Bigger isn't always better

As Stan and Mindy walked into the ER, I guessed from their attire that they had attended the senior prom. Noticing the blood on Mindy's gown, I surmised that this was the reason for the ER visit. I was correct on both counts.

Having never attended a prom, I have only secondhand, anecdotal reports of what goes on during and after such an event. Suffice it to say that losing one's virginity after the prom is not a rare occurrence. Indeed, Stan and Mindy had succumbed to their youthful passion and consummated their three-week relationship. While most women manage to lose their virginity without a subsequent visit to the ER, most women do not have to contend with Stan or someone like him. More about him in a minute.

Initially, I guessed that the source of the blood was from the ruptured hymen. Sure enough, I found the hymen was bleeding as I performed the pelvic examination. But that wasn't all. The vagina itself was torn and bleeding. I wondered how that had happened.

Mindy: Oh, God, it really hurt when he put it in me.

Dr. Pezzi: I can imagine . . .

Mindy: I've never had sex before, Doctor, but this isn't the first time I've seen a penis. But I've never seen one so huge! I mean, I didn't think they came that big.

Neither did I. To make a long story short, Stan wanted my medical opinion on whether or not he was a freak of nature. His terminology, not mine. A caring physician would be amiss not to euphemize such an aberrancy in a more sensitive manner. Having been trained at Wayne State, I thought I was ready for this.

Let me digress for a minute. At Wayne State University's School of Medicine, we were shown dozens of pornographic (OK, highly pornographic) films as part of the curriculum. The rationale for such an unusual academic inclusion, we were told, was so that we would not react in disgust or surprise if a patient revealed sexual proclivities that were, well, strange. By exposing us to every imaginable sexual practice, they hoped to desensitize us so that we could just deal with the medical issues, leaving judgment about such practices to God, or perhaps to Jerry Springer and his audience.

As Stan dropped his trousers, my eyebrows reflexively rose.

Stan: What do you think, Doctor?

Dr. Pezzi: Well, Stan, it's certainly a very large penis.

Stan: Do you think I'll be able to have a normal sex life—you know, without hurting women?

Dr. Pezzi: That depends upon your partner. If she has a small vagina, it will be uncomfortable for her.

And dangerous, too. Knowing how sensitive young people can be, I didn't want to give him a complex about his penis. In truth, I should have answered that he would be unlikely to find a human female who would be a suitable match for him, size wise. Although I have seen thousands of penises, I'd never seen one that was even remotely similar in size to that of Stan. The next largest penis was, I'm sure, at least four times smaller in terms of volume. I bet Stan's Mom rinsed their dishes well when he was a kid!

Are you wondering why I said that? As I explained in The Science of Sex (, people are routinely exposed to various chemicals in dishwashing detergents and other household chemicals that partially neutralize the effects of testosterone (and other androgens). These chemicals interfere in a dose-dependent way with male sexual development, including that of the penis. Therefore, with everything else being equal, a man with less exposure to those anti-androgens will have a larger penis than a man with greater exposure. (Incidentally, greater exposures are also more likely to dampen his libido and reduce his sexual pleasure, too.)

Don't breathe a sigh of relief just because you're a woman. Women have androgens, too, and—just as in men—those hormones are the primary regulators of libido and sexual sensation. So if you are disappointed by your libido, sexual sensation, or orgasmic ability, one of the culprits may be anti-androgens.

While I am on this subject, I should also mention that other chemicals can partially block the effects of estrogen in your body. Is that good? If you get your scientific education from the 6 PM news, you probably think that estrogen is bad, so blocking it is good.

Not so fast. First, estrogen is the primary hormone that makes women attractive to men. As estrogen levels (or, more precisely, estrogen effects, as I discuss in The Science of Sex) plummet, so do the wonderful effects of estrogen. What do men crave? Larger, fuller breasts, or ones that look like deflated bags? Lush, bouncy, radiant hair, or a scalp covered by sparse, dull, lifeless strands? Skin that is soft, glowing, and youthful, or dry, wrinkled, and sagging? Lips that are soft and full, or shriveled? A vagina that is silky and lubricated, or one that's dry with a texture less able to give men pleasure? In every case, what men crave is what estrogen gives. Less estrogen, less estrogen effects, less men begging you for a date.

But what about the dark side of estrogen? Haven't I heard about its supposed association with breast cancer and heart disease? You bet I have, and I can't think of any topic in which women have been so misled. Reporters have twisted the facts about estrogen, yet failed to give you information that could do far more to reduce your risk of cancer and heart disease than avoiding supplemental estrogen in your postmenopausal years. If you read what I wrote about estrogen in The Science of Sex, you can have your cake and eat it, too: you can have all the beneficial effects of estrogen, and live a better quality, longer life than women who don't take estrogen because they made the mistake of listening to reporters with little or no scientific education.

Or, tragically, you may have an anti-estrogen doctor with simplistic thinking and a woefully incomplete grasp of this topic. If so, you should know that not all doctors are created equal. I graduated in the top 1% of my class in medical school. Some of the tests were so hard that a passing score was about 45%, because our exams were graded on the curve (as is true in many medical schools). Many people who are now doctors (and possibly giving you advice) squeaked by with such low grades, while I was acing exam after exam and getting more than twice as many questions correct. So did I learn about twice what the bottom-tier doctors learned? No, the difference was even greater. An elementary school student could score about 20% on a multiple-choice test just by guessing, so it is clear that students with scores of 45 were benefited by a lot of guessing. It is impossible to get the 95+% scores that I achieved by guessing. I learned almost everything taught in medical school (and then some, because I did a lot of reading on my own), while some other doctors—yes, maybe even those attractive physicians you see on the 6 PM news giving you their take on estrogen—may have really known only a third of what I did.

I mentioned this because your life may very well depend on the quality of the medical information that you receive. Please don't listen to reporters who know next to nothing about science, and don't assume that all doctors are equally qualified.


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