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The pediatric wisdom is that it’s often the mother who asks the question. But she usually says the question comes from the boy’s father.
His dad is worried, she begins. Is our son’s penis a normal size? Is it too small? Is something wrong?
Most of the time, everything is perfectly normal. But what most of those boys have in common is their physique: They tend to be overweight.
Questions about penis size have become more common over the past decade, as my colleagues and I have all seen more overweight children coming in for physical exams. And these worries reflect cultural preoccupations and anxieties, which can make the conversation highly fraught for all concerned.
“I see dissatisfaction with the phallus very regularly,” said Dr. Aseem Shukla, a pediatric urologist at Children’s Hospital of Philadelphia and associate professor of urology at the Perelman School of Medicine at the University of Pennsylvania. He said that with 10- to 11-year-old boys, “a common thing is, my son’s penis is too short.”
The vast majority of the parents who bring up the issue with their pediatricians after the newborn period have children whose genitals fall in the normal range. A baby or toddler’s penis can look very small, and maybe especially when the child himself is larger rather than smaller. Watching their bodies as they grow, parents sometimes begin to worry about heavier boys and whether their genitals are normal.
The penis can be buried in the fat pad that sits in front of the pubic bone, and it can remain hidden as boys go through adolescence. What is called a “hidden penis” can be a combination of being prepubertal (so the penis has not begun to grow), being overweight (so the fat pad is significant), and in some cases an anatomical condition in which the soft tissue below the skin of the penis doesn’t adhere well to the Buck’s fascia, the thick covering that surrounds the penile nerves and arteries. This fixation problem can yield what Dr. Shukla described as a “slidey” penis, in which the actual shaft retreats and only the skin, or the foreskin, in an uncircumcised boy, is clearly apparent.
There are some surgical procedures which can unbury that concealed penis, but Dr. Shukla said that except in extreme cases, it made more sense to wait and let the child grow older — and, ideally, slimmer.
And for preadolescent boys that is often a very welcome solution. “The kids are usually pretty relieved that we’re not going to cut,” Dr. Shukla said.
But while they are relieved, they still want reassurance.
“I basically say, first of all I want you to know that you are absolutely and completely normal,” Dr. Shukla said. “We don’t all walk around with our pants down, and we don’t see how everybody is. But you should realize the private area can be different, and because yours looks different from your brother’s doesn’t mean there is something wrong.”