Most urologists are well aware that despite the concern manifested by many men about small penile size, the organ's size in the majority of men seeking penile augmentation is actually normal. A two-year study at the University of Florence, involving 67 men aged 16 - 55 who requested surgical lengthening, recently confirmed this observation. Although all of them considered their penises "short" and in need of reconstruction, none turned out to have a penis that was very short according to established norms or to suffer any other penile abnormality. About 85% of them erroneously expected a normal flaccid penis to measure 3.9 to 6.7 inches (10 - 17 cm); about 15% could not estimate a normal size. The majority related their misconceptions of penis size to childhood comparisons with their fathers or friends, or to later comparisons with actors in pornographic movies.
Cases of real micropenis, although rare, merit full evaluation and management. A suggested objective definition of a penis as abnormally short is based on proposed measurements of less than 4.5 cm for flaccid length and less than 7 cm erect or stretched - or, more accurately, when stretched flaccid, length is more than two standard deviations below average, according to approved norms. A thorough medical workup for a man whose penis meets the above definition of small should include karyotyping (chromosomal examination), genetic studies, and evaluation of pituitary and testicular hormones in the bloodstream as well as testosterone and dihydrotestosterone in the genital tissue.