In historical culture-bound cases, reassurance and talks on  sexual anatomy  are given. [ 13 ]  Patients are treated with  psychotherapy  distributed according to symptoms and to etiologically significant points in the past. Prognosis appears to be better in cases with a previously functional personality, a short history and low frequency of attacks, and a relatively uncomplicated sexual life. [ 7 ]


For sporadic Western cases, careful diagnostic workup including searching for underlying sexual conflict is common. The choice of psychotherapeutic treatment is based on the psychiatric pathology found. [ 31 ]


In China, traditional treatment based on the causes suggested by cultural beliefs are administered to the patient. Praying to gods and asking Taoist priests to perform exorcism is common. If a  fox spirit  is believed to be involved, people may hit  gongs  or beat the person to drive it out. The person will receive a yang- or yin-augmenting Chinese medicine to try to balance the internal conditions, usually including herbs, pilose antler (stag of deer) or deer tail, and  tiger penis ,  deer penis , or  fur seal  penis. Other medicinal foods for therapy are pepper soup, ginger soup and  liquor . [ 12 ]


Among the Chinese, koro is confined to  South China  and the lower  Yangtze Valley . [ 7 ]  A 1992 study of self-report questionnaires suggests that in the epidemic area of China, individuals with koro are mostly  Han , male, young, single, poorly educated and fearful of  supernatural forces  and koro. [ 12 ]  The phenomenon is also found among overseas Chinese in  Southeast Asia , especially  Malaysia  and  Indonesia , and less frequently among the  Malay  and  Indonesian  inhabitants of the countries. [ 7 ]  Though there are speculations that the occurrence of koro among people in Malaysia and Indonesia was the result of Chinese migrants, this cultural diffusion view is challenged since koro epidemics have been reported in  Thailand  and India, involving masses of non-Chinese people. [ 32 ]


Sporadic cases of koro among people with non-Southeast-Asian ethnicity have been reported across the globe, for example,  Nepali , [ 33 ]   Sudanese , [ 34 ]   Jordanian , [ 35 ]   Tanzanian , [ 36 ]   Nigerian , [ 37 ]   French , [ 38 ]   British , [ 39 ] [ 40 ] [ 41 ]   American [ 42 ] [ 43 ]  and  Canadian . [ 44 ] [ 45 ]  In most of the non-Chinese cases in the  Western hemisphere , fear of genital shrinkage is reported but not all the other typical koro symptoms, such as fear of death, as in endemic countries. [ 46 ]  The incomplete forms of koro are regarded as the non-cultural forms, while the complete form with acute anxiety is the classical culture-bound type. [ 15 ]


Local official records indicate genital retraction epidemics in  Hainan Island  and  Leizhou Peninsula  in  Guangdong , China, as early as the late nineteenth century.  There were a series of epidemic outbursts in 1948, 1955, 1966, and 1974, whenever there was social tension or impending disaster, followed by the last widespread episode in 1984–1985 and a much smaller outbreak in 1987.  The 1984–1985 epidemics lasted for over a year and affected over 3,000 people in 16 cities and provinces.  A mental health campaign was conducted for the epidemic and since then no further episodes of the epidemic has occurred in China.  Improvement in local economic conditions, associated with a better quality of life, is suggested to contribute to the fading of the episodic occurrences of koro. [ 12 ] [ 32 ]


A koro epidemic struck  Singapore  in October 1967 for about ten days. Newspapers initially reported that some people developed koro after eating the meat of pigs inoculated with a  vaccine  for  swine influenza . Rumours relating eating pork and koro spread after a further report of an inoculated pig dying from penile retraction. The cases reported amounted to 97 in a single hospital unit within one day, at five days after the original news report. Government and medical officials alleviated the outbreak only by public announcements over television and in the newspapers. [ 47 ] [ 48 ] [ 49 ]


An epidemic outbreak in November 1976 in  Isan , Thailand caused at least 350 cases, most of them Thai and males. Popular opinion and news media echoed the affected individuals' projection of viewing the epidemic as caused by Vietnamese food and tobacco poisoning in a hideous assault against the Thai people. [ 50 ] [ 51 ]  Another large-scale epidemic in Thailand occurred in 1982. [ 50 ]


In 1982, a koro epidemic episode in  Northeast India  affected, in majority, poorly educated people from lower socio-economic strata. There was no evidence of significant premorbid or sexual psychopathology in most cases. [ 52 ]


Mass Koro epidemic was reported in Labour Camps in Kochi, Kerala in South India during August and September 2010 among migrant labour population from North and North-east India. Reportedly, the epidemic spread to about 100 individuals in 3 labour Camps within 2 weeks.


Mass Koro epidemic was reported in the state of  West Bengal ,  India  from July to December 2010, in the districts near southern part of  India - Bangladesh  border, affecting hundreds of people. It is called  Disco Rog  ( Bengali :  ডিস্কো রোগ ) meaning weird disease or  Jhinjhinani Rog  ( Bengali :  ঝিনঝিনানি রোগ ) meaning tingling disease, in that region. Locals created some folk managements for this condition like partly submerging the patient in a pond and pulling and holding her nipples or his genital. It is reported and published in many newspapers like  Anandabazar Patrika  at that time.


In the 1970s and early 1980s, newspapers reported incidents of genital shrinking in Western Nigeria. Since late 1996, a small-scale epidemic of genital shrinking was reported in West African nations. Affected individuals in the African outbreaks often interpreted the experience as genital theft, accusing someone with whom they had contact of "stealing" the organ and the spiritual essence, causing impotence. The perceived motive for theft was associated with local  occult  belief, the  witchcraft  of  juju , to feed the spiritual agency or to hold the genital for ransom.  Social representations  about juju constitute consensual realities that propose both a means and motivation for genital-shrinking experience. [ 17 ]


The epidemic began in  Nigeria  and  Cameroon , and spread to  Ghana ,  Ivory Coast  and  Senegal  by 1997. [ 17 ]  Cases were reported in  Cotonou ,  Benin  where mobs attacked individuals accused of the penis theft and authorities ordered security forces to curb the violence, following the deaths of five people by  vigilantes . [ 53 ]  Later reports of outbreak suggest a spread beyond West Africa, including the coverage of episodes in  Khartoum ,  Sudan  in September 2003;  Banjul ,  Gambia  in October 2003; [ 17 ]  and  Kinshasa ,  DR Congo  in 2008. [ 54 ]


Comparing West African genital-shrinking epidemics with koro in Southeast Asia, the latter has symptoms centered on genital retraction (instead of shrinkage) and fear of death (which is absent in African cases). [ 17 ]  A study analyzing the West African epidemics from 1997 to 2003 concluded that rather than  psychopathology , the episodes were the product of normal psychological functioning in undisturbed individuals, who were influenced by the local cultural models or social representations. [ 17 ]


In the late Middle Ages in Europe, it was believed that men could lose their penises through magical attacks by witches. [ 3 ]  The  Malleus Maleficarum , a fifteenth-century European manual for witchcraft investigations, relates stories of men claiming that their genitals had disappeared, being "hidden by the devil … so that they can be neither seen nor felt." They were said to have reappeared after the men had appeased the witches responsible. [ 55 ]   Witches were said to store the removed genitals in birds' nests or in boxes, where "they move themselves like living members and eat oats and corn". [ 55 ]


At least three publications of the 1880s, from the US, Russia and England, reported genital retraction pathology, without using the Malay or Chinese term.  Koro epidemics in China were first noticed in a French report in 1908 and descriptions of koro entered clinical books of western medicine in 1936.  In the 1950s, koro is noted in  nosological  and diagnostic psychiatry. [ 50 ]


Most of the ancient literature concerning koro was related to Chinese ethnic groups. For example, koro (in its Chinese term of  shuk yang ,  shook yong  or  suo yang  (simplified Chinese: 缩阳; traditional Chinese: 縮陽)) is documented in the old medical book  New Collection of remedies of value  ( simplified Chinese :  验方新篇 ;  traditional Chinese :  驗方新篇 ) which was published in  Qing Dynasty . The book described the condition as " yin  type of  cold qi  invasion" ( simplified Chinese :  阴症伤寒 ;  traditional Chinese :  陰症傷寒 ) which involved a sudden  seizure  during  sexual intercourse  with the penis retracting into the abdomen. It asserts that the patient will die if not treated with " heaty " drugs in time. [ 13 ]


Factors of cultural expectation in the genesis of koro can be built upon ideas of sex physiology in the  traditional Chinese medicine , with free play of imagination which links fatality with genital retraction. [ 13 ]


In the ancient Chinese medical book  Zhong Zang Jing  ( simplified Chinese :  中藏经 ;  traditional Chinese :  中藏經 ), retraction of the penis with distension of the abdomen was described as a certain sign of death. [ 13 ]  The  yin and yang  theory proposes that an unbalanced loss of the yang humour produces genital shrinkage. [ 7 ]


In  Taoism  and  traditional Chinese medicine , frequent  ejaculation  is regarded as detrimental to health, as  semen  is considered to be related to a man's vital energy, and hence excessive depletion of semen may lead to illness or death.  Some authors believe that the idea of death caused by the semen depletion resembles the idea of death caused by genital disappearance, although such linkage between koro and Taoism, which influences Chinese medicine to some degree, is only speculative. [ 12 ]


The popularity of  Chinese folklore  also plays a role. The novel about ghost stories  Strange Stories from a Chinese Studio  describes a  fox spirit  which can make people weak physically and sexually and shrink their tissues. Belief in koro being caused by the fox ghost among the southern Chinese has been reported. [ 12 ]


The earliest Western reference to the term  koro  is found in B.F. Matthes'  Dictionary of  Buginese Language  (1874) of  South Sulawesi ,  Indonesia . [ 50 ]  The name could be derived from a river, its surrounding valley, and a local tribe of the same name which is located at northwestern sector of  Sulawesi , Indonesia. [ 56 ]  The word is also used in  Makassarese language , meaning "to shrink"; the full expression is  garring koro . [ 5 ]  Koro may also be derived from  Malay  term  Kura  which means "head of turtle" [ 56 ] [ 12 ]  or  keruk  which means "to shrink". [ 57 ]  The term  shuk yang  (缩阳), adapted from Chinese, means "the shrinkage of penis". [ 12 ]  The term  koro  is also known as  rok loo  (genital shrinkage disease) in  Thailand ,  jinjinnia bemar  in  Assam ,  India , and  lanuk e laso  by the Bogoba tribe in  Philippines . [ 56 ]


Male accessory gland infection  ( MAGI ) is a condition with signs of inflammation involving one or more sites in the male genital tract. Diagnosis is made according to parameters defined by the  World Health Organization , and it is particularly made in relation to infectious or inflammatory causes of  male infertility .


Although it is usually caused by infection spreading from the  urethra , non-infectious causes also exist.


Along with  testicles  ( orchitis ), MAGI includes infections (bacterial, viral, fungal etc.) involving one or more of the following male genital organs or tracts: [ 2 ]


As infection has a negative impact on the secretory function of the accessory glands, findings that could indicate the presence of MAGI include: [ 3 ]


MAGI can be diagnosed when there are two or more factors present that meet criteria defined by the  World Health Organization  (WHO): [ 1 ] [ 4 ]


Physical signs :


or


One study has proposed that elevated levels of  soluble urokinase-type plasminogen activator receptor  (SuPAR) in seminal plasma might be useful as a marker for MAGI. [ 5 ]


The main infectious agents are  Enterobacteriaceae  (such as  Escherichia coli  and  Klebsiella ),  Neisseria gonorrhoeae , and  Chlamydia trachomatis . [ 2 ]


One study has shown that men with MAGI who have lower serum levels of total  testosterone  tend to have a more complicated form of MAGI, such as involving more than one site, than those with normal levels. [ 6 ]


Potential complications include: [ 2 ] [ 3 ] [ 7 ]


These complications can result in
 sexual dysfunction [ 7 ]  and  male subfertility . [ 4 ] [ 8 ]


The  male infertility crisis  is an increase in  male infertility  since the mid-1970s. [ 1 ]  The issue attracted media attention after a 2017  meta-analysis  found that  sperm counts  in  Western countries  had declined by 52.4 percent between 1973 and 2011. [ 2 ] [ 3 ]  The decline is particularly prevalent in Western countries such as  New Zealand ,  Australia ,  Europe , and  North America . [ 4 ]  A 2022 meta-analysis reported that this decline extends to non-Western countries, namely those in Asia, Africa, Central America, and South America. [ 5 ]  This meta-analysis also suggests that the decline in sperm counts may be accelerating. [ 5 ]


This decline in male fertility is the subject of research and debate. Proposed explanations include lifestyle factors, such as changes in diet and physical activity levels, and increased exposure to  endocrine disrupting chemicals , such as those found in  plastics  and pesticides. [ 6 ] [ 7 ]  Some scientists [ 8 ] [ 9 ]  have questioned the extent of the crisis; the  scientific community , however, generally acknowledges increasing male infertility as a  men's-health  issue. [ 10 ]


The term  male fertility crisis  dates to the 1970s. [ 11 ]  Increased awareness during the 1990s expanded the scope of research to address social and biological factors. [ 12 ]  Academia and the scientific community have reached consensus in favor of the use of the term  male infertility crisis , citing it as necessary to prompt preventative action to remedy the issue in the present time before it affects future generations on a greater scale. [ 11 ]   Social commentators  have said that the wide-ranging consequences of male infertility necessitate the use of  crisis , [ 13 ]  since widespread involuntary  childlessness  can be viewed as a crisis. [ 14 ]


Research analysis has found that amongst a sample of  British newspapers  in the 1990s, there was a recognizable discourse about a male fertility crisis. [ 12 ]  Media coverage increased during the 2010s, often coinciding with (or in response to) releases of studies and using words like "crisis", "apocalypse", "time bomb", and " threat to the human race ". The mass-media coverage is controversial, since the use of such terms has led to concern that it has fostered  clickbait  or hysterical coverage playing on community fears. [ 11 ] [ 15 ]  Media coverage often uses vivid comparisons, such as sperm counts in other animals. [ 12 ]  The long-term effects of male infertility have been explored in  dystopian fiction  such as  Children of Men  and  The Handmaid's Tale . [ 1 ] [ 16 ]


During the 1970s and 1980s, the first studies were published which observed declines in human  semen quality  and, later, sperm quantity. One of the earliest studies, published in 1974, noted a reduction in sperm quality (lower sperm concentration and semen volume) and a higher percentage of abnormal sperm. [ 17 ]  These early studies' methodology has been criticized for  sampling bias  and the inclusion of men with testicular and fertility issues. [ 11 ]  Other reports published during the two decades had not found similar declines; a 1982 research paper by Niecheslag et al. concluded that there were no changes in semen quality. [ 18 ]  The decline in sperm quality reflected a shift in societal patterns of  sexual behaviour , widespread  recreational drug use , and preferences for  marriage  and  fatherhood  later in life. [ 19 ]


The  World Health Organization  published its first laboratory manual for semen analysis in 1980, which sets global standard parameters for the measurement of sperm quality and normality. [ 20 ]  Limited research in the 1980s found the first indications behind the decline, with links to environmental-toxin exposure and excessive heat in the genital area. [ 19 ]


The 1990s saw significant development in research on male infertility, with reliable results indicating a decline. A 1992  Danish  meta-analysis, commonly known as the Carlsen study after its principal author, showed that between 1938 and 1990 a population described as healthy had experienced a significant decrease in sperm count and semen volume. [ 21 ] [ 22 ]  Following this study, other studies supported this thesis. During the late 1990s, the first studies of the social and psychological impact of male infertility were published. [ 23 ]  Near the end of the decade, the conception technique of  intracytoplasmic sperm injection  (ICSI, similar to  in vitro fertilisation ) was introduced. [ 24 ]


By the 2010s, it was clear that there had been a significant, steady decline in sperm count and semen volume. A 2017 meta-analysis led by  Hagai Levine  from the  Hebrew University  reported decreases in sperm concentration of 52.4 percent and in sperm count of 59.3 percent, from 1973 to 2011 in Western countries (Australia, New Zealand, Europe, and North America). [ 25 ]  Two other studies presented at the 2018  American Society for Reproductive Medicine  (ASRM) scientific congress had similar findings: reduced sperm counts and  motility  during the 2000s. [ 11 ]  A 2012 paper published by French researchers and  Yeshiva University 's  Institute for Public Health Sciences  in the  Journal of Human Reproduction  studied French males from 1989 to 2005 and concluded that sperm counts and the proportion of normal, motile sperm fell by 32.2 and 8.1 percent, respectively. [ 26 ] [ 27 ]


Mt. Sinai Medical School  epidemiologist  Shanna Swan  wrote in her 2021 book,  Count Down: How Our Modern World Is Threatening Sperm Counts, Altering Male and Female Reproductive Development, and Imperiling the Future of the Human Race , "If you look at the curve on sperm count and project it forward – which is always risky – it reaches zero in 2045". [ 28 ]


Another meta-analysis in 2022, again led by  Hagai Levine , reported that sperm concentration declined by 53.3 percent and sperm count by 56.3 percent in Western countries (1973-2015), and by 27.6 and 24.7 percent respectively, in non-Western countries (1986-2018). [ 5 ]  Moreover, when the dataset was restricted to more recent studies (post-2000), the declines in semen parameters became steeper. For instance, the decline in worldwide sperm concentration doubled, suggesting that these declines may be accelerating. [ 5 ]


A 2022 review by prominent researchers in the field of human fertility suggested that increasing  industrialisation  over the 20th century has led to an increase in exposure to  endocrine disrupting chemicals , which may have contributed to the decline in sperm counts. [ 6 ]  Other research published in 2023 has linked the change in diet associated with  industrialisation , termed the  nutrition transition , to declining sperm counts, estimating that the transition from an unprocessed to modern processed diet may account for up to 30 percent of the decline in sperm counts. [ 7 ]


Male fertility issues have been overlooked in the past, [ 29 ] [ 30 ]  and fertility research has focused on women. [ 23 ]  Sociologists studying male infertility have found that awareness has shifted societal attitudes on fertility and gender more toward men. [ 29 ]


Believers that male infertility has reached crisis proportions say that more must be done to remediate potential causes of male infertility, such as lifestyle factors and exposure to toxic environmental chemicals. [ 31 ] [ 10 ]  They advocate modernizing health care with improved practices and increased funding. [ 32 ]


Social programs to alleviate the impact of the crisis have been implemented as part of men's reproductive health. Events such as  International Men's Health Week  and  Movember  advocate reforms to address the crisis. [ 33 ] [ 34 ]


The  Australian  federal government funded the Healthy Male, a program to support male reproductive health and fertility, and issued a  A$ 3 million research  grant  to Andrology Australia. [ 35 ]  Other national-government responses include recommendations by the UK's  National Health Service  for a healthy lifestyle and loose-fitting underwear to improve fertility. [ 36 ]


Critics of labeling male infertility a crisis have cited research which has partially  stigmatized  men, and say that male infertility has inadvertently been conflated with  mental health  and  social vulnerability . However, no direct evidence supports such stigmatization. [ 37 ]  Gannon  et al.  wrote in 2004 that media coverage of the crisis has posed it as a threat to  hegemonic masculinity . [ 12 ]


Scientists disagree on the impact of observed fertility declines to date, and sperm counts remain above the 15 million considered to be below normal by the  World Health Organization . The issue of most concern is reducing average abnormal-sperm counts. [ 38 ]   Health practitioners  and  fertility doctors  who work in the field are skeptical about a crisis in male fertility, since they had not observed a dramatic decline first-hand; a disconnect exists between what has been observed in published research and what is seen in clinical practice. [ 39 ]


It has also been pointed out that sexual and masturbatory cultural shifts may be the true driver of the phenomenon, as more frequent ejaculation quickly reduces sperm counts.  [ 40 ] [ 41 ]


Andrologists  have said that not enough research has been conducted on male fertility to address the crisis effectively. [ 42 ]  Existing treatments, such as  assisted reproductive technology , are difficult to access and may have severe complications. [ 43 ]


Production of milk ( lactation ) from a male mammal's  mammary glands  is well-documented in the  dayak fruit bat  and the  Bismarck masked flying fox . The term "male lactation" is not used in human medicine. It has been used in popular literature, such as  Louise Erdrich's   The Antelope Wife , to describe the phenomenon of male  galactorrhea , which is a human condition unrelated to childbirth or nursing. Newborn babies of both sexes can occasionally produce milk. This is called  neonatal milk  (also as "witch's milk") and not considered male lactation.


Male lactation was of some interest to  Alexander von Humboldt , who reports in  Voyage aux régions équinoxiales du Nouveau Continent  about a citizen of the Venezuelan village of Arenas (close to  Cumana ) who allegedly nurtured his son for three months when his wife was ill, [ 1 ]  as well as  Charles Darwin , who commented on it in  The Descent of Man, and Selection in Relation to Sex  (1871):


It is well known that in the males of all mammals, including man, rudimentary mammae exist. These in several instances have become well developed, and have yielded a copious supply of milk. Their essential identity in the two sexes is likewise shown by their occasional sympathetic enlargement in both during an attack of the  measles . [ 2 ]


Darwin later considered the nearly perfect function of male nipples in contrast to greatly reduced structures such as the  vesicula prostatica , speculating that both sexes may have nursed young in early mammalian ancestors, and subsequently mammals evolved to inactivate them in males at an early age. [ 3 ]


Male mammals of many species have been observed to lactate under unusual or pathogenic conditions, such as extreme stress, castration, and exposure to  phytoestrogens , or  pituitary tumors . Therefore, it is hypothesized that while most male mammals could easily develop the ability to lactate, there is no selective advantage to male lactation. While male mammals could, in theory, improve their offspring's survival rate through the additional nourishment provided by lactation, most have developed other strategies to increase the number of surviving offspring, such as mating with additional partners. Presently, very few species are known where male lactation occurs and it is not well understood what  evolutionary factors  control the development of this trait. [ 4 ]


The phenomenon of male lactation occurs in some species, notably the  dayak fruit bat  ( Dyacopterus spadiceus ),  lesser short-nosed fruit bat  ( Cynopterus brachyotis ), and the  Bismarck masked flying fox  ( Pteropus capistratus ). Lactating males may assist in the  nursing  of their infants. In addition, male goats are known to lactate on occasion. [ 5 ]


Spontaneous production of milk not associated with childbirth, known as  galactorrhea , can occur in human males and females. [ 6 ]  Case reports of lactation induced in  transgender women  have been published. [ 7 ] [ 8 ]


Male pregnancy  is the incubation of one or more  embryos  or  fetuses  by organisms of the  male   sex  in some species. Most species that reproduce by  sexual reproduction  are  heterogamous — females  producing larger gametes ( ova ) and  males  producing smaller gametes ( sperm ). In nearly all animal species, offspring are carried by the  female  until birth, but in fish of the family  Syngnathidae  ( pipefish ,  seahorses  and the  leafy seadragon ), males perform that function. [ 1 ]


The fish family  Syngnathidae  has the unique characteristic of a highly derived form of male brood care referred to as "male pregnancy". [ 2 ]  The family is highly diverse, containing around 300 different species of fish. Included in Syngnathidae are  seahorses , the  pipefish , and the  weedy  and  leafy seadragons . The males of some of these species possess a brood pouch on the trunk or tail; in other species, the  eggs  are merely attached to the male's trunk or tail when the female lays them. Although biologists' definitions of pregnancy somewhat differ, all members of the family are considered by  ichthyologists  to display male pregnancy, even those without an external brood pouch.


Fertilization may take place in the pouch or in the water before implantation, but in either case, syngnathids' male pregnancy ensures them complete confidence of paternity. [ 3 ]  After implantation in or on the brood pouch or brood patch, the male incubates the eggs. Many species  osmoregulate  the brood pouch fluid to maintain a suitable  pH  level for the developing embryos. In at least some species, the male also provisions his offspring with nutrients such as glucose and amino acids through the highly vascularized attachment sites in or on his body.


This period of incubation can take much longer than the production of another clutch of eggs by the female, especially in temperate regions where pregnancies last longer, [ 4 ]  leading to a reproductive environment in which  sexual selection  can be stronger on females than on males due to increased male parental investment. This reversal of usual sex roles has only been found in pipefishes, whereas seahorses have largely been accepted as monogamous. [ 5 ]  Some pipefish species display classical  polyandry  because of this unique situation. Male syngnathids usually prefer females with large body size and prominent ornaments such as blue skin pigmentation or skin folds. Syngnathid males in some species are apparently capable of absorbing eggs or embryos while in the brood pouch. [ 6 ]  In these cases, embryos with the highest survival rate are those whose mothers display the preferred phenotype.


Syngnathidae is the only family in the animal kingdom to which the term "male pregnancy" has been applied. [ 1 ]


In 2021, Chinese researchers at the  Naval Medical University in Shanghai  published a  preprint  of a study that attempted to impregnate male rats, using  parabiosis  with female rats. Each male rat was castrated, surgically joined to a female, and given a transplanted uterus. The researchers then implanted embryos in both the uterus of the male and female parabionts. Pregnancies were allowed to develop until two days before the end of a full term, and were terminated by  caesarean section . The researchers studied 46 such parabiotic pairs. In over half of the pairs, neither the male nor female became pregnant with normal embryos; in about one-third of the pairs, only the female became thus pregnant; and in six pairs, both the female and male became pregnant. There were no pairs in which only the male parabiont rat became pregnant. [ 7 ]  The study attracted much attention and controversy, with some researchers questioning the utility of such research, and others raising questions of bioethics issues. [ 8 ] [ 9 ] [ 10 ]


In 2023, Japanese scientists used skin cells from 2 male mice to create  eggs  and fathered a litter of seven babies. [ 11 ]  The eggs were implanted in surrogate female mice. [ 11 ]  The current downside is the success rate is 1% (7 mice were born out of 630 attempts). [ 11 ]  This milestone in reproductive biology was published in  Nature  and should open more reproductive possibilities in the future. [ 11 ]  The team was led by developmental biologist Katsuhiko Hayashi of the Osaka and Kyushu universities. [ 11 ]


Mammalian  males, including humans, do not possess a  uterus  to gestate offspring. [ 1 ]  The theoretical issue of male  ectopic pregnancy  (pregnancy outside the uterine cavity) by surgical implantation has been addressed by experts in the field of  fertility medicine , who stress that the concept of ectopic implantation, while theoretically plausible, has never been attempted and would be difficult to justify – even for a woman lacking a uterus – owing to the extreme health risks to both the parent and child. [ 12 ] [ 13 ]


Robert Winston , a pioneer of in-vitro fertilization, told London's  Sunday Times  that "male pregnancy would certainly be possible" by having an embryo implanted in a man's abdomen – with the placenta attached to an internal organ such as the  bowel  – and later delivered surgically. [ 14 ] [ 15 ] [ 16 ]  Ectopic implantation of the embryo along the  abdominal wall , and resulting  placenta  growth would, however, be very dangerous and potentially fatal for the host, and is therefore unlikely to be studied in humans. [ 14 ] [ 17 ]  Gillian Lockwood, medical director of Midland Fertility Services, a British fertility clinic, noted that the abdomen has not evolved to separate from the placenta during delivery, hence the danger of an ectopic pregnancy. Bioethicist  Glenn McGee  said "the question is not 'Can a man do it?'. It's 'If a man does have a successful [ectopic] pregnancy, can he survive it? ' " [ 15 ]


Since 2000, several  hoax  web sites have appeared on the Internet [ 17 ]  purporting to describe the world's first pregnant man. While some rely on legitimate scientific claims, no such experiment has ever been reported. Fertility clinician  Cecil Jacobson  claimed to have transplanted a fertilized egg from a female baboon to the  omentum  in the  abdominal cavity  of a male  baboon  in the mid-1960s, which then carried the fetus for four months; however, Jacobson did not publish his claims in a scientific journal, and was subsequently convicted on several unrelated counts of fraud for ethical misconduct. [ 13 ]


Transplanting a uterus into a male body poses a challenge due to the lack of natural ligaments, vasculature, and hormones required to support the uterus. The uterus would either have to be donated by a willing donor or be  tissue-engineered  using the male's stem cells and then implanted into the pelvic region. [ 18 ]  Afterward, an  in vitro fertilisation (IVF)  procedure would be followed to insert the embryo into the male's transplanted womb.


In 1931, transgender female  Lili Elbe  (assigned male at birth) underwent a uterus transplant in an attempt to achieve pregnancy, but died of complications following the procedure. [ 19 ] [ 20 ]


Some  transgender men  choose to become pregnant or wish to preserve their fertility. [ 21 ]  Those with functioning  ovaries  and a  uterus  can become pregnant.  Masculinizing hormone therapy  reduces fertility and stops the  menstrual cycle , but is not considered an effective contraceptive—trans men taking  testosterone  may still become pregnant even if their periods have stopped. [ 21 ] [ 22 ]  Trans men who undergo some  masculinizing surgeries , including  hysterectomy  (removal of the uterus) and  bilateral salpingo-oopherectomy  (removal of both ovaries) are infertile.


Some  intersex  people with a male genotype develop an entirely or near entirely female phenotype and, if the individual develops a uterus, they may become pregnant by  in vitro fertilization . [ 23 ]


In the 2nd-century novel  A True Story  by  Lucian , there are no women on the moon, and as such boys below 25 are  considered wives bearing children in their calves. Some modern  science fiction  writers have picked up on the concept of male pregnancy in various ways.


Ursula K. Le Guin 's novel  The Left Hand of Darkness  contains the sentence "The king was pregnant", and explores a society in which pregnancy can be experienced by anyone, since individuals are not sexually differentiated during most of their life and can become capable of inseminating or gestating at different times.


Lois McMaster Bujold 's  Ethan of Athos  features an all-male society in which men use artificial wombs, but experience many of the  psychological effects of pregnancy  (anticipation, anxiety, etc.).


In  Marge Piercy 's feminist  utopian  novel  Woman on the Edge of Time , neither men nor women get pregnant, leaving that to artificial wombs, but both sexes may  lactate and nurse the infant ; the specifically female experiences of pregnancy and nursing were opened to men in the cause of  gender equality . [ 24 ]


Larry Niven 's 1969 essay " Man of Steel, Woman of Kleenex " ends with considering Superman as a carrier for his own baby, due to the difficulties a human female might encounter carrying a superpowered fetus.


The concept of male pregnancy has been the subject of popular films, generally as a comedic device.


The 1978 comedy film  Rabbit Test  stars  Billy Crystal  as a young man who inexplicably becomes pregnant instead of his female sex partner.


The 1990 BBC television comedy drama  Frankenstein's Baby  features a Dr. Eva Frankenstein helping a male patient to become the “world's first” pregnant man. [ 25 ]


The 1994  science fiction  comedy/drama  Junior  stars  Arnold Schwarzenegger  as a fertility researcher who experiments on himself; the screenplay was inspired by a 1985 article in  Omni  magazine. [ 13 ]


The 2015 romantic comedy  Paternity Leave  explores the concept of a gay couple surprised with a miraculous pregnancy in feature length.


The 2017 film  Mamaboy  stars Sean O'Donnell as a teenager who decides to undergo an experimental procedure that enables him to carry his girlfriend's baby to term.


In 2019, as a social commentary on the issue of abortion,  The Blacklist  had an episode which had  anti-abortion  men being kidnapped and forced to be pregnant. One stayed consistent with their belief and gave birth while the other became hypocritical and sought to get an abortion despite it being illegal in their state.


Horror rarely dips into male pregnancy in depth. Minor appearances exist in the well-known  Alien  series, in which the first  chestburster  appears, as a result of the host organism using human bodies to gestate its young. While this concept is repeated and parodied widely, the origin is as much sci-fi as it is horror. In the 2019 anthology film  The Mortuary Collection , a predatory fraternity brother named Jake has sex with a woman, using stealthing to trick her into having sex with him without a condom. As a result, her young grows in him rapidly over the course of a day, resulting in his bloody death when the child emerges. In 2020, the horror film  Amulet  depicts a soldier returning from war to live in a claustrophobic house with a woman and her mother, and a dark presence that may be lurking there as well. Like the former movie, male pregnancy serves as a sort of punishment for a man's sins.


The concept appears frequently as a comedic gag in numerous television programs as well.


In a 1981 episode of the Canadian sketch comedy series  Bizarre , the show's resident daredevil character  Super Dave Osborne  ( Bob Einstein ) performs, as one of his many stunts, carrying and giving birth to a baby.


In the  BBC  science fiction comedy series  Red Dwarf , the main character  Dave Lister  becomes pregnant after having sex with a female version of himself in an alternate universe.


In an episode of  Sliders , the quartet "slides" into an alternate world in which babies develop during their final months in the father because a worldwide disease has kept women from being able to carry children beyond their first trimester.


In the popular fantasy series  Charmed ' s fifth season, during a dream spell gone wrong, Leo ends up pregnant with Piper's baby for a good deal of the episode, leading to her referring to him as an "incubator" and at times berating him for "upsetting the baby".


The possibility of extraterrestrial life having different reproductive sexuality is the basis for many references. In the  Star Trek: Enterprise  episode " Unexpected ",  Trip Tucker  becomes pregnant with the offspring of a female of another species. In the video game  The Sims 2  male characters can be impregnated via cheat codes or alien abduction. In the  American Dad!  episode " Deacon Stan, Jesus Man ", the boy Steve becomes impregnated after giving the mouth-to-mouth resuscitation to the extraterrestrial Roger, then unwittingly passes it on to his girlfriend via a kiss. In the animated series  Futurama , the extraterrestrial  Kif  can be impregnated by a touch. In  Doctor Who  (series 11) ,  an episode  features an alien man going into labor. In the  SciFi Channel  miniseries,  Farscape: The Peacekeeper Wars , the extraterrestrial Rygel becomes impregnated with human John and Aeryn's baby. In the series  Alien Nation , when Tectonese main character George Francisco and his wife Susan decide to have a third child, it is revealed that, in order to conceive, a Tectonese couple needs a third party, called a  binnaum , to complete impregnation, and that the male carries the baby—encased in a pod—during the final months of gestation. In the animated series  The Fairly OddParents  in the TV film  Fairly OddBaby , the fairy  Cosmo  was pregnant with  Baby Poof . Additionally,  Robert Sheckley 's  1989 short story  Love Song From the Stars  also contains this element.   My Friends from Afar , a science fiction Singaporean drama series, Xiang Lin becomes pregnant to his surprise by kissing Tianning and his pregnancy provides an ongoing plotline in the latter half of the series. However, after he gives birth, it turns out that his species gives birth to eggs, which hatch, after some time, a child that appears to be roughly four years old. [ citation needed ]


In the  Ozzy & Drix  episode "Ozzy Jr.", Ozzy thinks he is having a baby but is actually a parasite growing in his belly caused by an infection by Strepfinger.


In the  Ren & Stimpy "Adult Party Cartoon"  episode "Stimpy's Pregnant", Stimpy is thought to be pregnant but Mr. Horse finds out that he is actually constipated.


In the  Bluey  episode "Dad Baby",  Bandit Heeler  shows Bluey and Bingo how to use a baby carrier, and he pretends to be pregnant and giving birth.


In the  Ben 10: Alien Force  episode "Save the Last Dance", it is revealed that Necrofriggians have an ability to asexually reproduce once every 80 years, building a large nest made of digested metal where their eggs will hatch and their offspring will feed on the metal, first eating from the nest before they instinctively feed on solar plasma until they mature and starts their own separate lives. Due to the Necrofriggian reproduction cycle, Big Chill overtook  Ben 's personality to carry out the process, but Ben did not remember anything he did as Big Chill during this cycle, like eating metal and having 14 babies, and he felt very embarrassed when Gwen, Kevin and Julie explained, and Kevin's teasing and calling him "mommy" did not help.


In  The Three Stooges  episode "Even as IOU" Curly accidentally swallows a Vitamin Z pill meant for a horse. However, the error allows Curly to give birth to an Equidae, which the Stooges crown as a winning race horse.


The manga series  He's Expecting  takes place in the future where men are suddenly capable of becoming pregnant, though it is only a 10% chance of happening. The series explores the workplace prejudice that men and women experience and the titular character's efforts to change public opinion once he himself becomes pregnant. It was later adapted into a television series of the  same name .


Virgil Wong, a  performance artist , created a  hoax  site [ 17 ] [ 26 ]  featuring a fictitious male pregnancy, claiming to detail the pregnancy of his friend Lee Mingwei. [ 27 ] [ 28 ] [ 29 ]


Male pregnancy is also commonly explored in  hentai , the  subgenre  of  speculative   erotic fiction  known as the  Omegaverse , and  slash  (homosexual)  fan fiction , usually based upon fantasy series such as  Supernatural ,  Harry Potter , and video game series such as  Sonic the Hedgehog . [ 30 ] [ 29 ] [ 31 ]


In 2021,  Unicode  approved the "pregnant man" and "pregnant person"  emojis  in version 14.0, and added to Emoji 14.0. [ 32 ]  However, this came with some controversy, as some viewed it to be "absurd". [ 33 ] [ better source needed ]


Manliness  is a book by  Harvey C. Mansfield  first published by  Yale University Press  in 2006. Mansfield is a professor of  government  at  Harvard University . In this book, he defines manliness as "confidence in a situation of risk" and suggests this quality is currently undervalued in Western society. [ 1 ]


He suggests the quality is more common in men than in women, but does not strictly exclude women, for example he names  Margaret Thatcher . He also suggests the quality is "good and bad", not all good, but not all bad. His main point is that  gender neutral  ideology denies both the reality of sex-specific qualities, and the valuable components of these, to the detriment of society. [ 1 ]


Mansfield attributes the rise of gender neutral ideology firstly to  Friedrich Nietzsche ,  Karl Marx  and  Jean-Paul Sartre , and then to  feminists  who repackaged the ideas as part of a political program. He names  Simone de Beauvoir ,  Betty Friedan  and  Germaine Greer .


Today the very word  manliness  seems quaint and obsolete. We are in the process of making the English language gender-neutral, and manliness, the quality of one gender, or rather, of one sex, seems to describe the essence of the enemy we are attacking, the evil we are eradicating.
-Harvey Mansfield,  Manliness


Mansfield evaluates the concept of manliness as it has been expressed over the course of  Western civilization , and considers its virtues. As Mansfield stated to  NPR 's  Tom Ashbrook , "Some people say manliness doesn't exist. Others say it does exist and it's bad. I say it exists and it's good ... and bad." [ 2 ]


Drawing on classical philosophy, literature, and science, Mansfield argues that manliness is a virtue primarily associated with the male sex which is preferable to widespread institutional gender-neutral ideology.


Beginning with modern scientific discoveries, Mansfield appropriates them for insights on how these innate biological realities might exert an influence on  gender identity  and  gender role  preferences. Mansfield then proceeds to literature, drawing on  Homer ,  Rudyard Kipling , and  Hemingway  to support his thesis that manliness has been a perpetual component of the male psyche and behavior.


Mansfield then offers an analysis of the historical forces in the nineteenth and early twentieth centuries, singling out  Simone de Beauvoir ,  Betty Friedan , and  Germaine Greer  as the key writers to have influenced, what he considers to be, the dismantling of manliness. These writers shared two common hypotheses they derived from earlier writers: from Marx they drew the theory of economic exploitation, and from Nietzsche their flirtations with  nihilism . Finally, Mansfield turns to  Aristotle  as the archetypal expounder of manliness to identify the quality of "philosophical courage," which Mansfield concludes is the ideal understanding of manliness.


Men's health  is a state of complete physical, mental, and social well-being, as experienced by men, and not merely the absence of  disease . [ 1 ] [ failed verification ]  Differences in men's health  compared to women's  can be attributed to biological factors, behavioural factors, and social factors (e.g., occupations). [ 2 ] [ failed verification ]


Men's health often relates to biological factors such as the  male reproductive system  or to conditions caused by hormones specific to, or most notable in, males. Some conditions that affect both men and women, such as  cancer , and  injury , manifest differently in men. [ 3 ]  Some diseases that affect both sexes are  statistically more common in men . In terms of behavioural factors, men are more likely to make unhealthy or risky choices and less likely to seek medical care.


Men may face issues not directly related to their biology, such as gender-differentiated access to medical treatment and other  socioeconomic  factors. [ 4 ] [ 5 ] [ 6 ]  Outside Sub-Saharan Africa, men are at greater risk of  HIV/AIDS . This is associated with  unsafe  sexual activity that is often  nonconsensual . [ 7 ] [ 8 ]


Men's health refers to the state of physical, mental, and social well-being of men, and encompasses a wide range of issues that are unique to men or that affect men differently than women. This can include issues related to reproductive health, sexual health, cardiovascular health, mental health, and cancer prevention and treatment. Men's health also encompasses lifestyle factors such as diet, exercise, and stress management, as well as access to healthcare and preventative measures. [ 9 ]


Despite overall increases in  life expectancy  globally, men's life expectancy is less than women's, regardless of race and geographic regions. [ 10 ] [ 11 ]  The global gap between the life expectancy of men and women has remained at approximately 4.4 years since 2016, according to the WHO. [ 12 ]  Life expectancy is a statistical measure that represents the average number of years that a person is expected to live, based on the current mortality rates. It is typically calculated at birth, and can vary depending on factors such as gender, race, and location. For example, life expectancy in many developed countries is higher than in developing countries, and life expectancy for women is generally higher than for men.


However, the gap does vary based on country, with low income countries having a smaller gap in life expectancy. [ 13 ]  Biological, behavioural, and social factors contribute to a lower overall life expectancy in men; however, the individual importance of each factor is not known. [ 14 ]  Overall attitudes towards health differ by gender. Men are generally less likely to be proactive in seeking healthcare, resulting in poorer health outcomes. [ 15 ]


Men are difficult to recruit to health promotion interventions. The value of adopting a gender-sensitive approach to engage and retain men in health promotion interventions has been reported. [ 16 ]


Biological influences on lower male life expectancies include genetics and hormones. For males, the 23rd pair of chromosomes are an X and a  Y chromosome , rather than the two X chromosomes in females. [ 11 ]  The Y chromosome is smaller in size and contains fewer genes. This distinction may contribute to the discrepancy between men and women's life expectancy, as the additional X chromosome in females may counterbalance potential disease producing genes from the other X chromosome. Since males don't have the second X chromosome, they lack this potential protection. [ 11 ]  Hormonally,  testosterone  is a major male sex hormone important for a number of functions in males, and to a lesser extent, females. [ 17 ]  Low testosterone in males is a risk factor of cardiovascular related diseases. [ 18 ]  Conversely, high testosterone levels can contribute to prostate diseases. [ 11 ]  These hormonal factors play a direct role in the life expectancy of men compared to women.


In terms of behavioural factors, men have higher levels of consumption of alcohol, substances, and tobacco compared to women, resulting in increased rates of diseases such as  lung cancer ,  cardiovascular disease , and  cirrhosis of the liver . [ 11 ] [ 19 ]  Sedentary behaviour, associated with many chronic diseases seems to be more prevalent in men. [ 20 ]  These diseases influence the overall life expectancy of men. For example, according to the World Health Organization, 3.14 million men died from causes linked to excessive alcohol use in 2010 compared to 1.72 million women.  Men are more likely than women to engage in over 30 risky behaviours associated with increased morbidity, injury, and mortality. [ 21 ] [ 22 ]  Additionally, despite a disproportionately lower rate of suicide attempts than women, men have significantly higher rates of death by  suicide . [ 23 ] [ 24 ] [ 25 ]


Social determinants of men's health involve factors such as greater levels of occupational exposure to physical and chemical hazards than women. [ 15 ]  Historically, men had higher work-related stress, which negatively impacted their life expectancy by increasing the risk of  hypertension ,  heart attack , and  stroke . [ 11 ]  However, as women's role in the workplace continues to be established, these risks are no longer specific to just men. [ 11 ]


Although most stress symptoms are similar in men and women, stress can be experienced differently by men. [ 26 ]  The  American Psychological Association  says that men are not as likely to report emotional and physical symptoms of stress compared to women. [ 26 ]  They say men are more likely to withdraw socially when stressed and are more likely to report doing nothing to manage their stress. [ 26 ]  Men are more likely than women to cite that work is a source of stress; women are more likely to report that money and the economy are a source of stress. [ 26 ]


Mental stress in men is associated with various complications which can affect men's health: high blood pressure and subsequent cardiovascular morbidity and mortality, [ 27 ]   cardiovascular disease , [ 28 ]   erectile dysfunction  (impotence) [ 29 ]  and possibly reduced fertility (due to reduced  libido  and frequency of intercourse). [ 30 ]


Fathers experience stress during the time shortly before and after the time of birth ( perinatal period ). [ 31 ]  Stress levels tend to increase from the prenatal period up until the time of birth, and then decrease from the time of birth to the later  postnatal period. [ 31 ]  Factors which contribute to stress in fathers include negative feelings about the pregnancy, role restrictions related to becoming a father, fear of childbirth, and feelings of incompetence related to infant care. [ 31 ]  This stress has a negative impact on fathers. [ 31 ]  Higher levels of stress in fathers are associated with mental health issues such as  anxiety ,  depression ,  psychological distress , and  fatigue . [ 31 ]


Substance use disorder  and  alcohol use disorder  can be defined as a pattern of harmful use of substance for mood-altering purposes. [ 32 ]   Alcohol  is one of the most commonly substances used in excess, and men are up to twice as likely to develop alcohol use disorder than women. [ 33 ]  Gender differences in alcohol consumption remain universal, although the sizes of gender differences vary. [ 34 ]  More drinking and heaving,  binge drinking  occurs in men, whereas more long-term abstention occurs in women. [ 34 ]  Moreover, men are more likely to abuse substances such as drugs, with a lifetime prevalence of 11.5% in men compared to 6.4% in women, in the United States. [ 35 ]  Additionally, males are more likely to be substance addicts and abuse substances due to  peer pressure  compared to females. [ 35 ]


Substance and alcohol use disorders are associated with various  mental health  issues in men and women. [ 36 ]  Mental health problems are not only a result from drinking excess alcohol; they can also cause people to drink too much. [ 35 ]  A major reason for consuming alcohol is to change mood or mental state. [ 37 ]  Alcohol can temporarily alleviate feelings of  anxiety  and  depression , and some people use it as a form of  self-medication  in an attempt to counteract these negative feelings. [ 38 ]  However, alcohol consumption can worsen existing mental health problems. [ 35 ]  Evidence shows that people who consume high amounts of alcohol or use illicit substances are vulnerable to an increased risk of developing mental health problems. [ 39 ]  Men with mental health disorders, like  post-traumatic stress disorder , are twice as likely as women to develop a  substance use disorder . [ 40 ]


There have been identified  gender differences  in seeking treatment for mental health and substance abuse disorders between men and women. [ 41 ]  Women are more likely to seek help from and disclose mental health problems to their  primary care  physicians, whereas men are more likely to seek specialist and  inpatient care . [ 42 ]  Men are more likely than women to disclose problems with alcohol use to their health care provider. [ 43 ]  In the United States, there are more men than women in treatment for substance use disorders. [ 43 ]  Both men and women receive better mental health outcomes with early treatment interventions. [ 44 ]


Suicide  has a high incidence rate in men but often lacks public awareness. [ 45 ] [ 46 ]  Suicide is the 13th leading cause of death globally, and in most parts of the world, men are significantly more likely to die by suicide than women, although women are significantly more likely to attempt suicide. [ 46 ] [ 47 ] [ 48 ]  This is known as the "gender paradox of suicidal behaviour". [ 47 ]  Worldwide, the ratio of suicide deaths was 1.8:1 men per woman in 2016 according to the World Health Organization. [ 49 ]  This gender disparity varies greatly between countries. For example, in the United Kingdom and Australia, this men/women ratio is approximately 3:1, and in the United States, Russia, and Argentina approximately 4:1. [ 50 ] [ 51 ] [ 52 ] [ 53 ]  In South Africa, the suicide rate amongst men is five times greater than women. [ 54 ]  In East Asian countries however, the gender gap in suicide rates are relatively smaller, with men to women ratios ranging from 1:1 to 2:1. [ 55 ]  Multiple factors exist to explain this gender gap in suicide rates, such as men more frequently completing high mortality actions such as  hanging ,  carbon-monoxide poisoning , and the use of lethal weapons. [ 56 ] [ 57 ]  Additional factors that contribute to the  disparity in suicide rates  between men and women include the pressures of  traditional gender roles  for men in society and the socialization of men in society. [ 50 ] [ 58 ] [ 59 ]


Because variations exist in the risk factors associated with suicidal behaviour between men and women, they contribute to the discrepancy in suicide rates. [ 47 ] [ 60 ] [ 61 ]  Suicide is complex and cannot simply be attributed to a single cause; however, there are psychological, social, and psychiatric factors to consider. [ 58 ] [ 61 ] [ 62 ]


Mental illness is a major risk factor for suicide for both men and women. [ 62 ] [ 63 ] [ 64 ]  Common mental illnesses that are associated with suicide include  depression ,  bipolar disorder ,  schizophrenia , and  substance abuse disorders . [ 63 ] [ 64 ] [ 65 ]  In addition to mental illness, psychosocial factors such as unemployment and occupational stress are established risk factors for men. [ 47 ] [ 66 ] [ 67 ]   Alcohol use disorder  is a risk factor that is much more prevalent in men than in women, which increases risks of depression and impulsive behaviours. [ 68 ] [ 69 ]  This problem is exacerbated in men, as they are twice as likely as women to develop alcohol use disorder. [ 33 ] [ 70 ]


Reluctance to seek help is another prevalent risk factor facing men, stemming from internalized notions of  masculinity . [ 58 ] [ 66 ] [ 71 ] [ 59 ]  Traditional masculine stereotypes place expectations of strength and stoic, while any indication of vulnerability, such as consulting mental health services, is perceived as weak and emasculating. [ 58 ] [ 66 ] [ 71 ] [ 59 ]  As a result, depression is under-diagnosed in men and may often remain untreated, which may lead to suicide. [ 59 ] [ 72 ]


Identifying warning signs is important for reducing suicide rates world-wide, but particularly for men, as distress may be expressed in a manner that is not easily recognisable. [ 56 ] [ 73 ] [ 74 ]  For instance, depression, and suicidal thoughts may manifest in the form of anger, hostility, and irritability. [ 58 ] [ 73 ]  Additionally, risk-taking and avoidance behaviours may be demonstrated more commonly in men. [ 58 ] [ 71 ]


The following is a list of diseases or conditions that have a high prevalence in men (relative to women).


Cardiovascular conditions:


Respiratory conditions:


Mental health conditions:


Cancer:


Sexual health:


Other:


In the UK, the  Men's Health Forum  was founded in 1994. It was established originally by the  Royal College of Nursing  but became completely independent of the RCN when it was established as a charity in 2001. [ 75 ]  The first National Men's Health Week was held in the US in 1994. The first UK week took place in 2002, and the event went international ( International Men's Health Week ) the following year. [ 76 ]  In 2005, the world's first professor of men's health, Alan White, was appointed at  Leeds Metropolitan University  in north-east England.


In Australia, the Men's Health Information and Resource Centre advocates a  salutogenic  approach to male health which focuses on the causal factors behind health.  The centre is led by John Macdonald and was established in 1999. [ 77 ]   The Centre leads and executes  Men's Health Week  in Australia with core funding from the NSW Ministry of Health.


The Global Action on Men's Health (GAMH) was established in 2013 and was registered as a UK-based charity in May 2018. It is a collaborative initiative to bring together men's health organizations from across the globe into a new global network. GAMH is working at international and national levels to encourage international agencies (such as the  World Health Organization ) and individual governments to develop research, policies and strategies on men's health. [ 78 ]


Men's Health Forum  is a  charity  based in  Great Britain . Its mission is to improve the health of men and boys in England, Wales, and Scotland.


The Men's Health Forum was founded in 1994. [ 1 ]  It was set up by the  Royal College of Nursing  but became completely independent of the RCN when it was established as a registered charity in 2001. It is now an independent body with working with a wide range of individuals and organisations to develop health services that meet men's needs and enable men to change their risk-taking behaviours. It is a strategic partner of the  Department of Health . [ 2 ]


The Chief Executive is Martin Tod; and the chair of trustees is Dr  John Chisholm . The world's first professor of men's health, Alan White from the Centre for Men's Health at Leeds Metropolitan University, is Patron.


It lobbies policy-makers and service commissioners, runs projects, carries out research, publishes reports and health information booklets and online information and coordinates Men’s Health Week in Great Britain.


Joseph DePasqualin,
Mark Perry, Ph.D,
Jerome Tokars, MD,
Warren Farrell, Ph.D,


Men's Health Network  (MHN) is a  non-profit  international educational organization of  health care professionals  and interested individuals that focuses on improving male health and wellness. [ 1 ]  MHN has since been classified as a tax-exempt entity under Section 501(c)(3) of the U.S. Internal Revenue Service code.


MHN is based in the  United States  and is incorporated in the  District of Columbia .


In 1994, MHN provided the impetus for  Men's Health Week  in the week leading up to and including  Father's Day  and  Men's Health Month  (June), typical events include educational lectures by sports figures, free  health screenings , and health fairs. [ 1 ]  The organization also offers health information online through digital libraries, directories, free screening calendars, and websites such as www.checkmensfacts.com and as over the phone through Men’s Healthline. [ 1 ] [ 2 ]


Nocturnal penile tumescence  ( NPT ) is a spontaneous  erection  of the  penis  during  sleep  or when waking up. Along with  nocturnal clitoral tumescence , it is also known as  sleep-related erection . Colloquially, the term  morning wood , or less commonly,  morning glory  is also used, [ 1 ]  although this is more commonly used to refer specifically to an erection  beginning  during sleep and persisting into the period just after waking. Men without physiological  erectile dysfunction  or severe depression [ 2 ]  experience nocturnal penile tumescence, usually three to five times during a period of sleep, typically during  rapid eye movement sleep . [ 3 ]  Nocturnal penile tumescence is believed to contribute to penile health. [ 4 ]


The cause of nocturnal penile tumescence is not known with certainty. In a wakeful state, in the presence of mechanical  stimulation  with or without an  arousal , erection is initiated by the parasympathetic division of the autonomic nervous system with minimal input from the central nervous system. [ 5 ]  Parasympathetic branches extend from the sacral plexus of the spinal nerves into the arteries supplying the erectile tissue; upon stimulation, these nerve branches release acetylcholine, which in turn causes release of nitric oxide from endothelial cells in the trabecular arteries, that eventually causes tumescence. Bancroft (2005) hypothesizes that the  noradrenergic  neurons of the  locus ceruleus  in the brain are  perpetually inhibitory  to penile erection, and that the cessation of their discharge that occurs during rapid eye movement sleep may allow  testosterone -related excitatory actions to manifest as nocturnal penile tumescence. [ 6 ]  Suh et al. (2003) recognizes that in particular the spinal regulation of the cervical cord is critical for nocturnal erectile activity. [ 7 ]


The nerves that control one's ability to have a reflex erection are located in the  sacral nerves  (S2-S4) of the  spinal cord . [ 8 ]  Evidence supporting the possibility that a full  bladder  can stimulate an erection has existed for some time and is characterized as a 'reflex erection'. [ 9 ]  A full bladder is known to mildly stimulate nerves in the same region.
The possibility of a full bladder causing an erection, especially during sleep, is perhaps further supported by the beneficial physiological effect of an erection inhibiting urination, thereby helping to avoid  nocturnal enuresis   [ citation needed ] .  However, given females have a similar phenomenon called  nocturnal clitoral tumescence , prevention of nocturnal enuresis (bed-wetting) is not likely a sole supporting cause. [ 10 ]


In a study published in 1972, [ 11 ]  during puberty, the average tumescence time per night was 159 min; average REM sleep time was 137 min. Average simultaneous REM sleep and penile tumescence per night was 102 min. Study subjects averaged 6.85 tumescence episodes/night, and, of these, 5.15 occurred during a REM sleep period. Tumescence episodes during REM averaged 30.8 min in duration, whereas episodes which occurred when no REM was present averaged 11.75 min. Study subjects had at least four REM periods per night and at least three tumescence episodes.


In another study of healthy older people published in 1988, frequency and duration of nocturnal penile tumescence decreased progressively with age independent of variations in sleep. In contrast to younger age groups, the majority of those above age 60 did not have full sleep erections even though they and their partners reported regular intercourse. [ 12 ]


Unlike physiological penile tumescence, sleep-related painful erections (SRPE) and stuttering  priapism  (SP) are  much rarer pathological erections, resulting in poor sleep and daytime tiredness, and long term cardiovascular morbidity. [ 13 ]  SRPE is a rare parasomnia consisting of nocturnal penile tumescence accompanied by pain that awakens the individual. [ 14 ]  It occurs predominantly during REM sleep, without an apparent underlying illness or penile anatomic abnormalities. On the contrary, stuttering priapism can occur spontaneously at any time of the day, but more commonly so during REM sleep. SP is a subtype of ischemic priapism that is characterized by recurrent, self-limiting, painful erections that often require maneuvers (compression, cold packs or a cold shower, voiding, or exercise, etc.) to aid detumescence. In ischemic priapism, most of the penis is hard; however, the  glans penis  is not. Much rarer priapism is secondary to blunt trauma to the perineum or penis, with laceration of the cavernous artery, which can generate an arterial-lacunar fistula resulting in a high blood flow state, hence the tumescence. Tumescence lasting for more than four hours is a medical emergency. [ 15 ]  At the time being, no treatment consensus for SRPE has been established.  Baclofen  tablets taken before sleep is the most commonly used medication, having a tolerable profile of adverse effects. [ 14 ]


The existence and predictability of nocturnal  tumescence  is used by  sexual health  practitioners to ascertain whether a given case of erectile dysfunction is  psychological  or  physiological  in origin. [ 3 ]  A patient presenting with erectile dysfunction is fitted with an elastic device to wear around his penis during sleep; the device detects changes in girth and relays the information to a computer for later analysis. If nocturnal tumescence is detected, then the erectile dysfunction is presumed to be due to a  psychosomatic illness  such as sexual anxiety; if not, then it is presumed to be due to a physiological cause. [ 3 ]


Regularly, those who experience  erectile dysfunction  are given a nocturnal penile tumescence test, usually over a three-day period. Such a test detects the presence of an erection occurring during sleep using either:


The goal of nocturnal penile tumescence testing is to determine whether one can experience an erection while sleeping after reporting that they are unable to experience an erection while awake. On average, one has 3–5 episodes of NPT each night, and each episode lasts 30–60 minutes, although the duration is reduced with advanced age. [ 16 ]  If one does obtain an erection while sleeping, but cannot obtain one while awake, a psychological cause or a medication side effect is usually suspected. Otherwise, if one does not obtain an erection in either state, a  physiological  cause is usually suspected.


A  penile implant  is an  implanted device  intended for the treatment of  erectile dysfunction ,  Peyronie's disease , ischemic  priapism , deformity and any traumatic injury of the penis, and for  phalloplasty  or  metoidioplasty , including in gender-affirming surgery. Men also opt for penile implants for aesthetic purposes. Men's satisfaction and sexual function is influenced by discomfort over genital size, which leads some to seek surgical and non-surgical solutions for penis alteration. [ 1 ]  Although there are many distinct types of implants, most fall into one of two categories: malleable and inflatable transplants. [ 2 ]


The first modern prosthetic reconstruction of a penis is attributed to NA Borgus, a German physician who performed the first surgical attempts in 1936 on soldiers with traumatic  amputations of the penis . He used  rib cartilages  as prosthetic material and reconstructed the genitals for both  micturition  and  intercourse  purposes. [ 3 ]  Willard E. Goodwin and William Wallace Scott were the first to describe the placement of synthetic penile implants using  acrylic  prosthesis in 1952. [ 4 ]   Silicone -based penile implants were developed by Harvey Lash and the first case series were published in 1964. [ 5 ]  The development of a high-grade silicone that is currently used in penile implants is credited to  NASA . [ 6 ]  The prototypes of the contemporary inflatable and malleable penile implants were presented in 1973 during the annual meeting of the  American Urological Association  by two groups of physicians from  Baylor University  (Gerald Timm, William E. Bradley and F. Brantley Scott) and  University of Miami  (Michael P. Small and Hernan M. Carrion). [ 3 ] [ 7 ] [ 8 ]  Small and Carrion pioneered the popularization of semi-rigid penile implants with the introduction of Small-Carrion prosthesis ( Mentor , USA) in 1975. Brantley Scott described the initial device as composed of two inflatable cylindrical bodies made up of silicone, a reservoir containing  radiopaque  fluid and two pumping units. [ 7 ]  The first generation products were marketed through American Medical Systems (AMS; currently  Boston Scientific ), with which Brantley Scott was associated. [ 6 ] [ 9 ]  Many device updates have been released by AMS since the first generation implants. In 1983, Mentor (currently  Coloplast ) joined the market. [ 6 ]  In 2017, there were more than ten manufacturers of penile implants in the world, however only a few now remain in the market. [ 10 ]  The latest additions to the market are  Zephyr Surgical Implants  and  Rigicon Innovative Urological Solutions . [ 11 ] [ 12 ]  Zephyr Surgical Implants, along with penile implants for biological men, introduced the first line of inflatable and malleable penile implants designed for  sex reassignment  for  trans men . In recent years, Rigicon Innovative Urological Solutions, a US-based company, has made significant advancements in the field of penile implants. In 2017, they released the 'Rigi10,' a malleable implant that expanded the market's options. Following this, in 2019, they introduced both the 'Infla10' series, which includes the Infla10 AX, Infla10 X, and Infla10 models, and the 'Rigi10 Hydrophilic.' These inflatable and hydrophilic-coated malleable models respectively were important additions to the range of penile implant technologies available. These advancements have contributed to the diversity and progress in the development of penile implants, offering patients more varied and tailored treatment solutions. [ 13 ]   [ 14 ]


According to analysis of the 5% Medicare Public Use Files from 2001 to 2010 approximately 3% of patients diagnosed with erectile dysfunction opt for penile implantation. [ 15 ]  Each year nearly 25,000 inflatable penile prostheses are implanted in the USA. [ 16 ]


The list shows penile implants available in the market in 2020.


The malleable (also known as non-inflatable or semi-rigid) penile  prosthesis  is a pair of rods implanted into the corpora of the penis. The rods are hard, but 'malleable' in the sense that they can be adjusted manually into the erect position. [ 18 ]  There are two types of malleable implants: one that is made of silicone and does not have a rod inside, also called soft implants, and another with a silver or steel spiral wire core inside coated with silicone. Some of the models have trimmable tails intended for length adjustment. [ 10 ]  Currently, a variety of malleable penile implants are available worldwide. [ 19 ]


The inflatable penile implant (IPP), more recently developed, is a set of inflatable cylinders and a pump system. Based on the differences in structure, there are two types of inflatable penile implants: two-piece and three-piece IPPs. Both types of inflatable devices are filled with sterile  saline solution  which is pumped into cylinders when in process. The cylinders are implanted into the  cavernous body of the penis . The pump system is attached to the cylinders and placed in the  scrotum . [ 10 ]  Three-piece implants have a separate large reservoir connected to the pump. The reservoir is commonly placed in the  retropubic space  (Retzius' space), however other locations have also been described, such as between the  transverse muscle  and  rectus muscle . Three-piece implants provide more desirable rigidity and girth of the penis resembling natural erection. Additionally, due to the presence of a large reservoir, three-piece implants provide full flaccidity of the penis when deflated, thus bringing more comfort than two-piece inflatable and malleable implants. [ 6 ]


The saline solution is pumped manually from the reservoir into bilateral chambers of cylinders implanted in the shaft of the penis, which replaces the non- or minimally-functioning erectile tissue. This produces an erection. The  glans of the penis , however, remains unaffected. Ninety to ninety-five percent of inflatable prostheses produce erections suitable for  sexual intercourse . In the United States, the inflatable prosthesis has largely replaced the malleable one, due to its lower rate of infections, high device survival rate and 80–90% satisfaction rate. [ 2 ]


The first IPP prototype presented in 1975 by Scott and colleagues was a three-piece prosthesis (two cylinders, two pumps and a fluid reservoir). Since then, the IPP has undergone multiple modifications and improvements for device reliability and durability, including change in the chemical material used in implant manufacturing, using hydrophilic and antibiotic eluting coatings to reduce the rates of infections, introducing one-touch release etc. [ 10 ]  Surgical techniques used for the implantation of penile prostheses have also improved along with evolution of the device. Inflatable penile implants were one of the first interventions in urology where the "no-touch" surgical technique was introduced. This has significantly reduced the rates of post-operative infections. [ 20 ]


In spite of recent rapid and extensive development of non-surgical management options for  erectile dysfunction , especially novel targeted medications and  gene therapy , the penile implants remain the mainstay and the gold standard choice for the treatment of erectile dysfunction refractory to oral medications and injectable therapy. [ 21 ] [ 6 ]  Additionally, penile implants can be a relevant option for those with erectile dysfunction who want to proceed with a permanent solution without medical therapy. Penile implants have been used for the treatment of erectile dysfunction with various etiologies, including vascular,  cavernosal , neurogenic, psychological and post-surgical (e.g.  prostatectomy ). The  American Urological Association  recommends informing all men with erectile dysfunction about penile implants as a choice of treatment and discussing the potential outcomes with them. [ 22 ]


Penile implants can help recover the natural shape of the penis in various conditions that have led to penile deformity. These can be traumatic injuries, penile surgeries, disfiguring and  fibrosing  diseases of the penis, such as  Peyronie's disease . [ 6 ]  In Peyronie's disease, the change in penile curvature affects normal sexual intercourse as well as causing  erectile dysfunction  due to disruption of blood flow in the  cavernous bodies  of the penis. [ 23 ]  Therefore, implantation of penile prosthesis in Peyronie's disease addresses several mechanisms involved in the pathophysiology of the disease.


Although different models of penile prostheses have been reported to be implanted after  phalloplasty  procedures, [ 24 ]  with the first case described in 1978 by Pucket and Montie, [ 25 ]  the first penile implants designed and produced specifically for  female-to-male gender reassignment surgery  for  trans men  were introduced in 2015 by  Zephyr Surgical Implants . [ 26 ]  Both malleable and inflatable models are available. These implants have more realistic shape with an ergonomic glans at the tip of the prosthesis. The inflatable model has an attached pump resembling a testicle. The prosthesis is implanted with a sturdy fixation on  pubic bone . Another, thinner malleable implant is intended for  metoidioplasty .


The overall satisfaction rate with penile implants reaches over 90%. [ 6 ]  Both self- and partner-reported satisfaction rates are evaluated to assess the outcomes. It has been shown that implantation of inflatable penile prosthesis brings more patient and partner satisfaction than medication therapy with  PDE5 inhibitors  or  intracavernosal injections . [ 21 ]  Satisfaction rates are reported to be higher with inflatable rather than malleable implants, but there are no differences between two-piece and three-piece devices. [ 27 ] [ 28 ]  The most frequent reasons for dissatisfaction are reduced penis length and girth, failed expectations and difficulties with device use. [ 21 ] [ 27 ]  Thus, it is vital to provide patients and their partners with detailed preoperative counselling and instructions. [ citation needed ]


33% to 90% of cases of patients with Peyronie's disease that have had an inflatable PI procedure have successfully corrected their penile deformity. [ 23 ]  The residual curvature after penile implant placement usually requires intraoperative surgical intervention.


Dilation of the corpora cavernosa, typically with Hegar sounds, before inserting the device has been a common part of implantation procedures. This dilation destroys erectile tissue. It has been shown that a tissue-sparing technique, i.e.  without  dilation, correlates with superior outcomes – some remaining natural erectile response can be preserved, and post-operative pain is reduced as well. [ 29 ] [ 30 ]


The most common complication associated with penile implant placement appears to be infections with reported rates of 1–3%. [ 27 ]  Both surgical site and device infections are reported. When the infection involves the penile implant itself, implant removal is required and irrigation of the cavities with  antiseptic  solutions. In this scenario, placement of a new implant is needed to avoid further tissue fibrosis and shortening of the penis. The rate of repeat surgeries or device replacements ranges from 6% to 13%. [ 23 ]  Other reported complications include perforation of the  corpus cavernosum  and  urethra  (0.1–3%), commonly occurring in patients with previous  fibrosis , prosthesis erosion or extrusion, change in  glans  shape,  hematoma , shortening of penis length, and device malfunction. Due to continuous improvement of surgical techniques and modifications of implants, complication rates have dramatically decreased over time. [ citation needed ]


To overcome post-operative penile shortening and to increase the perceived length of the penis and patient satisfaction, ventral and dorsal  phalloplasty  procedures in combination with penile implants have been described. [ 21 ]  Modified glanulopexy has been proposed to prevent supersonic transporter deformity and glandular hypermobility which are possible complications of penile implants. [ 31 ]


Sliding techniques in which the penis is cut and elongated with penile implants have been performed in cases of severe penile shortening. However, these techniques had higher rates of complications and are currently avoided. [ citation needed ]


Premature ejaculation  ( PE ) is a male  sexual dysfunction  that occurs when a male  expels semen  (and most likely experiences  orgasm ) soon after beginning  sexual activity , and with minimal  penile stimulation . [ 1 ]  It has also been called  early ejaculation ,  rapid ejaculation ,  rapid climax ,  premature climax  and (historically)  ejaculatio praecox.  There is no uniform cut-off defining "premature", but a consensus of experts at the International Society for Sexual Medicine endorsed a definition of around one minute after penetration. [ 2 ]  The  International Classification of Diseases  (ICD-10) applies a cut-off of 15 seconds from the beginning of  sexual intercourse . [ 2 ]


Although men with premature ejaculation describe feeling that they have less control over ejaculating, it is not clear if that is true, and many or most average men also report that they wish they could last longer. In males, typical  intravaginal ejaculation latency time  is approximately 4–8 minutes. [ 3 ]  The opposite condition is  delayed ejaculation . [ 4 ]


Men with PE often report emotional and relationship distress, and some avoid pursuing sexual relationships because of PE-related embarrassment. [ 5 ]  Compared with males, females consider PE less of a problem, [ 6 ]  but several studies show that the condition also causes female partners distress. [ 5 ] [ 7 ] [ 8 ]


The causes of premature ejaculation are unclear. Many theories have been suggested, including that PE was the result of masturbating quickly during adolescence to avoid being caught,  performance anxiety ,  passive-aggressive behavior  or having too little sex; but there is little evidence to support any of these theories. [ 3 ]


Several physiological mechanisms have been hypothesized to contribute to causing premature ejaculation, including  serotonin  receptors, a genetic predisposition, elevated penile sensitivity and nerve conduction atypicalities. [ 9 ]   Scientists  have long suspected a  genetic  link to certain forms of premature ejaculation. However, studies have been inconclusive in isolating the gene responsible for lifelong PE.


The  nucleus paragigantocellularis  of the brain has been identified as having involvement in ejaculatory control. [ 10 ]  PE may be caused by  prostatitis [ 11 ]  or as a medication side effect.


PE has been classified into four subtypes - lifelong, acquired, variable and subjective PE. The pathophysiology of lifelong PE is mediated by a complex interplay of central and peripheral serotonergic, dopaminergic, oxytocinergic, endocrinological, genetic and epigenetic factors. Acquired PE may occur due to psychological problems - such as sexual performance anxiety, and psychological or relationship problems - and/or co-morbidity, including  erectile dysfunction , prostatitis and hyperthyroidism. [ 12 ]


The physical process of ejaculation requires two actions: emission and expulsion. The emission is the first phase. It involves deposition of fluid from the  ampullary   vas deferens ,  seminal vesicles  and  prostate gland  into the  posterior   urethra . [ 13 ]  The second phase is the expulsion phase. It involves closure of bladder neck, followed by the rhythmic contractions of the  urethra  by pelvic-perineal and  bulbospongiosus muscle  and intermittent relaxation of the  external male urethral sphincter . [ 14 ]


Sympathetic motor neurons control the emission phase of ejaculation reflex, and expulsion phase is executed by somatic and autonomic motor neurons. These motor neurons are located in the thoracolumbar and lumbosacral  spinal cord  and are activated in a coordinated manner when sufficient sensory input to reach the ejaculatory threshold has entered the  central nervous system . [ 15 ] [ 16 ]


The 1948  Kinsey Report  suggested that three-quarters of men ejaculate within two minutes of penetration in over half of their sexual encounters. [ 17 ]


Current evidence supports an average  intravaginal ejaculation latency time  (IELT) of six and a half minutes in 18- to 30-year-olds. [ 18 ] [ 19 ]  If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested by an IELT of less than about two minutes. [ 20 ]  Still, it is possible for some men with abnormally low IELTs to be satisfied with their performance and not report a lack of control. [ 21 ]  Likewise, those with higher IELTs may consider themselves premature ejaculators, and suffer from quality of life issues normally associated with premature ejaculation, and even benefit from non-pharmaceutical treatment. [ 22 ]


The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5 ) defines premature ejaculation as "A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the person wishes it," with the additional requirements that the condition occurs for a duration longer than 6 months, causes clinically significant distress, and cannot be better explained by relationship distress, another mental disorder, or the use of medications. [ 2 ]  These factors are identified by talking with the person, not through any diagnostic test. [ 2 ]  The DSM-5 allows for specifiers whether the condition is lifelong or acquired, applying in general or only to certain situations, and severity based on the time under one minute, however these subtypes have been criticised as lacking validity due to insufficient evidence. [ 23 ]


The 2007  ICD-10  defined PE as ejaculating without control, and within around 15 seconds. [ 2 ]


Several treatments have been tested for treating premature ejaculation. A combination of medication and non-medication treatments is often the most effective method. [ 24 ]


Many men attempt to treat themselves for premature ejaculation by trying to distract themselves, such as by trying to focus their attention away from the sexual stimulation. There is little evidence to indicate that it is effective and it tends to detract from the sexual fulfilment of both partners. Other self-treatments include thrusting more slowly, withdrawing the penis altogether, purposefully ejaculating before sexual intercourse, and using more than one condom. Some men report these to have been helpful. [ 3 ]


Several techniques have been developed and applied by sex therapists, including  Kegel exercises  (to strengthen the muscles of the pelvic floor) and Masters and Johnson's "stop-start technique" (to desensitize the male's responses) and "squeeze technique" (to reduce excessive arousal). [ 24 ] : 27


To treat premature ejaculation, Masters and Johnson developed the "squeeze technique", based on the Semans technique developed by James Semans in 1956. [ 25 ]  Men were instructed to pay close attention to their  arousal pattern  and learn to recognize how they felt shortly before their "point of no return", the moment ejaculation felt imminent and inevitable. Sensing it, they were to signal their partner, who squeezed the head of the penis between thumb and index finger, suppressing the ejaculatory reflex and allowing the male to last longer. [ 26 ] [ 27 ] [ 28 ]


The squeeze technique worked, but many couples found it cumbersome. From the 1970s to the 1990s, sex therapists refined the Masters and Johnson approach, largely abandoning the squeeze technique and focused on a simpler and more effective technique called the "stop-start" technique. During intercourse, as the male gets the sensation of approaching climax, both partners stop moving and remain still until the male's feelings of ejaculatory inevitability subside, at which point, they are free to resume active intercourse. [ 26 ] [ 29 ] [ 30 ] [ 31 ] [ 32 ]


The functional-sexological approach to treating premature ejaculation, as developed by François de Carufel & Gilles Trudel, offers a novel method focusing on sexual function improvement without interrupting sexual activity. This treatment, distinct from traditional behavioral techniques like the squeeze and stop-start methods, has demonstrated significant improvements in the duration of intercourse, sexual satisfaction, and overall sexual function. A pivotal study by De Carufel & Trudel (2006) showcases the effectiveness of this approach. [ 33 ]  Moreover, the Cochrane review on psychosocial interventions for premature ejaculation recognizes the De Carufel study as having a low risk of bias, highlighting its methodological robustness among psychosocial intervention studies. [ 34 ]  This acknowledgment points to the functional-sexological treatment as a promising avenue for individuals and couples grappling with premature ejaculation, suggesting a shift towards more contemporary and empirically supported treatments in the field. [ 35 ]


Dapoxetine , a  selective serotonin reuptake inhibitor  (SSRI), has been approved for the treatment of premature ejaculation in several countries. [ 36 ] [ 37 ] [ 38 ]  Other SSRIs are used off-label to treat PE, including  fluoxetine ,  paroxetine ,  sertraline ,  citalopram ,  escitalopram  and  clomipramine . [ 36 ]  The opioid  tramadol , an atypical oral  analgesic  is also used. [ 36 ] [ 39 ]  Results have found  PDE5 inhibitors  to be effective in combination treatment with SSRIs. [ 36 ]  The full effects of these medications typically emerge after 2-3 weeks, with results indicating about ejaculatory delay varying between 6–20 times greater than before medication. [ 36 ]  Premature ejaculation can return upon discontinuation, [ 36 ]  and the side effects of these SSRIs can also include  anorgasmia ,  erectile dysfunction , and diminished  libido . [ 36 ]


Topical anesthetics  such as  lidocaine  and  benzocaine  that are applied to the tip and shaft of the penis have also been used. They are applied 10–15 minutes before sexual activity and have fewer potential side effects as compared to SSRIs. [ 40 ]  However, this is sometimes disliked due to the reduction of sensation in the penis as well as for the partner (due to the medication rubbing onto the partner). [ 41 ]  Another research was conducted in 21 men who were randomized (15 treatment, 6 placebo) and had complete follow-up data. Baseline mean ± standard deviation IELT was 74.3 ± 31.8 vs 84.9 ± 29.8 seconds among the treatment and placebo groups, respectively (p=0.39). After 2 months, men in the treatment group had significant improvement in IELT with a mean increase of 231.5 ± 166.9 seconds (95% confidence interval of 139-323 seconds) which was significantly greater than men on placebo (94.2 ± 67.1 seconds, p= 0.043).  [ 42 ]


Two different surgeries, both developed in  South Korea , are available to permanently treat premature ejaculation: selective dorsal  neurectomy  (SDN) [ 43 ]  and glans penis augmentation using a  hyaluronan  gel. [ 44 ] [ 45 ]   Circumcision  has shown no effect on PE. [ 46 ]  The  International Society for Sexual Medicine  guidelines do not recommend either surgical treatment due to the risk of permanent loss of sexual function and insufficient reliable data [ 46 ] [ 47 ] [ 23 ]  and on the basis of violating the medical principle of  non-maleficence  as the surgery can lead to complications, of which some might not yet be known. [ 46 ]  The most common complication of surgery is the recurrence of PE, reported to occur in about 10% of surgeries. [ 46 ]  Other sources consider SDN as a safe and efficient treatment [ 48 ]  and these surgeries are popular in Asian countries. [ 23 ] [ 47 ]


Premature ejaculation is a prevalent  sexual dysfunction  in males; [ 49 ]  however, because of the variability in time required to ejaculate and in partners' desired duration of sex, exact prevalence rates of PE are difficult to determine. In the "Sex in America" surveys (1999 and 2008),  University of Chicago  researchers found that between  adolescence  and age 59, approximately 30% of men reported having experienced PE at least once during the previous 12 months, whereas about 10 percent reported  erectile dysfunction  (ED). [ 50 ]  In males, although ED is the most prevalent sex problem after age 60, and may be more prevalent than PE overall according to some estimates, [ 51 ]  premature ejaculation remains a significant issue that, according to the survey, affects 28 percent of men age 65–74, and 22 percent of men age 75–85. [ 50 ]  Other studies report PE prevalence ranging from 3 percent to 41 percent of men over 18, but the great majority estimate a prevalence of 20 to 30 percent—making PE a very common sex problem. [ 5 ] [ 11 ] [ 49 ] [ 52 ] [ 23 ] [ 53 ] [ 54 ] [ 55 ]


There is a common misconception that younger men are more likely to develop premature ejaculation and that its frequency decreases with age. [ 56 ] [ 57 ]  Prevalence studies have indicated, however, that rates of PE are relatively constant across age groups. [ 9 ]


Male  mammals  ejaculate quickly during intercourse, prompting some  biologists  to speculate that rapid ejaculation had  evolved  into genetic makeup of human males to increase their chances of passing their  genes . [ 58 ] [ 59 ]


Ejaculatory control issues have been documented for more than 1,500 years. The  Kamasutra , the 4th century BCE Indian marriage handbook, declares that “if a male be long-timed, the female loves him the more, but if he be short timed, she is dissatisfied with him.” [ 60 ] [ 61 ]


Waldinger summarizes professional perspectives from early in the twentieth century. [ 62 ]


Sex researcher  Alfred Kinsey  did not consider rapid ejaculation a problem, but viewed it as a sign of "masculine vigor" that could not always be cured. [ 63 ]  The belief that it should be considered a disease rather than a normal variation, has also been disputed by some modern researchers. [ 64 ]


In the 19th century, a symptom called  spermatorrhoea  invented by  William Acton  in 1857, meaning excessive or involuntary semen discharge, was developed and at the time used as a medical justification of  celibacy . [ 65 ] [ 66 ]  Spermatorrhoea was later sub-classified into other symptom clusters based partially on how it affected semen. [ 66 ]  Treatment for spermatorrhoea at the time included  catheterisation ,  cauterisation ,  circumcision , and sticking needles through the  perineum  into the  prostate . [ 66 ]  In the 19th and early 20th centuries, the cultural stigma towards researching sexuality which drove its unpopularity among doctors and in publications. [ 65 ]  The first recognition the symptoms described in spermatorrhoea as a disorder in itself is believed to be in 1883, termed  ejaculatio praecox . [ 66 ]  The origin of the modern version of ejaculatio praecox, called premature ejaculation, is thought to have begun with  Alfred Adler  before major developments of  psycohanalytic theory . [ 67 ]


Through the mid 20th century,  Sigmund Freud  published widely accepted and virtually unchallenged theories that rapid ejaculation was due to neurosis, that penetrative sex was the only right way to achieve female orgasm, and that a man's erection was essential to female orgasm. [ 68 ] [ 69 ]  It stated that males who ejaculate prematurely have unconscious hostility toward females, so they ejaculate rapidly, which satisfies them but frustrates their partners, who are unlikely to experience  orgasm  that quickly. [ 70 ]  Freudians claimed that premature ejaculation could be cured using psychoanalysis. But even years of psychoanalysis accomplished little, if anything, in curing premature ejaculation. [ 70 ]  In 1974, there was no evidence found to suggest that men with premature ejaculation harbor unusual hostility toward females. This so-called  coital imperative  has later been argued as a medically recognised disorder that did not actually serve the satisfaction of women but rather contributed to the pressure on and pathologisation of men in obtaining a so-called optimal time to ejaculation. [ 69 ] [ 71 ]


2ZCH ,  2ZCK ,  2ZCL ,  3QUM


NP_001025218 NP_001025219 NP_001639


Prostate-specific antigen  ( PSA ), also known as  gamma-seminoprotein  or  kallikrein-3  ( KLK3 ), P-30 antigen, is a  glycoprotein   enzyme  encoded in humans by the  KLK3   gene . PSA is a member of the  kallikrein -related  peptidase  family and is secreted by the  epithelial cells  of the  prostate  gland in men and the  paraurethral glands  in women. [ 5 ]


PSA is produced for the  ejaculate , where it liquefies  semen  in the seminal coagulum and allows  sperm  to swim freely. [ 6 ]  It is also believed to be instrumental in dissolving  cervical mucus , allowing the entry of sperm into the  uterus . [ 7 ]


PSA is present in small quantities in the  serum  of men with healthy prostates, but is often elevated in the presence of  prostate cancer  or other prostate disorders. [ 8 ]  PSA is not uniquely an indicator of prostate cancer, but may also detect  prostatitis  or  benign prostatic hyperplasia . [ 9 ]


Clinical practice guidelines  for prostate cancer  screening  vary and are controversial, in part due to uncertainty as to whether the benefits of screening ultimately outweigh the risks of  overdiagnosis  and overtreatment. [ 10 ]  In the United States, the  Food and Drug Administration  (FDA) has approved the PSA test for annual screening of prostate cancer in men of age 50 and older. [ medical citation needed ]  The patient is required to be informed of the risks and benefits of PSA testing prior to performing the test. [ medical citation needed ]


In the United Kingdom, the  National Health Service  (NHS) as of 2018 [update]  does not mandate, nor advise for PSA test, but allows patients to decide based on their doctor's advice. [ 11 ]  The NHS does not offer general PSA screening, for similar reasons. [ 12 ]


PSA levels between 4 and 10   ng/mL (nanograms per milliliter) are considered to be suspicious, and consideration should be given to confirming the abnormal PSA with a repeat test. If indicated,  prostate biopsy  is performed to obtain a tissue sample for histopathological analysis.  [ citation needed ]


While PSA testing may help 1 in 1,000 avoid death due to prostate cancer, 4 to 5 in 1,000 would die from prostate cancer after 10 years even with screening. This means that PSA screening may reduce mortality from prostate cancer by up to 25%. Expected harms include anxiety for 100–120 receiving false positives, biopsy pain, and other complications from biopsy for false positive tests. [ medical citation needed ]


Use of PSA screening tests is also controversial due to questionable test accuracy. The screening can present abnormal results even when a man does not have cancer (known as a  false-positive  result ), or normal results even when a man does have cancer (known as a  false-negative  result ). [ 13 ]  False-positive test results can cause confusion and anxiety in men, and can lead to unnecessary prostate  biopsies , a procedure which causes risk of pain, infection, and  hemorrhage . False-negative results can give men a false sense of security, though they may actually have cancer. [ medical citation needed ]