Roe: On Small Penises, and on PrEP in Ireland

Dear Roe,

This week, I had a one-night stand with a good friend of mine – but that’s not the problem. It’s done, we had fun, it hasn’t affected our relationship (so far) or how we feel for each other (platonic and full of mutual respect).

The problem is this. On my trip downtown I noticed that he had a very small penis – not a micropenis, where the girth would be normal for a male but small all over like a young adolescent’s. And I couldn’t immediately locate his testicles. And he had very little body hair. I asked him if they were normally like that and he said yes, that they were just small but no, he hadn’t gone for a check up about it.

Undescended testicles are no joke – they can lead to infertility and testicular cancer, and my friend is getting to an age where he could be too old for treatment (if indeed that is the only problem). It’s also possible that, due to some related health problems, he’s had delayed puberty. Which can have alllll kinds of ramifications.

I should say something to him about it, I know, but I don’t know how to frame it without going, “So I was thinking about your miniscule penis and balls and …” And aside from that, I am not a medical professional and don’t want to scare the shit out of him unnecessarily. I have seen a lot of dicks in my time and this isn’t normal.

He’s understandably a bit sensitive about his man bits. I would love for some pointers to talk to him about this in a considerate, respectful way.

Dear Letter Writer,

Good on you for looking out for your mate, and believe it or not I’ve actually been in a vaguely similar predicament.

After not seeing a casual hook-up for quite a while, I noticed his usually straight-as-a-rod penis had developed a major curve, which I knew could be a sign of Peyronie’s disease. (I’m very useful at a very niche type of table quiz.)

I, like you, felt worried about my friend and obligated to say something. When I brought it up and asked had he noticed anything, I was worried that my mate would be embarrassed or angry, but he was completely fine and assured me that he had had it checked out.

“It’s my dick, Roe,” was his suitably matter-of-fact answer. “Of course I fucking noticed.”

So, first of all, rest assured that your friend has probably noticed his own genitals and at least googled it once or twice, if not had it checked out by a doctor.

Remember that while you two are friends, your night together was only a one-night stand, and so if he does know that he has some form of medical condition, he just might not have felt comfortable chatting about it in the moment.

Saying “no, I haven’t been for a check up, I’m fine, please carry on doing whatever delightful activity you’re doing down there” may have just been an easier answer to give at the time.

It’s also important to remember that while sometimes small genitalia is indicative of a medical issue, it can be indicative of a benign condition, or a condition that has been dealt with, or that is under control – or nothing at all.

So the size of his genitalia is not at all a definite indicator of something being “wrong”. Bodies come in all shapes and sizes and as long as he’s healthy, that’s the only thing that matters.

If it is a medical condition, it could be one of a few. Like you, I’m not a medical doctor so my column isn’t a substitute for visiting a GP. (Or love, just in case you were wondering.) But a few things can cause underdeveloped genitalia, including some hormonal issues or chromosome disorders.

The most common of these is Klinefelter syndrome, or XXY syndrome. It’s actually quite a common condition, affecting about 1 in every 450 male babies.

As the name indicates, this syndrome causes some men to develop an additional X chromosome, which can hinder testosterone production. This can delay or halt puberty, and cause the penis and testicles to remain underdeveloped.

Most men with Klinefelters are not diagnosed until adulthood, and should definitely visit a doctor if they suspect they may have it, as it is associated with higher risks of infertility, diabetes, and certain types of cancer.

While there is no cure for Klinefelter, it can be treated with hormone therapy that can compensate for missing or deficient testosterone and can have a huge array of benefits, from physical development to increased energy and improved motor function and coordination.

This is merely one example of what could be affecting your friend. Another possibility is that he was born intersex, and had surgery on his genitalia, which can have an impact on the size of the penis and testicles. His parents at least would be aware of this and keeping an eye on his health.

If you do feel the need to say something, just on the chance that he’s ignoring his health, just make sure you don’t shame his body in any way. I’d actually keep it relatively casual.

Remember, it’s not your job to force him into a doctor’s office. He’s an adult and can follow up himself. What you’re doing is just asking whether he has been checked out, and planting a seed that it could be a good idea, just to be on the safe side.

The good news is that because you mentioned it at the time, your concerns won’t completely blindside him – you’ve already nudged that conversation’s door ajar. As for opening that door up a bit more, I’d bring it up in the context of general health and looking after yourself.

Talk about any health problems of your own, mention a podcast about men’s health, or share (or invent) a tale about a friend who didn’t get a mild symptom checked out for ages, which then turned out to be something more serious. Ask him to take care of himself, then get ready to change the subject in case he’s uncomfortable.

For wording, I’d just throw out a casual-but-concerned, “I’m just on a bit of a health-paranoia buzz right now, so do me a favour would you? Remember that night when we hooked up and you said you hadn’t been checked out by a doctor? Do it for me, would you?

“I’ve been reading too much about men’s health and cancer scares and stuff and I don’t want to be worrying about you – or to have you get sick. So go to a doctor so I stop feeling like a concerned mother, because since we’ve had sex that just opens up a whole can of Freudian nonsense. Anyway, that American election shit was terrifying, wasn’t it??”

Good luck.

***

Dear Roe,

Irish man also living in San Francisco here. I’m 29 and gay and a lot of my American friends over here are on PrEP. They keep telling me I should try get on it through my work insurance. I don’t know a lot about it and am not even sure if it’s available in Ireland. I haven’t lived at home in a good few years now, so maybe it is, but I definitely haven’t seen much about it in the media. I thought you might be able to give me some insight into how it works and if you can get it back home? Thanks a million, maybe I’ll bump into you around the city sometime!

Dear Letter Writer,

You’re right that PrEP is not widely discussed in Ireland – nor, I’m sad to say, is it widely available there, though it is available in the US. PrEP, for those not in the know, stands for pre-exposure prophylaxis, and is a drug used not only to treat HIV, but to prevent transmission of the virus.

When taken daily, and before and after exposure to HIV, it is extremely effective in preventing the infection. Trials in the UK as well as Thailand, France and America have confirmed that PrEP can reduce HIV infection by up to 86 percent, among “at-risk” categories. Studies define at-risk categories as men who have sex with men, sex workers, intravenous-drug users, and people whose partners have HIV and are not on successful treatment.

In Ireland, the number of HIV cases has been steadily increasing. The 2014 report from the HSE shows that there were 377 case in 2014, compared to 341 in 2013; a rise of 11 percent.

Infections among men who have sex with men had “increased threefold”, while the rise among 25- to 29-year-olds was “fivefold”. Among intravenous drug users, women were most at risk, and their chance of contracting HIV rose almost fivefold between 2012 and 2014.

With these numbers and the positive outcomes from PrEP trials and use in the States, it seems obvious that making PrEP available in Ireland would be a wise and safe things to do. The World Health Organisation agrees with me, recommending that PrEP should be offered to all population groups at substantial risk of HIV infection.

According to WHO, “PrEP should be an additional prevention choice in a comprehensive package of services that also includes HIV testing, counselling, male and female condoms, lubricants, ARV treatment for partners with HIV infection, voluntary medical male circumcision and harm-reduction interventions for people who use drugs.”

Of course, as is sadly always the case with issues that address HIV, sex or the sexual activities of gay people in particular, the Morality Police (a notoriously ill-informed and unstylish bunch) decide to get up in arms about nothing and nonsense, claiming that PrEP promotes risky behaviour like unprotected sex.

Do these claims sound familiar? Of course they do, because the Morality Police really are a one-note bunch. They make the same “This promotes sex!” argument about every development in pregnancy- and STI-prevention.

PrEP promotes unprotected sex, abortion promotes unprotected sex, sex education promotes sex, condoms promote sex, rock and roll promotes sex, flashing your ankles promotes sex, looking at each other promotes sex, that apple in that made-up magical God garden of theirs promotes sex, etc etc ad infinitum.

What they’re ignoring of course, are those pesky little things called facts. First of all, taking PrEP is one form of protected sex. Are you protected form everything? Nope; if you don’t use condoms, you’re still at risk for STIs, and pregnancy. But you’re protected more from HIV than you are without it.

The Morality Police are also ignoring the fact that people who use PrEP were less likely to engage in unprotected sex. Several large studies have shown that people who engaged in risky sex practices adopted safer strategies both when on PrEP and when on a placebo, indicating that both the awareness of and use of PrEP actually promotes safe sex.

Finally, they’re also ignoring the general overall issue: you don’t get to withhold health services from people just because you disagree with their orientation, lifestyle or sex practices. Even if some people do use PrEP and don’t use other forms of protection, that’s none of your fucking business.

While you’re working in the States, if you feel like your sex practices merit a bit of extra protection, I would absolutely recommend going on PrEP.

Studies show that side effects are rare, affecting under 2 percent of users, and are mild, including abdominal pain, headaches, and slight weight loss. Coordinate with your doctor and insurance provider to ensure the cost is covered, because America’s medical system is still a capitalist hellhole where many medications are prohibitively expensive.

Meanwhile, activists and the media should be highlighting Ireland’s lack of discussion about PrEP, and campaigning for its use – and now. As we’ve seen with other battles against the Morality Police, these fights can take far too long, so the sooner we get to work, the better.

Do you have a question for Roe? Submit it anonymously at dublininquirer.com/ask-roe