Basic Investigation

If you suspect any problems with your sexual health, the best thing you can do is go to a doctor and undergo all the required tests. You can find the description of the main tests used for the diagnosis of men’s disorders below.

Digital Rectal Examination

Digital rectal exam results

Digital rectal exam results

This procedure plays an important role in the diagnosis of prostate gland disorders. Rectal examination is usually performed during a routine medical checkup that males should undergo regularly. During this examination medical specialist determines the size of the gland (normal size is about 1.6 / 1 / 1.2 inches), its shape, checks if there are any spots of induration or softening, as well as gets the prostate gland secretion for the further analysis.

Doctors from Cleveland Clinic say that all men who are over 45 should be annually screened for prostate cancer using digital rectal examination. This method is recommended in combination with blood test for prostate-specific antigen (PSA) in the following groups of men:

  • All men who are over 50;
  • Afro-American males who are over 40;
  • Men who have a family history of prostate cancer should be screened annually starting from the age of 40 (or even earlier if it is recommended by a doctor);
  • Males who develop persistent urinary symptoms.

Painfulness, asymmetry and heterogeneous structure of the prostate gland detected during digital rectal exam are the possible signs of prostatitis.

Digital rectal examination is contraindicated in patients with severe anal pain, anal stricture or some forms of hemorrhoids.

Blood Count

Blood for this test should be collected in the morning

Blood for this test should be collected in the morning

If there are any inflammatory processes in male’s body, the results of this test will show the increase in white blood cells and erythrocyte sedimentation rate (ESR). Depending on the phase and course of the inflammation, these indicators may exceed the normal levels by several times.
Blood for this test should be collected in the morning, thus, if you are going to have your blood tested, do not eat anything before the procedure (if necessary, some water is allowed).

Bacteriological tests


This test is of a particular clinical importance when it is required to determine the treatment strategy of a certain infection

Bacterial culture test is a laboratory diagnostic method that is highly effective when it is necessary to understand what microorganisms are causing the disease. This test is of a particular clinical importance when it is required to determine the treatment strategy of a certain infection.

It involves bacterial inoculation of the urine, sperm and prostatic secretion to check it for pathogenic flora and fungi and, if present, find antibacterial preparations they are sensitive to.
How to prepare for this test?
Before the procedure:

  • You should avoid sex for 1 or 2 days as well as stop taking the drugs that can misrepresent the real disease pattern;
  • In addition, it is recommended to not urinate for 2 hours before the test, because urine washes away the microflora that is required for the analysis.

The procedure

The material for the analysis is taken from the urethra and glans penis. It is performed with the help of a sterile spatula or gauze tampon. Once the specimen is collected, biological material is placed into a special growth medium that is beneficial for microorganisms. For 3-7 days microorganism grows there and forms colonies. When the growth is over, the colonies are studied and basing on their nature and microscopy results a final diagnosis is made. Also, in terms of this test, they can determine the sensitivity of microorganisms to certain antibiotics by adding small amounts of this or that antibiotic agent to their colonies.

Semen analysis

Semen analysis kit

Semen analysis kit

Semen analysis or spermogram is a diagnostic method used to evaluate the fertilizing capacity of male sperm. Ejaculate analysis is one of the most subjective laboratory tests and its results depend largely on the skill level of the doctor who does it.

This test shows the quantitative and qualitative sperm properties, usually it is performed to determine male fertility and detect various genital system disorders (oligozoospermia, necrozoospermia and etc.)
Sperm analysis is indicated in the following cases:

  • In infertile couples to identify male factor. Infertile couples are considered those who cannot conceive a child within 1 year of regular sex life without using any birth control products;
  • Male infertility (prostatitis, varicocele, infections, injuries, hormonal disorders);
  • Preparation for artificial insemination;
  • Planning for pregnancy;
  • When a man wants to check his fertility.

The procedure

The material for the analysis should be collected into a special sterile container by means of masturbation. If a part of the semen is lost, particularly it is important for the first portion of sperm, it makes the overall result of the test inaccurate. It is best to collect the sperm in a fertility clinic (a specialized room is provided for this purpose). However, the collection of the material can be done at home, but on one condition – patient should bring the sample to the laboratory within 40 minutes.

How to prepare for the test?

To get a correct diagnosis based on the results of ejaculate analysis it is necessary to comply with the following conditions:

  • Abstain from sex and masturbation for 3-5 days (the optimal period is 4 days);
  • Do not drink any alcohol, including beer; do not take any strong drugs (sleeping pills or tranquilizers) for 5 days;
  • Abstain from saunas and hot baths for 2-7 days;
  • The sample for the test can be collected not earlier than 2 weeks after the use of antibiotic drugs.

Semen analysis results

If the results are different from the normal values, then it’s recommended to do the test once again in 1 or 2 weeks and show its results to a doctor who specializes in andrology in order to find what causes the pathology. The only exception is a suspected genital infection, in this case the treatment should be started immediately.

Semen analysis results help detect prostatitis. In the case of prostatitis the test will show reduced sperm motility. Infectious prostatitis has a great influence on the quality of the sperm (especially that caused by sexually-transmitted infections). The inflammation in the prostate gland reduces sperm motility and promotes its agglutination (when sperm sticks together, it is caused by the presence of bacterial bodies or their metabolic products on the surface of spermatozoa) and formation of defective forms (for example, bad sperm analysis may be caused by ureaplasmosis).

Transrectal ultrasound


Transrectal Ultrasound Device

This diagnostic method helps indicate such conditions as prostatitis, benign prostatic hyperplasia, cancerous growths in the prostate gland, seminal vesiculitis. This procedure helps get a very clear and accurate image of the prostate gland and seminal vesicles as well as detect the slightest changes in the structure of the prostate.

Transrectal ultrasound (transrectal ultrasonography or TRUS) of the prostate is performed with the help of a special, very sensitive ultrasound transducer (or probe) that is placed into the rectum. At that moment the probe is in the immediate proximity to the organ under study, being separated from it only by the wall of the rectum (the distance between the active surface of the probe and the organ is only 5 mm). Such proximity of the prostate makes it possible to use high-frequency probes – 8-12 MHz. TRUS has distinct advantages over a typical ultrasound procedure, because it gives an image of a better quality and, thus, provides doctors with more accurate information. Quite often transrectal ultrasound can be accompanied with prostate biopsy (prostate cells are collected for further analysis). To avoid any pain that can be caused by biopsy, the site where the needle will be inserted is anesthetized.

It is necessary to stick to a low-residue diet for the whole day and use an enema 2-3 hours before the procedure in order to clean out the colon.

Indications for transrectal ultrasound:

  • Erectile disorders;
  • Painful, difficult or frequent urinations;
  • Pains in the perineum, pubic region, lower abdomen or small of the back;
  • Blood in semen;
  • Suspected infertility;
  • Clinical data indicating renal failure;
  • Painful sexual intercourses.


There are some contraindications as well:

  • The state after the extirpation (removal) of the rectum;
  • Relative contradictions to transrectal ultrasound are as follows:
    • Recent surgery on the rectum;
    • Deep rectal fissures;
    • Inflamed hemorrhoids;
    • Urinary incontinence.


Needle Biopsy

Single Action Biopsy Needles

Single Action Biopsy Needles

This test is used to diagnose the diseases of the prostate gland, testicle and epididymis, as well as seminal vesicle (oncological or inflammatory pathology).

Testicular biopsy

The main aim of testicular needle biopsy is to get the sperm when the ducts through which the semen gets from the testicles to the urethra are blocked. The doctor performs this procedure as follows – the area where the needle will be inserted is treated with an antiseptic and then locally anesthetized, after that a sample of testicular tissues is collected (testicular aspiration) with the help of a special needle. Testicular needle biopsy requires no skin closure.

There can be three main reasons to have testicular biopsy:

  • Azoospermia (when there is no spermatozoa in the patient’s semen);
  • It is used to get the sperm for in vitro fertilization;
  • Suspected testicular cancer.


There is a small risk of bleeding or infection. Patients may have irritation and inflammation on the skin (in the area of the biopsy) for 2 or 3 days after the procedure. The scrotum may be swollen or change its color, this will pass within several days after the biopsy.

Prostate biopsy

Biopsy of the prostate gland is one of the most accurate methods used for the diagnosis of prostate cancer; it is always performed if this type of cancer is suspected and once all other required tests are done. The doctor decides on a treatment method for every particular patient relying on the results of this procedure.

There are several techniques for prostate biopsy, but transrectal prostate biopsy is the most common and least painful one. The sample of prostate tissue is collected with the help of a special device consisting of a biopsy gun and special disposable needles.

All patients should comply with the following recommendations:

  • One must not use drugs that affect blood coagulation (aspirin, heparin, etc.) for 7 days before the procedure;
  • 3 days before prostate biopsy it is necessary to stop taking any anti-inflammatory preparations;
  • Enema should be used the day before biopsy (in the evening) and on the day of the procedure (in the morning) to clean out the colon;
  • The procedure should be performed on an empty stomach;
  • It is important to limit your physical activity during 1 day after biopsy;
  • Antibiotic therapy is usually administered for 3-5 days before the procedure in order to prevent inflammation of the prostate;
  • The next day after biopsy, it is allowed to remove the tampon the doctor inserted into the rectum to prevent possible bleeding.


The following complications after prostate biopsy are possible:

  • Hematuria (blood in the urine);
  • Hemospermia (blood in the semen);
  • Inflammation of the testicle and epididymis;
  • Pains in the perineum and rectum;
  • Exacerbation of chronic prostatitis or inflammation of the prostate gland;
  • Acute urinary retention;
  • Bleeding from the rectum.