超重儿童父母的烦恼 我儿子那里太短了

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

儿科医生们发现，往往是母亲问这个问题。

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

不过她通常会说，这是孩子爸爸让问的。

His dad is worried, she begins.

一般她会这样开始：他爸爸有点担心。

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

我们儿子的阴茎大小正常吗？是不是太小了？有没有问题？

Most of the time, everything is perfectly normal.

大多数时候，一切都很正常。

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

不过，这些男孩大多有一个共同的体形问题：他们往往都超重。

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.

过去10年中，我和同事们见到更多超重儿童来体检；这期间，关于阴茎大小的问题也变得更加常见。

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

这些担忧反映出一种文化痴迷和焦虑，它让谈话对于关心这个问题的所有人来说都显得充满压力。

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

我经常见到对阴茎的不满，费城儿童医院(Children’s Hospital of Philadelphia)的小儿泌尿科医生阿西姆•舒克拉博士(Aseem Shukla)说。

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.

他也是宾夕法尼亚大学(University of Pennsylvania)佩雷尔曼医学院(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.

他说，对10到11岁的男孩来说，一个常见的担心是，我儿子的阴茎太短。

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.

对于大部分在新生儿阶段过后向儿科医生提出这个问题的父母来说，他们孩子的阴茎大小往往在正常范围内。

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

婴儿或学步期儿童的阴茎可能看起来非常小，尤其是如果孩子本身体形较胖的话。

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

父母们看着他们慢慢长大的身体，开始担心他们是否超重，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.

阴茎可能埋在耻骨上面的脂肪垫里，在整个青春期可能都藏在里面。

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,

它被称为隐藏阴茎，成因可能包括以下三个方面：没到青春期（所以阴茎还没开始生长）；超重（所以脂肪垫很明显）；在某些情况下是生理结构问题——阴茎皮肤下的软组织没有与巴克筋膜很好地结合起来。

the thick covering that surrounds the penile nerves and arteries.

巴克筋膜是围绕阴茎神经和动脉的厚厚的覆盖物。

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.

这个连接问题可能会导致舒克拉博士所说的滑滑的阴茎，真正的柱状体缩进去了，只有皮肤（也就是包皮）很明显地留在未接受环切手术的男孩体外。

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.

手术可以让隐藏的阴茎显露出来，不过舒克拉说，除非在极端情况下，更合理的做法是等孩子长得更大一些——而且最好是让他瘦一些。

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

对于青春期前的男孩来说，这通常是很受欢迎的解决方案。

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

孩子们得知我们不会动刀子，一般都会松一口气，舒克拉博士说。

But while they are relieved, they still want reassurance.

不过，虽然他们松了口气，但依然想要得到保证。

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

我基本上会说，首先我想让你知道，你绝对、完全正常，舒克拉说。

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

我们并不是都光着屁股四处走，我们看不见别人的长什么样。

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.

但是你必须知道，私处可能各有不同，你的与哥哥的不一样，并不意味着你有什么问题。

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.

有一种疾病叫小阴茎，它在新生儿阶段就应该被诊断出来，因为它能反映出孕期激素系统的某些异常，这在某一阶段阻碍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.

小阴茎能反映出罕见基因综合征和激素问题，早期诊断对于确保没有其他激素问题危及婴儿生命很重要，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.

不管是多大年龄的男孩，有意义的测量都应该是伸展的阴茎长度，也就是把没有勃起的阴茎最大限度拉伸，从耻骨量到阴茎末端。

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.

足月新生儿的阴茎平均伸展长度为3.5厘米。小阴茎（在所有年龄）是指比这个平均值低2.5个标准差或更多的阴茎，所以我们担心的是所有阴茎短于2至2.5厘米的足月新生儿。

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

对于更大一些的男童，医生使用的是反映孩子年龄和身体成熟度的成长图表。

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.

在青春期激素开始发挥作用、阴茎开始生长之前，在一位担忧的父母看来，从统计学角度来说正常的阴茎在一个偏胖的身体上，就会显得太小。

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

儿科心理医生梅丽特•詹森(Merritt Jensen)与费城儿童医院泌尿科合作。

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.

很多父母只是想确认，它在合适、典型的范围内，将来会功能正常，她说，

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

母亲经常会说出来，但你能看到父亲脸上如释重负的表情。

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

这些谈话都不容易——从儿科诊室里紧张不安的问题到转诊意见。

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.

舒克拉说，他努力让青春期前儿童放心，如果他们体重有所减轻，到青春期之后依然觉得有问题，可以再来咨询。

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

我给他们看长度和粗细度，舒克拉说。

Shukla said.

他对他们说：你完全不会有问题，你会拥有美好的人生。

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