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Topic: Urology

Expert: Arthur Goldstein, M.D.
Date: 8/15/2008
Subject: TESTICLES/HERNIA

Question
TESTICLES AND PENIS SEEM TO BE PULLING INSIDE MY BODY.ESPCIALY WHEN TEMP. IS BELOW 70 DEGREASE.DO I HAVE A HERNIA? IF SO WHERE CAN I GET TREATMENT.DOCTORS DO NOT SEEM TO WANT TO HELP ME.PREMATURE EJACULATION ALSO IS PRESENT.JEFF TACOMA WA.

Answer
Jeff, you have sent 3 separate questions to me but I shall try to help you. It is normal for the scrotum to contact thus pulling the testicles (& penis) upward when the temperature decreases. The scrotum actually has the function of keeping the testicles at the maximum temperature for sperm production which is 1-2 degrees lower than the core body temperature. This is why the testes appear to hang lower in warm weather and are drawn up closer to the body when subjected to cold.

As far as hernias are concerned, these are more in the field of general surgery than urology. However, most can be easily diagnosed by any physician.   Although there are a number of hernia types, most occur in the inguinal (groin) area and present as a bulge. This prominence is more apparent when standing & straining down or coughing. Obviously I cannot diagnose a hernia over the internet as this requires a physical examination. If you were not satisfied by your doctor visit and are concerned about the possibility of having a hernia, make an appointment to see a general surgeon. If a hernia is present, the surgeon can discuss with you the pros & cons of repair and the various types of repair available (open surgical versus laparoscopic).

Premature ejaculation is a common condition. It refers to men who ejaculate prior to intromission or within a minute or so after insertion. It is more common in younger men and tends to spontaneously improve with age. In general, it occurs more often in those men who ejaculate relatively infrequently.   The commonly used treatments are:

1. EMLA cream, a prescription drug that contains a potent      relative of novocaine is used to numb the skin of the glans penis. I have not had much success with it. There is also the potential of becoming allergic to "caines" making them unsafe for you to use in the future.

2. Certain antidepressants (ie Prozac, Anafranil, Zoloft, etc.) can be used successfully in delaying ejaculation.   However, they also have possibly harmful side effects. They are prescription drugs and should not be taken without medical supervision.

3. The "squeeze technique" of behavioral modification is successful and safe. It is well described in most books on sexual therapy and dysfunction. However, it requires frequent practice and a cooperative partner.

4. The use of condoms decreases sensation and helps some individuals.

5.   Having sexual intercourse a second time in the same session usually produces a greater time to ejaculation. If one can't get aroused again, the use of Viagra may help. However, Viagra does not treat the premature ejaculation per se. It is best to see a urologist skilled in the evaluation and treatment of sexual dysfunction for more information about the above options.

6.   I have heard that some intense meditation techniques allow one to train their body to resist ejaculation. Personally, I am not familiar with these techniques but you could probably find more about them on the internet. Good luck!

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