Archive for November 29, 2015

Small Penis

Q. My penis is so small that only the head can be seen when it is soft. When erect it looks normal. Somehow or other, the fatty tissue at the base of the shaft is quite pronounced, and it envelops the shaft, leaving only the head to be seen. Walking around the men’s shower is really embarrassing. I’m 45, and I’ve had this problem all my life. Can anything be done to correct this affliction?

A. The situation you describe may be what is called a “buried penis.” This means that when you were born, the shaft skin did not develop properly, and the penis itself lies buried under the skin of the prepubital fat pad. Many times men with this condition only see the head of their penis until they have an erection and the penis protrudes from the fat pad.

The condition is easy to diagnose by your physician simply looking at the penis and determining if there is sufficient shaft skin. When the doctor pulls on the head of the penis, the shaft skin should be long enough to allow lengthening of the penis without stretching the scrotum or body skin.

Treatment of a buried penis is rather difficult. It may require a plastic surgeon to create new skin for the shaft of the penis to get it out from underneath the fat pad. The results, however, can be excellent, and the penis can look normal.

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Erection Points Up

Q. When I have an erection, my penis points straight up. I experience a lot of pain when I try to lower it. This makes it really hard for me to try different positions with my lover. Is there surgery or anything else I can do to make my erection more perpendicular instead of parallel to my stomach?

A. From what you are describing, it sounds like you might have a condition called Peyronie’s disease. Don’t be alarmed; this is not dangerous or contagious. It refers to a specific type of curvature caused by a scar inside the penis.

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Bent Penis

Q. After years of being normal, at age 42, my penis took a bend of about a 45-degree angle halfway down. What might cause this, and can it be returned to normal?

A. Peyronie’s disease is often the cause of painful erections, difficulty achieving or maintaining erections and curvature of the penis with erections. Peyronie’s is described as an inflammation of the blood-filled corpora cavernosa (penile erector sets). Patients can often feel a firm plaque at the site of the bend in the penile shaft. Connective tissue disorders such as Dupuytren’s contracture, trauma to the penile shaft, and infection have been thought to cause this condition.

While sometimes the condition resolves by itself, surgery may be necessary to remove the scar-like plaques that interfere with the normal blood-filling of the corpora cavernosa at the time of arousal and erection. Following surgery, a penile prosthesis may be necessary to achieve satisfactory intercourse. Other treatments have been tried, but with limited success.

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Urinary, Ejaculation Problems after TURP

Q. Five months ago I had my prostate removed through my penis. The doctors recommended this procedure because I had difficulty urinating and the gland was swollen. The surgery was difficult and painful. Now I have no pressure when I urinate. It drips out. Also, there is no sperm when I ejaculate. I do get the sensation in both cases. Is this something I should expect? Can surgery correct this condition?

A. The procedure you describe is known as a transurethral resection of the prostate, or TURP. It involves “shelling out” the prostate using an instrument that is inserted into the penis with a special scope. The prostate tissue that is blocking the outflow of urine is resected, allowing improved urine flow.

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Alcohol for Premature Ejaculation?

Q. I just read your article about Overcoming Premature Ejaculation, which described some drugs that a man might be able to take. The drugs were all antidepressants. I think I have a premature ejaculation problem, and for me, if I have a couple of beers first, I don’t have the problem. Alcohol is a depressant, isn’t it? Is it possible that alcohol could work as a cure for this?

A. Alcohol is not a cure for anything. It is true that alcohol is a depressant, and it may lower inhibitions and soothe some psychological causes for premature ejaculation, such as performance anxiety and the fear of failure. But this is a temporary solution, and simply serves as a way of avoiding the problem rather than solving it.

When a man has a complex about his sexual performance, it can ruin all the pleasure that comes naturally with being intimate with someone else. The man becomes so preoccupied with worrying about climaxing too quickly, he can’t enjoy himself or please his mate. In addition, having fears of not satisfying your mate before you actually start can lead to a fear of failure and performance anxiety. Once this cycle of stress is triggered, premature ejaculation is inevitable.

To break the cycle, talk to your mate. Don’t be afraid to say, “I’m worried about climaxing too soon — can we go slowly?” Then work your way into lovemaking at a pace you are comfortable with. If your mate cares for you, nothing but good will follow.

If you are still not satisfied with your sex life, then seek medical help. You might see either a psychiatrist (a specialist with a medical degree) or a psychologist or other trained therapist. But never use alcohol or other drugs as a cure. That sort of behavior has been shown to lead to addictions. If you think alcohol can make you last longer sexually, then you may need a different sort of help.

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Ejaculation During Bowel Movement

Q. What might be the cause of ejaculating while having a bowel movement? Should this be a concern?

A. It is not uncommon for some men to expel some semen when they have a bowel movement. Most of the fluid that comes out during ejaculation comes from the seminal vesicles and the prostate. Both of these organs sit up against the rectum. (That is why the doctor inserts a finger in the rectum to examine these organs.) Sometimes, a large bowel movement can place enough pressure on these organs to force some semen into the urethra and out of the penis. This is not a cause for concern.

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Man Can’t Reach Orgasm with Partner

Q. I have been with six different partners in two years since I lost my virginity, but I have only orgasmed for the first girl. What’s wrong with me? I can orgasm by masturbating, but when I get in the bedroom with a girl, I never can achieve an orgasm. This keeps frustrating girlfriends, and my relationships go down the drain. How can I overcome this? I’m with a girl right now I really like, and even after just one time, she’s already frustrated because I made her orgasm but she didn’t make me.

A. You can achieve orgasm when you are alone, so there is nothing physically preventing you from getting to that point. The problem you are experiencing is a common one. In order to experience orgasm, a man must be able to relax to a certain degree. Tension and worry are not conducive to orgasm. You are obviously concerned about this problem, and your fear of not being able to have an orgasm is actually worsening the problem.

You will be able to overcome this problem, but it will take the assistance of an understanding partner. Try involving your partner actively in this. Take things in a slow, step-by-step manner. You can learn relaxation techniques to help deal with your anxiety. Understand that this is a common problem. If you and your partner cannot overcome it yourselves, a sex therapist or psychologist can train you in techniques that will help.

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Prostate Treatment & Retrograde Ejaculation

Q. I am 50, and I have suffered from BPH for a few years now. Recently I had an ultrasound and biopsies (negative) of the right and left lobules. I also had cystoscopy of the bladder. What exactly is the cystoscopy procedure about? I had been told that it involves a transurethral procedure and may cause retro-ejaculating problems.

A. It sounds as though you’re confusing two similar procedures that have different purposes and effects. A cystoscopy is a common diagnostic procedure in which a doctor passes a tiny telescopic lens through your urethra (the tube that carries urine out of the penis) up to your bladder. This can be done in the office, with either a rigid or flexible scope that enables the doctor to view the entire surface of the lining of the bladder. Cystoscopy is usually performed when blood is found in the urine, or if there are other signs of a problem with the bladder.

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Post-Ejaculatory Pain after Prostate Removal

Q. After having a radical prostatectomy one year ago, I am experiencing post-“ejaculatory” pain that is increasing in severity and frequency. What is the cause, and is there any treatment?

A. I have seen several patients suffering from pelvic pain following ejaculation. As in your case, these men had radical prostatectomies (removal of the prostate). Post-ejaculatory pain after radical prostate surgery appears to be due to the cutting and clamping of the vas. In order to remove the prostate and seminal vesicles, the surgeon must clip and cut the sperm duct (vas) from each testicle. This has been known to cause post-ejaculatory pain.

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Severe Headaches with Sex

Q. When I have sex or masturbate, I get severe headaches as I get close to orgasm. The pain is behind my left ear and in the back of my head and neck. This headache sometimes makes me sick to my stomach. The first time I got this headache, I heard a pop in the back of my head. What is causing this, and how can I get rid of it?

A. I would recommend you see a neurologist as soon as you can. You see, during ejaculation, a man’s blood pressure and heart rate both rise. This is normally part of the nervous system’s response to the climax. This is why some men who have coronary artery disease suffer heart attacks during sex. In your case, I am concerned that you might have an aneurysm in one of small blood vessels in your brain. An aneurysm is a weak spot in a blood vessel wall. When your blood pressure goes up during sexual activity, such an aneurysm might swell, causing pain and pressure.

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