A cut to be above the rest

Dear Dr. G,

I often read your articles addressing the issues of penis size, and as a 25-year-old man I am constantly aware that my penis is just average or even smaller compared to my peers.

Indeed, I feel short-changed about my “asset in the pants” and this is really affecting my self-confidence.

I measured my own penis and the flaccid state is usually 3.6 inches and the erect length can get to a maximum of 5.2 inches, which is average according to your previous articles.

As such I went to several doctors to express my frustration. The doctors told me I am normal and that I may suffer from Small Penile Syndrome, which is all in my mind!

I would like to put Dr. G on the spot to scrutinize the truth about Small Penile Syndrome. Does it really exist? If so, how is the diagnosis made?

What are the ways to treat Small Penile Syndrome?

Lastly, I read a lot about surgeries to enlarge the penis; what operations are they? Are they risky? Do you think these can help me to reverse my shortcoming?

In truth, I just don’t want to be just average and therefore do you think I need the cut to be above the rest?

Yours truly,
Average Adam

The British Journal of Urology International (BJUI) published an extensive study on the average size of a penis and reported that the mean penile length when flaccid is 3.61 inches, and the erect state can measure up to 5.16 inches. This systemic review scrutinized data from 17 studies with more than 15,000 participants.
The analysis charted sizes and placed them into statistical percentiles.

According to the publication, only 5% of men would have a penis longer than 6.3 inches, and only five men out of 100 would have a penis shorter than 3.94 inches. Additionally, a penis that is shorter than 2.5 standard deviations below the mean of 3.6 inches is generally diagnosed as micropenis.

An individual who has normal size penis but experiences persistent anxiety about the size of their penis is suffering from Short Penis Syndrome. The sufferer worries their penis is too small, and others will judge them for its size.

Some doctors refer this as Penile Dysmorphic Disorder (PDD). The individual has the size and shape of their penis as the main focus of dysmorphia, having a preoccupation and obsessive emphasis on the penis which leads to significant shame and handicap in daily life.

A diagnosis of PDD requires the recognition of certain criteria, the first being an observation of the actual size and shape of the penis. Secondly, the degree of psychological impact is observed, including depression and anxiety.

Lastly, the degree of handicap, such as social phobia, quality of life and sexual functions are also observed. PDD is then treated as any form of body dysmorphic disorder through cognitive therapy and counselling for the anxiety.

Men failing the psychological treatment to overcome the ideation of being average often seek surgical interventions to overcome the shortcomings. To date, there is no robust evidence suggesting surgical procedures can bring about long lasting improvement. However, some small studies have demonstrated some positive outcomes in a small number of patients in short-term evaluations.

These include the injection of silicone implants, autologous fat injections and incisional correction of the penile suspensory ligaments. Currently, the Penuma procedure is the only penis enlargement procedure that is approved by the FDA in the USA. These are silicone implants that will require a surgeon to make an incision above the penis and insert a silicone slip into the penile shaft.

The other mode of penile enhancement is an autologous fat transfer. In this procedure, liposuction is carried out, removing fat cells from other areas of the body. These fat cells are then purified and injected into the shaft of the penis.

A 2018 study reported the Penuma intervention has a success rate of enhancing the penile girth by 56.7%, improving self-confidence and self-esteem. Another study also demonstrated it can help to correct a “retractile penis”, making it more prolonged and visible. The complications of the injections were noted to be infections and bruising of the injection sites. Other long-term issues also include changes in shape and sensation of the penis.

Finally, the suspensory ligament division operation or ligamentolysis offers a way to make a flaccid penis appear longer by cutting the suspensory ligament, which attaches and stabilizes penis to the pubic bone.

Surgeons can also remove fat from the base of the penis at the same time, making the penis appear more protruding. The surgery can make the penis hang further down, but does not actually increase the size. Such intervention has reported satisfaction rates ranging from 30-65%.

The complications of an “unstable” penis is the usual complaint, making sexual intercourse troublesome. Keeping up with a partner’s sexual needs does not depend solely on penile sizes. A healthy lifestyle can also ensure persistent erections to sustain better sexual endurance, despite having an “average” penis.

More importantly, open communication and prolonged foreplay are all the techniques necessary for a fulfill ng pleasurable sex life.

Stephen Hawking once said: “We are just an advanced breed of monkeys on a minor planet of a very average star. But when we can understand the universe, that makes us something special”.

Men with average penises often put Dr. G on the spot, having no issues pleasing their partners but only trouble self-pleasing.

His response is “Understanding the universe of lovemaking; even being average can overcome the shortcomings, without undergoing a cut to be above the rest!”