Penis size doesn't vary as much as people think

The average is 5.4 inches. Most men are between four

and six inches. When you have less than three inches,

then that's a real problem fertility-wise

- it's too small of a penis to actually reach the cervix

Does Size Matter? [Source]

As a long-time urologist, nothing fazes Dr. Harry Fisch when it comes to sexuality.

Ask him any question, and he'll give you the answer straight-up (sorry, there's no way around the puns here).

And that's exactly what Fisch does in his new question-and-answer book called Size Matters: The Hard Facts About Male Sexuality That Every Woman Should Know (Three Rivers Press, 2008, $15.95).

"This is sex education for adults. The last time you got sex education you were in elementary school and then you had to fend for yourself," he says in a telephone interview from New York City, where he is also a professor of clinical urology at Columbia University.

"The book is for couples, but it's directed towards women because a lot of guys are in denial about problems. And a lot of women blame themselves for certain issues in a relationship. And yet, it's really the guy's fault."

Kara Baskin and her girlfriends know this to be true.

Baskin, the co-author of Size Matters and the editor of the Boston Globe's Lola magazine, says in her single days she and her friends would obsess over issues in their own relationships.

"Women do a lot more analyzing and dwelling," she says in a telephone interview. "Women think they're doing something wrong, and very often there is a scientific explanation for what's going on, which can be very reassuring."

In Size Matters, Baskin asks Fisch the questions -- sometimes serious, sometimes witty -- that women may be too shy or embarrassed to ever vocalize. (Sample: "What about guys with incredibly teeny penises -- in other words, our ex-boyfriends?")

Though the tone is conversational and light, the information behind every answer is solid.

"It's a little bit giggly because that's what people's response always is when you talk about sex," says Fisch.

"But the giggles stop when they get the answers."

We asked Fisch our own questions about the most common problems in the bedroom, how long sex should really last and when size does matter.

Q: Tell me about the title Size Matters. Most people assume size refers to just one thing. What does it actually refer to?

A: It's not exactly bait and switch, but size does matter in many different instances. Certainly at the extremes, you can have a problem.

For penises that are very small or very large, it can be a problem. But usually in the middle range, which nearly all men are, it's not a problem.

And penis size doesn't vary as much as people think. The average is 5.4 inches. Most men are between four and six inches.

When you have less than three inches, then that's a real problem fertility-wise -- it's too small of a penis to actually reach the cervix.

If a person's belly is too fat, then they have lower testosterone levels because belly fat acts like a sink -- testosterone is taken out of the body in the belly fat, moreso than if you have fat around the legs or the arms or things like that.

And of course, one of the most important things is size of the testicles, and nobody talks about it! I'm a fertility doctor, so every time I see a patient for fertility I have to examine the size of the testicles.

And we know that you can have asymmetrical testicles, small testicles, large testicles, but the larger the testicle, the better the fertility and the better chance to have a good testosterone level. Bigger is better.

If testosterone is a problem and they're worried about sex drive, we give testosterone to men who need it.

And for fertility purposes, there are certain ways to try to improve the fertility of men. One of the most common things that causes smaller-size test are varicoceles, which are like a bag of worms in the scrotum.

Just like people have varicose veins in the legs, they have it in the scrotum. That can cause a problem with fertility and testicular size.

Can you fix that?

Yes, with a micro-surgery technique.

There are rumours that certain races are more well-endowed than others. Is that true?

That really is a misconception. It only seems different when it's non-erect but that doesn't mean anything, because once it's erect all the penises are similar in size.

You can have some men who are very large, some men who are very small, but if you average them out, they're all about the same right through the races.

And shoe size, earlobe size, nose size -- nothing correlates with penis size. However, if men want to increase the size of the penis, what they should do is to lose weight because the belly fat can actually obscure the penis.

If a couple is having a hard time conceiving, what should their first steps be?

One of the first things you've got to do for men is have a semen analysis. About 40 per cent of the time, the infertility is directly related to the male.

If it's a low sperm count, you can do something about it. One of the most common things that people overlook is infections.

Men tend to have urinary tract infections. Many times we just give antibiotics and they do very well. The second thing it could be is the varicocele, which is an engorgement of the veins around the scrotum.

And a lot of times it could just be low testosterone or being overweight. If you're overweight, particularly with a body mass index of over 25, you can have a lower sperm count and a 20 per cent increased chance of being infertile. So when you're trying to get pregnant, you've got to be in the best shape of your life.

You don't want to leave anything to chance.

What's one of the most common problems in the bedroom?

Premature ejaculation. One out of three men have it. It's more common than erectile dysfunction.

Once vaginal intercourse is initiated, men, on average, last between five and 10 minutes, so if you last less than two minutes, it's a problem. Certainly if it's less than one minute, it's a severe problem.

(Premature ejaculation) is a major relationship killer. A lot of women think, "I must have done something wrong, he's not that into me, he wants to finish quickly."

No! It's a physiological problem because, while there are many non-medical treatments, the medical treatment is giving a low dose of antidepressant medication because the side-effect prolongs the ejaculation.

It's not a psychological problem. Premature ejaculation tends to be a chemical imbalance that the medication seems to work wonders with.

I often hear women say they have higher sex drives than their significant others. Is this common? What can you do about it?

That is an important question. How can you tell if a guy has a low sex drive?

Look at him. If he has a big belly, he's going to have a low sex drive. If he has small testicles, big problem. That's how you can tell.

The other thing is, there are some things we do to ourselves. Even if you're thin, if you drink excessive alcohol, your sex drive is going to be really low. If you drink three glasses of wine a day, no way!

I think (men and women) have always had a sex drive, it's just that the men are deteriorating at a quicker rate, at least with their weight and drinking.

Women are supposed to have a good sex drive and men are just not responding because a lot of times they have a lower testosterone level than they should have.

Guys reading all of this may freak out a little.

I don't want them to freak out. I want them to buy the book and to read to see what questions women are asking, because we've got to get men to understand what women are thinking.