Penile Length and Circumference: an Indian Study

ORIGINAL ARTICLE Penile length and circumference: an Indian study

K Promodu1, KV Shanmughadas2, S Bhat3 and KR Nair1

1Dr Promodu’s Institute of Sexual & Marital Health, Panampilly Nagar, Kochi, Kerala, India; 2Department of Urology, Medical College, Calicut, Kerala, India and 3Department of Urology, Medical College, Kottayam, Kerala, India

Apprehension about the normal size of penis is a major concern for men. Aim of the present investigation is to estimate the penile length and circumference of Indian males and to compare the results with the data from other countries. Results will help in counseling the patients worried about the penile size and seeking penis enlargement surgery. Penile length in flaccid and stretched conditions and circumference were measured in a group of 301 physically normal men. Erected length and circumference were measured for 93 subjects. Mean flaccid length was found to be 8.21 cm, mean stretched length 10.88 cm and circumference 9.14 cm. Mean erected length was found to be 13.01 cm and erected circumference was 11.46 cm. Penile dimensions are found to be correlated with anthropometric parameters. Insight into the normative data of penile size of Indian males obtained. There are significant differences in the mean penile length and circumference of Indian sample compared to the data reported from other countries. Study need to be continued with a large sample to establish a normative data applicable to the general population. International Journal of Impotence Research (2007) 19, 558–563; doi:10.1038/sj.ijir.3901569; published online 14 June 2007

Keywords: penis; penile dimensions; penile length; penile size; short penis

Introduction Methods

Apprehension about the adequacy of external Sample genitalia has been a major concern for men of all This study was conducted in Kerala, South India. ages and cultures. The definition of normal penile Five hundred men, age ranging from 18 to 60 years size has become more significant in the context of were randomly selected from the sexual dysfunction increasing demand for penile augmentation.1–4 Data clinic run by the principal investigator and out- on normal size of penis will help (1) to perform patient clinic of the urology department at Medical correct diagnostic assessment and therapeutic College, Calicut, Kerala. The study was IRB choices, (2) to educate and counsel the patients approved and informed consent was taken from with concerns about ‘penile size adequacy’, and (3) the subjects. All the subjects who were willing to to manufacture condoms with correct size.5 participate in the study have undergone clinical Previous studies on phallic dimensions (Table 1) evaluation. Individuals with congenital or acquired are limited and there is a wide difference in genital abnormalities were excluded. Finally, 301 methodology.6 So far no study has been reported subjects were included in the study. on this topic from India. Present study is designed to obtain normative data on penile length and circumference of Indian males and to compare it with the Measurement data obtained from other countries. Penile length was defined as the linear distance along the dorsal side of the penis extending from the pubo – penile skin junction to the tip of the glans. Penile circumference was measured at the middle of the shaft. Correspondence: Dr K Promodu, Dr Promodu’s Institute of Sexual & Marital Health, G-255, Cross Road 11, Panam- Consent was taken from all the subjects. Age was pilly Nagar, Kochi, Kerala 682 036, India. recorded, height and weight were measured. Measure- E-mail: [email protected] ment of penile length was performed by first three Received 13 July 2006; revised 19 March 2007; accepted investigators. Practice trials for the method of 23 March 2007; published online 14 June 2007 measurement were taken before the beginning of Penile length and circumference K Promodu et al 559 the study. It was performed jointly by all the three investigators to ensure uniformity of measurement. Adequate precautions (adopting same method of measurement, using similar types of tapes, main-

Erected taining comfortable room temperature) were taken to (cm) mean s.d. circumferences standardize the techniques of measurement. All the 301 subjects (group I) have undergone measurements of flaccid length, flaccid circumference and stretched length (in fully stretched but still flaccid state). This was taken by one of the first three investigators with the help of a tape graduated to the nearest of 0.5 cm, immediately after the subjects Erected length (cm) mean s.d. undressed in order to minimize the effect of room temperature. Adequate privacy was ensured. From the same sample, a group of 119 subjects were willing to make self-rating of erected penile length and circumference. They were given training and was advised to take the measurement on two

(cm) mean s.d. different occasions at home in a state of full erection. Stretched length Only 93 subjects could perform it correctly (group 2). Results of the 26 subjects were discarded for reasons such as inability to achieve full erection or loss of erection at the time of measurement and

Flaccid those who obtained different values at two different measurements. circumference (cm) mean s.d. In order to find out whether any major errors such as overestimation or underestimation had occurred during the time of self-measurement, another group of 41 subjects (group 3) were taken from the same

Flaccid sample and subjected to measurement by one of the mean s.d. length (cm) investigators for erected length and circumference. Initially 50 subjects were chosen and individually provided with adequate privacy and visual sexual stimulation with the help of a videotape. Only 41 subjects could achieve full erection. On achieving (years)

Age range maximum erection, erected length and circumference were measured by the investigator. Out of 50 subjects, nine were excluded as they could not achieve either full erection or lost it during the time of measurement. No. of Subjects

Data analysis Data management and statistical analysis was under- taken using the Statistical Package for Social 18991942 50 5419951998 17–35 20–25 156 184 9.41 NA NA NA NASciences NA NA NA (SPSS), NA 13.02 NA version NA NA NA 10, NA for NA windows. NA NA 15.99 15.71 Descrip- NA NA publication tive statistics, Pearson’s product moment correlation and critical ratios were computed. Regression analysis was performed to see whether any of the variables can predict the erected length and circumference. USANigeriaFranceBrazilCalifornia 1985 1948Israel 1992Italy 1994 1996GermanyGermany 2770 320KoreaJordan 905 2000Jordan 2001 150 2000 80 2001 20–59 17–23 2003 17–91 2004 55 111 2004 3300 NA 21–82 8.16 (0.94) 32 9.7 123 10.7 271 8.83 (0.02) 8.85 21–78 18–19 (2.38) 109 17–19 NA 40–68 9.71 (1.17) NA 19–27 17–83 8.3 NA (1.3) NA 22–68 8.6 9.0 12.45 9.22 (2.71) NA 6.9 (0.8) 9.3 (1.9) NA 7.7 12.89 (1.3) NA (2.91) 16.74 NA NA 10.0 8.5 8.98 (1.1) NA (1.4) 12.30 NA (1.31) NA 12.5 (1.4) 15.5 13.5 NA 9.6 (2.3) (0.8) 12.5 NA NA NA 13.6 (1.7) 11.6 (1.4) 14.5 NA NA NA NA 14.48 NA 11.8 (1.5) 14.18 NA NA NA NA NA NA NA NA 6 5 5 .

1 Results 11 . 7 7 8 15 . . 12 10 . 16 et al 9 et al. et al. . Previous reports on penile dimensions 3 et al . et al. Descriptive statistics for different variables of group et al et al et al. et al. et al et al. 13 et al.

et al 1 (301 subjects) are given in Table 2. The mean 14 et al flaccid length, flaccid circumference and stretched Loeb Table 1 Author Country Year of Ajmani Bondil Da Ros Richters Smith Ponchietti Schneider Schneider Son Awwad Awwad Abbreviation: NA, not available. s.d. is given in parantheses where ever available. Schonfeld and Beebed Kinsey Wessells Chen length are found to be 8.21, 9.14 and 10.88 cm.

International Journal of Impotence Research Penile length and circumference K Promodu et al 560 Table 2 Group 1: descriptive statistics for different variables.

Variables N Mean s.d. Range

Age (years) 301 31.58 6.38 18–60 Height (cm) 301 167.27 6.91 130–187 Weight (kg) 301 65.53 10.82 36–118 Flaccid length (cm) 301 8.21 1.44 4.50–13.00 Flaccid circumference (cm) 301 9.14 1.02 6.00–12.50 Stretched length (cm) 301 10.88 1.42 6.50–16.00

Table 3 Penile dimensions of groups 2 and 3

Group 2 Group 3

Self-measurements by the subjects Measured by investigators

Erected length 1 Erected circumference 1 Erected length 2 Erected circumference 2

Mean 13.01 11.46 12.93 11.49 s.d. 1.62 1.35 1.63 1.04 Range 10–17 8.5–16.50 10.5–17.00 9.00–13.5 N 93 93 41 41

Table 4 Correlation between variables

Variable Height Weight BMI Flaccid Flaccid Stretched Erected Erected length circumference length length circumference

Height (N – 301) 1.00 Weight (N – 301) 0.38** 1.00 BMI (N – 301) À0.14* 0.85** 1.00 Flaccid length (N – 301) 0.05 À0.21** À0.24** 1.00 Flaccid Circumference (N – 301) 0.25** 0.33** 0.22** 0.13* 1.00 Stretched length (N – 301) 0.09 À0.21** À0.27** 0.84** 0.21** 1.00 Erected length (N – 93) 0.25* À0.13 À0.24** 0.63** 0.31** 0.61** 1.00 Erected circumference (N – 93) 0.26* 0.23* 0.06 0.30** 0.45** 0.26* 0.46** 1.00

Abbreviation: BMI, body mass index. *Po0.05. **Po0.01.

The mean erected length and circumference were circumference. Height has significant correlation found to be 13.01 and 11.46 cm when measured by with the flaccid length (Po0.01), erected length the subjects and 12.93 and 11.49 cm respectively and erected circumference (Po0.05). Weight is when measured by the investigators (Table 3). found to have a positive correlation with erected Paired sample ‘t-test’ was carried out to see circumference (Po0.05), but a significant inverse whether there is any significant difference between relationship with flaccid and stretched lengths the measurements taken by the subjects and the (Po0.01). Body mass index (BMI) has significant investigators. Measurements obtained for erected inverse correlation with flaccid, stretched and length are found to be significantly different erected lengths. BMI is found to be positively (t ¼ 2.59, Po0.01), but there is a high correlation correlated with flaccid circumference. (r ¼ 0.93) between the two sets of measurements. Penile measurements obtained in the present There is no significant difference between the two study are compared with the data available from measurements obtained for erected circumference other countries (Table 5). (t ¼ 0.247) and a high correlation (r ¼ 0.89) was Regression modeling for erected length (EL) was noticed between the measurements performed by performed using the correlated factors that affect the the subjects and investigators. erected length. The adjusted R-square of the model Table 4 shows that there is significant inter- is 0.387 (R2 ¼ 0.387) and the model was found to be correlations between flaccid length, flaccid circum- significant (Po0.05) as found by analysis of variance ference, stretched length, erected length and erected (ANOVA). Only flaccid length (FL) was present in

International Journal of Impotence Research Penile length and circumference K Promodu et al 561 the model. Linear regression model for the EL was ** ** ** CR 3 123 formed. ¼ 8.83 4.68 11.91 N EL ¼½7:622 þ 0:690ÂðFLÞ 0.8, 1.1, 0.8, SE ¼ 1:2713: Son et al. 7 7 7 Mean, s.d., (Korea)

6.9 Regression modeling was performed for erected circumference (EC) using the significantly corre- *NA ** 9.6 lated factors that affect the erected circumference. 9 55

CR 2 2.04 9.44 0.46 The adjusted R-square (R ¼ 0.221) of the model is ¼ À À À N 0.221 and the model was significant (Po0.05) as 1.7, 1.4, 1.3, found by ANOVA. Model included flaccid circum- 7 7 7

Chen et al. ference (FC) and height (H) for the prediction (Israel) Mean, s.d., erected circumference (EC). Linear regression model for erected circumference was formed. ** 12.5 7 ** 13.6 ** 8.3 EC ¼½0:234 þ 0:586ÂFC þ 3:416ÂH CR 6.63 1:1903: 5.52 À 3.41 SE ¼ 109 NA NA 8.5 ¼ 1.5, 1.4, 1.3, N 7 7 7 Awwad et al. Mean,s.d., Discussion (Jordan) group 2 The definition of normal penile size is of consider- ** 11.6 ** 7.7 7 able interest as there is a steady increase in the CR number of people complaining of ‘short penis’ and 18.18 7.67 0.58 À À 271 seeking penile enlargement procedures. Mondaini NA 11.8 ¼ 2 1.4, et al. reported that most men who seek penile 2.3, 1.9, N 7 7 7 lengthening surgery ‘overestimate’ the ‘normal’ Awwad et al. Mean, s.d., (Jordan) group 1 penile length. In their study of 67 patients complaining of ‘short penis’, none were found to be ** NA NA NA NA ** 13.5 ** 8.98 * 9.3 having a severely short penis. Both flaccid and

1 erected lengths are important as patient’s perception CR 80 4.16 6.03 4.68 2.29 0.35 À À À À

¼ of penile inadequacy could be often related to either

N of this. 2.91, 1.31, 2.71, 1.17, 2.38, Number of patients visiting the sexual dysfunc- 7 7 7 7 7

(USA) tion clinics with the concern of short penis is found Mean, s.d., Wessells et al.

8.85 to be increasing steadily. However, studies on penile dimensions are limited and no study is reported from India. ** 9.71 8

320 The average flaccid penile length is found to be CR ¼ 12.07 0.51 8.21 cm in the present study, which is significantly N lower than that of the mean length reported from 1 7 0.02, 0.94, USA and Jordan. The mean flaccid penile length 7 7 8 9

Ajmani et al. reported from Nigeria is 8.16 and from Israel (Nigeria) 8.3 cm, which are similar to the findings of the present study without any significant difference.

93)93) NA NA 12.89 12.30 The mean flaccid circumference obtained in the ¼ ¼ 301 present study is 9.14, which is significantly lower N N ¼ than the findings reported from USA1 but signifi- N cantly higher than that of reported from Nigeria.8 Mean flaccid circumference reported from Jordan7 is

(India) 8.98 cm, which is similar to the findings of the present study. The mean stretched length obtained in the present study is 10.88 cm which is found to be significantly 0.01. lower than the mean values reported from USA,1 o P Jordan7 and Israel9 but significantly higher than that Comparison of Indian data with data from other countries mean, s.d. and critical ratio of reported from Korea.3 In the present study, erected length and erected 0.05, **

o circumference were also obtained through self- P Erected lengthErected circumference 11.46, 1.35 ( 13.01, 1.62 ( NA, required values for* comparison were not available. Stretched length 10.88, 1.42 NA 12.45 Flaccid circumference 9.14, 1.02 8.83 Table 5 Authors & country Present study Flaccid length 8.21, 1.44 8.16 Variables Mean, s.d. Mean, s.d., measurements by the subjects. Paired sample ‘t-test’

International Journal of Impotence Research Penile length and circumference K Promodu et al 562 showed significant difference (CR ¼ 2.59) between tion between height and midpoint circumference, the two measurements of erected length performed but could not find any relationship with flaccid or by the subjects (group 2) and the investigators stretched lengths. Present study shows that BMI has (group 3). The mean erected length obtained in a significant inverse correlation with flaccid, self-measurement by the subjects (group 2) was stretched and erected lengths (Po0.01), which goes 13.01 cm and when measured by the investigators consistent with the findings of Ponchietti et al.6 But (group 3) it decreased to 12.93 cm. Probable reasons in the present study, BMI is found to have a positive for obtaining lower mean erected length when correlation with flaccid circumference (Po0.01) measured by the investigators could be the psycho- unlike what is reported by Ponchietti et al.6 logical factors like inhibitions due to the presence of Although weight is found to be positively corre- another person. However, there is a very high lated with erected circumference and BMI, very correlation between the two sets of measurements significant (Po0.01) inverse relationship was found (r ¼ 0.93). No significant differences were found with flaccid and stretched lengths. Ponchietti et al.6 between the two sets of measurements of erected also found a similar inverse relationship between circumference and there is high correlation between weight and flaccid as well as stretched lengths. the two (0.89). Hence for the final results of erected Ponchietti et al.6 arrived at the conclusion that length and circumference the values obtained by the penile dimensions are correlated with other anthro- group 2 (EL: 13.01 cm and EC: 11.46 cm) were pometric measurements such as height and weight, considered. suggesting that penile dimensions are themselves Reports on mean erected length are available only anthropometric measures. Result of the present from USA,1 Jordan7 and Israel.9 Erected length study goes consistent with this observation. obtained in the present study (13.01 cm) does not Although different correlated factors are there, differ significantly from the mean erected length flaccid length is found to be the single best predictor reported by Wessells et al.1 from USA (12.89 cm), of erected length as observed from the regression but the finding reported from Israel9 (13.6 cm) is model. Flaccid circumference and height were significantly higher. The mean value reported from found to be the best predictors for erected circum- Jordan7 (11.8 cm) is found to be significantly low. ference as revealed by the model. Bondil et al.10 reported the longest penile length in the flaccid (10.7 cm) and stretched conditions (16.24 cm). In their study, measurements were Limitations and suggestions obtained after three manual stretches of the penis. This study is conducted in a limited sample of 301 Owing to the methodological difference in deter- subjects who are not drawn directly from general mining stretched length, it cannot be compared with population. They are the patients came to seek the present study. Longest erected length reported is treatment either for sexual dysfunction or any other 15.99 cm (Richters et al.11) followed by 15.5 cm 12 urological problems. Hence, a chance of bias in (Kinsey et al. ). Details of these studies were not sample selection cannot be excluded completely. It available for a statistical comparison. For erected would be better to study a larger sample directly circumference, the only data available are from 1 drawn from the general population. More anthropo- USA and it does not show any significant differ- metric parameters could also be considered. ence from the Indian data. Overall data show that there is variation in flaccid length, flaccid circumference, stretched length, Conclusions erected length and erected circumference reported from different countries. This could be due to the racial or constitutional difference or some other Mean flaccid, stretched and erected lengths are factors. found to be 8. 21, 10.88 and 13.01 cm, respec- Inter-correlations were computed to see whether tively. Mean flaccid and erected circumference are there is any relationship between flaccid length, found to be 9.14 and 11.46 cm. flaccid circumference, stretched length, erected Significant inter-correlations observed between all length and erected circumference. It is found that measures of penile dimensions. there is significant relationship between all these Penile dimensions are found to be correlated with variables. anthropometric measures such as height, weight Height is found to have a significant positive and BMI. correlation with flaccid length (Po0.01) erected Flaccid penile length is found to be most closely length and erected circumference (Po0.05). Ponch- correlated with erected length. ietti et al.,6 in a subgroup of 325 males, found Flaccid circumference and height are found to be similar correlation for height with midpoint circum- most closely correlated with erected circumfer- ference, flaccid and stretched penile lengths. This ence. goes consistent with the findings of the present Regression equation was formed and flaccid study. Awwad et al.7 also found significant correla- length is found to be the best predictor of erected

International Journal of Impotence Research Penile length and circumference K Promodu et al 563 length. Flaccid circumference and height were 6 Ponchietti R, Mondaini N, Bonafe M, Loro FD, Biscioni S, found to be the best predictor of erected circum- Masieri L. Penile length and circumference: a study on 3300 ference. young Italian males. Eur Urol 2001; 39: 183–186. 7 Awwad ZM, Abu-Hijleh MO, Basari SN, Shegam NSh, Significant difference observed between the penile Murshid MS, Ajlouni K. Penile measurements in normal dimensions reported from different countries. adult Jordanians and in patients with erectile dysfunction. To gain more insight into the morphological Int J Impot Res 2005; 17: 191–195. aspects of penile dimensions, a multicentered 8 Ajmani ML, Jain SP, Saxena SK. Anthropometric study of male genitalia of 320 healthy Nigerian adults. Anthropol Anz 1985; multiethnic study is needed. 43: 179–186. 9 Chen J, Gefen A, Greenstein A, Matzkin H, Elad D. Predict- ing penile size during erection. Int J Impot Res 2001; 12: 328–333. References 10 Bondil P, Cost P, Daures JP, Louis JF, Navratil H. Clinical study of the longitudinal deformation of the flaccid penis and of its 1 Wessells H, Lue TF, Mc Aninch JW. Penile length in the flaccid variations with aging. Eur Urol 1992; 21: 284. and erect states: guidelines for penile augmentation. J Urol 11 Richters J, Georofi J, Donovan B. Are condoms the right size(s): 1996; 156: 995–997. a method for self measurement of erect penis. Venerology 2 Mondaini N, Ponchietti R, Gontero P, Muir GH, Natali A, 1995; 8: 77–81. Caldarera E et al. Penile length is normal in most men seeking 12 Kinsey AC, Pomeroy WB, Martin CE. Sexual Behaviour in the penile lengthening procedures. Int J Impot Res 2002; 14: Human Male. Sauders: Philadelphia, 1948. 283–286. 13 Schonfeld WA, Beebe GW. Normal growth and variation in the 3 Son H, Lee H, Huh JS, Kim SW, Paick JS. Studies on self male genitalia from birth to maturity. J Urol 1942; 48: 759. esteem of penile size in young Korean military men. Asian J 14 Loeb H. Harnrohrencapacitat und Tripperspritzen. Munch Androl 2003; 5: 185–189. Med Wochenschr 1899; 46: 17. 4 Alter GJ. Penis enhancement. AUA Update Series 1996; 15: 15 Da Ros C, Teloken C, Sogari P, Barcelos M, Silva F, Souto C 93–100. et al. Caucasian penis. What is the normal size? J Urol 1994; 5 Schneider T, Sperling H, Lummen G, Syllwasschy J, Rubben H. 151: 323A. Does penile size in younger men cause problems in condom 16 Smith AM, Jolley D, Hocking J, Benton K, Gerofi J. Does penis use? A prospective measurement of penile dimensions in 111 size influence condom slippage and breakage? Int J STD AIDS young and 32 older men. Urology 2001; 57: 314–318. 1998; 9: 444–447.

International Journal of Impotence Research