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Podofilox is a treatment option for people who are traveling or are otherwise unable to get to a health care provider easily. Although (at approximately $65 a bottle) it is expensive, it may nevertheless be economical if a person does not have to visit a health care provider for treatment. It has a clearance rate of 45-88 percent and a recurrence rate of 33-60 percent. It should not be used during pregnancy.

TCA stings when applied and may cause more scarring than podophyllin. It can be used safely on warts on the mucosal surfaces of the body, such as the inner labia and the vagina, as well as on external warts on the genitals and around the anus. It is applied only to visible warts. After treatment with TCA, a follow-up visit is recommended in about a week, when the irritation from the first treatment has healed, to determine whether the wart has persisted. TCA has about an 80 percent success rate in clearing the visible wart after treatment and a recurrence rate of 36 percent. It is safe to use during pregnancy.

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Male condoms made of latex have been tested more extensively than plastic condoms, but so far the plastic ones appear to be just as good (studies are still under way to verify this). In the laboratory, condoms do not allow the passage of HIV, herpes virus, cytomegalovirus, hepatitis B virus, chlamydia, and gonorrhea. They may not provide complete protection (although they do offer some protection) against herpes and other infections, such as genital warts. This is because a person could have infection with these viruses outside the area that a condom protects and thus still transmit these infections.

Practicing with condoms usually helps a man use them more effectively and feel less awkward about it. Studies show that most condom failures are a result of inexperience in using them, or using them incorrectly, not flaws in the condoms themselves.

Most men can find a brand of condom that works well for them. If not, then female condoms (discussed later in this chapter) may be an option for heterosexual couples. There is no difference in effectiveness between the different name brands of latex condoms. Some men find that they like the newer plastic condoms better than the latex ones, because they believe that sensation is improved with the plastic ones. Some have an allergy to latex, which prevents them from using latex condoms, and the plastic ones offer an alternative. The best suggestion is to try different types and see which one works best for you or your partner.

All condoms are regulated by the Food and Drug Administration, and each individual condom is tested to make sure it is not defective. You do not need to “test” the condom yourself before using it, and in fact this may cause the condom to break during use. Do not leave condoms exposed to the air or sunlight for lengthy periods of time, because they can become brittle and break more easily.

Condoms with spermicide (nonoxynol-9) on them are not any more effective in preventing pregnancy or STD transmission than condoms without it. Only a tiny amount of spermicide is used on a condom that comes prelubricated with spermicide. As will be described however, using nonoxynol-9 foam or cream in addition to the condom helps prevent unwanted pregnancy and may help prevent the spread of some STDs.

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Doctors are also working to make the PSA a more meaningful and specific test. Some new approaches to PSA include:

PSA Density. This technique begins with a theory, that most men in the age group for prostate cancer also have at least some BPH, which can elevate the PSA concentration and make diagnosis more difficult. One way to distinguish between BPH and cancer, some doctors believe, is PSA density—the blood PSA score divided by the volume of the prostate, as determined by transrectal ultrasound. Basically, if you have benign disease, your PSA should not be more than 15 percent of the weight of your prostate.

In a preliminary study of sixty-one men, scientists found a difference in PSA density in prostate cancer and BPH; the average PSA density value for forty-one men with clinically localized cancer (confined to the prostate) was 0.58; for the twenty men with BPH, it was 0.04. About 83 percent of the men with prostate cancer who had a normal PSA test had an elevated PSA density score; only two men with prostate cancer had a PSA density under 0.05. The highest PSA density reading for any of the men with BPH was 0.117; most men with BPH had a PSA density level under 0.10. This study also led investigators to develop a probability curve for PSA density that helps doctors gauge a man’s likelihood of having prostate cancer.

Results from this and other work suggest that PSA density may be most helpful for men with a PSA score that is higher than normal (between 4 and 10); and that if a man has a slightly elevated PSA score and a PSA density level greater than 0.15, he has a greater chance of having prostate cancer.

PSA density, concludes one study, may be “a useful tool for helping physicians decide which patients with a high normal or mildly elevated serum PSA level to subject to prostatic biopsy and which to (simply) follow.”

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We get asked this question a lot and to tell you the truth, we find it hard to answer. It’s very difficult to explain in words how it feels. Also, sex feels differently to different people. But if people are considerate of each other’s feelings, if they are relaxed and take their time, if they tell or show each other what kind of touching and rubbing feels good to their bodies, then sexual intercourse feels good. In fact, most people agree that it feels wonderful.

Of course, how it feel depends a lot on the situation. If you’re having sex with someone you love and the two of you both feel comfortable about what you’re doing, then sex can bring pleasure, fun, passion and joy. There’s a rush of good feeling when you share a good sexual experience with someone you truly care about. Sex can be a very special way of being close with someone and of discovering more about each other. But sex can also bring sadness and emotional pain. If you don’t truly care about each other or you don’t feel it’s right for you to be having sex, intercourse may not be a pleasant feeling at all. So, as we say, it depends a lot on the situation. If you’re wondering about how you’d know if it was right for you, you might be interested in reading the section called ‘Making decisions about how to handle your sexual and romantic feelings’.

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While we’re on the subject of breasts, we’d like to mention one very important topic, breast self-examination. Doctors encourage adult women to examine their breasts once a month so that they will be able to detect lumps, bumps, thickenings in the breast tissue or other abnormalities in the feel or appearance of the breasts that might be a sign of breast cancer. Fortunately, most of the lumps a woman discovers are not cancerous. In fact, many of the no cancerous breast lumps are just simple cysts, collections of fluid. Sometimes non-cancerous breast lumps disappear on their own; at other times, they must be removed surgically. But whenever a woman discovers a lump or other abnormality in her breast, she needs to see a doctor and have certain tests done to make sure it’s not cancerous.

Each year more than 24,000 women in the United Kingdom develop breast cancer. In some cases breast cancer can’t be cured, and the woman dies from the disease. But if the disease is caught in its early stages, there is a good chance of a cure. In fact, if the disease is caught early enough, it may be cured by simply removing the lump (although in other cases the entire breast must be removed).

Because early detection and treatment of the disease dramatically increase the chance of a cure, breast self-examination is vitally important for women. Unfortunately, far too many women don’t examine their breasts or even know about it. All women over the age of 25 (breast cancer rarely occurs in younger women) should examine their breasts every month.

If you have a sister, mother, grandmother or another adult female you’re close to and encourage her to discuss breast self-examination with her GP and to practise it on a monthly basis. Or if someday you marry or have a regular sexual partner, you could help and encourage her to examine her breasts.

Although it might be difficult or somewhat embarrassing for you to bring up the topic of breast self-examination with your older sister, mother or grandmother, we urge you to do so. By sharing this important information you might get your female relative started on the important habit of examining her breasts. And, who knows, you might just save her life.

We should also mention that men can develop breast cancer, although it is very rare. However, it’s a good idea for adult men to check their nipples and chest area regularly and to have any unusual lumps or other abnormalities checked by a doctor. (Teenagers, both boys and girls, should, however, remember that they may feel a lump under one or both of their breasts during puberty. This is not a sign of cancer or any other medical problem.)

In addition to checking their breasts, males should also examine their testicles.

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No, masturbation is not in any way harmful. Back when your grandmother and grandfather were children, people thought that all sorts of horrible things would happen if you masturbated. Masturbation was supposed to cause warts on your nose, hair to grow on the palms of your hands, pale skin, spots, wet and clammy hands, blindness, softening of the brain, idiocy and insanity (to mention just a few problems) . Nowadays we know that none of these things is true.

Even though people no longer believe these old stories, the idea that masturbation might be harmful or just not good for you still lingers on. Some people think that masturbating too much will cause you to ‘run out of or ‘use up’ all your sperm. But, as you know from reading this book, your body is constantly making millions of new sperm each day. There’s just no way you could run out. Other people think that masturbating too much will somehow hurt your penis or sex organs. Again, this isn’t true. If you masturbate and ejaculate a lot, your penis might get sore from all the rubbing, but other than this soreness, masturbating cannot hurt your body. In fact, it’s just not possible for you to masturbate and ejaculate too much. Your body sets its own limits. If a boy is masturbating a great deal, after a while his penis won’t get erect anymore. He’ll have to rest for a while before he can get an erection again.

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Another change you may notice as you go through puberty is that your voice becomes lower and deeper. This happens because testosterone causes your larynx, or voice box (the part of your throat that contains your vocal cords), to grow larger. Your vocal cords get thicker and longer, and this changes the tone of your voice. Voice changes usually happen when a boy is about 14 or 15, but they may happen earlier or later than this.

For some boys, this voice change happens without their really noticing it:

I didn’t realize that my voice had changed, except that people stopped thinking I was my mother or my sister when I’d answer the phone.

Bill, age 19

For some boys the change in their voices is more sudden and noticeable:

My throat was sore for about a month or so, sort of scratchy. I thought I just had some kind of sore throat. My voice was froggy. I was always going ahem, ahem – you know, how you clear your throat. Afterwards I noticed my voice was deeper than before.

Phil, age 17

Some boys experience what is called ‘breaking’ of their voices as they’re going through this voice change. They’ll be talking in a normal voice and all of a sudden their voice will get very high and squeaky. A lot of boys found this breaking one of the most embarrassing things about going through puberty.

As one man explained:

I’d finally get up my nerve to call a girl on the phone and ask her for a date. I’d say, ‘Hi, Susie,’ or whatever her name was, ‘this is John’, and my voice would be just fine. I’d sound perfectly cool. Then I’d say, ‘Would you like to go to the cinema?’ – and right in the middle my voice would go all high and funny. It would sound like it was Minnie Mouse talking.

John, age 36

Another man said:

Really, it was the most embarrassing thing. It seemed like it happened all the time. I’d try to control my voice and never get really excited or happy-sounding. Any time I got nervous and excited, that’s when it would happen. I tried not to get too emotional, but of course I did. I never really got control over it. Finally, after a year or maybe it was two years, it stopped happening.

Tyrone, age 28

Your voice may change suddenly and dramatically or it may happen without your really noticing it. Like John and Tyrone, your voice may break and you may feel embarrassed about it, although there’s no real reason to be embarrassed, because people know it’s just a part of growing up. Eventually, though, your voice will ‘settle down’ and you’ll find yourself sounding more adult.

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Doctors have divided the growth and development of the genital, or sex, organs into the five stages. You may be in one of these stages or you may be between one stage and another. See if you can find the stage you are closest to.

Stage 3

By the time a boy reaches Stage 3 his penis has begun to get bigger too. The penis gets quite a bit larger than it was in Stage 1 or 2. It gets both longer and wider. The scrotum and testicles also grow during this stage, but the most noticeable change is in the size of the penis. The skin of the penis and scrotum also continues to deepen in colour.

By the time a boy’s penis has started to grow larger, his testicles are usually between 7 and 16 ml (1 2/5-3 1/5 teaspoons) in volume, although some boys in Stage 3 have testicles that are larger or smaller than this.

One testicle usually hangs lower than the other. In most grown men, it is the left testicle that hangs lower, but in some it is the right. If you have not noticed one testicle hanging lower than the other by the time you get to Stage 3, you will probably notice it during this stage.

The reason one testicle hangs lower than the other is to keep them from crushing each other when you walk. If you have ever been hit in the testicles, you know that they are very sensitive. It can be really painful if your testicles get crushed together or if you get hit there. That is why boys often wear jockstraps or cup-shaped protectors in physical education classes and when they are playing games or, other sports. The jockstrap or cup holds the testicles snugly up against the body so that they do not hang out and are protected from injury.

In grown men both testicles are just about the same size, although sometimes one may be just a bit larger than the other. As you are developing you may notice that one testicle is much larger than the other. This is because one testicle may grow faster. Often, the one that hangs lower is the largest. As the other grows, it may start to hang lower. So a boy who notices that his right testicle hangs lower in Stage 3 may find that his left testicle hangs lower in Stage 4. (If you are concerned about the difference in the size of your testicles or notice a sudden, dramatic change in size or in which one is lowest).

If a boy has not started to develop pubic hair in Stage 2, he may notice the first curly hairs growing around the base of his penis during Stage 3. The first pubic hairs are usually not very dark or really curly. There aren’t very many at first and you may have to look very closely to see them. But as puberty continues, they will get darker and there will be more of them. They begin growing around the base of the penis, just where the penis joins the body. After a while they start growing on the scrotum as well. They may also grow in the area round the anus.

Some of the boys and men we talked to were a bit worried when they started to grow pubic hair. Here is what some of them had to say:

It looked like I was getting all these spots on the skin around my cock.

Jim, age 16

There were little raised bumps and I thought I had some kind of disease.

Phil, age 24

First I got these tiny, kind of whitish, raised spots. I was frightened to say anything. I just waited. Then I noticed these fuzzy hairs growing out.

Bill, age 17

When pubic hair starts to grow, there are often raised bumps on the surface of the skin that may look like spots.

These raised bumps are caused by the tiny pubic hairs trying to push through the skin. Soon little hairs begin to poke through the surface of the bumps. If you don’t know what is going on, it can be a bit worrying. But it is a perfectly normal part of growing up and it is not anything to worry about.

You may also notice that you have other little bumps or dots on the skin of the penis and scrotum, ones that do not grow little hairs. These are oil and perspiration (sweat) glands. They begin to develop during puberty and to make small amounts of oil and perspiration. You may notice that the skin in this area feels moister or smells a bit different. This is because your oil and perspiration glands are becoming active. Once again, this is a normal and natural part of growing up, another sign that you are becoming a man.

Just as it is impossible to say when a boy will reach Stage 2 and start puberty, so it is impossible to say when he will reach Stage 3. The usual age is about 13, although there are some who reach Stage 3 when they are younger than this and some who reach it when they are older.

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