{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T10:07:16Z","timestamp":1792318036827,"version":"4.4.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2017,11,1]],"date-time":"2017-11-01T00:00:00Z","timestamp":1509494400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2017,11,1]],"date-time":"2017-11-01T00:00:00Z","timestamp":1509494400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["jsm.jsexmed.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>To determine a maximal upper limit for girth compatible with penetrative intercourse based on measurements of bestselling realistic dildos and published erect penile dimensions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We collected measurements for \u201crealistic dildos\u201d 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcomes<\/jats:title>\n                  <jats:p>Length and circumference of overall bestselling and largest bestselling realistic dildos as reported on top websites and measured by investigators.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The average insertive length of the compiled dildos (16.7 \u00b1 1.6 cm) was 1 SD longer than natal functional erect penile length as reported in the literature (15.7 \u00b1 2.6 cm); however, their average circumference (12.7 \u00b1 0.8 cm) mirrored natal erect penile girth (12.3 \u00b1 1.3). The average girth of vendors' top 3 largest-girth dildos was 15.1 \u00b1 0.9 cm, 2 SD wider than natal erect penile girth. Index patients had an average length of 16.3 \u00b1 3.2 cm and an average girth of 17.6 \u00b1 1.3 cm. Index patient girth was 4 to 5 SD wider than the average natal erect girth.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Implications<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strengths and Limitations<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1016\/j.jsxm.2017.09.012","type":"journal-article","created":{"date-parts":[[2017,10,28]],"date-time":"2017-10-28T16:05:30Z","timestamp":1509206730000},"page":"1455-1461","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":11,"title":["How Big is Too Big? The Girth of Bestselling Insertive Sex Toys to Guide Maximal Neophallus Dimensions"],"prefix":"10.1093","volume":"14","author":[{"given":"Dylan","family":"Isaacson","sequence":"first","affiliation":[{"name":"UCSF School of Medicine , San Francisco, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana","family":"Aghili","sequence":"additional","affiliation":[{"name":"Campbell University Ringgold Standard Institution \u00a0 , Buies Creek, NC , USA"},{"name":"School of Osteopathic Medicine \u00a0 , Buies Creek, NC , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Non","family":"Wongwittavas","sequence":"additional","affiliation":[{"name":"Department of Surgery \u00a0 , Roi-Et, , Thailand"},{"name":"Roi-Et Hospital \u00a0 , Roi-Et, , Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurice","family":"Garcia","sequence":"additional","affiliation":[{"name":"Department of Urology \u00a0 , Los Angeles, CA , USA"},{"name":"Cedars-Sinai Medical Center Ringgold Standard Institution \u00a0 , Los Angeles, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2017,11,1]]},"reference":[{"key":"2023011111043963500_bib1","article-title":"Gender confirmation surgeries rise 20% in first ever report","author":"American Society of Plastic Surgeons"},{"key":"2023011111043963500_bib2","article-title":"Gender identity clinic services under strain as referral rates soar","author":"The Guardian"},{"key":"2023011111043963500_bib3","article-title":"Sex reassignment surgery","author":"Ontario Ministry of Health and Long-Term Care"},{"key":"2023011111043963500_bib4","first-page":"156","article-title":"Overall satisfaction, sexual function, and the durability of neophallus dimensions following staged female to male genital gender confirming surgery: the Institute of Urology, London U.K. experience","volume":"3","author":"Garcia","year":"2014","journal-title":"Transl Androl Urol"},{"key":"2023011111043963500_bib5","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1097\/PRS.0b013e3181a659fe","article-title":"Scrotal reconstruction in female-to-male transsexuals: a novel scrotoplasty","volume":"123","author":"Selvaggi","year":"2009","journal-title":"Plast Reconstr Surg"},{"key":"2023011111043963500_bib6","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/00000637-198702000-00006","article-title":"New concepts in phallic reconstruction","volume":"18","author":"Gilbert","year":"1987","journal-title":"Ann Plast Surg"},{"key":"2023011111043963500_bib7","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1097\/01.sap.0000238428.91834.be","article-title":"Genital sensitivity after sex reassignment surgery in transsexual patients","volume":"58","author":"Selvaggi","year":"2007","journal-title":"Ann Plast Surg"},{"key":"2023011111043963500_bib8","article-title":"Genital gender affirming surgery for transgender patients; American Urologic Association AUA Updates series","author":"Garcia","year":"2016","journal-title":"Accepted for publication"},{"key":"2023011111043963500_bib9","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.eururo.2009.03.013","article-title":"Erectile implants in female-to-male transsexuals: our experience in 129 patients","volume":"57","author":"Hoebeke","year":"2010","journal-title":"Eur Urol"},{"key":"2023011111043963500_bib10","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/S0302-2838(02)00396-2","article-title":"What importance do women attribute to the size of the penis?","volume":"42","author":"Francken","year":"2002","journal-title":"Eur Urol"},{"key":"2023011111043963500_bib11","doi-asserted-by":"crossref","first-page":"e0133079","DOI":"10.1371\/journal.pone.0133079","article-title":"Women's preferences for penis size: a new research method using selection among 3D models","volume":"10","author":"Prause","year":"2015","journal-title":"PLoS One"},{"key":"2023011111043963500_bib12","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1007\/s10508-008-9441-y","article-title":"Human physique and sexual attractiveness in men and women: a New Zealand-U.S. comparative study","volume":"39","author":"Dixson","year":"2010","journal-title":"Arch Sex Behav"},{"key":"2023011111043963500_bib13","first-page":"3079","article-title":"Women who prefer longer penises are more likely to have vaginal orgasms (but not clitoral orgasms): implications for an evolutionary theory of vaginal orgasm","volume":"9","author":"Costa","year":"2012","journal-title":"J\u00a0Sex Med"},{"key":"2023011111043963500_bib14","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1111\/bju.13010","article-title":"Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15,521 men","volume":"115","author":"Veale","year":"2015","journal-title":"BJU Int"},{"key":"2023011111043963500_bib15","first-page":"995","article-title":"Penile length in the flaccid and erect states: guidelines for penile augmentation","volume":"156","author":"Wessells","year":"1996","journal-title":"J\u00a0Urol"},{"key":"2023011111043963500_bib16","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/S0090-4295(00)00925-0","article-title":"Does penile size in younger men cause problems in condom use? A prospective measurement of penile dimensions in 111 young and 32 older men","volume":"57","author":"Schneider","year":"2001","journal-title":"Urology"},{"key":"2023011111043963500_bib17","first-page":"1402","article-title":"Erect penile dimensions in a cohort of 778 Middle Eastern men: establishment of a nomogram","volume":"12","author":"Habous","year":"2015","journal-title":"J\u00a0Sex Med"},{"key":"2023011111043963500_bib18","first-page":"641","article-title":"Vibrators and other sex toys are commonly recommended to patients, but does size matter? Dimensions of commonly sold products","volume":"12","author":"Herbenick","year":"2015","journal-title":"J\u00a0Sex Med"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S174360951731439X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S174360951731439X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/14\/11\/1455\/48525898\/jsm_14_11_1455.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/14\/11\/1455\/48525898\/jsm_14_11_1455.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T14:39:41Z","timestamp":1673447981000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/14\/11\/1455\/6973552"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,1]]},"references-count":18,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2017,11,1]]},"published-print":{"date-parts":[[2017,11,1]]}},"URL":"https:\/\/doi.org\/10.1016\/j.jsxm.2017.09.012","relation":{},"ISSN":["1743-6109","1743-6095"],"issn-type":[{"value":"1743-6109","type":"electronic"},{"value":"1743-6095","type":"print"}],"subject":[],"published-other":{"date-parts":[[2017,11]]},"published":{"date-parts":[[2017,11,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"How Big is Too Big? The Girth of Bestselling Insertive Sex Toys to Guide Maximal Neophallus Dimensions","name":"articletitle","label":"Article Title"},{"value":"The Journal of Sexual Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jsxm.2017.09.012","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2017 International Society for Sexual Medicine. Published by Elsevier Inc.","name":"copyright","label":"Copyright"}]}}