Phimosis and Paraphimosis

Phimosis is a condition in which the foreskin gets too tight to be pulled back over the head or glans of the penis.

It occurs in males who have not undergone circumcision (removal of the foreskin covering the tip of the penis). Phimosis resolves or improves on its own with age.

Paraphimosis is a more severe condition affecting the foreskin, in which repositioning of the foreskin to the unretracted position is not possible, and this limits the blood flow to the penis and thus causes a lot of pain and discomfort. Since it affects blood supply it is more often a medical emergency.

In adults, there are certain factors that may lead to Phimosis or Paraphimosis such as-

  1. Repeated urinary tract infections.
  2. Foreskin infection
  3. Repeated rough handling of the foreskin
  4. Sexually Transmitted Infections
  5. Certain other health conditions such as Diabetes (which predisposes one Eczema, Psoriasis, Lichen planus, Lichen sclerosis

Certain symptoms such as those below should hint on Phimosis or Paraphimosis- 

  1. Inability to pull back the foreskin*
  2. Redness, soreness, or swelling of the foreskin
  3. A tight foreskin which may interfere with the normal passage of urine and cause incomplete emptying of the bladder.
  4. Bulging of the foreskin (especially during urination)
  5. Phimosis can lead to inflammation of the penis, called balanitis, or inflammation of both the glans and the foreskin.
  6. Difficulty ejaculating
  7. Difficulty urinating
  8. Discoloration or bruising of the tip of the penis *
  9. Swelling of the tip of the penis *

The diagnosis of phimosis or paraphimosis is made by history and physical examination. Due to the sensitivity of the situation many men feel shy to discuss it with medical practitioners. However, it is very important to talk about it especially if you have any of the symptoms that have been marked with * as they may turn into an emergency.

The treatment most often depends on the cause.

Phimosis is a relatively non- emergency situation and a visit to a urologist can help. The treatment advise is based on the severity of the condition and if it has been recurring. Certain tips on hygiene and treatment for the underlying cause is given if it is non-recurrent. However, if it is serious and recurrent, the doctor may advise you for circumcision.

Paraphimosis, on the other hand, if often an emergency and painful situation which may require minor surgery.

Tips to prevent Phimosis and paraphimosis

  1. Good hygiene – Gently cleaning the penis and under the foreskin, with warm water, every day will help avoid problems. This will help in keeping the skin loose and avoiding infection.
  2. Carefully replacing the foreskin – It is important to replace the foreskin every time it is pulled back.
  3. Being sexually responsible – It is important to use condoms and practice safe sex.
  4. Take care of underlying health issues – that may give rise to either- If you are a diabetic or suffer from any condition that may give rise to recurrent urinary tract infection then it is advisable to keep a check on your underlying condition.
  5. Circumcision – Recurrent Phimosis can be prevented by circumcision.


Written by Dr.Afroze Fatima

Everything you need to know about delayed menstrual periods

A delayed period can be really stressful for women who usually have regular periods. The best way to deal with this anxiety is to educate oneself about the situation.

The first and the most important thing is to know what is normal and what is abnormal so that you are not stressed by a mere normal variation of your menstrual cycle! 

 Menstrual cycle: The time from the day a menstrual period starts to the time the next period starts. 

An average menstrual cycle is about 28 days long. However, a normal cycle may be shorter or longer and may range anywhere from 21 to 35 days long. 

The factors that may cause variation in a menstrual cycle are- Stress, travel, diet, illness, medication, contraceptive pills, excessive exercise, being on extremes of body weight range-either low weight or overweight, hormonal imbalances such as thyroid hormone imbalances and PCOS (polycystic ovarian syndrome), infections of the genital tract.

To know if or not your period is actually delayed, it is important that you have regular cycles – the dates and the length of the cycle must be known to you. It can be difficult to know for sure if your period is late if you don’t know your average cycle length and the date of your last period. 

Quick tip 1- if you have trouble remembering the dates or maintaining calendars- there are many apps online that can help you. Downloading one and feeding the date per month can really help.

If you have a regular cycle then a variation of 5-7days is considered to be normal. A menstrual period is considered to be late if it hasn’t started 7 or more days after the day you expected it to start. A period is said to be missed if there is no menstrual flow for 6 or more weeks after the start of the last period.

What is to be done in case of the delayed or missed period depends on the following factors-

Whether you have a regular cycle or not

Whether you are sexually active or not; If sexually active, whether you are using contraception; If yes, which method?

Whether you suffer from any major hormonal imbalance disorders such as hypothyroidism or PCOS or any other chronic health issues

If your cycles are regular and you have been sexually active, then it is advised to take a pregnancy test if your period is around 9-10 days late. In case of getting a negative result, it is advisable to wait for another week and repeat the test. If your cycles are irregular and you have been sexually active then you can take a pregnancy test about two weeks after your last unprotected sexual encounter.

If you are not sexually active and yet have missed periods, it is advisable to visit your doctor after observing for at least 1 more cycle.

If the pregnancy tests came out to be negative and you still haven’t had a period in more than 90 days, it is important to meet with your doctor for a detailed evaluation and testing on what could be the cause in delay of the period.

Quick tip 2- having a log of periods (dates, duration, any stressful activities, changes in diet, recent fitness activity, any recent illness, any changes that were observed in the previous period) for at least a month before visiting your doctor can come really handy!

Written by-

Dr. Afroze Fatima



Low libido usually indicates decreased interest in sexual activity.

It may be difficult to say if one’s low sex desire is worrisome because normally it varies between individuals, situations, various periods in life. But losing sex desire for long duration may need medical attention for a healthy life physically, mentally and emotionally. 

One in every 5 men is reported to have low sex desire according to studies. 

Sexual desire may decrease naturally as age progresses in men by about 60s and 70s.  

Testosterone is the hormone, that is normally responsible for the muscle build, bone mass, stimulation of sperm production in testicles, sex desire in men. 


  • Hormonal changes- Low testosterone levels are the most important and the most common causes of low libido among hormonal changes. Levels below 300-350 ng/dL can be considered low. Other hormonal changes causing libido can be low thyroid hormone levels, high prolactin levels, low dopamine levels. 
  • Stress, depression.
  • Emotional disturbances, relationship issues with the partner. 
  • Medications- Antidepressants, medications for hypertension (high blood pressure) such as ACE inhibitors, beta blockers but libido may or may not be seen in all individuals taking the medications. 
  • Sleep disturbances such as inadequate sleep for less than 6-7 hours in a day, disturbed sleep, nightmares, etc. 
  • Chronic medical conditions such as cancer, Diabetes, hypertension, high cholesterol levels, obesity, etc. but may vary between individuals.
  • Frequent intake of alcohol, drug abuse such as marijuana. 
  • Age from about 60-65 years. 


Many men hesitate to discuss with doctor regarding decreased sex desire and other sexual health issues. However, it is important to discuss the same with the treating doctor as treatment can be very simple, most of the times.

The doctor may take history to understand if there is an underlying cause such as stress, depression, sleep disturbances, medical conditions, current medications, etc. and may advise tests to check for testosterone hormone levels in  the blood. 

  • Hormone replacement therapy of testosterone may be prescribed, if the levels are less than normal in blood. This is not needed or prescribed by the doctor, if testosterone levels are normal. 
  • Underlying medical conditions are treated with appropriate medications accordingly. 
  • Stress, depression may be treated with medications, counseling, psychotherapy, etc. Other measures, that may help can be deep breathing exercises, practicing yoga, meditation, hobbies like listening to music, reading books, going for a walk/jog in a park. Regular exercises, playing with pets, spending more time with family and loved ones, hot shower, gentle body massage with aromatic oils, getting adequate sleep of at least 6-7 hours a day, etc. may also help.
  • Medications may cause loss of libido and usually it is attributed to the starting of the medication. If that is the possible cause, the treating doctor may change it’s dose or give an alternate medication. 
  • Restricting or decreasing the frequency and amount of alcohol, abstinence from drug abuse. 
  • Getting adequate sleep of about 6-7 hours in a day.



–   Dr. Divya Teja Pasupuleti


You can do a lot to take care of your health and still over the time the body ages in ways which you can’t control. One of the conditions that affects men at older age is benign prostatic Hypertrophy.

It is a common condition where in there is enlargement of the prostate leading to urinary symptoms, such as blocking of urinary flow from bladder leading to bladder distension.


  • Frequent or urgent need to urinate
  • Bladder distension
  • Difficulty in urinating
  • Dribbling at the end of urination
  • Unable to completely empty the bladder
  • Urinary tract infection
  • Blood in urine

Risk factors:

  • Aging: by the age of 60 years most of the men suffer from symptoms and signs of BPH.
  • Family history: there is high chances of you getting the condition, if your father or brother is has suffered from BPH
  • Lifestyle: obese people are more prone to BPH
  • Medications: studies show that use of beta blockers may increase the size of the prostate.


Doctor would first ask you about detailed personal and familial history . Then based on the signs and symptoms would suggest below test:

  • Digital rectal examination: doctor examines by inserting the finger in the rectum to check for prostate enlargement.
  • Urine test: to rule out the urinary tract infection and other conditions which may cause such symptoms
  • Prostate Specific Antigen: it is produced by prostate and the levels are increased in case of enlargement
  • Ultrasound test: to check the size of the prostate and to look whether it’s healthy.


Depends on the severity and age of the patient


Doctor may prescribe medications to relax your prostate and bladder muscles. In few cases medications are used to reduce the size of prostate.


Minimally invasive procedures: such as TUIP, TUMT, TUNA, and TURP.

Most common is TURP- Transurethral resection of prostate, where in a scope is inserted into urethra and the prostate is removed with the help of scope. It quickly relieves the symptoms and faster recovery is seen.

Prostatectomy: where in the entire prostrate or a part of it is removed.


Lifestyle changes:

Do exercises to strengthen the pelvic floor muscles

Reduce intake of fluids at bedtime or before you go out.

Drink less caffeine and alcohol.






Bartholin glands are located on either side of the vaginal wall opening. These glands help secrete fluids which lubricate the vagina.

In some cases these glands become obstructed, causing the fluid to back up in the gland leading to formation of the cyst. It is called as bartholins cyst.

If the fluid in the cyst becomes infected you may develop collection of pus surrounded by inflamed tissue.


If the cyst becomes infected, you may experience:

  • Painful lump near the vaginal opening
  • Pain during intercourse
  • Fever
  • Discomfort while walking and sitting


Only a doctor can tell you for sure. She/he will physically examine and if there is abscess or pus formation then he/she may take a culture of it and send it to lab.


Most of the cases don’t require any treatment if there are no symptoms.

Sometimes treatment depends on severity of the symptoms

Treatment options include:

Sitz baths:  soaking in tub filled with warm water three to four times a day may rupture the cyst and drain on its own.

Surgical drainage: large cysts are drained by making incision which can be done under local anesthesia.

Antibiotics: if the culture reports are indicative of infection, then antibiotics are prescribed for a period of time.


It is not clear why bartholin’s cysts develop. But it can be prevented by taking few measures such as

  • Practicing safe sex
  • Prevent sexually transmitted diseases
  • Maintaining Personal hygiene

                                                                                                                            …….. Dr.chandrashekar




Torsion testis – How is it managed and who is at risk for it?

Testes are the reproductive organs in men. Torsion of the testis is a condition where the testis spins leading to twisting of the spermatic cord. As the spermatic cord undergoes twisting due to any cause, the blood vessel to the testis (testicular artery) would undergo occlusion, decreasing the blood supply of the testis leading to testicular damage and ultimately causes death if not treated immediately.

Testicular torsion usually occurs in two different age groups:

     Neonatal period (fortunately very rare)

     Peri-pubertal period (i.e. in adolescents aged 12 to 18 years)

Risk Factors of Testicular Torsion are:

  • If someone in your family has suffered from this condition, you could be susceptible to it. Presence of the bell-clapper deformity can also lead to testicular torsion.
  • If you receive minor trauma such as the one during playing any kind of contact sports, outdoor activities or even while doing house work, it can be a reason of this condition as well.
  • Heavy exercising or running in an unbalanced or improper manner can cause torsion as well.
  • Improper sleeping positions can also cause torsion and is a common cause behind frequent torsion and detorsion.
  • Previous history of testicular pain that became alright on its own (torsion and detorsion) may increase the chances of it happening again.
  • Other factors: Excessively cold temperatures wherein the scrotum contracts rapidly and prolonged contraction can cause torsion. Fast growth of the scrotum during the adolescent years after puberty may cause torsion.

Testicular Torsion Diagnosis:

1.Physical Examination

In most cases, diagnosis is made based on the patient’s or patient’s family history and physical findings. Testicular torsion is a surgical emergency, and delaying surgery might cause irreversible damage to the testis and infertility.

2.Scrotal Doppler Ultrasound Study

In certain cases, if the pain is of very recent onset, the surgeon may order a Doppler ultrasound to check the blood flow to the testis. In torsion, the blood supply will be reduced.

However, in most cases if the pain has been there for a prolonged duration of time, the patient is directly taken up for surgery without any further delay in a bid to salvage the testis.

Management of testicular torsion:

Manual Detorsion

Testicular torsion is a surgical emergency. In some cases, the torsion might be manually corrected during initial examination, before any diagnostic imaging.

Surgery for Torsion Testis

Immediate surgical treatment is the best option to salvage the testis when torsion occurs in children or young adults.

A good history, clinical experience of the doctor and a high index of suspicion are usually the factors on which a decision is taken for performing the surgery and in most instance the surgery is done under local or regional anesthesia within 2 to 4 hours if not earlier.  

The rate of salvage of the testis is high if the surgery is done within 4 to 6 hours and drops to almost zero at 12 hours. In this procedure the testes are fixed to the posterior wall and they are preserved functionally. Its called as orchidopexy.

If the testis looks gangrenous and does not get restored after the cord is untwisted, it is best advised to be removed. It’s called orchiectomy.

Complications of Testicular Torsion:

If untreated, torsion of the testis may lead to-

  • Damage to the testis due to lack of blood flow (infarction) and its atrophy
  • Decreased fertility or infertility – reduced or absent chances of fathering children

-Dr.Bhavani Sagar Surampally


Enlarged male breast tissue

The enlargement of male breast tissue is known as Gynecomastia in medical terms. It is a fairly common problem and is benign. It can affect one or both breasts and can often be an embarrassing situation for males. It may be seen in newborn males, males undergoing puberty or older men.

Gynecomastia is different from pseudogynecomastia or lipomastia, which refers to the presence of fat deposits in the breast area of obese men. True gynecomastia  results from growth of the glandular breast tissue, which is present in minor amounts in men- and does not respond to exercise or weight loss.

Gynecomastia results from an imbalance in the hormones in the body, with a relative excess of oestrogens (female hormones) when compared to androgens or testosterone (male hormones).

Certain medications (like antibiotics, anti-anxiety drugs, antacids, Anabolic steroids)  health conditions (like thyroid issues, liver failure, renal failure) or intake of certain products (like soy, Street drugs , alcohol,) may also result in this problem.

If the gynecomastia happens during puberty, it may go on its own. However, if it happens later on in life, it mostly requires medical intervention.

After a careful evaluation of the breast, and differentiating between true gynecomastia and lipomastia, you may be advised by your doctor to-

  1. Try weight loss
  2. Visit an endocrinologist to get your hormones assessed.
  3. Treat the underlying cause

And if none of the above work, treatment options, including medication and surgery are explored.

Many men suffer from it and face teasing and the disapproval of peers. The problem of gynecomastia is very common and embarrassing but the good news is that it can easily be corrected. It is highly advisable to reach out to a physician if you or any of your family members suffer from this.


Dr.Afroze Fatima


Patchy beard (Alopecia Barbae)

It is a specific form of Alopecia areata which usually affects beard. It is a autoimmune disease which affects hair follicles. The exact cause of alopecia areata is unknown, but it seems to be caused by the immune system attacking the hair follicles by mistake. It’s a sudden onset of losing  beard hair in small circular patches, often seen along jawline. It can be isolated to the beard or sometimes it may even occur in scalp or face. Exact cause is not known, but psychological and physical stress are linked to it. Increased risk in case of family history of autoimmune diseases. Some medications and viruses can trigger the condition.  Itching and pain can be felt at the area of hair loss.

Blood test and scalp biopsy may be needed to diagnose the signs of infection or the underlying cause. But most of the time based on the way it looks and the pattern of hair loss, dermatologist will diagnose it. Other tests to rule out fungal infections and thyroid disorders are advised.

There is no cure for Alopecia Barbae, but the symptoms can be controlled. People with mild early alopecia areata may need no treatment, as their hair is likely to come back anyway without it. With treatment hair may grow back, but there is no guarantee that it won’t fall again. Treatment always depends on the age, hair loss you have and the underlying condition. If there is very extensive hair loss from the start, the chances of it regrowing are not as good. Any treatments that carry serious risks should be avoided, as alopecia barbae itself has no adverse effect on physical health.

Some other options are:

» Topical steroid creams or ointments
» Steroid injections into the bald patches
» Contact sensitizers, such as squaric acid or DPCP(Diphencyprone)
» Other topical medications, like anthralin or minoxidil



Dr. Y. Alekhya


Missed abortion

A miscarriage is the loss of foetus before 20 weeks of pregnancy. It is also called silent abortion.

A missed abortion gets its name because this type of miscarriage doesn’t cause symptoms of bleeding and cramps that occur in other types of miscarriages. This can make it difficult for you to know that the loss has occurred.  

Causes of missed abortion

The causes of missed abortion are not fully known. About 50% of miscarriages happen because the embryo has the wrong number of chromosomes. Other causes can be-

  • Uterine scarring
  • Heavy smoker
  • Autoimmune disease
  • Physical trauma

If you have a missed miscarriage, your doctor most likely won’t be able to pinpoint a reason. In a missed miscarriage, the embryo simply stops developing and there’s usually no clear explanation.


It is common to have no symptoms with a missed abortion. There may be a slight brownish discharge or pregnancy symptoms like nausea, breast tenderness lessen or disappear.

How is missed abortion diagnosed?

After a diagnosis of pregnancy, a woman may not have any obvious symptoms and  missed miscarriage may be diagnosed by ultrasound before 20 weeks gestation. Usually, the doctor diagnoses it when they cannot detect a heartbeat at a prenatal checkup. In pregnancy less than 10 weeks, your doctor will check for Hcg hormone in the blood.  If the hCG level doesn’t rise at a typical rate, it’s a sign the pregnancy has ended.


Expectant management-This is a wait and watch approach. In almost 65% of the cases, missed abortion is left untreated and the embryonic tissue passes on its own. If it’s not successful,  medication or a minor procedure may be needed to pass the embryonic tissue and placenta.

Medical management- In this, you may be advised to take tablet misoprostol by your doctor which triggers the passing of remaining embryonic tissue to complete the abortion.

Surgical management-Dilation and curettage (D&C) surgery may be necessary to remove remaining tissue from the uterus. Your doctor may recommend a D&C immediately following your diagnosis of a missed miscarriage, or they may recommend it later if the tissue doesn’t pass on its own or with the use of medication.

Usually normal periods return after 4-6 weeks, physical recovery takes weeks to months and emotional recovery takes longer.

Your doctor might recommend waiting for at least three months after the miscarriage before trying to conceive again.

If you feel you have missed your periods and developed initial signs or pregnancy like nausea, vomiting, breast tenderness or fatigue which disappear abruptly, there may be strong suspect of missed abortion and you should see your doctor at the earliest.

-Dr Prerna Gaur



Pic Credits: Internet


Injectable contraceptives

Depo-Provera (medroxyprogesterone acetate or DMPA) is a form of birth control. It is an injection, or shot, that contains progestin. This is a natural hormone that your ovaries produce each month as part of your menstrual cycle.

How does it work?

Depo-Provera prevents pregnancy by stopping ovulation (the release of an egg by your ovaries). It thickens your cervical mucus, which makes it hard for sperm to reach and fertilize an egg. It also thins your uterine lining, which makes it hard for a fertilized egg to implant, or attach, to your uterus.

How is it administered?

Your doctor will give you the injection in either in your upper arm or buttock. It is given into  your muscle (intramuscular).

Depo-Provera works for about 3 months at a time. To prevent pregnancy, you have to get 1 shot from your doctor 4 times a year, about 12 to 14 weeks apart. If you get it in the first 7 days of your cycle, it works right away. If you don’t, you’ll need to use another form of birth control for 1 week. Your doctor will confirm you are not pregnant before giving you the injection.

What is the effect of DMPA on periods?

Most women who use Depo-Provera have changes in their menstrual periods. These may include:

  • bleeding or spotting between menstrual periods
  • an increase or decrease in menstrual bleeding or no menstrual bleeding at all

About half of women who use Depo-Provera stop having periods after 1 year. This is not harmful. Menstrual bleeding usually returns to normal when you stop using Depo-Provera. It may take about 9 to 10 months to get pregnant after your last shot.

What are the advantages?

  • Convenient, requires only four shots per year
  • Discreet
  • Very effective
  • Reversible
  • Very light or no periods beneficial in conditions like iron deficiency anemia,excessive bleeding,cramping during periods. May be a desired lifestyle change; can also decrease the risk of dysfunctional menstrual bleeding in women who are overweight.
  • Lack of estrogen in DMPA makes it appropriate for smokers older than age 35, postpartum, breastfeeding women, and others who have contraindications to estrogen.

What are the disadvantages?

  • Requires visit to clinician for quarterly injection.
  • Initial irregular bleeding
  • Weight gain may occur in some women due to increased appetite, particularly those who are sedentary or overweight when they begin DMPA.
  • Short term reversible bone mineral density loss.
  • Delayed return to fertility: the median time to conception for those who do conceive is 10 months after the last injection, much longer than with other hormonal methods.
  • No protection against STIs.

 What are the possible side effects?

  • weight gain
  • headaches
  • nervousness
  • abdominal pain
  • dizziness
  • weakness or fatigue
  • osteoporosis (loss of bone density)
  • blood clots

Contact your doctor right away if you have abnormally heavy or nonstop bleeding.

Also To renew your DMPA prescription you will need to see a doctor for review once a year. A review of risks for loss of bone density (osteoporosis) will take place at this visit.

Injectable contraceptive is a good option for you if you choose to use contraception methods at a leisure and to avoid daily usage of pills or insertion of IUDs.Discuss with your doctor if DMPA is a good choice for you keeping in mind the risks and benefits.


-Dr Prerna Gaur