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| LUKE BLACKFORD AND CHUCK CAMPBELL | |||
| {{Infobox_Disease | |||
| | Name = Micropenis | |||
| | Image = Flacid_micropenis2_highres.jpg | |||
| | Caption = A flaccid micropenis | |||
| | DiseasesDB = 14839 | |||
| | ICD10 = | |||
| | ICD9 = {{ICD9|752.64}} | |||
| | ICDO = | |||
| | OMIM = | |||
| | MedlinePlus = | |||
| | eMedicineSubj = ped | |||
| | eMedicineTopic = 1448 | |||
| | MeshID = }} | |||
| '''Micropenis''' is a medical term that describes an unusually small ]. A common criterion is a dorsal (measured on top) erect ] of at least 2.5 ]s smaller than the ] ].<ref name="pmid7366061">{{cite journal |author=Lee PA, Mazur T, Danish R, ''et al'' |title=Micropenis. I. Criteria, etiologies and classification |journal=The Johns Hopkins medical journal |volume=146 |issue=4 |pages=156–63 |year=1980 |pmid=7366061 |doi=}}</ref> The condition is usually recognized shortly after ]. The term is most often used medically when the rest of the penis, ], and ] is without ] such as ]. | |||
| ==Causes== | |||
| ] penis with the micropenis condition.]] | |||
| Of the abnormal conditions associated with micropenis, most are conditions of reduced prenatal ] production or effect. Examples include abnormal testicular development (], ], ]), specific defects of ] or dihydrotestosterone synthesis (], ]), ]s, inadequate ] stimulation (] deficiency) or other forms of congenital ]. Micropenis can also occur as part of many genetic malformation syndromes not involving the sex chromosomes. It sometimes is a sign of congenital ] or congenital ]. Finally, several ] genes have been identified which affects penis and digit size without detectable hormone abnormalities. | |||
| After evaluation to detect any of the conditions described above, micropenis can often be treated in infancy with injections of various ]s, such as ] or ]. | |||
| Most eight to fourteen year old boys referred for micropenis do not have the micropenis condition. Such concerns are usually explained by one of the following: | |||
| # a penis concealed in ] (extra fat around the mons pubis). | |||
| # a large body and frame for which a prepubertal penis simply appears too small. | |||
| # ] with every reason to expect good future growth. | |||
| ==Treatment== | |||
| ===Hormone treatment=== | |||
| ] | |||
| Growth of the penis both before birth and during childhood and puberty is strongly influenced by ] and, to a lesser degree, ], but their value in the treatment of micropenis is mainly limited to conditions of hormone deficiency such as ] or ]. | |||
| Regardless of the cause of micropenis, if it is recognized in infancy, a brief course of testosterone is often prescribed<ref name="pmid15201804">{{cite journal |author=Ishii T, Sasaki G, Hasegawa T, Sato S, Matsuo N, Ogata T |title=Testosterone enanthate therapy is effective and independent of SRD5A2 and AR gene polymorphisms in boys with micropenis |journal=J. Urol. |volume=172 |issue=1 |pages=319–24 |year=2004 |pmid=15201804 |doi=10.1097/01.ju.0000129005.84831.1e}}</ref> (usually no more than 3 months). This will usually induce 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 ] and ]. (There is also some evidence that premature administration of testosterone can lead to reduced penis size in the adult.)<ref name="pmid7609189">{{cite journal |author=McMahon DR, Kramer SA, Husmann DA |title=Micropenis: does early treatment with testosterone do more harm than good? |journal=J. Urol. |volume=154 |issue=2 Pt 2 |pages=825–9 |year=1995 |pmid=7609189|doi=10.1016/S0022-5347(01)67175-1}}</ref> | |||
| Testosterone treatment is resumed in adolescence only for boys with hypogonadism. Penile growth is completed at the end of puberty, similarly to the completion of ], and provision of extra testosterone to post-pubertal adults will produce little or no further growth. | |||
| ===Surgery=== | |||
| Because hormone treatment rarely achieves average size, a number of surgical techniques like ] for ] have been devised and performed but are not generally considered successful enough to be widely adopted and are rarely performed in childhood. | |||
| 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 not unusual for ] and ] to be recommended. This was especially likely if evidence suggested that response to additional testosterone and pubertal testosterone would be poor. If parents accepted, the boy would be reassigned and renamed as a girl, and surgery performed to remove the testes and construct an artificial ]. This was based on three now questioned assumptions: | |||
| #gender identity and sex differences were solely a matter of social learning rather than biology. | |||
| #a male with a penis too small to put into a vagina could not find a satisfactory social and sexual place in society. | |||
| #a functionally acceptable vagina could be constructed surgically. | |||
| The center most known for this approach (]) performed twelve such reassignments between 1960 and 1980, most notably, that of ], overseen by Dr. ]. By the mid-1990s reassignment was less often offered, and all three premises had been challenged. Former subjects of such surgery, vocally dissatisfied with adult outcome, played a large part in discouraging this practice. As a result, sexual reassignment is rarely performed today for severe micropenis (although the issue of raising the child as a girl is sometimes still discussed.)<ref name="pmid10228285">{{cite journal |author=Calikoglu AS |title=Should boys with micropenis be reared as girls? |journal=J. Pediatr. |volume=134 |issue=5 |pages=537–8 |year=1999 |pmid=10228285 |doi=}}</ref> Much inaccurate or exaggerated folklore on this topic is available on the internet. (See ] for a more complete discussion of this issue.) | |||
| ==See also== | |||
| * ] | |||
| * ] | |||
| * ] | |||
| ==References== | |||
| <references/> | |||
| ==External links== | |||
| *, by Melissa Hendricks, '']'' | |||
| *, from '']'' (]) | |||
| * from the '']'' | |||
| {{Congenital malformations of genital organs and urinary system}} | |||
| ] | |||
| ] | |||
| ] | |||
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Revision as of 04:48, 28 July 2008
LUKE BLACKFORD AND CHUCK CAMPBELL