Ask a Doctor: Are small testes a pointer to male infertility?

A recent evaluation of all fertility data in Africa, including Kenya, showed sperm count to have declined by 72 per cent since 1965. The most affected age group was 30-49, although a significant number of those in their 20s presented with low sperm count.

The data points to decreasing fertility amongst men. Dr Patrick Gitobu Mburugu, a consultant urologist at Kenyatta National Hospital answered some of the common concerns around male fertility.

In your practice, which is the most common reason for male infertility in Kenya?

Male infertility is described as the inability to effect conception despite one year of regular unprotected intercourse. Fertility in men is a very complex issue and can be caused by very many factors.

The main broad factors can be genetic abnormalities, hormone abnormalities, abnormalities of the testes and reproductive organs, lifestyle issues such as smoking, cannabis, khat, and alcohol, underlying diseases and medications, previous surgery radiotherapy and chemotherapy among others.

It is vital to note that a lot of times we are not able to pinpoint the actual cause of infertility in a man.

How frequently do you get men seeing a doctor over their fertility?

This is a hard question to answer, but on the whole women are more likely to consult regarding fertility issues than men, and many men will only seek help after the partner has been found to have no fertility problem by the doctor.

What are some of the signs of male infertility?

Tell-tale signs include small soft testis, absent testes, testes that are placed high up in the groin rather than in the scrotum, failure to develop secondary sexual maturity (unbroken voice, absence of facial hair, breast development, small testes and penis), history of previous testicular swelling, hernia surgery, radiotherapy or chemotherapy.

Is it normal to feel something in my testicles or scrotum?

Any new lump or swelling that you feel on the testes or scrotum must be further investigated by a doctor. The scrotum contains the testes, epididymis, the vas and blood vessels, and to the untrained, it is not possible to differentiate normal from abnormal.

How do you know your sperm is healthy/unhealthy?

Freshly ejaculated sperm should be thick in consistency and pearl white in colour. After about 5 to 10 minutes, it becomes thin and runny.

Any changes in colour such as blood stained appearance should be investigated further by a doctor.

How do I know if I have erectile dysfunction?

If you are unable to attain or maintain a penile erection sufficient for satisfactory sexual performance of either partner for a period of more than 3 months.

Which is one the greatest misconception on fertility that needs to be stopped?

That fertility is mainly a female issue. One third of infertility is solely due to the man, one third due to the woman and the rest due to both.

Can a man break his penis?

Yes, forceful bending of the erect penis can result in penile fracture, e.g. when the penis slips out during intercourse and then slams against the partner’s perineum, or she sits on it hard when positioned on top. I see such cases infrequently; say once every two or three months.

How many times a day should I be urinating? 

If you pass urine more than once every 2 hours, that is known as frequency and should be investigated by a doctor. It can be due to very many factors but could commonly be from a urinary infection or an enlarged prostate.

Do men get UTIs?

Yes, they do, but much less frequently than women. It presents as painful urination, frequency and urgency of urination, smelly urine, blood in urine etc. It does not resolve on its own and urgent medical attention should be sought because urinary tract infections in men are usually an indication of a structural abnormality of the urinary tract.

Can I give my partner a urinary tract infection or can she transmit one to me?

Not directly as such like in a sexually transmitted disease. However, the act of intercourse can facilitate entry of bacteria from the female perineum to the bladder and cause a urinary tract infection in the female

As a urologist, what are your top tips for men to keep their reproductive system in tip top condition?

Physical activity, avoid alcohol, obesity, smoking and recreational drugs, balanced healthy diet, and seek immediate medical help once you notice anything out of the ordinary.