Challenged by feeling
less well-endowed (where your penis is concerned)?
Suppose you were four and a half
inches long when erect: would you feel better knowing most men are around 5.9
inches? What if your penis was only four inches long and very thick, but your
partner loved it because it stretched her vagina where she was most sensitive?
Would you feel more of a man if she
told you your size was ideal for her? The probable answer to these questions is
"no", because so much of the size "problem" is in the mind of the man attached
to the end of the penis.
What's more, the smaller
the flaccid penis, the more it tends to expand on erection. In fact, the average
expansion is actually around 3 inches, though penises of 6 inches in length or
more often don't grow in length at all when they become erect.
Now, when I tell you that how
big you are most probably doesn't matter to a woman, do you believe me? The
truth is that it's not the way most women assess your suitability as a partner,
and if it does matter it only matters as yet another factor in the complex
mix of things that go into sex. You can give a woman all the pleasure she
needs with your hands, your tongue, your lips, and of course your mind (we're
talking emotional bonding here!).
And yet, having said all
that, I still understand that we judge our masculinity by the size of
our sexual organs. How would you feel if one of these was your penis?
It's not meant to be a
question with any easy answer, for there obviously is none. As long as we men
see the size of our penises as the measure of masculinity, then men with penises
like those above are
set up for a sense of inferiority, regardless of what their partners might say
to try and disabuse them of the idea.
The problems of the well-endowed
And while I suppose we all secretly admire
the large swinging dicks we see in the locker room, how much fun can having a
penis like this actually be? I mean, where do you put it?
There are several problems
with having such a large organ (above, I suppose, 7 inches
in length or 6 inches in girth). First, you may not be able to enjoy
Second, you're much more vulnerable to injury
during sex - Peyronie's disease seems to affect the larger penis
more often than the smaller penis.
Third, there's the simple physical inconvenience and embarrassment
of it all - which, for a well-endowed teenager, with spontaneous
erections occurring all the time, I'd imagine to be
considerable. There's a large
penis support group, presumably designed for the owners of
these organs to exchange stories of good and bad luck.
The only other comment I want to make is the
observation that size does not correlate with sexual satisfaction for a woman.
Women want to be loved and get most enjoyment from having sex and orgasms within
a loving relationship.
These orgasms are most often produced by oral sex
or masturbation: few women (less than one in four, for sure) can come through
vaginal thrusting, though I suspect that number would be rather higher if men
didn't ejaculate so quickly and could go on for longer during lovemaking.
What is clear, however, is that if a woman gets
satisfaction from a large penis, it's because it stretches the opening of her
vagina rather than because it's so long it can poke her cervix, which several
women have told me can be very painful.
(Unfortunately for my argument, several others
have told me that it can be very intensely orgasmic, provided they are extremely
aroused at the time.) I suppose any shame that accrues from having a large penis
is just as likely to cause sexual problems as a small penis. Particularly the
thorny issue of stopping premature ejaculation.
This is a congenital condition of the
penis - meaning that a boy is born with it - which affects a heck of a lot of
baby boys. The latest estimates vary between 1 in 300 and 1 in 125 live births -
it is, in fact, the most common male birth defect. Does it matter? Well, that
depends chiefly on how serious it is. The milder forms of
the opening of the urethra being misplaced down the glans or penile shaft:
While the more serious ones involve some considerable
distortion of the penile shaft and the foreskin:
In the past, corrective surgery was generally
carried out around the age of five years, often in a series of operations, and
frequently with pretty poor results.
Nowadays techniques have improved a lot and the
surgery can be carried out at a much younger age, often producing a penis which
is indistinguishable from a circumcised penis.
Having counseled many men with
hypospadias, I would say the major problem is the impact it can have on a guy's
self-image. To have an abnormal penis - one that is different from the
"norm" - is a painful thing.
There are the taunts of fellow children
as one grows up; there is the lack of support (for even now it is a condition rarely
discussed openly in the family environment, and this secretiveness around his
penis often feels
very shameful to the child); there is the sense of being different from other
boys and men; there are doubts about one's masculinity; and there is often an obsession
with normal penises which can lead a man with hypospadias to believe he is gay -
which is no more or less likely than for any other man. If in addition, the hypospadic
penis is smaller than average (as many tend to be) then there is the double
challenge of size and appearance to cope with.
Why would a man with hypospadias be
obsessed with the appearance of the penis? I think it's something to do with the search for
understanding: the understanding of how he is different, and perhaps it also has
something to do with an attempt to see how different he actually is.
What's most interesting to me about the men I
have seen with hypospadias is that even if their partners tell them again and
again that the hypospadias doesn't matter, their self-image often doesn't
change. Women are not penis-centered in the way men are, and they simply cannot
understand how much the penis really is the center of our sense of masculinity.
If you have hypospadias, I recommend that
you join the support group you can find here:
Hypospadias support group.
Ah, a twist in the tale here, and no
mistake. Have a look at these photographs:
If your penis looked like this, you wouldn't have much choice but to
undergo surgery if you wanted to enjoy penetrative sex. And the problem? Well, surgery does work, but it often shortens the penis. See
below for more details.
Peyronie's affects between 1 and 2% of
men. It can come on very suddenly - indeed, it can appear almost overnight. What
happens is that after an injury in
albuginea, the internal chambers of
the penis form scar tissue as they heals.
This reduces the elasticity of the erectile
chambers so that a bend develops at that point. There are, however, several
variations of this condition.
The penis may be hard at the
base and soft and skinny up top due to restricted
blood flow. Or it may look
like an hour glass shape, with a constricted band around the middle. But most
often it develops a sharp bend to the left or right, or up or down.
Of course, many penises do naturally bend
a bit one way or the other.
But it's the suddenness with which Peyronie's comes on, or the extreme degree of
bending, or the painfulness inside the penile shaft which tends to accompany it,
that are the giveaway features of this distressing condition.
Many men will injure the layer of tissue
that is responsible for Peyronie's formation during sex, but only occasionally
does it heal so badly as to produce the massive bend that is so characteristic
of Peyronie's. In some cases the problem begins merely as a painful inflammation
of the tunica albuginea.
In all cases this becomes a hardened lump of scar
tissue, which may become calcified. In fact you can usually feel the lump of scar tissue with your fingers; and a doctor can certainly detect
it with an ultrasound scan.
theory that bleeding in the erectile chambers causes Peyronie's is probably true in
cases where an identifiable injury to the penis has occurred, but in other cases
there seems to be no precipitating event, and Peyronie's develops slowly from
(There is another disease of the connective tissue:
10 - 20 % of men with Peyronie's also develop
contracture. This is a
benign condition which manifests as bent fingers: the cause is the contraction
of a sheet of connective tissue just under the surface of the palm of the hand.
This layer, or fascia, is a kind of reinforcing
structure to the palm of the hand. In some cases, the threads of collagen which
give the fascia its strength begin to contract in length, and the fingers
gradually become unable to straighten. These cords are not themselves tendons:
they are situated between the tendons and the skin.)
It was François de la Peyronie who gave
his name to the condition in 1743. He thought it was a form of impotence, though
he was wrong: impotence may be associated with the disease, but it is not
If the condition heals in less than a
year, the scar tissue does not usually calcify; but if Peyronie's progresses
for more than a year, the plaque develops the characteristic tough fibrous
tissue and calcification typical of the more advanced form.
Symptoms of Peyronie's disease
The plaque is non-cancerous and not related to
arterial cholesterol as some men fear. It is most often found on top of the
shaft, which makes the penis bend upwards.
If the plaque is on the bottom side, the penis
will bend in the opposite direction - downwards. (Likewise for side to side
bends.) If the plaque forms on both sides of the shaft, indentation and
shortening of the penis are likely to develop. The erection can be painful,
and the bending or indentation of the penis can be psychologically and
Ways to diagnose Peyronie's
The appearance of the bent penis is usually
enough for diagnosis, but in addition the doctor may wish to conduct an
ultrasound scan of the penis, or a Doppler examination, which measures blood
flow inside the blood vessels of the penis.
Peyronie's disease: can it be treated?
Factors which affect the action taken by a
doctor after diagnosis include the man's age, health, medical history,
medications, any previous procedures, and a view of the effectiveness of the
At the very least, a doctor will aim to keep a
patient sexually active - which means able to enjoy penetrative intercourse.
Sometimes the disease heals spontaneously within a year or so. Therapies
Injection of chemicals into the plaques:
the various agents tried over the years have included Vitamin E, Potaba,
Colchicine, Verapamil, and collagenase.
Vitamin E is an antioxidant: it's been
used in the treatment of scars and has been used as an agent in treating
Peyronie's for many years.
POTABA (potassium para-amino-benzoate)
has been described by the Food and Drugs Administration as a possibly
Colchicine has been used as an anti-gout
medication, which reduces inflammation and inhibits the production of scar
Verapamil is injected directly into the
scar. It inhibits the manufacture of scar tissue in the body.
Collagenase is an enzyme which dissolves
All of these treatments are of variable effectiveness, but urologists with
experience may recommend one or other of them depending on the antecedent
Radiation therapy is not recommended due
to the high preponderance of side-effects, but it has been used to reduce
inflammation and relieve pain.
Treatment of Peyronie's
There's no simple cure for Peyronie's, though
it does sometimes go away with time. The best thing to do is to find a really
good urologist who has extensive experience in dealing with it - often you'll find
a high level of expertise at a teaching hospital.
One of the more promising treatments
involves the injection of a drug into the scar tissue of the penis that seems to
soften it. But in the end, surgery may be the best option. There are several
options to remove the scar tissue or plaque in the tunica albuginea which line
the corpora cavernosa.
As you may have realized by now, one of the major issues
with this disease is that treatment varies in effectiveness between men. There
is therefore little consensus on when intervention with medication or surgery
gives optimal results.
The early stages of the disease may offer greater
opportunity to reverse its progress, while the later stages, which involves
scarring and plaque formation, tend not to be reversible. This means that early
treatment can be more successful - certainly within the first six months.
success rate of treatment in reducing bending is around 60%: the factors which
make it likely that the bending will be irreversible are the presence of Dupuytren's contractures, advanced plaque calcium deposits, and severe curvature
(over forty-five degrees, say).
If you're thinking of surgery...
You should have a stable bend, which is
not getting worse or better; you should have a severe bend; you should have
tried other therapies; and the usual health risks for surgery should be
What are the risks of penile surgery?
Surgery can be effective, but there are
risks: of incomplete correction, of shortening of the penis, of sensory loss
(usually temporary), and in the worst cases, of impotence.
Used for moderate bends or those that
have been present since birth, the Nesbit procedure relies on plicating (or
gathering) the tunica albuginea on the opposite side of the corpora cavernosa
to the bend.
There is much less likelihood of erectile
dysfunction, as the process does not involve grafting; it's effectively a
counterpoint to the bend on the outer, longer side of the curve, and it is the
procedure least likely to reduce diameter or produce erection problems. It
will shorten the penis to some extent, though.
1 Plication or removal of several pieces
of the tunica albuginea on the non-affected side of the penis. The side-effect
of this surgery is to shorten the penis, so a simultaneous operation to lengthen
the penis by cutting the suspensory ligaments and allowing it to drop down may
be performed. However this in itself has the effect of rendering the erect penis
2 When there is a slight curve, incision
or excision of the plaque with a graft of artificial material to repair the
tunica may be possible.
When the diameter of the penis is
reduced or the bend is severe, tissue grafting, which involves excising the
plaque and grafting healthy tissue from some other site in the body into the
site of the excised plaque can be an effective treatment.
There is some risk
of erectile dysfunction, but it is a remedy that substantially maintains the
length of the erection. As you may expect doctors have considered many options
for the material used in such grafts, including pericardial tissue from
cadavers, Gore-Tex, small intestinal submucosa, dermis and vein grafts. The
important issue is that the graft does not produce inflammation, loss of
muscle fibre or loss of elasticity through fibrosis in the penis.
These are inflatable cylinders,
biologically compatible with the tissues of the penis, which can be implanted
in the corpus cavernosa. They are now only used in a few cases since grafting
surgery is so effective.
At least one expert has a theory that some
men may have a genetic predisposition to injury to the internal tissues of the
penis. Others disagree: they think it's just the cumulative result of too much
energetic sex over a period of time.
In any event, if you want to avoid Peyronie's you
should avoid the more extreme sex positions - the ones which put a considerable
strain on the penis.
You should also be careful in some of the more
common ones - the worst of these being the woman on top position, in which
you're liable to pop out of her vagina; if she then comes down seeking reentry,
and misses your penis.....well, snap and ouch! Lastly, enjoy a constant stream
of new sex positions.
Finally, just to confuse the issue, here's
a photo of a penis which does not have symptoms of Peyronie's.
This seems to be
a rather uncommon condition in which a penis just naturally bends more than
usual. If you have this problem (e.g., if you're a teenager who hasn't had sex
or injured himself, and it still looks like this), see a doctor to get some
advice on whether corrective surgery for your penis is possible.