Men frequently voice a variety of concerns about sexual functioning. Several of these are addressed throughout this textbook. At this point we want to discuss two areas that receive considerable attention: the significance of penis size and the necessity and impact of circumcision. Claims are frequently made that one or both of these physical characteristics can influence the sexual pleasure of a man or his partner. In the following sections we examine the available evidence.
Penis Size
When I was a kid, my friends were unmerciful in their comments about my small size. They would say things like, "I have a penis, John has a penis, but you have a pee-pee." Needless to say, I grew up with a very poor self-image in this area. Later it was translated into anxiety-ridden sexual encounters where I would insist that the room be completely dark before I would undress. Even now, when I realize that size is irrelevant in giving sexual pleasure, I still worry that new partners will comment unfavorably about my natural endowment. (Authors’ files)
All my life I have been distressed about the size of my penis. I have always avoided places such as community showers where I would be exposed to others. When my penis is hard it is about five inches long; but when it is flaccid, it is rarely longer than an inch or inch and a half, and thin as well. I don’t like to be nude in front of the girls I sleep with, and that feeling of uneasiness is often reflected during sex. (Authors’ files)
These men are not alone in their discomfort. Their feelings are echoed in more accounts than we can remember. Penis size has occupied the attention of most men and many women at one time or another. In general, it is more than idle curiosity that stimulates interest in this topic. For many it is a matter of real concern, perhaps even cause for apprehension or anguish.
It does not take much imagination to understand why penis size often seems so important. As a society, we tend to be overly impressed with size and quantity; bigger cars are better than compacts, the bigger the house the better it is, and by implication, big penises provide more pleasure than smaller ones. Certainly, the various art forms, such as literature, painting, sculpture, and movies, do much to perpetuate this obsession with big penises. The concern some men feel over perceived size inadequacy has contributed to a surge in cosmetic surgery to enlarge this body part.
Introduced in the United States over a decade ago, phalloplasty, or penis augmentation, involves lengthening the penis, increasing its girth, or a combination of both. To increase length, a surgeon makes an incision at the base of the penis and severs the
Male Sexual Anatomy and Physiology
ligaments that attach the penile root to the pelvic bone. This allows the portion of the penis normally inside the body cavity to drop down to the exterior, increasing its visible length by an inch or more (Li et al., 2006). Additional thickness or girth can be added by tissue grafts or by injections of fat taken by liposuction from other body areas, usually the abdomen (Austoni & Guarneri, 1999; J. Taylor, 1995).
There have been no controlled clinical studies of penile augmentation to date, and no reputable scientific research validates any method of penile augmentation (CNN HEALTH Library, 2008). A number of anecdotal reports suggest that the results of these procedures are rarely impressive and can be disconcerting, disfiguring, and even dangerous (Collins, 2002; Fraser, 1999). Ligament-cutting surgery can result in some loss of sensation, scarring, and a changed angle of erection (the erect penis may point down instead of up). Many men who have undergone these procedures have reported being dissatisfied, embarrassed, and embittered by the results (Hitti, 2006; Li et al., 2006; Wessells et al., 1996). Anyone contemplating this potentially dangerous or disfiguring procedure should be extremely cautious. Both the American Urological Association and the American Society of Plastic and Reconstructive Surgeons have issued policy statements against penile surgical augmentation procedures that have not been shown to be either safe or effective (CNN HEALTH Library, 2008).
The result of all this attention to penis size is that men often come to view size in and of itself as an important attribute in defining their masculinity or their worth as lovers. Such a concept of virility can contribute to a poor self-image. Furthermore, if either a man or his partner views his penis as being smaller than it should be, this evaluation can decrease sexual satisfaction for one or both of them—not because of physical limitations but rather as a self-fulfilling prophecy.
As we learned in Chapter 3, the greatest sensitivity in the vaginal canal is concentrated in its outer portion. (We focus here on heterosexual penile-vaginal intercourse because concerns about penis size often relate to this kind of sexual activity.) Although some women do find pressure and stretching deep within the vagina to be pleasurable, this sensation is not usually required for female sexual gratification. In fact, some women find deep penetration painful, particularly if it is quite vigorous:
You asked if size was important to my pleasure. Yes, but not in the way you might imagine. If a man is quite large, I worry that he might hurt me. Actually, I prefer that he be average or even to the smaller side. (authors’ files)
A physiological explanation exists for the pain or discomfort some women feel during deep penetration. Because the female ovaries and male testes originate from the same embryonic tissue source, they share some of the same sensitivity. If the penis bangs into the cervix and causes the uterus to be slightly displaced, this action can in turn jar an ovary. The resulting sensation is somewhat like a male’s experience of getting hit in the testes. Fast stretching of the uterine ligaments has also been implicated in deep-penetration pain. However, some women find slow stretching of these same ligaments pleasurable.
These observations indicate the importance of being gentle and considerate during intercourse. If one or both partners want deeper or more vigorous thrusting, they can experiment by gradually adding these components to their coital movements. It might also be helpful for the woman to be in an intercourse position other than underneath her partner (see Figure 8.17), so that she has more control over the depth and vigor of penetration.
I Figure 4.8 shows several flaccid (nonerect) penises. Penis size is not related to body shape, height, length of fingers, race, or anything else (Money et al., 1984). Small flaccid penises tend to increase more in size during erection than do penises that are larger in the flaccid state (Masters & Johnson, 1966). Even though physiological evidence
indicates that large penises are not necessary for female sexual pleasure during coitus, some women do have subjective preferences regarding penis size and shape, just as some men have such preferences about breasts. Research indicates, however, that women are no more sexually aroused by depictions of large penises than by portrayals of medium or small penises (Fisher et al., 1983).
Finally, as we close this section, we take a look at another interesting cultural phenomenon that reflects a rather unusual, even bizarre, concern about penises that some men in other cultures experience in epidemic proportions: koro.