Xiaflex’s Odd ‘Bent Carrot’ Ad Sparks Penile Health Awareness

An Ad About Penile Health Has Added New Meaning to the Term ‘Bent Carrot’

Xiaflex’s first campaign offers a healthy visual

By Leonardo Faierman

November 17, 2021

This article is a repost which originally appeared on ADWEEK

Edited for content.

A new pharmaceuticals ad is prompting conversations surrounding its eyebrow-raising use of a slightly misshapen root vegetable.

Prescription medication Xiaflex’s first-ever TV ad, titled “Bent Carrot,” recently prompted some awareness of Peyronie’s Disease, a condition stemming from repeated injuries that leads to a significantly bent or curved penis. The spot sees a man and woman in a kitchen, standing before a stack of carrots. The topmost carrot is prominently bent, which elicits notably concerned glances from the couple.

While the carrot serves as a mild metaphor for Peyronie’s Disease, the remainder of the spot goes on to break down the cause and treatment of the condition, a regimen that includes injections and, per the ad, “daily penile-stretching and -straightening exercises.”

“We’re bringing awareness and education about treatment to consumers—part of Endo’s long-standing commitment to addressing men’s health issues,” said Thomas Kolaras, senior vp and general manager of Medical Therapeutics at parent company Endo, in a statement.

“Through this eye-catching, multi-channel campaign, we’re encouraging men with possible signs of Peyronie’s Disease to start a conversation with a urologist about their symptoms and about whether Xiaflex could be an option.”

The root (veggie) of the message

Of course, the symbolic produce, which the brand hopes will help destigmatize the condition, allows Xiaflex to safely advertise the product on various platforms. Still, the minute-long spot’s juxtaposition of the bent carrot along with its frank suggestions of targeted stretching and exercises has drawn some colored commentary online.

“What exactly are “stretching and straightening” exercises,” one YouTube commentator jokes. “My husband thinks I’ve lost my mind because I laugh every time this commercial comes on.” Another commentator—this time on Twitter— notes that the bent carrot might not “convince anyone,” likely referring to the seriousness of the condition.

In addition to TV, “Bent Carrot” is also currently airing digitally and on radio and audio streaming platforms.

 

“His penis is too big” – Woman begs court to dissolve one-week-old marriage

“His penis is too big” – Woman begs court to dissolve one-week-old marriage

Andreas Kamasah | April 26, 2021 4:00 PM

This article is a repost which originally appeared on pulse

Edited for content.

A newly wedded wife who has realised that the size of his husband’s manhood is not something she can cope with for the rest of her life has asked a court to dissolve the marriage.

The Nigerian lady identified as Aisha Dannupuwa has reportedly filed divorce processes at the Sharia court to end her one-week-old marriage because ‘she can’t come and die’.

According to a report by Dailytimes.ng, the mother of three told the court that she simply cannot continue to endure the nightmarish pain during sex just because of her husband’s overendowed penis.

She reportedly decided to marry another man after her first marriage failed, but she appears to have jumped out of a frying pan and landed in the fire.

In her statement to the court, Aisha revealed that she first moved into her parents’ house and finally into her husband’s home as tradition demands, and there, they had sexual intercourse which was not a pleasant experience at all.

“When he came, we had sex but the experience was a nightmare.

“Instead of enjoying the sex, it turned out to be something else because his penis was too big,” she told the court.

She further disclosed that the first sexual encounter with her new husband left her private part in pain and she had to take some native medication prepared by her mother who assured and encouraged her that she would get used to the ‘bazooka’.

“Two days later when he came to visit me, we had sex again; but the experience was too much to bear.

It was then I knew that I could not continue with the marriage because of the size of his penis,” she added.

It is reported that the husband has confirmed Aisha’s concern and acknowledged that he indeed has a manhood that is not meant for just any woman.

He reportedly agreed to the dissolution of the one-week-old marriage.

The Best Ways to Increase Penis Sensitivity, According to Doctors

The Best Ways to Increase Penis Sensitivity, According to Doctors

The fix might be simple!

By Zachary Zane Mar 30, 2021

This article is a repost which originally appeared on Men’sHealth

Edited for content

Over the years, you may have noticed that your penis has become less sensitive. We’re not talking completely numb, which is a different story—just a little less receptive to stimulation. This can be a bit of a bummer; while some sexual pleasure is psychological, a lot of it comes from physical stimulation, meaning you might not enjoy sex as much when you have decreased sensitivity. You might even struggle to orgasm, which can be extra frustrating, and leave you desperate for ways to increase your penis sensitivity ASAP.

The issue is relatively common in people with a penis, according to experts. “We see a lot of men in our sexual health clinic who complain of decreased penile sensation,” says Michael Ingber, MD, a urologist and urogynecologist at Garden State Urology. While that may not sound like good news, it does mean urologists are adept at treating folks who experience reduced sensitivity. They know the common causes and can provide solutions.

But before getting to the best ways to reverse the condition, it’s important how penis sensitivity works in the first place. “The penis is innervated [supplied with nerves] by a nerve called the pudendal nerve,” Ingber says. The pudendal nerve doesn’t just provide sensation to the skin of the penis, but also the perineal region, scrotum, and anus.

“Still, the skin on the phallus is the same skin that’s on the rest of your body,” says Jamin Brahmbhatt, MD, a urologist and sexual wellness expert at Orlando Health. “Depending on the thickness of the skin and presence of nerve fibers, sensation can be felt in different ways.” The skin on your penis is less thick than, say, the skin on the soles of your feet, which is why your penis is more sensitive.

Alright, now that you have a better understanding of the skin on your penis and the nerves that cause stimulation, let’s go ahead and address why you may be seeing a decrease in sensitivity and what you can do about it.

Cause: Too much friction

“Your body will naturally decrease sensation to the penis if there is constant mechanical friction in a short period,” Brahmbhatt says. There’s actually a word for the diminishing physiological response to a frequently repeated stimulus: habituation. So habituation can happen “with too much masturbation” or if you “go at it all night.”

Solution: You gotta switch it up! If you’re masturbating aggressively with a ton of pressure (often referred to as white-knuckling), they you need to loosen that grip. At first, it won’t feel as pleasurable, but over time, your body will reacclimate, and you’ll regain sensitivity.

Having sex or masturbating with a little less frequency is another way to increase sensitivity, Brahmbhatt adds. If you’re going at it for hours on end or jerking it three or four times a day, give your little fella a break.

Lastly Brahmbhatt recommends changing sexual positions. Again, habituation is a response to doing the same thing the same way over and over again. So if you’re always jerking off with a death grip in the same position, your body will habituate to it. If you only do it in doggy style, your body will habituate. Switch things up so your penis can experience multiple sensations and never habituate to a single one.

Cause: Frequent bike riding

“Riding a bike, especially one with a narrow seat, can constrict blood flow over time, as much as 60%,” Ingber says. “This is because the artery that supplies blood to the penis gets compressed [when you’re sitting].”

Solution: Obviously, biking less would help, but we don’t want to suggest that to avid bike riders. Ingber recommends investing in a split bike seat, which will allow for better blood flow.

Cause: Sitting for too long

Just like riding a bike, “Working from home can put pressure on your perineum and prostate. This is where the nerves and blood vessels that go into the penis travel,” Brahmbhatt says. This can affect sensation and even erection quality.

Solution: Find ways to spend less time sitting, like scheduling daily walks or getting a standing desk. It can also be helpful to set hourly reminders on your phone that tell you to get up and move around.

Cause: Low testosterone

Sensation is a complex process, and your hormones could play a role. “Low T can cause a decreased libido which can translate into a decrease in how you ‘feel’ sexual activity,” Brahmbhatt says.

Solution: Get your testosterone levels checked. If low, your doctor may suggest administering testosterone replacement therapy, Brahmbhatt says. (FYI, there are several delivery methods for TRT. Often, we think TRT and then think injections, but there are also skin patches, gels, and tablets that dissolve in your mouth.) Most people will notice relief from symptoms within 4–6 weeks of starting TRT.

Cause: Alcohol

If whiskey dick doesn’t strike, you still might not have a rewarding sexual experience if you drank too much because your penis will become less sensitive. “Alcohol is a depressant and can cause you to have decreased sensation—as well as a whole line of other things—especially when you’ve had one too many,” Brahmbhatt says.

Solution: There’s no magic number for how many drinks you can have and still be able to get hard, or how many will decrease your level of sensitivity even if you can get erect. If you’re worried about your performance on a day you’re also drinking, keep it to two drinks, max. If you overdo it, don’t panic: whiskey dick or lack of penis sensitivity caused from excessive drinking abates once you sober up. (However, chronic heavy drinking can lead to long-term ED, so be careful there!)

Cause: Medications

“There are several medications that can decrease your ability to perceive pain—a big one is opioids,” Brahmbhatt says. Many meds that decrease pain decrease sensitivity overall, which might be why you don’t have as much feeling down there as you used to.

Solution: Let your doctor know you’re having decreased penis sensitivity. Ask if it has anything to do with your current medications, and then see if your doctor can adjust your meds.

What if there’s no direct cause?

When the direct cause is unclear, lack of penis sensitivity can be challenging to solve. That said, there are some other things you can do to help remedy the problem. “I’ve had patients who have practiced tantra, meditation, and have been able to improve their sensitivity based on this alone, but we also have some innovative therapies that have been working great in several men,” Ingber says.

One therapeutic option is “Platelet-Rich Plasma” or PRP. “This therapy involves taking your own blood and isolating the ‘stem cells.’ These cells are then reinjected into your penis in a few different locations,” Ingber says.

There’s a far less invasive option that works for some folks, and that’s cream specifically designed to increase penis-sensitivity. However, we don’t promise any miracles with these products. A quick read through the reviews of Amazon’s most popular creams shows that it works for some and really does nothing for others. But there’s no harm in giving it a shot.

Shower vs grower: What is the difference and does it matter?

What is the difference between a ‘shower’ and a ‘grower’ and does it really matter?

Medically reviewed by Joseph Brito III, MD — Written by Beth Sissons on February 9, 2021

This article is a repost which originally appeared on MEDICALNEWSTODAY

Edited for content

How much a penis extends in length while erect varies from person to person. It may also change over time and with age. However, there is no evidence to suggest this affects an individual’s health or sex life.

A “shower” or “grower” refers to how much a penis expands in length when erect compared with its flaccid state.

This article explores the science behind the terms, how common they are, and whether being a shower or a grower has any significant impact on health and sex life.

Distinction between the two

According to the popular colloquialism, a shower is a person with a penis that does not expand relatively significantly in length when it becomes erect.

In contrast, a grower is a person with a penis that grows relatively significantly longer when erect.

What determines whether you’re a shower or grower

The erectile tissue of the penis comprises:

  • elastic fibers
  • collagen
  • smooth muscles
  • arteries and veins

All of these allow the penis to become erect.

However, with age, the penis can lose tissue elasticity, which may affect how it stretches.

People may also experience inflammation and less blood flow to the penis as they age, which can affect erection.

A 2018 study involving 274 males found that age played a role in whether participants were a grower or a shower.

The researchers defined a grower as having a flaccid to erect penile length increase of 4 centimeters (cm) or more, while an increase of less than 4 cm indicated that a person was a shower.

All of the participants had previously undergone penile duplex ultrasound (PDDU) for erectile dysfunction.

Researchers measured flaccid penile length and gave participants a vasodilation drug before measuring erect penile length.

Growers had an average length change of 5.3 cm, while showers had an average length change of 3.1 cm. The mean age of the growers was 47.5 years, compared with an average of 55.9 years in the showers.

The research also reported that 37% of males who fell into the grower category were single, compared with 23% in the showers category, although this may also relate to age.

Growers also had a lower dose of the vasodilation drug.

There were no differences in the showers or growers regarding:

  • race
  • smoking history
  • comorbidities
  • erectile function
  • flaccid penile length
  • penis firmness after vasodilation injection
  • PDDU results

The study notes that confirming these findings requires more research, including larger scale, multicultural, and multinational studies.

The research did find an age difference between growers and showers. According to the International Society for Sexual Medicine, the way the penis changes as people age may account for this age differentiation.

Is one more common?

The 2018 study found that out of 274 participants, 73 males (26%) were growers, while 205 males (74%) were showers, according to the researchers’ criteria on flaccid to erect penis length.

This suggests that showers may be more common, but there is not enough evidence to reflect the whole population.

Further studies are needed to confirm the findings.

Which group are you?

People may be able to tell if they are a shower or grower without any tests.

If people have a penis that does not significantly change size between a flaccid and erect state, they may be a shower.

In contrast, if an individual’s penis size changes drastically between a flaccid and erect state, they may be a grower.

People can measure their penis when flaccid, from the base to the tip. They can then take the same measurement when their penis is erect.

If the difference between the two measurements is greater than 4 cm, people meet the definition of a grower.

However, if the difference is less than 4 cm, people meet the definition of a shower.

Can this change over time?

The 2018 study found that age was the main factor in whether people were a grower or a shower, which suggests that people may change between a grower and a shower as they age.

When people age, collagen and elastic fibers in the penis decrease, which may affect whether they are a shower or grower.

Other penis changes can also happen as people age. Testosterone levels start to decline after a person reaches 40 years of age, which can cause the penis to shrink slowly.

Health conditions that impair blood flow can also affect penis color and erection.

Does it impact overall erection size?

According to the Kinsey Institute, flaccid penis size is not a reliable indicator for its erect size.

Generally, shorter flaccid penile lengths enlarge by a greater percentage than longer flaccid penile lengths.

The 2018 study found that growers had a larger erect penis size, measuring 15.5 cm compared with 13.1 cm in the showers group.

Does it affect your sex life?

There is no research to suggest whether being a shower or a grower impacts a person’s sex life.

However, concerns about penis appearance may affect sexual activity.

A 2016 survey looked at genital dissatisfaction in 4,198 males aged 18–65 years and living in the United States.

Participants reported the lowest satisfaction with flaccid penile length, with 27% reporting dissatisfaction. Different demographics had no bearing on survey answers.

Those who reported dissatisfaction with their genitals reported less sexual activity, including less vaginal sex and less receptive oral sex.

If a person has concerns that their penis appearance is affecting their self-esteem, confidence, or sex life, people may find it helpful to talk with their partner or healthcare professional.

Summary

Being a shower or a grower refers to the change in penis length from a flaccid to erect state.

If people have a penis that increases significantly in length from a flaccid to erect state, they may be a grower. If there is no significant change, they may be a shower.

Some research suggests being a shower or a grower relates to age. Therefore a person’s category may change over time.

However, there is no evidence to suggest that being a shower or grower affects their health or sex life.

Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Understanding male sexual health: More men now reporting low sex drive, Peyronie’s disease, finds study

Understanding male sexual health: More men now reporting low sex drive, Peyronie’s disease, finds study

Scientists found that earlier, more men were diagnosed with erectile dysfunction and premature ejaculation.

Myupchar July 20, 2020 22:17:59 IST

This article is a repost which originally appeared on Firstpost.

Edited for content

Male infertility is a topic that is rarely discussed. However, doctors have seen an increase in the number of male patients coming to sexual health clinics to seek help in recent years. Doctors have seen that different sexual health problems are being reported by men which were not prevalent before, also indicating more awareness and openness regarding male sexual health.

Different male sexual health problems

A study published in the journal International Journal of Impotence Research on 1 July 2020 stated that there has been a switch in the sexual problems which males complain about now.

The scientists accumulated complete data of 2,013 patients who were continuously evaluated by a sexual medicine expert between the years 2006 to 2019. The scientists found that 824 patients were assessed for erectile dysfunction, 369 patients were diagnosed with curvature of the penis (Peyronie’s disease), 322 patients had premature ejaculation, 204 suffered from low sex drive and the remaining 294 had other sexual dysfunctions.

In this study, the scientists found that earlier, more men were diagnosed with erectile dysfunction and premature ejaculation. However, more recently, men have been diagnosed with low sexual desire and Peyronie’s disease.

With the successful treatment options for erectile dysfunction such as Viagra and Cialis and awareness, men have been reporting more about other sexual dysfunctions as well.

Cap-Score: A test to find out sperm quality

Male infertility is one of the major reasons behind the increasing numbers of in-vitro fertilization (IVF) cases throughout the world. Earlier tests like semen analysis, also called seminogram, were done to find out the quality and ability of sperm to fertilize. However, due to the lack of an appropriate diagnostic test for evaluating the fertilizing ability of men, most of the infertility cases get classified as idiopathic or unexplained.

In a recent research article in the journal Reproductive BioMedicine Online, scientists from various universities in the US used Cap-Score to test the sperm capacitation of males.

Sperm capacitation is a natural process where the spermatozoa (motile male sex cell) changes its shape to be able to penetrate and fertilize the female egg. The Cap-Score is a test which determines the percentage of sperm that undergoes capacitation in a certain amount of time. Usually, 35 percent of sperms of a man with normal fertility would undergo capacitation.

In this study, the scientists took the sperm samples from 292 patients and tested their ability to reproduce with the help of traditional sperm analysis test and Cap-Score. Out of these patients, 128 couples became pregnant after three cycles of Intrauterine Insemination (placing sperm inside a woman’s uterus to facilitate fertilisation).

The scientists found that those with high Cap-Score were able to fertilize more efficiently and resulted in a higher number of pregnancies. The scientists also found that men who constantly questioned their fertility showed impaired or reduced capacitation ability.

Benefits of Cap-Score over traditional sperm analysis

Scientists found that traditional semen analysis is unable to identify impairments in fertilising ability, which typically leads to a diagnosis of idiopathic infertility. The scientists found that unlike the traditional semen analysis, capacitation is a better test which helps in determining whether or not there would be a successful generation of pregnancy.

Both these studies indicate that with better awareness of male sexual health issues, men choosing to report as well as get treatment for these diseases, and with the widespread adoption of better sperm analysis tests like the Cap-Score by the medical community, male sexual dysfunction and infertility can be better addressed globally.

For more information, read our article on Low Sperm Count.

Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health.

13 Questions About Erections: What It Is, How It Works, What to Do

What Is an Erection? A First-Timer’s Guide to Getting Hard

Medically reviewed by Jennifer Litner, LMFT, CST — Written by Adrienne Santos-Longhurst on December 15, 2020

This article is a repost which originally appeared on Healthline

Edited for content. Some of the recommendations below may not be recommended by the forum- e.g.- watching porn

Got questions about erections? Like why do they happen, and usually at the most random times?

Or what the heck is dribbling out of it? And what’s up with raging semis?

Keep reading, because we’re answering all of your burning questions here. (Not that your boner should burn, BTW.)

So, what exactly is it?

An erection — or boner, wood, or chubby, if you prefer — is a hardening of the penis.

Most of the time, the penis is flaccid and just hangs around minding its own business.

During an erection, it becomes temporarily engorged with blood and enlarged. This makes it feel stiff and causes it to stand up and away from the body.

Why does it happen?

Sexual arousal is often the reason, which is caused by seeing, feeling, or even thinking of something that turns you on.

Erections can also happen for no particular reason. There’s actually a name for these random boners: spontaneous erections.

So if you get a stiffy while watching a documentary on slugs, it’s just a penis doing what a penis does and it’s NBD.

It’s also normal to wake up with morning wood, whether you’ve had a sex dream or not.

How does it work?

To know how an erection works, we need to start with a little lesson on penis anatomy.

There are two chambers that run the length of your penis called the corpora cavernosa. Each contains a maze of blood vessels that create sponge-like spaces.

When those blood vessels relax and open, blood rushes through and fills them, causing the penis to engorge, creating an erection.

A membrane around the corpora cavernosa helps trap the blood so your D stays hard.

Erections aren’t just about the penis, though. Your brain plays a role, too.

When you get aroused, your brain sends signals to your penis that cause the muscles in it to relax and let the blood in.

Does everyone get them?

Everyone with a penis does.

That said, certain lifestyle factors can make it difficult for you to get an erection, like being tired, stressed, or intoxicated.

Certain medications and medical conditions can also cause erectile dysfunction.

Does it hurt?

It shouldn’t. Mostly boners just make you super aware of your D when you don’t generally really feel it or think about it otherwise.

However, there are some instances when an erection might be uncomfortable.

Pee boners are an example of this. They happen because your penis is designed to not let you wet yourself. It’s quite marvelous, really. Try to pee when you’re still hard and you’ll feel the burn.

Excessive or especially vigorous masturbation can also cause some discomfort down there. So, if your pain starts after you’ve been especially heavy-handed lately, giving your penis a rest should help.

Otherwise, an underlying medical condition or injury can cause painful erections. If you have penis pain, a trip to a healthcare provider is in order.

What if stuff starts coming out? Is that normal?

Totally normal — assuming that what’s coming out isn’t bloody, green, or yellow, or has a dank stank to it. (Those are all signs of an STI or other infection.)

Barring those things, what you’re seeing is either ejaculate or pre-ejaculate — or precum, as most people call it.

Ejaculation typically happens during orgasm. This is when your arousal builds and leads to an intense, feels-so-good release that’s accompanied by ejaculate shooting from your penis.

That said, it’s possible to orgasm without ejaculating. It’s also possible to ejaculate without having an O.

That thin, slippery fluid that dribbles out of your D when you’re hard before ejaculation is called precum. It happens to anyone with a penis and is no biggie.

An FYI about precum: It can contain a small amount of sperm and therefore can cause pregnancy.

What’s the point of all this?

The point of an erection is so you can partake in penetrative sex.

Granted, you don’t need to have penetrative sex if you don’t want to, but in order to be able to get it in there — whether there is a vagina or anus — you need to at least be a bit hard.

Penetration without an erection is kind of like pushing rope.

How do you make it go away?

The penis is designed to lose an erection once you’ve ejaculated, so that’s one way.

Other than ejaculating, you may be able to able to make it go away by eliminating the source of stimulation, like:

  • shifting positions (or your boner) so your jeans or thighs aren’t rubbing it
  • thinking about something else, preferably something nonsexual
  • distracting yourself by reading anything in sight or counting backward

You can also just wait it out and hide it in the meantime by holding something over it, like your bag or jacket. If your shirt is long enough, you can try untucking it (the shirt, not the boner).

For a menacing rager that pops up at a particularly inopportune time, hightailing it to the nearest exit or washroom might be your best bet.

How often are you supposed to get one?

There’s no hard and fast rule when it comes to how many erections a person should get.

People with penises have an average of 11 erections per day and three to five more each night, but everyone is different.

There are numerous factors that can affect how often you get hard, like your age, hormone levels, and lifestyle.

If you’re concerned about your ability to get or maintain an erection, talk to a healthcare provider. Same if you feel like you’re hard more often than not or have an erection that persists for more than 2 hours straight.

Is there anything you can do to prevent it from happening?

Not really.

Erections are a normal part of having a penis. They’re bound to happen whether you want them to or not.

Using some of the methods we gave to stop an erection might also help you prevent one, but it’s not a sure thing, especially if you have an especially sensitive penis.

What if you want to make it happen?

Now we’re talkin’!

The key to getting an erection is being relaxed and allowing yourself to get aroused.

Here are some things that can help things along:

  • Fantasize about something you find sexually stimulating.
  • Look at images you find arousing.
  • Watch porn.
  • Read erotica.
  • Touch yourself anywhere it feels good, not just your penis.
  • Try a sex toy.

How do you know if you’re doing it right?

As long as it’s not causing you — or anyone — pain or distress, then it’s all good.

Sexual arousal should feel good. Erections shouldn’t be a source of discomfort or guilt.

If you’re concerned about your erections or are struggling with negative feelings about your sexuality, you may find it helpful to talk to a professional.

You can speak to your primary care provider or find a sexual health professional in your area through the American Association of Sexuality Educators, Counselors and Therapists (AASECT) directory.

What’s the bottom line?

Erections are natural and just part of owning a penis. As inconvenient as they may be when they come up spontaneously, the ability to have them is a sign of health.

Their main purpose may be to facilitate penetrative sex, but no pressure. Your erection, your choice.

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Penis health: Conditions, safety, lifestyle, and care

What to know about penis health

Medically reviewed by Kevin Martinez, M.D. — Written by Jenna Fletcher on April 2, 2020

This article is a repost which originally appeared on MEDICAL NEWS TODAY

Edited for content

A healthy penis should be free of lesions, warts, and abnormal discharge. In general, the penis should be roughly the same color as the surrounding skin, though it may be a shade darker or lighter.

Also, a person should not experience any pain in their penis when urinating or engaging in sexual activity.

A sudden change in the appearance, sensation, or function of the penis may signal an underlying issue that requires medical attention.

This article describes certain lifestyle factors and health conditions that can affect penis health. It also outlines some possible symptoms of poor penis health and provides tips on penis care.

Lifestyle factors that affect penis health

Lifestyle factors that can affect penis health include sexual relationships, weight management, and alcohol use.

The sections below outline some common lifestyle factors that can affect penis health.

Sexual relationships

Sexually transmitted infections (STIs) can negatively affect penis health. Some of the most common STIs include:

  • human papillomavirus (HPV)
  • chlamydia
  • gonorrhea
  • herpes

The Centers for Disease Control and Prevention (CDC) recommend that people practice safe sex in order to reduce their risk of contracting an STI. This involves using barrier methods during sexual activity and getting vaccinated against hepatitis B and HPV.

The following can also help reduce the risk of spreading and contracting STIs:

  • limiting the number of sexual partners
  • maintaining a monogamous sexual relationship
  • abstaining from sexual activity

Often, people who contract an STI do not experience any symptoms. This is why it is important for people who are sexually active to attend regular sexual health screenings.

Weight management

Obesity can negatively affect many aspects of a person’s health, including penis function.

People with obesity may be more likely to experience erectile dysfunction, or impotence. This occurs when a person is unable to develop or maintain an erection during sexual activity.

According to the Obesity Action Coalition, obesity can contribute to erectile dysfunction by:

  • decreasing testosterone levels
  • causing inflammation throughout the body
  • damaging the blood vessels, including those that supply blood to the penis

However, one 2018 study suggests that the relationship between obesity and sexual health is not completely clear. Although obesity may contribute to erectile dysfunction, other factors may also give rise to poor sexual health. These include:

  • anxiety
  • stress
  • self-esteem issues

Diet

Eating a healthful, balanced diet can help prevent obesity and related sexual health problems.

A 2017 animal study investigated the potential link between diet, obesity, and erectile function. In this study, one group of rats consumed a calorie-rich diet, while a second group consumed a standard diet.

The rats that consumed the calorie-rich diet were more likely to develop obesity, and they also showed significantly poorer erectile function.

The types of food a person eats could also affect their penis health. For example, one 2016 study found that a diet rich in flavonoids was associated with a reduced risk of erectile dysfunction in men below the age of 70.

Flavonoids are chemicals that occur naturally in a range of vegetables, fruits, and grains. Some examples of flavonoid-rich foods include:

  • root vegetables
  • legumes
  • berries
  • grapes
  • citrus fruits
  • teas
  • chocolate

Exercise

Exercise is important in helping a person maintain a moderate weight. This means that it also helps reduce the risk of obesity-related sexual health concerns.

Exercise may also benefit sexual health more directly. For example, one 2015 study investigated whether or not regular walking exercise could help improve erectile dysfunction in men who had recently had a heart attack.

Those who took part in the regular walking program reported a 71% decrease in erectile dysfunction symptoms. Those who did not take part in the program reported a 9% increase in erectile dysfunction symptoms.

The researchers conclude that regular exercise may help reduce symptoms of erectile dysfunction.

A 2011 meta-analysis investigated the effects of aerobic exercise on erectile dysfunction. The researchers analyzed five studies involving a total of 385 participants.

All the studies showed improvements in erectile dysfunction following aerobic activity. The researchers conclude that men with erectile dysfunction may benefit from aerobic training, though further studies are necessary to confirm this.

Alcohol and tobacco use

Drinking a lot of alcohol can negatively impact many aspects of a person’s health.

According to the CDC, excessive drinking can interfere with male hormone production, potentially contributing to impotence and infertility.

Alcohol also increases the likelihood that a person will engage in risky sexual behavior. Such behavior puts a person at increased risk of contracting or transmitting an STI.

Tobacco smoking can also have a negative effect on penis health. According to the Truth Initiative, smoking may play a role in the following sexual health issues:

  • erectile dysfunction
  • infertility
  • decreased libido

Health conditions that may affect penis health

There are several health conditions that can directly affect penis health. Some of the more common ones include:

  • STIs, such as chlamydia, herpes, or genital warts
  • phimosis, which occurs when the foreskin cannot extend over the head of the penis
  • balanitis, which is inflammation of the head or foreskin of the penis

Other conditions not directly related to the penis can also affect its health. Many of these conditions may cause erectile dysfunction or issues with fertility. These include:

  • obesity
  • diabetes
  • high blood pressure
  • stress
  • certain heart conditions

When to see a doctor

Anyone who is sexually active should check for symptoms of STIs regularly. They should look for:

  • rashes, sores, or blisters on the penis
  • burning or itching sensations in the penis
  • abnormal discharge from the penis
  • a foul odor coming from the penis or groin area
  • pelvic pain
  • pain when urinating or passing stools

Anyone who thinks that they may have an STI should visit their doctor for a diagnosis and appropriate treatment.

Importantly, many people who contract an STI will not experience any symptoms. Regular sexual health screenings will help detect STIs that a person may not have noticed otherwise.

Anyone who thinks that they may have erectile dysfunction should also see their doctor, who will work to diagnose the cause.

How to care for the penis

A person should clean their penis at least once per day using a mild soap. Using abrasive or heavily scented soaps could irritate the skin of the penis.

A person should wash all parts of the penis, including:

  • the pubic hair
  • the scrotum
  • the area between the legs and scrotum
  • the penis shaft
  • the area underneath the foreskin, if uncircumcised

Tips for a healthy penis

The tips below can help a person keep their penis healthy:

  • using a barrier method during sex
  • limiting the number of sexual partners they have
  • undergoing a sexual health screening at least once per year if in a monogamous relationship
  • undergoing a sexual health screening as often as every 3–6 months if having sex with multiple partners
  • keeping the penis and genital area clean
  • limiting alcohol consumption
  • avoiding the use of tobacco products
  • exercising regularly
  • eating a healthful, balanced diet

Summary

A person can take several steps to maintain the health of their penis. This includes exercising regularly and eating a healthful diet. A person may also wish to avoid having unprotected sex, drinking a lot of alcohol, and using tobacco products.

To maintain a healthy penis, a person should thoroughly wash the penis at least once per day. Those who are sexually active should also go for sexual health screenings at least once per year and perform regular self-checks at home.

If a person has any concerns about their penis, they should talk to a doctor as soon as possible. The doctor will work to diagnose the cause of the issue and provide appropriate treatments.

 

Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Types of penises: Shape, size, circumcision, and more

What to know about types of penises

Medically reviewed by Joseph Brito III, MD — Written by Mathieu Rees on November 23, 2020

This article is a repost which originally appeared on MEDICAL NEWS TODAY

Edited for content

The penis is a male organ with functions that include reproduction and urination. As with any body part, no two people have the same penis.

The penis has two main features. The body, or shaft, connects the penis to the abdomen. At the opposite end of the shaft is the glans, or head.

This article lists some common types of penises, categorized primarily by measurement, and provides some related information.

Length

Penises come in different lengths when flaccid or erect.

Estimates about average penis length can vary. For example, one 2014 study looked at the penis size of United States males. It found that the average erect length was around 5.6 inches.

However, another article suggests there are issues with many penis length studies, including the fact that participants self-report measurements.

These studies use self-reported data and are therefore subject to bias, which likely fuels the widespread belief that the average penis size is closer to 6 inches. In reality, the average is likely to be lower

Girth

Penises also have different girths or circumferences.

A 2014 study into the penis size of U.S. males found that the average erect girth was around 4.8 inches.

However, as with penis length, a person should note that many penis girth studies use self-reported measurements, which are known to be fairly unreliable.

Curvature

Some penises are completely straight when erect. However, many have a bend or curvature. There are three main types of curved penis. These include penises that:

  • curve upwards from its base
  • curve downwards from its base
  • curve to the left or right

Additionally, some people may have multiple kinds of curvature. For instance, some penises may curve to the left and upwards.

Penile curvatures are common and typically benign. They are rarely painful and do not usually make penetrative sex more difficult.

However, abnormal penile curvature can sometimes be a symptom of Peyronie’s disease. One review lists the following as possible symptoms:

  • a thickened area, or plaque, in the penile shaft
  • curvature of the penis during erection
  • pain in the penis
  • erectile dysfunction

Scientists are not sure what causes Peyronie’s disease.

One common explanation is that the condition results from mild, recurring trauma to the penis. This can occur during intercourse or masturbation.

Peyronie’s disease can also be due to a rupture in the penis, known as a penile fracture. Genetic factors may also contribute to the development of this condition.

Anybody who suspects they may have Peyronie’s disease should seek medical advice. Sometimes, people with the condition who experience no other issues, such as pain, could still use their penis for sexual activity without needing medical treatment.

In some cases, doctors may recommend surgery to remove the plaque or reduce the curvature in the penis.

The base to head ratio

For some people, the circumference of the base of their penile shaft is the same as the circumference of their penile head.

For others, this ratio is different. Some may have a penile head with more girth than the base of their shaft, or vice versa.

Circumcised and uncircumcised

A person with a penis is born with a retractable layer of skin that covers the penile head, commonly referred to as the foreskin.

Many people around the world have their foreskin surgically removed, in a process known as male circumcision.

A trained person may carry out male circumcision on children and adults, often for cultural or religious reasons. Doctors can also perform them in medical treatments.

Circumcised penises do not have a foreskin, which means that the glans is always visible. Uncircumcised penises have a foreskin, which often covers the glans, especially when the penis is flaccid.

Some infants can be born without a foreskin, which is a condition called hypospadias. Here, the opening of the penis is not found at the tip. Surgery is usually required to correct this issue.

Uncircumcised men can also develop phimosis, where the foreskin cannot retract over the hood of the glans. This can lead to irritation and infection. People with the condition generally require medical circumcision.

Because circumcision is a surgical process, it can sometimes lead to health issues, including:

  • infection
  • necrosis of the penile head
  • cut to the penile head or urethra
  • penile loss

However, people should note that this procedure is very common. Infections following circumcision, one of the most common possible complications, affect just 0.5% of people.

Summary

Many internet sources misinform and perpetuate myths about penises. In reality, they are highly varied, just like other body parts.

Anyone who has concerns about their penis can seek medical advice from a trained professional.

Addressing male sexual and reproductive health in the wake of COVID-19 outbreak

Addressing male sexual and reproductive health in the wake of COVID-19 outbreak

J Endocrinol Invest. 2020 Jul 13 : 1–9.
doi: 10.1007/s40618-020-01350-1 [Epub ahead of print]
PMCID: PMC7355084
PMID: 32661947

A. Sansone,1 D. Mollaioli,1 G. Ciocca,2 E. Limoncin,1 E. Colonnello,1 W. Vena,3,4 and E. A. Janninicorresponding author1

This abstract is a repost which originally appeared on PMC-NCBI

Edited for content

Abstract

Purpose

The COVID-19 pandemic, caused by the SARS-CoV-2, represents an unprecedented challenge for healthcare. COVID-19 features a state of hyperinflammation resulting in a “cytokine storm”, which leads to severe complications, such as the development of micro-thrombosis and disseminated intravascular coagulation (DIC). Despite isolation measures, the number of affected patients is growing daily: as of June 12th, over 7.5 million cases have been confirmed worldwide, with more than 420,000 global deaths. Over 3.5 million patients have recovered from COVID-19; although this number is increasing by the day, great attention should be directed towards the possible long-term outcomes of the disease. Despite being a trivial matter for patients in intensive care units (ICUs), erectile dysfunction (ED) is a likely consequence of COVID-19 for survivors, and considering the high transmissibility of the infection and the higher contagion rates among elderly men, a worrying phenomenon for a large part of affected patients.

Methods

A literature research on the possible mechanisms involved in the development of ED in COVID-19 survivors was performed.

Results

Endothelial dysfunction, subclinical hypogonadism, psychological distress and impaired pulmonary hemodynamics all contribute to the potential onset of ED. Additionally, COVID-19 might exacerbate cardiovascular conditions; therefore, further increasing the risk of ED. Testicular function in COVID-19 patients requires careful investigation for the unclear association with testosterone deficiency and the possible consequences for reproductive health. Treatment with phosphodiesterase-5 (PDE5) inhibitors might be beneficial for both COVID-19 and ED.

Conclusion

COVID-19 survivors might develop sexual and reproductive health issues. Andrological assessment and tailored treatments should be considered in the follow-up.

Keywords: COVID-19, SARS-CoV-2, Erectile dysfunction, Sexual dysfunction, Male hypogonadism, Cardiovascular health

Introduction

The global outbreak of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents an unprecedented challenge for healthcare. Despite social distancing and isolation measures, the number of affected patients is growing daily. Hyperinflammation and immunosuppression are prominently featured in COVID-19 [, ], resulting in a cytokine storm [] ultimately leading to development of micro-thrombosis and disseminated intravascular coagulation (DIC). This cytokine storm is strongly associated with the development of interstitial pneumonia (IP) []; however, although lungs are the primarily targeted organs, the cardiovascular system is globally affected. Evidence in this regard supports the notion that the exaggerated production of early response proinflammatory cytokines, such as tumor necrosis factor (TNF), interleukin-1β, -6, and -10 (IL-1β, IL-6, and IL-10, respectively), increases the risk of vascular hyperpermeability, possibly progressing to multiple organ failure and, ultimately, death []. The presence of vascular dysfunction at multiple levels, including pulmonary embolisms, alveolar hemorrhage, microangiopathy and vasculitis has been ascertained in post-mortem examination [, ]. Additionally, both venous and arterial thromboembolic complications, including endothelial inflammation, have been reported [, ]. Indeed, a growing body of evidence seems to support the theory that the endothelium is targeted by the SARS-CoV-2 []; most importantly, the endothelium expresses the protein angiotensin-converting enzyme 2 (ACE2) [, ], through which the virus can access host cells []. Endothelial dysfunction is, therefore, a pivotal determinant of COVID-19 symptoms [, ].

As of June 12th, 2020, more than 7.5 million COVID-19 cases have been confirmed worldwide, with more than 420,000 lives lost due to the disease []. More than 3.5 million subjects have recovered from COVID-19; however, the long-term consequences of the disease are still largely unknown. Data from 2002–2004 epidemics of SARS suggest that cardiovascular sequelae, such as microangiopathy, cardiomyopathy and impaired endothelial function, are to be expected also in COVID-19 patients [, ]. However, while similarities with SARS have been identified, COVID-19 is largely more prevalent due to its high transmissibility, and its consequences, even for recovered patients, are likewise more worrying. Additionally, new evidence is suggesting that autoimmune conditions, such as type 1 diabetes mellitus, might be triggered by the onset of COVID-19 [], therefore, worsening the risk profile for survivors.

These findings can be extremely relevant for male sexual health: indeed, based on these premises, there is quite enough evidence to hypothesize that consequences of COVID-19 can extend to sexual and reproductive health. We investigated the current literature to understand the long-term clinical complications for COVID-19 survivors, aiming to provide adequate information for clinicians to plan adequate and timely intervention measures.

Testosterone and COVID-19: friend or foe?

It is well established that ACE2 is the entry point for the SARS-CoV-2 in host cells []. In males, adult Leydig cells express this enzyme, therefore, suggesting that testicular damage can occur following infection []. Testicular damage in COVID-19 might, therefore, induce a state of hypogonadism as proven by decreased testosterone-to-LH ratio in patients with COVID-19, suggestive of impaired steroidogenesis resulting from subclinical testicular dysfunction [, ]. Post-mortem examinations of testicular tissue from 12 COVID-19 patients showed significantly reduced Leydig cells, as well as edema and inflammation in the interstitium []. A recent report on 31 male COVID-19 patients in Italy identified that some patients developed hypergonadotropic hypogonadism following the onset of the disease []. In the same study, lower levels of serum testosterone (total and free) acted as predictors of poor prognosis in SARS-CoV-2 men []. Whether this state of hypogonadism is permanent or temporary is a question so far left unanswered. Testosterone acts as a modulator for endothelial function [] and suppresses inflammation by increasing levels of anti-inflammatory cytokines (such as IL-10) and reducing levels of pro-inflammatory cytokines such as TNF-α, IL-6 and IL-1β []. It can, therefore, be hypothesized that suppression of testosterone levels might be one of the reasons for the large difference in terms of mortality and hospitalization rate between males and females and might also explain why SARS-CoV-2 most commonly infects old men.

On the other hand, androgens seem to play a pivotal role in COVID-19 by promoting the transcription of the transmembrane protease, serine 2 (TMPRSS2) gene. The encoded protein primes the spike protein of SARS-CoV-2, therefore, impairing antibody response and facilitating the fusion between the virus and the host cells []. This hypothesis could explain the higher prevalence of COVID-19 in men, although it would fail to explain the rationale for the higher mortality rates, as well as the worse clinical outcomes, for elderly patients.

Additional studies would, therefore, be needed to understand whether testosterone treatment might be beneficial or deleterious for the clinical course of the disease. However, independently of whether testosterone is a friend or foe for COVID-19, it should be acknowledged that the testis is a target for SARS-CoV-2 and the possibility for long-lasting consequences on the endocrine function exists, even for recovered patients.

COVID-19 and the endothelium

Solid evidence accumulated in the last decades support the notion that erectile function is an excellent surrogate marker of systemic health in general, and vascular performance in particular [], sharing plenty of risk factors with cardiovascular disease. This is described by the equation ED = ED (endothelial dysfunction equals erectile dysfunction, and vice versa) []. Vascular integrity is necessary for erectile function [], and vascular damage associated with COVID-19 is likely to affect the fragile vascular bed of the penis, resulting in impaired erectile function [, ]. COVID-19 features a state of hyperinflammation promoted by TNF-α, IL-6 and IL-1β []; the same inflammatory cytokines have been associated with clinical progression of sexual dysfunction []. It is worth noticing that the pro-inflammatory cytokines are also closely tied to testosterone levels: as previously stated, hypogonadal patients have higher concentrations of TNF-α, IL-6 and IL-1β as a result of impaired suppression. This ultimately worsens the endothelial dysfunction, further impairing erectile function. However, whether testosterone replacement therapy (TRT) would improve endothelial function is still debated, while largely beneficial in the treatment of hypogonadal men, TRT has known harmful effects if inappropriately prescribed [], and a meta-analysis study did not find any conclusive evidence of a potentially therapeutic effect of testosterone administration, neither acute nor chronic, on endothelial function []. While erection is—of course—a trivial matter for patients in Intensive Care Units (ICUs), there is reason to suspect that impaired vascular function might persist in COVID-19 survivors and even become a public health issue in the next few months. Moreover, given that erectile function is a predictor of heart disease [, ], investigating whether COVID-19 patients develop ED might also be a good surrogate marker of general cardiovascular function, improving patient care and quality of life.

A COVID eclipse of the heart: potential for cardiovascular burden

Besides the effects on endothelium, SARS-CoV-2 infection can also dramatically affect the heart and exacerbate underlying cardiovascular conditions. Reports of myocarditis in COVID-19 patients have piled up in the last months []; similarly, arrhythmias and acute cardiovascular events have been described in other coronavirus and influenza epidemics [] and are likely to be expected for SARS-CoV-2 as well []. COVID-19 survivors are, therefore, more likely to develop severe cardiovascular consequences. However, treatment is not exempt from possible side effects, among which sexual dysfunctions are remarkably common. Drugs such as β-blockers and antihypertensive agents, routinely used in COVID-19 patients, have the potential to impair sexual function []; therefore, both the cardiovascular consequences and their treatment might ease progression from subclinical to a clinically overt ED [, ].

It is also worth mentioning that several cardiovascular risk factors involved in sexual dysfunctions, such as smoking [], diabetes [] and hyperhomocysteinemia [], are also possible predictors of worse outcomes in COVID-19 patients.

Additionally, as stated in the III Princeton Consensus Panel [], sexual activity should be delayed until the cardiac condition has been stabilized in high-risk patients. Such patients include those with uncontrolled hypertension, recent myocardial infarction or high-risk arrhythmia, which are all conditions closely associated with COVID-19 [].

Reproductive health and COVID-19

Another reason for worry lies in the reported testicular damage from COVID-19 infection. In fact, ACE2 is highly expressed in the testis, suggesting the possibility of testicular infection since the early stage of the disease []. Being expressed in both Sertoli and Leydig cells [, ], ACE2 plays key roles in spermatogenesis and in the regulation of steroidogenesis. Due to the involvement of Sertoli cells, reproductive function might similarly be affected. Additionally, ACE2 is also expressed by spermatogonia, therefore, increasing the risk of SARS-CoV-2 presence in seminal fluid [, ].

Studies investigating the presence of SARS-CoV-2 in seminal fluid have, for the largest part, found no evidence of the virus []. However, as other studies have shown different results [], the topic of reproductive health is still largely debated. In post-mortem examinations, seminiferous tubular injury was reported despite no evidence of the virus in the testis []. Identification of SARS-CoV-2 in semen is of the utmost importance, as sperm cryopreservation is an undelayable necessity for many men, such as those who are about to start gonadotoxic treatments []. In Italy, cryopreservation procedures for oncological patients have continued during the COVID-19 pandemic, using utmost care to limit the risk of transmission; for non-oncological patients, the prospects of biological parenthood could be compromised as a consequence of delaying diagnostic semen analysis and sperm banking []. At the beginning of the pandemic, discontinuation of reproductive care except was recommended by international societies for reproductive medicine, with only the most urgent cases allowed; as containment and safety strategies have mitigated the spread of the disease, several centers for assisted reproductive technology have resumed their activity, although with very precise rules for operators [, ].

Further studies should, therefore, be designed with the aim to clarify this point, above all among “COVID-19 asymptomatic” men requiring assisted reproductive technology (ART).

The psychological burden of COVID-19

Increased rates of post-traumatic stress disorder (PTSD), depression and anxiety are expected in the general population, and even more in COVID-19 survivors, following the pandemic []. A parallel can be drawn between the psychological consequences of COVID-19 and those coming from similar disasters, such as the 9/11 attacks [] or earthquakes [], and similar short- and long-term treatment strategies are, therefore, needed to provide adequate care. Confinement and the illness in itself are both causes of stress; while only a minority of individuals might be more vulnerable to psychological trauma, there is no doubt that most people would experience some degree of emotional distress following isolation, social distancing, loss of relatives and friends, difficulties in securing medications, as well as the obvious economic consequences of lockdown. Sexual activity is closely associated with mental and psychological health; it is, therefore, unsurprising that sexual desire and frequency have declined in both genders during this pandemic [, ]. There is, therefore, reason to suspect that psychological suffering might exacerbate pre-existing subclinical sexual dysfunctions []. Additionally, the potential for SARS-CoV-2 transmission by kissing might lead to increased distress in the couple [], with the resulting negative effects on sexual health and on couple dynamics. Additionally, the hypogonadal state reported in COVID-19 could lead to a significant worsening in sexual desire and mood [, ].

Pulmonary fibrosis and the effects of hypoxia

It has been suggested, with on the basis of interesting evidence, that there could be substantial fibrotic consequences following SARS-CoV-2 infection [, ]. Indeed, pulmonary fibrosis is a well-acknowledged consequence of acute respiratory distress syndrome (ARDS), with further evidence coming from survivors of the 2003 SARS outbreak (caused by the SARS-CoV) [, ]. Pulmonary fibrosis impairs the physiologic lung mechanisms, reducing the pulmonary gas exchange and, therefore, impairing oxygen saturation [, ]; functional disability has been proven in ARDS patients several years after the acute phase of the disease []. There is currently no evidence concerning the possible long-term impairment of lung function following SARS-CoV-2 infection; however, considering the scale of the current pandemic and the similarities between SARS-CoV and SARS-CoV-2 [], there is sufficient reason to suspect a high rate of fibrotic lung function abnormalities in COVID-19 survivors. In such patients, the impaired oxygen saturation could impair erectile function; some evidence in support comes from animal models [, ] as well as from clinical reports [, ]. From a pathophysiological standpoint, this is hardly surprising, as oxygen is one of the substrates required for the synthesis of nitric oxide (NO) by the enzyme NO synthase, whose activity is severely blunted in hypoxia [].

Phosphodiesterase-5 inhibitors in COVID-19

Phosphodiesterase-5 (PDE-5) belongs to the PDE superfamily of enzymes, the last step of the NO/cGMP/PDE pathway and is one of the key elements in drug treatment of ED. NO activates guanylate cyclase in responsive cells, such as endothelial cells, resulting in increased concentrations of the second messenger cGMP (cyclic guanosine monophosphate), which in turn induces relaxation of smooth muscle. PDE acts downstream and reduces effects of cGMP by catalyzing its degradation: PDE inhibitors prevent degradation of cGMP, resulting in prolonged or enhanced action [].

PDE-5 is highly expressed in vascular smooth muscle cells [], and, at high concentrations, in those of the penile corpora cavernosa []; therefore, thanks to their action and due to their high affinity for the specific type 5 isoform [], PDE-5 inhibitors have been approved for their use in treatment of ED since 1998. However, a growing body of evidence has also proven their usefulness as therapeutic agents in different conditions due to their anti-inflammatory and antioxidant actions, as reported in diabetes [], hypertension and chronic kidney disease []. Sildenafil, the first PDE-5 inhibitor approved for the treatment of ED following its serendipitous discovery [], has also been investigated as a treatment for COVID-19 patients; indeed, Sildenafil improves pulmonary hemodynamics, as shown in idiopathic pulmonary fibrosis [], by reducing vascular resistance and remodeling in the pulmonary circulation []. Additionally, by inhibiting neointimal formation and platelet aggregation, sildenafil also might prove beneficial in regard to the risk of vascular injury and thrombotic complications in COVID-19 patients []. Evidence from new trials will prove fundamental to assess the clinical benefits of PDE-5 inhibition on the overall burden of COVID-19 [].

Conclusions

In conclusion, there is quite enough reason to suspect that male sexual and reproductive health could be affected in the survivors, by the sequelae of the COVID-19, both in the short and long terms (Fig. 1). Erectile function, as a surrogate marker of cardiovascular/pulmonary health, could also become extremely valuable as a quick and inexpensive first-line assessment of the pulmonary and cardiovascular complications for COVID-19 survivors. In this regard, evidence coming from diagnostic procedures, such as penile color-doppler ultrasound [] and hypothalamic-pituitary–testicular axis evaluation [], will be necessary to assess the extent to which COVID-19 has been able to impair erectile, and finally vascular, function, the former being an efficient predictor of complete restitutio ad integrum. Additionally, tailored psychological interventions would be necessary to adequately support patients who develop sexual dysfunction consequently to the containment measures.

An external file that holds a picture, illustration, etc. Object name is 40618_2020_1350_Fig1_HTML.jpg

Graphical overview of the involvement of SARS-CoV-2 in the pathogenesis of erectile dysfunction

Acknowledgements

Open access funding provided by Universitá degli Studi di Roma Tor Vergata within the CRUI-CARE Agreement. The authors are in debt with Dr. Tarek Hassan (Pfizer, New York, NY) for discussion on the role of PDE5 and of PDE5i in COVID-19 management. This paper is partially supported by the PRIN Grant #2017S9KTNE_002.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This manuscript is a review of the literature and does not contain original research either on animal or on human subjects.

Research involving human participants and/or animals

This article does not contain any studies involving animals and/or human participants performed by any of the authors.

Informed consent

For this type of study, informed consent is not required.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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This Secret Muscle in Your Penis Makes You Seem Smaller Than You Are

This Secret Muscle in Your Penis Makes You Seem Smaller Than You Are

And more eye-opening insights from a leading urologist’s new book.

By Piet Hoebeke
Nov 18, 2020

This article is a repost which originally appeared on Men’s Health

Edited for content

The following is an excerpt from Members Club: A User’s Guide to the Penis, a new book by urologist Piet Hoebeke, M.D., Ph.D.


Funnily enough, the average penis in humans is far longer than strictly necessary. Gorillas and chimpanzees do it with a lot less and they still manage to fertilize their females. When erect, a grown gorilla has a penis length of four centimeters, and a chimpanzee erection measures eight centimeters. With an average length of over 13 centimeters, humans outshine their close relatives.

What do we have to thank for the over-proportional size? Usually, natural selection does away with characteristics that don’t serve a function–for example, the body hair that humans for the most part have lost. Things that aren’t needed are done away with, because making excess tissue wastes energy.

So why does man have such a long penis?

The answer is because, alongside natural selection, there is another mechanism at play: sexual selection. Natural selection ensures that a species adapts optimally to its environment, sexual selection supplies the characteristics to give a species the greatest chance of mating. Therefore, sexual selection exaggerates some characteristics without natural selection undoing them. Think of the long, colorful tails of birds of paradise or peacocks. For one reason or another, female birds like a long tail, so a male with a long tail has more chance of reproducing, even if such an impractical attachment increases the risk of him being caught by a predator.

In the animal kingdom, we see an endless range of tactics for attracting potential partners. The huge chest muscles of male gorillas are another example. The male gorilla has an imposing presence, even though he only has a small penis. Homo sapiens generally flaunt a smaller muscular structure, but they have the largest penis of all primates, in terms of both proportion to body height and absolute length. This points to sexual selection.

Exactly how this came about in evolution, we don’t know. There were no scientists around at the time observing primitive humans. We suspect the civilization process played a role in it. For a long time, man was a predator; a hunter-gatherer searching for food in the wild. Physical fitness was necessary to survive. At a certain time–or, even, over a period of time–humans became farmers. We took nature into our own hands and brute strength slowly lost importance. With farming, it wasn’t about who could run fastest or jump furthest; it was who could produce the most from his land. The physical characteristics needed to impress females became less prominent. Perhaps that is why, as compensation, the penis grew bigger.

Coitus was a brief affair in primitive humans. There was no foreplay: humans lived in a threatening environment and men were well aware that others could be close by on the look-out for a woman who was ready for sex. The faster they could deposit their sperm, the better. And how did women know that a man was ready for sex? Attraction is a game of smell, pheromones, blushing cheeks and deep breathing, but the most important sign of arousal is the erection. Because sex had to take place so quickly, a large penis facilitated a quick selection.

Over time, humans started wearing clothes and that created a nice paradox: the very fact that humans were covering up their body made the penis more prominent. For that we have a muscle to thank that has since lost its function.

Most mammals have a layer of muscle under the skin. Horses, for example, can use it to twitch their skin to get rid of flies. Primitive humans could do that too. Now we only have the remains of such a muscle in the human body, for example in the groin, where we have the fascia of Scarpa. We also still have one of these superficial muscles in the neck, a small muscle in the hand, and a muscle in the skin of the scrotum and penis: the dartos muscle.

Most people with a penis have no idea that there is a muscle around their sex organ, because you can only see it if you look at the penis skin under a microscope. Men don’t walk around displaying biceps in their penis, and the dartos muscle doesn’t let you twitch your penis, either. So what does it do?

Not a single male mammal walks around waving its penis, apart from when a male feels a great desire to mate. In most mammals, the dartos muscle neatly tucks the flaccid penis inside the body. When Homo sapiens walked around naked, their penis was also hidden from view. When you’re climbing over sharp rocks or running through thorny bushes, you want to keep your genitalia as close as possible to the body. Only with sexual arousal did the dartos muscle relax and the penis come out.

The muscle also runs as far as the skin of the scrotum, where it helps with the temperature regulation of the testicles. Each testicle is connected to a vas deferens which is also surrounded by a muscle. When the testicles get too warm, the vasa deferentia let the testicles hang down; if it suddenly gets cold, they tuck the testicles in. At the same time, the dartos muscle contracts the skin of the scrotum. That’s why your penis looks small if you swim in cold water.

As people started to wear clothes, the purpose of this muscle diminished. Clothing took on its protective role, and men with a strong dartos muscle no longer had an evolutionary advantage from this. Natural selection did its work, but a redundant body part doesn’t disappear in 20 or even 100 generations. In 10,000 years there have been around 330 generations, but the dartos muscle is still there.

It’ll keep the penis company for a while longer, but it just does less than before. The penis and scrotum are no longer drastically drawn inside the body of modern man; at most they shrivel up a little.

Some men might be sorry that the dartos muscle is an involuntary muscle, over which they have no control. I can imagine that some would jump at the chance to make their penis look longer in a communal changing room. But, alas, the dartos muscle only relaxes at higher temperatures or in the case of moderate arousal. In the case of strong sexual arousal, the dartos muscle contracts again, to prepare for ejaculation.

An erect penis doesn’t decrease in size because of this, but the testicles are pressed closer to the body. Two penises can be exactly the same length when erect, but the man with an active dartos muscle will appear to have the smallest penis when flaccid. He might think to himself about the other man: Blimey, he’s well hung! But what he could perhaps think is: Poor thing, he’s got a bit of a lazy dartos muscle there!

Therein lies the second paradox that burdens the male member. As I mentioned earlier, compared to other animals, men have an oversized penis. Because it also hangs outside the body, it catches the eye even more. So what do men do? They compare. And then all too quickly they come to the conclusion: Oh no, mine is too small.

Funnily enough, many men–and women–don’t even know how long the average penis is.