The Sexual Continuum

Discussing all things related to Lesbian, Gay, Bisexual, and Transgender (LGBT) health

Does Size Matter? The Impact of Penis Size on Sex and Health

Is penis size central to the sexual health and well-being of gay & bisexual men?

“Everybody knows [the saying] 'size doesn't matter'; and everybody knows [it] really means that size does matter.”  -- Alan McKee (2004) Does size matter? Dominant discourses about penises in Western culture.

 Recently there has been a lot of attention in the media on research on penis size and various aspects of health. As I have done before, I wanted to go right to the source and let some of the scientists who have been conducting this research share with you what they have found and how well it matches what the media has been saying. What follows is a guest blog entry by Joshua Guthals, a blogger at Hunter College’s Center for HIV Educational Studies and Training (aka CHEST), which has a mission is to identify and promote strategies that prevent the spread of HIV and improve the lives of people living with HIV. 

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Because in the United States men who have sex with men are disproportionately impacted by HIV, many of CHEST’s studies focus on the lives of gay and bisexual men—this includes their penises and what they do with them—which can be a political hotbed. As CHEST’s director Jeffrey T. Parsons describes it: “This type of public health research is very important, no matter how politically volatile. Studies like ours allow us to better understand sexual health and risk so that we can address effectively the health needs of gay and bisexual men.”

 And there’s simply no way to avoid talking about penises and sex and condoms when researching HIV-prevention. One of the primary mechanisms through which HIV transmission occurs is via unprotected anal intercourse between men, and after decades of global scientific research, consistent condom use remains the primary strategy to slow spread of HIV. Although promising research continues into microbicides and pre-exposure prophylaxis, the male condom maintains its position as the workhorse of STI- and HIV-prevention.

 But that doesn’t mean that men (gay or straight) use condoms consistently. Studies find that many people are inconsistent with their condom use. Why would this be the case, especially when decades of public health campaigns have hammered home the importance of using a condom every time? A better understanding of men’s feelings about condom use has the potential to bolster HIV-prevention.

 

Our researchers Dr. Christian Grov, Dr. Brooke E. Wells, Dr. David Bimbi, and Dr. Jeffrey T. Parsons spearheaded a series of studies looking at the impact of penis size on gay men’s emotional and sexual well-being, self-esteem, preferred sexual roles—and, notably, on their likelihood to use condoms during sex.  In CHEST’s 2010 paper on the topic, we found that “men with below average penises fared significantly worse [in their] psychosocial adjustment” than other men. Say Dr. Grov: “Compared to men with self-described ‘average’ and ‘above average’ penises, those with self-described ‘below average’ penises indicated significantly lower gay life satisfaction (e.g., not agreeing with statements like, "In most ways, my life as a gay/bi person is fulfilling") and significantly higher perception of preventing negative events in their lives (e.g. agreeing with statements like, "I am anxious that I will fall short of my responsibilities and obligations").” Dr. Grov also found that larger penis size “was positively related to satisfaction with size and inversely related to lying about penis size. In other words, the bigger your penis, the happier you are about the size of it and the less likely you are to lie about how big it is.

 In regards to the relationship between penis size and sexual roles, Dr. Grov found that men with below average penises were more likely to identify as bottoms and men with above average penises were more likely to identify as tops. A similar finding was reported by other researchers that year: “gay men’s sexual self-labels [top, bottom, or versatile] may depend on objective traits [e.g., penis size and masculinity] in addition to the subjective pleasure associated with receptive or insertive anal intercourse.”

 I asked Dr. Grov what he thought the implications were of the research and he described it as this: “Our findings related to sexual positioning and psychosocial adjustment are interesting in their own right, but there were also major public health implications which have been overlooked. For example, men who had above average penises were more likely to report viral skin-to-skin STIs—genital warts and genital herpes. We hypothesize that men with above averages penises may not be rolling the condom all the way down their penis, or rather, may not be using condoms that fit them properly.”

 Studies throughout the past decade have indicated that a man’s penis size (and his own perception of size relative to other men’s penises) plays a significant part in his self-esteem. Indeed a 2007 study concluded that “penis size is a major body image concern for many if not most men living in Western nations.” Here are some related findings:

  • A 2006 study among heterosexual couples found nearly half of men wanted their penis to be larger. The study also reported that men who reported larger penis sizes rated their own appearance more favorably.
  • Research in 2008 found that men were dissatisfied with their body and worried “primarily about body weight, penis size and height.” It also found that “weight, muscularity, height and penis size” were related to overall self-esteem. 
  • A 2012 study on male genital image found that “appearance and functioning of the genitals appear to have significant impact on genital image as well as on quality of life.”

What have researchers discovered on how penis size directly relates to condom use? As far back as fifteen years go, a study that found “condom breakage was strongly associated with penile circumference,” concluded that “condom manufacturers may need to increase the range of condom sizes available.”  A study in 2007 found that failure rates for condoms that had been specially fitted to a “man’s penile length and circumference” was “significantly less than for standard-sized condoms” and concluded that specially fitted condoms “may be valuable to sexually transmitted infection prevention efforts, particularly for men with larger penile dimensions.” Other findings:

  • A 2008 study suggested that sexually transmitted infections may spread because some men remain resistant to using condoms because of perceptions that they do not fit properly or feel comfortable.” The study found that penis length and circumference correlated to men’s perception of condoms being “too loose” or “too tight.”
  • A 2009 study found that men who reported condoms did not fit well were more likely to report difficulty achieving orgasm and to report that condoms caused erection loss. They were also more likely “to report removing condoms before penile–vaginal sex ended”. The conclusion: “Men and their female sex partners may benefit from public health efforts designed to promote the improved fit of condoms.” 
  • Researchers in 2011 found that among sex workers a significant predictor of condom breakage was “the condom being too small for the penis or too big for the penis.”

 One might infer from the research that that standard cliché “it just doesn’t feel as good with a condom” may be a legitimate reason people are taking off their condom during sex; especially if they are experiencing condom fit issues or performance issues.

In their first study on the topic, Dr. Grov and the CHEST researchers had asked men to report if they were “below average,” “average” or “above average.” “If we wanted to continue this work, we knew we needed to be more specific with regard to penile dimensions. We also wanted more in-depth questions about the fit and feel of condoms,” says Dr. Grov. So CHEST’s team surveyed nearly 500 men in NYC to gather information about penis size and condom failure rates.

What were our findings on penis size? The mode response for self-reported penis length among those surveyed was 6-8 inches long (51.4%). For circumference, the mode response was 4-6 inches around (31.5%) followed by 2-4 inches around (26.3%). Interestingly, only 6.3% of men said they had never measured their length but 22.9% of men said they had never measured their circumference. 

 And what did the research uncover about condom failure rates? Close to half of respondents reported condom slippage during sex and almost a third reported condom breakage in the previous three months. There was also an association between condom breakage and unprotected sex, suggesting that some men may have unprotected sex simply because they cannot find proper fitting condoms. Less than forty percent of those surveyed said it was “easy” to find a condom that fit them. (The results of the research will be published next month in the Archives of Sexual Behavior.)

 “These findings indicate that the fit of a condom matters,” says Dr. Grov. “A client at a community-based organization might see a bowl filled with ‘standard’ condoms and have to ask a provider if they have other sizes available. That extra step could make the difference between someone leaving with a condom—the right condom—or going home empty handed.”

 We blogged about these findings on our Facebook and Tumblr pages in late December 2012 and press response was immediate and breathless. Online news sources ranging from Perez Hilton’s fitperez.com to the Huffington Post picked up the story and posted their interpretations of the study’s findings. The primary take away from fitperez.com’s article is found in the final line of their post: “Don’t be a fool! Wrap up your enormous tool!” Cosmopolitan’s blogger summed things up for her female readers (not mentioning that CHEST had surveyed men who have sex with men): “Frankly if a guy refuses to wear a condom, we think you should refuse to sleep with him … it’s risky business when it comes to transmitting STDs or getting pregnant.” Jezebel.com’s article is titled “Size Queens Beware: Dudes with Big Dicks Less Likely to Use Condoms,” which would suggest that the point of CHEST’s research was to discourage bottoms from sleeping with well-endowed tops (certainly not the intention of the research).

 All of these sources glossed over a salient finding from the CHEST study, and previous studies on this topic (including the 1998 study mentioned above): penis girth (not length) correlated more strongly to reports of condom breakage and slippage. And issues with condom comfort impacted men with smaller than average penises along with men with larger than average penises. “Our findings tell us that a one-size-fits-all approach to condom distribution may not be an ideal approach for many individuals. Condom length, as well as circumference should be considered,” says Dr. Grov.  Of all the online articles we have been following, Jezebel.com perhaps said it best, “Imagine if someone invented a more comfortable, more flexible, more customizable condom – what would it do to STD rates worldwide?”

 The good news is that in recent years condom manufacturers have been expanding their selection to include different sizes. And the New York City Department of Health and Mental Hygiene has increased the distribution of condoms in a variety of sizes to health centers. “Unfortunately, the default condom freely distributed by many health care providers is still a standard size,” says Dr. Grov. Offering a wider assortment of condoms could improve the ease and enjoyment – and thus likelihood – of safer sex practices for men with penises of all shapes and sizes.

About the contributing blogger:

Joshua Guthals is passionate about gay men’s health. He earned his B.A. in Psychology with honors at Rice University and studied Developmental Psychology at Oxford University. His primary interests at CHEST are expanding study enrollment online and acting as blogger and webmaster for the CHEST website (chestnyc.org). In his spare time, Joshua plays volleyball, takes Instagram photos, and creates indie rock music under the name Kind Monitor.

 

 

Reference:

 “Self-reported penis size and experiences with condoms among gay and bisexual  men,” by Christian Grov, Brooke E. Wells, and Jeffrey T. Parsons will be published in the February 2013 issue of Archives of Sexual Behavior. Data were collected in 2010 from 463 gay and bisexual men in at large scale community events in New York City.

 To ask questions of the CHEST researchers, contact Dr. Jeffrey T. Parsons. Jeffrey.parsons@hunter.cuny.edu

Dr. Mustanski is the Director of the IMPACT LGBT Health and Development Program at Northwestern University. You can follow the Sexual Continuum blog by becoming a fan on Facebook. He periodically live tweets from research conferences on sexuality and you can follow him @sexualcontinuum.

 CHEST staff photos credit: Chris Heitikko

Image of man with ruler credit: yuanadesukma.wordpress.com

Brian Mustanski, Ph.D., is Associate Professor at Northwestern University and the founding Director of the IMPACT LGBT Health and Development Program.

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