Penile size affects attitudes towards condom use

Men with shorter or larger penile dimensions (length and circumference) are more likely to have negative attitudes towards condom fit and feel, according to a report published in the online edition of Sexually Transmitted Infections. However, the researchers found that most men do not have problems with condom fit and feel.

Previous studies have shown associations between penile dimensions and condom outcomes. Some studies have demonstrated improved performance when condoms fitted the penile length and circumference well. Some of these findings have led to calls for manufacturers to expand condom sizes and shapes.

The current study, conducted by the Centre for Sexual Health Promotion at Indiania University, therefore sought to add to our current understanding of this issue by exploring relationships between men’s actual penile dimensions and perceptions about condom fit and feel. It sought to clarify whether overall penile dimensions (length and circumference combined) provide more insight beyond the knowledge on the impact of length and circumference independently.

The study was conducted among 1661 participants recruited electronically through advertisements on sex and adult-oriented websites as well as print advertisements in local newspapers and sexual health community-based organisations across seven US states. The sites were selected based on their geographic diversity (representative of the US) and disproportionate prevalence of sexually transmitted infections, including HIV. Participants were aged 18 years and above, had no condom allergy and reported using condoms as contraception or disease prevention at the time of the study.

Data were collected on condom fit and feel through self-reporting by the men, who took the measurements using a paper-based measuring device that ranged from 0 to 23cm for length and 0 to 19cm for circumference.

Participants were broadly grouped into three categories of short, medium and large penile sizes. For the penile length, participants categorised as “shorter” had a mean penis length of 11cm (range 4 to 12cm); “medium” a mean length of 14cm (range 13 to 15cm); and “longer” a mean penile length of 18cm (range 16 to 26cm).

For penile circumference, men in the “smaller” category had a mean measurement of 9cm (range 3 to 11cm); the “medium” group had a mean measurement of 13cm (range 12 to 13cm); and the “larger” group had a mean measurement of 14cm (range 14 to 19cm). The mean age of participants was 29 years.

Considering the variables separately, men in the “longer” group were more likely to describe condoms as too short (p = .005), not rolling down enough and feeling too tight along the penile shaft (p = 0.002) than those in “smaller” or “medium” groups.

On the other hand, men in the “shorter” group reported unrolled condom at the base of the penis.

As regards circumference, men in the “larger” group described condoms as being too short and too tight particularly around the glans (head of the penis) and the penis base. When the two variables were combined, shorter penile lengths with smaller circumferences were predictive indicators of condoms being too loose (p = 0.047) or too long (p = 0.004) whereas longer penile lengths combined with larger circumferences were predictive of condoms being reported as too tight and too short (p = 0.001).

Overall, the majority of men did not complain about condom fit and feel. However, results show that those with complaints about these issues had negative perceptions of condom fit and feel (p = 0.024). Although unrolled latex at the base of the penis was an issue for the “shorter” penile length group, some individuals suggested that the unrolled latex might actually offer protection against condom slippage. The investigators also found out that men were likely to perceive challenges of condom fit and feel as they aged. They attributed this to more experiences with condoms over time and context as well as age-related challenges such as erectile dysfunction, arousal and ease of orgasm.

The investigators note that possible limitations of the study were that it used a convenience sample and relied on self-reporting, making it difficult to validate the accuracy of responses. Furthermore, study participants were active users of condoms and this implies that the study might have missed out on those more resistant to condom use. Furthermore, a lack of established standards of penile measurements means that the results could be different if other categories of penile dimensions had been used.

Apart from validating existing data on men’s complaints about condom feel and fit, these findings provide an insight into the challenges faced in implementing sexually transmitted infection prevention interventions when faced with men who insist that condoms do not fit or feel comfortable.

The investigators conclude that their findings may also help sexual health workers who are initiating discussions with men resistant to condom use about their perceptions regarding condom fit and feel. The authors point out that condoms are now available that are tailored to larger or to smaller penises.

Condomi and Pasante manufacture larger, wider condoms that can be bought online in Europe, and Pasante also manufactures a slightly shorter and tighter than average condom. In the United States Durex and Trojan market large condoms that are widely available both online and through pharmacies (these products are also available online in Europe). Durex and Mates manufacture smaller condoms that are widely available through online retailers.

However the choice of condoms tends to be much more limited when they are supplied free of charge in developing countries, and more work is needed to identify what range of condoms needs to be supplied in different settings in order to increase mens' comfort and satisfaction with using condoms.