Penis problems & solutions 

We get a lot of emails asking for help. And with the assistance of our sexual therapist we do our best to answer them all. If you would like to send in your problem feel free to do so. You'll get a personal reply and the question and answer may also be posted here (anonymously, of course) to help anyone else in similar straits. Send your problem to: moreinfo "at" penis-website.

Penis problems page 1  - click below to go to page 1

1 The retractile penis, and issues of size, both width and length, too big and too small
2 Foreskin problems, including the long foreskin, smegma and phimosis
3 Fordyce spots, pearly penile papules and genital warts

Penis problems page 2 - click on the problem below for our answer

4 My glans is over-sensitive
5 My glans is red, itchy and blotchy - I may have balanitis

6 I have webbed penis -the skin of the shaft joins onto my scrotum

7 I have skin bridges between my glans and foreskin
 

Penis problems page 3 - (this page) - click below to see our answers

8 My sexual organs didn't develop normally at puberty

Penis problems page 4 - click below to go to page 4

9 I can't get an erection as reliably as I used to

If your problem is not answered here, e mail it to: moreinfo "at" penis-website.com


Answers!

Q 8 My sexual organs didn't develop normally at puberty, especially my penis which didn't grow properly. I'm 17 years old, and I have a small penis which is 4 inches long when erect and 4 inches in girth. I wanted to know if this is what's called a micropenis, and will it grow any more?

A: the penis and its growth rate and especially the comparison with one's peers is a sensitive subject for all young men, but for those who think they haven't developed normally it can be a real problem, contributing to low self-esteem and feelings of inferiority.

The problem in answering a question like yours is knowing whether your size is the result of a problem with your development or whether you simply have genes which mean your penis will naturally always be smaller than most men's. Consider the normal distribution of size in the sexual organs: the average size of a white adult male's erect penis is 5.9 inches long and 5 inches in girth, i.e. circumference. The majority of men must by definition lie on one side or other of that normal distribution.

There are some medical conditions which will result in the penis's failure to develop normally. For example, his testicles may not produce enough testosterone during the crucial phases of his body's development, or his body may be insensitive to the effects of his own testosterone.

To decide if you fall into one of these groups, consider whether the other changes that you'd expect during puberty have happened: have you experienced any ejaculations, started masturbating, developed a deeper voice and hair on your body (especially around your genitals)?

If none of these things have happened, or you think they have happened less than they should have, you might wish to go and talk to your doctor and ask for a referral to an endocrinologist. This is a specialist doctor who can assess your level of development and perhaps kick-start your pubertal development with hormone therapy if it isn't proceeding as it should. 

On the other hand, if you appear to be developing normally in all other respects, then you may have to accept that you are a man who has a penis on the lower side of the size distribution. If you read the statistics, there are about 500,000 men in America alone whose erect penis is four inches or less in size. But knowing that you are not alone may be little comfort for you.

However, many of these men have happy relationships and are husbands and fathers. Women love men for much more than the size of their sexual organs! And of course while it is true that some women value a large dick, in the way that some men value large breasts, to many more it is irrelevant, and much less important than finding a man who is loving and caring.

The simple fact is that having a small penis is only a problem if it is stopping you getting into sexual relationships, trying out sex or causing you to lose your self-confidence. If it is, you may wonder how you are ever going to get sexual with anyone!

My suggestion is that when you meet a special person whom you care about, such things as the shape and size of your genitals will actually not matter. If she loves you (assuming it is a "she"...the same is true for gay men), and you trust her, you can tell her that you find it difficult to get intimate because of your fears and concerns about your penis. If her response is favorable, you can proceed without any risk of getting hurt, and if it isn't, you can end things there and then without ever having to reveal the appearance of your penis to her.


The more technical aspects of this problem - American Endocrinologists' Guidelines on Treatment of Male Hypogonadism

Lack of sexual function or sexual development in men can be caused by a number of factors, including hypogonadism  - that is, malfunctioning of the hormonal and endocrinological systems of the body.

A treatment protocol has been devised by the American Association of Clinical Endocrinologists, and it is summarized here for the benefit of men who think such treatment might help them; the original is easily available on the internet.

Primary testicular failure is hypergonadotropic hypogonadism and a treatment for this is testosterone replacement therapy; men who have gonadotropin deficiency or dysfunction may receive testosterone replacement therapy and/or treatment for infertility  - this is hypogonadotropic hypogonadism. 

Ageing men may also benefit from testosterone replacement therapy.

The two treatments of choice are testosterone replacement therapy or gonadotropin therapy; the latter acts on the testicles to stimulate them to produce testosterone. 

Hypogonadism basically means that you have not got enough testosterone circulating in your body for some reason. The symptoms are: small testes, penis and prostate; lack of pubic hair, armpit hair, and facial hair; lack of male musculature; breast development or gynecomastia; and untypically male proportions in the length of the arms and legs compared to the body - limb growth is normally inhibited by high levels of testosterone in the developing male, so a lack of that hormone means the arms and legs may become unusually long in relationship to the  trunk.

If loss of testicular function occurs after puberty, or in ageing men, the rate of growth of body hair will slow down, there will be a loss of libido, possibly impotence, and perhaps hot flushes or flashes. In older men, there may be a risk of osteoporosis.

The first thing a doctor will check is the existence of any obvious causes of primary testicular failure: such things as Klinefelter's syndrome, anorchism, testicular failure, mumps, chemotherapy and so on, all of which can cause the testicles to fail. There may also simply be an underlying genetic basis which predisposes a man to an insensitivity of his tissues to testosterone, either in utero or later in his a life. There are many metabolic deficiencies both of endocrine production and reception within the tissues which can lead to an effective lack of virilization, among these is 5 alpha reductase deficiency and androgen receptor abnormalities. In the extreme form, these can cause Tfm or testicular feminization syndrome.

Postpubertal onset of hypergonadotropic hypogonadism is caused by endocrinological failure, metabolic deficiency, pituitary tumor, or hypothalamic disease and manifests as lack of libido, sexual dysfunction, and so on.  

A complete physical examination is the next step in assessing the presence or absence of virilization: male pattern pubic hair, gynecomastia, beard growth, testicle size and texture assessed, presence or absence of varicocele, penis and prostate size are all indicators of normal or abnormal hormonal profiles.

Adult testicles are between 4.5 and 6.5 cm long and 2.8 to 3.3 cm wide.

The next step in the process of investigating hypogonadotropism is to assess hormone levels in the bloodstream. There is a daily and a circadian rhythm in blood testosterone, so morning levels of the hormone are measured after an overnight fast. Both free testosterone levels and the levels of testosterone bound to SHBG (sex hormone binding globulin), which is the principal form in which testosterone circulates in the blood, are measured. 

If the levels of testosterone in a man's bloodstream are low, then further endocrinological tests are indicated: luteinizing hormone, and follicle stimulating hormone (LH and FSH) are measured to assess pituitary function. There are a variety of other hormonal tests which may be conducted to understand the state of a patient's immune system, including GnRH (gonadotropin releasing hormone) stimulation test, Clomiphene stimulation test, and human chorionic gonadotropin stimulation test.

Other studies which can contribute to the understanding of the overall picture of a man's endocrine system include: sperm count and semen volume measurement, bone densitometry (hypogonadism often results in low bone density), pituitary gland imaging, genetic studies, testicular biopsy and testicular ultrasonography.

For more on varicoceles, click here.

Of especial interest to most men who have not been diagnosed with Klinefelter's syndrome or other obvious gross genetic abnormality, are the androgen receptor defects which can lead to varying degrees of masculinization, depending on the degree of defect of the receptor.

(By receptor, we mean the biochemical mechanism at the cellular level where the testosterone molecule interacts with the cell to influence its morphology and physiology in a masculine direction.) All of these hormonal abnormalities will affect sexual function, including premature and delayed ejaculation.

In the ultimate case, testicular feminization is a condition in which there is complete receptor insensitivity to testosterone. Such a person's body, although genetically male, has no responsiveness to testosterone, and the appearance of the individual concerned is completely female, though there may be structural defects in her vagina. 

Acquired hypergonadotropic hypogonadism may indicate a pituitary problem, and a scan of the pituitary gland may be required to eliminate tumors, lesions or other abnormalities of the gland. 

As an aside, since we are aware that this information is supplied under the heading of a young man enquiring how he could determine if his sexual development was abnormal or incomplete, it's worth mentioning the controversy over the question of a male climacteric or andropause.

Decreased levels of male hormone are sometimes associated with decreased libido, impotence, loss of muscle mass, fatigue and increased risk of myocardial infarction. In some men, testosterone replacement therapy can reverse these changes and encourage good health; a considerable level of expertise is needed to interpret the changes in hormone level correctly and prescribe effective treatment. 

For young male subjects, a total testosterone level of less that 300 ng/dL may indicate that testosterone therapy would be helpful. (When you apply this guideline to older men, it would indicate about 30% of men beyond the age of 75 years are candidates for testosterone therapy.)

The goal of any hormone replacement therapy program is to restore sexual function and well-being. Impaired sexual function and mood disturbances are characteristic of low testosterone levels: these improve with therapy. Men with untreated hypogonadism score highly for anger, depression, fatigue, and confusion. All the secondary sexual characteristics associated with normal testosterone levels will also improve when therapy is initiated. There are many preparations of testosterone suitable for replacement therapy: intramuscular injections, both long and short acting; scrotal patches and gels; and oral preparations. 

Testosterone enanthate and testosterone cypionate are long-acting testosterone esters suspended in oil, which prolongs the period over which they are absorbed into the body after injection. One problem associated with injected testosterone is that this method of administration may result in wide swings between the high and low levels of the cycle of injection, with associated increase and decrease in symptoms.

Adult male patients who are going through a series of pubertal like changes for the first time will receive a lower dose of testosterone than men with late onset hypogonadotropism.

There's no doubt that injections can be inconvenient and difficult for some men, who may prefer to use the scrotal patch or gels now available. For men with premature ejaculation, www.massivestayingpower.com may be useful.

Problems that need to be monitored include increased hematocrit, infertility, aromatization of testosterone to estradiol with concurrent production of gynecomastia, sleep apnea, and possibly changes in PSA (prostate specific antigen) levels. 

The alternative to testosterone therapy is gonadotropin therapy, although this is effective only in hypogonadotropic hypogonadism. These preparations can also be used to induce puberty in boys and to treat androgen deficiency. The agent usually used is human chorionic gonadotropin, which binds to Leydig cell LH receptors and stimulates the production of testosterone.

The advantages of this treatment regime include the long lasting effects of the injections (the half life of hCG is rather longer than the half life of testosterone treatments), and the maintenance of testicular volume or the promotion of testicular growth, which can be important both for the maintenance of fertility, and avoiding issues of changed body-image.  

Main pages on this site

Worried About Your Size? Think you don't measure up? Get the real deal on size here. (Home page)
Penis Size and Sex  Find out how your size can affect sex.
All there is to know about your most precious asset.
Got A Problem? Check out our problem page for the answer! (This page)

Other pages of penile problems

Problems with the glans
Penile warts, papules & spots
Penis and sex problems
Erection problems
My ejaculation is weak
Retractile testicles
More on Peyronie's disease
Pro-circumcision
Premature ejaculation
On premature ejaculation
Best Sex Positions!


Hypogonadism and failure of sexual development

Hypogonadism is a scientific term used to describe a reduced functional activity of the male gonads, the testicles, that can cause diminished sex hormone production - biosynthesis - and reduced sperm production and/or regulation. Low male hormone levels, aka androgens, of which testosterone is one example, are referred to as hypoandrogenism, and may occur as a symptoms of hypogonadism in men. other hormones produced by the testicles which may be decreased by hypogonadism include DHEA. Spermatogenesis in men may be impaired by hypogonadism, and this can cause partial or complete infertility, depending on the degree of severity of the condition.