retracted testicle

[miagi]

I am a 64 year old male. Due to a seminoma, my right testicle was surgically removed  about 32 years ago and replaced with a prosthesis.  In recent years there is a persistent tendacy for my left testicle to ascend into my groin.  There is also what seems to be a hernia, characterized by a puffy groin on the left side (though no pain). I'm wondering if there is a connection and whether there is a procedure which could correct these problems without severing important nerves etc.  A corresponding sympton is that erections have become fairly rare, and lack any real stiffness or duration.  A recent  exception was when I took a viagra pill shortly before a rare and rather unsuccessful attempt at intercourse.  Probably not enough lead time; less than half an hour.  But, the next morning I woke up with an erection so hard you could have hung a towel on it.  So, I 'm also concerned that perhaps there has been some atrophy or reduced sexual response in the remaining testicle...or is this just the onset of old age?  Finally, I've learned recently about the development of "malanotan", ostensibly for tanning the skin, but with the side effect of producing strong erections.  As I understand it, this molecule (discovered at Arizona University) is in development at Palatin Technologies in New Jersey, but not yet available to the public.  So, I also wonder if there is anything already on the market for reduced libido?  Sorry if this is more than one question, but it all seems related.

tl

[Kevin Pho, MD]

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

A retractile testicle is one that has fully descended but which can be lifted up out of the scrotum by the contraction of the cremaster muscle (cremasteric reflex), which attaches to the testicle. In the retracted position, the testicle may rise as far as the superficial inguinal pouch, a small pocket under the skin of the groin just below the inguinal canal.  

Retractile testicles appear to be otherwise normal and do not have the risks for infertility or testicular cancer that are associated with true undescended testicles. Some studies have suggested that retracted testicles lower testosterone production over time.

You will find that wearing warmer under clothes will definitely help as your scrotum will relax. You could also consider wearing a jock strap rather than ordinary pants, as these are more comfortable to wear with retractile testicles.

There are many reasons for the lack of an erection.  Most common reasons include psychogenic causes, hormonal causes, medications, and concurrent diseases (i.e. diabetes, peripheral neuropathy, or peripheral vascular disease). A thorough physical exam should be performed, as well as tests for testosterone, prolactin, and thyroid function.  Further tests such as nocturnal penile tumescence testing and ultrasound may be suggested in conjunction with your urologist.

Low libido may be suggestive of testosterone deficiency.  If this has been diagnosed, there are methods of replacing this hormone.  I am unaware of studies involving melatonin and sexual dysfunction.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.