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September 04, 2016

In New York Times, CHOP urologist fields prickly subject for parents

Fears multiply over boys growing in waist size, but not elsewhere

Pediatrics CHOP
090416_ChildhoodobesityCHOP Source/AP

An overweight boy in for a checkup.

A prominent urologist at the Children's Hospital of Philadelphia has some calming advice for parents who are concerned about the slight endowment of their growing boys.

In a piece that appeared recently in The New York Times, pediatric urologist Dr. Aseem Shukla addresses the concerns of parents who believe their overweight sons have abnormally tiny genitals.

“I see dissatisfaction with the phallus very regularly,” said Shukla, who is also a professor of urology at the University of Pennsylvania's Perelman School of Medicine.

Shukla says the complaint is often made about 10- and 11-year-old boys who carry extra weight, typically by mothers who are speaking on behalf of mortified fathers.

Written by Dr. Perri Klass, the Times' family health writer of "The Checkup," the article fearlessly delves into the social pressures surrounding puberty and anatomical masculinity.

What is called a “hidden penis” can be a combination of being prepubertal (so the penis has not begun to grow), being overweight (so the fat pad is significant), and in some cases an anatomical condition in which the soft tissue below the skin of the penis doesn’t adhere well to the Buck’s fascia, the thick covering that surrounds the penile nerves and arteries. This fixation problem can yield what Dr. Shukla described as a “slidey” penis, in which the actual shaft retreats and only the skin, or the foreskin, in an uncircumcised boy, is clearly apparent.

While there are surgical procedures to correct this worrisome issue, Dr. Shukla says that in the majority of cases the most prudent course is to encourage weight loss and wait until the child grows older. The condition of a micropenis, which must fall 2.5 standard deviations or more below average, is rarely the issue.

“We don’t all walk around with our pants down, and we don’t see how everybody is," Dr. Shukla said he often explains to his patients. "But you should realize the private area can be different, and because yours looks different from your brother’s doesn’t mean there is something wrong.”

In a culture that multiplies anxiety about such issues — breast size is, in many ways, a similar and much more visible feminine feature — Shukla believes it's essential to reassure his patients that they their lives are about much more than the size of their private parts.

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