The BBC reports that Indian men have smaller penises. Smaller than international condom standards, that is. A two-year study in India of 1,200 men, measuring the length and breadth of their penises, found that 60% of men had penises that were between 3 and 5 centimeters smaller than international condom standards. There were already studies showing that a whopping 1-in-5 times a condom is used in India, it either tears or falls off – a truly unacceptable failure rate for anyone, but even more alarming in the country with the highest number of HIV infections.
Given the health and contraception implications, the body of literature (so to speak) on penis size and condom size is surprisingly (ahem) small. Most of the existing studies were done in men who have sex with men (with an eye to AIDS prevention by increasing condom satisfaction/use) but there’s no reason to think the situation’s any different for men batting for the other team. One study looked at penis size and condom size by basing penis size on the man’s self-report of size (normal, above average, below average), and then asking about infections, behaviors, and condom problems. They found:
Doc Gurley & Byron, a 7-foot plush penis, from the Dept of Public Health’s Healthy Penis Campaign
“Though most men felt their penis size was average, many fell outside this ‘norm.’ The disproportionate [higher] number of viral skin-to-skin STIs (HSV-2 and HPV) [among men with larger than average penises] suggests size may play a role in condom slippage/breakage. Further, size played a significant role in sexual positioning and psychosocial adjustment. These data highlight the need to better understand the real individual-level consequences of living in a penis-centered society.”
(can I just say – I loved finding that phrase buried in a dusty pile of medical tomes…).
Another study looked at condom dissatisfaction and size (again, among MSMs) and found that there was a correlation, including reported condom failure rates for men who said they had larger than average penises.
One prior study actually lined up American men and measured them (a study done, of course, by urologists – the plumbers of the male reproductive tract). The theory was that small penis size is why young men complain about condoms so much. This study (http://www.ncbi.nlm.nih.gov/pubmed/11182344) measured flaccid and erect penis size in a group of young men (18-19) and compared sizes to older men (40-68). Young men had shorter flaccid penises, but slightly longer and thicker at the base penises when erect. Unexpectedly (to the urologists), the size of the glans didn’t change at all with age.
So are custom-condom sizes, or even custom-fitted condoms, the way to go? Or come? One study compared standard condoms to custom-fitted condoms and found less breakage and more satisfaction with a custom-condom, particularly for men with larger penises. The study did, however, show alarmingly more slippage in the custom-fitted condoms, particularly on withdrawal.
This custom-condom failure issue is so counter-intuitive, and so important, let’s take a moment to look at the study. [Brace yourself: Raw data in-coming: OBJECTIVE: This study compared failure rates of a standard-sized condom and a condom fitted to a man’s penile length and circumference and assessed users’ perceptions of condom acceptability and confidence in the efficacy of both condoms. METHOD: Using an experimental crossover design with Internet-based daily diaries, 820 men who wore at least one of each condom type reported outcomes and perceptions of condoms used during vaginal and anal intercourse events for which they were the insertive partner. RESULTS: Breakage for fitted condoms (0.7%) was significantly less than for standard-sized condoms (1.4%). When assessed by penile dimensions, significantly less breakage of fitted condoms than standard-sized condoms was observed among men in the middle circumference category (12-13 cm) during anal intercourse (1.2% versus 5.6%), men in the larger circumference category (> or =14 cm) during vaginal intercourse (0.6% versus 2.6%), and men in the longer length category (> or =16 cm) for both vaginal (0.5% versus 2.5%) and anal (3.0% versus 9.8%) intercourse. More slippage upon withdrawal after vaginal intercourse occurred with fitted condoms among men in the middle penile length (1.9% versus 0.9%) and circumference (2.2% versus 0.7%) categories. CONCLUSIONS: Fitted condoms may be valuable to sexually transmitted infection prevention efforts, particularly for men with larger penile dimensions. That fitted condoms slipped more for some men provides insights into the need for unique educational materials to accompany such products. Findings also highlight the need for participatory approaches between public health, condom manufacturers, and the retail industry to integrate fitted products into our work successfully.]
So the jury is still out on whether custom condoms are the way to go. But when it comes to getting the right condom size, custom or not, the unspoken problem here is a man’s self-reporting/self-selecting of size when choosing a condom in a semi-public purchase interaction. Other studies showed that self-reported penis size is strongly correlated with self-esteem, and, as I mentioned above, studies have shown that guys report that they’re “normal” way more than, statistically, they can be (kind of like everyone being above average in Lake Wobegon). What guy wants to be a petite penis? This leads, inevitably, to what I’d call the Starbucking of condoms. “Small” becomes “tall.” Before you know it, “medium,” will be “stallion with a hard-on” and “largish” will be “The Humpback.”
With those kind of names, who wants to be just “tall”? And then, oops, we’re back to the condom failure problem all over again…
So where does that leave Indian men and their publicized penile measurements? As the BBC article points out:
“Indian men need not be concerned about measuring up internationally according to Sunil Mehra, the former editor of the Indian version of the men’s magazine Maxim. ‘It’s not size, it’s what you do with it that matters,’ he said. ‘From our population, the evidence is Indians are doing pretty well. With apologies to the poet Alexander Pope, you could say, for inches and centimetres, let fools contend.'”
What do you think? Is condom sizing a health, or a marketing issue? If you’re a woman, would you ask your partner to trade a less-breakage (possibly less infections) off-the-rack (har) condom for a more slippage (possibly more pregnancies) custom condom? Sound off in the comments section. Doc Gurley is the only Harvard Medical School graduate, ever, to be awarded the coveted Shoney’s Ten Step Pin for documented excellence in waitressing, and is a Board-certified, practicing internist. You can get more health posts at www.docgurley.com, or jump on the Twitter bandwagon and follow Doc Gurley. Also check out Doc Gurley’s joyhabit and iwellth twitter feeds – so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your personal wellth.