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Fast Fact
Contrary to popular opinion, bed-wetting is a very common problem. It affects somewhere between five and six million children.
Bed-wetting, or nocturnal enuresis, can be divided into two types: primary nocturnal enuresis and secondary nocturnal enuresis. These two types are very different in their causes and treatments.
In primary nocturnal enuresis, children have never achieved complete nighttime control - always wetting at least two times a month.
Secondary nocturnal enuretics are completely dry at night for a period of at least six months and then begin wetting again.
The great majority of bed-wetting children are primary enuretics. For primary enuretics, the cause is decidedly NOT stress or behavioral concerns.
In a survey of 9,000 parents of kids ages 6 - 17, 22% stated that they thought the reason their child wet the bed was laziness (survey conducted by ICR Survey Group from July 10 1996, through August 6, 1996). I am happy to tell you that this could not be further from the truth!
Research has shown that primary nocturnal enuresis is often inherited. If both parents were bed-wetters, 77% of their children will be. If only one parent was, 44% of their offspring will. If neither parent wet the bed, only about 15% of their children will wet the bed.
With primary nocturnal enuresis one almost always finds another relative who was a bed wetter. This corresponds to what is called an autosomal dominant inheritance pattern.
In recent years, researchers have identified an association with bedwetting and two genes named ENUR1 and ENUR2. In studying certain families with primary nocturnal enuresis, researchers discovered that members who wet the bed were more likely to have the ENUR1 or ENUR2 gene than those who did not. More recently, the possibility of a third primary nocturnal enuresis-related gene (ENUR3) on chromosome 22 has also been uncovered. Presumably these genes affect either whether children will need to urinate at night or how easily they can wake up when their bladders are full.
Micropenis is a penis that is more than 2.5 standard deviations below the average size for age. In a newborn, a stretched penile length less than ¾ inch (1.9 cm) is micropenis.
Micropenis is a hormonal problem that takes place sometime after 14 weeks gestation when the penis has already formed. Hormone levels need to be checked. A boy's chromosomes should also be checked to see if there is an underlying genetic syndrome. An MRI may be needed to look at the hormone secreting glands. If the penis grows when a 3 month-trial of testosterone is given, the outlook is good for normal adult penis size and function.
If micropenis does not respond to testosterone stimulation, the difficult question of re-assigning gender arises. This decision has been made even more difficult by conflicting and changing recommendations of experts in the field. (Van Wyk JJ, Calikoglu AS, Should boys with micropenis be reared as girls? Journal of Pediatrics. 1999; 134(5)) At one time, gender re-assignment was the routine choice, even though it involves castration, surgical reconstruction, estrogen supplements, and huge emotional issues for the child and family. (Many people based their opinions on the case of a baby boy whose penis was accidentally amputated during circumcision. When he was 22 months old, he was castrated and reassigned a female sex. He had surgery to make his genitals appear female. He was raised as a girl. At puberty, he was given estrogens to promote breast growth. Reports said that he had a very good adjustment to the female sex, but it later became clear that from an early age he had rejected the idea that he was a girl. During his teen years, he insisted on switching back to living as a man. He later married as a man. (Diamond M, Sigmundson HK. Sex reassignment at birth. Long-term review and clinical implications. Arch Pediatr Adolesc Med 1997;151:298-304.)
The most recent consensus statement on the management of intersex disorders recommends raising boys with micropenis as males (i.e., no gender re-assignment). The reasoning is that this decision prevents surgery while allowing for fertility (Lee, Peter, “Consensus Statement on Management of Intersex Disorders,” Pediatrics, v118:2, August 2006, e488-e500).
Recent long-term studies of micropenis have found that even if the penis remains small, most boys-raised-as-boys end up as sexually active, heterosexual males who stand to urinate, have a strong male identity, normal erectile function, and who enjoy sex. (Reilly JM, Woodhouse CR. Small penis and the male sexual role. J Urol 1989;142:569-71.) Their partners also report sexual satisfaction. (van Seters AP, Slob AK. Mutually gratifying heterosexual relationship with micropenis of husband. J Sex Marital Ther 1988;14:98-107.) Teasing from peers can be a real problem, though. A penile prosthesis may help.
Adults who have themselves had intersex issues argue strongly against reassignment before the child is old enough to choose. (Van Wyk JJ, Calikoglu AS, Should boys with micropenis be reared as girls? Journal of Pediatrics. May 1999. 134(5).) Their opinion should be listened to carefully.
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