Young boys’ worries – circumcision? Circumcision? Penile stigma? Hypospadias? Hypospadias? Parents often ask me, “Is our baby’s penis normal? Why does it grow differently from other babies? Do I need to treat it? How to treat it? When is the best time to treat it? Will there be any after-effects? Does it affect future development? At present, many parents say they are not sure what kind of penis is normal. After this period of time, we will make a systematic answer to the above questions, hoping to make a better answer for more parents. First of all, what should be the normal size of the penis? The length of the penis of a full-term newborn boy is 3.5 plus or minus 0.7 cm in size after erection. After birth, the suppression of estrogen from the mother disappears and an early temporary peak of androgens occurs in the first three months, stimulating penile growth. A second peak occurs during puberty. In the mature male, the length of the penis after traction is between 10-16.5 cm. Second, what should a normal penis look like? Under the premise of normal size, the penis has a fully developed foreskin and a penile suture located in the middle of the penile body, the penis is independent below the pubic bone, the scrotum is sac-like with a mid-scrotal suture that continues with the mid-penile suture, and the testicles can be touched in the scrotum; the urethra opens at the top of the glans and the penis is not curved when erect. The foreskin and the glans are closely connected at birth, but with age, the foreskin is gradually separated from the glans by the accumulation of foreskin scale. at the age of 3, about 90% of men can turn down the foreskin, and less than 1% can’t turn down at the age of 17. The length of the foreskin in adulthood should be appropriate when the penis is erect with part or all of the glans exposed without tension. Common clinical problems: 1. Simple circumcision: normal penis shape and size, foreskin can be easily turned out and the complete glans can be seen, when the penis is erect a large amount of excess skin is visible to cover the glans completely. Hazards and treatment: The foreskin cavity is moist and conducive to the growth of bacteria. This often leads to urethritis, infection in the foreskin cavity, adhesions, etc. The inner plate and glans tissue are in this environment for a long time, making the epithelium soft and fragile, which can easily cause epithelial rupture during sex, resulting in easy infection with sexually transmitted diseases. For such cases, daily foreskin cleaning is the easiest and most effective means to avoid foreskin cavity infections. After puberty, when the penis is fully developed and then circumcision surgery to remove the excess foreskin can be performed. 2.Circumcision: The penis is normal in shape and size, and the foreskin is unable to expose the glans completely. The prepuce is also divided into two kinds: true prepuce and pseudo prepuce. True prepuce refers to the existence of a real narrow ring in the foreskin, which is a ring-shaped narrowing of the skin itself, resulting in the inability to expose the glans. Pseudo prepuce refers to the inability to expose the glans because the inner plate of the foreskin is still not completely separated from the glans, and there is no narrow ring of skin. Hazards and treatment: The incidence of penile cancer is much higher in circumcised patients than in non-circumcised patients, and circumcised patients are often prone to foreskin infection and urinary tract infection. Pseudocircumcision does not require special treatment after the natural separation of the foreskin adhesions. However, if inflammation occurs frequently, it may lead to a state where substantial adhesions —- cannot be separated between the inner plate of the foreskin and the glans. Therefore, early release of the foreskin adhesions is required when this problem occurs. True prepuce has a higher chance of inflammation and infection due to the presence of a narrow ring of skin and the inability to turn the foreskin out, and the tightly wrapped foreskin of the penis can also affect the overall development of the penis, so it should be treated as early as possible. Mild prepuce can try cortisol hormone applied to the narrow ring of prepuce 4-5 times a day for a month and a half, if it is effective then the narrow ring may be loosened and surgery can be avoided. However, for moderate and severe prepuce, the only solution is surgical treatment. 3, concealed penis: concealed penis and subcutaneous, appearance of penis short cone-shaped, foreskin like a bird’s mouth wrapped penis, and the penis body is not attached, most accompanied by prepuce, some children have obesity. In judgment, the hand gently pinch the foreskin, the first will feel the foreskin within the empty no physical sense, and then two fingers were placed on both sides of the penis root to the pubic bone after the direction of pressure, you can see the well-developed penis from the pubic mound of the skin fat is pressed out of the original shape. Once the fingers are relaxed, the penis returns to the tissue again. Hazards and treatment: First, the penis can not be exposed and buried under the skin at the pubic bone, patients with obesity will be buried in the fatty tissue as a whole, so that the external environment of the penile tissue changes —- temperature increases, the surrounding tissue estrogen levels rise (because the fatty tissue is able to secrete estrogen), seriously affecting penile development. At the same time, because of the still insufficient understanding of such diseases, children are easily mistaken as circumcised or simply circumcised when they visit the clinic and are often circumcised. In reality, the amount of foreskin in such children is not redundant or even insufficient. Once the tissues that pull the penis are loosened, the amount of skin used to cover it is very tight. The older the child is treated, the more inadequate the amount of skin is. Once diagnosed, it should receive surgical treatment as soon as possible. 4. Hypospadias: The location of the opening of the external urethral opening is abnormal and can be located anywhere on the ventral side of the penis. It is often accompanied by a ventral curvature of the penis (the head of the penis lowers towards the perineum during erection) and a turban-like distribution of the foreskin on the dorsal side of the penis, and more severe patients are even treated as girls. Treatment can only rely on surgical solution, which requires straightening the penis and reconstructing the defective urethra so that the patient can stand normally to urinate and obtain a normal penile appearance. 5. Penile scrotal transposition: It is caused by incomplete displacement of the lower and middle part of the scrotal bulge, and is mostly combined with perineal hypospadias, scrotal hypospadias, or penile scrotal hypospadias with penile recurvature deformity. This deformity should be observed to see if the urethral opening and the penis is bent ventrally, and if there is any abnormality, seek medical attention. 6, scrotal split: scrotal septum shortening dysplasia, so that the scrotum into the left and right two sacs. Scrotal splitting requires careful differentiation of the position of the urethral opening and whether the penis is abnormally curved. If there is an abnormality, seek medical attention promptly. 7, penile torsion: penile body rotation disorder, most penile torsion penile body mid-slit is oblique, mainly involving aesthetic problems. 8, penile scoliosis: usually caused by overgrowth or dysplasia of one side of the penile corpus cavernosum. The foreskin can be removed and the white membrane cut from the maximum bend so that the penis is straightened. 9, webbed penis: there is a lot of excess skin on the ventral side of the penis. Treatment requires plastic surgery to remove the excess skin.