Introduction
Concerns of men about the size of their penis are a well-known phenomenon and as treating doctors, we see many men seeking help in this matter., In the majority of the cases, such concerns are driven by the perceptions that the men have about the preferences of the women regarding the size of the penis. Such concerns are reinforced by the cultural influences, wherein the male genital represents manhood in some cultures and it represents masculinity, virility, and fertility in some other cultures., In addition to this, the men link sexual capacity, sexual functioning, as well as sexual satisfaction to the size of their penis., The ease of access to pornography, where the large penis positively correlates with exaggerated female sexual response, adds to the concerns of these men who are already upset with their genital size. These concerns drive the men for unscientific penis enlargement treatments. The number of men visiting the andrologists, despite their penile size being normal, is on the rise over the years., In reality, the majority of the females do not consider the size of the penis as an important factor sexual satisfaction.- The majority of these data are from the Western world. As such, there is no real data which speaks about the perception of women from a conservative society like India about the size of the penis of the men with respect to sexual satisfaction. Hence, we decided to evaluate the perception of Indian women about the size of penis with respect to sexual intercourse and satisfaction using online questionnaire as well as personal interviews. The study presents the results of such research which is the first of its kind in the Indian population, where the female partners have opined about the size of the penis and its relation to sexual satisfaction in them.
Materials and Methods
After obtaining written informed consent from the participants and institutional review board approval, the study was initiated.
Inclusion Criteria
Sexually active females aged 18 years and above were included in the study.
Exclusion Criteria
Those who had comorbidities which affect the sexual function such as diabetes, those suffering from psychiatric disorders, and those on long-term pharmacotherapy were excluded. The participants were excluded from the study, based on the answers given by the participants regarding the comorbidities and medication history.
Participants and Methods
The study participation was voluntary. None of the participants received any remuneration for participating in the study. Handouts containing details of the study were handed over by the investigator to the females aged 18 years or more, visiting the outpatient department of our institute as attenders of the patients or those who were visiting our outpatient department for nonsexual complaints. The participants were requested to answer a 20-item questionnaire as part of the study. Those who wished to answer the questionnaire in person were handed over the questionnaire. Those who were shy to answer the questionnaire in person were given the option of answering the question through social platform for conversation such as WhatsApp chat, if at all they wished to answer the questionnaire. Similar digital handouts were published in social media platforms to reach the participants from all over India and they were given the option of either returning the questionnaire filled or answer the questionnaire during personal chat with the investigator.
Questionnaire
The questionnaire used in this study is shown in Table 1. The original questionnaire was in English language. For the participants who wished to answer the questionnaire in Kannada (vernacular), Kannada translated version was used. The content validity and test-retest reliability of the English as well as the vernacular language questionnaire was assessed separately in a pilot study containing 10 sexually active women employees of a college, neighboring our institute. The survey questionnaire had a validity coefficient of 0.85 and 0.82 for English and vernacular versions, respectively. Similarly, the test-retest reliability was 0.91 and 0.86 for English and vernacular versions, respectively. The questionnaire referred to sexual activities and sexual experiences over the past 12 months.
Statistical Analysis
The questionnaire was intended to assess the perceptions of the participants about the size of the penis as well as its relation to the factors such as religious affiliation, educational status, place of residence, and interpersonal relationship in relation to sexual satisfaction. It included multiple options from which the participant was allowed to choose only one option. Hence, univariate as well as multivariate regression analysis was used to assess the effect of the above-named variables on sexual satisfaction. The mean and standard deviation were derived for demographic variables. The data analysis was done using GraphPad software (©2020 GraphPad Software, Inc, USA). A P value less than .05 was considered statistically significant.
Results
The study period was 4 years, which extended from January 1, 2015 to December 31, 2020. The sample size was 230. The study was conducted in a semi-urban setting for those who answered the questionnaires in person using pen and paper. The study setting didn’t apply for those who answered digital handouts. The participant flow diagram is given in Figure 1.
Participant Flow Diagram
Of these 230 participants, 87 participants answered the questionnaire through pen and paper method during personal interview with the investigator. Remaining 143 participants answered the questionnaire through WhatsApp chat. English language questionnaires were answered by 192 participants and the remaining 38 participants answered the questionnaire in vernacular, that is, Kannada.
The details of the demographic data are summarized in Table 2. Table 3 summarizes the participants’ answers to the questions in the questionnaire.
Multivariate as well as univariate analysis was performed keeping happiness with sex life as well as joyful sex as dependent variables. The independent variables analyzed were age, relationship duration, relationship status, religious affiliation, use of social media, educational status, professional status, annual income, place of residence and place of birth, size of the penis, desired length and girth of the penis, and opinion about their partner’s penis (size, look, length, and girth). It was found that none of the abovementioned factors affected sexual satisfaction or joyful sex in a statistically significant manner.
Similarly, univariate as well as multivariate analysis were performed keeping the perception of the size of the penis as the dependent variable, and age, relationship duration, relationship status, religious affiliation, use of social media, educational status, professional status, place of residence as well as place of birth, look of partner’s penis, perceptions about length and girth of penis, complaints about sexual life, and annual income as independent variables. During multivariate analysis, it was found that none of the abovementioned factors affected the perception of the participants about their partner’s penile size. However, on univariate analysis, those who used social media more frequently (P value = .000675), those who were born and brought up in an urban area (P value = .001478), those who were staying in urban area (P value = .008666), those who disliked partner’s erect penis looks (P value = .000326), those who reported the length and girth matters (P value = .00017), and those who had complaint about sexual life (P value = .000558) were more likely to opine that size of the penis matters and this was statistically significant.
On post hoc analysis, the power of the study at an effect size of 0.3 was 0.9846, suggesting that the study had adequate power to detect statistically significant differences at a P value of .05.
Discussion
We are discussing here the results of the study, which studied perception of Indian women about the size of the penis in relation to sexual satisfaction and joyful sex with their partners. It also addresses the myth of the small penis syndrome, an anxious inquiry by the males about their penile size, which is one of the most common complaints other than sexual dysfunction, faced by the treating doctor.
Masters and Johnson opined that size of the penis has nothing to do with the sexual satisfaction in females, considering the fact that the vagina adapts to any size or shape of the penis. Though the majority of our participants opined that the size of the penis is not important, those who opined that the size of the penis as an important parameter, felt length was more important than width, which is in contrast to Eisenman’s study, wherein in a college setting, females felt girth more important than the length of the penis. The women in the Netherlands had an opinion similar to our study as reported by Francken et al. Though Mautz et al opined that height and penile size were the major determinants of sexual attraction as well as the factors that determine the sexual satisfaction, our study found that the size of the penis had nothing to do with happiness in general as well as happiness with sexual life in particular.
Drasa et al and Costa and Miller opined that longer penises are known to produce more consistent orgasms compared to the average size or shorter ones. However, we could not find such an association in Indian population, wherein the size of the penis had no relation to sexual satisfaction, which is linked to orgasm.
The majority of our participants didn’t feel that the size of the penis has anything to do with sexual satisfaction. According to the participants of our study, better interpersonal relationship was associated with more happiness in their sex life. We found that women who used social media more frequently were more likely to consider the size of the penis as more important for sexual satisfaction. This was expected as they were more likely to be exposed to unscientific literature associating sexual satisfaction with penile size. Those born, brought up, as well as staying in an urban area were more likely to have concerns toward the size of the penis as shown in our study. This was also expected as they were more likely to be due to exposure to false propaganda about relation of sexual satisfaction to penile size. As expected, those who disliked the look of their partners’ penis also felt that penile size matters.
Strengths and Limitations
We have conducted the study using adequate sample size to address a very sensitive issue in a traditional oriental society. We have used a time tested method of questionnaire method to address this issue. This is the strength of the study.
However, use of the questionnaire method has its own drawbacks, as it depends on the self-reporting of the participants and has no objective crosscheck mechanism. This is the only limitation of the study.
Implications of the Study
Anxiety about the size of the penis is one of the most common complaints with which the patient confronts the treating doctor. Till now, we had no evidence either for or against such perceptions of the males in a conservative society like India. Our study results prove that Indian women do not consider size of the penis of their male partner as an important determinant of sexual satisfaction. This scientific evidence, which is the first of its kind on this subject from India, can help the treating doctor to allay the anxiety of men complaining of small penis in India.
Conclusion
Our study found that Indian females do not consider the size of the penis of their partners as the determinant of their sexual satisfaction. We also found that the factors that address the interpersonal relationship positively were the ones who affected the joy of sexual life positively.
Ethical Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Written informed consent was obtained from all individual participants included in the study.
Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The authors received no financial support for the research, authorship, and/or publication of this article.
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