Blanca Madurga, urologist: ‘The boys of the new generations have, on average, a larger penis’

From the cave paintings to graffiti. From Michelangelo’s David to any teenager’s notebook. The penis is probably the most represented human organ in history. More than an appendix, it has become a symbol. The only other organ that’s been depicted as often is the heart, which has become a representation of love and affection. Perhaps, reflects urologist Blanca Madurga Patuel, 65, the penis is depicted so often because it is also a symbol, one representing manhood and virility.

This is seen beyond art. In language, too, many expressions refer to the male sexual organ. Conversations often revolve around it. Men talk a lot about their penis, but not often in a medical context.

While women go to the gynecologist regularly from the age of 20, men do not go to the andrologist until they have a problem and typically don’t start seeing a urologist until they are over 50. While there is a lack of medical knowledge, biased and false information abounds on the internet, further muddying a difficult conversation, full of myths, taboos and ignorance.

With 30 years of experience, Madurga knows this well. The urologist works as a professor at the Hospital del Mar, in the Spanish city of Cádiz, and is an associate professor at Cádiz University. She has just published the book Todo lo que necesitas saber sobre el pene y nunca te atreviste a preguntar (in English: Everything you need to know about the penis and never dared to ask), which draws on the meta-analysis Worldwide Temporal Trends in Penile Length, published in 2023. This analyzed 75 studies carried out from 1942 to 2021, including data from 55,000 men. “Erect length increased significantly over time in several regions of the world and across all age groups,” the research states. “After adjusting for geographic region, subject age, and subject population, erect penile length increased 24% over the past 29 years.” A graph shows that the average penis went from measuring just over 12 centimeters in 1990 to exceeding 15.5 in 2021.

Madurga speaks to EL PAÍS about the fact and fiction behind the male reproductive organ.

Question. What should men know about penises that they don’t dare to ask?

Answer. Many things. A man only goes to the andrologist when he has an extremely serious problem, because first he has to overcome a cultural resistance, a general fear, because there is a lot of myth around the penis that relates it to being a macho, a leader, a strong guy. Most men, when they come for a consultation, what they want to know is if what is happening to them is normal. If it is normal to get older and for sexual potency to decrease. If it is normal for erections to not last as long as they should. If the size of their penis is normal or if it’s normal to lose an erection. Approximately 52% of men between 40 and 70 years old have erectile dysfunction, in most cases moderate. So yes, it’s normal. They are simple doubts that trigger many problems because enormous social stigma is associated with them. If you think about it, even the term impotent has a very pejorative connotation. I hate that word.

Q. And what word do you think would be more appropriate?

A. It is not necessary to catalog the person, but rather what is happening to them. And what is happening to him is that he has erectile dysfunction. Impotency suggests that we can’t do anything and never will be able to. And erectile dysfunction is a disorder that can simply be temporary.

Q. You spoke to me about penis sizes, but didn’t give me a figure.

A. There are several things to keep in mind on this subject. The first thing is that the average penis size that is considered normal is obtained by counting the measurements of the entire population, of all subjects. Logically, in those measurements, there will be someone who has a penis measuring 30 centimeters and another who has a six-centimeter penis. And both are normal. But the average is approximately 10 centimeters in erection. We always measure the penis in erection, because when the penis is relaxed we do not know how much it will multiply its size. There are very large penises at rest that do not grow and small penises that double in size. It should also be taken into account that this average is made all over the world and in sub-Saharan African countries they have one or two centimeters more on average. So the myth that Black men have giant penises is not true. There are differences, but they are small. Many people talk about micropenis when these penises, which are those smaller than six centimeters in erection, are very rare. And unfortunately they are usually associated with syndromes.

Q. In the last 30 years, new generations have become taller thanks to nutritional improvements. This is something that is known and discussed. It is more surprising to find out, as you explain in your book, that their penis has also grown...

A. Of course. The penis grows in line with the body. After all, it is made up of vascular tissue, especially blood vessels and covered by skin, which is generated with proteins. When you have a diet based more on protein, like the current one, the body develops more. We are taller than the previous generation. Girls start menstruating earlier, there is earlier development. And the boys of the new generations have, on average, larger penises.

Q. But that doesn’t mean they have any less complexes. How has easy access to porn changed men’s perception of their penis?

A. A lot. Especially in terms of size and performance. I have been working in this field for 35 years and there has been a rise in consultations, especially in very young patients. They will never reach expectations that are completely false, because porn is not real life. Young people have access to a lot of information about sex, but that does not guarantee that they are well-informed. More than 90% of the information about the penis on the internet is misleading or downright false. I did some work on it, I scoured about 300 pages and saw two, from two prestigious urologists, talking seriously about penis size. The rest were false, exaggerated, with the sole purpose of selling miracle products. There is an impressive industry behind it, all these complexes make a lot of money. Sex sells, especially if it is based on lies. And the problem is that the majority of men who have a problem don’t take action, only a minority come later for a consultation. The rest are left with that false information. The internet is the anteroom of the andrologist.

Q. There are many myths surrounding the penis, but science has proven the veracity of some, such as the one that links penis size to nose size...

A. It had always been considered an urban legend, until a Japanese group did a study demonstrating this similarity. [The study, published in 2023, analyzed 1,100 men and showed that “nose size was a significant predictor of penile size,” confirming “the truth of an erstwhile myth.”] The lengths would have to do with the levels of testosterone to which the fetus is exposed during pregnancy. But that same relationship does not exist with other parts of the body.

Q. It is interesting to know that this obsession with the big penis is cultural. They are fashions...

A. Indeed, there was a time during the Renaissance when sex was considered obscene. Back then having a very large member was something in bad taste, it was not fashionable. Now the idea that having a large member symbolizes being more of a man, being the alpha male, the chief of the tribe, has become popular. But at that time, the smaller the penis, the better. There are many examples of this ideal of beauty in art, for example in Michelangelo’s David, who has a very small penis compared to that huge, muscular body. But who knows, maybe the small penis fashion is back again. And all those who have a big penis will spend money to adapt and make it smaller [laughs].

Q. When it comes to the testicles, what is the most recurring question?

A. Many ask if it is normal for one to hang more than the other. And this, in reality, has an anatomical explanation. Normally, the left testicle hangs more than the right, not because it weighs more, but because the vessels that carry the cord of the testicle are longer on the left side.

Q. In the last five years in Spain, the number of phimosis operations, usually described as circumcision, went from 5,000 to 29,000. What’s behind the boom?

A. Yes, it is something we see more and more in consultations and it is a good practice. First, because it promotes the hygiene of the penis, not having a foreskin means that the glans is exposed to the air, and not as much smegma is secreted. This prevents penile cancer. And it also reduces infections in women. There are studies that indicate that Arab and Jewish women [where circumcision is performed for religious reasons on all children] have a lower incidence of cervical cancer. Normally, Westerners tend to operate on the foreskin when necessary, when it causes problems. For example, when a patient is diabetic. In these cases, since the urine has a greater amount of sugar, this facilitates germ and bacteria infections, it is a perfect breeding ground. And recurrent infections can occur. With the increase in obesity and diabetes in first world countries, it is normal that we have more older patients who want to undergo phimosis surgery.

Q. In your book you not only focus on young people, you talk a lot about older men and sexuality of the elderly...

A. We are animals. Yes, we are smart. Yes, we have evolved. But we do not stop being animals who are born, grow, multiply and die. There comes a time when, well, we no longer multiply due to a biological limitation. But why not continue having sex? I get 70-year-old men who tell me that they want more capacity, to be able to have more sex, and I think it’s great. Active sexuality improves quality of life; it has been seen, in nursing homes, that people who have sex tend to live longer. Sex is life. And I would also like to highlight the case of the LGBTQ+ collective. Older people who in their day could not show their affection. There are still negative stereotypes about the sexual lives of older people, but especially in this group, who have suffered so much and have had to hide their sexuality, they shouldn’t have to do that now. They don’t have to hide from anything.

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