A 13-year-old boy without a significant medical history presents with a painful erection that has persisted for 3 days. He denies any known stimulus, trauma, or new medications. He has not had any other symptoms except for vague headaches and leg pain in the past month. He has seen 2 providers in the past 3 days, who prescribed therapies including lidocaine, oral pseudoephedrine, and antibiotics without relief. No laboratory tests were obtained at either visit. On physical examination he is afebrile, his blood pressure is 146/76 mm Hg, and his heart rate is 117 beats/min. He appears uncomfortable from penile pain but is nontoxic. On abdominal examination, his spleen is palpable 4 cm below the costal margin, and his genitourinary examination reveals an erect penis that is erythematous, tender to palpation, and without any obvious perfusion defects. The remainder of his examination findings are normal. Pediatric urology is urgently consulted for management of priapism, and laboratory studies are sent, which reveal the etiology of his symptoms. Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: https://shop.aap.org/licensing-permissions/Reprints Information about ordering reprints can be found online: http:// classic.pedsinreview.aappublications.org/content/reprints AUTHOR DISCLOSURE Drs Clark, Hsu, Darves-Bornoz, Tanaka, Mason, and Katzenstein have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/ device.

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Objective: To determine the proportion of men presenting for fertility evaluation who reported having an established primary care physician (PCP). Design: Retrospective, observational study. Setting: Academic health center. Patient(s): All men presenting for initial male factor infertility consultation with a single reproductive urologist between 2002 and 2018. Intervention(s): Men were asked to provide the name of their PCP at the time of initial visit. Main Outcome Measure(s): Descriptive statistics characterized the proportion of men with a PCP at the time of evaluation and associations between PCP status and clinical characteristics. Result(s): Among 4,127 men presenting for initial fertility consultation, 844 (20.5%) reported having an established PCP, 480 (11.6%) reported no PCP, and 2,803 (67.9%) did not have data available. Among 1,302 men who had a prior primary care visit within our healthcare system, 414 (31.8%) had been seen within 1 year before their fertility evaluation. Men with an established PCP were slightly older than those without a PCP, with higher body mass index, and lower systolic blood pressure. Hormonal profiles were similar across groups, but men with an established PCP had a significantly higher total motile sperm count than those without a PCP, median 53 (interquartile range, 11-109) versus 35 (interquartile range, 8-98). Conclusion(s):More than one third of men presenting for fertility evaluation did not have an established PCP. Reproductive urologists are uniquely positioned to facilitate the critical relationship between young men and PCPs, which should be a key component of the male fertility treatment paradigm. (Fertil Steril Rep Ò 2020;1:9-14. Ó2020 by American Society for Reproductive Medicine.

Objective: To investigate internet search results available to couples searching for a male factor infertility specialist. Design: Cross-sectional. Setting: Online search engine. Patient(s): The phrase ''male infertility specialist '' was searched in Google for 50 states and Washington D.C. The top 10 results (i.e., first page) of each search were evaluated for website content. Intervention(s): None. Main Outcome Measure(s): The first page of each search was evaluated for provider type (urology vs. obstetrics and gynecology), level of training (fellowship vs. none), male factor fertility information provided, and procedures offered. We compared search position rank (1-10) to determine the likelihood of finding an urologist versus a practitioner in obstetrics and gynecology. Result(s): A total of 419 results were identified; the majority were obstetrics and gynecology-related (N ¼ 229, 54.7%). Urology-related results appeared higher than obstetrics and gynecology-related results (median, 4 vs. 5). Andrology fellowship-trained urologists were identified in 153 (36.5%) results. Among 229 obstetrics and gynecology results, 152 unique practices were identified. A small portion (N ¼ 38, 16.6%) of these practices had a fellowship-trained urologist identified on the website. Most obstetrics and gynecology websites did not mention vasectomy reversal (N ¼ 116, 76.3%) or varicocele repair (N ¼ 93, 61.2%). A minority of practices offered referral to urologists for sperm extraction (N ¼ 23, 15.1%) or offered sperm retrieval themselves (N ¼ 23, 15.1%). Conclusion(s):When searching online for a male factor infertility specialist, most results identified obstetrics and gynecology physicians. A large proportion of obstetrics and gynecology websites lacked information on male factor fertility treatments and did not offer these treatments. These data indicate the need for a more robust online presence of male reproductive urologists to optimize online access. (Fertil Steril Rep Ò 2020;1:227-32. Ó2020 by American Society for Reproductive Medicine.

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