Torsion of the Testis
Torsion of the testis is a condition that requires an emergency operation. It occurs when a testis twists around in the scrotum. In some people the testes can move around in the scrotum more than usual. If a testis twists round, the blood supply to the testis is blocked in the twisted spermatic cord. The effect of this is that the testis, with its blood supply cut off, becomes damaged and will ‘die’ unless the blood flow is quickly restored.
Torsion is most common in teenage boys, shortly after puberty, and it is uncommon in men over the age of 25.
What Are the Symptoms of Torsion of the Testis?
The main symptom of torsion is severe pain in the testicle. Sometimes pain is also felt in the belly area due to the nerve supply to the testes. The pain tends to come on quite quickly and becomes severe over a few hours. The affected testis soon becomes swollen, red and very sore to touch.
What Is the Treatment for Torsion of the Testis?
Torsion of the testis is an emergency because if the blood supply to the testis is cut off for more than about 6 hours, permanent damage to the testis is likely to result. An emergency operation is usually done to untwist the testis and spermatic cord and ‘fix’ the testis in position so that torsion can’t happen again. There is an increased chance of torsion occurring in the other testis at a later date so that testis is also fixed at the same time to prevent this from happening. The operation ideally should be within a few hours of the symptoms starting in order to maximize the chance of saving the testis. Otherwise, the testis may have to be removed.
Partial Torsion and Warning Pains
Sometimes sharp pains, which last a few minutes and go just as quickly, can occur in the testes of boys and young men. This can be due to partial twisting of the testis, which then untwists again with relief of symptoms. This can be an early warning sign of a possible torsion later on. It is important to get prompt medical advice if these symptoms occur. Sometimes if these warning pains occur, an operation is recommended to fix the affected testis so as to prevent full-blown torsion later on.
Blood In the Semen
The presence of blood in the ejaculate is called haematospermia (pronounced hem-at-o-sperm-e-a). This is usually a harmless symptom; however, it can cause major worry and anxiety for an affected man. Usually there is no underlying medical cause and detailed investigations are not needed. Less commonly, it may be associated with abnormalities of the urinary tract, including kidney and prostate problems, and occasionally is associated with other more generalised illnesses, such as cirrhosis of the liver or parasitic infections. Men aged over 40 with persistent haematospermia may need to be referred to a urologist, especially if they have other symptoms or abnormal findings on examination.
Alongside the pressure of making a decision about storage and acting on it hard on the heels of receiving a diagnosis of serious illness, all patients are now required to give informed consent to screening for hepatitis, HIV and sexually transmitted diseases – a tall order for anyone but perhaps additionally so for those who may be as young as 12 or 13.
Recent years have seen a rapid increase in the storage of the reproductive tissues of younger children. The rather different consent provisions for such storage make for a somewhat anomalous situation when compared with storage of mature gametes.
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Consent at any age to the removal of testicular or ovarian tissue for storage is covered by the Human Tissue Act 1961. This means that the usual consent provisions for minors apply rather than the more stringent ones of the HFE Act (providing that the tissue does not contain any mature gametes, in which case the HFE Act applies). Parents holding legal parental responsibility can make ‘best interests’ consent decisions for their underage offspring on the grounds that such a decision would ensure improvement or prevention of deterioration in their child’s physical or mental health. At a future stage, the responsibility for ongoing storage decisions and any treatment decisions would of course have to pass from parent to child. The HFE Act provisions ensure that parents may not make use of the tissue in fertility treatment buy Viagra Sydney online against the wishes of their child or in the event of their child’s death. Some centres have expressly included this in their in-house consent form to make the situation clear to all concerned.
Since 1 April 2003, reproductive tissue must be stored in tissue banks accredited by the Medicines Control Agency (now the Medicines and Healthcare Products Regulatory Agency – MHRA) under the Department of Health Code of Practice for Tissue Banks. Given the stringency of the accreditation requirements, and taking into account the forthcoming requirements of the European Union Tissues and Cells Directive due to be implemented in April 2006 (though with an extra year’s grace for those centres already licensed under national regimes to achieve full compliance), few centres currently offer such a facility. Indeed, there are concerns that some existing storage facilities may not be able to meet the new standards.
After considerable speculation and debate, it was announced in July 2004 that a new UK body is to be formed from a merger of the HFEA and the newly created Human Tissue Authority (which has responsibility for tis-sue storage). This development, together with the pending review of the HFE Act, may lead to some changes in both the legal situation and the regulation provisions, which will, it is hoped, address some of the apparently contradictory legal situations. The ethical and emotional challenges remain.
Any work with children and young people that concerns their fertility will have their sexuality and sexual health as a constant backdrop. Their understanding of what reduced fertility means and its effect on their lives as they grow towards adulthood will be influenced at least in part by how broader issues about sexuality and sexual health are dealt with by parents, carers and professionals. It is first and foremost essential to understand that sexuality forms part of our identity and experience from infancy onwards. An outline of how sexuality develops throughout the childhood and teenage years forms the first part of this chapter.
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In the second part, sexual health and well-being will be considered. Some young people coping with health conditions and disability as they are growing up will also have to deal with adverse experiences such as sexual abuse, sexually transmitted infections, unwanted pregnancies and struggles with sexual identity.
The third part of this chapter will discuss the provision of age- and context-appropriate sexual health services and education. This includes the need to pay particular attention to the influence of disability or health conditions, whether or not the young person is accessing informal sources of information from their peers and/or formal sex education and whether or not they are sexually active. Issues of confidentiality are also addressed.
Finally, two important questions that need to be considered by parents and professionals will be discussed:
- How is this young person’s sexuality affecting their behaviour, including what they are saying (or not) about their symptoms, feelings and relationships?
- How is the way this young person is being dealt with going to affect their future sexual health, sexual feelings and sexual relationships?
Development of sexuality and sexual identity
Sexuality is a dynamic concept and is about much more than sexual activity and sexual orientation alone. It includes what being male or female means to us and how we express our gender; how we feel about our bodies, about our appearance and about physical pleasure; whom we are attracted to and what we choose to do about it; and, if we have intimate relationships, how we behave with our partners. Our ability to reproduce comes from our sexual behaviour and our feelings about our sexuality and sexual identity by viagra pills 100mg can be deeply affected by our sense of our own fertility.
We are all born either male or female, with different chromosome patterns and body chemistry. From birth we are spoken to, handled and usually dressed differently as part of our socialization into our gender roles. As we grow up we learn how boys and girls are supposed to behave and our differing personalities and experiences leave us more or less comfortable with living up to these expectations. Some of these expectations and roles are based on the assumption that we will be parents in the future: for example, girls the world over may be given dolls with which to practise nurturing.