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Belladelli F, Del Giudice F, Glover F, Mulloy E, Muncey W, Basran S, Fallara G, Pozzi E, Montorsi F, Salonia A, Eisenberg ML. Worldwide Temporal Trends in Penile Length: A Systematic Review and Meta-Analysis. World J Mens Health 2023; 41:848-860. [PMID: 36792094 PMCID: PMC10523114 DOI: 10.5534/wjmh.220203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 02/17/2023] Open
Abstract
PURPOSE Normative male genital measurements are clinically useful and temporal changes would have important implications. The aim of the present study is to characterize the trend of worldwide penile length over time. MATERIALS AND METHODS A systematic review and meta-analysis using papers from PubMed, Embase, and Cochrane Library from inception to April 2022 was performed. PRISMA guidelines were used for abstracting data and assessing data quality and validity. Pooled means and standard deviations for flaccid, stretched, and erect length were obtained. Subgroup analyses were performed by looking at differences in the region of origin, population type, and the decade of publication. Metaregression analyses were to adjusted for potential confounders. RESULTS Seventy-five studies published between 1942 and 2021 were evaluated including data from 55,761 men. The pooled mean length estimates were flaccid length: 8.70 cm (95% CI, 8.16-9.23), stretched length: 12.93 cm (95% CI, 12.48-13.39), and erect length: 13.93 cm (95% CI, 13.20-14.65). All measurements showed variation by geographic region. Erect length increased significantly over time (QM=4.49, df=2, p=0.04) in several regions of the world and across all age groups, while no trends were identified in other penile size measurements. After adjusting for geographic region, subject age, and subject population; erect penile length increased 24% over the past 29 years. CONCLUSIONS The average erect penis length has increased over the past three decades across the world. Given the significant implications, attention to potential causes should be investigated.
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Affiliation(s)
- Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
- Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Francesco Del Giudice
- Department of Urology, University Sapienza, Rome, Italy
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Frank Glover
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Evan Mulloy
- Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Wade Muncey
- Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Satvir Basran
- Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Michael L Eisenberg
- Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA.
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Maurer V, Howaldt M, Feldmann I, Ludwig T, Vetterlein MW, Gild P, Weis S, Marks P, Soave A, Meyer CP, Fisch M, Dahlem R, Riechardt S. Penile Flap Inversion Vaginoplasty in Transgender Women: Contemporary Morbidity and Learning-Curve Analysis From a High-Volume Reconstructive Center. Front Surg 2022; 9:836335. [PMID: 35284483 PMCID: PMC8906498 DOI: 10.3389/fsurg.2022.836335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/25/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Numbers of PIV are rising. The aim of this study is to analyze the surgical learning-curve (LC) on the grounds of perioperative complications. Patients and Methods 108 PIVs, performed by a single surgeon between 2015 and 2018 have been analyzed. Learning-curve analysis was based on three factors: operating time, vaginal depth and complications. Results The median FU was 6.3 months. Median age at surgery was 36 years, median time of hormone treatment was 36 months. The median CI was 0.3 and the median BMI was 25 kg/cm3. Median CCI® was 8.08. 40.7% of the patients developed short-term complications, more than half of which were Clavien I. Overall only 1.9% had Clavien IIIb complications. There were no Clavien IV or V complications. 17.6% of patients had wound infections, 13% wound dehiscence, 9.3% introitus strictures, 13.9% suffered from atrophy of the neovagina, i.e. loss of depth or width, and 8.3% from meatus urethrae strictures. Duration of hormonal therapy, BMI and CI had no impact on surgical outcome. Age had a significant impact on CCI®, as younger patients had a higher risk for complications. Use of scrotal skin and surgeries performed had a significant influence. LC analysis via CUSUM analysis showed that after 32 surgeries, the PIV is performed safely. Conclusion The PIV is a safe GAS-technique, associated with minor complications leading to low rates of revision surgery. Younger age, the use of scrotal skin and surgeon's experience has significant impact on complications. Duration of hormonal therapy, circumcision and BMI has no impact on complications.
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Colonnello E, Limoncin E, Ciocca G, Sansone A, Mollaioli D, Balercia G, Porst H, Zhang H, Yu X, Zhang Y, Jannini EA. The Lost Penis Syndrome: A New Clinical Entity in Sexual Medicine. Sex Med Rev 2021; 10:113-129. [PMID: 34620562 DOI: 10.1016/j.sxmr.2021.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/22/2021] [Accepted: 08/28/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The "lost penis syndrome" (LPS) is a term often used in non-clinical settings to describe the subjective perception of the loss of cutaneous and proprioceptive feelings of the male organ during vaginal penetration. Although deserving clinical attention, this syndrome did not receive any consideration in the medical literature. Notwithstanding, it represents a relatively unexceptional condition among patients in sexual medicine clinics, and it is often reported together with other sexual dysfunctions, especially delayed ejaculation, anejaculation, male anorgasmia and inability to maintain a full erection. OBJECTIVES To draft a new conceptual characterization of the LPS, defined as a lack of penile somesthetic sensations during sexual penetration due to various causes and leading to several sexual consequences in both partners. METHODS Based on an extensive literature review and physiological assumptions, the mechanisms contributing to friction during penovaginal intercourse, and their correlation to LPS, have been explored, as well as other nonanatomical factors possibly contributing to the loss of penile sensations. RESULTS Efficient penile erection and sensitivity, optimal vaginal lubrication and trophism contribute to penovaginal friction. Whenever one of these processes does not occur, loss of penile sensation defined as LPS can occur. Sociocultural, psychopathological and age-related (ie, couplepause) factors are also implicated in the etiology. Four types of LPS emerged from the literature review: anatomical and/or functional, behavioral, psychopathological and iatrogenic. According to the subtype, a wide variety of treatments can be employed, including PDE5i, testosterone replacement therapy and vaginal cosmetic surgery, as well as targeted therapy for concomitant sexual comorbidity. CONCLUSION We held up the mirror on LPS as a clinically existing multifactorial entity and provided medical features and hypotheses contributing to or causing the occurrence of LPS. In the light of a sociocultural and scientific perspective, we proposed a description and categorization of this syndrome hypothesizing its usefulness in daily clinical practice. Colonnello E, Limoncin E, Ciocca G, et al. The Lost Penis Syndrome: A New Clinical Entity in Sexual Medicine. Sex Med Rev 2021;XX:XXX-XXX.
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Affiliation(s)
- Elena Colonnello
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Erika Limoncin
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy; Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Giacomo Ciocca
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Andrea Sansone
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Mollaioli
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giancarlo Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Hartmut Porst
- European Institute for Sexual Health (EISH), Hamburg, Germany
| | - Hui Zhang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PRC
| | - Xi Yu
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PRC
| | - Yan Zhang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PRC
| | - Emmanuele A Jannini
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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Cakir OO, Pozzi E, Castiglione F, Alnajjar HM, Salonia A, Muneer A. Penile Length Measurement: Methodological Challenges and Recommendations, a Systematic Review. J Sex Med 2021; 18:433-439. [DOI: 10.1016/j.jsxm.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/21/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022]
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Nguyen Hoai B, Pham Minh Q, Nguyen Cao T, Sansone A, Colonnello E, Jannini EA. Data from 14,597 penile measurements of vietnamese men. Andrology 2021; 9:906-915. [PMID: 33484108 DOI: 10.1111/andr.12978] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/28/2020] [Accepted: 01/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Penis size is a highly sensitive topic, which has often raised concerns associated with human masculinity and male sexual health. Although data regarding penile dimensions have been published worldwide, little is known about these measurements in South-East Asian countries. OBJECTIVE This study aimed to provide the reference range in penile length, circumference, and diameter of Vietnamese men and their variations among men with erectile dysfunction and other diseases. MATERIALS AND METHODS Information about flaccid length, stretched length, mid-shaft circumference, and glans diameter from the health records of 14,597 men attending the Andrology Consultation was collected. These men were classified into three groups being regular reproductive health screening group, sexual dysfunction group, and other disease groups. RESULTS We found that penile dimensions follow a non-parametric distribution, as tested by Kolmogorov-Smirnov test. The median values are 9.03 cm for flaccid length, 14.67 cm for stretched length, 8.39 cm for mid-shaft circumference, and 2.86 cm for unaroused glans diameter. Length and girth of the penis also changed among the different groups, especially in flaccid state; specifically, men with erectile dysfunction had a greater value in all penile dimensions except for change ratio compared with other groups. Circumcision, which rarely occurs in Vietnam, was associated with a 2 mm reduced penis length. DISCUSSION Findings on correlations between penile dimensions and somatometric parameters from previous studies are questionable and some measurements, such as glans dimension, have not been thoroughly investigated so far. Nevertheless, penile dimensions provide useful insight concerning conditions affecting sexual development and might be a valuable parameter in the assessment of erectile dysfunction. CONCLUSION Results of this study provide informative materials for the assessment of penile size, including reference values drawn from a large sample of Vietnamese men that can be useful in clinical practice and sexual health education.
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Affiliation(s)
- Bac Nguyen Hoai
- Hanoi Medical University, Hanoi, Vietnam.,Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Quan Pham Minh
- Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Thang Nguyen Cao
- Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
| | - Andrea Sansone
- Chair of Endocrinology and Sexual Medicine (ENDOSEX, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Elena Colonnello
- Chair of Endocrinology and Sexual Medicine (ENDOSEX, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Emmanuele A Jannini
- Chair of Endocrinology and Sexual Medicine (ENDOSEX, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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King BM. Average-Size Erect Penis: Fiction, Fact, and the Need for Counseling. JOURNAL OF SEX & MARITAL THERAPY 2020; 47:80-89. [PMID: 32666897 DOI: 10.1080/0092623x.2020.1787279] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Most men believe that the average length of an erect penis is greater than 6 inches (15.24 cm). This belief is due, in part, to several often-cited studies that relied on self-reported measurements, with means of about 6.2 inches (15.75 cm) for heterosexual men and even greater for gay men. These studies suffered from both volunteer bias and social desirability bias. In this review, the combined mean for 10 studies in which researchers took measurements of erect penises was 5.36 inches (13.61 cm; n = 1,629). For 21 studies in which researchers measured stretched penises, the mean was approximately 5.11 inches (12.98 cm; n = 13,719). Based on these studies, the average length of an erect penis is between 5.1 and 5.5 inches (12.95-13.97 cm), but after taking volunteer bias into account, it is probably toward the lower end of this range. Studies show that a majority of men wish they were larger, with some choosing penile lengthening surgery. These surgeries are considered by the American Urological Association to be risky. Most men seeking surgery have normal sized penises. Counseling with factual information about penis size might be effective in alleviating concerns for the majority of men who worry about having a small penis.
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Affiliation(s)
- Bruce M King
- Department of Psychology, Clemson University, Clemson, SC, USA
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Greenstein A, Dekalo S, Chen J. Penile size in adult men—recommendations for clinical and research measurements. Int J Impot Res 2019; 32:153-158. [DOI: 10.1038/s41443-019-0157-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 03/28/2019] [Accepted: 04/23/2019] [Indexed: 11/09/2022]
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Littara A, Melone R, Morales-Medina JC, Iannitti T, Palmieri B. Cosmetic penile enhancement surgery: a 3-year single-centre retrospective clinical evaluation of 355 cases. Sci Rep 2019; 9:6323. [PMID: 31004096 PMCID: PMC6474863 DOI: 10.1038/s41598-019-41652-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 08/06/2018] [Indexed: 11/15/2022] Open
Abstract
Men's satisfaction and sexual function is influenced by discomfort over genital size which leads to seek surgical and non-surgical solutions for penis alteration. In this article we report the results of a retrospective study of 355 cases of cosmetic elongation, enlargement and combined elongation and enlargement phalloplasty. We found a significant improvement in length at rest, stretched length and circumference at rest at 2, 6 and 12 months post-surgical procedure (all p < 0.0001). 5-item International Index of Erectile Function (IIEF-5) was also increased at 12 months post-surgery compared to baseline (p < 0.0001). This was consistent with an IIEF-5 improvement of 6.74% compared to baseline. This study is clinically relevant due to the large cohort of patients included and because it is the first study to use an inverse periosteal-fascial suture not described previously as part of the surgical methodology.
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Affiliation(s)
| | | | - Julio Cesar Morales-Medina
- Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de CP 90000, AP 62, Tlaxcala, Mexico
| | - Tommaso Iannitti
- KWS BioTest, Marine View Office Park, Portishead, BS20 7AW, United Kingdom
| | - Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy
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King BM, Duncan LM, Clinkenbeard KM, Rutland MB, Ryan KM. Social Desirability and Young Men's Self-Reports of Penis Size. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:452-455. [PMID: 30681032 DOI: 10.1080/0092623x.2018.1533905] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Previous studies demonstrate that many men have insecurities about the size of their penises, often resulting in low sexual self-esteem and sexual problems. In the present study, mean self-reported erect penis length by 130 sexually experienced college men (6.62 inches) was greater than found in previous studies in which researchers took measurements. This suggests that many of the men embellished their responses. Only 26.9% of the sexually experienced men self-reported penis lengths of less than 6 inches, while 30.8% self-reported lengths of 7 inches or more (with 10% self-reporting 8 inches or more). The correlation with Marlowe-Crowne social desirability scores was +.257 (p < .01), indicating that men with a high level of social desirability were more likely than others to self-report having a large penis.
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Affiliation(s)
- Bruce M King
- a Department of Psychology , Clemson University , Clemson , SC , USA
| | - Lauren M Duncan
- a Department of Psychology , Clemson University , Clemson , SC , USA
| | | | - Morgan B Rutland
- a Department of Psychology , Clemson University , Clemson , SC , USA
| | - Kelly M Ryan
- a Department of Psychology , Clemson University , Clemson , SC , USA
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Joki-Erkkilä M, Suikki E. Impact of mechanical force on posterior hymen - Implications for sexual abuse injury interpretations. Forensic Sci Int 2018; 292:204-211. [PMID: 30326366 DOI: 10.1016/j.forsciint.2018.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Residual anogenital findings following sexual abuse are rare. There is a need for further understanding of the interpretation of hymenal findings. OBJECTIVES This study evaluates which is more significant with respect to posterior hymenal tissue morphology - previous consensual penile vaginal penetrations or vaginal delivery. DESIGN A post hoc study comparing nulliparous and parous hymen in heterosexually active female volunteers, with the focus on healed hymenal defects. Adult posterior hymen configuration was evaluated using labial separation or traction. When needed, the hymenal status was evaluated using a swab. A colposcopy with photography was used for documentation. Experts reviewed all taken photographs and recorded the posterior hymenal defects. Photographs were analyzed to determine the level of agreement. PARTICIPANTS Eighty-seven adult female volunteers were recruited to participate in the study by a personal invitation to a gynecological examination to document anogenital findings. The examination was performed following consensual vaginal intercourse. Age ranged from 20 to 53 (median 26.6years). RESULTS Single site posterior hymenal transections were significantly more likely in the nulliparous volunteers, compared to the parous volunteers (22/51, 43.1% vs. 4/36, 11.1%, p<0.001). A deep notch, which extends nearly to the base of the hymen was detected in one (2.0%) sexually active nulliparous volunteer, and surprisingly two (3.9%) volunteers had a single, more superficial hymenal notch, that is not considered a sign of previous vaginal penetration. The width of the ridge of the posterior vaginal wall in the vestibule was measured from the anterior part of the navicular fossa to the base of the hymen. The mean width of the ridge of the posterior vaginal wall was 3.1mm (SD2.2, range 0-8) in the photos of 41 nulliparous volunteers. The prevalence of 'double leaf hymen' was 2/87 (2.3%). The inter-rater reliability with a Kappa score of 0.69 indicated strong agreement. CONCLUSION The myth "hymen is present only in virgins" has now been invalidated. The absence of posterior hymen increases delivery by delivery in adult female volunteers. The space between the anterior part of the navicular fossa and the base of hymen, 'the ridge of the posterior vaginal wall' in the vestibule was evaluated for the first time among studies evaluating hymenal status. Careful assessment of the ridge of the posterior vaginal wall is needed to avoid misinterpretations when evaluating the depth of a hymenal defect.
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Affiliation(s)
- Minna Joki-Erkkilä
- Departments of Forensic Child Psychiatry and Gynecology and Obstetrics, Tampere University Hospital, Finland.
| | - Elina Suikki
- Departments of Forensic Child Psychiatry and Gynecology and Obstetrics, Tampere University Hospital, Finland
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Habous M, Muir G, Soliman T, Farag M, Williamson B, Binsaleh S, Elhadek W, Mahmoud S, Ibrahim H, Abdelwahab O, Abdelrahman Z, Abdelkader M, Jenkins LC, Mulhall JP. Outcomes of variation in technique and variation in accuracy of measurement in penile length measurement. Int J Impot Res 2018; 30:21-26. [DOI: 10.1038/s41443-017-0013-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 09/18/2017] [Accepted: 10/23/2017] [Indexed: 11/09/2022]
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12
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Penile Length: Measurement Technique and Applications. Sex Med Rev 2017; 6:261-271. [PMID: 29289534 DOI: 10.1016/j.sxmr.2017.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/01/2017] [Accepted: 10/06/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Penile size has long been an important fixation in men's lives. On the one hand, a smaller penis has been associated with anxiety and apprehension; on the other hand, a larger penis has generally been related to virility and strength. These perceptions predominate during an erection, when penile size is representative of a man's masculinity. AIM To assess adult penile length and summarize average penile length assessments from the literature; analyze how various urologic diseases and therapies affect penile length and volume; and review how surgical treatments for Peyronie's disease, penile prosthesis implantation, and radical prostatectomy can affect penile size to appropriately counsel patients seeking such therapies and set realistic goals for patients. METHODS To achieve the aim of this review, we analyzed the literature on penile size and volume and how these can be affected by various urologic diagnoses and therapies. We summarize common diagnoses and therapies that can affect penile size. MAIN OUTCOME MEASURE We thoroughly discuss how the aforementioned diagnoses and therapies can negatively affect penile size. In doing so, we allow readers to understand the intricacies of penile size when faced with such diagnoses and therapies in their patients. RESULTS Surgical treatments for Peyronie's disease, penile prosthesis implantation for refractory erectile dysfunction, and radical prostatectomy for prostate cancer can lead to a decrease in penile size. CONCLUSION Urologists must recognize that the different therapies they offer can affect a man's penile size, often negatively. This in turn can lead to poorer satisfaction outcomes in patients. Davoudzadeh EP, Davoudzadeh NP, Margolin E, et al. Penile Length: Measurement Technique and Applications. Sex Med Rev 2018;6:261-271.
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Isaacson D, Aghili R, Wongwittavas N, Garcia M. How Big is Too Big? The Girth of Bestselling Insertive Sex Toys to Guide Maximal Neophallus Dimensions. J Sex Med 2017; 14:1455-1461. [PMID: 29110808 DOI: 10.1016/j.jsxm.2017.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 08/07/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND In our practice we have encountered 4 female-to-male transgender patients seeking neophallus revision surgery for girth precluding penetrative vaginal or anal intercourse. Despite this, there is little evidence available to guide transitioning patients in neophallus sizing. In this work we examined the dimensions of bestselling realistic dildos, presuming that the most popular dimensions would reflect population preferences for penetrative toys and phalluses. AIM To determine a maximal upper limit for girth compatible with penetrative intercourse based on measurements of bestselling realistic dildos and published erect penile dimensions. METHODS We collected measurements for "realistic dildos" designated as bestsellers for the top 5 Alexa.com-rated online adult retailers in the United States and for Amazon.com. We compared these with measurements of dildos available at Good Vibrations in San Francisco and with studies of erect natal dimensions. We compared all data with measurements of 4 index patients whose neophallus girth prevented penetrative intercourse. OUTCOMES Length and circumference of overall bestselling and largest bestselling realistic dildos as reported on top websites and measured by investigators. RESULTS The average insertive length of the compiled dildos (16.7 ± 1.6 cm) was 1 SD longer than natal functional erect penile length as reported in the literature (15.7 ± 2.6 cm); however, their average circumference (12.7 ± 0.8 cm) mirrored natal erect penile girth (12.3 ± 1.3). The average girth of vendors' top 3 largest-girth dildos was 15.1 ± 0.9 cm, 2 SD wider than natal erect penile girth. Index patients had an average length of 16.3 ± 3.2 cm and an average girth of 17.6 ± 1.3 cm. Index patient girth was 4 to 5 SD wider than the average natal erect girth. CLINICAL IMPLICATIONS Based on our data, we suggest that a surgically created neophallus should have a girth no wider than 15.1 cm after implantation of an inflatable penile prosthesis. This corresponds to 2 SD wider than the average natal man's erect girth. STRENGTHS AND LIMITATIONS Strengths include in-person measurements of patients whose girth prevented penetrative intercourse, the large number of dildos assessed, and correlations with in-person measurements. Limitations include the inability to account for the pliability of different materials, whether dildos were used for vaginal and/or anal insertion, the limited sample of 4 transmen for in-person measurement, and the absence of implanted inflatable penile prostheses in index neophalluses. CONCLUSIONS Neophallus girth wider than 15.1 cm could lead to difficulty in penetrative intercourse for many individuals. A conservative recommendation for neophallus girth is 13 to 14 cm, or 0.5 to 1.5 SD wider than natal erect penile girth. Isaacson D, Aghili R, Wongwittavas N, Garcia M. How Big is Too Big? The Girth of Bestselling Insertive Sex Toys to Guide Maximal Neophallus Dimensions. J Sex Med 2017;14:1455-1461.
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Affiliation(s)
| | - Roxana Aghili
- Campbell University Ringgold Standard Institution, School of Osteopathic Medicine, Buies Creek, NC, USA
| | | | - Maurice Garcia
- Department of Urology, Cedars-Sinai Medical Center Ringgold Standard Institution, Los Angeles, CA, USA.
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Reference range of flaccid and stretched penile lengths of adult males in Baghdad: A cross-sectional study. Arab J Urol 2017; 15:68-73. [PMID: 28275522 PMCID: PMC5329721 DOI: 10.1016/j.aju.2017.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 12/12/2016] [Accepted: 01/02/2017] [Indexed: 11/22/2022] Open
Abstract
Objectives To establish a baseline reference range for flaccid (FPL) and stretched penile lengths (SPL) in adult males and to compare with reports from different nationalities, as concerns over penile size are common among men and currently the number of men seeking help for the perceived problem of a ‘short’ penis is increasing. Subjects and methods Over a 1-year period, FPL and SPL measurements were taken from males undergoing medical examination in the outpatient clinic of the Al-Karama Teaching Hospital, using a rigid centimetre ruler. The correlation between penile length and age was investigated. Results In all, 223 apparently healthy males were included in this study with a mean (SD; range) age of 41.3 (15.0; 20–77) years. The mean (SD; range) FPL was 9.8 (2.0; 5–17) cm and the SPL was 12.6 (1.9; 7.5–19.5) cm. Statistical analysis showed that penile length is increased in older age (>55 years). A penile length nomogram was constructed, showing that the 50th percentiles of FPL and SPL were 9.0 and 12.5 cm, respectively. Conclusion Our data establish a baseline reference range for adult male penile lengths in the Capital of Iraq (Baghdad), which should be useful for urologists when counselling patients.
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Abstract
HIV infection rates remain steady in the USA despite the numerous prevention programs and tools available. Condoms play a central role in HIV prevention because they are highly effective, readily available, and affordable. Unfortunately, condom promotion efforts often incite fear as a motive force, while also taking the common "one-size-fits-all" approach. Reframing condom promotion through a sexual health framework, focusing on pleasure and highlighting condom fit issues, improves intervention efficacy. Condom distribution policies may further perpetuate condom users' difficulty, by withholding particular condom styles, brands, and information highlighting the nuances in shape, size, and material. Condom education and distribution practices focused on pleasure, proper fit, and condom access issues might increase condom utilization among high-risk populations.
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Affiliation(s)
- Joshua D O'Neal
- Department of Sexuality Studies, San Francisco State University, HSS 370, 1600 Holloway Ave, San Francisco, CA, 94132, USA,
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Prause N, Park J, Leung S, Miller G. Women's Preferences for Penis Size: A New Research Method Using Selection among 3D Models. PLoS One 2015; 10:e0133079. [PMID: 26332467 PMCID: PMC4558040 DOI: 10.1371/journal.pone.0133079] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 06/22/2015] [Indexed: 11/18/2022] Open
Abstract
Women's preferences for penis size may affect men's comfort with their own bodies and may have implications for sexual health. Studies of women's penis size preferences typically have relied on their abstract ratings or selecting amongst 2D, flaccid images. This study used haptic stimuli to allow assessment of women's size recall accuracy for the first time, as well as examine their preferences for erect penis sizes in different relationship contexts. Women (N = 75) selected amongst 33, 3D models. Women recalled model size accurately using this method, although they made more errors with respect to penis length than circumference. Women preferred a penis of slightly larger circumference and length for one-time (length = 6.4 inches/16.3 cm, circumference = 5.0 inches/12.7 cm) versus long-term (length = 6.3 inches/16.0 cm, circumference = 4.8 inches/12.2 cm) sexual partners. These first estimates of erect penis size preferences using 3D models suggest women accurately recall size and prefer penises only slightly larger than average.
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Affiliation(s)
- Nicole Prause
- Department of Psychiatry, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Jaymie Park
- Department of Psychiatry, University of California Los Angeles, Los Angeles, California, United States of America
| | - Shannon Leung
- Department of Psychiatry, University of California Los Angeles, Los Angeles, California, United States of America
| | - Geoffrey Miller
- Department of Psychology, University of New Mexico; Albuquerque, New Mexico, United States of America
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Salama N. Penile Dimensions of Diabetic and Nondiabetic Men With Erectile Dysfunction: A Case-Control Study. Am J Mens Health 2015; 12:514-523. [PMID: 26130730 DOI: 10.1177/1557988315592026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This study aimed to report penile dimensions in diabetic and nondiabetic men with erectile dysfunction (ED) and correlate their dimensions with other study variables. A case-control study was designed through retrospective data analysis of diabetic and nondiabetic patients consulting for ED and a control group ( n = 105, each group). Study data retrieved included history, clinical evaluation, and penile dimensions (pendulous length [PL], total length [TL], and circumference [CF]) at flaccid and erect states. Results identified that patients had lower values (mean, cm) for almost all penile dimensions. The diabetic patients identified significant differences in most dimensions, whether in flaccid (PL: 7.46 vs. 7.51 and 7.81, p = .11; TL: 11.8 vs. 12.77 and 12.88, p = .000; CF: 8.84 vs. 9.1 and 9.14, p = .016) or erect state (PL: 9.66 vs. 9.61 and 10, p = .092; TL: 13.96 vs. 14.88 and 15.04, p = .000; CF: 11.56 vs. 12.06 and 11.92, p = .018) as compared with the nondiabetic patients and controls, respectively. No significant correlation was detected between the dimensions and age, durations of diabetes and ED, or erectile function scores. In conclusion, diabetic and nondiabetic patients with ED presented, in varying degrees, significant decline in their penile dimensions, and this was more prevalent in diabetic patients. As changes in penile size could be a silent corollary of comorbidities, monitoring the changes in penile dimensions should be an important component of the clinical checkup of any patient with ED, especially a diabetic patient.
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Affiliation(s)
- Nader Salama
- 1 Alexandria Faculty of Medicine, Alexandria, Egypt
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Habous M, Tealab A, Williamson B, Binsaleh S, El Dawy S, Mahmoud S, Abdelwahab O, Nassar M, Mulhall JP, Veale D, Muir G. Erect Penile Dimensions in a Cohort of 778 Middle Eastern Men: Establishment of a Nomogram. J Sex Med 2015; 12:1402-6. [DOI: 10.1111/jsm.12894] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Veale D, Miles S, Bramley S, Muir G, Hodsoll J. Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15,521 men. BJU Int 2015; 115:978-86. [PMID: 25487360 DOI: 10.1111/bju.13010] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To systematically review and create nomograms of flaccid and erect penile size measurements. METHODS Study key eligibility criteria: measurement of penis size by a health professional using a standard procedure; a minimum of 50 participants per sample. EXCLUSION CRITERIA samples with a congenital or acquired penile abnormality, previous surgery, complaint of small penis size or erectile dysfunction. Synthesis methods: calculation of a weighted mean and pooled standard deviation (SD) and simulation of 20,000 observations from the normal distribution to generate nomograms of penis size. RESULTS Nomograms for flaccid pendulous [n = 10,704, mean (SD) 9.16 (1.57) cm] and stretched length [n = 14,160, mean (SD) 13.24 (1.89) cm], erect length [n = 692, mean (SD) 13.12 (1.66) cm], flaccid circumference [n = 9407, mean (SD) 9.31 (0.90) cm], and erect circumference [n = 381, mean (SD) 11.66 (1.10) cm] were constructed. Consistent and strongest significant correlation was between flaccid stretched or erect length and height, which ranged from r = 0.2 to 0.6. LIMITATIONS relatively few erect measurements were conducted in a clinical setting and the greatest variability between studies was seen with flaccid stretched length. CONCLUSIONS Penis size nomograms may be useful in clinical and therapeutic settings to counsel men and for academic research.
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Affiliation(s)
- David Veale
- The Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Miles
- The Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Sally Bramley
- King's College London Medical School, King's College London, London, UK
| | - Gordon Muir
- King's College NHS Foundation Trust, London, UK
| | - John Hodsoll
- The Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Herbenick D, Reece M, Schick V, Sanders SA. Erect penile length and circumference dimensions of 1,661 sexually active men in the United States. J Sex Med 2013; 11:93-101. [PMID: 23841855 DOI: 10.1111/jsm.12244] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Penile size continues to receive popular and empirical attention. Little is known about the process of self-measurement and whether the behaviors a man engages in to become erect for self-measurement are associated with his erect penile dimensions. AIMS The article aims to assess men's erect penile dimensions in a study in which the men would presumably be motivated to report accurate information about their penis size; and to explore associations between men's erect penile dimensions, their method of measurement, and their demographics. METHODS Data are from an Internet-based baseline phase of a large prospective daily diary study that compared men's use of a standard-sized condom to men's use of a condom sized to fit their erect penis. MAIN OUTCOME MEASURES The main outcomes are participant characteristics, activities engaged in during self-measurement process, and self-reported erect penile length and circumference. RESULTS For this sample of 1,661 men, the mean erect penile length was 14.15 cm (SD = 2.66; range = 4 to 26 cm), and the mean erect penile circumference was 12.23 cm (SD = 2.23; range = 3 to 19). Participant characteristics were not associated with measured length or circumference. Most men measured their penis while alone, using hand stimulation to become erect. CONCLUSIONS In this sample of men who measured their erect penile length and circumference for the purposes of receiving a condom sized to fit their erect penis, we found a mean erect penile length of 14.15 cm and a mean erect penile circumference of 12.23 cm. The self-reported erect penile dimensions in this study are consistent with other penile dimension research. Also, findings suggest that mode of getting an erection may influence erect penile dimensions. Additionally, how a man becomes erect for self-measurement may be associated with his erect penile length and/or circumference.
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Affiliation(s)
- Debby Herbenick
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
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21
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Hennekam RCM, Allanson JE, Biesecker LG, Carey JC, Opitz JM, Vilain E. Elements of morphology: standard terminology for the external genitalia. Am J Med Genet A 2013; 161A:1238-63. [PMID: 23650202 PMCID: PMC4440541 DOI: 10.1002/ajmg.a.35934] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 01/25/2013] [Indexed: 11/08/2022]
Abstract
An international group of clinicians working in the field of dysmorphology has initiated the standardization of terms used to describe human morphology. The goals are to standardize these terms and reach consensus regarding their definitions. In this way, we will increase the utility of descriptions of the human phenotype and facilitate reliable comparisons of findings among patients. Discussions with other workers in dysmorphology and related fields, such as developmental biology and molecular genetics, will become more precise. Here we introduce the anatomy of the male and female genitalia, and define and illustrate the terms that describe the major characteristics of these body regions. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Raoul C M Hennekam
- Department of Pediatrics and Clinical Genetics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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22
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Ghanem H, Glina S, Assalian P, Buvat J. Position Paper: Management of Men Complaining of a Small Penis Despite an Actually Normal Size. J Sex Med 2013; 10:294-303. [DOI: 10.1111/j.1743-6109.2012.02725.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Therapeutic strategies for patients with micropenis or penile dysmorphic disorder. Nat Rev Urol 2012; 9:499-507. [DOI: 10.1038/nrurol.2012.150] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Söylemez H, Atar M, Sancaktutar AA, Penbegül N, Bozkurt Y, Onem K. Relationship between penile size and somatometric parameters in 2276 healthy young men. Int J Impot Res 2011; 24:126-9. [PMID: 22189447 DOI: 10.1038/ijir.2011.53] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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 (P<0.01). 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.
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Affiliation(s)
- H Söylemez
- Department of Urology, Dicle University, Diyarbakir, Turkey.
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25
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Khan S, Somani B, Lam W, Donat R. Establishing a reference range for penile length in Caucasian British men: a prospective study of 609 men. BJU Int 2011; 109:740-4. [PMID: 21711435 DOI: 10.1111/j.1464-410x.2011.10338.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES • To establish a reference range for adult male genital size in the UK using penile length measurements. • To compare the reference ranges for normal penile length reported from several different countries and the anthropometric differences noted between different nationalities and ethnic backgrounds. METHODS AND MATERIALS • Over 20 months, genital measurements were taken from all men undergoing routine examination in clinics (n= 499) and in operating theatres during examination under anaesthetic (n= 110). • Using a rigid metric ruler three penile measurements were taken: flaccid pendulous penile length, flaccid penopubic penile length (to the pubic arch) and stretched flaccid penopubic length. In addition, testicular size was measured using an orchidometer. • The patient's age and the reason for referral were recorded. • Statistical analysis was carried out using Pearson correlation analysis. RESULTS • Measurements from 610 patients aged 16-90 years were available for analysis. • The mean penile lengths were: pendulous length 8.7 cm (sd 1.6 cm), penopubic length 10.2 cm (sd 1.4 cm) and stretched length 14.3 cm (sd 1.7 cm). The mean testicular volume was 19.8 mL (sd 5.4 mL) for both left and right testicles. • Men with penile disease (including phimosis and Peyronie's disease) had slightly reduced penile length (pendulous -3.3 mm, P= 0.014; penopubic -2.3 mm, P= 0.029; stretched -5.1 mm, P < 0.001) compared with other referral groups (erectile dysfunction, testicular disease, prostate and bladder disease). • There was no significant correlation between penile length and age or testicular size CONCLUSION • These data establish a reference range for adult male genital size in the UK, which should be helpful for urologists when counselling patients.
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Affiliation(s)
- Shahid Khan
- Department of Urology, Western General Hospital, Edinburgh and St John's Hospital, Livingston, UK.
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26
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Yu Ko WF, Degner LF, Hack TF, Schroeder G. Penile length shortening after radical prostatectomy: men's responses. Eur J Oncol Nurs 2009; 14:160-5. [PMID: 19811950 DOI: 10.1016/j.ejon.2009.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Revised: 08/28/2009] [Accepted: 09/01/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Prostate cancer (PC) is the most common type of male-specific cancer in North American men, and many men choose radical prostatectomy (RP) to remove their cancer. Although penile length shortening (PLS) occurs in a reported 68% to 71% of men undergoing RP, little is known about it. In an electronic journal search, only 9 medical articles (with no nursing publications) were published between 1980 and 2007. PURPOSE To provide an account of patients' perceptions and responses to living with PLS after RP. METHODS AND SAMPLE Semi-structured interviews and a grounded theory approach were used to discover the basic social processes regarding men's perceptions of a shortened penis and overall sense of self. A total of six men who underwent RP and consequently noticed PLS were recruited from a local PC support group for semi-structured interviews lasting between 40-60 min. RESULTS Based on subjects' own definitions of masculinity, no significant changes in the constructs of masculinity and overall self-image perception were reported. CONCLUSIONS Men undergoing RP may not be fully aware that PLS is a possible consequence related to treatment. In spite of this, subjects were not negatively affected by its occurrence.
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27
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Kamel I, Gadalla A, Ghanem H, Oraby M. Comparing Penile Measurements in Normal and Erectile Dysfunction Subjects. J Sex Med 2009; 6:2305-10. [DOI: 10.1111/j.1743-6109.2009.01305.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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28
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Abstract
Penile size is a considerable concern for men of all ages. Herein, we review the data on penile size and conditions that will result in penile shortening. Penile augmentation procedures are discussed, including indications, procedures and complications of penile lengthening procedures, penile girth enhancement procedures and penile skin reconstruction.
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29
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Promodu K, Shanmughadas KV, Bhat S, Nair KR. Penile length and circumference: an Indian study. Int J Impot Res 2007; 19:558-63. [PMID: 17568760 DOI: 10.1038/sj.ijir.3901569] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- K Promodu
- Dr Promodu's Institute of Sexual & Marital Health, Panampilly Nagar, Kochi, Kerala, India.
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30
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Hendrix CW, Fuchs EJ, Macura KJ, Lee LA, Parsons TL, Bakshi RP, Khan WA, Guidos A, Leal JP, Wahl R. Quantitative imaging and sigmoidoscopy to assess distribution of rectal microbicide surrogates. Clin Pharmacol Ther 2007; 83:97-105. [PMID: 17507921 DOI: 10.1038/sj.clpt.6100236] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Understanding the distribution of microbicide and human immunodeficiency virus (HIV) within the gastrointestinal tract is critical to development of rectal HIV microbicides. A hydroxyethylcellulose-based microbicide surrogate or viscosity-matched semen surrogate, labeled with gadolinium-DTPA (diethylene triamine pentaacetic acid) and 99mTechnetium-sulfur colloid, was administered to three subjects under varying experimental conditions to evaluate effects of enema, coital simulation, and microbicide or semen simulant over 5 h duration. Quantitative assessment used single photon emission computed tomography (SPECT)/computed tomography (CT) and magnetic resonance imaging (MRI) imaging, and sigmoidoscopic sampling. Over 4 h, radiolabel migrated cephalad in all studies by a median (interquartile range) of 50% (29-102%; P<0.001), as far as the splenic flexure (approximately 60 cm) in 12% of studies. There was a correlation in concentration profile between endoscopic sampling and SPECT assessments. HIV-sized particles migrate retrograde, 60 cm in some studies, 4 h after simulated ejaculation in our model. SPECT/CT, MRI, and endoscopy can be used quantitatively to facilitate rational development of microbicides for rectal use.
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Affiliation(s)
- C W Hendrix
- Department of Medicine, Division of Clinical Pharmacology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
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31
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Abstract
The male is often troubled by concerns that his penis is not large enough to satisfy his partner or himself. He is ashamed to have others view his penis, especially in the flaccid state. Such concerns might be unfounded in reality and might be a presentation of social anxiety or some other clinical problem, such as erectile dysfunction. Concern over the size of the penis, when such concern becomes excessive, might present as the 'small penis syndrome', an obsessive rumination with compulsive checking rituals, body dysmorphic disorder, or as part of a psychosis. However, it is often a worry that can be described as within the normal experience of many men. Various potential causal factors are considered. A thorough assessment, normalizing the worry and then exploring the treatment options in detail with the man, is essential to allow the matter to be consolidated satisfactorily within the male ego.
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Affiliation(s)
- Kevan R Wylie
- Porterbrook CLinic, Sheffield Care Trust, Sheffield, UK.
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32
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Miller GF, Penke L. The evolution of human intelligence and the coefficient of additive genetic variance in human brain size. INTELLIGENCE 2007. [DOI: 10.1016/j.intell.2006.08.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Ageing of the male reproductive system is characterized by changes in the endocrine system, hypogonadism, erectile dysfunction and proliferative disorders of the prostate gland. Stochastic damage accumulating within ageing leads to progressive dysregulation at each level of the hypothalamic-pituitary-gonadal (HPG) axis and in local auto/paracrine interactions, thereby inducing morphological changes in reproductive target organs, such as the prostate, testis and penis. Despite age-related changes in the HPG axis, endocrine functions are generally sufficient to maintain fertility in elderly men. Ageing of the male reproductive system can give rise to clinically relevant manifestations, such as benign prostatic hyperplasia (BPH), prostate cancer (PCa) and erectile dysfunction (ED). In this review, we discuss morphological/histological changes occurring in these organs and current views and concepts of the underlying pathology. Moreover, we emphasize the molecular/cellular pathways leading to reduced testicular/penile function and proliferative disorders of the prostate gland.
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Affiliation(s)
- N Sampson
- Institute for Biomedical Ageing Research, Austrian Academy of Sciences, Innsbruck, Austria
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34
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Mehraban D, Salehi M, Zayeri F. Penile size and somatometric parameters among Iranian normal adult men. Int J Impot Res 2006; 19:303-9. [PMID: 17151695 DOI: 10.1038/sj.ijir.3901532] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study aimed to determine the penile size and its correlation with somatometric parameters in physically normal Iranian adult men. To do this, a random sample of 1500 normal men aged between 20 and 40 years underwent tape measurements of penile dimensions in the stretched state under the same condition. The mean total penile length was 11.58+/-1.45 cm, the mean granular length was 3.04+/-0.33 cm and the mean girth was 8.66+/-1.01 cm. Multivariate regression analysis showed that penile dimensions are significantly correlated with age (P=0.018), height (P<0.001) and index finger length (P<0.001). This analysis provided no evidence for significant effect of waist/hip ratio and weight on penile dimensions. As the penile augmentation is still in its experimental stage and its indications have not yet been clearly established, providing standardized data on penile dimensions seems to be necessary to make convenient decisions in the counseling and/or treatment of people with short penis concerns.
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Affiliation(s)
- D Mehraban
- Department of Urology, School of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
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35
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Sarkar NN. Does the use of a condom involve a risk for contacting sexually transmitted infections, HIV/AIDS? J Public Health (Oxf) 2006. [DOI: 10.1007/s10389-006-0081-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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36
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Lever J, Frederick DA, Peplau LA. Does size matter? Men's and women's views on penis size across the lifespan. PSYCHOLOGY OF MEN & MASCULINITY 2006. [DOI: 10.1037/1524-9220.7.3.129] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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37
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Shamloul R. Treatment of men complaining of short penis. Urology 2005; 65:1183-5. [PMID: 15922413 DOI: 10.1016/j.urology.2004.12.066] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Revised: 12/04/2004] [Accepted: 12/21/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To report the outcome of a sex education-integrated treatment program of men complaining of a short-sized penis. METHODS This study included 92 patients presenting to our department in the past 2 years complaining of a small-sized penis. History, with particular stress on the duration of the complaint and sexual habits of the patients, was collected from all patients. All patients were asked to complete the International Index of Erectile Function short-form questionnaire. Also all patients were tutored by an andrologist on sex education. Penile length and girth were measured twice using a tape measure in both flaccid and fully stretched states. Every patient was informed that if his flaccid and stretched penis size was 4 cm and 7 cm or more, respectively, it was considered normal. RESULTS All patients complained of a short penis in either the flaccid or erect state. Of the 92 patients, 66 (71.7%) complained of a short penis only in the flaccid state, and 26 (28.3%) complained of a short penis in both the flaccid and the erect state. None of the patients had erectile dysfunction. None of the patients had short penis according to our measurements. Almost all patients overestimated the normal penile size. Most men found the combination of sex education with standard penile measurements helpful and relieving. CONCLUSIONS Men complaining of short penis could be treated using basic principles of sex education with objective methods of penile size evaluation. This combination can correct any previous sexual misconceptions, relieve unnecessary anxiety concerning penile size, and decrease the desire to undertake still-to-be verified lengthening procedures.
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Affiliation(s)
- Rany Shamloul
- Department of Andrology and Sexology, Cairo University Hospital, Cairo, Egypt.
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Voegeli TA, Effert PJ. Pentaethylene-terephthalate (PET) bottles: a new device for autoerotic strangulation of the penis causing serious injury. ARCHIVES OF SEXUAL BEHAVIOR 2005; 34:469-70. [PMID: 16010469 DOI: 10.1007/s10508-005-4346-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Strangulation of the penis by application of constricting devices may present a challenge for the treating physician. Depending on the type of constricting material, special equipment is essential for successful removal of the foreign bodies. We report a new form of constricting device, the neck of a Coca Cola bottle made of Pentaethylene-terephthalate (PET). Particular difficulties were encountered upon removal. Technical details of this case are described. Prior literature on the treatment of penile strangulation is discussed.
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Affiliation(s)
- Thomas A Voegeli
- Department of Urology, University of Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany.
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Awwad Z, Abu-Hijleh M, Basri S, Shegam N, Murshidi M, Ajlouni K. Penile measurements in normal adult Jordanians and in patients with erectile dysfunction. Int J Impot Res 2004; 17:191-5. [PMID: 15510185 DOI: 10.1038/sj.ijir.3901272] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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 8.98+/-1.4, mean flaccid length was mean 9.3+/-1.9, and mean stretched length was 13.5+/-2.3. In group two, mean flaccid length was 7.7+/-1.3, and mean stretched length was 11.6+/-1.4. The mean of fully erect penile length after trimex injection was 11.8+/-1.5. 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=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=0.001), and the mean stretched length 13.5 vs 11.6 (P=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.
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Affiliation(s)
- Z Awwad
- Department of Urology, Jordan University Hospital, Amman, Jordan.
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Spyropoulos E, Borousas D, Mavrikos S, Dellis A, Bourounis M, Athanasiadis S. Size of external genital organs and somatometric parameters among physically normal men younger than 40 years old. Urology 2002; 60:485-9; discussion 490-1. [PMID: 12350491 DOI: 10.1016/s0090-4295(02)01869-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To estimate the sizes of the external genital organs in physically normal adult males younger than 40 years old, as well as to correlate the resulting values with age and a number of somatometric parameters, to provide data that could be clinically applicable by the practicing urologist. METHODS Fifty-two physically normal men, 19 to 38 years old, underwent tape measurements of penile dimensions in the flaccid-stretched state (total, shaft, glanular lengths), penile shaft volume calculation, and ultrasonographic testicular volume estimation. The resultant values were correlated with age, height, weight, body mass index, waist/hip ratio, and index finger length. RESULTS The mean testicular volume was 16.9 +/- 4.7 cm(3), with the right testis (17.5 +/- 5.8 cm(3)) measuring slightly larger than the left (15.85 +/- 4.9 cm(3); P = not significant). The mean total penile length was 12.18 +/- 1.7 cm, the mean penile shaft length was 7.76 +/- 1.3 cm, the mean glanular length was 4.4 +/- 0.4 cm, and the mean penile shaft volume was 46.5 +/- 17.2 cm(3). Among the various correlations performed, the penile lengths (total, shaft, glanular) to index finger length (P <0.05) and to penile shaft volume (P <0.001) were statistically significant. CONCLUSIONS Data on the size of the external genital organs among physically normal young adult men were provided and a novel formula for penile shaft volume calculation was proposed. Age and somatometric parameters were not associated with the size of the genitalia, excluding the index finger length, which correlated significantly with the dimensions of the flaccid, maximally stretched, penis.
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Mondaini N, Ponchietti R, Gontero P, Muir GH, Natali A, Caldarera E, Biscioni S, Rizzo M. Penile length is normal in most men seeking penile lengthening procedures. Int J Impot Res 2002; 14:283-6. [PMID: 12152118 DOI: 10.1038/sj.ijir.3900887] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2002] [Accepted: 04/08/2002] [Indexed: 11/08/2022]
Abstract
Concerns over penile size and a desire for a longer penis are common in the male population. The number of male patients seeking an andrological consultation for the problem of 'short penis' is increasing. We looked at the numbers of patients presenting to a University andrology clinic over a 2-y period and correlated their perceived penis size with the accepted norms. Sixty-seven patients were evaluated with a median age of 27 (range 16-55) complaining of 'short penis' and requesting surgical correction. Clinical history, including the IIEF-5 questionnaire and an accurate physical examination were obtained. Data concerning measures of penile length and circumference were recorded in both the flaccid and fully stretched states and compared to the normal reference range as previously described in the nomogram we recently published (Eur Urol 2001; 39: 183-186.). All patients were also asked to estimate the length of a normal sized penis.Fourty-four (65.7%) complained of a short penis only while flaccid, 22 patients (32.8%%) while both flaccid and erect, and only one patient (1.5%) was worried only by the erect length of the penis. Fifteen (22.4%) also complained about their penile circumference. Fifty-seven (85%) patients thought a 'normal' penile length should range from 10 to 17 cm (median value of 12 cm). Ten patients (15%) were not able to estimate 'normal' penile size. No patient was found to have a penile length under the 2.5 percentile according to our nomogram. Forty-two (62.7%) subjects recalled the problem starting in childhood, when they felt that their penis was smaller than their friends'. In 25 patients (37.3%) the problem started in the teenage years after seeing erotic images. Our data show that most men who seek penile lengthening surgery overestimate 'normal' penile length. In our series, none of the patients could be classified as having a severely short penis according to our nomogram and none had any anatomical penile abnormality. Most found the use of a nomgram to show them how they compared with other men helpful. We suggest that documentation of such a demonstration should be made for any man seeking an opinion on penile lengthening surgery.
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Affiliation(s)
- N Mondaini
- Department of Urology, University of Florence, Italy.
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Affiliation(s)
- E. ALEXSANDRO DA SILVA
- From the Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - FRANCISCO J.B. SAMPAIO
- From the Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
PURPOSE The human male urethra has great capacity to extend under traction. This extensibility is the principle of some surgical techniques used to overcome urethral defects and for penile lengthening. However, to our knowledge safe limits of urethral extensibility in reconstructive surgery have not been yet established by a morphological study. To this end we measured fresh human cadaveric urethras with and without traction. MATERIALS AND METHODS We analyzed the macroscopically normal, fresh cadaveric urethra from 25 men 6 months to 73 years old at death (mean age 30.6). Penile length and length of the total, penile, bulbar and membranous urethra were measured. Length under maximal constant traction and the maximal stretched length without penile curvature at artificial erection were determined. Extensibility is expressed as the percent of the variation in initial length at rest and maximal constant traction length. Maximal stretched length without penile curvature at artificial erection is expressed as a percent of maximal constant traction length. RESULTS Total urethral extensibility was higher than penile extensibility (p <0.001). Urethral extensibility decreased with aging (r = -0.806, p <0.001). Mean extensibility of the whole male urethra was 66.2% +/- 7.2% and differences among urethral segments were not significant (p = 0.283). Mean maximal stretched length without penile curvature at artificial erection was 75.2% +/- 3.8% and it did not change with age. CONCLUSIONS Knowledge of the safe anatomical limit of urethral extensibility applied to reconstructive surgery may avoid complications and the necessity for more complex techniques. This limit should be approximately 75% of the maximal constant traction length or a gap-to-normal urethra ratio of 1:4. However, age related variations should be considered.
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Affiliation(s)
- E Alexsandro Da Silva
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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