Penis Enlargement Guide
Distal penile tumors (Fig. 6.2) involving the glans penis or distal corporal heads are traditionally successfully managed by performing a partial penectomy. Patients with such lesions can now benefit from penile-preserving surgery which maintains penile length and has a better cosmetic result. Austoni and coworkers highlighted the anatomical distinction between the corpora cavernosa and the corpus spongiosum and proposed glansectomy as a surgical option for patients with penile cancer confined to the glans.4 1 Approximately 80 of all cases of invasive penile carcinoma are potentially amenable to this operation. The extent of tumor invasion is confirmed with preoperative MRI imaging, with intracavernosal prostaglandin induced erection (Chap 4).42,43
The operation is similar to a total glansectomy described above but includes the resection of the distal corporal heads and adjacent urethra. A rounded neoglans is then reconstructed from the corpora. The shaft skin is fully mobilized to prevent later retraction and shortening, and the denuded corporal heads are then covered by a split thickness skin graft. Penile lengthening manoeuvres can be performed at the same time or at a later date.51 An extra 2-3 cm can be gained by dividing the penile suspensory ligaments beneath the pubic arch. A dorsal V-Y skin advancement and a ventral V-Y phalloplasty to lower the insertion of the scrotal skin may also help relieve tethering and traction.53 The cosmetic outcome is better than for conventional surgery. However, following excision of larger tumors not all patients will have an adequate penile length to allow voiding while standing or be able to have penetrative sexual intercourse. Therefore, patients need to be well informed prior to...
The time of onset of testosterone deficiency is of greater importance for the clinical symptoms than localization of the cause. Lack of testosterone or testosterone action during weeks 8 to 14 of fetal life, the period of sexual differentiation, leads to the development of intersexual genitalia (see Chapter 3). Lack of testosterone at the end of fetal life results in maldescended testes and small penis size. In later life the onset of testosterone deficiency before or after completion of puberty determines clinical appearance (Table 13.2).
It is an unfortunate circumstance that so many authors have applied hyperbole to descriptions of human penile morphology. Smith (1984) regarded the human penis as 'extraordinary relative to the other hominoids'. Baker and Bellis (like Smith) stressed that 'it is nearly twice as long and over twice as wide as that of the chimpanzee'. Jolly (1999) states that a 'peculiarity of humans is that the penis is twice the size for body weight as that of any other primate.' None of these statements, and many others of a similar nature which pervade the published literature, is accurate, with the exception of the observation that the thickness of the human penis exceeds that of the apes. It is regrettable that exaggerated accounts of human penile size and shape have been used to bolster the proposition that sexual selection 1. The length of the human penis has been selected to deliver sperm as close as possible to the female's os cervix during copulation, in order to gain an advantage in sperm...
Human penile length is exceptional among the primates. This is not the case. Does the thickness of the human penis have any significance as regards sexual selection during human evolution If human penile morphology evolved to promote pleasurable stimulation of the female partner, there might be at least two avenues of selective advantage. Firstly, if enduring relationships between the sexes with long-term reproductive benefit in terms of offspring survival are facilitated by pleasurable sexual activity, then penile morphology might be adaptive in this context. However, it will be recalled that in the monogamous and polygynous non-human primates, males tend to have the least specialized penile morphologies, despite the occurrence of long-term sexual relationships in such species. There is some evidence that women rate the thickness and length of a partner's penis as significant factors in their sexual satisfaction (Stulhofer 2006). Human mate choice and long-term relationship decisions...
The human penis expresses various subtypes of a-adrenergic receptors that are involved in smooth muscle contraction (85,86). Nevertheless, the a2-antago-nist yohimbine has only moderate efficacy in treating erectile dysfunction (87), and a1-adrenergic receptor antagonists have failed to demonstrate efficacy relative to placebo in clinical trials for this indication (9). P2 and P3-Adrenergic receptors have been shown to relax corpus cavernosum smooth muscle and thus are suggested as possible targets for treatment of erectile dysfunction (88).
Androgens and a functioning androgen receptor are necessary for normal development of the human penis. In humans, the penis grows in phases, initially during early gestation and then continuing until approximately the age of five. A latency period follows until puberty, when penile size responds to the increase of testosterone
In summary then, there is evidence that partial and total penectomy adversely affects sexual function, with the greatest degree of dysfunction occurring in men who undergo more radical surgery and therefore lose more penile length. A general rule is that a residual postoperative penile length of 4 cm or more can still allow patients to achieve an adequate erection as well as ejaculate. Attempts at conservative therapy appear to be oncologically safe, but the evidence that they provide better sexual outcomes is at this time limited. Indeed, the quality of the evidence is relatively poor, with most publications being small and retrospective in nature.
The psychological effects of penile cancer surgery have been poorly researched, although it is relatively easy to speculate on the relevant issues. Mental illness has been observed in 20 of men who have undergone treatment for penile cancer, most commonly related to anxiety disorders. 1 3 The central theme relates to the patient's perception that masculinity has somehow been lost or diminished.4 There will be a notable change in the appearance of the penis, and a probable loss of length for those who have undergone penile surgery. As described earlier, penile size has historically been associated with attributes such as strength, virility, endurance, ability, courage, intelligence, and knowledge, and the psychological effects of any form of excisional surgery should not be underestimated.
Decreased Penile Length Decreased penile length is actually not a complication of penile implantation, but rather is intrinsic to the surgery. The cylinders are of a fixed length. To obtain penile rigidity, the cylinders increase in width (girth). Very observant patients will note a 1- to 2-cm decrease in penile length after the procedure.
Long-term studies were also conducted in two nonhuman primate models, the rhesus monkey and the common marmoset. In these studies, neonatal androgen secretion was either blocked by the administration of GnRH agonist or antagonist. This interference delayed pubertal onset and attenuated the testicular weight gain (Mann etal. 1993 1998 McKinnell etal. 2001 Sharpe etal. 2000). Penile length and detachment of prepuce were also affected transiently but recovered by week 52 (Brown et al. 1999). Animals were followed until adulthood and various male reproductive parameters including fertility and mating behaviour (Lunn etal. 1994) were assessed. No untoward effects on testicular function and fertility could be detected (Lunn et al. 1997). Hence, on the basis of available data, it appears that the neonatal testosterone peak is not related to subsequent development of male reproductive functions, timing of puberty and fertility. The only effect of loss of neonatal testosterone production that...
MUSE is an on-demand medication, meaning that you must take it each time that you wish to achieve an erection. The suppository of the alprostadil is enclosed in a small applicator (Figure 33). You should void before inserting the tip of the applicator into your penis, because voiding helps lubricate the urethra. Other topical lubricants, such as K-Y Jelly, Vaseline, and mineral oil, cannot be used with MUSE because they interfere with the absorption of the alprostadil. Once the applicator
Peyronie's disease is evaluated by history and physical examination. It is important to know if there are any problems with achieving adequate erections, whether or not the curvature prevents penetration and the location of the curvature. Sometimes the physician will ask you to take a picture of your penis when it is erect to assess the location and degree of curvature. Another option is for the doctor to inject a medication, prostaglandin E1, into the penis, which causes you to have an erection and to examine you at that time.
Traditionally patients with penile cancer have been surgically managed using one of three procedures, circumcision for preputial tumors, partial penectomy for distal tumors involving the glans penis or distal penile shaft, total penectomy combined with a perineal urethrostomy for more extensive tumors infiltrating into the proximal penile shaft. These techniques have been utilized in order to ensure clear tumor margins which traditionally have been defined as being 2 cm. However, studies have challenged this and demonstrated that smaller resection margins do not appear to compromise oncological control.1,6,7 More recently penile-preserving surgery such as glansectomy or wide local excisions with grafting have been employed in order to maintain penile length resulting in a more acceptable functional and cosmetic outcome. Partial penec-tomy and total penectomy procedures are now reserved for cases where penile-preserving surgical options are not suitable due to the extent of the disease.
Of other mammals in relation to sperm competition pressures Finally, given that the penis plays a crucial role in placing sperm within the female reproductive tract, has sexual selection influenced the evolution of penile complexity in mammals If so, then how specialized, or complex, is the human penis by comparison with the intromittent organs of other primates, or mammals in general Accurate answers to these questions should help to improve our understanding of the origins of human mating systems and sexual behaviour.
Then he said, Penises can hurt sometimes. He talked about taking a bath and about the penis being small versus big. Themes of hurting again were mentioned. (I think he was talking about erections and how it is big when he plays with it or takes a bath, and either it hurts him or he feels it is vulnerable to being hurt.) The themes continued to have something that sticks out, something that hurts or can be hurt, and something that can get small and big.
In prepubertal patients penis growth will be induced by testosterone treatment and normal erectile function will develop. Since penile androgen receptors diminish during puberty, growth will cease even under continued testosterone treatment (Shabsigh 1997 see also Chapter 11).
Freud believed gender identity is acquired through identification with the same-sex parent. According to Freud, boys develop an Oedipal complex by which they experience sexual desire for their mother but because they fear that their father will find out about this and castrate them, they instead try to identify with their father to avoid discovery. Thus, resolution of the Oedipus conflict, in part, involves gender identity, adopted from the example set by the father. For girls identification with the mother derives from a similar process but instead of the fear of castration girls experience the Electra complex, identifying with the mother for fear of her finding out that she actually feels penis envy towards the father. Thus, these identification processes in the phallic stage of development (3-6 years) play a major role in the development of gender stereotypes.
Another possible complication of penile implant surgery is infection. This occurs in 3 percent to 5 percent of patients. The prosthesis is usually removed to allow the infection to be controlled and is replaced at some other time. Other complications such as erosion and persistent pain are rare. Some patients complain of reduced penile length.
Penis envy The ENVYof power and strength in others, unconsciously attributed to the other's possession of a bigger or better penis. While originally attributed primarily to girls envying the larger, more visible penis of boys, penis envy is considered today by many analysts to be a symbol of the social advantages of males in society.
Comparisons of mammalian testicular function, sperm morphology, and the structures and functions of the reproductive ducts and accessory glands, all support the view that human sexual behaviour does not spring from an evolutionary background involving specializations for sperm competition. Despite this, numerous authors argue that human penile morphology is exceptional and specialized by comparison with other primates (Fisher 1982 Smith 1984 Baker and Bellis 1995 Diamond 1997 Jolly 1999 Miller 2000 Buss 2003 Rolls 2005). Gallup and Burch (2004) attempted to test hypotheses advanced by Baker and Bellis, proposing that the human penis is morphologically specialized to displace the semen of rival males during copulation. Gallup et al. (2003) have also argued that penile size and the large glans with its pronounced coronal ridge aid sperm displacement during bouts of deep pelvic thrusting. Such patterns of deep thrusting are said to occur if men suspect that their partners have previously...
The defining feature of koro is a high degree of anxiety associated with penis size. The sufferer is convinced that his penis is shrinking and disappearing into his abdomen. The idea involves the same sort of body image distortion that we see in anorexia nervosa, except that the koro victim perceives the penis as much smaller than it is in reality. The body image distortion of the anorexic causes the victim to perceive her his body as larger than it is. Koro is a disorder that is found only in some south Asian countries (e.g., China, Taiwan, Malaysia) and can be traced to the cultural cognition Be virile that becomes a primary motivation of many men in these cultures.
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