Men's Health: A Scientific Understanding of Physical Development and Healthy Behaviors

What's the difference between phimosis and paraphimosis?

In most adult men, the glans penis is exposed, but in about one-third of men it's covered by the foreskin. This is the common condition known as phimosis or paraphimosis.

Phimosis occurs when the foreskin completely covers the glans penis and even the urethral opening. However, the foreskin circumference is not small, and it can be retracted to expose the glans without any tightness or pressure marks. Newborns and infants may have adhesions between the foreskin and the glans penis. These adhesions usually resolve in the first year, allowing the penis to separate and become exposed. Therefore, phimosis in children is not abnormal. However, if the glans penis still cannot be naturally exposed after puberty, it is called phimosis.

Phimosis, on the other hand, refers to a condition where the foreskin opening is too small, and the foreskin cannot be retracted, only revealing a pinhole-sized opening or just a small portion of the glans penis. Phimosis can be further divided into congenital and acquired phimosis. The former refers to a congenital developmental abnormality of the penis; the latter is caused by inflammation or trauma leading to a narrow foreskin opening, preventing the glans penis from being fully exposed.

According to a survey of 1000 normal adult males in my country, approximately 29.7% had phimosis (tight foreskin) and 8.5% had paraphimosis (tight foreskin).

The inner layer of the foreskin contains many secretory glands, which secrete smegma. Obviously, if the foreskin cannot be retracted, the smegma cannot be cleaned in time. In addition, urine will get trapped inside the foreskin during urination, inevitably leading to infection and causing balanitis. In severe cases, urethritis may also occur. If left untreated, erosion and ulceration may develop on the glans and foreskin. Long-term inflammation may even induce penile cancer. Furthermore, married adult men with balanitis can transmit the infection to their partners through sexual intercourse, causing vaginitis, cervicitis, salpingitis, or cystitis, a common clinical occurrence. A recent epidemiological study found that many women with cervical cancer had husbands with phimosis or paraphimosis, as smegma contains carcinogenic substances. Phimosis and paraphimosis can also reduce libido and affect sexual harmony; therefore, they should be taken seriously and treated promptly.

What to do about penile curvature?

Penile curvature can generally be classified into three types: lateral curvature (left or right side), dorsal curvature, and ventral curvature. In urology clinics, there are frequent consultations or visits regarding penile curvature. Generally speaking, if the penis is slightly curved, there are no obvious abnormalities in the development of the external genitalia, no urinary abnormalities, and it does not affect sexual intercourse, there is no need to worry excessively or require medication. This is due to uneven blood flow to the two corpora cavernosa of the penis, resulting in slight differences on both sides, which generally does not cause significant problems.

However, if the condition is caused by congenital malformations of the penis and urethra, such as a concealed penis or urethral curvature that prevents urine from being emitted and instead splashes onto the feet, making sexual intercourse impossible in adulthood; penoscrotal hypospadias, where fibrosis of the corpora cavernosa causes significant penile curvature and painful erections, affecting sexual intercourse; or full-type epispadias, with a short penis that curves dorsally and obstructs sexual intercourse, then early corrective or reconstructive surgery at a urology department is recommended.

Why is masturbation called "self-stimulation" internationally?

In recent years, many insightful individuals in China have advocated changing the term "masturbation" to "self-stimulation" according to international convention. However, because many people in the medical community and among the general public still commonly refer to it as "masturbation," it is unlikely to change quickly in the short term, and both terms will be used concurrently.

 

Why is masturbation called "self-stimulation" internationally? Compared to "masturbation," which is a neutral term, "self-masturbation" contains the character for "lewd" (淫), and given the traditional saying "of all evils, lewdness is the worst," it inevitably carries a negative connotation, consciously or unconsciously associating with "sin," "obscenity," "uncleanliness," and "vulgarity," creating an undue psychological burden on the user. Therefore, many men and women have masturbated, some feeling remorseful, others accepting it openly. How to view masturbation—affirming or condemning it—is a question worthy of study.

Many people, from their student years onward, experience sexual maturity, developing sexual desires and urges, and thus unconsciously manipulate or strongly stimulate their external genitalia to satisfy their sexual desires and obtain sexual pleasure. This behavior is called masturbation. Because it is an act of self-satisfaction and pleasure without the participation of a partner, it is called "masturbation behavior." This phenomenon can occur in men, women, and children of all ages, but it is more common among teenagers. There is no "standard" model for masturbation; it depends entirely on individual habits and preferences. It can be done whenever the mood strikes or when alone.

According to a 1989 survey of 679 young people conducted by a Shanghai hospital, 93.1% of men had a history of masturbation. It seems that masturbation is a relatively common phenomenon among young people. The survey results show that overall, 78.6% of men and 28.3% of women had masturbated. The average age of onset for men was 16.6 years old, and for women, it was 17 years old, both falling within puberty, roughly between the third year of junior high school and the first or second year of senior high school.

International sexologists have long confirmed through behavioral studies of various higher animals that masturbation is an instinctive behavior resulting from the evolution of the animal brain. Furthermore, depictions of monkeys masturbating in Dunhuang cultural relics in my country show that our ancestors recognized the relevant knowledge about masturbation long ago.

For centuries, people have viewed masturbation like opium—both loved and feared it. They loved the pleasure it brought, but feared its harmful effects on their health. So, is masturbation truly beneficial and harmless? If it is harmful, what is the basis for this claim?

Traditional views unanimously condemn masturbation, associating it with shame, vulgarity, and moral depravity. They also believe that masturbation depletes semen, damages kidney energy, disturbs the mind, and harms the body. Therefore, masturbators often dare not openly admit it. Some young people, on the one hand, pursue sexual pleasure and masturbate frequently; on the other hand, they feel guilty and remorseful, fearing it will affect their sexual function after marriage, causing high levels of psychological stress. This guilt, regret, and worry about masturbation are far greater than the harm caused by masturbation itself. They torment themselves psychologically and physiologically, unable to extricate themselves.

The reason some people believe "masturbation is harmful" is that the individuals already have this idea before they begin masturbating, and human instinct dictates that most people will spontaneously begin the act. This creates a psychological conflict between behavior and motivation: wanting to do it but not daring to, feeling comfortable while doing it but regretting it afterwards, and feeling ashamed yet finding it difficult to quit. Many people are actually driven by strong cultural pressure and instinct to engage in activities that disrupt their personality. The root of this misconception lies in the so-called "masturbation is harmful" theory; most of the discomfort caused by masturbation stems from misunderstanding. If it weren't for this misleading public opinion, perhaps they wouldn't even realize the harm masturbation causes.

In reality, very few people truly suffer harm from masturbation. These are those who excessively indulge in erotic fantasies, frequently and uncontrollably masturbate, and cannot control themselves, thus forming a habit. Some people masturbate every few days or even every day. This habit inevitably damages the body, keeping one constantly in a state of excitement, unable to get sufficient rest, easily feeling fatigued, experiencing loss of appetite, and even symptoms of neurasthenia. Meanwhile, excessive masturbation can indeed cause persistent congestion and other lesions in certain urogenital systems, such as prostatitis, seminal vesiculitis, urethritis, and varicocele. In women, it can cause chronic pelvic congestion and increased vaginal discharge. These conditions can affect sexual function. It's like eating; food itself may not be harmful, but eating too much can cause problems and lead to indigestion. Food itself may not harm you, but excessive eating can. Can you say "food is harmful"?

The neurological symptoms caused by excessive masturbation mainly manifest as central nervous system and systemic symptoms, including depression, memory loss, decreased comprehension, insomnia, dizziness, headaches, tinnitus, and palpitations. These symptoms are not specific; just as sports competitions, physical labor, or lack of sleep can cause these symptoms, excessive masturbation may also be accompanied by the symptoms of the aforementioned urogenital system inflammation. Once the masturbation habit is broken, these symptoms will quickly disappear.