What’s the Skinny on Weight and Male Infertility

Effect of Wight on Male Infertility Beverly Hills
The unbearable lightness of being (Courtesy Diana Polekhina, Unsplash)

Ok, so you’re a victim of the “quarantine-19,” the perfunctory weight gain associated with the (very real) stress of COVID. Maybe you pivoted to fast food and dropped your exercise routine. Or you began to relish those end-of-day ‘quarantini’ cocktails now that you’re not commuting anymore. Sure, you’ve been meaning to lose that pandemic weight, but life got really busy again and it hasn’t been easy. Need a little motivation? How’s this: a 5% weight loss (that’s 10 lbs out of 200) is known to hold the following health benefits:

  • Reduces insulin resistance and the risk of prediabetes and diabetes
  • Bumps up good cholesterol (HDL), which protects against heart disease
  • Drops triglycerides, which protects against heart disease
  • Lowers high blood pressure
  • Reduces severity of sleep apnea
  • Lowers risk of cancers including breast, colon, rectum, prostate, and pancreas
  • Reduces fatty liver disease
  • Improves body image

But did you know that your weight can also throw a monkey wrench into your efforts to conceive? In fact, when it comes to weight’s effect on male fertility, both extremes are problematic: being too thin or being overweight can both reduce sperm quantity and quality. But the bulk of evidence links obesity to male infertility.

Tipping the Scales

Using body mass index (BMI) as a measure (the ideal BMI for men being 20-25), a large Danish study showed that overweight men with a BMI > 25 had a 22% lower sperm concentration compared with healthy weight men. Other human and animal studies have confirmed this relationship and have also correlated obesity with reductions in sperm motility, increases in sperm DNA damage and lower testosterone levels. So, it’s clear that sperm don’t work as well in the setting of obesity. But is actual fertility affected by weight? It appears so. Another study showed that for every 20-pound increase in a man’s weight, there is a 10% increase in the chance of infertility. And this held true when other factors that influence results were taken into consideration. It’s as if adding weight starves sperm.

Exactly how does obesity influence sperm and fertility?  One way is through altered sex hormone balance. Testosterone is the “fuel” for the engine (testis) to make sperm. Obesity increases fat stores and fat converts testosterone into female hormones (estrogens). Too much estrogen in men depresses sperm production. Another issue is that the normal 3° temperature difference between the testes and the body proper is lost with obesity, as extra scrotal fat insulates the gonads and overheats the sperm-making machinery. Lastly, it is known that fat-producing cells are pro-inflammatory and more of them could induce a form of chemical imbalance known as oxidative stress within the testis and other genital organs. Added weight then poses a triple assault on male fertility.

A Heavy Weight

An even more compelling reason to keep your weight under control is that recent studies now show that obesity can introduce changes to sperm DNA, termed epigenetic alterations, that may be inherited by offspring. That means that by being overweight, you increase your children’s risk of having obesity and possibly other metabolic disorders. Remember, if it’s in sperm, then it’s gonna be handed down to kids, because that’s what sperm do. Why put your kids at risk of diseases even before they are born? Does that change things a bit for you?

So, to be clear, obesity adversely affects fertility. Another reason to be the best, and most healthy, person you can be, as you are one of your future family’s most important investments.

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When Should a Man Check His Fertility?

Men’s Fertility Clinic, Turek Clinic
The Holy Grail of health care is prevention. (Photo by Dawn McDonald on Unsplash)

Having practiced medicine for almost three decades now, I’ve learned quite a few things.  As one who always seeks to improve, the one thing that I would most like to change in our healthcare system is its “defensive” orientation. Medicine spends too much time reacting to health problems after they occur, like treating kidney stones and cancer. Medicine desperately needs to become more “preventative” in nature. In my view, identifying risk well before it becomes disease allows for disease prevention, and that my friends is the Holy Grail of medicine.

In the Box

People know this. That’s why they take $360 billion of nutritional supplements annually in the US alone. And maybe that’s why over 100 million individuals have mailed off their spit or blood for personal DNA testing since the technology was introduced 15 years ago. Many of us really want to know what might happen to us as we age. Along these lines, I’d like to propose another preventative measure: consider checking the fertility of young men before they consider family building.

Out of the Box

Why check young men’s fertility potential? Well, it can tell us a lot about their fertility potential and that may change how and when they approach family building. Equally importantly, a man’s fertility potential is now known to be a biomarker of his health. And not only his current health, but his future health.

What Does Being Infertile Mean for a Man?

The same lifestyle choices that make you healthy also keep you fertile. Here is a summary of the risk that being infertile brings to bear on a man’s health:

  • 30% increased risk of cardiovascular disease
  • 150-300% increased risk of cancer
  • 120-1000% increased risk of chronic disease
  • twofold increased risk of early mortality

How do I see this fertility check happening? Well, the lowest hanging fruit to grab would be to check a semen sample. Traditionally requiring a doctor’s order, my belief is that laboratory-certified semen analyses give better and more information than simpler over-the-counter sperm check kits. Luckily, high quality semen analyses can now be done from the comfort of your own abode through on-line, mail-in companies like Legacy. The best checkup would also involve a visit with a reproductive urologist for a good old-fashioned medical history and physical exam (it doesn’t hurt!) and an interpretation of the semen analysis, because the sperm count alone does not make or break the man. Bowing to the COVID pandemic, even a virtual visit or telehealth visit with a urologist would be better than no visit. And that’s it. Really.

I see the pre-fertility check for men as a neat way of instilling a little preventative care into the half of our species that for the better part of their lives, feels nothing if not immortal. As the old proverb goes, an ounce of prevention is worth a pound of cure.

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How is a Vasectomy Reversal Like a Bespoke Suit?

Vasectomy Reversal, Turek Clinic
Cloaked in the bespoke…can actually make sense! (Courtesy: Unsplash)

Maybe you wear suits, and maybe you don’t. If you do, maybe you wear them for work or just for pleasure. Either way, suits vary widely in quality, look and performance. One big difference between suits is whether they are “off the rack” or “bespoke,” meaning custom made just for you. How these two types of suits differ can be subtle but real, just like the differences found in the equally arcane world of vasectomy reversals.

Admittedly, my expertise in vasectomy reversals far outweigh my knowledge of bespoke suits. But what makes these products worth the money is worthy of discussion. It comes down to two things: quality and value.

Inseam Insights

Here’s how a quality vasectomy reversal is like a bespoke suit:

  • Craftmanship matters. They are both made by hand and reflect the skill of the tailor/surgeon. Training and experience matter greatly in the creation of each. In the words of the father of modern medicine, Sir William Osler: “The value of experience is not in seeing much, but in seeing wisely.”
  • Reputation matters. Like finding a quality suit, a quality vasectomy reversal depends on research and trust in the craftsperson that you choose. As Harvey Mackay has said, “You can’t buy a good reputation; you must earn it.”
  • The first go is the best for success. With both suits and reversals, try to have it done right the first time. Redoing either is often a more complicated prospect. As the tailoring adage goes: “Measure twice and cut once.”
  • No two are alike. Both reversals and bespoke suits are entirely custom-made for the owner. In each case, the craftsperson must approach it as a singular work commissioned for its owner. To quote Eileen Caddy: “A human being is a single being. Unique and unrepeatable.”
  • There’s an art and science to both. Both reversals and suits involve creative design, measuring and cutting and building or constructing. I view vasectomy reversals as a blend of art, architecture, and biology.
  • Both are made to last. A well-crafted reversal or suit is built to last. They are less likely to tear (suit) or fail (reversal) than “off the rack” or “fast-is-best” versions. To paraphrase the playwright Mehmet Ildan, careful minds build durable things.
  • Both fit well and are easy to use. Too tight or too baggy is much less likely with bespoke suits. Likewise, pain and complications are less likely with expertly done reversals. In the words of Leonardo da Vinci: “Details make perfection.”
  • Both products seek innovation but avoid trends. Wide lapels and pleated pants come and go and can easily “date” a bespoke suit. Similarly, lasers and robots are surgical “fashion” trends in reversal procedures. Seek the tried and true for both suits and reversals. As Joseph Pearce stated: “That which is timeless is also the most timely.”
  • Take care of them so they last and serve you well. There is a responsibility for owning something bespoke. Try not to abuse either your suit or your body. Stay healthy and the reversal will serve you well.

A high-quality vasectomy reversal, like a bespoke suit, may cost more, but the benefits are clear: A better fit that makes you look good and gets the job done for the long run. And that, my friends, is value. As Warren Buffett once said: “Price is what you pay. Value is what you get.”

 

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Update on Male Contraception: Do Vasectomies Still Rule?

the male pill
Wondering if there’ll ever be a “little pink pill” for male oral contraception (Courtesy Unsplash)

I know you’re wondering: What’s up with the male pill? Exactly where are we with male contraceptives other than condoms or vasectomy? Well, it’s a good time to ask as it’s now very clear that the desire for alternatives to vasectomy is great and growing. Studies of couples around the globe found that 25-75% of them would use a male hormonal contraceptive. That means that between 44 million and 130 million men in those nine surveyed countries alone would consider a male pill. That’s a need indeed!

A Storied Past

Contraception has been defined by innovations on the male side for almost 5000 years:

3000BCE: Evidence of condom use made from animal bladder or intestine or linen cloth in Crete and Egypt.

1800 BCE: Spermicides made by combining crocodile feces and fermented dough in Egypt

1830: First vasectomy performed in a human by R. Harrison in London. Its popularity rose dramatically after WWII. The first national program for vasectomy was launched in India in 1954

1855: The first rubber condom is made by…wait for it…Charles Goodyear, who later invented the rubber tire.

Over the last century, however female contraceptive innovations surpassed male contraception like it was standing still and female contraceptives are currently the preferred choice for most couples by a wide margin (5:1). What happened here? The most glaring issue is that funding has been sporadic as pharmaceutical companies haven’t been interested in developing male pills due to high development costs and the fear of lawsuits.

The Male Pipeline

Approaches to male contraception involve  stopping sperm production, rendering sperm immotile so they don’t move, or blocking the exit path from the testicle. They can be hormonal, non-hormonal or surgical in nature. There is currently one hormonal male contraceptive in clinical trials: a non-oral testosterone-progesterone gel applied to the skin daily to turn off or turn down sperm production. The goal is to reduce sperm to less than 1 million/mL in the semen. The questions are whether it can do this reliably in all men (remember the gold standard is vasectomy which is 99.99% effective) and whether hormonal side effects are tolerable: acne, moodiness, changes in sex drive or erections. After all, having significant sexual side effects from a pill that aims to take the worry out of sex kind of defeats the purpose, wouldn’t you say?

There is also good research developing on a sperm binding agent called Eppin that renders sperm immotile so they just sit there and can’t reach the egg to fertilize it. It’s being billed as “non-hormonal” and “reversible” but it has only been shown to be effective as an immunocontraceptive in monkeys (i.e., essentially a vaccine). It’s not clear to me how complete the sperm motility block generated with this pill can be, as we all know that sperm love to wiggle. Also, I am not entirely sure how reversible anything is with the human immune system as it literally remembers everything that it has ever seen. To date, this approach has not seen clinical trials. Lastly there is ADAM*, a non-hormonal, non-oral, hydrogel polymer “plug” that blocks the flow of sperm in the vas deferens without interrupting fluid flow. It is essentially a “screen door” for sperm and should be an improvement over the classic 100-year-old vasectomy, especially if it lives up to its promise of being reversible. It’s also in clinical trials right now. So, there’s a lot of window shopping in male contraceptive research right now, but no available product inventory.

Vasectomies Rule

So, it appears that we are left with the good ole’ vasectomy. Tried and true, nonhormonal and compliance-free, nothing on earth beats it in terms of reliability. In fact one of the reasons it’s so well-loved is that you don’t have to think about doing something every time sex is contemplated. All set to go, time after time after time. And, it has new and improved versions including the no-scalpel vasectomy, the Brosectomy® and the Nitrous-powered vasectomy, all developed with the goal of making the procedure as much of a “non-experience” as possible.

*Disclosure: I advise this company.

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Case Report: Disease Causing Low Testosterone: Look and You Shall Find

Male Fertility Specialist Los Angeles, CA
Your empty tank can be refilled but it’s good to ask why it emptied (Courtesy: Unsplash)

He came to my office out of sorts, looking for answers to his medical issues. As a 30-year-old, he had been experiencing fatigue, depression, low sex drive and erectile dysfunction for 8 years! Knowing that the average young male thinks about sex every 10 minutes during waking hours and ever so rarely fails to have an erection, I was very concerned for him and took his symptoms very seriously. He had seen his primary care provider, an endocrinologist and a neurologist before me. He was given antidepressants, psychotherapy and other treatments to no avail. This led to a diagnosis of low testosterone and subsequent treatment with testosterone injections. Like a recharged Energizer® bunny, testosterone replacement revived him entirely, making him feel “absolutely better in every way.” All good. Yet, he sat in front of me wondering whether or not he would have to take testosterone for the rest of his life, maybe 60+ years! He was more worried about how he would stay fertile when he learned that testosterone therapy acts as a contraceptive.

The Bottom of Things

I am a “root-cause” guy. By figuring out why things happen, you have the best chance for cure. The simple question here is: What was causing the testosterone drain on this young man, and could it be reversed? So, I went to work.

His medical history was a blank slate for risk, including no pot or other drug use, no untimely stress, and no sleep apnea or obesity. His physical examination was also unremarkable with normal testicle size and no varicoceles. The finding of normal sized testicles told me that whatever happened to his testosterone occurred after puberty and was not a lifelong problem of testicular failure. His blood work showed no diabetes, anemia, prolactin or thyroid issues, all of which can be associated with low testosterone.

But then I saw it, deep within his bundle of laboratory studies: his blood counts were high. He was polycythemic. But why? Well, just being on testosterone could do this, but he wasn’t taking high enough, anabolic doses of testosterone. Then, I came upon blood tests taken before he started testosterone and, lo and behold, he was polycythemic then too. Bingo! The diagnosis: hemochromatosis.

A Bloody Disease

Hereditary hemochromatosis is caused by a mutation in a gene that controls the amount of iron your body absorbs from food. It occurs in 1 of every 200-300 people and is found far more often in men than women. Because of this gene defect, excess iron is absorbed and then gets stored in body organs like the liver, pancreas and spleen. Over time, the stored iron causes scarring and organ damage that may lead to liver disease, diabetes and heart failure. Infertility, erectile dysfunction and low testosterone are also consequences of hemochromatosis. And, left untreated, it can be fatal.

You’ll never guess how it’s treated: Bloodletting (now known as therapeutic phlebotomy). Bloodletting, or draining of a patient’s blood to prevent or cure disease, was the most common medical procedure performed by surgeons from antiquity until the late 19th century, a span of over 2,000 years. And it still has application today. Does it cure hemochromatosis? No, but it prevents damage to organs by keeping iron from accumulating in them and results in an essentially normal lifespan.

So, this root cause analysis paid off handsomely. I asked this young man to consider donating blood regularly. I also took him off of the testosterone injections and started him on clomiphene citrate pills to push his “lazy” pituitary harder to make more of his own testosterone levels. In this way, we maintained his normal (high) quality of life that he enjoyed while on testosterone without using testosterone; he now also enjoys good sexual health and is fertile, and we added a few more years to his life.  We have done what Hippocrates, the Father of Medicine, ordered us to do: “Declare the past, diagnose the present, foretell the future.” And that, my friends, is the hat trick of great medicine!

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How Soon Should Couples Seek Fertility Treatment?

Snoopy is pretty smart
Charlie Brown had it down. And Snoopy did too. (Courtesy: Unsplash.com)

You’ve been trying to conceive but sparks just aren’t flying. You stopped using birth control pills (or pulled the IUD) and started having unprotected sex. With the help of an app, you figured out your most fertile time of the month and began timing sex to increase the odds. You switched to vegetable oils for lubricants and tried all sorts of positions, from missionary to doggie to cowgirl to kneeling lotus to quarter moon, full moon and even no moon, but still no luck. Maybe it’s time to get some help.

When To Seek Help?

Society guidelines define infertility as the inability to conceive after one year of trying. It’s that simple. How, when and where you have sex is all up to you, but if it doesn’t happen after 12 months, then infertility is present. The basis for this definition becomes apparent when you look at the trigonometry of trying: 30% get pregnant within the first month of trying, 60% get pregnant by 3 months, and 80% are pregnant by 6 months. After that another 5% of couples will conceive by 12 months and 15% will not have conceived.

So, the classic recommendation is to try for one year before seeking help. But, as a fertility specialist who sees infertile couples for a living, I would suggest that couples seek help whenever they get concerned about it. I say this because concern snowballs into stress and anxiety, and all of this can negatively impact the relationship, quality of life and fertility potential. Realizing that women’s fertility is known to decrease with age, I also recommend that couples seek help after 6 months if the female partner is older than 35 years. And, if either partner has a known medical history that might impact fertility, say like cancer treatment or surgery on their reproductive parts, then they should also consider seeking help even sooner than 6 months.

Who Goes First?

Society guidelines are clear on the issue of who gets evaluated once care is sought: Both partners. And at the same time.  However, what usually happens is that women make the first call to their gynecologists and the process begins. That evaluation should include a detailed medical and menstrual history, a physical examination and further blood and imaging studies as indicated. The male partner evaluation should also include a history, a proper physical examination, two semen analyses and blood and imaging studies as indicated. Importantly, since gynecologists do not typically take care of men, the male evaluation should be performed by a urologist with an interest or expertise in male infertility. In my practice, a thorough male infertility evaluation is completed in a single office visit, and one that I promise will not hurt.

Remember, although making babies is the most fun you might ever have without laughing (Woody Allen), behind the scenes there is a virtual symphony of precisely orchestrated biological events that must occur for its success.  The beauty and complexity of human conception is staggering if you really think about it. And getting professional help to tweak the process can mean all the difference in the world. Charlie Brown hit the nail on the head when he said: “Asking for help isn’t weak, it’s a great example of how to take care of yourself.”

Call us today at 1-888-887-3563 or visit our Los Angeles or San Francisco clinics to schedule an appointment.

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Does Producing More Semen Make You More Potent?

Sperm production treatment, Beverly Hills, CA
How to read spilled milk (Courtesy: Unsplash.com)

When it comes to health, love and possibly money, more may be better. But what’s the scoop when it comes to the amount of semen produced with ejaculation? Does more mean more potency or better fertility?

Funny thing is, this issue really runs deep with men. In several religions, semen is precious and can’t be spilled or wasted. Throughout human history, this liquid has some serious gravitas; in fact its importance is…wait for it…seminal.

A Poker Hand

As a male fertility specialist, I have reviewed literally hundreds of thousands of semen samples from tens of thousands of men. From this experience, I have concluded that a semen sample is like a hand of cards. Each measurement, such as semen volume, sperm concentration, motility and shape, is like a poker card with its own value or meaning. But together they also have a larger meaning or “look” that can have clinical significance. For example, if the semen volume and the sperm concentration are both low, then this could reflect something called retrograde ejaculation, in which semen preferentially goes backwards into the bladder instead of forward through the penis into the real world. In essence, the big picture matters most, and as with many things in life, the “look” and not the amount matters more for semen.

Larger Loads

Although one may think that unleashing a bigger load of semen makes you more of a man, outside of pornography, the facts do not bear this out. There is no real correlation of semen volume or force of ejaculation with testosterone levels, virility, erectile capability, sexual competence or fertility. Semen volume has less to do with manhood than simply the size of the seminal vesicles that produce it, as these paired internal organs behind the prostate are the main contributors to semen volume. And since, sperm enters the semen from separate channels leading out of the testicle, their numbers are relatively independent of semen volume. Therefore, high volume ejaculates may in fact have lower sperm concentrations due to dilution issues. However, fertility is typically unaffected either way, so no worries here.

Smaller Spurts

The story is quite different when semen volumes are low (< 2 mL). When this occurs, my interest perks up considerably as there are only a few good reasons for having a low ejaculate volume.

The most common among them is incomplete collection. Sometimes men simply miss the cup and hit the wall instead. This is especially common on the first attempt at procuring a semen sample as men must think about what they’re doing (and collect the sample) while ejaculating. I refer to this as “first sample syndrome” and it typically goes away with more experience and repeat samples.

If the seminal vesicles are missing or blocked, due to genetic or acquired disorders, ejaculate volumes are typically low, and fertility is impaired.

With low testosterone levels, semen volumes can also be reduced as sex gland secretions are Vitamin T-dependent in general.

Medications such as alpha blockers for prostatic enlargement or finasteride for hair loss can also impact semen volume by reducing production in the seminal vesicles.

Finally, medical conditions such as diabetes and multiple sclerosis and procedures involving the back and lower abdominal can redirect ejaculate toward the bladder instead of the outside world, causing reduced semen volume.

So, semen volume is more reflective of a man’s biology than his manhood. This means if you want to increase it, spend time thinking about how to stay healthy: eat well, sleep well, maintain a lean body weight, and eat a balanced diet. Exercise regularly and reduce your stress. These are the forces that matter most for sex and semen.

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Will the Office of Men’s Health Finally Arrive?

The hallowed halls of congress and the healing of men (Courtesy: Unsplash.com)

“You should go and see a doctor.” Who ignores this advice more often: men or women? To help you answer this, look at these U.S. medical facts:

  • Men lead in 9 of the top 10 causes of death.
  • 80% of suicide deaths are men.
  • There is a 5-year difference in life expectancy between men (76.2 yrs) and women (81.2 yrs).
  • The average black male in America barely lives long enough to collect social security.
  • Cancer death rates are 40% higher for men than women.
  • Women are twice as likely as men to seek preventative medical care.
  • The cost to government and society at large for early death and illness in men exceeds $300 billion annually.

It’s pretty obvious that the answer is “men.” The issue at heart is why such an egregious gender health care disparity exists in American medicine today. It starts with “typical” male behavior fed by testosterone and an immortality complex, leading to symptom avoidance and risk-taking behavior that is largely unregulated due to lack of mentors, communication, and poor access to care. Whatever the root causes, the consequence is that men are medically underserved.

A Captain Needed

The solution to this medical epidemic is clearly complex and involves many stakeholders, including family, friends, employers, peers, religious and sports organizations, and local, state, and federal governments working together. How best to pool and organize all these resources to improve men’s health? A federal Office of Men’s Health would be a great start! An Office of Women’s Health was established at the federal level in 1991. With the goal of improving awareness of, access to, and delivery of better health care to women, it succeeded in spades. Witness the fact that 90% of women with breast cancer are now cured of their disease.

The time has come for men to catch up! Bill H.R. 5986 entitled “Men’s Health Awareness and Improvement Act” was introduced into the 117th Congress this past month by Rep. Donald Payne (D-NJ). Hallelujah! It proposes to use the resources of the Department of Health and Human Services to promote, educate and coordinate men’s health activities at all levels in both the public and private sectors, just like the Office of Women’s Health has so successfully done over the past 30 years. It’s the ship captain that we so desperately need to bring men’s health into the 21st century.

A Sailing Ship

What excites me the most about this initiative is it’s potential to improve the health of males at all ages, from boys to men. Remember that after leaving the care of pediatricians as teenagers, men are essentially provider-less, whereas women have gynecologists who care for them throughout adulthood. This Congressional act has the potential to commit to and codify the medical care offered to American men throughout their lives by organizing all resources at hand around this great country, and thereby raising the tide of better medical care and floating all boats along with it. In so doing, we can teach men to invest in themselves, improve their lives and enhance the lives of those around them. In the words of Ernest Hemingway: “There is nothing noble in being superior to your fellow man; true nobility is being superior to your former self.” Please join me in supporting this long-overdue act of compassionate medical care and write your congressperson!

 

 

 

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Things That You Didn’t Know About Your Penis

Mona Lisa
Da Vinci knew a lot more about us than how to paint a great smile (Courtesy: Wikipedia)

Honestly the human penis, that ultimate love muscle, is an architectural and biological marvel. At rest, it serves as a conduit for urine. When rubbed like a genie’s lamp, it takes on a whole other, Jekyll and Hyde-like character. And did you know that pound-for-pound the human penis is the largest in proportion to body size among all mammals? But it’s also unique in other ways. Yep, this little appendage is a full of surprises.

A Boneless Organ

Here is another Snapple-cap fact: pretty much every mammal besides humans has a bone in their penis. The baculum or os penis bone evolved in mammals more than 95 million years ago. For some reason, humans lost that bone about 1.9 million years ago, sometime during our homo erectus phase. Theory has it that the bone was no longer needed as human reproduction drifted from polygamy to monogamy. Apparently, bony penises can stay in the female reproductive tract longer, keeping other penises away, and thereby increasing reproductive fitness.

Amazingly enough, even without a bone, one can still “fracture” a human penis. It’s not easy to do, but it happens when serious weight suddenly comes down on a semi-erect penis, bending it until it makes a snapping sound and then turning it all hues of black and blue. So be careful how and where you direct this little sword.

Sleepless Nights

Another little-known fact is that it takes more energy to keep a penis soft or flaccid than it does to keep it erect. Erections occur when blood flow opens like a spigot after being tightly clamped down. Notably, the blood pressure within the erect penis can be twice as high as your blood pressure; this is necessary to attain the required stiffness essential for a firm erection and proper use.

Along these lines, did you know that your penis “sighs” and relaxes about 3 times every night for 1 hour each while you are asleep? During these sighs, which occur during deep REM sleep, there is a full-blown erection. Since you’re in your deepest, dreamiest state, you might never know that it happened. Your partner might though.

Loading the Gun

The act of ejaculation is actually a reflex that, like a sneeze, has a point of no return. Fundamentally, it consists of two distinct events. The first, termed “emission,” occurs during foreplay and arousal. During this time, the body is busy pumping a glob of sperm from the scrotum up to the prostate through the vas deferens, effectively loading a bullet in the gun’s chamber. It may be felt as a pulsating sensation down there. Then comes the “ejaculation phase,” which is what we know as ejaculation. What happens here is a series of well-orchestrated events: the seminal vesicles contract, the bladder neck closes, and the urinary sphincter opens, all to allow the semen to traverse the penis and enter the free world. This clockwork-like activity is aided by contractions of the pelvic musculature every 0.9 secs to help force fluid from the penis. A magical moment in more ways than one.

Flipping the Switch

To get a good erection, the body must be relaxed. That’s why stress kills erections. Remember, our nervous systems are pretty primitive: Who wants an erection when being chased (stressed) by a woolly mammoth? But, once an erection is achieved and climax is imminent, the dormant “fight or flight” nervous system kicks in again and is responsible for ejaculation. Afterwards, the erection falls and cannot be regained for some time. This is termed the “refractory” period and it is during this post-coital moment when the nervous system switches back to “rest and restore” mode to allow for yet another erection. The marvelous interplay of both halves of our nervous system is present in every moment of the climacteric.

You know who knew a whole lot of these little penis secrets? Leonardo da Vinci, who said: “The penis does not obey the order of its master, who tries to erect or shrink it at will, whereas instead the penis erects freely while its master is asleep. The penis must be said to have its own mind, by any stretch of the imagination.”

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Abortion Access One Month After Texas Ban Goes Into Effect

Since news broke that SB 8—a law that bans all abortions after embryonic cardiac activitywould go into effect in Texas, the state of abortion access has been in chaos. Coverage of the law and challenges to it have been all over the map.

The ban also created a ripple effect: Other states, including Florida, have introduced similar bills, and abortion clinics in states bordering Texas are receiving more patients than they can handle, creating havoc for abortion providers.

In a virtual subscriber-only event, advocates and experts on the ground joined Rewire News Group‘s Executive Editor Jessica Mason Pieklo this week for an illuminating and urgent conversation on what the Texas ban actually means for providers and patients, not only in the state but across the country.

Hear from:

Watch the event below:

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