Saturday, August 31, 2013

Micropenis FAQ

Frequently asked questions about the micropenis condition

As you may have noticed from the "about" section of the site, I encourage anyone to send me an email if he/she has any questions regarding the micropenis condition or if there is anything else he would like to ask !

I have got some really great mails and I still encourage people to do so. So, click here if you want to contact me :)

However, in the past 6 months I have noticed a "pattern" in what people ask me and to tell you the truth it gets a bit boring answering the same questions again and again! For this reason, I have decided to create a "Micropenis FAQ", made exclusively from the most...frequently asked questions readers have send me, and the answers I have given again and again! So, without further ado, I present to you the:

Micropenis FAQ

1.  Question: "My penis is x inches long, do I have a micropenis ?", sometimes a reader sends a picture of his penis instead, asking the same question.

Answer: Consider yourself to have a micropenis if you are an adult with an erectile penile length of 3.5 inches or less. Please be aware that there are many methods to measure your penis, so make sure you have used the "proper" one that doctors actually use ! Check the "Do I have a micropenis" article, to learn how to measure your penis properly!

2. Question: "I think my son has a micropenis" or "My son has a micropenis please tell me what to do" etc

Answer: The best course of action is to take your son to a doctor (pediatrician and/or endocrinologist). If your sone is close to puberty please do it ASAP, as the effect of treatment (testosterone injections) diminishes once the patient has entered puberty.

I also suggest you to visit more than one doctor, as I have received many emails from guys who ended up with a micropenis in their adult life, because a doctor told their parents that they were normal and their penis would just grow over time (misdiagnosis)! Parents should also check this post which shows average penis size per age group and discusses the available treatment options.

3. Question: "Please help me, I have a micropenis is there any treatment" or "How can I enlarge my small penis" etc

Answer: If you check the medical literature section of the site you will see that there are currently three available options for penis enlargement:
  • Phalloplasty Surgery - Check this and this !
  • Using a certified penis extender - Sizegenetis is probably the best and most popular option, as it is approved by many doctors. Check my sizegenetics review and the sizegenetics FAQ if you want to learn more about it. There are many studies on penis extenders that prove their efficacy in enlarging a man's penis. However they take time to work. Don't expect a one night miracle!
  • HCG treatment - Check the micropenis hormone treatment for adults article. Please note that this treatment has only been tested once, in men with Idiopathic Hypogonadotrophic Hypogonadism.

4. Question: "My boyfried/husband/whatever has a micropenis, I really love him but I am seriously thinking of breaking up with him. What do you think / Do you have any advice etc"

Answer: Well, I really don't know what to answer in this question ! See a psychologist and get some professional advice. However, my honest opinion is that you have already took the decision to break-up and you are just too afraid to take action.

5. Question: "I have a micropenis. I want to talk with someone with the same problem!"

Answer: Please visit the members section or the photos section. Many of the people there have left an email for contact purposes.

6. Question: "I am a woman who wants to meet a guy with a micropenis"

Answer: Same as above

7. Question: "Is there a difference between a micropenis and a microphallus?"

Answer: Yes! A micropenis is just a very small penis. On the other hand, a microphallus is a very small penis that is also accompanied by other malformations, like epispadias. You can click here if you want to learn more about this subject.

Monday, August 12, 2013

Early Detection of Micropenis during Pregnancy

So, today we will examine a study published in 2011, in the "International Journal of Case Reports and Images" , named "Early detection of fetal micropenis after IVF-ICSI". 

In this research, the authors describe what is probably the earliest diagnosis of micropenis ever performed. While the condition is typically diagnosed sometime after birth, in this case it was diagnosed when the boy was still in the mother's womb, at the "age" of  15.5 weeks, just before the fourth month of pregnancy! The study emphasizes the importance of ultrasound and its ability to diagnose micropenis and other genital malformations during pregnancy.

The authors first mention that the micropenis term is used when the measured penile length is more than 2.5 standard deviations below the mean for age, and that it can either be isolated or the result of a syndrome (e.g. Klinefelter syndrome).

Next, they explain that possible treatment options include a course of HCG or testosterone, adding that early diagnosis is very crucial in choosing the proper treatment protocol and having a good final result.

Case Report
The authors describe the case of a primiparous - pregnant for the first time - woman, who got pregnant with the help of in vitro fertilization-intracytoplasmatic sperm injection (IVF-ICSI).

An early anatomy scan - via ultrasound - at 15.5 weeks,  revealed the baby to be a boy with a suspected micropenis with no other genital malformations. Penis length was measured and found to be 1.5 mm. The mother then had an amniocentesis which revealed a normal karyotype, 46 XY for the boy.

Following ultrasound scans found the penis length to be:
  • 2.4 mm at 20.5 weeks gestational age
  • 3.5 mm at 23 weeks
  • 4.2 mm at 28 weeks
  • 5.5 mm at 32 weeks

Image showing a fetal micropenis at 15.5 weeks of gestation
Fetal micropenis at 15.5 weeks gestation

The mother delivered normally after 38 weeks and gave birth to a 3 kg (2956 g) male infant. Psychical examination confirmed that the boy had a severe case of micropenis, with a stretched penile length of only 0,8 cm (borderline for micropenis is 2.5 cm at this age). The infant also presented with bilateral cryptorchidism

The patient soon received Human Chorionic Gonadotropin (HCG) treatment for three months without showing any improvement and later underwent three operations with "partial improvement".

Image showing a newborn with the micropenis condition
Micropenis at birth 

Conclusion & My thoughts
The authors finish their paper concluding that:
"The demonstration of the genital area during ultrasound anatomy scan is essential and important to determine normal anatomy and development. Early detection of micropenis requires detailed evaluation and multidisciplinary approach."

Now, now, diagnosing the condition so early during pregnancy is pretty impressive if you ask me! And definitely a handy tool so that the parents know what to expect before the young boy is even born!

Bashiri A, Hershkovitz R, Mazor M, Friedler JM. Early detection of fetal micropenis after IVF-ICSI. International Journal of Case Reports and Images 2011;2(10):1-5.

Tuesday, August 6, 2013

Researchers Describe New Genetic Causes Behind Isolated Micropenis

AR mutations may cause micropenis
Newly identified mutations in the AR gene may cause micropenis

Today we will examine a study named "Isolated 'idiopathic' micropenis: hidden genetic defects?" that was published in 2011, in the International journal of Andrology.

In this research, the authors discovered that isolated micropenis may also be the result of some previously unknown mutations in the AR and SF1 genes.

The study first mentions that the etiologies behind the micropenis condition vary and include:
  • Androgen resistance 5α-reductase 5αR deficiency
  • Defects in testosterone synthesis
  • Growth hormone deficiency (GHD)
  • Hypogonadotropic hypogonadism (also known as secondary or central hypogonadism)
  • Partial androgen insensitivity 
  • Testicular dysgenesis
  • Some other rare cause
  • Yet to be discovered causes
  • A combination of the above

Purpose of this study was to determine whether micropenis in patients with normal testosterone levels is the result of some hidden molecular defect in the androgen pathway that had yet to be described. 

A total of 26 boys with isolated micropenis enrolled for the study. All participants presented with:
  • 46XY karyotype
  • Normal levels of the luteinizing hormone (lutropin) and follicle-stimulating hormone
  • Normal levels of testosterone in their plasma 

During the study, the researchers sequenced the Androgen receptor (AR) and  5αR and the steroidogenic factor 1 (SF1) genes. 

A micropenis (click here for more micropenis images)

The researchers reported that they found a mutation in the AR gene in two of the patients, and a previously unknown mutation in the SF1 gene in one patient who also had a low level of inhibin B (InhB).

The authors reported that this is the first study to show that isolated micropenis may be the result of mutations in the AR and SF1 genes adding that "Anti-Mullerian hormone and InhB should thus be evaluated in patients with isolated micropenis, even when plasma testosterone is in the normal range." 

Paris F, De Ferran K, Bhangoo A, Ten S, Lahlou N, Audran F, Servant N, Poulat F, Philibert P, & Sultan C. (2011) Isolated 'idiopathic' micropenis: hidden genetic defects?. International journal of andrology, 34(6 Pt 2). PMID: 21535007

Saturday, August 3, 2013

Micropenis Associated with Decreased Nocturnal Erectile Activity

In this article, we will examine a 2005 study published in the "International journal of impotence research", named "Effect of penile size on nocturnal erections: evaluation with NPTR testing with men having micropenis".

The abstract of the study first explains that the published literature has conflicting evidence regarding the sexual function in hypogonadal men with the micropenis condition.

Purpose of the study was to evaluate the erectile functon of such men, by measuring "nocturnal penile tumescence and rigidity testing (NPTR)" and comparing their results with the scores achieved by young men with an average penile length.

Patient Profile
The researchers enrolled a total of 15 young males (from 17 to 30 years of age), all presenting with a micropenis. Their mean stretched penile length was found to be 6.8 cm (min: 3.6 cm max: 7.8 cm). 

Control Group
The control group was comprised of 22 potent and normal penile sized male young individuals (23 to 29 years old). 

Both groups completed three sessions of consecutive nights with the RigiScan Plus device (pictured below) fixed to their penis.

Photo of the RigiScan device that was used in the study
The RigiScan device

Results & My thoughts
After the experiment was finished, the researchers concluded that men with a micropenis "are associated with decreased nocturnal erectile activity".

According to wikipedia's article on "Nocturnal penile tumescence", this finding may be translated to higher incidences of physiological erectile dysfunction in men with micropenis.

Here's the abstract of the study:

"There has been conflicting opinions in the literature regarding sexual function in hypogonadal men with micropenis. In this study we aimed to evaluate erectile function in hypogonadal men with micropenis by nocturnal penile tumescence and rigidity testing (NPTR) and compared the results with young potent normal penile sized men. A total of 15 men (ages 17–30 y) defined having a micropenis with a stretched penile length of less than 9.3 cm were constituted the study group. Mean stretched penile length was 6.8plusminus1.6 cm (range 3.6–7.8 cm). Karyotype analysis showed 46XY in all cases. Control group included 22 potent and normal penile sized men (23–29 y). All subjects completed three sessions of consecutive nights using the RigiScan Plus device. Comparison of the results of NPTR of control group with study group revealed that number and duration of erectile episodes (P<0.001), duration of tip rigidity >60% (P<0.01), TAU tip and TAU base (P=0.001), and RAU base (P=0.01) were found to be significantly lower in men with micropenis. In conclusion, our study showed that men with micropenis are associated with decreased nocturnal erectile activity."

The study is available for free and you can read it by clicking the link provided down below.

Yaman O, Soygür T, Akand M, & Tokatli Z. (2005) Effect of penile size on nocturnal erections: evaluation with NPTR testing with men having micropenis. International journal of impotence research, 17(3), 243-7. PMID: 15690064