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  <head>
    <title>052-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Male reproductive and sexual health">
      <outline text="Orientation">
        <outline text="Embarrassment and stigma delay presentation">
          <outline text="Inclusive language, confidentiality, permission"/>
        </outline>
        <outline text="Time-critical: torsion, Fournier, priapism"/>
      </outline>
      <outline text="Hormonal control and hypogonadism">
        <outline text="Pulsatile releasing hormone stimulates gonadotropins">
          <outline text="Luteinising hormone drives Leydig testosterone"/>
          <outline text="Follicle-stimulating hormone acts on Sertoli cells"/>
        </outline>
        <outline text="Testosterone and inhibin give negative feedback"/>
        <outline text="Primary: testicular failure, high gonadotropins">
          <outline text="Chromosomal, orchitis, torsion, chemotherapy, radiation"/>
        </outline>
        <outline text="Secondary: hypothalamus or pituitary">
          <outline text="Tumours, prolactin, opioids, steroids, obesity"/>
        </outline>
        <outline text="Diurnal and illness-related variation">
          <outline text="Repeat properly timed testing with context"/>
        </outline>
        <outline text="Replacement only for proven deficiency">
          <outline text="Suppresses spermatogenesis, erythrocytosis"/>
          <outline text="Not a treatment for fatigue or ageing"/>
        </outline>
      </outline>
      <outline text="Sexual history and examination">
        <outline text="Concerns, partners, practices, function, fertility"/>
        <outline text="Do not infer identity from partners or anatomy"/>
        <outline text="Onset, consistency, morning erections, situation"/>
        <outline text="Palpate testis, then epididymis and cord">
          <outline text="Normal testis smooth and firm, not hard"/>
        </outline>
        <outline text="Ultrasound more reliable than transillumination"/>
      </outline>
      <outline text="Erectile and ejaculatory dysfunction">
        <outline text="Nitric oxide, inflow, relaxation, venous occlusion"/>
        <outline text="Vascular, neural, endocrine, drug, psychogenic, mixed"/>
        <outline text="Small penile arteries: early cardiovascular marker">
          <outline text="Assess pressure, diabetes, lipids, smoking, fitness"/>
        </outline>
        <outline text="Phosphodiesterase five inhibitors amplify nitric oxide">
          <outline text="Need sexual stimulation"/>
          <outline text="Never with nitrates: profound hypotension"/>
        </outline>
        <outline text="Vacuum, intraurethral, intracavernosal, prosthesis"/>
        <outline text="Premature ejaculation: distress and poor control"/>
        <outline text="Delayed ejaculation: serotonergic drugs, neuropathy"/>
        <outline text="Retrograde: bladder outlet fails to close"/>
      </outline>
      <outline text="Priapism and penile disease">
        <outline text="Priapism: erection over four hours"/>
        <outline text="Ischaemic: painful, rigid compartment syndrome">
          <outline text="Blood disorders, injections, psychotropics"/>
          <outline text="Urgent aspiration and sympathomimetics"/>
        </outline>
        <outline text="Non-ischaemic: arterial trauma, less painful"/>
        <outline text="Paraphimosis: oedema compromises blood flow">
          <outline text="Urgent reduction"/>
        </outline>
        <outline text="Balanitis and Peyronie plaque"/>
        <outline text="Penile cancer: biopsy persistent lesions">
          <outline text="Smoking, phimosis, oncogenic papillomavirus"/>
        </outline>
      </outline>
      <outline text="Acute scrotal pain">
        <outline text="Torsion blocks venous then arterial flow">
          <outline text="No sign safely excludes torsion"/>
          <outline text="Explore and fix both sides without imaging delay"/>
        </outline>
        <outline text="Epididymitis: gradual, posterior tenderness">
          <outline text="Test urine and infections, treat partners"/>
        </outline>
        <outline text="Fournier gangrene: rapid perineal necrosis">
          <outline text="Pain beyond visible findings"/>
          <outline text="Resuscitation, antibiotics, immediate debridement"/>
        </outline>
        <outline text="Hydrocele and left-sided varicocele">
          <outline text="Right-sided or non-reducing: secondary obstruction"/>
        </outline>
        <outline text="Solid intratesticular mass is malignant">
          <outline text="Urgent ultrasound, no trans-scrotal biopsy"/>
        </outline>
      </outline>
      <outline text="Testicular cancer">
        <outline text="Younger adults, painless lump or heaviness"/>
        <outline text="Undescended testis and previous tumour"/>
        <outline text="Markers classify but can be normal"/>
        <outline text="Radical inguinal orchidectomy"/>
        <outline text="Highly curable with stage-adapted care"/>
        <outline text="Discuss sperm banking before treatment"/>
      </outline>
      <outline text="Prostate disorders">
        <outline text="Hyperplasia: androgen-dependent transition-zone growth">
          <outline text="Symptoms reflect tone and bladder, not size"/>
          <outline text="Alpha-one blockers relax outlet quickly"/>
          <outline text="Five-alpha-reductase inhibitors shrink over months"/>
          <outline text="Retention, infection, renal compromise: surgery"/>
        </outline>
        <outline text="Acute prostatitis: cultures, penetrant antibiotics"/>
        <outline text="Chronic pelvic pain: no repeated antibiotics"/>
        <outline text="Prostate-specific antigen rises with benign causes"/>
        <outline text="Screening is preference-sensitive">
          <outline text="Deaths prevented versus overdiagnosis and harm"/>
        </outline>
        <outline text="Magnetic resonance and risk-adapted biopsy"/>
      </outline>
      <outline text="Male infertility">
        <outline text="Evaluate both partners"/>
        <outline text="Production, obstruction, ejaculation, endocrine"/>
        <outline text="Repeat semen analysis because results vary"/>
        <outline text="Treat reversible factors">
          <outline text="Stop exogenous testosterone"/>
        </outline>
        <outline text="Insemination, in-vitro fertilisation, sperm injection"/>
      </outline>
    </outline>
  </body>
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