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The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

(Testicular failure)

Testicular failure is the inability of the testicles to produce sperm or male hormones.

Causes of testicular failure include chromosomal abnormalities, testicular torsion, direct trauma to the testicles, diseases that affect the testicle (such as mumps, orchitis [inflammation of the testes], and testicular cancer ), and a variety of drugs. The condition is uncommon.

Increased risk is linked to activities that may cause constant, low-level injury to the scrotum, such as riding a motorcycle. Frequent use of a drug known to affect testicular function, such as heavy marijuana use or some prescription medications, also increases the risk of testicular failure. Men who had undescended testicles at birth are at higher risk.

* Lack of libido (sex drive)
* Delay in development or absence of secondary male sex characteristics (growth and distribution of hair, scrotal enlargement, penis enlargement, voice changes)
* Infertility
* Gynecomastia (enlarged breasts in males)
* Lack of muscle mass

A physical examination may reveal:
* Genitals that do not clearly look either male or female (usually noted in infancy)
* Abnormally small testicle
* Tumor or mass (group of cells) on or near the testicle

Hormonal levels determined through blood tests may detect low testosterone levels and high levels of gonadotropins (pituitary hormones FSH and LH).

(Treatment )
Supplementation of male hormones may be successful in treating some forms of testicular failure. In cases that seem to be due to specific exposure or activity, removal of the drug or activity may result in return of normal function.

Expectations (prognosis)
Many forms of testicular failure cannot be reversed. Androgen (male sex hormone) replacement is effective in reversing symptoms, though it may not restore fertility.

(Complications)
Testicular failure before to the onset of puberty will stop normal growth, specifically the development of adult male characteristics.

Call for an appointment with your health care provider if symptoms occur.
Avoid higher-risk activities, or watch testicular function when involved in such activities. Also, stop the activity with the first sign of symptoms.

(Mumps)

Mumps is a disease caused by a virus that usually spreads through saliva and can infect many parts of the body, especially the parotid salivary glands. These glands, which produce saliva for the mouth, are found toward the back of each cheek, in the area between the ear and jaw. In cases of mumps, these glands typically swell and become painful.

The disease has been recognized for several centuries, and medical historians argue over whether the name "mumps" comes from an old word for "lump" or an old word for "mumble."

Mumps was common until the mumps vaccine was licensed in 1967. Before the vaccine, more than 200,000 cases occurred each year in the United States. Since then the number of cases has dropped to fewer than 1,000 a year, and epidemics have become fairly rare. As in the prevaccine era, most cases of mumps are still in children ages 5 to 14, but the proportion of young adults who become infected has been rising slowly over the last two decades. Mumps infections are uncommon in children younger than 1 year old.

After a case of mumps it is very unusual to have a second bout because one attack of mumps almost always gives lifelong protection against another. However, other infections can also cause swelling in the salivary glands, which might lead a parent to mistakenly think a child has had mumps more than once.

Signs and Symptoms
Cases of mumps may start with a fever of up to 103 degrees Fahrenheit (39.4 degrees Celsius), as well as a headache and loss of appetite. The well-known hallmark of mumps is swelling and pain in the parotid glands, making the child look like a hamster with food in its cheeks. The glands usually become increasingly swollen and painful over a period of 1 to 3 days. The pain gets worse when the child swallows, talks, chews, or drinks acidic juices (like orange juice).

Both the left and right parotid glands may be affected, with one side swelling a few days before the other, or only one side may swell. In rare cases, mumps will attack other groups of salivary glands instead of the parotids. If this happens, swelling may be noticed under the tongue, under the jaw, or all the way down to the front of the chest.

Mumps can lead to inflammation and swelling of the brain and other organs, although this is not common. Encephalitis (inflammation of the brain) and meningitis (inflammation of the lining of the brain and spinal cord) are both rare complications of mumps. Symptoms appear in the first week after the parotid glands begin to swell and may include: high fever, stiff neck, headache, nausea and vomiting, drowsiness, convulsions, and other signs of brain involvement.

Mumps in adolescent and adult males may also result in the development of orchitis, an inflammation of the testicles. Usually one testicle becomes swollen and painful about 7 to 10 days after the parotids swell. This is accompanied by a high fever, shaking chills, headache, nausea, vomiting, and abdominal pain that can sometimes be mistaken for appendicitis if the right testicle is affected. After 3 to 7 days, testicular pain and swelling subside, usually at about the same time that the fever passes. In some cases, both testicles are involved. Even with involvement of both testicles, sterility is only a rare complication of orchitis.

Additionally, mumps may affect the pancreas or, in females, the ovaries, causing pain and tenderness in parts of the abdomen.

In some cases, signs and symptoms of mumps are so mild that no one suspects a mumps infection. Doctors believe that about one in three people may have a mumps infection without symptoms.

Contagiousness
The mumps virus is contagious and spreads in tiny drops of fluid from the mouth and nose of someone who is infected. It can be passed to others through sneezing, coughing, or even laughing. The virus can also spread to other people through direct contact, such as picking up tissues or using drinking glasses that have been used by the infected person.

People who have mumps are most contagious from 2 days before symptoms begin to 6 days after they end. The virus can also spread from people who are infected but have no symptoms.

Prevention
Mumps can be prevented by vaccination. The vaccine can be given alone or as part of the measles-mumps-rubella (MMR) immunization, which is usually given to children at 12 to 15 months of age. A second dose of MMR is generally given at 4 to 6 years of age, but should be given no later than 11 to 12 years of age. As is the case with all immunization schedules, there are important exceptions and special circumstances. Your child's doctor will have the most current information.

Incubation
The incubation period for mumps can be 12 to 25 days, but the average is 16 to 18 days.

Duration
Children usually recover from mumps in about 10 to 12 days. It takes about 1 week for the swelling to disappear in each parotid gland, but both glands don't usually swell at the same time.

Professional Treatment
If you think that your child has mumps, call your child's doctor, who can confirm the diagnosis and work with you to monitor your child's progress and watch for any complications. The doctor can also notify the health authorities who keep track of childhood immunization programs and mumps outbreaks.

Because mumps is caused by a virus, it cannot be treated with antibiotics.

Home Treatment
Monitor and record your child's temperature. You can use nonaspirin fever medications such as acetaminophen or ibuprofen to bring down a fever. These medicines will also help relieve pain in the swollen parotid glands. Unless instructed by your child's doctor, aspirin should not be used in children with viral illnesses because the use of aspirin in such cases has been associated with the development of Reye syndrome, which can lead to liver failure and death.

You can also soothe your child's swollen parotid glands with either warm or cold packs. Serve a soft, bland diet that does not require a lot of chewing and encourage your child to drink plenty of fluids. Avoid serving tart or acidic fruit juices (like orange juice, grapefruit juice, or lemonade) that make parotid pain worse. Water, decaffeinated soft drinks, and tea are better tolerated.

When mumps involves the testicles, the doctor may prescribe stronger medications for pain and swelling and provide instructions on how to apply warm or cool packs to soothe the area and how to provide extra support for the testicles.

A child with mumps doesn't need to stay in bed, but may play quietly. Ask your doctor about the best time for your child to return to school.

When to Call Your Child's Doctor
Call your child's doctor if you suspect that your child has mumps. If your child has been diagnosed with mumps, keep track of your child's temperature and call the doctor if it climbs above 101 degrees Fahrenheit (38.3 degrees Celsius).

Because mumps can also involve the brain and its membranes, call the doctor immediately if your child has any of the following: stiff neck, convulsions (seizures), extreme drowsiness, severe headache, or changes of consciousness. Watch for abdominal pain that can mean involvement of the pancreas in either sex or involvement of the ovaries in girls. In boys, watch for high fever with pain and swelling of the testicles.

(Testicular infection or torsion)
Testicular infection or torsion is a group of disorders in which testicular pain is a primary symptom.

Disorders associated with testicular infection or pain include epididymitis, orchitis, testicular trauma, and testicular torsion.

Epididymitis is an inflammation of the epididymis, the structure that is the first part of the duct draining the testicle. Orchitis is an inflammation of one or both of the testicles. These disorders may be caused by numerous bacterial and viral organisms. Epididymitis is the most common cause of scrotal or testicular pain in individuals over 18 years of age.

Testicular torsion is a twisting of the spermatic cord, artery and vein, which cuts off the blood supply to the testicle and surrounding structures within the scrotum. If not corrected promptly, the tissues of the testicle will die.

Diagnosis and surgery should take place within 6 hours. If surgery is delayed more than 6 hours, the testicle will often need to be removed. Testicular torsion is the most common cause of scrotal or testicular pain in boys and non-sexually active adolescents. The majority of cases of testicular torsion are in boys less than 6 years of age.

Symptoms:
* Sudden onset of testicle pain (in one or both testicles) with or without a previous event
* Scrotal swelling
* Extreme tenderness to pressure on the testis

Specific to orchitis and epididymitis:

* Fever
* Chills or chilling sensation
* Discharge (fluid) from penis

Additional symptoms that may occur:

* Testicle lump
* Blood in the semen
* Nausea and vomiting
* Light-headedness or fainting
* Blood in the semen
* Pain with urination
* Pain with intercourse or painful ejaculation
* Groin pain

Signs and tests:
Physical examination is often enough to diagnose testicular torsion, orchitis, and epididymitis. Radiographic tests may be required to tell the difference between testicular torsion and infectious causes of testicular pain. Often, tests will be needed to determine the cause of infection.

Treatment:
If the cause is bacterial, epididymitis and orchitis may respond to antibiotics. Pain medications and other treatments may be recommended.

Prompt surgery is required for testicular torsion.

Expectations (prognosis)
With appropriate diagnosis and adequate treatment, normal function of the testicle is usually preserved. If the infection is severe or testicular torsion is not surgically corrected promptly, infertility and testicular atrophy (shrinkage) may result.
Complications:
* Loss of testicular function (infertility)
* Severe infection

Any time there is persistent or severe testicular pain, with or without any of the other symptoms listed above, call your health care provider promptly.
Prevention:
Epididymitis and orchitis are frequently, but not always, associated with sexually-transmitted diseases.

There are no special preventive measures for testicular torsion. Paying attention to symptoms, and getting early diagnosis and treatment may prevent loss of a testicle.



(Testicular torsion repair)
Testicular torsion repair is surgery to untangle the twisted spermatic cord that is causing testicular torsion

Testicular torsion is a problem most often encountered by boys at early puberty or just after birth, but it can occur at any age. Torsion occurs when the testicle turns or spins on the axis of its blood supply, blocking the flow of blood into the testicle.

If prolonged, this causes tissue death in the testicle, resulting in pain, swelling, and possible testicular damage. Approximately 1 in 4,000 males are affected.

General anesthesia is generally used in testicular torsion repair. An incision is made in the scrotum, the testicle is uncoiled, and sutures are placed to keep the testis from rotating again. The other unaffected testicle is also secured because the unaffected side is at increased risk for torsion at a later date.

Testicular torsion is considered an emergency. Surgery is usually required, and it should be performed within 4 to 6 hours of onset of symptoms to save the testicle.

Risks for any anesthesia are:

* Reactions to medications
* Problems breathing
Risks for any surgery are:

* Bleeding
* Infection

Call your doctor if excessive bleeding occurs at the surgical site, a general ill feeling occurs or signs of infection develop including fever, chills, muscle aches, and headache.

If surgery is performed in time, complete recovery is expected. If one testicle has to be removed, the remaining healthy testicle should provide enough hormones for normal male maturation, sex life, and fertility.

After surgery, ice packs will relieve pain and swelling. A scrotal support may be worn for a week after surgery. Normal activity may be resumed gradually.

(Testosterone)



Serum testosterone



A testosterone test measures the amount of testosterone in the blood.



Blood is drawn from a vein, usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic. An elastic band is placed around the upper arm to apply pressure and cause the vein to swell with blood.

In infants or young children:

The area is cleansed with antiseptic and punctured with a sharp needle or a lancet. The blood may be collected in a pipette (small glass tube), on a slide, onto a test strip, or into a small container. A bandage may be applied to the puncture site if there is any bleeding.



The health care provider may advise you to withhold drugs that may affect the test.



Infants and children:

When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

This test is performed when symptoms indicate there may be abnormal androgen (male hormone) production.



In males, the testes produce the majority of the circulating testosterone. The pituitary hormone LH stimulates the testicular Leydig cells to produce testosterone. In females, the ovaries produce the majority of the testosterone. The adrenal cortex produces another androgen, called DHEAS.



In male children, testosterone levels are used to assess early or late puberty. In adult males, testosterone levels are critical in the evaluation of impotence and infertility. Testosterone levels are obtained in women in the work-up of excess hair growth, virilization (male body characteristics) and irregular menses.



*Normal Values*

* Male: 437 to 707 ng/dl

* Female: 24 to 47 ng/dl

Normal value ranges may vary slightly among different laboratories.

Note: ng/dl = nanograms per deciliter



Increased production of testosterone:

* Precocious puberty

* Androgen resistance

* Ovarian cancer

* Congenital adrenal hyperplasia

* Polycystic ovary disease

* Testicular cancer

Decreased production of testosterone:

* Hypopituitarism

* Testicular failure

* Delayed puberty

* Chronic illness

* Prolactinoma



The risks associated with having blood drawn from a vein are slight:



* Excessive bleeding

* Fainting or feeling lightheaded

* Hematoma (blood accumulating under the skin)

* Infection (a slight risk any time the skin is broken)

* Multiple punctures to locate veins



(Special considerations)

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.



The preparation you can provide for this test depends on your child's age, previous experiences, and level of trust. For general information regarding how you can prepare your child, see the following topics:

(Infant test or procedure preparation (birth to 1 year)

Toddler test or procedure preparation (1 to 3 years)

Preschooler test or procedure preparation (3 to 6 years)

School age test or procedure preparation (6 to 12 years)

Adolescent test or procedure preparation (12 to 18 years)