Sexual Health


Life Cycle of a Penis


Experts explain how a penis changes in size, appearance, and sexual function with age.


By David Freeman

WebMD Feature


Reviewed by Louise Chang, MD




It's no secret that a man's sexual function declines with age. As his testosterone level falls, it takes more to arouse him. Once aroused, he takes longer to get an erection and to achieve orgasm and, following orgasm, to become aroused again. Age brings marked declines in semen volume and sperm quality. Erectile dysfunction (ED), or impotence, is clearly linked to advancing years; studies show that between the ages of 40 and 70, the percentage of potent men falls from 60% to roughly 30%.


Men also experience a gradual decline in urinary function. A man's urine stream weakens over time as a consequence of weakened bladder muscles and, in many cases, prostate enlargement.


And that's not all. Recent research confirms what men have long suspected and, in some cases, feared. The penis itself undergoes significant changes as a man moves from his sexual prime -- around age 30 for most guys -- into middle age and on to older age. Changes include:


Appearance. There are two major changes. The head of the penis(glans) gradually loses its purplish color, the result of reduced blood flow. And there is a slow loss of pubic hair. "As testosterone wanes, the penis gradually reverts to its prepubertal, mostly hairless, state," says Irwin Goldstein, MD, director of sexual medicine at Alvarado Hospital in San Diego and editor-in-chief of The Journal of Sexual Medicine.


Penis Size. Weight gain is common as men grow older. As fat accumulates on the lower abdomen, the apparent size of the penis changes. Ira Sharlip, MD, clinical professor of urology at the University of California, San Francisco, says, "A large prepubic fat pad makes the penile shaft look shorter."






"In some cases, abdominal fat all but buries the penis," says Ronald Tamler, MD, PhD, co-director of the Men's Health Program at Mount Sinai Hospital in New York City. "One way I motivate my overweight patients is by telling them that they can appear to gain up to an inch in size simply by losing weight."


In addition to this apparent shrinkage (which is reversible) the penis tends to undergo an actual (and irreversible) reduction in size. The reduction -- in both length and thickness -- typically isn't dramatic but may be noticeable. "If a man's erect penis is 6 inches long when he is in his 30s, it might be 5 or 5-and-a-half inches when he reaches his 60s or 70s," Goldstein says.






What causes the penis to shrink? At least two mechanisms are involved. One is the slow deposit of fatty substances (plaques) inside tiny arteries in the penis, which impairs blood flow to the organ. This process, known as atherosclerosis, is the same one that contributes to blockages inside the coronary arteries -- a leading cause of heart attack.


Goldstein explains that another mechanism involves the gradual buildup of relatively inelastic collagen (scar tissue) within the stretchy fibrous sheath that surrounds the erection chambers. Erections occur when these chambers fill with blood. Blockages within the penile arteries -- and increasingly inelastic chambers -- mean smaller erections.


As penis size changes, so does the size of the testicles. "Starting around age 40, the testicles definitely begin to shrink," Goldstein says. The testicles of a 30-year-old man might measure 3 centimeters in diameter, he says; those of a 60-year-old, perhaps measures only 2 centimeters.


Curvature. If penile scar tissue accumulates unevenly, the penis can become curved. This condition, known as Peyronie's disease, occurs most commonly in middle age. It can cause painful erections and make intercourse difficult. The condition may require surgery.


Sensitivity. Numerous studies have shown that the penis becomes less sensitive over time. This can make it hard to achieve an erection and to have an orgasm. Whether it renders orgasm less pleasurable is still an open question.






Experts say these changes need not ruin your erotic life. One recent study showed significant declines in erectile function, libido, and ejaculatory function in the men studied but only moderate decreases in sexual satisfaction. The study's authors concluded that, "Older men may be less likely to perceive these declines as a problem and be dissatisfied."


As Goldstein puts it, "The most important ingredient for a satisfying sex life is the ability to satisfy your partner. And that doesn't require peak sexual performance or a big penis."













Male Masturbation: 5 Things You Didn't Know


By R. Morgan Griffin

WebMD Feature


Reviewed by Michael W. Smith, MD




If there's one thing that almost every guy is an expert at, it'smasturbation. After years of extensive, hands-on experience, you think you know everything there is to know. But according to the experts, maybe you don't. Here are some that may surprise you.



13 Sex Drive Killers
1. Masturbation doesn't have the health benefits that sex does.


"It appears that not all orgasms are created equally," says Tobias S. Köhler, MD, MPH, an associate professor at Southern Illinois University School of Medicine in Springfield.


Study after study shows that intercourse has all sorts of benefits for men -- for your blood pressure, heart and prostate health, pain, and more. You'd think that masturbation would, too. But it doesn't.


Why would it make a difference whether you ejaculate during sex or on your own? No one's sure. But your body seems to respond differently. Even the makeup of semen is different if you masturbate instead of having sex.






Still, does it really matter? Have you honestly been masturbating all these years only because you wanted to boost your prostate health? Didn't think so.
2. Masturbation is not risk-free.


Sure, it's low-risk. It's the safest form of sex possible. No one ever caught an STD from himself or made himself pregnant. But like other low-risk activities (chewing, walking), it still has some risks.


Frequent or rough masturbation can cause minor skin irritation. Forcefully bending an erect penis can rupture the chambers that fill with blood, a rare but gruesome condition called penile fracture.


Köhler has seen guys with it after vigorous masturbation. "Afterward, the penis looks like an eggplant," he says. "It's purple and swollen." Most men need surgery to repair it.
3. There's no "normal" amount of masturbation.


Guys can get hung up on whether they masturbate too much. But it's not how many times you masturbate in a week (or day) that really matters, says Logan Levkoff, PhD, a sexologist and sex educator. It's how it fits into your life.


If you masturbate many times a day and have a healthy, satisfying life, good for you. But if you masturbate many times a day and you're missing work or giving up on sex with your partner because of it, consider seeing a sex therapist.





Even then, there's nothing specific about masturbation that's the problem. Compulsive masturbation is like any behavior that disrupts your life -- whether it's compulsively playing poker or buying Beanie Babies on eBay.
4. Masturbating doesn't reflect on your relationship.



Levkoff says the most damaging myth about male masturbation is that it's a sign something is wrong in your relationship.


The fact is that most guys masturbate. They masturbate if they're single, in a bad relationship, or in a great relationship. It's just something they do that has nothing to do with their partners.


Masturbation isn't only about sex, Levkoff says. For many, it's a routine way of relieving stress, clearing your head before work, or going tosleep.

5. Masturbation is almost certainly good for your sex life.


Masturbation can help your sex life, since it's how guys learn what they like during sex. "I think women would be more satisfied sexually in theirrelationships if they masturbated as much as men do," Levkoff says.






Are there exceptions? Some guys do get so hooked on a certain amount of pressure during masturbation or the stimulation of porn that they can't perform with a partner, says Ian Kerner, PhD, a sex therapist and author of She Comes First.





Still, Kerner says those guys are the exception. "For the vast majority of men, masturbation is a healthy thing," he says. "I'm usually more concerned about a guy who's stopped masturbating -- which can be a sign of anxiety or health problems -- than a guy who's doing it regularly."
















Penis Enlargement: Does It Work?


Every guy knows pumps, pills, exercises, and surgery won’t build bigger penises -- Or do they?


By R. Morgan Griffin

WebMD Feature


Reviewed by Melinda Ratini, DO, MS




Guys, be honest: Do you wish you were bigger? Almost certainly, the answer is yes.


"I think there isn't a guy in the world who hasn't wished his penis were an inch or two longer," says Michael O'Leary, MD, professor of urologic surgery at Harvard Medical School and a urologist at Brigham and Women's Hospital in Boston.


However, after more than a century of generally dubious and sometimes lunatic penis enlargement attempts, there's still not much you can do. Sure, there are lots and lots of supposed options out there -- penis pills, creams, brutal stretching exercises, horrific-looking devices, and penis surgery. Almost none of it works. The few approaches that can work often have modest benefits and serious side effects. How serious? In some cases, erectile dysfunction-serious.


"Trust me, if I knew of a way to safely and effectively increase penis size, I'd be a billionaire," O'Leary tells WebMD. "But I don't. Nobody does."


Still, common sense doesn't stop size-obsessed guys from trying very sketchy treatments on a vital part of their anatomy -- and risking a lot in the process.


How Small Is a Small Penis?



Think you're smaller than average? You're probably not.


The typical erect penis is usually 5 to 6 inches long with a circumference of 4 to 5 inches. There's more variation in the size of flaccid penises.


Some guys are genuinely smaller than that. In rare cases, genetics and hormone problems cause a condition called micropenis -- an erect penis of under 3 inches. Sometimes Peyronie's disease or prostate cancer surgery can reduce a guy's size.


But studies show that most of the guys seeking penis enlargement are average-sized. They just think they're below average.


Why? Part of it is perspective. It's very hard to gauge the size of your own penis -- looking down, you've got a bad angle.


Psychology plays a role, too. Some average-sized guys become obsessed with the idea that they're too small. There's even a psychiatric diagnosis: penile dysmorphic disorder. It's similar to the perceptual distortion of anorexics who think they're fat no matter how thin they get.





According to one study, the majority of men who get penis enlargement surgery have this condition. They're also the least satisfied with the results.
What Works: Weight Loss



There is one safe and effective method for getting a larger-looking penis: weight loss.


"A lot of men who think that they have a small penis are overweight," says Jennifer Berman, MD, a urologist in Beverly Hills and co-author ofSecrets of the Sexually Satisfied Woman.


Losing weight will reveal more of that hidden shaft that's buried beneath belly fat. It doesn't actually increase your size, but it will look that way.


For guys who would rather have a surgical procedure than eat less,liposuction of the fat pad around the penis can work. Still, the effects aren't permanent -- if you don't change your eating habits, your penis will once again sink into your belly, like a pier at high tide.



Penis Enlargement: Pills, Creams, and Devices


What else is there? Here's a rundown of some unproven options to increase penis size.
The vacuum pump. This is a cylinder that sucks out air. You stick your penis in and the resulting vacuum draws extra blood into it, making it erect and a little bigger. You then clamp off the penis with a tight ring -- like a tourniquet -- to keep the blood from leaking back into your body. What are the drawbacks? The effect only lasts as long as you have the ring on. Using it for more than 20 to 30 minutes can cause tissue damage. This is sometimes used as a treatment for erectile dysfunction, but has not been proven to actually increase the size of the penis.
Stretching with weights. Weights or stretching exercises won't bulk up your penis -- it's not a muscle. But hanging weights off your flaccid penis may stretch it a bit, O'Leary says. The catch is that it requires a freakish degree of dedication. "You might have to wear aweight strapped to your penis eight hours a day for six months," says O'Leary. At the end of it, you could be lucky enough to gain about half an inch. Risks include tearing of the tissue, burst blood vessels, and other problems.
Pills, supplements, ointments, and creams. They don't work. None of them. "I think it's safe to say that all of that stuff is complete nonsense," Berman says.

Penis Enlargement Surgery



What about surgery? There are two basic penis enlargement surgeries.
Lengthening the penis. The most common procedure is to cut the ligament that connects the penis to the pelvic bone. This allows a little more of the shaft -- on average less than an inch -- to become visible outside the body. It's not really lengthening the penis so much as revealing more of what's usually hidden. To prevent the ligament from reattaching, a guy would need weights or stretching devices daily for about six months.
Widening the penis. For men who think their penis is too thin, more controversial procedures can thicken it using implanted fat, silicone, or tissue grafts.


The American Urologic Association states that these procedures have not been shown to be safe or effective for increasing the thickness or length of the penis in an adult.


One newer -- and possibly lower-risk -- procedure may work for certain men. In some cases, the scrotum attaches high up on the shaft of the penis. Partially disconnecting the scrotum can reveal more of the shaft, making the penis look longer. The surgery takes 20 minutes and can be done on an outpatient basis, O'Leary says.






Penis Enlargement Surgery Risks


Before you take out a penile improvement loan and unbuckle your pants, consider the risks of lengthening or widening surgery.


There are no well-studied approaches. No major medical organization approves of these surgeries. Some guys opt to travel to other countries for treatments that aren't approved in the U.S. If that thought has crossed your mind, slow down -- it's time to have a frank talk with your doctor about the risks you'd be taking.


The side effects of lengthening surgeries are numerous and include infections, nerve damage, reduced sensitivity, and difficulty getting an erection. Perhaps most disturbing, scarring can leave you with a penis that's shorter than what you started with. Widening the penis is even more controversial. Side effects can be unsightly -- a lumpy, bumpy, uneven penis.


The few studies that have been done aren't encouraging. The European Urology study looked at 42 men who had procedures to lengthen their penises by cutting the suspensory ligament and found that only 35% were satisfied with the results. Half went on to get more surgery.
Reconsidering Penis Enlargement



Wishing you were a little bigger is common. If it's becoming a fixation, stop and think before you do something rash.


Talking to a doctor or a therapist can help. Research has found that when a doctor honestly reassures a guy that his penis is average-sized, he is likely to stop searching for surgery.


You also need to be on guard against phony claims for miracle penis enlargement.


"The main target for penis enlargement advertising is insecure guys who think all their power lies in their penises," says Berman. "These guys are easy victims."


Ian Kerner, a sex counselor in New York, says that the imagined glories of a gargantuan penis are not all they're cracked up to be.



"When it comes to penis size, being average is really where you want to be," says Kerner, the author of books including She Comes First. "Having a penis that's too big can be a much larger problem -- pun unintended -- than one that's too small." For guys who are too big for their partners, oral or vaginal sex can be difficult.


"Size really doesn't matter nearly as much as being a good and creative lover," Kerner tells WebMD. "How you use your brains, your hands, your mouth, and everything else -- that's what counts in the bedroom."


So consider: A quest for a bigger penis could leave you with a lumpy, bruised, discolored, thickened, painful, dysfunctional member. (Not to mention a drained bank account.) Does risking the inches you have for the hope of an extra half inch make sense?

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