Slava Zaezjalkin, MD
ANDROLOGY (from Greek andros – a man) is the word that describes that field of medicine whose concern is how boys became men and what happens when things go wrong. For a long time, Andrology was a small section of urology that dealt with men’s infertility, but now Andrology is a separate medical discipline studying the whole process of how a small boy evolves into manhood physically, psychologically, sexually, with the potential for healthy fertility and responsible fatherhood. Any disorders of the male sexual organs and functions in any age belong to the field of Andrology. New achievements in immunology, genetics, and neuroendocrinology provide physicians with sophisticated tools for early diagnosis and successful treatment.
Actually, the concept underlying Andrology first appeared a long time ago. Hippocrates described eunuchs in Greece, which he attributed to chronic testicular trauma from horse riding. In old Persia, the famous physician Avicenna (Abu-Ali-ibn Cina) in his “Canon of Medical Science” (written in the 1200’s in 30 volumes and available in English translation thru Google) described hundred herbs and remedies for treating disorders of sexual organs and functions and created the first theoretical framework of Andrology.
A big part of Andrology now focuses on reproductology. If you think that the maturation of a male is an easy and natural process, think again. It is one of the troublesome areas of adolescent medicine. In the recent years the number of boys with problems of sexual identity, or endocrinological, neurological and psychological deviations affecting their sex organs and functions, were skyrocketing and became a real public health problem in many countries.
According to the World Health Organization, the frequency of childless couples in many countries is about 12-16%, and a half of it is due to male infertility. World statistics demonstrate that one in every eight families has a problem to conceive a child, and every sixth couple is childless. Given that the birth rate is decreasing in many European and western countries, the problem of infertility, especially male infertility, has a great social significance. Symptoms of delayed sexual development are as frequent in boys as in girls: 2.5%. Cryptorchism (undeveloped testicles) is seen in about 30% of prematurely born boys. Sexual identity problems, bisexuality, role reversal and many other psychological and psychiatric symptoms are a direct result of early development issues, including hypoxia during pregnancy and delivery
Russia is one of the few countries where male infertility is addressed as one of the main public health agendas. Due to the fact that many reproductive problems in adult males start as developmental issues in early childhood, Pediatric Andrology became a part of a formal education of pediatricians. There is a formal Organization of Andrological Services in St. Petersburg, Russia. Several textbooks and manuals are available for physicians and other health professionals.
The Andrological services in St. Petersburg:
Level 1. Regional Pediatric Screening: The goal of this service is routine screening of children for urological, endocrinological, and neurological conditions that might jeopardize future fertility;
Level 2. Specialized ambulatory office hours of the pediatric andrologist in the regional medical centers. The goal of these services is to finalize a diagnosis using sophisticated diagnostic tools, educating local doctors and consulting peripheral health care workers;
Level 3. Federal clinics and specialized recovery sanatoriums. The goal of this level of service is highly specialized ambulatory and hospital treatment and recovery. Within a few years of creating the Andrological services in St. Petersburg, about 80 000 children, adolescents, and adults were screened in all 5 regions of this large city and its suburbs. In the future we plan to share some of this experience with our American colleagues.
Slava Zaezjalkin, MD, PhD is Urologist and Plastic Surgeon in St. Petersburg, Russia specialized in Pediatric Andrology; Co-author of a textbook: The Organization of Andrological Services (SPB, Michailova Publishing Co. 2000. St. Petersburg, Russia).