The Penis and

Testes
2
The Penis
 Penises come in many shapes and sizes with
differences in both length and width.
 The penis does not have a bone in it.
 The penis is not a muscle.
 The flaccid (soft) penis comes in many sizes, all sizes are
common. Usually if a penis is small when it is flaccid it grows
substantially when it becomes erect (hard), and when a penis is
large when it is flaccid it does not grow much more when it
becomes erect.
 Penis size is not related to height, weight, foot size, hand size,
ethnicity etc.
 Most erect penises are between 5 and 6 inches long, however
many are smaller and many are bigger.
 The function of the penis is more important than the size.
 Penis functions: urination, erection, penetration, ejaculation,
reproduction and sensation.
 For many people penis size is not a factor in their sexual desire,
arousal, satisfaction or pleasure.
 Being cold, nervous, tense or frightened can make a flaccid
penis smaller.
 Being relaxed or warm can make a flaccid penis larger.
 Some penises curve up, down, left or right when they are erect.
As long as this does not cause pain or discomfort it is normal.

Erections and Ejaculation

 Urine, pre-ejaculate (pre-cum) and ejaculate come out of the

urethra opening (the pee hole).
 Pre-ejaculate is a clear fluid that comes out of the penis when it
first becomes erect. This fluid is slippery and can contain sperm
and STIs. Its purpose is to lubricate the urethra, neutralize traces
of acidic urine and flush residue.
 You cannot urinate and ejaculate at the same time.

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 It can be difficult to urinate with an erection (this
often happens in the morning with what some
people call morning wood).
 You cannot ejaculate without an erection.
 Sometimes erections are really strong and hard
and sometimes they are partial and softer.
 It is common and healthy to get multiple erections when you
are sleeping – often 3 or 4 a night during REM sleep.
 It is possible to ejaculate when you are sleeping. You may have
heard this called a “wet dream”. This is more common during
puberty but can happen to adults as well, especially if you are
not ejaculating regularly.
 The penis is made up of three cylinders – two corpora
cavernosa and one corpus spongiosum. These cylinders fill with
blood to cause an erection.
 After ejaculating the penis will need time to rest before it can
become erect and/or ejaculate again. This is called the
refractory period. How long the refractory period is will depend
on things such as your age and health. It could be only minutes
long, it could be an entire day.
 Most people ejaculate and orgasm at the same time, however it
is possible to orgasm without ejaculating.
 Usually adults get erections because they become aroused or
“turned on”, however an erection is a reflex that can happen
without participation of the brain.
 Arousal and erection may happen due to your thoughts, your
fantasies or what you see. For some people erections might not
happen without physical contact of the penis or other body
parts even if the brain is “turned on” or it could happen by
physical contact alone without brain participation.

4
Ejaculation has 2 Stages:

Emission Stage: contractions of prostate gland, seminal vesicles and

vas deferens causes fluids to build in the urethral bulb causing a
feeling of “ejaculatory inevitability” (I’m going to cum). The internal
sphincter of the bladder contracts preventing semen from entering
and urine from getting out.

Expulsion stage: muscles at the base of the penis contract

rhythmically, forcefully expelling semen. This is generally pleasurable
and accompanied by orgasm. The force of the expulsion depends on
things such as age and health. It is possible for ejaculate to travel as
fast as 50 km per hour!

Retrograde Ejaculation

Retrograde ejaculation is when semen is expelled into the bladder

during ejaculation instead of out the urethra opening. The sensation
of orgasm is still felt. It is not dangerous to your health. The semen
comes out upon urination. It can however cause fertility difficulties.

5
Pleasurable Sex

 Just because you have a penis does not mean that you want to
have sex anytime, anyplace with anyone. The media often
depicts people with a penis in this manner and it can place a
great amount of pressure on a person.
 Having a penis also does not mean you know how to pleasure a
partner or automatically know what your partner wants and
likes in bed.
 Pornography sometimes puts pressure on people to look and
act in certain ways. It is often unrealistic.
 Communication is an important factor in any sexual relationship
and can lead to pleasure and satisfaction by all involved.
 Consent is a must for a sexual relationship.

6
  The anus has many nerve endings and some people, regardless
of their sexual orientation, find anal touching and/or anal sex
pleasurable.
 Some people find stimulation of the prostate gland to be
pleasurable. To stimulate the prostate a finger or two must be
inserted into the anus.
 For anal play use lots of lube and start small, possibly a finger.
 Never touch a mouth, vagina or vulva with something that has
touched the anus before thoroughly cleaning it first.
 A large penis is not necessary for pleasurable sex. A
pleasurable sex life is dependent on such things as:
 your ability to communicate with your partner(s) and
make them feel good both mentally and physically
 how comfortable you are with your partner(s)
 how secure you are with your body
 sexual activities other than penetrative sex such as hand
sex, oral sex, touching and kissing
 Everyone is unique in what and who turns them on.
 Some people are attracted to people of the same sex, some
people are attracted to people of the opposite sex and some
people are attracted to people for who they are or what they
look like regardless of their sex.
 Sexual orientation can be fluid throughout life and is defined by
the person. Assumptions should not be made about another
person’s orientation.

Arriving too Quickly, Lasting Longer

Many people with a penis have, or will at some point, ejaculate before
they want to. This is common. It can be caused by being over
stimulated, excited, anxious, or nervous. Many people also have
unrealistic expectations about how long they are supposed to last
before ejaculating. Most people will ejaculate within 4-8 minutes, this
may be shorter if you are younger and longer if you are older. Talk to

7
your partner if you are unhappy with your lasting time. They may be
satisfied with it. Often people put too much pressure on themselves.
Some ideas to help you last longer:
 Try wearing a thicker latex condom to reduce sensation, instead
of a regular or thin condom.
 Think about something else for a short time that does not turn
you on.
 Talk to your partner about it. Together you can find ways to
pace yourself while having sex or use techniques such as the
stop-start technique where you stop right before orgasm for
30-60 seconds, then restart.
 Try again. Give yourself some time and then go for round two.
You can always concentrate on pleasuring
your partner(s) while you wait.
 Masturbate before you have sex.
 Try a different sexual position.

Getting and/or Maintaining an Erection

Most people with a penis have worried about getting and/or

maintaining an erection and most people with a penis experience
problems getting and/or maintaining an erection at some point in
their life. Chances are it is temporary. It is usually caused by stress,
fear, fatigue, and/or anxiety. Some people also worry so much about
getting and maintaining an erection that they cannot get one. It can
also be caused by medications you are taking, your weight and/or
health concerns you may have such as an illness or disability.
Smoking cigarettes, drinking alcohol, or doing recreational drugs
could also be the cause. Communicating with your partner and
enjoying other aspects of sex, not involving penile penetration, can
help. It is also helpful not to masturbate before sexual activity.

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What is Priapism?

Priapism is an erection that lasts for more than 4 hours that is not
brought on by sexual arousal. This occurs when mechanisms that
drain the blood from the penis are damaged and blood cannot leave
the penis, depriving penile tissues of oxygen leading to tissue
deterioration which can lead to permanent damage. Medical
intervention is required to drain the blood.

If you have an erection for more than 4 hours go to the Emergency

Room. You may feel weak and dizzy or you may faint. The blood that
is in your penis is needed elsewhere in your body in order for you to
function properly. Some causes of Priapism are: diseases that affect
circulation, diabetes, leukemia, drugs such as Viagra and Cialis, penile
injections, intravenous drug use using the veins in the penis and
injury to the perineum. Drugs such as Viagra and Cialis, that help to
get and maintain an erection, should be prescribed to you by your
health care provider and taken as prescribed.

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What is Hypospadias?

Hypospadias is an uncommonly
placed urethra opening on the
penis. It can be anywhere along
the underside of the penis, on the
scrotum or on the perineum. It
may be difficult to urinate standing
up, but it is possible to sit down to
urinate. It can also cause fertility
difficulties.

Testes

Testicle – singular Testes – plural

 Each testicle is contained within the scrotal sac (the scrotum).

 The scrotum is a stretchy piece of skin and can be wrinkly or
smooth.
 The scrotum is often thinly covered in pubic hair. The area
above the penis is often covered in pubic hair. Pubic hair can
also grow on the base of the penis and on the shaft.
 One testicle may hang lower than the other.
 One testicle may be larger than the other.
 The testes produce testosterone after puberty.
 The testes produce sperm after puberty.
 Testes do not shrink and grow, they are actually moving in and
out of the body ensuring they remain at a certain temperature.
This happens without you thinking about it.
 Sperm production is optimal at 3 degrees cooler than body
temperature.
 When testes are cold they move into the body to keep warm.

10
  When testes are warm or hot they hang as low as the scrotal sac
will allow to release extra heat.
 The spermatic cord suspends each testicle in the scrotum and
contains the vas deferens, blood vessels, nerves and cremaster
muscle.
 The cremaster muscle (a small tube like muscle) moves each
testicle up and down.

Sperm

 Sperm cells are produced during a process called

spermatogenesis in the testes.
 Sperm are formed in the seminiferous tubules in the
testes at an average of 1,500 per second (750 each testicle)
 Sperm continue to mature in the epididymis and are stored
here until they are ejaculated.
 Sperm can live for weeks or months in their host body. If they
are not released during an ejaculation within a certain period of
time, they are reabsorbed into the body.
 It takes approximately 72 days for sperm to form and mature.
 The average ejaculation contains about one teaspoon of semen,
which contains approximately 200 – 500 million sperm.
 Sperm are the smallest cell in the body.

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  Each sperm contain 23 chromosomes, including the sex
chromosome which is either an X or Y and determines the sex
of the fetus.
 Because sperm are so tiny, they account for only 1% of the
volume of semen. The rest is fluid from the Cowper’s gland,
seminal vesicles and prostate gland.

Semen is made up of:

 1% sperm
 1% Cowper’s fluid
 29% prostate fluid
 69% seminal vesicle fluid

 The average time a sperm survives in the uterus and fallopian

tubes is 3 – 5 days, although they could live for up to 7 days.
They do not live anywhere else this long.
 Sperm die quickly within the acidic environment of the vagina.
 Sperm die when they are dry outside of the body.
 People do not run out of sperm. Masturbation and sex do not
use it up. Testicles keeps producing sperm as long as at least
one testicle is functioning.
 Some people think that the semen of a vegetarian tastes better
than the semen of a person who eats meat.
 Not all sperm are created equal. Sperm that are not normal (see
below) do not have good mobility and cannot fertilize an egg.

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 Path of the Sperm

*Sperm are significantly smaller than they appear in diagram.

13
 How to Keep your Penis and
Testes Healthy & Happy

Do Do Not
Wear clean underwear that is
Do not hold your pee – pee if
comfortable and gives you the
you have to pee (and pull back
support you desire. Or try
your foreskin if you have one).
going commando!

Do not be afraid to ask

Wash under your foreskin if
questions about your penis and
you are not circumcised to
testes; it is a good thing to
prevent the build-up of
know and understand your
smegma.
body.

Clean your penis & scrotum Do not be afraid to seek

regularly with mild unscented information or talk to others
soap and warm water. about your penis and testes.

Ask your Health Care Provider Do not be afraid to masturbate.

about prostate exams. Do not share sex toys.

Have safer sex. Try lubricated Do not have sex in the sand,
condoms to protect your penis. dirt or submerged in water as it
Use lubrication as needed to can cause irritation and
reduce friction and irritation. infection.

Have regular STI and HIV Do not kick or hit another

testing if you are sexually person in the testes – and NO
active. wedgies!

14
 Do Do Not
Tight clothing can cut off blood
Have regular check-ups and see
circulation to your penis and
a health care provider
testes, prevent good air
immediately if you have lumps,
circulation and hinder sperm
bumps, discharge, swelling or
production – make sure yours
pain.
aren’t too tight.

Be careful when trimming,

Do not skimp on protection,
shaving or removing pubic hair
wear protective gear (jocks and
– the skin on your penis &
cups) when playing sports.
scrotum is sensitive.

Do not share unwashed towels,

Conduct monthly testicular
washcloths, underwear or
self-exams starting in puberty.
bathing suits.

Do not spray colognes or

Be careful when zipping up
perfumes on your penis or
your pants – you don’t want
scrotum – if they smell, wash
anything to get caught!
them.

Avoid perfumed soaps, bleach

Talk to a Health Care Provide if
and fabric softener. Chemicals
you have problems getting
can be harmful to your penis
and/or maintaining an erection
and scrotum, use as few as
on a regular basis.
possible.

Explore, look at, and touch Do not worry about the size of
your penis and testes often so your penis – it is how you treat
you will notice how and when your partners and self that
they change. counts!

15
Love ♥ your Penis and Testes.
Circumcision

 Circumcision is a surgical procedure performed on some

penises (usually in infancy) to remove the foreskin from the
penis.
 The foreskin is a double-layered fold of smooth muscle tissue,
blood vessels, neurons, skin, and mucous membrane that covers
and protects the glans of the penis (head of the penis) and the
urethra opening when the penis is not erect.
 According to the World Health Organization approximately 30%
of penises are circumcised worldwide. This rate is declining.
 In Canada 32% of penises are circumcised.
 Some cultures circumcise children on the brink of puberty as a
ritual into adulthood.
 Circumcision is usually performed for cultural, social or religious
reasons – not medical or hygienic reasons.
 Some people circumcise their infants because the father is
circumcised thinking they should look the same.
 Circumcision has no effect on penis size or functioning if
performed properly and without complications.
 Some research says circumcision affects the sensitivity of the
penis, some research says it does not.
 Uncircumcised people should gently pull back the foreskin
when they bathe to wash the foreskin and tip of the penis. If
they do not do this, smegma can build up under the foreskin.

What is Smegma?

 A buildup of skin cells, skin oils, bacteria and moisture.

 It is a pasty white colour and cottage cheese looking.
 It can be foul smelling.

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  Circumcision is no longer covered by OHIP for infants, children
or adults, unless there is a medical reason for the procedure.
Therefore you must pay out of pocket for the procedure.
 The cost for an infant to be circumcised can be anywhere from
$150 - $350. This cost varies from physician to physician and
may be dependent upon the age of the infant.
 A medical reason for penile circumcision in adulthood is
phimosis.

What is Phimosis?

 Phimosis is a condition of the penis where the foreskin

cannot be fully pulled back (retracted) over the head of the
penis. This would not be a reason for an infant to be
circumcised as the foreskin does not pull back in infancy.

 Circumcisions in children and adults may have more

complications than in infants, and general anesthetic may be
necessary.
 At birth, the inner layer of the foreskin is sealed to the head of
the penis. This seal forms early in fetal development and
provides a protective cocoon for the delicate developing glans.
 The foreskin is usually non-retractable in infancy and early
childhood.
 Medical associations advise not to retract the foreskin of an
infant, in order to prevent scarring. Some argue that non-
retractability may be considered normal for males up to and
including adolescence.
 “After reviewing the scientific evidence for and against
circumcision, the Canadian Pediatric Society does not
recommend routine circumcision for newborn boys. Many
pediatricians no longer perform circumcisions.” Canadian
Pediatric Society (www.caringforkids.cps.ca).

17
Peyronie’s Disease

Peyronie’s Disease is an inflammatory condition of the penis

characterized by the formation of scar tissue resulting in the curvature
of erections. The penis is not curved when it is flaccid, only when it is
erect. It could curve up, down, left or right. In its early stages the
penis may be tender or painful. Sometimes a lump can be felt on the
shaft or base of the penis. Pain may be felt with erections.

It is believed that Peyronie’s Disease is caused by injury, or micro-

injury, to the penis. There is evidence that suggests that some
individuals may also have a genetic predisposition to Peyronie's
Disease. The curve may heal on its own, however in some cases
treatment with medication or surgery is necessary.

When to see a Health Care Provider

Make an appointment with a health care provider if:

 You find any lumps or bumps in or on your penis, testicles or
groin
 You notice any skin sores or rashes in the genital area
 A sore appears and then goes away
 You notice swelling or changes in your genitals

18
  You experience burning or pain during urination or
defecation (peeing and pooing)
 You notice puss or discharge coming out of the penis
(discharge can be watery, thick, clear, white, yellowish or
greenish)
 Testicles ache or feel sore or painful
 The head of the penis is sore and the skin cracks
 You experience pain during or after intercourse
_________________________________________________________________________

If you are sexually active, get tested for Sexually Transmitted

Infections (STIs) and HIV regularly. Testing includes blood work and
peeing in a cup. If you engage in anal or oral sex, anal and throat
swabs should also be conducted.
__________________________________________________________________________

Vasectomy

A vasectomy is considered a permanent form of birth control but is

not 100% effective. However, according to The Society for
Obstetricians and Gynaecologists of Canada, it is 99.9% effective. This
surgery is paid for by OHIP in Ontario, however a reversal is not
covered by OHIP and can be difficult and expensive. There is also no
guarantee that a reversal will be successful.

A vasectomy is usually performed in a physician’s office. Each vas

deferens (the tubes that carry sperm from the testicles to the penis)
are cut, cauterized or clipped to prevent sperm from being released
from the testicles. To do this the physician will freeze the area and
make a small incision on both sides of the scrotum.

19
Vasectomy continued…

Ejaculation will still happen the same as usual after the procedure (it
will look, smell, taste, and feel the same), even without sperm in the
semen. Sperm is so small it only accounts for 1% of the volume in
ejaculate. The small incisions are closed with dissolving stitches or
skin stitches. It will only take a few weeks for these incisions to heal
completely.

The freezing from the local anaesthetic will wear off in a few hours.
You can expect some scrotal (the sac that carries your testicles)
discomfort. This may last a few days and can usually be controlled

20
with mild painkillers. You may feel more comfortable with snug
underwear. Swelling is also common and can be controlled with ice
packs (or frozen peas) to the scrotum for 15-20 minutes, three to four
times per day. There are no significant long term side effects.

Limit your physical activity to light work around the house for two to
three days. Avoid strenuous physical activity, heavy lifting or exercise
for one week. You can shower after 24 hours. Sexual activity can be
resumed in one week. However, you will remain fertile for several
weeks after your vasectomy due to sperm in the remaining tubes.
Use another form of birth control, such as a condom, until you are
advised by your physician that your semen is sperm free. Regular
ejaculation will help to clean out the tubes. Between 8 – 12 weeks
after your vasectomy you will be asked to produce a semen sample
by masturbation for laboratory analysis to check your sperm count. A
vasectomy does not protect against STI transmission.

A vasectomy is much less invasive than tubal ligations performed on

the fallopian tubes. There are fewer complications and fewer side
effects. This is because the fallopian tubes are located within the
abdominal cavity and therefore require surgery using general
anesthesia to make incisions in the abdomen. A vasectomy is also
more effective than tubal ligation which is 99.5% effective and
increases the risk of an ectopic pregnancy occurring.

Blue Balls

Blue Balls is a slang term for an uncomfortable or achy

feeling in the testes. The testes do not actually turn
blue. This can occur when a person has an erection but
does not ejaculate. This does not occur every time
there is an erection without ejaculation. Although it
may be uncomfortable, it usually goes away quickly
and is not harmful. If you do not like the discomfort –

21
masturbate! Blue balls are not a reason to have sex, to make someone
feel guilty about not having sex or to pressure someone into having
sex.

Prostate Cancer

Prostate cancer is one of the most common cancers in North America.

The older you are the more likely you are to be diagnosed with this
cancer, especially if someone blood related to you has been
diagnosed. The signs and symptoms of prostate cancer are: a need to
urinate frequently (especially at night), difficulty starting urination or
stopping urination, weak or interrupted flow of urine, painful or
burning urination, difficulty getting or keeping an erection, painful
ejaculation, blood in urine or ejaculate and frequent pain or stiffness
in the lower back or thighs. If you have any of these signs and
symptoms it does not mean you have prostate cancer, but you should
contact your health care provider. If you have questions about
prostate exams you should ask your health care provider.

Testicular Cancer

Testicular cancer is common in young people aged 15-34. Signs and

symptoms include: a hard painless lump like a pea on the testicle, a
change in the size, shape or tenderness of the testicle or scrotum,
swelling or pain in the testicle, dull ache or heaviness in the lower
stomach, unusual backache that does not go away, unexplained
weight loss and soreness or sudden unexplained growth of the chest.
However, some people get testicular cancer and do not have any of
these signs or symptoms. If you have any of these signs or symptoms
it does not mean you have testicular cancer but you should contact a
health care provider.

22
Testicular Self-Exam

Testicular self-examinations are recommended to become familiar

with how your testes and scrotum feel. If you are familiar with your
body you are more likely to detect any changes. Self-exams should be
conducted once a month after or during a hot shower or bath so the
testicles are relaxed. According to Testicular Cancer Canada
(testicularcancercanada.ca) you should:

1. Stand in front of a mirror and look for any swelling on the skin
of the scrotum (it can’t hurt to check out the penis as well).
2. Hold your scrotum in your hands and feel the size and weight
of each testicle. It is common for one testicle to be slightly
larger or hang lower than the other.
3. Feel each testicle and roll it between your thumb and finger. It
should feel smooth. It is normal to feel a soft, tender tube
towards the back of each testicle. You should not feel any pain
when checking your testicles.
4. Once familiar with how your testicles feel, keep an eye out for
any changes. If you detect a change see your health care
provider as soon as possible. Early detection can make a
positive difference in the treatment of the cancer.

23
Benefits of:
Solo Sex, Masturbation, Touching Yourself, Jacking Off

 It’s pleasurable, fun and relaxing

 It helps you get to sleep if you are
suffering from insomnia or can make
you feel energized and focused
 No need to worry about getting it up,
keeping it up, or coming too quickly.
 It allows you to find out what you like
sexually so that you can better share
your needs with a partner
 It allows you to get to know your body
 Great exercise
 It is always available when sexual tensions need releasing
 It allows you to have as much gratification as you want, when
you want it, and at your speed
 It takes the pressure off your partner if you have one, as they
are not the only source of your orgasms
 It is the one form of sex with no risk of disease, infection, or
pregnancy
 There is no relationship to worry about
 It fits in with your life – you say when, you say where, you say
how much
 It often results in more powerful and longer orgasms than other
forms of sex
 It allows you to fantasize and act as you want - please yourself
not your partner - you can be completely selfish
 No partner/audience (usually) means you can be less inhibited
in your use of toys and any other item you may personally find
erotic
 You can grunt, scream, yell and moan completely uninhibited
 It's free

If you do not want to masturbate this is fine as well, it’s your choice!

24
Condom Use

The best way to learn how to use a condom is practise. Try

masturbating with a condom on. The best way to find a condom that
you like, and fits you properly, is to try them. Some condoms fit more
snug than others. It is important the condom is not too tight or it will
be uncomfortable and could break. It is important the condom is not
too loose or it could slip off. A few condom tips:
 Make sure condoms are stored in a cool dry
place, out of direct sunlight or florescent
lighting.
 Check the expiry date.
 Do the “puff test” making sure there is air in the
package and therefore no holes in the condom.
 Push the condom aside and carefully open the package – DO
NOT use your teeth.
 Figure out which way the condom rolls – if you put the condom
on the wrong way, throw it out and start over with a new
condom. Pre-ejaculate (pre-cum) will be on the condom and
can contain sperm and STIs.
 For added pleasure add a small drop of water based lube inside
the condom.
 Pinch the tip of the condom – you need to leave room for the
ejaculate.
 Roll the condom all the way to the base of the penis.
 If the condom is not lubricated, or you would like extra lube,
add water based lubrication to the outside of the condom or
onto the vagina or anus.
 When withdrawing the penis hold onto the base of the penis
and the condom so the condom does not get left behind.
 Tie the end of the condom in a knot and throw it in the
garbage. DO NOT flush the condom down the toilet. Condoms
can clog the toilet or unexpectedly float back up in the toilet.

25
Steps to putting on a condom

26
27
For more information contact:

Stacey Jacobs, MSc

Community Sexual Health Education Manager

SHORE Centre
Sexual Health Options, Resources & Education

235 King Street East, Suite 130

Kitchener, ON N2G 4N5

Email: [email protected]
Website: shorecentre.ca
Phone: 519 743 9360