While many men are finding out ways to make their’s bigger and millions of dollars are spent on infomercials claiming ways to add inches, one teen has undergone the world’s first penis reduction according to a recent report by University of South Florida urologists.
The case was published online in the Journal of Sexual Medicine back in November but is just getting press now because of its coverage by The Daily Mail on February 12.
An unidentified 17-year-old boy with sickle cell disease had three episodes of priapism beginning at age 10. Priapism is the potentially dangerous condition of a continued penile erection in the absence of sexual stimulation and/or following orgasm. When erectile dysfunction drug commercials advise the user to seek medical attention for an erection lasting more than four hours, they are referring to priapism.
In this boy’s case, each instance of prolonged reduction in blood circulation caused a serious lack of oxygenation in the surrounding penile tissues, called the corpus cavernosum. His penis began to progressively grow fibrous tissue in response to these episodes, with substantial enlargement and deformity.
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When presented to the USF Health urology clinic at the Morsani College of Medicine in Tampa, his penis was shaped like a football or rugby ball.
Although 17 centimeters in length (about 6 3/4 inches), the major problem was that it was 8 centimeters in diameter (about 3 1/4 inches wide) and 25 centimeters in circumference (almost 10 inches around) at its widest point.
He wished to be sexually active and had several situations where intercourse with vaginal penetration was not possible because of the girth of his phallus, causing pain and discomfort to his partner. Hence, he has never been able to complete coitus.
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There’s An Emotional Side To This, Too
Just like a teenage woman with over-sized breasts, this young man also faced social embarrassment. He also told the doctors of the social embarrassment he suffered because this defect was readily apparent to the public through his pants and was compounded by the necessity of even tighter pants as a competitive football player.
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The doctors successfully completed an operation called reduction corporoplasty. The paper shows color photographs of the progression of the surgery which should give great pause to anyone making light of the story.
The surgeons made a incision around the circumference of the penis, rolled the skin back, and then removed some of the spongy and fibrotic tissue from both sides of the penis.
The surgeons described the tissue as healthy bleeding smooth muscle surrounded by a tough collagen rind.
The young man was reported to be pleased with the results, achieved erection without pain upon masturbation, but had no opportunity for sexual intercourse at the time of publication. The significance of the report is that little surgical information existed in the literature to guide the surgeons. The doctors were partly able to adopt techniques used to correct Peyronie’s disease, where the penis is abnormally curved but without changes to its girth.
And what’s the underlying cause? Sickle Cell.
Sickle cell disease alone is serious and painful enough, affecting about 80,000 U.S. citizens alone. The disease results from two copies of the adult hemoglobin gene encoding amino acid changes that cause the resulting hemoglobin to form long strands in red blood cells, given them a sickle-like shape after they deliver oxygen to tissues.
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These red blood cells are short-lived and reduced in abundance, called anemia. The cells are also fragile and can damage the lining of tiny blood vessels, resulting in periodic, painful “crisis” episodes.
The young man’s general medical history wasn’t included in the paper but these crisis episodes cause repeated hospitalizations, particularly for clots in the chest. The disease is routinely described as reducing life expectancy by 25 to 30 years.
No cure exists for sickle cell anemia. Hydroxyurea, a simple small-molecule first discovered in 1869, has been used somewhat successfully in sickle cell disease to reduce the number of crises requiring hospitalization and reducing the amount of normal blood transfusions necessary.
The drug, previously used to treat leukemias and other cancers, was only formally approved for sickle cell disease in 1998. It appears to active the production of a fetal form of hemoglobin and reduce damage to blood vessels.
Future Directions
But how this young man’s sickle cell disease led to his progressive, penile fibrosis is not entirely clear. Sickle cell disease does increase the risk of priapism but the excessive fibrosis seen in this case has not been reported previously.
Individuals of African descent do, however, show a propensity toward scars, called keloids or hypertrophic scars, resulting from excessive collagen production. In the penis, smooth muscle cells can revert to fibroblasts, the cells that produce collagen.
Hopefully, the report by the USF urology team will lead to greater attention of the risk factors for post-priapism fibrosis in men with sickle cell disease.
