Male Penis Research Articles

Systematic Literature Review of Pediatric Male and Female Genital Hair Thread Tourniquet Syndrome.

The aim of this study was to describe genital hair thread tourniquet syndrome (HTTS) and its treatment by pediatric and adolescent health care providers through a systematic literature review. We performed a systematic literature review on pediatric male and female genital HTTS. Studies were included if they involved genital HTTS in males or females 21 years and younger and were published in English. The main outcomes were body parts involved, symptoms, treatment, anesthetic type, providers involved in diagnosis and management, and implications of delayed or missed diagnosis. There were 38 female cases from 33 publications (1973-2020) and 147 male cases from 47 publications (1951-2019). The average age among females and males was 9.1 and 5.1 years, respectively. Among cases involving female patients, 93% of them were premenarchal; patients were circumcised in 90% of reviewed cases of male HTTS. The most commonly involved body parts were clitoris and labia minora in females, and penis and urethra in males. Males most commonly presented with edema and urinary symptoms, whereas females most commonly presented with edema and pain. General anesthesia was used for tourniquet excision in most cases. Male and female genital HTTS were mostly managed by urologists and emergency medicine physicians, respectively. This systematic literature review of more than 150 cases of male and female genital HTTS describes evaluation and management of genital HTTS spanning 7 decades. The main treatment of genital HTTS remains prompt diagnosis and removal of the tourniquet, as well as education on prevention strategies. Delayed diagnosis due to lack of recognition of the HTTS can lead to serious sequelae. Development of national guidelines regarding best practices in management of genital HTTS disseminated to all providers taking care of pediatric and adolescent patients will lead to improved patient care.

Novel Guidelines for Immunotherapeutic Treatment Options of Genital Warts: Review article Novel Guidelines for Immunotherapeutic Treatment Options of Genital Warts: Review article

Background: The appearance of genital warts varies. Flat or resembling raspberries or cauliflower, they can be found in a variety of shapes. They begin as little red or pink growths and can reach a diameter of four inches or more before interfering with sexual activity or delivery (in certain circumstances) (in some cases). The warts thrive in the vaginal area's moist tissues. On the external genitals and the walls of the cervix and urethra, in women, as well as on the shaft of the penis in males, they are found. Despite the availability of different therapeutic modalities, treating warts with immunotherapy is a tremendous benefit. HPV vaccination has shown promising efficacy in the treatment of genital warts. Objective: To hallmark the new guidelines of immunotherapeutic options for treatment of genital warts. Conclusion: Immunotherapy with HPV vaccines is an effective and safe treatment modality of anogenital warts.

Revision of the West Palaearctic Euura bergmanni and oligospila groups (Hymenoptera, Tenthredinidae)

Eight Western Palaearctic Euura species are here assigned to the bergmanni group (bergmanni, brevivalvis, dispar, glutinosae, leptocephalus, respondens, sylvestris, and viridis) and two species to the oligospila group (frenalis and oligospila). Euura pallens (Konow, 1903) (bergmanni group) is removed from the list of West Palaearctic taxa. Euura pyramidalis (Hellén, 1948) is treated as incertae sedis within the bergmanni group. Definitions of the bergmanni and oligospila groups are primarily based on genetic sequence data (mitochondrial COI and nuclear NaK and POL2). We report likely occurrence of heteroplasmy and amplification of NUMTs among some of the treated species, complicating the use of DNA barcoding in species discrimination. Based on morphological and genetic evidence, we establish that the correct name for the invasive willow sawfly in the southern hemisphere (South America, southern Africa, Australia, New Zealand), known there only in the female sex, is Euura respondens (Förster, 1854). The species is probably native to the Palaearctic (or even Holarctic) where males are common: possibly as common as females (examined from Europe and Central Asia). The name Euura oligospila (Förster, 1854) has been incorrectly used for the species in the southern hemisphere. The examination of type material and reliable association of males and females based on genetics revealed that females of E. oligospila are morphologically extremely similar to E. respondens (and to some other E. bergmanni group species), but male penis valves and genetics enable reliable separation of these species. Morphological separation of females of E. oligospila and E. respondens is possible, but challenging. Identification keys for males and females of the bergmanni and oligospila groups are provided. The following 15 new synonymies are proposed: Nematus validicornis Förster, 1854, syn. nov. with Euura bergmanni (Dahlbom, 1835); Pteronidea woollatti Lindqvist, 1971, syn. nov. and Nematus turgaiensis Safjanov, 1977, syn. nov. with Euura brevivalvis (Thomson, 1871); Pteronidea pseudodispar Lindqvist, 1969, syn. nov. with Euura dispar (Zaddach, 1876); Nematus (Pteronidea) fastosus var. ponojense Hellén, 1948, syn. nov. and N. (P.) fastosus var. punctiscuta Hellén, 1948, syn. nov. with Euura frenalis (Thomson, 1888); Nematus declaratus Muche, 1974, syn. nov. and N. desantisi D.R. Smith, 1983, syn. nov. with Euura respondens (Förster, 1854); Pteronidea straminea Lindqvist, 1958, syn. nov., P. angustiserra Lindqvist, 1969, syn. nov., and P. disparoides Lindqvist, 1969, syn. nov. with Euura sylvestris (Cameron, 1884); Pteronidea breviseta Lindqvist, 1946, syn. nov., P. breviseta Lindqvist, 1949, syn. nov., P. abscondita Lindqvist, 1949, syn. nov., and P. lauroi Lindqvist, 1960, syn. nov. with Euura viridis (Stephens, 1835). Lectotypes are designated for 18 nominal taxa: Amauronematus longicornis Konow, 1897; A. spurcus Konow, 1904; Nematus bergmanni Dahlbom, 1835; N. brevivalvis Thomson, 1871; N. curtispina Thomson, 1871; N. (Pteronidea) fastosus var. ponojense Hellén, 1948; N. (P.) fastosus var. punctiscuta Hellén, 1948; N. glutinosae Cameron, 1882; N. microcercus Thomson, 1871; N. polyspilus Förster, 1854; N. prasinus Hartig, 1837; N. respondens Förster, 1854; N. salicivorus Cameron, 1882; N. validicornis Förster, 1854; N. virescens Hartig, 1837; Pteronidea curtispina var. luctuosa Enslin, 1916; Pteronus fastosus Konow, 1904; and P. pallens Konow, 1903.

A clinico-epidemiological profile study of venereal genital dermatoses in a tertiary hospital in southern Nigeria: A 5-year review

Venereal genital dermatoses are cutaneous morbidities contracted and transmitted by sexual contact. They are caused by microorganisms that survive on the skin or mucous membranes, or that are transmitted via semen, vaginal secretions, or blood during sexual intercourse. Data on pattern of presentation and diagnoses of venereal genial dermatoses are limited in Nigeria. The aim of this study was to determine the pattern of presentation of venereal genital dermatoses over a 5-year period in the University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Nigeria. Information extracted from patients’ medical records included socio-demographic data, duration of symptom, distribution of lesions, symptomatology and diagnoses of the venereal genital dermatoses. There were 121 patients with venereal genital dermatoses amongst 1600 new cases seen over the 5-year period constituting a prevalence of 7.6%. The male:female ratio of the study population was 1.5:1 and their mean age was 26.2 ± 10.5 years. The predominant symptoms at presentation were abnormal genital growth in 108 (89.3%), genital ulcer in 12 (9.9%), and genital pain in 11 (9.1%). The common venereal genital dermatoses were anogenital warts in 108 (89.3%) and genital herpes in 11 (9.1%). Venereal genital dermatoses are a relatively common dermatological presentation in UBTH and anogenital wart was the most common type. Venereal genital dermatoses were more common in the young age group and males. The most predominant site of affectation was the vulva in females and penis in males.

Defining Aesthetic Preferences for the Penis: A Photogrammetric and Crowdsourcing Analysis.

Achieving an aesthetic phalloplasty result is important for patients with acquired or congenital defects of the penis, or with genital-related dysphoria. However, aside from length and girth, the aesthetic proportions of the male penis have not been defined. This study aimed to determine proportions of the male penis through photogrammetric analysis of nude male photographs and to verify these proportions with a crowdsourcing-based survey. Nude male photographs (n = 283) were analyzed to define aesthetic proportions of the male penis. Photographs were analyzed for the position of the penis on the torso in relation to the umbilicus and for the ratio of the dorsal and ventral glans of the penis in relation to the entire shaft length. Proportions were then further studied by crowdsourcing 1026 respondents with Amazon mechanical Turk. The ideal position of the penis below the umbilicus is about 55% (6/11th) of the distance from the jugular notch to the umbilicus (measured average, 53.6%; survey-weighted average, 58.9%). The dorsal glans of the penis is about 33% (1/3rd) of the length of the entire shaft (measured average, 32.1%; survey-weighted average, 37.5%). The ventral glans of the penis is about 12.5% (1/8th) of the length of the entire shaft (measured average, 12.6%; survey-weighted average, 11.7%). Measured proportions of the human penis follow exact fractions. Crowdsourcing data helped support photogrammetric analysis, with survey-preferred ratios within 5% of measured ratios. With further validation, these data can aid surgeons performing phalloplasty.

Dynamic erectile responses of a novel penile organ model utilizing TPEM†.

Male penis is required to become erect during copulation. In the upper (dorsal) part of penis, the erectile tissue termed corpus cavernosum (CC) plays fundamental roles for erection by regulating the inner blood flow. When blood flows into the CC, the microvascular complex termed sinusoidal space is reported to expand during erection. A novel in vitro explant system to analyze the dynamic erectile responses during contraction/relaxation is established. The current data show regulatory contraction/relaxation processes induced by phenylephrine (PE) and nitric oxide (NO) donor mimicking dynamic erectile responses by in vitro CC explants. Two-photon excitation microscopy (TPEM) observation shows the synchronous movement of sinusoidal space and the entire CC. By taking advantages of the CC explant system, tadalafil (Cialis) was shown to increase sinusoidal relaxation. Histopathological changes have been generally reported associating with erection in several pathological conditions. Various stressed statuses have been suggested to occur in the erectile responses by previous studies. The current CC explant model enables to analyze such conditions through directly manipulating CC in the repeated contraction/relaxation processes. Expression of oxidative stress marker and contraction-related genes, Hypoxia-inducible factor 1-alpha (Hif1a), glutathione peroxidase 1 (Gpx1), Ras homolog family member A (RhoA), and Rho-associated protein kinase (Rock), was significantly increased in such repeated contraction/relaxation. Altogether, it is suggested that the system is valuable for analyzing structural changes and physiological responses to several regulators in the field of penile medicine.

Changes in hemodynamics in the penis at Diabetic nephropathy and the Rehabilitation of Erectile function

Aim: To determine the possible positive influence on correction of erection duration with redistributing of blood flow in pelvic arteries. Materials and methods: Blood fl ow indices were determined with the methods of color Doppler ultrasound diagnostics of penis arteries in 9 middle-aged males with erectile dysfunction, in whose anamnesis there had been diabetic nephropathy. Results: We determined that the maximum blood flow velocity in the cavernous arteries of the penis was 31.5 cm/sec on average, and diastolic blood flow velocity was 13.4 cm/sec, compared to 60 cm/sec and 25 cm/sec respectively in the norm. The resistive index decreased to 0.58 compared to 0.92 in the norm. Gotten indices show the presence of erectile arterial dysfunction in middle-aged males with diabetic nephropathy. Performed experiments in animals with directing of arterial blood flow from the caudal sciatic artery to the deep and spinal arteries of the penis showed widened lumen in them to 50% in average that causes the continuous erection. Conclusions: According to the data of the Doppler ultrasound of the penis in middle-aged males, in whose anamnesis there had been diagnosed diabetic nephropathy, we found out bilateral cavernous dysfunction. According to the data of the angiography exclusion of the caudal sciatic artery directed the blood flow into the internal pubic artery and its final branches, the deep and spinal arteries of the penis with signif i cant (to 50% in average), increasing of their internal diameter and continuous erection.

Glans inflation morphology and female cloaca copulatory interactions of the male American alligator phallus†.

The phallic glans of the American alligator (Alligator mississippiensis) is the distal termination of the semen-conducting sulcus spermaticus and during copulation has the closest, most intimate mechanical interactions with the female urodeum, the middle cloacal chamber that contains the opening to the vaginal passages and oviducts. However, the details of this interface leading to insemination and gamete uptake are unclear. Here, we: (1) histologically characterize the underlying tissue types and morphologically quantify the shape changes associated with glans inflation into the copulatory conformation, (2) digitally reconstruct from MRI the 3D shape of functional tissue compartments, and (3) diffusible iodine-based contrast-enhanced computed tomography image the copulatory fit between male phallus and female cloaca. We discuss these results in relation to tissue type material properties, the transfer on intromittent forces, establishing potential copulatory lock, inflated glans volume scaling with body mass/length, the mechanics of semen targeting and insemination, and potential female cryptic choice impacting multiple clutch paternity. In part, this study further clarifies the phallic morphological variation observed among crocodylians and begins to investigate the role(s) these divergent male forms play during copulation interacting with female cloacal forms to increase reproductive success.

A quarter century of recovery of the whelk Thais orbita from tributyltin pollution off Perth, Western Australia

Imposex is a condition in which females of dioecious marine snails develop rudimentary male characteristics. It is caused by tributyltin (TBT) used as an antifoulant in vessel paints since the late 1960s. Following the 2008 international ban on TBT, a decreasing rate of imposex has been observed worldwide. In Western Australia, imposex surveys of the whelk Thais orbita up to 2011 in the Perth metropolitan area suggested a decreasing trend but a significant recovery has not been confirmed. Collection of T. orbita from 11 sites in 2019 demonstrated a virtually complete recovery from imposex. Although it is generally accepted that male snails are not affected by TBT, the historical data set allowed confirmation that the male penis is of similar size in T. orbita collected at heavily affected sites and at relatively unaffected sites. Similarly, imposexed female snails had similar shell lengths to female snails at non-impacted sites.

Haemangioma of the Penis: A Review and Update of the Literature

Haemangioma of the penis (HOP) is a rare benign vascular lesion which can affect the penis of males including infants, children, and adults of up to the over 80 year-olds. HOP does manifest as: asymptomatic lump or lesion on the penis; localised pain or tenderness anywhere within the penis; a tumoral mass anywhere on the penis; pain in the penis on erection; curvature of penis on erection; bright red compressible papule or papules on penis; nodules on penis; plaques on penis; ulceration on penis; haemorrhage on penis. HOP may be associated erectile dysfunction in some cases and could affect voiding if it is associated with the urethral meatus. HOP which tends to be solitary in most cases may mimic other diseases of the penis as well as may be associated with haemangioma in the scrotum and perineal region occasionally. Diagnosis can be established by the clinical features and this can be reaffirmed by radiology imaging features with the use of Doppler ultrasound scan, CT scan and MRI scan which show low-flow within the lesion. Majority of the lesions tend to be superficial and not associated with the corpora cavernosa and spongiosum. There is no consensus opinion on the best treatment options hence various treatment options for HOP have been successfully utilized including: complete surgical excision, sclerotherapy, laser treatment, cryotherapy, and other therapies. Most cases of HOP do not recur but following sclerotherapy and laser treatment of large HOPs repeat procedures tend to be required and there may be residual / recurrent lesion that may need to be treated again. Deep and large HOPs may require complete excision with insertion of tunica graft. Very large HOPs could be more effectively treated by one stage complete surgical excision but the choice of the patient is important. The diagnosis of the lesion can be confirmed by the histopathology features of the lesion and positive immunohistochemistry staining for CD31 (strong), Factor VIII, and HHF35 (myopericytes) and minimal staining for CD34. HOP needs to be carefully differentiated from epithelioid angiosarcoma of the penis and epithelioid haemangioendothelioma. A multi-centre trial of various treatment options for HOP would be required to provide treatment guidelines for HOP taking into consideration the size of the lesion and availability of the various treatment options.

FR02-14 ACCURACY OF UROLOGIC CONDITIONS PORTRAYED ON GREYʼS ANATOMY

INTRODUCTION AND OBJECTIVE: Benign and malignant urologic conditions are becoming increasingly prevalent in the aging population. However, studies have demonstrated that the general public often has little knowledge or insight into the field of urology or the role of a urologist (Gagnon 2009, Barayan 2011). One way to reach a large audience and increase the public’s awareness is through increased representation on medical television shows. Grey’s Anatomy is the longest running American primetime medical drama series (2005 to present) with an average of almost 20 million viewers for the first few seasons. In this study, we investigated the context, frequency, and accuracy of urologic conditions on Grey’s Anatomy to better understand how the field of urology is portrayed on this popular show. METHODS: We reviewed detailed plot synopses for each episode of the first 15 seasons of Grey’s Anatomy for common urologic keywords including kidney, prostate, bladder, penis, urethra, testicle, scrotum, stone, incontinence, prolapse, urine, catheter, retention, and urology. Episodes with urologic references were then screened and the urologic conditions, outcomes, and treatments were recorded. The medical accuracy of the conditions and treatments were agreed upon by two reviewing physicians. RESULTS: We identified a total of 21 urologic events across 15 seasons and 342 episodes of Grey’s Anatomy. This corresponds to an average of 1.4 urologic condition per season or one urologic condition for every 16.3 episodes. A total of 43% (9/21) of the conditions were related to the male penis or urethra (Table 1). The remainder were related to the kidney (19%), bladder (19%), testicle/scrotum (10%), prostate (5%) or other (5%). The portrayal of these conditions and the associated treatments were considered to be medically accurate within reason 62% (13/21) of the time. The show’s main urologist was introduced in the 8th season so most of the urologic surgeries in the prior episodes were performed by general surgeons and plastic surgeons. CONCLUSIONS: Urologic conditions are infrequently represented on Grey’s Anatomy and over half of the references were related to external male genitalia. There is significant room for improvement to increase the portrayal of common urologic conditions and malignancies to improve the public’s awareness and perception of our specialty.Source of Funding: None

Primary tuberculosis of the glans penis in an immunocompetent male

Primary tuberculosis of the glans penis in an immunocompetent male

A 3D journey on virtual surfaces and inner structure of ossa genitalia in Primates by means of a non-invasive imaging tool

Novel bio-imaging techniques such as micro-Computed Tomography provide an opportunity to investigate animal anatomy and morphology by overcoming limitations imposed by traditional anatomical drawings. The primate genital bones are complex anatomical structures whose occurrence in both male penis (baculum) and female clitoris (baubellum) may be difficult to assess in individual cadavers. We tested a 3-step methodological protocol, including different techniques ranging from inexpensive/simple to more expensive/sophisticated ones, by applying it to a sample of primate species, and resulting in different levels of data complexity: (1) presence/absence manual palpation method; (2) 2D X-ray plates; 3) 3D micro-CT scans. Manual palpation failed on 2 out of 23 specimens by detecting 1 false negative and 1 false positive; radiography failed once confirming the false positive, however firmly disproved by micro-CT; micro-CT analysis reported the presence of 9 bacula out of 11 male specimens and 1 baubellum out of 12 female specimens. A different baculum position was identified between strepsirrhine and haplorrhine species. We also aim to assess micro-CT as a non-invasive technique providing updated anatomical descriptions of primate ossa genitalia. Micro-CT 3D volumes showed the surface of some bones as rough, with a jagged appearance, whereas in others the surface appeared very smooth and coherent. In addition, four main types of bone internal structure were identified: 1) totally hollow; 2) hollow epiphyses and solid diaphysis with few or several channels inside; 3) totally solid with intricate Haversian channels; 4) totally solid with some channels (structure of single baubellum scanned). Ossa genitalia appeared as a living tissue having its own Haversian-like channels. The high resolution of micro-CT 3D-images of primate genital bones disclosed additional form variability to that available from genital bone 2D images of previous studies, and showed for the first time new internal and external morphological characters. Moreover, micro-CT non-invasive approach proved appropriate to recover much of scientific knowledge still hidden and often neglected in both museum specimens and primate cadavers only destined to necropsy.

Canine transmissible venereal tumor: A review

Canine Transmissible Venereal tumor (TVT) is one of the most commonly occurring benign reticulo-endothelial tumor of dogs affecting both the sexes. It is mostly transmitted by coitus with incidence rates ranging from 2 to 43% of all tumors prevalent in temperate climate and both young and sexually mature age groups are affected. Such tumor presents abnormal numbers of chromosomes ranging from 57 to 64 and averaging 59 (58 ± 5), in contrast to the normal 78 chromosome found in the species and is the only proven example of tumor that is transplanted as an allograft during cell transplantation. Metastases cases are uncommon but puppies and immune-compromised dogs are at greater risk. The etiology appears to be tumoral cell transplantation from affected host to healthy animals. Prevalence of this tumour was reported to be 23.5% to 28.6% in Punjab 28.6% in Andhra Pradesh and 42.8% in the state of Assam. Clinical cases are usually presented with tumor localized in the shaft of penis in males and along the vestibule of vagina in females. Small nodular lesions that bleed easily are the most consistent clinical finding. Cytological studies of smears made from such tumor reveals round cells with clear cytoplasmic vacuoles, mitotic figures with chromatin clumping and presence of one or two prominent nucleoli. The tumor is self-limiting and vincristine sulfate is currently the most effective therapy. Immune modulation therapy is yet to be validated for treatment purposes. The present review throws a light and narrates some of the critical aspects such as incidence, prevalence, transmission pattern, gross and microscopic findings and the treatment regime of dogs affected with TVT.

Imposex study on Thais aculeata (Gastropoda: Muricidae) in Ambon Bay, Eastern Indonesia

Study on imposex of Thais aculeata was conducted in September to October 2016 in Talake Shipyard, Ambon Bay. The aim of this study was to investigate and describe the imposex insidence in muricids T. aculeata. Level of imposex was calculated using some indices i.e. RPLI (Relative Penis Length Index), RPSI (Relative Penis Size Index) and PI (Percentage of Imposex). A total of 110 individuals T. aculeata consisted of eight size classes were found, which 39 females individuals were identified to be exposed of imposex. Females with imposex were characterized by the presence of pseudopenis in the form of a small bulge on the top right of the tentacles. Pseudopenis relatively smaller than that of male penis size i.e. 2.13 mm while male penis size was 4.95 mm. Percentage of imposex of T. aculeata was 41.05%, RPSI was 7.97; RPSI was 49.58, and sex ratio of male and female individuals was 1:6.3 The correlation between class size shell with imposex was moderate relationship (R = 0.44). Ratio between number of male individuals and female with imposex was significantly different, but ratio between normal females and females with imposex; and shell length average between normal females and females with imposex was not significantly different, respectively.

Revision of the “Lozopera” species group reveals peculiar structures on the male genitalia in moths (Insecta: Lepidoptera: Tortricidae)

The “Lozopera” species group of the genus Aethes Billberg, 1820 comprises at least 26 described valid species distributed in the Palaearctic region. Most of them share similar external morphology and are identified mainly after their genitalia. The genitalia morphology of both sexes is comparatively complex and the taxa of the group are surrounded by numerous taxonomical problems. A thorough study of the genital morphology, aiming to solve some of the problems, revealed the existence of a microscopic seta on the vesica of the male phallus. SEM and light microscopy observations suggest that it is sensillum chaeticum and probably has a (mechano) receptive function. It is present in some species and absent in others, but always located near the gonopore. In some species a large acantha with similar location was found, instead. Apart from the “Lozopera” species group, such a sensillum was observed in other Aethes spp. and in other genera of the tribe Cochylini as well. Such a structure has never been reported on the vesica of a moth.

Discovery of a specialist Copelatinae fauna on Madagascar: highly ephemeral tropical forest floor depressions as an overlooked habitat for diving beetles (Coleoptera, Dytiscidae).

Diving beetles are generally aquatic and live submerged in water during larval and adult stages. A few groups have colonised hygropetric habitats and fewer species still can possibly be referred to as terrestrial. Here we describe six new Copelatine species that were mainly found in dry shallow forest floor depressions in the eastern and northeastern lowland humid forests of Madagascar. Three new species are described in each of the two genera Copelatus and Madaglymbus: Copelatus amphibiussp. nov., Copelatus betamponasp. nov., Copelatus zanatanensissp. nov., Madaglymbus kelimasosp. nov., Madaglymbus menalambasp. nov., and Madaglymbus semifactussp. nov. Diagnosis, description, known distribution, ecology, and conservation notes are provided for each species. All species are illustrated with a dorsal habitus image, ventral and lateral views of the male penis, and parameres. Photographs of the unusual terrestrial habitats where the species were found are provided. Madaglymbus menalambasp. nov. is also documented with macrophotos and videorecordings of the terrestrial locomotion and behaviour in the field. Although these species should not be classified as terrestrial, or even semi-terrestrial Dytiscidae, they seem to be specialists of very ephemeral aquatic habitats and stay put instead of disperse when the habitat dries up. It is hypothesised that this lifestyle and behaviour on Madagascar is restricted to the high-precipitation humid forest regions mainly in the east. It may also represent a transition step, or stepping-stone, towards becoming fully terrestrial, a step that the few known terrestrial Dytiscid taxa once passed through. It is very likely that this type of habitat is overlooked for aquatic beetles, not only in Madagascar, and the six species herein described may be just the “tip of the iceberg”.

Some Comments on the Alternative Universe of the Trump Administration.

The psychoanalytic concept of an "anal universe" is a type of alternative universe in which reality is denied and falsehood prevails. This essay demonstrates how this concept illuminates much of the confusion and distortion of truth generated by the Trump administration. The author comments on several behaviors of President Trump and his administration including perverse thinking and lying, mocking disabled people, demeaning women, labeling journalists as enemies of the people, encouraging regressive forces in groups, and promoting policies that cruelly affect immigrants and refugees. The author also comments on the primacy of the male phallus in American politics. He contrasts the spatial metaphor of an "anal universe," where there is distortion of language and an absence of moral constraints and ethical principles, with the metaphor of a feminine psychic space, which enhances the capacity for symbolic thinking and the generation of creative ideas and solutions.

Why Did a Female Penis Evolve in a Small Group of Cave Insects?

The evolution of a female penis is an extremely rare event and is only known to have occurred in a tribe of small cave insects, Sensitibillini (Psocodea: Trogiomorpha: Prionoglarididae). The female penis, which is protrudable and inserted into the male vagina-like cavity during copulation to receive semen, is thought to have evolved independently twice in this tribe, in the Brazilian Neotrogla and the African Afrotrogla. These findings strongly suggest that there are some factors unique to Sensitibillini that have facilitated female penis evolution. Here, several hypothetical factors are presented that may have enabled the evolution of the female penis in Sensitibillini. The female-female competition for nutritious semen, the oligotrophic environment, and the twin insemination slots with switching valve are considered to be the driving factors for female penis evolution. Additionally, the following factors are considered responsible for relaxing the constraint against female penis evolution: preexistence of the female-above mating position, the elongated duct connecting the female pre-penis with the sperm storage organ, and the small male genital cavity accepting the female genital tubercle bearing the opening of this duct. Understanding the factors enabling female penis evolution may also shed light on the evolution of the male penis.

Prevalence, Concordance, and Transmission of Human Papillomavirus Infection Among Heterosexual Couples in Liuzhou, China: An Observational Perspective Study.

Knowledge of human papillomavirus (HPV) transmission dynamics, which have important public health implications for designing HPV vaccination strategies, is scarce in undeveloped areas. From May to July 2014, 390 couples were enrolled from the general population in Liuzhou, China. Exfoliated cells from male penis shaft/glans penis/coronary sulcus (PGC) and perianal/anal canal (PA) sites and from female vaginal, vulvar, and PA sites were collected biannually for 1 year. The HPV type-specific concordance rate between couples was 15.5% (95% confidence interval [CI], 8.5%-25.0%). For anogenital HPV transmission, the male-to-female transmission rate (11.5 [95% CI, 4.3-30.7] per 1000 person-months) was similar to the female-to-male transmission rate (11.3 [95% CI, 5.9-21.7] per 1000 person-months). The concordance rates between male PGC site and female vaginal, vulvar, and PA sites were 20.0%, 21.8%, and 14.9%, respectively, which were significantly higher than expected by chance. Infections transmitted from males to females seemed mainly originated from male genital sites, whereas for female-to-male transmission, the vaginal, vulvar, and PA sites might be all involved. Among the heterosexual couples with relatively conservative sexual behavior, the anogenital HPV transmission rate for females to males is similar to that of males to females. In addition to the vagina and vulva, the female PA site is also an important reservoir for HPV transmission.