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Common Urology Problems that Affect Fertility
Head Urologist & Andrologist
2021-06-28

Common Urology Problems that Affect Fertility

As specialists in fertility, we will often come across other problems that patients may be experiencing as part of their fertility issues. These are commonly urology problems, as many conditions which fall under this term are linked to cases of infertility. 

Here, we have provided a guide on urological problems associated with infertility, some of the most common causes behind these issues, and some information on what may be suggested to you for treatment after a diagnosis is made.

What is a Urological Problem?

Urological problems are diseases, conditions, or other issues relating to your urinary tract. This is the part of the body that removes urine, and includes your kidneys, ureters (the tubes that carry urine from your kidneys), and your bladder. In order to ensure that you can urinate normally and comfortably, each of these parts should be healthy and fully functioning. 

Urology Problems and Fertility

In some cases, it is possible that urology and bladder problems will have an impact on your fertility. Speaking with a urologist at a specialist fertility clinic may help to diagnose any that might be contributing to this, thereby preventing you from forming the family you’ve always wanted.

At GENNET City Fertility, we will be able to carry out a series of blood tests and other assessments which may help to diagnose these issues, and we will always discuss options for treatment or for moving forward with your journey to parenthood.

Here, we have provided further description and explanation on some of the most common male urology problems that may be causing a patient to have problems with infertility:

Anejaculation

Meaning “no ejaculation”, this condition is defined as the inability to ejaculate semen. A patient may be able to produce sperm, but will not be able to expel them during normal ejaculation even if they are able to experience a normal orgasm sensation. It can be divided into multiple categories

  • Situational anejaculation, in which a patient is able to ejaculate under certain conditions but not others
  • Total anejaculation, in which a patient isn’t able to ejaculate during intercourse or through masturbation. This type may also be divided into two sub categories:
    • Anorgasmic anejaculation, in which a patient is unable to achieve an orgasm while awake but may do so (and achieve ejaculation) while asleep
    • Orgasmic anejaculation, in which a patient can reach an orgasm but cannot ejaculate semen

In cases where retrograde ejaculation (see below for more information) has been found not to be the case, this condition occurs when the prostate and seminal ducts fail to release semen into the urethra. There are several possible causes of this:

  • Anxiety
  • Conditions that affect the nervous system (e.g. Parkinson’s, diabetes, multiple sclerosis, etc.)
  • Hormonal problems
  • Infections of the pelvis or groin area
  • Injuries to the spinal cord, pelvis, or groin area
  • Medications, especially those that are used to treat urinary symptoms
  • Surgeries that cause damage to the pelvic area
  • Surgeries that require the removal of lymph nodes located in the groin

Chronic Prostatitis

You may have heard of this condition before, under the term “enlarged prostate”. It is the inflammation of the prostate (a small gland that forms part of a male’s lower urinary tract) and may be considered a chronic condition if it continues for three months or more. The problem develops gradually and can last for months or even years if not treated before then.

The main symptom of this condition is pain in the pelvic or genital area, though you may also experience pain or problems with urinating, the feeling of having to urinate more often, pain in your lower back, or pain or difficulty when ejaculating. You may also have some symptoms relating to infection, such as fever, chills, nausea, or vomiting.

The causes behind this form of prostatitis fall into two categories, though these categories are broad within themselves:

  • Chronic bacterial prostatitis, in which a bacterial infection is the cause of the problem. This may develop following a urinary tract infection (UTI), and may persist as some bacteria are resistant to antibiotics
  • Chronic nonbacterial prostatitis, which is also called chronic pelvic pain syndrome. This type can have many different causes, including psychological stress or damage to the urinary tract, and may be harder to treat

Epididymo-Orchitis

This is the inflammation of the epididymis or the testicle (and often both at the same time). As both parts of the body lie next to each other it is often difficult to tell which part is inflamed, therefore the term epididymo-orchitis is used to describe both. Symptoms will normally develop quickly (over the course of about a day), and the area will become enlarged, tender to touch, and red. 

If the cause is a complication from another infection, you may also experience pain, or generally feel unwell.

Most cases diagnoses will have been caused by an underlying infection. Possible causes of these infections include:

  • Complications from urine infections
  • Diseases or infections that have travelled in the blood to the testicles
  • Sexually transmitted infections and diseases
  • Medications
  • Operations on the prostate or the urethra
  • The mumps virus

Erectile Dysfunction

This is the inability for a patient to maintain an erection. It’s a common problem and usually nothing to worry about, as most patients will experience it occasionally over the course of their lives. However, it is important to consult with a professional if it keeps happening, as it may be a symptom of an underlying problem.

Common causes of erectile dysfunction include:

  • Anxiety
  • Drinking too much alcohol
  • High blood pressure
  • High cholesterol
  • Hormonal problems
  • Narrowing of blood vessels in the penis
  • Side effects of medication
  • Stress
  • Tiredness

Penile Curvature

Also known as Peyronie’s Disease, this is a disorder in which scar tissue, commonly called plaque, forms under the skin of the penis. This then builds up inside the penis, into a thick membrane called the tunica albuginea. This membrane is what helps to keep a penis stiff during an erection, and plaque can develop anywhere inside one with this condition.

As the plaque develops, it pulls on the surrounding tissues and causes the penis to curve or bend, usually during an erection. This most often makes erections painful, and may make sexual intercourse painful, difficult, or even impossible in severe cases.

Penile curvature occurs in two phases:

  • The acute phase, in which plaque builds up. Inflammation may occur and plaque forms on the penis. The penis will also start to curve, may hurt without an erection, and erections may hurt when the scars start to develop
  • The chronic phase, which occurs after the plaque has formed (which may be up to 18 months after symptoms first appear). During this phase, the plaque and curvature may stabilise and not get worse and the pain in the penis may lessen, but erectile dysfunction may develop and get worse

The plaque that builds up when a patient has this condition will usually be caused by an injury, an autoimmune disease, aging, or diabetes with erectile dysfunction. It is not the same as plaque that develops inside arteries and is benign.

Premature Ejaculation

This is the most common ejaculation problem men or non-binary or transgender patients who were born male are likely to have. This is when a person ejaculates too quickly during intercourse, and is not considered a problem if it happens only occasionally. However, if a patient has found that around half their attempts at intercourse result in premature ejaculation, they may benefit from speaking to their doctor about treatment.

There are many physical and psychological causes of premature ejaculation. Physical causes include:

  • Having an overactive thyroid gland
  • Having an underactive thyroid gland
  • Problems with the patient’s prostate
  • Using recreational drugs

Psychological causes include:

  • Anxiety about sexual performance
  • Depression
  • Relationship problems
  • Stress

There are also a number of other causes that may have resulted in the patient experiencing premature ejaculation since becoming sexually active. These include:

  • Biological reasons (some patients may find that their penis is simply “extra sensitive”)
  • Conditioning, in which early sexual experiences have influenced later sexual behaviour
  • Having a strict upbringing with certain beliefs about sex
  • Traumatic experiences from childhood (these may range from being caught masturbating to abuse)

Retrograde Ejaculation

This is a rarer type of ejaculation problem than premature ejaculation. In these cases, the semen will travel backwards into the bladder instead of through the urethra. Patients will commonly still experience an orgasm and the issue is not a danger to health, however it can affect the ability to conceive a child.

The main symptoms of this ejaculation problem are:

  • Producing cloudy urine when first using the toilet after having sex
  • Producing little to no semen during ejaculation

Retrograde ejaculation is caused by damage to the nerves or muscles surrounding the neck of the bladder, as the neck would normally close tightly during an orgasm and prevent the semen from moving backwards. The damage may be the result of surgery on the bladder or prostate gland, or a side effect of diabetes, multiple sclerosis, or taking medication for high blood pressure.

Varicocele

This is the enlargement of the veins within the loose bag of skin that holds a patient’s testicles (the scrotum), and is similar to the varicose veins you may find on your leg. Over time they may enlarge and become more noticeable, or cause a swollen testicle. This is believed to be caused by the valves in the veins preventing proper blood flow, with the resulting backup causing the veins to dilate.

Usually, you should find that a varicocele will have no other symptoms, but on rare occasions they may cause pain. This pain may vary from sharp to dull discomfort, increase when standing or when carrying out bouts of physical exertion, and will often worsen over the course of the day. This pain may be relieved by lying on your back.

Most varicoceles will develop over time, are relatively easy to diagnose and often don’t require treatment. However, the problem is also a common cause of atrophy (shrinkage in the affected testicle), a low sperm count and a decrease in sperm quality, so if you have been planning on becoming a parent you may wish to consult with a fertility specialist.

If you are experiencing pain or swelling, have discovered a mass in your scrotum, have noticed that your testicles are different sizes, or develop a varicocele in your youth, please don’t hesitate to contact your doctor. These are also symptoms of other conditions, some of which may require immediate treatment.

Another Common Urology Problem and Your Fertility

Another common issue related to the issue of infertility is the possibility of urinary tract infections (UTIs), which are caused by the unwanted growth of bacteria in the urine. As this bacteria passes up the urinary tract, it may result in an infection. 

If this infection persists and is left untreated, it is also able to affect the prostate gland, testis, epididymis, and the accessory glands of the reproductive system in biologically male patients, which may lead to a decrease in sperm count and motility (the sperm’s ability to move). The fallopian tubes and the uterus may also become damaged in the case of biologically female patients, which could affect the ovulation process. 

Symptoms which may indicate that you have a UTI include:

  • Pain or a burning sensation when you pass urine (dysuria)
  • Needing to pass urine more often in the night (nocturia)
  • Needing to pass urine more suddenly or urgently than before
  • Needing to pass urine more often than before
  • Leaking urine during everyday activities, such as bending, lifting, coughing, or exercising
  • Passing urine which appears cloudy
  • Passing urine that has blood in it
  • Stomach pains, or pains in your lower back (just under your ribs)
  • Having a high temperature, or feeling hot and shivery
  • Having a very low temperature (under 36°C)

Urinary tract infections can affect all patients, no matter their gender identification. However, biologically female patients are more likely to be at risk of developing one, as the urinary tract is most often shorter. 

Other Common Male Urology Problems

Not every urology problem you may experience will be related to fertility. Other common male urology and bladder problems that a patient may experience include:

  • Bladder cancer
  • Kidney and ureteral stones
  • Overactive bladder (when your bladder, which normally stores urine, cannot do this properly)
  • Prostate cancer
  • Stress incontinence
  • Urinary incontinence

Some Symptoms of Common Male Urology Problems

Alongside the symptoms presented when discussing UTIs, there are a number of other signs you may wish to look for if you are experiencing difficulties with conceiving and believe that a urological problem may be the cause:

  • A lower than normal sperm count (fewer than 15 million sperm per millilitre of semen)
  • Blood in your semen
  • Pain, swelling, or lumps in the testicle area
  • Problems with sexual function (such as reduced sexual desire or difficulty with ejaculation)

Common Female Urology Problems

There are some common female urology and bladder problems which are not related to fertility, and may even develop after a patient has already been through childbirth:

  • Bladder cancer
  • Incontinence after pregnancy
  • Kidney and ureteral stones
  • Overactive bladder
  • Pelvic floor dysfunction
  • Pelvic organ prolapse
  • Stress incontinence

Some Symptoms of Common Female Urology Problems

If you are biologically female, or nonbinary or transgender but were born biologically female, the symptoms you may experience will often be less obvious than for male patients. Many will be the same or similar to the symptoms experienced with a UTI, though you may also find issues such as:

  • Discomfort when sitting
  • Feeling a “bulge” in the vagina
  • Foul-smelling urine
  • Pain during intercourse
  • Pain when passing urine

Diagnosis and Treatment of Urology Problems Related to Fertility

In many cases, once a UTI has been diagnosed it will be easy to treat. A doctor or nurse may advise on self-care, such as keeping hydrated, ensuring you are getting plenty of rest, and taking painkillers to manage the more uncomfortable symptoms. If they feel it is necessary, they may also write you a prescription for a series of antibiotics or other medication. They will also offer advice on whether you should start taking this right away, or if you should wait to see if your condition improves.

It is important to ensure that you finish the whole course of antibiotics, even if you start to feel better once you’ve started taking them. 

If your urology problem is found to be something else upon diagnosis, a specialist may suggest a number of different options for treatment. These may help to solve the problem you’re currently experiencing by curing it (or by relieving you of the symptoms), or in other cases may help you and your partner to conceive despite the issue. Some of the most common options for treatment and for aiding treatment include:

  • Advice on lifestyle changes (such as quitting smoking or reducing alcohol intake)
  • Antibiotics
  • Assisted reproductive technology (ART, which may involve IVF or ICSI)
  • Hormone treatments and medications
  • Surgery
  • Treatments for problems with sexual function (which may involve medication or counselling as necessary)

Book a Consultation with Us

If you and your partner are looking to take the next step on your journey to parenthood, but feel as though you may need a fertility assessment to decide on the best course of action for your treatment, please don’t hesitate to get in touch with us. We have packages available for both couples and single patients, so you’ll get to decide which suits your circumstances most.

Male patients will also be able to get their results quickly by choosing to book a session at our One Stop Male Fertility Clinic, which offers a comprehensive set of tests and results in a shorter amount of time. 

No matter which assessment route you choose, we will be happy to book you in for a free initial consultation with a discreet and understanding professional at our private clinic in London, UK. Once we have your results, we’ll be able to guide you in the direction of the advice or treatment you need to start your family.

Mr Amr Raheem
Head Urologist & Andrologist