Penile length and circumference: a study on 3,300 young Italian males

Plication surgery does not produce additional loss of length in Peyronie's disease patients

Nesbit's procedure remains a cornerstone in surgical management of Peyronie's disease, despite the subjective loss of penile length. This retrospective study demonstrates that the perceived length loss has already occurred prior to surgery and that the Nesbit's procedure does not produce additional loss of length. Ninety-one patients who had undergone Nesbit's procedure between 2017 and 2022 at the Department of Urology of the University of Trieste were enrolled in the study. Preoperative stretched penile length and postoperative stretched penile length were measured. The curvature was uniplanar in 78 patients and biplanar in the remainder. Mean degree of the main curvature was 52.58° ± 14.13° and mean number of plications was 2.42 ± 1.07. Analysis revealed that the median of the differences between preoperative stretched penile length and postoperative stretched penile length was not significant (p = 0.466). According to our results, no significant penile shortening occurs as immediate consequence of Nesbit's procedure, as length is defined by the shorter side of the shaft affected by Peyronie's disease. Hence the length loss should have to be attributed to Peyronie's disease itself and could have been accurately predicted preoperatively allowing for a more accurate counseling of patients. Further studies are pending to assess potential postoperative loss of length due to scarring contracture.

Worldwide Temporal Trends in Penile Length: A Systematic Review and Meta-Analysis

PURPOSE

Normative male genital measurements are clinically useful and temporal changes would have important implications. The aim of the present study is to characterize the trend of worldwide penile length over time.

MATERIALS AND METHODS

A systematic review and meta-analysis using papers from PubMed, Embase, and Cochrane Library from inception to April 2022 was performed. PRISMA guidelines were used for abstracting data and assessing data quality and validity. Pooled means and standard deviations for flaccid, stretched, and erect length were obtained. Subgroup analyses were performed by looking at differences in the region of origin, population type, and the decade of publication. Metaregression analyses were to adjusted for potential confounders.

RESULTS

Seventy-five studies published between 1942 and 2021 were evaluated including data from 55,761 men. The pooled mean length estimates were flaccid length: 8.70 cm (95% CI, 8.16-9.23), stretched length: 12.93 cm (95% CI, 12.48-13.39), and erect length: 13.93 cm (95% CI, 13.20-14.65). All measurements showed variation by geographic region. Erect length increased significantly over time (QM=4.49, df=2, p=0.04) in several regions of the world and across all age groups, while no trends were identified in other penile size measurements. After adjusting for geographic region, subject age, and subject population; erect penile length increased 24% over the past 29 years.

CONCLUSIONS

The average erect penis length has increased over the past three decades across the world. Given the significant implications, attention to potential causes should be investigated.

Smaller prize, bigger size? Exploring the impact of money on men's self-reported markers of masculinity

Bodily markers, often self-reported, are frequently used in research to predict a variety of outcomes. The present study examined whether men, at the aggregate level, would overestimate certain bodily markers linked to masculinity, and if so, to what extent. Furthermore, the study explored whether the amount of monetary rewards distributed to male participants would influence the obtained data quality. Men from two participant pools were asked to self-report a series of bodily measures. All self-report measures except weight were consistently found to be above the population mean (height and penis size) or the scale midpoint (athleticism). Additionally, the participant pool that received the lower (vs. higher) monetary reward showed a particularly powerful deviation from the population mean in penis size and were significantly more likely to report their erect and flaccid penis size to be larger than the claimed but not verified world record of 34 cm. These findings indicate that studies relying on men's self-reported measures of certain body parts should be interpreted with great caution, but that higher monetary rewards seem to improve data quality slightly for such measures.

Multidisciplinary approach and management of patients who seek medical advice for penile size concerns: a narrative review

We aimed to provide an overview of the strategies available to manage patients concerned about their penile size and to provide useful surgical hints regarding the most common penile enlargement approaches, based on our surgical expertise in this field. A comprehensive research was carried out on MEDLINE/PubMed database to identify pertinent studies concerning penile enlargement issues. The search strategy included a range of keywords; e.g. penis, penile, enlargement, augmentation, lengthening, girth. Management of penile size-related concerns represents a real challenge for the urologist, especially when dealing with patients suffering from penile dysmorphophobic disorder (PDD). A multidisciplinary preoperative assessment, including a psychiatric/psychological evaluation, may help in discerning those patients who would benefit the most from counselling/conservative management from those who would benefit from surgery instead. Conservative approaches include the use of vacuum-based and penile-stretching devices, which have shown encouraging levels of efficacy and safety. Over the last decades, different surgical strategies have been developed, aimed at either increasing flaccid penile length or improving penile girth. Penile lengthening procedures are more established, and satisfactory results can be achieved by experienced, large referrals' volume, surgeons. To date, there is lack of consensus regarding the penile girth enhancing techniques, and therefore these should be regarded as experimental. A multidisciplinary approach is necessary to identify patients with PDD, who should not be offered surgical intervention and should be referred for psychiatric/psychological counselling instead. The surgical approach should be tailored to the subject's unique anatomy and underlying conditions.

The Lost Penis Syndrome: A New Clinical Entity in Sexual Medicine

INTRODUCTION

The "lost penis syndrome" (LPS) is a term often used in non-clinical settings to describe the subjective perception of the loss of cutaneous and proprioceptive feelings of the male organ during vaginal penetration. Although deserving clinical attention, this syndrome did not receive any consideration in the medical literature. Notwithstanding, it represents a relatively unexceptional condition among patients in sexual medicine clinics, and it is often reported together with other sexual dysfunctions, especially delayed ejaculation, anejaculation, male anorgasmia and inability to maintain a full erection.

OBJECTIVES

To draft a new conceptual characterization of the LPS, defined as a lack of penile somesthetic sensations during sexual penetration due to various causes and leading to several sexual consequences in both partners.

METHODS

Based on an extensive literature review and physiological assumptions, the mechanisms contributing to friction during penovaginal intercourse, and their correlation to LPS, have been explored, as well as other nonanatomical factors possibly contributing to the loss of penile sensations.

RESULTS

Efficient penile erection and sensitivity, optimal vaginal lubrication and trophism contribute to penovaginal friction. Whenever one of these processes does not occur, loss of penile sensation defined as LPS can occur. Sociocultural, psychopathological and age-related (ie, couplepause) factors are also implicated in the etiology. Four types of LPS emerged from the literature review: anatomical and/or functional, behavioral, psychopathological and iatrogenic. According to the subtype, a wide variety of treatments can be employed, including PDE5i, testosterone replacement therapy and vaginal cosmetic surgery, as well as targeted therapy for concomitant sexual comorbidity.

CONCLUSION

We held up the mirror on LPS as a clinically existing multifactorial entity and provided medical features and hypotheses contributing to or causing the occurrence of LPS. In the light of a sociocultural and scientific perspective, we proposed a description and categorization of this syndrome hypothesizing its usefulness in daily clinical practice. Colonnello E, Limoncin E, Ciocca G, et al. The Lost Penis Syndrome: A New Clinical Entity in Sexual Medicine. Sex Med Rev 2021;XX:XXX-XXX.

Penile length of men attending urology outpatient clinic in Southwest Nigeria

Penile length varies worldwide. It is necessary to determine penile length in our region to enable adequate counselling on normal length and reduce avoidable anxiety. Two hundred and seventy-one men were recruited with 97 men in group I and 174 men in group II. Mean ages were 38.4 ± 6.9 (21-50) years and 68 ± 9.1 (51-98) years. In group I, the mean flaccid penile length (FPL)-I and stretched penile length (SPL)-I were 9.8± 2.7 and 10.6± 2.2, mean height 1.7±0.07m and body mass index (BMI) 24.1±3.1 kg/m². While in group II, mean FPL-II and SPL-II were 13.0± 2.9 and 14.1 ± 2.1, mean height was 1.69± 0.07m and BMI 24.3± 3.2 kg/m². There were positive correlations between the SPL-I and heights in group I; (r=0.305, p<0.002); height and FPL-I (r = 0.218, P<0.032). Similarly, in group II positive correlations of FPL-II and SPL-II with height; r = 0.166 P<0.028 and r = 0.183, P<0.015. There was negative correlation SPL-II and BMI-II r-0.224, p<0.003. FLR-II and BMI-II, -0.157, p<0.039. In conclusion, Flaccid and stretched penile length of men < 50 years was smaller than those > 50 years. In both age groups, flaccid and stretched penile lengths correlated with height. In group II, penile lengths correlated negatively with BMI.

Penile length and circumference dimensions: A large study in young Italian men

The aim of the present study was to evaluate the size of the penis in flaccidity and in erection of Italian men. A total of 4,685 men living in Italy and who have been visited at the Italian urology operating units were involved in the study between January 2019 and January 2020. Each patient was given details on how to measure their penis (erect length and circumference) in flaccidity and in erection, from the lower base to the distal penile tip. Mean (standard deviation [SD]) flaccid penis length was 9.47 (2.69), mean (SD) flaccid penis circumference was 9.59 (3.08), mean (SD) erect penis length was 16.78 (2.55) and mean (SD) erect penis circumference was 12.03 (3.82). At the linear regression analysis, height was associated with flaccid penis length (β = 0.04; p-value = .01), and erect penis length was (β = 0.05; p-value < .01) and erect penis circumference was (β = 0.06; p-value < .01). Height is proportional to the length of the penis in flaccidity and in erection, and to the circumference in erection. The increase in BMI leads to a reduction in the length of the erect penis, as well as weight gain reduces the length of the flaccid penis.

Reconstructing forked corpus spongiosum to correct glans droop in distal/midshaft hypospadias repair

Purpose

We reviewed our experience and efficacy of reconstruction of a forked corpus spongiosum (FCS) to correct glans droop in distal/midshaft hypospadias repair.

Methods

Eighty-five consecutive patients who underwent distal/midshaft hypospadias repair by the same surgeon in our center from October 2015 to June 2018 were retrospectively analyzed. All cases were accompanied by different degrees of glans droop, which we corrected by cutting off and reconstructing the FCS along the plate. We recorded the degrees of glans droop, development of the FCS, and postoperative complications including residual chordee, fistula, diverticulum, glans dehiscence, meatus stenosis, and urethral stricture.

Results

The follow-up period ranged from 5 to 37 months (mean, 19.7 months). Two patients (2.3%) developed a coronal fistula and underwent a second repair. Two patients (2.3%) developed a mild urethral diverticulum and underwent continued observation. One patient (1.2%) developed a meatus stenosis that resolved after 1 month of meatus expansion combined with external mometasone furoate. No patients developed postoperative residual chordee or urethral stricture.

Conclusions

The degree of glans droop is closely associated with the development of an FCS. Reconstructing the FCS to correct the glans droop can yield satisfactory outcomes and should be popularized in distal/midshaft hypospadias repair.

Data from 14,597 penile measurements of vietnamese men

BACKGROUND

Penis size is a highly sensitive topic, which has often raised concerns associated with human masculinity and male sexual health. Although data regarding penile dimensions have been published worldwide, little is known about these measurements in South-East Asian countries.

OBJECTIVE

This study aimed to provide the reference range in penile length, circumference, and diameter of Vietnamese men and their variations among men with erectile dysfunction and other diseases.

MATERIALS AND METHODS

Information about flaccid length, stretched length, mid-shaft circumference, and glans diameter from the health records of 14,597 men attending the Andrology Consultation was collected. These men were classified into three groups being regular reproductive health screening group, sexual dysfunction group, and other disease groups.

RESULTS

We found that penile dimensions follow a non-parametric distribution, as tested by Kolmogorov-Smirnov test. The median values are 9.03 cm for flaccid length, 14.67 cm for stretched length, 8.39 cm for mid-shaft circumference, and 2.86 cm for unaroused glans diameter. Length and girth of the penis also changed among the different groups, especially in flaccid state; specifically, men with erectile dysfunction had a greater value in all penile dimensions except for change ratio compared with other groups. Circumcision, which rarely occurs in Vietnam, was associated with a 2 mm reduced penis length.

DISCUSSION

Findings on correlations between penile dimensions and somatometric parameters from previous studies are questionable and some measurements, such as glans dimension, have not been thoroughly investigated so far. Nevertheless, penile dimensions provide useful insight concerning conditions affecting sexual development and might be a valuable parameter in the assessment of erectile dysfunction.

CONCLUSION

Results of this study provide informative materials for the assessment of penile size, including reference values drawn from a large sample of Vietnamese men that can be useful in clinical practice and sexual health education.

Circumferential dissection of deep fascia as ancillary technique in circumcision: is it possible to correct phimosis increasing penis size?

BACKGROUND

Phimosis is the inability to retract the preputium downward over the glans penis. Despite the various techniques of preputial plasty described in literature, the most performed surgical treatment is still the conventional circumcision.

METHODS

In this paper we retrospectively reviewed data of a homogeneous population of 36 consecutive adult patients who underwent phimosis correction by circumcsion with dissection of the Deep Fascia. Patients were followed up by one independent plastic surgeon that measured penis length and circumference in nonerected state preoperatively and at 6 month time postoperatively.

RESULTS

The Wilcoxon Signed Rank Test showed a significant (p < 0.0001) difference between the two groups both in terms of length and circumference.

CONCLUSIONS

In conclusion, the ancillary technique we described leads to an increase of penis size, is safe and easy to perform and does not increase significantly operative time nor complication rate to the conventional procedure.

Urethral plate in tubularized incised plate urethroplasty: how wide is enough?

Background

Previous reports found that a preincision urethral plate (UP) width <8 mm increased the occurrence of urethroplasty complications (UCs) in tubularized incised plate (TIP) hypospadias repair. However, is the classification of the UP width based on an 8 mm cut-off value to predict the outcome of TIP urethroplasty objective enough or universally applicable? The purpose of our study was to assess the effect of the UP width on the outcomes of TIP hypospadias repair in the Eastern population we served.

Methods

We retrospectively reviewed the records of patients who underwent TIP hypospadias repair by the same surgeon between August 2013 and December 2019 in our hospital. Data were collected, including demographics, intrinsic parameters of the penis, surgical parameters and subsequent surgical outcomes. The data were analyzed and the cut-off value of the UP width was calculated using a receiving-operator curve.

Results

Primary TIP urethroplasty was carried out in 116 patients with a mean age of 35.89±29.40 months. The meatal location was distal in 49 patients, midshaft in 56 patients and proximal in 11 patients. The mean glans width was 12.28±1.36 mm, the mean UP width was 5.74±1.37 mm, the mean neourethral length was 1.96±1.32 cm, and the mean operation duration was 87.52±11.47 min. During a median follow-up of 42 (range: 6 to 80) months, UCs developed in 12 patients, and the UP width was significantly related to the occurrence of UCs (P=0.014). According to the 6 mm cut-off value of the UP width by the receiver operating characteristic curve, patients were divided into two groups. Group A (UP width ≥6 mm) included 69 patients, and Group B (UP width <6 mm), 47 patients. UCs occurred in 3 patients in Group A vs. 9 patients in Group B, P=0.010.

Conclusions

UP width is a potential risk factor for UCs after TIP hypospadias repair. Using this technique with an UP width ≥6 mm is sufficient to result in a good outcome of hypospadias repair.

Penile circumference and stretched penile length in prepubertal children: A retrospective, single-center pilot study

Purpose

To determine references for penile circumference according to age in prepubertal children and whether this measurement can be used as a basic penile parameter along with stretched penile length in prepubertal children.

Materials and Methods

A total of 750 children (mean age, 4.2±3.4 years) aged under 14 years without penile problems were enrolled in this study. Children with penile or testicular abnormalities were excluded. All data were gathered at the outpatient clinic by a single pediatric urologist from July 2017 to April 2020. Penile parameters (baseline and stretched penile length, penile circumference) and testicular volumes were measured by using an elastic ruler and a Prader orchidometer, respectively.

Results

Mean baseline and stretched penile lengths were 3.0±1.0 cm and 4.2±1.0 cm, respectively. The mean penile circumference was 4.2±0.9 cm. The stretched penile length was similar to penile circumference (p=0.425). This similarity was found for each age group except for the 0–1-year-old and 3–4-year-old age groups (p=0.001 and p=0.034, respectively). As children grow into adolescence, stretched penile length increases significantly compared to penile circumference.

Conclusions

Penile circumference increased with age like stretched penile length and testicular volume in prepubertal children. Stretched penile length and penile circumference were found to be similar. This study can be used as a basic reference for penile circumference values in prepubertal children.

Application and efficacy of reconstructing forked corpus spongiosum in distal/midshaft hypospadias repair

We reviewed our experience in reconstructing forked corpus spongiosum (FCS) in distal/midshaft hypospadias repair and analyzed the efficacy of this surgical technique. From August 2013 to December 2018, 137 consecutive cases of distal/midshaft hypospadias operated by the same surgeon in Urology Department, Children's Hospital of Fudan University (Shanghai, China), were retrospectively analyzed. Sixty-four patients who underwent routine tubularized incised plate (TIP) or onlay island flap (ONLAY) surgery were included in the nonreconstructing group, and 73 patients who underwent reconstructing FCS during TIP or ONLAY surgery were included as the reconstructing group. Thirty-eight cases underwent TIP, and 26 underwent ONLAY in the nonreconstructing group, with a median follow-up of 44 (range: 30–70) months. Twenty-seven cases underwent TIP, and 46 underwent ONLAY in the reconstructing group, with a median follow-up of 15 (range: 6–27) months. In the nonreconstructing/reconstructing groups, the mean age at the time of surgery was 37.55 (standard deviation [s.d.]: 29.65)/35.23 (s.d.: 31.27) months, the mean operation duration was 91.95 (s.d.: 12.17)/93.84 (s.d.: 14.91) min, the mean neourethral length was 1.88 (s.d.: 0.53)/1.94 (s.d.: 0.53) cm, and the mean glans width was 11.83 (s.d.: 1.32)/11.56 (s.d.: 1.83) mm. Twelve (18.8%)/5 (6.8%) postoperative complications occurred in the nonreconstructing/reconstructing groups. These included fistula (5/2), glans dehiscence (3/0), diverticulum (1/2), residual chordee (3/0), and meatus stenosis (0/1) in each group. There was a significant difference in the overall rate of complications (P = 0.035). These results indicate that the technique of reconstructing FCS provides excellent outcomes with fewer complications in distal/midshaft hypospadias repair.

Sonographic measure techniques of fetal penile length

Postnatal penile length is a reliable, standardized, and widely used marker for the diagnosis of genitourinary pathology, as well as genetic and hormonal disorders. In contrast, prenatal diagnosis has not been developed equally and there is a lack of relevant literature. Our objective is to review the studies on fetal penile length, and apply findings to clinical practice. Although the most used technique is the outer penile length, there is no consensus regarding the appropriate technique for prenatal measurement. Several reports have provided reference data with high correlation. However, important issues like poor correlation with post-natal measures or presence of confounding variables are still present. Diagnosis of both a micropenis and macropenis can indicate related pathologies, and this information may benefit parental counseling and facilitate fetal management. Therefore, it is necessary to carry out prospective studies that provide reliable normative data.

Average-Size Erect Penis: Fiction, Fact, and the Need for Counseling

Most men believe that the average length of an erect penis is greater than 6 inches (15.24 cm). This belief is due, in part, to several often-cited studies that relied on self-reported measurements, with means of about 6.2 inches (15.75 cm) for heterosexual men and even greater for gay men. These studies suffered from both volunteer bias and social desirability bias. In this review, the combined mean for 10 studies in which researchers took measurements of erect penises was 5.36 inches (13.61 cm; n = 1,629). For 21 studies in which researchers measured stretched penises, the mean was approximately 5.11 inches (12.98 cm; n = 13,719). Based on these studies, the average length of an erect penis is between 5.1 and 5.5 inches (12.95-13.97 cm), but after taking volunteer bias into account, it is probably toward the lower end of this range. Studies show that a majority of men wish they were larger, with some choosing penile lengthening surgery. These surgeries are considered by the American Urological Association to be risky. Most men seeking surgery have normal sized penises. Counseling with factual information about penis size might be effective in alleviating concerns for the majority of men who worry about having a small penis.

Repeated penile girth enhancement with biodegradable scaffolds: Microscopic ultrastructural analysis and surgical benefits

Autologous tissue engineering using biodegradable scaffolds as a carrier is a well-known procedure for penile girth enhancement. We evaluated a group of previously treated patients with the aim to analyze histomorphometric changes after tissue remodeling and to estimate the benefits of repeated procedure. Between February 2012 and December 2016, a group of 21 patients, aged 22–37 (mean 28.0) years, underwent a repeated penile girth enhancement procedure with biodegradable scaffolds. Procedure included insertion of two poly-lactic-co-glycolic acid scaffolds seeded with laboratory-prepared fibroblasts from scrotal tissue specimens. During this procedure, biopsy specimens of tissue formed after the first surgery were taken for microscopic analysis. The mean follow-up was 38 months. Connective tissue with an abundance of connective tissue fibers, small blood vessels, and inflammatory cells were observed in all analyzed surgically removed tissue. Ultrastructural analysis of these tissue samples discovered the presence of large quantities of collagen fibrils running parallel to each other, forming bundles, with a few widely spread fibroblasts. In total, the mean values of flaccid and erect gain in girth after the second surgery were 1.1 ± 0.4 (range: 0.6–1.7) cm and 1.0 ± 0.3 (range: 0.6–1.5) cm, respectively. Microscopic evaluation of newly formed tissue, induced by autologous tissue engineering using biodegradable scaffolds, showed the presence of vascularized loose connective tissue with an abundance of collagen fibers, fibroblasts, and inflammatory cells, indicating active neovascularization and fibrinogenesis. The benefit of the repeated enhancement procedure was statistically significant.

Anogenital distance is associated with genital measures and seminal parameters but not anthropometrics in a large cohort of young adult men

STUDY QUESTION

Is the anogenital distance (AGD) correlated to anthropometric, genital and sperm parameters in young adult men?

SUMMARY ANSWER

We observed that reduced AGD is strongly associated with altered semen parameters and reduced testicular volume.

WHAT IS KNOWN ALREADY

Abnormalities in the foetal development of the testis have been suggested as causative of common male reproductive disorders, such as cryptorchidism, hypospadias, reduced semen quality and testicular germ cell tumour, collectively defined as 'testicular dysgenesis syndrome'. In human epidemiological studies, alterations in AGD have been frequently associated with clinically relevant outcomes of reproductive health, suggesting AGD as a marker of foetal testicular development.

STUDY DESIGN, SIZE, DURATION

This study was performed within the annual screening protocol to evaluate male reproductive health in the high schools of Padua and surroundings (Veneto Region, the North-East of Italy). Here we report the findings of 794 subjects who completed the study protocol between October 2016 and May 2017.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We evaluated 794 students aged 18-19 years recording the following parameters: height, weight, BMI, waist circumference, arm span, pubis-to-floor and crown-to-pubis length, penile length and circumference, testicular volumes, semen parameters and AGD (measured from the posterior base of the scrotum to the centre of the anus).

MAIN RESULTS AND THE ROLE OF CHANCE

Of the subjects, 49% had an abnormal arm span-height difference (>3 cm) and 63.4% had an altered ratio of crown-to-pubis/pubis-to-floor length (≤0.92). The rate of subjects with reduced testicular volume was 23%. Median sperm concentration was 51.0× 106/ml and total sperm count was 122.5 × 106. AGD showed a direct positive relation with testicular volume and penile length and circumference (R = 0.265, 0.176 and 0.095, respectively, all P < 0.05). No significant relation was observed between AGD and anthropometric parameters. Sperm concentration, total sperm count, progressive motility and normal morphology showed a significant and positive correlation with AGD (R = 0.205, 0.210, 0.216 and 0.117, respectively, all P < 0.05).

LIMITATIONS, REASONS FOR CAUTION

Our cohort of young adults is not representative of the general population. Hormonal evaluation was missing.

WIDER IMPLICATIONS OF THE FINDINGS

Our findings show that AGD is associated with testicular volumes, penile measures and seminal parameters in young adult men. Because AGD is hormonally determined during foetal life, the reported high incidence of reduced semen quality and reduced testicular volume could be related to a reduced androgenic exposure in utero. AGD could represent a simple and useful method to evaluate testicular and penile development in adult men.

STUDY FUNDING/COMPETING INTEREST(S)

The authors have no potential conflict of interest to declare. No external funding was obtained for this study.

TRIAL REGISTRATION NUMBER

N/A.

Cosmetic penile enhancement surgery: a 3-year single-centre retrospective clinical evaluation of 355 cases

Men's satisfaction and sexual function is influenced by discomfort over genital size which leads to seek surgical and non-surgical solutions for penis alteration. In this article we report the results of a retrospective study of 355 cases of cosmetic elongation, enlargement and combined elongation and enlargement phalloplasty. We found a significant improvement in length at rest, stretched length and circumference at rest at 2, 6 and 12 months post-surgical procedure (all p < 0.0001). 5-item International Index of Erectile Function (IIEF-5) was also increased at 12 months post-surgery compared to baseline (p < 0.0001). This was consistent with an IIEF-5 improvement of 6.74% compared to baseline. This study is clinically relevant due to the large cohort of patients included and because it is the first study to use an inverse periosteal-fascial suture not described previously as part of the surgical methodology.

Endocrine Disruption of Androgenic Activity by Perfluoroalkyl Substances: Clinical and Experimental Evidence

BACKGROUND

Considerable attention has been paid to perfluoroalkyl compounds (PFCs) because of their worldwide presence in humans, wildlife, and environment. A wide variety of toxicological effects is well supported in animals, including testicular toxicity and male infertility. For these reasons, the understanding of epidemiological associations and of the molecular mechanisms involved in the endocrine-disrupting properties of PFCs on human reproductive health is a major concern.

OBJECTIVE

To investigate the relationship between PFC exposure and male reproductive health.

DESIGN

This study was performed within a screening protocol to evaluate male reproductive health in high schools.

PATIENTS

This is a cross-sectional study on 212 exposed males from the Veneto region, one of the four areas worldwide heavily polluted with PFCs, and 171 nonexposed controls.

MAIN OUTCOME MEASURES

Anthropometrics, seminal parameters, and sex hormones were measured in young males from exposed areas compared with age-matched controls. We also performed biochemical studies in established experimental models.

RESULTS

We found that increased levels of PFCs in plasma and seminal fluid positively correlate with circulating testosterone (T) and with a reduction of semen quality, testicular volume, penile length, and anogenital distance. Experimental evidence points toward an antagonistic action of perfluorooctanoic acid on the binding of T to androgen receptor (AR) in a gene reporter assay, a competition assay on an AR-coated surface plasmon resonance chip, and an AR nuclear translocation assay.

DISCUSSION

This study documents that PFCs have a substantial impact on human health as they interfere with hormonal pathways, potentially leading to male infertility.

Combined Plaque Incision, Buccal Mucosa Grafting, and Additional Tunica Albuginea Plication for Peyronie's Disease

INTRODUCTION

Surgery remains the gold standard for treatment in stable patients with penile deformity associated to Peyronie's disease (PD).

AIM

To evaluate the long-term results of plaque incision and buccal mucosa grafting (BMG), with or without additional tunica albuginea plication (TAP), in the correction of severe penile curvatures secondary to PD.

METHODS

72 patients with severe curvature caused by PD, normal erections, and stable disease entered this prospective study. Preoperatively, they underwent penile duplex ultrasounds with measurement of curvature and length of affected side. All procedures were carried out by 1 surgeon. Patients were seen at 1, 3, 6, and 12 months postoperatively, then yearly. Subjective outcome was assessed by the Sexual Encounter Profile (SEP) questionnaire, and objective outcome was assessed by an intracavernous injection (ICI) test performed within the first year for evaluating penile rigidity, straightness, and length.

MAIN OUTCOME MEASURE

Long-term outcomes include penile straightening, penile shortening, and sexual satisfaction.

RESULTS

Mean curvature was 71.32 ± 17.6° (range 40-110); 33 (45.8%) patients had a 2-sided curvature with a mean second curvature of 33.79 ± 12.2° (range 10-60). Additional TAP was needed in 60% of patients for complete straightening or graft stretching. All patients resumed unassisted intercourse 1 month after surgery; 4 (5.5%) refused follow-up, claiming excessive penile shortening. In the remaining 68, the ICI test showed no recurvature, shortening, or de novo erectile dysfunction. At mean follow-up of 62.01 ± 34.3 months (range 12-135), all were able to obtain an erection (SEP-1), 97.1% to penetrate (SEP-2), and 89.7% to successfully complete intercourse (SEP-3); 80.9% of them were satisfied with erection hardness (SEP-4) and 86.8% were overall satisfied (SEP-5), with the main reason for dissatisfaction being expectation of better length and rigidity.

CONCLUSION

BMG, with or without TAP, provides excellent long-term results and is safe and reproducible, representing a valuable treatment option for PD, but great care should be taken in patient counseling to avoid unrealistic expectations. Cormio L, Mancini V, Massenio P. Combined Plaque Incision, Buccal Mucosa Grafting, and Additional Tunica Albuginea Plication for Peyronie's Disease. Sex Med 2019;7:48-53.

The Nomogram of Penile Length and Circumference in Iranian Term and Preterm Neonates

BACKGROUND AND OBJECTIVES

The normal length of penis in preterm and term neonates is different among different nations, and is affected by various factors. The present study aimed to determine stretched penile length (SPL) values and cutoff level of micropenis in term and preterm Iranian neonates, for the first time.

MATERIALS AND METHODS

All male neonates born in two general hospitals of Tehran (Akbarabadi, and Rasoul hospitals), center of Iran, with gestational age of 28-42 weeks were included and their SPL and penile circumference (PC) were examined on the first 3 days after birth by the same physician. Birth weight (BW), and height, gestational age, type of delivery, mother's age, twin/multiple pregnancy, drug, and medical history of mother during pregnancy were recorded and cutoff levels of two variables were calculated based on the collected variables for different gestational ages.

RESULTS

Among a total of 587 neonates, 203 neonates were born term and 384 preterm. Mean ± SD of neonates' BW were 2,682.51 ± 739.30 (850-4800) gr. Mean ± SD of their SPL was 22.48 ± 3.34 mm; 25.92 ± 1.54 mm in term and 20.66 ± 2.50 mm in preterm infants (P = 0.001). Mean ± SD of PC was 6.71 ± 1.31 mm; 8.14 ± 0.48 in term and 5.96 ± 0.92 in preterm infants (P = 0.001). SPL and PC were significantly correlated with type of delivery, number of parity, gestational age, BW, and crown-heel length, head circumference (P < 0.001).

CONCLUSION

This study suggested that SPL in male neonates was 22.48 mm and PC was 6.71 mm, both correlated with gestational age and BW. Due to the ethnical variety of this cutoff points and lack of an appropriate study in Iran, these cutoff points can be used by all physicians as a reference for Iranian newborns (term and preterm), in order to prevent misdiagnosis of micropenis and genital disorders.

Penile Length: Measurement Technique and Applications

INTRODUCTION

Penile size has long been an important fixation in men's lives. On the one hand, a smaller penis has been associated with anxiety and apprehension; on the other hand, a larger penis has generally been related to virility and strength. These perceptions predominate during an erection, when penile size is representative of a man's masculinity.

AIM

To assess adult penile length and summarize average penile length assessments from the literature; analyze how various urologic diseases and therapies affect penile length and volume; and review how surgical treatments for Peyronie's disease, penile prosthesis implantation, and radical prostatectomy can affect penile size to appropriately counsel patients seeking such therapies and set realistic goals for patients.

METHODS

To achieve the aim of this review, we analyzed the literature on penile size and volume and how these can be affected by various urologic diagnoses and therapies. We summarize common diagnoses and therapies that can affect penile size.

MAIN OUTCOME MEASURE

We thoroughly discuss how the aforementioned diagnoses and therapies can negatively affect penile size. In doing so, we allow readers to understand the intricacies of penile size when faced with such diagnoses and therapies in their patients.

RESULTS

Surgical treatments for Peyronie's disease, penile prosthesis implantation for refractory erectile dysfunction, and radical prostatectomy for prostate cancer can lead to a decrease in penile size.

CONCLUSION

Urologists must recognize that the different therapies they offer can affect a man's penile size, often negatively. This in turn can lead to poorer satisfaction outcomes in patients. Davoudzadeh EP, Davoudzadeh NP, Margolin E, et al. Penile Length: Measurement Technique and Applications. Sex Med Rev 2018;6:261-271.

Sonographic Assessment of the Fetal Penile Development

The intrauterine diagnosis of micropenis is an important clue in the discernment of some syndromes and hormonal deficiencies. In this study, we tried to establish reference ranges for the fetal penile length and penile width. This prospective cross-sectional study included 179 healthy singleton male fetus pregnancies that were between 17 and 37 weeks of gestation. Of these pregnancies, the fetal penile length and width were measured using trans-abdominal ultrasound. The correlation coefficients of gestational age with penile measurements were calculated. We observed that as the gestational age increased both the penile length and width increased (p < .0001, correlation coefficients R(2) = 0.854 and R(2) = 0.883; respectively). Reference values of the penile length in the Turkish Population were similar to previously evaluated populations including English, American and Israeli populations. The penile width measurement is a convenient way to diagnose micropenis, but penile width measurement alone might miss some penile abnormalities including chordee and hypospadias.

Women's Preferences for Penis Size: A New Research Method Using Selection among 3D Models

Women's preferences for penis size may affect men's comfort with their own bodies and may have implications for sexual health. Studies of women's penis size preferences typically have relied on their abstract ratings or selecting amongst 2D, flaccid images. This study used haptic stimuli to allow assessment of women's size recall accuracy for the first time, as well as examine their preferences for erect penis sizes in different relationship contexts. Women (N = 75) selected amongst 33, 3D models. Women recalled model size accurately using this method, although they made more errors with respect to penis length than circumference. Women preferred a penis of slightly larger circumference and length for one-time (length = 6.4 inches/16.3 cm, circumference = 5.0 inches/12.7 cm) versus long-term (length = 6.3 inches/16.0 cm, circumference = 4.8 inches/12.2 cm) sexual partners. These first estimates of erect penis size preferences using 3D models suggest women accurately recall size and prefer penises only slightly larger than average.

Testosterone regulates keratin 33B expression in rat penis growth through androgen receptor signaling

Androgen therapy is the mainstay of treatment for the hypogonadotropic hypogonadal micropenis because it obviously enhances penis growth in prepubescent microphallic patients. However, the molecular mechanisms of androgen treatment leading to penis growth are still largely unknown. To clarify this well-known phenomenon, we successfully generated a castrated male Sprague Dawley rat model at puberty followed by testosterone administration. Interestingly, compared with the control group, testosterone treatment stimulated a dose-dependent increase of penis weight, length, and width in castrated rats accompanied with a dramatic recovery of the pathological changes of the penis. Mechanistically, testosterone administration substantially increased the expression of androgen receptor (AR) protein. Increased AR protein in the penis could subsequently initiate transcription of its target genes, including keratin 33B (Krt33b). Importantly, we demonstrated that KRT33B is generally expressed in the rat penis and that most KRT33B expression is cytoplasmic. Furthermore, AR could directly modulate its expression by binding to a putative androgen response element sequence of the Krt33b promoter. Overall, this study reveals a novel mechanism facilitating penis growth after testosterone treatment in precastrated prepubescent animals, in which androgen enhances the expression of AR protein as well as its target genes, such as Krt33b.

Penile Dimensions of Diabetic and Nondiabetic Men With Erectile Dysfunction: A Case-Control Study

This study aimed to report penile dimensions in diabetic and nondiabetic men with erectile dysfunction (ED) and correlate their dimensions with other study variables. A case-control study was designed through retrospective data analysis of diabetic and nondiabetic patients consulting for ED and a control group ( n = 105, each group). Study data retrieved included history, clinical evaluation, and penile dimensions (pendulous length [PL], total length [TL], and circumference [CF]) at flaccid and erect states. Results identified that patients had lower values (mean, cm) for almost all penile dimensions. The diabetic patients identified significant differences in most dimensions, whether in flaccid (PL: 7.46 vs. 7.51 and 7.81, p = .11; TL: 11.8 vs. 12.77 and 12.88, p = .000; CF: 8.84 vs. 9.1 and 9.14, p = .016) or erect state (PL: 9.66 vs. 9.61 and 10, p = .092; TL: 13.96 vs. 14.88 and 15.04, p = .000; CF: 11.56 vs. 12.06 and 11.92, p = .018) as compared with the nondiabetic patients and controls, respectively. No significant correlation was detected between the dimensions and age, durations of diabetes and ED, or erectile function scores. In conclusion, diabetic and nondiabetic patients with ED presented, in varying degrees, significant decline in their penile dimensions, and this was more prevalent in diabetic patients. As changes in penile size could be a silent corollary of comorbidities, monitoring the changes in penile dimensions should be an important component of the clinical checkup of any patient with ED, especially a diabetic patient.

[Long-term outcomes after hypospadias surgery: Sexual reported outcomes and quality of life in adulthood]

OBJECTIVE

To evaluate outcomes and long-term sexual quality of life after hypospadias surgery. Seventeen-years-old patients operated for a posterior hypospadias in childhood were included in a transversal study.

PATIENTS AND METHODS

Fifteen patients, among the forty children treated since 1997, accepted to participate. These young men (mean age at the first surgery was 27.9±20months) were clinically reviewed and responded to questionnaires (EUROQOL 5, IIEF15 and non-validated questionnaire). This study arises about 8.4±5years after the last visit in paediatric department.

RESULTS

Mean study age was 21.2±4.7years. One third of patients thought that global quality of life was distorted. Although 33% of the patients had erectile dysfunction, 80% were satisfied with their sexual quality of life. The most important complains were relative to the penile appearance. Number of procedures was not predictive of patient's satisfaction about penile function and appearance. Thirty-three percents of the patients would have been satisfied to have psychological and medical support. They would be interested in having contact with patients who suffered from the same congenital abnormality.

CONCLUSION

These patients had functional and esthetical disturbances. This visit leads to a specific visit in 20% cases. In this study, medical follow-up does not seem to be counselling and had to be adapted. Adequate follow-up transition between paediatric and adult departments especially during adolescence seems to be necessary.

Penile length is a very important factor for cosmesis, function and psychosexual development in patients affected by hypospadias: Results from a long-term longitudinal cohort study

Few studies of long-term outcome of hypospadias treatment in terms of voiding, surgical complications, sexual functioning, intimate relationships and cosmetic results have been investigated and contrasting results have been obtained so far. The aim of our study is to investigate the long-term outcome of urinary and sexual function, cosmesis and the quality of intimate relationships in a series of hypospadias. In this study, 42 patients who underwent surgery for hypospadias were prospectively followed for 15 years. Medical records provided the hypospadias data, the number of reconstructive operations and the reconstruction technique that was used. Patients underwent physical examination, including penile length measurement and completed International Prostatic Symptoms Score (I-PSS), International Index Of Erectile Function (IIEF 15) and the Penile Perception Score questionnaire (PPPS). Twenty patients agreed to participate in the study. At the enrolment, the median value of HOSE was 13, as regards PPPS, 18/20 (90%) were satisfied, while in 1998 only 80% were satisfied. No significant statistical difference has been reported from the results obtained at enrolment and those obtained at follow-up, in terms of PPPS (P = 0.81), IPSS and IIEF-15. Penile length was 6.5 cm flaccid and 10.5 cm stretched. Our data show how cosmesis, function and psychosexual development for these patients are highly connected to surgical outcome, which is understood to be a decrease in penile size.

Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15,521 men

OBJECTIVE

To systematically review and create nomograms of flaccid and erect penile size measurements.

METHODS

Study key eligibility criteria: measurement of penis size by a health professional using a standard procedure; a minimum of 50 participants per sample.

EXCLUSION CRITERIA

samples with a congenital or acquired penile abnormality, previous surgery, complaint of small penis size or erectile dysfunction. Synthesis methods: calculation of a weighted mean and pooled standard deviation (SD) and simulation of 20,000 observations from the normal distribution to generate nomograms of penis size.

RESULTS

Nomograms for flaccid pendulous [n = 10,704, mean (SD) 9.16 (1.57) cm] and stretched length [n = 14,160, mean (SD) 13.24 (1.89) cm], erect length [n = 692, mean (SD) 13.12 (1.66) cm], flaccid circumference [n = 9407, mean (SD) 9.31 (0.90) cm], and erect circumference [n = 381, mean (SD) 11.66 (1.10) cm] were constructed. Consistent and strongest significant correlation was between flaccid stretched or erect length and height, which ranged from r = 0.2 to 0.6.

LIMITATIONS

relatively few erect measurements were conducted in a clinical setting and the greatest variability between studies was seen with flaccid stretched length.

CONCLUSIONS

Penis size nomograms may be useful in clinical and therapeutic settings to counsel men and for academic research.

Consultation for Small-Sized Penis in the Egyptian Males

This study aimed to report penile dimensions in adult Egyptian males consulting for small-sized penis (SSP) and describe their demographics and andrological profile. A case control study was designed through retrospective data analysis of patients ( n = 239) seeking advice for SSP and a control group ( n = 59). This included sociodemographics, other andrological complaints, and penile dimensions (pendulous length [PL], penopubic or total length [TL], and circumference [CF]) at flaccid and erect states and the size of the prepubic fatty pad. The results reported that most patients were single, students, and smokers and had not completed a university education. Several patients reported falsely premature ejaculation (PE), penile curvature (PC), and small-sized testes. Most penile dimensions of the patients (mean, cm) were significantly lower than those of the controls, whether in flaccid (PL: 7.4 vs. 8.05, p = .008; CF: 8.7 vs. 8.98, p = .026) or erect state (PL: 11.8 vs. 13, p = .000; TL: 14.2 vs. 15, p = .000; CF: 11.3 vs. 11.8, p = .003). However, no patient presented with a pendulous penile length <4 cm in flaccid or <7 cm in erect state. In conclusion, Egyptian men consulting for SSP did not have true small organs, but their penile dimensions were slightly smaller than those of men without such complaint. The proper sexual education program is highly advisable in these situations to avoid the myths and misconceptions about sexuality.

A comprehensive, prospective study of penile dimensions in Chinese men of multiple ethnicities

This study aimed to establish a reference range of penile length and circumference of adult males in China, and to compare the penile dimensions of different ethnical backgrounds. To do this, penile length and circumference measurements were obtained from 5196 healthy males attending the Urology Counseling Clinic. The mean value of penile dimensions was a flaccid length of 6.5 ± 0.7 cm, a stretched length of 12.9 ± 1.2 cm and a flaccid circumference of 8.0 ± 0.8 cm. In the subgroup of 311 males, the mean erectile length was 12.9 ± 1.3 cm and the mean erectile circumference was 10.5 ± 0.9 cm, the mean flaccid and erectile glans lengths were 2.7 ± 0.3 and 3.4 ± 0.4 cm, respectively, and the mean flaccid and erectile glans diameters were 2.6 ± 0.2 and 3.4 ± 0.4 cm, respectively. We found that flaccid penile length and circumference varied among different ethnicities. This study established a reference range for penile dimensions, which will help when counseling patients worried about their penile size or seeking penis enlargement surgery. We also found that penile dimensions are different in different ethnicities, but further investigations are needed to validate this.

Penile length-somatometric parameters relationship in healthy Egyptian men

This study aimed to assess the penile length-somatometric parameters relationship in healthy Egyptian men. Two thousand physically normal men (22-40 years) were subjected to measurement of stretched penile length, glans penis, testis size, index finger, weight, height, span, body mass index (BMI), waist circumference, hip circumference and waist/hip ratio. The mean stretched penile length of the studied subjects was 13.84 ± 1.35 cm (range 12-19 cm), and the mean glans penis length was 2.6 ± 0.4 cm (range 1.7-3.8 cm). Penile length demonstrated positive significant correlation with glans penis length, index finger length, BMI and significant negative correlation with waist/hip ratio. On the other hand, penile length demonstrated nonsignificant correlation with age, weight, height, waist circumference, span or testicular size. It is concluded that the penile length-somatometric parameters relationship in healthy Egyptian men is mostly related to glans penis and index finger lengths.

Erect penile length and circumference dimensions of 1,661 sexually active men in the United States

INTRODUCTION

Penile size continues to receive popular and empirical attention. Little is known about the process of self-measurement and whether the behaviors a man engages in to become erect for self-measurement are associated with his erect penile dimensions.

AIMS

The article aims to assess men's erect penile dimensions in a study in which the men would presumably be motivated to report accurate information about their penis size; and to explore associations between men's erect penile dimensions, their method of measurement, and their demographics.

METHODS

Data are from an Internet-based baseline phase of a large prospective daily diary study that compared men's use of a standard-sized condom to men's use of a condom sized to fit their erect penis.

MAIN OUTCOME MEASURES

The main outcomes are participant characteristics, activities engaged in during self-measurement process, and self-reported erect penile length and circumference.

RESULTS

For this sample of 1,661 men, the mean erect penile length was 14.15 cm (SD = 2.66; range = 4 to 26 cm), and the mean erect penile circumference was 12.23 cm (SD = 2.23; range = 3 to 19). Participant characteristics were not associated with measured length or circumference. Most men measured their penis while alone, using hand stimulation to become erect.

CONCLUSIONS

In this sample of men who measured their erect penile length and circumference for the purposes of receiving a condom sized to fit their erect penis, we found a mean erect penile length of 14.15 cm and a mean erect penile circumference of 12.23 cm. The self-reported erect penile dimensions in this study are consistent with other penile dimension research. Also, findings suggest that mode of getting an erection may influence erect penile dimensions. Additionally, how a man becomes erect for self-measurement may be associated with his erect penile length and/or circumference.

Is V-Y plasty necessary for penile lengthening? Girth enhancement and increased length solely through circumcision: description of a novel technique

Our objective is to describe a novel ligamentolysis approach using a subcoronal incision technique and to determine its safety and efficacy. During the last 7 years, 82 consecutive patients had penile augmentation surgery. Ligamentolysis, through a lower abdominal incision (V-Y plasty) in the first 35 males, was performed (Group A), followed by circumcision ligamentolysis in the next 47 males (Group B). The operation time, complications, and the preoperative and postoperative values of penile length and girth along with the self-esteem and relations questionnaire score as well as satisfaction score was calculated before and after the surgery, and a comparison was conducted between the groups. The mean age at presentation was 32 years (range: 18-56 years). Seventy-nine patients suffered from penile dysmorphophobia, and three patients had micropenises (length <7.5 cm). The mean surgical times were 150.7 and 125.2 min for Groups A and B, respectively (P=0.005). Postoperatively, four Group A patients and three Group B patients (11% versus 6%, respectively) experienced penile retraction (P=0.453). Hypertrophic scars were observed in 18 men (51%) in the former [corrected] group. In the circumcision group, no major wound complications were recorded. The length and girth improvements between the groups were similar. In terms of satisfaction and SEAR improvement, the resulting difference for both variables favored the circumcision group (P=0.007 and <0.001, respectively). With strict selection criteria, the circumcision ligamentolysis procedure compared to the V-Y plasty demonstrated improved results in terms of safety, operation time, retraction rate and cosmetic appearance without any compromise in the gained penile size.

Elements of morphology: standard terminology for the external genitalia

An international group of clinicians working in the field of dysmorphology has initiated the standardization of terms used to describe human morphology. The goals are to standardize these terms and reach consensus regarding their definitions. In this way, we will increase the utility of descriptions of the human phenotype and facilitate reliable comparisons of findings among patients. Discussions with other workers in dysmorphology and related fields, such as developmental biology and molecular genetics, will become more precise. Here we introduce the anatomy of the male and female genitalia, and define and illustrate the terms that describe the major characteristics of these body regions. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Anthropometric, penile and testis measures in post-pubertal Italian males

BACKGROUND

Relationships between anthropometric measures, body proportions, weight and penile dimensions in young adult males have not been previously analyzed. Furthermore, although male fertility has declined in last decades, no data on testicular volume (the best surrogate measure for spermatogenic potential) are available for the general population of young men in Italy.

AIM

To analyze anthropometric measures and proportions, testicular volumes, and penile dimensions in a large cohort from the general population of young Italian men aged 18-19 yr. MATERIALS/SUBJECTS: We analyzed 2019 students aged 18-19 years for height, weight, body mass index (BMI), waist circumference, arm span, pubis-to-floor and crown-to-pubis length, and penile dimensions. Testicular volumes were measured by ultrasound in 776 subjects.

RESULTS

Thirty-six percent of the subjects had a pathological arm span-height difference (>3 cm) and 44.7% had a pathological pubis-to-floor/ crown-to-pubis ratio (≤ 0.92). The mean penis length was 8.9 ± 1.4 cm and the penis circumference was 9.5 ± 1.0 cm. BMI was positively associated with arm span-height difference and negatively with penis length; 23.2% of the subjects had low mean testicular volume (<12 ml).

CONCLUSIONS

The findings highlight a strong influence of BMI on skeletal proportions and penis length, identify a large proportion of subjects with testicular hypotrophy at risk for future fertility, and suggest to consider worldwide studies to redefine normal values for arm span-height difference and upper/ lower body segment ratio.

Penis size interacts with body shape and height to influence male attractiveness

Compelling evidence from many animal taxa indicates that male genitalia are often under postcopulatory sexual selection for characteristics that increase a male's relative fertilization success. There could, however, also be direct precopulatory female mate choice based on male genital traits. Before clothing, the nonretractable human penis would have been conspicuous to potential mates. This observation has generated suggestions that human penis size partly evolved because of female choice. Here we show, based upon female assessment of digitally projected life-size, computer-generated images, that penis size interacts with body shape and height to determine male sexual attractiveness. Positive linear selection was detected for penis size, but the marginal increase in attractiveness eventually declined with greater penis size (i.e., quadratic selection). Penis size had a stronger effect on attractiveness in taller men than in shorter men. There was a similar increase in the positive effect of penis size on attractiveness with a more masculine body shape (i.e., greater shoulder-to-hip ratio). Surprisingly, larger penis size and greater height had almost equivalent positive effects on male attractiveness. Our results support the hypothesis that female mate choice could have driven the evolution of larger penises in humans. More broadly, our results show that precopulatory sexual selection can play a role in the evolution of genital traits.

Pelvic, Perineal and Genital Reconstructions

Perineogenital and pelvic surgery is challenging due to the complex anatomy and physiology, multi-organ involvement and microbial environment of this region. In reconstructive surgery local and pedicled flaps are usually applicable. Microvascular flaps are rarely needed. Positioning of the scars, tension in the wound edges and pressure conditions must be taken into account, because failed correction may create more functional and aesthetic problems as the defect itself. This brief review focuses on the reconstructive methods of perineum, genitals and pelvic floor, site by site, with special emphasis on functional details.