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      It is of a great importance for the currant physician of a man who deals with this kind of clinical condition to start with a short medical history of the patient followed by a physical exam and laboratory tests.
     Also it is very important to complete a questioner related to two of the most important steps in the patient’s medical history: his childhood medical history and his adult medical history.
     Child medical history should cover the following aspects: first the prenatal factors – mother’s state of health during pregnancy, the medication she used during pregnancy, post natal factors- testicular abnormalities (hernia, cryptorchidism), penis abnormalities, the diseases he had in his childhood, the medication he took, pubertal development, the age when he shaved for the first time, testicular dysfunctions.
      Also the adult’s medical history has to be carefully analyzed and the following factors have to be taken into consideration: the marriage duration, the period of infertility, the frequency of sexual intercourses, possible pregnancies with other partners, occupation and possible occupational exposure to certain toxic substances (hydrocarbons, plumb, extreme temperatures, etc.), diseases, if he received treatment for a certain medical condition, a lifestyle evaluation which should involve smoking historical, alcohol use historical, erectile or ejaculatory problems, testicular affections, traumas, infections, possible changes in the testicles dimensions, testicular pain.
     Various maternal diseases acquired by the mother during pregnancy can interfere with the normal evolution of the male fetus; also the drugs used in the treatment of those conditions, like DES- diethylstilbestrol, are associated with infertility. Also the natal presence of the ambiguous genital organs (microphallus, cryptorchidism, or inguinal hernia) suggests the presence of congenital hypogonadism. Many chronic diseases experienced in childhood can also interfere with the normal body growth of the boy and his sexual development. Late puberty or incomplete puberty indicates testicular absence or gonadotrophic deficit, while early puberty points to congenital adrenal hyperplasia.
     Hypogonadism in an adult man leads to decreased libido, sexual dysfunction, gynecomastia, sellar or suprasellar mass symptoms as headaches or visual problems.
     Varicocele patients also suffer from scrotal pain. Chronic prostatitis can lead to painful ejaculation, nycturia aka nocturia, and dysuria. Orchite, testicular torsion and epididymitis are characterized by brusque apparition of pain and scrotal edema.
     A short historical of patient’s sexual behavior (sex duration and technique) has to be made, and also it has to be established if he had children with other partners, also it is very important to be established if he suffers from any systemic diseases as gastro-intestinal or renal diseases usually associated with testicular dysfunction.
     The physical examination has to determine the length and thickness of the testicles. The average testicle is 5 cm long and the equivalent of 25 ml volume.
     The presence of a varicocele can be visible or palpable in a standing up position. Palpation is more efficient when Valsalva maneuver is used. Left testicle volume reduction is very common in varicocele patients; also gynecomastia is a frequent condition in patients who suffer from severe testicular dysfunctions. The prostate must also be examined and the presence of white cells in the prostatic secretion must be microscopically analyzed.

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