How Big is Too Big? The Girth of Bestselling Insertive Sex Toys to Guide Maximal Neophallus Dimensions

Abstract

Background In our practice we have encountered 4 female-to-male transgender patients seeking neophallus revision surgery for girth precluding penetrative vaginal or anal intercourse. Despite this, there is little evidence available to guide transitioning patients in neophallus sizing. In this work we examined the dimensions of bestselling realistic dildos, presuming that the most popular dimensions would reflect population preferences for penetrative toys and phalluses. Aim To determine a maximal upper limit for girth compatible with penetrative intercourse based on measurements of bestselling realistic dildos and published erect penile dimensions. Methods We collected measurements for “realistic dildos” designated as bestsellers for the top 5 Alexa.com-rated online adult retailers in the United States and for Amazon.com. We compared these with measurements of dildos available at Good Vibrations in San Francisco and with studies of erect natal dimensions. We compared all data with measurements of 4 index patients whose neophallus girth prevented penetrative intercourse. Outcomes Length and circumference of overall bestselling and largest bestselling realistic dildos as reported on top websites and measured by investigators. Results The average insertive length of the compiled dildos (16.7 ± 1.6 cm) was 1 SD longer than natal functional erect penile length as reported in the literature (15.7 ± 2.6 cm); however, their average circumference (12.7 ± 0.8 cm) mirrored natal erect penile girth (12.3 ± 1.3). The average girth of vendors' top 3 largest-girth dildos was 15.1 ± 0.9 cm, 2 SD wider than natal erect penile girth. Index patients had an average length of 16.3 ± 3.2 cm and an average girth of 17.6 ± 1.3 cm. Index patient girth was 4 to 5 SD wider than the average natal erect girth. Clinical Implications Based on our data, we suggest that a surgically created neophallus should have a girth no wider than 15.1 cm after implantation of an inflatable penile prosthesis. This corresponds to 2 SD wider than the average natal man's erect girth. Strengths and Limitations Strengths include in-person measurements of patients whose girth prevented penetrative intercourse, the large number of dildos assessed, and correlations with in-person measurements. Limitations include the inability to account for the pliability of different materials, whether dildos were used for vaginal and/or anal insertion, the limited sample of 4 transmen for in-person measurement, and the absence of implanted inflatable penile prostheses in index neophalluses. Conclusions Neophallus girth wider than 15.1 cm could lead to difficulty in penetrative intercourse for many individuals. A conservative recommendation for neophallus girth is 13 to 14 cm, or 0.5 to 1.5 SD wider than natal erect penile girth.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

“…There are numerous examples of this in the extant literature: Surgery may result in a decrease, a total loss, or a possible increase in erogenous stimulation and/or experienced sensation compared with the patient’s presurgery anatomy (Garcia, 2018 ; Sigurjónsson et al., 2017). A particular surgical option may be associated with specific limitations to sexual function that may manifest immediately, in the future, or at both timepoints, and which patients should consider before finalizing their choice when considering different surgical options (Frey et al., 2016; Garcia, 2018 ; Isaacson et al., 2017 ). Postsurgical complications can adversely affect sexual function by either decreasing the quality of sexual function (e.g., discomfort or pain with sexual activity) or by precluding satisfactory intercourse (Kerckhof et al., 2019 ; Schardein et al., 2019 ).…”

“…A particular surgical option may be associated with specific limitations to sexual function that may manifest immediately, in the future, or at both timepoints, and which patients should consider before finalizing their choice when considering different surgical options (Frey et al., 2016; Garcia, 2018 ; Isaacson et al., 2017 ).…”

Circumferential Acquired Macropenis: Definition, Literature Review and Proposal of Geometrically-Based Reduction Corporoplasty

“…The study concluded that a maximal final girth of 15.1 cm should not be exceeded, as a wider girth could be associated with an inability to engage in penetrative intercourse and/or result in pain for the patient's partner. 11 Among the cases we retrieved, along with our case, those associated with impossibility of normal penetration and/or dyspareunia 2,4,6,7,9 have all a maximal penile girth at erection that exceeds the above values, ranging from 16 to 25 cm. This consideration further supports our definition of "circumferential acquired macropenis" syndrome, as the development over time of a penile girth enhancement that mechanically hampers penetration.…”

“…The study concluded that a maximal final girth of 15.1 cm should not be exceeded, as a wider girth could be associated with an inability to engage in penetrative intercourse and/or result in pain for the patient's partner. 11 …”

‘Modified Phallourethroplasty’ as a Surgical Alternative to Phalloplasty With Urethral Lengthening: Technique, How We Present This Option to Patients, and Clinical Outcomes

“…When the P+UL flap is tubularized in a “tube within a tube” design, the resulting phallus will often be too thick, heavy, and not usable for insertive intercourse. 19 With P-UL, the absence of a full-length urethra segment makes the phallus less heavy and thick. Furthermore, because there is no full-length urethra, there is minimal to no risk with opening the phallus (at Stage II surgery) to thin and narrow it by excising excess adipose tissue and skin.…”