What Are Different Types of Penile Diseases?
The small penis refers to the person whose penis extension length is less than 2.5 standard deviations of the average penis length of people of the same age or normal sexual development, but the anatomical structure and appearance are normal. The average static length of an adult male penis in Chinese is about 5 ~ 6cm, and the average stretch length is about 11 ~ 13cm. It is generally believed that when the adult penis is soft, <4cm, and the stretch length is <9.5cm, that is, the penis is short. For children, a small penis can be diagnosed if the length of the penis <average plus 2.5 standard deviations. The etiology of the small penis is complex. Although it can be treated with drugs and surgery, the overall effect is not good.
Basic Information
- English name
- micropenis
- Visiting department
- Urology
- Multiple groups
- child
- Common symptoms
- Short penis, less than 2.5 standard deviations in length from normal penis
Causes of small penis
- The development of the penis mainly depends on the androgen-testosterone (T) secreted by testicular mesenchymal cells. Testosterone is converted to dihydrotestosterone by 5-reductase, and then acts on the androgen receptor to make the penis grow. The production of testosterone requires the role of the hypothalamic-pituitary-gonadal hormone. The gonadotropin-releasing hormone (GnRH) produced by the hypothalamus stimulates the anterior pituitary to secrete gonadotropins (FSH and LH), which stimulates the testicular mesenchymal cells to secrete testosterone. . Any abnormality in any of the above links can affect the development of the penis and may produce a small penis seen in the clinic.
- 1. hypogonadotropin hypogonadism
- The lesions originated from the hypothalamus and pituitary.
- (1) Abnormal brain tissue structure , children without cerebral malformations, congenital pituitary hypoplasia, partial corpus callosum development, cerebellar malformations, etc., can cause small penis due to insufficient gonadotropin secretion.
- (2) Congenital gonadotropin-releasing hormone deficiency without brain tissue abnormalities includes hypothalamic GnRH deficiency and pituitary gonadotropin deficiency. The former includes Kallmann syndrome, idiopathic and secondary GnRH deficiency, and the latter includes combined pituitary hormone deficiency, simple FSH or LH deficiency.
- 2. High gonadotropin hypogonadism
- Including primary gonadal dysgenesis in the testis, such as Klinefelter syndrome; gonadotropin receptor deficiency; androgen synthesis or metabolic disorders, such as androgen receptor deficiency and 5-reductase deficiency. The hypothalamus and pituitary secretion of these patients are normal, and the cause of the small penis is mainly the testis itself.
- 3. Primary small penis
- That is, there is no clear cause, but post-pubertal development can be basically normal.
- In addition, some people think that environmental endocrine disruptors such as dioxins and organochlorine pesticides can also cause small penis. Low gonadotropin hypogonadism and high gonadotropin hypogonadism are the most common clinically.
Small penis clinical manifestations
- The small penis, as the name suggests, shows a short penis with a length less than 2.5 standard deviations from the average length of a normal penis, which is not consistent with age but has a normal appearance and a normal ratio of length to diameter. On physical examination, there were no scrotal and testicular deformities, and a smaller prostate may be found during digital anal examinations.
- Penis length measurement should be strictly regulated: put the erect penis in an extended state, use a portable penis head to straighten as much as possible, and measure the length from the pubic bone to the top of the penis with a ruler along the dorsal side of the penis. For concealed penis and webbed penis, try to push the fat and surrounding tissues as much as possible and measure accurately.
Small penis examination
- Laboratory inspection
- Routine blood glucose, potassium, sodium measurement, thyroid function measurement, growth hormone test and hypothalamic-pituitary-gonadal axis function test. The latter includes determination of gonadotropin (FSH, LH) and gonadotropin (T, dihydrotestosterone) levels, GnRH stimulation test, human chorionic gonadotropin (HCG) stimulation test, and adrenocorticotropic hormone (ACTH) challenge test Wait.
- 2. Imaging examination
- All patients required routine CT or MRI to determine the anatomy of the hypothalamus and pituitary. Patients with craniofacial deformity should pay special attention to the situation of optic cross, fourth ventricle and corpus callosum. When Kallmann syndrome is suspected, special attention must be paid to the condition of the olfactory sulcus.
- 3. Karyotype analysis
- All patients with small penis should be routinely tested for karyotype to detect chromosomal abnormalities. Such as Kallmann syndrome, Prader-willi syndrome and Klinefelter syndrome can be accompanied by a small penis.
Small penis diagnosis
- The small penis is an external manifestation of a variety of diseases. A clear diagnosis must be made through detailed history, physical examination and comprehensive auxiliary examinations. Medical history inquiry to understand in detail the history of sexual organ dysplasia, the clinical symptoms associated with it, family history and mother and pregnancy history. Physical examination in addition to focus on examining the patient's penis length and testicle size, but also pay attention to the patient's appearance.
Small penis treatment
- For the treatment of patients with small penis, the treatment methods for different causes are different, and the treatment plan should be decided on the basis of accurate diagnosis.
- Endocrine therapy
- Endocrine therapy is the main method for the treatment of small penis, but there is no unified opinion on the drugs, dosage forms, dosages, routes of administration, treatment options, efficacy and side effects.
- (1) Insufficiency of gonadotropin secretion Hypogonadism can be treated with GnRH pulse, gonadotropin (FSH, LH, HCG, HMG) and androgen replacement therapy, which can be used alone or in combination. The route of administration is oral, intramuscular, intradermal, inhalation (nasal spray) or topical application. The most commonly used treatment is HCG with similar functions to FSH and LH. Some people think that the combination of growth hormone (GH) and HCG in the treatment of small penis is better than HCG alone.
- (2) Abnormal gonad function, such as abnormal testosterone secretion, testosterone replacement therapy, oral testosterone undecanoate, topical testosterone cream or intramuscular injection of testosterone.
- 2. Surgical treatment
- It is suitable for those with short penis after puberty, not for infants. The main surgical method is penile extension. If the penis is too small, the patient insists on using male penis reshaping and penile prosthesis placement. Transsexuals undergo bilateral testicular resection, vulvectomy, and estrogen replacement therapy.