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Your testicles are a very sensitive part of your body. So whether it’s an occasional twinge or constant ache, testicular pain can be worrying. Most of the time there isn’t a cause for concern, but it’s worth knowing the most common causes of testicular pain and when it’s smart to get checked out. 

## What does testicular pain feel like?

Testicular pain can feel different from person to person, usually depending on the cause. The pain can be short and sharp or a dull ache that’s always there. You might feel pain in your left testicle, right or both, and the pain may spread to the lower abdomen and the area surrounding your testicles.

## What is chronic testicular pain?

Chronic testicular pain is called chronic orchialgia. This is where testicular pain lasts for more than 3 months and affects your daily life, for example by making it too difficult to do physical activity. The pain can be intermittent or constant. 

Chronic orchialgia might start from something small like a knock to the testicles or an infection, but if the pain is long-lasting it’s important to seek medical help.

## 8 common causes of testicular pain

### 1. Trauma

Almost everyone with testicles knows how much it can hurt when they’re knocked. A lot of testicular pain is simply down to trauma to the testicles which could be caused by an accident or playing sport. The pain is often accompanied by bruising or swelling. 

If you’ve experienced a blow to your testicles, over-the-counter painkillers can help with the pain, and a warm bath can help reduce any swelling. If the pain is severe, get urgent medical help. 

### 2. Epididymitis 

[Epididymitis](https://www.livi.co.uk/medical-advice/urology/epididymitis/) is where the tube at the back of your testicles, called your epididymis, becomes swollen and painful.

It’s often caused by an [STI](https://www.livi.co.uk/your-health/10-common-stis-and-their-treaments/) like [gonorrhoea](https://www.livi.co.uk/medical-advice/sexual-health/gonorrhoea/) or [chlamydia](https://www.livi.co.uk/medical-advice/sexual-health/chlamydia/), though it may also be down to an infection that isn’t transmitted through sex. As your body works to fight the infection you can feel pain in the area around your testicles. 

As well as pain in one or both of your testicles, you may experience:
- A warm feeling, swelling, redness or tenderness in your scrotum
- A lump or swelling in your testicle – this is caused by fluid around your testicle
- Difficulty or pain when you pee
- A white, yellow or greenish discharge from the tip of your penis

If epididymitis is caused by an infection you’ll need antibiotics to treat it, so speak to a doctor if you have symptoms.

It’s worth getting an STI test if you haven’t had one recently. Visit a sexual health clinic – they can advise you further, arrange for treatment if you need and anonymously let past and present sexual partners know. 

### 3. Orchitis

Orchitis is an inflammation of the testicles caused by a virus or infection. It’s often a complication of epididymitis that hasn’t been treated.

Orchitis causes severe testicular pain that can be debilitating, so seek urgent medical help if you’re experiencing symptoms.

In orchitis, the pain may be accompanied by:
- Swelling and tenderness in one or both testicles
- Fever
- Nausea or vomiting
- Fatigue

Orchitis can be caused by mumps. This is usually accompanied by a temperature, headache and swelling of the glands at the side of your face. Many people are vaccinated against mumps, so it’s not common.

### 4. Cyst

Epididymal cysts are lumps caused by a collection of fluid in the epididymis, the tube behind the testicles. These cysts are common, harmless and usually don’t need treatment, but the lump can be mistaken for testicular cancer so it’s worth seeing a doctor to identify the cause. 

### 5. Hernia

A [hernia](https://www.livi.co.uk/medical-advice/digestive-system/hernia/) happens when an internal part of your body, like an organ or fatty tissue, pushes through a weak spot in the surrounding muscle or tissue wall. This causes a lump or swelling in your groin or lower abdomen, leading to testicular pain and swelling.

You can check if you have a hernia looking for lumps around your tummy and groin. The lump may disappear when you push it back in or if you lie down, only for it to pop out again if you strain.

Hernias aren’t usually serious, but they can cause complications so it’s good to get it checked by a doctor.

### 6. Kidney stones

[Kidney stones](https://www.livi.co.uk/medical-advice/urology/kidney-stones/) are hard lumps that form in your kidneys from waste products in your blood. They can travel down the tubes that connect your kidney to your bladder, causing testicular pain. 

If your testicular pain is caused by kidney stones, you may also have:
- Pain your groin or the side of your abdomen
- Nausea or vomiting
- Sweating and a high temperature
- Blood in your pee
- A [urine infection](https://www.livi.co.uk/medical-advice/urology/urinary-tract-infection-uti/) – this can cause a burning sensation when you pee and make you feel like you need to go more often

Small kidney stones will usually pass on their own, but it can be painful. A doctor can advise you on how to help the process or suggest other treatments if they’re large.

### 7. Varicoceles

Varicoceles are a large group of dilated veins that gather in your testicles. Sometimes varicoceles are symptomless, but in some cases it causes testicular pain that gets worse throughout the day or during physical activity, and the testicle can feel heavy and lumpy.

Varicoceles tends to happen mostly in the left testicle, so if you only have pain in your left testicle, it’s worth having a feel to see if it feels different from the other.

### 8. Testicular torsion

Testicular torsion happens when your spermatic cord gets twisted which restricts blood flow to the testicles. It’s a serious condition that needs urgent medical attention so go to A&E if you experience:
- Sudden and severe testicular pain
- Pain in your abdomen
- Your scrotum turning a darker colour
- Swelling
- Vomiting

Testicular torsion can usually be resolved with surgery if you’re treated within 6 hours. 

## Could I have testicular cancer?

Thankfully, testicular cancer isn’t very common and will usually present with a lump, not testicular pain alone. If you have a dull ache in your testicle with no lump present, it’s very unlikely you have testicular cancer, but there could be a different cause for your pain. 

Find out more on the symptoms of testicular cancer and [how to check your testicles for lumps](https://www.livi.co.uk/your-health/testicular-cancer-how-to-spot-the-signs/).

## When should I speak to a doctor?

Seek medical help if:
- Your pain lasts longer than a few days
- There’s a lump or swelling around your testicles
- You have a fever
- Your scrotum is red, tender and hot to touch

If your testicular pain is very sudden and severe, it could be an emergency like testicular torsion, so call 111 or go to your nearest A&E.

__This article has been approved by Dr Bryony Henderson, Lead GP at Livi.__


Article page > When to worry about testicular pain > CTA

Speak to a GP about testicular pain

Article page > When to worry about testicular pain

When to worry about testicular pain

There are many reasons you might feel pain in one or both of your testicles. Discover the different causes of testicular pain and when to seek help.

Meta information > When to worry about testicular pain

When to take notice of testicular pain | Livi 

livi.co.uk > medical reviewer

Dr Bryony Henderson

Lead GP at Livi

Men Health

Men's Health

When to take notice of testicular pain

Feeling itchy on or around your testicles can simply be caused by sweating in your groin area from lots of walking or being sat in a stuffy office. But there are other medical reasons that cause itching which can be easily treated. 

## What are the causes of itchy testicles?
Although the problem is usually benign, itchy testicles can be caused by a number of different factors.

### Dryness
Dryness is the result of not enough moisture in the skin. The symptoms of skin dryness are quite varied. You may notice peeling skin on the surface layer, a rough appearance, redness or dry patches.

Symptoms of dryness are often associated with itching, a feeling of tightness in the skin and occasionally a painful or burning sensation.

### Irritation
Skin irritation can be caused by several things. In some cases it may be the result of chafing, but it could also be an allergy to a chemical substance such as shower gels, soap, washing powder, fragrance or latex.

### Crabs
Crabs (pediculosis pubis or phtiriasis pubis), also known as pubic lice, are classified as a [sexually transmitted infection (STI)](https://www.livi.co.uk/your-health/6-common-stis-and-their-treaments/). They are usually transmitted via sexual contact, infested bed linen or clothing. If they’re not treated promptly, crabs can spread to other areas of the body including the eyelashes, chest, face and armpits.

### Maceration
Maceration is extremely common and is caused by excessive sweating ([hyperhidrosis](https://www.livi.co.uk/your-health/what-causes-excessive-sweating-doctors-guide-to-hyperhidrosis/)) and occurs mainly during the summer months, particularly in sporty or overweight people. Certain clothing like swimwear can also be a cause of maceration.

### Genital thrush
Genital thrush is usually caused by a fungus called candida albicans. This fungus spreads and causes redness associated with itching, and can also cause an intense burning sensation. It can be accompanied by white discharge and a bad smell.

Genital thrush may be confined to the testicles, but can also affect the glands and cause inflammation of the penis (balantis), and even spread to the anal area or thigh.

### Eczema and psoriasis 
Chronic inflammatory skin diseases like [eczema](https://www.livi.co.uk/medical-advice/skin-conditions/eczema/) and [psoriasis](https://www.livi.co.uk/medical-advice/skin-conditions/psoriasis/), may be specifically located in the genital area. These diseases are usually long-term but not contagious.

### Scabies
[Scabies](https://www.livi.co.uk/medical-advice/skin-conditions/scabies/) is a highly contagious disease caused by a tiny parasite called sarcoptes. It penetrates the skin and reproduces there. It’s most often transmitted through direct, close or repeated contact with an infected person.

It’s also considered to be an STI because of potential contamination during sexual intercourse. Scabies-induced itching affects several areas of the body, including male genitals.

## Other symptoms of itchy testicles
Pruritus is an itchy sensation of the skin or mucous membranes, triggering the need to scratch. It can affect any part of the body, including the pubic area in men. Sometimes it can spread to the thighs or anus.

There are multiple symptoms associated with itching, depending on the cause of the itch, and these can vary from one person to another. Some men only experience itching at night. Other symptoms that often accompany itching include:

- Little spots or a rash 
- Redness
- Stinging 
- Flaking of the outer layer of skin
- Dry patches
- Bad smell 
- Pain or a burning sensation 
- Changes in the colour or appearance of the skin 
- Discharge

## What should you do if you have itchy testicles?
If the irritation around the testicles continues and does not go away within a couple of days, or if skin lesions develop, get medical advice from a GP. They can recommend a treatment or refer you to a dermatologist.

The right treatment depends on what’s causing your symptoms. In the case of an STI, a complete check-up should be performed and generally, all sexual partners should seek treatment.


Speak to a GP about itchy testicles

livi.co.uk > Your health > Why are my testicles itchy?

why are my testicles itchy

Itchy testicles are a common problem for men. We take a look at the possible causes and how it can be treated.

Why are my testicles itchy? | Livi

Why are my testicles itchy?

The prostate is a small gland, about two inches inside the bottom in men. It helps make semen by producing the fluid that sperm cells are mixed with. 

As you age, your prostate changes. It grows in size and can sometimes develop cancer. Around [22% of all newly diagnosed cancers in Europe](https://www.efpia.eu/publications/cancer-comparator-report/cancer-types/prostate-cancer/#:~:text=Prostate%20cancer%20is%20the%20development,men%20die%20from%20prostate%20cancer.) are prostate cancer. This type of cancer only usually develops after the age of 50. But the good news is that the survival rate is very high.  

A prostate exam looks for physical abnormalities. If a healthcare professional has recommended you have one, then it’s worth getting your prostate checked out.

## What happens during a prostate exam?

The idea of having your prostate examined might be daunting, but the check is carried out by a medical professional who’s likely done it many times before. Here are the key steps of a prostate exam: 

### 1. Your doctor lets you know what to expect

Before getting started, the doctor or nurse will discuss things with you and give you the chance to ask any questions. 

You can ask to have someone else in the room during the prostate exam, like a friend, family member or another medical professional.

### 2. You get undressed from the waist down 

To make the exam easier, you need to fully remove your clothes from the waist down, including your underwear.

You’ll be given privacy while you get undressed and you can let the doctor know when you’re ready. 

### 3. Your doctor tells you what position to get into 

You can have the prostate exam standing up or lying down, depending on the examination room and your physical capabilities. 

In the upright position, you stand with your legs apart and rest your arms on a surface so that you’re bent over. If you have the exam lying down, you’ll be on a medical examination table. You lie on one side and hug your knees up to your chest. 

In either case, the doctor or nurse approaches you from behind, and you can ask them to explain each step as they go.

### 4. The doctor inserts a lubricated, gloved finger into your bottom

Once you’re ready, the doctor or nurse will carefully insert one finger into your bottom. The lubrication means it will go in easily, and they don’t need to go very deep because the prostate is quite close to the entrance.

It might feel unusual at first, but take a deep breath and try not to tense up or clench. After a couple of seconds, your anal sphincter (the muscle that controls your anus) should relax. 

### 5. They check your prostate for any abnormalities

This part is a little bit uncomfortable but only takes 3-20 seconds. The doctor or nurse lightly presses on your prostate with their finger to check for any abnormalities, such as: 

- Lumps
- Swelling
- Tenderness 
- Size

It shouldn’t hurt, so be sure to let the doctor know if you’re in any pain. 

### 6. You can get dressed again 

The whole process only takes a couple of minutes. You’ll be given some tissue to wipe up any excess lubrication and privacy to get dressed. 

## Should I prepare for a prostate exam? 

You don’t need to do anything special before getting your prostate examined. You will be examined by a medical professional and they’ll be wearing gloves. 

If you’re worried, then it can help to pee and poo before your appointment, but don’t force it. Some people feel more comfortable if they’re clean before their exam but you don’t need to douche – you can just clean the area gently in the shower as usual. 

## How does a prostate exam feel? 

A prostate exam can cause some discomfort but it will be over before you know it. It feels like a slight pressure in your bottom and sometimes like you need to pee. 

Some people worry about having an accident or becoming aroused, but the exam is over so quickly that there’s not much time for anything like this to happen. If you feel nervous, let your doctor know and they can talk to you about your concerns. 

## What happens after a prostate exam?

After the exam, the doctor can tell you straight away whether everything felt normal with your prostate. However, sometimes the prostate can feel fine even though there might be a problem. It can also have abnormalities caused by something other than cancer, such as inflammation (prostatitis) or benign prostate enlargement.

This is why your prostate exam is often combined with a blood test called a PSA test. It looks for levels of a certain enzyme, which, if higher than normal, can be a sign of cancer. 

It usually takes between 1-2 weeks to get the results back. Your prostate exam and PSA will determine whether any further tests are needed and help the doctor decide how regularly you need to be checked in the future. 

## How does a doctor diagnose prostate cancer? 
If your prostate shows any signs of abnormality, you may be referred for more tests, such as an MRI or a biopsy, to see whether you have [prostate cancer](https://www.livi.co.uk/your-health/prostate-cancer-a-doctors-guide/) or if something else is causing the issue.

## Who should be screened for prostate cancer? 

Prostate screening is when you get your prostate or PSA levels checked even though you don’t have any symptoms. 

Most countries don’t offer routine screening because [studies suggest](https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004720.pub3/pdf/full) that it doesn’t help reduce the number of deaths from prostate cancer. This may be because prostate cancer is often slow growing, may not need treatment and is [usually unlikely to be fatal](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529593/). There is also the possibility of a false positive result, which may lead to unnecessary investigations. 

In the UK, anyone over the age of 50 can get their prostate checked. Your doctor should discuss the pros and cons of prostate tests with you to decide how to move forward. 

If you’re at [higher risk](http://perspectivesinmedicine.cshlp.org/content/8/12/a030361.full.pdf), such as being symptomatic, of black ethnic origin, or have a family history of prostate cancer, then a doctor may recommend getting a prostate check up earlier or more regularly. 

## When should I speak to a doctor? 
Although the following symptoms don’t necessarily mean you have cancer, it’s a good idea to talk to a doctor if you have any of these:

- Changes in your peeing habits
- Blood in your urine or semen
- Pain in the lower back, pelvis, or genitals

__This article has been medically reviewed by Livi GP Dr Roshaan Salojee__


livi.co.uk > CTA > Prostate exam

Speak to a GP

livi.co.uk > Your Health > Prostate exam

Prostate exam

Having your prostate examined is quick and easy – and can help catch cancer early. Here’s what to expect during and after your prostate check-up.

Meta information > Your Health > Prostate exam

What happens during a prostate exam? | Livi UK

Livi.co.uk > H&L page > Medical review > Prostate exam

Dr Roshaan Salojee

Livi GP

What happens during a prostate exam?

The testicles have two basic functions. First, they’re responsible for the production of sperm. Second, they help make testosterone – this is the hormone that helps develop traits like a deep voice and beard growth. 

## How should a testicle feel?
Most men’s testicles are roughly the same size, though one is usually slightly bigger than the other and one may hang lower than the other. 

Testicles should feel smooth, without any lumps or bumps, and firm but not hard. You may feel a soft tube at the back of each testicle called the epididymis. This transports and stores sperm from the testicles. 

It’s important to check your testicles regularly from puberty onwards. It’ll help you get to know what’s normal for you so that you can spot any changes quickly. 

## What are the signs of testicular cancer?
Common signs of testicular cancer include:

- A lump in the testicles
- A change in size or shape of testicles 
- A dull ache or pain
- A feeling of heaviness in the testicles

Testicular cancer is rare – there are several other reasons why the testicles may be painful, like an infection, trauma, inflammation or cysts. 

Testicular cancer is very treatable, but it’s easier to treat when diagnosed early, so make sure you get any symptoms checked by a doctor. 

## How to check for testicular cancer

![22GL448 organic content testicle-check 16x9 40s UK (1)](//videos.ctfassets.net/h8qzhh7m9m8u/2NvqeWRO1HHMCodzI2dwUW/1c984c86cecdc047dd56bf43201b96c0/22GL448_organic_content_testicle-check_16x9_40s_UK__1_.mp4)

The best time to check is during, or immediately after, a warm bath or shower when your scrotum is relaxed. 

1. Cup your testicles in the palm of your hand.

2. Use your fingers and thumb to feel each testicle.

3. Ask yourself these questions:
- Are there any lumps or swellings?
- Do you feel any aches or pains?
- Are there any new differences between your testicles?
- Have they changed in size or shape?

Don't panic if you notice anything unusual, but see a doctor as soon as you can.

## How common is testicular cancer?
Though it’s still rare, testicular cancer is on the rise. It only accounts for 1% of all male cancers, but rates are predicted to [increase by 25% by 2025 in Europe](https://www.sciencedirect.com/science/article/abs/pii/S095980491301054X).

Testicular cancer occurs most frequently in young adult men – it’s the most common cancer in men from age 20-35. Unlike [prostate cancer](https://www.livi.co.uk/your-health/prostate-cancer-a-doctors-guide/), testicular cancer risk decreases as you get older. 

## What causes testicular cancer?
Though the exact cause is not known, there are factors that can increase your risk — these include:

### 1. An undescended testicle
‘This is where the testicles do not descend from the abdomen into the scrotum by early childhood, and is the most important risk factor,’ says Dr Rhianna McClymont, Lead GP at Livi. 

### 2. Family history
‘If your dad or brother developed testicular cancer, you’re at higher risk,’ Dr McClymont explains.

### 3. Twins
Twins may be at increased risk of developing testicular cancer.

### 4. Height
Men who are taller than average may also be at a higher risk. 

## How is testicular cancer treated?
The best treatment depends on the person and the stage of cancer. It often involves an operation to remove the testicle with cancer – this is called an orchidectomy. 

Removing a testicle doesn’t usually affect your ability to have sex or get someone pregnant. ‘Having an orchidectomy will not prevent erection,’ says Dr McClymont. 

In some cases, your doctor might recommend storing some of your sperm in a ‘sperm bank’ before your treatment.

When it comes to testicular cancer, early detection is key. So make self-checking a habit, and see a doctor if you notice anything that isn’t normal for you.

__This article has been medically approved by Dr Roshaan Saloojee, a Livi GP.__


livi.co.uk  >    article page >    CTA

See a GP about a testicle lump

Livi.co.uk > Your health > How to check for testicular cancer

How to check for testicular cancer

What are the signs of testicular cancer and how do you check yourself at home? Read our expert advice on why regularly checking your testicles is so important

How to check for testicular cancer | Livi

Premature ejaculation is a common sexual problem and while occasional experiences are not a cause for concern, it can put a strain on your sex life and relationships. 

Ejaculation is controlled by the central nervous system and it usually occurs simultaneously with the male orgasm. Premature ejactulation is when you ejaculate too quickly during sex, while some men orgasm before ejaculation or experience a climax without actually ejaculating semen.

## So, what exactly is premature ejaculation?

On average, men ejaculate after 5 minutes of sexual intercourse. But everyone is different, so this can range from less than 1 minute to more than 30 minutes. Occasionally ejaculating too early is common and absolutely nothing to worry about.

A medical diagnosis of premature ejaculation is determined if early ejaculation becomes problematic, for instance if ejaculation always occurs very early on for you – even before penetration or immediately after.

Often, the cause for premature ejaculation is about [low self-esteem](https://www.livi.co.uk/your-health/how-can-i-build-my-self-esteem/), since sex come somtimes come with a high level of pressure to perform. The associated stress can make the problem even worse, and can result in avoidance behaviour and cause other symptoms like [erectile dysfunction](https://www.livi.co.uk/medical-advice/urology/erectile-dysfunction/). 

## How many men are affected by premature ejaculation?

It’s estimated that around 20% of men are affected by premature ejaculation, with far fewer men experiencing the problem speaking to a doctor. It’s therefore assumed that about 4% of men have little or no control over ejaculation and experience [stress](https://www.livi.co.uk/medical-advice/mental-health/stress/) as a result. 

## Who does it affect most?

Premature ejaculation can occur at any age, from puberty onwards. The initial symptoms often happen when you have your first sexual experiences, and they can reoccur or continue in later life and with different partners.

## What are the key causes of premature ejaculation?

Premature ejaculations can be primary (life-long) or secondary (acquired). Those affected by primary premature ejaculation will experience it during their first sexual activities, whereas acquired premature ejaculation can develop over the course of your life. 

### Possible causes of premature ejaculation include:

- Mental health problems
- Stress and [depression](https://www.livi.co.uk/medical-advice/mental-health/depression/) – relationship problems or unrealistic ideas of sexual performance can further contribute 
- Physical disorders 
- Premature ejaculation may occur as a symptom of various underlying problems, like prostatitis (inflammation of the prostate gland), erectile dysfunction or [thyroid issues](https://www.livi.co.uk/your-health/thyroid-symptoms-overactive-underactive/). 

## What can help with premature ejaculation?

If the issue is troubling you and your partner, try to address it in your relationship. Having open, honest conversations means you can work through it together. Remember that sex can be fulfilling for both partners, even with premature ejaculation.

These methods may also help:

### - The stop-start method
  Just as it sounds, this method means deliberately pausing during intercourse to delay ejaculation. This requires some practice but by doing so, you can learn to pay more attention to how you react sexually and to recognise the point at which ejaculation becomes inevitable. 
### - Pelvic floor training
  You can train the pelvic floor muscle, just like the biceps and abdominals. In the case of premature ejaculation, pelvic floor exercises can help with better bodily control. You’ll find some tips on [pelvic floor training here](https://www.livi.co.uk/your-health/how-to-exercise-weak-pelvic-floor-muscles/).
### - Use a condom
  A condom can reduce the sensitivity of the penis, helping to delay ejaculation during sex. There are even special condoms containing gels that have a slight numbing effect.
### - Try again
Some people benefit from a ‘second round’ of sex, after the initial early ejaculation. Once ejaculation has happened, the level of sensitivity decreases, so sex can last longer the second time around. Masturbating an hour before intercourse can also be helpful.

## When should I see a doctor about premature ejaculation?

If it continues to bother you or becomes a problem in your relationship, you could speak to a doctor. In most cases, premature ejaculation is easily treated. 

The doctor will ask you if you’ve always experienced premature ejaculation (primary) or whether it’s developed over time (secondary). A blood or urine test may also be performed to rule out underlying causes such as prostatitis.  

## Can I get premature ejaculation treatment in the UK?

If it can’t be treated by different stimulation techniques, like the stop-start method, seeking advice from a urologist may be helpful. 

There are different therapeutic approaches – including a drug treatment. However, they can also have unpleasant side effects like nausea and dizziness. Such premature ejaculation drugs should only be used as a last resort and only after a medical consultation. 


livi.co.uk > See a GP about premature ejaculation

See a GP about premature ejaculation

livi.co.uk > Your Health > What causes premature ejaculation – and what can help?

Premature ejaculation

Meta description: Premature ejaculation can put a strain on sex life and relationships. Read our expert advice on managing and treating premature ejaculation. 

livi.co.uk > Your health > What causes premature ejaculation – and what can help?

What causes premature ejaculation? | Livi UK

IMG 20200730 224911 865-33- 1 .jpg

Dr Rhianna McClymont

What causes premature ejaculation – and what can help?

## Quick facts

- Over half of men between 40 and 70 will experience erectile dysfunction (ED)
- 90% of men have at least 1 underlying physical cause 
- Underlying causes can include cardiovascular disease, diabetes and hormone problems, which is why it's important to speak up

Most men experience trouble getting or maintaining an erection at some point in their lives. This is often referred to as erectile dysfunction or ED. According to the British Association of Urological Surgeons, ED affects more than half of men between the ages of 40 and 70.  

But awareness of ED is low in men and women aged 20 to 70, a recent survey commissioned by the European Association of Urology (EAU) has found. The majority of the respondents did not know what ED was, and 1 in 4 had never heard of any of the most common treatments for ED. 

## Why you should talk to a doctor about erection problems

It’s not helpful that our culture often refers to men as having to ‘perform’ in bed. This can lead to undue pressure and anxiety, which can compound the problem.

But while many will keep quiet, feeling ashamed or too awkward to broach the subject witha doctor, it’s essential they do. 

That’s because ED isn’t just a problem that affects your sex life. It can also be one of the first signs of underlying health problems that may have no other symptoms, including [heart disease](https://www.livi.co.uk/medical-advice/cardiovascular-diseases/congenital-heart-disease/) or type 2 diabetes. 

What’s more, ED can affect self-esteem and lead to frustration, anger and mental health issues.

The good news is, simple lifestyle changes can sometimes reverse ED. Where they don’t, a variety of medical and psychological help is available, starting with a doctor's appointment.

We’ve called on the expertise of Dr Rhianna McClymont, Lead GP at Livi, to help raise awareness of ED and answer some commonly asked questions. 

## What’s the best way to talk about erectile dysfunction (ED) with a partner?

Whether you’re the person affected, or you have a partner who is experiencing ED, it can be a tricky thing to talk about. Of course, it’s worrying when ED happens but don’t panic and assume your sex life is over.

‘Any man can struggle to get or maintain an erection at times, and there can be a number of reasons — in particular, psychological factors — why this might occur,’ says Dr McClymont.

‘So, give your partner time, gently encourage him to get help but don’t pressure him, listen in a non-judgemental way if he’s experiencing stress or struggling with mental health, and try not to take your partner’s erection difficulties personally.’

And remember, penetration doesn’t have to be the endgame of sex. ‘You can adjust your sexual activity as a couple to find other ways to please each other and remain intimate.’ 

## What causes erection problems?

There are many factors that can contribute to erectile dysfunction and 90% of men have at least 1 underlying physical cause for their problem. 

These can commonly include underlying or undiagnosed [cardiovascular disease](https://www.livi.co.uk/medical-advice/cardiovascular-disease/) or diabetes — which is why it’s so important to talk to a doctor about it. 

ED can also be caused by hormone problems, neurological disorders, pelvic surgery or physical trauma.

Around 10% of men’s erection problems are caused by psychological factors like stress, [anxiety](https://www.livi.co.uk/medical-advice/mental-health/anxiety/), depression or ‘performance anxiety’.  

Although it’s rare, around 1-3% of men may have an anatomical abnormality like a tight foreskin or penile inflammation or curvature. 

## What is ED and who commonly get it?

Getting and maintaining an erection requires a healthy supply of blood flow to the penis. But common circulatory problems that restrict blood flow such as atherosclerosis (a narrowing of the arteries due to fatty deposits of substances like cholesterol) can impede this process, resulting in erection problems. 

‘Occasional episodes of erectile dysfunction can happen to a man at any age,’ says Dr McClymont.

‘Persistent difficulties in erections, however, are more common in men over the age of 40, when conditions that may contribute to it, such as diabetes, high blood pressure, heart disease or neurological conditions, more frequently occur,’ Dr McClymont points out.

‘Various medications can also cause ED as a side effect,’ Dr McClymont adds. These include widely prescribed medicines for conditions such as [depression](https://www.livi.co.uk/medical-advice/mental-health/depression/), high blood pressure and prostate enlargement.

## What lifestyle changes can help erection problems?

Simply becoming more active may reduce your risk of erectile dysfunction by up to 70%.  

In fact, a review of studies  found that doing 40 minutes of moderate to intense cardiovascular activity (the type that gets you sweaty), 4 times a week could decrease ED within 6 months.

Stopping smoking, losing weight, reducing alcohol intake, lowering stress levels and avoiding illicit drugs can also play a big part in alleviating erectile problems.

‘Things like stress and excess alcohol are common triggers for ED,’ says Dr McClymont. ‘So, if occasionally a man struggles to get or maintain an erection when perhaps he’s had a bit too much to drink or is under exceptional pressure at work, then he should not worry,’ says Dr McClymont. 

If you ride a bike for more than 3 hours a week, your doctor might recommend you try a period without cycling to see whether that helps improve things. If you do cycle, it’s vital you have a properly fitted, comfortable seat — some saddles are specifically designed to relieve pressure on the blood vessels and nerves supplying the penis. 

## When should you see a GP?

Many men find this issue embarrassing so they wait for more than 2 years before seeing a medical professional, research has found — but doctors are trained to deal with ED. 

If you’ve been having erection problems for a few weeks, book an appointment with a Livi doctor. 

‘If it’s your partner that’s affected, and he is reluctant, encourage him to seek further help as his doctor may need to run further tests to exclude a physical cause,’ says Dr McClymont.

## How can a GP treat erectile dysfunction?

Thankfully, the majority of cases of ED can be treated. A doctor will first ask you for your full medical history and may also perform blood and urine tests to help detect any underlying medical conditions. 

Your doctor may then recommend lifestyle changes. If these don’t help, other treatments are available for ED:

#### Medication 
There are currently four tablets available: sildenafil (brand name Viagra), tadalafil (Cialis), vardenafil (Levitra) and avanafil (Spedra). These belong to a group of medicines called phosphodiesterase inhibitors (PDE5i).

Viagra is now available in the UK to buy without a prescription and at least two-thirds of men have improved erections after taking it. 

But you should always talk to a doctor or pharmacist before taking such drugs — and never buy them online as they may be fake. 

Drugs used to treat ED can produce side effects which commonly include headache, stuffy nose, flushing or upset stomach. If that happens to you — or they don’t work for you — a GP may prescribe other treatments to support erectile function. These may include penile injections or, if physical trauma is the cause, surgery.

Occasionally, Viagra-type drugs can produce serious side effects such as chest pains, seizures, painful erections and a sudden loss of vision. Always call a doctor straight away if you suffer from any of these.  

If atherosclerosis is the cause of your ED, a doctor may also prescribe statins to control your cholesterol levels and drugs to lower your blood pressure.

#### Vacuum pumps 
You’ve probably read reports online about treatment options like vacuum pumps. These cause an erection by encouraging blood to flow to the penis. They can be used if drugs are not suitable and work for most men. Speak to your doctor about the best way to get a pump.  

#### Testosterone treatment 
Your doctor may find your hormone levels are contributing to your ED . They may be able to prescribe Testosterone Replacement Therapy (TRT) or refer you to an appropriate specialist to consider this.  TFT comes in the form of a gel rubbed into the skin every day or as a long-acting injection given every 6-12 weeks.  

## Does depression cause erectile dysfunction?

This can work in two ways. ‘[Depression](https://www.livi.co.uk/medical-advice/mental-health/depression/) can cause erectile dysfunction,’ says Dr McClymont, ‘and some of the medications that are used to treat depression can also contribute to erection issues.

‘Conversely, many men who suffer with persistent erectile dysfunction from another cause such as heart disease or diabetes find that having ED adversely affects their mental health — with men suffering feelings of anger, sadness and frustration.’

In both instances, counselling or Cognitive Behavioural Therapy (CBT) may help. A Livi doctor can help refer you for a course of psychological therapies to help with dealing with ED.


Livi.co.uk > Your health > Erection problems — a doctor’s guide to getting help 

Erection problems — a doctor’s guide to getting help 

Erectile dysfunction is common and it can be embarrassing at times, but there are plenty of solutions available. Dr Rhianna McClymont, Livi Lead GP, has advice

Livi.co.uk > Your health > Erection problems — a doctor’s guide to getting help Erection problems 

Reviewer > Dr Rhianna

IMG 20200730 224911 865[33] (1)

If you’re trying for a baby, what defines healthy sperm is probably high on your list of concerns. 

In fact, the quality and quantity of the sperm people produce can vary considerably as a result of all sorts of external factors. 

Here, we outline everything you need to know about sperm health and its impact on fertility.

## What constitutes healthy sperm?

There are 4 main factors that doctors look for when checking the quality of a person’s sperm:

### Sperm count
On average, there are between 40 and 50 million sperm in a millilitre of semen, and anything below 15 million per millilitre is classed as a low sperm count, according to the NHS. Having a low sperm count reduces the chance of conception but, as long as some sperm are present, it doesn’t rule it out – only one is needed to fertilise the egg. 

### Sperm motility
This is measured by looking at the semen sample under a microscope to see how many sperm are moving, how well they can swim, and how many are swimming in a straight line or going around in circles. It also takes into account whether sperm are clumped together or moving freely.

### Sperm morphology
This refers to how healthy the sperm look and is assessed by looking at the shape of the sperm to see if there are any obvious defects to the head, body, or tail of each gamete. 

### Volume of semen
This relates to the amount of fluid that is ejaculated, which might be a factor in how many sperm are released, and also provides a guide to how well glands within the testicles are working. 

## Are sperm problems common?
Sperm problems are a factor for 1 in 3 couples who are struggling to conceive, and in another third of cases the cause may not be known. Dr McClymont advises, ‘If you’ve been trying for a baby for a year, and your partner has not become pregnant, then it’s best to see your doctor to discuss further tests such as semen analysis.’

This routine test involves providing a fresh sample of semen so a laboratory can check several measures of sperm health. 

## Does abstaining from sex make your sperm more effective?
It’s not clear whether long periods without sex may increase the risk of some damaged sperm.

‘Aiming for sex every day during a person’s most fertile days will give you the best chance of conceiving,’ Dr McClymont advises. ‘But if that seems a little too much, then every 2 or 3 days will still give you an excellent chance.’

## Is there such a thing as healthy sperm colour?
Most semen is white-greyish. ‘Some men may notice a variation in colour from time to time,’ Dr McClymont says. But if you notice a persistent change – particularly if you also experience pain when passing urine or in your testicles, or there is blood in your semen – it should be investigated.’

Infections including chlamydia, gonorrhoea, and prostatitis can all impact male fertility. So can a structural problem like damage to the tubes that carry sperm, having undescended testicles as an infant, or previous surgery to the testicles or for a hernia.

## 6 lifestyle factors that affect sperm quality
Sperm health can be affected by a number of lifestyle factors. But if you’re trying to start a family, the good news is that it takes just 70-90 days for sperm to develop and mature. That means improvements to your diet and lifestyle should show benefits within 2-3 months.

### 1. Being overweight or obese 
This is associated with lower sperm counts. If you’re trying for a baby, and are overweight or obese, talk to a doctor about the treatment and options available for healthy weight loss.

### 2. Alcohol
Drinking any alcohol impairs semen volume and sperm morphology to some degree, according to an analysis of studies involving more than 16,000 men. The research found that drinking daily was the most damaging.

‘If you’ve started trying for a baby, or are thinking of doing so, then drinking alcohol at below the recommended limit of 14 units per week is recommended’, says Dr McClymont. ‘Drinking excessively can reduce sperm production, as well as adversely affecting the shape, size and swimming ability of sperm. For couples who are already experiencing fertility issues, men may wish to consider abstaining from alcohol completely.’

### 3. Temperature
Working in a hot environment reduces the quality and quantity of sperm. That’s why it can be helpful to avoid using a laptop on your lap or having saunas  if you’re trying to start a family. 

Wearing boxers, rather than close-fitting briefs can also help keep the testicles cooler and improve sperm concentrations and counts.

### 4. Diet
A healthy diet provides the fuel needed to produce healthy sperm. A recent Danish study found that men who ate plenty of fruit and vegetables, high-fibre foods, and fish, but minimised their intakes of red and processed meat, and sugar also had better sperm. Fat intakes did not seem to make any difference. 

### 5. Smoking
The harm smoking can do is well known, so it probably comes as no surprise that it’s bad news for sperm health too. Studies show smoking reduces sperm counts, motility, and morphology. This is probably due to increased oxidative stress, with one study describing the impact on sperm as ‘devastating’. 

### 6. Anabolic steroids
Illegal use of these muscle-building drugs is a growing problem in the UK, Sweden, and other European nations. Research shows that anabolic steroids can not only render men infertile, but it can also cause organ damage and violent outbursts.

See a GP about sperm health

Livi.co.uk > Your health > Is my sperm healthy? 6 things that can affect sperm quality

Is my sperm healthy?

How can you tell if your sperm is healthy? Dr Rhianna McClymont, Livi Lead GP, has a guide to healthy sperm, including the lifestyle changes that may help

Is my sperm healthy? 6 things that can affect sperm quality

6 things that can affect sperm health and quality | Livi UK

Changes in hormone levels are a natural part of ageing. For women, oestrogen levels drop drastically during the menopause – but do men experience something similar?

A term predominately used by the media, the ‘male menopause’ is used to describe an age-related decline in testosterone and the symptoms associated with it – including low energy, poor concentration, weight gain and [erectile dysfunction](https://www.livi.co.uk/your-health/erection-problems-a-doctors-guide-to-getting-help/).

‘The term “male menopause” isn’t quite right because the declining fertility in men is very different from menopause in women,’ explains Dr Céline Guyomar, a Livi medical doctor. ‘Male hormones decline gradually with age. However, a small proportion of men experience testosterone deficiency, also known as hypogonadism and androgen deficiency, where the body is unable to make enough testosterone,’ she says.

## So, what exactly is testosterone and what happens to it as I get older?

Testosterone – often described as the male sex hormone – plays an important role in emotional and physical wellbeing. In men, it’s primarily made in the testicles – also called the testes. ‘Testosterone is responsible for the production of sperm and red blood cells. It also stimulates sex drive, maintains muscle and bone strength and regulates the distribution of body fat,’ says Dr Guyomar. 

Men start to produce testosterone during puberty, peaking at around the age of 20. From the age of 30, testosterone levels normally start to decrease by around 1% to 2% per year. Known as the andropause, this decline happens more gradually than female menopause and is unlikely to cause any issues in itself.

## Can certain lifestyle factors trigger menopause-like feelings? 

Reaching middle age can mean a few life adjustments. Many of us experience changes to our health, the loss of relationships or loved ones, or problems with money. Thinking about your life as if it’s at the halfway stage could also lead to a ‘midlife crisis’. In situations like these, some people may get ‘male menopause’-like symptoms, such as self-doubt, shifts in energy levels, mood changes, lowered motivation, a lack of self-esteem and [changes in sexual drive](https://www.livi.co.uk/your-health/8-causes-of-low-libido-a-doctors-guide/#:~:text=A%20low%20libido%20can%20be,an%20issue%20within%20the%20relationship.).

Other things that can contribute to menopause-like feelings include:

- A poor diet
- Not exercising enough
- Lack of sleep
- Drinking too much alcohol

## But what about testosterone deficiency? 

In some cases, symptoms of the ‘male menopause’ may be caused by testosterone deficiency – or hypogonadism – which happens when the testes begin to work less efficiently and make few or no hormones. One large European study found that testosterone deficiency affects about 2% of males aged 40-79 and about 5% of men aged 70-79.

Although hypogonadism can occur at any age, men are more likely to develop it as they get older. Known as late-onset hypogonadism, this condition affects around 2% to 6% of older men. Some of the most common symptoms include:

- An increased risk of breaking a bone 
- Decreased muscle mass and strength
- Decreased growth of body hair
- Hot flushes and sweats
- A decreased libido
- Erectile dysfunction
- Infertility 
- Low self-esteem
- Changes in mood, e.g. [anger](https://www.livi.co.uk/your-health/how-to-cope-with-anger-in-yourself-and-those-close-to-you/), depression, irritability and sadness
- Fatigue
- Poor concentration and memory
- Increased body fat
- [Trouble sleeping](https://www.livi.co.uk/your-health/5-sleep-problems-to-discuss-with-a-doctor/)

## What causes testosterone deficiency? 

Hypogonadism can be caused by normal ageing. ‘Other factors that can affect testosterone include injury to the testicles, being overweight, alcohol misuse, a sedentary lifestyle, certain medical conditions – such as cancer, HIV, lupus, mumps and organ failure – and some medicines,’ says Dr Guyomar. 

Hypogonadism rates are also higher among men with high blood pressure, diabetes, prostate disease, [asthma](https://www.livi.co.uk/medical-advice/respiratory-conditions/asthma/) and chronic obstructive pulmonary disease (COPD).

## What can I do to help boost my testosterone?

‘Certain lifestyle choices can speed up the decline of testosterone,’ says Dr Guyomar. Here are some lifestyle changes you can make to increase your testosterone levels naturally:

__1. Maintain a healthy weight__
A raised body mass index (BMI) can have a direct and negative impact on testosterone levels. One study found that being overweight was the most significant risk factor for testosterone deficiency in men.

__2. Cut back on alcohol__
Drinking excessive amounts of alcohol affects the system of endocrine glands and [hormones involved in male reproductive health](https://www.livi.co.uk/your-health/male-fertility-9-lifestyle-factors-that-help/#:~:text=For%20couples%20experiencing%20difficulties%20in,fertilise%20an%20egg%20during%20conception). It reduces levels of luteinising hormone (LH), one of the main hormones that controls the body’s reproductive system. Produced in the pituitary gland, LH stimulates the production of testosterone. 

__3. Stay active__
Exercising regularly has heaps of health benefits, from improving muscle strength to reducing the risk of disease. One study found that resistance strength training may also boost testosterone levels. 

__4. Prioritise sleep__
Sleep is essential for the body to function correctly. As well as lowering the risk of heart disease and [depression](https://www.livi.co.uk/medical-advice/mental-health/depression/), sleep can also help to maintain testosterone levels. Research has shown that one week of sleeping just five hours a night lowered testosterone by as much as 15%. 

__5. When should I speak to a doctor?__
If you’re in your late forties or older and you’re experiencing symptoms, it’s important to talk to your doctor. As well as ruling out low testosterone levels, they can also check for other conditions that may be causing your symptoms. 

‘Your doctor may also ask you some questions from the screening questionnaire for androgen deficiency in ageing males (ADAM),’ says Dr Guyomar. These questions include: 

1. Do you have a decrease in libido?
2. Do you lack energy?
3. Do you have a decrease in strength and/or endurance?
4. Have you lost height?
5. Have you noticed a decreased enjoyment of life?
6. Are you sad and/or grumpy?
7. Are your erections less strong?
8. Have you noticed a recent deterioration in your ability to play sports?
9. Are you falling asleep after dinner?
10. Has there been a recent deterioration in your work performance?

__This article has been medically reviewed by Dr Céline Guyomar, a Livi medical doctor.__


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Speak to a GP about ‘male menopause’

Livi.co.uk > Your health > The ‘male menopause’ – what does the medical evidence say?

The ‘male menopause’ – what does the medical evidence say?

Can a decline in male hormones be compared to the menopause? Dr Céline Guyomar, a Livi medical doctor, explains what you need to know about the ‘male menopause’

What is the ‘male menopause’? | Livi UK

### Quick facts
- Prostate cancer is the second most common cancer in men
- Most cases are diagnosed in men over 50
- It might not show symptoms, and may require little or no treatment

It’s that time of year again, when men grow moustaches — ranging from flattering to funny — in support of Movember. 

The campaign raises awareness and funds in three areas: [male suicide](https://www.livi.co.uk/your-health/signs-of-depression-in-men/) — which claims 60 men every hour globally — as well as [testicular cancer](https://www.livi.co.uk/your-health/testicular-cancer-how-to-spot-the-signs/) and prostate cancer. 

Here we talk to Dr Rhianna McClymont, a Livi GP, about the facts on prostate cancer.

### What is the prostate? 

Around the size of a walnut, the prostate is located just below the bladder and in front of the rectum. It’s a gland only men have.

Its main function is to produce the thick, white fluid that creates semen when mixed with sperm produced by the testicles. 

### Prostate cancer — common among older men

The Movember campaign has made many of us more aware of prostate cancer. Thankfully so, as it’s the second most common cancer in men, and the fourth most common cancer overall.

In fact, more than 1.2 million new cases of prostate cancer were recorded globally in 2018 and in excess of 350,000 deaths. 

The UK is in the top 18 countries with the highest rate of prostate cancer.

### What increases the risk of prostate cancer?

__Age__ – Most prostate cancer cases are diagnosed in men over 50. ‘Age is an important risk factor, with the risk of getting prostate cancer rising as you get older,’ says Dr McClymont. 

__Ethnicity__ – ‘Research has shown that men from an African-Caribbean or African descent are more likely to get prostate cancer’.

__Family history__ – ‘If you have a dad or brother who has developed prostate cancer, particularly if this developed earlier in life before the age of 60, then the risk is higher,’ Dr McClymont says. 

__Obesity__ – According to the NHS, recent research suggests obesity increases the risk of prostate cancer.

### What are the symptoms?

Prostate cancer often shows no symptoms in its early stages and, in fact, may require no or minimal treatment. 

However, as the disease progresses common symptoms can include:
-  Passing urine more frequently (particularly at night)
- Difficulty in starting to pee, or a weak flow of urine
- Feeling like your bladder hasn’t emptied completely 
- Feeling like you need to pee urgently

### How is prostate cancer tested?

‘If you have any of the above symptoms, you may be offered a Prostate-Specific Antigen (PSA) test (taken as a blood test) and an examination of your prostate by your GP,’ says Dr McClymont. The latter will include a rectal exam. 

‘A PSA test can indicate a problem such as prostate cancer, but your PSA level can also be raised for a number of other reasons, so it’s not conclusive,’ she points out. 

‘Usually, an MRI scan will also be used to assess the prostate if a PSA level is raised, and prostate cancer is then diagnosed with a biopsy.’ 

### How is it treated?

Treatment for prostate cancer depends on the severity of the cancer, whether it has spread outside the prostate to other areas of the body, your general medical fitness, and other health conditions you may have. 

‘There are numerous treatment options, including surgery, radiotherapy, hormone therapy or “watchful-waiting”. This is where the cancer is unlikely to affect your natural lifespan, so symptoms are controlled while the cancer is monitored, to make sure it’s not progressing,’ says Dr McClymont. 

‘Any form of treatment involves potential side effects,’ she points out. ‘If surgery to remove the prostate gland is recommended to treat the cancer then these are important considerations. 

‘Following a prostatectomy (removal of the prostate), for example, many men subsequently suffer with difficulties getting or sustaining an erection, and also with urinary incontinence.’

It‘s worth remembering that while prostate cancer may be a serious disease, most men who are diagnosed with it do not actually die from it. 

Watchful waiting has advantages and disadvantages. You won’t have side effects from any treatment or need regular scans or biopsies, and if you begin to suffer from symptoms such as pain or swelling, there is treatment to help manage them. But most men never need treatment. 

Disadvantages can include the possibility of the cancer growing and spreading, and the man and his loved ones having the psychological worry that he’s not being treated.

‘Usually, the watchful waiting approach is for men with mild cancers that are not causing significant problems — and are unlikely to develop them throughout their lifetime. Or for men with other health problems who may not benefit from more invasive treatments like surgery or radiotherapy,’ Dr McClymont points out.

Talk to a doctor if you have any symptoms or concerns.

__This article has been medically approved by Dr Rhianna McClymont, Lead GP at Livi__


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See a GP about prostate cancer

Livi.co.uk > Your health > Prostate cancer — a doctor’s guide

Header GettyImages-1181205697

Men are less likely than women to see a GP over worrying symptoms. But here’s why prostate cancer shouldn’t be ignored

Prostate cancer — a doctor’s guide

Around a fifth of men have a low sperm count. For couples experiencing difficulties in conceiving, male infertility is the main cause in about 20% of cases.
  
But research has found that lifestyle factors play a key role in semen quality and healthy sperm motility (this refers to the sperm’s ability to move forward or ‘swim’ to fertilise an egg during conception).
 
In fact, 3 months before you’re planning to start trying for a baby, it’s advisable to deal with pre-existing health problems with your doctor and to make healthy lifestyle changes such as those listed below. This will help to make sure that your sperm quality is the best it can be.

## 1. Lose excess weight

If you have a raised body mass index (BMI), then try to lose weight. Obesity has a massive influence on male fertility problems, and studies show that it can affect hormone levels causing reduced sperm production and concentration. Similarly, although the evidence is more conflicted here, there may also be a link between obesity and reduced sperm motility and morphology (this refers to the shape of a sperm). All of this can reduce the chances of the sperm fertilizing the egg. 

It is also becoming clearer that male obesity can affect the molecular health of sperm and damage sperm DNA. Integrity of sperm DNA is essential for successful fertilization and normal development of a baby.
Some research shows that paternal obesity can even affect the health of your future children, through increased susceptibility of offspring to chronic disease. 

The best way to achieve an ideal weight is through healthy diet and exercise.  

## 2.  Stop smoking

Smoking can reduce ejaculate volume as well as sperm density and motility. Smokers might have a lower zinc content in their semen, which can reduce sperm production.
 
The tiny hairs that help semen move along the tubes of the epididymis (the tube that transports sperm produced in the testes) may be damaged in smokers, which can also negatively affect sperm function. Smoking can also harm erectile function.
 
Continuing to smoke also puts your partner at risk through passive smoking.
 
The good news is that these negative effects can be reversed if you give up smoking. Do ask your doctor if you need help stopping smoking, as there are NHS stop-smoking programmes that could improve your chances of stopping.

Want to give up smoking? Read our guide on the options available.


## 3.  Cut back (or cut out) alcohol

Drinking alcohol excessively can affect the quality of sperm. It lowers levels of testosterone, follicle-stimulating hormone and luteinising hormone (LH), which is one of the main hormones that controls the reproductive system. Alcohol raises oestrogen, which can contribute to reduced sperm production: one study found that drinking as little as 5 units of alcohol a week could adversely affect sperm quality.


## 4.  Avoid recreational drugs

Marijuana and cocaine are thought to affect male fertility, but large-scale studies are perceived as unethical, so it’s impossible to say for sure.
 
Anabolic steroids (sometimes taken by men to bulk up their bodies), amphetamines (speed), as well as heroin and methadone also damage sperm quality. If you’re using any of these drugs then talk to your doctor to work out a way to stop your habit.


## 5.   Do regular exercise

It’s important to be active for good cardiovascular health and to be at an ideal weight for fertility.
 
But research has repeatedly shown that generally active men also have higher sperm counts than their sedentary counterparts. Aim for at least 30 minutes of moderate exercise, 5 times a week.


## 6.   Manage your stress levels

Stress can reduce hormones such as LH and testosterone. In theory, this can affect sperm quality, although more studies are needed to make a definite connection.
 
‘Mental stress affects us in many ways. It affects our libido, potentially our reproductive abilities and probably also sperm quality,’ says Dr Rosen, Livi GP.
 
Learn a few simple breathing and meditation techniques that you can regularly turn to during stressful moments. [The Headspace app](https://www.headspace.com/headspace-meditation-app) is a great starting point.


## 7.    Keep an eye on temperature

Increased temperature of the testicles might impair sperm quality. Try to avoid sitting for prolonged periods with a warm laptop on your groin area or carrying a warm phone in your pocket. Also, don’t take long hot baths, saunas and Jacuzzis.
 
Instead, wear loose-fitting trousers and undergarments (such as boxer shorts). If you work in a hot environment or sit down for hours at a time, it’s important to move around and get outside regularly.


## 8.    Eat a healthy diet

Diets that are high in processed meat, caffeine, red meat, saturated fatty acids and trans fats are linked to low quality semen.
 
Fruit, vegetable, wholegrain and fish rich diets are linked to better sperm quality. In fact, a Mediterranean style diet for heart health will support fertility.
 
Make sure your diet is rich in antioxidants such as vitamin C, folate, zinc and B12. These are best obtained from your diet, so aim to eat at least 5 portions of fruit and vegetables each day. Talk to your doctor about your diet specifically, just in case you might need to take a food supplement - for example, because you’re vegan.
 
Foods rich in omega-3 fatty acids such as walnuts or oily fish (including salmon, sardines, mackerel and herring) help sperm production.


## 9.    Talk to your GP

If you have existing medical conditions that might affect fertility, such as sickle cell or thalassaemia or other hereditary diseases, take the opportunity to see your doctor for a preconception chat.

Similarly, if you are a man who has had groin surgery or treatment for testicular cancer, then you might want to discuss fertility with a doctor sooner.
 
Remember to get STI excluded (or treated) by being tested as soon as possible, if that’s appropriate.
 
If you have not conceived as a couple after having unprotected sex for a year, then consult your doctor together; fertility treatment options such as IVF might be a consideration.


__Reviewed by: Dr Rhianna McClymont, Lead GP, Livi__






livi.co.uk > Your health > Male fertility – 9 lifestyle factors that help

Male fertility – 9 lifestyle factors that help

livi.co.uk > Men’s health > Articles

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