Doctors have already begun to grow patches for infarcted hearts. We learned how to perform operations on the fetus, briefly removing it from the mother’s womb and returning it back. But are surgeons really capable of creating the most important thing out of nothing - a penis? This question tormented Ilya Kolmanovsky so much that we instructed him to look into it.
GIVEN:
The basis of the penis is two powerful rods of cavernous tissue (see figure). They are most easily imagined as two airships with a strong, hermetically sealed shell. When blood fills the “airships,” they harden. Below, along the rods, there is a tube of spongy tissue, the urethra. During an erection, its tissue also turns to stone, and then the tube helps to maintain the gaping of the duct - so that it is not squeezed by the walls of the vagina and freely passes the genetic material in the right direction. The spongy tissue of the tube at the end extends into the head of the penis. The cavernous bodies are fixed deep in the pelvis. Only half of the penis sticks out, about the same amount serves as the base. This is important - surgeons have learned to use these bins. The penis is covered with a very special skin. If you move it along the axis of the organ (without getting too carried away!), you will notice that all the vessels move with it; Nerves behave the same way; the skin is completely autonomous from the penis itself. That is why surgeons easily remove the skin from the penis, perform magic on it and put it back on. The terrifying procedure is called tenderly and elegantly: degloving (glove - “glove”).
The skin of the penis is easily stretched, because its volume increases five times during an erection. When the erection subsides, the skin pulls back the entire contents of the penis, and this is also important. The skin is so stretchable that after cutting it can still be put back. Everything about the penis can be replaced, but if there is not even that much skin left of it, then we are talking about its complete reconstruction.
About an hour's drive from Moscow lives one of the most reputable plastic surgeons, who started back in Soviet years from 24-hour operations to reattach soldiers' fingers. Professor Alexey Borovikov. We sit down at a long oak table, I turn on the laptop, and Borovikov immediately outlines the entire narrative plan for me:
- To deal with modern capabilities phalloplasty, first let's agree what is given...
Having sketched out this plan, Borovikov took out a disk with photographs. I inserted the disk into the laptop, and the surgeon quickly showed me what it all looks like in practice...
COSMETICS
Most often, candidates for phalloplasty are men with normal erections and quite capable of sexual intercourse. Paradoxically, they are most interested in how the penis will look in a relaxed state.
“In essence, this is an analogue of breast enlargement, which is perceived by everyone as something normal,” says Borovikov, “penis enlargement, unlike breast enlargement, is usually not discussed, although it is performed often and has the same rationale. The vanity of people amazes me. I saw swimming trunks with a special insert, like in a bra, the seller explained:
“Just to highlight what a healthy unit you have.” The amount of what's in a swimsuit matters to people. After all, a woman is not going to dance on the piano with her bare chest; it is important for her to wear a tight-fitting sweater to emphasize what type of equipment she has.
“Tell me more about the operations,” I asked, because this information greatly excited me.
- There are two types of operations: increasing the diameter and increasing the length. Which one do you need?
DETAILS
Diameter increase Most ancient look phalloplasty. Basic practices of past civilizations - biting poisonous insects, uploading different substances into the skin foreskin, the implantation of balls there - they still have direct heirs today. Thus, in the army and in prison, injecting Vaseline under the skin of the penis is widely practiced. The diameter increases, but part of the point of this procedure is the suffering endured by the victim; something like an initiation rite (remember the Kenyan tribes, where circumcision is performed at the age of 13 precisely as a test of fortitude). There really is suffering: in addition to the painful injection, Vaseline causes oleogranuloma - a purulent swelling that must be tediously cleaned at the cost of several operations.
Modern medical practices increasing the diameter of the penis “in half an hour”: introducing gels under the skin, own fat or enveloping plates made of synthetic materials. But all these “additions”, as a rule, are expelled at best, often asymmetrically and with other unpleasant effects.
Borovikov tells me about two more advanced, but also difficult ways to increase the diameter:
- Firstly, wrapping a piece of your own fabric. A piece of skin is taken from the buttock subcutaneous fat. Then everything is simple: the penis undergoes a degloving operation (see box on the left), is wrapped in the resulting “blanket” and again wrapped in its own skin. Success depends on whether the vessels grow into the new flap.
The second method: transplantation of a muscle flap with a bundle of its own vessels. They are sutured to the vessels of the penis, and the flap takes root well.
It should be noted that as the diameter increases, the penis sags slightly under its own weight, but this effect is insignificant.
Increase in length Contrary to all advertising claims, medical science still faces a key limitation: the length of the corpus cavernosum shell. They cannot be cut, an extension cylinder inserted and sewn back up (there are isolated reports of such operations, but the effect has not been confirmed). So doctors are forced to cheat by pulling extra centimeters out of the pelvis.
The fact is that the root of the penis makes up up to 50% of its length. After releasing a few centimeters of quivering flesh, the skin is sutured. The shape of the seam is similar to the letter Y (the leg of the letter Y is the gained centimeters).
The effect is most noticeable when a proud patient finds himself next door to us near a urinal or in a bathhouse. However, if during an erection the penis is directed upward, it returns to its original position, towards the pelvis, so the gain is not so great.
A slightly weakened foundation cannot but have an effect in some situations, but after penetration this is no longer important. The quality of the friction will not suffer unless violent actions are involved.
“There was also a Dutch technique like the Elizarov apparatus,” says Professor Borovikov, “two rings were put on the penis, one rested on the pubis, the other supported the head, and the spacers between them were controlled by wheels. This stretching - half a centimeter per year - does not give anything, because during an erection, the “airships” inflate several times, while they do not even remember that while hanging, someone stretched them.
Erectile dysfunction Having finished talking about cosmetics, my interlocutor moves on to more serious problems. From his tone I understand that my spirit will now be subjected to terrible tests, but there is nowhere to retreat.
- If erection is impaired due to psychological or neurological reasons, today medications can cope with this. But sometimes it’s not about device connection problems, but about its failures. own work. In Soviet times, people sometimes saved themselves by injecting papaverine into each of the cavernous bodies. The vessels expanded, blood filled the cavernous bodies, and for several hours everything stood in its place, so to speak.
Doctors still use papaverine today; When Borovikov told me exactly how, I regretted asking.
- After all, during the operation we need an erect penis, a good frame for our maneuvers; so we inject papaverine and get to work. The operation is over, 3-4 hours have passed - and papaverine is still working; then adrenaline is needed - to spasm the blood vessels and empty the “airships”, the cavernous bodies.
But if papaverine did not help, ambitious reconstructive surgeons came to the rescue:
- We performed ultrafine microvascular operations. We repaired pianos instead of throwing them away and sitting down to the synthesizer. Now this is forgotten. Dentures are inserted there. There were prosthetics in the 70s - simple silicone rods. We cut the shells into corpora cavernosa they inserted thick metal sticks... moving them back and forth, completely destroying the corpora cavernosa, at the same time determining their length and inserting silicone rods according to size. I used to have them lying around everywhere... they were so blue... there was a factory in Rostov, they were worth nothing.
- But how can this be, since “there was no sex” in the Soviet Union? Why then dentures?
- There was no sex, but there was a penis - such an interesting distortion in the consciousness of the Bolsheviks. The Soviet Union signed the WHO preamble, which talks about the medical role of the psychosocial component of the individual.
- And I heard that reconstruction, or even more so breast augmentation, was in full swing in the USSR; told me famous surgeon Alexander Nerobeev that when he asked for money for the development of this area, he was told: we must sew on the workers’ fingers, and breasts are all debauchery. If a woman is faithful to her husband, she does not need breasts.
- Yes, it turned out to be such chauvinism. They probably thought that a man with such problems made him a bad worker.
Today's modern stage The evolution of prosthetics is amazing. The essence of these prostheses is inflatable cylinders with a valve system; a reservoir with saline solution is hidden in the scrotum; when an erection is needed, the person squeezes the scrotum, water flows through the valves into the prosthesis and inflates it. Another trick allows you to drain the water back when needed.
- What can we expect in the future - how will these miracle prostheses change?
- I think any solutions that can provide a quick change in volume and control over this change will be used. For example - Wi-Fi.
Erection via Wi-Fi! Not a bad slogan for advertising campaign some mobile phone. Probably, they will learn to grow a second penis from stem cells... however, we have not yet talked about reconstruction. What to do if your friend was studying too zealously oral sex and clenched her teeth in a fit of passion?
We reveal secrets about increasing “dignity”
RECONSTRUCTION
They brought us tea and I'm glad for the break. Professor Borovikov fishes a packet out of his glass, takes a sip and thoughtfully says:
- Let's say there is no penis at all - it is completely lost due to cancer surgery or injury; it may almost not exist due to congenital pathology, or we are talking about transsexuals.
I put down my tea and drum doomedly on the keyboard; but my interlocutor talks so captivatingly that I unnoticeably forget about fear:
- Let's take a transsexual. The essence of the operation is this. The patient's forearm is marked for future cutting. According to the markings, several large flaps of skin are taken from subcutaneous tissue; this huge wound on the arm is covered with a small piece of skin from the thigh.
The thigh flap stretches many times due to the fact that it is very thin and a lattice of numerous slits is made in it - all these tiny wounds heal easily; the wound on the thigh is much smaller than the wound on the arm; a cascade of “credits” results - from the thigh to the hand, from the hand to the penis. Surgeons sometimes call this system “Trishkin caftan.”
To create a penis, a cylinder and a head are sewn from two large flaps. A narrow tube made from a separate flap of skin is inserted inside this cylinder - the future urethra, urethra. The canal is lined with the patient's skin epithelium.
A serious problem for these patients: the epithelium of the real urethra in the real penis is unique - it is adapted to constant contact with urine. The skin taken from the hand is not suitable for this, and it begins to become inflamed and scarred. The channel has to be regularly stretched and cleaned with a metal rod. But the urethra is very important to these patients: although there is no talk of ejaculation, they value the opportunity to urinate in the men's room next to other people.
The resulting penis is strengthened on the pubis. The clitoris either remains in place (then it is stimulated simply by friction), or it has to travel forward along the new penis. This task is made easier by the fact that the clitoris has its own neurovascular stalk on which it can be carried.
The skin of the labia majora is very stretchable, like the scrotum - a lot of things can be placed there for a very convincing imitation. The vaginal opening is left open as it continues to secrete secretions that must be removed.
An erection of such a penis is achievable only if it has a prosthesis, although it is much more difficult than in the cases described in the section “Erectile dysfunction”. The fact is that the tissues of the hand are not adapted to stretching. The penis enlarges five times during erection - without any violence to its tissues, it is adapted to this. A penis created artificially cannot swell; it can be carefully inflated for several months, but then it will not deflate...
Surgeons often take a route that reminds us of whales and walruses with their penis bones: can be inserted into the penis metatarsal bone or a piece of rib. If Adam knew how today's Eves would dispose of his inheritance.
Penises, airships and blue sticks from the Rostov plant are swarming in my head. What about people? What do they really want, what feelings do they experience?
Borovikov says that he often thinks about the psychology of patients:
“They are all very strong in spirit, they undertake the most difficult operations, and agree to put up with all the costs. Man is squeezing everything out of this absurd creation with which I am trying to replace God’s plan. These people get something hanging from the underside of their pubic area and are absolutely delighted. This is where such a variety of methods comes from.
One of my colleagues transplants a piece of the latissimus dorsi muscle with a nerve into the perineum and fuses this nerve with the pudendal nerve. When the patient brings the thigh - the same nerve that carries this order to the thigh turns the “penis” from a drooping tube into a ball - how is penetration possible there? But people are happy. They are not satisfied at all with what we imagine as a penis; they find a use for it.
- Do patients understand what complications arise from all these interventions?
- Any foreign body“rapes the tissue from the inside,” explains the professor. - When the fabric is violated from the outside, it is a bedsore. The same bedsores arise from the inside. People go to all these troubles. An impotent person is usually a middle-aged, mature person, having regained the ability to have full sex for some time, and sees what he pays for it. Once there was a fistula or something else - it was healed, he waited - until we healed, put it on, then the second time - over the years he begins to weigh everything pro et contra - and decides whether the game is worth the candle?
Borovikov is constantly faced with the most literal definition of courage:
- People are ready to achieve psychosexual well-being in completely unimaginable ways. They find options for the existence of these new organs that are unknown to us. These are the flagships of humanity, they show us how something can be made from nothing.
Many of us various reasons may be dissatisfied with what they have. Inexorable years, man-made disasters and excesses do not spare anyone. Perhaps, technological progress and the “flagships of humanity” can divide our friendly community into three camps - according to ways of achieving disturbed harmony:
1. Innovators will grow organs in test tubes - from stem cells.
2. Gadget addicts will send text messages from the control panels of their new “friends” - $0.5 to achieve an erection and $10 (robbery!) to withdraw.
3. Conservatives will follow the beaten path: they will raise grandchildren and collect colonial stamps of Victorian England. Perhaps this is the path of wisdom.
Material from Wikipedia - the free encyclopedia
Caves (cavernous from Latin caverna "cavity, cave") body- This structural unit erectile tissue of the shaft of the male penis (penis). This tissue also includes its corpus spongiosum. Two longitudinal cavernous bodies together with one spongy body form the shaft of the penis.
The corpus cavernosum provides blood supply to the penis - its erectile function. An erection is necessary for a man to have sexual intercourse. During erection, the corpus cavernosum can be felt on the top and sides of the shaft of the penis in the form of hard ridges.
Inside the corpus spongiosum is the male urethra, which has an external opening at the top of the continuation of the corpus spongiosum - the glans penis.
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Excerpt characterizing the Corpus cavernosum
All of them, even the middle-aged Dimmler, did not want to interrupt the conversation and leave the corner of the sofa, but Natasha stood up, and Nikolai sat down at the clavichord. As always, standing in the middle of the hall and choosing the most advantageous place for resonance, Natasha began to sing her mother’s favorite piece.She said that she did not want to sing, but she had not sung for a long time before, and for a long time since, the way she sang that evening. Count Ilya Andreich, from the office where he was talking with Mitinka, heard her singing, and like a student, in a hurry to go play, finishing the lesson, he got confused in his words, giving orders to the manager and finally fell silent, and Mitinka, also listening, silently with a smile, stood in front of count. Nikolai did not take his eyes off his sister, and took a breath with her. Sonya, listening, thought about what a huge difference there was between her and her friend and how impossible it was for her to be even remotely as charming as her cousin. The old countess sat with a happily sad smile and tears in her eyes, occasionally shaking her head. She thought about Natasha, and about her youth, and about how there was something unnatural and terrible in this upcoming marriage of Natasha with Prince Andrei.
Dimmler sat down next to the countess and closed his eyes, listening.
“No, Countess,” he said finally, “this is a European talent, she has nothing to learn, this softness, tenderness, strength...”
- Ah! “how I’m afraid for her, how afraid I am,” said the countess, not remembering who she was talking to. Her maternal instinct told her that there was too much of something in Natasha, and that this would not make her happy. Natasha had not yet finished singing when an enthusiastic fourteen-year-old Petya ran into the room with the news that the mummers had arrived.
Natasha suddenly stopped.
- Fool! - she screamed at her brother, ran up to the chair, fell on it and sobbed so much that she could not stop for a long time.
“Nothing, Mama, really nothing, just like this: Petya scared me,” she said, trying to smile, but the tears kept flowing and sobs were choking her throat.
Dressed up servants, bears, Turks, innkeepers, ladies, scary and funny, bringing with them coldness and fun, at first timidly huddled in the hallway; then, hiding one behind the other, they were forced into the hall; and at first shyly, and then more and more cheerfully and amicably, songs, dances, choral and Christmas games began. The Countess, recognizing the faces and laughing at those dressed up, went into the living room. Count Ilya Andreich sat in the hall with a radiant smile, approving of the players. The youth disappeared somewhere.
Half an hour later, an old lady in hoops appeared in the hall between the other mummers - it was Nikolai. Petya was Turkish. Payas was Dimmler, hussar was Natasha and Circassian was Sonya, with a painted cork mustache and eyebrows.
Cavernous (cavernous) body- This is the structural part of the penis. The corpora cavernosa (right and left) are cylindrical in shape and located inside the penis. To the ventral surface of the cavernous bodies, parallel to them, is the spongy (spongiosum) body of the penis.
Anatomically, the corpus cavernosum is divided into:
(1) apex (apex) - distal part;
(2) middle part;
(3) pedicle - proximal part.
In the apical part, the cavernous bodies are covered by the glans penis, which is part of the corpus spongiosum. At the symphysis pubis in the proximal part, the cavernous bodies diverge downward and posteriorly parallel to the descending (ischial) branches of the pubic bones, to which they are attached by ligaments. In the area of the symphysis pubis, the corpus cavernosum is attached to the bones using the unpaired infundibular ligament. The corpora cavernosa can be felt as ridges on the right and left inside the penis.
Main function of the corpora cavernosa- ensuring erection of the penis (increase in size and hardening of the penis during sexual arousal).
The corpus cavernosum consists of cavernous tissue surrounded by a tunica albuginea. Cavernous tissue has a cellular structure. Each cavity (cell) has the ability to change its internal volume by changing the tone of the smooth muscle elements (trabecular muscles) included in the structure of the cavern walls. Blood enters the caverns through arterioles radiating from the cavernous artery, located centrally inside the corpus cavernosum. During sexual arousal, in response to the release of a mediator (NO - nitric oxide), due to the relaxation of the trabecular muscles and the muscles of the walls of the cavernous arteries, the lumen of the cavernous arteries and the volume of the caverns increase. Increased blood flow to the cavernous tissue and filling of the caverns with a larger volume of blood leads to an increase in the total volume of cavernous tissue (tumescence or swelling of the penis). Normally, the outflow of blood from the cavernous tissue occurs through the venous plexuses located directly under the tunica albuginea. When the venous plexuses are pressed to the tunica albuginea due to an increase in the volume of cavernous tissue during tumescence (the basis of the veno-occlusive mechanism), the outflow of blood from the cavernous bodies decreases, leading to the appearance of a hard erection. At the end of sexual activity (usually after ejaculation), the release of norepinephrine, a sympathetic transmitter that increases the tone of the trabecular muscles, leads to the disappearance of an erection (detumescence) in the reverse order to the appearance of an erection. Insufficient blood flow to the corpora cavernosa, excessive outflow venous blood from the cavernous bodies, damage to the nerves that conduct signals for the appearance of an erection, as well as damage to the cavernous tissue leads to a deterioration in the quality of erection up to its complete absence ().
The tunica albuginea of the corpus cavernosum is the case of the cavernous bodies and consists of elastic connective tissue. During an erection, the tunica albuginea, evenly stretching in different directions, ensures a symmetrical enlargement of the penis. Congenital disorders of the elasticity of the tunica albuginea, scar changes after injuries to the penis and the formation of fibrous plaques on the tunica albuginea can lead to curvature of the penis during erection.
The penis is formed by two cavernous and one spongy bodies. The two cavernous bodies of the penis are cylindrical in shape with slightly pointed ends and are attached to the lower branches of the pubic bones. Both bodies converge under the pubic symphysis and then grow together, forming a groove on the lower surface where the spongy body of the penis lies, ending in front with the head; the posterior end of the spongy body forms a bulb located in the thickness of the muscles of the perineum (Fig. 193). The cavernous and spongy bodies are covered with a dense connective tissue tunica albuginea devoid of muscle fibers, which is absent only on the head of the penis. From inner surface The membranes have processes (trabeculae) that are formed by dense fibrous connective tissue containing many smooth muscle cells and elastic fibers. Trabeculae branch into the tissues of the spongy and cavernous bodies and intertwine with each other. Between them a system of cells (lacunae, caverns) is formed, which are wide blood capillaries. Blood is delivered to the cavernous bodies mainly by the deep artery of the penis, which splits into branches running along the trabeculae. When the penis is in a calm state, they are convoluted, which gives rise to the name helical or cochlear. Arteries open directly into cells (cavities). The lumen of these arteries is wide, and their walls have a thick muscular lining; in addition, the inner lining of the arteries is thickened due to additional bundles of smooth muscle fibers, which close the lumen when the vascular wall contracts. The walls of the veins also have a well-developed muscle layer. The main role in erection is played by smooth muscle cells arteries, arterioles and sinusoidal capillaries. During an erection, the size of the penis increases sharply, it straightens, becomes dense, ready for
Cavernous or cavernous bodies(eng. corpora cavernosa) are structural parts of the erectile tissue of the penis, covered with a dense protein (fibrous) capsule. The key function of the corpora cavernosa is blood filling; they contain the prevailing part of the blood volume in the male penis during erection.
Anatomy
The two corpora cavernosa, along with the corpus spongiosum, through which the urethra passes, form the male penis. Corpora cavernosa are located along the entire length of the organ, from the pubic bone to the head. They consist of porous tissue, including blood-filled spaces of varying sizes (larger in the center than at the periphery), lined by an endothelial layer and delimited by connective tissue septa, the so-called trabeculae. Trabeculae contain numerous nerves and arteries. All three bodies are surrounded by muscles that hold male organ during erection and contracting during ejaculation.
Physiological features
At sexual arousal the release of NO causes the three bodies of the penis to relax. The tissues fill with blood from the arteries along the entire length of the male genital organ. A small volume of blood enters the corpus spongiosum, and the remainder (about 90 percent) fills the corpora cavernosa, which expand in both width and length. Unlike the corpora cavernosa, the corpora spongiosum remains soft even during coitus, otherwise it would compress the urethra and become an obstacle to ejaculation. Blood is able to leave the erectile tissue only through the drainage system of venous vessels around the outer wall of the corpus cavernosum. The swollen spongy tissue presses against the surrounding white capsule, causing the veins to contract, preventing the outflow of blood. The penis becomes hard, but its head remains softer, since its membrane is thinner than in the cavernous bodies. This minimizes the possibility of injury to a woman’s genitals during coitus.
Diseases and injuries
Pathologies of the corpora cavernosa include:
- cavernous fibrosis (tissue sclerosis);
- Peyronie's disease (also known as fibroplastic induration of the penis);
- incomplete absence of corpora cavernosa (extremely rare).
- Rough sexual intercourse can lead to rupture of the corpora cavernosa under the skin, the so-called. "penis fracture".
Corpora cavernosa in the clitoris
The body of the female clitoris houses erectile tissue in the form of a pair of corpora cavernosa. However, the clitoris does not have a spongy body, unlike the penis, and the urethra is located separately - behind the female genital organ. The corpora cavernosa provide the clitoris with the ability to achieve an erection, but it is relatively small in size and is not intended for sexual penetration. During sexual arousal, blood fills the corpora cavernosa. This causes extrusion of the clitoral glans and increases sensitivity to physical contact.
| Anatomy of the human reproductive system | ||
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| Male reproductive system | Corpora cavernosa | |