Skip to main content
PMC home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2010 Jun 1.
Published in final edited form as: Arch Sex Behav. 2009 Jan 13;39(3):788–797. doi: 10.1007/s10508-008-9439-5

The Association between Penis Size and Sexual Health among Men Who Have Sex with Men

Christian Grov 1,2, Jeffrey T Parsons 2,4,3, David S Bimbi 2,5
PMCID: PMC2874247  NIHMSID: NIHMS199643  PMID: 19139986

Abstract

Larger penis size has been equated with a symbol of power, stamina, masculinity, and social status. Yet, there has been little research among men who have sex with men assessing the association between penis size and social-sexual health. Survey data from a diverse sample of 1,065 men who have sex with men were used to explore the association between perceived penis size and a variety of psychosocial outcomes. Seven percent of men felt their penis was “below average,” 53.9% “average,” and 35.5% “above average.” Penis size was positively related to satisfaction with size and inversely related to lying about penis size (all p < .01). Size was unrelated to condom use, frequency of sex partners, HIV status, or recent diagnoses of HBV, HCV, gonorrhea/Chlamydia/urinary tract infections, and syphilis. Men with above average penises were more likely to report HPV and HSV-2 (Fisher’s exact p ≤ .05). Men with below average penises were significantly more likely to identify as “bottoms” (anal receptive) and men with above average penises were significantly more likely to identify as tops (anal insertive). Finally, men with below average penises fared significantly worse than other men on three measures of psychosocial adjustment. Though most men felt their penis size was average, many fell outside this “norm.” The disproportionate number of viral skin-to-skin STIs (HSV-2 and HPV) suggest size may play a role in condom slippage/breakage. Further, size played a significant role in sexual positioning and psychosocial adjustment. These data highlight the need to better understand the real individual-level consequences of living in a penis-centered society.

Keywords: penis size, penis satisfaction, condom use, sexually transmitted infections, men who have sex with men (MSM), gay and bisexual men

INTRODUCTION

Though it is well known that men’s penises come in many shapes and sizes, larger penis size has been equated with a symbol of power, fertility, stamina, masculinity, and social status (Bogaert & Hershberger, 1999; Bordo, 1999; Connell, 1987, 1995; Drummond & Filiault, 2007; Lehman, 1998; Paley, 2000; Pope, Phillips, & Olivardia, 2000; Stulhofer, 2006). It is no surprise that researchers have found most men are unsatisfied with their penis size, wishing it were larger (Lever, Frederick, & Peplau, 2006). Others have found that many men seek penile augmentation surgery despite the fact that they have normal penis sizes (Dotson, 1999; Mondaini et al., 2002; Pope et al., 2000). Using data from the Body Image Survey, Lever et al. (2006) reported on 25,594 heterosexual men and 26,437 heterosexual women on attitudes and perceptions of penis size. They found even though 66% of men rated their penis size as average, 46% of these same men desired a larger penis and 45% of all men desired a larger penis. Further, less than one percent of men desired a smaller penis.

In addition, Lever et al. (2006) also found men’s penis size was significantly related to satisfaction with other body traits, including one’s face, overall physical attractiveness, and comfort in a swimsuit. Despite the fact that many men were unsatisfied with their penises, Lever et al. reported that 84% of women were very satisfied with the size of their partner’s penis size, and similar findings have been documented elsewhere (Stulhofer, 2006). While researchers have attempted to assess the average penis size for various groups of men (Bogaert & Hershberger, 1999; Ponchietti et al., 2001; Spyropoulos et al., 2002), there remains little research on how penis size effects an individual’s sense of satisfaction, self, and other sociosexual outcomes (Drummond & Filiault, 2007).

Research on the effectiveness of condoms to prevent HIV/STI transmission is vast (Davis & Weller, 1999; Holmes, Levine, & Weaver, 2004; Steiner & Cates, 2006, 2008; Steiner, Cates, & Warner, 1999), and there is a large body of research highlighting the roles that both substance use and condom use skills can play in condom efficacy (De Graaf, Vanwesenbeeck, Van Zessen, Straver, & Visser, 1995; Leigh, Ames, & Stacy, 2008; Leigh, Morrison, Hoppe, Beadnell, & Gillmore, 2008; Munoz-Silva, Sanchez-Garcia, Nunes, & Martins, 2007). Building from these findings, some researchers have argued penis size too can impact correct and consistent condom use and HIV/STI transmission (Reece et al., 2007; 2008). Herbenick and Reece (2006) have highlighted how there are only a limited range of condom sizes available, with a majority of manufacturers producing condoms to fit an “average” penis (Garside, 2004). Researchers have suggested that experiences with the fit and feel of condoms (Crosby, Yarber, Sanders, & Graham, 2005; Grady, Klepinger, Billy, & Tanfer, 1993; Grady, Klepinger, & Nelson-Wally, 1999; Jadack, Fresia, Rompalo, & Zenilman, 1997) and condom breakage and slippage (Crosby, DiClemente, Yarber, Snow, & Troutman, 2008; Crosby, Salazar et al., 2008; Crosby et al., 2007; Herbenick & Reece, 2006; Richters, Donovan, & Gerofi, 1993; Richters, Gerofi, & Donovan, 1995; Rosenberg & Waugh, 1997) reduce consistent use by some men. As a result, this has been hypothesized to inadvertently lead to greater incidence of HIV and STIs (Herbenick & Reece, 2006; Reece et al., 2007; 2008).

With few exceptions (Bergling, 2007; Drummond & Filiault, 2007), there has been surprisingly little research among men who have sex with men (MSM) assessing the association between penis size and social-sexual health. Drummond and Filiault (2007) argued, “Penis size may be of increased importance to some gay men due to the erotic nature of the body in many gay cultures and the ‘double presence’ of the penis in a gay relationship or sexual encounter” (p. 122). In addition, they proposed that the importance of penis size may be “exacerbated by the overall importance of the body in dominant gay male culture” (p. 122).

As such, MSM may be a particularly well-positioned group, compared with heterosexual men, for such inquiry, as they have had greater and more intimate exposure to other men’s penises (via sexual partners and erotica) during the course of their lifetimes, and thus have potentially had more opportunities to compare their penises to those of others. As a result, they may have a more accurate assessment of what “average” may be. Furthermore, because U.S. MSM continue to comprise a disproportionate number of new HIV transmissions (Osmond, Pollack, Paul, & Catania, 2007; Schwarcz et al., 2007), active HIV/AIDS cases (Hall, Byers, Ling, & Espinoza, 2007; Malebranche, 2003), and STI incidence (Palefsky, 2007; Samuel et al., 2003), and because penis size has been related to correct and consistent condom use, MSM may be a particularly vital group in which to closely assess the relationship between penis size and condom use.

In assessing the association between condom use and penis size among gay and bisexual men, yet another layer to consider is the potential role that penis size may play in men’s sexual positioning with their partners (i.e., anal insertive “top” versus receptive “bottom”) (Grov et al., 2007; Parsons et al., 2005). Because of the “value” placed on larger penis size, are men with larger penises more likely to assume the anal insertive role? In contrast, a larger penis size may make penetrative anal sex more difficult and uncomfortable. In this case, are men with larger penises less likely to assume the insertive role? To our knowledge, no researchers have investigated this, though this connection may play a considerable role in condom use, condom breakage/slippage, and the transmission of HIV and STIs.

Current Study

Drawing from a diverse sample of MSM, these analyses sought to explore four questions. First, to what extent is perceived penis size associated with penis size satisfaction? Second, understanding that condoms are often limited to a narrow range of available sizes, to what extent is perceived penis size associated with condom use, HIV, and STIs? Third, to what extent is perceived penis size associated with men’s sexual positioning (anal insertive vs. receptive)? Finally, to what extent is perceived penis size associated with psychosocial outcomes (e.g., adjustment in the GLBT community)? Though the term “sexual health” encompasses a diverse range of physical, spiritual, social, and psychological constructs as they relate to sexuality (World Association for Sexual Health, 2008), this analysis used the term “sexual health” in operationalizing its broad exploration the four aforementioned research questions. Certainly, this analysis did not address all aspects of sexual health, however its themes were intimately concerned with the associations between perceived penis size and a variety of health-related outcomes, thus we believe our manuscript captures the spirit of “sexual health.”

METHOD

Participants and Procedure

A cross-sectional, street-intercept method (Miller, Wilder, Stillman, & Becker, 1997) was adapted to survey 1,065 gay and bisexual men at a series of gay, lesbian, and bisexual (GLB) community events in New York City in the fall of 2006 through the Sex and Love Study, version 5.0. This approach to collecting data has been used in numerous studies (Carey, Braaten, Jaworski, Durant, & Forsyth, 1999; Chen, Kodagoda, Lawrence, & Kerndt, 2002; Kalichman & Simbaya, 2004; Rotheram-Borus et al., 2001), including those focused on GLB persons (Benotsch, Kalichman, & Cage, 2002; Kalichman et al., 2001) and has been shown to provide data that are comparable to those obtained from other more methodologically rigorous approaches (Halkitis & Parsons, 2002), such as time-space sampling.

At both two-day long community events, the research team hosted a booth, and a member of the research team actively approached each person who passed the booth. Potential participants were provided with information about the project and offered the opportunity to participate. The response rate was high, with 83.0% of those approached consenting. The survey required 15–20 minutes to complete, and–to promote confidentiality–participants were handed the survey on a clipboard so that they could step away from others to complete the questionnaire privately. Upon completion, participants deposited their own survey into a secure box at the booth. As an incentive, those who completed the survey were given a voucher for free admission to a movie. Survey data were entered into an SPSS database and checked/verified by project staff for accuracy.

Table I reports characteristics of the sample. The sample was diverse with ages ranging from 18 to 90 (M = 37.9, SD = 12.5), and 42% being persons of color. Most men (89.2%) identified as gay, 9.4% as bisexual, and the remainder as queer (1.1%) or “straight” (but reported having sex with men; 0.3%). Most men (74.6%) were HIV negative, 12.5% were HIV positive, and 9.9% of men were never tested.

Table I.

Sample characteristics (N = 1065)

N %
Age
 18–29 325 30.5
 30–39 300 28.2
 40–49 257 24.1
 50+ 183 17.2
Race and Ethnicity
 White/Caucasian 618 58.0
 African American 152 14.3
 Latino 177 16.6
 Asian/Pacific Islander 62 5.8
 Multiracial and “other” 56 5.3
Education
 Some college or less 265 24.9
 College degree 438 41.1
 Graduate school 298 28.0
HIV status
 Positive 133 12.5
 Negative 794 74.6
 Untested 105 9.9
 Refused 33 3.1
Sexual identity
 Gay 950 89.2
 Bisexual 100 9.4
 Straight, has sex with men 3 0.3
 Queer, has sex with men 12 1.1
Sexual Role, Positioning
 Top (anal insertive) 354 33.2
 Versatile (insertive, receptive) 397 37.3
 Bottom (anal receptive) 270 25.4
 Refused 44 4.1
Perceived penis size
 Below average 73 7.1
 Average 574 56.0
 Above or way above average 378 36.9
Lied about penis size
 Never 654 64.1
 Rarely 238 23.3
 Sometimes, often, most/all of the time 128 12.5
Satisfaction with penis size
 Wish it were smaller 14 1.4
 I’m satisfied 664 65.1
 Wish it were bigger 342 33.5
Open in a new tab

Measures

Demographics

Participants were asked to indicate their age (in years), sexual identity, education (in ordinal categories), and race and ethnicity (by checking all that applied to them). Response categories to race and ethnicity included “African American,” “Asian/Pacific Islander,” “European/White,” “Hispanic/Latino,” and “Other, specify.” Men also indicated their HIV status.

Perceived Penis Size and Satisfaction

In evaluating the association between perceived penis size and variables such as penis satisfaction, Lever et al.’s (2006) operationalization of penis size was adapted. Men were asked, “Do you consider your penis size to be?” with response categories “below average,” “average,” “above average,” and “way above average.” For this analysis, men indicating “above average” (n = 341, 32.0%) and “way above average” (n = 37, 3.5%) were collapsed into a single category as to preserve statistical power and limit the use of degrees of freedom in χ2 analyses. Men also indicated how often they lied to others about their penis size (never, rarely, sometimes, often, most or all of the time), and how satisfied they were with their penis (wish it were smaller, I’m satisfied, wish it were bigger),

Sexuality and Sexual Health

Participants indicated if they had experienced a variety of STIs ever in their lives and in the last year (anal/genital warts HPV; anal/genital herpes HSV-2; crabs/scabies/lice; gonorrhea, Chlamydia or other urinary tract infection; Hepatitis B [HBV]; Hepatitis C [HCV]; and syphilis). In addition, men indicated if they had recently (< 90 days) engaged in anal sex without condoms with non-main sex partners, separately for partners of the same HIV status and partners whose status was discordant (or unknown/undisclosed). Response choices were dichotomous (yes/no). Men also indicated the number of non-main HIV seroconcordant and serodiscordant male partners they had sex with in the last 90 days. Finally, men indicated their preferred sexual positioning/role (Top 100%; Mostly top; Versatile 50/50; Mostly bottom; Bottom 100%). This was trichotomized for the purposes of this analysis (Top and Mostly top were coded “top,” Versatile remained “versatile,” and Bottom and Mostly Bottom were coded “bottom”).

Psychosocial well being and adjustment

Psychosocial well being and adjustment were operationalized using three scales. The Prevention/Promotion Scale (Lockwood, Jordan, & Kunda, 2002) was adapted from the original 18-item measure to a 16-item five point Likert type scale (1 = not true at all 5 = very true). The two excluded items were ones pertaining to school. The Prevention/Promotion Scale has two subscales. The 8-items that comprise the prevention aspects of the scale measured the extent individuals were focused on preventing negative events from happening in their lives, α = .75 (e.g., “I am anxious that I will fall short of my responsibilities and obligations,” “I often think about the person I am afraid I might become in the future”). The 8-items that comprise the promotion aspects of the scale measured the extent individuals were focused on positive aspects of their future, α = .84 (e.g., “I frequently imagine how I will achieve my hopes and aspirations,” “In general, I am focused on achieving positive outcomes in my life”).

The Gay-related Stigma Scale (Frost, Parsons, & Nanín, 2007) is a 10-item Likert-type scale (1 = strongly disagree, 4 = strongly agree) assessing stigma and negative consequences resulting from disclosure of one’s sexual identity, α = .90 (e.g., “People who know I’m gay/bi tend to ignore my good points,” “I have lost friends by telling them I’m gay/bi,” “People I care about stopped calling after learning that I’m gay/bi”). Frost et al. adapted the gay-related stigma scale from the HIV stigma scale (Berger, Ferrans, & Lashley, 2001).

Finally, the Gay Life Satisfaction Scale (Bimbi & Parsons, 2004; Bimbi, Parsons, & Nanín, 2005) was derived from an adapted version of the Life Satisfaction Index (Lawrence & Liang, 1988). This measure consisted of eight items, five of which were positively worded (e.g., “In most ways, my life as a gay/bi person is fulfilling”) and three items that were negatively phrased (e.g., “Being gay/bi is a difficult life experience”). Participants were instructed to respond to the items on a 4-point Likert scale (1 = strongly agree, 4 = strongly disagree) and the negatively phrased items were reverse scored, α = .75. See Appendix 1.

Analytic Plan

Where appropriate, chi-square and ANOVA F tests were conducted. To supplement chi- square tests and facilitate interpretation in cases involving two ordinal variables, Goodman- Kruskal Gamma (γ) tests were performed. As a posthoc for ANOVA, Bonferroni tests were used for group comparisons. As cell sizes were too small for traditional chi-square analyses, Fisher’s exact p tests were used to assess group differences in the prevalence of STIs (i.e., infrequently occurring variables).

RESULTS

Perceived Penis Size in Relation to Penis Satisfaction

Table I reports univariate characteristics of the sample. In total, 6.9% (n = 73) of men felt their penis was “below average,” 53.9% (n = 574) felt their penis was “average,” and 35.5% (n = 378) felt their penis was “above average.” Perceived penis size was positively related to penis size satisfaction such that 79.2% (n = 57) of men with below average penises wished their penis were larger, compared to 40.5% (n = 230) of men with average penises, and 14.7% (n = 55) of men with above average penises, χ2(2) = 138, p < .001, γ = .66. In addition, perceived penis size was inversely related to lying about penis size such that 45.2% (n = 33) of men with below average penises had lied to others about their size, compared to 38.6% (n = 219) of men with average penises, and 30.1% (n = 113) of men with above average penises, χ2(2) = 9.99, p < .01, γ = −.19. Further, lying about penis size was inversely related with size satisfaction, such that 48.2% (n = 164) of men who wished their penis was bigger had lied to others about its size, compared to 28.8% (n =193) of men who did not wish their penis was bigger but had lied to others about its size, χ2(1) = 37.3, p < .001, γ = −.39.

Perceived Penis Size in Relation to Condom Use, HIV, and STIs

Table II reports bivariate associations between perceived penis size and sexually transmitted infections. Perceived penis size was not related to recent condom use (< 90 days) neither with HIV seroconcordant nor HIV serodiscordant (or unknown status) partners. In addition, perceived penis size was not significantly related to men’s frequency of sex partners (HIV seroconcordant or serodiscordant), their HIV status, or diagnoses (recent or lifetime) of hepatitis B, hepatitis C, syphilis, or crabs/scabies/lice. It was, however, related to recent infections/outbreaks of viral skin-to-skin STIs, anal/genital warts (HPV), and anal/genital herpes (HSV-2). Men with above average penises were significantly more likely than men with average and below average penises to report recent genital warts (HPV). In addition, men with above average penises were significantly more likely than men with average sized penises to report genital herpes (HSV-2), Fisher’s exact ps ≤ .05. Finally, men with above average penises were significantly more likely than men with average size penises to report having ever been infected with gonorrhea/Chlamydia/urinary tract infection, Fisher’s exact p < .001.

Table II.

Perceived penis size and sexually transmitted infections*

Perceived penis size
 Fisher’s exact p Difference
Below average (A) Average (B) Above average (C)
n % n % n %
Anal/genital warts (HPV)
 Ever, n = 157 10 14.1 82 14.8 65 17.9 ns --
 Last year, n = 38 1 10.0 15 20.3 22 36.1 < .05 C > A, B
Anal/genital herpes (HSV-2)
 Ever, n = 61 5 7.0 37 6.7 19 5.3 ns --
 Last year, n = 20 2 40.0 8 25.0 10 62.5 < .05 C > B
Crabs, scabies, lice
 Ever, n = 374 23 31.9 201 36.0 150 40.9 ns --
 Last year, n = 43 0 0.0 24 12.8 19 13.6 ns --
Gonorrhea/Chlamydia/UTI
 Ever, n = 208 13 18.1 100 17.9 95 26.2 < .001 C > B
 Last year, n = 36 0 0.0 16 17.2 20 22.5 ns --
Hepatitis B
 Ever, n = 72 7 9.9 38 6.8 27 7.5 ns --
 Last year, n = 9 0 0.0 6 17.1 3 12.0 ns --
Hepatitis C
 Ever, n = 32 2 2.8 20 3.6 10 2.8 ns --
 Last year, n = 13 0 0.0 8 28.6 5 17.9 ns --
Syphilis
 Ever, n = 92 6 8.2 45 8.1 41 11.3 ns --
Last year, n = 17 0 0.0 7 17.5 10 27.0 ns --
Open in a new tab
*

Percents reported for infections in the last year are nested among those having ever experienced that STI

Perceived Penis Size and Sexual Positioning

Table III reports the bivariate association between perceived penis size and men’s sexual positioning. Perceived penis size was significantly related to sexual positioning. Men with below average penises were more likely to identify as a “bottom” (anal receptive), men with average penises were more likely to identify as “versatile” (receptive or insertive), and men with above average penises were more likely to identify as a “top” (insertive), χ2(4) = 19.7, p < .001, γ = −.20.

Table III.

Perceived penis size and sexual positioning

Perceived penis size
Below average Average Above average
n % n % n %
Top (anal insertive) 21 29.2 174 30.7 155 41.6
Versatile (anal insertive and receptive) 23 31.9 229 40.5 141 37.8
Bottom (anal receptive) 28 38.9 163 28.8 77 20.6
Total 72 100 566 100 373 100
Open in a new tab

χ2(4) = 19.7, p < .001, γ = −.20

Perceived Penis Size and Psychosocial Outcomes

Table IV reports on the bivariate association between perceived penis size and measures of socio-psychological well being. On all three psychosocial outcomes (the Prevention/Promotion Scales, the Gay-related Stigma Scale, and the Gay Life Satisfaction Scale), men with below average penises fared significantly poorer than other men. Men with below average penises were significantly lower than men with average and above average penises on gay life satisfaction (F(2, 1022) = 9.53, p < .001). Men with below average penises were significantly lower than men with above average penises on life promotion (promoting good things in one’s life; F(2, 1022) = 4.57, p < .01). In addition, men with below average penises were higher than men with average penises on gay-related stigma (F(2, 1022) = 3.19, p < .05), and higher than men with average and above average penises on life prevention (i.e., focused on preventing negative outcomes; F(2, 1022) = 3.85, p < .05).

Table IV.

Perceived penis size and socio-psychological well being.

Scale properties, full sample, N = 1065 Perceived penis size
 F (2, 1022) Bonferroni post hoc
Below average (A) Average (B) Above average (C)
M SD Range M SD M SD M SD
Prevention scale 25.1 5.88 9 to 40 27.0 5.84 25.0 5.99 25.0 5.69 3.85* A > B, C
Promotion scale 31.3 5.82 9 to 40 29.9 5.85 31.2 5.84 31.9 5.50 4.57** A < C
Gay-related stigma scale 18.3 6.97 10 to 40 20.1 7.88 18.0 6.89 18.2 6.68 3.19* A > B
Gay life satisfaction scale 23.0 4.62 8 to 32 20.8 4.68 23.1 4.68 23.4 4.47 9.53*** A < B, C
Open in a new tab
*

p < .05,

**

p < .01,

***

p < .001

DISCUSSION

Historically, the size of one’s penis has been equated as symbol of power, masculinity, social status, fertility, and stamina (Bogaert & Hershberger, 1999; Bordo, 1999; Connell, 1987, 1995; Drummond & Filiault, 2007; Lehman, 1998; Paley, 2000; Pope et al., 2000). To date, the penis’ connection to masculinity and virility is continually perpetuated throughout popular media (Drummond & Filiault, 2007; Lehman, 1998); thus, it is not surprising researchers have found many men are unsatisfied or feel shame about their penis size (Dotson, 1999; Lever et al., 2006; Mondaini et al., 2002; Pope et al., 2000). To that end, a growing body of research has intimated a link between penis size and social-sexual health outcomes (Reece et al., 2007; 2008), though there has been surprisingly little research with MSM (Drummond & Filiault, 2007).

This analysis explored four research questions, each assessing the connection between perceived penis size and sociosexual health outcomes. Though most of the men indicated their penis sizes were average, many (44%) fell outside this “norm,” either indicating a below average or above average perceived penis size. Further, perceived penis size was inversely related to penis satisfaction and positively related to lying to others about the size of one’s own penis. These data provide further evidence of the real socially-scripted cultural pressures MSM may feel about their penis size. Comparing these results with a sample of heterosexual men from the Body Image Survey (Lever et al., 2006), fewer men in our sample classified their penises as below average (6.9% versus 12% from the Body Image Survey) or average (53.9% versus 66% from the Body Image Survey). Meanwhile, a larger portion of men from the Sex and Love Study classified their penises as above average (35.5% versus 22% from the Body Image Survey). This is not to suggest MSM may actually have larger penises than other men, but rather this may be an indication that MSM, because of the intimate nature of exposure they have had with other men’s penises via sexual encounters, have a more accurate assessment of how their penis may contrast with other men, and thus more positive feelings about its size. Nevertheless, it is not surprising that far more men rated their penis size as above average compared to below average (both in our data and in the Body Image Survey). Researchers who investigated similar effects about body image (Frederick et al., 2007) have attributed such a bias to positive illusions (Taylor & Brown, 1988). In contrast, this might be an indication that, as a result of increased focus on the body within mainstream gay cultures (Drummond & Filiault, 2007), MSM may feel pressured to inflate their estimates, thus resulting in additional self-reporting of above average penis sizes. In total, these data highlight the need for a comprehensive assessment of the association between perceived penis size and satisfaction in a diverse sample of men that includes MSM and heterosexuals.

In terms of sexual health outcomes, findings were mixed. Perceived penis size was not related to frequency of partners, HIV status, or condom use (i.e., HIV risk-associated behavior). In recent years, condom manufactures have made concerted efforts to advertise a wider range of condom sizes (ranging from “Magnum” to “Snug” fits) (Herbenick & Reece, 2006). This wider range of available sizes may be impacting condom use such that men who fall above or below the average condom size are more easily able to find condoms they believe will fit them. This may be particularly salient for our sample of men from New York City, where there exists a vast range of retail stores that sell a wide variety of condoms and are open around the clock. Future research might consider such an analysis among rural populations where access there may be reduced access to such a wide range of available condom sizes.

Nevertheless, this does not speak to the issue of condom slippage and breakage. Though our data did not capture experiences of condom slippage and breakage, other researchers have suggested this may play a significant role in the transmission of STIs, particularly for men with above or below average penis sizes (Herbenick & Reece, 2006; Reece et al., 2007; 2008). In the present analysis, men with above average penises reported significantly higher incidence of viral skin-to-skin STIs, specifically HSV-2 and HPV. In essence, although when compared with other men, men with above average penises reported similar rates of condom use, and statistically similar numbers of sex partners, improper condom fit (i.e., not being able to roll the condom all the way down), breakage, or irritation (caused by wearing a condom that may be too tight) may be exposing some men to skin-to-skin STIs. This is striking given that reported rates of condom use were consistent regardless of men’s reported penis size. Further, it is unsurprising that penis size was unrelated to non-skin-to-skin viral STIs, such as hepatitis B, hepatitis C, or HIV (which are spread through fluid exchange), or pubic lice/scabies (which can be spread on bedding or contact with pubic hair). Nevertheless, these postulations may not adequately explain the increased incidence of some bacterial STIs (gonorrhea/Chlamydia/urinary tract infections) among men with above average penises, and the non-significant association between syphilis (also a bacterial STI) and perceived penis size. In all, these data support previous research having associated penis size with STI transmission; however, more research is needed before definitive conclusions can be drawn.

Perceived penis size also played a role in sexual positioning, whereby men with smaller penises were more likely to identify as bottoms and men with above average penises were more likely to identify as tops. The direction of this relationship further supports notions of the ingrained social value of having a large penis and the presumed masculine penetrative role these men are socially–and sexually–scripted to enact (Drummond & Filiault, 2007). These data beg the question, “To what extent are men with below average penises being socially-sexually-scripted into anal receptive roles?” Does their having a “smaller” penis devalue these men’s sexual potential, socially-coercing them into sexual roles they may not have otherwise assumed? Though our data cannot answer these questions, it is striking that men with below average penises fared significantly worse on three measures of psychosocial adjustment. Certainly, a variety of factors may also be playing a role in these associations (Connell, 1987, 1995), but the strength and consistent direction of the relationships indicate a need to better understand the individual-level consequences of living in a penis-centered “size matters” society (see also Messner, 1997).

As a word of caution, several limitations should be addressed. Clearly, these data do not generalize to all MSM, as this sample was limited to those who attended large-scale GLB events in New York City. Furthermore, as these analyses drew from cross-sectional data, causality between variables should not be inferred, nor do these analyses rule out the potential for confounding effects from other variables not assessed. This sample does, however, give a very comprehensive picture about the types of individuals that attend large scale GLB events, and comprise a considerable (and accessible) portion of the gay, bisexual, and MSM communities in New York City. Although efforts were taken to ensure confidentiality, there was potential for biased responses due to social desirability in the reporting of sensitive information. As with all social research, these factors must be considered when evaluating the findings.

The survey instrument used for this analysis assessed a broad range of variables related to social-psychological and sexual health. Such an instrument helps provide a general perspective about a variety of characteristics; however, it has its limitations. Consistent with the brief street-intercept survey method (Miller et al., 1997), many of the questions on this survey were quantitative and close-ended. Additional qualitative research is necessary to better capture the full range of experiences. Although a wide range of STIs were assessed in this analysis, gonorrhea, Chlamydia, and urinary tract infections were captured using a single indicator. Our analysis found men with above average penises were more likely to report having been diagnosed with gonorrhea/Chlamydia/urinary tract infections, yet we are unable to disentangle which of the three, if any, might have been more common. Finally, in an effort to increase response rates for questions on penis size, men were not asked to report a numeric measurement (i.e., in inches), but rather select from a nuanced range of values (i.e., average, above average, etc.). Our use of a non-metric scale to capture penis size reduces some precision; however, a numeric measure (i.e., inches) is still subject to self-report biases, as not all men have actually measured their penis, and those who have may not use identical levels of precision.

Though it may not be a topic well explored in academic literature, perceptions of one’s penis size were clearly and consistently associated with a variety of psychosocial and sexual health outcomes among the men sampled for this analysis. These data highlight the need to provide comprehensive sexual health education that is inclusive of the varying physical and psychosocial needs that men with differing sized penises may require. If indeed MSM with above average penises are more likely to assume the anal insertive role, then it is important for them to wear sized-to-fit condoms and use sufficient amounts of lubricant as not to injure their partners nor increase their risk of HIV or STI transmission. Thus, it is essential to improve access to (and education about) sized-to-fit condoms. In contrast, if MSM who perceive themselves to have below average penises are more likely to assume the anal receptive role and to fare significantly worse on psychosocial measures, then it is essential to develop health education programs that dualistically address the HIV, STI, and other health risks that accompany anal receptive sex (e.g., encouraging routine checks for anal STIs), and that also focus on improving psychosocial well being. Finally, these data highlight the need to challenge the culturally ingrained notion that “bigger is better,” as the social consequences of these messages may have lasting negative psychosocial and sexual health effects on the individuals receiving them.

Acknowledgments

Christian Grov was supported in part as a postdoctoral fellow in the Behavioral Sciences training in Drug Abuse Research program sponsored by Public Health Solutions and the National Development and Research Institutes, Inc. (NDRI) with funding from the National Institute on Drug Abuse (T32 DA07233). The Sex and Love v5.0 Project was supported by the Hunter College Center for HIV/AIDS Educational Studies and Training (CHEST), under the direction of Jeffrey T. Parsons. The authors acknowledge the contributions of other members of the Sex and Love v5.0 Research Team: Michael R. Adams, Virginia Andersen, Anthony Bamonte, Jessica Colon, Armando Fuentes, Catherine Holder, James P. Kelleher, Brian C. Kelly, Juline Koken, Jose E. Nanin, Brooke E. Wells, Jaye Walker, and the DIVAS (Drag Initiative to Vanquish AIDS). An earlier version of this paper was presented at the 2008 meeting of the Society for the Scientific Study of Sexuality Mid-Continent and Eastern Region Joint Conference.

Appendix 1. The Gay Life Satisfaction Scale, α = .75

Coded: 1 Strongly Disagree

2 Disagree

3 Agree

4 Strongly Agree

About being gay/bisexual …
  In most ways, my life as a gay/bi person is fulfilling
  I think as a gay/bi person I worry about being alone in the future (Reverse coded)
 The conditions of my life as a gay/bi person are just as good as any one else’s
  Being gay/bi is a difficult life experience (Reverse coded)
  I will be able to get all the important things I want in my life as a gay/bi person
  My life as a gay/bi person could be happier (Reverse coded)
  I am satisfied with my life as a gay/bi person
Open in a new tab

References

  1. Benotsch EG, Kalichman SC, Cage M. Men who have met sex partners via the Internet: Prevalence, predictors, and implications for HIV prevention. Archives of Sexual Behavior. 2002;31:177–183. doi: 10.1023/a:1014739203657. [DOI] [PubMed] [Google Scholar]
  2. Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV Stigma scale. Research in Nursing and Health. 2001;24:518–529. doi: 10.1002/nur.10011. [DOI] [PubMed] [Google Scholar]
  3. Bergling T. Chasing Adonis: Gay men and the pursuit of perfection. New York: Harrington Park Press; 2007. [Google Scholar]
  4. Bimbi DS, Parsons JT. The impact of intolerance: Stigma, satisfaction with gay life and generativity among gay men and lesbians. Paper presented at the Society for the Scientific Study of Sexuality.2004. [Google Scholar]
  5. Bimbi DS, Parsons JT, Nanín JE. Stigma, life satisfaction, generativity and attachment to the gay community. Paper presented at the American Psychological Association.2005. [Google Scholar]
  6. Bogaert AF, Hershberger S. The relation between sexual orientation and penile size. Archives of Sex Behavior. 1999;28:213–221. doi: 10.1023/a:1018780108597. [DOI] [PubMed] [Google Scholar]
  7. Bordo S. The male body: A new look at men in public and private. New York: Farrar, Straus & Giroux; 1999. [Google Scholar]
  8. Carey MP, Braaten LS, Jaworski BC, Durant LE, Forsyth AD. HIV and AIDS relative to other health, social, and relationship concerns among low-income women: A brief report. Journal of Women’s Health and Gender Based Medicine. 1999;8:657–661. doi: 10.1089/jwh.1.1999.8.657. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Chen JL, Kodagoda D, Lawrence AM, Kerndt PR. Rapid public health interventions in response to an outbreak of syphilis in Los Angeles. Sexually Transmitted Diseases. 2002;29:285–287. doi: 10.1097/00007435-200205000-00005. [DOI] [PubMed] [Google Scholar]
  10. Connell RW. Gender and Power: Society, the Person, and Sexual Politics. Palo Alto: Stanford University Press; 1987. [Google Scholar]
  11. Connell RW. Masculinities. Berkeley: University of California Press; 1995. [Google Scholar]
  12. Crosby RA, DiClemente RJ, Yarber WL, Snow G, Troutman A. An event-specific analysis of condom breakage among African American men at risk of HIV acquisition. Sexually Transmitted Diseases. 2008;35:174–177. doi: 10.1097/OLQ.0b013e3181585bf5. [DOI] [PubMed] [Google Scholar]
  13. Crosby RA, Salazar LF, Yarber WL, Sanders SA, Graham CA, Head S, et al. A Theory-Based approach to understanding condom errors and problems reported by men attending an STI clinic. AIDS and Behavior. 2008;12:412–418. doi: 10.1007/s10461-007-9264-1. [DOI] [PubMed] [Google Scholar]
  14. Crosby RA, Yarber WL, Sanders SA, Graham CA. Condom discomfort and associated problems with their use among university students. Journal of American College Health. 2005;54:143–147. doi: 10.3200/JACH.54.3.143-148. [DOI] [PubMed] [Google Scholar]
  15. Crosby RA, Yarber WL, Sanders SA, Graham CA, McBride K, Milhausen RR, et al. Men with broken condoms: Who and why? Sexually Transmitted Infections. 2007;83:71–75. doi: 10.1136/sti.2006.021154. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Davis KR, Weller SC. The effectiveness of condoms in reducing heterosexual transmission of HIV. Family Planning Perspectives. 1999;31:272–279. [PubMed] [Google Scholar]
  17. De Graaf R, Vanwesenbeeck I, Van Zessen G, Straver CJ, Visser JH. Alcohol and drug use in heterosexual and homosexual prostitution, and its relation to protection behaviour. AIDS Care. 1995;7:35–47. doi: 10.1080/09540129550126948. [DOI] [PubMed] [Google Scholar]
  18. Dotson EW. Behold the man: The hype and selling of male beauty in media and culture. Albany, NY: Harrington Park Press; 1999. [Google Scholar]
  19. Drummond MJN, Filiault SM. The long and short of it: Gay men’s preceptions of penis size. Gay and Lesbian Issues and Psychology Review. 2007;3:121–129. [Google Scholar]
  20. Frederick DA, Buchanan GM, Sadehgi-Azar L, Peplau LA, Haselton MG, Berezovskaya A. Desiring the muscular ideal: Men’s body satisfaction in the United States, Ukraine, and Ghana. Psychology of Men & Masculinity. 2007;8:103–117. [Google Scholar]
  21. Frost DM, Parsons JT, Nanín JE. Stigma, concealment and symptoms of depression as explanations for sexually transmitted infections among gay men. Journal of Health Psychology. 2007;12:636–640. doi: 10.1177/1359105307078170. [DOI] [PubMed] [Google Scholar]
  22. Garside R. Shape: A neglected factor influencing use and acceptability. International Journal of STD and AIDS. 2004;10:785–790. doi: 10.1258/0956462991913556. [DOI] [PubMed] [Google Scholar]
  23. Grady WR, Klepinger DH, Billy JO, Tanfer K. Condom characteristics: The perceptions and preferences of men in the United States. Family Planning Perspectives. 1993;25:67–73. [PubMed] [Google Scholar]
  24. Grady WR, Klepinger DH, Nelson-Wally A. Contraceptive characteristics: The perceptions and priorities of men and women. Family Planning Perspectives. 1999;31:168–175. [PubMed] [Google Scholar]
  25. Grov C, Debusk J, Bimbi DS, Golub SA, Nanín JE, Parsons JT. Barebacking, the Internet and harm reduction: An Intercept survey with gay and bisexual men in Los Angeles and New York City. AIDS and Behavior. 2007;11:527–536. doi: 10.1007/s10461-007-9234-7. [DOI] [PubMed] [Google Scholar]
  26. Halkitis PN, Parsons JT. Recreational drug use and HIV-risk sexual behavior among men frequenting gay social venues. Journal of Gay & Lesbian Social Services. 2002;14:19–38. [Google Scholar]
  27. Hall HI, Byers RH, Ling Q, Espinoza L. Racial/ethnic and age disparities in HIV prevalence and disease progression among men who have sex with men in the United States. American Journal of Public Health. 2007;97:1060–1066. doi: 10.2105/AJPH.2006.087551. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Herbenick D, Reece M. Penis length and circumference as contributors to condom breakage, slippage, and perceived discomfort. European Journal of Sexual Health. 2006;15:35. [Google Scholar]
  29. Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bulletin of the World Health Organization. 2004;82:454–461. [PMC free article] [PubMed] [Google Scholar]
  30. Jadack RA, Fresia A, Rompalo AM, Zenilman J. Reasons for not using condoms of clients at urban sexually transmitted diseases clinics. Sexually Transmitted Diseases. 1997;24:402–408. doi: 10.1097/00007435-199708000-00004. [DOI] [PubMed] [Google Scholar]
  31. Kalichman SC, Benotsch E, Rompa D, Gore-Felton C, Austin J, Luke W, et al. Unwanted sexual experiences and sexual risks in gay and bisexual men: Associations among revictimization, substance use and psychiatric symptoms. Journal of Sex Research. 2001;28:1–9. [Google Scholar]
  32. Kalichman SC, Simbaya L. Traditional beliefs about the cause of AIDS and AIDS-related stigma in South Africa. AIDS Care. 2004;16:572–580. doi: 10.1080/09540120410001716360. [DOI] [PubMed] [Google Scholar]
  33. Lawrence RH, Liang J. Structural integration of the Affect Balance Scale and the Life Satisfaction Index A: Race, sex, and age differences. Psychology and Aging. 1988;3:375–384. doi: 10.1037//0882-7974.3.4.375. [DOI] [PubMed] [Google Scholar]
  34. Lehman P. In an imperfect world, men with small penises are unforgiven. Men and Masculinities. 1998;1:123–137. [Google Scholar]
  35. Leigh BC, Ames SL, Stacy AW. Alcohol, drugs, and condom use among drug offenders: an event-based analysis. Drug and Alcohol Dependence. 2008;93:38–42. doi: 10.1016/j.drugalcdep.2007.08.012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Leigh BC, Morrison DM, Hoppe MJ, Beadnell B, Gillmore MR. Retrospective assessment of the association between drinking and condom use. Journal of Studies on Alcohol and Drugs. 2008;69:773–776. doi: 10.15288/jsad.2008.69.773. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Lever J, Frederick DA, Peplau LA. Does size matter? Men’s and women’s views on penis size across the lifespan. Psychology of Men and Masculinity. 2006;7:129–143. [Google Scholar]
  38. Lockwood P, Jordan CH, Kunda Z. Motivation by positive or negative role models: Regulatory focus determines who will best inspire us. Journal of Personality and Social Psychology. 2002;83:854–864. [PubMed] [Google Scholar]
  39. Malebranche D. Black men who have sex with men and the HIV epidemic: Next steps for public health. American Journal of Public Health. 2003;93:862–865. doi: 10.2105/ajph.93.6.862. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Messner M. Politics of Masculinities: Men in Movements. Thousand Oaks, CA: Sage Publications, Inc; 1997. [Google Scholar]
  41. Miller KW, Wilder LB, Stillman FA, Becker DM. The feasibility of a street-intercept survey method in an African-American community. American Journal of Public Health. 1997;87:655–658. doi: 10.2105/ajph.87.4.655. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Mondaini N, Ponchietti R, Gontero P, Muir GH, Natali A, Caldarera E, et al. Penile length is normal in most men seeking penile lengthening procedures. International Journal of Impotency Research. 2002;14:283–286. doi: 10.1038/sj.ijir.3900887. [DOI] [PubMed] [Google Scholar]
  43. Munoz-Silva A, Sanchez-Garcia M, Nunes C, Martins A. Gender differences in condom use prediction with Theory of Reasoned Action and Planned Behaviour: The role of self-efficacy and control. AIDS Care. 2007;19:1177–1181. doi: 10.1080/09540120701402772. [DOI] [PubMed] [Google Scholar]
  44. Osmond DH, Pollack LM, Paul JP, Catania JA. Changes in prevalence of HIV infection and sexual risk behavior in men who have sex with men in San Francisco: 1997–2002. American Journal of Public Health. 2007;97:1677–1683. doi: 10.2105/AJPH.2005.062851. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Palefsky J. Human papillomavirus infection in HIV-infected persons. Topics in HIV Medicine. 2007;15:130–133. [PubMed] [Google Scholar]
  46. Paley M. The book of the penis. New York, NY: Grove/Atlantic, Inc; 2000. [Google Scholar]
  47. Parsons JT, Schrimshaw EW, Bimbi DS, Wolitski RJ, Gomez CA, Halkitis PN. Consistent, inconsistent, and non-disclosure to casual sexual partners among HIV-seropositive gay and bisexual men. AIDS. 2005;19(Suppl 1):S87–S97. doi: 10.1097/01.aids.0000167355.87041.63. [DOI] [PubMed] [Google Scholar]
  48. Ponchietti R, Mondaini N, Bonafe M, DiLoro F, Biscioni S, Masieri L. Penile length and circumference: A study on 3,300 young Italian males. European Urology. 2001;39:183–186. doi: 10.1159/000052434. [DOI] [PubMed] [Google Scholar]
  49. Pope HG, Phillips KA, Olivardia R. The Adonis complex: The secret crisis of male body obsession. New York, NY: Free Press; 2000. [Google Scholar]
  50. Reece M, Dodge B, Herbenick D, Fisher C, Alexander A, Satinsky S. Experiences of condom fit and feel among African-American men who have sex with men. Sexually Transmitted Infections. 2007;83:454–457. doi: 10.1136/sti.2007.026484. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Reece M, Herbenick D, Monahan PO, Sanders SA, Temkit M, Yarber WL. Breakage, slippage, and acceptability outcomes of a condom fitted to penile dimensions. Sexually Transmitted Infections. 2008;84:143–149. doi: 10.1136/sti.2007.028316. [DOI] [PubMed] [Google Scholar]
  52. Richters J, Donovan B, Gerofi J. How often do condoms break or slip off in use? International Journal of STD and AIDS. 1993;4:90–94. doi: 10.1177/095646249300400206. [DOI] [PubMed] [Google Scholar]
  53. Richters J, Gerofi J, Donovan B. Why do condoms break or slip off in use? An exploratory study. International Journal of STD and AIDS. 1995;6:11–18. doi: 10.1177/095646249500600104. [DOI] [PubMed] [Google Scholar]
  54. Rosenberg MJ, Waugh MS. Latex condom breakage and slippage in a controlled clinical trial. Contraception. 1997;56:17–21. doi: 10.1016/s0010-7824(97)00069-3. [DOI] [PubMed] [Google Scholar]
  55. Rotheram-Borus MJ, Lee M, Zhou S, O’Hara P, Birnbaum JM, Swendeman D, et al. Variation in health and risk behavior among youth living with HIV. AIDS Education and Prevention. 2001;13:42–54. doi: 10.1521/aeap.13.1.42.18923. [DOI] [PubMed] [Google Scholar]
  56. Samuel M, Lo T, Klausner J, Kerndt P, Coulter S, Gould G, et al. Epidemic syphilis among gay and other men who have sex with men in California--lessons for HIV prevention. Paper presented at the 2003 National HIV Prevention Conference; Atlanta, Georgia. 2003. [Google Scholar]
  57. Schwarcz S, Scheer S, McFarland W, Katz M, Valleroy L, Chen S, et al. Prevalence of HIV infection and predictors of high-transmission sexual risk behaviors among men who have sex with men. American Journal of Public Health. 2007;97:1067–1075. doi: 10.2105/AJPH.2005.072249. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Spyropoulos E, Borousas D, Mavrikos S, Dellis A, Bourounis M, Athanasiadis S. Size of external genital organs and somatometric parameters among physically normal men younger than 40 years old. Urology. 2002;60:485–489. doi: 10.1016/s0090-4295(02)01869-1. [DOI] [PubMed] [Google Scholar]
  59. Steiner MJ, Cates W. Condoms and sexually-transmitted infections. New England Journal of Medicine. 2006;354:2642–2643. doi: 10.1056/NEJMp068111. [DOI] [PubMed] [Google Scholar]
  60. Steiner MJ, Cates W. Are condoms the answer to rising rates of non-HIV sexually transmitted infections? Yes. BMJ. 2008;336:184. doi: 10.1136/bmj.39402.488727.AD. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Steiner MJ, Cates W, Warner L. The real problem with male condoms is nonuse. Sexually Transmitted Diseases. 1999;26:459–462. doi: 10.1097/00007435-199909000-00007. [DOI] [PubMed] [Google Scholar]
  62. Stulhofer A. How (un)important is penis size for women with heterosexual experience? Archives of Sexual Behavior. 2006;35:5–6. doi: 10.1007/s10508-006-8989-7. [DOI] [PubMed] [Google Scholar]
  63. Taylor SE, Brown JD. Illusion and well-being: A social psychological perspective on mental health. Psychological Bulletin. 1988;103:193–210. [PubMed] [Google Scholar]
  64. World Association for Sexual Health. Sexual Health for the Millennium. A Declaration and Technical Document. Minneapolis, MN. USA: 2008. [Google Scholar]

RESOURCES