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AIDS Foundation Focuses On Men’s Health

29 August 2002

AIDS Foundation Focuses On Men’s Health

The New Zealand AIDS Foundation (NZAF) has declared September 5th National Penis Day as a fun way to promote a serious issue, men’s health particularly men’s sexual health AIDS Foundation Executive Director Kevin Hague said.

“The prevailing culture in New Zealand tells men they have to be tough, What this means in practice is when men do become ill they don’t seek help they tough it out and this approach to health care can have devastating results. From an HIV prevention perspective this view of masculinity results in men taking inadequate care of themselves and their sexual partners. Men feel they have to be seen to be knowledgeable and in control. They’re afraid to reveal vulnerability and embarrassed by sexuality a lethal combination”

By focusing the penis something shared by every man, the AIDS Foundation aims to generate discussion about men’s health issues. “We want to use the day as a way to advocate for a new focus on men’s health so we can tackle men’s health effectively” said Mr. Hague

“We need a new approach for example new policies which are more gender sensitive and specifically include men’s health.”

Mr. Hague listed a number of other strategies to illustrate area’s where attention was need:

- Health services focus on being attractive and accessible to men

- Health services target specific groups of men

- Health services actively seek out men

- Health promotion initiatives specifically aimed at men

- Mens health research is prioritised

- And finally and perhaps most importantly men’s awareness of their health needs is a focus for improvement

By generating discussion the NZAF wants to create an environment where men can talk comfortably about men’s health issues. “Let’s face facts, ignoring a problem and hoping it will go away is just plain dumb yet that’s just what many men do! I’m hoping that people will see the problem and use National Penis Day as a springboard to promote men’s health.

For further comment contact:

Kevin Hague

NZAF

Executive Director

Ph: 09 303 33124 (office)

Ph: 09 372 9780 (home)

Ph: 027 291 7628 (mobile)

FACT SHEETS ATTACHED:

National Penis Day Fact Sheet

Aims

- To reinforce and support the “condom culture’ in New Zealand through the dissemination of baseline information which enables men to make accurate and informed decisions and provides the tools to support those actions.

- A reduction in new transmissions of HIV in New Zealand.

- The creation of an environment, which supports supportive and honest discussion around the male body and men’s sexuality.

- Improve men’s health (particularly sexual health) in New Zealand

Objectives

- Increasing men’s knowledge and understanding of male sexual anatomy

- Increasing knowledge and understanding of condom and lubricant varieties and appropriate and skilled use

- Provision of the “tools’ (condom and lubricant) to successfully engage in safer sex

- Increase capacity in Maori communities to access and utilise condoms and lubricants

Additional Information

- The condom works better at controlling the spread of HIV than any other strategy. (Condoms do a better job of preventing new HIV infection than the BCG vaccine does at controlling tuberculosis in countries where it is in use.)

- Chlamydia infections (the commonest bacterial STI in New Zealand) are still increasing and may soon overtake genital warts as the most common STI in sexual health clinic patients

- Rates of Trachomatis are five times higher and Gonorrhoea double those reported in Australia (from participating labs) during the same period (2001)

- Groups at higher risk of Gonorrhoea are Maori and Pacific Islands People and males aged under 20

- Being infected with other sexually transmitted infections increases the risk of both acquiring and transmitting HIV infection

- Effective prevention initiatives have been shown to lead to increased knowledge, delays in sexual activity and increased use of condoms among those having sex for the first time

- Knowledge = power. (Sweden/Netherlands)

***

HIV and STDs Information Sheet

- The condom works better at controlling the spread of HIV than any other strategy. (Condoms do a better job of preventing new HIV infection than the BCG vaccine does at controlling tuberculosis in countries where it is in use.)

- Chlamydia infections (the commonest bacterial STI in New Zealand) are still increasing and may soon overtake genital warts as the most common STI in sexual health clinic patients

- Rates of Trachomatis are five times higher and Gonorrhoea double those reported in Australia (from participating labs) during the same period (2001)

- Groups at higher risk of Gonorrhoea are Maori and Pacific Islands People and males aged under 20

- Being infected with other sexually transmitted infections increases the risk of both acquiring and transmitting HIV infection

- Effective prevention initiatives have been shown to lead to increased knowledge, delays in sexual activity and increased use of condoms among those having sex for the first time

HIV and AIDS

- To date there are no appreciable differences in the rates of HIV diagnosis between Maori, Pacific Islands and European populations

- The predominant challenge to HIV strategies among men who have sex with men is the initiation and maintenance of regular condom use.

- The cumulative incidence of AIDS notifications (to December 2001) is 755 of these 77.7% or 587 are men who have sex with men. *

- The cumulative incidence of HIV (to December 2001) is 1558 of these 52.4% or 816 are men who have sex with men. *

- The single largest group of new HIV infections in the 12 months to 31/12/01 occurred in men who have sex with men at 40% (or 38 out of 95). *

*AIDS New Zealand, Issue 49 - February 2002, AIDS Epidemiology Group, Department of Preventive & Social Medicine, University of Otago.

***

How to Do a Testicular Self Examination:

It is common knowledge that a monthly breast self-exam for women is an effective part of early breast cancer detection. For men, starting at age 15, monthly self-exams of the testicles are also an effective way of getting to know this area of your body and thus detecting testicular cancer (TC) at an early -- and very curable -- stage.

The self exam for TC is best performed after a warm bath or shower.

(Heat relaxes the scrotum, making it easier to spot anything abnormal)

The TCRC recommends following these steps every month:

- Stand in front of a mirror. Check for any swelling on the scrotal skin.

- Examine each testicle with both hands. Place the index and middle fingers under the testicle with the thumbs placed on top. Roll the testicle gently between the thumbs and fingers -- you shouldn't feel any pain when doing the exam. Don't be alarmed if one testicle seems slightly larger than the other, that's normal.

- Find the epididymis, the soft, tubelike structure behind the testicle that collects and carries sperm. If you are familiar with this structure, you won't mistake it for a suspicious lump. Cancerous lumps usually are found on the sides of the testicle but can also show up on the front. Lumps on the epididymis are not cancerous.

- If you find a lump on your testicle, see a doctor, preferably a urologist, right away. The abnormality may not be cancer, it may just be an infection. But if it is testicular cancer, it will spread if it is not stopped by treatment. Waiting and hoping will not fix anything. Please note that free floating lumps in the scrotum that are not attached in any way to a testicle are not testicular cancer. When in doubt, get it checked out - if only for peace of mind!

Other signs of testicular cancer to keep in mind are:

- Any enlargement of a testicle

- A significant loss of size in one of the testicles

- A feeling of heaviness in the scrotum

- A dull ache in the lower abdomen or in the groin

- A sudden collection of fluid in the scrotum

- Pain or discomfort in a testicle or in the scrotum

- Enlargement or tenderness of the breasts

I hesitate to mention the following list, since anything out of the ordinary down there should prompt a visit to the doctor, but you should be aware that the following symptoms are not normally signs of testicular cancer:

- A pimple, ingrown hair or rash on the scrotal skin

- A free floating lump in the scrotum, seemingly not attached to anything

- A lump on the epidiymis or tubes coming from the testicle that kind of feels like a third testicle

- Pain or burning during urination

- Blood in the urine or semen

***
Remember, only a physician can make a positive diagnosis
***

For that matter, only a physician can make a negative diagnosis too. If you think something feels strange, go see the doctor!

Finally, embarrassment is a poor excuse for not having any problem examined by a doctor. If you think there is something wrong or something has changed, please see your doctor!

***

The Testicular Cancer Primer

Let's start off with some quick facts:

- Testicular cancer is the most common cancer in young men between the ages of 15 and 35 years old--but it can strike any male, any time.

- Testicular cancer is almost always curable if it is found early.

- Most testicular cancers are found by men themselves, either as a painless lump, a hardening or change in size of the testicle, or pain in the testicle.

- Children born with an undescended testicle have an increased risk of getting testicular cancer regardless of whether surgery is done to correct the problem. However, the surgery should still be done to preserve fertility.

- Testicular cancer can be treated with surgery, radiation therapy, chemotherapy, surveillance, or a combination of these treatments.

What are the testicles?

The testicles (also called testes or gonads) are the male sex glands. They are located behind the penis in a pouch of skin called the scrotum. The testicles produce and store sperm, and they also serve as the body's main source of male hormones. These hormones control the development of the reproductive organs and other male characteristics, such as body and facial hair, low voice, wide shoulders and libido.

What is cancer?

Cancer is a group of more than 100 diseases. Although each kind differs from the others in many ways, every type of cancer is a disease of some of the body's cells. (In our case, we call it testicular cancer, but as many as 14 different types of cancer can start in the testicle....) Healthy cells that make up the body's tissues grow, divide, and replace themselves in an orderly way. This process keeps the body in good repair. Sometimes, however, some cells lose the ability to limit and direct their growth. They grow too rapidly and without any order. Too many cells are produced, and tumors are formed. Tumors can be either benign or malignant.

Benign tumors are not cancer. They do not spread to other parts of the body and are seldom a threat to life. Benign tumors can often be removed by surgery, and they are not likely to return. Some tumors of the testicle are benign, but most are not.

Malignant tumors are cancer. They can invade and destroy nearby healthy tissues and organs. Cancerous cells can also spread, or metastasise, to other parts of the body and form new tumors.

Cancer that develops in a testicle is called testicular cancer. When testicular cancer spreads, the cancer cells are carried by blood or by lymph, an almost colourless fluid produced by tissues all over the body. The fluid passes through lymph nodes, which filter out bacteria and other abnormal substances such as cancer cells. Doctors use CT scans of the abdomen and chest in an attempt to determine if the cancer has spread to the lymph nodes or lungs.

What is testicular cancer?

Testicular cancer is one of the most common cancers in young men between the ages of 15 and 35, but the disease also occurs in other age groups, so all men should be aware of its symptoms. While testicular cancer is common among young men, young men typically do not get a lot of cancer, so overall testicular cancer is a relatively rare disease.

Most testicular cancers are found by men themselves, by accident or when doing a testicular self-examination. The testicles are smooth, oval-shaped, and rather firm. Men who examine themselves regularly (once a month) become familiar with the way their testicles normally feel. Any changes in the way they feel from month-to-month should be checked by a doctor, preferably a Urologist.

In men under 60, 95% of testicular tumors originate in the germ cells, the special sperm-forming cells within the testicles. These tumors fall into one of two types, seminomas or non-seminomas. (Note that in the UK and a few other places, non-seminomas are called teratoma instead.) Other forms of testicular cancer include leydig and sertoli cell tumors. Rarely tumors such as PNET, leiomyosarcoma, rhabdomyosarcoma, mesothelioma and others can arise in the testicle. These tumors are much harder to treat and patients with them should absolutely get a second opinion from an expert. Men over the age of 60 can still get a germ cell tumor, but they are more likely to get leukemia, lymphoma, or a benign tumor called spermatocytic seminoma. Unless otherwise noted, all the information on this web site concerns testicular germ cell tumors.

- Pure Seminomas account for about 40 percent of all testicular cancer and are made up of immature germ cells. Usually, seminomas are slow growing and tend to stay localized in the testicle for long periods.

- Non-seminomas are a group of cancers that often occur in combination with one another, including choriocarcinoma, embryonal carcinoma, immature teratoma and yolk sac tumors. Non-seminomas arise from more mature, specialized germ cells and tend to be more aggressive than seminomas.

There are three stages of testicular cancer:

- Stage I--The cancer is confined to the testicle.

- Stage II--The cancer has spread to the retroperitoneal lymph nodes, located in the rear of the body below the diaphragm and between the kidneys.

- Stage III--The cancer has spread beyond the lymph nodes to remote sites in the body, including the lungs, brain, liver and bones.

What's the prognosis? Can Testicular Cancer be cured?

Don't ever say that there has not been progress in the war against cancer. In 1970 90% of testicular cancer patients with metastatic disease died of their cancer. By 1990, because of the introduction of chemotherapy drugs such as cisplatin, the numbers had basically flipped. Now almost 90% of men with metastatic disease are cured of their cancer.

Specifically, the survival rate for men diagnosed with Stage I seminoma is about 99%. The survival rate for men with Stage I non-seminoma is about 98%. Cure rates for Stage II tumors range above 90%, while cure rates for Stage III tumors vary between 50-80%. In addition to Stage, a variety of institutions have created classifications of Good and Poor risk tumors. Good risk tumors are generally those that have not spread outside of the retroperitoneal lymph nodes or lungs and do not have overly elevated tumor markers. Poor risk tumors generally have very high tumor markers or have spread outside of the lungs and lymph nodes. As you might expect, the survival rate for good risk tumors is high (more than 90%), while the survival rate for poor risk tumors is lower (50-60%).

What are the causes of testicular cancer?

To date, no one really knows. Researchers study patterns of cancer in the population to discover whether some people are more likely than others to develop certain cancers. If they can learn what causes the disease, they may be able to suggest ways to prevent it. At this time, there is no way to prevent testicular cancer apart from the obvious one...

Testicular cancer is not contagious: no one can "catch" it from another person. Exactly what causes this disease is unknown and seldom can it be explained why one person gets it while another doesn't. Research does show that some men are more likely than others to develop testicular cancer. For example, the risk is higher than average for boys born with their testicles in the lower abdomen rather than in the scrotum (called undescended testicles or cryptorchidism). The cancer risk for boys with this condition is increased regardless of whether the condition is corrected, and in fact, the risk exists even in the normal testicle. The theory is that the increased risk of testicular cancer is due to whatever caused the undescended testicle, not just by the fact that the testicle was undescended.

Research has also shown that testicular cancer is sometimes linked to certain other rare conditions in which the testicles do not develop normally. There is even some line of thought that pollutants may be contributing to this problem, evidenced by the considerable increase in occurrences over the last few decades and paralleled with industrial growth and waste.

Some men whose mothers took a hormone called DES (diethylstilbestrol) during pregnancy to prevent miscarriage have testicular abnormalities. But scientists have never proven that prenatal exposure to DES (or any other female hormone) increases the risk of testicular cancer. To date, this link has never been verified.

Some patients with testicular cancer have a history of injury to the scrotum. But again, no one knows whether such an injury can actually cause cancer. Many doctors think such an injury simply calls attention to a tumor that was already growing.

What are the symptoms of testicular cancer?

Testicular cancer can cause a number of symptoms. Listed below are warning signs that men should watch for:

o A lump in either testicle; the lump typically is pea-sized, but sometimes it might be as big as a marble or even an egg.

o Any enlargement of a testicle;

o A significant shrinking of a testicle;

o A change in the consistency of a testicle (hardness);

o A feeling of heaviness in the scrotum;

o A dull ache in the lower abdomen or in the groin;

o A sudden collection of fluid in the scrotum;

o Pain or discomfort in a testicle or in the scrotum;

o Enlargement or tenderness of the breasts.

These symptoms are not sure signs of cancer; they can also be caused by other conditions. There are numerous other causes of swelling of the testis that are harmless, including hydrocele, a collection of fluid in the scrotum; epididymitis, a swelling of the epididymis (the structure behind the testis where sperm mature) which may also cause fever and discharge from the penis; and varicocele, varicose veins in the scrotum which is described as feeling like "a bag of worms". Inflammation of the testis can also be related to bacterial infections. Torsion of the testis occurs when a testicle rotates and the spermatic cord becomes obstructed and the blood supply is cut off. This most commonly occurs around puberty and causes excruciating pain and swelling of the testis. (If this happens, it is a surgical emergency and the patient should be rushed to an emergency room.)

However, it is important to see a doctor, preferably a urologist, if any of these symptoms occur -- any illness should be diagnosed and treated as soon as possible. Early diagnosis of testicular cancer is especially important because the sooner cancer is found and treated, the better a man's chance for complete recovery and the easier the treatment protocol. We realize that it may be difficult to discuss this or let yourself be examined, but it is very important. Cancer is not going to go away on its own, and neither will your concern. If you are suspicious that something is going on down there, get it checked out. You will feel better that you did, even if it turns out to be nothing serious!

How is testicular cancer diagnosed?

When a man's symptoms suggest that there might be cancer in a testicle, a personal and family medical history is taken and a complete physical examination is conducted. In addition to checking general signs of health (temperature, pulse, blood pressure, and so on), the scrotum will be carefully examined. The patient will usually have an ultrasound, a chest x-ray, and blood and urine tests. If the ultrasound shows a solid mass inside the testicle, then cancer is presumed because most tumors in the testicles are cancerous. If the doctor says maybe it is an infection, prescribes antibiotics, and says to come back in 2-3 weeks, but does not order an ultrasound, be sure to ask why not. Testicular cancer is missed by the doctor the first time around almost 30% of the time. Since TC is so rare, they figure it must be something else. In this scenario, it is important that you remember to follow up or ask to be seen by a urologist!

The only sure way to know whether cancer is present is for a pathologist to examine a sample of tissue under a microscope. To obtain the tissue, the affected testicle is removed through the groin. This operation is called inguinal orchiectomy. The surgeon does not cut through the scrotum and does not remove just a part of the testicle because, if the problem is cancer, cutting through the outer layer of the testicle might cause a local spread of the disease.

How is testicular cancer treated?

Testicular cancer is almost always curable if it is found early. This disease responds well to treatment, even if it has spread to other parts of the body.

Before Treatment

If a man has testicular cancer, it is important to find out the extent, or stage, of the disease (whether it has spread from the testicle to other parts of the body). Staging procedures include a thorough physical exam, blood tests, x-rays and scans, and, in some cases, additional surgery.

Most patients will CT or CAT scan of their abdomen and chest. A CT scan is a series of x-rays of various sections of the body that gives the doctors a good look to see if the cancer has spread. Special blood tests can also reveal certain substances in the blood. These substances are called tumor markers because they often are found in abnormal amounts in some patients with testicular cancer. The levels of specific tumor markers in the blood can help the doctor determine what type of testicular cancer the patient has and how advanced it is.

Surgery may be recommended to remove the lymph nodes deep in the abdomen (called RPLND surgery). A pathologist then examines the nodes to determine whether they contain cancer cells. For patients with non-seminoma, removing the nodes can also help stop the spread of their disease. Seminoma patients do not usually need this surgery because cancer cells in their lymph nodes can be destroyed with radiation therapy.

Treatment Methods

Testicular cancer can be treated with surgery, radiation therapy, chemotherapy, and surveillance. One method or a combination of methods may used.

Surgery

In most cases, surgery is initially performed to remove the testicle (called an Inguinal Orchiectomy). Sometimes it is also necessary to remove lymph nodes in the abdomen (called RPLND surgery). Additionally, tumors that have spread to other parts of the body may be partly or entirely removed by surgery.

Radiation Therapy

In radiation therapy (also called x-ray therapy, radiotherapy, cobalt treatment, or irradiation), high-energy rays are used to damage cancer cells and stop their growth. Like surgery, radiation therapy is a local treatment and affects only the cells in the treated area. The patient usually receives radiation therapy on an outpatient basis.

Seminomas are highly sensitive to radiation. Following surgery, men with seminomas often have radiation therapy to their abdominal lymph nodes.

Non-seminomas are much less sensitive to radiation. Patients with this type of cancer usually have other types of treatment, such as surgery and/or chemotherapy.

Chemotherapy

The use of drugs to treat cancer is called chemotherapy. Anticancer drugs are recommended when there are signs that the cancer has spread and the type and stage of the tumor is appropriate for this treatment. Chemotherapy is also sometimes used when the doctor suspects that undetected cancer cells remain in the body after surgery or irradiation--this is known as "adjuvant therapy".

Surveillance

For stage I testicular cancer waiting and regular testing, called surveillance, is an option. The theory is that for many Stage I patients the cancer was cured by the orchiectomy. Since the doctors know that chemotherapy can cure the patient if the cancer comes back, why not just avoid any further treatment until there is evidence that the cancer has indeed spread. It can NOT be stressed enough that men under surveillance must follow the exact directions of their medical team to ensure that recurrent disease is caught as early as best possible! Surveillance is only effective if you actually follow the protocol.

What are the side effects of treatment for testicular cancer?

The treatments used against cancer must be very powerful, and that is why some patients may have some unpleasant side effects.

Many men worry that losing one testicle will affect their ability to have sexual intercourse or make them sterile. But a man with one healthy testicle can still have a normal erection and produce sperm. Therefore, an operation to remove just one testicle does not make a patient impotent and seldom interferes with fertility.

Men can also have an artificial testicle, called a prosthesis, placed in the scrotum. The implant has the weight and feel of a normal testicle. Note that finding a source for this implant in the USA is not impossible, but can be difficult. Check the TCRC implants page for more information on availability.

Surgery to remove the lymph nodes does not change a man's ability to have an erection or an orgasm, but the operation can cause infertility because it may interfere with the nerves involved in ejaculation. Severing these nerves causes the bladder neck to relax during an ejaculation allowing the semen to travel backwards into the bladder instead of forward through the penis. Some men may have temporary stoppage then recover the ability to ejaculate without treatment; others may be helped by medication - for many it will be permanent. Patients should talk with their doctor about the possibility of removing the lymph nodes using a nerve sparing surgical technique that may protect the ability to ejaculate. This may not be possible in every given case, and not every doctor is capable of performing this surgery.

Radiation therapy affects both normal and cancerous cells, but normal cells are able to recover, and recent updates in radiation therapy have greatly reduced the amount of collateral "scatter". Having treatments 5 days a week, for several weeks, spreads out the total dose of radiation and gives the patient weekend rest breaks to recover. Nevertheless, the body must work very hard during radiation therapy to repair the tissues injured by the treatment. Patients may feel unusually tired with periods of nausea, and they should try to rest as much as possible. Radiation therapy does not change the ability to have sex. Radiation therapy may, however, interfere with sperm production. Usually the effect is temporary, and most patients regain their fertility within a matter of months. Some other unpleasant effects of radiation therapy include diarrhea and vomiting. These problems can usually be controlled with medication. There may also be skin reactions in the area being treated, and it is important to treat the skin gently. Lotions and creams should not be used on these areas without the doctor's advice.

Chemotherapy causes side effects because it damages not only cancer cells, but other rapidly growing cells as well, such as hair and gum tissue. Often anticancer drugs are given in cycles, with treatment periods alternating with rest periods. The side effects of chemotherapy depend on the specific drugs that are given and the response of the individual patient. These drugs commonly affect hair cells, blood-forming cells, and cells that line the digestive tract. As a result, they may cause various problems, including hair loss, lowered resistance to infection, loss of appetite, nausea and vomiting, and mouth sores. Most men who receive chemotherapy for testicular cancer can continue to function sexually, although some anticancer drugs interfere with sperm production. Although this effect is permanent for some patients, many recover their fertility within a few years. Patients about to have chemotherapy who are interested in having children just attempt to bank sperm, just in case.

Loss of appetite can be a serious problem for patients receiving either radiation therapy or chemotherapy. Researchers are learning that patients who eat well are better able to withstand the side effects of their treatment. Therefore, good nutrition is important. Eating well means getting enough calories to prevent weight loss and having enough protein to build and repair skin, hair, muscles and organs. Many patients find that having several small meals and snacks throughout the day is easier than trying to eat three large meals.

The side effects of cancer therapy vary from person to person and may even be different from one treatment to the next in the same patient. Attempts are made to plan treatment to minimize problems. Fortunately, most side effects are temporary. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and suggest ways to deal with them.

What happens after patients are treated for testicular cancer?

Regular follow-up exams are very important for anyone treated for testicular cancer. A patient who has had testicular cancer should be closely monitored for several years to be sure the cancer is completely gone. If the cancer does recur, early detection is very important so that additional treatment can be started and the disease contained quickly.

Follow-up care regimens vary for the different types and stages of testicular cancer. Generally, patients are checked and have blood tests to measure tumor marker levels every month or two for the first 2 years after treatment. They also have regular x-rays and CT scans. After that, checkups may be needed just once or twice a year. For more detailed information on follow-up protocols. Non-seminoma seldom recurs (less than 5%) after a patient has been free of the disease for 2 years. Seminoma seldom recurs (less than 5%) after a patient has been cancer free for 5 years.

Patients who have been treated for cancer in one testicle have about a 3 percent chance of developing cancer in the remaining testicle. If cancer does arise in the second testicle, it is nearly always a new disease rather than a metastasis from the first tumor. Patients should be checked regularly by their doctor and should continue to perform testicular self-examinations every month. Any unusual symptoms should be reported to the doctor without delay. As with the patient's first cancer, the earlier a new tumor is detected and treated, the greater the chance of cure - which is also very good, even in secondary TCs.

***

The Great Penis Fact Sheet

Average length (flaccid) 93.9mm or 9.4cm

Average diameter (flaccid) 31.7mm or 3.18cm

Average length (erect) 129.5mm or 12.9cm

Average diameter (erect) 40.6mm or 4.1cm

Penises usually reach their full size by the time a male turns 17.

On average the shorter a guy’s penis, the bigger it gets when erect.

Erections fill your penis with oxygen-rich blood, and oxygen is essential for the survival of the smooth muscle tissue within the arteries of your penis. A shortage of oxygen can eventually lead to a build-up of collagen, making erections difficult.

The average male between the ages of 15 and 60 will ejaculate 34.11 to 56.85 litres of semen containing 350 to 500 billion sperm cells.

Average volume of ejaculate: 0.5 to 1 teaspoon

Chief ingredient: Fructose

Caloric content: 5 calories per teaspoon

Protein content: 6 milligrams per teaspoon

Average number of ejaculatory spurts: 3 to 10

Average speed of ejaculation: 40.2km per hour

Average interval of ejaculatory contractions: 0.8 seconds

Average duration of orgasm: 4 seconds

Farthest medically recorded ejaculation: 59.7cm

Average number of sperm cells in

Ejaculate of a healthy man: 200 to 600 million

Average number in ejaculate of infertile man: 50 million

Average swimming speed: 1 to 4 millimeters per minute

Source: The Penis Book, Joseph Cohen, 1999, Fresh Ideas Daily, New York City.


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