Small Penis Syndrome

The penis, especially when erect represents a male’s masculinity. Penis size in most cultures is associated with being “large, the ability to endure, courage, power and dominance over men’, possession of women.

There is tremendous historical context when we discuss the topic of ‘penis size’.   Indian Sadhus using weights increased penis size, and the topinama people of Brazil who use the bite of poisonous snakes to bite their organ to enlarge it!.  As absurd as these practices may sound, even prehistoric cave dwellers attributed strength to the size of the penis. The Kama sutra also elaborates and emphasizes the importance of penis size.

Given the cultural and historical interest in penis size, it is not surprising that a large majority of men place an overwhelming amount of importance on penis size. Penis size as such is important in both the ‘flaccid state’ and the ‘erect state’

Small penis syndrome is classically seen in individuals who actually have a normal penis size as compared to those who have a true ‘Micropenis’. While most men by default assume that women are attracted to men with larger organs, this is not always true!.

Penis width is more important than length and more importantly a man’s personality is what counts. The issues of male attractiveness though are definitely more complex than mere size of the penis. However, one cannot deny the fact that

Larger penis size = a more masculine body image and more sexual competence

A small penis syndrome problem is not something trivial. It can manifest as an increased sense of anguish or anxiety that can occur while viewing one’s genitals (clothed and unclothed). Men with this problem feel there is something terribly wrong with the size of their organ. They feel that they cannot satisfy their partners. Moreover, they frequently become depressed and suicidal thoughts also set in. Most men with this condition frequently visit numerous specialists but are never actually convinced about their size. Men with small penis syndrome also tend to avoid social gatherings as well as intimate relationships in general. They also firmly believe that a marked change in the size of their organ is an absolute must for them to lead a normal life.

An interesting study conducted on a large population of heterosexual men found that only 55% of men are actually fully satisfied about the size of their organ. Furthermore over 45% of men actually wanted a larger organ size!

Penis Size estimates:-

Penis length to a certain extent varies from one population to another. However, the average girth across different populations remains surprisingly stable at 9-10 cm in the non erect state. Erect girth is usually 12-13 cm. On the other hand, stretched penis length as measured in different studies is about 12-13 cm. While the erect length is about 14-16 cm.

If the stretched penis length is less than <7 cm it is probably a true ‘MICROPENIS’

Nevertheless, more large scale studies are definitely required to assess true penis length estimates and the various factors that affect it.

Causes of small penis syndrome:-

Men seem to develop small penis syndrome for a variety of reasons. Some of them are outlined below

  1. Locker room syndromes:- In this condition, the patient when he was a young child would have observed the large organ of a sibling or friend. In some instances he might have looked at erotic images, feelings of inadequacy might have cropped up and may persist till adulthood
  2. Derogatory remarks:- Fears and serious anxieties about penis size can also occur when the patients partner or loved one might have passed some nasty comments during sexual activity. The partner might have stated that she is unable to ‘feel’ him inside. This can severely affect the man’s body image and self confidence. The anxiety is primarily related to erect size here. These acts can usually disturb the relationship to such an extent that, he eventually will avoid intercourse putting the relationship in serious strain.
  3. Small testicles:- In some men, testicle size and development may be genuinely affected affecting the man’s concept of genital image as such. Androgen defects and other complex neurological issues may aggravate the problem. Sometimes, the male may not feel the proper sensations in certain areas around the penile region.
  4. Psychiatric conditions – Anxiety issues, body dysmorphic disorder, social phobia and depression have all been well associated with small penis syndrome.
  5. Obesity:- In overweight individuals, prepubic fat can sometimes bury the penis leading to a complete underestimation of penis size.

Assessment of size

Penis size assessment must be done by the clinician preferably. Self assessment of size can often lead to erroneous measurements. Usually when a man presents with a suspected small penis size problem, a thorough medical and psychosexual history should be taken. The patients’ general belief, value systems, assumptions and behaviours should also be assessed. Some common questions that can be asked include

What is bothering you the most?

Do you avoid social gatherings?

Do you avoid swimming and other athletic sports in general?

Do you avoid your intimate partner?

A thorough physical exam combined with a detailed genital examination should also be done. Measurements of flaccid length and girth will also usually be performed. Endocrine workup is recommended in select patients.

Treatment of Small penis syndrome:-

A combination of treatment strategies works best for small penis syndrome. A well trained Andrologist or sexologist should never dismiss the genuine concern of the patient suffering from small penis syndrome. This will only work in a counterproductive fashion and heighten the patients worry/anxiety.

A great treatment strategy would be

  1. Give the right education to patient
  2. Explain and counsel about the relative importance of penile size
  3. Mirror work with the doctor or training to do it at home
  4. Psychotherapy which involves substitution of belief systems, exploring and correction of thinking patterns can have dramatic effects.
  5. Use of vacuum devices, penis size extenders and traction devices. While these devices are not failsafe, they do have some limited benefits. Modest increment of 1-2 cm after a 90 days of treatment is possible
  6. Medical therapy for penis size improvement is unproven except in the case the patient is diagnosed with hypgonadotrophic hypogonadism

While a few urologists and general surgeons advocate surgical enhancement of penis size, I am strongly against it. Unfortunately a large number of surgical procedures done to enhance penis size cause more harm than good. Many patients end up with post surgical ‘Erectile dysfunction’

Cosmetic procedures like fat injection also sound fascinating, but are unfortunately not proven yet. Scarring, bruising and disfigurement have been reported in the literature.

All said and done, careful physical examination combined with counselling, education and mirror work is usually quite effective in treating a large number of patients with small penis syndrome.

I hope you enjoyed reading article, do share it with your friends and loved ones!

Stay healthy and stay happy.

Meet Dr. Shah at the Male Infertility & Sexual health Clinic

Dr. Shah is Consultant Andrologist and Sexologist in Chennai. His passion for helping men facing infertility issues stems from the fact that “Men never ever get the care they deserve as far as fertility treatments is concerned”

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