Micorpenis
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Micorpenis
From Wikipedia, the free encyclopedia
For the legal term, see Small penis rule .
^ Lee PA, Mazur T, Danish R, et al. (1980). "Micropenis. I. Criteria, etiologies and classification". The Johns Hopkins Medical Journal . 146 (4): 156–63. PMID 7366061 .
^ ScienceDaily.com (2004). " Surgeons Pinch More Than An Inch From The Arm To Rebuild A Micropenis ," 6 Dec. 2004, URL accessed 2 April 2012.
^ Center for Disease Control. "DES Update: Consumers" .
^ Hatipoglu N, Kurtoglu S (December 2013). "Micropenis: Etiology, Diagnosis and Treatment Approaches" . Journal of Clinical Research Pediatric Endocrinology . 5 (4): 217–223. doi : 10.4274/Jcrpe.1135 . PMC 3890219 . PMID 24379029 .
^ "Hypogonadism" . The Lecturio Medical Concept Library . Retrieved 26 July 2021 .
^ Ishii T, Sasaki G, Hasegawa T, Sato S, Matsuo N, Ogata T (2004). "Testosterone enanthate therapy is effective and independent of SRD5A2 and AR gene polymorphisms in boys with micropenis". J. Urol . 172 (1): 319–24. doi : 10.1097/01.ju.0000129005.84831.1e . PMID 15201804 .
^ McMahon DR, Kramer SA, Husmann DA (1995). "Micropenis: does early treatment with testosterone do more harm than good?". J. Urol . 154 (2 Pt 2): 825–9. doi : 10.1016/S0022-5347(01)67175-1 . PMID 7609189 .
^ Hatipoglu N, Kurtoglu S (December 2013). "Micropenis: Etiology, Diagnosis and Treatment Approaches" . Journal of Clinical Research Pediatric Endocrinology . 5 (4): 217–223. doi : 10.4274/Jcrpe.1135 . PMC 3890219 . PMID 24379029 .
^ Calikoglu AS; Calikoglu, A (1999). "Should boys with micropenis be reared as girls?". J. Pediatr . 134 (5): 537–8. doi : 10.1016/S0022-3476(99)70236-2 . PMID 10228285 .
Male congenital anomalies of the genitalia, including Intersex and DSD
Micropenis is an unusually small penis . A common criterion is a dorsal (measured on top) erect penile length of at least 2.5 standard deviations smaller than the mean human penis size , [1] The condition is usually recognized shortly after birth . The term is most often used medically when the rest of the penis, scrotum , and perineum are without ambiguity , such as hypospadias . Micropenis occurs in about 0.6% of males. [2]
Of the abnormal conditions associated with micropenis, most are conditions of reduced prenatal androgen production or effect, such as abnormal testicular development (testicular dysgenesis), Klinefelter syndrome , Leydig cell hypoplasia , specific defects of testosterone or dihydrotestosterone synthesis ( 17,20-lyase deficiency , 5α-reductase deficiency ), androgen insensitivity syndromes , inadequate pituitary stimulation ( gonadotropin deficiency), and other forms of congenital hypogonadism . Micropenis can also occur as part of many genetic malformation syndromes that do not involve the sex chromosomes. It is sometimes a sign of congenital growth-hormone deficiency or congenital hypopituitarism . Several homeobox genes affect penis and digit size without detectable hormone abnormalities. [ citation needed ]
In addition, in utero exposure to some estrogen based fertility drugs like diethylstilbestrol (DES) has been linked to genital abnormalities or a smaller than normal penis. [3]
After evaluation to detect any of the conditions described above, micropenis can often be treated in infancy with injections of various hormones , such as human chorionic gonadotropin and testosterone . [4]
Growth of the penis both before birth and during childhood and puberty is strongly influenced by testosterone and, to a lesser degree, the growth hormone . However, later endogenous hormones mainly have value in the treatment of micropenis caused by hormone deficiencies, such as hypopituitarism or hypogonadism . [5]
Regardless of the cause of micropenis, if it is recognized in infancy, a brief course of testosterone is often prescribed [6] (usually no more than three months). This usually induces a small amount of growth, confirming the likelihood of further growth at puberty, but rarely achieves normal size. No additional testosterone is given during childhood, to avoid unwanted virilization and bone maturation . (There is also some evidence that premature administration of testosterone can lead to reduced penis size in the adult.) [7]
Testosterone treatment is resumed in adolescence only for boys with hypogonadism. Penile growth is completed at the end of puberty, similar to the completion of height growth , and provision of extra testosterone to post-pubertal adults produces little or no further growth. [8]
Because hormone treatment rarely achieves average size, several surgical techniques similar to phalloplasty for penis enlargement have been devised and performed, but they are not generally considered successful enough to be widely adopted and are rarely performed in childhood. [ citation needed ]
In extreme cases of micropenis, there is barely any shaft, and the glans appears to sit almost on the pubic skin. From the 1960s until the late 1970s, it was common for sex reassignment and surgery to be recommended. This was especially likely if evidence suggested that response to additional testosterone and pubertal testosterone would be poor. With parental acceptance, the boy would be reassigned and renamed as a girl, and surgery performed to remove the testes and construct an artificial vagina . This was based on the now-questioned idea that gender identity was shaped entirely from socialization, and that a man with a small penis can find no acceptable place in society. [ citation needed ]
Johns Hopkins Hospital , the center most known for this approach, performed twelve such reassignments from 1960 to 1980, [ citation needed ] most notably [ citation needed ] that of David Reimer (whose penis was destroyed by a circumcision accident), overseen by John Money . By the mid-1990s, reassignment was less often offered, and all three premises had been challenged. Former subjects of such surgery, vocal about their dissatisfaction with the adult outcome, played a large part in discouraging this practice. Sexual reassignment is rarely performed today for severe micropenis (although the question of raising the boy as a girl is sometimes still discussed). [9]
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Verywell Health's content is for informational and educational purposes only. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Ⓒ 2022 Dotdash Media, Inc. — All rights reserved
Verywell Health is part of the Dotdash Meredith publishing family.
Jerry Kennard, PhD, is a psychologist and associate fellow of the British Psychological Society.
Matthew Wosnitzer, MD, is a board-certified urologic surgeon and physician scientist. He specializes in male infertility.
Micropenis is an extremely rare condition that occurs in only 1.5 per 10,000 male children in the United States. 1 The term is used when the penis is abnormally small compared to other normal-sized genital structures, including the scrotum, testicles, and perineum.
Micropenis is the result of abnormal fetal development. Experts believe it is triggered by a genetic aberration or hormonal abnormalities.
This article discusses the symptoms, causes, and diagnosis of a micropenis. It also covers the treatments available and ways to cope.
At birth, a penis that is less than 0.75 inches in length is considered a micropenis. As an adult, a flaccid penis less than 2.75 inches in length is considered a micropenis. An erect penis is considered a micropenis if it is less than 5 inches in length. 1
A micropenis develops during gestation or before the baby is born. It will often be the only abnormality noted in the pregnancy. 1
One of the possible causes of this is the low production of human chorionic gonadotropin (hCG) during the early part of the pregnancy. This is a hormone that stimulates the developing testes to produce testosterone . 1
After 14 weeks, the growth of the penis falls under the influence of another hormone, known as luteinizing hormone (LH). LH also stimulates testosterone in the so-called Leydig cells of the testicles. If the production of LH or testosterone is blocked, the child's penis length may be affected. 1
Genetics may also play a role. While there is no single gene that causes a micropenis, the condition is commonly linked to such chromosomal disorders as: 2
There is also evidence that estrogen-based fertility drugs like diethylstilbestrol (DES) may cause smaller-than-normal penis size if taken during early pregnancy. 3
While environmental pollutants are a less common cause, some research suggests that exposure to chlorinated pesticides during pregnancy may cause micropenis and other genital abnormalities in male babies. 4
In newborns, a healthcare provider must take a proper measurement of the baby's penis when diagnosing micropenis. They will measure the stretched penis length (SPL) rather than flaccid or loose. This more closely correlates to the erect penis length in boys and men. 1
For this, the healthcare provider needs to hold a rigid ruler firmly against the pubic bone at a right angle. The penis is then held at the sides with a tool just below the glans (head). It's stretched to its maximum length without pain. Newer syringe-like tools can be placed over the penis and suction the organ to its fully stretched length. 1
Correctly identifying a micropenis in babies is crucial as it offers the opportunity for a potentially effective treatment. The healthcare provider should also explore conditions commonly associated with a micropenis. These include problems with the pituitary gland , which produces hormones, or the hypothalamus , which controls the pituitary gland. 1
For full-term newborns, a micropenis is defined as an SPL of less than 1.9 centimeters. For older boys and men, it's characterized by a penis length that's 2.5 standard deviations (SD) smaller than the average for the age. 1
As a guideline, the Harriet Lane Handbook from John Hopkins University defines micropenis as follows: 5
The variations in average penis size from age 7 are due to the differences in development as boys approach puberty. By puberty, it becomes far more difficult to define micropenis by centimeters alone. Mathematical calculations are needed until puberty is complete.
While the clinical definition of a micropenis seems to offer a definitive roadmap for diagnosis, that's not always the case. This is especially true in boys over the age of 8.
Most prepubescent boys brought in by their parents because of an underdeveloped penis rarely have a micropenis. In most cases, the boy is either experiencing delayed puberty or obesity (obscuring the penis length with excessive pubic fat). Or he simply has a larger frame compared to an otherwise normal penis.
In cases like these, the term "inconspicuous penis" may be more appropriately applied. It may be secondary to congenital conditions such as penoscrotal webbing. This is a condition where the scrotum extends up the underside of the penis, creating an indistinct junction between the two.
Another possible diagnosis is a megaprepuce in which the foreskin cannot retract and balloons abnormally. 6
The treatment of micropenis will vary between children and adults. Given that the genitals of babies and toddlers are still developing, testosterone treatment can support penis growth, often significantly. Surgical options, while limited, may be explored in boys and men whose penises have reached their maximum growth.
Depending on the treatment plan, the medical team may include a pediatrician , urologist, endocrinologist , geneticist, or psychologist.
A micropenis can be treated in infants and children with three monthly intramuscular (IM) injections of testosterone. Research shows one or two courses of three testosterone shots (25 to 50 milligrams) can increase penis size to the appropriate age range. The shots should be given in four-week intervals. 1
For a male baby with a micropenis, circumcision should be delayed until the testosterone therapy is completed. Generally speaking, the therapy is most effective in children under 3 but may benefit boys up to the age of 8.
In the past, young children with a micropenis often underwent gender reassignment surgery . This was more in response to a general cultural discomfort with small penis size rather than a real medical need. 7
Today, that practice has largely subsided, with most experts questioning its wisdom. They cite the benefits of testosterone therapy, the need for lifelong male-to-female hormone therapy in later life, and the lack of individual consent.
If pursued, gender reassignment would generally be considered at a later age. That way, the child has the ability to make an informed choice and has undergone extensive psychological evaluation.
Some men with a micropenis will opt to undergo penis enlargement surgery (phalloplasty) with varying degrees of success. One such operation, called a suspensory ligament release, involves the detachment of the ligament that supports the penis during an erection. 8
Doing so allows the penis to lie at an obtuse rather than an acute angle, creating the perception of greater length. Potential risks include nerve damage, loss of penile sensation, and erectile dysfunction. It could also lead to the retraction of the penis if scar tissue develops at the incision site. 8
Other forms of phalloplasty, such as flap surgery (grafting skin from another of the body), are less commonly pursued. That's because they carry a considerable risk of complications and may interfere with sexual function.
Other techniques are more likely to increase the girth rather than the length of the penis. These include silicone implants (prostheses), synthetic dermal fillers, and subcutaneous fat injections. Even if length gains are achieved, it would only affect the flaccid length. The erect length would remain the same.
There are also commercially marketed penis pumps and stretchers that have not demonstrated consistent results in delivering gains in penis length. If achieved, they tend to be modest at best. These devices are intended for males with erectile dysfunction—an entirely separate concern.
From a practical standpoint, a micropenis may complicate urination by making it difficult to direct the stream. Many men will simply compensate for this by sitting on the toilet when urinating.
On a more significant note, a penis length of fewer than 2 inches is associated with a lower likelihood of conception. 9 Moreover, some men with a micropenis will have a low sperm count as the result of an underlying pituitary disorder.
In such cases, assisted reproductive techniques are available to significantly improve one's chances of conceiving.
While there are treatments that may enhance penis size, the reality is that some individuals will have a smaller-than-normal penis. Some people assume that this will cause inherent psychological harm. However, those beliefs are more reflective of our cultural attitudes about penis size rather than the person's individual experience.
Long-term research shows that men with micropenises have similar masculine self-images as men of average or above-average penis size. 10
A micropenis doesn't interfere with a man's libido, sexual function, sexual satisfaction, erection ability, or capability for mutually gratifying sexual relationships. 11
Micropenis is a rare condition that's the result of abnormal fetal development. It can be due to genetic conditions or low hormone production. Healthcare providers will measure a newborn baby's penis to help diagnose the condition.
Early detection is important for effective treatment, which may include testosterone therapy.
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Hatipoğlu N, Kurtoğlu S. Micropenis: etiology, diagnosis and treatment approaches. J Clin Res Pediatr Endocrinol. 2013;5(4):217-23. doi:10.4274/Jcrpe.1135
Walia R, Singla M, Vaiphei K, Kumar S, Bhansali A. Disorders of sex development: a study of 194 cases. Endocr Connect. 2018;7(2):364-371. doi:10.1530/EC-18-0022
Johns Hopkins Hospital, Kleinman K, McDaniel L, Molloy M. The Harriet Lane Handbook: The Johns Hopkins Hospital (Mobile Medicine) . 22nd ed. Elsevier; 2020.
Srinivasan AK, Palmer LS, Palmer JS. Inconspicuous penis. ScientificWorldJournal. 2011;11:2559-64. doi:10.1100/2011/238519
Campbell J, Gillis J. A review of penile elongation surgery. Transl Androl Urol. 2017;6(1):69-78. doi:10.21037/tau.2016.11.19
Tsang, S. When size matters: A clinical review of pathological micropenis. J Ped Health Care. 2010;24(4):231-40. doi:10.1016/j.pedhc.2009.05.001
Lee PA, Houk CP. Outcome studies among men with micropenis. J Pediatr Endocrinol Metab. 2004;17(8):1043-53.
Srinvasan, A.; Palmer, L.; and Palmer, J. Inconspicuous Penis. Sci World J. 2011;11:2559-64. DOI: 10.1100/2011/238519.
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Less than 2.3 centimeters (0.9 inches)
Less than 2.6 centimeters (1.02 inches)
Less than 2.9 centimeters (1.14 inches)
Less than 3.3 centimeters (1.3 inches)
Less than 3.5 centimeters (1.38 inches)
Less than 3.8 centimeters (1.5 inches)
Less than 3.9 centimeters (1.54 inches)
Less than 3.7 centimeters (1.46 inches)
Less than 3.8 centimeters (1.5 inches)
Less than 3.8 centimeters (1.5 inches)
Less than 3.7 centimeters (1.46 inches)
Less than 9.3 centimeters (3.66 inches)
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