Confidential Medical Records

🔎 Initial Consultation - Primary Care Physician

Physician: Dr. Andrew R. Peterson, MD

Diagnosis: Micropenis (ICD-10: Q55.62)

Diagnostic Criteria: Stretched Penile Length (SPL) is confirmed to be **greater than 2.5 standard deviations below the mean adult penile length**, meeting the **diagnostic threshold for micropenis** (SPL < 9.32 cm).

Physical Examination:

• **Stretched Penile Length (SPL):** 2.3 cm (Measured under standardized clinical protocol)
• **Penile Length (Flaccid):** 1.9 cm
• **Penile Length (Erect):** 3.1 cm
• **Girth (Circumference, Flaccid):** 1.7 cm
• **Girth (Circumference, Erect):** 2.3 cm
• **Testicular Volume (Left):** 2.8 mL
• **Testicular Volume (Right):** 2.5 mL
• **Prostate Size:** Within normal limits
• **Visibility:** Manual displacement of suprapubic adipose tissue required for full exposure.

Diagnostic Tests Ordered:

• Comprehensive Blood Panel (CMP, Hormone Profile, Free & Total Testosterone)
• Penile Doppler Ultrasound (Vascular assessment)
• Prostate Examination (DRE & PSA Testing)
• Neurological Reflex Testing (Bulbocavernosus Reflex Assessment)
• Forced Ejaculation Test (Via Vibrostimulation to assess ejaculatory response)
• Semen Collection (Patient unable to produce; sample collected via electroejaculation)

Signed,
**Dr. Andrew R. Peterson, MD**
General Practitioner

🩺 Urology Consultation

Specialist: Dr. Jonathan M. Reynolds, MD

Diagnosis: Micropenis (ICD-10: Q55.62)

Referral Reason: Further evaluation of congenital **micropenis (SPL < 9.32 cm)**, erectile function concerns, and suspected vascular insufficiency.

Stretched Penile Length (SPL) Confirmation:

• **Stretched Penile Length (SPL):** 2.1 cm (**Below the 2.5 standard deviation threshold for adult males**).
• **Penile Length (Flaccid):** 1.7 cm
• **Penile Length (Erect):** 3.0 cm
• **Girth (Circumference, Flaccid):** 1.6 cm
• **Girth (Circumference, Erect):** 2.2 cm
• **Testicular Volume (Left):** 2.7 mL
• **Testicular Volume (Right):** 2.4 mL

Vascular & Neurological Testing:

• **Penile Doppler Ultrasound:** - **Peak systolic velocity (PSV):** 11.2 cm/s (**Severely reduced arterial inflow**) - **End-diastolic velocity (EDV):** 4.7 cm/s (**Consistent with venous leak syndrome**)
• **Neurological Reflex Assessment:** - **Bulbocavernosus Reflex:** Absent (**Lack of reflexive contraction to perineal stimulation**). - **Somatosensory Evoked Potentials (SSEPs):** Mild delay noted (**Suggestive of impaired sensory input**).

Erectile Function Testing:

• **Intracavernosal Injection (ICI) Response Test:** - Minimal rigidity achieved at **maximum dose** of prostaglandin E1. - Inability to sustain erection beyond **30 seconds post-stimulation**.

Diagnostic Conclusion:

Findings confirm **congenital micropenis with significant vascular insufficiency and compromised erectile function**. The patient presents with **severely impaired rigidity and insufficient penile length for penetrative intercourse**.

Treatment Discussion:

• **Hormonal Therapy:** Not indicated (testosterone levels within normal range).
• **Surgical Lengthening:** Low probability of success; risks include fibrosis and further reduction in function.
• **External Assistive Devices:** Recommended (**penile extenders, vacuum devices, prosthetic implants**).
• **Referral to Fertility Specialist:** Advised due to likelihood of infertility.

Signed,
**Dr. Jonathan M. Reynolds, MD**
Department of Urology

🧬 Fertility & Endocrinology Consultation

Specialist: Dr. Emily S. Carter, MD

Diagnosis: Micropenis (ICD-10: Q55.62)

Referral Reason: Evaluation of **reproductive viability** due to **inability to achieve penetration and concerns about ejaculatory dysfunction.**

Physical Examination Findings:

• **Penile Length (Flaccid):** 1.8 cm
• **Penile Length (Erect):** 3.2 cm
• **Girth (Circumference, Erect):** 2.1 cm
• **Testicular Volume (Left):** 2.5 mL
• **Testicular Volume (Right):** 2.3 mL

Semen Analysis:

• **Ejaculate Volume (Electrostimulation):** 0.3 mL (**Severe hypospermia**)
• **Sperm Concentration:** < 5,000/mL (**Non-viable for natural fertilization**)
• **Sperm Motility:** Non-progressive motility in 97% of observed sperm**
• **Morphology:** >80% of sperm exhibit **abnormal forms**.

Ejaculatory Function Assessment:

• **Attempted Natural Ejaculation:** **Unsuccessful** (Patient unable to produce a sample via self-stimulation).
• **Forced Ejaculation (Electrostimulation):** **Achieved minimal ejaculate volume with poor sperm viability.**

Reproductive Prognosis:

Findings indicate **profound infertility due to mechanical and physiological limitations.** Natural conception is **functionally impossible** due to **insufficient penile length for vaginal intromission and critically low sperm viability**.

Treatment Recommendations:

• **Assisted Reproductive Technology (ART):** Required (**Intrauterine insemination (IUI) or in-vitro fertilization (IVF) advised**).
• **Donor Sperm Consideration:** Suggested due to **poor sperm viability**.
• **Marital Counseling Referral:** Recommended due to **high psychological distress associated with infertility diagnosis**.

Signed,
**Dr. Emily S. Carter, MD**
Reproductive Endocrinology & Infertility