I read a sobering article the other day. It was so galvanising that it prompted me to check if I fell short of the normal range. For purposes of anonymity, I am not going to reveal the identity of the author and the website where it was posted. Nor am I going to be extremely specific, since this is part of a wealth of articles articulating the same theme, which in itself presents nothing short of major social ramifications. It started off as a joke about the issue that always rests on the forefront of a man's mind (well, not always, but you never know you've cared about it until something dismantles your shield of confidence): there are expectations regarding the parameters of the 'manhood'. A survey was done to ask women their preferred length and width of the male sex organ (funnily enough, the opinions of men were brutally disregarded). Results were varied, especially when different situations were proffered. For instance, it transpired that the size of the organ mattered more when women were looking for casual sex. With reference to long-term relationships, this factor was less important. However, the conclusion drawn is this: if your manhood is less than 6.2 inches in length, then basically you will never have the chance to get laid. Yes, 6.2 inches. For those of you wondering what 'state' the article is referring to, it is most certainly not the one to your advantage.
Frantic, I was obsessed with the notion to the extent of immediately producing the soft tape from my drawer and measuring mine. The correct way of measurement is from the tip of the glans penis (the most distant point of the outward protrusion) to the tip of the pubic symphysis. [1] I was shocked when the number rolled in front of my eyes. 6. I rubbed my eyes and checked again. 6. I cursed under my breath and desperately tugged on the skin folds, hoping to artificially enlarge it (don't). Then, in the style of my traditional breakdowns, I collapsed on the floor and started sobbing.
Why did I care that much to begin with? In fact, a study shows that the average length of a flaccid penis is 3.61 inches, while the average length of an erect penis is 5.16 inches. Nomograms (showing which percentile a datum of a measure lies) are constructed regarding the girth (width) and length of the penis in three different states: flaccid, flaccid-stretched, and erect. [2] Theoretically, according to the nomogram, 6 inches in length would be way beyond the average. What was I worried about?
The truth is, society has bred a generation, or generations, of men who are hyper-focused about their manhood, to the degree of obsession. Articles from popular magazines reiterate the masculine ideal, showing pictures of men with ripped bodies doing sit-ups and push-ups, without an ounce of extra body fat. A random Google research would return thousands of results regarding a procedure called 'penoplasty' - the surgical enlargement of the penis. I originally understood this procedure as the mere transfer of fat from other parts of the body (abdominal, for instance) to the penis. Fat is often used as a cosmetic device since it is (a) part of the patient's own tissue, thus there is no concern regarding possible post-operative autoimmune reactions, and (b) easy to obtain and transfer. I was wrong. It turns out that there are more than three types of surgery available for those who wish to have their manhood enlarged. Androfill Clinics explain several of the procedures they offer, including hyaluronic acid injections (the enhancement of the extracellular matrix), division of the suspensory ligament (thus the penis in flaccid state appears longer) and fat transfer (as mentioned above). [3] The London Centre of Aesthetic Surgery website shows a suited man leisurely lounging on a sofa, coolly staring in the horizon - a testimony to the well-rendered services of the Centre. [4]
This is not helped by pornography. A sweep browse of different porn websites gives illuminating insights as to how the porn industry works (cough cough, I have never watched porn, cough cough...). The porn industry prides itself for establishing the standards of modern masculinity and femininity, where muscular men dominate over screeching toothpick women. Objectification is ubiquitous. Adult film studios compete in hiring actors with the biggest penises. Titles and captions grow aggressive in promoting how big their manhoods are. 12 inches. 11 inches. Such actors are praised as gods. Conversely, on the rare occasion that a man with a normal-sized penis is cast, the title reads 'small dick' (I repeat, I've never watched porn, cough cough). Such a phrase is used in a denigratory fashion, where the scientific average is reduced to a mere message of condolence. The porn industry echoes the belief that men should always be ready to satisfy women with their excruciatingly large organs. Instead of accepting them as they are, men should strive for the artificial standard of 'bigger is better'.
Even the law is to blame. I am greeted with a litany of cases where the courtroom is so preoccupied with the penis that it supersedes the victim or defendant. The male sex organ has usurped the personality of the person they are dealing with. In Harrington v Almy [5], a police officer was suspected of being involved in a series of child abuse cases. He could only be reinstated provided that he underwent a test called 'penile plethysmography', which is essentially an invasive test to measure the size of the penis. The premise of the order was that if it were subsequently proven that the volume of the police officer's penis did increase, such would constitute to evidence impugning the police officer's claim of innocence. Erection, as an involuntary physiological process [6], is deemed representative of what would otherwise be an intentional act. In law, there are two elements in a crime - the mind (mens rea) and the act (actus reus). Using erection as a parameter in evaluation of the defendant's cognitive processes is not only ridiculous, but highly risible. Courtroom obsession with the male sexual organ does not, unfortunately, end here. I've written an article on male rape as an exemplification of gross injustice in modern times. I am baffled upon learning that victims presenting with erections when being raped can actually acquit the defendant. [7, 8]
Such manifestations of an in-built, toxic standard of masculinity have, frankly speaking, pushed many boys and men to the edge. When it comes to body concerns, there is a line. Once this line is crossed, it is pathological. I thereby introduce to you one of the most under-researched psychiatric conditions: Body Dysmorphic Disorder (BDD).
BDD is traditionally classified as a somatoform disorder (DSM-4), where the focus lies on concerns regarding bodily features. However, the publication of DSM-5 has offered us a novel insight. It is now categorised under the Obsessive-Compulsive spectrum of disorders. Such disorders present with, as their name suggests, two important features: (a) obsession with a particular facet of their life, and (2) ritualistic behaviour to be performed to assuage that concern. Such obsession is not merely a concern - it goes far beyond it. Patients with Obsessive Compulsive Disorder (OCD) have intrusive, persistent thoughts which are disturbing to their lives. Such preoccupation in BDD focuses on one or more perceived defects or flaws that appear normal or are not even observable by others. [9] Such perceived blemishes can concern anywhere in the body. As I mentioned previously, men tend to worry more about their genitalia. Hair-thinning and body build are other typical concerns of male patients. [10] Ritualistic behaviours in BDD operate on a huge spectrum, ranging from individual-oriented to social-oriented. Patients engage in acts such as mirror-checking, excessive grooming and camouflaging (the use of make-up to shield perceived flaws from the public eye). They would also seek constant reassurance from friends and family regarding their appearance. [11] This persistent form of torture is compounded by the existence of co-morbidities - in psychiatry, a patient does not come to the clinic with the condition written on his/her forehead. Often, a patient's presentation can meet the criteria of two or three conditions listed on DSM-5 or ICD-11. We call conditions in addition to the main issue, co-morbidities. For instance, a patient with BDD is highly likely to have co-morbid major depressive disorder (reaching as high as 80% [10]), where body issues breed self-doubt and worthlessness. The failure of meeting self-imposed and societal expectations also leads to persistent low mood. On the extreme end of the spectrum, patients with BDD are more likely to seek relief from suicide. While patients with OCD, for instance, are 10 times more likely to seek suicide than the general population [12], the figure is much higher for patients with BDD, reaching 45 times [13]. In a study of 185 subjects with BDD lasting for up to 4 years, a history of suicidal ideation (the mere thought of acting out suicide; not having actually attempted it) was present in 79.5% of patients. 27.6% had a history of suicide attempts. [13] Unlike eating disorders, which on face, are quite similar to BDD owing to their shared concerns over physical appearance, BDD is not a predominantly female illness. It is prevalent in both men and women. [14]
Where do we go from here?
A study showed that up to 16.0% of the cohort met the criteria for BDD. [15] Although genetics does exhibit a role, since BDD is found to be more common in first-degree relatives of patients with OCD [16], we cannot blame hereditary factors wholly for the rise of such a debilitating disorder. Societal norms, as vividly illustrated above, have wronged male individuals. Unrealistic expectations breed unrealistic expectations. Stained beliefs breed stained beliefs. Such entrenched ideals will only augment in importance and eminence if they remain longer in society. As I elaborately discussed in my previous blog post on homosexuality, humans are never individualistic enough to ignore what other people think. It is our nature. We convince ourselves that we are endowed with full autonomy in our actions. In reality, we look up to people. We look up to the latest trends. We morph ourselves according to the environment, in order to fit in. We are vastly reluctant to become the odd one out, since the tiara of safety is conferred whenever we stay in our lane.
The only way out for humanity is the gradual acceptance of what male individuals actually are. Male individuals are human with their own minds and souls. Male individuals are classified as male not because of the standards of behaviour they exhibit. They are male because of a biological designation - the possession of certain genitalia and the operation of intrinsically male physiological mechanisms. Nothing more. We are born with bodies of all shapes and sizes. What truly constitutes acceptance is to proudly proclaim that we are perfecting our bodies because we want to, consistent with the manner we prefer, not the manner assented by archaic beliefs. It does not follow that acceptance only involves the constant seeking of perfection. Acceptance can also be achieved by not seeking perfection. We can stare in the mirror and proudly proclaim that we love our bodies, without feeling the need to conform to whatever is expected of us. After all, the majority of women don't actually care about the size of a man's manhood. [17]
I saw the soft tape I used the other day. I threw it in the dustbin and never looked back.
[1] Is Your Penis Too Small?. Men's Health. (2018). Retrieved 12 November 2020, from https://www.menshealth.com/uk/health/sexual-health/a744094/is-your-penis-too-small-9248/.
[2] Veale D, Miles S, Bramley S, Muir G, & Hodsoll J. (2015). Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15 521 men. BJU International, 115(6), 978-986. https://doi.org/10.1111/bju.13010
[3] Horn, D. (2020). Penis Enlargement Surgery. Androfill Clinic. Retrieved 12 November 2020, from https://www.androfill.co.uk/penis-enlargement-surgery/.
[4] Male enhancement penoplasty - LCAS. LCAS. (2020). Retrieved 12 November 2020, from https://www.lcas.com/invasive-treatments/penoplasty-enlargement-and-lengthening/.
[5] 977 F.2d 37 (1992).
[6] Dean R, & Lue T. (2005). Physiology of Penile Erection and Pathophysiology of Erectile Dysfunction. Urologic Clinics Of North America, 32(4), 379-395. https://doi.org/10.1016/j.ucl.2005.08.007
[7] R v RJS (1993) 31 NSWLR 649.
[8] Willan v Willan 2 All E.R. 463 (1960).
[9] Philips K. (2020). Diagnosing BDD - BDD. International OCD Foundation. Retrieved 12 November 2020, from https://bdd.iocdf.org/professionals/diagnosis/.
[10] Ross J, Gowers S. (2011). Body Dysmorphic Disorder. Advances in psychiatric treatment, 17, 142-149. doi: 10.1192/apt.bp.109007716.
[11] Philips K. (2004). Body dysmorphic disorder: recognizing and treating imagined ugliness. World Psychiatry, 3(1): 12-17.
[12] Eskander N, Limbana T, & Khan F. (2020). Psychiatric Comorbidities and the Risk of Suicide in Obsessive-Compulsive and Body Dysmorphic Disorder. Cureus. https://doi.org/10.7759/cureus.9805
[13] Philips K, Menard W. (2006). Suicidality in Body Dysmorphic Disorder: A Prospective Study. American Journal of Psychiatry, 163:7, 1280-1282.
[14] Bjornsson AS, Didie ER, & Phillips KA. (2010). Body dysmorphic disorder. Dialogues in clinical neuroscience, 12(2), 221–232.
[15] Conroy M, Menard W, Fleming-Ives K, Modha P, Cerullo H, & Phillips K. (2008). Prevalence and clinical characteristics of body dysmorphic disorder in an adult inpatient setting. General Hospital Psychiatry, 30(1), 67-72. https://doi.org/10.1016/j.genhosppsych.2007.09.004.
[16] Grant JE, Philips KA. (2004). Is Anorexia Nervosa a Subtype of Body Dysmorphic Disorder? Probably Not, but Read on... Harvard Review of Psychiatry, 12(2), 123-126.
[17] Castleman M. (2014). How Women REALLY Feel About Penis Size. Psychology Today. Retrieved 12 November 2020, from https://www.psychologytoday.com/gb/blog/all-about-sex/201411/how-women-really-feel-about-penis-size.