testicular torsion (e.g., sudden lower abdominal pain), an emergent ultrasound of the scrotum is ordered. This imaging test is used to check for blood flow to the testicles and determine the extent of any damage. It is important that this imaging be performed quickly in case the patient requires surgery to restore blood flow to the testicles. Diagnosis of testicular cancer is also often made with the use of ultrasound imaging. If the patient reports a lump in the testicles, ultrasound can be used to further investigate its characteristics and determine if it appears to be cancerous. In addition to imaging, blood tests can be performed to look at various tumor markers that may be indicative of cancer. Markers that may indicate the presence of testicular cancer include

• alpha-fetoprotein
• beta–human chorionic gonadotropin
• lactate dehydrogenase

Prioritizing Hypotheses, Generating Solutions, and Taking Action

Nursing care of patients with male reproductive system disorders must be delivered in a nonjudgmental, friendly manner. This assists the nurse to develop rapport with the patient so they are more comfortable sharing information about their condition. Specifically, care for the male patient with ED requires the nurse to provide a safe environment where the patient can discuss their sexual concerns comfortably. Other nursing interventions for the patient with ED include providing education about lifestyle modifications, medications, and psychotherapy, all three of which are main treatment options. Education about medications for ED is an especially important aspect of nursing care. For example, patients receiving current antihypertensive therapy should be educated about their potential cumulative effects, to prevent serious episodes of hypotension and syncope. Additionally, patients taking medications for ED should be instructed to never take nitrates for chest pain, because this could also result in severe hypotension.

One of the main nursing interventions in the care of patients with testicular torsion is immediate referral for imaging and potential surgery. As mentioned, this condition is an emergency and must be treated immediately to restore blood flow and function to the affected testicle. Patients with testicular torsion are often encountered in the emergency department and present with new-onset, severe lower abdominal or scrotal pain. Nurses must be aware of this common clinical manifestation and understand the severity of this condition. If the nurse suspects a patient is experiencing testicular torsion, they will need to contact the provider quickly for immediate medical intervention.

Most of the nursing care of patients with testicular cancer is performed as part of the patient’s hospital stay following orchiectomy, because this is the most common treatment option for this disorder. Preoperative care is similar to that of most other surgical procedures, including obtaining informed consent, ensuring the patient ingests nothing by mouth for the number of hours ordered by the provider, and preparing the patient for surgery. Postoperative care of the patient after orchiectomy may involve caring for an indwelling catheter until the patient is ready to void on their own. The nurse will provide meticulous cleaning and care to the catheter site to prevent infection and other complications. Additionally, these patients will require education about the importance of maintaining follow-up appointments and the potential impact of the surgery on their fertility.

Evaluating Outcomes

During evaluation of a patient who has been treated for ED, the nurse will ask about the patient’s sexual function to determine whether prescribed medications or lifestyle modifications have helped improve the condition. If the patient reports the interventions have not been effective, this would warrant further investigation and possible referral to specialists who may be able to prescribe different medications or therapies. For patients recovering from orchiectomy, it is important for the nurse to inquire about postoperative pain or discomfort to evaluate their recovery process. Although minimal postsurgical pain is common, if the patient reports experiencing more severe or frequent pain than expected, the nurse should report the findings to the surgeon to determine next steps.

Patients who have experienced disorders of the male reproductive system often require lifelong counseling or psychotherapy, because these conditions can have negative effects on both mental and social health. It is important for the nurse to facilitate these experiences by providing the patient with appropriate referrals for counseling and therapy. Though nurses are not trained to provide official psychotherapy or counseling, it is important that they create a safe space where the patient can openly discuss their health and sexual concerns free from judgment and without embarrassment.