Manhood

by Mels van Driel

  Lymphoedema

  The scrotum can grow to an enormous size due to an accumulation of lymph. There are many underlying causes. One is the wearing of a clamp around the penis which passes behind the scrotum. This type of tourniquet does not generally lead to problems if continued for only a short time, and sometimes greatly adds to sexual pleasure.

  Lymphoedema of

  unknown origin.

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  Lymphoedema is caused by the accumulation of lymph in subcutaneous tissue. A Sanskrit book shows that treatments for lymph -

  oedema of the penis and scrotum were practised as long ago as the third century bc. Worldwide the most common cause is filariasis. It is a disease in which the lymph canals become clogged by worms. Other causes include erysipelas, tuberculosis, syphilis, leprosy and cancer in the pelvis minor. Sometimes the cause is the total absence of any lymph vessels in that area: this is in fact an innate abnormality, the results of which usually manifest themselves only after the age of four.

  There are various possible treatments, for example the use of diuretic pills, supporting bandages (cycling shorts are excellent), an operation to make connections between lymph vessels and veins, and best of all, the complete removal of the diseased tissue and the covering of the lower layers with skin grafts.

  Injuries

  According to George Gould and Walter Pyle in Anomalies and Curio -

  sities of Medicine, ancient medical texts from India describe how women of the Cossiah tribe killed their husbands premeditatedly by grabbing their balls in a single movement and then squeezing as hard as possible until they dropped down dead. Not that long ago the author had to stitch a tear running lengthways across the scrotum of a man of about 40. Following a nocturnal row after excessive indulgence in alcohol his wife had decided to try to tear his scrotum literally to shreds, and she had partly succeeded. She must have had very sharp nails . . . Six months after this incident they were divorced – the wound healed very nicely, though.

  Men themselves also do weird things. When in the spring of 2006

  Wales inflicted a painful defeat on England at rugby, 31-year-old Geoffrey Huish cut off his own testicles. He carried out the operation in ten minutes with a blunt pair of pincers. He then threw the testicles into a plastic bag and set off proudly for the pub to show his mates that he had been as good as his word. Only when he reached the pub did the heavily bleeding Huish collapse. His drinking companions kept the testicles in a beer glass full of ice. But once he arrived at hospital it was clear that there was no hope for the Welshman: he would have to go through life without balls, and subsequently spent some months in a psychiatric institution.

  Six months after this idiotic gesture Huish explained the facts. ‘I said before the match to my friend Gethin that Wales didn’t have a hope in hell of winning. It wasn’t a bet, I just said I’d cut my balls off if we won. So after the match I kept my word. I went to work with the 128

  a i l m e n t s o f t h e s c ro t u m clippers. It took about ten minutes and I was in a lot of pain, but I just went on. The pincers were so blunt that it was a difficult job. There was a lot of blood, though I’d expected even more.’ He concluded on a philosophical note: ‘I think about what I’ve done every day, but I can’t give any reason why I did it. I had a lot on my mind and felt a bit down. Well, I can forget kids now. I’d still like a family, though, so perhaps I’ll adopt.’

  Contrasting with this ludicrous and at the same time gruesome story is a beautiful poem by Richard Newman called ‘The Silence of Men’: A man I’ve never dreamed of before walks

  into my apartment and sits in the green chair

  where I do my writing. He carries

  in his left hand a large erect penis

  which he places silently on the floor.

  The phallus begins to waltz to music

  I cannot hear, its scrotum a skirt;

  its testicles, legs cut off at the knees.

  I want to know why this disfigured

  manhood has been brought to me. I look up,

  but my guest is gone. His organ, deflating

  in short spasms like an old man coughing,

  spreads itself in a pool of shallow blood.

  The silence between us is the silence of men.

  In the urological literature there are regular reports of human bite wounds to the scrotum. Such bite wounds are quite frequently complicated by a bacterial infection, and that also applies to dog bites. Post-treatment research at Groningen University Medical Centre showed that virtually all patients who had reported to A & E with bite wounds in the crotch had been attacked by a pitbull terrier.

  In the past conscripts were taught that a vicious kick in the crotch was the best way of taking out a potential enemy. Nowadays there are martial arts from the Far East that have turned dirty kicking into a fine art. Women doing a course in self-defence learn how to teach manners to an attacker. That sensation will be familiar to every man who has ever sat on the saddle of his bike too enthusiastically. It is no accident that footballers forming a wall to keep out their opponents’ free kick hold their hands over their crotch.

  Such injuries are a source of embarrassment. Injuries to the scrotum are common in hockey and kick-boxing. They are extremely painful because of the previously mentioned remnants of abdominal membrane 129

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  in the scrotum, which make the pain nauseating. If the kick or ball is hard enough, the cover of the testicle, the tunica albuginea, can even rupture. If this is stitched as soon as possible, there is a 90 per cent chance that the testicle will be saved. If things are allowed to take their course, the chance is only 50 per cent. The operation is almost always performed under general anaesthetic, gas or injection; local anaesthetic is insufficient.

  The testicle collector

  Human craziness takes the oddest forms. Years ago I was approached by a female second-year medical student with the question ‘whether I as a urologist could get hold of a human testicle for her?’ She was so beautiful I was too flabbergasted to give the only correct response, namely:

  ‘Are you out of your mind?’ With a sophisticated grin she told me that her father saved testicles . . . Still under her spell, I replied that everything that urologists and other surgical specialists saw fit to remove from a human being was always sent to the pathologist, who had the last word, especially important if we were dealing with an unpleasant disease. Anyway, the pathologist always decides, though in very many cases when it is too late for the patient! Years later I came across the same beautiful student as a doctor – you guessed: as a trainee urologist!

  One day I decided to use her as an intermediary to see her father, the testicle collector, and his collection. I didn’t dare go without her accompanying me, as I kept getting flashes of The Silence of the Lambs.

  The man I met had a grey beard fringing his face and spoke with a slight Amsterdam accent. He lived opposite a cemetery, and told me that it was full, but that a new one had been built just outside the village. He had once studied mathematics and had gained his doctorate in medicine with a thesis on cranial measurements in growing children. He told his story.

  It had all begun with two tiger testicles from a well-known wild animal refuge. One spring day in a café the decision had been taken: he was going to start a testicle collection, with tiger balls as the founda-tion. The two tiger testicles had been removed by a famous vet, and were now on display in a village to the north of Groningen, together with the testicles of, for example, bulls, monkeys, stallions, hippo -

  potami, sea lions, polar bears, cocks, camels, walruses, panthers, guinea pigs, llamas, tomcats, rats, water voles, and others too numerous to mention.

  Only after long and persistent questioning did it emerge that there was a kind of testicle mafia behind his operations: doctors attached to well-known zoos, local pig castrators, vets from surrounding villages, 130

  a i l m e n t s o f t h e s c ro t u m a farmer from the village its
elf, a chicken keeper who still knew how to make capons, a globetrotter who went off to Egypt to castrate camels, and his enchanting daughter.

  In the presence of his future son-in-law the testicle collector, who in my eyes was becoming increasingly reminiscent of Anthony Hopkins, informed me that he wasn’t ruling out the possibility that at least one testicle of his future son-in-law would find its way into the collection.

  After a glass of wine I hastily beat a retreat.

  Once she started training as a urologist the testicle collector’s daughter also turned out to be slightly mentally disturbed: together with a young, friendly, red-haired fellow trainee she had the nerve to clean a dog’s penis she had been given by a friendly vet – that is to remove all the flesh with a spanking new operating set in a sterile operating theatre, leaving nothing but the penis bone, which was what she was after. The whole mess cost a fortune, since the instruments could never now be used for operations on human beings. To my great surprise she was allowed to continue training as a urologist. Probably her fairly gullible red-haired colleague had taken all the blame on herself.

  Punishments, wars, tortures

  ‘He that is wounded in the stones, or hath his privy parts cut off, shall not enter into the congregation of the Lord’, said Moses in Deuteronomy 23:1.

  For the unsuspecting Bible reader this probably seems a very severe utterance. I couldn’t make head or tail of it until I found P. Dufour F. Helbing’s The History of Sexual Mores in All Peoples and at All Periods. And what happened at the time of Moses? Jewish men were in the habit of grabbing each other’s genitals when fighting in order to win.

  Even their spouses joined in. In Deuteronomy 25 we read: When men strive together one with another, and the wife of the one draweth near for to deliver her husband out of the hand of him that smiteth him, and putteth forth her hand, and taketh him by the secrets:

  Then thou shalt cut off her hand, thine eye shall not pity her.

  In order to put an end to the above-mentioned practices, Moses ordained that those who had been castrated or had their penis cut off would no longer be permitted to attended the congregation of Jehovah.

  Bullet and grenade wounds to the penis belong more to our age. In the Vietnam War, in pre-Nelson Mandela South Africa and in recent 131

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  years in Bosnia these have been documented extensively, as has castration. The latter humiliating procedure is as old as the hills. In the Middle Ages in particular men were castrated as a punishment for sexual misdemeanours or miscalculations.

  In the twelfth century the testicles of Pierre Abélard, the great theologian and philosopher, were cut off after his elopement with his beloved pupil Héloïse. Abélard deeply mourned the loss of his manhood and wrote extensively about it in his memoirs. As for Héloïse, she was sent intact to a convent, and later gained fame as the head of an establishment called Le Paraclet, founded by her former lover. The two of them eventually found the same resting place in the cemetery of Père Lachaise in Paris.

  It is said that Rasputin’s sizable testicles and penis are preserved in a specially made velvet box. This crazy Russian monk died an unenvi-able death: he was poisoned, shot, raped, castrated and finally drowned. However, no one seems to know what has happened to the box, any more than we know what has become of Napoleon’s private parts!

  In 1934 Professor Johannes Lange published a monograph on The Consequences of Castration in Adults – Illustrated with Reference to War Experiences. Adolf Hitler is not mentioned in the book, but it is known that he lost a testicle, probably at the Battle of the Somme in 1916. He became what I once heard an up-and-coming urologist describe as a ‘single-stoner’. Hitler’s case is not absolutely certain: it might of course have been an innate abnormality. During the Second World War the Allies made fun of the Führer in the song ‘Hitler Has Only Got One Ball’, which was later recorded by Bette Midler.

  Torture involving the genitals is typical of ‘dirty wars’ and, more especially of dictatorships. In The Feast of the Goat Mario Vargas Llosa devotes page after page to it. From 1930 to 1961 the Dominican Republic was ruled by a dictatorship of the worst kind. A certain Rafael Castration of

  the lover.

  a i l m e n t s o f t h e s c ro t u m Leonidas Trujillo Molina ruled like a little Hitler. The writer gives an unvarnished and compelling picture of the absurd manipulations of this despot. After days of torture one of the rebels is slowly finished off: When they castrated him, the end was near. They did not cut off his testicles with a knife but used a pair of scissors, while he was on the Throne. He heard excited snickers and obscene remarks from individuals who were only voices and sharp odours of armpits and cheap tobacco. He did not give them the satisfaction of screaming. They stuffed his testicles into his mouth, and he swallowed them, hoping with all his might that this would hasten his death, something he never dreamed he could desire so much.

  Chronic testicular pain

  Men who have a tendency towards hypochondria quite often express this by complaining about their testicles. This may relate to a feeling of heaviness, a nagging or a stabbing pain. Complaints about such symptoms can become a source of frustration for everyone involved, the patient, the gp and the urologist. For the patient because he feels he isn’t being taken very seriously, for the gp because he/she does not know what to do and for the urologist because by the time the patient is referred to him/her a great deal of frustration has built up and the uro -

  logist knows in advance that no objectively verifiable abnormalities will be found. So we are not talking about the acute pain of a twisted stalk of the testicle or the chronic pain of a swelling in the scrotum; with this pain a physical examination reveals no abnormalities.

  Those affected are mostly relatively young, sexually active men, who have intermittent problems. Pain is signalled in one or both tes ticles, sometimes spreading to the groin. It is important to ask certain questions: when does the patient feel pain? Only during the day? Only when sitting for long periods or on the contrary when standing for long periods? Did the problem appear suddenly and continue from then on?

  Does the testicle pull towards the groin during an attack of pain? Does the pain sometimes pass when the patient is lying down? Has the patient undergone sterilization? Is there also pain during and/or after ejaculation? How frequent are the patient’s ejaculations?

  The physical examination of course comprises the careful feeling of the groin, the seminal cord, testicles and epididymides. The epididymis is normally sensitive to the touch, meaning that pain on contact by no means always points to an inflammation. Examination of the patient in a standing position is an absolute must (if medical students omit this in 133

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  an examination, they fail outright). This can help one diagnose a ruptured varicose vein as the cause of the nagging pain. In this case the person examining feels and sees a ‘can of worms’ next to the left testicle, which disappears when the patient lies flat.

  When the patient is in a lying position the doctor can provoke the cremaster reflex by stroking the inside of the thigh or the lower abdomen. If the testicle pulls towards the groin and this is accompanied by the typical pain, the patient has an exaggerated cremaster reflex: because the muscle fibres are relatively too strong, the testicle is pulled into the groin. Information on this condition is vital; in extreme cases it may be decided to sever the muscle fibres in an operation.

  Pain after a hernia operation can also occur and is caused by damage, which may or may not be temporary, to the tiny nerves that run along the inguinal canal to the scrotum. Generally speaking, patients often tell us that they only have a problem when sitting and when asked often turn out to have a sedentary occupation. Examples are taxi drivers, lorry drivers, sales reps, etc. In that case it is good to pay attention to clothing. Tight jeans are fatal to men with testicular pain – jeans are stiff and constrict the testicles.

  Often testicular pain is related to sexual activities
, since the patient sometimes has more pain during ejaculation or afterwards. It can sometimes go on for days. It is not always clear whether this is connected with the degree of arousal, too much or too little sex. Think of Zorba the Greek, who one fine day, after a month of abstinence on an island where he has been doing some building work for an Englishman, says: ‘I’m downing tools, I’m off back to the mainland – my groin is killing me.’

  Often testicular pain is accompanied by pain in the area between the anus and the scrotum. This is usually wrongly diagnosed as chronic inflammation of the prostate when it is actually chronic pelvic pain caused by insufficient relaxation of the pelvic floor muscles. Treatment by a physiotherapist in such cases is often much more effective than long-term treatment with antibiotics.

  Unfortunately there are by no means always ready-made solutions.

  Careful gathering of the facts is important, which in practice means taking the time to go through the symptoms and not giving the impression that one is not taking the case seriously. Chronic testicular pain is hard to treat. If the pain really derives from the scrotum and is not referred pain, severing the nerve pathways on a level with the external inguinal ring or a little higher will interrupt the conduction of pain sensation. If a trial blockage high in the seminal cord with a local anaesthetic results in a reduction in pain for the period for which the medication is presumed to work (for example, lidocaine one to two hours, marcaine three to seven hours), there are grounds for severing 134

  a i l m e n t s o f t h e s c ro t u m the nerves (denervation). A ‘positive’ blockage of the nerves in the seminal cord therefore also confirms that the pain actually derives from the scrotum. In addition the blockage has prognostic value for the success of the surgical denervation.