I’ve examined thousands of penises as a urologist and seen every size. Here’s what REALLY counts as small… the true average length… and ‘growing’ treatment that actually works: DR ARTHUR BURNETT

It’s a question I’ve been asked countless times over my 40-year career as a urologist, though men rarely ask it outright.

More often, they come to see me about something else, such as erectile dysfunction or a rash. Then, as the consultation draws to a close, they’ll finally ask me: ‘Doctor, is my penis too small?’

As a urologist who has examined thousands of men over more than four decades, I always try to answer with compassion but also with the medical facts.

My job is to reassure – where reassurance is appropriate – recognize when there is a genuine medical problem and help men separate fact from the many misconceptions surrounding penis size.

So what do I say?

First, it’s important to understand what is normal.

Contrary to what you might imagine, I don’t routinely reach for a ruler or measuring tape when a man tells me he has these concerns.

In most cases, I can tell at a glance whether a man’s penis falls within the broad range considered medically typical.

One of the first things I explain is that flaccid length doesn’t necessarily predict erect length.

We even have a locker-room phrase for it: ‘showers’ and ‘growers’.

Some men appear quite small at rest but gain much more length during an erection, while others change relatively little. Both are entirely normal, and erect length is what matters most.

There has been no shortage of research into penis size over the years. The problem is that many older studies relied on men measuring themselves at home, introducing obvious sources of error, from differing techniques to, perhaps, a little wishful thinking.

The study most urologists regard as the gold standard is a 2015 King’s College London-led systematic review, which pooled data from 17 studies involving more than 15,500 men. Crucially, measurements were taken by trained health professionals using a standardized method rather than being self-reported.

Doctors are particularly interested in what is known as stretched flaccid length. Rather than measuring the penis in its relaxed state, which varies enormously depending on temperature, anxiety and other factors, they gently stretch it to its maximum comfortable length.

Research has shown this closely predicts erect length, which is why urologists use it when they need an objective measurement.

The review found that the average flaccid penis measured 9.16cm (3.6in), while the average stretched flaccid penis measured 13.24cm (5.2in).

A handful of studies measured erect length directly and arrived at virtually the same figure, 13.12cm (5.16in), as the average stretched flaccid length.

In my experience, many men who worry about their size have a penis well within the normal range.

I try to reassure them of that, drawing on the perspective of someone who has seen thousands of penises throughout his career.

Some men, however, remain convinced they are too small. I’ve even seen men with penises measuring six to eight inches who still believed they were inadequate.

Some of these men have what we call penile dysmorphic disorder.

They have a completely normal, healthy penis but have become convinced that it is too short or should be considerably larger.

I think pornography has played a role by giving many young men unrealistic expectations about penis size and reinforcing the myth that a larger penis is inherently more satisfying for women.

Of course, some men genuinely do have what doctors call a micropenis, formally defined as a stretched penile length of around 9.3cm (3.7in) or less in adulthood.

This is usually the result of something disrupting normal penile development before birth. That may be due to hormonal or genetic abnormalities, or occur as part of a broader disorder of sexual development, in which the reproductive organs do not develop in the typical way.

In my field, we do seem to be seeing more congenital abnormalities affecting the male genitals.

It’s difficult to know exactly why, but there are concerns that exposure during pregnancy to environmental chemicals such as plasticizers may play a role in disrupting normal fetal development.

If these conditions are recognized in infancy or childhood, hormone treatment can sometimes be used to encourage penile growth.

Once someone reaches adulthood, however, the options become far more limited.

Another condition I see is known as a buried penis, in which part or all of the shaft is hidden beneath the skin or fat around the pubic area, making the penis appear much shorter than it really is.

Obesity is by far the most common cause, although it can also result from previous surgery, including circumcision if too much skin has been removed.

If obesity is the underlying problem, losing weight can make a dramatic difference to the penis’s apparent length. Newer weight-loss drugs are helping many patients achieve that. However, some are left with excess fat or skin around the pubic area and may still benefit from reconstructive surgery or procedures such as liposuction.

If the problem stems from previous surgery, for example a circumcision in which too much penile skin was removed, we may work alongside plastic surgeons to perform skin grafts and reconstructive procedures that can restore some of the penis’s visible length.

If a man genuinely has a significantly undersized penis, I won’t deceive him. Where there is a genuine anatomical problem, I want patients to know there may be ways to help.

Some men, for example, are born with penoscrotal webbing, where the scrotal skin extends unusually far up the underside of the penis, making the shaft appear shorter than it really is. Correcting this can reveal more of the existing shaft.

What I don’t support are cosmetic enlargement procedures simply because a man wants to be bigger.

Some doctors offer injections of dermal fillers, typically hyaluronic acid, the same gel-like substance widely used to plump lips and smooth wrinkles, to increase penile girth.

The problem is that these fillers can migrate, become lumpy or misshapen, and leave men looking worse than before. Whenever I’m asked about these procedures, my question is always the same: is the potential benefit really worth the risk?

The same applies to procedures such as suspensory ligament release, in which the ligament attaching the penis to the pubic bone is cut. This does not create a longer penis. It simply allows more of the shaft that normally sits inside the body to hang outside.

While this may make the penis appear longer when flaccid, it does not necessarily achieve what patients hope for. Because the suspensory ligament helps support the penis during an erection, cutting it can alter the angle of the erection.

If scar tissue develops, the penis may even end up appearing shorter than before.

I’ve also treated men who injured themselves using traction devices that claim to lengthen the penis through prolonged stretching.

Some developed permanent numbness, while others suffered nerve or skin damage. That makes me very cautious about whether the potential benefits justify the risks.

The worst complications I’ve seen have involved tissue loss, severe scarring and permanent disfigurement. Some men have been left with an irregular penis, with lumps, curves and scarring that can never be fully corrected.

The reality is that I don’t think we currently have any procedure that is particularly successful at making the penis genuinely longer.

Could that change one day? Perhaps. I’m always optimistic about science. Gene therapies or regenerative techniques may eventually allow us to recreate or grow penile tissue. But we are a long way from that point.

My impression is that concerns about penis size are particularly common among younger men who are single and trying to form relationships. They often feel under enormous pressure and worry they will be judged by a prospective partner.

Some tell me they have received unkind comments about their penis, or at least interpreted an experience that way. Others are struggling with relationships and have convinced themselves that penis size is to blame.

I don’t try to be a psychiatrist. That isn’t my area of expertise. But if I think a man’s distress goes beyond normal anxiety, I will refer him to colleagues who can help him work through those psychological issues.

One of the biggest misconceptions is the idea that bigger is automatically better.

As far as I am aware, there is no good evidence that men with larger penises enjoy better sex lives simply because of their size.

In fact, I’ll share one observation from my own practice, with an important caveat. Over the years, I’ve noticed that some of the men who come to me needing penile implants for severe erectile dysfunction have relatively long penises.

I want to stress that this is simply a clinical impression, not a scientific finding. Nevertheless, it has made me wonder whether having a greater volume of erectile tissue could, in some men, make it harder to achieve complete rigidity.

What I can say with much greater confidence is that there is no good evidence that a larger penis is more sexually satisfying for women.

That is one of the biggest myths pornography has perpetuated. It has created the impression that size is the key to female pleasure when female sexual anatomy is far more complex than that.

The main nerve tissue responsible for female sexual pleasure is the clitoris and the surrounding external genitalia. The most sensitive part of the vagina is also its outer portion. Simply having a longer penis does not necessarily provide greater stimulation.

After all, I tell every man the same thing: we are not measured by our penile dimensions. We are measured by how we use what we have.

To borrow an old saying, it’s not the size of the paintbrush, it’s how you do the painting.

Ultimately, satisfying sex is not determined by the length of your penis.

It’s about how you perform as a lover and, more broadly, who you are, how you treat your partner, and the kind of person you are.

That’s the perspective I hope every patient leaves my office with.