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Does underestimated penile size impact erectile function in healthy men?

Abstract

The aim of this study is to assess the impact of objective (stretched) and subjective penile size in the erectile function in a urological check-up program on a cross-sectional study including 689 men aged 35–70 years. IIEF-5 questionnaire, physical examination (penile length, prostate volume, blood pressure, body mass index-BMI), metabolic syndrome (MS), comorbidities, habits (sexual intercourse frequency, physical activity, alcohol, and tobacco use), level of education, serum glucose, total testosterone, estradiol, PSA, lipid profile, and self-perceptions (ejaculation time and subjective penile size) were examined in multivariate models using logistic and linear regressions. Penile objective mean length was 13.08 cm ± 2.32 and 67 (9.72%) patients referred small penis self-perception. Seventy-six (11.03%) participants had severe erectile dysfunction (ED), 75 (10.88%) had mild to moderate and moderate ED, 112 (16.25%) had mild ED and 426 (61.83%) had no ED. Risk factors for ED that held statistical significance were self-perceived small penis (OR = 2.23, 95% CI 1.35–3.69, p = .0017), sexual intercourse frequency (per week) (OR = 0.45, 95% CI 0.38–0.52, p < .0001), satisfactory ejaculation time (no vs. yes, OR = 2.06, 95% CI 1.46–2.92, p < .0001), comorbidity (yes vs. no, OR = 2.01, 95% CI 1.46–2.76, p < .0001), age >65 years (OR = 2.93, 95% CI 1.53–5.61, p < .0001), tobacco use (yes vs. no, OR = 1.41, 95% CI 1.02–1.96, p < .0375), regular physical activity (no vs. yes, OR = 1.59, 95% CI 1.13–2.23, p < .0083), serum total testosterone < 200 ng/dl (OR = 3.48, 95% CI 1.69–7.16, p = 0.0009), serum glucose > 100 mg/dl (OR = 1.69, 95% CI 1.18–2.43, p = 0.0044) and systolic blood pressure > 130 mmHg (OR = 1.60, 95% CI 1.16–2.19, p = 0.0037). Results suggest that in addition to previously reported risk factors, patient’s subjective impressions of penile size negatively impacts sexual life in about 10% of men considered healthy, while objective penile length does not play significant role in erectile function.

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References

  1. Capogrosso P, Colicchia M, Ventimiglia E, Castagna G, Clementi MC, Suardi N, et al. One patient out of four with newly diagnosed erectile dysfunction is a young man—Worrisome picture from the everyday clinical practice. J Sex Med. 2013;10:1833–41.

    Article  PubMed  Google Scholar 

  2. Costa IC, Carvalho HN, Pacheco-Figueiredo L, Tomada I, Tomada N. Hormonal modulation in aging patients with erectile dysfunction and metabolic syndrome. Int J Endocrinol. 2013;2013:107869.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U. Epidemiology of erectile dysfunction: results of the ‘Cologne Male Survey’. Int J Impot Res. 2000;12:305–11.

    Article  PubMed  CAS  Google Scholar 

  4. Tsujimura A, Kiuchi H, Soda T, Takezawa K, Okuda H, Fukuhara S, et al. Sexual life of Japanese patients with erectile dysfunction taking phosphodiesterase type 5 inhibitors: an internet survey using the psychological and interpersonal relationship scales-short form questionnaire. Int J Urol. 2014;21:821–5.

    Article  PubMed  Google Scholar 

  5. Wylie KR, Eardley I. Penile size and the ‘small penis syndrome’. BJU Int. 2007;99:1449–55.

    Article  PubMed  Google Scholar 

  6. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822–30.

    Article  PubMed  CAS  Google Scholar 

  7. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11:319–26.

    Article  PubMed  CAS  Google Scholar 

  8. Reis AL, Reis LO, Saade RD, Santos CA Jr, Lima ML. Fregonesi. Validation of Portuguese version of quality of erection questionnaire (QEQ) and comparison to International Index of Erectile Function (IIEF) and RAND 36-Item Health Survey. Int Braz J Urol. 2015;4:155–67.

    Article  Google Scholar 

  9. 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. 2015;115:978–86.

    Article  Google Scholar 

  10. Reis LO, Simão AF, Baracat J, Denardi F, Gugliotta A. Digital rectal examination standardization for inexperienced hands: teaching medical students. Adv Urol. 2013;2013:797096.

    PubMed  PubMed Central  Google Scholar 

  11. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 2001; 285: 2486–97.

  12. Veale D, Eshkevari E, Read J, Miles S, Troglia A, Phillips R, et al. Beliefs about penis size: validation of a scale for men ashamed about their penis size. J Sex Med. 2014;11:84–92.

    Article  PubMed  Google Scholar 

  13. Veale D, Miles S, Read J, Troglia A, Wylie K, Muir G. Sexual functioning and behavior of men with body dysmorphic disorder concerning penis size compared with men anxious about penis size and with controls: a cohort study. Sex Med. 2015;3:147–55.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wessells H, Lue TF, McAninch JW. Penile length in the flaccid and erect states; guidelines for penile augmentation. J Urol. 1996;156:995–7.

    Article  PubMed  CAS  Google Scholar 

  15. Rajkumar RP, Kumaran AK. Depression and anxiety in men with sexual dysfunction: a retrospective study. Compr Psychiatry. 2015;60:114–8.

    Article  PubMed  Google Scholar 

  16. McCabe MP, Althof SE. A systematic review of the psychosocial outcomes associated with erectile dysfunction: does the impact of erectile dysfunction extend beyond a man’s inability to have sex? J Sex Med. 2014;11:347–63.

    Article  PubMed  Google Scholar 

  17. Shaeer O, Shaeer K. The Global Online Sexuality Survey (GOSS): ejaculatory function, penile anatomy, and contraceptive Usage among Arabic-speaking internet users in the Middle East. J Sex Med. 2012;9:425–33.

    Article  PubMed  Google Scholar 

  18. Promodu K, Shanmughadas KV, Bhat S, Nair KR. Penile length and circumference: an Indian study. Int J Import Res. 2007;19:558–63.

    Article  CAS  Google Scholar 

  19. Aslan Y, Atan A, Omur Aydın A, et al. Penile length and somatometric parameters: a study in healthy young Turkish men. Asian J Androl. 2011;13:339–41.

    Article  PubMed  Google Scholar 

  20. 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. 2012;109:740–4.

    Article  PubMed  Google Scholar 

  21. Shalaby ME, Almohsen AE, El Shahid AR, Abd Al-Sameaa MT, Mostafa T. Penile length—somatometric parameters relationship in healthy Egyptian men. Andrologia. 2015;47:402–6.

    Article  PubMed  CAS  Google Scholar 

  22. Habous M, Tealab A, Williamson B, Binsaleh S, El Dawy S, Mahmoud S, et al. Erect penile dimensions inacohort of 778 Middle Eastern men: establishment of a nomogram. J Sex Med. 2015;12:1402–6.

    Article  PubMed  Google Scholar 

  23. Kamel I, Gadalla A, Ghanem H, Oraby M. Comparing penile measurements in normal and erectile dysfunction subjects. J Sex Med. 2009;6:2305–10.

    Article  PubMed  Google Scholar 

  24. Ma YM, Wu KJ, Dang Q, Shi Q, Gao Y, Guo P, et al. Testosterone regulates keratin 33B expression in rat penis growth through androgen receptor signaling. Asian J Androl. 2014;16:817–23.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Garimella PS, Paudel ML, Ensrud KE, Marshall LM, Taylor BC, Fink HA, et al. Association between body size and composition and erectile dysfunction in older men: osteoporotic fractures in men study. J Am Geriatr Soc. 2013;61:46–54.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

To the participant patients.

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Funding

CNPq Research Productivity, Brazil—grant: 302622/2015-2 (Reis LO).

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Correspondence to Leonardo O. Reis.

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Sanches, B.C., Laranja, W.W., Alonso, J.C. et al. Does underestimated penile size impact erectile function in healthy men?. Int J Impot Res 30, 158–162 (2018). https://doi.org/10.1038/s41443-018-0039-1

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