It's less important than you think. The penis, particularly in its erect state, is a symbol of masculinity and in many cultures it has come to symbolise attributes such as largeness, strength, endurance, ability, courage, intelligence, knowledge, dominance over men, possession of women and a symbol of loving and being loved.

There is compelling evidence that prehistoric cave dwellers attributed the symbolic values of strength and power to penile size, as well as those of virility and fertility.

The male is often troubled by concerns that his penis is not large enough to satisfy his partner or himself. His penis size, shape, length, girth and appearance can be a cause for happiness or severe distress and can lead a man to go to extreme lengths to try to change its appearance.

He often tries many methods, devices, pills and exercises in the hope of enlarging it. Here are some classical examples:

Until the 16th century, men in the Topinama tribe of Brazil encouraged poisonous snakes to bite their penises to enlarge them for six months!

Wandering holy men in India, or Sadhus are known to attach weights to their penises to elongate cthem.

Dayak men in Borneo pierce the glans of their penis and insert items into the holes to stimulate their partners.

Many men buy a plethora of potions and lengthening devices from the Internet to enhance their virility.

If a man is overly concerned about the size of his penis, it is called the small penis syndrome (SPS), or locker room syndrome.

This is defined as an anxiety about the genitals being observed, directly or indirectly (when clothed) because of concern that the flaccid penis length and/or girth is less than the normal for an adult male, despite evidence from a clinical examination to counter this concern.

Urologists Kevan R. Wylie of Royal Hallemshire Hospital and Ian Eardley of St. James Hospital in Leeds, England, reviewed the literature on penis size in the June 2007 issue of the urology journal BJU International. They analysed the findings of more than 50 international research projects on penile size and SPS carried out since 1942. Their findings were:

Twelve studies which measured the penises of 11,531 men discovered that average erect penises ranged from 14-16cm (5.5-6.2 inches) in length and 12-13cm (4.7-5.1 inches) in girth.

66 per cent of men said their penises were average size, 22 per cent said large and 12 per cent said small.

85 per cent of women were satisfied with their partner's penile size, but only 55 per cent of men were satisfied.

Men with a larger penis both in length and circumference have a better body image and genital image and have a feeling of greater sexual competence. But 90 per cent of women prefer a wide penis to a long one.

SPS is much more common in men with normal size penises than those with a small or micropenis with a flaccid leng th of less than 7cm (2.7 inches).

There was little evidence of racial differences, with the exception of one Korean study where the men had smaller than average-size penises.

What causes small penis syndrome?

Penis envy

Sixty-three per cent of men complaining of small penises said their anxieties started with childhood comparisons with an elder sibling, a friend, or even his father and 37 per cent blamed erotic images viewed in their teenage years.

Relationships with others

Fears and anxieties about penile size might also arise after the breakdown of a relationship, or after derogatory or malicious remarks made by a partner during sexual activities. The denigrating remarks of other men might also have a profound effect on a man's self-image.

Developmental issues

There is some evidence that for those men with poorly developed and small testicles, the problem might be accentuated, as there is no upward and forward lift to the penis, and so the genital bulge is minimal.

Psychiatric disorders

SPS might be part of a body dysmorphic disorder (BDD) which is a fixation on an imaginary flaw in the physical appearance, resulting in embarrassment and fear of being scrutinised or mocked. SPS is also seen in certain psychiatric disorders such as obsessive-compulsive disorder, social phobia, anxiety and depression.

Obesity

In men who are overweight, the penis cannot be seen with the abdominal overhang or the presence of a significant suprapubic fat pad causes the penis to be partly buried.

Treating SPS

Conservative approaches to therapy should be the initial interventions in all men, namely:

Education which gives the man some reassurance about the condition and his symptoms.

Mirror work in which the patient is asked to look at himself undressed in front of a full-length mirror. By doing so, he will observe the penis in the way that he would see other men. The penis looks longer and larger than when observed from above.

Psychological therapies: Whether the penis is actually small or just perceived to be small, cognitive behavioural therapy (CBT) can be useful in building confidence and counteracting negative thoughts.

Physical treatment options could be pursued if the above does not work, but their effectiveness is not guaranteed. However, some men experience psychological benefits from using them. They are:

Vacuum devices

Penile extenders

Stretching devices

Penoscrotal rings

Hot towels and wraps

Penis exercise programme (Jelqing or penis milking) - an ancient Arab penile massage technique that forces blood into the penis to facilitate its growth in length and girth.

Medication is sometimes indicated such as: The selective serotonin reuptake inhibitors (SSRIs) for depression, anxiolytics for anxiety and anti-psychotics for delusional BDD. Testosterone therapy is only of value in men with micropenis.

Surgery

There are four surgical options:

Penis-lengthening surgery - Division of the suspensory ligament is the procedure that has been most commonly described for flaccid penile lengthening.

Penis widening: This method involves injection of silicone, PMMA (polymethylmethacrylate) microspheres, and other materials into the penis and scrotum, to achieve girth enlargement.

Liposuction or suprapubic lipectomy is potentially valuable in men with a significant suprapubic fat pad, thereby making a partly buried penis appear more prominent.

Several techniques to augment the glans penis have been tried. A common one is injecting the glans with hyaluronic acid gel.

Please note that the results of surgery are poorly documented and significant complications can occur.

For all you men out there with small penis syndrome, please remember that women are much more interested in a man's personality and looks than the size of his penis.

It doesn't matter how long or how short your penis is, the vagina is so well designed. You see, the vagina of a woman who hasn't had a child is only a mere 7.5cm (3") long when she's not sexually excited. The figures for women who have had children only varies slightly and even when she is aroused, her vagina usually extends only to a length of about 10cm (4"). But it will lengthen by 150 per cent or even 200 per cent to accommodate a man with a large member if necessary.

So, if you think you are too small, why don't you ask your partner for her expert opinion?

Dr Alverston Bailey is a medical doctor and immediate past president of the Medical Association of Jamaica. Send comments and questions to editor@gleanerjm.com or fax 922-6223.