madman
Super Moderator
-I have some GH too, maybe I'll add a bit of that for good measure.
Again!
*What is realized depends on the influence of androgens DURING DEVELOPMENT. Testosterone, its metabolite Dihydrotestosterone and Growth hormone play a critical role as they contribute with 70-75% to penile development. There are three testosterone surges during development: in early fetal development, soon after birth and during puberty. In ADULT LIFE, the penis will not grow when exposed to testosterone
Throw this in there too!
I am truly convinced by all those grown ass men lurking on those bumass forums, I just don't GEDDIT, Facepalm, Gootube channels, so called GURU forums littered on the internet!
Bruh where's my rigid ruler at LMFAO!
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Nah BRUH I like the soft one!
Penile Length Measurement: Methodological Challenges and Recommendations, a Systematic Review
Omer Onur Cakir, MD, MSc, FEBU, FECSM,1 Edoardo Pozzi, MD,1,2 Fabio Castiglione, MD, PhD, FEBU, FECSM,1,2Hussain M. Alnajjar, ChM(Urol), FEBU, FRCS(Urol),1 Andrea Salonia, MD, PhD,2,3 and Asif Muneer, MD, FRCS(Urol)1,4,5
Moreover, if medical or surgical intervention is required, then underlying issues can be resolved. In the modern era, men often underestimate the size of their own penis relative to that of others, because of unrealistic expectations from internet sources and underestimation of the true size of their external genitalia due to high body mass index and suprapubic fat deposition.3 Some attempts have been made by researchers in order to define nomograms of male penis size measurements across different populations, races, and ages. However, the variability between the studies in the literature was too large to create such a standard nomogram.3 In addition, several widespread beliefs have been divulged regarding a possible correlation between the size of some body parts and penile length (eg, hands, feet, nose,and height).4,5 Owing to these expectations, a number of nonevidence based products have been advertised and commercially available for penile elongation (eg, penile pumps,pills, creams, etc), resulting in disastrous consequences in somecases.6 Finally, underlying genital body dysmorphic disorders(BDD) should always be considered. Genital BDD usually occurs due to patients’ misperception of the size and other characteristics of his penis and is characterized by obsessive thinking about it. BDD leads to worrisome signs and symptoms of compulsive checking, attempting to minimize the genital appearance, and social isolation requiring a clear and accurate diagnosis in order to provide immediate appropriate treatment and management. Several studies investigated the penile size in adults and adolescents both in the erect and flaccid states, whereas other authors have proposed different ways to obtain accurate and most reliable measurements; however, the accurate consensus is far from consistent in the clinical setting.7 Moreover, high heterogeneity in the aforementioned studies regarding the methodology used thus limiting the usefulness and completeness of the data reported. As a consequence, the current literature hampers in providing researchers and clinicians with well-defined standardized penile size measurement techniques. In addition to that, there is a potential observer bias in measuring penile size, which may cause inter-examiner variability resulting in significant measurement variation. Thus, the possibility of obtaining a reliable recommended penile length measurement could result in a very useful tool for everyday clinical practice and for unified and reliable data reporting for medical research. In this context, recent findings from a multicenter, multi-observer study on penis size, flaccid measurements were only moderately accurate in predicting erect length as well as significant observer bias. Moreover, authors demonstrated that measuring penile length from the pubic bone to the tip of glans is more accurate and reliable and that discrepancies are mostly present in overweight patients.8 In the light of this, the present study aimed to systematically review the published literature on penile length studies to obtain and propose useful and methodological information on how to accurately measure the penile length. This could provide a useful resource used to conduct more standardized future research studies on this topic.
Literature Search and Study Eligibility
This systematic review was conducted according to the PRISMA guidelines.9 We searched MEDLINE using the query (((penis AND (size AND (length OR circumference)) “English”[Language])) AND ("1980"[Date - Publication]: “2019" [Date -Publication]) with the advanced research filter “Human”. For the specific purpose of this study, randomized clinical trials, open label prospective studies, or retrospective studies investigating penile length measurements (up to April 2019) were included. Studies were included if 2 of the co authors agreed: (i) quantitative measurement of the penile size, (ii) flaccid or erect states, that is, stretched length or multiple measured from the root, (iii) flaccid or erect circumference measured at the base and/or midshaft of the penis, and (iv) English language original articles.Non-English studies, case-series, letters, and editorials were excluded. Studies reporting penile measurements on congenital penile curvatures, Peyronie’s Disease, and measurements from cadavers were excluded from the study.
Review Methods
This methodology study aims to systematically review the published literature on penile length studies in order to offer physicians and researchers a more rigorous and standardized methodology regarding penile length measurements.
EVIDENCE SYNTHESIS
A total of 320 papers related to penile length measurements were retrieved. After the screening and review process, 70 articles investigating penile measurements were considered suitable for evaluation (Figure 1). The complete list of included studies is shown in Supplementary Table S1. The majority of published studies were cross-sectional (47; 67.14%). Of the remaining studies, 16 (22.86%) were prospective and 5 (7.14%) were randomized clinical trials (Table 1). A total of 51 (72.85%) studies included at least 50 patients. Studies reporting data relating to penile length measurement were mainly conducted on adults (65; 85.71%); only 9 (12.86%) investigated the penile length among adolescents; 4 (5.71%) studies reported data for both adults and adolescents. The length was measured in all 70 studies selected, and the circumference was evaluated in 40 (57.14%). The most commonly used measuring instrument was a semi-rigid ruler, with 44 (62.86%) studies using it as the measuring aid; 10 (14.29%) reported using a flexible ruler, whereas 16 (22.85%) used a range of different devices (eg, tape measurer, self-measurement kit, cylinder sizer). Thirteen(18.57%) studies performed measurements with the patient in a supine position; only 1 (1.43%) study reported to measure patients’ penile length in the orthostatic position. Most studies (56;79.82%) did not specify the patients’ position. Measurements were mainly conducted in clinical settings by health care practitioners (Table 2). Finally, the presence of BBD was only investigated in one study.
DISCUSSION
The methodology used to measure penile size has remained unchallenged. Penile length measurement has not achieved a proper consensus regarding the use of a validated or standardized technique. This occurred due to the following reasons. First, the penis is a dynamic organ which has flaccid, semi-erect, and fully rigid phases.10,11 Furthermore, different external and internal parameters, such as the ambient temperature or patient’s anxiety evel, may affect the degree of flaccidity and rigidity.12,13 In addition, the presence of specific comorbidities such as erectile dysfunction and/or Peyronie’s disease can dramatically affect the measurements.14-16 Moreover, lack of standardized protocols due to inaccuracies and high variability of the published literature makes it difficult to have uniform and reliable results that allow formal comparisons between studies. Therefore, this systematic review aimed to investigate the methodology of data reporting of studies evaluating penile length in order to provide a detailed recommendation on how to perform future standardized high quality research on this topic. The main limitation of the present study relies on a relatively limited number of databases searched for the identification of potentially eligible studies. Finally, risk of bias assessment was not performed.
Measuring the Length and Circumference
Several methods have been reported to measure penile length and circumference. This review found that the majority of selected studies reported the use of a rigid ruler (63%) to measure penile length. Alternatively, 14% and 23% used a flexible ruler or other instruments (eg, tape measurer), respectively. Although this holds true, different measurement techniques can lead to extremely heterogeneous results. In this context, Habous et al17 found that flaccid measurements underestimated the erect size with a significant interobserver variability. Likewise, in a larger, multicenter, multi-observational study, the same group confirmed that flaccid measurements were only moderately accurate in predicting the penile erect size. In addition, measuring penile length from the pubic bone to the tip of the glans was found to be more accurate and reliable, especially among overweight men.8 In contrast, Sengezer et al18 demonstrated that the most accurate results could be obtained using the stretched penile length, confirming that flaccid length had little importance in determining and predicting an erect penile length. These findings were confirmed by many other groups.3,6,18-23 In our systematic review, 60% of studies reported measuring the penile length with a stretched penis. Although measuring the penile length during an erection would be the most accurate method, this can be a challenging procedure in routine clinical practice. In this context, studies reporting penile length measurement at an erect state were only performed during invasive diagnostic procedures such as penile duplex Doppler ultrasound or intraoperatively (eg, intraoperative artificial erection).8,24-30 However, we acknowledge that reporting penile length measurements during erection would be difficult in both a clinical and research setting. To overcome this issue, authors could consider reporting penile length by measuring it with a stretched penis from the pubic bone to the tip of the glans.8,17,19,22,29,31-46 Thereof, the penis should be gradually stretched to its maximal length with a 90 angle relative to the abdominal wall and measured from the pubic bone to the tip of the glans (dorsally); the pubic symphysis is exposed by pressing and/or displacing abdominal fat. In this context, we believe in the implied superiority of using a rigid ruler for length measurement especially on examining patients with high body mass index with a suprapubic fat pad. Regarding penile circumference, less heterogeneity has been observed because fewer techniques exist. Most studies reported on taking measurements at the base or at the midshaft of the penis that does not comprise final measurements.3 Therefore, we believe that this should be performed using a tape measurer at the base and/or midshaft, the penis should be flaccid and unstretched. Finally,80% of reviewed studies did not report optimal patients’ position during penile length measurement. Moreover, supine position was acknowledged to be the most reliable and comfortable position for both the patient and examiner (Box 1).
Examiner and Settings
The examiner plays a major role in this context. Fewer studies, 10%, reported that patients’ themselves performed the measurements. Instead, 90% reported that measurements were carried out by health care practitioners within a clinical setting. Particular attention should be paid regarding examination conditions. Stressful context and room temperature can negatively affect the results as different studies have shown 12,13 (Box 1)
CONCLUSIONS
The penile size measurement technique has not yet achieved proper consensus due to high heterogeneity in terms of data assessment and reporting methodologies among different studies. In this systematic review, published literature on studies evaluating penile length should be evaluated in order to obtain and propose useful and methodological information on the accurate measurement of penile length and girth. Proper penile size measurement should fulfil specific methodological criteria by collecting a precise medical history, arranging the optimum clinic settings, and performing ideal measurement techniques (Box 1).
Conducting studies in the field of penile length measurement with a homogeneous methodology would allow adequate and internationally standardized measurement techniques to detect penile length and girth. Therefore, this would provide better counselling on the patients’ penile size.
-I have other reasons to experiment with DHT cream. I had a very positive response to scrotal cream with regard to libido and erectile function - actually the best results to date. I am not terribly concerned with increasing the size of my penis as I'm already doing pretty well in that department. I'm mostly doing this for science and for probable libido benefits. Also, this discussion around the prospect of penile enlargement has already been very entertaining and brought joy to my life.
Fair enough!
