16. Causes of testicular atrophy, size differences, and management of micropenis.

Causes of testicular atrophy

The testicles are located in the scrotum, one on each side, averaging 4-5 cm in length and 2.5-3.5 cm in width, weighing approximately 10.5-14 grams. In normal adult males, both testicles are roughly the same size. Currently, internationally recognized testicular volume measuring instruments (including the scrotal skin) are commonly used to measure testicular volume. The average testicular size for Chinese men is between 15 and 25. Clinically, testicular size smaller than 12 is often diagnosed as "testicular atrophy."

The causes of small testicles can be broadly divided into two categories: congenital and acquired. Congenital causes include testicular hypoplasia. When suffering from conditions such as infantile sexual organs or hypopituitarism, both testicles often fail to develop fully. If abnormalities occur during embryonic development, resulting in incomplete testicular descent or cryptorchidism, the affected testicle will also fail to develop fully because the temperature inside the abdominal cavity is higher than that inside the scrotum.

Acquired testicular atrophy is mostly caused by trauma, testicular diseases, and infections. Closed injuries to the testicle can cause testicular hemorrhage and infarction; sharp objects such as nails and wires can also puncture the testicle. Trauma can not only cause spermatic cord torsion, obstructing blood supply, but also endanger testicular survival. Therefore, testicular injuries should be treated as early as possible.

Certain diseases, such as varicocele, can sometimes cause testicular atrophy. Varicocele occurs when the veins in the spermatic cord become obstructed for various reasons, resulting in a piedrous, dilated appearance. Varicocele accounts for approximately 15% to 20% of male infertility cases. Severe varicocele-related infertility often presents with testicular atrophy. The causes of testicular atrophy may include venous congestion in the spermatic cord, a higher than normal scrotal temperature, testicular nutritional deficiencies, and toxins.

Infection is also a significant cause of testicular atrophy. The most common cause is mumps, which can lead to viral orchitis. If the disease develops after puberty, orchitis complicated by mumps can cause severe local inflammation. Excessive fluid accumulation in the tunica vaginalis can occur, resulting in acute hydrocele. Smallpox, chickenpox, measles, influenza, and other similar infections can occasionally cause secondary orchitis.

In clinical practice, determining whether testicular atrophy has occurred involves not only measuring the size of the testicles but also assessing their texture. In outpatient settings, a softer testicular texture indicates more severe damage to the testicular parenchyma. Semen analysis can be helpful when determining testicular atrophy is difficult.

Testicular atrophy can occur on one side or both sides. For example, if one testis is congenitally absent, surgically removed, or destroyed by disease, the contralateral testis may have compensatory hyperplasia.

The most accurate method for diagnosing testicular atrophy is testicular biopsy and pathological examination. This examination should be considered when diagnostic difficulties arise.

Reasons for one testicle being larger than the other

In normal individuals, the two testicles are not exactly the same size. Statistically, the right testicle is larger than the left. If calculated by length, width, and thickness, the average right testicle measures 3.38 × 2.37 × 1.78 cm, while the average left testicle measures 3.30 × 2.27 × 1.71 cm. Even within the same age group, testicular size varies considerably. In normal adults, the testicle volume can range from as large as 25 ml to as small as 15 ml. Generally, as long as the testicle volume is above 15 ml, its function is the same.

Currently, the method used to measure testicular volume, especially the method of comparing measuring instruments, is simple and easy to implement, and has gradually become popular in China. The specific method involves using oval-shaped, hard objects of varying sizes, numbered 1-25, to measure testicular volume. During measurement, the testis is pulled up to stretch the scrotal skin, and the measuring instruments are placed next to the testis and compared one by one. The volume of the measuring instrument that is closest in size to the testis is considered the testicular volume.

Knowing the normal size of your testicles makes it easier to detect pathological changes. In a normal person, the two testicles are not exactly the same size, but the difference is usually not significant. If both testicles were previously symmetrical, and one suddenly becomes noticeably larger, this should be taken seriously. If testicular enlargement is accompanied by fever and localized pain, it may be epididymitis or orchitis. If testicular enlargement is not accompanied by any symptoms, testicular tumors are more likely, and you should promptly consult a urologist for further examination; do not take it lightly.

Some people have testicles that are different sizes from birth, with a very noticeable difference. This is often caused by congenital diseases. For example, congenital unilateral testicular hypoplasia manifests as one testicle being very small and soft, like that of a child; while the other testicle is enlarged and larger than normal, resulting in one testicle being larger than the other. However, this condition is rare.

Unilateral testicular trauma can also cause one testicle to be larger than the other. Trauma causing testicular hemorrhage and hematoma can lead to insufficient blood supply to the testicle, causing it to gradually atrophy and become significantly smaller than the contralateral one. The mumps virus can damage the epithelial cells of the seminiferous tubules within the testicle, which is also a significant cause of unilateral testicular atrophy, ultimately leading to unilateral testicular atrophy.

Of course, some people mistake other scrotal conditions for uneven testicular size. For example, hydrocele is actually just a small sac surrounding the testis, not an enlargement of the testis itself. Some people also mistake inguinal hernia, varicocele, epididymal tuberculosis, epididymitis, etc., for testicular enlargement, because these conditions sometimes present as one side of the scrotum being larger than the other.

In short, regardless of the reason, if one side of the scrotum is significantly larger than the other, it is generally abnormal and a medical examination should be sought promptly.

Is micropenis a disease?

Since ancient times, people have paid special attention to the development, size, and shape of the penis, considering it a symbol and marker of sexuality, a tool for sexual intercourse, and even believing it to be sex itself. This special "worship" has also led to various questions, such as: Is a small penis a disease? Will it affect marital sex life and fertility?

To answer this question, let's first look at some information about male penile development.

The penis typically develops slowly before the age of 10, then accelerates, reaching its peak development around age 18. After age 30, growth essentially ceases. In adult males, the length of a flaccid penis, measured from the dorsal side, ranges from 4 to 11 centimeters, with an average of 6.5 centimeters, and the diameter is 2 to 3.5 centimeters. Common penile types include: test tube-shaped, bottle-shaped, and airplane-head-shaped. The shape of the glans penis can also be triangular, square, oval, or cap-shaped, just like the diverse features of human faces.

A research report indicates that men shorter than 155 cm have an average penis length of 7.4 cm and a circumference of 8.1 cm; those between 156 and 159 cm have 7.4 cm and 8.3 cm respectively; and those over 170 cm have 7.5 cm and 8.7 cm respectively. Men weighing less than 50 kg have an average penis length of 7.4 cm and a circumference of 8.1 cm; those weighing 55-65 kg have 7.4 cm and 8.3 cm respectively; and those weighing 66-70 kg have 7.5 cm and 8.5 cm respectively. Therefore, while height and weight can influence penis length, the differences are not significant. Even if the size of the penis varies when flaccid, it can be partially compensated for during erection. For example, a shorter penis may more than double in length when erect, while a longer penis may only increase slightly. Thus, the size of the penis after erection is almost uniform.

We know that male sexual function is governed by androgens secreted by the testes, and sexual intercourse involves erection, ejaculation, and orgasm. The anterior wall of a woman's vagina is about 7-9 cm long, and the posterior wall is 10-12 cm long, normally close together. Because of its elasticity, it can expand or lengthen accordingly with the size of the penis during intercourse. A woman's erogenous zones are mainly the clitoris, labia minora, and the outer third of the vagina. Therefore, female sexual satisfaction is primarily related to the firmness and duration of the male's erection, and not to the size or shape of the penis. Regarding fertility, as long as both partners have normal sexual intercourse and the ejaculated semen contains sperm (more than 60 million per milliliter), the woman can generally conceive and give birth. Thus, a large penis does not necessarily equate to masculinity, and a short penis does not necessarily mean a lack of masculinity. However, if the penis is excessively short, it is considered pathological and requires a proper diagnosis and treatment at a hospital.

What to do about micropenis?

Micropenis refers to a condition in adult men where the penis is short and thin, affecting normal sexual intercourse and accompanied by the degeneration of male physical characteristics. Traditional Chinese medicine believes that the kidneys are the foundation of innate essence, governing the two lower orifices (urethra and anus); the liver governs the tendons, and the genitals are the meeting point of the tendons. Insufficient innate endowment; childhood illnesses damaging the liver and kidneys; early marriage injuring kidney qi; or excessive masturbation in adolescence harming the immature kidneys can all lead to kidney essence deficiency, liver meridian damage, and insufficient nourishment of the genitals by the essence and blood of the liver and kidneys, thus affecting the normal development of the penis and resulting in micropenis.

Besides the significant shortness of the penis, micropenis is often accompanied by the gradual decline of male physical characteristics, sparse pubic hair, lethargy, general weakness, decreased libido, and even sexual dysfunction. A normal male penis is 4-11 cm in length when flaccid and can double in length when erect. However, due to kidney essence deficiency and liver damage, the normal development of the penis is affected, resulting in a short, childlike penis in adulthood. Insufficient kidney essence leads to impaired transformation of essence into qi, resulting in malnourishment of the marrow, hence the lethargy, general weakness, and insufficient essence and blood, which in turn cause sparse pubic hair. When kidney qi is abundant, essence overflows and libido is strong; however, with insufficient essence, libido decreases.

Treatment for micropenis should primarily focus on tonifying the kidneys and replenishing essence, strengthening the body's foundation, and supplementing with methods to invigorate qi and strengthen the spleen, and nourish liver blood, depending on the patient's overall physical condition. The main formula includes: Rehmannia glutinosa and Cuscuta chinensis to tonify the kidneys and replenish essence; Cistanche deserticola, Morinda officinalis, Yangqi stone, Cynomorium songaricum, Aconitum carmichaelii, and Cinnamomum cassia to warm and tonify kidney yang; Cornus officinalis and Angelica sinensis to nourish the liver and blood; and Ginseng, Astragalus membranaceus, Atractylodes macrocephala, and Dioscorea opposita to invigorate qi, strengthen the spleen, and replenish acquired deficiencies. The combination of these herbs works synergistically to tonify the kidneys and replenish essence, strengthen the body's foundation, invigorate qi and nourish blood, and nourish yang, thereby promoting penile development through increased marrow and muscle strength.

Eat more beef, mutton, dog meat, and legumes. You can also use the testicles of pigs, sheep, or dogs, dry them on a tile, grind them into a fine powder, take 1-3 grams each time, 1-2 times a day, with rice wine. Long-term use has a certain therapeutic effect.

The following self-rehabilitation methods can be used for this disease:

① Persist in rubbing your back and penis with cold water. First, wash with cold water until it turns red, then rub with a dry towel until it feels warm. Be careful not to rub too vigorously to avoid breaking the skin.

② Soak a soft cotton cloth in hot water, wrap it tightly around the penis for about 10 minutes, and then rub it with a soft brush. Do this twice a day.

③ Half an hour before going to bed at night, rub the penis with your fingers or gently tap it with your thumb and forefinger 50 times, while concentrating all your attention on the penis.