Size of external genital organs and somatometric parameters among physically normal men younger than 40 years old

Testicular volume and clinical correlates of hypothalamic-pituitary-testicular function: A cross-sectional study in obese men

The aim of this study was to determine whether testicular volume is correlated with clinical and biochemical markers of hypothalamic–pituitary–testicular (HPT) axis function. This was a cross-sectional substudy of a larger randomized controlled trial including obese men, body mass index (BMI) ≥30 kg m⁻², with a total testosterone level <12 nmol l⁻¹. Testicular volume was measured by orchidometer, testosterone by liquid chromatography/tandem mass spectrometry, and body composition by dual-energy X-ray absorptiometry. Men completed the Aging Males' Symptoms (AMS) score, International Index of Erectile Function-5 (IIEF-5), physical function, and handgrip dynamometer testing. Eighty-nine men participated with a median (interquartile range [IQR]) age of 53.1 (47.6, 59.2) years, BMI of 37.0 (34.6, 40.5) kg m⁻², and a total testosterone of 7.0 (6.1, 7.9) nmol l⁻¹. Median testicular volume was 18 (IQR: 10, 20) ml. Testicular volume was negatively correlated with BMI (τ = −0.1952, P = 0.010) and total fat mass (τ = −0.2115, P = 0.005) independent of age and testosterone. When BMI, testosterone, sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) were present in a multivariable model, only BMI (-0.38 ml change in testicular volume per 1 kg m^-2 BMI; 95% CI: −0.74, −0.02; P = 0.04) and LH (-0.92 ml change in testicular volume per 1 IU l^-1 LH; 95% CI: −1.75, −0.095; P = 0.03) remained independent significant predictors of testicular volume. Testicular volume was positively correlated with IIEF-5 (τ = 0.2092, P = 0.021), but not related to handgrip strength, physical function tests, or AMS. In obese men, testicular volume is inversely and independently associated with measures of adiposity, but not with most clinical or biochemical markers of HPT axis action. From a clinical perspective, this suggests that obesity might compromise the reliability of reduced testicular volume as a sign of androgen deficiency in men.

Data from 14,597 penile measurements of vietnamese men

BACKGROUND

Penis size is a highly sensitive topic, which has often raised concerns associated with human masculinity and male sexual health. Although data regarding penile dimensions have been published worldwide, little is known about these measurements in South-East Asian countries.

OBJECTIVE

This study aimed to provide the reference range in penile length, circumference, and diameter of Vietnamese men and their variations among men with erectile dysfunction and other diseases.

MATERIALS AND METHODS

Information about flaccid length, stretched length, mid-shaft circumference, and glans diameter from the health records of 14,597 men attending the Andrology Consultation was collected. These men were classified into three groups being regular reproductive health screening group, sexual dysfunction group, and other disease groups.

RESULTS

We found that penile dimensions follow a non-parametric distribution, as tested by Kolmogorov-Smirnov test. The median values are 9.03 cm for flaccid length, 14.67 cm for stretched length, 8.39 cm for mid-shaft circumference, and 2.86 cm for unaroused glans diameter. Length and girth of the penis also changed among the different groups, especially in flaccid state; specifically, men with erectile dysfunction had a greater value in all penile dimensions except for change ratio compared with other groups. Circumcision, which rarely occurs in Vietnam, was associated with a 2 mm reduced penis length.

DISCUSSION

Findings on correlations between penile dimensions and somatometric parameters from previous studies are questionable and some measurements, such as glans dimension, have not been thoroughly investigated so far. Nevertheless, penile dimensions provide useful insight concerning conditions affecting sexual development and might be a valuable parameter in the assessment of erectile dysfunction.

CONCLUSION

Results of this study provide informative materials for the assessment of penile size, including reference values drawn from a large sample of Vietnamese men that can be useful in clinical practice and sexual health education.

Average-Size Erect Penis: Fiction, Fact, and the Need for Counseling

Most men believe that the average length of an erect penis is greater than 6 inches (15.24 cm). This belief is due, in part, to several often-cited studies that relied on self-reported measurements, with means of about 6.2 inches (15.75 cm) for heterosexual men and even greater for gay men. These studies suffered from both volunteer bias and social desirability bias. In this review, the combined mean for 10 studies in which researchers took measurements of erect penises was 5.36 inches (13.61 cm; n = 1,629). For 21 studies in which researchers measured stretched penises, the mean was approximately 5.11 inches (12.98 cm; n = 13,719). Based on these studies, the average length of an erect penis is between 5.1 and 5.5 inches (12.95-13.97 cm), but after taking volunteer bias into account, it is probably toward the lower end of this range. Studies show that a majority of men wish they were larger, with some choosing penile lengthening surgery. These surgeries are considered by the American Urological Association to be risky. Most men seeking surgery have normal sized penises. Counseling with factual information about penis size might be effective in alleviating concerns for the majority of men who worry about having a small penis.

Relationship between Body Mass Index (BMI) and testicular and hormonal parameters of sexually active male greater cane rats (Thryonomys swinderianus)

The current upsurge in intensive farming practices of greater cane rat has not only lead to higher growth rate but is accompanied by increased fat deposition especially in the males. This study attempts to characterize one of the most commonly used fat estimation parameter, the body mass index (BMI) as well as evaluates its relationship with testicular and hormonal parameters in seventy-two sexually active male cane rats over a period of one year. Six animals, kidded and raised in a farm, with known ages were used each month. The experimental protocols entail body measurements of weight, height and length; histology; orchidometry; and hormonal immunoassay of testosterone, estradiol, progesterone, LH and FSH using their various kits. The mean values of the body mass (BMI) and Lee (LI) indices of male greater cane rats were 1.18±0.20g/cm² and 0.30±0.02g/cm respectively with the testicular histology indicating normal spermatogenesis. BMI/LI, both of which followed the same pattern, neither correlate with testicular parameters nor with serum testosterone, progesterone, LH and FSH concentrations but had low correlations with serum estradiol concentration (r² = 0. 2; p = 0.0023). So, these relationships may provide clue on obesity and its effect on reproductive performance and strengthened the possibility of the characterized BMI/LI as obesity marker for breeding selection in male cane rat.

Cosmetic penile enhancement surgery: a 3-year single-centre retrospective clinical evaluation of 355 cases

Men's satisfaction and sexual function is influenced by discomfort over genital size which leads to seek surgical and non-surgical solutions for penis alteration. In this article we report the results of a retrospective study of 355 cases of cosmetic elongation, enlargement and combined elongation and enlargement phalloplasty. We found a significant improvement in length at rest, stretched length and circumference at rest at 2, 6 and 12 months post-surgical procedure (all p < 0.0001). 5-item International Index of Erectile Function (IIEF-5) was also increased at 12 months post-surgery compared to baseline (p < 0.0001). This was consistent with an IIEF-5 improvement of 6.74% compared to baseline. This study is clinically relevant due to the large cohort of patients included and because it is the first study to use an inverse periosteal-fascial suture not described previously as part of the surgical methodology.

Measurement of stretched penile length in prepubertal boys in Egypt

BACKGROUND

Early diagnosis of penile size abnormalities is both medically and psychologically important. It is important in the diagnosis of penile problems. Therefore, a current established reference for penile size in newborns and children is vital for diagnosis and early management of micropenis.

OBJECTIVES

The aim of the present study was to establish reference values for penile length in newborn and prepubertal boys at different ages in Minia Governorate, Egypt.

METHODS

The study was conducted on 1000 boys with ages ranging from 1 day to 13 years. Stretched penile length (SPL) was measured in mm by using a ruler with markings along the dorsum of the penis. The suprapubic fat tissue was pressed with one end of the ruler through the pubic ramus, and the penis was fully stretched and measured.

RESULTS

The mean SPL increased with age from newborn to 5 years, with a rapid growth observed in the first 8 months of life. After 5 years, SPL showed a slower growth rate until the age of 10 years, where it started to increase significantly again.

DISCUSSION

Comparison of the SPL in different age groups revealed significant statistical differences between most groups. It showed a noticeable and significant increase, especially from birth to the age of 5 years. Although there was a mild increase in SPL from 5 to 10 years, it showed a significant level in few age groups, indicating that the change is trivial. After that, high growth rate occurred again and statistical differences remained from age 10-13 years.

CONCLUSION

An updated reference for normal SPL in Egyptian boys from birth to 13 years old was provided in this study.

Paraffinoma, siliconoma and Co: Disastrous consequences of failed penile augmentation-A single-centre successful surgical management of a challenging entity

The purpose of this study was to present our series of patients with disastrous consequences of failed penile self-augmentation and suggested surgical reconstruction. Ten patients with median age of 23 years and a variety of penile and scrotal deformities due to injections of several substances had undergone successful surgical reconstruction of external genitalia. The injections were self-performed in nine cases and the patients reported from 4 to 20 substance injections throughout the penile shaft. Three patients presented with fibrotic scirrhous masses in their scrotum, although they did not report any injections in scrotal area. All patients underwent extended penile-shaft skin excision, while all palpable scrotal lesions were removed in one-by-one fashion, as an attempt to destroy the less possible scrotal tissue. All patients were discharged on first post-operative day and reassessed at 2 months post-operatively. As a result, penile self-augmentation with injected substances may cause severe complications. Our proposed single-staged procedure seems safe and effective.

Determinants of physiological uptake of 18F-fluorodeoxyglucose in palatine tonsils

To determine the extent of physiological variation of uptake of F-flurodeoxyglucose (FDG) within palatine tonsils. To define normal limits for side-to-side variation and characterize factors affecting tonsillar uptake of FDG.Over a period of 16 weeks 299 adult patients at low risk for head and neck pathology, attending our center for FDG positron emission tomography/computed tomography (PET/CT) scans were identified. The maximum standardized uptake value (SUVmax) was recorded for each palatine tonsil. For each patient age, gender, smoking status, scan indication and prior tonsillectomy status as well as weather conditions were noted.There was a wide variation in palatine tonsil FDG uptake with SUVmax values between 1.3 and 11.4 recorded. There was a strong left to right correlation for tonsillar FDG uptake within each patient (P < .01). The right palatine tonsil showed increased FDG uptake (4.63) compared to the left (4.47) (P < .01). In multivariate analysis, gender, scan indication, and prevailing weather had no significant impact of tonsillar FDG uptake. Lower tonsillar uptake was seen in patients with a prior history of tonsillectomy (4.13) than those without this history (4.64) (P < .01). Decreasing tonsillar FDG uptake was seen with advancing age (P < .01). Significantly lower uptake was seen in current smokers (SUVmax 4.2) than nonsmokers (SUV 4.9) (P = .03).Uptake of FDG in palatine tonsils is variable but shows a strong side-to-side correlation. We suggest the left/ right SUVmax ratio as a guide to normality with a first to 99th percentiles of (0.70-1.36) for use in patients not suspected to have tonsillar pathology.

Relationships between total testicular volume, reproductive parameters and surrogate measures of adiposity in men presenting for couple's infertility

The objective of this study was to investigate the relationships between total testicular volume (TTV), reproductive parameters and adiposity measures: body mass index, waist circumference and waist-to-height ratio. Semen analysis was performed, and reproductive hormone levels were measured in 2,672 male patients (mean age 32.6) due to couple's infertility. Significant, positive correlations between semen parameters and the TTV were found. Gonadotrophins were negatively related to the TTV, and testosterone was not related to the TTV. Three anthropometric parameters were negatively correlated to the total sperm count, and sperm concentration seen in men with a TTV of ≤46 ml. In the case of a TTV >46 ml, only the semen volume was inversely correlated with WC and WHtR. These changes occurred from a WHtR ≥0.56, WC ≥102 cm and BMI ≥29 and were more pronounced between WHtR and the TTV. Adiposity was associated with a significant testosterone level decline but did not have a major impact on the gonadotrophin levels. This study shows the divergent results in sperm parameters in different TTV groups in the presence of central adiposity.

Reference range of flaccid and stretched penile lengths of adult males in Baghdad: A cross-sectional study

Objectives

To establish a baseline reference range for flaccid (FPL) and stretched penile lengths (SPL) in adult males and to compare with reports from different nationalities, as concerns over penile size are common among men and currently the number of men seeking help for the perceived problem of a ‘short’ penis is increasing.

Subjects and methods

Over a 1-year period, FPL and SPL measurements were taken from males undergoing medical examination in the outpatient clinic of the Al-Karama Teaching Hospital, using a rigid centimetre ruler. The correlation between penile length and age was investigated.

Results

In all, 223 apparently healthy males were included in this study with a mean (SD; range) age of 41.3 (15.0; 20–77) years. The mean (SD; range) FPL was 9.8 (2.0; 5–17) cm and the SPL was 12.6 (1.9; 7.5–19.5) cm. Statistical analysis showed that penile length is increased in older age (>55 years). A penile length nomogram was constructed, showing that the 50th percentiles of FPL and SPL were 9.0 and 12.5 cm, respectively.

Conclusion

Our data establish a baseline reference range for adult male penile lengths in the Capital of Iraq (Baghdad), which should be useful for urologists when counselling patients.

Mutations in TBL1X Are Associated With Central Hypothyroidism

CONTEXT

Isolated congenital central hypothyroidism (CeH) can result from mutations in TRHR, TSHB, and IGSF1, but its etiology often remains unexplained. We identified a missense mutation in the transducin β-like protein 1, X-linked (TBL1X) gene in three relatives diagnosed with isolated CeH. TBL1X is part of the thyroid hormone receptor-corepressor complex.

OBJECTIVE

The objectives of the study were the identification of TBL1X mutations in patients with unexplained isolated CeH, Sanger sequencing of relatives of affected individuals, and clinical and biochemical characterization; in vitro investigation of functional consequences of mutations; and mRNA expression in, and immunostaining of, human hypothalami and pituitary glands.

DESIGN

This was an observational study.

SETTING

The study was conducted at university medical centers.

PATIENTS

Nineteen individuals with and seven without a mutation participated in the study.

MAIN OUTCOME MEASURES

Outcome measures included sequencing results, clinical and biochemical characteristics of mutation carriers, and results of in vitro functional and expression studies.

RESULTS

Sanger sequencing yielded five additional mutations. All patients (n = 8; six males) were previously diagnosed with CeH (free T₄ [FT4] concentration below the reference interval, normal thyrotropin). Eleven relatives (two males) also carried mutations. One female had CeH, whereas 10 others had low-normal FT4 concentrations. As a group, adult mutation carriers had 20%-25% lower FT4 concentrations than controls. Twelve of 19 evaluated carriers had hearing loss. Mutations are located in the highly conserved WD40-repeat domain of the protein, influencing its expression and thermal stability. TBL1X mRNA and protein are expressed in the human hypothalamus and pituitary.

CONCLUSIONS

TBL1X mutations are associated with CeH and hearing loss. FT4 concentrations in mutation carriers vary from low-normal to values compatible with CeH.

Autologous dermal graft combined with a modified degloving procedure for penile augmentation in young adults: a preliminary study

In order to evaluate the effect of penile enhancement, we retrospectively reviewed the data of the patients operated with autologous dermal graft implantation combined with a modified penile degloving procedure. The patients with the complaints of small penis, asking for penile augmentation, and normal erectile function were psychologically screened and enrolled. Data of follow-up visit including patient demographics, medical history, surgical procedure, patient-reported outcomes were analysed. In all, 30 eligible persons were operated. After degloving of the penis, the suspensory ligament was incised and the tunica albuginea was fixed to the proximal tunica dartos at the penile base. Then, the dermis graft was implanted on the dorsal surface of the tunica albuginea. The file of follow-up visit was available in 17 (57%) patients. The mean age was 23.7 years (19-35 years) and the mean follow-up was 13 months (range, 4-24 months). During the follow-up period, the average gain in the penis length was 2.7 cm in flaccid and 0.8 cm in erection, respectively. And the average gain in the penis circumference was 1.5 cm in flaccid and 1.2 cm in erection, respectively. Also, psychosexual sexual self-esteem and confidence of the patients were significantly improved (p < 0.001). Overall, 13 (76%) patients reported satisfaction with the penile appearance. We believe that the surgery is both safe and effective in the enhancement of the penis, however, further clinical studies with a larger patient population are necessary.

Surgical treatment of primary disease for penile squamous cell carcinoma: A Surveillance, Epidemiology, and End Results database analysis

Current guidelines recommend penile sparing surgery (PSS) for selected penile cancer cases. The present study described the use of PSS in a population-based cohort, and also examined the role of PSS on penile cancer-specific mortality (PCSM). Data from the Surveillance, Epidemiology, and End Results (SEER) database were used to identify individuals that were diagnosed with penile squamous cell carcinoma between 1998 and 2009 and treated with surgery. Patients were sorted into two groups: Local tumor excision (LTE) and partial/total penectomy (PE). Factors associated with the receipt of LTE and PCSM following LTE were examined. In addition, PCSM was compared between LTE and PE following propensity score matching. Of the 1,292 eligible patients, 24.2% underwent LTE. For stage T1 disease, the rates of LTE increased moderately from 29 to 40% over the last decade. Following multivariate analyses, young age, African descent, a tumor size of <3 cm and stage T1 disease were identified to positively influence the receipt of LTE. With a median follow-up period of 55 months, the four-year PCSM rate was 9.8% in patients treated with LTE. Older age, a tumor size of 3-4 cm and regional/distant disease (SEER stage) were significant predictors of PCSM. Furthermore, in matched cohorts with stage T1 disease, the four-year PCSM rates were 8.9 and 10.0% for patients that received LTE or PE, respectively (P=0.93). In conclusion, underuse of PSS is pronounced in the general community with significant age and ethnicity disparities. The current population-based study provides evidence supporting the oncological safety of PSS compared with PE in early-stage disease.

Perceptions about penis size among supposedly healthy 40 to 60-year-old Brazilian men: a cross-sectional pilot study

CONTEXT AND OBJECTIVE

Many men seek medical treatments complaining that their penises are too small (short) when in fact they are not (they are not cases of micropenis). The objective of the present study was to evaluate men's satisfaction with their own bodies and sex life and the prevalence of erectile dysfunction, among men who were not seeking medical or psychological advice.

DESIGN AND SETTING

Cross-sectional study in a private, philanthropic hospital in São Paulo, Brazil.

METHODS

In this study, 300 male blood donors aged between 40 and 60 years old answered a questionnaire, in privacy, about their sex life and their satisfaction with their own bodies. They were also screened for erectile dysfunction by means of the International Index of Erectile Function questionnaire.

RESULTS

Seven men (2.3%) reported that they were dissatisfied with their penis size (they thought that it was small), and among these, one was found to have mild erectile dysfunction. However, none of them had sought medical attention. Among these seven, only two had normal body mass index; the other five were overweight (three) or obese (two).

CONCLUSION

The prevalence of dissatisfaction with penis size was low. Among the seven dissatisfied men, only one had erectile dysfunction, of mild type, and all of them felt potent.

Neonatal stretched penile length: relationship with gestational maturity and anthropometric parameters at birth

BACKGROUND

It is inappropriate to use universal cut-off points to interpret stretched penile length (SPL) measurements in newborns with variable body dimensions.

AIM

To assess neonatal SPL on the basis of gestational maturity and anthropometric parameters at birth.

METHODS

A cross-sectional observational study of SPL was conducted on stable newborns at a referral teaching hospital in north India between January and June 2012. Gestational maturity, SPL and anthropometric parameters (weight, length, head circumference and foot length) were recorded within 24 hours of birth. Variation of SPL in relation to gestational age and anthropometric parameters were evaluated using multiple linear regression models. The equation using lower confidence limits of 95% confidence intervals for the correlation coefficients provides cut-off points to define a small penis.

RESULTS

Data from 1249 newborns demonstrated that penile growth follows the pattern of increase in body dimensions in newborns. SPL can be predicted best in relation to body and foot length taken together.

CONCLUSIONS

SPL should be interpreted in relation to anthropometric parameters in newborns, particularly body and foot length.

A comprehensive, prospective study of penile dimensions in Chinese men of multiple ethnicities

This study aimed to establish a reference range of penile length and circumference of adult males in China, and to compare the penile dimensions of different ethnical backgrounds. To do this, penile length and circumference measurements were obtained from 5196 healthy males attending the Urology Counseling Clinic. The mean value of penile dimensions was a flaccid length of 6.5 ± 0.7 cm, a stretched length of 12.9 ± 1.2 cm and a flaccid circumference of 8.0 ± 0.8 cm. In the subgroup of 311 males, the mean erectile length was 12.9 ± 1.3 cm and the mean erectile circumference was 10.5 ± 0.9 cm, the mean flaccid and erectile glans lengths were 2.7 ± 0.3 and 3.4 ± 0.4 cm, respectively, and the mean flaccid and erectile glans diameters were 2.6 ± 0.2 and 3.4 ± 0.4 cm, respectively. We found that flaccid penile length and circumference varied among different ethnicities. This study established a reference range for penile dimensions, which will help when counseling patients worried about their penile size or seeking penis enlargement surgery. We also found that penile dimensions are different in different ethnicities, but further investigations are needed to validate this.

Penile length-somatometric parameters relationship in healthy Egyptian men

This study aimed to assess the penile length-somatometric parameters relationship in healthy Egyptian men. Two thousand physically normal men (22-40 years) were subjected to measurement of stretched penile length, glans penis, testis size, index finger, weight, height, span, body mass index (BMI), waist circumference, hip circumference and waist/hip ratio. The mean stretched penile length of the studied subjects was 13.84 ± 1.35 cm (range 12-19 cm), and the mean glans penis length was 2.6 ± 0.4 cm (range 1.7-3.8 cm). Penile length demonstrated positive significant correlation with glans penis length, index finger length, BMI and significant negative correlation with waist/hip ratio. On the other hand, penile length demonstrated nonsignificant correlation with age, weight, height, waist circumference, span or testicular size. It is concluded that the penile length-somatometric parameters relationship in healthy Egyptian men is mostly related to glans penis and index finger lengths.

Testicular volume is inversely correlated with nurturing-related brain activity in human fathers

Despite the well-documented benefits afforded the children of invested fathers in modern Western societies, some fathers choose not to invest in their children. Why do some men make this choice? Life History Theory offers an explanation for variation in parental investment by positing a trade-off between mating and parenting effort, which may explain some of the observed variance in human fathers' parenting behavior. We tested this hypothesis by measuring aspects of reproductive biology related to mating effort, as well as paternal nurturing behavior and the brain activity related to it. Both plasma testosterone levels and testes volume were independently inversely correlated with paternal caregiving. In response to viewing pictures of one's own child, activity in the ventral tegmental area--a key component of the mesolimbic dopamine reward and motivation system--predicted paternal caregiving and was negatively related to testes volume. Our results suggest that the biology of human males reflects a trade-off between mating effort and parenting effort, as indexed by testicular size and nurturing-related brain function, respectively.

Erect penile length and circumference dimensions of 1,661 sexually active men in the United States

INTRODUCTION

Penile size continues to receive popular and empirical attention. Little is known about the process of self-measurement and whether the behaviors a man engages in to become erect for self-measurement are associated with his erect penile dimensions.

AIMS

The article aims to assess men's erect penile dimensions in a study in which the men would presumably be motivated to report accurate information about their penis size; and to explore associations between men's erect penile dimensions, their method of measurement, and their demographics.

METHODS

Data are from an Internet-based baseline phase of a large prospective daily diary study that compared men's use of a standard-sized condom to men's use of a condom sized to fit their erect penis.

MAIN OUTCOME MEASURES

The main outcomes are participant characteristics, activities engaged in during self-measurement process, and self-reported erect penile length and circumference.

RESULTS

For this sample of 1,661 men, the mean erect penile length was 14.15 cm (SD = 2.66; range = 4 to 26 cm), and the mean erect penile circumference was 12.23 cm (SD = 2.23; range = 3 to 19). Participant characteristics were not associated with measured length or circumference. Most men measured their penis while alone, using hand stimulation to become erect.

CONCLUSIONS

In this sample of men who measured their erect penile length and circumference for the purposes of receiving a condom sized to fit their erect penis, we found a mean erect penile length of 14.15 cm and a mean erect penile circumference of 12.23 cm. The self-reported erect penile dimensions in this study are consistent with other penile dimension research. Also, findings suggest that mode of getting an erection may influence erect penile dimensions. Additionally, how a man becomes erect for self-measurement may be associated with his erect penile length and/or circumference.

The use of an acellular collagen matrix in penile augmentation: A pilot study in Saudi Arabia

OBJECTIVES

To assess the use of an acellular collagen matrix (Pelvicol, Bard Medical, Covington, GA, USA), a successful agent for reconstructive surgery, for enhancing penile girth.

PATIENTS AND METHODS

Between June and December 2011, 18 patients (mean age 24 years, range 19-38) had their penis augmented with Pelvicol; the mean (range) penile circumference was 9.2 (7-13) cm before treatment. They were divided into two groups; the first (10 patients) had a Pelvicol sheet of 8 × 12 cm inserted through a V-Y suprapubic incision and wrapped around the shaft in a bilayer under the dartos fascia, but not covering the urethra, with division of the suspensory ligament. The second group of eight patients had the Pelvicol inserted through a subcoronal degloving incision and placed in one layer. The penile circumference was measured at 6 and 12 months after surgery. Patient satisfaction at 1 year after surgery was assessed as 'poor', 'unsatisfied', 'moderately satisfied', 'highly satisfied', or 'excellent'.

RESULTS

The mean (range) increase in girth (circumference) was 2.8 (2-3.2) cm in group 1 and 1.7 (1.2-2) cm in group 2. In group 1, two patients were highly satisfied, four moderately satisfied and four unsatisfied; in group 2, three were moderately satisfied and five unsatisfied. Complications were common in both groups, with five patients in group 1 and three in group 2 developing severe penile oedema and ischaemic shaft ulcers. Removal of the graft was required in two patients in each group.

CONCLUSION

This pilot study shows that Pelvicol is not an ideal option for enhancing penile girth, and the method of placement did not apparently influence the result.

Pelvic, Perineal and Genital Reconstructions

Perineogenital and pelvic surgery is challenging due to the complex anatomy and physiology, multi-organ involvement and microbial environment of this region. In reconstructive surgery local and pedicled flaps are usually applicable. Microvascular flaps are rarely needed. Positioning of the scars, tension in the wound edges and pressure conditions must be taken into account, because failed correction may create more functional and aesthetic problems as the defect itself. This brief review focuses on the reconstructive methods of perineum, genitals and pelvic floor, site by site, with special emphasis on functional details.

Use of Macrolane VRF 30 in emicircumferential penis enlargement

BACKGROUND

Penis enlargement is increasingly in demand. Methods for penis enlargement can be classified into surgical, nonsurgical (filling), and mechanical. Each method has shown only relatively successful results. A new formulation of injectable, stabilized, hyaluronic acid (HA)-based, nonanimal gel is available that may have applications for this use.

OBJECTIVES

The authors propose a new technique for emicircumferential-injection filling of the penis and assess the safety and efficacy of this procedure compared with lipofilling.

METHODS

The authors retrospectively reviewed the charts of 83 patients who underwent penis enlargement with either their HA-injection technique or lipofilling between December 2007 and July 2011. Safety, efficacy, and patient satisfaction were assessed.

RESULTS

The circumferential enlargement obtained from both techniques ranged from 3.2 to 4.5 cm, with a decrement during erection. In all patients, the increase in penis length ranged from 1.8 to 3.6 cm. No complications were seen in patients treated with HA, whereas 8 patients treated with lipofilling developed granuloma, and another experienced fat necrosis. The vast majority (n = 72) of patients reported being "very satisfied" with the results.

CONCLUSIONS

The ideal technique for penis enlargement should be nonsurgical, with a satisfactory and predictable result, a low rate of complications, and long-term stability. Emicircumferential enlargement with HA filler meets these requirements. However, results have been durable but not definitive, and repeated treatment (with associated costs) is necessary.

Penile reconstruction

A variety of surgical options exists for penile reconstruction. The key to success of therapy is holistic management of the patient, with attention to the psychological aspects of treatment. In this article, we review reconstructive modalities for various types of penile defects inclusive of partial and total defects as well as the buried penis, and also describe recent basic science advances, which may promise new options for penile reconstruction.

Why women have orgasms: an evolutionary analysis

Whether women's orgasm is an adaptation is arguably the most contentious question in the study of the evolution of human sexuality. Indeed, this question is a veritable litmus test for adaptationism, separating those profoundly impressed with the pervasive and myriad correspondences between organisms' phenotypes and their conditions of life from those who apply the "onerous concept" of adaptation with more caution, skepticism or suspicion. Yet, the adaptedness of female orgasm is a question whose answer will elucidate mating dynamics in humans and nonhuman primates. There are two broad competing explanations for the evolution of orgasm in women: (1) the mate-choice hypothesis, which states that female orgasm has evolved to function in mate selection and (2) the byproduct hypothesis, which states that female orgasm has no evolutionary function, existing only because women share some early ontogeny with men, in whom orgasm is an adaptation. We review evidence for these hypotheses and identify areas where relevant evidence is lacking. Although additional research is needed before firm conclusions can be drawn, we find that the mate-choice hypothesis receives more support. Specifically, female orgasm appears to have evolved to increase the probability of fertilization from males whose genes would improve offspring fitness.

Original technique for penile girth augmentation through porcine dermal acellular grafts: results in a 69-patient series

INTRODUCTION

Although different techniques for augmentation phalloplasty have been reported in the medical literature, this issue is still highly controversial, and none of the proposed procedures has been unanimously approved.

AIMS

The aim of this study is to describe an innovative surgical technique for penile girth augmentation with porcine dermal acellular grafts, through a small transverse incision at the penile base, along the penopubic junction.

METHODS

Between 2000 and 2009, 104 patients were referred to our institution for penile enhancement. After a preoperative psychosexual consultation and a general medical assessment, 69 patients were deemed suitable good candidates for surgery. The average penis circumference was measured at the mid-length of the penis and was 8.1 cm (5.4-10.7 cm) and 10.8 cm (6.5-15.8 cm) during flaccidity and erection, respectively. All patients received penile augmentation with porcine dermal acellular grafts.

MAIN OUTCOME MEASURES

Results evaluation of an innovative technique for penile girth augmentation through exogenous porcine grafts and small penobubic incision.

RESULTS

Postoperative measurements were performed at 6 and 12 months. At the 1-year follow-up, the average penis circumference was 11.3 cm (8.2-13.2 cm, 3.1 cm mean increase) during flaccidity and 13.2 cm (8.8-14.5 cm, 2.4 cm mean increase) during erection. No major complications occurred in the series. Minor complications were resolved with conservative treatment within 3 weeks. Sexual activity was resumed from 1 to 2 months after surgery. The psychosexual impact of the operation was beneficial in the majority of cases.

CONCLUSION

Penile girth enlargement with acellular dermal matrix grafts has several advantages over augmentation with autogenous dermis-fat grafts: the elimination of donor site morbidity and a significantly shorter operation time. With this approach, through a short dorsal incision at the base of the penis, the scar is concealed in a crease covered by pubic hair and thus hardly visible.

Long-term testicular position and growth of acquired undescended testis after prepubertal orchidopexy

PURPOSE

The aim of the study was to determine long-term testicular position and growth of acquired undescended testis (UDT) after prepubertal orchidopexy.

METHODS

Patients who had undergone prepubertal orchidopexy for acquired UDT at our hospital between 1986 and 1999 were recruited to assess long-term testicular position and volume. Testis position was assessed by physical examination. Testis volume was measured with Prader orchidometry and ultrasound and was compared with normative values reported in the literature.

RESULTS

A total of 105 patients (aged 14.0-31.6 years) were included with 137 acquired UDT (32 bilateral, 33 left sided, and 40 right sided). All but 1 of the orchidopexied testes (99.3%) were in low scrotal position. The mean volume of the orchidopexied testes in unilateral UDT (n = 73, 10.57 ± 3.74 mL) differed significantly from the size of the testes at the contralateral side (14.11 ± 4.23 mL) (P = .000). The operated testes (10.28 ± 3.45 mL) were smaller than the mean adult testis volume reported in the literature (13.4-13.6 mL; cutoff, 13.2 mL).

CONCLUSION

Testis position after prepubertal orchidopexy for acquired UDT was nearly always low scrotal. The volume of the orchidopexied testes was smaller than both the volume of the contralateral testes and the normative values reported in the literature.

Relationship between penile size and somatometric parameters in 2276 healthy young men

The aim of this study was to determine the average penile length of a group of healthy, young Turkish men, and to investigate the relationship between penile length and somatometric parameters in the same group. The flaccid and stretched length and circumference of the penis was measured in a group of 2276 physically normal, young men. The correlation between penile length and weight, height and body mass index (BMI) of the participants was determined by Pearson's analysis. The mean age of the participants was 21.1 ± 3.1 (18-39) years. The mean flaccid, fully stretched and circumferential length of the participants' penises were 8.95 ± 1.04, 13.98 ± 1.58 and 8.89 ± 0.86 cm, respectively. There was a significant relationship between all of these variables (P<0.01). Although weak positive correlations were found between the mean circumference length and BMI, there were no correlations between both the flaccid and stretched lengths and BMI. The penile length must be known to be able to determine the abnormal penile sizes and to make convenient decisions in the counseling and/or treatment of people with short penis concerns. Our study provides mean penile lengths in a large sample of healthy, young Turkish men, and the penile dimensions were found to be weakly correlated with somatometric parameters.

Second to fourth digit ratio: a predictor of adult penile length

The second to fourth digit ratio (2D:4D) has been proposed as a putative biomarker for prenatal testosterone and covaries with the sensitivity of the androgen receptor (AR). Both prenatal testosterone and the AR play a central role in penile growth. In this study, we investigated the relationship between digit ratio and penile length. Korean men who were hospitalized for urological surgery at a single tertiary academic centre were examined in this study, and 144 men aged 20 years or older who gave informed consent were prospectively enrolled. Right-hand second- and fourth-digit lengths were measured by a single investigator prior to measurement of penile length. Under anaesthesia, flaccid and stretched penile lengths were measured by another investigator who did not measure nor have any the information regarding the digit lengths. Univariate and multivariate analysis using linear regression models showed that only height was a significant predictive factor for flaccid penile length (univariate analysis: r=0.185, P=0.026; multivariate analysis: r=0.172, P=0.038) and that only digit ratio was a significant predictive factor for stretched penile length (univariate analysis:r=-0.216, P=0.009; multivariate analysis: r=-0.201, P=0.024; stretched penile length=-9.201×digit ratio + 20.577). Based on this evidence, we suggest that the digit ratio can predict adult penile size and that the effects of prenatal testosterone may in part explain the differences in adult penile length.

Establishing a reference range for penile length in Caucasian British men: a prospective study of 609 men

OBJECTIVES

• To establish a reference range for adult male genital size in the UK using penile length measurements. • To compare the reference ranges for normal penile length reported from several different countries and the anthropometric differences noted between different nationalities and ethnic backgrounds.

METHODS AND MATERIALS

• Over 20 months, genital measurements were taken from all men undergoing routine examination in clinics (n= 499) and in operating theatres during examination under anaesthetic (n= 110). • Using a rigid metric ruler three penile measurements were taken: flaccid pendulous penile length, flaccid penopubic penile length (to the pubic arch) and stretched flaccid penopubic length. In addition, testicular size was measured using an orchidometer. • The patient's age and the reason for referral were recorded. • Statistical analysis was carried out using Pearson correlation analysis.

RESULTS

• Measurements from 610 patients aged 16-90 years were available for analysis. • The mean penile lengths were: pendulous length 8.7 cm (sd 1.6 cm), penopubic length 10.2 cm (sd 1.4 cm) and stretched length 14.3 cm (sd 1.7 cm). The mean testicular volume was 19.8 mL (sd 5.4 mL) for both left and right testicles. • Men with penile disease (including phimosis and Peyronie's disease) had slightly reduced penile length (pendulous -3.3 mm, P= 0.014; penopubic -2.3 mm, P= 0.029; stretched -5.1 mm, P < 0.001) compared with other referral groups (erectile dysfunction, testicular disease, prostate and bladder disease). • There was no significant correlation between penile length and age or testicular size

CONCLUSION

• These data establish a reference range for adult male genital size in the UK, which should be helpful for urologists when counselling patients.

Penile length and somatometric parameters: a study in healthy young Turkish men

The purpose of this study was to determine average penile length and to investigate the relationship between penile length and somatometric parameters in a group of young, healthy Turkish men. A total of 1,132 men were included in the study. The age, height and weight of the subjects were recorded. Penile length was measured in both flaccid and stretched states. The correlation between penile length and somatometric parameters was analysed. The mean age of the subjects was 20.3±0.9 years. The mean penile length in flaccid and stretched states was 9.3±1.3 and 13.7±1.6 cm, respectively (P<0.001). There was a positive correlation between flaccid and stretched penile length (r=0.800, P<0.001). The mean testicular volume was 22.0±2.8 cm(3). A weak positive correlation was detected between penile length and mean testicular volume (r=0.143 for flaccid penile length and r=0.140 for stretched penile length, P<0.001 for both). Similarly, weak positive correlations were found between penile length (both flaccid and stretched) and height, weight and body mass index, respectively (P<0.001, for all). These results demonstrate that somatometric parameters are correlated with penile length. We believe that further studies would provide more information about the causal relationship.

Cut-off value of testes volume in young adults and correlation among testes volume, body mass index, hormonal level, and seminal profiles

OBJECTIVES

To set a population-based cut-off value of normal adult and to determine correlations of testicular volume with body mass index (BMI), seminal profiles, and hormone levels. Testicular volume is an index of male fertility but cut-off values of normal adult has not been reported.

METHODS

During 54 months from January 2004, 1139 normal young men, 19-27 years old in military service were enrolled. Testicular volumes were measured by ultrasonometry. Height, body weight, and BMI were measured and semen analysis and hormone assay (follicle-stimulating hormone [FSH], luteinizing hormone [LH], and testosterone) were performed.

RESULTS

The mean age was 23.52+/-2.74. The mean testicular volume was 18.37+/-3.62 cm3 in left, and 18.13+/-3.85 cm3 in right. The mean body weight was 67.4+/-7.91 kg, the mean height was 176.2+/-6.64 cm, and mean BMI was 22.49+/-2.02 kg/m2. Testicular volumes had significant but weak correlations with height, body weight, and BMI. The semen analyses showed a mean pH of 7.63+/-0.74, volume of 2.49+/-1.12 mL, count of 68.63+/-13.62x10(6), motility of 69.93%+/-10.28%, and morphology of 68.62%+/-7.48%. Sperm counts and motility had positive correlations with testicular volume. The mean hormonal levels of FSH, LH, and testosterone were 7.31+/-2.42 mIU/mL, 7.81+/-2.49 mIU/mL, and 6.23+/-1.69 ng/mL, respectively. Testicular volume was negatively correlated with FSH and LH and positively with testosterone.

CONCLUSIONS

In this population-based study, we conclude that the cut-off testicular volume in normal young adults is around 18 mL and that testicular volume is positively correlated with height, body weight, BMI, semen profile, and testosterone, and negatively correlated with FSH and LH.

The association between penis size and sexual health among men who have sex with men

Larger penis size has been equated with a symbol of power, stamina, masculinity, and social status. Yet, there has been little research among men who have sex with men assessing the association between penis size and social-sexual health. Survey data from a diverse sample of 1,065 men who have sex with men were used to explore the association between perceived penis size and a variety of psychosocial outcomes. Seven percent of men felt their penis was "below average," 53.9% "average," and 35.5% "above average." Penis size was positively related to satisfaction with size and inversely related to lying about penis size (all ps < .01). Size was unrelated to condom use, frequency of sex partners, HIV status, or recent diagnoses of HBV, HCV, gonorrhea/Chlamydia/urinary tract infections, and syphilis. Men with above average penises were more likely to report HPV and HSV-2 (Fisher's exact p <or= .05). Men with below average penises were significantly more likely to identify as "bottoms" (anal receptive) and men with above average penises were significantly more likely to identify as "tops" (anal insertive). Finally, men with below average penises fared significantly worse than other men on three measures of psychosocial adjustment. Though most men felt their penis size was average, many fell outside this "norm." The disproportionate number of viral skin-to-skin STIs (HSV-2 and HPV) suggest size may play a role in condom slippage/breakage. Further, size played a significant role in sexual positioning and psychosocial adjustment. These data highlight the need to better understand the real individual-level consequences of living in a penis-centered society.

The Virtual Family--development of surface-based anatomical models of two adults and two children for dosimetric simulations

The objective of this study was to develop anatomically correct whole body human models of an adult male (34 years old), an adult female (26 years old) and two children (an 11-year-old girl and a six-year-old boy) for the optimized evaluation of electromagnetic exposure. These four models are referred to as the Virtual Family. They are based on high resolution magnetic resonance (MR) images of healthy volunteers. More than 80 different tissue types were distinguished during the segmentation. To improve the accuracy and the effectiveness of the segmentation, a novel semi-automated tool was used to analyze and segment the data. All tissues and organs were reconstructed as three-dimensional (3D) unstructured triangulated surface objects, yielding high precision images of individual features of the body. This greatly enhances the meshing flexibility and the accuracy with respect to thin tissue layers and small organs in comparison with the traditional voxel-based representation of anatomical models. Conformal computational techniques were also applied. The techniques and tools developed in this study can be used to more effectively develop future models and further improve the accuracy of the models for various applications. For research purposes, the four models are provided for free to the scientific community.

Timing of reproductive maturation in rural versus urban Tonga boys, Zambia

BACKGROUND

Population variation in the timing of reproductive maturation among boys has received relatively little attention. However, evidence that the timing of pubertal onset is related to measures of adiposity suggests that the onset of reproductive maturation among boys in populations with poor nutritional status will be delayed.

AIM

This study seeks to determine the impact of nutritional status on the timing of reproductive maturation by comparing urban and rural boys in an African population.

SUBJECTS AND METHODS

Subjects were 794 rural and urban Tonga boys from Zambia, ages 5-19. Onset of puberty was defined as testicular volume >3 mL, which was measured using Prader beads. Data on height, weight, triceps skinfolds, and dental development were also obtained.

RESULTS

Onset of testicular growth was 11.2 years (95% CI 10.9-11.4) for urban boys and 12.4 (95% CI 12.1-12.9) years for rural boys. Completion of testicular growth was also earlier in the urban sample: 15.3 years (95% CI 15.0-5.6) versus 17.1 years (95% CI 15.6-25.2). Both onset and completion of testicular growth were significantly and positively related to height and arm muscle area. In addition, triceps skinfolds by residence interaction was a significant predictor of testicular maturity, indicating a stronger relationship between energetic status and testicular growth in the rural sample.

CONCLUSION

Our results demonstrate that delayed onset and slow testicular development among rural Gwembe boys is related to poor nutritional status.

Structured Management and Counseling for Patients with a Complaint of a Small Penis

INTRODUCTION

Penile augmentation surgery has become increasingly common though there is no consensus about the management strategy for men with a complaint of small penis.

AIM

To introduce and evaluate the outcome of a structured management and counseling protocol for patients with a complaint of a small-sized penis.

METHODS

A structured protocol for consultation and management of (physically normal) patients with a complaint of a small penis through a descriptive study comprised of a series of 250 patients.

MAIN OUTCOME MEASURES

Percentage of patients who elect to undergo penile augmentation surgery.

RESULTS

Only nine patients (3.6%) chose to seek further surgical intervention. Two had a buried penis, two had true micropenis and five had normal penile size.

CONCLUSIONS

Using a structured management and counseling protocol, most men chose not to undergo penile augmentation surgery, even when offered for free.

Augmentation Phalloplasty Patient Selection and Satisfaction Inventory: A Novel Questionnaire to Evaluate Patients Considered for Augmentation Phalloplasty Surgery Because of Penile Dysmorphophobia

OBJECTIVES

To introduce a novel questionnaire by which we attempted to identify the most suitable candidates for augmentation phalloplasty surgery for penile dysmorphophobia and to objectively estimate the outcome.

METHODS

A total of 45 physically normal young adult men who presented with complaints of a "small penis" and were seeking surgical correction were included in the study. In addition to the ordinary evaluation, all completed the questionnaire devised by our department, the Augmentation Phalloplasty Patient Selection and Satisfaction Inventory (APPSSI). The APPSSI aims to quantitatively assess the severity of the condition and the degree of the patient's willingness to undergo penile augmentation and to numerically measure the postoperative result. The APPSSI consists of four questions, with each having five possible answers (scale 0 to 4). Questions 1 through 3 were asked preoperatively (suitability assessment) and questions 1, 2, and 4 postoperatively (outcome evaluation). The eligibility threshold for surgery was a preoperative score of 6 or less. The preoperative scores ranged from 0 (surgery justified) to 12 (surgery not justified), and the postoperative scores ranged from 0 (disappointed) to 12 (excited). The Student t test was used for statistical analysis, and P <0.05 was considered to indicate statistical significance.

RESULTS

Of the 45 patients, 13 (28.8%) with an APPSSI score of 6 or less (mean 3.18) underwent penile lengthening (n = 7), lengthening-enlargement (n = 4), or celioplasty-penile lengthening (n = 2). Postoperatively, the score increased by 4.36 (mean 7.54, P <0.001), and the condition improved by 25% to 50% in 11 patients, 66.6% in 1, and remained unchanged (0%) in 1 patient.

CONCLUSIONS

The APPSSI questionnaire properly identified patients who significantly benefited from augmentation phalloplasty. Nevertheless, because of the small sample size and nonrandomized study, the questionnaire's validation requires a larger number of patients tested in a randomized manner by more researchers to become a valuable clinical instrument and patient eligibility criterion for this type of surgery.

Penile size and somatometric parameters among Iranian normal adult men

This study aimed to determine the penile size and its correlation with somatometric parameters in physically normal Iranian adult men. To do this, a random sample of 1500 normal men aged between 20 and 40 years underwent tape measurements of penile dimensions in the stretched state under the same condition. The mean total penile length was 11.58+/-1.45 cm, the mean granular length was 3.04+/-0.33 cm and the mean girth was 8.66+/-1.01 cm. Multivariate regression analysis showed that penile dimensions are significantly correlated with age (P=0.018), height (P<0.001) and index finger length (P<0.001). This analysis provided no evidence for significant effect of waist/hip ratio and weight on penile dimensions. As the penile augmentation is still in its experimental stage and its indications have not yet been clearly established, providing standardized data on penile dimensions seems to be necessary to make convenient decisions in the counseling and/or treatment of people with short penis concerns.

Cancer and laterality: a study of the five major paired organs (UK)

OBJECTIVE

The human body displays marked asymmetry: paired organs differ bilaterally exerting effects upon cancer incidence and progression. However the factors involved remain contentious. In this large study involving over a quarter of a million cancer patients, we examine the epidemiological correlates of cancer laterality including incidence, stage at diagnosis and survival in the five major paired organs: the breasts, lungs, kidneys, testes and ovaries.

METHODS

Cancer patients were selected from the Thames Cancer Registry database and age-standardised incidence rates (ASRs), stage distribution at diagnosis and survival rates computed, stratifying appropriately.

RESULTS

Cancer incidence differed significantly by laterality at all sites studied (p < 0.01) but substantially in the lung (left-right incidence-rate ratio [IRR] 0.87), breast (IRR 1.07), testis (IRR 0.87) and in ovarian cancer (IRR 0.86). Autopsy data showed strongly coincident left-right organ size ratios (0.87 in the lungs and 0.87 in the testes). Patients with left testicular cancer, right lung cancer and left ovarian cancer showed significantly better survival than those with contralateral disease (p < 0.05).

CONCLUSIONS

In the lungs and testes, asymmetries in cancer incidence closely coincided with asymmetries in organ size. Our results suggest that tissue mass in these organs is an important contributor to asymmetry in cancer incidence.

Augmentation phalloplasty surgery for penile dysmorphophobia in young adults: considerations regarding patient selection, outcome evaluation and techniques applied

OBJECTIVES

To report on the efficacy and safety of augmentation phalloplasty procedures in physically normal young men, to introduce a patient selection and outcome evaluation questionnaire as well as, to propose a surgical technique modification.

METHODS

Eleven (11) out of 28 psychosomatically normal men (25-35 years) who presented complaining of penile dysmorphophobia (subjective perception of small penis), were subjected to: (a) penile lengthening (suprapubic skin advancement--ligamentolysis): n=5, (b) penile lengthening and shaft thickening (free dermal-fat graft shaft coverage): n=3 and (c) panniculectomy--suprapubic lipectomy and penile lengthening: n=2. A self administered questionnaire was employed in order to facilitate selection of the patients qualifying for the operation as well as to evaluate the outcome. In addition, a technical modification regarding dermal-fat graft handling was applied.

RESULTS

The postoperative course was uneventful with minor complications. The mean penile length gain (flaccid--stretched penis) was 1.6 cm (1-2.3 cm) [p=0.0014], the mean circumference gain was 2.3 cm [p=0.003] at the base and 2.6 cm [p=0.0012] subcoronaly. Significant (20%-53%) [p<0.0001] sexual self-esteem and functioning improvement was reported by the majority (91%) of patients.

CONCLUSIONS

Although penile size alteration was not spectacular or satisfying the patients' "great" expectations, the substantially uneventful clinical course coupled with the significant improvement in sexual self-esteem and function and the highly accepted outcome by the patients, render augmentation phalloplasty reasonable treatment modality for the management of strictly selected and thoroughly informed young adults who suffer from penile dysmorphophobia.