Scientific Analysis of Penile Development and the Treatment of the Urological Emergency "Erectile Retraction"

Most young men are very curious and will secretly compare the size of their penises with those around them in public bathhouses and similar places. Once they find that their penises are shorter than others', they will feel ashamed, inferior, and depressed, and may even refuse to go to public bathhouses again.

Measurements of male penis size vary among different scholars, and are also influenced by factors such as region and ethnicity. Furthermore, the length of a man's penis is not constant under normal conditions; stress, cold, or severe fatigue can cause it to shorten. In addition, measurement methods themselves differ significantly, making it difficult to determine whether a penis is normal solely based on length. Therefore, measurements should only be used as a reference and should not be rigidly adhered to. Clinicians typically do not judge penile normality based on length. As long as normal sexual intercourse and the ability to reproduce are achieved, the penis is considered normal.

So, what constitutes true micropenis? A penis shorter than 2.5 cm before puberty and shorter than 5 cm after puberty, with abnormal development and no erectile function; especially if accompanied by underdeveloped secondary sexual characteristics, sexual dysfunction, infertility, and azoospermia, this can be considered abnormal penile development. Causes of true micropenis include: (1) Hypergonadotropic hypogonadism: Primary hypergonadotropic hypogonadism originating in the testes. In this case, the hypothalamus and pituitary gland are normal and can issue strong commands, but the testes are diseased and unable to execute the commands to produce sex hormones and sperm. (2) Hypogonadotropic hypogonadism: This is due to lesions in the hypothalamus and pituitary gland, which cannot send commands downward to secrete testosterone. (3) Anti-androgen syndrome: This is when the penis is insensitive to androgens. The patient's testosterone levels are normal, but secondary sexual characteristics are abnormal, and hypospadias may even be present. (4) Idiopathic micropenis: The cause remains unknown.

For patients with true micropenis, it's crucial to understand the underlying cause to ensure targeted treatment, which may involve growth hormone, gonadotropins, or androgens. These treatments are often effective for micropenis before puberty. However, if penile development fails after proper treatment during puberty, androgen therapy in adulthood is often ineffective. The use of negative compression devices for suction and injection of penile corpora cavernosa vasoactive agents can be effective for micropenis complicated by erectile dysfunction.

Patients with testicular problems, whose underlying issue is androgen deficiency, can use sex hormones as replacement therapy long-term. After medication, improvements in secondary sexual characteristics are often observed, such as increased pubic hair and facial hair, but fertility does not improve. Relapses may occur after discontinuation of medication. Testosterone should be started as early as possible; treatment should begin once a diagnosis is confirmed. However, other underlying conditions must be ruled out during diagnosis, especially delayed puberty, which does not require treatment. It must be noted that excessive use of testosterone during childhood can cause premature bone fusion, affecting physical development and height. Testosterone may also be tried for unexplained micropenis, but it should not be abused and should be taken under the guidance of a specialist.

If the penis is insensitive to androgens, there is no effective treatment. Some people abroad have undergone sex reassignment surgery (from male to female), but the sex determination must be made before the age of 3; otherwise, if it's changed during puberty, the patient will find it psychologically difficult to cope. Some people abroad have used silicone injections to enlarge the penis, but the actual results are very poor: firstly, the penis can only increase in girth, not length; secondly, the glans penis cannot increase in girth; thirdly, silicone can easily cause local irritation, and its toxicity may be carcinogenic; fourthly, it may cause pain during erection. Therefore, this method has been abandoned.

For men with normal sexual development but a smaller-than-average penis, this is a normal difference and they shouldn't feel burdened; they should boost their confidence. From a sexual function perspective, the key is erection. A large penis is useless if it can't achieve an erection. From a woman's perspective, the vagina has strong elasticity and can accommodate penises of different sizes. All the nerve endings in the vagina are concentrated in the outer third, which becomes significantly congested and tightens during the plateau phase, creating a "gripping" effect on the penis, which is crucial for sexual stimulation for both partners. The inner two-thirds of the vagina expands considerably during sexual response and lacks sufficient nerve endings. Therefore, the size of the penis is less significant for vaginal sensation. Currently, the most sensitive point in the vagina has been found on the anterior wall, 2-5 cm from the external os, corresponding to the prostate area in men, known as the "G-spot." Stimulating this point is crucial for women to achieve orgasm. This further illustrates that a penis exceeding 8 cm in length when erect is sufficient.

Finally, it's crucial to avoid self-medicating with hormone drugs. Improper use can lead to serious adverse reactions, such as liver toxicity from alkylated testosterone, acne, and inhibition of endogenous testosterone production. Abuse of traditional Chinese medicine generally does more harm than good and offers no benefit. Since the penis lacks muscle tissue, mechanical methods like vacuum techniques or massage cannot enlarge it. Temporary enlargement only results in slightly increased blood flow, and improper operation can lead to subcutaneous bleeding or damage to the corpora cavernosa, which would be counterproductive. As a foreign sex therapist aptly stated, the penis cannot be enlarged mechanically, just as no statue can be enlarged mechanically.

Does the penis really "shrink"? Many people have this feeling, which indicates both their concern about changes in themselves and a lack of sexual knowledge, leading to an incomplete understanding of their physical development. As we all know, the human eye is not a scale, nor is it a precision instrument; it cannot accurately judge length or precision. Without precise measurements or scientific evidence, it's difficult to rule out errors caused by visual effects, environmental temperature, and measurement methods. For example, young men who are still growing may appear to have a smaller penis as they grow taller and more robust, even though its actual size hasn't changed; it's purely a matter of visual perception.

The penis is mainly composed of smooth muscle fibers and elastic fibers, and its size depends to a considerable extent on androgen levels. Generally speaking, the size of a young man's penis is relatively constant during pre-puberty. If there are changes, it is only due to the gradual growth towards adult size under the influence of hormones. Of course, since it lacks skeletal tissue and is relatively soft, its length and girth cannot remain constant at all times. For example, the length of the penis measured before swimming in hot summer and after swimming in cold water for two hours will be different. Measurements taken in summer and winter will also show differences. Additionally, if a person gains weight, the accumulation of fat tissue around the base of the penis can make it appear shorter and thicker. In severe cases, this can even cause difficulty urinating; however, this is merely an illusion, not true penile atrophy. Some men grow taller later than others, and their penis may appear shorter after full development. Some people also experience psychological effects; the more they worry, the more they perceive it as "small." In reality, the penis does not atrophy. As long as secondary sexual characteristics and sexual function are normal, there is no need to carry a heavy psychological burden.

Erectile retraction, also known as "penile retraction" or "retracted penis syndrome," is a urological condition characterized by sudden onset, pain and retraction of the penis or scrotum, accompanied by lower abdominal cramping and severe pain. It primarily affects young adults. The disease is mainly caused by a deficiency of kidney yang, exacerbated by exposure to cold pathogens, prolonged lying on cold ground, wading through cold water, or exposure to cold after sexual activity. These factors can lead to the invasion of cold pathogens into the liver and kidney meridians, causing contraction and stagnation, resulting in spasm and contraction of the genital muscles, pain and retraction of the penis and testicles, and lower abdominal pain. The occurrence of erectile retraction is closely related to the patient's psychological factors, primarily whether they have a concept of "retracted penis syndrome." Those who do not believe in this concept will not develop the disease. Objectively, there are no or only minimal changes to the external genitalia, and it will not actually retract into the body or cause death. The most fundamental way to prevent and treat "retracted penis syndrome" is to strengthen psychological treatment, helping patients correct erroneous disease beliefs and eliminate anxieties. This is the key to preventing and controlling this disease.

In addition, it is important not to confuse the sensation of penile and testicular retraction that accompanies conditions such as chronic prostatitis, erectile dysfunction, and nocturnal emission with "penile retraction syndrome." The main difference is that these conditions do not present with external genital cramping or lower abdominal pain, and these symptoms usually subside or disappear as the primary disease improves.

The treatment methods for this disease based on syndrome differentiation are as follows: ① Yang retraction caused by kidney yang deficiency. Its main symptoms include: penile and testicular contraction and pain, lower abdominal pain, accompanied by cold limbs, soreness and weakness of the lower back and knees, pale complexion, clear and copious urine, pale tongue with white coating, and a deep and thready pulse. The treatment principle is to warm the kidney and strengthen yang. The prescription is a modified version of the Ten-Supplement Pill, mainly composed of: 10 grams each of Aconitum carmichaelii, Cinnamomum cassia, Morinda officinalis, Psoralea corylifolia, Trigonella foenum-graecum, Evodia rutaecarpa, Melia toosendan, Aucklandia lappa, and Foeniculum vulgare. Decoct in water and take twice daily. ② Yang retraction caused by cold congealing the liver meridian. Its main symptoms include: sudden onset, penile and testicular retraction with pain and coldness, lower abdominal cramping and cold pain, accompanied by aversion to cold and cold limbs, even cold extremities, cyanosis of the lips, pale tongue with a white and moist coating, and a deep and wiry or wiry and tense pulse. The treatment principle is to warm the liver, dispel cold, regulate qi, and relieve pain. The prescription is a modified version of Nuangan Decoction, with the main ingredients being: 10 grams each of Angelica sinensis, Lycium barbarum, Foeniculum vulgare, Poria cocos, Cinnamomum cassia, Lindera strychnifolia, Aquilaria sinensis, Zingiber officinale, Evodia rutaecarpa, Paeonia lactiflora, Corydalis yanhusuo, and Citrus reticulata seed, and 3 grams of Glycyrrhiza uralensis. Decocted in water and taken twice daily.

The acupuncture treatment for this disease follows the principle of warming and tonifying the liver and kidneys, dispelling cold, and relieving pain. The acupoints selected are Guanyuan (CV4), Qihai (CV6), Baihui (GV20), and Sanyinjiao (SP6). The procedure involves first inserting filiform needles into Guanyuan and Sanyinjiao (bilateral) using a balanced tonifying and reducing technique, retaining the needles; then applying moxibustion to Qihai and Baihui (GV20); after 20 minutes, remove the needles and continue moxibustion on the above four acupoints until all symptoms are relieved.