Does size matter? It does to men, according to this month's BJU International, which contains a review of over sixty years worth of research into penile size and small penis syndrome. The researchers, Dr Kevan Wylie from Royal Hallamshire Hospital, UK, and Mr Ian Eardley from St James' Hospital, UK, found that men can experience real anxiety - even if they are of average size. And while men often have greater confidence if they have a large penis, women don't necessarily feel that bigger is better, citing looks and personality as more important than penis size.

Drawing together the results of 12 studies that measured the penises of more than 11,000 men, the researchers established that average erect penises ranged from 14-16cms (5.5 to 6.2 inches) in length and 12-13cm (4.7 to 5.1 inches) in girth. They noted that there was little evidence of racial differences influencing size, although one Korean study recorded smaller than average-sized penises. The researchers, however, questioned the accuracy of this study and suggested further investigation was required.

Dr Wylie says the review will provide doctors and other health professionals with an accurate summary of the many studies that have been carried out in the past into penile size and size-related syndrome. "It is very common for men to worry about the size of their penis and it is important that these concerns aren't dismissed as this can heighten concerns and anxieties," he explained. "It is helpful to normalize the situation and provide as much accurate information as possible, as many men either lack any information or have been misinformed."

Key findings of the review included:

A survey taking in 50,000 heterosexual men and women found that while 85 percent of the women were satisfied with their partner's penile size, only 55 percent of the men were satisfied.
Factors that make a male attractive to a woman were numerous, but penile size was not the most important factor for women. Several studies indicated that around 90 percent of women prefer a wide penis to a long one.
Somewhat counter-intuitively, small penis syndrome is much more common in men with average-sized penises than those men suffering from micropenis.
Men afflicted by small penis syndrome typically cite childhood comparisons and erotic imagery as the main contributing factors to their anxiety.
Interestingly, on average, homosexual men had larger penises than heterosexual men. The researchers suggest that exposure to male reproductive hormones in the womb may be one explanation for this disparity.

Techniques used by men to enhance the size of their penis were also covered in the review. The Topinama men of Brazil practice what is perhaps the most bizarre method, encouraging poisonous snakes to bite their penises to enlarge them.

The researchers said that evidence for the effectiveness of more popular (but mundane) enlargement methods - such as jelqing exercises and traction devices - was limited, but they noted that patients may experience psychological benefits from their use.

They authors are, however, very cautious when it comes to treating a psychological condition like small penis syndrome with gadgets or surgery. "There is poorly documented evidence to support the use of penile extenders, and while information is starting to emerge on the success of some surgical techniques, this is not backed up by data on patients' satisfaction with such procedures," stressed Dr Wylie.

In summary, the researchers said that small penis syndrome should be approached via a thorough urological, psychosexual, psychological and psychiatric assessment. "Conservative approaches to therapy, based on education and self-awareness, as well as short-term structured psychotherapies, are often successful," they concluded.

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