A Structured Review and Critical Analysis of Male Perceptions of the Penis: A Comparison between Heterosexual Men and Men Who Have Sex with Men (MSM)

Abstract

Current research into male body image has identified several areas of body dissatisfaction among men, including perceptions associated with the penis. This is the first article to present a structured review, synthesis, and critical analysis of research into male perceptions of the penis, the psychosocial, and sexual correlates and to provide a comparison of outcomes between men who have sex with men (MSM) and heterosexual men. Analysis of twenty-six international studies suggests that men’s accounts of the penis indicate diverse ways of negotiating normative masculinity. Key findings include that most men perceive their penis to be of an average size but would still like a larger one; and differences exist between MSM and heterosexual men in ratings of penis size, emphasis placed upon penis size, and impact of penis size upon sexual behavior. This narrative synthesis has addressed a gap in knowledge concerning how accounts of the penis by men expressing different forms of sexual identification indicate diverse ways of negotiating masculinity.

Full text

Article
A Structured Review and
Critical Analysis of Male
Perceptions of the Penis:
A Comparison between
Heterosexual Men and
Men Who Have Sex with
Men (MSM)
Paul Simpson
1
and Julie Adams
1
Abstract
Current research into male body image has identified several areas of body dis-
satisfaction among men, including perceptions associated with the penis. This is the
first article to present a structured review, synthesis, and critical analysis of research
into male perceptions of the penis, the psychosocial, and sexual correlates and to
provide a comparison of outcomes between men who have sex with men (MSM) and
heterosexual men. Analysis of twenty-six international studies suggests that men’s
accounts of the penis indicate diverse ways of negotiating normative masculinity. Key
findings include that most men perceive their penis to be of an average size but
would still like a larger one; and differences exist between MSM and heterosexual
men in ratings of penis size, emphasis placed upon penis size, and impact of penis size
upon sexual behavior. This narrative synthesis has addressed a gap in knowledge
concerning how accounts of the penis by men expressing different forms of sexual
identification indicate diverse ways of negotiating masculinity.
1
Faculty of Applied Health and Social Care, Edge Hill University, Ormskirk, Lancashire, United Kingdom
Corresponding Author:
Julie Adams-Guppy, Faculty of Applied Health and Social Care, Edge Hill University, St. Helen’s Road,
Ormskirk, Lancashire L39 4QP, United Kingdom.
Email: guppy.j@st-annes.oxon.org
Men and Masculinities
1-36
ªThe Author(s) 2017
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/1097184X17715054
journals.sagepub.com/home/jmm

Keywords
masculinities, penis, penis size, body image, MSM, psychosocial, genital image
The penis and penis size have been understood differently across times and cul-
tures (Friedman 2008). For example, smaller penises have been favored in some
ancient Greek and Roman contexts (see Kimmel, Milrod, and Kennedy 2014). In
contrast, larger penises, in more recent times, have been understood (and with
racial overtones) as animalistic, being made to stand for closeness to brute nature
as opposed to (human) culture (Dines 2007), thus signaling loss of status if not
infrahumanity (Hall 1997).
However, contemporary research into male body image has identified several
areas of body dissatisfaction among men (Mellor et al. 2010; Janlowski, Diedrichs,
and Halliwelle 2014; Murray and Lewis 2014), where penis size, appearance (Lever,
Frederick, and Peplau 2006; Tiggemann, Martins, and Churchett 2008; Grov, Par-
sons, and Bimbi 2010), and overall genital appearance (Liossi 2003; Janlowski,
Diedrichs, and Halliwelle 2014) feature prominently. Body dissatisfaction usually
manifests in distorted body size estimation, a discrepancy between ideal versus
perceived reality, and negative feelings about the body (Ogden 2012). Concerns
about penis size compared to other males are associated with adverse psychosocial
and sexual outcomes (Tiggemann, Martins, and Churchett 2008; Herbenick et al.
2013; Veale et al. 2014). The penis is prized in virtually every culture as it is
symbolic of power (Wylie 2008), but it can also be a source of anxiety if one is
considered underendowed (Vardi and Lowenstein 2005). Indeed, Wylie and Eardley
have observed a link between dis/satisfaction with the body and penis size that
represents a form of body dysmorphia among men with sizes within the normal
range. Also, evidence suggests that men who have sex with men (MSM) may be
more vulnerable than heterosexual men to body dissatisfaction (Morrison et al. 2004;
Strong, Singh, and Randall 2000; Tiggemann et al. 2008) and that this may arise
from the increased importance of appearance ideals within gay subcultures (Gettle-
man and Thompson 1993; Janlowski, Diedrichs, and Halliwelle 2014; Siever 1994),
but evidence suggesting the reverse is also discussed in what follows. It is though
worth noting that MSM who engage usually in receptive anal sex (whether self-
identified transmen and/or “bottoms”) might downplay/disregard the significance of
penis size for themselves (Grov, Parsons, and Bimbi 2010) but not necessarily
apropos any sexual partners (Drummond and Filiault 2007).
This structured narrative review of twenty-six studies across various nations/
continents (American Europe, Asia, and Australasia) argues that men’s accounts
of the penis represent diverse ways of negotiating normative masculinity, though we
note transmen’s appropriation of the penis/phallus in ways that challenge this form
of masculinity.
1
While there is some convergence between the accounts of hetero-
sexual men and MSM concerning penis size and overall body image, some key
distinctions indicate the persistence of a heteronormative masculinity understood
2Men and Masculinities XX(X)

as more traditional, which can weigh heavy on heterosexual men and affect their
sexual and overall self-esteem as much as MSM. Research into male perceptions of
the penis has not been evaluated systematically, and such a study will assist the
development of research into male genital body image and differences of sexual
identity. Throughout this article, the term MSM is used rather than gay because some
MSM identify as bisexual, heterosexual, fluid, or may prioritize other aspects of
identity (such as ethnicity) over their sexuality and thus reject the label “gay.”
Conversely, not all men who have sex with women are exclusively heterosexual
in terms of their sexual/sexualized behavior. Ward (2015) questions the rigidity of
heteromasculinity in drawing attention to forms of sexualized behavior ranging from
hazing rituals, online personal adverts seeking other men with whom to masturbate
(practices that still objectify women and deride effeminacy), to anonymous sex in
public toilets (see also Humphreys’s [1970] classic study of “tearoom trade”).
The aim of this article is to present a structured review and synthesis of the
available research into male perceptions of the penis, the psychosocial, and sexual
correlates and to provide a comparison of outcomes between MSM and hetero-
sexual men. We are also motivated by concern for the self-esteem if not mental
health of men who are encouraged to feel anxious about penile dimensions. We are
thus concerned to contribute to questioning of dominant, heteronormative models
of masculinity which can inflict emotional harm not just on MSM but also hetero-
sexual men who have been persuaded to invest in or revere such ways of thinking
(Connell 1995). Providing an overview of the literature also helps to mark limits to
the homogenizing view that a small penis is almost universally a matter of shame
as a symbol of failed masculinity and allows clarification of the conditions under
which different men from different cultures might react in varying ways to dis-
courses concerning penis size. While shame and misery might be a dominant story
about (smaller) penis size, this story should not be universalized and may occlude
other stories and experiences, which we aim to illuminate. The results and discus-
sion below indicate that men capitulate, negotiate with, ignore, or challenge dis-
courses of shame.
The key questions addressed in this review concern similarities and differences
between straight men and MSM in relation to (i) subjective estimation of penis size;
(ii) ideal penis size compared with perceptions of straight men and MSM and, in
some cases, actual measurements; (iii) the importance of genital dis/satisfaction
relative to dis/satisfaction with other parts of the body; (iv) genital perceptions and
effects on general self-esteem; and (v) psychosocial/sexual outcomes—effects of
perceptions of the penis on social and sexual behavior.
We recognize the contingency of meanings attached to the penis and how, in
particular, being well-endowed can operate in gay male cultures as sexual capital
often independently of socioeconomic power (Green 2011). However, our findings
offer support for Connell’s (1995) theorizing about hegemonic masculinity. This
concept refers to a form of masculinity that is prized over others. Simultaneously, it
refers to a collection of practices that constitute and are constituted by social,
Simpson and Adams 3

economic, political, and cultural structures and institutions and that underpin and
normalize relations of (male) domination and (female) subordination. Also, within
this hierarchy, men who embody subordinate masculinities, variously gay, non-
white, or working-class men, find themselves disadvantaged in comparison to white,
elite/middle-class, heterosexual men. In distancing themselves from femininity,
gayness, and low status, the latter are thought to represent the most legitimate form
of masculinity marked by success, social esteem, emotional self-control, and favor-
able access to formal political power. As will be seen in the Discussion section,
semen and, by definition, the penis are implicated in this power complex and rep-
resent extension and renewal of hegemonic masculinity (Moore 2002, 2007).
Method
Our study was motivated by a wish to deepen and extend knowledge on how
differences in sexual identity affect body and genital image. In particular, we wanted
to examine whether MSM may be more vulnerable than heterosexual men to such
body dissatisfaction (Morrison et al. 2004; Strong, Singh, and Randall 2000; Tigge-
mann et al. 2008). Such knowledge could inform differentiated strategies designed
to overcome any lack of genital self-esteem.
Search Strategy
The search strategy was divided into two stages. The first stage involved the iden-
tification of existing reviews focusing on male genital perceptions and psychosocial/
sexual outcomes. This search was conducted by searching the Cochrane Library and
five major databases (PsycINFO, Pubmed, EMBASE, CINAHL, and SocIndex). No
systematic reviews were identified.
The second stage of the search strategy consisted of a search for English-language
primary studies published up until June 2015 on male genital perceptions and psy-
chosocial/sexual outcomes. The following databases were searched: PsycINFO,
Pubmed, EMBASE, CINAHL, and SocIndex until June 2015. The same search
strategy was employed in all databases: (men OR gay men OR bisexual men OR
heterosexual men) AND (genital OR penis OR penis size OR penis satisfaction)
AND ((body image OR body satisfaction OR body dissatisfaction) OR (masculinity)
OR (wellbeing) OR (self-image) OR (self-esteem)). Using the above search strategy,
449 articles (again, up to June 2015) were identified.
The two authors scrutinized all the titles and abstracts returned and identified
studies eligible for inclusion based on the review’s inclusion and exclusion
criteria (as detailed below). Further searches were conducted of the bibliogra-
phies of relevant reviews and publications to identify additional studies for
inclusion.
4Men and Masculinities XX(X)

Inclusion and Exclusion Criteria
After the removal of duplicates, the titles and abstracts of papers were screened by
both authors to assess whether they met the inclusion criteria. For a study to be
included, it had to
(i) report genital perceptions, genital satisfaction, genital self-esteem, or psy-
chosocial/sexual outcomes associated with genital perceptions,
(ii) provide sufficient detail on the above outcome measures to allow compar-
ison across studies,
(iii) report data on participants who were not part of a sample that had under-
gone genital surgery,
(iv) report quantitative, qualitative, or mixed methods methodology,
(v) written in the English language, and
(vi) published in a peer-reviewed journal.
Included studies focused specifically on men’s perceptions of their genital size/
appearance, genital satisfaction, genital self-esteem, or psychosocial/sexual out-
comes associated with genital perceptions. A wide range of study designs were
included, spanning quantitative, qualitative, and mixed methods. Exclusion criteria
included any study that was not published in English, was not published in a peer-
reviewed journal, did not contain primary data, did not include a sample of male
participants, did not include male genital body image as the main focus, focused on
clinically diagnosed or postsurgery patients, and was a review article.
Data Extraction
Data were extracted from full texts by the authors and included information about
study aims, authors, date of publication, location of study, sample size and composi-
tion (including sexual orientation), study design, validated outcome measures/tools,
and genital perception, image, esteem measures, and associated psychosocial/sexual
outcomes. Data extraction was reviewed by the authors with a view to highlighting
any discrepancies; a discrepancy occurred for only a small number of studies which
was resolved by discussion. The search strategies identified 449 articles. Following
review of abstracts and titles and the removal of duplicates, 391 articles were
excluded and the remaining 58 were considered eligible and retrieved for full-text
review. Articles were rejected for one or more reasons: no outcome measures on
male self-perception of the penis, the article was a review article, the article reported
data on males with clinical diagnoses related to the genitals or on males who had
undergone genital surgery, the article contained only objective penis outcome mea-
sures, insufficient information regarding measurement of variables, and an absence
of original data.
Clinical studies which reported data on participants who had undergone urologi-
cal surgery (e.g., for cancer or hypospadias) or who had received a physical
Simpson and Adams 5

urological diagnosis (e.g., small penis syndrome) or psychiatric diagnosis (e.g.,
anxiety or depression disorder) were excluded from this review. While it is acknowl-
edged that this is a wide area in the medical literature, the inclusion of such studies
would have made the study samples too heterogeneous. Men who have undergone
genital surgery or who have been diagnosed with genital or psychiatric conditions
bring with them a range of related experiences and comorbidities that were outside
of the scope of this article.
The full texts of the fifty-eight articles were then examined by both authors to
assess whether the inclusion/exclusion criteria were met. A further thirty-two arti-
cles were excluded for failure to meet the inclusion criteria. A total of twenty-six
articles met the inclusion criteria and have been included in this review. Figure 1
presents a flowchart of study selection at each stage, along with categorical data on
excluded studies.
Study quality was assessed by authors employing the Timmer, Sutherland, and
Hilsden (2003) checklist for qualitative studies and the National Institute for Health
Pubmed
N = 153
EMBASE
N = 17
PSYINFO
N = 185
CINAHL
N = 29
Total number of publications
reviewed
N = 449
Total number of titles and
abstracts screened
N = 429
Records excluded
after reading titles
and abstracts
N=371
Full text articles assessed for
eligibility
N = 58
Full text articles excluded
N=32
- Insufficient inclusion of
genital perceptions or genital
body image as a focus, n = 15
- Review article, n = 3.
- Clinical samples, n = 3.
- Commentary article, n = 11.
Duplicates removed
N = 20
Studies included in systematic
review
N = 26
SocIndex
N = 65
Figure 1. Flow diagram of search and selection strategy of included articles.
6Men and Masculinities XX(X)

and Care Excellence (United Kingdom; 2007) appraisal checklist for quantitative
studies. The Timmer, Sutherland, and Hilsden’s (2003) checklist for quantitative
studies, which has been demonstrated to have good construct validity, was adapted
for this review (three items pertaining to intervention studies were removed; Roy
and Payette 2012). A total of sixteen items were utilized and, as per the guidelines,
two points were allocated if the item was fully met, one if partially met and none if
not met at all. Up to five extra points were awarded based on study design. A ratio
score between 0 and 1 was computed, with 1 representing the highest-quality score
and 0 the lowest.
The National Institute for Health and Clinical Excellence quality appraisal check-
list for qualitative studies was used to assess the quality of the qualitative studies in
this review (National Institute for Health and Clinical Excellence [NICE] 2012). It
employs thirteen items to assess six components of qualitative studies (aims, design,
recruitment and data collection, analysis, findings/interpretation, and research impli-
cations). Items were scored dichotomously, with total quality scores of “þþ” where
an article has addressed at least eleven of the thirteen items, “þ” for articles addres-
sing seven to ten of the thirteen items, and “” for articles addressing fewer than
seven of the thirteen items. Quality ratings for each study are presented in Table 1.
Data analysis was undertaken by means of a thematic content analysis, whereby a
systematic classification process of coding for themes by the two authors enabled a
subjective interpretation of the data (Braun and Clarke 2006). The following five
themes were identified: (1) subjective penis size estimation; (2) ideal penile size
versus perceived reality; (3) relative importance of genital image dissatisfaction; (4)
genital perceptions and self-esteem; and (5) psychosocial/sexual outcomes.
Results
Study Characteristics
The findings presented are synthesized from twenty-six studies (detailed in Table 1),
published between 1995 and 2014, sampling a total of over 37,000 men worldwide.
Nine of the twenty-six studies had samples that either partially or totally comprised
gay/bisexual men (see Table 1). Sample sizes ranged from small-scale studies
(Drummond and Filiault 2007; n¼14) to very large-scale surveys (Lever, Frederick,
and Peplau 2006; n¼25,594). All studies were cross-sectional, twenty-two were
quantitative, three were qualitative, and one consisted of a mixed-methods design.
Findings: Describing the Data
Five themes were identified: (1) subjective penis size estimation; (2) ideal penile
size versus perceived reality; (3) relative importance of genital image dissatisfac-
tion; (4) genital perceptions and self-esteem; and (5) psychosocial/sexual outcomes.
Table 1 presents details of the studies in terms of methodological design, sample
Simpson and Adams 7

Table 1. Study Details and Summary of Results.
Study and sample
characteristics
Methods
Relevant validated
outcome measures
Quality rating Results summary
1. Algars et al. (2011), Finland
N¼3,331 males (response rate ¼45
percent of 9,532). Age range ¼18–
49 years (twins and their siblings).
Mean ¼26 years. Sexuality not
specified.
Quantitative
Cross-sectional
Structured questionnaire
DFSI (Derogatis and Melisaratos 1979)
and IIEF (Rosen et al. 1997)
Quality: 0.84
Majority—68 percent of men satisfied with penis but 49 percent wished for a
larger one (though all correlations low). Those satisfied reported lower
levels of premature or delayed ejaculation, positive erectile function, and
more sex (kissing, oral, vaginal, and anal sex and enjoyment of and
satisfaction with sexual intercourse). Sexual body image related to general
body image and overall self-esteem. Positive general body image and sense
of attractiveness are positively associated with penis size satisfaction (r¼
.4) and negatively correlated with wishing for larger penis (r¼.31). Small
penis size affects self-esteem in sexual context.
2. Carballo-Die
´guez et al. (2004), New
York
N¼294 males. Age range 18–67
years. Mean age ¼32 years. Men
who have sex with men (MSM)
though mostly gay identified.
Qualitative and quantitative
Cross-sectional
Structured interviews and focus
groups
Adapted sexual identity scale (Stern,
Barak, and Gould 1987)
Quality: 0.77 and “”
Penis size, height, age, and proximity to normative masculinity influence men’s
role during sex and could bring about change from normal role. Stigma
could be associated with “pasivo” (passive–receptive) role could explain
preponderance of men identifying as “activo” (active–insertive).
3. Cranney (2015), the Netherlands
N¼1,005 men. No age given.
Sexuality not covered.
Quantitative
Cross-sectional
Longitudinal survey
Quality: 0.78
Tendency for men to be satisfied with penis size. Dissatisfaction strongly
related to pornography when heterosexual men have fewer opportunities
to compare erect penis—hence, compared selves with nonrepresentative
and well-endowed pornography actors. Supports Peter and Valkenburg
(2014), though few had watched pornography in recent past.
(continued)
8

Table 1. (continued)
Study and sample
characteristics
Methods
Relevant validated
outcome measures
Quality rating Results summary
4. Davis et al. (2013), Canada
N¼636 males. Age range ¼15–73
years. Mean age ¼33.93 years.
Heterosexual and homosexual
samples.
Quantitative
Cross-sectional
Structured questionnaire
Index of male genital image (Davis et al.
2013) and body areas satisfaction
scale (Cash 2000)
Quality: 0.96
Generally, high satisfaction scores reported on all factors of genital image
(penis size, circumcision status, ejaculation, pubic hair, genital appearance,
and shape). Penis size best predictor of genital satisfaction (over
circumcision, shape, appearance, and ejaculation). Lower genital image
satisfaction found in circumcised men, men experiencing erectile difficulty,
and men experiencing premature ejaculation.
5. Del Rosso (2011), United States
Sample characteristics not specified/
specifiable
Qualitative
Online ethnographic study
Quality: “þ”
Size relates to perceptions of masculinity—small penis stigmatized as lack
thereof, which could result in insecurity and deficits in self-esteem. Small
size affects behaviors in communal showers and fear of being seen by other
men and sex partners. However, respondents created opportunities for
self-validation online that could challenge size hierarchy and reject stigma.
6. Drummond and Filiault (2007),
Australia
Study 1: Focus group with ten men and
semistructured interviews with
fourteen men. All participants aged
18–25 years. Studies 2 and 3 based
on semistructured interviews.
Study 2: Men of “baby boomer”
generation (age range unspecified).
Study 3: Men aged 28, 34, and 48
years. All participants self-selected,
gay identified, and no age means
given.
Qualitative
Semistructured interviews
Phenomenological metathematic
analysis of three studies
Quality: þ
Varied responses to size as signifier of desirability. Penis also a signifier of
masculine self-esteem, but this thinking attributed to other gay men
(deemed superficial), who prefer well-endowed partners. While penis size
generally matters, it is not definitive and needs to be seen in context of
other body parts, for example, muscles and broad shoulders.
(continued)
9

Table 1. (continued)
Study and sample
characteristics
Methods
Relevant validated
outcome measures
Quality rating Results summary
7. Ferreira dos Reis et al. (2013), Brazil
N¼300 male blood donors aged 40–
60 years sampled from 785, aged
40–49 years. No mean age given.
Sexuality not covered.
Quantitative
Cross-sectional
Structured questionnaire
IIED and BMI
Quality: 0.57
Ninety-seven percent felt sexually attracted to their partners and 253 (84
percent) satisfied with their bodies. Only seven (2.3 percent) dissatisfied
with penis as too small. All felt “potent” and no confirmation of small penis
being associated with erectile difficulties.
8. Grov, Parsons, and Bimbi (2010),
United States
N¼1,065. Range ¼18–90 years.
Mean age ¼37.9 years. MSM (gay
and bisexual).
Quantitative
Cross-sectional
Structured questionnaire
Prevention/promotion scale
(Lockwood, Jordan, and Kunda
2002), gay-related stigma scale
(Frost, Parsons, and Nanı
´n 2007),
and gay life satisfaction scale (Bimbi,
Parsons, and Nanı
´n 2005)
Quality: 0.90
While most men reported an average or larger than average penis (89.4
percent), 33.5 percent desired a larger penis. There was a positive
relationship between reported penis size and (i) satisfaction with penis size
and (ii) preferred sexual role. Lying about penis size negatively correlated
with reported penis size. Men with below average penis sizes fared
significantly worse on three measures of psychosocial adjustment: gay life
satisfaction, promoting positive aspects of their lives, and registered higher
on gay-related stigma.
9. Herbenick et al. (2013), United
States
N¼1,047. Age range ¼18–60 years.
No mean age. MSM.
Quantitative
Cross-sectional
Structured questionnaire
Quality: 0.89
Heterosexual men reported higher genital satisfaction than homosexual/
bisexual men. About 20 percent of men reported some dissatisfaction with
genital size and 1:6 reported experiencing genital embarrassment.
10. Johnston, McLellan, and McKinlay
(2014), New Zealand
N¼67. No age range. Mean age ¼25
years and 10 months.
Heterosexual.
Quantitative
Cross-sectional
Structured questionnaire
Quality: 0.71
Men reported significant dissatisfaction with their penis size, despite seeing
themselves (accurately) to be of average size. Their ideal size was larger.
Men believed that both women and other men women would prefer a penis
larger than their own. Men were more comfortable with women seeing
their penis than other men doing so. The level of comfort apropos others
seeing their penis was related to the discrepancy between reported and
desired penis size.
(continued)
10

Table 1. (continued)
Study and sample
characteristics
Methods
Relevant validated
outcome measures
Quality rating Results summary
11. Khan et al. (2008), Bangladesh
N¼50. Age range ¼18–55 years. No
mean age. Heterosexual.
Qualitative
Focus groups
In-depth interviews
Quality: þ
Qualitative evidence that men see a strong link between masculinity, sexual
power, and penis size. Perception of a small penis affects self-general self-
esteem as male. Most men dissatisfied with size and shape of penis and
comparing selves with pornographic actors could exacerbate this, though
some men more concerned with girth than length.
12. Lee (1996), United States.
N¼112 male, university students. Age
range ¼18–28 years. No mean
given. Sexual difference referred to
but not covered in the analysis.
Quantitative
Cross-sectional
Structured questionnaire
Quality: 0.73
Majority (68.8 percent) rated themselves within the normal range and 25.9
percent felt they were “smaller or much smaller than average.” Generally,
no more concerned about penis size than attractiveness or weight/build.
No effect on the use of communal showers or concerns about sex. Men
with smaller penises more likely to judge themselves negatively against
pornographic actors and to wonder about homosexual tendencies. Those
perceiving themselves as smaller more likely to report being recipients of
cruel comments about size around puberty in changing rooms.
13. Lever, Frederick, and Peplau
(2006), United States
N¼25,594. Age range ¼18–65 years.
Mean age ¼36.9 years.
Heterosexual.
Quantitative
Cross-sectional
Structured questionnaire
Quality: 0.86
Most men rated their penis size as average (66 percent), but a significant
number wanted a larger one (46 percent). Penis size perception was
negatively correlated with age and positively correlated with penis size
satisfaction. Men who reported having a small penis were less likely to
undress in front of a partner and more likely to hide the penis during sex.
Reported penis size was related to perceptions of body attractiveness,
comfort in a swimsuit, and satisfaction with facial features.
14. Martins, Tiggemann, and Churchett
(2008), Canada
N¼92. Age range ¼18–40 years.
Mean age ¼33.08 years.
Homosexual.
Quantitative
Cross-sectional
Structured questionnaire
Body part and extent of worry scale
(Stunkard, Sorenson, and
Schulsinger 1980) adapted by
Tiggemann, Martins, and Churchett
(2008)
Quality: 0.90
Men reported a high level of dissatisfaction with the size of their penis, with
many wanting a larger one (59.8 percent). However, body weight and
muscularity were more important than perceptions of penis size in
participants’ perceptions of themselves as attractive, which were the body
parts most associated with anxiety.
(continued)
11

Table 1. (continued)
Study and sample
characteristics
Methods
Relevant validated
outcome measures
Quality rating Results summary
15. Mondaini et al. (2002), Italy
N¼67. Age range ¼16–55 years.
Median age ¼27 years. Sexuality
not mentioned.
Quantitative
Cross-sectional
Structured questionnaire
Standardized penile measurements
BMI and IIEF (Rosen et al. 1997)
Quality: 0.82
Most participants (n¼44, 66 percent) concerned about size in the flaccid
state. Most (85 percent) overstated average by 1. Of the sixty-seven men
(who measured themselves using a nomogram), none of those complaining
were very small—under fifth percentile. The nomogram measurements
reassured men of their size normality. Mostly anxiety problem started in
childhood (63 percent) comparing with others.
16. Morrison, Harriman, et al. (2004),
Canada
N¼202. Age range ¼17–42 years.
Mean age ¼19.8 years.
Heterosexual.
Quantitative
Cross-sectional
Structured questionnaire
MGIS (Winter 1989), self-esteem scale
(Rosenberg 1965), sexual anxiety
inventory (Janda and O’Grady
1980), SES (Snell and Papini 1989),
and sexual experience (Rothman
et al. 1999)
Quality: 0.81
Males reported fairly positive genital self-image, high levels of self-esteem,
moderate levels of sexual esteem, and low levels of sexual anxiety. Virgins
had less positive genital perceptions, higher levels of sexual anxiety, and
lower levels of sexual esteem.
17. Morrison et al. (2005), Canada
Study 1:N¼149 males, age range ¼
17–56 years, mean age ¼23.2
years.
Study 2:N¼202 males, age range ¼
17–42 years, mean age ¼19.65
years.
Study 3:N¼64 males, range¼18–55
years, mean age ¼24.4 years.
Heterosexual.
Quantitative
Cross-sectional
Structured questionnaire
Body image inventory (Levitan 1983),
MGIS (Winter 1989), and SSS (Snell
and Papini 1989)
Quality: 0.93
Males reported moderate mean scores for genital image, body image, and
sexual self-esteem. More positive genital perceptions were reported by
nonvirgins. The highest genital dissatisfaction was with length,
circumference, and appearance of their nonerect penis. Overall, 82.6
percent were satisfied with the length of their nonerect penis.
(continued)
12

Table 1. (continued)
Study and sample
characteristics
Methods
Relevant validated
outcome measures
Quality rating Results summary
18. Morrison et al. (2006), Canada
N¼188 males. No age range. Mean
age ¼23.4 years. Primarily
heterosexual.
Quantitative
Cross-sectional
Structured questionnaire
Body image scale (Winter 1989), MGIS
(Winter 1989), and SES (Snell and
Papini 1989)
Quality: 0.80
Negative correlations found between exposure to pornography images on the
Internet and genital image and sexual self-esteem. These correlations did
not vary as a function of sexual experience. No significant correlations
between pornography exposure and ratings on the body image scale.
19. Morrison, Morrison, and Bradley
(2007), Canada and United States
N¼66. No age range. Mean age ¼
35.5 years. Homosexual.
Quantitative
Cross-sectional
Structured questionnaire
MGIS (Winter 1989), Sexual self-
esteem scale (Snell and Papini
1989), drive for muscularity
questionnaire (Morrison, Morrison,
et al. 2004), and internalized
homonegativity inventory (Mayfield
2001)
Quality: 0.90
Overall, MSM reported high levels of genital and sexual self-esteem (which
were positively correlated). Genital self-esteem was negatively correlated
with the drive for muscularity and internalized homonegativity. Sexual self-
esteem was negatively correlated with internalized homonegativity.
20. Moskowitz and Hart (2011),
United States
N¼429 sampled from “thousands”
(unspecified), who responded by e-
mail and response rate “impossible
to calculate.” Aged 18–79 year and
mean age ¼40.88 year. Most aged
30–50 years. Eighty-five percent
identified as white, 6 percent as
Latino, and 4 percent black. MSM.
Quantitative
Cross-sectional
Online survey
Quality: 0.70
Penis size most significant effect on sex role (compared to hairiness weight or
height)—whether “top” (masculine dominant), “bottom,” and whether
“versatiles” switched either way. Gay men who were bottoms less likely to
be masculine and less likely to have larger erect penises (r¼.59).
(continued)
13

Table 1. (continued)
Study and sample
characteristics
Methods
Relevant validated
outcome measures
Quality rating Results summary
21. Nutgeren et al. (2010), the
Netherlands
N¼60. Age range ¼14–67 years.
Mean ¼40.5 years. Heterosexual ¼
58 (98 percent) and 1 homosexual
(2 percent).
Quantitative
Cross-sectional
Structured questionnaire
Standardized penile measurements
Diagnostic and statistical manual of
mental disorders 4 (DSM-IV)
Quality: 0.42
Majority (67 percent) felt shame in intimate situations with women and in
communal showers with men. Average size at “maximum extension” 9.4
cm or 3.700. Nine men (20 percent) reported problems with intercourse
related to embarrassment about small penis that did not stay in the vagina.
Thirteen men (30 percent) reported difficulties forming relationships as a
result of small size, which affected the search for a sympathetic (female)
partner.
22. Peter and Valkenburg (2014), the
Netherlands
N¼1,879 men and women. Forty-
seven percent male, aged 12–87
years, and mean male age ¼46.57.
Ninety-four percent of men
identified as straight and 6 percent
as gay or bisexual.
Quantitative
Random groups
Structured questionnaire
Eating disorder inventory, Kinsey H
scale (Kinsey, Pomeroy, and Martin
1948) for sexual identification
Quality: 0.94
Majority did not consider their penis too small but extent of exposure to
pornography associated more with general body dissatisfaction (stomach
fat, muscularity) than penis size. More frequent porn viewers more likely to
see themselves as small. Gay men no more concerned with perceived size
than straight men.
23. Reinholz and Muehlenhard (1995),
United States
N¼160 male and 160 female
psychology students. Aged 18–37
years and mean age ¼19 years. Of
320, 95 percent identified as
heterosexual, 2.5 percent as
bisexual, and 2.5 percent as
homosexual.
Quantitative
Cross-sectional
Structured questionnaire
Quality: 0.77
Participation in various sexual acts related to perceptions of and satisfaction
with genitals. Positive perception of genitals positively correlates with
amount of sex and greater enjoyment, especially receiving oral sex.
Participants moderately positive about their genitals.
(continued)
14

Table 1. (continued)
Study and sample
characteristics
Methods
Relevant validated
outcome measures
Quality rating Results summary
24. Son et al. (2003), South Korea
N¼123 male military recruits, aged
19–27 years. Mean ¼21.7 years.
Sexuality not offered.
Quantitative
Cross-sectional
Structured interviews
Psychometric test, standardized penile
measurements, and Minnesota
multiphasic personality inventory
Quality: 0.58
Mean flaccid length 6.9 cm, circumference 8.5 cm, and stretched 9.8 cm. Most
(70 percent) estimated penis size as within normal range. Those who
reported being small/very small were smaller than average but understated
actual size. Those underestimating adjudged to be hypochondriac with
phobic tendencies, self-punitive, and rigidly moral. Those who reported
large size adjudged suggestible, superficial, egocentric, and in denial about
mental state. Concerns about size suggest dissatisfaction with masculinity.
25. Tiggemann, Martins, and Churchett
(2008), Australia
N¼200, age range ¼18–40 years.
Mean age ¼27 years.
Heterosexual.
Quantitative
Cross-sectional
Questionnaire
Appearance self-esteem assessed by
an adaptation (questions converted
into statements) of the six-item
scale developed by Pliner, Chaiken,
and Flett (1990).
Quality: 0.89
Majority (68 percent) of participants wanted a larger penis and generally
believed that the ideal male body image contained a larger penis than their
own. Appearance self-esteem was best predicted by (i) dissatisfaction with
muscularity, body weight, and height; (ii) the importance of penis size,
followed by body weight; and (iii) worry about body weight, followed by
worry about penis size. Penis size was viewed as the fifth most important
body part.
26. Veale et al. (2014), United
Kingdom
N¼172 (120 heterosexual and 52
MSM). Mean age ¼28 years.
Quantitative
Cross-sectional
Structured questionnaire
BAPS scale (Veale et al. 2014), social
phobia inventory (Connor et al.
2000), body image QoL inventory
(Cash and Fleming 2002), and
hospital anxiety and depression
scale (Zigmond and Snaith 1983)
Quality: 0.94
There were generally high levels of concern over penis size (54 percent of
study participants) and significant dissatisfaction with this (30 percent).
Heterosexuals expressed greater concern than MSM (67 percent vs. 48
percent). There were significant positive correlations between BAPS and
anxiety, depression, and social phobia. Also, significant negative
correlations between BAPS and body image quality of life, erectile function,
satisfaction with penis size, importance attached to penis size, and concerns
about penis size. Age and effects of sexual identification indicated that men
with penis size concerns tended to be older, and older MSM were
significantly more likely to have penis size concerns than heterosexual men.
Note: BMI ¼Body Mass Index; DFSI ¼Derogatis Sexual Functioning Inventory; IIEF ¼international index of erectile function; IIED ¼International Index of Erectile
Dysfunction; MGIS ¼male genital image scale; QoL = quality of life; SSS ¼sexual self-esteem scale.
15

composition and demographics, study quality rating, key study characteristics (vali-
dated outcome measures), and a summary of results.
Penis Size Estimations
Five studies provided quantitative data on male perceptions of penis size compared
to the norm (Lee 1996; Son et al. 2003; Lever, Frederick, and Peplau 2006; Grov,
Parsons, and Bimbi 2010; Johnston, McLellan, and McKinlay 2014). Of these five
studies, only one used a sample of gay men (Grov, Parsons, and Bimbi 2010).
Earlier studies into male penile perception estimates suggest that a large propor-
tion of the population inaccurately perceived their penis to be smaller than it is
objectively and thus believed their penis to be smaller than average (Lee 1996; Son
et al. 2003). Similar results regarding “average” perceptions were reported by Lever,
Frederick, and Peplau (2006) with a large-scale study of heterosexual men. Lever
et al. found that that two-thirds of the (heterosexual) respondents rated their penis
size as average, 12 percent rated themselves as below average, and 22 percent rated
themselves as above average. Penis size perception was inversely correlated with
age. These estimates are supported by Johnston, McLellan, and McKinlay’s (2014)
research, which also found that most of their heterosexual sample accurately saw
themselves as having an average-sized penis. However, differences between hetero-
sexual and gay samples become apparent when Grov, Parsons, and Bimbi’s (2010)
sample of gay men is used as a comparison. The latter report that a lower percentage
of gay men rated their penis size as average (53.9 percent as compared to Lever
et al.’s 66 percent of heterosexual men), but a much higher percentage rated their
penis as above average (35.5 percent as compared to Lever et al.’s 22 percent of
heterosexual men). Further, fewer in Grov et al.’s homosexual sample rated them-
selves as having a below average penis compared to Lever et al.’s heterosexual
sample (6.9 percent compared to 12 percent). This is echoed in Moskowitz and
Hart’s (2011) study of MSM, who generally rated themselves above average in
response to items on masculinity and penis size.
While distorted penis size estimation error may form the basis for penis size
dissatisfaction in some men, research has shown that even when men accurately
perceive their size as being average, they may still experience dissatisfaction arising
from dissonance between their accurate penile perceptions and preferred ideal size
(Johnston, McLellan, and McKinlay 2014; see also Wylie and Eardley 2006). This
theme of dissonance is discussed just below.
Mind the gap: Ideal penile size versus perceived reality. Ten studies provided quantitative
data on male perceptions of ideal penis size versus perceived reality (Mondaini et al.
2002; Lever, Frederick, and Peplau 2006; Martins, Tiggemann, and Churchett 2008;
Tiggemann, Martins, and Churchett 2008; Grov, Parsons, and Bimbi 2010; Algars
et al. 2011; Ferreira dos Reis et al. 2013; Herbenick et al. 2013; Cranney 2015;
Johnston, McLellan, and McKinlay 2014). Of these ten studies, only two utilized a
16 Men and Masculinities XX(X)

sample of gay men (Martins, Tiggemann, and Churchett 2008; Grov, Parsons, and
Bimbi 2010).
Four studies containing samples of heterosexual men (with medium- to high-
quality scores) reported a high level of dissatisfaction with the size of the penis
(Lever, Frederick, and Peplau 2006; Tiggemann, Martins, and Churchett 2008;
Herbenick et al. 2013; Johnston, McLellan, and McKinlay 2014). Herbenick
et al.’s (2013) study of heterosexual, gay, and bisexual men found the highest
genital self-image among heterosexualmen,followedbygaymenthenbisex-
uals. Among heterosexual men, the percentage of men who were dissatisfied
with their penis and desired a larger one ranged from 45 percent (Lever, Fre-
derick, and Peplau 2006) to 68 percent (Tiggemann, Martins, and Churchett
2008), with satisfaction with penis size decreasing as penis size perception
decreased (Lever, Frederick, and Peplau 2006). Tiggeman, Martins, and Church-
ett (2008) also found that heterosexual men believed that their penis size was
smaller than the body image ideal of the average man (the size that they
believed other men would want). Herbenick et al.’s (2013) study found that one
in five men indicated some dissatisfaction with their genital size, but this study
did not provide data on the component genital body parts. A similar discrepancy
between ideal size versus perceived reality among gay men has also been
demonstrated by Grov, Parsons, and Bimbi (2010) who reported that over
two-thirds expressed a desire for a larger penis. A similar study to Tiggeman,
Martins, and Churchett (2008) but with a sample of gay men (Martins, Tigge-
mann, and Churchett 2008) demonstrated a discrepancy between their percep-
tions of their own penile size and their rating of the ideal size and of the male
ideal(whattheybelievegaymenwouldfindmostattractive);nearlysixinten
respondents wished they had a larger penis.
Further, even men who perceive their penis to be of an average size express a
desire for a larger penis (Lever, Frederick, and Peplau 2006; Grov, Parsons, and
Bimbi 2010). This is supported by research which indicates that many of the men
who seek penile augmentation do so in spite of having normal-sized penises
(Mondaini et al. 2002). Indeed, this report notes that “ ...all penile measurements
were within the normal range, which is defined by a length above the 2.5 percentile
(flaccid length of 4 cm; stretched length of 7 cm).” The authors stated that there
was an “absence of any penile abnormality” in their study (Mondaini et al. 2002,
285). In Grov, Parsons, and Bimbi’s (2010) study of gay men, four in ten respon-
dents who perceived their penis size to be of an average size and 14.7 percent who
reported an above average size, wished they had a larger penis. Similar findings
have been reported in respect of heterosexual men. Lever, Frederick, and Peplau
(2006) found that nearly half of the respondents reporting an average size penis
also wished they had a larger penis, which is similar to the 45 percent of all
respondents in the same study. Further, the desire for a larger penis (range 42–
46 percent) does not significantly decrease as men get older (Lever, Frederick, and
Peplau 2006).
Simpson and Adams 17

Relative importance of specific body part dissatisfaction. Seven quantitative and two
qualitative studies addressed the related issues of genital satisfaction, the relative
importance of component genital parts, and the importance of these in relation to
other body image concerns (Lever, Frederick, and Peplau 2006; Morrison et al.
2005; Drummond and Filiault 2007; Khan et al. 2008; Martins, Tiggemann, and
Churchett 2008; Tiggemann, Martins, and Churchett 2008; Algars et al. 2011; Davis
et al. 2013; Veale et al. 2014). Three out of the seven studies contained gay or
bisexual samples (Drummond and Filiault 2007; Martins, Tiggemann, and Churchett
2008; Veale et al. 2014).
Studies addressing the issue of genital satisfaction and associated concerns indi-
cate some variability in study results plus some differences according to sexual
identification. Morrison et al. (2005) found generally high genital satisfaction scores
among heterosexual men. The study highlighted that men are more dissatisfied with
the length of their penis as opposed to other features of their genitals. This was also
reflected in a study by Davis et al. (2013) of gay and straight men in their validation
of the Index of Male Genital Image scale. The authors noted, despite their differ-
ences, that men generally scored highly on genital satisfaction ratings and the best
predictor of genital satisfaction was (in order) penis size, shape, ejaculation, appear-
ance, and circumcision status (whether circumcised or not). Circumcision, which is
widely practiced among followers of Judaism and Islam as well as in the United
States (World Health Organization 2008), has an important bearing on penile aes-
thetics because it is often experienced as beautifying and making the penis appear
larger (Kennedy 2015) and perhaps more sexualized and adult-looking. Indeed,
Kennedy draws attention to a complex politics of anticircumcision that promotes
nonsurgical, do-it-yourself methods of foreskin restoration (the latter can involve
stretching the remaining skin to cover more of the glans). This social movement
regards both circumcision and surgical attempts to replace a foreskin as forms of
mutilation that can impair rather than enhance sexual experience. The movement
invokes the (socially constructed) idea of the foreskin as a natural masculine state
that they have been denied. Lack of foreskin is felt to compromise status as a real/
entire male. Further, Kennedy (2015) highlights how such discourses are implicated
in “homosocial performances” that are obsessed with size and involve distancing
from the feminine. Such thinking can be contrasted with work, for example,
addressing transmen and the penis (Wylie, Wootton, and Carlson 2016) that
self-consciously avoids gender in binary terms. Nonetheless, Kennedy’s theorizing
usefully connects the kind of body projects she identifies with other kinds (i.e.,
Viagra or body building) and to the broader issue of how individualism encourages
control/fixing of the body-self when (dominant) masculinity is felt as threatened.
Also, this work usefully connects these body projects (like Viagra or body-building)
to the broader issue of how individualism encourages control/fixing of the body-self
when (dominant) masculinity is felt as threatened.
In contrast to Davis et al.’s (2013) observations noted in the previous paragraph
on generally higher levels of satisfaction concerning penile dimensions and
18 Men and Masculinities XX(X)

appearance, Khan et al. (2008, 41) concluded from their qualitative study of a
heterosexual sample that “only a few men were satisfied with the size, shape and
action of their penis.” A study by Veale et al. (2014) of gay and straight males
revealed that 30 percent of study participants were dissatisfied with their penis size
and 54 percent had concerns over penis size. Concerns over penis size also differed
markedly by a margin of nearly 20 percent between heterosexuals (48 percent) and
MSM (67 percent). Veale et al.’s mixed sample demonstrated that men with penis
size concerns tend to be older and were more likely to be homosexual or bisexual (p
< .05). Qualitative research by Drummond and Filiault (2007) further attests to the
importance placed upon penis size by gay men and beliefs about how other gay men
see size as an important signifier of masculinity.
Results from studies which have examined the importance of and concerns
about the genitals in comparison to other body parts indicate that genital con-
cern (but not importance of genitalia) varies as a function of sexual identifica-
tion (Martins, Tiggemann, and Churchett 2008; Tiggemann, Martins, and
Churchett 2008). While gay men have demonstrated dissatisfaction with the size
of their penis (59.8 percent), the more visible body weight and muscularity rank
higher in perceptions of being attractiveandarepartsofthebodythatgivemore
cause for concern (Martins, Tiggemann, and Churchett 2008), though see the
section below on psychosexual outcomes. While heterosexual men have also
demonstrated penis size dissatisfaction, and to a higher degree, they too rank
body weight, muscularity, head hair, and height as more important than penis
size (Tiggemann, Martins, and Churchett 2008). Further, these two studies found
that heterosexual men (Tiggeman, Martins, and Churchett 2008) and gay men
(Martins, Tiggemann, and Churchett 2008) ranked penis size as the fifth most
important body part, but heterosexual men ranked this third in terms of body
parts causing “worry” and gay men as fifth in order of concern about aspects of
the body. The latter datum indicates that penis size is more a concern for
heterosexual men.
The relative importance of satisfaction with penis size and its relationship to body
image satisfaction for heterosexual men is highlighted by two further studies (Lever,
Frederick, and Peplau 2006; Morrison et al. 2005). Lever, Frederick, and Peplau
(2006) revealed that heterosexual men’s penis size perception was significantly
related to their satisfaction with other parts of body/traits, including the face, overall
perceived physical attractiveness, and comfort of being seen in swimming trunks
(where an outline of penile dimensions usually discernible—with or without padded
gusset). Morrison et al. (2005) also established that genital perceptions were posi-
tively correlated with body image satisfaction among heterosexual men with the
three key areas of genital dissatisfaction being the nonerect penis length (28.6
percent), penis circumference (15.9 percent), and penis appearance (25.4 percent).
Further, a study by Algars et al. (2011), involving 3,331 men (sexual orientation
unspecified), reported an association between overall body image and satisfaction
with penis size.
Simpson and Adams 19

Genital perceptions and self-esteem. Eight quantitative studies and one qualitative
study provided data on genital perceptions and measures of genital, sexual, and
overall self-esteem (Herbenick et al. 2013; Khan et al. 2008; Morrison, Harriman,
et al. 2004; Morrison et al. 2005, 2006; Morrison, Morrison, and Bradley 2007;
Tiggemann, Martins, and Churchett 2008; Grov, Parsons, and Bimbi 2010; Cranney
2015). Three out of the seven studies contained gay or bisexual samples (Herbenick
et al. 2013; Grov, Parsons, and Bimbi 2010; Morrison, Morrison, and Bradley 2007).
All studies had medium- to high-quality ratings.
While heterosexual men may worry more than MSM about their penis (Martins,
Tiggemann, and Churchett 2008; Tiggemann, Martins, and Churchett 2008), this
does not necessarily correspond to levels of genital self-image. Research indicates
that genital perceptions and self-esteem vary to some extent by sexual identification.
It has been demonstrated that heterosexual men have a higher genital self-image than
gay or bisexual men (Herbenick et al. 2013), which is supported by findings that a
high proportion of gay MSM admit to having lied about the size of their penis (Grov,
Parsons, and Bimbi 2010). It has also been noted that men with children, more likely
to identify as heterosexual, report higher levels of penile satisfaction and are less
likely to be concerned about its size (Algars et al. 2011). Further, genital self-esteem
is significantly positively correlated with sexual self-esteem in gay men (Morrison,
Morrison, and Bradley 2007) and quality of gay life (Grov, Parsons, and Bimbi
2010). This could be linked to gay aesthetics that place a primacy on youthful
appearance (Simpson 2015) such as a desire for more head hair if balding (a sign
of ageing), less body hair, given the fashion for muscularity—a hairless or shaven
body enables clearer display of a muscled torso (“six-pack”). We acknowledge,
however, that gay aesthetics are more heterogeneous not necessarily tied to youth,
for instance, “bears” (bigger/fatter, hairier men) and daddies (mature men; see
Hennen 2005; Simpson 2015; Whitesel 2014). Nonetheless, we found that important
factors associated with genital self-esteem for gay men include the desire for mus-
cularity and internalization of homonegativity; factors which have been significantly
negatively correlated with genital self-esteem (Carballo-Die´guez et al. 2004; Grov,
Parsons, and Bimbi 2010; Morrison, Morrison, and Bradley 2007). Furthermore,
sexual self-esteem and internalized homonegativity are also negatively correlated
(Morrison, Morrison, and Bradley 2007).
Evidence suggests that while dissatisfaction with penis size is not a key predictor
of overall self-esteem for heterosexual men, the importance that an individual places
upon their penis size and anxiety over such a priority are key predictor variables
(Tiggermann et al. 2008). In a multivariate analysis, worry about penis size came
second in importance to worry about body weight in predicting self-esteem. Further,
for heterosexual men, there is a significant correlation between genital perceptions
and sexual self-esteem (Morrison et al. 2005), a negative correlation between expo-
sure to pornography images on the internet and genital and sexual self-esteem
(Morrison et al. 2006) and significant correlations between sexual experience and
genital perceptions, sexual self-esteem, and sexual anxiety (Morrison, Harriman,
20 Men and Masculinities XX(X)

et al. 2004). This is supported by Khan et al.’s (2008, 41) qualitative findings that
heterosexual men watched pornography to learn what constituted a “good” penis,
what good sex meant, where “the erect penis of a ‘sexually potent’ man is shown as
10–12 inches long” and a small penis is deemed shameful.
Also, the effects of pornography on genital and general self-esteem emerged as a
key theme in seven studies (Cranney 2015; Khan et al. 2008; Lee 1996; Morrison
et al. 2004a, 2006, 2007; Peter and Valkenburg 2014). While Kahn’s (2008) study
allows that pornography can influence perceptions of “ideal” size and appearance,
care should be taken to qualify the effects of pornography to avoid overstating its
influences. Indeed, there is evidence that consumers are able to distinguish the
exceptional from the ordinary in adjudging the penile proportions of pornographic
actors atypical (Peter and Valkenburg 2010). Further, while the “big dick” discourse
remains hegemonic, there is evidence of resistance to such thinking. In a qualitative
study of photographic and social media images, Lehman (2007) has highlighted the
complex aesthetics and politics of the penis. In particular, displays of the (smaller)
penis on D-I-Y porn/sex sites and naked marchers at gay pride parades normalize
diversity of shape and size. For Lehman, such instances render visible the smaller
penis (with minimal shaft when flaccid) that has been absent from media and cultural
production. The men involved in these activities are thought to expose the culturally
constructed character of the desire for a large(r) penis.
Psychosocial/Psychosexual Outcomes: Masculinity, Body Image,
and Sexual Practices
Ten quantitative studies, one qualitative study, and one mixed-method study pro-
vided data on psychosocial and psychosexual outcomes associated with genital
perceptions (Del Rosso 2011; Reinholz and Muehlenhard 1995; Carballo-Die´guez
et al. 2004; Grov, Parsons, and Bimbi 2010; Herbenick et al. 2013; Johnston,
McLellan, and McKinlay 2014; Khan et al. 2008; Lever, Frederick, and Peplau
2006; Morrison et al. 2005; Nutgeren et al. 2010; Moskowitz and Hart 2011; Veale
et al. 2014). Three out of the seven studies contained gay or bisexual samples (Grov,
Parsons, and Bimbi 2010; Herbenick et al. 2013; Veale et al. 2014).
The psychosocial and psychosexual outcomes described in this review include
experience of stigma, which can encompass embarrassment, level of comfort when
seen in a swimsuit, hiding one’s penis during intimacy, lying about the size of
one’s penis, sex role behavior, sexual experience and anxiety, depression, and
social phobia. Approximately one in six men experience embarrassment in relation
to their genitals (Herbenick et al. 2013). This is reflected in the relationship
between perceived penis size and the level of comfort reported in swimming trunks
and overall body satisfaction (Lever, Frederick, and Peplau 2006). Similar results
were reported by Johnston, McLellan, and McKinlay (2014) who found that the
level of comfort with others seeing their penis was related to a discrepancy
between their reported and ideal penis size. As Lever, Frederick, and Peplau
Simpson and Adams 21

(2006) have documented, men who perceived their penis to be small were less
likely to undress in front of their partners (15 percent) and were more likely to hide
their penis during sex (15 percent) than those reporting average or above average
size. Hiding the penis during sex was also related to penis size satisfaction. Nut-
geren et al.’s (2010) study of heterosexual men (who perceived their penis to be
“too small”) found that 67 percent of participants felt shame in intimate situations
with women and in communal male showers.
Within one MSM study (Grov, Parsons, and Bimbi 2010), perceived penis size
was unrelated to the number of sexual contacts. In contrast, within heterosexual
samples, there appears to be a stronger relationship between genital perceptions and
quantity and kind of sexual activity. For example, heterosexual men were more
satisfied with their penis size and reported higher levels of sexual satisfaction, less
sexual anxiety, and less delayed or premature ejaculation (Algars et al. 2011),
though the direction of causality here is undetermined (Algars et al. 2011; Reinholz
and Muehlenhard 1995).
Moreover, men who considered themselves underendowed reported discom-
fort when engaging in certain kinds of sexual activity, for example, fellatio in a
heterosexual context (Reinholz and Meuhlenhard 1995). Consequently, such
men made “careful partner choices” to find one who was supportive or under-
standing (Nutgeren et al. 2010). Finding such a partner may not be too difficult
when women seem seldom concerned about penis size (Nutgeren et al. 2010)
and prioritize other qualities or attributes, including emotional commitment
(Illouz 2012). While Martins, Tiggemann, and Churchett (2008) have reported
that for gay men, body weight and muscularity rank higher than penis size in
perceptions of attractiveness, in contrast, Moskowitz and Hart (2011) conclude
that for MSM, penis size and a general sense of masculinity are more influential
than muscularity, height, weight, and hairiness on the role adopted during sexual
activity, that is, whether individuals fulfill receptive or insertive
2
roles. While
there is a difference between these two studies in their findings of the relative
importance of penis size, these outcomes can be interpreted in the light of the
associations that were employed. In an Australian study populated by ninety-two
gay men aged between 18 and 40 and largely resident (64 percent) in Sydney/
New South Wales, Martins, Tiggemann, and Churchett (2008) found that penis
size was not ranked highly in terms of the impact on men’s perceptions of
themselves as attractive. In their study conducted in 2008, of 429 Canadian gay
men (mostly white and aged between thirty and fifty years with a mean age of
40.88), Moskowitz and Hart (2011) found that penis size was considered an
important body part in the determination of the role adopted during sexual
activity (receptive or insertive). These two findings on the importance of per-
ceived penis size are not necessarily conflicting: the former study relates per-
ceived penis size to another self-perception (that of attractiveness), while the
later relates it to one’s behavior that is one’s type of sexual interaction with
another. Nonetheless, self-perceptions were by no means uniformly negative.
22 Men and Masculinities XX(X)

For instance, Morrison et al. (2005) found that heterosexual male nonvirgins
evidenced more favorable genital perceptions than male virgins. Similarly, sexu-
ally active males reported more favorable genital perceptions than nonsexually
active males. In their study, virgins were those who had never engaged in anal
or vaginal intercourse, while nonsexually active refers to those who had not
been sexually active within the four weeks immediately preceding participation
in the study. This finding is echoed by Reinholz and Muehlenhard (1995) who
reported that genital perceptions were positively correlated with the frequency
of sex.
Concerns over perceived penis size also affect experience in social domains
where, for example, men have reported lying about the size of their penis to
maintain masculine status. A negative correlation between perceived penis size
and lying about penis size was reported by Grov, Parsons, and Bimbi’s (2010) gay
sample and this held true even for those men who perceived their penis to be of an
average size; 38.6 percent of such men stated that they had lied about the size of
their penis. While the perceptions of penis size among gay and bisexual men have
been found to be unrelated to their frequency of sexual partners (Grov, Parsons,
and Bimbi 2010), there would appear to be a strong association between penis size
and sex role behavior. Grov, Parsons, and Bimbi (2010) reported that gay men with
below average penises are more likely to identify as “bottoms” (taking an anal-
receptive role) and those with above average penises are significantly more likely
to identify as “tops” (taking an anal-insertive or more dominant role). Similar
findings were reported by Moskowitz and Hart (2011) and Carballo-Die´guez
et al. (2004). This potential relationship between penis size, sex role behavior,
and perceived masculinity has some support from the qualitative research of Khan
et al. (2008). This study in Bangladesh reported that a large penis was associated
with being “sexually potent,” while a small penis was a “weak” penis one that was
deemed shameful. The authors argued that “the penis is situated at the core of
masculinity” (2008, 45) and that “the size, shape, length, appearance and overall
performance of a penis are crucial indicators of cultural concepts of masculinity”
(2008, 45–46). Such thinking is redolent of Del Rosso’s (2011) ethnographic study
where a small penis was considered stigmatizing and men reported anxiety about
exposure and fear of shame and ridicule and Buchbinder’s view of masculinity as
“phallocentric” (1998, 49).
Wider psychosocial adjustment effects for gay men have also been reported. Gay
men who perceive their penises to be below average size have been found to also
score lower on gay life satisfaction, promoting the positive aspects of one’s life and
higher on gay-related stigma (Grov, Parsons, and Bimbi 2010). Veale et al.’s (2014)
study of heterosexual and gay men found wide-ranging associations with beliefs
about penis size which positively correlated with anxiety, depression, and social
phobia. Such beliefs also negatively correlated with body image quality of life,
erectile function, satisfaction with penis size, importance attached to penis size, and
concerns about penis size, shape, or appearance.
Simpson and Adams 23

Discussion
Following the above format, we discuss the theoretical implications of the findings
in terms of size estimations; the ideal versus reality, which we have collapsed with
considerations of genitalia and association with self-esteem; dissatisfaction with the
penis in relation to other elements of body image; and psychosexual and psychoso-
cial outcomes. Our analysis concerns men’s responses to normative masculinities,
which, although subject to change, are those which are more highly esteemed,
legitimated, and require a distancing from femininity or gender ambiguity (Connell
[1995] 2007). Our findings indicate support for Connell’s (1995) theory of hege-
monic masculinity where concerns about penis size as part of this discourse can
weigh just as heavily if not more on heterosexual men. As intimated, this concept
refers to a culturally idealized form of manhood that undergirds a hierarchy that
privileges all-round strength including economic and political power (at institutional
and interpersonal levels) as well as physical strength and essentially “manly” char-
acteristics (Wylie and Eardley 2006), which could include being well-endowed as an
enhancer of masculinity (Lever, Frederick, and Peplau 2006). Hegemonic forms of
masculinity are thought to be implicated not just in the subordination of women but
also of nonnormative expressions of masculinity like those associated with gay men
or straight men who cannot or even refuse to embody performances of masculinity
associated with aggression, competitiveness, and domination.
Further, we would support Moore’s (2002, 2007) appropriation of Connell’s
concept in her exploration of the symbolic value of semen. For Moore, hegemonic
masculinity, as expressed in scientific and popular discourses concerning semen,
works in ways that naturalize (as common sense) sexual and gender differences and
inequalities. Indeed, the author argues that in an era of gains in equality for women
courtesy of feminism, scientific sperm narratives (which have commonly used
metaphors from football, competition/war, and motor racing) reproduce heteronor-
mative beliefs about gender which sustain hegemonic masculinity.
Size Estimations
The tendency across studies for men to estimate within the average range is clear
(Lee 1996; Lever, Frederick, and Peplau 2006), and it appears that older men also
seem prone to underestimating their penis size. This desire to appear within the
normal range indicates the operation of discursive pressure to avoid a stigmatized
masculinity that risks ridicule. The age dimension suggests the strength of this
discourse may not diminish as men grow older and especially among gay men
(Veale et al. 2014), who might remain sexually experimenting into midlife and
beyond (Simpson 2015). This phenomenon could also be connected with a wider
perceived loss of masculinity with age as physical, economic, and political power
might also diminish as men are thought to lose status as they grow older (Connell
and Messerschmidt 2005). MSM’s tendency to claim a larger size (Grov, Parsons,
24 Men and Masculinities XX(X)

and Bimbi 2010) indicates pressures to claim legitimate masculine status (on hetero-
normative terms) and thus belonging within a sexual hierarchy where they are less
esteemed as men and where (even in conditions of greater tolerance toward gayness)
their masculinity is in doubt because the benchmark is heterosexual (Connell [1995]
2007). It should be borne in mind that MSM will have grown up in normatively
heterosexual male social worlds. Such a conclusion is indicated in Moskowitz and
Hart’s (2011) study which found that gay men tend to rate themselves as above
average on (related) items concerning penis size and masculinity.
The Ideal, the Reality, and Self-esteem
Although the majority of men regardless of sexual identification described them-
selves as being within the average or normal range, there were high levels of dis-
satisfaction with penis size (Lever, Frederick, and Peplau 2006; Tiggemann,
Martins, and Churchett 2008; Algars et al. 2011; Herbenick et al. 2013; Johnston,
McLellan, and McKinlay 2014). It has also been observed that gay men commonly
report larger sizes (Grov, Parsons, and Bimbi 2010) yet record lower genital
self-esteem than heterosexuals (Herbenick et al. 2013). Again, a normative mascu-
linity could be at work when it appears that men with children (commonly hetero-
sexual) are less likely to be exercised by penis size, having affirmed their
masculinity through reproduction (Algars et al. 2011). It appears that the common
desire even among those of average size for a bigger penis affects men regardless
of sexual identification (see Lever, Frederick, and Peplau 2006, for heterosexuals,
and Grov, Parsons, and Bimbi 2010, for homosexuals).
In humanistic psychology, which stresses human needs for self-realization, self-
esteem has been theorized as a function of the gap between the ideal self (what we
would like to be) and the actual self (what we think we are). These selves operate
dialectically and are products of a mix of the individual’s own self-perceptions and
understanding of how others view us (Rogers 1980; Mala¨r et al. 2011). The reasoning
here is that the smaller the gap between the two selves, the higher the self-esteem and
vice versa. While it appears that size matters to many men, we need to bear in mind the
contexts in which such concerns are articulated. Indeed, it seems likely that influences
of penis size on overall esteem are fairly negligible as is evidenced in findings on
pornography use (Cranney 2015; Khan et al. 2008; Lee 1996; Morrison et al. 2004a,
2006; Morrison, Morrison, and Bradley 2007; Peter and Valkenburg 2014). However,
evidence in Algars et al. (2011) indicates that, where this does it occur, it is likely to
weigh more heavily on MSM, which, again, suggests the operation of heteronormative,
phallocentric masculinities that equate authentic masculinity with larger penis size.
The Penis and General Body Image
In terms of satisfaction with the penis itself, findings remain variable and incon-
clusive from Morrison et al.’s (2005) finding of generally high genital satisfaction
Simpson and Adams 25

scores among heterosexual men to Veale et al.’s (2014) finding of higher levels of
dissatisfaction with penis size that was heightened among (older) gay men. Such
differences could reflect sample bias and/or cohort characteristics, though it appears
that the penis is the main component of satisfaction with genitalia and was prior-
itized even over general appearance of the latter and ejaculation (Veale et al. 2014).
However, again, concerns about the penis are contextual when we consider that,
regardless of sexual identification, anxieties can be related to even eclipsed by
anxieties over other aspects of the body. Morrison et al. (2005) and Algars et al.
(2011) showed an association between satisfaction with penis size and overall body
image among heterosexual men and apropos gay men penis size was ranked lower in
gay men’s considerations of importance (and attractiveness; Tiggemann, Martins,
and Churchett 2008) than straight men (Martins, Tiggemann, and Churchett 2008).
Not only do such findings highlight how men generally negotiate masculine attrac-
tiveness and the need to appraise the penis and attractiveness in terms of wider
bodily, psychosocial, and psychosexual contexts, they also present a challenge to
reductive, homophobic stereotypes that construct gay men as obsessed with genitalia
and sexual activity (Drummond and Filiault 2007; Klesse 2012). Such findings also
offer support for Bordo’s (1999) theorizing that media and societal attention on
men’s bodies, now more commodified and (appropriately) sexualized, have meant
that younger heterosexual men face pressures similar to gay men to manufacture a
more athletic look.
Psychosexual and Psychosocial Consequences
As intimated, the self-perception of falling short of the better-endowed masculine
ideal can influence not just identity performance but also psychosexual behavior.
The reviewed studies have tended to highlight the stigma of the small penis as lack
of masculinity when we consider men’s attempts to hide or disguise putative under-
endowment (Lever, Frederick, and Peplau 2006; Johnston, McLellan, and McKinlay
2014; Lever, Frederick, and Peplau 2006; Nutgeren et al. 2010; Reinholz and Meuh-
lenhard 1995). A smaller penis could affect sense of stigma and quality of life for
gay and straight men (Veale et al. 2014). However, we also need to consider the
psychosexual contexts for the responses of MSM and straight men to a small penis,
which reflect a key distinction between them and can affect each group in different
ways. While we have noted the operation of heteronormative discourse on MSM’s
accounts of penis size, this has not gone without challenge. Despite gay men’s
prioritization of penis size, it appears that having a small penis is not necessarily
a barrier to sexual contact or experimentation with many partners (Grov, Parsons,
and Bimbi 2010). This is reinforced by findings in the previous paragraph about the
lower ranking accorded to penis size by MSM in relation to other physical attributes.
This makes sense when we consider that the nonnormative positioning of MSM, as a
“subordinated” form of masculinity, furnishes opportunities for critical deconstruc-
tion of notions of a “real” or hegemonic masculinity (Connell 1995; Carballo-
26 Men and Masculinities XX(X)

Die´guez et al. 2004). Another distinction for MSM is that perceptions of penis size
can influence the role adopted during sexual activity, that is, whether receptive or
insertive (Grov, Parsons, and Bimbi 2010; Moskowitz and Hart 2011; Carballo-
Dieguez et al. 2004; Khan et al. 2008). This indicates another expression of heter-
normativity that can encourage MSM (and wider society) to apprehend gay sex
though the lens of heterosexual gender differences. In sum, we see a range of
contextual responses to a small penis by sexual identification, psychosocial, and
psychosexual contexts.
It is worth considering the impact of circumcision status upon men’s perception
of their penis, for while research is limited within nonclinical populations, this has
been raised by some studies evaluating patient satisfaction following urological
surgery (where circumcision was an additional outcome of the procedure; e.g.,
Aulagne et al. 2010; Mureau 1997; Bracka 1999; Eray et al. 2005). It may be
expected that the impact of circumcision status upon men’s perception of the penis
may be culturally determined; in some countries, it is considered the norm and
desirable, whereas in others, its incidence is rare and may cause social embarrass-
ment. Considering the importance of circumcision as one aspect of penile appear-
ance, it is worth noting Ruppen-Greeff et al.’s (2013) study which while reporting
differences in genital perceptions between male patients who had undergone penile
surgery and controls also found that these differences persisted in statistical analyses
even when the variable of circumcision was held constant.
While much of our findings and discussion on men’s accounts of the penis in
research offer support for hegemonic masculinity theory, such theorizing warrants
some discussion in view of recent challenge to it. Although it doesn’t specifically
focus on concerns with the penis, inclusive masculinity theory (IMT) has developed
a critique of hegemonic masculinity. IMT holds that cultural change, mainly in the
form of secularization and emergence of the women’s and gay liberation movements
together with socioeconomic changes associated with globalization, have resulted in
lower levels of “homohysteria” and sexism (Anderson 2010). Such changes have
facilitated exploration of a wider range of more emotionally attuned masculinities
organized more horizontally than hierarchically that incorporate progay and progen-
der equality stances and thus represent a challenge to existing power structures. In
view of the social changes identified, IMT argues that hegemonic masculinity, with
its emphasis on hierarchy and a dominant kind, has little explanatory value in a more
egalitarian age where men are more emotionally attuned.
We certainly recognize the profound changes in masculinity brought about in
response to the work of liberation movements, but we also concur with Bridges and
Pascoe (2014) that the “hybrid masculinities” identified by IMT, which involve
borrowing from subordinate masculinities such as gay/emotionally sensitive men,
reveal more about the flexibility and survivability of patriarchal discourse, and
social–institutional structures. Such expressions of masculinity obscure and, in
doing so, help to shore up existing systems of dominance and inequalities between
men as well as between men and women. If anything, IMT, based largely on research
Simpson and Adams 27

with young, white, middle-class heterosexual men, focuses on styles of emotional
self-expression and leaves unexamined underlying differences in social positioning
and enduring power asymmetries. Having the cultural resources (privilege) to incor-
porate hybridity (borrowed from gay struggles for recognition and equality) suggests
renewal not replacement of the patriarchal dividend and is the antithesis of challenge
to the status quo. Indeed, hybrid masculinities are often expressed in ways that
define selves against nonwhite and working-class men who are represented as
bearers of regressive masculinity. Again, such thinking simultaneously obscures and
reestablishes rather than blurs sexual differences inequalities that result from differ-
entiation (Bridges and Pascoe 2014; Ward 2015). Similarly, and in relation to the
penis, Kennedy (2015) has argued that while a movement of men seeking foreskin
restoration challenge dominant penile aesthetics (in favor of circumcision in the
United States), emphasis on the foreskin as restoring length, and priority accorded
the penis in their definition of masculinity reinforces hegemonic masculinity.
Finally, a strand of poststructuralist–feminist scholarship has highlighted
changes, courtesy of Viagra, in expectations of performance of the (ageing and/or
faulty) penis. Loe (2001) has highlighted a crisis in masculinity in terms of how
erectile functioning has become even more closely tied to legitimate and hegemonic
maleness. On this view, failure to achieve tumescence represents a “broken
masculinity” that can now be repaired by a quick technofix, which itself represents
an intensification of pharmacological–discursive control over sex, gender identity,
and reproduction. The pathologization of erectile dysfunction as failed heteromas-
culinity (seen largely as a physical problem for men) is further examined by Potts
(2000). This work extends hegemonic masculinity theory in ways that recognize its
implication in reductive, genitocentric view of male sexual pleasure that impairs its
enjoyment at physical and emotional levels.
Concluding Thoughts
This structured review has addressed a gap in knowledge concerning how hetero-
geneous accounts of the penis by men expressing different forms of sexual identi-
fication (heterosexual, gay, and MSM) indicate a variegated politics of the penis.
Such a politics involves diverse ways of negotiating penis size (inter alia) as a totem
of masculinity. Our review has highlighted contradictions in perceptions and
accounts of the penis, drawing attention to both convergences and differences
between the accounts of heterosexual and MSM concerning penis size and overall
body image, the latter suggesting the endurance of a more traditional, heteronorma-
tive masculinity, as theorized by Connell (1995, 2005), which can have esteem costs
for both heterosexual men and MSM. It appears that hegemonic masculinity remains
the organizing principle of men’s accounts of and relations with the penis.
The intended audience of this article is wide-ranging. It is hoped to be of value to
not only academics working in the area but also health-care professionals, surgeons
28 Men and Masculinities XX(X)

and, not least, those who are the subject of this study via distributed health-care
information, support, and minority interest group websites.
There are some limitations to this study. First, non-Anglophone research or that
reported in the “gray” literature has been missed. The inclusion and synthesis of
studies from different countries may have affected the validity of the synthesis due to
cultural nuances and differences. Second, while the majority of studies had medium-
to high-quality ratings, a small number (n¼4) did score lower. However, the peer-
reviewed nature of the studies represents a modicum of quality. Third, the greater
bias toward studies concentrating on heterosexual samples provides somewhat unba-
lanced samples for comparison, though some pertinent results have been obtained by
synthesizing the available research. Directions for future research clearly indicate
not only a need for more samples containing MSM but also for studies with samples
of MSM and heterosexual men that enable comparison and contrast. As part of an
agenda for research, we have highlighted the need for studies exploring penile
aesthetics (which include circumcision status—whether men are “cut” or “uncut”)
and penile anxieties among male virgins or those who are not sexually active. We
also advocate studies on transmen and concerns/practices in relation to prosthetic or
fashioned penises and the testing of hegemonic masculinity in relation to men from
differing ethnic communities and disabled men (currently conspicuous by their
absence from scholarly work) and how such influences interact with social class
in relation to stories/concerns about the penis.
Moreover, there were variations between studies in terms of sampling strategy.
Some limitations include small sample sizes, convenience sampling and response
rates, sampling methods, or measurements not being reported. We are also conscious
that our analysis reflects the apparent bias in the literature toward “Western” sam-
ples save for those few articles that focus on Asian (Khan et al. 2008), Latin Amer-
ican (Carballo-Die´guez et al. 2004), and South East Asian men (Son et al. 2003).
Nevertheless, the issues just described highlight the need for more robustly designed
comparative studies that might also factor in the influence of the ageing process
more fully to understand specific body image concerns and their correlates. Further
limitations are related to the fact that different measuring instruments were used
across the studies, some validated and others not. This is an indication of the relative
infancy of research within this field and also acts as a guide for greater rigor and
consistency in future studies.
However, we consider the limitations of the study counterweighted by contribu-
tions to knowledge and by the fact that our arguments are informed by theorizing of
Connell (1995), which not only explains reasons for penile/bodily anxieties but also
serves as a resource to question hegemonic masculinities and recuperate various
other forms. In more practical terms, our theoretically informed work could help
counselors and clinicians develop both common and differentiated resources and
strategies for helping and advising men who present with concerns about penile/
genital dimensions. Note that anxiety appears endemic—an institutionalized and
widely internalized narrative. Practitioners could, depending on service users’
Simpson and Adams 29

circumstances, emphasize a form of size realism (see Wylie and Eardley 2006),
which owns that well-endowed porn star dimensions are uncommon; bodily factors
over which men can have more control (such as weight and appearance); and that
partners are usually more concerned with broader aspects of subjectivity. We would
though qualify that more effort needs to be made by specialists to make helpful
information available in plainer terms that are accessible to nonspecialists and their
significant others who are seeking or in need of support. Such information could be
used to inform and educate through public literature and group events, meetings and
conferences, and so on. Fundamentally though, our study has illustrated how con-
cerns at the individual/microlevel are inextricably linked with broader social issues.
Following the sociological classic, it seems that privately felt concerns have decid-
edly social causes (Mills 2000).
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or
publication of this article.
Notes
1. The political and practical responses of transmen (female-to-male gender) to the penis as a
marker of masculinity are varied. According to Zimman (2014, 11), phalloplasty (the
making of a penis from other bodily regions) is uncommon among transmen concerned
to challenge the rigidity of biologically ordained gender. But, it is part of a range of options
that involve clitoral alteration to stand more freely away from the body and be “more
phallic in appearance and function” or having no alterative surgery at all. In a footnote,
Zimman (2014, 11) observes that “different trans men prioritize different goals, such as
being able to urinate while standing, retaining full erotic sensation, engaging in insertive
intercourse, or having an average sized penis.” These priorities influence the kind of
surgery desired or whether to have no genital surgery. While phallosplasty can enable
some transmen to feel complete (Cotton 2012), those eschewing surgery variously recode/
rename the genitals in a more masculine way (Wylie, Wootton, and Carlson 2016), self-
define as “a man with a vagina” (Cromwell 1999, 159) and thus blur gender rigidity, or
develop a psychic–symbolic penis that enables achievement of gendered realness and a
sense of being at home in the body (Prosser 1998). Drawing on psychoanalytic and post-
structuralist theorizing, rather than essentializing gender, a phalloplasty can be seen as a
reappropriation from normative masculinity in a way that can blur the clitoris and phallus
(Hansbury 2011). Hansbury has also argued that such practices represent permission to
construct another more fluid masculinity that is both multiform and vulnerable in being
shorn of the dominance over women associated with normative masculinity.
30 Men and Masculinities XX(X)

2. Gay/men who have sex with men sexual roles are not necessarily static can fluctuate over
the life course and even during an encounter.
References
Algars, M., P. Santtila, P. Jern, A. Johansson, M. Westerlund, and N. K. Sandnabba. 2011.
“Sexual Body Image and Its Correlates: A Population-based Study of Finnish Women and
Men.” International Journal of Sexual Health 23:26–34.
Anderson, E. 2010. Inclusive Masculinity: The Changing Nature of Masculinities. London,
UK: Routledge.
Aulagne, M. B., L. Harper, S. de Napoli-Cocci, J. M. Bondonny, and E. Dobremez. 2010.
“Long-term Outcome of Severe Hypospadias.” Journal of Pediatric Urology 6:469–72.
Bimbi, D. S., J. T. Parsons, and J. E. Nanı´n. 2005. “Stigma, Life Satisfaction, Generativity
and Attachment to the Gay Community.” Paper presented at the American Psychological
Association.
Bordo, S. 1999. The Male Body. New York: Farrar, Straus and Giroux.
Bracka, A. 1999. “Sexuality after Hypospadias Repair.” BJU International 83:29–33.
Braun, V., and V. Clarke. 2006. “Using Thematic Analysis in Psychology.” Quantitative
Research in Psychology 3:77–101.
Bridges, T., and C. J. Pascoe. 2014. “Hybrid Masculinities: New Directions in the Sociology
of Men and Masculinities.” Sociology Compass 8:246–58.
Buchbinder, D. 1998. Performance Anxieties: Re-producing Masculinity. New South Wales,
Australia: Allen and Unwin.
Carballo-Die´guez, A., C. Dolezal, L. Nieves, F. Dı´az, C. Decena, and I. Balan. 2004.
“Looking for a Tall, Dark, Macho Man ...Sexual-role Behaviour Variations in Latino
Gay and Bisexual Men.” Culture, Health and Sexuality 6:159–71.
Cash, T. F. 2000. User’s Manual for the Multidimensional Body-self Relations Questionnaire.
Norfolk, VA: Old Dominion University.
Cash, T. F., and E. C. Fleming. 2002. “The Impact of Body-image Experiences: Development
of the Body Image Quality of Life Inventory.” International Journal of Eating Disorders
31:455–60.
Connell, R. 2005. Masculinities. Power and Social Change. 2nd ed. Berkeley: University of
California.
Connell, R., and J. Messerschmidt. 2005. “Hegemonic Masculinity: Rethinking the Concept.”
Gender and Society 19:829–59.
Connell, R.W., 1995/2005. Masculinities. University of California Press: Berkeley (CA).
Connor, K. M., J. R. T. Davidson, L. E. Churchill, A. Sherwood, R. H. Weisler, and E. Foa.
2000. “Psychometric Properties of the Social Phobia Inventory (SPIN): New Self-rating
Scale.” British Journal of Psychiatry 176:379–86.
Cotton, T. ed. 2012. Hung Jury: Testimonies of Genital Surgery by Transsexual Men. Oak-
land, CA: Transgress Press.
Cranney, S. 2015. “Internet Pornography Use and Sexual Body Image in a Dutch Sample.”
International Journal of Sexual Health. 27, 3: 316–323.
Simpson and Adams 31

Cromwell, J. 1999. Transmen and F-T-Ms: Identities, Bodies, Genders and Sexualities. Chi-
cago: University of Illinois Press.
Davis, S., Y. M. Binik, R. Amsel, and S. Carrier. 2013. “The Index of Male Genital Image: A
New Scale to Assess Male Genital Satisfaction.” The Journal of Urology 190:1335–39.
Del Rosso, J. 2011. “The Penis as Public Part: Embodiment and the Performance of Mascu-
linity in Public Settings.” Sexualities 14:704–24.
Derogatis, L. R., and N. Melisaratos. 1979. “The DSFI: A Multidimensional Measure of
Sexual Functioning.” Journal of Sex and Marital Therapy 5:244–81.
Dines, G. 2007. “King Kong and the White Woman: Hustler Magazine and the Demo-
nization of Black Masculinity.” In Not For Sale: Feminists Resisting Prostitution and
Pornography, edited by R. Whisnant and C. Stark, 89–101. Melbourne, Australia:
Spinifex Press.
Drummond, M. J., and S. M. Filiault. 2007. “The Long and the Short of It: Gay Men’s
Perceptions of Penis Size.” Gay and Lesbian Issues and Psychology Review 3:121–29.
Eray, N., B. Dogangun, L. Kayaalp, H. Emir, Y. Soylet, N. Danismend, and S. Buyukunal.
2005. “Emotional Effects of Hypospadias Surgery on Turkish Boys.” Journal of Pediatric
Urology 1:75–80.
Ferreira dos Reis, M., S. GlinaII, C. Helena, and N. Abdo. 2013. “Perceptions about Penis
Size among Supposedly Healthy 40 to 60-year-old Brazilian Men: A Cross-sectional Pilot
Study.” Sao Paulo Medical Journal. 133, 2: 84–90.
Friedman, D. 2008. A Mind of Its Own: A Cultural History of the Penis. London, UK: Simon
and Schuster.
Frost, D. M., J. T. Parsons, and J. E. Nanı´n. 2007. “Stigma, Concealment and Symptoms of
Depression as Explanations for Sexually Transmitted Infections among Gay Men.”
Journal of Health Psychology 12:636–40.
Gettleman, T. E., and J. K. Thompson. 1993. “Actual Differences and Stereotypical
Perceptions in Body Image and Eating Disturbance: A Comparison of Male and Female
Heterosexual and Homosexual Samples.” Sex Roles 29:545–62.
Green, A. 2011. “Playing the (Sexual) Field: The Interactional Basis of Sexual Stratification.”
Social Psychology Quarterly 74:244–66.
Grov, C., J. T. Parsons, and D. S. Bimbi. 2010. “The Association between Penis Size and
Sexual Health among Men Who Have Sex with Men.” Archives of Sexual Behaviour 39:
788–97.
Hall, S. 1997. Representation: Cultural Representations and Signifying Practices. Vol. 2.
London, UK: Sage.
Hansbury, G. 2011. “King Kong & Goldilocks: Imagining Transmasculinities through the
Trans–trans Dyad.” Psychoanalytic Dialogues 21:210–20.
Hennen, P. 2005. “Bear Bodies, Bear Masculinity Recuperation, Resistance, or Retreat?”
Gender & Society 19:25–43.
Herbenick, D., V. Schick, M. Reece, S. Sanders, and J. D. Fortenberry. 2013. “The Devel-
opment and Validation of the Male Genital Self-image Scale: Results from a Nationally
Representative Probability Sample of Men in the United States.” Journal of Sexual Med-
icine 10:1516–25.
32 Men and Masculinities XX(X)

Humphreys, L. 1970. Tearoom Trade, Enlarged Edition: Impersonal Sex in Public Places.
London, UK: Duckworth.
Illouz, E. 2012. Why Love Hurts: A Sociological Explanation. Cambridge, UK: Polity.
Janda, L. H., and K. E. O’Grady. 1980. “Development of a Sex Anxiety Inventory.” Journal
of Consulting and Clinical Psychology 48:169–75.
Janlowski, G. S., P. C. Diedrichs, and E. Halliwelle. 2014. “Can Appearance Conversations
Explain Differences between Gay and Heterosexual Men’s Body Dissatisfaction?” Psy-
chology of Men and Masculinity 15:68–77.
Johnston, L., T. McLellan, and A. McKinlay. 2014. “(Perceived) Size Really Does Matter:
Male Dissatisfaction with Penis Size.” Psychology of Men and Masculinity 15:225–28.
Kennedy, A. 2015. “Masculinity and Embodiment in the Practice of Foreskin Restoration.”
International Journal of Men’s Health 14:38–54.
Khan, S., N. Hudson-Rodd, S. Saggers, M. Bhuiyan, A. Bhuiya, S. Karim, and O. Rauyajin.
2008. “Phallus, Performance and Power: Crisis of Masculinity.” Sexual and Relationship
Therapy 23:37–49.
Kimmel, M., C. Milrod, and A. Kennedy, eds. 2014. Cultural Encyclopedia of the Penis.
Lanham, MD: Rowman & Littlefield.
Kinsey, A. C., W. B. Pomeroy, and C. E. Martin. 1948. Sexual Behaviour in the Human Male.
Philadelphia, PA: Saunders.
Klesse, C. 2012. The Spectre of Promiscuity: Gay Male and Bisexual Non-monogamies and
Polyamories. Farnham, UK: Ashgate.
Lee, P. A. 1996. “Survey Report: Concept of Penis Size.” The Journal of Sex and Marital
Therapy 22:131–35.
Lehman, P. 2007. “You and Voyeurweb: Illustrating the Shifting Representation of the Penis
on the Internet with User-generated Content.” Cinema Journal 46:108–16.
Lever, J., D. A. Frederick, and L. A. Peplau. 2006. “Does Size Matter? Men’s and Women’s
Views on Penis Size across the Lifespan.” Psychology of Men and Masculinity 7:129–43.
Levitan, J. 1983. “The Relationship between Body-image and Sexual Control, Sexual Anxi-
ety, and Sexual Assertiveness in Selected Groups of College Women.” Unpublished
doctoral dissertation, New York University, New York.
Liossi, C. 2003. Appearance Related Concerns across the General and Clinical Populations.
Accessed January 2, 2015. http://ukpmc.ac.uk/theses/ETH/407535.
Lockwood, P., C. H. Jordan, and Z. Kunda. 2002. “Motivation by Positive or Negative Role
Models: Regulatory Focus Determines Who Will Best Inspire Us.” Journal of Personality
and Social Psychology 83:854–64.
Loe, M. 2001. “Fixing Broken Masculinity: Viagra as a Technology for the Production of
Gender and Sexuality.” Sexuality and Culture 5:97–125.
Mala¨r, L., H. Krohmer, W. D. Hoyer, and B. Nyffenegger. 2011. “Emotional Brand Attach-
ment and Brand Personality: The Relative Importance of the Actual and the Ideal Self.”
Journal of Marketing 75:35–52.
Martins, Y., M. Tiggemann, and L. Churchett. 2008. “The Shape of Things to Come: Gay
Men’s Satisfaction with Specific Body Parts.” Psychology of Men and Masculinity 9:
248–56.
Simpson and Adams 33

Mayfield, W. 2001. “The Development of the Internalised Homonegativity Inventory for Gay
Men.” Journal of Homosexuality 41:53–76.
Mellor, D., M. Fuller-Tyszkiewicz, M. P. McCabe, and L. A. Ricciardelli. 2010. “Body
Image and Self-esteem across Age and Gender: A Short-term Longitudinal Study.” Sex
Roles 63:672–81.
Mills, C. W. 2000. The Sociological Imagination. Oxford, UK: Oxford University Press.
Mondaini, N., R. Ponchiett, M. Bonafe, S. Biscioni, F. Di Loro, P. Agostini, F. Salvestrini, and
M. Rizzo. 2002. “Hypospadias: Incidence and Effects on Psychosexual Development as
Evaluated with the Minnesota Multiphasic Personality Inventory Test in a Sample of
11,649 Young Italian Men.” Urology International 68:81–85.
Moore, L. J. 2002. “Extracting Men from Semen Masculinity in Scientific Representations of
Sperm.” Social Text 20:91–119.
Moore, L. J. 2007. Sperm Counts: Overcome by Man’s Most Precious Fluid. New York: New
York University Press.
Morrison, T. G., A. Bearden, S. R. Ellis, and R. Harriman. 2005. “Correlates of Genital
Perceptions among Canadian Post-secondary Students.” Electronic Journal of Human
Sexuality. Accessed February 26, 2015. http://www.ejhs.org/volume8/GenitalPercep
tions.htm.
Morrison, T. G., S. R. Ellis, M. A. Morrison, A. Bearden, and R. L. Harriman. 2006.
“Exposure to Sexually Explicit Material and Variations in Body Esteem, Genital Attitudes,
and Sexual Esteem among a Sample of Canadian Men.” The Journal of Men’s Studies 14:
209–22.
Morrison, T. G., R. Harriman, M. A. Morrison, A. Bearden, and S. R. Ellis. 2004. “Correlates
of Exposure to Sexually Explicit Material among Canadian Post-secondary Students.”
Canadian Journal of Human Sexuality 13:143–56.
Morrison, T. G., M. A. Morrison, and B. A. Bradley. 2007. “Correlates of Gay Men’s
Self-reported Exposure to Pornography.” International Journal of Sexual Health 19:
33–43.
Morrison, T. G., M. A. Morrison, C. Hopkins, and E. T. Rowan. 2004. “Muscle Mania:
Development of a New Scale Examining the Drive for Muscularity.” Psychology of Men
and Masculinity 5:30–39.
Moskowitz, D. A., and T. A. Hart. 2011. “The Influence of Physical Body Traits and
Masculinity on Anal Sex Roles in Gay and Bisexual Men.” Archives of Sexual Behavior
40:835–41.
Mureau, M. A. 1997. “Psychosexual and Psychosocial Development of Patients with Hypos-
padias.” Nederlands Tijdschrift voor Geneeskunde 141:188–91.
Murray, T., and V. Lewis. 2014. “Gender-role Conflict and Men’s Body Satisfaction: The
Moderating Role of Age.” Psychology of Men & Masculinity 15:40–48.
NICE (National Institute for Health and Clinical Excellence). 2012. Methods for the Devel-
opment of NICE Public Health Guidance (third edition): Appendix H Quality Appraisal
Checklist – Qualitative Studies. London, UK: NICE. Accessed March 7, 2015. https://
www.nice.org.uk/article/pmg4/chapter/appendix-h-quality-appraisal-checklist-qualita
tive-studies#checklist-2.
34 Men and Masculinities XX(X)

Nutgeren, H. M., G. T. Balkema, A. L. Pascal, W. C. M. Weijmar Schultz, J. M. Nijman, and
M. F. van Driel. 2010. “18-year Experience in the Management of Men with a Complaint
of a Small Penis.” Journal of Sex and Marital Therapy 36:109–17.
Ogden, J. 2012. Health Psychology. Maidenhead, UK: Open University Press.
Peter, J., and P. M. Valkenburg. 2014. “Does Exposure to Sexually Explicit Internet Material
Increase Body Dissatisfaction? A Longitudinal Study.” Computers in Human Behavior 36:
297–307.
Peter, Jochen, and Patti M. Valkenburg. 2010. “Processes underlying the effects of adoles-
cents’ use of sexually explicit internet material: The role of perceived realism.” Commu-
nication Research 37, 3: 375–399.
Pliner, P., S. Chaiken, and G. L. Flett. 1990. “Gender Differences in Concern with Body
Weight and Physical Appearance over the Life Span.” Personality and Social Psychology
Bulletin 16:263–73.
Potts, A. 2000. ““The Essence of the Hard On”: Hegemonic Masculinity and the Cultural
Construction of “Erectile Dysfunction.”” Men and Masculinities 3:85–103.
Prosser, J. 1998. Second Skins: The Body Narratives of Transsexuality. New York: Columbia
University.
Reinholz, R. K., and C. L. Muehlenhard. 1995. “Genital Perceptions and Sexual Activity in a
College Population.” The Journal of Sex Research 32:155–65.
Rogers, C. 1980. A Way of Being. Boston, MA: Houghton Mifflin.
Rosen, R., A. Riley, G. Wagner, I. Osterloh, J. Kirkpatrick, and A. Mishra. 1997. “The
International Index of Erectile Disfunction (IIEF): A Multidimensional Scale for Assess-
ment of Erectile Dysfunction.” Urology 49:822–30.
Rosenberg, M. 1965. Society and the Adolescent Self-image. Princeton, NJ: University Press.
Rothman, A. J., K. M. Kelly, N. D. Weinstein, and A. O’Leary. 1999. “Increasing the
Salience of Risky Sexual Behaviour: Promoting Interest in HIV Antibody Testing among
Heterosexually Active Young Adults.” Journal of Applied Social Psychology 29:531–51.
Roy, M., and H. Payette. 2012. “The Body Image Construct among Western Seniors: A
Systematic Review of the Literature.” Archive of Gerontological Geriatrics 55:505–21.
Ruppen-Greeff, N. K., D. M. Weber, R. Gobet, and M. A. Landolt. 2013. “Health-related
Quality of Life in Men with Corrected Hypospadias: An Explorative Study.” Journal of
Pediatric Urology 9:551–58.
Simpson, P. 2015. Middle-aged Gay Men, Ageing and Ageism: Over the Rainbow? Basing-
stoke, UK: Palgrave Macmillan.
Siever, M. D. 1994. “Sexual Orientation and Gender as Factors in Socio-culturally Acquired
Vulnerability to Body Dissatisfaction and Eating Disorders.” Journal of Consulting and
Clinical Psychology 62:252–60.
Snell,W. E., and D. R. Papini. 1989. “The SexualityScale: An Instrument to Measure Sexual Self-
esteem, Sexual-depression, and Sexual Preoccupation.” Journal of Sex Research 26:256–63.
Son, H., H. Lee, J. Huh, S. W. Kim, and J. Paick. 2003. “Studies on Self-esteem of Penile Size
in Young Korean Military Men.” Asian Journal of Andrology 5:185–89.
Stern, B. B., B. Barak, and S. J. Gould. 1987. “Sexual Identity Scale: A New Self-assessment
Measure.” Sex Roles 17:503–19.
Simpson and Adams 35

Strong, S. M., D. Singh, and P. K. Randall. 2000. “Childhood Gender Nonconformity and
Body Dissatisfaction in Gay and Heterosexual Men.” Sex Roles 43:427–39.
Stunkard, A. J., T. Sorenson, and F. Schulsinger. 1980. “Use of the Danish Adoption Register
for the Study of Obesity and Thinness.” In The Genetics of Neurological and Psychiatric
Disorders, edited by S. Kety, 115–20. New York: Raven Press.
Tiggemann, M., Y. Martins, and L. Churchett. 2008. “Beyond Muscles: Unexplored Parts of
Men’s Body Image.” Journal of Health Psychology 13:1163–72.
Timmer, A., L. R. Sutherland, and R. J. Hilsden. 2003. “Development and Evaluation of a
Quality Score for Abstracts.” BMC Medical Research Methodology 3:2.
Vardi, Y., and L. Lowenstein. 2005. “Penile Enlargement Surgery-fact or Illusion?” Nature
Clinical Practice Urology 2:114–15.
Veale, D., E. Eshkevari, J. Read, S. Miles, A. Troglia, R. Phillips, L. Echeverria, C. Fiorito, K.
Wylie, and G. Muir. 2014. “Beliefs about Penis Size: Validation of a Scale for Men
Ashamed about Their Penis Size.” Journal of Sexual Medicine 11:84–92.
Ward, J. 2015. Not Gay: Sex between Straight White Men. New York: NYU Press.
Whitesel, J. 2014. Fat Gay Men: Girth, Mirth, and the Politicsof Stigma. New York: NYU Press.
Winter, H. C. 1989. “An Examination of the Relationship between Penis Size and Body
Image, Genital Image, and Perception of Sexual Competency in the Male.” Dissertation
Abstracts International 50:1225.
World Health Organization. 2008. Male Circumcision: Global Trends and Determinants of
Prevalence, Safety, and Acceptability. Geneva, Switzerland: World Health Organization.
Wylie, K. 2008. “The Way Forwards with the Obsession with the Penis.” Sexologies 17:S46.
Wylie, K., and I. Eardley. 2006. “Penile Size and the ‘Small Penis Syndrome.’” BJU Inter-
national 99:1449–55.
Wylie, K., E. Wootton, and S. Carlson. 2016. “Sexual Function in the Transgender Popula-
tion.” In Principles of Transgender Medicine and Surgery, 2nd ed., edited by R. Ettner, S.
Monstrey, and E. Coleman, 159–81. New York: Routledge.
Zigmond, A., and R. P. Snaith. 1983. “The Hospital Depression and Anxiety Scale.” Acta
Psychiatrica Scandinavica 67:361–70.
Zimman, L. 2014. “The Discursive Construction of Sex: Remaking and Reclaiming the
Gendered Body in Talk about Genitals among Trans Men.” In Queer Excursions: Retheor-
izing Binaries in Language, Gender, and Sexuality, edited by L. Zimman, J. Davis, and J.
Raclaw, 13–34. New York: Oxford University Press.
Author Biographies
Paul Simpson is a lecturer in the Sociology of Health and Care who has published extensively
on ageing gay masculinities, masculinities and the life course and sex, sexuality and intimacy
among older people/care home residents.
Julie Adams is a chartered psychologist and university lecturer who has taught and published,
inter alia, in the field of Applied Psychology.
36 Men and Masculinities XX(X)