Our society is obsessed with size, and bigger is almost always better. Men boast about driving the biggest truck. Hunting with the biggest rifle. Having the biggest biceps. Women pay thousands of dollars for bigger breasts. Movie posters exclaim The Biggest Hit of the Summer! and athletes live by the mantra go big or go home. We love bigger. Bigger is good. Bigger works.
This pattern of avoidance continues into adulthood. Beaches, pool parties, and bike rides are just a few of the things that strike fear into the hearts of the over-hung. A man who carries a huge penis also carries a sack full of painful memories: being teased and physically attacked by schoolmates and co-workers. Accidentally making sexual partners hemorrhage or vomit. Suffering the sweltering days of summer in long pants.
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When people speak of penis size, they typically refer to length. Thus, a man with a short but wide penis would probably think of himself as having a small penis, and would be so thought of by others, too. However, width is part of size, although usually not acknowledged. Does width contribute to female sexual satisfaction? Is length more important? Or, perhaps size is unrelated to female sexual enjoyment.
It is not obvious why a wide penis would be preferred to a long penis, but speculation would suggest the following. Penis width may be important due to a penis thick at the base providing greater clitoral stimulation as the male thrusts into the female during sexual intercourse. That is, a wide penis would seem to offer a greater degree of contact with the outer part of the vagina, including the clitoral area. If this is correct, then Masters and Johnson are wrong about penis size being unrelated, physiologically, to female sexual satisfaction. Masters, Johnson, and Kolodny [3] do not totally rule out penis size being relevant, but they suggest that it is likely of minor importance for female sexual satisfaction (see especially pages 509-510 in Masters, Johnson, and Kolodny [3]). Another possibility is that a wider penis provides the woman with a greater feeling of fullness, which is psychologically, and perhaps physiologically, satisfying.
Women reported that penis width was more important for their sexual satisfaction than penis length. The results were statistically significant. Penis width needs to be given more consideration, and taken into account when one discusses penis size. Also, it may be that Masters and Johnson [1,2,3] were wrong about penis size having little or no physiological effect on women's sexual satisfaction. However, the current data cannot provide a final answer, since they are based on self reports of women surveyed about penis length vs. width, and their sexual satisfaction. The results reflect either a psychological preference or a true physiological reality, but we cannot say which, with the present method that was employed.
As expected, a significant correlation was found between SPL and FPL. This finding is attributed to the fact that a person with a longer FPL may naturally have a longer SPL given the flexibility of penile tissue. Contrary to our data, showing that FPL was negatively correlated with penile stretched rate would suggest that the individual had a different penile extension rate. The same result was also noted in another report [13]. The elasticity of a small, flaccid penis may be greater than that of a large, flaccid penis.
Penis erection, or tumescence, is the physiological process of spontaneous or sexually induced enlargement and hardening of the penis, as a result of a complex interaction of psychological, neural, vascular, and endocrine factors [1]. The first trigger of penis tumescence derives from the peripheral nervous system, which induces, through the inhibition of sympathetic and the stimulation of parasympathetic activity, the relaxation of the smooth muscle belonging either to the wall of the arterial system, which flows into the typical lacunar spaces, or to the trabecular structure, which delimitates the lacunar spaces, of the corpora cavernosa; the smooth muscle relaxation leads to cavernous arteries vasodilation and cavernous lacunar spaces extension, with consequent increase of blood inflow into the corpora cavernosa of the penis [1]. The engorgement of cavernous lacunar spaces induces a compression of the cavernous venous system, with consequent decrease of blood outflow from the corpora cavernosa, ultimately entrapping the blood into the penis and maintaining penis tumescence [1]. The process is reversed by the inhibition of parasympathetic and the stimulation of sympathetic activity, which induces the contraction of the cavernous smooth muscle, leading to a decrease of blood inflow, and the consequent gradual decompression of the cavernous venous system, leading to an increase of blood outflow, ultimately inducing the passage from tumescence to detumescence of the penis, till the achievement of penis flaccidity, a condition characterized by a tonic contraction of the cavernous smooth muscle allowing a small amount of arterial blood flow for nutritional purpose [1].
The current study is a randomized, double-blind, placebo-controlled clinical trial on the effects of a 3-month l-ARG supplementation on penile erectile function in male patients with vasculogenic ED. The main outcome of the study was the penile erectile function assessed by IIEF 6-item (IIEF-6) score and cavernous arteries peak systolic flow velocity (PSV) obtained at dynamic PDU. A secondary aim of the study was to detect differential responses to l-ARG supplementation according to the degree of baseline vasculogenic ED assessed at dynamic PDU. At study entry, patients were allocated to l-ARG or placebo group using standard randomization tables; patients and clinicians were blinded regarding the treatment modality. Intervention schedule included a 3-month treatment with l-ARG (6 g/day), administered orally thrice a day after standard meals, using vials containing 2 g l-ARG/20 ml (Bioarginina, Farmaceutici Damor S.p.A., Napoli, Italy), or placebo. Daily l-ARG supplementation regimen was established according to current l-ARG administration schedule used in clinical practice and, particularly, to l-ARG administration schedule used in interventional studies performed in patients with ED. l-ARG and placebo were provided in vial packaging of the same color, shape, and size. At study entry, participants received 160 vials in 8 packs containing 20 vials (135 bottles for treatment and 25 as a reservoir). At 45 days after study entry, excess of unused vials was withdrawn, and patients received additional 160 vials in 8 packs containing 20 vials (135 bottles for treatment and 25 as a reservoir) for treatment completion, occurring at 90 days after study entry. The evaluation of patients was performed at two time-points, namely at study entry or baseline (T0), and at study completion or end of treatment (T1). At T0 and T1 the assessment of penile erectile function was performed by IIEF-6 questionnaire and dynamic PDU, and associated with the registration of medical, pharmacological and sexual anamnesis, a complete physical examination, comprising the measurement of clinical parameters [height, weight, body mass index (BMI), heart rate (HR), and systolic (SBP) and diastolic (DBP) blood pressure], as well as a blood collection, performed in the morning and after an overnight fast, for the evaluation of biochemical parameters [fasting glucose (FG), triglycerides (TG), total and HDL cholesterol, and indexes of renal and liver function], for either the exclusion of confounding factors or safety. An endocrine evaluation with the measurement of the most important hormones involved in the regulation of sexual function (total testosterone and prolactin) was performed at baseline to exclude the main endocrine disorders affecting penile erectile function; total testosterone levels were also re-tested at study completion. The occurrence of adverse events was recorded during the entire study and up to 15 days after study completion; adverse events were scored as mild (well tolerated and not interfering with daily activities), moderate (poorly tolerated but not interfering with daily activities) or severe (determining death, impairment of vital functions, disability, hospitalization). The study was performed in line with the principles of the Declaration of Helsinki, after the approval by a local Ethics Committee.
The rationale behind the administration of l-ARG as a suitable treatment for vasculogenic ED relies on the matter of fact that l-ARG is an important donor of NO, which is a prominent molecular mediator of the penile erectile process, for the ability to induce cavernous smooth muscle relaxation, and particularly to contribute to the cavernous arteries performance and cavernous blood flow, crucial for penis erection [4, 7]. Moreover, NO production in the vascular endothelium of the penis has been found to be decreased in vasculogenic ED, such as in the case of ED caused by atherosclerosis and diabetes [16, 17, 19], and a reduction of circulating l-ARG levels has been detected in patents with vasculogenic ED [20], further confirming that l-ARG supplementation might be beneficial in the treatment of vasculogenic ED.
The genitalia of the female closely resembles that of the male; the clitoris is shaped and positioned like a penis, a pseudo-penis, and is capable of erection. The female also possesses no external vagina (vaginal opening), as the labia are fused to form a pseudo-scrotum. The pseudo-penis is traversed to its tip by a central urogenital canal, through which the female urinates, copulates and gives birth.[52][53] The pseudo-penis can be distinguished from the males' genitalia by its somewhat shorter length, greater thickness, and more rounded glans.[10][54][55] In both males and females, the base of the glans is covered with penile spines.[56][57] The formation of the pseudo-penis appears largely androgen independent, as the pseudo-penis appears in the female fetus before differentiation of the fetal ovary and adrenal gland.[10] When flaccid, the pseudo-penis is retracted into the abdomen, and only the prepuce is visible. After giving birth, the pseudo-penis is stretched, and loses many of its original aspects; it becomes a slack-walled and reduced prepuce with an enlarged orifice with split lips.[39] be457b7860
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