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.
Apprehension about the adequacy of external genitalia has been a major concern for men of all ages and cultures. The definition of normal penile size has become more significant in the context of increasing demand for penile augmentation.1, 2, 3, 4 Data on normal size of penis will help (1) to perform correct diagnostic assessment and therapeutic choices, (2) to educate and counsel the patients with concerns about ‘penile size adequacy’, and (3) to manufacture condoms with correct size.5
Previous studies on phallic dimensions (Table 1) are limited and there is a wide difference in methodology.6 So far no study has been reported on this topic from India. Present study is designed to obtain normative data on penile length and circumference of Indian males and to compare it with the data obtained from other countries.
This study was conducted in Kerala, South India. Five hundred men, age ranging from 18 to 60 years were randomly selected from the sexual dysfunction clinic run by the principal investigator and outpatient clinic of the urology department at Medical College, Calicut, Kerala. The study was IRB approved and informed consent was taken from the subjects. All the subjects who were willing to participate in the study have undergone clinical evaluation. Individuals with congenital or acquired genital abnormalities were excluded. Finally, 301 subjects were included in the study.
Penile length was defined as the linear distance along the dorsal side of the penis extending from the pubo – penile skin junction to the tip of the glans. Penile circumference was measured at the middle of the shaft.
Consent was taken from all the subjects. Age was recorded, height and weight were measured. Measurement of penile length was performed by first three investigators. Practice trials for the method of measurement were taken before the beginning of the study. It was performed jointly by all the three investigators to ensure uniformity of measurement. Adequate precautions (adopting same method of measurement, using similar types of tapes, maintaining comfortable room temperature) were taken to standardize the techniques of measurement. All the 301 subjects (group I) have undergone measurements of flaccid length, flaccid circumference and stretched length (in fully stretched but still flaccid state). This was taken by one of the first three investigators with the help of a tape graduated to the nearest of 0.5 cm, immediately after the subjects undressed in order to minimize the effect of room temperature. Adequate privacy was ensured.
From the same sample, a group of 119 subjects were willing to make self-rating of erected penile length and circumference. They were given training and was advised to take the measurement on two different occasions at home in a state of full erection. Only 93 subjects could perform it correctly (group 2). Results of the 26 subjects were discarded for reasons such as inability to achieve full erection or loss of erection at the time of measurement and those who obtained different values at two different measurements.
In order to find out whether any major errors such as overestimation or underestimation had occurred during the time of self-measurement, another group of 41 subjects (group 3) were taken from the same sample and subjected to measurement by one of the investigators for erected length and circumference. Initially 50 subjects were chosen and individually provided with adequate privacy and visual sexual stimulation with the help of a videotape. Only 41 subjects could achieve full erection. On achieving maximum erection, erected length and circumference were measured by the investigator. Out of 50 subjects, nine were excluded as they could not achieve either full erection or lost it during the time of measurement.
Data management and statistical analysis was undertaken using the Statistical Package for Social Sciences (SPSS), version 10, for windows. Descriptive statistics, Pearson's product moment correlation and critical ratios were computed. Regression analysis was performed to see whether any of the variables can predict the erected length and circumference.
Descriptive statistics for different variables of group 1 (301 subjects) are given in Table 2. The mean flaccid length, flaccid circumference and stretched length are found to be 8.21, 9.14 and 10.88 cm.
The mean erected length and circumference were found to be 13.01 and 11.46 cm when measured by the subjects and 12.93 and 11.49 cm respectively when measured by the investigators (Table 3).
Paired sample ‘t-test’ was carried out to see whether there is any significant difference between the measurements taken by the subjects and the investigators. Measurements obtained for erected length are found to be significantly different (t=2.59, P<0.01), but there is a high correlation (r=0.93) between the two sets of measurements. There is no significant difference between the two measurements obtained for erected circumference (t=0.247) and a high correlation (r=0.89) was noticed between the measurements performed by the subjects and investigators.
Table 4 shows that there is significant inter-correlations between flaccid length, flaccid circumference, stretched length, erected length and erected circumference. Height has significant correlation with the flaccid length (P<0.01), erected length and erected circumference (P<0.05). Weight is found to have a positive correlation with erected circumference (P<0.05), but a significant inverse relationship with flaccid and stretched lengths (P<0.01). Body mass index (BMI) has significant inverse correlation with flaccid, stretched and erected lengths. BMI is found to be positively correlated with flaccid circumference.
Penile measurements obtained in the present study are compared with the data available from other countries (Table 5).
Regression modeling for erected length (EL) was performed using the correlated factors that affect the erected length. The adjusted R-square of the model is 0.387 (R2=0.387) and the model was found to be significant (P<0.05) as found by analysis of variance (ANOVA). Only flaccid length (FL) was present in the model. Linear regression model for the EL was formed.
Regression modeling was performed for erected circumference (EC) using the significantly correlated factors that affect the erected circumference. The adjusted R-square (R2=0.221) of the model is 0.221 and the model was significant (P<0.05) as found by ANOVA. Model included flaccid circumference (FC) and height (H) for the prediction erected circumference (EC). Linear regression model for erected circumference was formed.
The definition of normal penile size is of considerable interest as there is a steady increase in the number of people complaining of ‘short penis’ and seeking penile enlargement procedures. Mondaini et al.2 reported that most men who seek penile lengthening surgery ‘overestimate’ the ‘normal’ penile length. In their study of 67 patients complaining of ‘short penis’, none were found to be having a severely short penis. Both flaccid and erected lengths are important as patient's perception of penile inadequacy could be often related to either of this.
Number of patients visiting the sexual dysfunction clinics with the concern of short penis is found to be increasing steadily. However, studies on penile dimensions are limited and no study is reported from India.
The average flaccid penile length is found to be 8.21 cm in the present study, which is significantly lower than that of the mean length reported from USA1 and Jordan.7 The mean flaccid penile length reported from Nigeria8 is 8.16 and from Israel9 8.3 cm, which are similar to the findings of the present study without any significant difference.
The mean flaccid circumference obtained in the present study is 9.14, which is significantly lower than the findings reported from USA1 but significantly higher than that of reported from Nigeria.8 Mean flaccid circumference reported from Jordan7 is 8.98 cm, which is similar to the findings of the present study.
The mean stretched length obtained in the present study is 10.88 cm which is found to be significantly lower than the mean values reported from USA,1 Jordan7 and Israel9 but significantly higher than that of reported from Korea.3
In the present study, erected length and erected circumference were also obtained through self-measurements by the subjects. Paired sample ‘t-test’ showed significant difference (CR=2.59) between the two measurements of erected length performed by the subjects (group 2) and the investigators (group 3). The mean erected length obtained in self-measurement by the subjects (group 2) was 13.01 cm and when measured by the investigators (group 3) it decreased to 12.93 cm. Probable reasons for obtaining lower mean erected length when measured by the investigators could be the psychological factors like inhibitions due to the presence of another person. However, there is a very high correlation between the two sets of measurements (r=0.93). No significant differences were found between the two sets of measurements of erected circumference and there is high correlation between the two (0.89). Hence for the final results of erected length and circumference the values obtained by the group 2 (EL: 13.01 cm and EC: 11.46 cm) were considered.
Reports on mean erected length are available only from USA,1 Jordan7 and Israel.9 Erected length obtained in the present study (13.01 cm) does not differ significantly from the mean erected length reported by Wessells et al.1 from USA (12.89 cm), but the finding reported from Israel9 (13.6 cm) is significantly higher. The mean value reported from Jordan7 (11.8 cm) is found to be significantly low. Bondil et al.10 reported the longest penile length in the flaccid (10.7 cm) and stretched conditions (16.24 cm). In their study, measurements were obtained after three manual stretches of the penis. Owing to the methodological difference in determining stretched length, it cannot be compared with the present study. Longest erected length reported is 15.99 cm (Richters et al.11) followed by 15.5 cm (Kinsey et al.12). Details of these studies were not available for a statistical comparison. For erected circumference, the only data available are from USA1 and it does not show any significant difference from the Indian data.
Overall data show that there is variation in flaccid length, flaccid circumference, stretched length, erected length and erected circumference reported from different countries. This could be due to the racial or constitutional difference or some other factors.
Inter-correlations were computed to see whether there is any relationship between flaccid length, flaccid circumference, stretched length, erected length and erected circumference. It is found that there is significant relationship between all these variables.
Height is found to have a significant positive correlation with flaccid length (P<0.01) erected length and erected circumference (P<0.05). Ponchietti et al.,6 in a subgroup of 325 males, found similar correlation for height with midpoint circumference, flaccid and stretched penile lengths. This goes consistent with the findings of the present study. Awwad et al.7 also found significant correlation between height and midpoint circumference, but could not find any relationship with flaccid or stretched lengths. Present study shows that BMI has a significant inverse correlation with flaccid, stretched and erected lengths (P<0.01), which goes consistent with the findings of Ponchietti et al.6 But in the present study, BMI is found to have a positive correlation with flaccid circumference (P<0.01) unlike what is reported by Ponchietti et al.6
Although weight is found to be positively correlated with erected circumference and BMI, very significant (P<0.01) inverse relationship was found with flaccid and stretched lengths. Ponchietti et al.6 also found a similar inverse relationship between weight and flaccid as well as stretched lengths.
Ponchietti et al.6 arrived at the conclusion that penile dimensions are correlated with other anthropometric measurements such as height and weight, suggesting that penile dimensions are themselves anthropometric measures. Result of the present study goes consistent with this observation. Although different correlated factors are there, flaccid length is found to be the single best predictor of erected length as observed from the regression model. Flaccid circumference and height were found to be the best predictors for erected circumference as revealed by the model.
Limitations and suggestions
This study is conducted in a limited sample of 301 subjects who are not drawn directly from general population. They are the patients came to seek treatment either for sexual dysfunction or any other urological problems. Hence, a chance of bias in sample selection cannot be excluded completely. It would be better to study a larger sample directly drawn from the general population. More anthropometric parameters could also be considered.
Mean flaccid, stretched and erected lengths are found to be 8. 21, 10.88 and 13.01 cm, respectively. Mean flaccid and erected circumference are found to be 9.14 and 11.46 cm.
Significant inter-correlations observed between all measures of penile dimensions.
Penile dimensions are found to be correlated with anthropometric measures such as height, weight and BMI.
Flaccid penile length is found to be most closely correlated with erected length.
Flaccid circumference and height are found to be most closely correlated with erected circumference.
Regression equation was formed and flaccid length is found to be the best predictor of erected length. Flaccid circumference and height were found to be the best predictor of erected circumference.
Significant difference observed between the penile dimensions reported from different countries.
To gain more insight into the morphological aspects of penile dimensions, a multicentered multiethnic study is needed.
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Promodu, K., Shanmughadas, K., Bhat, S. et al. Penile length and circumference: an Indian study. Int J Impot Res 19, 558–563 (2007). https://doi.org/10.1038/sj.ijir.3901569
- penile dimensions
- penile length
- penile size
- short penis
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