A penis by any other name is still a

9/6/2012
Videos , certain photographs, cartoons, and my personal lecture notes used during my presentation have been deleted from the course handouts due to copyright and/or privacy issues.
Rod Moser, PA, PhD
Sutter Roseville Pediatrics
CAPA Founding President
This presentation has been copyrighted
NO PORTION OF THIS PRESENTATION CAN BE USED WITHOUT THE EXPRESSED PERMISSION OF THE SPEAKER.
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A penis by any other name is still a ??? P
N
Ace in the hole
Acorn Andy
Action Jackson
Adam Halfpint
Admiral Winky
African black snake
Afro man
AIDS baster
AIDS grenade, The
Alabama blacksnake
Albino cave dweller
All‐day sucker
Anaconda
Anal impaler
Anal intruder
Anal Spear
Ankle spanker
Apple‐headed monster
Ass blaster
Ass pirate
Ass wedge
Astralgod
Auger‐headed gut wrench
B
Ba‐donk‐a‐donk
Baby maker
Baby's arm holding an apple
Baby's arm in a boxing glove
Bacon bazooker
Bacon rod
Badboy
Bagpipe
Bald Avenger, The
Bald butler
Bald‐headed beauty
Bald‐headed giggle stick
Bald‐headed hermit
Bald‐headed Jesus
Bald‐headed yogurt slinger
Baldy‐headed spunk‐juice dispenser
Ball buddy
Baloney pony
Banana
Bat and balls
Battering ram
Bayonet
Beard splitter
Bearded burglar
Beastus maximus
Beaver buster
Beaver Cleaver
Bed snake
Beef baton
Beef bayonet
Beef belt buckle
Beef bugle
Beef bus
Beef missile
Beef soldier
Beef stick
Beefy McManstick
Bell rope
Belly stick
Best leg of three
(Big) Beanpole
Big Dick & the twins
Big Dickus
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Primary Purposes of the Penis
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 Urination
 Procreation through ejaculation and fertilization
 Recreation through Copulation and Masturbation
 Admiration
Facts and Myths About the Penis
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S
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Facts and Myths About the Penis
 The average length of a flaccid penis is 3.7 inches with a diameter of 1.25 inches
 The average length of an erect penis is 5.1 inches with a diameter of 1.6 inches
 Penises reach their manly maximum at age 17
 Growers and Showers: Smaller flaccid penises double in size when erect; larger, flaccid ones never experience such generous growth
 There is (usually) no correlation to big noses, big ears, big feet, or big hands to penis size
 Yes, fear, stress, and cold water will shrink the penis to grade school dimensions
 The “use it or lose it” rule actually applies  Foreskins may be sold to pharmaceutical companies 2
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What’s It supposed to look like?
 New parents often have no clue as to what the newborn penis should look like. Some even expect the child to be born already circumcised.
 The “first look” may be influenced by maternal hormones, body fat, and unrealistic expectations.  The first decision? Cir or not
The Circumcision Controversy
 Most males are NOT circumcised
 Each year, at least 1.2 million American boys lose their foreskins
 Circumcision is among the most commonly performed surgical procedures in the U.S.
 Conflicting notions about personal hygiene, STDs, masculinity, sexuality, and religion
 Cosmetic or not? The helmet vs the turtle neck sweater
H
C
T
U
V
Circumcision: The Debate
Cuts Deep
 Jewish and Muslim people practiced circumcision for millennia
 Medically unnecessary
 Many insurance companies will not pay for “cosmetic” procedure
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Circumcision: The Debate
Cuts Deep
The Pro‐Circumcision Side:
 A boy should look like his father
 1900: Felt to prevent masturbation.
 Infants boys less susceptible to UTIs
 Virtually precludes penile cancer
 Eliminates foreskin infections (Daah!)
 Uncircumcised men may be more prone to certain STDs, but that is debatable. Studies only in Africa.
F
They’re
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Circumcision: The Debate
Cuts Deep
Anti‐Circumcision Side:
 Consider it an inhuman act of genital mutilation
 Improved hygiene standards made foreskin infections rare
 Numerous nerve endings in foreskin lost
 Foreskin protects and lubricates glans
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C
M
 Twenty‐five years ago; about 90% of infant boys were circumcised
 Now, only 57% are circumcised and the number is rising (so to speak). CDC estimate: 65%
 Circ rate is 80% in the Midwest; 32% in the West
 More and more Jewish families are rejecting this ancient ritual.  There is extreme emotion and passion on both sides of the issue: Don’t let it become a “bone of contention”. Parent decision.
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Caring for the Uncircumcised Penis
Newborn Penile Issues
 Size matters (mostly to new Dads)
 Microphallus / Hidden Penis
 Anatomical anomalies
 Hypospadias / Epispadias
 Bridging
 Penile Torsion
 Phimosis / Paraphimosis
 Hair tourniquet
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 Most small‐appearing penises are buried/hidden
 Press firmly on the suprapubic fat to exteriorize the penile body
 Micropenis should be referred to a pediatric endocrinologist and urologist  Testosterone can help in some cases; some require surgery
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P
H
 Congenital malformation of urethral development
 Urethral opening is on the ventral aspect of the penis
 May have some degree of Micropenis: Before Surgery
After Surgery
chordee (ventral curvature of the penis)
 May be associated with other genital malformations (karotype and endo evaluation)
 Requires surgical correction prior to toilet training (18 mon) 5
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E
P
 Rare. 1:40,000
 Urethral opening on P
the dorsal aspect of the penis (as shown)
 Some will have urinary incontinence T
 Photo shows a 90 degree penile torsion / flat ventral surface facing thigh instead of midline
 60 degrees if felt to be variation of normal
 Must be surgically corrected – will cause painful or dysfunctional erections later
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 Penile skin adhesion
 Consequence of improperly‐healed circumcision  If painful erections, will require surgical correction
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 Physiologic phimosis is the norm for uncircumcised boys
 Give it time to spontaneously resolve without an medical, surgical, or parental manipulation.
 Can take to age 5‐8
 Mild cases may be treated with topical steroids
 More severe cases with a fibrotic ring will need surgery or circumcision
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Hair Tourniquets P
 Uncommon condition where the foreskin, once pulled back, cannot be brought back to its original position
 A urological emergency
 Ice packs, penile wraps, manual compression. Osmotic agents –like granulated sugar can be used
 Local anesthesia, IV sedation followed by manual compression
 Dorsal slit or circumcision
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I
A
 Non‐retractable foreskin
 Balanitis
 Frenulum tears / Minor Injuries
 Masturbation
 Sexually‐transmitted Disease
 Herpes genitalis
 HPV / Venereal warts
 Molluscum contagiosum
 Erectile Issues
 Use the blunt probe P
method if the hair is not too deep
 Local anesthesia is optional
 Topical antibiotics
Non‐Retractable Foreskin
Non‐surgical treatment
 Topical betamethasone
cream for 4‐6 weeks
 Manual stretching
 Balloon dilatation
Surgical Methods
 Circumcision
 Dorsal or ventral slits, removing the frenulum
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Frenulum Tears
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 6% of uncircumcised males; 3% of circumcised males
 1% HC or topical antibiotic ointments
 If Candida, use nystatin or miconazole cream, or use in combination with 1% HC cream. Treat like a diaper rash
 Barrier ointments for comfort
Masturbation: Five Things You didn’t
1. There is no such thing as “abnormal” masturbation
2. Masturbation is very safe, but not entirely safe
3. Solo sex can supercharge your sex life or scuttle it
4. Certain form of masturbation can lead to sexual dysfunction or death
5. Masturbation may reduce the risk of prostate cancer
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 Called the “banjo string”
 Common with masturbators  May bleed profusely and be quite alarming
 Will usually heal, but may tend to break again in the same place.
Sexually‐Transmitted Diseases
The Top Three STDs
 Herpes
 Chlamydia
 Molluscum contagiosum
Pseudo‐STDs
 Balanitis
 Aphthous ulcers
 Epidermal Inclusion cysts / Sebaceous
 Pealy Penile Papules
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E
D
 Yes, it can happen to teenagers.
 Most ED is related to stress
 Consider diabetes, MS, or vascular disorders
 SSRIs can cause ED
 Request for ED meds often related to drug use
(Sextacy)
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