International Journal of Impotence Research (2005) 17, 191–195 & 2005 Nature Publishing Group All rights reserved 0955-9930/05 $30.00 www.nature.com/ijir Penile measurements in normal adult Jordanians and in patients with erectile dysfunction Z Awwad1*, M Abu-Hijleh2, S Basri2, N Shegam3, M Murshidi1 and K Ajlouni3 1Department of Urology, Jordan University Hospital, Amman, Jordan; 2Jordan Center for the Treatment of Erectile Dysfunction, Amman, Jordan; and 3National Center for Diabetes, Endocrinology and Genetics, Amman, Jordan The purpose of this work was to determine penile size in adult normal (group one, 271) and impotent (group two, 109) Jordanian patients. Heights of the patients, the flaccid and fully stretched penile lengths were measured in centimeters in both groups. Midshaft circumference in the flaccid state was recorded in group one. Penile length in the fully erect penis was measured in group two. In group one mean midshaft circumference was 8.9871.4, mean flaccid length was mean 9.371.9, and mean stretched length was 13.572.3. In group two, mean flaccid length was 7.771.3, and mean stretched length was 11.671.4. The mean of fully erect penile length after trimex injection was 11.871.5. In group 1 there was no correlation between height and flaccid length or stretched length, but there was a significant correlation between height and midpoint circumference, flaccid and stretched lengths, and between stretched lengths and midpoint circumference. In group 2 there was no correlation between height and flaccid, stretched, or fully erect lengths. On the other hand, there was a significant correlation between the flaccid, stretched and fully erect lengths. Comparing group 1 and group 2, the patients in group 1 were slightly older than in group 2 (P ¼ 0.035), but there was no significant difference in their height. However, there was a significant difference regarding the mean flaccid length 9.3 vs 7.7 (P ¼ 0.001), and the mean stretched length 13.5 vs 11.6 (P ¼ 0.000). We divided both groups into those who are less than 40 y of age, and over 40 y old. There was no statistical difference in the stretched and flaccid lengths between the younger and older individuals in each group. However, when we compared the stretched and flaccid lengths in those of less than 40 y old in group 1 and 2, a significant difference was noticed. Similarly, a significant difference in the stretched and flaccid lengths in those patients over 40 y of age was also present. International Journal of Impotence Research (2005) 17, 191–195. doi:10.1038/sj.ijir.3901272 Published online 28 October 2004 Keywords: penis; measurement; Jordan Introduction The knowledge of what normal penile size is has become more important in the presence of demand for penile lengthening procedures.3 Moreover, pe- Penile size is often associated with much interest in nile size might be important in the manufacturing of different cultures including the Arab culture. Larger condoms.4 size is perceived to validate sexual function and Several studies regarding phallic size have been fertility potential, although a recent study showed published.3,5,6 The aim of this study is to report that only one-third of women attach substantial penile measurements in two groups of adult Jorda- 1 importance to the size of the male sexual organ. nian populations. The first group is of normal Clinicians especially urologists are confronted by individuals, while the second group is of patients questions regarding the normal penile dimensions with erectile dysfunction as well as to compare our as well as the relation to different parts of the body results with previously published data. such as foot size.2 *Correspondence: Z Awwad, Urology, Jordan University Patients and methods Hospital, Queen Rania Street, PO Box 13046, Amman, Jordan. E-mail: [email protected] Individuals included in group one were patients Received 2 April 2004; revised 21 September 2004; aged 17 y and older attending urology clinic for accepted 21 September 2004 reasons other than erectile dysfunction. Penile measurements in normal adults and impotent Jordanian patients Z Awwad et al 192 Individuals of the second group were patients Statistical analysis by age was also performed to attending Jordan specialized center for the treatment remove the possible effect of age on these compa- of erectile dysfunction. Patients in both groups were nions correlation between height, penile length, and further subdivided into those who are below 40 y of midpoint circumference. age and those over 40 y. Patients with hormonal or chromosomal abnorm- ality as well as patients with previous history of Results congenital penile problems, surgery or Peronyie’s disease were excluded from the study. Verbal consent was obtained from all patients. A total of 271 patients were included in group one Height of the patients in both groups was recorded. (mean age 44.6716.3) y, range (17–83). Table 1 Penile measurements were taken immediately after shows the clinical characteristics and measurements the patient undressed to minimize the effect of of group one. temperature and touch on penile size. The measure- In group two, 109 patients were included (mean ments were taken while the patients were lying age 41711.7) y (range 22–68). Table 2 shows the down and the legs slightly abducted. The flaccid clinical characteristics and measurements of this and fully stretched penile lengths were measured in group. both groups. In addition, midshaft circumference in In group 1, there was no correlation between the flaccid state was measured in group one, and in height and flaccid length (r ¼ 0.03, P40.05) or the second group, penile length in the fully erect stretched length (r ¼ 0.05, P40.05). On the other penis was measured. Full erection state was hand, there was a significant correlation between achieved using intracavernosal injection of trimex height and midpoint circumference (r ¼ 0.14, (each 1 ml of trimex is composed of papaverine Po0.05). There was also a significant correlation 30 mg, phentolamine 1 mg, and prostaglandin 10 mg). between flaccid and stretched lengths (r ¼ 0.60, The dose of trimex ranging from 0.1 to 0.4 ml. Po0.05), and between stretched lengths and mid- Patients who did not achieve full nonbendable point circumference (r ¼ 0.30. Po0.05) as shown in erection were excluded from the study. Table 3. A measuring tape was used to measure the length, In group 2, there was no correlation between and the midshaft circumference of the penis. The height and flaccid length (r ¼ 0.04, P40.05), starting point was on the dorsal aspect of the penis stretched length (r ¼ 0.04, P40.05), or fully erect at its base at the pubic–penile skin junction, length (r ¼ 0.17, P40.05). On the other hand, there pushing the prepubic fat pad against the pubic bone was a significant correlation between the flaccid and 3 as described by Wessels et al, while the tip of the stretched lengths (r ¼ 0.65, Po0.05), the flaccid and penis was the other reference point. Measurements were taken by the two urologists, and endocrinologist involved in the investigation Table 1 Clinical characteristics and measurements of Group1 for group one and two, and each one was instructed (271 patients) on the same and exact method of measurement. In addition, several measurements were repeated by Variable Mean þ s.d. Range two investigators on different visits and found to be similar. All measurements were approximated to the Age (y) 44.6716.3 17–83 Height (cm) 171.676.6 150–195 nearest 0.5 cm. Length stretch (cm) 13.572.3 7.5–20 Length flaccid (cm) 9.371.9 4.0–15 Circumference mid (cm) 8.971.5 2.0–12 Statistical analysis Data management and statistical analysis Table 2 Clinical characteristics and measurements of Group 2 (109 patients) Data were entered and analyzed using EPI info Variable Mean7s.d. Range version 6. Initially, range and logical checks were performed on the data. Defected errors were cor- Age (y) 41.0711.7 22–68 rected by returning to original data forms. Height (cm) 171.576.7 153–190 7 The stretched and flaccid penile length was Length stretch (cm) 11.6 1.4 8.0–15 Length flaccid (cm) 7.771.3 4.0–10 compared between the group with and without Fully erected (cm) 11.871.5 8–16 erectile dysfunction. Statistical significance of ob- Duration ED (weeks) 154.67161.9 1–1300 scene difference was assessed using the two-sample independent t-test. ED: erectile dysfunction. International Journal of Impotence Research Penile measurements in normal adults and impotent Jordanian patients Z Awwad et al 193 fully erect length after trimex injection (r ¼ 0.44, Table 6 Stretched and flaccid penile lengths of both groups by Po0.05), and the stretched and fully erect length age (r ¼ 0.51, Po0.05) (Table 4). Comparing group 1 and group 2, the patients in Age group Stretch length Flaccid length the first group were slightly older than in group 2 Mean7s.d. P-value Mean7s.d. P-value (P ¼ 0.035), but there was no significant difference in their height. There was a significant difference o40 regarding the mean flaccid length 9.3 vs 7.7 EDÀ 13.5 (2.1) 0.001 9.2 (1.7) 0.000 (P ¼ 0.001), and the mean stretched length 13.5 vs ED þ 11.8 (1.5) 7.8 (1.2) 11.6 (P ¼ 0.000) (Table 5). The two groups were further divided into those 440 EDÀ 13.6 (2.5) 0.000 9.5 (2.1) 0.000 less than 40 and more than 40 y old.