Your sexual health questions answered by a urologist

Maybe you’ve had this experience — you’re at a doctor’s appointment and you have a question about your sexual health, but you feel self-conscious so you hesitate to ask.

Mark Anderson, MD, a board-certified urologist at MultiCare Urology Puyallup, refers to these as “doorknob questions.”

“They’re often the ones that people wait to ask until the very end of the appointment, when their hand is on the doorknob to leave,” he says. “We know it can feel embarrassing sometimes, but your sexual health is part of your overall health, so we welcome these questions.”

Here are answers to six sexual health questions patients commonly ask Dr. Anderson.

Q: I’m having trouble getting an erection. Is that normal?

Difficulty getting or maintaining an erection — known as erectile dysfunction (ED) — is common as you age, particularly if you’re over 50. However, just because ED is common doesn’t mean you should ignore it. It’s important to talk to your doctor or other health care provider about erection difficulties, regardless of your age.

“The first thing we do is look at your overall health because the risk factors that lead to erectile dysfunction are the same ones that will shorten your lifespan,” Dr. Anderson says. “Once we determine what’s causing ED, then we can work toward treating those issues and setting realistic goals for sexual functioning.”

There are often multiple factors that contribute to ED, from underlying conditions like hypertension, heart disease or diabetes, to side effects from medications. There can also be a psychological component — depression, anxiety and high levels of stress can contribute to ED, Dr. Anderson shares. Your lifestyle makes a difference, too.

“Habits that are good for your overall health, like getting enough quality sleep, exercising regularly and minimizing alcohol use, are also going to support your sexual health,” he says.

Erectile dysfunction symptoms and treatments

Learn more

Q. Is there a male version of menopause, and do I need testosterone replacement?

As you age, your testosterone levels will naturally fall, but it’s gradual, happening in small increments over the course of decades — unlike what happens during menopause. While declines in testosterone can lead to changes that affect your body, most men don’t need hormone replacement therapy.

But if you experience symptoms like fatigue, low sex drive or changes in your ability to think and remember, then you should talk to your provider.

“Sometimes lifestyle factors can lead to these symptoms, so it’s important to examine those,” Dr. Anderson says. “We can also check your testosterone level with a blood test, and if it falls below a certain threshold, we can discuss the risks and benefits of testosterone replacement therapy.”

Dr. Anderson advises against taking testosterone supplements without first talking to a doctor or other health care provider. Testosterone supplements touted online are not tested or regulated by the U.S. Food and Drug Administration (FDA). They may offer little to no benefit and can also pose risks to your health.

Q. My penis curves when erect. Should I be worried about it?

A mild degree of curvature can be normal, whether it’s developed over time or you’ve had it your whole life. Sometimes Peyronie’s disease, a condition where scar tissue builds up in the penis, can cause it to bend or curve. This condition can lead to erectile dysfunction, cause pain or interfere with sex.

“Curvature in the penis doesn’t need to be treated unless it’s causing a problem for you or your sexual partner,” Dr. Anderson says. “If that’s the case, then we can evaluate your situation. Sometimes the curvature may resolve or settle on its own, and in other cases treatment may be necessary.”

Common treatments for Peyronie’s disease include injectable medication or surgery.

Q. I feel something weird in my scrotum. What’s normal to feel down there?

The scrotum is the sac that houses and protects your testicles. Any bumps you feel are most likely part of your normal anatomy or cysts — benign growths that can contain fluid or other tissue.

However, lumps or bumps can also be a sign of testicular cancer, particularly if the mass grows quickly over the course of a few months.

“If you notice something new or different that persists, or if you’re experiencing pain or swelling in your groin area, then it’s best to get it checked out,” Dr. Anderson says. “Testicular cancer is rare but can be treated and, in some cases, even cured.”

Q. How do I know if my semen is normal?

Semen is typically whitish-gray and thick, but its consistency and shade can vary across individuals. The only time you should be concerned is if there is blood in your semen.

“While this can be alarming, it typically doesn’t indicate a serious problem,” Dr. Anderson says. “It can be a sign of a prostate condition or an infection, so you should still make an appointment with your doctor to have it looked at.”

Q: My partner and I aren’t having luck getting pregnant. Should I get my fertility tested?

If you and your partner have been actively trying to conceive for at least a year without success, then it may be time to seek a urologist for an evaluation.

“Often the focus is on women, at least initially, in these situations,” Dr. Anderson says. “But men need to have a thorough workup, too.”

During an evaluation, your provider will review your medical history, perform a physical exam and order a semen analysis to examine the volume and quality of your sperm.

As with sexual health, lifestyle factors can also affect fertility. Maintaining a healthy weight, living an active lifestyle, eating a nutritious diet and avoiding substances like tobacco and marijuana can support sperm health.