Adolescent Section: Indications for Penile Curvature, Morning Erection, and Circumcision

**31. Is it normal for the penis to be curved during erection?**

Many men are very worried when they find their penis is curved during erection. Actually, if the angle of curvature is not too large and doesn't change over a long period, there's generally no need to worry. Penile curvature during erection is common; statistics show that only about 30% of men have a completely straight penis during erection, while the other two-thirds have varying degrees of curvature. However, if the curvature is significant, it's necessary to seek medical attention promptly.

Excessive penile curvature can be caused by both congenital and acquired factors. Congenital curvature is mainly due to uneven development of the two corpora cavernosa on the sides of the penis during puberty. In a small number of patients, the corpora cavernosa on the same side may also develop unevenly in terms of height, direction, left and right, resulting in a certain angle of curvature. Acquired factors such as penile trauma, pelvic fractures, and Peyronie's disease can also cause curvature during erection.

Generally speaking, as long as the curvature is not too severe and does not affect sexual life, it is considered normal. When the penis is erect, a forward curvature angle of no more than 40° and a backward, left, or right curvature angle of no more than 30° are all within the normal range. However, if it exceeds this range or affects sexual life, you should seek medical attention promptly for treatment.

**32. Why do morning erections occur?**

Morning erection refers to the spontaneous erection of the penis in men between 4 and 7 a.m., occurring unconsciously and without the control of circumstances, actions, or thoughts. Morning erection is a normal physiological phenomenon, and while its exact mechanism is not yet fully understood, several factors can influence it.

(1) After reaching sexual maturity, morning erections become more frequent and last longer with age. After age 30, morning erections gradually weaken or decline with age.

(2) Sleep: Whether the sleep time is sufficient and the quality of sleep will affect the secretion of male hormones to varying degrees, thus affecting morning erection.

(3) Mental factors: Severe mental trauma, excessive grief and anger, depression, etc. can significantly reduce morning erection. Such people are slow to start or unable to start during the day; excessive fatigue and mental exhaustion can also affect morning erection.

(4) Diseases Many diseases can affect sexual function and morning erection, such as hypertension, diabetes, lumbar disc herniation, coronary heart disease, tuberculosis, spinal cord injury, sexually transmitted diseases, etc.

(5) Drugs: Anti-tumor drugs, antihypertensive drugs, hypoglycemic drugs, antacids, sedatives, and traditional Chinese medicines such as Anemarrhena asphodeloides and Phellodendron chinense can all reduce the frequency of morning erections, while drugs such as ginseng, Astragalus membranaceus, deer antler, deer penis, seal kidney, and wolfberry can increase the frequency of morning erections.

(6) Holding urine causes excessive urine storage in the bladder, which increases the pressure inside the bladder and produces a stimulating effect, which can cause a subconscious reflex erection of the penis. This is often referred to as "getting hard from holding in urine".

(7) Unhealthy lifestyle habits such as excessive smoking, drinking, and irregular work and rest times can also affect morning erection.

**33. Is surgery always necessary for phimosis?**

Phimosis refers to a condition where the foreskin covers the urethral opening but can be retracted to expose the glans penis and urethral opening; while in cases of paraphimosis, the foreskin cannot be retracted. Phimosis is divided into true phimosis and pseudo-phimosis. True phimosis is when the glans penis cannot be exposed after erection, while pseudo-phimosis allows the glans penis to be fully exposed after erection.

Phimosis (excess foreskin) can affect urination and increase the risk of infection. When the foreskin is too long, the urine flow is obstructed, causing it to split and easily soak clothing. The sebaceous glands under the foreskin secrete smegma, which, if not cleaned promptly, allows bacteria to proliferate, leading to balanitis and, in severe cases, urethral inflammation. Long-term inflammation can cause urethral stricture, resulting in difficulty urinating, and further development can lead to hydronephrosis and kidney damage. Phimosis can also affect penile growth and development. Because the glans penis is tightly covered by the foreskin, it does not receive adequate external stimulation, potentially restricting its development and even causing depression and low self-esteem in children. Furthermore, because the glans penis cannot have proper contact with the outside world due to phimosis, local nerve sensitivity is quite high, easily leading to premature ejaculation. These patients should seek medical treatment as soon as possible and undergo circumcision. For patients with inflammation who cannot undergo surgery temporarily, they should keep the external genitalia clean, wash the penis daily, and avoid relying on folk remedies. Surgical treatment should be performed promptly after the inflammation has healed.

Currently, circumcision is recommended before marriage for men with phimosis. This is because men with phimosis may introduce bacteria and smegma into the vagina during sexual intercourse, causing genital inflammation in their sexual partners. However, for some patients with phimosis who do not experience inflammation and who consistently retract and clean their foreskin without affecting their sex life, surgery may not be necessary.