超重兒童父母的煩惱 我兒子那裏太短了

The pediatric wisdom is that it’s often the mother who asks the question.

兒科醫生們發現，往往是母親問這個問題。

But she usually says the question comes from the boy’s father.

不過她通常會說，這是孩子爸爸讓問的。

His dad is worried, she begins.

一般她會這樣開始：他爸爸有點擔心。

Is our son’s penis a normal size? Is it too small? Is something wrong?

我們兒子的陰莖大小正常嗎？是不是太小了？有沒有問題？

Most of the time, everything is perfectly normal.

大多數時候，一切都很正常。

But what most of those boys have in common is their physique: They tend to be overweight.

不過，這些男孩大多有一個共同的體形問題：他們往往都超重。

Questions about penis size have become more common over the past decade, as my colleagues and I have all seen more overweight children coming in for physical exams.

過去10年中，我和同事們見到更多超重兒童來體檢；這期間，關於陰莖大小的問題也變得更加常見。

And these worries reflect cultural preoccupations and anxieties, which can make the conversation highly fraught for all concerned.

這些擔憂反映出一種文化癡迷和焦慮，它讓談話對於關心這個問題的所有人來說都顯得充滿壓力。

I see dissatisfaction with the phallus very regularly, said Dr.

我經常見到對陰莖的不滿，費城兒童醫院(Children’s Hospital of Philadelphia)的小兒泌尿科醫生阿西姆•舒克拉博士(Aseem Shukla)說。

Aseem Shukla, a pediatric urologist at Children’s Hospital of Philadelphia and associate professor of urology at the Perelman School of Medicine at the University of Pennsylvania.

他也是賓夕法尼亞大學(University of Pennsylvania)佩雷爾曼醫學院(Perelman School of Medicine)的副教授。

He said that with 10- to 11-year-old boys, a common thing is, my son’s penis is too short.

他說，對10到11歲的男孩來說，一個常見的擔心是，我兒子的陰莖太短。

The vast majority of the parents who bring up the issue with their pediatricians after the newborn period have children whose genitals fall in the normal range.

對於大部分在新生兒階段過後向兒科醫生提出這個問題的父母來說，他們孩子的陰莖大小往往在正常範圍內。

A baby or toddler’s penis can look very small, and maybe especially when the child himself is larger rather than smaller.

嬰兒或學步期兒童的陰莖可能看起來非常小，尤其是如果孩子本身體形較胖的話。

Watching their bodies as they grow, parents sometimes begin to worry about heavier boys and whether their genitals are normal.

父母們看着他們慢慢長大的身體，開始擔心他們是否超重，生殖器是否正常。

The penis can be buried in the fat pad that sits in front of the pubic bone, and it can remain hidden as boys go through adolescence.

陰莖可能埋在恥骨上面的脂肪墊裏，在整個青春期可能都藏在裏面。

What is called a hidden penis can be a combination of being prepubertal (so the penis has not begun to grow), being overweight (so the fat pad is significant), and in some cases an anatomical condition in which the soft tissue below the skin of the penis doesn’t adhere well to the Buck’s fascia,

它被稱爲隱藏陰莖，成因可能包括以下三個方面：沒到青春期（所以陰莖還沒開始生長）；超重（所以脂肪墊很明顯）；在某些情況下是生理結構問題——陰莖皮膚下的軟組織沒有與巴克筋膜很好地結合起來。

the thick covering that surrounds the penile nerves and arteries.

巴克筋膜是圍繞陰莖神經和動脈的厚厚的覆蓋物。

This fixation problem can yield what Dr. Shukla described as a slidey penis, in which the actual shaft retreats and only the skin, or the foreskin, in an uncircumcised boy, is clearly apparent.

這個連接問題可能會導致舒克拉博士所說的滑滑的陰莖，真正的柱狀體縮進去了，只有皮膚（也就是包皮）很明顯地留在未接受環切手術的男孩體外。

There are some surgical procedures which can unbury that concealed penis, but Dr. Shukla said that except in extreme cases, it made more sense to wait and let the child grow older — and, ideally, slimmer.

手術可以讓隱藏的陰莖顯露出來，不過舒克拉說，除非在極端情況下，更合理的做法是等孩子長得更大一些——而且最好是讓他瘦一些。

And for preadolescent boys that is often a very welcome solution.

對於青春期前的男孩來說，這通常是很受歡迎的解決方案。

The kids are usually pretty relieved that we’re not going to cut, Dr. Shukla said.

孩子們得知我們不會動刀子，一般都會鬆一口氣，舒克拉博士說。

But while they are relieved, they still want reassurance.

不過，雖然他們鬆了口氣，但依然想要得到保證。

I basically say, first of all I want you to know that you are absolutely and completely normal, Dr. Shukla said.

我基本上會說，首先我想讓你知道，你絕對、完全正常，舒克拉說。

We don’t all walk around with our pants down, and we don’t see how everybody is.

我們並不是都光着屁股四處走，我們看不見別人的長什麼樣。

But you should realize the private area can be different, and because yours looks different from your brother’s doesn’t mean there is something wrong.

但是你必須知道，私處可能各有不同，你的與哥哥的不一樣，並不意味着你有什麼問題。

There is a condition called micropenis, and it should be diagnosed in the newborn period, because it can reflect a variety of disruptions of the hormone system during pregnancy, which at some point prevented the usual effects of testosterone.

有一種疾病叫小陰莖，它在新生兒階段就應該被診斷出來，因爲它能反映出孕期激素系統的某些異常，這在某一階段阻礙了睾丸素的正常作用。

Micropenis can reflect any of a number of rare genetic syndromes and hormone problems, and early diagnosis is important to make sure that other hormonal issues, like low blood sugar, don’t endanger the baby.

小陰莖能反映出罕見基因綜合徵和激素問題，早期診斷對於確保沒有其他激素問題危及嬰兒生命很重要，比如低血糖。

The relevant measurement, in a boy of any age, is the stretched penile length, measuring from the pubic bone, and stretching the nonerect penis to the point of resistance; in a full-term newborn, the mean stretched penile length is 3.5 centimeters.

不管是多大年齡的男孩，有意義的測量都應該是伸展的陰莖長度，也就是把沒有勃起的陰莖最大限度拉伸，從恥骨量到陰莖末端。

Micropenis (at any age) is defined as a penis 2.5 standard deviations or more below the mean, so in full-term newborns, we worry about any child below 2 to 2.5 centimeters.

足月新生兒的陰莖平均伸展長度爲3.5釐米。小陰莖（在所有年齡）是指比這個平均值低2.5個標準差或更多的陰莖，所以我們擔心的是所有陰莖短於2至2.5釐米的足月新生兒。

For older boys, doctors use growth charts that reflect the child’s age and physical maturity.

對於更大一些的男童，醫生使用的是反映孩子年齡和身體成熟度的成長圖表。

And until the hormones of puberty kick in and the penis begins to grow, a statistically normal penis on a disproportionately large body can look small to a worried parent.

在青春期激素開始發揮作用、陰莖開始生長之前，在一位擔憂的父母看來，從統計學角度來說正常的陰莖在一個偏胖的身體上，就會顯得太小。

Merritt Jensen, a pediatric psychologist, works with the division of urology at the Children’s Hospital of Philadelphia.

兒科心理醫生梅麗特•詹森(Merritt Jensen)與費城兒童醫院泌尿科合作。

I hear a lot of parents just wanting to be reassured it is within the realm of appropriate and typical and that it’s going to work correctly, she said.

很多父母只是想確認，它在合適、典型的範圍內，將來會功能正常，她說，

The mom often will say it but you can see the relief in Dad’s face.

母親經常會說出來，但你能看到父親臉上如釋重負的表情。

None of these conversations are easy, from the nervous questions in the pediatric office to the specialist referrals.

這些談話都不容易——從兒科診室裏緊張不安的問題到轉診意見。

Dr. Shukla said that he tries to reassure preadolescents that if they lose some weight and still feel that there is a problem when they reach puberty, they can come back to address it.

舒克拉說，他努力讓青春期前兒童放心，如果他們體重有所減輕，到青春期之後依然覺得有問題，可以再來諮詢。

I push down and I show them the length and width, Dr.

我給他們看長度和粗細度，舒克拉說。

Shukla said.

他對他們說：你完全不會有問題，你會擁有美好的人生。

And he tells them: You are going to be totally fine, you are going to have a great life.