Basic morphological data of external genitals in 177 healthy central European men.код для вставкиСкачать
Basic Morphological Data of External Genitals in 177 Healthy Central European Men L. G. FARKAS The Research Institute, The Hospital for Sick Childrerz, Toronto, Ontario, Cnnadn ABSTRACT Five basic measurements were made of the penis, the scrotum and the testicles of 177 healthy Bohemian (Czechoslovakian) men, 18-20 years of age. The average length of the penis was 72.18 mm. The average circumference of the penis was 95.65 mm. The length of the right testicle was 47.37 mm, the length of the left was 45.17 mm. In 16.2% of those examined slight deformations of the urethral opening and mild malformations of the prepuce and the frenum were found. These defects did not disturb function. The method of measurement used has been described. As a continuation of some recent studies (Trosev, '69; Farkas et al., '68) on the postnatal development of the penis from birth until the age of six or seven years in members of two national populations, I measured the male genitals in normal adults. The information gained might be useful to the surgeon and other specialists dealing with congenital and acquired defects of the male genitalia. MATERIAL One hundred and seventy-seven healthy men 18 to 20 years of age, selected at random from among personnel of military units stationed in Prague (Czechoslovakia) were examined during the first half of 1968. METHOD Five objective basic measurements of the genitals obtained by anthropometry, and three qualitative signs related to the penis, assessed by anthroposcopy, were recorded in each case. The subject was recumbent during the examination. Measurements were made with the penis flaccid. The maximum-minimum measurements in millimeters were recorded on coded charts and the mean and standard deviations calculated. All measurements were performed by one person, AM. J. PHYS. ANTHROP., 34: 325-328. Measurements 1 . The total length of the penis: measured by sliding calipers on the dorsal side of the penis between the root of the penis and the tip of the glans (fig. 1). 2. The circumference of the penis: measured by measuring tape in the mid portion of the penile shaft (fig. 1). 3 . The circumference of the scrotum: measured by measuring tape from the right scrotal base along its circumference to the left scrotal base (fig. 1). 4. The size of each testicle: (a) the length: measured by sliding calipers between the two most distant points of its longitudinal axis (fig. 2), (b) the width: measured by sliding calipers in the mid portion of the testicle (fig. 2). Qualitative signs 1. The site and the shape of the urethral orifice. 2. The shape and the state of development of the frenum. 3. The prepuce: its size, configuration, the size of the opening of the preputial pouch. RESULTS The results are shown in table 1 and table 2. 325 326 L. G . FARKAS Fig. 1 Showing method of measuring penile length (A) and circumference (B) in flaccid state and circumference of the scrotum (C). DISCUSSION AND CONCLUSIONS The findings in both age groups (18 to 19 years and 19 to 20 years) were analyzed in one group because in my experience the size of the genitalia does not change significantly between 18 and 20 years of age. Other authors' findings support this suggestion (Schonfeld, '43; Figalova et al., '68). The men in this study group were healthy adults, found fit for military service by a military medical committee and were under constant medical supervision. None of them had pathological body configuration, abnormal body size, or manifested endocrine disturbances. Fig. 2. Showing method of measuring testes. No measurements other than those of the genitalia were undertaken. The surgeon repairing congenital or acquired defects of the genitalia prefers to use penile skin (or scrota1 skin) for correction of the failure. The length and circumference of the penis in the flaccid state are of great value in the planning TABLE 1 Metric data of external genitals in s t u d y g r o u p in millimeters Region Penis Scrotum Right testicle Left testicle Sign N Max-Min Mean SD Length Circumference Circumference Length Width Length Width 177 176 177 176 176 176 176 110-45 72.18 95.65 195.14 47.37 28.02 45.17 27.42 11.24 8.31 22.43 4.71 3.44 4.78 3.22 120-77 250-105 65-34 42-17 62-34 36-15 TABLE 2 Qualitative signs oj'externnl genitals i n s t u d y group Region Urethral orifice Frenum Prepuce Total Sign N % Markedly elongated ventrally Blind hole on the tip of glans and the separated urethral meatus situated ventrally O n l v one of its root4 w a s tlc~vcloprda n d placed o b l i q ~ e l v Phimosis 17 10 9.6 5.6 1 0.5 1 0.5 29 16.2 NORMS OF ADULT MALE GENITALIA of corrective surgery. The circumference of the flaccid hypospadiac penis can be decisive in choosing the method of the urethroplasty (Farkas, '68). For these practical reasons the penis was measured in the flaccid state in all studies dealing with boys with hypospadias and also in controls (Farkas et al., '68; Farkas, '70). The penis was measured between the same landmarks used by Schonfeld ('43). In only a few cases I found similar difficulties in the localization of the landmark at the penopubic junction as Schonfeld. I do not agree with Schonfeld that assessment of the length of the stretched penis is more precise than that of the flaccid penis. Both methods are open to inaccuracy. The error in measurement of length of the penis was estimated by me 1-2 mm, established by repeated measurement in cases where the landmark at the penopubic junction was not sufficiently visible. The inaccuracies in measuring the scrotal circumference are even greater ( * 2-3 mm) than in the length of the penis because it is difficult to determine the exact base of the scrotum. The thickness of the scrotal skin makes the measured length and width of the testicles greater than they really are. The average length of the penis (72.18 mm) in the study group is considerably less than the 100-120 mm recorded in some textbooks of anatomy (Borovansky, cited by Hromada), but the method of measuring is not known. The length of the penis in this study group cannot be compared directly with the data in Schonfeld's paper because of the difference in measurement techniques. In my experience a flaccid penis 72 mm in length can be extended by approximately one-half of the original length when stretched. Thus the length of the penis of men in my study group would be markedly shorter (about 118 mm) in comparison with the findings given by Schonfeld (130 mm). Hajnis and coworkers ('70) measuring the length of the penis between the tip of the glans and penoscrotal angle in normal Czech boys, from birth to six years of age, found the length of the erect penis almost double the length of the flaccid * 327 penis. However, the small number of the observations makes a valid conclusion impossible. If Schonfeld's calculation is correct stating that on an average there is about 20-30 m m difference between the circumference of a flaccid and erect penis, then the circumference of the penis in males of this study group, recorded in flaccid state as 95.6 mm would be about 125 m m in state of erection which is markedly more than the medium measurement of Schonfeld (90 mm). The differences found between the Schonfeld norms and the study group are not surprising. There are similar differences between the size of the penis of normal Czech and Bulgarian boys from birth up to six years of age (Farkas et al., '68; Trosev, '69) using the same method of measurement. The method of assessment of the size of testicles I used differed from that used by others (Albert, '53; Schonfeld, '43), which excludes a comparison of the findings. The right testicle in men studied was larger than the left, in accordance with the observation of Trosev ('69) i n normal Bulgarian boys, and of Hajnis and coworkers ('70) in normal Czech boys. Schonfeld ('43) found a larger right testis in 23% of boys studied. The relatively high frequency in my study of slight morphological changes of the urethral orifice and the shape of the frenum is unusual but similar to those found in slight degrees of hypospadias (Farkas, '70). The question remains: which anatomical changes of the urethral opening should be considered as variations of normal state, and which should be classified as microforms (forme frustes or minor defects), of hypospadias or epispadias? A larger sample of the general population would yield more reliable results. Precise measurements of male genitals would be helpful for evaluating the effect of treatment on hypospadias, epispadias and for establishing the growth potential of the congenitally damaged penis (Figalova et al., '68). The above mentioned findings in different populations and those observed during my long clinical practice in Central Europe, support our belief that there 328 L. G. FARKAS exists differences between populations (of the same racial origin) in some anthropometric signs probably caused by different ethnic, social, alimentary, geographical and other factors. However, a man’s reticence to undergo this type of examination limits the number of subjects and makes it difficult to establish the reported or valid norms for each population. Although the sample studied cannot be regarded as representative of the general population, it offers some valuable information about the size and configuration of the genitalia of adult males. ACKNOWLEDGMENTS I am especially indebted to Professor D. R. Hughes and Mr. James Webb of the Department of Anthropology, University of Toronto, for the statistical evaluation of data. LITERATURE CITED Albert, A. 1953 Male Hypogonadism: 1. The Normal Testis. Proc. Staff Meetings Mayo Clin., 28: 409. Farkas, L. G. 1968 Experience with our urethroplasty after two years. Acta Orthoped. Traumat. CSL, 35: 540 (in Slovak). 1970 Minor defects of the penis. Microforms or stigmata of hypospadias and epispadias? Plast. Reconstr. Surg., 45. 1. Farkas, L. G., K. Hajnis and M. Novakova 1968 Time of correction of chordee in hypospadias as seen from the viewpoint of postnatal dwelopment. Rev. Lat. Am. Cir. Plast., 12: 215. Farkas, L. G., and J. Hynie 1970 Aftereffects of hypospadias; repair in childhood. Postgrad. Med., 47: 103. Figalova, P., L. G . Farkas, and K. Hajnis 1968 Eine Studie zur Erforschung somatischer Merkmalebei Patienten mit Hypospadie. Z. Urol., 61: 313. Hajnis, K., V. Novakova, and L. G . Farkas 1970 Anthropometric parameters for operative practice of most frequent development defects of organorum genitalium masculinum (Partes Externae). Acta Univ. Carol. Biol., 1969: 421. Hromada, J. 1969 Quoted from J. Borovansky, Systemic Human Anatomy, Prague (in Czech). Schonfeld, W. A. 1943 Primary and secondary sexual characteristics. Am. J. Diseases in Children, 65: 535. Trosev, K. 1969 Contribution to the anthropometric study of the penis in a group of Bulgarian boys from birth to the age of seven years, Acta Chir. Plast. (Praha), 11: 140.