Andrology, Male Infertility and Sexual Medicine
Core concepts
This domain spans male reproductive and sexual function. Infertility evaluation includes history, examination for varicocele and testicular size, and semen analysis using WHO reference parameters; repeat abnormal analyses before acting. Distinguish obstructive (normal volume, normal FSH, low or absent fructose) from non-obstructive azoospermia (small testes, elevated FSH). Varicocele is the most common correctable cause. Understand the hypothalamic-pituitary-gonadal axis and the roles of FSH and testosterone. Erectile dysfunction requires evaluation of vascular, neurogenic, hormonal, and psychogenic causes; PDE5 inhibitors are first-line, with contraindication to nitrates. Testosterone therapy suppresses spermatogenesis and is inappropriate for men seeking fertility. Peyronie's disease and priapism (especially low-flow) need prompt recognition; low-flow priapism is a compartment syndrome requiring aspiration and treatment.
Traps
Questions test the distinction between obstructive and non-obstructive azoospermia using volume, FSH, and testicular size. Do not offer testosterone to a man desiring fertility. Distinguish high-flow from low-flow priapism - high-flow may be observed or managed by embolization, low-flow is an emergency.
Worked example / rule of thumb
A man with azoospermia, normal ejaculate volume, normal FSH, and small testes: think obstruction (e.g., ejaculatory duct obstruction or CBAVD) and evaluate further. Rule of thumb: low volume plus normal FSH suggests obstruction; small testes plus high FSH suggests testicular failure.