Women's Preferences for Penis Size: A New Research Method Using Selection among 3D Models

Personal genital satisfaction is associated with differences in perception of male and female sexual anatomy and function

BACKGROUND

Prior studies primarily of men correlated low personal genital satisfaction (PGS) with decreased sexual activity; however, the association between PGS and genital anatomy perceptions is unknown, and there is a paucity of studies examining women.

AIM

We assessed the relationship between genital satisfaction, survey respondent sexual activity, and perceptions of anatomy and function.

METHODS

A 54-item REDCap survey was distributed to any-gendered volunteers ≥18 years of age through ResearchMatch from January to March 2023. Responses were split into (1) high PGS and (2) low PGS. Analysis was performed using chi-square tests on survey responses and a Mann Whitney U test on median satisfaction level.

OUTCOMES

Outcomes were genital anatomy perceptions, sexual activity, and respondents' PGS.

RESULTS

Of the 649 respondents who started the survey, 560 (86.3%) completed it. Median PGS was 7 of 10, forming subgroups of high (≥7 of 10) satisfaction (n = 317 of 560 [56.6%]) and low (<7 of 10) satisfaction (n = 243 of 560 [43.4%]). The mean age was 45.8 ± 16.8 years, and demographics were notable for 72.1% women (n = 404 of 560), 83.2% White (n = 466 of 560), 47.9% married (n = 268 of 560), and 75.5% bachelor's degree holders (n = 423 of 560). Comparing high- and low-PGS groups, more low-PGS respondents felt normal flaccid penis length to be <2 inches (11.1% vs 5.1%; P = .008). High-PGS respondents more often responded that it is normal for women to have orgasms over half the time (20.8% vs 13.2%; P = .0002) or to identify as being sexually active (81.1% vs 71.6%; P = .008). Women were more likely than men to report larger normal testicle sizes as 60.1 to 90 mL (24.5% vs 10.3%; P < .0001), whereas more men felt that normal testicle size was 7 to 15 mL (26.3% vs 11.4%; P < .0001). Orgasm length perceptions also differed: more women felt female orgasm length was 2.6 to 5 seconds (36.6% vs 16.7%; P < .0001), and more men believed female orgasms to be longer, at 7.6 to 10 seconds (29.5% vs 17.3%; P = .002), 10.1 to 12.5 seconds (11.5% vs 5.2%; P = .0008), and >12.5 seconds (12.2% vs 5.7%; P = .009). Respondents' views on their genitalia differed by gender, with women more likely to feel that their genitals are normal compared with men (89.4% vs 75.0%; P < .0001).

CLINICAL IMPLICATIONS

PGS may be a useful screening tool given its association with sexual activity.

STRENGTHS AND LIMITATIONS

Our large-scale survey assesses public perceptions of genital anatomy and function. Limitations include a lack of gender nonbinary perceptions.

CONCLUSION

Gender and PGS interact with perceptions of male anatomy and female sexual activity, and the frequency of sexual activity was higher among high-PGS respondents; however, the direction of these interactions remains unclear and requires future causal analysis.

Morphometric Predictors of Penile Length Increase After Division of its Suspensory Ligament

INTRODUCTION

Division of the suspensory ligament of the penis has emerged as a popular surgical approach for penile lengthening, but accurate preoperative predictions of lengthening outcomes remain elusive. This study aimed to identify readily measurable anatomical parameters associated with post-ligamentolysis penile length gain, facilitating more reliable preoperative estimations.

METHODS

An experimental cross-sectional study was performed on 16 adult cadavers. Data collected before dissection included: age at death, ethnicity, height, length of the penis before dissection and width of the suspensory ligament of penis. Following the complete dissection of the suspensory ligament of penis, the depth of the pubic symphysis and the penile length after the procedure were measured. The absolute and relative length differences pre- and post-ligamentolysis were calculated. Correlation coefficients were used to study relations between these variables.

RESULTS

Penile length increased uniformly after complete division of the suspensory ligament (average gain: 26.38 mm, SD = 14.83 mm; range 4-60 mm). Pearson correlation revealed a significant negative correlation between pre-ligamentolysis penile length and post-ligamentolysis increase (r = - 0.601; p = 0.014), suggesting greater gains in individuals with shorter pre-ligamentolysis lengths. Age, ligament width, and pubic arch depth showed no significant correlations. Ethnicity did not impact post-ligamentolysis length increase (t = - 0.135; p = 0.894).

CONCLUSIONS

This study highlights the potential to predict penile length gain post-ligamentolysis through measurable anatomical parameters. The ability to anticipate the outcome of this procedure could empower surgeons to provide informed counseling, potentially elevating patient satisfaction. An experimental cross-sectional study was performed to investigate the outcomes of penile lengthening surgery Penile lengthening was achieved in all subjects via complete dissection of the suspensory ligament of the penis Penile length increase may be predicted preoperatively using easily measurable anatomical parameters NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

What Drives Sex Toy Popularity? A Morphological Examination of Vaginally-Insertable Products Sold by the World's Largest Sexual Wellness Company

There is limited research into the morphology of sex toys, and specifically into (the often phallic-shaped) vibrators and dildos and what they may represent in terms of user preferences for male genital morphology. This study provides insight into consumer preference around vaginally insertable sex toys, their features, and what contributes to their popularity. Using a data set compiling information from the world's largest online sexual wellness retailer Lovehoney, we examined the dimensions, price, and morphological features of 265 sex toys designed for vaginal insertion to determine what contributes to item popularity. Using regression models, we found that realistic features did not predict item popularity, whereas price (p < .001) and circumference (p = .01) significantly predicted the overall popularity of a toy. It appears that consumers show a preference for insertable sex toys that are not direct replicas of the male penis, which suggests they are not seeking a realistic partner substitute. Further, we found that the length of the toy did not significantly predict popularity which is consistent with other work showing that women do not place considerable emphasis on large phallus size. Our results can contribute to future product design and marketing, as well as reveal preferences toward particular characteristics of the phallus (whether real or toy).

Utility of a penile compression device for the quality of life in male patients with urinary incontinence after prostatectomy (the MORE study): a randomized prospective study

OBJECTIVES

To verify the effects of penile clamping on the degree of stress urinary incontinence and quality of life in post-radical prostatectomy patients.

RESULTS

Thirty-seven patients suffering from stress urinary incontinence after undergoing radical prostatectomy were enrolled. A total of 19 and 18 patients were analyzed in the non-clamp and clamp groups, respectively. The mean ages of the patients in non-clamp and clamp groups were 68.3 ± 7.1 years and 71.2 ± 4.8 years, respectively; the mean time after radical prostatectomy was 28.9 ± 44.0 months and 26.2 ± 39.0 months, respectively. The penile clamp used was the CLAMPMED® (URINE CONTROL CLAMP) size M (MURANAKA MEDICAL INSTRUMENTS Co., Ltd.). Specific urinary care pads (Sawayaka Pad for Men, Small Quantity®, Unicharm Corporation), were provided; the average daily usage was monitored for four weeks. The quality of life was evaluated using the King's Health Questionnaire. The average daily use of urinary care pads was significantly reduced in the clamp group than in the non-clamp group (-0.83 ± 1.51 vs. -0.16 ± 0.69, P = 0.0071). King's Health Questionnaire scores did not change significantly in either group. Wearing the CLAMPMED® reduced the amount of urinary incontinence but did not improve the quality of life.

TRIAL REGISTRATION

The Japan Registry of Clinical Trials (jRCT1052230083). Registered 2 August, 2023.

The effect of penis size on partner sexual satisfaction: a literature review

Larger penis size has been associated with a sign of strength, masculinity, and social standing. Little study has examined the relationship between men's penis size and their partners' sexual satisfaction. The purpose of the present study was to detail and evaluate the effect of penis size on partner sexual satisfaction with a design of narrative literature review. A systematic search of MEDLINE/PubMed was conducted to discover relevant studies on this issue. Currently, available studies show incomplete results between the penis size and partners' sexual satisfaction and are limited by methodological drawbacks, including small sample's size. The link between penis size and the sexual satisfaction of the partner need to be supported by more robust scientific evidence.

Smaller prize, bigger size? Exploring the impact of money on men's self-reported markers of masculinity

Bodily markers, often self-reported, are frequently used in research to predict a variety of outcomes. The present study examined whether men, at the aggregate level, would overestimate certain bodily markers linked to masculinity, and if so, to what extent. Furthermore, the study explored whether the amount of monetary rewards distributed to male participants would influence the obtained data quality. Men from two participant pools were asked to self-report a series of bodily measures. All self-report measures except weight were consistently found to be above the population mean (height and penis size) or the scale midpoint (athleticism). Additionally, the participant pool that received the lower (vs. higher) monetary reward showed a particularly powerful deviation from the population mean in penis size and were significantly more likely to report their erect and flaccid penis size to be larger than the claimed but not verified world record of 34 cm. These findings indicate that studies relying on men's self-reported measures of certain body parts should be interpreted with great caution, but that higher monetary rewards seem to improve data quality slightly for such measures.

Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease

INTRODUCTION

Across many cultures, penis size has been associated with virility, and concerns about penile length are commonplace. Peyronie's disease (PD) is a known acquired cause of penile shortening.

OBJECTIVES

This paper describes the psychosocial impacts of penile length on men and their partners, both generally and in men with PD, and evaluates the effect of PD treatments (eg, collagenase clostridium histolyticum , surgery, mechanical therapy) on this outcome measure.

METHODS

A PubMed database search was performed for English language articles through July 2021. Main outcome measures were association of penile length with emotional well-being, selfesteem, and relationship satisfaction in men with PD, and change from baseline penile length after treatment.

RESULTS

Shortened penile length caused by PD can negatively impact patient and partner quality of life, including effects on body image, emotional well-being, sexual function, and interpersonal relationships. In men with PD, studies have demonstrated an association between loss of penile length and emotional problems, reduced satisfaction with sexual performance, poor self-esteem, depression, and relationship difficulties. Loss of penile length can frequently occur after surgery for PD (including plication, plaque incision/excision with grafting, and penile implant). Advanced surgical techniques may preserve/increase penile length, but the increased risks associated with these complex procedures must be carefully considered. Treatment with collagenase clostridium histolyticum does not appear to negatively impact penile length, and 5-year follow-up data suggest potential longterm posttreatment improvements in this outcome measure. Penile traction therapy, either alone or as adjunctive therapy, may increase penile length in men with PD, but nonadherence may limit improvement.

CONCLUSION

Changes in penile length are important to many men, particularly those with PD, and should be considered during PD treatment selection. Penile length should be measured objectively before and after treatment for PD and should be included as an outcome measure in future studies on treatment effectiveness. Goldstein I, Gelbard MK, Lipshultz LI. Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease. Sex Med Rev 2022;10:409-420.

Defining Aesthetic Preferences for the Penis: A Photogrammetric and Crowdsourcing Analysis

BACKGROUND

Achieving an aesthetic phalloplasty result is important for patients with acquired or congenital defects of the penis, or with genital-related dysphoria. However, aside from length and girth, the aesthetic proportions of the male penis have not been defined.

OBJECTIVES

This study aimed to determine proportions of the male penis through photogrammetric analysis of nude male photographs and to verify these proportions with a crowdsourcing-based survey.

METHODS

Nude male photographs (n = 283) were analyzed to define aesthetic proportions of the male penis. Photographs were analyzed for the position of the penis on the torso in relation to the umbilicus and for the ratio of the dorsal and ventral glans of the penis in relation to the entire shaft length. Proportions were then further studied by crowdsourcing 1026 respondents with Amazon mechanical Turk.

RESULTS

The ideal position of the penis below the umbilicus is about 55% (6/11th) of the distance from the jugular notch to the umbilicus (measured average, 53.6%; survey-weighted average, 58.9%). The dorsal glans of the penis is about 33% (1/3rd) of the length of the entire shaft (measured average, 32.1%; survey-weighted average, 37.5%). The ventral glans of the penis is about 12.5% (1/8th) of the length of the entire shaft (measured average, 12.6%; survey-weighted average, 11.7%).

CONCLUSIONS

Measured proportions of the human penis follow exact fractions. Crowdsourcing data helped support photogrammetric analysis, with survey-preferred ratios within 5% of measured ratios. With further validation, these data can aid surgeons performing phalloplasty.

Penile length of men attending urology outpatient clinic in Southwest Nigeria

Penile length varies worldwide. It is necessary to determine penile length in our region to enable adequate counselling on normal length and reduce avoidable anxiety. Two hundred and seventy-one men were recruited with 97 men in group I and 174 men in group II. Mean ages were 38.4 ± 6.9 (21-50) years and 68 ± 9.1 (51-98) years. In group I, the mean flaccid penile length (FPL)-I and stretched penile length (SPL)-I were 9.8± 2.7 and 10.6± 2.2, mean height 1.7±0.07m and body mass index (BMI) 24.1±3.1 kg/m². While in group II, mean FPL-II and SPL-II were 13.0± 2.9 and 14.1 ± 2.1, mean height was 1.69± 0.07m and BMI 24.3± 3.2 kg/m². There were positive correlations between the SPL-I and heights in group I; (r=0.305, p<0.002); height and FPL-I (r = 0.218, P<0.032). Similarly, in group II positive correlations of FPL-II and SPL-II with height; r = 0.166 P<0.028 and r = 0.183, P<0.015. There was negative correlation SPL-II and BMI-II r-0.224, p<0.003. FLR-II and BMI-II, -0.157, p<0.039. In conclusion, Flaccid and stretched penile length of men < 50 years was smaller than those > 50 years. In both age groups, flaccid and stretched penile lengths correlated with height. In group II, penile lengths correlated negatively with BMI.

Does Size Matter? Perceptions of Indian Women About the Size of the Penis

Background:

Many men express concerns about their penile size, with respect to its role in sexual satisfaction of their female partners. The evidence to the contrary exists in the Western literature. However, similar evidence is lacking in a conservative society like India.

Aim:

This study aimed to evaluate the perception of Indian women about the size of the penis of their male partners with respect to sexual satisfaction.

Methodology:

A questionnaire-based study was carried out using a 20-item questionnaire in a sample of 230 sexually active Indian women, who answered the questionnaire either using pen and paper or using social media platform such as WhatsApp. Both the univariate and multivariate regression analysis was done using GraphPad software (©2020 GraphPad Software, Inc, California, USA). A P value less than .05 was considered statistically significant.

Results:

The study was conducted from January 2015 to December 2020. As per the accrued opinion of the women who participated in the study, there was no statistically significant correlation between the size of the penis and the sexual satisfaction.

Conclusion:

There is hardly any literature on the perception of women from a conservative society like India about the size of the penis of their partners in relation to the sexual satisfaction. Hence, the data from this study, which is the first of its kind form the Indian subcontinent, can be the basis to allay fears of men expressing their concerns about the size of their penis in this part of the world.

A preliminary investigation of a novel method to manipulate penis length to measure female sexual satisfaction: a single-case experimental design

OBJECTIVES

To investigate a novel methodology and explore whether artificially reducing the depth of penetration during intercourse matters to women.

STUDY DESIGN AND METHODS

A study with a single-case experimental design ('n of 1'), in which a heterosexual couple act as their own control and the study is then replicated in subsequent couples, was conducted. Thirty-five couples were assessed for eligibility to participate. Twenty-nine couples without any sexual problems were randomized and 12 submitted sufficient data to analyse. As a proxy for reducing penis length, we artificially reduced the depth of penetration by using different sizes of silicone rings around the base of the man's erect penis. The main outcome measures were provided by the female partner on a scale of 0-100 and comprised: degree of (i) overall sexual pleasure; (ii) sexual pleasure from intercourse alone; and (iii) emotional connection to the male partner. The female partner was also asked before the experiment began to rate the degree of positive or negative change that would be personally meaningful for her.

RESULTS

On average, reducing the depth of penetration led to a statistically significant 18% reduction of overall sexual pleasure with an average 15% reduction in length of the penis. The longer the erect penis, the less likely the rings were to have an impact on sexual pleasure. There was a range of individual responses, however, with a minority of women reporting that reducing the depth of penetration was more pleasurable on some occasions.

CONCLUSIONS

Size may matter in women in a healthy stable relationship when there is penile shortening. Because of the small number of couples and the inclusion of men with an apparently long penis, our results are preliminary, and we welcome replication in a larger sample with a more diverse range of penile lengths. Our results should not be misinterpreted as meaning that increasing penile length will increase sexual pleasure in women.

Complications and management of penile augmentation with hyaluronic acid injection

Hyaluronic acid injection is becoming a popular way for penile augmentation. However, only few studies and follow-ups have investigated the various complications of hyaluronic acid injection and their corresponding management. In this study, a total of 230 patients who had penile augmentation with hyaluronic acid injection from January 2018 to December 2019 were examined on follow-up for penile girth, complications, and their corresponding management. At 1-month, 3-month, and 6-month postoperative follow-ups, the penile circumference had increased by 2.66 ± 1.24 cm, 2.28 ± 1.02 cm, and 1.80 ± 0.83 cm, respectively. During the entire 6-month follow-up, 4.3% had complications such as subcutaneous bleeding, subcutaneous nodules, and infection. There were no systemic or local allergic reactions among all the patients. All complications were treated accordingly, and no further deterioration or severe sequelae were observed. Although complications of hyaluronic acid injections are mild and rare, these may affect the patient's satisfaction postoperatively. Preoperative redundant prepuce may increase the incidence of penile edema or postoperative gel migration. Standardization of the surgery protocol and elucidation of the effects of other injection parameters are still lacking. Nevertheless, it still highlights the importance of preoperative preparation and surgical technique.

Average-Size Erect Penis: Fiction, Fact, and the Need for Counseling

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.

An Innovative Strategy for Non-Grafting Penile Enlargement: A Novel Paradigm for Tunica Expansion Procedures

BACKGROUND

Peyronie's disease, diabetes, trauma, pelvic surgeries, and aging are conditions that promote penile fibrosis and trigger erectile dysfunction associated with penile reduction. These pathologies require an objective preoperative diagnosis and intraoperative management of penile shrinkage.

AIM

The goal is to develop a non-grafting procedure to promote lengthening using geometric patterns of multiple staggered small cuts on the tunica albuginea with an optimal ratio between tissue expansion and resistance to confine the cylinders inside the corpora cavernosa.

METHODS

Between February 2016 and February 2019, 416 patients suffering penile shortening with or without Peyronie's disease received implants using the tunica expansion procedures (TEP). Incisions were distributed in respective areas of the tunica to allow maximum expansion while maintaining strength to confine prosthetic cylinders within the corpora cavernosa to prevent bulges and denting.

OUTCOMES

In accordance with these principles, surgical objectives and patient satisfaction were achieved in length and girth restoration regardless of the type of implant used to obtain adequate axial rigidity.

RESULTS

The sample of 416 patients included 287 cases of Peyronie's disease having a mean axial deviation of 51° (0-90°) whose curvature was corrected in surgery, with pressure from the cylinders maintaining straightness for malleable and inflatable devices. Tunica constriction in 40.86% of cases was corrected with vertical relaxing incisions. Ventral glanspexy was performed intraoperatively in 92.8% of patients to prevent hypermobility. A penile gain of 3.3 cm (2-6) was measured intraoperatively.

CLINICAL IMPLICATIONS

Diagnosis of penile shortening was performed by a stretch length test and pharmacologically induced erection together with the patient's subjective opinion of penile loss. Lengthening procedure depends on the limit of the dissected neurovascular bundle. The patient and surgeon select the type of implant in accordance with his individual anatomic characteristics.

STRENGTHS AND LIMITATIONS

The TEP strategy is a non-grafting procedure based on tissue restitution by expansion instead of substitution, which provides surgeons a solution for penile enlargement to the limit of the dissected neurovascular bundle.

CONCLUSIONS

The TEP strategy has been demonstrated to be safe and effective to resolve problems of penile size reduction independently of penile curvature. It eliminates grafting and improves penile lengthening techniques using small, staggered cuts on the tunica albuginea, while maintaining tunica structural resistance to contain cylinders inside the corpora, preventing bulges and denting, facilitating tissue regeneration, and improving axial rigidity. Paulo H. Egydio, An Innovative Strategy for Non-Grafting Penile Enlargement: A Novel Paradigm for Tunica Expansion Procedures. J Sex Med 2020;17:2093-2103.

Formation, structure, and function of extra-skeletal bones in mammals

This review describes the formation, structure, and function of bony compartments in antlers, horns, ossicones, osteoderm and the os penis/os clitoris (collectively referred to herein as AHOOO structures) in extant mammals. AHOOOs are extra-skeletal bones that originate from subcutaneous (dermal) tissues in a wide variety of mammals, and this review elaborates on the co-development of the bone and skin in these structures. During foetal stages, primordial cells for the bony compartments arise in subcutaneous tissues. The epithelial-mesenchymal transition is assumed to play a key role in the differentiation of bone, cartilage, skin and other tissues in AHOOO structures. AHOOO ossification takes place after skeletal bone formation, and may depend on sexual maturity. Skin keratinization occurs in tandem with ossification and may be under the control of androgens. Both endochondral and intramembranous ossification participate in bony compartment formation. There is variation in gradients of density in different AHOOO structures. These gradients, which vary according to function and species, primarily reduce mechanical stress. Anchorage of AHOOOs to their surrounding tissues fortifies these structures and is accomplished by bone-bone fusion and Sharpey fibres. The presence of the integument is essential for the protection and function of the bony compartments. Three major functions can be attributed to AHOOOs: mechanical, visual, and thermoregulatory. This review provides the first extensive comparative description of the skeletal and integumentary systems of AHOOOs in a variety of mammals.

Penis size and sperm quality, are all bats grey in the dark?

Penises play a key role in sperm transport and in stimulating female genitals. This should impact post-copulatory competition, and expose penis characteristics to sexual selective pressures. Studies of male genitalia have repeatedly reported negative static allometries, which mean that, within species, large males have disproportionally small genitals when compared with smaller individuals. Males of some sperm-storing bat species may stand as an exception to such a pattern by arousing from hibernation to copulate with torpid females. The selection for large penises might take place, if a long organ provides advantages during post-copulatory competition and/or if females have evolved mechanisms allowing the choice of sire, relying on characters other than pre-copulatory traits (e.g., penis size). In this study, we measured dimensions of the erected penis in 4 sperm-storing bat species. Furthermore, we collected sperm and evaluated the link between penis dimensions and sperm velocity. Our results revealed steep allometric slopes of the erected penis length in Barbastella barbastellus and an inverse allometry of penis head width in Myotis nattereri. More detailed studies of copulatory behavior are urgently needed to explain the range of observed scaling relations. Furthermore, penis head width correlates with sperm velocity in Plecotus auritus. For this last species, we propose that penis shape might act as a marker of male fertility.

Sociocultural Influences on Men's Penis Size Perceptions and Decisions to Undergo Penile Augmentation: A Qualitative Study

BACKGROUND

An increasing number of men, dissatisfied with their penises, are seeking cosmetic procedures to enhance their penis size. However, little is known about the social and cultural factors that influence men to consider these procedures.

OBJECTIVES

The aim of this study was to investigate the sociocultural factors affecting men's attitudes toward their penis size as well as their decisions to undergo penile augmentation.

METHODS

One-on-one semistructured interviews were conducted with 6 adult men who had previously undergone a penile augmentation. The men were asked about the sociocultural factors that they thought contributed to dissatisfaction with their penis size, and their motivations for having penile augmentation. All interviews were audio recorded and then transcribed verbatim. Interview transcripts were analyzed through the use of thematic analysis.

RESULTS

Three main themes emerged from the interviews, namely "influence of pornography," "comparison with peers," and "indirect appearance-related teasing." The men noted that the large penises of male actors in pornography had skewed their perception of normal penis size. All men had compared their penises with those of their peers, usually in the locker room, and often felt their own penis was smaller as a result. None of the participants had received direct negative comments about their penis size, but were aware that having a small penis was a source of mockery from exposure to jokes on mainstream media sources.

CONCLUSIONS

These new insights into the sociocultural factors, namely media and peers, that influence men's desire for penile augmentation may assist clinicians in enhancing their communication with prospective patients.

Growers versus showers: a meaningful (or useful) distinction?

Yafi et al. have conducted a study that will be of great interest to the lay community and also of import to practicing urologists who routinely encounter patients with concerns about the appearance of their phallus [1]. In one study 14% of men expressed dissatisfaction with their genitals with flaccid penile length being the most common source of dissatisfaction [2]. The concerns of such men tend to be the perception that their penis is small, or at least smaller than the penises of other men.

The naked ape as an evolutionary model, 50 years later

Evolution acts through a combination of four different drivers: (1) mutation, (2) selection, (3) genetic drift, and (4) developmental constraints. There is a tendency among some biologists to frame evolution as the sole result of natural selection, and this tendency is reinforced by many popular texts. “The Naked Ape” by Desmond Morris, published 50 years ago, is no exception. In this paper I argue that evolutionary biology is much richer than natural selection alone. I illustrate this by reconstructing the evolutionary history of five different organs of the human body: foot, pelvis, scrotum, hand and brain. Factors like developmental tinkering, by-product evolution, exaptation and heterochrony are powerful forces for body-plan innovations and the appearance of such innovations in human ancestors does not always require an adaptive explanation. While Morris explained the lack of body hair in the human species by sexual selection, I argue that molecular tinkering of regulatory genes expressed in the brain, followed by positive selection for neotenic features, may have been the driving factor, with loss of body hair as a secondary consequence.

How Big is Too Big? The Girth of Bestselling Insertive Sex Toys to Guide Maximal Neophallus Dimensions

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.

Nonsurgical Medical Penile Girth Augmentation: Experience-Based Recommendations

Penile augmentation is increasingly sought by men who are dissatisfied with the size and/or appearance of their penis. However, augmentation procedures are still considered to be highly controversial with no standardized recommendations reported in the medical literature and limited outcome data. Nevertheless, these procedures continue to be performed in increasing numbers in private settings. Therefore, there is a need for safe, effective, and minimally invasive procedures to be developed, evaluated, and reported in the research literature. In this article, we focus particularly on girth enhancement procedures rather than lengthening procedures as penile girth appears to be particularly important for sexual satisfaction. We discuss the advantages and disadvantages of the common techniques to date, with a focus on the minimally invasive injectable girth augmentation techniques. Based on considerable operative experience, we offer our own suggestions for patient screening, technique selection, and perioperative care.

The effect of leg-to-body ratio on male attractiveness depends on the ecological validity of the figures

Leg-to-body ratio (LBR) predicts evolutionary fitness, and is therefore expected to influence bodily attractiveness. Previous investigations of LBR attractiveness have used a wide variety of stimuli, including line drawings, silhouettes, and computer-generated images based on anthropometric data. In two studies, community samples of heterosexual women from the USA rated the attractiveness of male figures presented as silhouettes and as detailed computer-generated images with three different skin tones (white, black, and an artificial grey). The effects of LBR depended on the image format. In particular, a curve-fitting analysis indicated that the optimally-attractive LBR for silhouettes was fractionally below the baseline, whereas the optima for more detailed computer-generated images was approximately 0.5 s.d. above the baseline and was similar for all three skin-tones. In addition, the participants' sensitivity to changes in the LBR was lowest for the silhouettes and highest for the grey figures. Our results add to evidence that the most attractive LBR is close to, but slightly above, the population mean, and caution that the effects of limb proportions on attractiveness depend on the ecological validity of the figures.

[Inaccurate information about the size of the penis in the Democratic Republic of the Congo: about 21 information sources]

Introduction

La taille du pénis constitue une préoccupation de beaucoup des gens actuellement et certains ne sont pas satisfaits de la dimension de leur pénis comme le montre l’étude de Tiggemann en 2008. Il existe relativement peu d'études sur le pénis en érection. Cela peut refléter les tabous culturels des chercheurs ou des médecins en interaction avec les hommes qui sont dans un état d’excitation sexuelle. Toutes fois, il est important pour les personnes qui annoncent des détails sur la taille du pénis d’annoncer d’abord les repères de la mesure du pénis puis ensuite donner les chiffres que proposent les chercheurs.

Méthodes

Notre enquête de type descriptif transversale s’est effectuée dans les deux grandes villes de la République Démocratique du Congo à savoir la ville de Kinshasa et la ville de Lubumbashi, pendant une période de deux ans soit de Mai 2014 à Mai 2016. Au total, 21 sources d’information ont constitué notre échantillon dont 8 à Kinshasa et 13 à Lubumbashi et nous avons trouvé cela suffisant car les sujets à caractère sexuel sont souvent rares chez nous. Les paramètres étudiés étaient: la nature de la source, la précision de la technique de la mesure, la présence de référence bibliographique, la longueur annoncée du pénis.

Résultats

La majorité des sources d’information sont faites des émissions de radio et de télévision (23,8%), ceci pourra s’expliquer par le fait que dans notre milieu il y a de plus en plus des chaines de radio et télévision et surtout dans les grandes villes. Concernant la précision de la technique de la mesure du pénis lors du partage du message sur la taille du pénis, l’étude nous montre que la majorité des sources d’information ne signale pas cela lorsqu’elles annoncent la taille du pénis au public soit 85,7%. Plusieurs sources ne déclarent pas les références bibliographiques (57,1%). Lorsqu’on regarde même les chiffres de la taille du pénis annoncée, l’on voit les proportions majoritaires suivantes: 14 cm comme taille normale soit 28,6%, suivi de ceux là qui disent 15 cm soit 23,8% et de 15 à 20 cm soit 19%.

Conclusion

Ces résultats sont une interpellation des tous les acteurs responsables de la diffusion de l’information sur la santé sexuelle (taille du pénis): la rigueur scientifique consiste à chercher l’information dans des sources fiables.