Sizing up the Social and Cultural Influences of Male Patients Seeking Penile Augmentation
Too often, we keep medical procedures within the scope of science, logistics, and reasoning. We believe healthcare is about facts, not feelings. While the progression of effective medical procedures requires such an approach, we must not neglect to view them from our patients’ perspectives: To understand their motivations is to create better solutions and to provide better care.
A part of this requires us to study the behavioural trends, emotional needs, and mindset shifts evolving in modern society. One phenomenon that’s at least survived since the 16th century is penile augmentation. From the inflammation of venomous snake bites to weighted stretching devices, men have found a way to increase penis size throughout history.1 As a long-standing symbol of masculinity, attraction, and fertility, penis size affects how men see themselves and interact with others. Today, genital size is still a running joke found throughout the media.
This desire to become bigger isn’t anything new, but the number of those actively seeking penile augmentation is growing. The number of cosmetic procedures performed for both men and women is increasing year after year. From 2001 to 2021, The American Society of Plastic Surgeons reported a 99% rise in male patients seeking injectable aesthetic treatments. In 2020, multiple Harley Street clinics experienced a 50% increase in men seeking such treatments.2
Why is this? To understand the social, cultural, and psychological motivations behind size, researchers in a 2019 study conducted one-on-one interviews with six adult men who received penile augmentation treatments.3 However, instead of analysing their physical results, the researchers assessed the patients’ emotional, mental, and social motivations. As a result, they identified three core themes amongst the patients’ answers: “Influence of pornography,” “comparison with peers,” and “indirect appearance-related teasing.”
Pornography consumption has not only increased but evolved. A 2022 YouGov survey found that approximately one-third of UK men watch pornography at least once per week, with 13% watching daily.4 Male actors depicted in pornographic content are often disproportionately represented in size. Analyses have found that the average male actors in pornography are in the “top third percentile” for erect penis size.5 While they’re not impossibly oversized, frequent exposure can lead men to inaccurately compare and perceive their own size. In another 2019 study, participants were shown pornographic imagery and asked to report their levels of self-esteem, specifically regarding genital appearance. The experiment group experienced “statistically significant reduced satisfaction” with the appearance of their own genitalia than the control group. In addition, the experiment group reported lower self-esteem scores. Even if men are aware that these sizes are above average, they can still be affected by social comparison. Some researchers have found this effect is especially damaging to developing adolescents, warping their perceptions of a “normal size” as they learn about their bodies.
All men who participated in the initial study had compared their size to their peers, especially in the locker room. This is what we know as locker room syndrome — the phenomenon that men are more concerned about how their mates view their size compared to how romantic partners perceive them. As a historical symbol of manhood, the pressure of comparing sizes with one’s peers can trigger feelings of self-consciousness, loneliness, and poor body image. Research shows that the social comparison of size can be more distressing for gay and bisexual men, as they’re often in more situations to compare sizes with partners, not just peers.6
The pursuit of the “perfect penis” is more about perception than actual size. One study found that less than half of men are satisfied with their size. Most believe the ideal size is over 15 to 18 centimetres. In reality, the average size is about 13 cm.7 This false perception is not just rooted in the media but in medicine. Penis-size surveys fall victim to the inaccuracy of false self-reporting. Whether due to pornography, social comparison, or the media, many men feel undersized. To compensate, many participants in self-measuring studies overreport their results. In a survey of college men, 30.8% self-reported their length at 18 centimetres or more – when in reality, those measuring at 15 centimetres are considered to be in the 90th percentile. Nevertheless, a correlation was found between those who likely over reported their size and their scores on the social desirability scale.8
Interestingly, none of the six men first mentioned in the initial study had ever directly received negative comments about their size. However, the social and cultural pressures influenced their choice, and the narrative found in the media felt direct.
Penile augmentation is a matter of how men perceive themselves. It’s a matter of confidence, not just size, and it appears to increase both. As healthcare providers, we must seek to understand our procedures’ social and emotional benefits — not just the physical.
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests:
I am a physician who provides penis augmentation procedures using dermal fillers with financial interest in performing them, but I am writing in a personal capacity.
Jack Chang is a Clinical Instructor at the University of British Columbia and Physician at Pollock Clinics based in Vancouver, British Columbia. March 22 2023