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Adjusting penis length and the potential impact on female sexual satisfaction
BJU International  (IF5.588),  Pub Date : 2021-08-30, DOI: 10.1111/bju.15502
Kevan R. Wylie

The study by Veale et al. [1] whether artificially reducing the depth of penetration of a penis during intercourse can impact female sexual satisfaction. The researchers used different sizes of silicone rings as a proxy for reducing penis length and report that reducing the depth of penetration led to a statistically significant 18% reduction of overall sexual pleasure following an average 15% reduction in length of the penis. They report that the longer the erect penis the less likely the rings were to have an impact on sexual pleasure.

The possible sites of activation during coitus have traditionally been limited to the clitoris and vagina. Recently, several erotogenic genito-pelvic sites with the possible stimuli that generate neural afferent sexual arousal inputs to the brain during foreplay, masturbation or coitus have been reviewed by Levin [2]. The influence of stimulation from various structures is likely to be multimodal, with different sensitivities of both peripheral and central neural structures impacting on the creation of orgasm for any woman.

Turning from the body part or object (such as a sex toy) that stimulates or penetrates the vagina, a recent publication has documented the specific vaginal stimulation and penetration techniques that women themselves report employing for sexual pleasure. Using nationally representative probability data from the second OMGYES pleasure report allowed the identification of four previously unnamed but distinct techniques that women use to make vaginal penetration more pleasurable: angling (87.5%), rocking (76.4%), shallowing (83.8%) and pairing (69.7%) [3]. The first of these, angling, is important because the angle or position of the hips of the woman can make a big difference to where the toy or penis rubs and what it feels like. The second, rocking, can be helpful with constant rubbing of the clitoris by the base of the partner's penis or by a sex toy during penetration and by the penis staying all the way inside the vagina rather than thrusting in and out. The third, shallowing, includes being touched just inside of the entrance of the vagina with the tip of the penis. Pairing includes forms of clitoral touch in combination with vaginal penetration to allow orgasm more often or to have more pleasurable sex than using penetration alone.

The report in the study by Veale et al. [1] that a minority of women found a reduction in the depth of penetration was more pleasurable is in keeping with the findings reported by Hensel et al. [3].

Focusing attention on the vagina, this is an elastic muscular tube of between 7 and 10 cm in length that will lengthen further with penetration by the penis or other object. The typical erect penis is between 14 and 16 cm in length [4]. Several factors can impact on total vaginal length including hysterectomy and pelvic reconstructive surgery, contributing to a shortening of 0.63 cm and 0.22 cm, respectively. Increasing age and menopause can shorten vaginal length by a lesser amount [5].

Likewise, the impact of concomitant disease on penile dimensions should be noted [6]. For men with a penis of shorter length and dimensions then those of a culturally similar population, the impact on sexual confidence and psychological wellbeing can be considerable. This may be primary or following penile shortening observed with Peyronie's disease, postpriapism and following certain types of prostate surgery. Some men have body dysmorphophobia and normal penile dimensions and this demands additional assessment. The authors statement that their results should not be misinterpreted as meaning that increasing penile length will increase sexual pleasure should be noted and respected. Counselling should advise against the inappropriate use of penile elongation surgery as the basis of increasing penile length to ensure improved sexual pleasure in the partner.

Regardless of aetiology, many men fear that they will be unable to penetrate their partner deeply enough to bring about sexual pleasure. Subsequent emotional distress (and sexual dysfunction including erectile dysfunction and rapid ejaculation) may be experienced by the man with significant impact on his partner. Any reduction in sexual pleasure in the partner that is experienced (or anticipated) because of the shorter penile length may accentuate sexual difficulties for the couple. For this reason, it is important that accurate information is readily available to men and their partners about normal penile (and vaginal) dimensions [4] as well as the multimodal impact of bringing about sexual pleasure for both partners.

Awareness of potential problems following penile or vaginal surgery for the partner and the opportunity to provide proactive education and advice regarding enhanced foreplay, adjunctive pleasure-enhancing techniques and the use of devices can all have a beneficial impact on sexual wellbeing and pleasure. The impact of penile shortening on sexual pleasure reported by Veale et al. [1] should form part of the informed consent process without raising unduly significant concern. The impact due to disease may be mitigated by the employment of these educational techniques and by provision of psychosexual support in advance of, alongside and after surgical procedures that may impact on penile length.