Relationship Between Penile Size and Somatometric Parameters in 2276 Healthy Young Men

ORIGINAL ARTICLE Relationship between penile size and somatometric parameters in 2276 healthy young men

HSo¨ ylemez1, M Atar1, AA Sancaktutar1, N Penbegu¨l1, Y Bozkurt1 and K O¨ nem2

The aim of this study was to determine the average penile length of a group of healthy, young Turkish men, and to investigate the relationship between penile length and somatometric parameters in the same group. The flaccid and stretched length and circumference of the penis was measured in a group of 2276 physically normal, young men. The correlation between penile length and weight, height and body mass index (BMI) of the participants was determined by Pearson’s analysis. The mean age of the participants was 21.1±3.1 (18--39) years. The mean flaccid, fully stretched and circumferential length of the participants’ penises were 8.95±1.04, 13.98±1.58 and 8.89±0.86 cm, respectively. There was a significant relationship between all of these variables (Po0.01). Although weak positive correlations were found between the mean circumference length and BMI, there were no correlations between both the flaccid and stretched lengths and BMI. The penile length must be known to be able to determine the abnormal penile sizes and to make convenient decisions in the counseling and/or treatment of people with short penis concerns. Our study provides mean penile lengths in a large sample of healthy, young Turkish men, and the penile dimensions were found to be weakly correlated with somatometric parameters.

International Journal of Impotence Research (2012) 24, 126--129; doi:10.1038/ijir.2011.53; published online 22 December 2011 Keywords: penile size; somatometric parameters; young men

INTRODUCTION and somatometric parameters in a group of healthy, young Morphological abnormalities of the penis can affect interpersonal Turkish men. relations and provoke emotional disorders, affecting quality of life.1 Additionally, the penis appears in virtually every aspect of life, such as medicine, religion, art and culture, the media and the common folklore. Concerns over penile size and a desire for a MATERIALS AND METHODS longer penis are common in the male population, and the number After the Local Institutional Review Board of Dicle University Medical of male patients seeking andrological consultations for a ‘short Faculty’s approval was obtained contingent upon receiving informed penis’ is increasing.2 consent, 2276 healthy, adult men, 18--39 years old were involved in the Penile length measurement is necessary in many situations. study, which took place between March 2009 and May 2010. Individuals Some of these situations include a diagnosis of micro penis with congenital or acquired genital abnormalities (e.g., Peyronie’s disease, (including hormone deficiencies), anatomic malformations of the penile curvature) were excluded from the study. All measurements were genitalia, defining the situations requiring penile-lengthening performed by the same examiner (HS) to minimize the inter-observer error procedures, evaluating the results of medical or surgical interven- and under similar environmental conditions (room light, air-conditioned tion of the penis and experimental studies.3,4 On the other hand, it room and at temperatures varying from 23 to 25 1C). would help to educate and inform patients about normal penile Penile length was measured along the dorsum of the penis by a ruler sizes, who are anxious about the size of their penis and to with millimeter markings, with the subjects standing up. The penile manufacture condoms in the correct sizes.5 measurements assessed were the circumference; the diameter at the Many studies have investigated penile measurement and its midpoint of the penile shaft, at the flaccid length; from the pubopenile relationship to somatometric parameters such as height, weight, skin vertex, depressing the pubic fat, to the extremity of the glans, with the waist/hip ratio, body mass index (BMI), shoe size and index finger ruler placed against the dorsal part of the penis, at the fully-stretched length.6--9 The largest study on penile length in the current length; and from the pubopenile skin vertex, under maximal---but not literature was done by Ponchietti et al.9 on 3300 young Italian painful---extension and depressing the pubic fat, to the extremity of the males. They also correlated it with weight and height, but only glans with the ruler placed against the dorsal part of the penis. for a random sample of 325 subjects of the same set of subjects. All participants’ ages were recorded. Their height and weight were So far, this is the largest study to investigate both penile measured and recorded, and their BMI (ratio of weight in kilograms to measurements and somatometric parameters like height, weight height in meters squared) was calculated. and BMI. The statistical analyses were performed by SPSS for Windows 15.0 (SPSS The aim of this study was to determine the average penile Inc., Chicago, IL, USA). Data were presented as mean±s.d. Results were length and to investigate the relationship between penile length evaluated using descriptive statistics and a Pearson’s correlation analysis

1Department of Urology, Dicle University, Diyarbakir, Turkey and 2Department of Urology, Dr Munif Islamoglu State Hospital, Kastamonu, Turkey. Correspondence: Professor Dr H Soÿlemez, Department of Urology, Dicle University, Medical Faculty, Diyarbakir 21100, Turkey. E-mail: [email protected] Received 9 June 2011; revised 28 September 2011; accepted 20 October 2011; published online 22 December 2011 Penile length and somatometric parameters HSoÿlemez et al 127 (two-tailed Pearson’s correlation coefficient, or r). A P-value of less than friends, whereas 36% said that their concerns began during their 0.05 was used as a threshold for statistical significance. teenage years, after seeing pornography.10 If a man perceives his penis to be inadequate---whether real or imagined---negative feelings invade his interactions with his sexual partner, and even RESULTS with his professional associates.11 The mean age of the participants was 21.1±3.1 (18--39) years. Of The ‘small penis syndrome’ is defined as an anxiety and found these, 2259 (99.25%) were circumcised. Table 1 shows the in men with a normal-sized penis, but who are anxious about the size of the penis, in contrast to men who have a truly small penis characteristics of the study sample. In addition, Table 2 shows 12 the descriptive statistics for the penile dimensions among the (micropenis). The number of patients visiting sexual dysfunction clinics, who are concerned with having a short penis has been members of this sample. 2 The mean flaccid, fully stretched and circumferential lengths of found to be increasing steadily. Mondaini et al. reported that the penis of all participants were 8.95±1.04, 13.98±1.58 and most men who seek penile-lengthening surgery ‘overestimate’ the 8.89±0.86 cm, respectively. The mean flaccid penile length was ‘normal’ penile length. In their study of 67 patients complaining of shorter than the mean stretched penile length, and there was a a short penis, none were found to have a severely short penis. Of positive correlation between them (r ¼ 0.672, P ¼ 0.000). A these, 19 patients (28.3%) still wished to explore the possibility of positive, statistically significant correlation was found between surgery, despite after a thorough explanation during the visit. The data from Turkish population about penile length were the mean circumferential length, mean flaccid length and 3,6,13 stretched penile length: r ¼ 0.608, P ¼ 0.000 and r ¼ 0.371, reported previously. In 331 volunteers, 67% of them were satisfactory about their penile size (13.6±2.3), with a desire to P ¼ 0.000, respectively. 13 There was a weak negative correlation between age and have bigger penises during erection. Also, 62% of them were the mean circumferential length (r ¼À0.051, P ¼ 0.016), but no thought that a larger penis is more necessary for female sexual satisfaction. However, it is shown that women do not necessarily correlation was found with other penile measurements (P40.05). 14 Weight and height were found to have a weak positive correlation believe that a larger penis is ‘better’. This data showed that not with all penile measurements. Likewise, BMI was found to have a only patients with small penis syndrome, but also men who think weak positive correlation with flaccid and circumferential lengths, his penis is normal want to enhance his penis in Turkey as a result but not with the stretched length. of penis is a symbol of masculinity. Although the desire for penile augmentation is increasing worldwide, indications of such have not yet been clearly 15 DISCUSSION established, and many complications have been reported. Surgical techniques for penile elongations offered to young men There has been a steady increase in the number of people that think their penis is too small are limited, and the few complaining of having a ‘short penis’ and consequently seeking described lack high numbers of patients and long-term follow- penile enlargement procedures. This is likely a result of many up.16 Liposuction can provide a ‘visual’ lengthening effect only. young men who seemingly base their idea of normality on the Suspensory ligament release followed by post-operative penile images of penises seen in pornography. It seems that the stretching provides some length gain (1--2 cm), associated with percentage of men worried about having a short penis will relatively rare complications such as penile shortening, decreased increase in the near future as a result of misleading messages angle of elevation or penile instability.17,18 Skin enhancement coming from these media, particularly in the Internet era, where techniques can cause severe deformities, dehiscence, and in some pornographic images of very large penises are often co-marketed cases, hypertrophic scarring.16 Thus, providing standardized data with devices or clinics claiming to be able to increase penile size.2 on penile dimensions seem necessary to make convenient In a recent study, of the 250 patients with a complaint of a small decisions in the treatment of people with short-penis concerns. penis, 64% said that their concerns about penile size started in The tissue quality of the penis has been found to decrease childhood, when they compared their penis with that of their significantly with aging, and the biomechanical behavior of the flaccid penis during stretching is significantly different for young men than it is for old men.19 This reality is why we used young Table 1. Descriptive statistics for the general characteristics of the men for the study. Turkish adult male There has still not been enough study on the topic, and there is no standard technique for getting an accurate penile length Characteristics Min Max Mean s.d. measurement. Some of the authors measured penile length at the dorsum of the penis from the pubopenile junction to the tip of the Age (years) 18.00 39.00 21.12 3.08 glans.6,20 However, others described a more accurate method to Weight (kg) 50.00 103.00 69.04 6.93 measure penile length.21 --23 On the basis of this method, in this Height (cm) 159.00 193.00 174.79 5.44 study, researchers preferred to push the caliper into the pubic BMI 16.90 34.81 22.59 1.97 bone at the dorsal aspect of the penis to eliminate the effect of Abbreviations: BMI, body mass index; Max, maximum; Min, minimum. the pubic fat pad. Measurements of the penile length are generally made during flaccid, stretched and erect states. The first study about penile length was reported by Loeb24 in 1899, and the average Table 2. Descriptive statistics for penile measurements of Turkish flaccid penile length as he measured it was 9.41 cm. The average adult male flaccid penile length, circumference and the mean stretched length obtained in the present study are similar to the other Penile measurements Min Max Mean s.d. countries shown in Table 3. In the relevant literature, some general observations are possible about the penile length. First, the values Circumference (cm) 6.50 13.5 8.89 0.86 for penile length show some consistency. Second, with a value of Flaccid length (cm) 6.00 15.00 8.95 1.04 8--10 cm, the flaccid length is usually 3--4 cm shorter than the Fully stretched length (cm) 9.00 20.00 13.98 1.58 stretched penile length and 5--6 cm shorter than the erect length. Abbreviations: Max, maximum; Min, minimum. Third, there is a good correlation between stretched penile length and erect length.12,20 It is generally accepted that a true

& 2012 Macmillan Publishers Limited International Journal of Impotence Research (2012), 126 --129 Penile length and somatometric parameters HSo¨ylemez et al 128 Table 3. Previous reports on penile measurements in the current literature

Publication Age Flaccid penile Stretched penile Circumference Authors year Country N (years) length (cm) length (cm) length (cm)

Kinsey et al.27 1948 USA 2770 20--59 9.7 15.5 NA Ajmani et al.28 1985 Nigeria 320 17--23 8.16 NA 8.83 Wessells et al.20 1996 USA 80 21--82 8.85 12.45 9.71 Chen et al.23 2000 Israel 55 21--78 8.3 12.5 NA Ponchietti et al.9 2001 Italy 3300 17--19 9.0 12.5 10.0 Sengezer et al.3 2002 Turkey 200 20--22 6.8 12.7 NA Spyropoulos et al.8 2002 Greece 52 19--39 7.76 12.18 8.68 Awwad et al.29 2005 Jordan 271 17--83 9.3 13.5 8.98 Mehraban et al.4 2007 Iran 1500 20--40 NA 11.58 8.66 Promodu et al.30 2007 India 301 18--60 8.21 10.88 9.14 Aslan et al.6 2010 Turkey 1132 19--30 9.3 13.7 NA Present study 2011 Turkey 2276 18--39 8.95 13.98 8.89 Mean dimensions of 1948--2011 Worldwide Total 12 257 17--83 8.64 12.87 9.11 all cited reports Abbreviation: NA, not applicable.

micropenis is 42.5 s.d. below the mean length, and it was addressed the impact of circumcision on penile measurements suggested that any penis with a stretched length of o7cmisa in adults. To the our best knowledge, only one report have true micropenis.20 demonstrated a statistically significant difference between The above-mentioned studies tried to determine the normal circumcised and uncircumcised penises in Brazilian child.26 penile length. However, the variability among these values However, they report that the length of penile corporeal body reflects the ethnic diversity of populations that were studied, as evaluated by ultrasound are not significantly affected neither in well as different measurement techniques. The differences in age circumcised, nor uncircumcised penises. We could not compare characteristics and study samples of the patient groups used for the circumcised with the uncircumcised men, as there were so few the studies could also be contributing factors. To our knowledge, of the latter. To investigate the effects of circumcision on the the current study is the third-largest series in the relevant penile measurement, further studies are needed. literature, and the average penile length was found to be parallel to the other series, as shown in Table 3. In the previous decades, numerous urological studies have Conclusion focused on penile measurements in different populations, but few To inform a man who perceives his penis as being inadequate, studies are available about the relationship between penile and before surgical planning for penis enlargement, urologists measurements and different explanatory variables, such as must know the normal penile length in their patients’ specific somatometric parameters. Shah and Christopher7 reported no population. In this study, the mean flaccid, stretched and correlation between shoe size and penile length. A study of 52 circumferential lengths were found to be 8.95, 13.98 and Greek males, aged 19--38, revealed that the glanular and total 8.89 cm, respectively. Significant inter-correlations were observed penile lengths are insignificantly inversely correlated to age, between all measures of penile dimensions. Penile dimensions are weight, BMI and height/weight ratio, and positively to height and found to be correlated with somatometric measures, such as (statistically significantly) with index finger length.8 In the largest height, weight and BMI. A significant difference was observed study of literature, Ponchietti et al.,9 in a subgroup of 325 males, between the penile dimensions reported from different countries. showed that penile measurements (length and circumference The results demonstrate that, like other studies, penile lengths and at the midshaft) are correlated to height, weight, and BMI. In circumference measurements are somatometric characteristics a sample of 1500 young men, Mehraban et al.4 reported a and, as such, are related to somatometric parameters, even if this significant correlation among age, height, index finger length and relationship is not of clinical significance. To gain more insight into penile dimensions, but no significant effect of waist/hip ratio or the morphological aspects of penile dimensions, a multi-centered, weight. In the present study, weak positive correlations were multi-ethnic study is needed. found between penile measurements (circumference, flaccid and stretched lengths), and height and weight (the r-value varies from 0.076 to 0.205). Although weak positive correlations were found CONFLICT OF INTEREST between the mean circumference length and BMI, there were no correlations between the flaccid and stretched lengths and BMI. The authors declare no conflict of interest. To our knowledge, this is the largest study in the literature, until now, that investigated the relationship between penile size and somatometric parameters. Both the previous reports and our REFERENCES results demonstrate that there is no exact association between 1 Diseth TH, Bjordal R, Schultz A, Stange M, Emblem R. Somatic function, mental penile length and somatometric parameters. Therefore, this health and psychosocial functioning in 22 adolescents with bladder exstrophy correlation is inadequate to make a clinical application in which and epispadias. J Urol 1998; 159: 1684 --1689; discussion 1689 --1690. penile length measurements are necessary. However, these results 2 Mondaini N, Ponchietti R, Gontero P, Muir GH, Natali A, Caldarera E et al. Penile may demonstrate variability among different study samples, age length is normal in most men seeking penile lengthening procedures. Int J Impot Res 2002; 14: 283 --286. groups and ethnic populations. 3 Sengezer M, Ozturk S, Deveci M. Accurate method for determining functional Circumcision is a very common procedure in the world, though penile length in Turkish young men. Ann Plast Surg 2002; 48: 381 --385. 25 this ratio may vary in different countries. In our study, 99.25% of 4 Mehraban D, Salehi M, Zayeri F. Penile size and somatometric parameters among those seen were circumcised in Turkey. There is no study that has Iranian normal adult men. Int J Impot Res 2007; 19: 303 --309.

International Journal of Impotence Research (2012), 126 --129 & 2012 Macmillan Publishers Limited Penile length and somatometric parameters HSoÿlemez et al 129 5 Schneider T, Sperling H, Lummen G, Syllwasschy J, Rubben H. Does penile size in 17 Murtagh J. The ‘small’ penis syndrome. Aust Fam Physician 1989; 18: 218, 220. younger men cause problems in condom use? a prospective measurement of 18 Li CY, Kayes O, Kell PD, Christopher N, Minhas S, Ralph DJ. Penile suspensory penile dimensions in 111 young and 32 older men. Urology 2001; 57: 314 --318. ligament division for penile augmentation: indications and results. Eur Urol 2006; 6 Aslan Y, Atan A, Omur Aydin A, Nalcacioglu V, Tuncel A, Kadioglu A. Penile length 49: 729 --733. and somatometric parameters: a study in healthy young Turkish men. Asian J 19 Bondil P, Costa P, Daures JP, Louis JF, Navratil H. Clinical study of the longitudinal Androl 2010; 13: 339 --341. deformation of the flaccid penis and of its variations with aging. Eur Urol 1992; 21: 7 Shah J, Christopher N. Can shoe size predict penile length? BJU Int 2002; 90: 284 --286. 586 --587. 20 Wessells H, Lue TF, McAninch JW. Penile length in the flaccid and erect states: 8 Spyropoulos E, Borousas D, Mavrikos S, Dellis A, Bourounis M, Athanasiadis S. Size guidelines for penile augmentation. J Urol 1996; 156: 995 --997. of external genital organs and somatometric parameters among physically 21 Ting TH, Wu LL. Penile length of term newborn infants in multiracial Malaysia. normal men younger than 40 years old. Urology 2002; 60: 485 --489; discussion Singapore Med J 2009; 50: 817 --821. 490 --481. 22 Gabrich PN, Vasconcelos JS, Damiao R, Silva EA. Penile anthropometry in Brazilian 9 Ponchietti R, Mondaini N, Bonafe M, Di Loro F, Biscioni S, Masieri L. Penile length children and adolescents. J Pediatr (Rio J) 2007; 83: 441 --446. and circumference: a study on 3,300 young Italian males. Eur Urol 2001; 39: 23 Chen J, Gefen A, Greenstein A, Matzkin H, Elad D. Predicting penile size during 183 --186. erection. Int J Impot Res 2000; 12: 328 --333. 10 Ghanem H, Shamloul R, Khodeir F, ElShafie H, Kaddah A, Ismail I. Structured 24 Loeb H. Harnrohrencapacitat und Tripperspritzen. Munch Med Wochenschr 1899; management and counseling for patients with a complaint of a small penis. J Sex 46:17. Med 2007; 4: 1322 --1327. 25 Burgu B, Aydogdu O, Tangal S, Soygur T. Circumcision: Pros and cons. Indian J Urol 11 Alter GJ. Augmentation phalloplasty. Urol Clin North Am 1995; 22: 887 --902. 2010; 26:12--15. 12 Wylie KR, Eardley I. Penile size and the ‘small penis syndrome’. BJU Int 2007; 99: 26 Smith DP, Rickman C, Jerkins GR. Ultrasound evaluation of normal penile 1449 --1455. (corporeal) length in children. J Urol 1995; 154(2 Part 2): 822 --824. 13 Kuzgunbay B, Turunç T, Gu¨vel S, O¨ zkardes¸ H. The average penile size of 27 Kinsey A, Pomeroy W, Martin C. Sexual Behaviour in the Human Male. WB Saunders the Turkish men and their opinions about the penile size. Turk J Urol 2007; 33: Co.: Philadelphia, PA, 1948. 290 --293. 28 Ajmani ML, Jain SP, Saxena SK. Anthropometric study of male external genitalia of 14 Francken AB, van de Wiel HB, van Driel MF, Weijmar Schultz WC. What importance 320 healthy Nigerian adults. Anthropol Anz 1985; 43: 179 --186. do women attribute to the size of the penis? Eur Urol 2002; 42: 426 --431. 29 Awwad Z, Abu-Hijleh M, Basri S, Shegam N, Murshidi M, Ajlouni K. Penile 15 Son H, Lee H, Huh JS, Kim SW, Paick JS. Studies on self-esteem of penile size in measurements in normal adult Jordanians and in patients with erectile young Korean military men. Asian J Androl 2003; 5: 185 --189. dysfunction. Int J Impot Res 2005; 17: 191 --195. 16 Vardi Y, Gruenwald I. The status of penile enhancement procedures. Curr Opin 30 Promodu K, Shanmughadas KV, Bhat S, Nair KR. Penile length and circumference: Urol 2009; 19: 601 --605. an Indian study. Int J Impot Res 2007; 19: 558 --563.

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