If I were to name one problem where my counseling skills are challenged constantly, then it would be with men who are unhappy with the size of their penis. The “Micropenis”! Is it really that common or are my patients just paranoid? Where does this fixation on the male organ come from? Well, the penis in many cultures including the Indian has been revered as a symbol of masculinity. It represents strength, courage and virility among men. In India tales abound that the Himalayan sadhus attach weights to their penis to increase the size and girth. In South America, in the 16th century, the Topinamas of Brazil used poisonous snakes to bite their penis which would then result in its enlargement. It sure shows that the penile enhancement fad has been around for ages.
View on Penis Size
In an internet survey of more than 50,000 men and women, men who rated their penis as large had significantly more positive views about their body and the attractiveness of their face than did other men. However, the funny side was that a higher percentage of women were satisfied with their partner’s penis size than the percentage of men who were satisfied with their own penis size (84% vs. 55%). So what are you guys worried about?
How to measure normal penile size?
Penile size usually reported by patient self measurement is longer than what physicians measure. All of us like to gloat ..don’t we? Extent of supra pubic fat should be taken into account every time penile length is measured. A flaccid length and a stretched penile length are important. The penis is usually measured from the pubic bone to the tip of the glans in a flaccid and stretched state. The width of the penis is usually measured at the mid shaft in both the flaccid and erect states. Many a time obese men with nearly 2 inches of supra pubic fact land up at my clinic worried about a small penis.
Micropenis is defined as a stretched penile length ±2.5cms standard deviations less than the mean for age group without the presence of any other penile anomalies.
The flaccid penile length at birth is only 4cms. The penis grows after exposure to hormones after about 12 weeks in the womb. This adds another 2cms to the penis and subsequent growth happens only at puberty.
Common Reasons for Micropenis
The connection between the brain and the gonads (testes) and the hormones have to be intact for penile development to occur. When there is disarray in this axis, penile growth can get stunted. A few may be due to unknown or idiopathic reasons. When the receptors for testosterone are defective, Micropenis may occur.
Treatment if you have a smaller penis (Small Penis Treatment)
Testosterone replacement therapy can be undertaken when there is evidence of Micropenis due to a deficiency in the brain gonad axis in infancy as well as in puberty depending on when it was diagnosed. This can be done by means of injections. Surgery may involve girth enhancement, abdominopubopelvic liposuction, skin flaps, suspensory ligament dissection. Usually men with an erect penis length of less than 7.5cm should be considered as candidates for lengthening procedure.
Counseling (You will need this if you ‘think’, your manhood is small)
Counseling forms the most important part of treatment in men presenting with illusions of micropenis. It is important to explain about the true range and averages of the size of the normal adult penis, correcting any misconceptions. Supra pubic fat may make the penis appear smaller than it is. Only the length of the erect penis may be of functional significance. Men should be made to understand that the clitoris and the external vagina are supremely sensitive. The depth of the vagina and hence the length of the penis may not matter. Mirror work where a patient stands in front of the mirror to appreciate the size of his penis is advocated.
To me, the most important thing I tell my patients is to stay off from internet sites which offer magical cures to increase penis size. For all you know, the guys running these sites may have a smaller penis than yours!