Concerns over penile size and the desire to have a bigger penis are not unusual feelings in the male population, as can be seen not only from the andrological literature but by the universal jokes about the problem.
What is a normal penile size is a knotty question which some studies have tried to answer.
Penile length has to be measured along the dorsal side of the penis, from the pubo-penile skin junction to the meatus, while the circumference is measured at the mid-shaft.
According to Wessells et al. , normal penile dimensions should be considered to be any length within 2 standard deviations of the mean, that is >4 cm for the flaccid state and >7.5 cm for the stretched state.
Ponchietti et al.  confirmed these findings, concluding that >4 and >7 cm, respectively for the flaccid and stretched states, represent the normal range, bearing in mind that these measurements have to be interpreted in the light of other variables, such as body mass index. (1 ½ inch and 2 ¾ inch, phew!)
The main problem with patients who complain of ‘short penis’ and who request surgical correction is that they often overestimate ‘normal’ penile length . They suffer from so-called ‘dysmorphophobia’, a condition consisting of an imaginary flaw in the physical appearance , in this case a false perception of inadequacy of the penis even though its dimensions fall within the normal range . Dysmorphophobia can be an aesthetic issue, if the altered perception concerns the penis in its flaccid state, or functional, during erection . In both cases, the psychological aspect should be the main concern and a multidisciplinary approach, comprising urological, psychosexual and psychological assessment, is advised . A nomogram was developed to show to the patients how they compared with other men . This tool was found to be very useful to reassure these patients: in a study by Mondaini et al. , 70% of their sample felt reassured after being educated about the normal variation in penile size and was no longer interested in undergoing a surgical procedure for penile enlargement.
Penile shortening is a phenomenon associated with several medical and surgical conditions, such as prostate cancer treated with radical prostatectomy, Peyronie’s disease and congenital abnormalities. A significant reduction in penile length was recorded 3 months after radical retropubic prostatectomy , although the aetiology is not clear. A statistically significant decrease in penile length was also found in men treated with hormonal suppression plus radiation . One of the most common causes of penile shortening is represented by Peyronie’s disease, an acquired penile deformity of the erect penis, caused by fibrous plaque. Both the natural history of the disease and the scarring process after surgical repair can cause a decrease in penile length . Short penis can also be congenital, as a result of embryonic or developmental defects. Lastly, sometimes the shortness of the penis is the result of the so-called ‘hidden penis’, a condition caused by obesity, aging with an overlying fold of abdominal fat and skin, and a shortage of penile skin from chronic inflammation or an aggressive circumcision.Oderda M and Gontero P. Non-invasive methods of penile lengthening: fact or fiction? British Journal of Urology International. 107, pp1278-1282. (April 2011)
Ponchietti R, Mondaini N, Bonafe M, Di Loro F, Biscioni S, Masieri L. Penile length and circumference. A study on 3300 young Italian men. Eur Urol 2001; 39: 183–6. FULL TEXT
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