Pelvic Health Blog

Q&A for men: fourth edition

1/14/2020

Varicoceles, circumcision, rectal spasms, oh my!

Hear Becca's answers regarding these hot topics in men's health in her 4th Q&A for men.

Question from Dave: I have blue veins on one side of my scrotal sack. They have been there for a while. Is this normal? I don’t have any pain or anything, the veins just make my testicles look a little strange.

Answer from Becca: What you have, Dave, is called a varicocele. This is similar to having varicose veins in the legs, only it is happening in your left testicle. Varicose veins occur when the valves of veins get damaged and are not as good as circulating blood back to the rest of the body thereafter. The cause of varicose veins in any part of the body is largely unknown.
Having a varicocele, or a varicose vein in the testicles, is seen in 10-15% of men. Varicoceles usually arise in men around puberty and it is very typical that you see this only on your left testicle, Dave, as they are more prevalent on this side of the scrotum. The awesome news for you is that varicoceles rarely present with any actual symptoms that would impact your sex life or cause pain. If you do have symptoms down the road, they would most likely involve infertility or poor sperm quality. That said, the incidence of this is not common with the presence of a varicocele. And if you did want to get treatment for pain or infertility should they arise, there is surgery available.

Otherwise, my suggestion would be to acknowledge that you are in good company with other men and that your varicocele is not a sign of anything that you did or did not do. The blue veins will remain, but think of them like a cool tattoo that you didn’t have to pay for and carry on with your sex life!

Question from Alex: I am 28 years old and I live in the United States. My parents never had me circumcised, because they didn’t believe in it. Yet I always felt like there was something wrong with me when I took a shower in the locker room after football practice. Many of the women I have slept with have never seen an uncircumcised penis before. What is the point of circumcision and why am I so unusual for not having one?

Answer from Becca: Alex, this question could not be asked at a better time in history. I’ll explain why. The fact that you live in the United States and are not circumcised reveals how we perceive this medical procedure. We live in a country with some of the highest rates of circumcision in the world. Israel’s rates are higher than America’s, which makes sense because the removal of the foreskin is a religious celebration in Jewish culture shortly after the birth of a male child. Men born in Muslim countries are also commonly circumcised, though this usually happens at an older age of approximately ten years. But why are the circumcision rates so high in the United States, if we are not performing this surgery in accordance to religion?

The reason that many cultures have historically embraced circumcision is because it was perceived as keeping the penis “cleaner”. This argument it not scientifically based, because if a young boy learns how to pull back the foreskin of his penis and clean it properly, there aren’t documented increased risks of things becoming dirty or infected. Americans appear to embrace circumcision for their baby boys because of what you mentioned about your locker room experience as a teenager, Alex. Parents believe that circumcision is the social norm, that it is “the right thing to do” to avoid the shame of men later in life.

The purpose of the foreskin is to protect the head of the penis. From an anatomical standpoint, it exists for a reason. When it is surgically removed, as it is in circumcision, this actually decreases sensation to the head of the penis. Imagine a part of your body that is routinely exposed to the outside air and friction against surfaces. Like your hands. Your hands will get dry and cracked in cold weather and your sensitivity to touch will decrease on your fingertips. Wearing gloves would protect your hands and improve the nerve sensation. When the head of the penis is rubbing up against boxers all day, as it will in a circumcised guy, that skin might toughen up with that friction and sensation may decrease. In an uncircumcised man, the head of his penis is protected by the foreskin, thus potentially enhancing the sexual response.

The trend of circumcising boys in America seems to be dropping. The Center for Disease Control reported a steep decline in circumcision rates to merely 30% of male births in 2010. I hope that this trend will dispel the myth that the uncircumcised penis is somehow “unclean” or “unsanitary” and help the next generation feel more confident about being “uncut” down there.

To sum things up, I have a friend who is Hungarian named Katalina. She had her first sexual experiences in Hungary, where the circumcision rate is quite low. When she moved to the U.S. and she saw her first circumcised penis, Katalina thought, “What is this odd-looking thing? Why would anyone allow surgery to his penis? I mean, it is beyond the guy’s control if he got a circumcision as a baby, but STILL!” Hearing Katalina say this in her Hungarian accent was priceless. Let that be a message to you, Alex, and to all the other men out there! This decision was made for you. There is no right or wrong answer to the circumcision question and there is little medical evidence to support the idea that cutting off the foreskin of the male penis has much benefit. Whether you are circumcised or not, rock on with your bad selves! And if you have a baby boy one day, consider all these aspects before you make this decision for him

Question from Juan: I have spasms in my rectum. They are so uncomfortable that I can barely sit. These spasms get worse after I have a bowel movement and last for 2-3 hours. I am at the point where I am severely constipated, because I now avoid going to the bathroom. I have been to a gastroenterologist, who can find nothing wrong in testing. Is there any treatment available for this?

Answer from Becca: Juan, I feel your pain. This is a tough condition, but fortunately for you, you are alive at a time where pelvic floor physical therapy for men is becoming more widely available. The reason that you have rectal spasms is likely because the muscles of your saddle region are too tight. Just like having neck spasms and having difficulty turning your head, spasms in the pelvic floor or saddle region will make it so you cannot open up your rectum to get poop out without discomfort. It is often that simple.

The fact that you are constipated is consistent with the rectal spasms. This is because the human brain is very clever. It wants to protect the body from pain, so your intestines will hold onto that fecal matter to prevent the rectal spasms from overwhelming your nervous system. This contributes to the cycle of pain and spasm and it can become a never-ending loop of constipation.

So, what can be done? A pelvic floor physical therapist can assess your saddle muscles to see how tight they really are. Then, stretching within the rectum can be performed with a gloved finger to allow them to relax. It sounds pretty crazy, I know, but if you can get over the fact that a medical professional is in your bum, you will find that this treatment is extremely beneficial. I have treated many men like you. Once the indignity of the initial exam has been conquered, most patients report a sense of quiet in their pelvises when they are receiving the appropriate treatment. They report decreased pain in the rectum over time and have more regular bowel movements.

The action plan for you, Juan, is to find a pelvic floor physical therapist. I have a good feeling that this will allow your pelvis to return to a calm state and facilitate more consistent and pain-free bathroom relief.

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