title: Analysis of the Interobserver Variability in Penile Length Assessment.
abstract: BACKGROUND
  Many men seek penile augmentation treatments-a standard tool for their counseling is to inform them of what is "normal." Although some studies suggest good correlation between stretched and erect penile length, those that have measured stretched and erect length simultaneously have shown significant variability.
  
  
  OBJECTIVE
  To assess the accuracy of differing penile measurements with multiple observers.
  
  
  METHODS
  We recruited 201 adult men (mean age 49.6 years) who achieved full erection using intracavernosal injection.
  
  
  METHODS
  Penile measurements were taken by one of seven andrology specialists in a private, temperature-controlled (21°C, 72°F) environment. Stretched flaccid and erect length and circumference were measured. We analyzed the accuracy of each flaccid measurement using the erect measurements as a reference, for the overall patient population and for each observer.
  
  
  RESULTS
  The mean underestimate of length from stretched flaccid to erect was 2.64 cm (21.4%) and girth 2.27 cm (19.5%). Interobserver variability ranged from a mean underestimate of 16-27% (length) and 15-27% (girth).
  
  
  CONCLUSIONS
  In this large, multicenter, multi-observer study of penis size, flaccid measurements underestimated erect size. It also seems likely that there is significant interobserver variability. We believe erect penis measurements should be used for men being considered for treatment of small penis anxiety.
authors.affiliation: Urology and Andrology Department, Elaj Medical Centers, Jeddah, KSA.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Habous
authors.affiliation: Urology Department, King's College, London, UK.
authors.forename: Gordon
authors.initials: G
authors.lastname: Muir
authors.affiliation: Urology Department, Zagazig University, Zagazig, Egypt.
authors.forename: Alaa
authors.initials: A
authors.lastname: Tealab
authors.affiliation: University Hospitals Birmingham, Birmingham, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Williamson
authors.affiliation: Urology and Andrology Department, Elaj Medical Centers, Jeddah, KSA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elkhouly
authors.affiliation: Urology and Andrology Department, Elaj Medical Centers, Jeddah, KSA.
authors.forename: Waleed
authors.initials: W
authors.lastname: Elhadek
authors.affiliation: Urology and Andrology Department, Elaj Medical Centers, Jeddah, KSA.
authors.forename: Saad
authors.initials: S
authors.lastname: Mahmoud
authors.affiliation: King Khaled Hospital, Tabouk, KSA.
authors.forename: Osama
authors.initials: O
authors.lastname: Laban
authors.affiliation: Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, KSA.
authors.forename: Saleh
authors.initials: S
authors.lastname: Binsaleh
authors.affiliation: Urology Department, Benha University, Benha, Egypt.
authors.forename: Osama
authors.initials: O
authors.lastname: Abdelwahab
authors.affiliation: Sexual and Reproductive Medicine Program, Memorial Sloan Kettering Cancer, New York, NY, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Mulhall
authors.affiliation: Institute of Psychiatry, Psychology, and Neuroscience, Kings College, London, UK.
authors.forename: David
authors.identifier: http://orcid.org/0000-0002-1717-4766
authors.initials: D
authors.lastname: Veale
mesh_terms: D000328:Adult; D001007:Anxiety; D001828:Body Image / Q000523:psychology*; D037001:Directive Counseling; D006801:Humans; D008297:Male; D054526:Men's Health; D015588:Observer Variation; D009929:Organ Size / Q000502:physiology; D017063:Outcome Assessment, Health Care; D010410:Penile Erection / Q000502:physiology* / Q000523:psychology; D010413:Penis / Q000033:anatomy & histology* / Q000601:surgery; D012016:Reference Values
keywords: Interobserver Errors; Methodology; Penile Size Measurement; Underestimate