A penis by any other name is still a ???
A penis by any other name is still a ???
A penis by any other name is still a ???
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9/6/2012<br />
Rod Moser, PA, PhD<br />
Sutter Roseville Pediatrics<br />
CAPA Founding President<br />
Videos , certain photographs, cartoons, and my personal lecture<br />
notes used during my presentation have been deleted from the<br />
course handouts due to copyright and/or privacy <strong>is</strong>sues.<br />
Th<strong>is</strong> presentation has been copyrighted<br />
NO PORTION OF THIS PRESENTATION CAN BE USED<br />
WITHOUT THE EXPRESSED PERMISSION OF THE<br />
SPEAKER.<br />
A <strong>pen<strong>is</strong></strong> <strong>by</strong> <strong>any</strong> <strong>other</strong> <strong>name</strong> <strong>is</strong> <strong>still</strong> a ???<br />
A<br />
P N<br />
Ace in the hole<br />
Acorn Andy<br />
Action Jackson<br />
Adam Halfpint<br />
Admiral Winky<br />
African black snake<br />
Afro man<br />
AIDS baster<br />
AIDS grenade, The<br />
Alabama blacksnake<br />
Albino cave dweller<br />
All‐day sucker<br />
Anaconda<br />
Anal impaler<br />
Anal intruder<br />
Anal Spear<br />
Ankle spanker<br />
Apple‐headed monster<br />
Ass blaster<br />
Ass pirate<br />
Ass wedge<br />
Astralgod<br />
Auger‐headed gut wrench<br />
B<br />
Ba‐donk‐a‐donk<br />
Ba<strong>by</strong> maker<br />
Ba<strong>by</strong>'s arm holding an apple<br />
Ba<strong>by</strong>'s arm in a boxing glove<br />
Bacon bazooker<br />
Bacon rod<br />
Badboy<br />
Bagpipe<br />
Bald Avenger, The<br />
Bald butler<br />
Bald‐headed beauty<br />
Bald‐headed giggle stick<br />
Bald‐headed hermit<br />
Bald‐headed Jesus<br />
Bald‐headed yogurt slinger<br />
Baldy‐headed spunk‐juice d<strong>is</strong>penser<br />
Ball buddy<br />
Baloney pony<br />
Banana<br />
Bat and balls<br />
Battering ram<br />
Bayonet<br />
Beard splitter<br />
Bearded burglar<br />
Beastus maximus<br />
Beaver buster<br />
Beaver Cleaver<br />
Bed snake<br />
Beef baton<br />
Beef bayonet<br />
Beef belt buckle<br />
Beef bugle<br />
Beef bus<br />
Beef m<strong>is</strong>sile<br />
Beef soldier<br />
Beef stick<br />
Beefy McManstick<br />
Bell rope<br />
Belly stick<br />
Best leg of three<br />
(Big) Beanpole<br />
Big Dick & the twins<br />
Big Dickus<br />
1
9/6/2012<br />
Primary Purposes of the Pen<strong>is</strong><br />
• Urination<br />
• Procreation through<br />
ejaculation and<br />
fertilization<br />
• Recreation through<br />
Copulation and<br />
Masturbation<br />
• Admiration<br />
M <br />
<br />
<br />
<br />
T <br />
<br />
S <br />
B <br />
<br />
Facts and Myths About the Pen<strong>is</strong><br />
• The average length of a flaccid <strong>pen<strong>is</strong></strong> <strong>is</strong> 3.7 inches<br />
with a diameter of 1.25 inches<br />
• The average length of an erect <strong>pen<strong>is</strong></strong> <strong>is</strong> 5.1 inches<br />
with a diameter of 1.6 inches<br />
• Pen<strong>is</strong>es reach their manly maximum at age 17<br />
• Growers and Showers: Smaller flaccid <strong>pen<strong>is</strong></strong>es<br />
double in size when erect; larger, flaccid ones<br />
never experience such generous growth<br />
• There <strong>is</strong> (usually) no correlation to big noses, big<br />
ears, big feet, or big hands to <strong>pen<strong>is</strong></strong> size<br />
Facts and Myths About the Pen<strong>is</strong><br />
• Yes, fear, stress, and cold<br />
water will shrink the <strong>pen<strong>is</strong></strong><br />
to grade school<br />
dimensions<br />
• The “use it or lose it” rule<br />
actually applies<br />
• Foreskins may be sold to<br />
pharmaceutical<br />
companies<br />
2
9/6/2012<br />
What’s It supposed to look like?<br />
• New parents often have no<br />
clue as to what the newborn<br />
<strong>pen<strong>is</strong></strong> should look like. Some<br />
even expect the child to be<br />
born already circumc<strong>is</strong>ed.<br />
• The “first look” may be<br />
influenced <strong>by</strong> maternal<br />
hormones, body fat, and<br />
unreal<strong>is</strong>tic expectations.<br />
• The first dec<strong>is</strong>ion? Cir or not<br />
H<br />
C<br />
T U V<br />
The Circumc<strong>is</strong>ion Controversy<br />
• Most males are NOT circumc<strong>is</strong>ed<br />
• Each year, at least 1.2 million American boys lose<br />
their foreskins<br />
• Circumc<strong>is</strong>ion <strong>is</strong> among the most commonly<br />
performed surgical procedures in the U.S.<br />
• Conflicting notions about personal hygiene,<br />
STDs, masculinity, sexuality, and religion<br />
• Cosmetic or not? The helmet vs the turtle neck<br />
sweater<br />
Circumc<strong>is</strong>ion: The Debate<br />
Cuts Deep<br />
• Jew<strong>is</strong>h and Muslim people<br />
practiced circumc<strong>is</strong>ion for<br />
millennia<br />
• Medically unnecessary<br />
• M<strong>any</strong> insurance companies will not<br />
pay for “cosmetic” procedure<br />
3
9/6/2012<br />
Circumc<strong>is</strong>ion: The Debate<br />
Cuts Deep<br />
The Pro‐Circumc<strong>is</strong>ion Side:<br />
• A boy should look like h<strong>is</strong> father<br />
• 1900: Felt to prevent masturbation.<br />
• Infants boys less susceptible to UTIs<br />
• Virtually precludes penile cancer<br />
• Eliminates foreskin infections (Daah!)<br />
• Uncircumc<strong>is</strong>ed men may be more prone to certain<br />
STDs, but that <strong>is</strong> debatable. Studies only in Africa.<br />
Circumc<strong>is</strong>ion: The Debate<br />
Cuts Deep<br />
Anti‐Circumc<strong>is</strong>ion Side:<br />
• Consider it an inhuman<br />
act of genital mutilation<br />
• Improved hygiene<br />
standards made foreskin<br />
infections rare<br />
• Numerous nerve endings<br />
in foreskin lost<br />
• Foreskin protects and<br />
lubricates glans<br />
F<br />
They’re G <br />
• Twenty‐five years ago; about 90%<br />
of infant boys were circumc<strong>is</strong>ed<br />
• Now, only 57% are circumc<strong>is</strong>ed<br />
and the number <strong>is</strong> r<strong>is</strong>ing (so to<br />
speak). CDC estimate: 65%<br />
• Circ rate <strong>is</strong> 80% in the Midwest;<br />
32% in the West<br />
• More and more Jew<strong>is</strong>h families are<br />
rejecting th<strong>is</strong> ancient ritual.<br />
• There <strong>is</strong> extreme emotion and<br />
passion on both sides of the <strong>is</strong>sue:<br />
Don’t let it become a “bone of<br />
contention”. Parent dec<strong>is</strong>ion.<br />
AC M<br />
4
9/6/2012<br />
Caring for the Uncircumc<strong>is</strong>ed Pen<strong>is</strong><br />
Newborn Penile Issues<br />
• Size matters (mostly to new<br />
Dads)<br />
• Microphallus / Hidden Pen<strong>is</strong><br />
• Anatomical anomalies<br />
• Hypospadias / Ep<strong>is</strong>padias<br />
• Bridging<br />
• Penile Torsion<br />
• Phimos<strong>is</strong> / Paraphimos<strong>is</strong><br />
• Hair tourniquet<br />
M H P<br />
• Most small‐appearing<br />
<strong>pen<strong>is</strong></strong>es are buried/hidden<br />
• Press firmly on the<br />
suprapubic fat to exteriorize<br />
the penile body<br />
• Micro<strong>pen<strong>is</strong></strong> should be<br />
referred to a pediatric<br />
endocrinolog<strong>is</strong>t and<br />
urolog<strong>is</strong>t<br />
• Testosterone can help in<br />
some cases; some require<br />
surgery<br />
Micro<strong>pen<strong>is</strong></strong>: Before Surgery<br />
After Surgery<br />
H<br />
• Congenital malformation of<br />
urethral development<br />
• Urethral opening <strong>is</strong> on the<br />
ventral aspect of the <strong>pen<strong>is</strong></strong><br />
• May have some degree of<br />
chordee (ventral curvature of<br />
the <strong>pen<strong>is</strong></strong>)<br />
• May be associated with <strong>other</strong><br />
genital malformations<br />
(karotype and endo evaluation)<br />
• Requires surgical correction<br />
prior to toilet training (18 mon)<br />
5
9/6/2012<br />
E<br />
• Rare. 1:40,000<br />
• Urethral opening on<br />
the dorsal aspect of the<br />
<strong>pen<strong>is</strong></strong> (as shown)<br />
• Some will have urinary<br />
incontinence<br />
P B<br />
• Penile skin<br />
adhesion<br />
• Consequence of<br />
improperly‐healed<br />
circumc<strong>is</strong>ion<br />
• If painful erections,<br />
will require surgical<br />
correction<br />
P T<br />
• Photo shows a 90 degree<br />
penile torsion / flat<br />
ventral surface facing<br />
thigh instead of midline<br />
• 60 degrees if felt to be<br />
variation of normal<br />
• Must be surgically<br />
corrected –will cause<br />
painful or dysfunctional<br />
erections later<br />
P<br />
• Physiologic phimos<strong>is</strong> <strong>is</strong> the<br />
norm for uncircumc<strong>is</strong>ed<br />
boys<br />
• Give it time to<br />
spontaneously resolve<br />
without an medical, surgical,<br />
or parental manipulation.<br />
• Can take to age 5‐8<br />
• Mild cases may be treated<br />
with topical steroids<br />
• More severe cases with a<br />
fibrotic ring will need<br />
surgery or circumc<strong>is</strong>ion<br />
6
9/6/2012<br />
P<br />
• Uncommon condition where<br />
the foreskin, once pulled<br />
back, cannot be brought<br />
back to its original position<br />
• A urological emergency<br />
• Ice packs, penile wraps,<br />
manual compression.<br />
Osmotic agents –like<br />
granulated sugar can be used<br />
• Local anesthesia, IV sedation<br />
followed <strong>by</strong> manual<br />
compression<br />
• Dorsal slit or circumc<strong>is</strong>ion<br />
Hair Tourniquets<br />
• Use the blunt probe<br />
method if the hair <strong>is</strong><br />
not too deep<br />
• Local anesthesia <strong>is</strong><br />
optional<br />
• Topical antibiotics<br />
C A P<br />
I<br />
• Non‐retractable foreskin<br />
• Balanit<strong>is</strong><br />
• Frenulum tears / Minor<br />
Injuries<br />
• Masturbation<br />
• Sexually‐transmitted D<strong>is</strong>ease<br />
• Herpes genital<strong>is</strong><br />
• HPV / Venereal warts<br />
• Molluscum contagiosum<br />
• Erectile Issues<br />
Non‐Retractable Foreskin<br />
Non‐surgical treatment<br />
• Topical betamethasone<br />
cream for 4‐6 weeks<br />
• Manual stretching<br />
• Balloon dilatation<br />
Surgical Methods<br />
• Circumc<strong>is</strong>ion<br />
• Dorsal or ventral slits,<br />
removing the frenulum<br />
7
9/6/2012<br />
B<br />
• 6% of uncircumc<strong>is</strong>ed males; 3%<br />
of circumc<strong>is</strong>ed males<br />
• 1% HC or topical antibiotic<br />
ointments<br />
• If Candida, use nystatin or<br />
miconazole cream, or use in<br />
combination with 1% HC<br />
cream. Treat like a diaper rash<br />
• Barrier ointments for comfort<br />
Frenulum Tears<br />
• Called the “banjo string”<br />
• Common with<br />
masturbators<br />
• May bleed profusely and<br />
be quite alarming<br />
• Will usually heal, but may<br />
tend to break again in the<br />
same place.<br />
Masturbation: Five Things You didn’t<br />
<br />
1. There <strong>is</strong> no such thing as “abnormal”<br />
masturbation<br />
2. Masturbation <strong>is</strong> very safe, but not entirely safe<br />
3. Solo sex can supercharge your sex life or scuttle it<br />
4. Certain form of masturbation can lead to sexual<br />
dysfunction or death<br />
5. Masturbation may reduce the r<strong>is</strong>k of prostate<br />
cancer<br />
|<br />
Sexually‐Transmitted D<strong>is</strong>eases<br />
The Top Three STDs<br />
• Herpes<br />
• Chlamydia<br />
• Molluscum contagiosum<br />
Pseudo‐STDs<br />
• Balanit<strong>is</strong><br />
• Aphthous ulcers<br />
• Epidermal Inclusion<br />
cysts / Sebaceous<br />
• Pealy Penile Papules<br />
8
9/6/2012<br />
E D<br />
• Yes, it can happen to<br />
teenagers.<br />
• Most ED <strong>is</strong> related to<br />
stress<br />
• Consider diabetes, MS,<br />
or vascular d<strong>is</strong>orders<br />
• SSRIs can cause ED<br />
• Request for ED meds<br />
often related to drug use<br />
(Sextacy)<br />
9
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