tag:theconversation.com,2011:/us/topics/penis-27072/articlesPenis – The Conversation2024-02-15T16:22:44Ztag:theconversation.com,2011:article/2226342024-02-15T16:22:44Z2024-02-15T16:22:44ZJelqing: the latest in a long history of attempts to enlarge the male member<figure><img src="https://images.theconversation.com/files/575356/original/file-20240213-28-manb71.jpg?ixlib=rb-1.1.0&rect=15%2C15%2C5217%2C3467&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-caucasian-male-doctor-holding-measuring-1677475939">RealPeopleStudio/Shutterstock</a></span></figcaption></figure><p>Advice about a penis-enlargement method called jelqing (also “jelquing”) is being <a href="https://torontosun.com/news/world/penis-enlarging-trend-jelqing-explodes-online-can-actually-damage-your-manhood">widely shared</a> online. Posts advise that stretching a semi-erect penis could add up to an inch in length and girth by exploiting the body’s repair mechanisms. </p>
<p>Jelqing is just the latest in a long line of dubious penis enlargement techniques stretching (sorry) back millennia. </p>
<p>The ancient Greek method of <a href="https://www.cirp.org/library/history/hodges2/">lengthening the foreskin</a> with a <em>kynodesme</em> (dog leash) seems positively mild compared with ancient Indian methods. A Sanskrit text on medicine and surgery, called the <a href="https://link.springer.com/article/10.1007/s10508-008-9417-y">Sushruta Samhita</a>, advises rubbing the penis with bristled insects, then oils and then more bristled insects, which probably caused short-term enlargement due to infection or inflammation. </p>
<p>Then there are the men of the Brazilian Topinamá tribe who, in the 16th century, <a href="https://www.europeanurology.com/article/S0302-2838(08)00935-4/fulltext">allowed poisonous snakes</a> to bite their penises to increase size.</p>
<p>These days, pills are more likely to be proffered as a method of penis enlargement. They are far less painful than bristled insects and poisonous snakes, but equally as ineffective.</p>
<p>Most penis-enlargement pills are probably nothing more than vitamins. Although there are drugs, such as <a href="https://pubmed.ncbi.nlm.nih.gov/12414330/">Viagra</a>, that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1874251/">enhance the stiffness</a> of the penis, they treat <a href="https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/">erectile dysfunction</a>. </p>
<p>Penis pumps are also used for erectile dysfunction, but unlike some online claims, they <a href="https://pubmed.ncbi.nlm.nih.gov/16536772/">don’t lengthen</a> the penis. And persistent or incorrect use of these devices can lead to <a href="https://pubmed.ncbi.nlm.nih.gov/9586618/">bruising, bleeding or penile tissue death</a>.</p>
<p>Penis stretching devices require significant daily time investment over prolonged periods. There are small studies that show <a href="https://academic.oup.com/jsm/article-abstract/8/11/3188/6966755?redirectedFrom=fulltext&login=false">some improvement</a>, but these are over ten years old and haven’t led to larger studies or a revolution in treatments.</p>
<h2>Surgical interventions</h2>
<p>Penoplasty or phalloplasty surgeries are most effective for lengthening the penis. They are typically used for men with a decreased penis length following prostatectomy (removal of the prostate gland) or other conditions where the <a href="https://pubmed.ncbi.nlm.nih.gov/25733292/">length of the penis is affected</a> by structural factors, such as being <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655706/">buried by skin</a>.</p>
<p>Fillers are increasing in popularity, particularly <a href="https://www.ncbi.nlm.nih.gov/books/NBK482440/">hyaluronic acid (HA) injections</a>. HA is popular because it is <a href="https://pubmed.ncbi.nlm.nih.gov/17466613/">doesn’t generate</a> an immune response. Injections with this substance increase penis volume and draw water in. Some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8987147/">trials</a> have shown “significant enhancement of girth”. </p>
<p>However, HA is broken down over several months and requires top-ups. And incorrect administration can have <a href="https://www.sciencedirect.com/science/article/pii/S2050116121001252">serious side-effects</a>, from infection to preventing urination.</p>
<p>Surgery to cut the suspensory ligament anchoring the penis is the most widely accepted <a href="https://pubmed.ncbi.nlm.nih.gov/16473458/">surgical elongation method</a>. This surgery alters the angle that the <a href="https://pubmed.ncbi.nlm.nih.gov/9932326/">penis hangs from the body</a>, increasing the appearance of length. It can also be combined with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436850/">liposuction to reduce pubic fat</a>, but these surgeries have <a href="https://pubmed.ncbi.nlm.nih.gov/16473458/">poor satisfaction rates</a>.</p>
<p>Fat transplantation from another region can <a href="https://pubmed.ncbi.nlm.nih.gov/22527585/">enhance girth</a>, with some success. However, about 30% of the <a href="https://pubmed.ncbi.nlm.nih.gov/16547638/">fat is lost</a> in the first two months, and scar tissue and infections are common, which can cause longer-term complications and, occasionally, even <a href="https://pubmed.ncbi.nlm.nih.gov/28749069/">death</a> when the fat breaks free and causes an embolism.</p>
<p>Implants, which come as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719505/">inflatable</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10350748/">non-inflatable</a>, are used to treat erectile dysfunction. But they are also used cosmetically for penis enlargement. The results, though, are not great. There have been various reports of lack of <a href="https://karger.com/cur/article/13/2/94/102452/Clinical-Outcome-Patient-and-Partner-Satisfaction">satisfaction for the patient and their partner</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3126071/">infection</a>, damage to <a href="https://pubmed.ncbi.nlm.nih.gov/19453911/">internal organs</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483239/">complications</a> such as <a href="https://pubmed.ncbi.nlm.nih.gov/31474579/">“floppy glans syndrome”</a> and, in some cases, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5715172/">death</a>.</p>
<p>A recent review concluded that <a href="https://bjui-journals.onlinelibrary.wiley.com/doi/10.1111/bju.15145">evidence</a> for supporting surgical procedures for penis enlargement is weak and the complications are <a href="https://www.sciencedirect.com/science/article/abs/pii/S2050052118301197">under-reported</a>.</p>
<h2>Not needed, in most cases</h2>
<p>Penis enlargement surgery is the <a href="https://www.nature.com/articles/s41598-019-41652-w">second</a> most sought after cosmetic surgery in men. But only men with a <a href="https://my.clevelandclinic.org/health/diseases/17955-micropenis">micropenis</a> may need treatment. </p>
<p>A micropenis, usually diagnosed at birth, is where the penis is 2.5 standard deviations less than the average stretched penis length (<a href="https://pubmed.ncbi.nlm.nih.gov/11805431/">2.3 to 2.5cm</a> depending on ethnicity). It is typically caused by a deficiency or imbalance of hormones such as <a href="https://www.jpeds.com/article/S0022-3476(99)70244-1/fulltext">testosterone</a> or <a href="https://pubmed.ncbi.nlm.nih.gov/8393754/">human chorionic gonadotropin</a> (hCG), or <a href="https://pubmed.ncbi.nlm.nih.gov/21535007/">genetics</a>. </p>
<p>Micropenis usually responds to <a href="https://pubmed.ncbi.nlm.nih.gov/37920173/">hormone therapy</a> in childhood, bringing size to the normal range.</p>
<p>Other than a man’s desire for a larger penis, is there any anatomical benefit? </p>
<p>The average male penis is between <a href="https://pubmed.ncbi.nlm.nih.gov/32666897/">5.1 and 5.5 inches</a> in length, with a recent study showing the latter value is a <a href="https://pubmed.ncbi.nlm.nih.gov/36792094/">24% increase on</a> three decades ago. The female vagina is on average <a href="https://pubmed.ncbi.nlm.nih.gov/16478763/">2.5</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2893226/">3.8</a> inches deep, but <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC28302/">lengthens during sexual arousal</a> to accommodate a penis longer than this.</p>
<p>Research studies also show that <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-1-1">penile girth</a> is a more important characteristic than length for sexual satisfaction and there is no definite consensus on <a href="https://www.nature.com/articles/s41443-022-00636-7">length correlating with sexual satisfaction</a> – at least for heterosexual couples. The female genitalia have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3894744/">multiple erogenous structures</a> that can <a href="https://onlinelibrary.wiley.com/doi/10.1002/ca.22471">result in orgasm</a>, so penile length isn’t the key characteristic.</p>
<h2>A closer look at jelqing</h2>
<p>The <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/penis">penis</a> consists of three cylindrical structures. Two <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/corpus-cavernosum">corpus cavernosum</a> and a <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/corpus-spongiosum">corpus spongiosum</a>. The top two consist of numerous spaces that are surrounded by smooth muscle, which keeps most blood out of the spaces. </p>
<p>During an erection, the muscles relax allowing blood to flow in, filling these spaces, and enlarging penile volume. This enables penetration to occur. Among and around these structures are various bundles of connective tissue, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0022534717366302">primarily collagen</a>.</p>
<p>Jelqing appears to try and exploit the body’s repair mechanisms to heal microtears in the penile tissues, in the same way <a href="https://pubmed.ncbi.nlm.nih.gov/22522284/">microfractures</a> in bone and <a href="https://www.science.org/doi/10.1126/science.abe5620">microtears</a> in skeletal muscle heal bigger and stronger. </p>
<p>While the theory sounds good, smooth muscle cells in the penis don’t respond in the same way <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075408/">skeletal muscle</a> does. <a href="https://pubmed.ncbi.nlm.nih.gov/2291488/">Smooth muscle increase in size</a> is usually due to disease or damage, and more importantly, when the penis is erect, the smooth muscle cells are actually relaxed and not working, so are not going to increase in size.</p>
<p>Jelqing also increases the risk of developing <a href="https://www.mayoclinic.org/diseases-conditions/peyronies-disease/symptoms-causes/syc-20353468">Peyronie disease</a> where scar tissue formation under the skin of the penis causes excessively curved erections and pain, particularly in the acute phase where the scar is still growing.</p>
<p>Scar tissues are <a href="https://www.ncbi.nlm.nih.gov/books/NBK554402/">weaker</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352699/">not well aligned</a>, jeopardising normal function. Penile scar tissue <a href="https://pubmed.ncbi.nlm.nih.gov/11424963/">reduces penile blood flow</a> causing inability to get or maintain an erection. Developing this condition will also result in a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4893519/">shortening of the penis</a>.</p>
<p>If jelqing, or any other trend, was really that effective, we would have seen evidence of it in medical journals, and the sale of extra-large underwear would be making the headlines.</p><img src="https://counter.theconversation.com/content/222634/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Taylor does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Men will go to almost any length to increase their length. Mostly with disastrous consequences.Adam Taylor, Professor and Director of the Clinical Anatomy Learning Centre, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2116752023-11-21T23:30:20Z2023-11-21T23:30:20ZHere’s what happens to your penis as you age<figure><img src="https://images.theconversation.com/files/558209/original/file-20231108-29-2x75fz.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-stethoscope-yellow-banana-on-blue-1070813387">Shutterstock</a></span></figcaption></figure><p>All parts of your body age and the penis is no exception. </p>
<p>Changes to how your penis looks or works can be signs of underlying health issues and can affect your quality of life. So understanding which changes are normal and when to seek help is important.</p>
<p>Here’s what you can expect to happen to your penis as you age, and when to be concerned.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-i-clean-my-penis-125135">'How do I clean my penis?'</a>
</strong>
</em>
</p>
<hr>
<h2>Will my penis shrink?</h2>
<p>There is no definitive evidence your <a href="https://bjui-journals.onlinelibrary.wiley.com/doi/abs/10.1111/bju.13010">penis length and girth</a> will naturally change as you age, despite what you may <a href="https://www.healthline.com/health/mens-health/penis-shrinkage">read</a>.</p>
<p>This is because there is no study that follows the same adults and their penis measurements over decades; existing studies only compare penis size between different adults of different ages. </p>
<p>There are also many different ways to <a href="https://www.nature.com/articles/s41443-019-0157-4">measure</a> penis size – including stretched, flaccid (floppy) and erect. This makes it difficult to compare studies.</p>
<p>However, for some people, conditions associated with ageing can appear to decrease penis length. These include:</p>
<ul>
<li><p>obesity (which hides the base of the penis)</p></li>
<li><p>the effects of <a href="https://www.auajournals.org/doi/10.1016/j.juro.2007.03.119">prostate surgery</a> (temporarily)</p></li>
<li><p><a href="https://www.healthymale.org.au/mens-health/peyronies-disease">Peyronie’s disease</a> (where scarring in the fibrous layer of the penis causes it to bend abnormally).</p></li>
</ul>
<p>Erect penis length may also decrease with age due to:</p>
<ul>
<li><p>erectile dysfunction (the inability to achieve erections sufficient for sexual activity)</p></li>
<li><p>less <a href="https://pubmed.ncbi.nlm.nih.gov/1459150/">penile elasticity</a>, which reduces how much the penis expands.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-chemicals-shrinking-your-penis-and-depleting-your-sperm-heres-what-the-evidence-really-says-160007">Are chemicals shrinking your penis and depleting your sperm? Here's what the evidence really says</a>
</strong>
</em>
</p>
<hr>
<h2>Will I still have erections?</h2>
<p>Erectile dysfunction affects 15% of men in their 50s to almost 90% of men over 80, according to an <a href="https://link.springer.com/article/10.1007/s10508-014-0465-1">English study</a> of more than 6,000 people. Existing health conditions increased the risk significantly, and the risk was more than doubled in those who rated their health as fair to poor.</p>
<p><a href="https://www.healthymale.org.au/mens-health/erectile-dysfunction">Medications</a> such as sildenafil (Viagra) and tadalafil (Cialis) can help. But they do not reverse the underlying blood vessel and nerve damage that cause erectile dysfunction. Eventually other treatments – such as injections or <a href="https://www.healthymale.org.au/news/what-are-penis-pumps-and-how-do-they-work">penile pumps</a> – may be options.</p>
<p>Other changes that occur with age include <a href="https://pubmed.ncbi.nlm.nih.gov/9836563/">decreased penis sensitivity</a>, which might reduce arousal. Ejaculation is <a href="https://pubmed.ncbi.nlm.nih.gov/8254833/">delayed</a> and happens <a href="https://linkinghub.elsevier.com/retrieve/pii/S0302283816003778">less often</a>.</p>
<p>Semen volume and the force of ejaculation <a href="https://pubmed.ncbi.nlm.nih.gov/27652226/">decrease</a> with age. The time taken to “recover” from ejaculating and become sexually responsive again (known as the <a href="https://pubmed.ncbi.nlm.nih.gov/31405769/">post-ejaculatory refractory time</a>) also increases with age. </p>
<p>Reaching orgasm is “impossible” or “moderately difficult” for <a href="https://pubmed.ncbi.nlm.nih.gov/25624001/">33% of men</a> in their 70s.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weekly-dose-the-hard-facts-on-viagra-58289">Weekly dose: the hard facts on Viagra</a>
</strong>
</em>
</p>
<hr>
<h2>Will the shape of my penis change?</h2>
<p>The shape of your penis is not usually expected to change with age. However, Peyronie’s disease (an abnormally bent or curved penis) becomes <a href="https://www.healthymale.org.au/mens-health/peyronies-disease">more common</a> with age. This may be because of accumulation of damage from minor injuries over time.</p>
<p>This condition affects <a href="https://pubmed.ncbi.nlm.nih.gov/11890244/">6.5% of men</a> over 70 and can cause short-term pain and long-term erectile dysfunction.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/558561/original/file-20231109-15-6so9wq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older smiling man holding banana in each hand, one large, one small" src="https://images.theconversation.com/files/558561/original/file-20231109-15-6so9wq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558561/original/file-20231109-15-6so9wq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558561/original/file-20231109-15-6so9wq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558561/original/file-20231109-15-6so9wq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558561/original/file-20231109-15-6so9wq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558561/original/file-20231109-15-6so9wq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558561/original/file-20231109-15-6so9wq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">No, your penis doesn’t automatically change shape as you age. But you might notice other changes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/old-country-doctor-smiling-while-comparing-758197381">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Will I pee more?</h2>
<p><a href="https://www.healthymale.org.au/mens-health/urinary-problems-luts">Lower urinary tract symptoms</a> such as incontinence, a weak urine stream, problems with starting and stopping peeing, and nocturia (frequent night time urination) increase as we get older. </p>
<p>These symptoms are moderate to severe in <a href="https://pubmed.ncbi.nlm.nih.gov/17070357/">almost 50% of men</a> over 65, and in <a href="https://pubmed.ncbi.nlm.nih.gov/18554695/">70% of men</a> over 80. This is likely due to <a href="https://pubmed.ncbi.nlm.nih.gov/6206240/">higher rates</a> of benign prostatic hyperplasia (enlarged prostate) as men age, which has various effects, including on urine flow.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-can-your-doctor-tell-from-your-urine-74990">Health Check: what can your doctor tell from your urine?</a>
</strong>
</em>
</p>
<hr>
<h2>Changes can take their toll …</h2>
<p>Physical and functional changes in the penis can affect a man’s <a href="https://pubmed.ncbi.nlm.nih.gov/25624001/">health and wellbeing</a>. </p>
<p>Problems with erections or ejaculating can reduce someone’s <a href="https://pubmed.ncbi.nlm.nih.gov/30554952/">quality of life</a> if they still want to have sex. So <a href="https://www.healthymale.org.au/partners-guide">open discussion</a> with a partner, seeking support and professional advice can help.</p>
<p>Lower urinary tract symptoms can also <a href="https://pubmed.ncbi.nlm.nih.gov/15814179/">affect</a> a man’s mental health and personal relationships. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/558565/original/file-20231109-25-sl40tf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older gay couple sitting on sofa, one with hand on shoulder, looking at open laptop" src="https://images.theconversation.com/files/558565/original/file-20231109-25-sl40tf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558565/original/file-20231109-25-sl40tf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558565/original/file-20231109-25-sl40tf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558565/original/file-20231109-25-sl40tf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558565/original/file-20231109-25-sl40tf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558565/original/file-20231109-25-sl40tf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558565/original/file-20231109-25-sl40tf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Be open with your partner about any concerns.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/older-same-sex-male-couple-browsing-2356931529">Shutterstock</a></span>
</figcaption>
</figure>
<h2>… but can be sign of disease</h2>
<p>Erectile dysfunction can also hint at serious health problems <a href="https://www.healthymale.org.au/mens-health/erectile-dysfunction">such as</a> heart disease, high blood pressure, diabetes and disorders of the nervous system.</p>
<p>In this way, the penis reflects vascular health in the rest of the body. So having erectile dysfunction can <a href="https://pubmed.ncbi.nlm.nih.gov/30665816/">predict</a> your risk of a future heart attack or stroke.</p>
<p>Lower urinary tract symptoms are also often associated with sexual dysfunction, and can <a href="https://www.healthymale.org.au/mens-health/urinary-problems-luts">increase the risk</a> of urinary tract infections and chronic kidney disease.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-it-matter-if-you-sit-or-stand-to-pee-and-what-about-peeing-in-the-shower-206869">Does it matter if you sit or stand to pee? And what about peeing in the shower?</a>
</strong>
</em>
</p>
<hr>
<h2>What’s normal and when should I see my GP?</h2>
<p>Normal ageing includes changes to the penis’ blood vessels, nerves, and associated organs, such as the prostate. So, as you age, it is normal to have:</p>
<ul>
<li><p>minor changes in the size and shape of the penis</p></li>
<li><p>a gradual decrease in erectile function and sensitivity</p></li>
<li><p>mild urinary symptoms that don’t bother you.</p></li>
</ul>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/28217447/">Staying healthy</a>
and regularly seeing your GP to <a href="https://www.healthdirect.gov.au/essential-screening-tests-for-men">check for</a> common conditions (such as high blood pressure) should slow down these age-related changes. Other health conditions (such as diabetes) accelerate these changes.</p>
<p>However, it is important to seek medical attention if:</p>
<ul>
<li><p>there is a significant change in size or shape of the penis, or if you develop unusual lumps</p></li>
<li><p>there is pain or discomfort in or around your penis</p></li>
<li><p>erectile dysfunction becomes persistent or bothers you</p></li>
<li><p>urinary symptoms occur suddenly or bother you.</p></li>
</ul>
<hr>
<p><em>For more information about men’s health, including resources for partners, see the <a href="https://www.healthymale.org.au">Healthy Male website</a>.</em></p><img src="https://counter.theconversation.com/content/211675/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Moss works for Healthy Male, a website to promote men's health.</span></em></p><p class="fine-print"><em><span>Jinghang Luo and Rob McLachlan do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Understanding which changes are normal and when to seek help is important. Here’s what you need to know.Rob McLachlan, Professor and clinician in fertility medicine, Hudson InstituteJinghang Luo, Andrology Fellow, Hudson InstituteTim Moss, Adjunct Associate Professor, Department of Obstetrics and Gynaecology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2086142023-08-15T09:15:15Z2023-08-15T09:15:15ZThe orgasm gap and why women climax less than men<figure><img src="https://images.theconversation.com/files/541030/original/file-20230803-29-k3l5ag.jpg?ixlib=rb-1.1.0&rect=0%2C60%2C6709%2C4396&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sex isn't just about penetration.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/legs-couple-bed-1086622124">Kaspars Grinvalds/Shutterstock</a></span></figcaption></figure><p>Imagine a steamy sex scene involving a woman and a man from your favourite television show or movie. It’s likely that both parties orgasm. But this doesn’t reflect reality.</p>
<p>Because during heterosexual sexual encounters, women have far fewer orgasms than men. This is called the orgasm gap. And it has been documented in the <a href="https://link.springer.com/article/10.1007/s11930-020-00237-9">scientific literature</a> for more than 20 years. </p>
<p>In one <a href="https://pubmed.ncbi.nlm.nih.gov/28213723/">study</a> of more than 50,000 people, 95% of heterosexual men said they usually or always orgasm when sexually intimate, while only 65% of heterosexual women said the same. </p>
<p><a href="https://journals.sagepub.com/doi/full/10.1177/03616843221076410?casa_token=EIMMOZmLRmwAAAAA%3AKmP6abzrDfsJRvoSO5LN9EOWUgnXBZGQepNAw9oFPzf-dZE-T-6g9HU1vScVwyNrNdGEuzaGslo">Research</a> shows that some people believe this gap is because women’s orgasms are biologically elusive. Yet, if this were true, women’s orgasm rates would not differ depending on circumstance. Indeed, <a href="https://www.amazon.com/Hite-Report-National-Female-Sexuality/dp/1583225692/ref=sr_1_1?crid=G68WDZ96BFZV&keywords=Hite+report&qid=1691488140&sprefix=hite+repor%2Caps%2C122&sr=8-1">many</a> <a href="https://www.tandfonline.com/doi/full/10.1080/0092623X.2011.628440">studies</a> show that women orgasm more when alone than with a partner.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<hr>
<p>At least 92% of women orgasm when pleasuring themselves. Women also orgasm more when having sex in relationships compared with casual sex. In a <a href="https://nyuscholars.nyu.edu/en/publications/orgasm-in-college-hookups-and-relationships">study</a> of more than 12,000 college students, only 10% of the women said they orgasm during first-time hookups while 68% said they orgasm during sex that occurs in a committed relationship. </p>
<p>Women also <a href="https://link.springer.com/article/10.1007/s10508-017-0939-z">orgasm more</a> when having sex with other women. In one <a href="https://www.tandfonline.com/doi/abs/10.1080/14616660412331330875">study</a> 64% of bisexual women said that they usually or always orgasm when being sexually intimate with other women. </p>
<h2>Why does this happen?</h2>
<p>In all these scenarios where women are climaxing more, there is a greater focus on <a href="https://theconversation.com/the-clitoris-a-brief-history-196817">clitoral stimulation</a>. The majority of women need clitoral stimulation to orgasm – which makes sense given that the clitoris and the penis originate from the same kind of tissue. And both the clitoris and the penis are chock full of touch-sensitive nerve endings and erectile tissue. </p>
<p>In <a href="https://www.amazon.com/Becoming-Cliterate-Orgasm-Equality-Matters/dp/0062664557/ref=rvi_sccl_4/140-9533092-3796527?pd_rd_w=CRFWT&content-id=amzn1.sym.f5690a4d-f2bb-45d9-9d1b-736fee412437&pf_rd_p=f5690a4d-f2bb-45d9-9d1b-736fee412437&pf_rd_r=PK44YHEX9GFG4VED8TNR&pd_rd_wg=QmJlm&pd_rd_r=0289449b-513a-4ade-ba30-cac1e6ed4d2b&pd_rd_i=0062664557&psc=1">my work</a>, I’ve asked thousands of women: “What is your most reliable route to orgasm?” Only 4% say penetration. The other 96% say clitoral stimulation, alone or paired with penetration.</p>
<p>The main reason for the orgasm gap, then, is that women are not getting the clitoral stimulation they need. And cultural messages about the supremacy of intercourse feed into this. Indeed, countless films, <a href="https://hellogiggles.com/tv-shows-women-orgasm/">TV shows</a>, books and plays portray women <a href="https://www.tandfonline.com/doi/full/10.1080/00224499.2017.1332152?casa_token=902PI2QuMXYAAAAA%3AYh7bCZV7QyaAja715u13wPWv-F3aZkcS6R0gVJDlVag8lD9JG_FsHOvxl4_EnW_rISFvNNAj6UI">orgasming from intercourse alone</a>. </p>
<p>Popular men’s <a href="https://www.menshealth.com/sex-women/a19523926/4-sex-positions-that-guarantee-her-orgasm/">magazines</a> also give advice on intercourse positions to bring women to orgasm. And while some of the positions do include clitoral stimulation, the message is still that intercourse is the central and most important sexual act.</p>
<figure class="align-center ">
<img alt="Two women in bed together." src="https://images.theconversation.com/files/541031/original/file-20230803-29-pvbxh2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541031/original/file-20230803-29-pvbxh2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541031/original/file-20230803-29-pvbxh2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541031/original/file-20230803-29-pvbxh2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541031/original/file-20230803-29-pvbxh2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541031/original/file-20230803-29-pvbxh2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541031/original/file-20230803-29-pvbxh2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women are much more likely to orgasm from same-sex encounters.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/photo-of-two-women-1215709/"> pixels/mahrael boutros</a></span>
</figcaption>
</figure>
<p>The language used in these articles – and in the culture as a whole – reflects and perpetuates this overvaluing of intercourse. We use the words “sex” and “intercourse” as if they are the same. We relegate the clitoral stimulation that comes before intercourse as “foreplay”, implying it is a lesser form of sex. </p>
<p><a href="https://link.springer.com/article/10.1007/s11930-020-00237-9">Multiple studies</a> have demonstrated that such messages give the idea that sex should proceed as follows: foreplay (just to get the woman ready for intercourse), intercourse, male orgasm and sex over. In this version of sex, it’s the man’s job to “give” a woman an orgasm by lasting a long time and thrusting hard. </p>
<p>No wonder <a href="https://www.tandfonline.com/doi/full/10.1080/00224499.2017.1283484">research</a> finds that men feel more masculine when their partner orgasms during intercourse. And, it’s no surprise that <a href="https://link.springer.com/article/10.1007/s10508-013-0212-z">women fake orgasms</a>, <a href="https://www.tandfonline.com/doi/full/10.1080/00224490903171794">primarily during intercourse</a>, <a href="https://www.tandfonline.com/doi/abs/10.1080/00224499.2013.838934">to protect their partner’s egos</a>. </p>
<p>Indeed, studies suggest that between <a href="https://link.springer.com/article/10.1007/s10508-013-0212-z">53%</a> to <a href="https://journals.ekb.eg/article_29394.html">85%</a> of women admit to faking an orgasm. Some <a href="https://link.springer.com/article/10.1007/s10508-019-01510-2">research</a> indicates that the majority of women have faked at least once in their lifetime.</p>
<h2>Closing the gap</h2>
<p>There is hope though, because given that cultural factors are responsible for the orgasm gap, changing how we view sex and intercourse will help to improve women’s sexual experiences. Indeed, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0191886919305604?via%3Dihub">educating</a> people on the fact that women don’t have a <a href="https://books.google.com/books?hl=en&lr=&id=iaXrAgAAQBAJ&oi=fnd&pg=PA99&ots=etC2y_CwaZ&sig=7SzjXzrkutfYuPnB9YIGeIHmnBE#v=onepage&q&f=false">limited biological capacity for orgasm</a> is important. Likewise, education for both men and women about the clitoris could be a game-changer. </p>
<p>Still, such knowledge alone is unlikely to close the orgasm gap on a personal level. According to a chapter in a <a href="https://www.amazon.com/Principles-Practice-Sex-Therapy-Sixth/dp/1462543391/ref=sr_1_5?crid=ZODK2JIGHTZO&keywords=Sex+therapy&qid=1689803436&sprefix=sex+therapy+%2Caps%2C102&sr=8-5&ufe=app_do%3Aamzn1.fos.18ed3cb5-28d5-4975-8bc7-93deae8f9840">sex therapy textbook</a>, women need skills to put this knowledge into practice. This means women must be encouraged to masturbate to learn what they want sexually. And this needs to be coupled with training in communication so they can share this information with partners. </p>
<p>Women need to feel entitled to pleasure and empowered to get the same type of stimulation alone as with a partner. This means heterosexual couples’ must rid themselves of the old script that calls for foreplay followed by intercourse after which sex is over.</p>
<p>Instead, they can take turns having orgasms using oral sex or manual stimulation where she orgasms followed by intercourse. Alternatively, women can touch themselves with hands or a vibrator during intercourse. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/19453881/">Research</a> shows that women who use vibrators have more orgasms. And because many women worry about how they look during sex or if they are pleasing their partner, <a href="https://pubmed.ncbi.nlm.nih.gov/31570137/">research</a> shows that mindfulness can help, too.</p>
<figure class="align-center ">
<img alt="Vibrators and sex toys on pink background." src="https://images.theconversation.com/files/541032/original/file-20230803-27-d46oqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541032/original/file-20230803-27-d46oqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541032/original/file-20230803-27-d46oqe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541032/original/file-20230803-27-d46oqe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541032/original/file-20230803-27-d46oqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541032/original/file-20230803-27-d46oqe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541032/original/file-20230803-27-d46oqe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women are more likely to experience orgasms when using a vibrator.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/sex-toys-5187378/"> Pexels/anna shvets</a></span>
</figcaption>
</figure>
<p>But orgasm equality is about so much more than quality sex. Multiple women have told me that once they felt empowered in the bedroom, they were more confident in the rest of their life. </p>
<p>Importantly, according to <a href="https://journals.sagepub.com/doi/full/10.1177/0361684320917395?casa_token=Vy8RNRR1p_oAAAAA%3A47r5DQh2M1CkFNZxj4i0kiH6bobsX8JgyNY7xxbXdifhnoQkbuOOlgda1DRP6kAaSl4V2SUioOk">one study</a>, feeling entitled to pleasure increases a woman’s agency in telling partners what they want sexually and their agency in protecting themselves sexually. </p>
<p>Indeed, the study found that feeling entitled to sexual pleasure increased women’s confidence in both refusing to do sexual acts they were not comfortable with and using protection against both pregnancy and sexually transmitted infections. </p>
<p>According to another <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2019.305320">article</a> on sex education and pleasure by two US health researchers, when young people learn that sex should be pleasurable, they may be less likely to use it in manipulative and harmful ways. So teaching that sex is about pleasure for both partners, rather than something done to women for men’s pleasure, might also help to decrease levels of sexual violence. </p>
<p>Clearly, teaching about women’s pleasure will do more than increase orgasm rates.</p><img src="https://counter.theconversation.com/content/208614/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laurie Mintz does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Women have fewer orgasms than men. But this gap is cultural, not biological. Closing it is possible, both on a societal and personal level.Laurie Mintz, Emeritus Professor of Psychology, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1968172023-01-04T11:59:35Z2023-01-04T11:59:35ZThe clitoris – a brief history<figure><img src="https://images.theconversation.com/files/503461/original/file-20230106-10808-lihvhq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/vector-graphics-seamless-pattern-art-illustration-1812247132">Christina Paliy/Shutterstock</a></span></figcaption></figure><p>“What’s the difference between a bar and clitoris? Most men have no trouble finding a bar.” In the <a href="https://www.jokes2go.net/joke/9165/diff-between-bar-and-clitoris">world of humour</a>, the clitoris remains a mystery: supposedly small, and so inevitably difficult to locate. “Which dinosaur will never be discovered? The <a href="https://jokojokes.com/clit-jokes.html">Clitaurus</a>.”</p>
<p>It sometimes seems medical science has been far <a href="https://www.scientificamerican.com/video/the-clitoris-has-been-lost-to-science-for-centuries-but-its-making-a-comeback/">more interested in the penis</a> than the clitoris. Indeed, up until very recently the number of nerve endings thought to be on a woman’s clitoris was only an estimate and this was based upon <a href="https://www.medicalnewstoday.com/articles/why-is-the-clit-so-sensitive-thanks-to-over-10000-nerves-first-real-count-finds">research on cows</a>. </p>
<p>But recent research on the actual human clitoris has found it has more than <a href="https://news.ohsu.edu/2022/10/27/pleasure-producing-human-clitoris-has-more-than-10-000-nerve-fibers">10,000 nerve fibres</a> – 20% more than previously thought. The new research studied tissue donated by trans men during female to male gender affirming surgery. Tissues were dyed and magnified 1,000 times under a microscope so individual nerve fibres could be counted.</p>
<p>This follows the 2005 research of the Australian urologist <a href="https://journals.openedition.org/gss/4403">Helen O’Connell</a> who become famous as the first person to fully map the clitoris, using MRI scans of women. And it turns out that it’s not small at all, it’s just that only 10% of the organ is visible. </p>
<p>O’Connell has <a href="https://www.smh.com.au/lifestyle/health-and-wellness/get-cliterate-how-a-melbourne-doctor-is-redefining-female-sexuality-20181203-p50jvv.html">described</a> how her initial medical training used textbooks that never mentioned the clitoris and which regarded female genitalia as a “failure”. So she made it her mission to better understand this part of a woman’s body.</p>
<h2>An erotic place</h2>
<p>Both the penis and the clitoris are <a href="https://pubmed.ncbi.nlm.nih.gov/23169570/">erectile organs</a>. Along with the “small” oblong of the visible part – the glans – the clitoris includes erectile tissue. This engorges with blood on arousal and extends up to 9cm, making it larger than an unaroused penis. That matters because, once aroused, the “bulbs” of the clitoris will extend to touch the vagina and urethra. Pleasure travels.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/501966/original/file-20221219-13540-vepg40.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Drawing of female anatomy with labels." src="https://images.theconversation.com/files/501966/original/file-20221219-13540-vepg40.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/501966/original/file-20221219-13540-vepg40.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=457&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501966/original/file-20221219-13540-vepg40.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=457&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501966/original/file-20221219-13540-vepg40.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=457&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501966/original/file-20221219-13540-vepg40.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=574&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501966/original/file-20221219-13540-vepg40.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=574&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501966/original/file-20221219-13540-vepg40.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=574&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Female anatomy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/vector-illustration-female-reproductive-organs-anatomy-562286413">Mister_X/Shutterstock</a></span>
</figcaption>
</figure>
<p>The history of the clitoris goes back much further than the last few decades. Indeed, in <a href="https://eugesta-revue.univ-lille.fr/pdf/2022/8.Rebecca_Flemming_Eugesta_12_2022.pdf">ancient Greek and Roman medicine</a>, it was known as “an erotic locus (place) in its own right”. It was called the womb-gate, the little tongue, the chick-pea and the myrtle-berry. Yet most of the words used still suggested it to be small. </p>
<p>Through its long history, studies of the clitoris were more likely to be based upon the dissection of dead bodies or animals rather than real live women. In 1844 the German anatomist, <a href="https://www.ub.uni-heidelberg.de/Englisch/helios/digi/anatomie/kobelt.html">George Ludwig Kobelt</a>, used dissected clitorises to illustrate not just the visible part, but the internal parts as well, giving a much better sense of its true size.</p>
<p>Kobelt would inject the blood vessels and lymphatic vessels so he could better understand how the erectile organs were supplied with blood. He argued there were many more nerves supplying the clitoris than the vagina, and saw it as far more important for sexual pleasure. </p>
<h2>‘A new and useless part’</h2>
<p>Kobelt wasn’t the first to realise that the clitoris was a substantial organ. In 1672, in his book, Treatise on the Generative Organs of Women, the Dutch physician and anatomist <a href="https://www.britannica.com/biography/Reinier-de-Graaf">Regnier de Graaf</a> observed that every female body he’d dissected had a visible one, “quite perceptible to sight and touch”. </p>
<p>He went on to describe “other parts” of the clitoris hidden in the fatty area of the pubis, including those bulbs of the clitoris. <a href="https://studylib.net/doc/8339689/anatomy-of-the-clitoris---journal-of-urology--the">He commented</a>: “we are extremely surprised that some anatomists make no more mention of this part than if it did not exist at all in the universe of nature.”</p>
<p>Indeed, before de Graaf, some anatomists had denied there even was such a thing as the clitoris. In 1543 <a href="https://www.britannica.com/biography/Andreas-Vesalius">Andreas Vesalius</a>, an anatomist, physician, and author of one of the most influential books on human anatomy, <a href="https://www.nlm.nih.gov/exhibition/historicalanatomies/vesalius_home.html">De Humani Corporis Fabrica</a> (On the Fabric of the Human Body), responded to rumours of its existence by dismissing it as “a new and useless part”. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1551867777329385472"}"></div></p>
<p>Not everyone agreed, and in 1559 the Italian surgeon, Realdo Colombo, published his <a href="https://www.britannica.com/topic/De-re-anatomica">De re anatomica</a> (On Things Anatomical). What’s striking about Colombo’s work is that, like O'Connell’s, it was not just based on dissection, but also on the living female body – hands-on experience of it. </p>
<p>He described finding a beautiful thing, “made with such art”, the very seat of women’s erotic pleasure: a small oblong which, if rubbed with a penis or even simply touched “with your little finger”, causes great pleasure and the flowing out of “seed” in all directions, “swifter than the wind”. One of the words for clitoris in Latin was the “gaude mihi”, which translates as “please me”.</p>
<h2>Pleasure vs procreation</h2>
<p>But caution is in order here, because all this earlier historical attention on the clitoris wasn’t due to scientists being interested in female pleasure in its own right. It was because <a href="https://www.theguardian.com/science/the-h-word/2012/aug/20/legitimate-rape-medieval-medical-concept">people believed</a> that both sexes had to reach orgasm for conception to happen. Pleasure was seen as necessary for procreation, not as something to be experienced on its own terms. </p>
<p>This ancient claim was recently resurrected in a 2019 <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/ca.23498">article</a> in the journal Clinical Anatomy, where the reproductive physiologist Roy Levin suggested that clitoral excitement changes the lining of the reproductive tract to make it more likely that conception will occur. </p>
<p>For pleasure, procreation or both, even though science now knows far more about the clitoris than ever before, it’s clear there’s still a way to go given <a href="https://link.springer.com/article/10.1007/s00192-021-04727-9">recent research</a> shows many women are still not able to properly identify their genital parts.</p><img src="https://counter.theconversation.com/content/196817/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen King does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The clitoris is not small at all, it’s just that only 10% of the organ is actually visible.Helen King, Professor Emerita, Classical Studies, The Open UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1869842022-08-05T12:10:37Z2022-08-05T12:10:37Z500K American men get vasectomies every year – a specialist explains the easy and reversible procedure<figure><img src="https://images.theconversation.com/files/475921/original/file-20220725-20-yvadro.jpg?ixlib=rb-1.1.0&rect=0%2C14%2C4915%2C3664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">This year, many vasectomy patients are young or single men concerned about unwanted pregnancy at a time when abortion care may not be as available as before.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-in-discussion-with-patient-in-exam-room-royalty-free-image/97863283">Thomas Barwick/Stone via Getty Images</a></span></figcaption></figure><figure class="align-center ">
<img alt="Green plate reading: 500,000 Number of men in the US who undergo vasectomies each year" src="https://images.theconversation.com/files/474983/original/file-20220719-4704-cux94h.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/474983/original/file-20220719-4704-cux94h.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=255&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474983/original/file-20220719-4704-cux94h.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=255&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474983/original/file-20220719-4704-cux94h.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=255&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474983/original/file-20220719-4704-cux94h.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=321&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474983/original/file-20220719-4704-cux94h.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=321&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474983/original/file-20220719-4704-cux94h.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=321&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>About half a million men undergo a vasectomy in the United States in any given year. The percentage of men getting them had been <a href="https://doi.org/10.1111/andr.13093">dropping for the past two decades</a>, but it looks like those numbers are going up in the wake of the June 24, 2022, Supreme Court <a href="https://www.oyez.org/cases/2021/19-1392">decision overturning Roe v. Wade</a>. </p>
<h2>Appointments up</h2>
<p>It’s too early for official numbers, but as a urologist and <a href="https://doctors.umiamihealth.org/provider/Ranjith+Ramasamy/526160">microsurgeon specializing in vasectomies</a>, I can report that more new patients are coming to see me. We used to perform about 20-25 vasectomies a month in our Miami clinic. But since the Dobbs v. Jackson decision came down, we’re now fully booked at 30 vasectomies scheduled each month through next year. I’m also seeing about 30% more online queries about vasectomies. It’s the first such increase I’ve seen in my 15-year career.</p>
<p>Other <a href="https://www.newsweek.com/male-contraception-vasectomies-inquiries-increase-roe-v-wade-supreme-court-1724739">urologists have rising numbers, too</a>. One Kansas City doctor said that he had <a href="https://www.cbs19news.com/story/46797913/urologist-says-vasectomy-consults-have-increased-by-900-since-roe-v-wade-decision">a 900% increase in vasectomy inquiries</a> in just the four days after the decision.</p>
<p>Most of our clinic’s new vasectomy patients are young or single men. They tell me they are concerned about getting a woman pregnant when abortion care isn’t as available as it was before. They also ask about <a href="https://doi.org/10.1007/978-3-030-47767-7_36">freezing their sperm first</a> in case they want biological children in the future. <a href="https://doi.org/10.1007/s10815-022-02545-6">Frozen storage is a viable option</a>, and some patients have even <a href="https://doi.org/10.1093/humrep/deac107.023">successfully frozen their own sperm</a>. </p>
<h2>Quick and simple</h2>
<p>Most vasectomies are straightforward, with 98% of them performed <a href="https://www.urologyhealth.org/educational-resources/vasectomy">in an outpatient clinic</a>. For the duration of the 15- to 20-minute procedure, most men are <a href="https://doi.org/10.1016/j.juro.2012.09.080">wide awake in a medical office</a>.</p>
<p>Only 2% of vasectomy patients get them in a hospital under anesthesia. That’s usually because of anatomical issues or previous surgeries complicating the procedure – or the personal preference of the patient to go to sleep.</p>
<p>The doctor starts by making a small opening in the scrotum. Then the doctor pulls out the vas deferens, the tube that delivers sperm out of the testes and to the ejaculatory duct. After placing permanent clips on the tube in two places, the doctor removes a small piece of tube between the clips. The clips remain in place, closing and permanently sealing the cut tube ends. Now there is no longer any connection between the testes where sperm is produced and the urethra, where it once exited the body. </p>
<p>Patients usually go home and recover for about four hours with some ice on the area. Most can go back to work a day or two later if their job doesn’t involve manual labor. We recommend no sex and no heavy lifting for about a week after the vasectomy.</p>
<p>The recovery period is a popular excuse for sports fans to plan their vasectomy around <a href="http://doi.org/10.21037/tau.2019.08.33">major sports events on TV</a> so that while they heal they can watch the Masters golf tournament, baseball’s World Series or the bowl games of American football. In fact, “March Madness vasectomy” promotions timed to college basketball playoffs are among the reasons <a href="https://doi.org/10.1016/j.urology.2018.03.016">March is a popular month</a> for appointments.</p>
<h2>More concerns than changes</h2>
<p>About two to three months later, the patient returns to the clinic. We take a sample of semen to check the sperm count. That tells us whether his vasectomy was successful. If any sperm are in the ejaculate, we might need to do a second one, but that happens in <a href="https://doi.org/10.21037%2Ftau.2017.07.08">fewer than 1% of cases</a>. Most of the time, we can give the patient the all-clear that their procedure is complete.</p>
<p>Of course, this is a surgery, so patients naturally have significant questions and concerns. A common one I’ll hear from a patient is that getting a vasectomy will make him “less of a man” because he is no longer able to father children. But that is absolutely not true. It won’t make you less of a man. </p>
<p>Some men fear it will damage their penis because the procedure is so close to it. But a vasectomy will not damage a man’s penis or any other surrounding structures. And he will not have any changes in sexual function or enjoyment after recovery from the procedure. </p>
<p>While everything else is the same as before, ejaculate volume obviously decreases slightly after a vasectomy. This worries some men. But it’s not a noticeable decrease, since <a href="https://onlinelibrary.wiley.com/doi/10.1111/andr.12983">sperm is only 5% of semen volume</a>. </p>
<p>If patients do change their minds, however, they can get their vasectomies reversed, and <a href="https://doi.org/10.1016/j.urology.2018.03.016">about 5% of U.S. patients do</a>.</p>
<p>Most commonly this involves a man with a new partner who wants to have biological kids. Nearly all vasectomy reversals succeed, with sperm returning to the ejaculate <a href="https://doi.org/10.1016/j.urology.2018.03.016">90% to 95% of the time</a>. And pregnancies follow vasectomy reversals about 50% to 60% of the time, depending on the age of the woman.</p><img src="https://counter.theconversation.com/content/186984/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ranjith Ramasamy receives funding from Acerus Pharmaceuticals (Consultant, Grant Recipient), Boston Scientific (Consultant, Grant Recipient), Coloplast (Consultant, Grant Recipient), Endo Pharmaceuticals (Consultant, Grant Recipient), Empower Pharmacy (Grant Recipient), Nestle Health (Consultant), Olympus (Grant Recipient), Hims, Inc (Advisory Board). </span></em></p>As more younger, single men ask for one following the Supreme Court abortion decision, a urologist explains what to expect with a vasectomy.Ranjith Ramasamy, Associate Professor of Urology, University of MiamiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1790842022-03-18T12:31:54Z2022-03-18T12:31:54ZHow prosthetic penises in shows like HBO’s ‘Minx’ reinforce existing stereotypes and taboos<p>Entertainment Weekly <a href="https://ew.com/tv/taylor-zakhar-perez-minx-cover/">recently published an interview</a> with actor Taylor Zakhar Perez, teasing the piece with a headline about Perez “baring it all” as a nude model for a 1970s magazine centerfold in the first episode in HBO Max’s “scandalous” new show, “<a href="https://www.imdb.com/title/tt11947418/">Minx</a>.” </p>
<p>The real scandal, in my view, is not the promised nudity but the way it’s misrepresented. Perez never actually appears fully nude in that episode. He wears a prosthetic penis. </p>
<p>As prosthetic penises have become more common in film and on TV, I’ve watched publications eagerly document the trend with cheeky headlines: “<a href="https://nypost.com/2022/02/07/power-of-the-dong-hollywood-unleashed-the-penis-this-year/">The power of the dong: The year the penis was unleashed in Hollywood</a>,” “<a href="https://www.thrillist.com/entertainment/nation/how-prosthetic-penises-are-made-tv-movies">How the Sausage Gets Made: Inside Hollywood’s Prosthetic Penis Craze</a>” and “<a href="https://theface.com/culture/nudity-cock-penis-dicks-euphoria-and-just-like-that-tv-film-culture">Welcome to the year of the cock</a>.”</p>
<p>But to me, their growing use, and the way in which actors wielding them are deceptively described as partaking in “full frontal nudity,” often reinforces existing taboos under a guise of progressivism and gender equality.</p>
<p>What’s wrong with just showing the real thing?</p>
<h2>No more than a costume</h2>
<p>I’ve been researching representations of penises and <a href="https://doi.org/10.1080/15240657.2020.1857528">the way they’re connected to masculinity</a> since the 1993 publication of my book “<a href="https://www.wsupress.wayne.edu/books/detail/running-scared">Running Scared: Masculinity and the Representation of the Male Body</a>.”</p>
<p>The media, it seems, has become fascinated with prosthetic penises while skirting the issue of why filmmakers and actors are avoiding actually baring it all.</p>
<p>“Minx” is <a href="https://www.nytimes.com/2022/03/01/arts/television/hbo-hulu-amazon-march.html">set in the 1970s</a> and tells the story of an activist who becomes the editor of an erotic feminist magazine that includes nude male centerfolds. Her partner in the enterprise is a successful pornographer.</p>
<p>The premise seems ripe for actors to appear in the flesh. And sure enough, early coverage of the show plays up this element. “Minx,” <a href="https://decider.com/2022/03/01/minx-on-hbo-max-review/">according to a review in Deadline</a>, uses nudity “to defang the insidious shame associated with sexuality in all forms. … [In the show] a penis is just a penis and a breast a mere breast.”<br>
But a prosthetic penis is not just a penis; it is not even a penis. </p>
<p>The “Minx” pilot does include a minutelong scene in which about 18 bottomless men audition to appear in the centerfold, and flashes of their purportedly <a href="https://www.nytimes.com/2022/03/16/arts/television/minx-hbo-max-male-nudity.html">real penises are shown</a>.</p>
<p>Although The New York Times <a href="https://www.nytimes.com/2022/03/16/arts/television/minx-hbo-max-male-nudity.html">praised the montage</a> for its “unusual degree of realism,” I think it highlights how the show carefully regulates the representation of penises. </p>
<p>None of the men in this brief scene are major characters. It turns out <a href="http://www.vanityfair.com/hollywood/2022/03/minx-euphoria-tvs-increase-in-full-frontal-male-nudity-prosthetics">some actually wore prosthetic penises</a>. And the one who’s ultimately chosen, played by Perez, wears a prosthesis, which simply amounts to a costume. </p>
<h2>Titillating PR</h2>
<p>Furthermore, the phony phalli on screen often reflect cultural stereotypes.</p>
<p>In the 2015 film “<a href="https://www.imdb.com/title/tt3844362/?ref_=nv_sr_srsg_0">The Overnight</a>,” a character with a small prosthetic penis is comically obsessed about its size and his sexual performance. As one prosthetic artist <a href="https://www.fastcompany.com/3049594/what-hollywoods-prosthetic-penis-genius-can-teach-you-about-ahem-growing-y">explained to Fast Company</a>, “Filmmakers will always give a bigger penis to more manly, virile characters and smaller penises are usually just about the gag factor.” </p>
<p>He added that he’d welcome diverse, real penises because they’d make people “a little bit more comfortable with sexuality” and combat the “taboo” of showing the penis.</p>
<p>Culture writer Christina Izzo <a href="https://www.myimperfectlife.com/features/tv-prosthetic-penis-trend">derides the popularity of prosthetics</a> as a “cock-out cop-out.”</p>
<p>But Izzo is a lonely voice. <a href="https://www.esquire.com/uk/culture/tv/a38949715/male-nudity-tv-euphoria-pam-tommy-talking-penis">Most coverage of prosthetic penises</a> tends to portray them as progressive for purportedly providing a visual balance to female nudity and feminist for making actresses more comfortable on set.</p>
<p>I believe the issues should be separated. <a href="https://www.cnn.com/2021/06/07/entertainment/intimacy-coordinators-michaela-coel-baftas-intl-scli-gbr/index.html">When intimacy consultants</a> require the use of prosthetic penises in intimate sexual scenes with bodily contact for the comfort of actresses, they perform a profoundly important role. However, many of the instances of frontal male nudity I’ve analyzed involve no intimate sexual contact. </p>
<p>Eric Dane and Jacob Elordi are two of many actors in “Euphoria” <a href="https://www.thewrap.com/eric-dane-on-why-he-used-a-prosthetic-penis-for-euphoria-full-frontal-sex-scene/">who purportedly wore prosthetic penises</a> even as <a href="https://www.bustle.com/entertainment/jacob-elordi-euphoria-stunt-penises-mullet-kissing-booth">they implied</a> that they’ve broken the taboo of showing penises. </p>
<p>It is impossible to verify most claims about the extent of the use of prosthetic penises on any show, and <a href="https://www.cosmopolitan.com/uk/entertainment/a37062869/sex-life-brad-prosthetic-penis/">some actors refuse to answer the question</a>. An “is it real or not” tease encourages speculation and has become its own form of publicity for shows and actors. </p>
<h2>Sculpting meaning into something trivial</h2>
<p><a href="https://www.routledge.com/Masculinity-Bodies-Movies-Culture/Lehman/p/book/9780415923248">My research</a> <a href="https://quod.lib.umich.edu/cgi/t/text/text-idx?c=acls;cc=acls;view=toc;idno=heb08133.0001.001">on sexuality and the male body</a> shows that representations of the penis in the media influence cultural notions of sexuality and gender. Since the penis is a potent cultural symbol, people are bombarded with conflicting messages attempting to control its meaning.</p>
<p>For example, medicine reassures men that nearly all of them are average. Pornography shows extremely large penises. Men with small penises are the butt of size jokes. Racist stereotypes suggest men of some races have large penises and are hypersexual, while others are undersexed with small ones.</p>
<p>Prosthetic penises are just another way to attach significance to the organ.</p>
<p>Of course, the truth is that penises have no fixed meanings. The first issue of <a href="https://www.esquire.com/entertainment/a55592/playgirl-magazine-history/">Playgirl magazine</a>, which featured real frontal male nudity, was published in 1973; it makes the use of prostheses in 2022 seem overly prude. Mature representations of real, diverse penises, without shame or special significance, would be far more worthy of media attention than prostheses. </p>
<p>That, to me, would be truly revolutionary.</p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=weekly&source=inline-weeklybest">Sign up for our weekly newsletter</a>.]</p><img src="https://counter.theconversation.com/content/179084/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Lehman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Often described as a sign of progressivism and gender equality, they’re neither.Peter Lehman, Emeritus Professor, Film and Media Studies in English, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1776542022-02-24T10:24:37Z2022-02-24T10:24:37ZPolar penis: the hazards of winter sports<p>The Olympics has concluded with almost 3,000 <a href="https://olympics.com/beijing-2022/olympic-games/en/results/all-sports/athletes.htm">athletes</a>, showcasing their skills to the world. While slips, trips and falls are common on the ice and snow, causing embarrassment and injury, spare a thought for Finnish cross-country skier <a href="https://olympics.com/beijing-2022/olympic-games/en/results/cross-country-skiing/athlete-profile-n1035596-remi-lindholm.htm">Remi Lindholm</a> who revealed after competing in the 50km skiing event that his penis had frozen during the competition.</p>
<p>Because of the extreme weather in Beijing, officials reduced the race to <a href="https://www.reuters.com/lifestyle/sports/cross-country-skiing-mens-50km-race-delayed-shortened-30km-due-high-winds-2022-02-19/">30km</a>, and the start was delayed by an hour because of high winds, with the air temp -16°C, and the windchill causing it to drop into the minus twenties.</p>
<p>Cross-country skiers only wear very light clothing for the event, so frostbite is a real risk. Indeed, Lindholm suffered from frostbite to this part of his anatomy in Ruka, Finland last year.</p>
<p>Frostbite occurs when exposed skin is subject to temperatures below 0°C. The body has an automatic response to cold and one change is to undergo “<a href="https://physoc.onlinelibrary.wiley.com/doi/full/10.1113/EP087718">vasoconstriction</a>”, where the blood vessels in the cold area of skin narrow, to prevent blood flowing into the cold area and returning to the body, where it may cause cooler temperatures in and around the vital organs and lead to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4593810/">hypothermia</a>.</p>
<p>The body is programmed to keep the core of our body at <a href="https://www.ncbi.nlm.nih.gov/books/NBK279457/">37°C</a> for optimal function. The vasoconstriction also prevents <a href="https://pubmed.ncbi.nlm.nih.gov/9460447/">ice crystals</a> from forming in the blood and tissues, when they drop to -4°C or below and begin to destroy the tissue structure.</p>
<h2>Structure of the penis</h2>
<p>The penis, like all other tissues in the body, relies on a blood supply and, contrary to popular belief, it is not a muscle. It is, in fact, three tubes that are more like a sponge with spaces inside them. When aroused, these spaces fill with blood to cause an erection, containing up to <a href="https://www.nature.com/articles/3900278.pdf?origin=ppub">140 milliletres</a> of blood. The portion of the penis that is located external to the body continues deep under the skin towards the rectum, where it originates. The external part is most susceptible to damage from the cold.</p>
<p>The penis responds to temperature using nerves that function automatically, and when subject to cold the natural response is for the blood to flow out of the tissues back to the body, this reduces the size and protects the blood from freezing or chilling the body when it returns to it but also keeps the penis closer to the body to prevent it freezing. A similar change happens with the testicles, which, when cold, are drawn closer to the body to keep them warm.</p>
<p>Even though the penis shrinks and drastically reduces its blood flow, it is still susceptible to cold temperatures. The penis has nerve <a href="https://pubmed.ncbi.nlm.nih.gov/25644189/">endings</a> that detect hot and cold temperatures and are responsible for expressing pain when the temperatures become uncomfortable. Typically, temperatures above 45°C and below 15°C are felt as <a href="https://www.sciencedirect.com/science/article/pii/B9780723434122100033">painful</a> by these nerves. When temperatures rise above 50°C and below 0°C, tissue damage occurs, the length and extremity of temperature is linked to the likelihood of <a href="https://www.nature.com/articles/s41572-020-0145-5">lasting damage</a>.</p>
<p>The recommended <a href="https://www.nhs.uk/conditions/frostbite/treatment/">treatment</a> for frostbite of extremities is to warm them for about 30 minutes at a temperature very close to body temperature. Lindholm described the pain from this process as <a href="https://www.rollingstone.com/culture/culture-news/finnish-skier-frozen-penis-reni-lindholm-beijing-olympics-1310303/">unbearable</a>. The reason the treatment is so painful is because the nerve fibres in the tissues become <a href="https://academic.oup.com/brain/article/140/10/2557/4100656">hypersensitive</a> in order to protect the tissues from further damage, the same way sunburn is painful after the injury.</p>
<p>As the tissues warm, the blood rushes back into the tiny blood vessels causing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8465633/">inflammation and blood clots</a>, which is painful. Alongside this, the normal temperature feels hotter and more painful than it should because the temperature receptors are in a heightened state.</p>
<h2>Do animals suffer a similar fate?</h2>
<p>You may wonder why this doesn’t happen to animals that live in frigid parts of the world. Scientists have discovered that mammals that live at higher latitudes where snow accumulates have <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.0030-1299.2004.13173.x">longer</a> penises than those that live at lower latitudes. This potentially allows for some temperature-related “shrinkage”.</p>
<figure class="align-center ">
<img alt="A polar bear" src="https://images.theconversation.com/files/448017/original/file-20220223-27-yk653f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/448017/original/file-20220223-27-yk653f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/448017/original/file-20220223-27-yk653f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/448017/original/file-20220223-27-yk653f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/448017/original/file-20220223-27-yk653f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/448017/original/file-20220223-27-yk653f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/448017/original/file-20220223-27-yk653f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Do polar bears get polar penis?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/polar-bear-ursus-maritimus-630373091">Vaclav Sebek/Shutterstock</a></span>
</figcaption>
</figure>
<p>Some of these animals also have an additional bone that humans don’t – the <a href="https://www.cell.com/current-biology/pdf/S0960-9822(12)01308-5.pdf">baculum</a>, or penis bone. While the exact function of this bone is still unclear, it potentially reduces some of the reliance on blood flow to maintain an erection, which is helpful in colder climates.</p>
<p>Polar bears have tufts of long hair on their penile sheaths (similar to foreskin) that probably offer protection against cold exposure. But humans are not alone in being affected by the cold. <a href="https://www.google.co.uk/books/edition/Blackwell_s_Five_Minute_Veterinary_Consu/VD3Rz8JaQXkC?gbpv=1">Horses</a> and <a href="https://www.cambridge.org/core/journals/animal/article/review-abnormalities-of-the-bull-occurrence-diagnosis-and-treatment-of-abnormalities-of-the-bull-including-structural-soundness/9E73D9CBD6320CA8B7F5717F3D9117F7">bulls</a> are reported to suffer similar frostbite-related issues with their genitalia.</p><img src="https://counter.theconversation.com/content/177654/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Taylor is affiliated with the Anatomical Society. </span></em></p>Finnish cross-country skier Remi Lindholm suffered from a frozen penis during the Beijing Winter Olympics.Adam Taylor, Professor and Director of the Clinical Anatomy Learning Centre, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1600072021-05-03T20:08:22Z2021-05-03T20:08:22ZAre chemicals shrinking your penis and depleting your sperm? Here’s what the evidence really says<figure><img src="https://images.theconversation.com/files/398259/original/file-20210503-13-ocd03y.jpg?ixlib=rb-1.1.0&rect=14%2C0%2C4977%2C3323&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>A doomsday scenario of an end to human sperm production has been <a href="https://www.theguardian.com/commentisfree/2021/mar/18/toxic-chemicals-health-humanity-erin-brokovich">back in the news recently</a>, now with the added threat of shrinking penises.</p>
<p>Professor Shanna Swan, a US epidemiologist who studies environmental influences on human development, recently published a <a href="https://www.shannaswan.com/countdown">new book</a> called Countdown.</p>
<p>In it, she suggests sperm counts <a href="https://www.theguardian.com/society/2021/mar/28/shanna-swan-fertility-reproduction-count-down">could reach zero by 2045</a>, largely owing to the impact of a range of environmental pollutants used in manufacturing everyday products: phthalates and bisphosphenol A (BPA) from plastics, and per- and poly-fluoroalkyl substances (PFAS) used, for example, in waterproofing. Under this scenario, she says, most couples wanting to conceive would need to rely on assisted reproductive technologies.</p>
<p>She has also warned these chemicals are shrinking penis size.</p>
<p>Such extraordinary claims require extraordinary evidence. I would argue the evidence is not strong enough.</p>
<h2>Correlation doesn’t equal causation</h2>
<p>Epidemiologists find associations between disease and potential contributing factors, like lung cancer and smoking. But their work can’t identify the causes of disease — just because two things are associated doesn’t mean one is causing, or caused by, the other.</p>
<p>An article written by environmental activist Erin Brockovich in <a href="https://www.theguardian.com/commentisfree/2021/mar/18/toxic-chemicals-health-humanity-erin-brokovich">The Guardian</a> in March leads by referring to “hormone-disrupting chemicals that are decimating fertility”. But causation is <a href="https://pubmed.ncbi.nlm.nih.gov/33385395/">far from established</a>. </p>
<p>It’s reasonable to expect chemicals that <a href="https://pubmed.ncbi.nlm.nih.gov/33385395/">affect hormone function</a> in our bodies, like BPA and PFAS, could affect reproduction in males and females, given available evidence. But we don’t have irrefutable proof.</p>
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<img alt="A man and a pregnant woman outside with their dog." src="https://images.theconversation.com/files/398265/original/file-20210503-17-fzbt4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398265/original/file-20210503-17-fzbt4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398265/original/file-20210503-17-fzbt4d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398265/original/file-20210503-17-fzbt4d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398265/original/file-20210503-17-fzbt4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398265/original/file-20210503-17-fzbt4d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398265/original/file-20210503-17-fzbt4d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Could environmental pollutants be leading to infertility? Establishing cause and effect isn’t clear-cut.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Selective reporting</h2>
<p>In 2017, Swan and several colleagues published <a href="https://pubmed.ncbi.nlm.nih.gov/28981654/">an exhaustive review study</a> showing an apparent drop in men’s sperm counts of 59.3% between 1973 and 2011. This research informs the arguments Swan makes in Countdown and those we’ve seen in the media.</p>
<p>What’s not often mentioned is the fact the researchers only observed a decline in sperm count in groups of men from North America, Europe, Australia, and New Zealand, but not in groups of men from South America, Asia or Africa.</p>
<p>When Swan and her colleagues combined the data from all countries, they saw a decline because the studies of “Western” men outweigh those of men elsewhere (in the number of studies and participants).</p>
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<em>
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Read more:
<a href="https://theconversation.com/huge-drop-in-mens-sperm-levels-confirmed-by-new-study-here-are-the-facts-81582">Huge drop in men's sperm levels confirmed by new study – here are the facts</a>
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<p>Swan and her colleagues worked hard to avoid bias when conducting their study. But <a href="https://pubmed.ncbi.nlm.nih.gov/9455838/">selection bias</a> (related to how study participants are chosen), <a href="https://pubmed.ncbi.nlm.nih.gov/2406472/">publication bias</a> (resulting from researchers’ tendency to report only observations they think will be of interest) and other limitations of the original work used as the basis for their investigation could be influencing the results of the larger study.</p>
<p>Many studies from different parts of the world show declining sperm counts, which is concerning, but we don’t fully understand the <a href="https://pubmed.ncbi.nlm.nih.gov/32168194/">reasons for the apparent decline</a>. Blaming chemicals in the environment overlooks <a href="https://pubmed.ncbi.nlm.nih.gov/29774489/">other important factors</a> such as chronic disease, diet, and obesity, which people can act on to improve their fertility.</p>
<h2>The problem with extrapolation</h2>
<p>Swan’s 2017 study boils down to a straight descending line drawn between sperm counts of groups of men studied at different times between 1973 and 2011.</p>
<p>Just because a straight line can be drawn through the data, this doesn’t justify extrapolation of that line beyond its earliest and latest data points. It’s unscientific to assume trends in data exist outside the range of observations.</p>
<p>We know sperm counts of men in the early 1940s were around <a href="https://pubmed.ncbi.nlm.nih.gov/1393072/">113 million sperm per ml of semen</a>, not the roughly 140 million/ml you get from extrapolating backwards from Swan’s research. Concluding sperm counts will reach zero in 2045, based on extrapolating forward from the available data, is just as likely to be incorrect. </p>
<p>When Swan told <a href="https://www.axios.com/newsletters/axios-future-e58ada65-1a84-4550-afd8-79d698bb7d38.html?stream=future&utm_campaign=newsletter_axiosfutureofwork&utm_medium=email&utm_source=newsletter">news website Axios</a> “If you look at the curve on sperm count and project it forward” she was encouraging unjustifiable and unscientific interpretation of her data — even though she acknowledged it was “risky” to extrapolate in this way. Unfortunately this caution is too often unmentioned.</p>
<p>For example, <a href="https://www.theguardian.com/commentisfree/2021/mar/18/toxic-chemicals-health-humanity-erin-brokovich">Brockovich writes</a>: “That would mean no babies. No reproduction. No more humans.” That’s hyperbole. It’s just not science.</p>
<figure class="align-center ">
<img alt="An illustration of sperm." src="https://images.theconversation.com/files/398266/original/file-20210503-23-8j0tma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398266/original/file-20210503-23-8j0tma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398266/original/file-20210503-23-8j0tma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398266/original/file-20210503-23-8j0tma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398266/original/file-20210503-23-8j0tma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398266/original/file-20210503-23-8j0tma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398266/original/file-20210503-23-8j0tma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Swan has extrapolated from recent data to predict sperm counts could reach zero by 2045. But this isn’t necessarily accurate.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Relax, your penis isn’t shrinking</h2>
<p>Claims of shrinking penises are obvious clickbait. But only <a href="https://pubmed.ncbi.nlm.nih.gov/30403786/">a single study</a>, of 383 young men from the Veneto region in northeastern Italy, links men’s penis size to the types of chemicals Swan attributes to declining sperm counts.</p>
<p>Within Veneto there are <a href="https://figshare.com/articles/figure/Supplemental_Figure_1/7016234">geographic zones</a> with varied levels of PFAS contamination. A group of 212 men who live in areas with high or intermediate PFAS exposure and have high levels of these chemicals in their bodies, had an average penis length of 8.6cm, about 10% lower than the average of a group of 171 men from an area without exposure (9.7cm).</p>
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<p>
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Read more:
<a href="https://theconversation.com/science-or-snake-oil-do-men-need-sperm-health-supplements-84379">Science or Snake Oil: do men need sperm health supplements?</a>
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<p>But a few features of this study affect the reliability of the observations and whether we can generalise them to other populations.</p>
<ol>
<li><p>men were grouped according to where they lived, not where they were born. Since genital size is <a href="https://pubmed.ncbi.nlm.nih.gov/30403786/">determined before birth</a>, the environment during their mothers’ pregnancies is more relevant to penis size than where the men lived at the time of the study. Some men will likely have relocated from their place of birth but how many, and where they may have moved to and from, we don’t know</p></li>
<li><p>the levels of PFAS exposure for men living in the contaminated regions of Veneto are extreme, because of <a href="https://pubmed.ncbi.nlm.nih.gov/29108835/">decades of industrial pollution</a>. How the potential effect of such large exposures relates to smaller and more common exposures to pollutants, like from plastic food wrap, we don’t know</p></li>
<li><p>the study is missing details about its subjects and the conditions under which measurements were made. It’s <a href="https://pubmed.ncbi.nlm.nih.gov/33748967/">usual</a> to exclude people with conditions that might affect study outcomes, such as congenital abnormalities, but it’s not clear whether this happened in the study. Variables that <a href="https://pubmed.ncbi.nlm.nih.gov/31171853/">influence penile measurements</a> (such as room temperature, posture, and whether the penis is held straight or hanging) are not mentioned.</p></li>
</ol>
<p>And from a semantic perspective, for penises to be “shrinking” they must be getting shorter over time, on either an individual or population basis. I cannot find any reports of men’s penises shortening as a consequence of environmental pollution. <a href="https://pubmed.ncbi.nlm.nih.gov/31171853/">Available data</a> <a href="https://pubmed.ncbi.nlm.nih.gov/25487360/">don’t suggest</a> a decline in penis size over the past few decades.</p>
<p>While environmental pollution is a pressing concern, the evidence suggests the catastrophic collapse of human reproduction and accompanying penis shrinkage is thankfully a pretty unlikely prospect.</p>
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Read more:
<a href="https://theconversation.com/considering-using-ivf-to-have-a-baby-heres-what-you-need-to-know-108910">Considering using IVF to have a baby? Here's what you need to know</a>
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<img src="https://counter.theconversation.com/content/160007/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Moss is Health Content Manager at Healthy Male (formerly Andrology Australia). He is the current President of The Perinatal Society of Australia and New Zealand. </span></em></p>Warnings of an end to human sperm production have been making headlines recently, now with the added threat of shrinking penises. Is this science or sensationalism?Tim Moss, Adjunct Associate Professor, Department of Obstetrics and Gynaecology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1469062020-10-09T12:28:23Z2020-10-09T12:28:23ZMore penises are appearing on TV and in film – but why are nearly all of them prosthetic?<figure><img src="https://images.theconversation.com/files/362230/original/file-20201007-14-ijqgh6.png?ixlib=rb-1.1.0&rect=202%2C3%2C869%2C504&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">'Euphoria' is one of many premium cable TV shows to feature an abundance of prosthetic penises.</span> <span class="attribution"><a class="source" href="https://preview.redd.it/20xysq8yfm631.jpg?width=1920&format=pjpg&auto=webp&s=e35414d051b88b125e005186b66bb4b236cd826e">HBO</a></span></figcaption></figure><p>If you’ve noticed an uptick of male frontal nudity in TV and in movies in recent years, you’re onto something.</p>
<p>In 1993, I studied patterns of male nudity in my book “<a href="https://www.wsupress.wayne.edu/books/detail/running-scared">Running Scared: Masculinity and the Representation of the Male Body</a>.” After the old <a href="https://daily.jstor.org/end-american-film-censorship/">Motion Picture Production Code</a> was replaced by a new ratings system in 1968, frontal male nudity in Hollywood movies in certain contexts was permitted. “<a href="https://www.imdb.com/title/tt0068509/?ref_=nv_sr_srsg_1">Drive, He Said</a>,” directed by Jack Nicholson in 1971, was an early film to include such a scene, while Richard Gere’s <a href="https://foxwilmington.com/headlines/american-gigolo-star-carole-cook-recalls-working-with-richard-gere-he-was-carrying-the-mother-lode/">nude scene</a> in 1980’s “<a href="https://www.imdb.com/title/tt0080365/?ref_=nv_sr_srsg_0">American Gigolo</a>” helped to transform the young actor into an international sex symbol.</p>
<p>Yet female nudity remained far more common in movies, and there was no frontal male nudity on mainstream television as of 1993.</p>
<p>Since then, a lot has changed. Directors and audiences are becoming more and more comfortable showing male nudity. </p>
<p>But nowadays, while we’re much more likely to see penises in mainstream film and television, they’re seldom real. Prosthetic penises – once used for exaggerated effect – have become the norm. </p>
<p>To me, this says something about the unusual significance we continue to grant the penis, along with our cultural need to carefully regulate its representation. In a way, the use of prosthetic penises maintains a certain mystique about masculinity, preserving the power of the phallus. </p>
<h2>Skirting the production code</h2>
<p>There are a number of factors fueling the current wave of frontal male nudity. </p>
<p>In the 1990s, premium cable television channels like HBO became more popular, while streaming platforms like Amazon and Netflix took off in the 21st century. </p>
<p>These channels and platforms aren’t governed by the Motion Picture Association’s <a href="https://www.motionpictures.org/film-ratings/">ratings system</a>, which strictly limits the circumstances under which the penis can be shown. </p>
<p>According to the ratings – which still regulate theater releases – penises can be shown in nonsexual situations, such as when they appear during a concentration camp scene in “<a href="https://www.imdb.com/title/tt0108052/">Schindler’s List</a>.” But if a scene involves sex and frontal male nudity, the actors have to be a certain distance apart. So when Bruce Willis’ penis briefly appeared during an underwater swimming pool lovemaking scene in the “<a href="https://www.imdb.com/title/tt0109456/?ref_=nv_sr_srsg_0">The Color of Night</a>,” the MPAA objected, citing his proximity to the woman, and the shot had to be cut. Uncensored versions of the film are now available on DVD. </p>
<p>Premium cable TV channels are not governed by these guidelines, and the HBO show “<a href="https://www.imdb.com/title/tt0118421/?ref_=fn_al_tt_1">Oz</a>,” which aired from 1997 to 2003, marked a major turning point. Set in a prison, it was notable for the sheer quantity of full frontal male nudity, with characters shown in a variety of contexts, including showering and in their cells, fully naked. </p>
<p>Another reason for the trend in male nudity has to do with justifiable criticism of the ways women <a href="https://rb.gy/fzbhdt">have been sexually objectified</a> on TV and in film. Female nudity has been much more common than male nudity, and most of it tends to involve young, attractive women being showcased in a variety of erotic contexts, with an emphasis on their breasts and buttocks. </p>
<p>Some filmmakers, such as <a href="https://slate.com/culture/2019/08/the-righteous-gemstones-male-nudity-hbo-series-review.html">Judd Apatow</a> and <a href="https://www.buzzfeednews.com/article/manuelbetancourt/penises-euphoria-nudity-hbo-game-of-thrones">Sam Levinson</a>, have said they’ve wanted to level the playing field by featuring more male nudity.</p>
<h2>The proliferation of the prosthetic</h2>
<p>Like “Oz,” Starz’s “<a href="https://www.imdb.com/title/tt1442449/">Spartacus</a>,” which premiered in 2010, was full of frontal male nudity. </p>
<p>However, there was a key difference: all the penises were prosthetic, which are made to be worn by the actors and look realistic when filmed. </p>
<p>One of the most famous prosthetic penises appeared in Paul Thomas Anderson’s 1997 film “<a href="https://www.imdb.com/title/tt0118749/?ref_=nv_sr_srsg_0">Boogie Nights</a>,” which is about a porn star, played by Mark Wahlberg. At the end of the film, viewers see a closeup shot of the actor’s extremely large prosthetic penis. </p>
<p>Prosthetics were used on and off through the years. But after “Spartacus,” their use became the norm. Now in shows like HBO’s “<a href="https://www.imdb.com/title/tt4998350/?ref_=nv_sr_srsg_0">The Deuce</a>” and “<a href="https://www.imdb.com/title/tt8772296/?ref_=nv_sr_srsg_0">Euphoria</a>,” they’re everywhere. Sometimes they’re even digital. In “<a href="https://www.imdb.com/title/tt1937390/?ref_=nv_sr_srsg_0">Nymphomaniac: Vols. I and II</a>,” director Lars von Trier digitally replaced the actors’ penises with those from body doubles.</p>
<p>Whether they’re tangible or digital they tend to have one thing in common: they’re big. </p>
<h2>The obsession with size</h2>
<p>The prosthetic penis gives filmmakers total control over its representation, and some have used its flexibility to directly address this issue of size. </p>
<p>Take the 2015 romantic comedy “<a href="https://www.imdb.com/title/tt3844362/?ref_=nv_sr_srsg_0">The Overnight</a>.” </p>
<p>Penis size is first introduced in the opening scene, when a couples has awkward sex due to the husband’s small penis. Later at a dinner party with another couple, penis size becomes the big issue again when a wife swap between the two couples is discussed. </p>
<p>The other man, played by Jason Schwartzman, has an extremely large one, while the man from the opening scene, played by Adam Scott, has a much smaller one, and becomes uncomfortable with the idea of being “exposed.” During a protracted skinny dipping scene, viewers get to see each actor’s prosthetic penis. Within the conventions of the romantic comedy, both couples are united at the end and committed to saving their marriages. </p>
<p>“The Overnight” attempts to deflate the myth that penis size matters. But at the same time that it tackles the obsession with size, it ends up reinforcing the notion – in part because of the opening scene – that bigger is better. </p>
<p>Similarly, “Euphoria,” a bold, experimental high school drama, also explores penis size, connecting the fixation on size to toxic masculinity. It shows how girls are also complicit by dwelling on size themselves – and assuming that it’s linked to sexual performance and masculinity. </p>
<h2>Toward a more honest representation</h2>
<p>“The Overnight” and “Euphoria” strive to critique our culture’s obsession with the penis, as do movies like “Boogie Nights” and TV shows like “The Deuce,” both of which are serious explorations of the pornography industry. </p>
<p>Yet by making the penis a central theme, these films and TV shows continue to grant it an aura of mystique and power that existed long before prosthetics and weaker regulations. </p>
<p>[<em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>.]</p>
<p>In the end, the use of prosthetics comes at the expense of the most mature thing filmmakers could do: show diverse, real penises in a manner that holds no special meaning for the character or plot.</p>
<p>While “Spartacus” would lead you to believe otherwise, all gladiators did not have big penises. Nor did their penis size and shape have anything to do with their strength, power, masculinity or sexuality. </p>
<p><a href="https://historycollection.com/10-of-the-most-famous-quotes-never-said-or-misattributed/3/">Although apocryphal</a>, Sigmund Freud supposedly remarked, “Sometimes a cigar is just a cigar,” which was meant to suggest that cigars are not always phallic symbols.</p>
<p>It’d be nice if, on screen, sometimes a penis were just a penis.</p><img src="https://counter.theconversation.com/content/146906/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Lehman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Directors and audiences are becoming more comfortable with male frontal nudity. But what message does it send when almost all of the penises shown aren’t real?Peter Lehman, Emeritus Professor, Film and Media Studies in English, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1251352019-12-09T01:11:07Z2019-12-09T01:11:07Z‘How do I clean my penis?’<figure><img src="https://images.theconversation.com/files/305101/original/file-20191204-70167-1dlj45h.png?ixlib=rb-1.1.0&rect=538%2C0%2C2958%2C2000&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Wes Mountain/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><blockquote>
<p>Growing up, no one ever gave me the rundown on how or what I should do to keep my penis clean […] I’ve never read any reliable answer beyond washing it with water. Do I use soap? Any soap? How normal is smegma? If my penis gets itchy from smegma should I go see a doctor? If so, my GP or a urologist? — Anonymous</p>
</blockquote>
<h2>Key points</h2>
<ul>
<li>clean under the foreskin, using soap, but not too much</li>
<li>smegma is normal</li>
<li>if you have any concerns, see your GP.</li>
</ul>
<p><a href="https://theconversation.com/au/topics/i-need-to-know-66587"><img src="https://images.theconversation.com/files/290837/original/file-20190904-175686-polw3q.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=90&fit=crop&dpr=2" width="100%"></a></p>
<p>It’s a shame some people think talking about cleaning and caring for our genitals is embarrassing or taboo. We probably know more about hair care than penis care.</p>
<p>The penis is simply another part of our anatomy, so cleaning should be relatively straight forward.</p>
<p>If you’ve been circumcised, where your foreskin was removed soon after birth, your penis will look something like the one in the diagram (below, right), with the head (or glans) always exposed.</p>
<p>But if you have a foreskin (below left and centre), there are some extra things to think about when washing, which we’ll get to soon.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/305077/original/file-20191204-70116-1vv28db.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Foreskin facts</h2>
<p>But first, some foreskin facts. From around the time you turn five, your foreskin <a href="http://www.cirp.org/library/hygiene/camille1/">separates</a> from the head of your penis, bit by bit. This allows you to pull back your foreskin (retract it). In some boys, the foreskin can stay partially stuck to the head of the penis until puberty.</p>
<p>You should <a href="https://www.berghahnjournals.com/view/journals/boyhood-studies/1/2/bhs010206.xml">never forcibly pull back</a> your foreskin. That’ll be painful, you could bleed, you could scar, or have other complications.</p>
<h2>OK, now for the washing part</h2>
<p><a href="http://www.cirp.org/library/hygiene/camille1/">Once your foreskin separates easily from the glans</a>, gently retract and clean underneath the foreskin with each bath or shower. Then, after washing, pull the foreskin forward to its normal position.</p>
<p>When it’s time to dry off, retract the foreskin again so you can dry the head of the penis with a towel. Then, you guessed it, pull the foreskin forward to its normal position.</p>
<p>It’s OK to clean with soap whether you have a foreskin or not. But generally, too much soap is worse than none at all. Excessive cleaning removes essential body oils that would normally keep our skin moist and reduce friction. If you have sensitive skin, you can use a soap-free wash from the chemist.</p>
<h2>What about smegma?</h2>
<p><a href="https://www.healthline.com/health/smegma">Smegma</a> is a thick, whitish discharge consisting of a build-up of dead skin cells, oil and other fluids under the foreskin. And it’s very useful. It protects and lubricates the penis. </p>
<p>Some people have oilier skin than others and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1464-410x.1999.0830s1034.x">tend to have more smegma</a>.
So some smegma is normal, but if you have too much or it becomes smelly, you may need to clean more.</p>
<h2>Things to watch out for (and when to see your GP)</h2>
<p>If the head of your penis becomes painful, red, itchy and has a discharge, you may have a treatable condition called <a href="https://www.mshc.org.au/SexualHealthInformation/SexualHealthFactSheets/BALANITIS/tabid/134/Default.aspx#.XcJiPfZuKUk">balanitis</a>.</p>
<p>It’s more common if you have a foreskin. And the bacteria and fungus that cause it like the warm and moist conditions under there.</p>
<p>Skin disorders, infection, poor hygiene, friction from sexual activity, and using too much soap all <a href="https://www.dermnetnz.org/topics/balanitis/">cause the condition</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-make-your-next-sexual-health-check-less-erm-awkward-72498">How to make your next sexual health check less, erm ... awkward</a>
</strong>
</em>
</p>
<hr>
<p>You can clear a mild case with good hygiene and simple treatments, such as an antiseptic or antifungal cream. You can buy these from any pharmacy. In addition to the medication, the cream itself helps protect and moisturise the inflammed skin. </p>
<p>If you have balanitis you may need to be more careful than usual to avoid urine irritating your inflamed skin. Retract your foreskin when you urinate. Dry the head of the penis gently after you finish.</p>
<p>If your penis is still inflamed after a week of these simple measures it’s <a href="https://www.aafp.org/afp/2018/0115/p102.html">best to see your GP</a>. They can then investigate other causes, such as <a href="https://www.ncbi.nlm.nih.gov/books/NBK537143/">psoriasis or an allergy</a>.</p><img src="https://counter.theconversation.com/content/125135/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David King does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s a surprisingly common question. Here’s what you need to know.David King, Senior Lecturer in General Practice, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1118772019-02-14T21:40:01Z2019-02-14T21:40:01ZMove over testosterone, another hormone is also vital for making boys – and it doesn’t come from the testes<figure><img src="https://images.theconversation.com/files/259112/original/file-20190214-1751-1i0273f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Little boy blue. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-4-day-old-baby-boy-115541389?src=iUQ6kT-yWLCpx-YHU2uQMg-1-91">noBorders - Brayden Howie</a></span></figcaption></figure><p>Often the first question parents are asked after the birth of their child is “congratulations, girl or boy?”. For <a href="https://www.ncbi.nlm.nih.gov/pubmed/17875484">parents of</a> one in 2,000 to 4,000 births, however, there is not an easy answer. This is when the baby has “ambiguous” genitalia, where it is not clear which sex they belong to. In baby boys, this was long thought to be caused by problems linked to testosterone – as were more common disorders such as undescended testicles and malformed penises, which <a href="https://www.ncbi.nlm.nih.gov/pubmed/20865786">respectively occur</a> in 9% and 1% of births. </p>
<p>But now it is clear that the reality is slightly different. According <a href="http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.3000002">to new research</a> in which I am a co-author, another hormone known as androsterone – which originates in the placenta and foetal adrenal gland – is also vital to the process that turns foetuses in boys. These insights have the potential to make a big difference to how we treat sexual disorders in male babies in future – and are also relevant to the whole debate about male and female identity. </p>
<p>Even small children are aware that men and women usually look different. It is common knowledge that boys become men because the testes of the man produce the “male” hormone testosterone and, in turn, testosterone makes men masculine. We know this thanks to the French endocrinologist Alfred Jost’s <a href="https://www.ncbi.nlm.nih.gov/pubmed/18577872">groundbreaking studies</a> in the early 1950s.</p>
<p>There are several times in boys’ lives in which bursts of testosterone play a key role in their development as males. The most well known is of course puberty, in which the testes start making much more testosterone. This makes boys hairier, grows their genitals and makes their voices break. </p>
<p>The other times are the “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462291/">mini-puberty</a>” that takes place at around three months after birth, which leads certain changes in the testes and brain; and when a boy is still a foetus in the womb, around three months into his mother’s pregnancy. While all these bursts of testosterone are probably very important in making a normal male, it is the one in the womb that affects whether the child will be a boy at all. What is now clear is that testosterone and the testes have been hogging the podium when in fact we need to share the honours around. </p>
<h2>Testosterone and super-testosterone</h2>
<p>Testosterone is part a family of male sex hormones called androgens. To get a normal male, testosterone needs to be turned into another androgen called dihyrotestosterone or DHT, a “super-testosterone” that is five times more potent than its cousin. This conversion is done in the tissue of what will become the penis, along with the other parts of the body that develop male characteristics. The consequences of the process are clear: boys who cannot turn testosterone into DHT are born looking female and only become more obviously male at puberty. </p>
<p>These include the <em><a href="https://www.bbc.co.uk/news/magazine-34290981">Guevedoces</a></em> in the Dominican Republic, who, due to a genetic mutation, lack the enzymes to make the DHT conversion. Studying these extraordinary children in the early 1970s led the American researcher <a href="http://vivo.med.cornell.edu/display/cwid-jimperat">Julianne Imperato-McGinley</a> to <a href="http://science.sciencemag.org/content/186/4170/1213">develop</a> the drug finasteride to treat prostate cancer. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/6FBR_OLm86E?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>For years, this story was considered complete – masculinisation was due to testosterone and the conversion of testosterone to DHT. Then an Australian zoologist named Marilyn Renfree, in an elegant <a href="https://www.ncbi.nlm.nih.gov/pubmed/12538619">series of studies</a> in the 2000s, <a href="https://www.newscientist.com/article/dn18782-how-female-wallabies-boost-their-males-testosterone/">published</a> the first evidence that things may not be that simple. She was actually studying wallabies, since the young in the pouch were easily accessible for experimental purposes and they mimic much of the period of pregnancy in humans and other <a href="http://www.ucmp.berkeley.edu/mammal/eutheria/placental.html">mammals with placentas</a>. Renfree found that the genitals of the young male wallabies made DHT even without testosterone from their testes. The only reliable conclusion was that they were converting other androgens to DHT.</p>
<p>It became clear that there are two ways to make a “male signal” in a wallaby foetus, both of which are necessary to normal sexual development. The first is by testosterone from the testes. The second is through different androgens that can also be made by other organs in the human, including the foetus’s adrenal glands, liver and the placenta. These other processes came to be known as the “backdoor” pathway. </p>
<p>But was the same thing true in humans? It was <a href="https://www.ncbi.nlm.nih.gov/pubmed/17875484">later shown</a> that it was, by studying male human newborns who were not properly masculinised; they had undescended testes and ambiguous genitals, despite having testes that made testosterone. It turned out they were unable to make the backdoor androgens because they had mutations in the genes of enzymes that were key to the process of the conversion into DHT. </p>
<p>As further evidence that both types of male signal are essential to normal development of human male foetuses, it was <a href="https://www.ncbi.nlm.nih.gov/pubmed/28755466">also discovered</a> that foetuses whose placentas are not working properly are around twice as likely to be born with undescended testes or with malformed penises – especially if they are also born abnormally small (for their gestational age). </p>
<h2>What we have shown</h2>
<p>In our research, which also involved the University of Glasgow and French and Swedish collaborators, we have been able to explain why. We measured the levels of different male sex hormones in the blood of male and female foetuses, and were surprised to find that only two androgens were higher in males than females: testosterone and androsterone. The relevance to the placenta is that it is up to 6,000 times heavier than the foetus and it makes large amounts of a hormone called progesterone, which it can convert into androsterone – as can the foetal liver and adrenal glands. The human foetuses’ testes have no ability to make this conversion. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/259115/original/file-20190214-1758-lk1cj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/259115/original/file-20190214-1758-lk1cj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/259115/original/file-20190214-1758-lk1cj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259115/original/file-20190214-1758-lk1cj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259115/original/file-20190214-1758-lk1cj8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259115/original/file-20190214-1758-lk1cj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259115/original/file-20190214-1758-lk1cj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259115/original/file-20190214-1758-lk1cj8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Foetal development.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendered-medically-accurate-illustration-fetus-727111831?src=_Sa4j1zE-PH_P17EdzcYww-1-28">Sebastian Kaulitzki</a></span>
</figcaption>
</figure>
<p>We then also showed that the testosterone and adrosterone were converted into DHT in male target tissues like the penis. And not only are both androgens required to masculinise the foetus, there can be abnormalities where levels are lower than normal: for example, a good index of the degree of masculinisation is the distance between the anus and genitals, and this is shorter than usual in newborns with malformed penises. </p>
<p>People affected by disorders of sexual development, including malformed penises, can have a very difficult time and face delicate surgery, hormone therapy and other treatments. Every new piece of information into how masculinisation happens raises the prospect of improving when and how these disorders are detected and treated in future. Early enough diagnosis of reduced placental function related to androgen production in early pregnancy might enable treatment before penis formation is complete, avoiding the need for corrective surgery later in life. </p>
<p>A final take-home message from our study is that while testosterone and androsterone are indeed higher on average in male than female foetuses, the difference is quite small. There is also considerable overlap between the lowest levels in boys and the highest levels in girls. Those in society who are adamant that the only choice for people is a binary choice of man or woman are not basing their views on biological reality. Treasured beliefs about the supremacy of testosterone and the testes in making a man are also obviously flawed.</p><img src="https://counter.theconversation.com/content/111877/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Fowler receives/has received funding from the MRC, BBSRC, Wellcome Trust, European Commission, Chief Scientist Office, NHS Grampian Endowment, Glasgow Children’s Hospital Charity, Tenovus, Society for the Study of Fertility, Society for Endocrinology, Endocrine Society, Holly Hill Trust, Arthritis Research UK, Royal Society.</span></em></p>What we thought we knew about male development since the 1950s has now been turned on its head.Paul A. Fowler, Chair in Translational Medical Services, University of AberdeenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1116252019-02-14T19:07:53Z2019-02-14T19:07:53ZYou need more than just testes to make a penis<figure><img src="https://images.theconversation.com/files/258965/original/file-20190214-1721-14ua0u2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Testosterone is primarily made in the testes, and creates many of the characteristics we see in adult men. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/jeans-man-on-dark-background-766127614">from www.shutterstock.com</a></span></figcaption></figure><p>In prenatal ultrasounds or at delivery, many new parents look between their baby’s legs: the presence of a penis is taken as a strong sign that it’s a boy.</p>
<p>For humans and other animals, development of a penis was thought to be driven by “male hormones” (androgens) produced entirely by the testes of the male fetus as it grows in the uterus. </p>
<p>However, a <a href="http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.3000002">new paper</a> released today indicates this might not be the case. Instead, some of the masculinising hormones that drive penis development may come from other sources in the developing fetus. These include the liver, the adrenals (small glands found on the kidneys) and placenta. </p>
<p>For the first time, this work comprehensively looks at the possible sites of hormone production outside the testes and their role in regulating masculinisation – the process of gaining typical male characteristics. This helps us see how we develop as embryos, and might feed into a bigger picture of why disorders of penis development are increasing.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/our-relationship-with-dick-pics-its-complicated-103444">Our relationship with dick pics: it's complicated</a>
</strong>
</em>
</p>
<hr>
<h2>Testosterone is not enough</h2>
<p>The penis develops from an embryonic structure called the genital tubercle or GT. </p>
<p>The GT is present in both males and females, and develops into either a clitoris or penis, depending on its exposure to hormones secreted by the developing gonads (ovaries or testes). </p>
<p>In females, the developing ovaries do not produce early hormones and the GT becomes feminised, forming a clitoris. </p>
<p>In males, the developing testes produce testosterone. This circulates in the developing fetus and causes masculinisation of target tissues and induces penis development from the GT. </p>
<p>Testosterone itself is a relatively weak hormone. It is converted in the penis to another hormone called dihydrotestosterone (DHT), which has a much more potent masculinising effect. </p>
<p>It is the local conversion of testosterone to DHT within the tissue that is important for penis development and other changes. </p>
<p>There are several ways in which the fetus can make DHT. The most simple is via conversion from testicular testosterone (the so-called “canonical” pathway). However, DHT can also be produced via other steroid hormone pathways active in many tissues, which is explored further in this new paper. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-makes-you-a-man-or-a-woman-geneticist-jenny-graves-explains-102983">What makes you a man or a woman? Geneticist Jenny Graves explains</a>
</strong>
</em>
</p>
<hr>
<h2>Common birth defects</h2>
<p>Understanding the pathways that control penis development is important. Disorders affecting penis development are among the most common birth defects seen in humans, with hypospadias (a disorder affecting development of the urethra) currently affecting around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2083775/">1 in every 115 live males born in Australia</a>, and rates are on the rise. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/258647/original/file-20190213-90504-lw517s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/258647/original/file-20190213-90504-lw517s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/258647/original/file-20190213-90504-lw517s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/258647/original/file-20190213-90504-lw517s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/258647/original/file-20190213-90504-lw517s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/258647/original/file-20190213-90504-lw517s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/258647/original/file-20190213-90504-lw517s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The urethra, the hole through which urine passes out of the body, is found in a range of different locations in the disorder known as hypospadias</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/newborn-malformation-hypospadia-main-types-315283037?src=q7V1zs7wS25RVKHm_q7jsg-1-2">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>In fact, the incidence of hypospadias has <a href="https://www.ncbi.nlm.nih.gov/pubmed/11392374">doubled over the past 40 years</a>. Such a rapid increase in incidence has been attributed to environmental factors, with endocrine disrupting chemicals (EDCs) being proposed as a major cause. EDCs are man-made chemicals used in many industries – for example, in the production of plastics, cosmetics, flame retardants and pesticides. They can interfere with hormone and metabolic systems in our bodies.</p>
<p>Of the <a href="https://endocrinedisruption.org/interactive-tools/tedx-list-of-potential-endocrine-disruptors/search-the-tedx-list">1,484 EDCs currently identified</a>, a large number are known to negatively affect male reproductive development. </p>
<p>Many <a href="https://www.publish.csiro.au/RD/RD18505">studies</a> have identified how EDCs negatively affect organs, such as the liver and adrenals, leading to diseases and disorders which damage the health of these organs and disturb male development. </p>
<h2>Backdoor pathway</h2>
<p>By measuring hormones from blood samples and tissues during the second trimester of human fetal development, this new research helps us understand the pathways driving the production of DHT, and masculinisation of the penis. </p>
<p>It suggests that in addition to the canonical pathway (testosterone from the testis converted to DHT in the GT and driving penis development), male steroids are synthesised by other organs, such as the placenta, liver and adrenal gland via a process called the “backdoor” pathway to contribute to masculinisation. Notably, the backdoor pathway was <a href="https://www.ncbi.nlm.nih.gov/pubmed/12538619">first discovered</a> through research conducted here in Australia on marsupials. </p>
<p>The findings of this research suggest that EDCs might have effects in non-reproductive tissues, including the adrenals and liver, and then cause male reproductive diseases such as hypospadias. </p>
<p>Also, it indicates that placental defects, such as intrauterine growth restriction that results in babies being born small, might contribute to male reproductive diseases in humans. </p>
<p>Further research is now required to follow-up on these interesting findings to explore possible new causal pathways of disorders that begin during pregnancy.</p><img src="https://counter.theconversation.com/content/111625/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Mark Green receives funding from the National Health and Medical Research Council, as well as the University of Melbourne for his research on fertility and endocrine disruptors. He is the Secretary for the Society for Reproductive Biology (SRB) and advisor on the effects of endocrine disruptors to the Victorian Assisted Reproductive Treatment Authority (VARTA). </span></em></p><p class="fine-print"><em><span>Andrew Pask receives funding from the Australian Research Council and National Health and Medical Research Council. </span></em></p>Disorders affecting penis development are among the most common birth defects seen in humans, and rates are on the rise.Mark Green, Merck Serono Senior Lecturer in Reproductive Biology, The University of MelbourneAndrew Pask, Professor, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/716522017-01-25T09:33:16Z2017-01-25T09:33:16ZWhy did humans evolve big penises but small testicles?<figure><img src="https://images.theconversation.com/files/154062/original/image-20170124-16062-gqpicb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">POJ THEVEENUGUL / shutterstock</span></span></figcaption></figure><p>Humans have a much longer and wider penis than the other great apes. Even the largest of gorillas, more than twice as heavy as a human, will have a penis just two and half inches long when erect.</p>
<p>However our testicles are rather small. A chimpanzee’s testes weigh more than a third of its brain while ours weigh in at less than 3%. The relative size of our penis and testes is all down to our mating strategies, and can provide some surprising insights into early human culture.</p>
<p>Primates exhibit all sorts of mating behaviour, including monogamous, polygynous – where males have multiple mates – and multimale-multifemale. One indicator of which behaviour occurs in a species is the size difference between males and females. The greater this <a href="http://www.mnn.com/earth-matters/animals/blogs/9-most-dramatic-examples-sexual-dimorphism">sexual dimorphism</a>, the more likely the mating is either polygynous or multi-male to multi-female. This can be shown by observing chimpanzees and gorillas, our closest living relatives. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/154053/original/image-20170124-16070-v8lwj1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/154053/original/image-20170124-16070-v8lwj1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/154053/original/image-20170124-16070-v8lwj1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=436&fit=crop&dpr=1 600w, https://images.theconversation.com/files/154053/original/image-20170124-16070-v8lwj1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=436&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/154053/original/image-20170124-16070-v8lwj1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=436&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/154053/original/image-20170124-16070-v8lwj1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=548&fit=crop&dpr=1 754w, https://images.theconversation.com/files/154053/original/image-20170124-16070-v8lwj1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=548&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/154053/original/image-20170124-16070-v8lwj1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=548&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Great ape sexual organs, compared for size (bonobos are flat chested until they get pregnant).</span>
<span class="attribution"><a class="source" href="https://global.oup.com/academic/product/the-cradle-of-humanity-9780198704522?cc=gb&lang=en&">Mark Maslin, The Cradle of Humanity</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Male chimpanzees are much larger than females, and they have a multi-male to multi-female mating system. Essentially, male chimps have sex all the time with any female and with any excuse. A female therefore may contain sperm from multiple partners at any one time, which puts the sperm itself – and not just the animals that produce it – into direct competition. For this reason, chimpanzees have evolved huge testicles in order to produce massive amounts of sperm, multiple times a day.</p>
<p>Male gorilla are also much larger than females, but they have a polygynous or harem-style mating system where many females live with a single male. With little or no competition actually inside the uterus, gorillas have had no need for a testicular arms race to facilitate the production of more and more sperm. Their testes, therefore, are relatively small. This is similar to modern humans, whose testes are also of very modest size and produce a relatively small amount of sperm. In fact human sperm count reduces by more than 80% if men ejaculate more than about two times a day.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/154065/original/image-20170124-16066-5krmk7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/154065/original/image-20170124-16066-5krmk7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/154065/original/image-20170124-16066-5krmk7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/154065/original/image-20170124-16066-5krmk7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/154065/original/image-20170124-16066-5krmk7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/154065/original/image-20170124-16066-5krmk7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/154065/original/image-20170124-16066-5krmk7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/154065/original/image-20170124-16066-5krmk7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Chimps have huge testicles for their size.</span>
<span class="attribution"><span class="source">Steffen Foerster / shutterstock</span></span>
</figcaption>
</figure>
<p>The human penis is large when compared with those of our closest relatives: chimpanzees, gorillas, and orangutans. However, primatologist <a href="https://www.researchgate.net/profile/Alan_Dixson">Alan Dixson</a> in his wonderfully detailed book, <a href="https://global.oup.com/academic/product/primate-sexuality-9780199544646?cc=gb&lang=en&">Primate Sexuality</a>, suggests that if we look at all primates, including monkeys, this is just wishful thinking. </p>
<p>Comparative measurements show the human penis is not exceptionally long. The Hamadryas baboon, for instance, a native of the Horn of Africa, has an erect penis that is <a href="https://www.youtube.com/watch?v=Da8KDkaRk8c&feature=youtu.be&t=3m40s">five and half inches long</a> – slightly shorter than an average human male, but they weigh only a third of our weight. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/154055/original/image-20170124-16083-ai2ide.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/154055/original/image-20170124-16083-ai2ide.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/154055/original/image-20170124-16083-ai2ide.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=659&fit=crop&dpr=1 600w, https://images.theconversation.com/files/154055/original/image-20170124-16083-ai2ide.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=659&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/154055/original/image-20170124-16083-ai2ide.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=659&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/154055/original/image-20170124-16083-ai2ide.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=828&fit=crop&dpr=1 754w, https://images.theconversation.com/files/154055/original/image-20170124-16083-ai2ide.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=828&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/154055/original/image-20170124-16083-ai2ide.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=828&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some of the complex penises found in multi-male to multi-female mating primates such as chimpanzees (h), brown lemurs (a) or macaques (d, e, f).</span>
<span class="attribution"><a class="source" href="https://global.oup.com/academic/product/primate-sexuality-9780199676613?cc=gb&lang=en&">Alan F. Dixson, Primate Sexuality</a></span>
</figcaption>
</figure>
<p>The human penis is in fact extremely dull – it does not have lumps, ridges, flanges, kinks or any other exciting feature that other primates have. In primates, this lack of penis complexity is usually found <a href="https://global.oup.com/academic/product/primate-sexuality-9780199544646?cc=gb&lang=en&">in monogamous species</a>.</p>
<h2>Monogamy mystery</h2>
<p>This observation clashes with the fact that men are significantly larger than women. This suggests our evolutionary background involved a significant degree of polygynous, rather than exclusively monogamous, mating. This is supported by anthropological data showing that most modern human populations engage in polygynous marriage. Anthropologists Clellan Ford and Frank Beach in their book Patterns of Sexual Behaviour suggested that 84% of the 185 human cultures they had data on engaged in polygyny.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/154056/original/image-20170124-16089-12sce5o.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/154056/original/image-20170124-16089-12sce5o.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/154056/original/image-20170124-16089-12sce5o.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=866&fit=crop&dpr=1 600w, https://images.theconversation.com/files/154056/original/image-20170124-16089-12sce5o.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=866&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/154056/original/image-20170124-16089-12sce5o.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=866&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/154056/original/image-20170124-16089-12sce5o.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1088&fit=crop&dpr=1 754w, https://images.theconversation.com/files/154056/original/image-20170124-16089-12sce5o.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1088&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/154056/original/image-20170124-16089-12sce5o.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1088&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Primates with simpler penises tend to be monogamous like cotton top tamarins (a) or polygynous like gorillas (g).</span>
<span class="attribution"><a class="source" href="https://global.oup.com/academic/product/primate-sexuality-9780199676613?cc=gb&lang=en&">Alan F. Dixson, Primate Sexuality</a></span>
</figcaption>
</figure>
<p>However, even in these societies most people remain monogamous. Polygynous marriages are usually a privilege reserved only for high status or wealthy men. It is worth noting that hunter-gathers around the world practice only monogamy or serial-monogamy which suggests that our ancestors may have used this mating system. </p>
<p>At first sight, however, it would seem sensible for males to reproduce with as many females as possible. Human monogamy has long puzzled anthropologists, and lots of effort has gone in to working out what keeps males hanging around.</p>
<p>Three main theories have been put forward. First is the need for long-term parental care and teaching, as our children take a long time to mature. Second, males need to guard their female from other males. Third, our children are vulnerable for a long time and infanticide could be a risk from other males. So to ensure that children are able to reach maturity the male is likely to stay to protect them, both socially and physically. This may be why males have maintained their larger relative size.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/154134/original/image-20170124-16074-893a23.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/154134/original/image-20170124-16074-893a23.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/154134/original/image-20170124-16074-893a23.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/154134/original/image-20170124-16074-893a23.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/154134/original/image-20170124-16074-893a23.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/154134/original/image-20170124-16074-893a23.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/154134/original/image-20170124-16074-893a23.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/154134/original/image-20170124-16074-893a23.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hamadryas baboons have unusually long penises.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Hamadryas_baboon.jpg">المُصوّر: مُعتز توفيق إغباريّة</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>If we view the evolution of monogamy mating systems in humans through the lens of human society it is clear that it takes a huge amount of social effort to maintain and protect more than one mate at a time. It is only when males have access to additional resources and power that they can protect multiple females, usually by ensuring other males protect them. So monogamy seems to be an adaptation to protect one’s mate and children from other males. This monogamy is reinforced by the high social cost and stress of attempting to do this for multiple partners, and it has become supported by cultural norms.</p>
<p>So when living in complex human societies the largest and most important sexual organ is the brain. Somewhere in our evolutionary past how smart and social we are became the major control on our access to sexual partners – not how big or fancy a male’s penis is.</p><img src="https://counter.theconversation.com/content/71652/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Maslin is a Professor at University College London, a Royal Society Industrial Fellow, Founding Director of Rezatec Ltd, Director of The London NERC Doctoral Training Partnership and a member of Cheltenham Science Festival Advisory Committee. He is an unpaid member of the Sopra-Steria CSR Board. He has received funding in the past from the NERC, EPSRC, ESRC, Royal Society, DIFD, DECC, BIS, FCO, Innovate UK, Carbon Trust, UK Space Agency, European Space Agency, Leverhulme Trust, WWF, JLT Re, Channel 4, RICS, British Council, and CAFOD.Prof. Maslin's latest book The Cradle of Humanity, published Oxford University Press, is out now.</span></em></p>We have the penis of a monogamous primate yet our body sizes suggest our ancestors slept around a lot.Mark Maslin, Professor of Palaeoclimatology, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/684192016-11-28T03:23:17Z2016-11-28T03:23:17ZHealth Check: why men wake up with erections<figure><img src="https://images.theconversation.com/files/146942/original/image-20161122-24550-1gkhp4s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many men are not actually aroused when they wake up erect. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>The morning penile erection, or as it is medically known, “nocturnal penile tumescence”, is not only an interesting physiological phenomenon, it can also tell us a lot about a patient’s sexual function.</p>
<p>Morning penile erections affect all males, even <a href="https://www.ncbi.nlm.nih.gov/pubmed/2192091">males in the womb</a> and male children. It also has a female counterpart in the less frequently discussed nocturnal clitoral erection.</p>
<h2>What causes erections?</h2>
<p>Penile erections occur in response to complex effects of the nervous system and endocrine system (the glands that secrete hormones into our system) on the blood vessels of the penis. </p>
<p>When sexually aroused, a message starts in the brain, sending chemical messages to the nerves that supply the blood vessels of the penis, allowing blood to flow into the penis. The blood is trapped in the muscles of the penis, which makes the penis expand, resulting in an erection. </p>
<p>Several hormones are involved in influencing the brain’s response, such as testosterone (the main male hormone).</p>
<p>This same mechanism can occur without the involvement of the brain, in an uncontrolled reflex action that is in the spinal cord. This explains why people with spinal cord damage can still get erections and why you can get erections when not sexually aroused.</p>
<h2>What about erections while we sleep?</h2>
<p>Nocturnal penile erections occur during Rapid Eye Movement (REM) sleep (the phase during which we dream). They occur when <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1351051/">certain areas of the brain</a> are activated. This includes areas in the brain responsible for stimulating the parasympathetic nerves (“rest and digest” nerves), suppressing the sympathetic nerves (“flight and fight” nerves) and dampening areas <a href="https://faculty.washington.edu/chudler/auto.html">producing serotonin</a> (the mood hormone).</p>
<p>Sleep is made up of several cycles of REM and non-REM (deep) sleep. During REM sleep, there is a shift in the dominant system that’s activated. We move from sympathetic (fight and flight) stimulation to parasympathetic (rest and digest) stimulation. This is not found during other parts of the sleep cycle. </p>
<p>This shift in balance drives the parasympathetic nerve response that results in the erection. This is spontaneous and does not require being awake. Some men may experience nocturnal penile tumescence during non-REM sleep as well, particularly older men. The reason for this is unclear.</p>
<p>The reason men wake up with an erection may be related to the fact we often wake up coming out of REM sleep.</p>
<p>Testosterone, which is at its highest level in the morning, has also been shown to enhance the frequency of nocturnal erections. Interestingly, testosterone has <a href="https://www.ncbi.nlm.nih.gov/pubmed/8848520">not been found to greatly impact</a> visual erotic stimuli or fantasy-induced erections. These are predominantly driven by the “reward system” of the brain which secretes dopamine.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/147520/original/image-20161125-15325-3s9i7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/147520/original/image-20161125-15325-3s9i7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/147520/original/image-20161125-15325-3s9i7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/147520/original/image-20161125-15325-3s9i7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/147520/original/image-20161125-15325-3s9i7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/147520/original/image-20161125-15325-3s9i7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/147520/original/image-20161125-15325-3s9i7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/147520/original/image-20161125-15325-3s9i7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Men don’t wake up with erections because they’ve been having sexy dreams.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Since there are several sleep cycles per night, men can have as many as five erections per night and these can last up to 20 or 30 minutes. But this is very dependent on sleep quality and so they may not occur daily. The number and quality of erections declines gradually with age but they are often present well beyond “retirement age” - attesting to the sexual well-being of older men.</p>
<p>It’s also important to highlight the counterpart phenomenon in women, which is much less researched. Pulses of blood flow in the vagina during REM sleep. The <a href="http://www.tandfonline.com/doi/abs/10.1080/00926237908403713">clitoris engorges</a> and vaginal sensitivity increases along with vaginal fluidity.</p>
<h2>What’s its purpose?</h2>
<p>It has been suggested “pitching a tent” may be a mechanism for alerting men of their full overnight bladder, as it often disappears after emptying the bladder in the morning. </p>
<p>It’s more likely the reason for the morning erection is that the unconscious sensation of the full bladder stimulates nerves that go to the spine and these respond directly by generating an erection (a spinal reflex). This may explain why the erection goes away after emptying one’s bladder.</p>
<p><a href="https://www.sciencedaily.com/releases/2008/07/080702091346.htm">Scientific studies</a> are undecided as to whether morning erections contribute to penile health. Increased oxygen in the penis at night may be beneficial for the health of the muscle tissues that make up the penis.</p>
<h2>What does it mean if you don’t get one?</h2>
<p>Loss of nocturnal erection can be a useful marker of common diseases affecting erectile function. One example is in <a href="http://psycnet.apa.org/psycinfo/1978-32025-001">diabetics</a> where the lack of morning erections may be associated with erectile dysfunction due to poor nerve or blood supply to the penis. In this case, there’s a poor response to the messages sent from the brain during sleep which generate nocturnal erections. </p>
<p>It is thought nocturnal erections can be used as a marker of an anatomical ability to get an erection (a sign that the essential body bits are working), as it was thought to be independent of psychological factors that affect erections while awake. <a href="http://www.sciencedirect.com/science/article/pii/0006322388901199">Studies have suggested</a>, however, that mental health disorders such as severe depression can affect nocturnal erections. Thus its absence is <a href="http://jamanetwork.com/journals/jamapsychiatry/article-abstract/492087">not necessarily a marker</a> of disease or low testosterone levels.</p>
<p>The frequency of morning erections and erection quality <a href="http://www.sciencedirect.com/science/article/pii/S0090429500008414">has also been shown to</a> increase slightly in men taking medications for erectile dysfunction such as Viagra.</p>
<h2>So is all this morning action good news?</h2>
<p>While some men will put their nocturnal erections to good use, many men are not aroused when they have them and tummy sleepers might find them a nuisance.</p>
<p>Since good heart health is associated with an ability to have erections, the presence of nocturnal erections is generally accepted to be good news. Maintaining a healthy lifestyle is important in <a href="https://www.ncbi.nlm.nih.gov/pubmed/22072232">avoiding and even reversing</a> erectile dysfunction, so it’s important to remember to eat healthily, maintain a healthy weight, exercise and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291878/">avoid smoking and alcohol</a>.</p><img src="https://counter.theconversation.com/content/68419/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sergio Diez Alvarez does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Morning penile erections affect all males, even males in the womb and male children.Sergio Diez Alvarez, Director Of Medicine, The Maitland and Kurri Kurri Hospital, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/587722016-10-05T19:15:27Z2016-10-05T19:15:27ZBoys should also get the HPV vaccine to protect themselves from oral and genital cancers<p>The human papillomavirus (HPV), which causes cervical cancer in women, is also responsible for many cancers in men. It causes most cancers of the tonsils (known as oropharyngeal cancers), which are more common in men than women. HPV is also to blame for cancers of the anus, vulva, vagina and penis. </p>
<p>Oral cancers – which include those of the tonsils, mouth and tongue – affect more than 300,000 people globally each year. A person living in Australia has a one in 49 estimated risk of <a href="https://head-neck-cancer.canceraustralia.gov.au/statistics">being diagnosed with head and neck cancer</a> by their 85th birthday, which includes oral cancers.</p>
<p>The chance is higher in males (one in 32) than females (one in 98). An estimated 769 males will die from head and neck cancer in Australia in 2016, compared to 247 females.</p>
<p>The best way to prevent these cancers is to get the HPV vaccine, which is available for free under <a href="http://www.hpvvaccine.org.au/the-hpv-vaccine/how-when-where-vaccine-given.aspx">Australia’s National HPV Vaccination Program</a> to boys and girls aged 12 and 13. Those over 14 can obtain the vaccine from their GP or local immunisation provider, but they will need to pay for it.</p>
<h2>What is the human papillomavirus (HPV)?</h2>
<p>Most of us (<a href="http://www.hpv.com.au/">around 80%</a>) will acquire an infection from a virus in the human papillomavirus family at some point in our lives – usually without knowing it, as there are often no symptoms. HPV infections <a href="https://www.ncbi.nlm.nih.gov/pubmed/25392180">are transmitted through vaginal and oral sex</a>, and even kissing.</p>
<p>HPV is a group of viruses <a href="https://www.ncbi.nlm.nih.gov/pubmed/174077">first identified in the mid-1970s</a>. There are <a href="https://www.ncbi.nlm.nih.gov/pubmed/23683837">now more than 170 known types</a>, which <a href="http://cmr.asm.org/content/16/1/1.short">can infect</a> the skin and live in the genital tract and on the lining inside our mouth. </p>
<p>When they live on your skin, <a href="http://www.hpv.com.au/what-is-hpv.aspx">they manifest into the common wart</a>. The viral culprits responsible are usually the “low risk” HPV types: 6, 11, 13 and 32.</p>
<p>But when the virus invades the lining of the mouth, throat, respiratory tract and genitals, the infection can lead to cancer. Long-term infection with “high risk” HPV types such as 16, 18, 31, 33, 45, 52 and 58 are major risk factors for cervical cancer, cancer of the anus, genitals and oropharyngeal cancers.</p>
<p>The oropharynx is <a href="http://onlinelibrary.wiley.com/doi/10.1002/hed.20460/full">the middle part of the throat</a> which includes the base of the tongue, tonsils, the soft palate and the walls of the pharynx.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/126029/original/image-20160610-5872-1wf46mw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/126029/original/image-20160610-5872-1wf46mw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/126029/original/image-20160610-5872-1wf46mw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=535&fit=crop&dpr=1 600w, https://images.theconversation.com/files/126029/original/image-20160610-5872-1wf46mw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=535&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/126029/original/image-20160610-5872-1wf46mw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=535&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/126029/original/image-20160610-5872-1wf46mw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=672&fit=crop&dpr=1 754w, https://images.theconversation.com/files/126029/original/image-20160610-5872-1wf46mw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=672&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/126029/original/image-20160610-5872-1wf46mw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=672&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The oropharynx is the middle part of the throat.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>A <a href="http://jnci.oxfordjournals.org/content/107/6/djv086.abstract">recent study</a> showed HPV was present in 91% of cervical and anal cancers, 75% of vaginal cancers, 69% of vulvar cancers, 63% of penile cancers and 70% of oropharyngeal cancers.</p>
<p>HPV 16 is the main virus responsible for mouth infections; and both men and women are equally affected by the virus. </p>
<p>There is no medical treatment for the virus itself but the <a href="http://www.jci.org/articles/view/57149">body will often clear the virus</a>, usually within two years of detection. However, the virus can live in some people for years, with visible symptoms only appearing ten to 20 years after the first infection. </p>
<p>When the virus causes oropharyngeal cancer, patients with early-stage tumours are treated with radiation therapy or the tumour is removed surgically. These patients have a 90% survival rate past five years and most live a normal life. </p>
<p>Unfortunately, most patients will <a href="https://www.ncbi.nlm.nih.gov/pubmed/25255960">present with late-stage disease</a> where the five-year survival rate is 40%. The grim prognosis for patients with advanced oropharyngeal cancer <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124330/">has not changed in the last decade</a> despite vast improvements in treatment techniques. </p>
<p>While the population incidence of oropharyngeal cancer is relatively low, it is rising exponentially. In the United States, the incidence of HPV 16-positive oropharyngeal cancers has <a href="https://www.ncbi.nlm.nih.gov/pubmed/21969503">increased by 225%</a> between 1988 to 2004 (from 0.8 per 100,000 people to 2.6 per 100,000). </p>
<p>If these trends were to continue, the annual number of HPV 16 positive oropharyngeal cancers would surpass the annual incidence of cervical cancers (<a href="http://seer.cancer.gov/statfacts/html/cervix.html">currently 7.5 per 100,000 people</a>) by the year 2020.</p>
<h2>The HPV vaccine</h2>
<p>The HPV vaccine was developed by <a href="https://home.cancerresearch/10th-anniversary-of-worlds-first-hpv-vaccine/?mkt_tok=eyJpIjoiTm1NNE1UazJaak5tWmpGbSIsInQiOiIrRjJ3TlZmUFBZQUFuK0lvZWN2bExkWjFcL3hJSzFIRHhoOWJ5dHVUVm1rZmZcL3A3SlZjZ1RxWml6SlphMWdHV0J3RHBraTc0TUVlV05wMXNTRmlyNnROUm1NVXI4RUltUUs0VFp2R2VBQVhRPSJ9?mkt_tok=eyJpIjoiTm1NNE1UazJaak5tWmpGbSIsInQiOiIrRjJ3TlZmUFBZQUFuK0lvZWN2bExkWjFcL3hJSzFIRHhoOWJ5dHVUVm1rZmZcL3A3SlZjZ1RxWml6SlphMWdHV0J3RHBraTc0TUVlV05wMXNTRmlyNnROUm1NVXI4RUltUUs0VFp2R2VBQVhRPSJ9">Australian scientists</a> in 2006 to protect women from cervical cancer. In 2007, Australia was one of the first countries to implement a secondary high school HPV vaccination program for girls, which was then extended to include boys in 2013. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/140241/original/image-20161004-20217-rofvbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/140241/original/image-20161004-20217-rofvbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/140241/original/image-20161004-20217-rofvbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=284&fit=crop&dpr=1 600w, https://images.theconversation.com/files/140241/original/image-20161004-20217-rofvbm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=284&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/140241/original/image-20161004-20217-rofvbm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=284&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/140241/original/image-20161004-20217-rofvbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=357&fit=crop&dpr=1 754w, https://images.theconversation.com/files/140241/original/image-20161004-20217-rofvbm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=357&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/140241/original/image-20161004-20217-rofvbm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=357&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Gardasil can protect men and women from oropharyngeal cancers.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/neofedex/3447506652/in/photolist-6fDnBS-nzdi73-3wC83r-5JAu1B-49RPnG">FedEx/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Although initially intended as a preventative vaccine against cervical, anal and genital cancers, the vaccine can <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0068329">also protect men and women from oropharyngeal</a> cancers. The two HPV vaccines available in Australia (<a href="http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home%7Ehandbook10part4%7Ehandbook10-4-6#4-6-4">Cervarix and Gardasil</a>) are licensed for males aged nine to 26 and females aged nine to 45.</p>
<p>A decade has now passed since the initial administration of HPV vaccines in certain countries to pre-adolescent girls. As of January 2016, one of the four branded vaccines, Gardasil, has been administered in more than 200 million doses worldwide. </p>
<p>In Australia and the United States, infections with HPV types 6, 11, 18 and 16 have reduced by 87%. There was a 85% <a href="http://cid.oxfordjournals.org/content/early/2016/06/14/cid.ciw354.abstract">reduction in high-grade cervical abnormalities</a> in Australia, Europe, North America, and New Zealand. </p>
<p>The impact of the vaccine in preventing mouth cancer can’t yet be accurately assessed, as the average age of disease is 56 years, and the girls vaccinated haven’t yet reached that age. However, the reduction in HPV infections worldwide due to the vaccine would suggest a future decrease in all HPV associated cancers.</p>
<p>In Australia, 83% of girls aged 15 <a href="http://www.hpvregister.org.au">were vaccinated with HPV in 2015</a>, compared to 70% of males. Only 55% of females between 18 and 24 years were vaccinated. These figures suggest that between 20% to 30% of young males and females are not protected against HPV infection.</p>
<p>Modern medicine has delivered the opportunity to prevent HPV-related cancers. If international health organisations can implement a global immunisation program to high-, middle- and low-income countries, these cancers will become rare events and no longer pose a threat for future generations.</p>
<p><em>*Since publication, Samantha Khoury has been added as a co-author.</em></p><img src="https://counter.theconversation.com/content/58772/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The best way to prevent head and neck cancers, which are more common in men, is to get the HPV vaccine. It’s free for boys and girls aged 12 and 13.Nham Tran, Laboratory Head and Senior Lecturer, University of Technology SydneySamantha Khoury, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/619772016-07-04T04:04:57Z2016-07-04T04:04:57ZWhy dick doodles on the ballot paper are their own election statement<figure><img src="https://images.theconversation.com/files/129124/original/image-20160704-18321-q3hbkp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It is reasonable to conclude that it's more likely to be men than women who scribble dicks and balls on ballot papers.</span> <span class="attribution"><a class="source" href="http://www.abc.net.au/triplej/programs/hack/how-to-vote-guide-and-what-a-donkey-vote-really-is/7553578">ABC</a></span></figcaption></figure><p>If people are forced to go to a polling booth, then they’re forced to put in at least three or four seconds into the process. It’s why I favour compulsory voting. </p>
<p>And even if only three or four seconds are put in every three or four years, then that vote – in all its complexity or complete lack thereof – becomes a statement of intent. And that ballot paper becomes just as worthy a contribution to democracy as the one filled in by the voter who spent a career studying politics.</p>
<p>So what happens when those three or four seconds are used to draw a penis?</p>
<p>The penis scrawl – carved into desks, painted on fences, scribbled onto <a href="https://www.facebook.com/DrawingDicksOnTheHeraldSun/">newspaper photos</a> – is an instantly recognisable image that, no matter how crudely drawn, cuts through language and cultural barriers to say, simply, “cock”.</p>
<p>As a social researcher, I’m interested in the why. What’s the motivation in turning your infrequent opportunity to have a say in governance into a penis portrait? Is this <em>really</em> the very best use of that polling booth pencil?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"749180534341775361"}"></div></p>
<p>An obvious point, sure, but the gendered nature of all this needs spotlighting. There’s no easy (or legal) way to ascertain the sex of those who submitted a dick-adorned ballot. Nonetheless, a few cultural hints point to a correlation between having a dick and drawing one. </p>
<p>The use of the penis to convey territorialism is a distinctly male preoccupation: it’s males who are spritzing their urine onto surfaces to mark out terrain. It’s men who in porn externally ejaculate in a “ta-daa!” money shot to convey <em>I was here</em>. It’s men who use rape in conflict to showcase all the many ways “conquer” can be achieved. And it’s men who use the internet to send dick pics to unsuspecting women for fun or reprimand. </p>
<p>No, I don’t have the data to support that it’s <em>only</em> men scrawling dicks on ballots, but the difficulty in imagining vulva drawings on a textbook or a clit pic sent to torment indicates that this is likely uniquely male behaviour.</p>
<p>Outside of the apparently gendered imperative for lads with dicks to draw them, there are some other explanations worth proposing.</p>
<p>Year 8 in high school. A kid named Mark was thrown out of class repeatedly for loudly asking to borrow a “dick-tionary”. Apparently there’s a period in life when all things genital are hilarious. While some people grow out of this, others retain a fervent appreciation for all things Adam Sandler and will find it funny – without any depth of thought – to just draw a dick on a ballot. </p>
<p>There’ll be a genuine belief that such a sketch is the height of hilarity and a happily naughty and subversive contribution. For others, hilarity will be a driver, sure, but it’ll be done with a tongue planted firmly in their cheek. Funniness will come from artistic petulance directed towards the process, to politics, rather than simply schoolboy scrawl.</p>
<p>There is, of course, a more aggressive reading. In my book <a href="http://laurenrosewarne.com/books/american-taboo/">American Taboo</a> I have a chapter on the politics of “flipping the bird”. </p>
<p>While, akin to any gesture, “the finger” is open to interpretation, one reading is its representation of a penis: the middle finger as the erection, the curled fingers as the testicles. The gesture thus, is deployed as an aggressive “fuck you!” </p>
<p>A dick on a ballot can function similarly. Be it a fuck you to compulsory voting, to the politicians, to the person counting your vote, it’s all rather unclear – I’m still, for example, unsure who the finger is directed at in all those adolescent, hoodie-clad mirror-selfies – but the gesture can be read as one of defiance, of protest, of contempt. </p>
<p>Many times I’ve consciously deposited a blank ballot into a box. Ultimately, my deeply contemplated opt-out is just as powerful (read: every bit as squandered) as the dick ballot.</p>
<p>Thinking of a dicked-up ballot as just one of waste is too easy. Taking the time to craft a cock requires more seconds time and thought than a donkey vote. It’s a statement – ill-thought or strategically crafted – about politics today. Juvenile in execution or not.</p><img src="https://counter.theconversation.com/content/61977/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Rosewarne does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It might be juvenile, but scribbling a dick and balls on a ballot paper actually requires some thought. And that in turn has meaning.Lauren Rosewarne, Senior Lecturer, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/574882016-05-04T20:17:56Z2016-05-04T20:17:56ZKlinefelter’s syndrome: being unable to produce testosterone has serious implications for men<figure><img src="https://images.theconversation.com/files/121123/original/image-20160504-19860-1hxmuv.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most men don't know the normal size of testes. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This is part of our series on hidden or stigmatised health conditions in men. Read the other articles in the series <a href="https://theconversation.com/au/topics/mens-hidden-health-conditions">here</a>.</em></p>
<hr>
<p>Klinefelter’s syndrome is a genetic disorder that affects approximately <a href="http://www.ncbi.nlm.nih.gov/pubmed/21449864">one in 450 males</a>. Each cell in the human body has 23 pairs of chromosomes. The sex chromosomes in a female are XX, and XY in men. Typically, men have 46 chromosomes with an arrangement of 46XY, while those with Klinefelter’s syndrome have a 47XXY arrangement.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/119059/original/image-20160418-23612-2pabxf.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/119059/original/image-20160418-23612-2pabxf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/119059/original/image-20160418-23612-2pabxf.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/119059/original/image-20160418-23612-2pabxf.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/119059/original/image-20160418-23612-2pabxf.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/119059/original/image-20160418-23612-2pabxf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/119059/original/image-20160418-23612-2pabxf.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/119059/original/image-20160418-23612-2pabxf.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The chromosomal arrangement in someone with Klinefelter’s.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Klinefelter’s syndrome is not commonly diagnosed, with only <a href="http://www.ncbi.nlm.nih.gov/pubmed/21449864">four in 10 men</a> diagnosed after birth and <a href="http://www.ncbi.nlm.nih.gov/pubmed/12574191">10% diagnosed pre-puberty</a>. Klinefelter’s syndrome is not typically diagnosed at birth, although physical characteristics may include a small penis and undescended testicles. </p>
<p>Klinefelter’s syndrome is the most common form of <a href="http://www.mayoclinic.org/diseases-conditions/male-hypogonadism/basics/definition/con-20014235">hypogonadism</a>, where men are unable to produce sperm or sufficient levels of the male sex hormone, testosterone. The low levels of testosterone result in the underdevelopment of typical male characteristics. </p>
<p><a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/klinefelter-syndrome">Symptoms of Klinefelter’s syndrome</a> vary between individuals, but typically include small testicles, lack of facial, pubic and underarm hair, gynaecomastia (breast tissue enlargement), poor muscle development, disproportionately long arms and legs (compared to the body), and potential learning and language difficulties. </p>
<p>As adults, men with Klinefelter’s syndrome are infertile, as the extra X chromosome affects the ability to produce sperm, known as <a href="https://www.andrologyaustralia.org/your-health/klinefelters-syndrome/">azoospermia</a>. Men with this condition may also experience a low libido, depression and are at risk of osteoporosis. </p>
<h2>Causes</h2>
<p>While Klinefelter’s syndrome is a genetic disorder, it is not one that is inherited, as <a href="https://www.andrologyaustralia.org/your-health/klinefelters-syndrome/">brothers</a> of men with Klinefelter’s syndrome typically have the 46XY pattern. </p>
<p>The addition of the extra X chromosome is believed to occur as a <a href="https://ghr.nlm.nih.gov/condition/klinefelter-syndrome">random event</a> during the formation of the reproductive cells, either within the fertilised egg or during cell division as the baby develops. </p>
<h2>Diagnosis</h2>
<p>Klinefelter’s syndrome can be diagnosed through a variety of tests. Physical examination of the genitals will confirm the size of the testes, with the size typically <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1686046/">less than four millilitres</a> (the size of a sultana grape). </p>
<p>Klinefelter’s syndrome can be confirmed using a blood test, which involves chromosomal analysis. Further blood tests can also examine the levels of testosterone (and other sex hormones), as well as semen examination for levels of sperm. Klinefelter’s syndrome may also be diagnosed prenatally, through maternal blood testing.</p>
<h2>Treatment</h2>
<p>Men diagnosed with Klinefelter’s syndrome cannot be cured; rather treatment aims to overcome some aspects of the symptoms. Hormone therapy, specifically testosterone replacement, is a lifelong therapy that increases physical strength, body tone and general wellbeing in men. </p>
<p>Testosterone therapy is available in various formats including gels, injections, lotions, creams and patches. If diagnosis occurs during the teenage years, testosterone therapy is initiated at a low dose and increased through the adult years. </p>
<p>In some men with Klinefelter’s syndrome, sperm may be found in the testicular tissue. For such men, assisted reproductive therapies such as intracytoplasmic sperm injection (<a href="http://www.ivf.com.au/fertility-treatment/icsi-treatment#what-is-icsi-">ICSI</a>) may be used to achieve pregnancy with their partners. ICSI is a form of in vitro fertilisation (<a href="http://www.ivf.com.au/fertility-treatment/ivf-treatment">IVF</a>) whereby a single sperm is injected into each egg during the IVF procedure. </p>
<p>Donor insemination and adoption are alternatives in cases where assisted reproductive therapies are not an option. </p>
<p>Cosmetic surgery may be performed to remove the enlarged breast tissue. Counselling, physical and speech therapy may also be performed to assist men with the psychosocial aspects of the diagnosis. </p>
<h2>Why is it hidden?</h2>
<p>Lack of knowledge, awareness and psychosocial impact are all reasons Klinefelter’s syndrome is typically underdiagnosed. Men typically use <a href="http://www.ncbi.nlm.nih.gov/pubmed/16411874">health services</a> less frequently <a href="http://theconversation.com/men-more-reluctant-to-go-to-the-doctor-and-its-putting-them-at-risk-57420">than women</a>. Even when men do see a doctor, a reproductive health examination is not routinely performed.</p>
<p>Few men have ever heard of Klinefelter’s syndrome, and similarly would be unaware of the symptoms. For example, many men would not know what the typical size of the testes is, and so may be unaware they have small testes. </p>
<p>In teenagers, symptoms of Klinefelter’s syndrome may be clouded by learning problems and the onset of puberty, with Klinefelter’s syndrome not primary in the thoughts of many health professionals. Embarrassment, stoicism and fear of the unknown are common psychosocial issues perceived by men that prevent them from seeing their doctor about reproductive health issues. </p>
<p>Treatment and management strategies for Klinefelter’s syndrome can ensure men diagnosed with the condition have good health outcomes. Further engagement with Klinefelter’s syndrome support groups can provide men with peer support and assist in overcoming any perceived psychosocial barriers associated with its diagnosis.</p>
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<p><em>Further reading:</em></p>
<p><em><a href="http://theconversation.com/dads-get-postnatal-depression-too-55829">Dads get postnatal depression too</a></em></p>
<p><em><a href="http://theconversation.com/men-more-reluctant-to-go-to-the-doctor-and-its-putting-them-at-risk-57420">Men more reluctant to go to the doctor - and it’s putting them at risk</a></em></p>
<p><a href="https://theconversation.com/breast-cancer-campaigns-might-be-pink-but-men-get-it-too-56663"><em>Breast cancer campaigns might be pink, but men get it too</em></a></p>
<p><em><a href="https://theconversation.com/hows-your-walnut-mate-why-men-dont-like-to-talk-about-their-enlarged-prostate-58209">How’s your walnut, mate? Why men don’t like to talk about their enlarged prostate</a></em></p>
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<p><em>Correction: the chromosomal arrangement has been corrected to say 47XXY</em></p><img src="https://counter.theconversation.com/content/57488/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dragan Ilic does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Men with Klinefelter’s syndrome are infertile, as the extra X chromosome affects the ability to produce sperm.Dragan Ilic, Associate Professor, Department of Epidemiology and Preventive Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.