Dr Solomon is a plastic surgeon, Division of Plastic Surgery, Pennsylvania Hospital, Philadelphia, PA, USA.
Corresponding Author: Dr Mark P. Solomon, 191 Presidential Boulevard, LN24, Bala Cynwyd, PA 19004, USA.
These authors are to be commended for their efforts to determine the aesthetic standards of the male genitalia.1 Perhaps the earliest effort in this area was by Michelangelo in creating his sculpture of David (Figure 12). This idealized figure’s torso is similar to the drawing in this paper and demonstrates many features of an idealized male figure. However, although concepts of beauty are well established for the human face, they are less clear for other areas of the body. Furthermore, the penis on the David demonstrates different ratios than that of the ideal penis used in these drawings, yet there is little doubt through history of the aesthetic appearance of this sculpture.
Although plastic surgeons have incorporated the concepts first outlined by DaVinci regarding facial aesthetics, attempts have been made to elucidate normative data regarding human anatomy to include penis size and breast dimensions, among others.3-5
This is in contrast to the efforts in this article in which an idealized image is employed as a template for the determination of an aesthetic standard. This is a more difficult concept to quantify and may not be practical for surgeons who work with genitalia. Facial aesthetics rely on ratios to the surrounding anatomic landmarks, but have, over time, been related to more quantifiable data, such as cephalometrics. The value of these quantifiable data points is that the surgeon can easily apply them to an individual case. Similarly, a large database exists for the male genitalia.6-10
Another confounding factor at play here is the Ebbinghaus illusion in which the perception of size is affected by the size of the surrounding image. Therefore although the absolute size of genitals may be similar between 2 individuals, the perceived size will vary with the overall size of the individual. A similar analysis exists regarding the size of the penis in relation to the surrounding scrotal and pubic anatomy. In a similar manner, an individual will make some decisions about penis appearance based on their own phenotype.11 This inherent bias will influence the observer’s perspective and skew the data from something such as crowdsourcing. Moreover, studies that evaluate the attractiveness of penis size do not demonstrate any consistent pattern of preference.11
Surgeons who will find value in this paper fall into 2 groups. The first of these is surgeons who perform gender reassignment surgery. Although I do not perform these procedures, I am aware that they fall into 2 areas for female to male surgery. The first of these is the procedure known as metoidioplasty. This procedure creates a neophallus from existing clitoral tissue, with a range in size of 3.5 to 7cm.12 This phallus is not generally useful for penetrative intercourse but is widely created for a number of reasons. Among these are the relative ease of the surgical procedure and the lesser cost. Given the size of a metoidioplasty, it would not fit into the paradigm described by the authors yet this procedure remains widely available. The second method of neophallus creation involves the utilization of a free tissue transfer. The data presented here is more ap-plicable to patients who choose to undergo this method of phalloplasty. However, it assumes that their surrounding morphology approaches the line drawings utilized. Again, these drawings, like Michelangelo’s David, are an ideal but not a reality for the majority of patients we see.
The second group of surgeons who may find value in this paper are those of us who perform aesthetic and re-constructive surgery of the penis. I am in this latter group. Although the data presented here is interesting, I have found that a familiarity with the collected, quantifiable data regarding male genitals is more useful for several reasons. First, most of my patients do not fit the idealized appearance of these line drawings. Second, most men are looking to be “normal.” By this I mean that men have a range of images for the appearance of their genitals that goes from something that is realistic to something that is fantasy. A familiarity with the actual data provides me with a basis on which to compare an individual patient who is in my office. Measurements of penis length and girth provide a ratio that is helpful in determining which, if any, dimension is deficient. Generally, in an ideal situation, the length and circumference in either the flaccid or erect state are almost equal. This allows for correction of that deficiency to provide a patient with a penis that is more “normal.” The data provided here does not allow for that type of analysis, which is useful on the level of the individual patient.
In addition, much like the face, when viewing the male genitals, it is important to appreciate the surrounding anatomy. Often men will present with a buried penis due to pubic and abdominal issues. Reliance on an idealized penis will not provide useful guidance in determining surgical options. On the other hand, a knowledge of average penis size is helpful in determining whether a given patient requires length enhancement, girth enhancement, alteration of the pubic area, alteration of the scrotum, or any combination of these entities.
There is no doubt that the appearance of the genitals is important, not just from a surgical perspective, but from an anthropological one.11 There is ample data on the value of penis size and appearance in relation to reproductive success. However, there is also data that demonstrate a variance among ethnic groups in terms of penis size.7,8 Despite this, each of these groups continues to reproduce successfully, regardless of penis size.
One final consideration is that penis transplantation is now a real entity.13 As such, for those men who require a transplant for treatment of a devastating loss, the aesthetics will take a back seat to the availability of a donor penis. Facial transplantation has given surgeons a tool that allows for restoration of facial landmarks in a more natural way than all of our planned reconstructions that utilize the traditional hallmarks of a beautiful face. For those with total penis loss, transplantation will do the same for this valued structure.
Crowdsourcing is an interesting way in which to quantify aesthetics, but the classic definitions of facial aesthetics arise from the world of art as noted by the authors. The utility of knowledge of the range of penis size across a large population is, I think, more useful to surgical planning than a notion of proportions to a random crowd of observers. After all, beauty is in the eye of the beholder and the ultimate success of any plastic surgical endeavor is the patient’s appreciation of the surgical result. If anything, the authors demonstrate that there is a wide range of acceptable penis dimensions to the general public. Surgeons can incorporate these ideas into their surgical planning to optimize patient outcomes, regardless of the indication for surgery
The author declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.
The author received no financial support for the research, authorship, and publication of this article.
- Massie JP, SoodR, NolanIT, etal. Defining aesthetic preferences for the penis: a photogrammetric and crowdsourcing analysis. Aesthet Surg J. 2021. doi: 10.1093/asj/sjab082 [Epub ahead of print].
- Unna JB. David by Michelangelo, Florence, Galleria dell’Accademia, 1501–1504. Wikipedia website. https://commons.wikimedia.org/wiki/File:%27David%27_by_Michelangelo_Fir_JBU002.jpg. July 28, 2016. Accessed January 1, 2021.
- Penn J. Breast reduction. Br J Plast Surg. 1955;7(4):357-371.
- Mallucci P, Branford OA. Concepts in aesthetic breast dimensions: analysis of the ideal breast. J Plast Reconstr Aesthet Surg. 2012;65(1):8-16.
- Ricketts RM. Divine proportion in facial esthetics. Clin Plast Surg. 1982;9(4):401-422.
- Veale D, Miles S, Bramley S, Muir G, Hodsoll J. Am Inormal? Asystematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15,521 men. BJU Int. 2015;115(6):978-986.
- Ponchietti R, Mondaini N, Bonafè M, DiLoro F, Biscioni S, Masieri L. Penile length and circumference: a study on 3300 young Italian males. Eur Urol. 2001;39(2):183-186.
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- Wessells H, Lue TF, McAninch JW. Penile length in the flaccid and erect states: guidelines for penile augmentation. J Urol. 1996;156(3):995-997.
- Littara A, Melone R, Morales-Medina JC, Iannitti T, Palmieri B. Cosmetic penile enhancement surgery: a 3-year single-centre retrospective clinical evaluation of 355 cases. Sci Rep. 2019;9(1):6323
- Mautz BS, Wong BB, Peters RA, Jennions MD. Penis size inter-acts with body shape and height to influence male attractiveness. Proc Natl Acad Sci U S A. 2013;110(17):6925-6930.
- Djinovic RP. Metoidioplasty. Clin Plast Surg. 2018;45:381-386.
- Redett RJ 3rd, Etra JW, Brandacher G, etal. Total penis, scrotum, and lower abdominal wall transplantation. N Engl J Med. 2019;381(19):1876-1878.