“So at the end of the day, you should examine your wife’s breasts and she should examine your testicles”. That was my summary advice to Oscar and Rachel the last time I met them at the Sexology Clinic. I can confidently send this same message to all couples having noted the tribulations that befell Oscar and Rachel.
Oscar was a 38-year-old lawyer running his private law firm in the city. Rachel, 35, was a pharmacist working for the government. The couple had been married for eight years, and they did not have children.
“We have attempted to have a baby all these years with no success,” Rachel explained when I saw them for the first time in the clinic. She had been brought to the clinic, not because of the infertility problem, but because she was discharging blood from her nipples.
Incidentally, the couple had been romancing when Oscar noticed blood on Rachel’s breasts “It was a very strange experience, my mouth was all bloody, I got so scared,” Oscar explained.
I examined Rachel but could not feel any lumps in her breasts. There was however some blood stained discharge from the left nipple. The breast was also a bit painful. I sent her for tests including scans of the breast. Fortunately, there was no sign of cancer, which is what we fear most when one has a bloody discharge from the nipples. I gave Rachel antibiotics to be taken for five days and asked her to come for review after a week.
Rachel came for the review accompanied by Oscar. As they walked into the consultation room, I could tell they were more relaxed and happier than when I met them the first time. Oscar was rather talkative, making jokes and punctuating them with staccato laughter.
“I repeated my usual examination last night and checked my mouth in the mirror again and I can assure you the problem is sorted out,” he said and burst out laughing. Rachel smiled shyly.
“Maybe you should also help us with the infertility problem,” Rachel said staring into the horizon. I could tell she was disturbed.
I once again examined both of them with the intention of identifying the cause of the infertility. The only abnormality I could put a finger to was that Oscar’s testicles were smaller than normal.
“Wow! So I have baby balls?” he asked with jest as I explained the need for them to undergo a battery of tests to identify the cause of the infertility.
They did all the tests as required. Rachel was perfectly normal. Oscar had low sperm count and most of his sperms were abnormal. He also had low levels of testosterone.
An ultrasound confirmed that his testicles were smaller. I concluded that Oscar had hypogonadism — sub-normal testosterone levels interfering with his fertility. He also opened up and said he had in the past suffered erection, a further testimony to the fact that testosterone was the culprit in this case.
I put Oscar on testosterone replacement therapy. Six months later, Rachel conceived. They came to the clinic soon after to seek advice on whether to have sex during the pregnancy or not. Rachel feared that sex could interfere with the pregnancy.
“I really need this baby so if sex can interfere I would rather we keep off,” she explained. Fortunately, sex is pretty safe in normal pregnancy and all I needed to do was to explain how to safely have it at different stages of the pregnancy for the comfort of the woman. I also discussed the danger signs to be aware of that call for postponing sex and asked them to be on the lookout.
Rachel had a safe delivery to a baby girl. I saw the couple less and less thereafter. They passed by only when they had a question about their sexuality. In their last visit, they came to find out if there was a way of monitoring if the testicles had a problem in the future.
“You see, if we knew how to assess the size of the testes, we would not have lived for eight years without a baby,” Oscar said, to which Rachel nodded.
“Is there a way of always checking if the testes are normal the way he does for my breasts?” Rachel asked.
I taught the couple how to examine the testes. Normally a man can examine his own testes but the wife can also do it for him. I therefore showed Rachel how to take measurements and how to assess consistency and shape.
I also appreciated Oscar’s way of examining breasts but took it a notch higher by teaching him the conventional way of doing it. We agreed that they would be examining each other every month and in case of any questions, they would always get back to me.