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23. Dyspareunia (painful intercourse) is common. Women may experience pain during arousal, at the time of orgasm, at the initiation of intercourse, midway during intercourse, or after
intercourse. The pain may have a burning, sharp, searing, or cramping quality and may be described as external, vaginal, deep abdominal, or pelvic. A variety of psychosocial and organic causes have been identified.Chapter 265. Balanitis is an inflammation of the glans penis. It usually occurs in conjunction with posthitis,an inflammation of the prepuce. It is associated with poor hygiene and phimosis. The accumulation under the foreskin of glandular secretions (smegma), sloughed epithelial cells, and Mycobacterium smegmatis can irritate the glans directly or lead to infection. Skin disorders (e.g., psoriasis, lichen planus, eczema) and candidiasis must be differentiated from inflammation resulting from poor hygienic practices.6. Peyronie disease (bent nail syndrome) is a fibrotic condition of the tunica albuginea of the penis resulting in varying degrees of curvature and sexual dysfunction. Peyronie disease develops slowly and is characterized by tough, fibrous thickening of the fascia in the erectile tissue of the corpora cavernosa. A dense fibrous plaque is usually palpable on the dorsum of the penile shaft. The problem usually affects middle-age men and is associated with painful erection distal to the involved area.7. Cryptorchidism is a condition of testicular maldescent. In cryptorchidism the descent of one or both testes is arrested, with unilateral arrest occurring more often than bilateral arrest. Cryptorchidism is a common congenital anomaly. Cryptorchidism is commonly associated with vasal or epididymal abnormalities.8. Orchitis is an acute infection of the testes. It is uncommon except as a complication of systeminfection or as an extension of an associated epididymitis. Infectious microorganisms may reach
the testes through the blood or the lymphatics or, most commonly, by ascent through the urethra, vas deferens, and epididymis. Most cases of orchitis are actually cases of epididymo-orchitis.10. Spermatoceles (epididymal cysts) are benign cystic collections of fluid of the epididymis located between the head of the epididymis and the testis. Efferent ducts of the epididymis have potential for cystic dilation to form a spermatocele. Spermatoceles are filled with milky fluid that contains sperm. Spermatocele is differentiated from a hydrocele in that aspiration of the hydrocele recovers a clear, yellow fluid, and unlike a hydrocele, a spermatocele does not cover the entire anterior surface of the testis. Spermatoceles manifest as discrete, firm, freely mobile masses distinct from the testis that may be transilluminated.