Andrology and Male Sexual Health
What this domain tests
This domain tests erectile dysfunction, male infertility, hypogonadism, and genital reconstruction. Expect questions on vascular and neurogenic mechanisms, semen analysis, testosterone evaluation, varicocele, Peyronie disease, and priapism.
Core rules and concepts
- Erection requires arterial inflow, cavernosal smooth-muscle relaxation, and veno-occlusion. PDE5 inhibitors augment nitric oxide signaling and are contraindicated with nitrates.
- ED evaluation includes medication review, vascular risk factors, testosterone, and psychosocial history. Young men with ED or penile curvature need careful examination.
- Semen analysis uses 2–5 days of abstinence and is repeated when abnormal. Assess volume, concentration, motility, and morphology. A clinically palpable varicocele with abnormal parameters may be repaired; testosterone is not infertility therapy.
- Hypogonadism requires symptoms plus low morning testosterone on repeated testing. Exclude other causes and discuss fertility plans before replacement.
- Priapism is an emergency: aspiration and irrigation for ischemic priapism, then shunt surgery if needed. Peyronie disease may require plaque manipulation, injections, or prosthesis.
Worked example
A 32-year-old man has infertility and a grade 2 left varicocele with low motility on two semen analyses. Reasoning: treat the clinically palpable varicocele only when fertility is a goal and parameters are abnormal; counsel that improvement is not guaranteed. Check testosterone and partner factors before surgery.
Traps
Do not prescribe testosterone to a man seeking fertility. Do not miss nitrate use before PDE5 inhibitors. Do not manage prolonged ischemic priapism with observation.