Immunological Infertility in Men

First stage in treatment of immunological infertility in men is elimination of all possible causative factors of autoimmune process development in reproductive system such as urogenital infections, varicocele, seminiferous path blocking, etc.

However, blood circulation normalization, absence of sexually transmitted diseases, repair of seminiferous paths (when is possible), elimination of production harms do not provide elimination of antisperm antibodies when they already started to reproduce themselves.

Therefore, second stage requires usage of one or complex of additional treatments:

• medication therapy (systemic enzyme therapy, hormonal therapy)
• special washings with further intrauterine or intratubal insertion of spermal cells
• extracorporal fertilization including fertilization with single spermal cell using method of microinjection in plasma

Remember that any stimulating therapy is contraindicated to patients with aspartate transaminase. When patient or/and his partner have antispermal antibodies and no other pathologies, then the diagnosis of isolated immune infertility is made.

In isolated immune infertility the nonsurgical empiric treatment is ineffective. The only real alternative here is assisted reproductive treatment.

Treatment of Male Infertility

Obstructive infertility
Obstructive azoospermia is characterized with normal testes size, normal rate of hormones, deficiency of spermatogenesis in ejaculate, genitalia inflammatory diseases, surgery on organs of scrotum and small pelvis, pathology of adnexas and seminiferous paths during palpation.

Optimal treatment for obstructive azoospermia is microsurgical regeneration of seminiferous paths with single-step obtainment of sperm cells from area before barrier. Obtained sperm cells may be used in ISCI (Intra Cytoplasmic Sperm Injection). Here a number of sperm cells undergo cryopreservation (deep freezing) and they are used in extracorporal fertilization in case of unsuccessful surgery.

Secretory infertility
Most complicated problem when using extracorporal fertilization is treatment of patients with secretory (non-obstructive) form of infertility. This form is characterized with signs of hypogonadism, singular sperm cells or spermatogenesis cells in ejaculate, hormonal shifts, genetic and chromosomal changes.

In secretory azoospermia may be preserved partial spermatogenesis. Thus optimal method of getting sperm cells in non-obstructive azoospermia during ISCI is bilateral multifocal testicular biopsy with usage of microsurgical methods. This is an instrumental control of research of spermatogenesis areas which were kept with the help of test centesis of different testicular areas.

Bilateral multifocal testicular biopsy helps to obtain up to 65% of sperm cells. In non-obstructive azoospermia on the back of hypogonadism (low testosterone rate resulted from hypothalamus pathology) it is necessary to undergo stimulation therapy with gonadotropic hormones.

In frank pathospermia on the back of genetic abnormalities, hypogonadism, obstructive semiology, varicocele is used empiric treatment. Combination of non-obstructive azoospermia with antispermal antibodies is contraindicated for performing stimulation therapy.

Antisperm Antibody Testing

Investigation of immunological factor of infertility is based on making tests on presence of antisperm antibodies in semen and in blood plasma in patient and his partner. Standard tests are performed:

• MAR is standard test for detecting percentage of spermatozoids with antisperm antibodies (positive result is 50% of spermatozoids with antibodies);
• IFA (immunofluorescent assay) detects level of antisperm antibodies in blood plasma in patient and his sexual partner.

Positive results of test prove the immune factor of infertility. When another pathologies are not found, the diagnosis of isolated immune infertility, which is found in 10% of marriages, is made. At this stage may be diagnosed varicocele, obstructive azoospermia, and may be detected group of patients with reduced fertility without specification of ethiology at this stage or immunologic factor of infertility. Results obtained at this stage help to narrow diagnostic algorithm of second stage.

On second stage next tests are performed:

• identification of hormonal level is required in patients with azoospermia. It detects the rate of testosterone, follicle-stimulating hormones interstitial cell-stimulating hormone and also sex-hormone that binds globulin which shows not only the amount of testosterone but also its biological activity.
• ultrasound investigation of scrotum organs helps to find structural changes and pathologic growths in testes, adnexas, prostate gland. This test shows changes in seminal vesicles in case of seminiferous paths distal sections blocking or no changes in innate agnesia of spermoduct. Chromatic doppler investigation helps to detect venous hyperemia in the system of spermatic veins and also detects subclinical varicocele.
• identification of urogenital infections agents is made to see if infertility is caused by infection. Indications for this test are: undetermined character of fertility reduction, recurrent pregnancy loss, and also preparation for additional reproductive techniques. Diagnostics of sexually transmitted infections must be made using immunofluorescent assay together with PCR (polymerase chain reaction).
• genetic investigations are made in azoospermia. Karyotyping detects abnormalities in chromosome set. Today becomes popular test which investigates AZF-segment of Y-chromosome. Around 10% of non-obstructive azoospermia cases are connected with dropping of one or several locuses in Y-chromosome on AZT-segment. Genetic investigations provide not only data about genes, but also about the chances that the disease may be transmitted to masculine descents.
• investigations of centrifuged semen and post-orgasmic urine helps to define causes of azoospermia. Investigation of post-orgasmic urine is made in case of retrograde ejaculation.
• seeding of semen is made in pyospermia, and also in case of bad results of spermogram.

Types of Male Infertility

Male infertility is male inability to conceive a child during 12 months of regular tries without using contraception. Contrary to common belief, male infertility occurs as frequently as female infertility and is 35% of total number of infertility cases.

Types of male infertility
1) Obstruction
In this form the normal maturation of spermatozoids in testicles is not broken but there is a barrier on the way of spermatozoids movement from testicles in urethra. This may be caused by inherent absence or narrowing of a portion of seminiferous tubules, commissures left after inflammation, scar left after surgery, cyst, growth in genitalia or in near-by organs. Anatomical defects of penis (phimosis, penile curvature) may also cause obstructive infertility in males.

2) Secretory problem
In this form of infertility testicles cannot produce healthy spermatozoids in counts enough to fertilize ovule. Causes of this problem:

• genetic factors
• hormonal dysregulations
• severe chronic diseases (diabetes)
• past inflammatory diseases of genitalia (orchitis, parotitis, etc) including sexually transmitted diseases

Factors provoking disease:

• protein deprivation
• avitaminosis
• testicles trauma
• occupational hazards (ionizing radiation, high temperatures, contact with various toxins, etc)

3) Immunological problem
This form of infertility develops after testicles trauma. Normally, testicles tissues are separated from blood stream with a special barrier. When testicles traumas occur, this barrier may get damaged which may put into contact testicles tissues with blood immune cells. Body starts to accept testicles as foreign formation and as a result develops immune reaction with formation of antibodies against testicles tissues. Antibodies may be developed also against apermatozoids. Antisperm antibodies may block spermatogenesis, break sperm motility, prevent spermatozoids from entering cervical canal of uterus, aggravate fertilization, interrupt fission and even contribute to termination of early pregnancy.

Diagnosis
First stage of examination includes accurate history taking (past fertilizations and urological diseases). Must be performed spermogram analysis, detection of immunologic infertility factor.

Infertility – Common Problem in Partners

Infertility is most pressing problem in modern couples. According to WHO data, around 16% couples in the world have diagnosis “infertility”. Infertility sounds like a definitive verdict for couples who dream of having a baby.

However, often the diagnosis is made too early when not all tests have been made. The talk is about detailed tests before making exact diagnosis. According to statistics, after narrow examination the diagnosis “infertility” is recalled in 50% cases because most couples have problems with fertilization and carrying of a pregnancy but this has nothing to do with infertility.

Conception and pregnancy are very delicate biological processes and even most insufficient derivations in body of one of partners may make both partners put much more efforts than put others.

Infertility is common problem for both partners which must be solved together. If you and your partner strictly decided to make everything to conceive a baby then you should be ready to change your lifestyle. Sometimes a couple needs several months of painstaking preparations to achieve wishful result. During all this period it is important to support each other all the time and to follow all doctor's recommendations.

Partial Circumcision

Is it possible to maintain penis naturalness when circumcised? Yes, when the talk is about partial circumcision when foreskin is half cut. However, surgeons and general public opinion do not find the final result aesthetically beautiful. In phimosis sometimes is made not circumcision but dissection of foreskin. This solves problem of phimosis and not problems of hygiene and aesthetics.

Surgery Methods
Is short frenum cut in this surgery? Often surgeon cuts frenum because it makes him work easier. It is possible to keep frenum untouched and thus it would make surgery last longer. There exist three next methods of partial circumcision surgery:
!) Surgeon marks line of the cut and works with scalpel. This method is most simple and safe.
2) Surgery is performed with a special device and surgeon makes cut only by template.
3) Non-surgical circumcision is performed rarely. Foreskin is pulled over with a special device and in several days occurs self-amputation.

Choosing an appropriate device
Most important thing for the patient is to know surgery device and not circumcision methods.

!) electrocoagulator is a electrical surgery knife. It welds up crossed vessels, makes it needless usage of surgical sutures, as a result stitch looks quite nice. Widely used opinion that stitch heals longer than after usage of traditional scalpel is wrong.
2) laser scalpel. It has no great advantages over electrocoagulator. There is no reason to worry about anesthetic drugs – novocaine reliably provides anaesthesia. General anesthesia is used only when children are operated.

Postoperative period lasts two weeks, then patient may start sexual life with his “elegant” penis.

Circumcision Improves Sex

Around 90% of American males are circumcised. Main reason they do it is to make it look better. Urologists have positive attitude towards circumcision and they recommend all males to do it motivating it with next reasons.

1. Cancer prevention
Circumcised males, especially in early childhood, never get diseased with penis cancer. Though this disease occurs rarely, but is treated with radical surgical methods, so in comparison with it foreskin removal looks like an absolute nothing.

2. Hygiene
Smegma (emission of sebaceous glands of penile head and foreskin), humid environment, rests of urine establish favourable conditions for bacteria development. Therefore wash penis regularly.

3. Protection against infection
After foreskin removal, urethra end mucous having no cover anymore quickly becomes callous and due to this gets less traumatized during sexual intercourse. Therefore chance to get infected, for example with HIV, reduces increasingly. Even banal muguet is hardly to get.

4. Improvement of sexual life
This is most pleasant effect of circumcision. Men who got their foreskin removed, say that sexual intercourse became longer.

However, there are two moments about which surgeons do not talk.

• sometimes surgeons cut too much penile skin together with foreskin. Then after regeneration, skin left becomes insufficient which causes penis shortening during erection. Certainly, skin will expand with the time and all this time of waiting it the man will have not his initial penis size to make boast in bed.
• urologist may leave too much skin of inner leaflet of foreskin. It looks worse than uncircumcised penis because of smooth red line around penis head like a scarf. Fortunately, this may be easily corrected by an experienced surgeon.

Sometimes circumcision leaves rough scars and suture sinus. Surgeon should put stitiches vary carefully. However, if there were suture sinus left please do not get upset – experienced surgeon will eliminate them together with rough scar.

Indication for circumcision is phimosis and foreskin injury. Phimosis may be different:

• mild phimosis when foreskin hardly relieves glans during erection but easily relieves glans in non-erected state
• severe phimosis which may result in balanoposthitis (inflammation of penis head and foreskin) or paraphimosis (entrapment by foreskin of penis glans)

These conditions are dangerous because may cause penis mortification or necrosis of its head.

Things You Didn't Know About Your Penis

Sex and things connected with it are blanketed with myths and rumors and often it is hard to define what is truth and what is myth. One of the most mysterious and wrongly interpreted subjects in sex is male penis.

Though penis is not a bone it may break! This fraction is called “penile fraction” and may occur during wild sex or intensive masturbation.

Penis fraction is an injury of fibrous tissue which may be followed by a peep similar to a crack. When penis fraction occurs, male loses erection immediately and on penis is formed large wound . In this case it is necessary to call the doctor.

Erections may be caused not only by physical stimulation or look of a sexy woman. Erection may occur in a male at most inappropriate time and in most inappropriate place, for example, at funerals, without any sufficient reason.

Average penis size is not so big as consider most males. In most males penis size is 12 – 15 cm. Big penis sizes meet rarely, however, for females most important is technique and not penis size. A male with a most big penis in the world (33 cm) spends less of his time with females and lives with his mother.

Can you guess penis size by male appearance?
Many people believe that it is possible to define penis size by male appearance. For example, it is believed that males with large palms and long fingers have big penises. This believe is wrong. If a male has large palms and long fingers it does not mean he has big penis.

However, penis size is connected with male height. Tall men more often have big penises than others. Men get penis size according to their body proportion. According to studies, homosexual men have bigger and wider penises than heterosexuals.

Size of penis cannot be measured in non erected state. Average sizes of penis in relaxed state is 7 – 8 cm, however, some penises do greatly increase in size during erections and some increase just a little. It should be mentioned that penis size cannot be inherent and this parental characteristics not influences his son. Formation of male penis occurs in female alvus when sexless embryo turns into a boy or a girl under the influence of hormones.

Circumcision: Is It A Necessity?

Circumcision is a full or partial removal of foreskin from male penis. Nowadays circumcision is performed on religious, medical or esthetic grounds.

Medical indications for circumcision:

• phimosis (inability to retract the distal foreskin over the penis head)
• condyloma (genital verrucas caused by papillomavirus)
• premature ejaculation
• foreskin traumas

Phimosis is major indication for circumcision. Inflammation causes foreskin narrowing and difficulty of penis head relief not only in relaxed state but in erected state too. The disease may be complicated with balanoposthitis (penis head inflammation) which may cause scarring of foreskin.

Treating premature ejaculation with circumcision reduces sensibility of penis head which helps to prolong sexual intercourse and helps to better control of situation.

How circumcision is preformed?
Circumcision is performed under local anesthesia. Duration of the operation is 20 – 30 minutes. In the course of operation may be removed full foreskin or just its part. Penis frenulum linking penis head with foreskin usually is not removed because it has vascular and lymphatic vessels. Process of recovery lasts for 2 – 3 weeks.

Possible complications after circumcision
Complications may be mainly caused by inexperience of surgeon who performed operation. Circumcision is contraindicated to people with blood disorder which results in blood coagulability break. In other cases circumcision is an absolutely benign procedure. Some males after operation complain at pains and decrease of penis head sensibility. And it should be told that regenerative process normalizes male condition and after total recovery male not feels pains anymore.

Different specialists have different opinions on circumcision. However, most of them claim that circumcision improves quality of sexual life, prolongs sexual intercourse, reduces development of urogenital system infections and foreskin cancer, reduces risk of papilloma transmission to female.

Men without foreskin have their smegma (foreskin sebum) reduced and this prevents from prostatitis, ureteritis, cystitis development. Circumcision makes it more easy to look after penis head which reduces risk of development of sexually transmitted diseases (herpes, syphilis, condylomata acuminata).

Circumcision aesthetics
There exist various opinions about beauty of male penis. Some women like big penises and some are indifferent to penis size saying that most important is techniques. What is better – circumcised penis or not? The answer is simple: so many heads, so many minds. Male should decide how does his penis look better because he will live all his life with his penis. It is necessary to consult your doctor before circumcision.

Religious Circumcision

At all times circumcision was practiced by many nations such as Phoenicians, Egyptian sacrificers, Australians, Africans, Muslims, Jewish. There were many reasons for circumcision. African people living in hot region performed circumcision for simplification of hygienic procedures because of small amounts of water. Australians used the given method to perform essential ritual of initiating when boy becomes male. There do exist many hypothesis around circumcision for religious reasons. Up to the present day in Egypt was kept cave art depicting circumcision procedure.

It should be noted that in Egypt the only men who had right to marry were men with removed foreskin. In most nations, who practice circumcision, this operation is made in males aged between several months and 17 years.

Jewish ritual of circumcision bears just religious character and is based on Bible. It should be performed in presence of rabbin (or rabbin performs circumcision himself) on eighth day after birth.

In children of early age pain killers are not used. Disagreeable sensations in early childhood are removed from memory quickly and this procedure not seems so fearful anymore. Jewish say that circumcision is a process of redemption from wickedness and malice of a human. “Circumcise yourselves to the Lord” (Jer:4:4)

Circumcision in Judaism is a symbol of dispensation between male and the God. Independent from prohibitions on circumcision at different times on the ground of death penalty, corporal punishment and so on, circumcision existed anyway.

Circumcision at eighth day after birth is performed by the next rules:
1. it must be performed at day time
2. it must be performed by a male
3. in traditional circumcision are used most simple instruments

Penis Foreskin Removal (Circumcision)

Circumcision is a surgery during which in a male is removed penis foreskin around penis head. Major indication is phymosis (foreskin narrowing) which causes constrictions in penis erections and prevents from undergoing normal sexual intercourse (narrow foreskin acts on penis like a collar that squeezes penis head).

Also circumcision is indicated in cases of chronic inflammation in preputial punch (area between penis head and foreskin) that causes itch and bad smell in genitals – this results in narrowing and roughening of foreskin. Extra skin is removed.
Circumcision is indicated in next cases:

• when foreskin is affected by human papilloma virus (HPV)
• foreign bodies in foreskin
• premature ejaculation

Circumcision improves greatly male sexual function. Penis size increases - penis becomes bigger not only in relaxed state but in erected state too. This is connected with improved blood circulation in penis.

Surgery is performed under local or general anesthesia. Most often surgery is performed under local anesthesia. General anesthesia is used only in cases where children are operated or when it is patient's desire. During operation are used conventional, traditional surgical instruments. Cuts may be closed up with stitch material that later resolves itself and in this case patient is saved from unpleasant procedure of their removal.

How circumcision is made?
First, penis head is processed with bleach solution, then local anesthesia is made, after which on penis head is applied a rubber binder, and anesthetic is injected into penis. It helps pain sensitivity to disappear for the time necessary for surgery. Around penis head is made a circular cut, then “leafs” of foreskin are cut, and plastics of frenulum of prepuce of penis is performed. Edges of wounds are closed up with stitch materials that are further resolved or not. After surgery aseptic dressing is applied.

Circumcision lasts 20 – 40 minutes. Much time is spent on sealing of wound because doctor models penis in order to make it look better. Pre-hospitalization is not needed. Patient spends in hospital only 1 – 3 hours and after operation may go home. Wound is healed during 7 – 10 days, however, edema persists much longer. Patient must have sexual intercourse only in one month after operation.

Truth About Penis Widening

Although today do exist effective methods of penis widening, the question “Is there any need in penis widening?” still remains opened.

Indeed, with the help of surgery it is possible to thicken penis. However, penis widening not always solves male problem, for example, when the problem is not in penis girth but in poor sexual technique. Usually male with a normal penis girth seeks medical advice due to his partner complaints when she says his small penis size is the cause of their sexual problems. It is quite clear that after surgery the situation would not change because in such cases the reason of woman's complaints rather is partner's poor techniques. Also it is necessary to understand that thickened penis may be unsuitable for alternative sex because of its big size.

On the other hand, if the male is satisfied with his penis size and the only problem is individual anatomical incompatibility of both partners then it would be more reasonable to make an operation on vagina size reduction called labia reduction surgery (or labiaplasty) that is more simple and safe than transplantation of muscle flap for penis enlargement. Usually this occurs in women after childbirth.

More reasonable is surgery when a male wants to get big penis to not be ashamed when demonstrating it in sauna. The great advantage of penis widening is that penis not only becomes thicker but visually it looks longer in non-erected condition. The point is that muscle flap fixed on penile skin not allows penis to shorten in non-erected condition. Therefore stressful situation such as fright or chill would never lead to this reaction of cavernous body tissue and as a result to penis shortening.

In this connection before you decide to enlarge your penis you should weigh all pros and cons and understand that performance matters and not size.

Tips On Using Penis Extender

Clothes for penis extender
1. You should pay special attention on your underwear. Underpants should be large enough. If extender is down then tight underpants may pull it reducing tension of its bars. Also, tight underpants hardly allow to wear extender up.
2. Pants should be large especially when you intend to wear extender at office.

Sexlife
It is necessary to make sex frequently। Sometimes men may experience psychological problems resulting in problems with erection, especially when man is not pleased with his penis size. Moreover, erection not always occurs before you manage to undress and this aggravates stress even more.

On the back of stress, anger and fear man suffers from blood pressure increase, his vessels become narrow and as a result erection may not occur. However, this not means that this man suffers from statical erectile problem, because as a rule, during masturbation he has no problems with erection.

The problem may be solved by using special drugs containing inhibitors of type 5 phosphodiesterase (PDE-5) such as Cialis, Viagra and Levitra. First times when you use these drugs do not say about it to your partner. On the back of firm erection your fears will get away along with uncertainty in personal sexual inability. Although these drugs are sold without prescription, it is necessary consult your doctor before using them because Viagra, Cialis and Levitra have contraindications and side effects.

What to do if you have only 30 minutes – 1 hour daily for wearing extender? There are two variants for you to choose:
1. Follow general recommendations, except terms of increasing bars length. It should be 15 days instead of 10.
2. Alternative way of extender wearing. Each time set extender bars on maximum length and in 10 – 15 minutes after penis relaxing, bars should be set again on maximum length till the end of necessary time.

Useful Tips For Penis Enlargement

Extender Usage
1. Place extender on clean penis washed with soap. Penile skin should be dry. Plastic support and silicone strap should also be clean and preliminarily give them a swill with warm water and soap. This is extremely topical from the point of view of hygiene, this makes extender stay stick and not slide.

2. It may occur that when you wear extender once again, you cannot extend penis and fix it on last fixed bars length. Do not worry. Your penis might shrink but this is a normal phenomenon. In order to extend penis to original length, you should wear extender for 15 – 20 minutes at reduced length (you may screw additional bars by 2sm), and then you may continue to wear extender on the original bars length.

3. After surgery it is necessary to wear extender below for one month in order to extend maximally the inner part of the penis and stabilize the result of the surgery. If extender is worn alternatively below and above it is necessary to take into account that traction in both cases will be different. Equal length of bars makes traction stronger and the extender must be directed below.

4. In men after posthetomy is possible skin “siding over” on the back part of penis (where urethra runs) while wearing extender because penis leans over via extender base. This may occur because on the back part of penis after posthetomy (especially ritual) sometimes is left less skin. In these men during erection always draws scrotum skin and is formed “sail”. In order to avoid discomfort while wearing extender below you should after some time wear extender above and to screw skin with your hand, after this extender returns to the original position.

What Factors Influence On Penis Size?

In case of genetic mutations of sex chromosome (these mutations are called Klinefelter syndrome), genetic set of chromosomes in men has additional chromosome responsible for body formation of female type. These males usually are tall, have narrow shoulders and are slim, their penis has a small size and often scrotum hypoplasia.

Penile hypoplasia results in endocrine control disorder in childhood or adolescence. These males may have problems with reproduction, however, sometimes reproductive function may not be affected. Major manifestation of low hormonal effect become small sizes of penis and psychological discomfort associated with this. Such people often delay for a long time visit to the doctor thinking that their problems are not connected with health but are just personal feature. So the main treatment problems are penis enlargement and social rehabilitation.

It is necessary to say that penis size depends not just on testosterone stimulation but also on genetic and geographical factors. For example, in Russia average penis size is 15cm in erection state, penis having 12cm is considered small and penis less than 10cm is called macropenis. On the other hand, average penis size in China is 9cm. That is considered an absolute pathology for Russian man.

Evaluation of genitals development in childhood is quite difficult, and into account are taken not just penis size depending on the age, but also testicles size and other anthropometric parameters. That is why it is recommended to consult periodically children's doctor - urologist or andrologist. Never try to define your child condition basing on tabular values of age-related measures of penis size and scrotum size.

Today question about penis enlargement and, respectively, elimination of possible mental disorders in these patients may be considered practically solved. Here the main methods are
1) hormonal replacement therapy that is effective at any age;
2) penis enlargement with the use of extending device along with operation and topical hormonal stimulation;
The more early treatment is started, the more frank result of penis size enlargement would be.

Restoration of reproductive function is a real problem. Most decisive factors in treatment of infertility is patient's age when male testicles yet not lost their ability to produce spermatozoids. In case of lack of contraindications is prescribed surge hormonal therapy that gives best results.

The main factor of treatment effectiveness is patient's age. Modern medicine in most cases is able not just to lengthen penis size but also to solve problems of infertility, and additionally helps in social rehabilitation of these men.

Medical Problems Of Penis Enlargement

Despite common saying that “the most important is quality of sex and not penis size”, most men anyway want to increase their penis length at least at several centimeters not depending on the initial penis length. This desire is quite reasonable and it may hardly be called cranky one, first of all because it is subconsciously put by the nature and expressed the more strongly, the more a man feels like a male or a leader in the community.

Insufficient penis length may cause male enchainment with women, loss of interest, diffidence and a number of complexes. So penis size becomes one of the major factors in realization of male as an individual as well as an important indicator that directly affects the quality of life.

Besides its social significance, penis size also reflects general men's health, particularly the condition of endocrine and reproductive system. The point is that penis length depends on the level of sex hormones (testosterone) at puberty, when occurs most intensive growth of external genitalia. Low testosterone level leads not just to slow growth of penile tissues, it also leads to further emergence of mental problems that may result in infertility because of lowering and finally full stopping of sperm cells production. The more earlier you detect the disease the more quickly you start its treatment.

Today are known about 20 congenital diseases characterized by breaking production of sex hormones and resulting in small penis length. In some cases it may even result in male infertility. Congenital diseases prevalence is high enough and it is about 1 in 500 newborn boys. It is necessary to make examinations of the child. Those examinations should be made by andrologist or endocrinologist that specializes at men's health.

Examinations should be made when the boy is achieved 14 years old, because at early age treatment of this pathology will be very effective. One of the most frequent causes of poor development of penis is Kallmann syndrome. Early stage of body development in this syndrome is characterized by dyspoiesis of brain hypophysis cells responsible for synthesis of hormone producing testosterone. As a result, diseased children of 3-4 years have no testes in the scrotum. After making corrective operation on testes omission, parents usually calm down thinking that problem is solved.

However, when boy achieves 18-25 years old and he compares himself with other boys he understands that he has evident problems with the development of penis and testicles. This may lead to development of inferiority complex, as a result boy reduces his social circle, he refuses from sports and swimming pool. Fear of being made fun of makes him refuse from communication with girls. As a result these boys become isolated and they chose professions that are not connected with frequent communication with people. In this case there is no talk about brilliant career of journalist, businessman, politician and lawyer.

Penis Enlargement Motivation

Changing the priority of public morality and consciousness in favor of humanization made the improvement of sexual life a major direction in modern medicine.

Quality of sexual life is one of the most important components of this notion. Today operations that help to increase penis length are very popular. 90% of men who make such operations have a normal penis length. What is their reason for making operation?

The results of the research show that the main reason for doing penis enlargement operation is malaise with quality of sexual life. Thus, it is known that penis length has no influence on achieving vaginal orgasm by partner. Moreover, greater importance for coitus may have penis density of coverage during frictions, or in other words, penis diameter. Therefore, the desired density is much easier to achieve by making relatively simple surgery that narrows vagina.

So it is clear that the main motivation for penis enlargement is male wish to correspond to the image of sexuality and masculinity. This image has been developed historically and now is promoted by the media.
One more important reason is that big penis is an additional visual erogenous stimulation factor. Here may be made an analogy with the size of the mammary glands, for their increase is made implantation of endoprosthesis.

Medical indications for making operation to increase penis length are not determined and in most cases the only indication for penis enlargement is patient's wish.

Social Aspects Of Penis Enlargement

Health is a condition of full physical, mental and social well-being and nut just absence of diseases and physical defects.

Men's wish to change external look of penis is main indication to esthetic corrections.

The problem of penis enlargement traces its roots from ancient phallic cults. In trade and sculptural pictures of ancient Hindu prevailed males with very big penises. On Corsica Island were found phallic monuments of Bronze Age having length of 15-25cm.

Extremely big penis is the main theme of numerous Japanese “night books” used over ages as an visual stimulant. In Europe in Renaissance period in vogue were male left flypiece. D. Richards explains this phenomenon: “Penis size is very important for a man. In penis is concentrated all male great pride. In penis lives the greatest part of male “ego”.

Therefore, exists a particular cultural and social tendency for big penis worship. Research workers claim that exists huge documented information proving that feeling of disappointment caused by distress of soul, their anxieties, matrimonial problems, along with mental disorders result from ignorance and lack of exact information about sex and genital organs.

Recent years was increased popularity of penis enlargement operations and it requires statistic researches. Wessels H., et al. (1998) tried to establish mathematical relationship between penis length in rest state and penis length in erected state. According to the results, relationship between penis length in rest state and in erected state is not so great to use it for prognosis.

The increase of penile length compared with the initial size is more frank for small penises, but anyway the difference can not be considered statistically significant. The most accurate length of penis during erection can be predicted by the maximum tension.

The popularity of this kind of researches once again proves that big penis is firmly associated in public mind with domination and this certainly is an important argument in favor of a more delicate attitude to genital surgery.

What Is A Normal Penis Length?

Normally, erect penis length is from 12 to 18cm and non-erected is from 7.5 to 10.5cm. Thickness of a normal penis is 3-3.5cm. Erected penis is called small when its length is less than 12cm and penis called micropenis when its length is less than 8-10cm.

In a non-erected state the length of penis is determined by the degree of blood filling in cavernous bodies. Cavernous bodies are a spongy mass consisting of many small vessels and bladders which, like other vessels, are able to respond on action of active substances in the blood and on effects of temperature factors. So, when the temperature lowers, in a penis occurs vessel constriction which leads to blood admission into cavernous bodies and thus leading to penis decrease.

Rising of temperature causes a reverse reaction. Vessel constriction and penis length decrease also may be caused by adrenalin ejection into the blood in response to fright and other stressful situations. That is why penis, that usually is big during erection, multiply decreases in non-erected state.

Erect penis length is limited by fibrous tunic that is a texture having in its structure firm connective tissue which is responsible for limiting of penis stretching during erection.

Today is considered that testosterone level during puberty plays the main role in penis development because it determines penis length. Small penis length (less than 8-10cm) may indirectly speak about serious endocrine disorders linked with low production of male hormones. On the other hand, the big difference in measures of penis length (12 and 18cm) depends on personal differences in inguinal region anatomy and namely it depends on correlation between insidious and open parts of cavernous bodies and surrounded fibrous tunic.

There is an opinion that normal level of hormones and normal development of cavernous bodies in different males due to individual characteristics showed differently developed insidious parts of cavernous bodies that are responsible for cavernous bodies attachment to pubic bones and penis fixation.

However, for most men are important their own ideas about a normal penis length that is based on personal sexual experience or on the attempt to be better than others. Statistics here is not taken into account.

How To Measure Penis Length?
Penis length should be measured in room temperature. For that purpose should be used a ruler. Penis should be measured in a erected state by its back (dorsal surface) from pubis to the end of penis head. This is the most adequate way of measure because it reflects functional penis length. Such factors as extra subcutaneous fat depot in pubic region and insufficient erection may influence on functional penis size making penis smaller.

Ideal Penis Size

Penis sizes do differ as male growths। When we talk about penis size, we mean its size in erected state. Penis sizes may be divided according to the next criteria:
1. statistical indicators – average/small/big sizes
2. growth proportions – penis size makes up 10% of male growth

As penis sizes do vary in a relatively wide range, so during research it was established the average statistical penis size. Penis, according to its size, may be divided into average, small and big sizes. According to the results of the research, the average penis size is from 6 to 7.2 inch (15-18cm), and diameter 5.2 inch (13cm). Penis having size less than 6 inch is considered small, and penis with the size more than 7.2 inch is considered big. Most men (70%) have penis size more than 6 inch when erected!

Human body is proportionate. Those proportions are strictly taken into account when drawing a man. Penis size also has particular proportions: proportion between size and diameter, head size towards whole penis and proportion of penis and male growth.

Ideally, erected penis must be 10% of male growth, and in a relaxed state it must have 2cm+5% of male growth. So man with growth 72 inch should have penis 7.2 inch when erected, and 4.4 inch in relaxed state. In a man having growth 76 inch may have average penis size is 6.4 inch which visually looks small, but penis with 7.6 inch will be proportionate to his growth.

Ideal Penis Size
When defining parameters of ideal penis size it is necessary to take into account all parameters mentioned above along with penis shape, foreskin, proportion between penis head size and penis body, and also anatomic and functional factors. The ideal penis is long and thick enough, it has well-developed foreskin and penis head, with right placed urethra and firm erection.

There are not many men with ideal penis. As well as many men try to make athletic build in a gym it is necessary to improve penis in order to bring it to the ideal.