Congenital malformations of the external genitalia. Such defects are easily diagnosed during an external examination of the child.

Afalia- absence of the penis, an extremely rare defect. In 50% of patients it is combined with cryptorchidism, arenia and renal dysplasia.

Megalopenis (macrophallus)- enlargement of the penis caused by excessive testosterone during the prenatal period.

Micropenis (microphallus)- hypoplasia of the penis, length in a newborn is less than 2 cm. Characterized by the absence of a preputium, the head is very small, the corpora cavernosa are short. It is combined with a cleft scrotum, hypospadias in 50% of cases, cryptorchidism, hypoplasia of the internal genital organs. The most common etiological factors include: hypogonadotropic hypogonadism and hyper-gonadotropic hypogonadism with gonadal dysgenesis. There may also be an idiopathic micropenis with normal hypothalamic-pituitary-testicular function.

Diphallus- duplication of the penis, is the result of incomplete fusion of the genital tubercle. There are two forms - full and incomplete, or split penis. The urethral opening is normally located, or there is hypospadias or epispadias. It can be combined with congenital malformations of the gastrointestinal tract, urinary, reproductive and musculoskeletal systems.

Phimosis- congenital narrowing of the foreskin.

Paraphimosis- pinching of the head by the narrow foreskin. Complicated by ulceration, balanoposthitis, stone formation, and bedsores of the preputial sac.

Congenital malformations of the internal genital organs

Such defects mainly concern testicular abnormalities.

The rest are rare and are combined with testicular PR.

Testicular agenesis- absence of testicles. It can be bilateral (anorchism, anorchidia) and unilateral (monorchism, monorchidia). Most children with anorchidia have normal external genitalia or the latter are underdeveloped. Monorchidia is more common. The absence of a testicle is considered proven by histological confirmation. To do this, each thickening along the path of descent of the testicle is examined, and ectopia should also be excluded.

Polyorchid (polyorchidism)- increase in the number of testicles. Triorchidism is usually observed. Torsion of the accessory testicle is occasionally observed.

Testicular hypoplasia (hypogonadism)- small testicles with underdeveloped secondary sexual characteristics. It is often found as part of a syndrome, mainly Klinefelter syndrome (47 XXY). It can be combined with hermaphroditism, hypospadias and other congenital malformations of the urinary and genital organs. Occurs in Bid-Bardetg syndrome. Histologically, the testicle has a normal structure or (more often) dysplastic. In such cases, it is more correct to speak of dysplasia rather than hypoplasia. An autosomal recessive mode of inheritance is assumed. Family character described. Hypoplastic testes with congenital absence of germ cells have been described in Del Castillo syndrome. Only supporting cells remain in the seminiferous tubules, the amount of testosterone in the blood decreases and the amount of follicle-stimulating hormone increases. It is based on gonocyte aplasia. The type of inheritance is autosomal dominant, limited to the male sex. Family character described.

Testicular dysplasia (vestigial testis, testicular dysgenesis)- abnormal differentiation of the testicle. Macroscopically: the testicle is small, less than 0.7 cm, rather dense. Microscopically: among the excess amount of stroma there is a small number of small, often primitive tubules. containing a small number of Sertoli cells and spermatogonia. In some cases, the testicle is represented by single embryonic tubules and overdeveloped embryonic mesenchyme. Cystic testicular dysplasia occurs (an abundance of cysts among immature mesenchyme, single tubules). Cases of testicular dysgenesis due to a heterozygous mutation of the steroidogenic factor (SF-1), which regulates the action of many genes involved in the development of the adrenal glands and gonads, as well as in the biosynthesis of various hormones, including AMH, adrenal, gonadal steroids and gonadotropins, have been described.

Ectopia- displacement of the testicle away from the normal path. There are inguinal, perineal, femoral, pubic-penial and pelvic ectopia. It can be one- or two-sided. There is a cross (transverse) ectopia, when both testicles are located on the same side. However, they are usually hypoplastic and not connected with the epididymis and vas deferens.

Cryptorchidism- retention of the testicle on its natural path as it descends into the scrotum. It is common, especially unilateral cryptorchidism. At birth it is observed in 3.4% of boys (30% in premature babies). Half of these undescended testicles descend at the end of the 1st month of life. The testicle with ectopia and cryptorchidism is predisposed to torsion, strangulation, trauma, and tumors arise in it 14 times more often. Cryptorchidism has been described in almost all chromosomal and many gene syndromes, and also occurs sporadically. Familial cases with an autosomal dominant mode of inheritance are known.

Spermatocele- seminal cyst. They are blindly ending seminiferous tubules or embryonic testicular cysts that are connected to them or detached from them. The cyst is located above the posterior surface of the testicle. Most cysts have a diameter of less than 1 cm. Spermatocele can be unilateral or bilateral.

Hydrocele (hydrocele)- excessive amount of fluid between the two layers of the tunica vaginalis due to non-fusion of the processus vaginalis of the peritoneum. It occurs more often in young boys. It is a cystic mass that becomes more intense at night.

Splenognodal fusion- CDF, which affects both sexes with a boy:girl ratio of 16:1. In boys, the left testicle or other mesonephros derivatives are connected to splenic tissue, usually the accessory spleen. In girls, a similar fusion is observed between the left ovary and spleen tissue. Fusion may be ongoing (56%) or non-continuing (44%). When fusion continues, the spleen is connected to the gonad through a fibrous or splenic cord; when fusion does not continue, there is no such connection. In patients with the ongoing type of splenogonadal fusion, limb anomalies, micrognathia or other congenital malformations are observed, such as microgastria, spina bifida, craniosynostosis, diaphragmatic hernia, pulmonary hypoplasia, etc. The non-continuing type is usually not combined with other congenital malformations and the fused gonads do not connect to the native spleen . In many cases, an accessory spleen that is attached to the gonad may be mistaken for a primary testicular malignancy or adenomatoid tumor.

Sexual life is no less important to the spiritual component of a love relationship between two people. Restriction, and even more so a prolonged absence of sexual relations, has a negative impact on the physical health and psychological state of representatives of both sexes.

How exactly does irregular sex life affect general health, what are the consequences for women and men? – These are the questions we will discuss with you today:

Irregular sex - consequences for women

Absence or irregular sex life in women is a common cause of hormonal disorders in the female body, leading to an imbalance of female sex hormones between estrogens, progesterone and the male hormone androgen.

As a result of this imbalance, the risk of developing gynecological diseases such as fibroids and uterine fibroids, mastopathy (diffuse, nodular), as well as oncological diseases such as breast tumors and uterine tumors, increases significantly.

In addition to physical health problems, a woman’s mental state also suffers. This is expressed in the appearance of depression, up to deep neurosis. Mood swings, tearfulness, hysteria, and increased aggressiveness are observed.

In addition, due to the lack of sex, a decrease in thyroid function is observed, and severe manifestations of premenstrual syndrome are observed.
The mental state of young women of reproductive age - from 20 to 30 years old - suffers especially.

Also, women with a high content of estrogen in the blood - busty, with a narrow waist and steep hips - also suffer greatly from the lack or insufficiency of sexual relations. This type of representative of the fair sex experiences sexual abstinence more than others. Although, of course, there are exceptions.

Disturbed hormonal balance due to forced abstinence or irregular sex life helps to slightly balance sports, especially swimming. You can also improve your condition by increasing the consumption of protein foods, taking sedative herbal preparations, infusions of soothing plants: oregano, valerian, motherwort, mint and lemon balm.

Irregular sex life in men

It must be said that both women and men tolerate sexual abstinence differently. For some it is easier, but for others it is very difficult to give up sex. In the first case, men already have a not very intense sex life, and in the second, they cannot imagine life without daily sex.

For men with a strong sexual desire, the lack or interruption of intimate intercourse can seriously affect their overall health. So, for example, if a person is prone to neurotic manifestations, then the absence or irregularity of sex, as well as too frequent contacts, can lead him to a neurotic state.

This is expressed in increased irritability, short temper and even aggressiveness. In men who do not have a very intense sex life, abstinence can be expressed in a bad mood and blues.

Experts say that long-term abstinence among sexually active men seriously harms their physical and mental health.

So, for example, if a man already suffers from any chronic inflammatory diseases of the genital organs, the lack of intimate relationships can provoke their exacerbation.

Blood flowing to the genitals stagnates in the absence of orgasm, which provokes an exacerbation of chronic diseases and increases the risk of developing new pathologies. In particular, long-term abstinence provokes the appearance of prostatitis, prostate adenoma and even cancer of the pelvic organs.

In addition, mental health suffers, which is reflected in the appearance of deep long-term depression, emotional and sexual disorders. Sex, as such, effectively saves you from the harmful effects of stress. The fact is that during sexual intercourse the body actively produces endorphin, the so-called hormone of happiness. And even intense sports and an active physical life cannot fully replace real sexual contact.

In addition, according to doctors, the lack of full-fledged regular sex increases the risk of developing impotence. After all, with prolonged abstinence, the body receives a signal that sexual function as such is unnecessary and simply “forgets” what and how to do.

However, it should be noted that men with a low sex drive can exist quite normally in the absence of a relationship. This also fully applies to the man’s age.

For example, the older a person is, the easier and safer it is for him not to have regular contact. However, a full, regular sex life at a young age is the basis of a healthy old age.

If, due to some forced circumstances, a person must do without full-fledged contacts for a long time, switching attention to creative activities and spiritual practices can help, that is, you need to try to spend time without compromising your health.

Sexual life and reproductive system

Irregular sex life, and especially its absence, have a negative impact on overall health, in particular on the functionality of the reproductive system of men and women, which is responsible for successful conception.

It has been proven that with healthy regular contacts, a man’s hormonal levels are normalized, stabilized, and leveled; in men, sperm contains healthy, mobile, viable sperm.

In women, the patency of the fallopian tubes is restored, the menstrual cycle is stabilized, hormonal levels are also leveled, and the woman’s ability to conceive improves.

Sex is a natural need of all living beings. As we have found out, its absence or insufficiency has a serious negative impact on the health of both sexes.

Therefore, regular, sufficient relationships with a permanent partner will help you maintain health, peace of mind and make you happy. Sexologists recommend having sex twice a week (on average). They also warn against casual relationships and advise not to neglect contraception. Be healthy!

From the book “Thousands... of questions and answers on gynecology” (2008)

What are sexual disorders?
Sexual disorders, or sexual dysfunction, are problems associated with any phase of the sexual response to sexual intercourse that prevents a woman or couple from experiencing pleasure and satisfaction from sexual intercourse. Unfortunately, there are many conflicting rumors and myths about women's sexuality and their ability to obtain satisfaction during sexual intercourse. Women often hide their feelings towards sex, blame themselves and are accused by men of indifference, frigidity and other problems. However, a woman's sexual dysfunction is a problem for two, a married couple, and often has a psychological basis. Statistics show that sexual disorders occur in 31% of men and 43% of women, and are a very common problem among the adult population. As a survey conducted in the United States in 1970 showed, more than 50% of women cannot experience orgasm during intercourse, and from 30 to 50% of men experience problems with potency. Talking about sexual problems is becoming very popular in society, which is supported by the media. Therefore, to some extent, having a personal sexologist (as well as a psychotherapist) has become fashionable in many developed countries.

What are the phases of the sexual response cycle?
There are four phases of the sexual response cycle:
- Arousal (the first level of sexual response, indicating the first signs of sexual arousal).
- Plateau (the second level of sexual response, during which physical arousal increases).
- Orgasm (menopause and release of sexual arousal).
- Resolution (resolution, satisfaction).

What is libido?
Libido is the desire for sexual intercourse, which includes sexual fantasies and thoughts. Synonyms for libido are “desire”, “sexual desire”, “desire”, “passion”.

What types of female sexual disorders are most common?
Some of the most common sexual complaints among women are:
. decreased sexual desire, coldness, frigidity (30‑40%);
. lack of pleasure and orgasm (20-40%);
. pain during intercourse, vaginismus;
. insufficient vaginal hydration.

Sexual dysfunction often develops gradually and depends on the sexual constitution, the personal characteristics of women and the interpersonal relationships of spouses.
What are the causes of sexual dysfunction in women?
All causes of sexual disorders in women can be divided into two main groups: psychological and physical. Psychological reasons include:
. Stress
. Irritability
. Concerns about sexual intercourse
. Relationship problems with your husband or partner
. Depression
. Guilt
. Exposure to previous sexual trauma (rape, deviant sexual intercourse, sexual violence)

Physical reasons include:
. Systemic diseases (diabetes, neurological diseases, cardiovascular diseases, kidney disease, liver diseases)
. Hormonal imbalances
. Menopause
. Alcoholism
. Drug use
. The use of a number of medications (antidepressants, COCs, etc.)

What are the differences in men's and women's reactions to sex?
Very often, men blame women for coldness or other sexual problems, not realizing that the sexual reaction in men and women can be different, despite the same phase of sexual response. Women usually go through sexual phases more slowly than men. Men can experience all four phases within 4-5 minutes. It takes a woman 10 to 20 minutes just for the first two phases to get an orgasm. Only half of women reach orgasm within 10-12 minutes. At the beginning of sexual activity, when there is sexual desire, a feeling of love between partners, orgasm can be achieved within 1 minute in 25% of women after insertion of the penis into the vagina.

Does penis size affect female response?
Numerous studies have proven that the vagina adapts to the size of the penis during sexual intercourse and the subjective sensations of pleasure and intensity of orgasm are not related to the size of the penis. During an erection, the size of a tense penis decreases. Contrary to popular belief, there is no relationship between penis size and male sexual potency. The obstacle may just be a penis that is too large in a woman with a narrow vagina.

Does the size of the clitoris affect sexual sensitivity and orgasm?
The size of the clitoris does not affect the frequency of orgasm in a woman.
The sensitivity of the clitoris is approximately 3-5 times higher than the sensitivity of the head of the male penis, but the occurrence of orgasm and satisfaction during sexual intercourse depends on many factors.

If a woman doesn't have an orgasm, is she frigid?
On average, 1 in 3 women does not experience orgasm in the first year of marriage, and only 30% regularly achieve orgasm during one sexual encounter. This may be due to the inexperience of sexual partners, psychological (fear of partner dissatisfaction, fear of pregnancy) and other factors.

What is decreased sexual desire?
A decrease in sexual desire can occur in both women and men, but it is women who are most often accused of being “cold.” However, there is a very famous expression: “There are no frigid women, but there are inattentive men and lazy women.” True frigidity is extremely rare. Sexual desire and arousal decrease in the presence of chronic diseases of any location, depression, pregnancy, chronic stress. Socio-economic factors can suppress sexual desire: changing or losing a job, financial problems, having small children in the family, living with parents or other relatives in the same apartment or house. Strict upbringing, childhood psychological trauma, and strict control by parents can leave a negative imprint on a woman’s life and be the cause of her sexual disorders. An unpleasant situation and a crisis in intimate life awaken old unconscious fears and prohibitions, which are the cause of sexual problems.

What could be the reason for the lack of orgasm in women?
Anorgasmia, or lack of orgasm, has the same reasons as a decrease or absence of sexual desire, and most often occurs due to the inexperience of sexual partners to bring each other pleasure. It has been proven that 90% of women experience orgasm during masturbation. This means that true anorgasmia, when erotic receptors do not respond to stimulation, is extremely rare. Lack of orgasm can be the result of premature ejaculation in a man, interrupted sexual intercourse, insufficient psycho-erotic preparation of a woman for intimacy (due to the lack of foreplay), or incorrectly chosen position. Due to the lack of sexual education and old traditional views on sex, a woman is most often a passive sexual partner, providing only parts of her body to satisfy the sexual needs of a man, as a result of which the erogenous zones (both genital and extragenital) do not receive sufficient stimulation. Typically, a man determines the frequency, rhythm, and form of sexual intercourse, being an active partner. Sometimes the lack of orgasm can be associated with disorders of puberty.

For what reasons can a woman experience pain during sexual intercourse?
There are many reasons why a woman may experience pain during sexual intercourse.
. Inflammatory diseases of the reproductive system (vaginitis, cervicitis, abscess of the Bartholin gland, inflammation of the appendages)
. Other diseases of the reproductive system (endometritis, ovarian cysts, uterine leiomyoma)
. Vaginismus, primary or secondary (pain due to fear of sexual intercourse)
. Lack of hydration (lubrication) during sexual intercourse.

What are the reasons for insufficient vaginal hydration?
Insufficient production of “lubrication” during sexual intercourse most often occurs due to a woman’s unpreparedness for sexual intercourse (lack of desire, arousal), in the presence of inflammatory processes in the vagina and vulva, while taking a number of medications, with atrophy of the vaginal mucosa (postmenopause, radiation), in the presence of vaginal scars.

How is a woman with sexual dysfunction assessed?
For many years, the issue of female sexual dysfunction has not received the attention it deserves. They were usually accused of “natural coldness,” while sexologists and sex therapists dealt only with issues of male sexual dysfunction. Most clinics specialize in the diagnosis and treatment of male sexual dysfunctions. Female sexual dysfunction is a problem for a married couple or both partners. To exclude a number of causes of sexual dysfunction, a woman may be offered to undergo an examination by a gynecologist, laboratory tests to detect sexually transmitted infections, and an ultrasound. Interviewing the woman and her partner can help the doctor choose the right direction for diagnosing and treating sexual dysfunction.

How are female sexual disorders treated?
In most cases, female sexual dysfunction does not require medication or other treatment. Explaining to a woman and her partner the causes of such disorders, teaching sex techniques, eliminating psychological causes helps in solving the problem in most cases of sexual disorders.

All types of measures and treatment can be divided into the following groups:
1. Teaching the anatomy of the genital organs, their function, changes that occur in the body with age, the rules of sexual behavior and sexual reaction.
2. Encouraging the use of means that increase arousal (watching erotic films, reading erotic books, erotic lingerie, masturbation, new sex positions and techniques, vibrators and sexual toys).
3. The use of stimuli (music, light, decorations, new places, erotic fantasies, sexual experiments).
4. Encouraging non-sexual relationships (a man’s help with household chores, raising children, creating trust, respect and understanding, walking together, traveling and visiting public places, etc.).
5. Reducing pain (treatment of inflammatory processes, surgical removal of tumors of the vagina and uterus, training in relaxation techniques, use of lubricants, medications, hormones).

Can a woman take Viagra and are there such drugs for women?
Women should not take Viagra, which was created to improve male erection, due to its ineffectiveness for the female body and the presence of many side effects. Attempts to create “female Viagra” are being carried out by many pharmaceutical laboratories around the world, but so far have not been successful.

Such an anomaly in the development of the male genital organs as the congenital absence (complete) of the penis is considered an extremely rare developmental defect. This is a pathological condition in which the penis of a newborn baby is completely absent.

With this developmental anomaly, the external opening of the existing urethra can exit either somewhere in the middle part of the perineum, or directly into the cavity of the rectum itself.

Such a developmental anomaly can form as a result of a variety of external causes leading to disruption of the physiologically correct (normal) development of the embryo during the formation of its external genitalia.

Doctors separately highlight another type of congenital pathology, such as the absence of only the head of the penis. Note that with such a pathology, a strong narrowing of the outward opening of the existing urethra can often be observed.

In addition, with such a rare developmental anomaly as Aphallia, the baby’s scrotum is often also underdeveloped. Moreover, in some cases, the scrotum in appearance may well resemble the labia majora. Of course, in this case, some difficulties may arise in determining the sex of the baby. Moreover, it is in such situations that a newborn child’s gender may often be incorrectly assigned.

Naturally, some newborns with such a developmental defect are classified exclusively as female. Moreover, in the future, such a mistake can be reinforced by parental education.

Subsequently, the absence of the cavernous bodies necessary for a man, combined with inadequate psychosexual orientation given by upbringing, can extremely complicate the necessary surgical correction. And exactly the opposite, the presence of at least small remains of the male cavernous bodies, combined with an exclusively male psychological and sexual orientation, allows doctors to carry out the desired correction, fully create a male penis and a completely correctly located urethra.

And, nevertheless, in some of the most complex cases, such a developmental anomaly may be accompanied by multiple other developmental defects associated with the genitourinary system. Unfortunately, in some cases, the combination of such anomalies can often be incompatible with life.

In any case, after identifying the pathology of the congenital absence of the penis, doctors need to clearly determine whether such a child has any internal genital organs at all, and also understand whether the general set of chromosomes corresponds to the female/male set.

It is extremely important to promptly identify or exclude the possible presence of any concomitant anomalies associated with the development of the genitourinary system.

Symptoms

As already mentioned, with the congenital absence of the penis (penis) in a condition called aphallia, it is present the urethra can open outward in a variety of places. Namely in the perineal area, and in some cases noticeable directly in the lumen of the rectum.

As a rule, in newborns with such a developmental anomaly, even with an external unarmed examination, it can be extremely difficult to correctly determine the baby’s gender.

In cases where, during subsequent examinations, an already matured child will exhibit exactly male behavioral characteristics and characteristics, and also if at least the rudiments of male cavernous bodies are found in the baby, then, undoubtedly, such a patient will need corrective surgery. Naturally, such operations are always aimed at forming a normal penis, which, of course, has a full-fledged urethra.

Unfortunately, this pathology practically never occurs as an independent disease. In the vast majority of cases, the pathology is accompanied by other developmental defects, with corresponding symptoms. Moreover, the presence of concomitant anomalies often makes the normal functioning of such a newborn impossible.

Diagnostics

Almost all traditional methods (simple examination and palpation) are suitable for diagnosing congenital absence of the penis in a newborn. Moreover, it is these techniques that make it possible to recognize almost all congenital diseases associated with the penis.

The only difficulty usually lies in correctly determining the gender of such a baby. And for this purpose, ultrasound examinations, etc. can be carried out.

Prevention

As a rule, preventive measures to avoid the development of such a pathology as congenital absence of the penis are no different from those to avoid other anomalies of intrauterine development.

It is important for a woman planning a pregnancy to understand that the penis, as well as the scrotum of the future boy, are formed exclusively under the influence of a substance such as dihydrotestosterone. It is this hormone that is usually formed directly in the cells of the so-called genital tubercle, as well as in the labial-scrotal folds from ordinary testosterone. The full formation of both the penis and the same scrotum of the fetus is completely completed approximately by the 12th maximum by the 16th week of normal embryogenesis.

This congenital anomaly of the male genital organ can occur with the development of fetal malformations directly in the womb, and can also be a negative result of incorrect distribution of chromosomes. Also, this anomaly, like all others, can be caused by the effects of certain medications and simply radioactive radiation. This defect can also be a negative consequence of certain diseases of the embryo.

It is logical that a pregnant woman up to the 16th week of pregnancy should be as careful as possible with taking medications and avoid any toxic effects.

To prevent abnormal development of the embryo, all pregnant women are strongly recommended to completely avoid any ionizing radiation (and in particular powerful X-rays). A woman should not take medications that are dangerous for pregnancy; it is advisable to completely give up such bad habits as smoking and drinking alcohol.

And remember, only in this way can a pregnant woman avoid the development of some damage to the developing fetus and protect herself and the unborn baby from factors that can subsequently cause such congenital anomalies.

Treatment

Without a doubt, treatment of aphallia (if the developmental anomalies are compatible with life and if such is carried out) can be exclusively surgical. This treatment consists of creating a penis exclusively through surgery and then immersing the existing urethra into the artificially formed penis.

Of course, if possible, adequate treatment (whether surgical or conservative) is carried out for all concomitant developmental anomalies (if, of course, there are any). In any case, adequate treatment is determined by the general nature and actual severity of the anomalies.

The sensitivity of the penis is important for a man’s full, high-quality sexual life. It is thanks to the sufficient sensitivity of the head of the penis that a representative of the stronger sex has the opportunity to experience, feel bright, sharp sensations during sex, and achieve orgasm. A decrease, partial or complete loss of sensitivity leads to problems such as disappearing, unstable erections, lack of orgasmic sensations, and sexual dysfunction. What can reduce the sensitivity of the penis and how to increase it?

Why is this happening?

First of all, you need to understand what constitutes low sensitivity of the penis. This sexual disorder can be identified thanks to the following characteristic signs:

1. It becomes more difficult to achieve a state of sexual arousal.
2. Poor, less pronounced erection or complete inability to achieve one.
3. Sexual contact becomes shorter.
4. Orgasmic sensations are absent even during ejaculation.
5. Difficulty achieving ejaculation.
6. The pleasure of intimate contact is lost.

The reasons for decreased sensitivity of the penis are quite numerous and varied. The following diseases can provoke the problem.