**By Una Lee, MD**
Since writing the post “Five Things Worth Knowing about the Vagina,” I’ve been meaning to give equal time to the complex organ belonging to the other team: the penis. As a urologist, I’m committed to demystifying the parts of our bodies that we all wonder about. Knowledge is power, especially when you are the one in the know and your friends are floundering with questions.
1) What you see is not all you get. Here’s something that will change the way you view a penis: Up to half of the length of the erectile organ is actually tucked up inside the body. That’s right, a significant part of the penis is invisible, attached to the pubic bone by a suspension ligament. Still, that’s little comfort for men who may be feeling “insufficient.”
So when does size matter? Given the average erect penis size is between 5.1 and 5.7 inches (remembering average means half are smaller, half are larger), only penises less than 3 inches long when erect are considered unusually small. What’s more, there is no consistent relationship between the size of a flaccid penis and an erect one. So don’t assume that a man with a big appearing penis gets much bigger with an erection. Similarly, a flaccid penis that looks small can still, well, rise to the occasion. And when you consider that on average sexual intercourse lasts two to three minutes (not hours), penis size may not be the biggest consideration.
2) Penile curvature is common. Penises vary in shape and size, and some males are born with penile curvature. While a mild curvature isn’t generally a cause for concern, an excess of scar tissue inside the penis, known as Peyronie’s disease, may cause pain, problems getting an erection or having intercourse. As long as you are able to have intercourse no treatment is generally needed. If the penis bends more than 30 degrees and interferes with intercourse and/or causes distress and pain, there are treatment options. Seeing a urologist who specializes in the condition is important, as treatment may involve medication, surgery and other therapies.
3) Erectile function is a barometer of a man’s health. To get erect, the penis must become engorged with blood. Diseases that impair the arteries and blood vessels, such as diabetes, high blood pressure and cardiovascular disease, can obstruct the blood flow needed to get and keep an erection. Even in seemingly healthy men, studies over the last decade have shown erectile dysfunction (ED) can be an early predictor of their risk of developing heart disease. That’s why it’s a good idea for men over 45 who are experiencing ED to consider lifestyle changes like quitting smoking, a better diet and exercise, along with a plan to visit their doctor. In the meantime, help is definitely available for ED related to blood flow in the form of medications we’ve all seen the ads for (though I’m not sure what a guy does with an erection in a separate bath tub from his partner).
There are also “psychogenic” causes of ED, which encompass psychological factors such as stress, anxiety, depression, relationship problems or other mental health issues. Your brain is also a sex organ, so anything that disrupts normal thoughts and feelings, such as a traumatic life event, can cause ED. Professional counselling can be the key to overcoming this cause of ED.
4) Circumcision rates vary greatly around the world. According to the World Health Organization, 30 percent of males aged 15 and over are circumcised worldwide. Circumcision is a common practice in the Jewish and Islamic faiths, and traditional in some African communities. Circumcision is much less common in the United Kingdom, where it is not funded by the National Health Service except when medically necessary.
In the U.S. about 60 percent of newborns are circumcised. While there is some evidence that circumcision may slightly decrease a man’s risk of getting HIV, some sexually transmitted infections and penile cancer, the American Academy of Pediatrics has stated that circumcision is a personal decision best left to the parents of the newborn child.
5) The penis can break, and it’s an emergency. I saved the hardest to read for last: A penis can break. While there is no penis “bone,” thick tissue that surrounds the erectile tissue can rupture and bleed. Called penile fracture, the injury most commonly occurs during sexual intercourse when the woman is on top. It can also happen if a man is thrusting too hard during sex and forcefully hits his partner’s pubic bone. There is usually a popping sound, an immediate loss of the erection, followed by purplish bruising as the blood escapes. If it’s a true penile fracture, the tear needs immediate surgical repair (ideally within 24 hours), so seek medical attention right away.
Una Lee, MD, is board certified in Urology and subspecialty certified in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) at Virginia Mason. The Sexual Health Clinic at Virginia Mason in Seattle provides expert consultation and treatment of sexual dysfunction and related problems for both men and women. To schedule an appointment, call (206) 223-6772.