Article Text
Abstract
Objectives: Sexual health professionals continue to promote correct and consistent condom use among sexually active individuals yet research indicates that some men remain resistant to using condoms because of perceptions that they do not fit properly or feel comfortable. This study empirically assessed relations between men’s penile dimensions and their perceptions of condom fit and feel.
Methods: Data related to demographics, a bivariate calculation of erect penile length and circumference, and perceptions of condom fit and feel were analysed from 1661 adult men from 50 US states
Results: While many men reported that condoms generally fit fine and feel comfortable, at clearly identifiable intersections of length and circumference relations between penile dimensions and perceptions of condom fit and feel existed, particularly for those men who felt that condoms were “too long” (p<0.004), “too short” (p<0.001), “too loose” (p<0.047) or “too tight” (p<0.001).
Conclusions: These analyses provide empirical insights into the relations between bivariate penile dimensions (the intersection of length and circumference) and men’s perceptions of the positive and negative aspects of condom fit and feel. Those men with the most negative perceptions of condom fit and feel may benefit from an assessment of their condom-related concerns as a component of community and clinic based STI prevention interventions in order to help them select from the variety of condoms in the marketplace that they may find to be better fitting or more comfortable.
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The male condom remains one of the most practical and effective devices for the prevention of sexually transmitted infections (STIs) and unintended pregnancy, yet increasing correct and consistent condom use by sexually active individuals remains a challenging public health priority.1–3 Empirical work has identified general complaints about condoms in which some men have expressed a desire for condoms that are more pleasurable, better fitting or better suited to their unique size, shape or preferences of their sexual partners.4–9 Additionally, recent research suggests that men are able to identify specific penile areas (for example, glans, shaft, base) where they perceive discomfort or poor fit.9
A wide range of penile dimensions has been documented through both self-reports and physiological measures.8 10–14 Associations between penile dimensions and condom outcomes have also been found leading some to call for manufacturing standards that expand condom shapes and sizes.7 15–17 Recently, researchers discovered improvements in condom performance with condoms that were sized to penile length and circumference and that men perceived to fit better and feel more comfortable.18 Not fully explored are relations between men’s actual penile dimensions and perceptions of condom fit and feel. Understanding this may be helpful to those who promote the correct and consistent use of condoms to prevent STIs, particularly those who do so through community and clinic based STI prevention interventions and who may encounter individuals who resist condoms because of issues related to size.
This study provides an empirical assessment of the relations between men’s penile dimensions and their perceptions of condom fit and feel. A bivariate penile measure (a numerical representation of the intersection between penile length and circumference) was used in an effort to provide an understanding of whether overall penile dimensions provide more insight than length and circumference independently.
METHODS
Participant recruitment and data collection
Participants included 1824 men in the USA recruited through electronic advertisements placed on sex and adult-oriented websites. Print advertisements were also placed in community newspapers and at STI/HIV prevention organisations located in seven US states. These states were selected for their disproportionate rates of STIs and HIV and the extent to which they represented diverse geographic regions of the USA. Upon visiting the study website, men were asked questions to assess whether they met study eligibility, including being over the age of 18 years, using condoms for contraception or disease prevention at the time of the study and having no history of adverse reactions to condoms. After documenting eligibility, men signed an online informed consent statement and printed materials for taking a centimetre-based measure of their erect penile dimensions. Subsequently, 1661 men (91.1%) returned to the study website and reported data related to penile dimensions and other measures.
Measures
Demographics and STI history
Men provided data related to their demographics, including gender, age, ethnicity and sexual orientation. Participants also reported on whether they had ever been screened for, or diagnosed with, specific STIs.
Penile dimensions
Men reported erect penile length using a paper-based measuring device that ranged from 0–23 cm for length and from 0–19 cm for circumference. This measure has been described further in a previous report.18
Condom fit and feel
Men completed the Condom Fit and Feel Scale: a 14-item Likert-type scale on which men report experiences with the fit and feel of condoms.9 The scale has five subscales, including that condoms fit fine, or are too loose, too tight, too long and too short. An overall score of “condom fit and feel problems” is calculated by reverse scoring the two positive items in the “condoms fit fine” subscale and creating a summed score. In this sample, reliability coefficients of the subscales ranged from 0.69–0.89, which is slightly higher than ranges reported in other studies (0.60–0.86).9 18
RESULTS
Description of participants
The mean age of the 1661 participants was 29.96 years (range: 18–70; SD 8.69). Participants included men from all 50 of the US states. The majority of men reported their ethnicity as Caucasian or White (79.0%; n = 1312), identified as heterosexual (88.6%; n = 1472) and had been having sexual relations with the same person for over 6 months (65%; n = 1079), with 76% of these men describing their relationships as monogamous (n = 820).
The majority of participants reported having never been knowingly screened for STIs (54.3%; n = 901) and very few reported having ever received a STI diagnosis, with the most frequent diagnosis reported being chlamydia (2.2%; n = 36).
Penile dimensions
Penile length ranged from 4.0–26.0 cm (mean: 14.15 cm; SD 2.66) and penile circumference ranged from 3.0– 19.0 cm (mean: 12.23 cm; SD 2.23).
Perceptions of condom fit and feel
Large proportions of men endorsed (responding to each item with “agree” or “strongly agree”) the idea that condoms fit fine (49.8%; n = 789) and feel comfortable (40.8%; n = 646). With regard to perceived problems of fit and feel, men’s endorsement of scale items indicated that 16.9% (n = 266) described condoms as being too long and 12.1% (n = 191) describe them as being too short. Similarly, 32.3% (n = 511) described condoms as being too tight and 10% (n = 158) as too loose. Regarding condoms being too tight, significant proportions of men reported tightness on the base of the penis (28.4%; n = 448), the penile shaft (27.3%; n = 430) and the glans (22.8%; n = 360). Regarding condoms being too loose, men reported looseness on the base (8.8%; n = 139), shaft (9.3%; n = 146) and glans (11.4%; n = 180). Additionally, 38.8% (n = 611) reported that they have unrolled condom at the base of the penis after application while 13.3% (n = 209) reported that condoms will not roll down far enough to cover their penis.
When assessing potential relations between perceptions of overall condom fit and feel and the demographic characteristics of the sample, a significant association was detected for age; as age increased men’s reports of problems with the fit and feel of condoms on all subscales increased (p<0.001).
Penile dimensions and condom fit and feel
Analyses of variance (ANOVA) with Tukey’s honestly significant difference (HSD) post-hoc analyses were conducted to examine differences in mean scores on items within the subscales of the Condom Fit and Feel Scale between men in different penile dimension groups. Each participant was assigned to one each of three penile circumference and three penile length groups based upon the interquartile range of the relatively normal distribution of each of the penile dimensions, resulting in approximately 25% in the small-sized and large-sized dimension groups and approximately 50% in the middle-sized group.
Regarding penile length, the “shorter” group contained men whose penile lengths ranged from 4.0–12.0 cm (mean: 10.89 cm; SD 1.21), “medium” ranged from 13.0–15.0 cm (mean: 14.43 cm; SD 1.10) and “longer” ranged from 16.0–26.0 cm (mean: 18.11 cm; SD 1.59). Regarding penile circumference, the “smaller” group contained men whose penile circumference ranged from 3.0–11.0 cm (mean: 9.48 cm; SD 1.72), “medium” ranged from 12.0–13.0 cm (mean: 12.84 cm; SD 0.78) and “larger” contained men with a penile circumference of 14.0 cm or greater (range: 14.0–19.0 cm; mean: 15.57 cm; SD 0.82).
When item scores were examined across the penile length groups, men in the “longer” group (⩾16 cm) compared with those in the “shorter” and “medium” groups were significantly more likely to describe condoms as being too short (p = 0.005), not rolling down far enough (p = 0.002) and generally feeling too tight (p = 0.002), specifically describing condoms as being too tight along the penile shaft (p = 0.025). On the contrary, men in the “shorter” group were significantly more likely than men in the “longer” group to report having unrolled condom left at the base of the penis (p = 0.002). Small to large effect sizes were observed for the statistically significant comparisons by penile length (ω2p = 0.04–0.14), with larger effect sizes observed with comparisons between the longest and shortest length categories and smaller effect sizes observed between the medium and longer groups. There were no significant differences between men in the shorter and medium length groups.
When examined across the penile circumference groups, men in the “larger” group (⩾14 cm) compared with the “smaller” and “medium” groups were significantly more likely to describe condoms as being too short (p = 0.008), too tight (p = 0.002) and specifically too tight on the glans (p = 0.036) and base (p = 0.003). “Larger” men were also significantly more likely to describe condoms as been too tight along the shaft than “smaller” men (p = 0.037) and more likely to report condoms not rolling down far enough than the “middle” sized men (p = 0.042). As with penile length groups, larger effect sizes were observed with comparisons between the larger and shorter length categories and smaller effect sizes observed between the medium and larger groups (ω2p = 0.05–0.16). These comparisons are provided in table 1.
Predictive capacity of penile dimensions and condom fit and feel
To examine whether our bivariate measure of penile dimensions (the intersection of penile length and circumference) was predictive of men’s perceptions of condom fit and feel, regression analyses were conducted using the univariate general linear method19 while controlling for age and assessing the consistency of scores within each subscale. The bivariate measures of penile dimensions held statistically significant predictive capacity for each scale construct with the exception of the construct related to “condoms fitting just fine.” Shorter penile lengths combined with smaller penile circumferences were predictive of higher endorsement of condoms being too loose (R2 = 0.007; p = 0.047) and too long (R2 = 0.011; p = 0.004) while longer penile lengths combined with larger penile circumferences were predictive of higher endorsement of condoms being too tight (R2 = 0.014; p<0.001) and too short (R2 = 0.016; p<0.001). Overall, as the point of intersection occurred at the extreme ends of both length and circumference, penile dimensions were predictive of men’s overall complaints about condom fit and feel (R2 = 0.008; p = 0.024). These results are presented in table 2.
DISCUSSION
This study provided an empirical assessment of the relations between men’s penile dimensions and their perceptions of the fit and feel of condoms. Additionally, a bivariate penile measure (the intersection of length and circumference) was used to assess whether overall penile dimensions provided greater insight into men’s perceptions of condom fit and feel than is offered by independent assessments of length and circumference that is more traditional in studies related to penile dimensions. Findings indicate that the majority of men do not have complaints about the fit and feel of condoms and that there is consistency in the penile dimensions among those who do have such complaints.
Longer penile length and larger penile circumference were both significantly associated with men’s reports that condoms are too short and too tight, longer length and larger circumference both associated with perceived tightness along the penile shaft, and perceived tightness on the glans and base associated only with larger circumference. Men with shorter penile lengths described having some unrolled condom left at the base of the penis after application. However, while some may find this to be an undesirable characteristic of condoms, some have suggested that this unrolled latex may offer protection against condom slippage.18 While penile length and circumference as independent measures were associated with perceived condom fit and feel, the bivariate measure of penile dimensions indicated that consistently larger and consistently smaller dimensions across both length and circumference were predictive indicators of men’s negative perceptions of condom fit and feel.
We also found that men are more likely to perceive challenges to the fit and feel of condoms as they age. This may be a function of older men having had more experiences with condoms over the course of their lives that may have influenced their perceptions of condoms across a range of various partners and situational contexts, or it may reflect age-related changes related to erectile function, arousal or ease of orgasm that may affect perception of condom fit and feel.
Limitations to this study were that all data were self-reported via the internet and collected from a convenience sample. It is also impossible to determine whether men were accurate and honest when completing the penile measures, the reliability of which can also be challenged by psychological, physiological and situational factors that may influence penile rigidity. Additionally, men in this study indicated that they were actively using condoms at the time of this study to reduce their risk of a STI and unintended pregnancy, and it may be that those who are more resistant to condoms or who perceive themselves to have either reduced (or increased) risk for STI exposure were not reflected in this sample. Also present is the possibility of type 1 error in a study with a large sample size, and an assessment of effect sizes indicated that more practically significant differences with regard to perceived fit and feel are present between the extreme groups by size (for example, longer length vs shorter length) and less so between groups that are more proximal (for example, medium circumference vs large circumference). Lastly, the interquartile range was used to establish the groups of penile dimensions. Given the lack of an established method for categorising penile dimensions, it may be the case that results would be different had we used a more arbitrary method to categorise size (for example, created more extreme dimension groupings at each end of the continuum without regard to statistical quartiles).
These findings provide further validation to previous research that has reported men’s complaints about condoms but that has not done so while considering relations with penile dimensions. Perhaps more importantly, these data provide some validation to challenges faced by those implementing STI prevention interventions who have encountered men who assert that condoms do not fit or feel comfortable. While manufacturers have designed condoms that are efficacious for men regardless of penile dimensions and that come in a variety of shapes and sizes, that some men continue to hold negative perceptions about condom fit and feel continues to pose challenges to efforts to increase correct and consistent condom use. These data suggest that men who most strongly have negative perceptions about condom fit and feel may be among those who would benefit from validation of their concerns and help with choosing from the ever-expanding choices of condom sizes, shapes and textures. Thus, the Condom Fit and Feel Scale may be helpful to those who implement behavioural interventions and need a mechanism for initiating discussions with men who use fit and feel as a rationale for their condom resistance.
Key messages
Having a better understanding of relations between men’s penile dimensions and their experiences with condom fit and feel may help to better understand condom resistance.
The largest proportion of men in this study reported that condoms fit fine and feel comfortable.
Men who reported perceived problems with the fit and feel of condoms were those with longer penile lengths or larger penile circumferences.
Sexually transmitted infection prevention providers may find the Condom Fit and Feel Scale to be helpful for initiating discussions with men about their perceptions of condoms.
REFERENCES
Footnotes
Competing interests: None.
Ethics approval: Received by the Indiana University-Bloomington Institutional Review Board.
Contributors: MR and DH were responsible for the design and conduct of this study. MR led the development of the manuscript. MR, BD and DH all contributed to the interpretation of statistical analyses and the development of the manuscript.