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6 December 2004
Micropenis Rebuilt With Flesh From Arm
by George Atkinson

University College London (UCL) urologists are pioneering a surgical technique that is enabling men born with a very small penis to acquire an average-sized, functioning penis which not only allows them to urinate normally, but also to enjoy a full sex life. The phalloplasty procedure was described at the European Society for Sexual Medicine conference in London by Dr David Ralph.

A micropenis can develop from inadequate testosterone during fetal growth, or androgen insensitivity, where the fetus begins as a male but is insensitive to the male hormone testosterone during growth. A number of treatments are available for micropenis and gender reassignment is sometimes considered. Dr Ralph said that an average erect penis measures around 12.5 cm (5 inches) while a micropenis spans less than 7 cm (just over two inches). Micropenis affects 0.6 percent of the male population.

The phalloplasty - or penile enlargement - technique involves cutting a flap of skin from the patient's forearm and shaping it into a penis four or five inches long. To maintain sensation, the original penis is incorporated into the surface of the transplanted skin.

Patients receive a urethra to enable them to urinate and an inflatable penile prosthesis to achieve an erection allowing them to engage in sexual intercourse. UCL surgeons performed the operation on nine men with a range of medical backgrounds, including three hermaphrodites and two men who had problems with androgen (one of whom became deficient in androgen after chemotherapy).

Following the surgery, all patients were found to be satisfied with the cosmetic appearance of their penis, with four patients able to urinate standing up and four able to have regular sexual intercourse. In several cases complications arose, such as infections or a shift in the cylinder position, with further revision operations needed. "This operation can change the life of young men, improving their self-esteem and quality of life and allowing many of them to have sexual intercourse, sometimes for the first time in their life. However, patients should be aware of the high risk of complications from this procedure," concluded Dr Ralph.

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