OBJECTIVE: This study aimed to perform a systematic review and meta-analysis of stretched, erect, and flaccid penis length as well as circumference according to geographic WHO regions. METHODS: PubMed, Embase, Scopus, and Cochrane Library were searched for articles published until February 2024. Studies in which a healthcare professional evaluated the penis size were considered eligible. After assessing the risk of bias, a systematic review and meta-analyses were performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement, and the outcomes were grouped based on the WHO regions. RESULTS: A total of 33 studies comprising 36 883 patients were included. The risk of bias in the included studies was moderate/low. A comprehensive systematic review was done and meta-analyses performed for flaccid length [n = 28 201, mean (SE) 9.22 (0.24) cm], stretched length [n = 20 814, mean (SE) 12.84 (0.32) cm], erect length [n = 5669, mean (SE) 13.84 (0.94) cm], flaccid circumference [n = 30 117, mean (SE) 9.10 (0.12) cm], and erect circumference [n = 5168, mean (SE) 11.91 (0.18) cm]. The mean length of the stretched penis was largest in Americans [14.47 (0.90) cm]. The mean length of the flaccid penis was the largest in the Americas [10.98 (0.064) cm]. The mean flaccid penile circumference was largest in Americans [n = 29 714, mean (SE) 10.00 (0.04) cm]. CONCLUSIONS: Penis sizes vary across WHO regions, suggesting the need to adjust standards according to geography to better understand councilmen and their partners. These data provide a framework for discussing body image expectations and therapeutic strategies in this sensitive and emotional subject matter.

Department of Urology Charles University 2nd Faculty of Medicine Prague Czech Republic

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Urology King Fahad Specialist Hospital Dammam Saudi Arabia

Department of Urology Medical University of Silesia Zabrze Poland

Department of Urology Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Okayama Japan

Department of Urology The Jikei University School of Medicine Tokyo Japan

Department of Urology University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Urology University of Texas Southwestern Medical Center Dallas TX USA

Department of Urology Weill Cornell Medical College New York New York USA

Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan

Institute for Urology and Reproductive Health Sechenov University Moscow Russia

Karl Landsteiner Institute of Urology and Andrology Vienna Austria

Medical Philosophy and History Research Center Tabriz University of Medical Sciences Tabriz Iran

Men's Health and Reproductive Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran

Research Center for Evidence Based Medicine Iranian EBM Center A JBI Centre of Excellence Tabriz University of Medical Sciences Faculty of Medicine Tabriz Iran

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