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Sexual Medicine Penile size differs between men of different ethnic backgrounds and large studies of penis girth and length have been conducted by condom manufacturers. What many men perceive as a short penis actually falls into normal range size. Based on many published charts, scientific articles, and self-reported web-based surveys, 95 % of Caucasian men will fall into one of the following categories of size:
- The average length of the flaccid penis is between 3.4 inches and 3.7 inches (8.6 cm and 9.3 cm)
- The average length of an erect penis is between 5.1 inches and 5.7 inches (12.9 cm and 14.5 cm)
- The average circumference of an erect penis is between 3.5 inches and 3.9 inches (8.8 cm and 10.0 cm)
Penis size is an important issue for many men and men of all ages are concerned about the length and thickness of their penises. As with any health concern, men who are worried about their penis size should consult with a urologist trained in sexual medicine.
Shortening of the penis can be a result of weight gain and the deposition of fat around the pubic area. This results in the visual shortening of the penis. Obesity increases the risk of erectile dysfunction and heavy men who complain of loss of length may simply have inadequate blood flow to achieve adequate rigidity.
Less common reasons for shortening of the penis are inborn defects in response to a male hormone (testosterone), congenital chordee (tethering of penis), chromosomal abnormalities (rare), or a scar from Peyronie’s disease (development of scars/plaques in the penis). Penile length may slightly decrease with age because of atrophy related to a decrease in testosterone level and the decreased frequency of erections. Prostate surgery may also damage the nerves and result in shortening of the penis. Thus, men who are concerned about penile size should be fully evaluated by a urologist specializing in sexual medicine, to exclude medical reasons for a change in penile size.
A comprehensive medical and sexual history is the most important aspect in the diagnosis of men with ejaculatory dysfunction. A focused genital exam is also indicated in most circumstances. Testosterone is often the most commonly performed blood test in the evaluation of ejaculatory dysfunction.
Premature ejaculation (PE), also known as rapid ejaculation, lacks a definition that is agreed upon by all practitioners but essentially is the condition whereby a patient ejaculates with minimal sexual stimulation and before he wishes it to occur.
Premature ejaculation is currently defined by the International Society of Sexual Medicine as a lifelong history of ejaculation occurring within less than one minute of penetration (lifelong PE), or a clinically significant and bothersome reduction in latency time, often to about three minutes or less (acquired PE). Patients will also have reduced or absent ejaculatory control. Premature ejaculation often causes negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.
Patients with retrograde ejaculation will have a normal sensation of orgasm and climax but will have little to no anterograde (forward) propulsion of semen. This is often referred to as a dry orgasm. This process is diagnosed by the finding of seminal fluid and/or sperm within a urine specimen obtained immediately after orgasm.
Delayed ejaculation or anorgasmia involves the inability of the patient to achieve orgasm (ejaculation) in a timely manner, and in severe cases, involves failure to achieve orgasm on any occasion. As men age, there is an increase in the time it takes to achieve ejaculation. However, in some men, this increase may lead to the inability to ejaculate within a 30-minute time period from the initiation of sexual stimulation.