Condoms and Ethnicity II

[This is a continuation of Condoms & Ethnicity I]

UPDATE: 2013-10-27: A latter portion of the post has been invalidated, my apologies.

UPDATE: 2013-08-31: The claim at this link is incorrect. The WHO report was written by an Australian condom manufacturer who arbitrarily used these three studies to propose that different sizes may be preferred by persons in different countries. These studies do NOT indicate that penile width differs by ethnic group as none of the studies were performed by medical professionals nor were they replicated.

The Family Health International (FHI) & JP Rushton

In a FHI monograph by Spruyt (1996), we read:

The World Health Organization bases its specifications for condom width on consumer preference and penis size, citing three studies. Taken together, the studies show significant variations in penis size within all population groups, but also indicate that men of African descent on average have a slightly wider and longer penis size, Caucasian men have a medium size, and Asian men a slightly narrower and shorter size (WHO).

Based on the consideration that anatomical differences exist among regions, a series of FHI studies were conducted in three Asian countries to compare small and standard width condoms (49 mm and 52 mm), and in three African countries to compare larger and standard width condoms (55 mm and 52 mm). Among the African sites, breakage rates were slightly higher and slippage was slightly lower for the smaller of the two condoms being compared. (Joanis) However, results from the Asian sites were inconsistent. (Neupane; Andrada) Moreover, almost none of the differences in breakage and slippage rates from either the Asian or African sites were statistically significant. Thus, results from these studies pertaining to penis size and condom failure were inconclusive.

So the FHI found it necessary to launch three studies based on one page of a WHO condom report. The report itself (WHO 1998) is most interesting and highlights the need for not accepting data at face value.

ANALYSIS OF THE WHO ETHNIC PENILE DIMENSIONS

The table below is the one page WHO listing of three studies which purport to show ethnic variations in both penile length and girth.
c7

Unsurprisingly, infamous race realist Rushton (2000) poses questions and answers using the same WHO data in his book Race, Evolution, and Behavior: A Life History Perspective. Two questions are of importance to penis variations and source analysis.

Q: Doesn’t the evidence on race and penis size come from 19th Century stories by racist Europeans in colonial Africa?

A: The earliest findings come from the Arabic explorers in Africa and one study by a French army surgeon originally published in 1898. More up-to-date information comes from the World Health Organization. Their studies show the same three-way race pattern as do all the other studies.

Q: Isn’t the material on race and sex a kind of pornography? Isn’t race controversial enough without bringing sex and AIDS into the picture?

A: One World Health Organization study I mentioned in the previous answer examined penis size in order to provide the right size condoms to slow the spread of AIDS. Finding out which groups are most at risk for sexually transmitted diseases can help slow their spread and save lives.

ANALYSIS: The WHO did not study penis sizes. It relied on three separate studies, two of which were not peer-reviewed and the data was included as “Appendix III” (which should have alerted Rushton that this was not an original study). The first study references Africans in the US (not Africa!) and Europeans in the US (not Europe!), the second Europeans in Australia (not Europe!) and the third, Thais.

The first study is Alfred Kinsey’s flawed self-reported study on incarcerated males (a highly truthful bunch no doubt). The sampling, methodology and measurements are biased.

The reference for Asians is stated as an unpublished study by Bangkok Medical University (Muangman 1978) and nothing is known about the sample size or methodology (besides that prostitutes measured with paper tapes). Thus this is another biased study and does not represent the average Thai male.

The Aussie study was peer-reviewed but submitted a method for self-measurement. For a sample of 156, they found an average erect length of 15.99 cm or 6.3” (Richters, Gerofi & Donovan 1995 as mentioned in Mondaini et al. 2002) which is larger than Rushton’s upper European limit of 6″. While this value of 15.99 cm is the largest value from 8 different studies (Promodu et al. 2007), it does seem accurate given another study.

Estimated applicability of Rushton’s values to the WHO data

Rushton proposes to have found the following: East Asians: 4 to 5.5″ (10.2 to 14.0 cm) in length and 1.25″ (3.2 cm) in diameter, Europeans: 5.5 to 6″ (14 to 5.2 cm) in length and 1.5″ (3.8 cm) in diameter and Africans: 6.25 to 8″  (15.9 to 20.3 cm) in length and 2″ (5.1 cm) in diameter. In other words, the average European is 21% longer and 50% thicker than the average East Asian, while an average African is 50% longer and 60% thicker.

Kinsey - US EuropeansIf this link is accurate (see pic above), Rushton’s US European length claim only correlates some 43% with that of Kinsey’s data. The Thai study found 51% with 5 to 5.9” penises which correlates more than that for Europeans and yet is larger than his 4 to 5.5″ assertion.

The WHO girth data gives 29% of Euro-Americans, 68% of Euro-Australians, 34% of Afro-Americans and 17% of Thais having circumferences above 5”. Why so large a value for Aussie-Europeans compared to US Europeans? A portion of the WHO states:

Condoms are made in various widths. Based on studies in Australia, Thailand and the USA, and the experience of major agencies, the wider condoms (flat width 52-55 mm) will be preferred in Australia, Africa, Europe, Latin America, the Middle East and North America, and the narrower condoms (47-51 mm) will be preferred in several Asian countries (see Appendix III). Other widths are also made for small specialized markets.

[This portion has been invalidated, see comments below] While wondering which Asian countries are being referenced and if any are not, one would be inclined to treat the ‘experience of major [unnamed] agencies’ as authoritative. The Asian preferred circumference range is 147.7 to 160.2 mm. Similarly, the non-Asian preference circumference is 163.4 to 172.8 mm. From the data, 95% of Euro-Americans, 91% of Afro-Americans, 86% of Euro-Australians and 100% of Thais have penile girths less than or equal to 150 mm. Why then would there be a preference among Africans and Europeans for condoms some 13.4 to 32.8 mm larger?

2013-02-22, update: The answer to the last question can be found here, here and here.

SOURCES:

Andrada A, Ravelo N, Spruyt A, et al. 1993. Acceptability and Functionality of Standard and Smaller Latex Condoms during Human Use: Philippines. Durham, USA: Family Health International.

Joanis, C., Brookshire, T., Piedrahita, C., Steiner, M., Diakite, M., and J. Esibi. 1990. Evaluation of Two Condom Designs: A Comparison of Standard and Larger Condoms in Ghana, Kenya, and Mali. Durham, USA: Family Health International.

Mondaini, N., Ponchietti, R., Gontero, P., et al. 2002. Penile length is normal in most men seeking penile lengthening procedures. International Journal of Impotence Research 14: 283-286.

Muangman, D. 1978. Report on measurement of Thai male genital sizes and recommendation for appropriate condom usage [unpublished paper]. Bangkok Faculty of Public Health, Mahidol University.

Neupane, S., Abeywickrema, D., Martinez, K., et al. 1992. Acceptability and Actual Use Breakage and Slippage Rates of Standard and Smaller Latex Condoms: Nepal and Sri Lanka. Durham, USA: Family Health International.

Promodu, K., Shanmughadas, K., Bhat, S., and K. Nair. 2007. Penile length and circumference: an Indian study. International Journal of Impotence Research 19: 558-563.

Richters J., Gerofi J., and B. Donovan. 1995. Are condoms the right size(s): a method for self measurements of erect penis. Venerology 8: 77-81.

Rushton, J.P. 2000. Race, Evolution, and Behavior: A Life History Perspective. Port Huron, USA: Charles Darwin Research Institute.

Spruyt, Alan. 1996. User Behavior and Characteristics related to Condom Failure in McNeill, E., et al. (eds.) The Latex Condom: Recent Advances, Future Directions. Durham, USA: Family Health International. http://www.fhi360.org/en/RH/Pubs/booksReports/latexcondom/behavcharac.htm [accessed: 2012-01-15].

WHO. 1998. The Male Latex Condom: Specification & Guidelines for Condom Procurement. WHO & Joint UN Programme on HIV/AIDS. http://whqlibdoc.who.int/hq/1998/WHO_RHT_FPP_98.15_spec&guidelines.pdf [accessed: 2012-01-23].

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Condoms and Ethnicity I

Family Health International (FHI) performed three studies using stereotypes for ethnic populations (yes you read that correctly). In one they measured the preference in African countries (Ghana, Kenya and Mali) for a larger condom (55 mm). In two Asian studies (Nepal, Philippines, Sri Lanka) they studied the preference for a smaller condom (49 mm). They did not explain why they should not have investigated the preference for all three standardized sizes (55, 52 and 49 mm) in either population sets.

The AFRICAN study: Joanis et al. (1990) c1 Study Question: Which condom did you like better? If the African stereotype is correct (i.e. African males require the largest condom size), we should expect the majority preferring the larger condoms. However, only 41% did and some 48.5% preferred the standard size. Also, there was a two-fold preference for the larger condom by Malians (60% vs. 30%). Make of that what you will. Problem #1: About half preferred the standard size. 

c2Study Question: Which condom was bigger? If the African stereotype is correct, we should expect the majority to be able to tell which condom is wider. But of the total sample, 36% did not detect that the larger condom was actually larger. Also, it would have been better if a smaller condom was also an option. Problem #2: Over one third could not identify the larger condom.

c3Study Question: Which condom(s) broke? If the African stereotype is correct, we should expect more condom breaks with the standard size. Only 7.5% broke the standard condoms, 5.5% broke the larger condom and 6.5% broke both. So only 6.5% were too big even for 55 mm condoms and this would incorporate the 5.5% who only broke the larger condom and 1.0% who broke the standard size. Additionally only, 14% (6.5 + 7.5) were larger than the standard condom. That means that 86% could use standard condoms. Problem #3: More than four-fifths could use the standard size.

c4Study Question: Which condom(s) slipped off during use? Slippage can occur if the penile girth is somewhat smaller than the condom width. If the African stereotype is correct, we should expect almost no slippage especially with the standard size. There was 6% slippage with the standard condom, 8.5% slippage with the larger condom and 8.5% slippage with both condoms (including the 6% for the standard size). Thus 94% did not slip from the standard condom and this would seem to confirm the stereotype.

We thus have three problems with the stereotype that African males are more endowed in penile thickness.

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The ASIAN studies: Andrada et al. (1993) & Neupane et al. (1992)

The Neupane study could not be sourced. Thus we only have the Andrada study to examine Asians and this is only applicable to the Philippines. Unfortunately, the Andrada study is riddled with problems. They used a sample of 150 Malay Filipinos and gave them 5 smaller condoms to use first. They then waited a month before gathering data. They repeated the process with 5 of the standard condoms so that the study lasted two months. In contrast, the African study lasted 2 weeks and they had to use both condoms during this time. Thus Andrada et al. skewed the results by implying that the second condoms were different. In other words, this study is practically useless. The data representation also leaves much to be desired as the number of condoms is used for sampling instead of the number of individuals (see table below).

c6But what does the data signify if we assume that the results are correct? If the East Asian stereotype is correct (East Asians require the smallest sized condoms), we would expect the following:

Expectation

Findings

Very low breakage for small condoms

Confirmed

Very low breakage for standard condoms

Confirmed

Low slippage for small condoms

Confirmed

High slippage for standard condoms

Not confirmed

This may indicate that the average Malay Filipino penis is not likely to require a larger condom but we cannot state this scientifically since a larger condom was not used in the study. But Andrada et al. (1993) also states:

The United States Agency for International Development (A.I.D.) currently provides smaller (49mm) latex condoms to several Asian countries, including the Philippines. An article which appeared in the Philippine popular press in 1992 [see PDE (1992)] summarized results of a survey of condom users commissioned by the Philippine Department of Health. According to the article, the study found that among typical condom users, the most common complaints were that condoms are oversized, painful for women, not effective, and easily torn. Among the 2477 commercial and public outlets in three cities included in the study, 10% reported that they received complaints from the condom recipients.

From this it is not clear if they had issues with the smaller or standard condoms. Here is the abstract from PDE (1992) article from Popline (n.d.):

The typical condom buyer is male, middle-aged and a middle class employee. His most common complaint is that condoms are oversized. A study commissioned by the Department of Health, showed that only 10% of 2477 outlets surveyed in 3 cities–Metro Manila, Greater Cebu City and Davao City–received complaints from buyers of condoms. The other 3 complaints about condoms are that they are painful for women, that they are not effective, and that they get torn easily. Of the 247 outlets which received complaints, 87% said their customers complained that the condoms they bought were either oversized or did not fit. Mike Gomez, DOH information officer, theorized that complaints about oversized condoms may be traced to improper use. He said the user may not be fully erect when he puts the condom on. Peter Resurrection of the National AIDS Center said the women may be hurt by condoms that are ribbed or are not lubricated. Metro Manila dealers included in the survey received the most number of complaints (225 of 1878 drug stores and supermarkets where condoms are available), followed by Davao dealers (28 of 148). But the 450 storeowners interviewed in Cebu City said they had received no complaints whatsoever.

So there are many issues with the PDE (1992):

  1. The study did not directly study the complaints but relied on the reported complaints to condom outlets;
  2. There is no metric stating how many of the outlet’s customers complained about ‘over-sized’ condoms, it may be that a few complained and this resulted in the outlet being used as a data point;
  3. If women were being hurt by the condoms, then the condoms were most likely of poor quality and not well lubricated;
  4. If there was a size or quality issue, there would be a somewhat uniform level of complaint which does not explain the wide differences between cities (19, 12 & 0 %).
  5. We do not know if the complaints were due to size or differences in manufacturing quality. Perhaps controlling for quality would diminish or extinguish the ‘over-size’ claim.

It should be clear that these studies do not verify any ethnic stereotypes. Scientifically, one study per population would not be able to do this anyway. If anything, these studies might question the premise that the majority of Africans require larger condoms but also does not rule out that some East Asians may require larger condoms as well. Unfortunately, both studies were not rigorous though the African study was better designed and presented. Both studies should have used all three condoms sizes as well as a set questionnaire and report format. Rather, both relied on Eurocentric stereotypes (explained in Condoms and Ethnicity part II) from one page of a WHO latex condom document (WHO 1998) wasting time, money and resources.

Condoms and Ethnicity II will investigate a FHI’s monograph’s assertion that there are differences in ethnic penile girth and also investigate psychologist J.P. Rushton’s use of said assertion/data to further his race-realist cause.

SOURCES:

Andrada, A., Ravelo, N., Spruyt, A., et al. 1993. Acceptability and Functionality of Standard and Smaller Latex Condoms during Human Use: Philippines. Durham, USA: Family Health International.

Joanis, C., Brookshire, T., Piedrahita, C., et al. 1990. Evaluation of Two Condom Designs: A Comparison of Standard and Larger Condoms in Ghana, Kenya, and Mali. Durham, USA: Family Health International.

Neupane, S., Abeywickrema, D., Martinez, K., et al. 1992. Acceptability and Actual Use Breakage and Slippage Rates of Standard and Smaller Latex Condoms: Nepal and Sri Lanka. Durham, USA: Family Health International.

PDE. 1992. Condoms are too big, city users complain. Philippine Daily Enquirer, Feb 25: 11.

Popline n.d. Condoms are too big, city users complain. Popline. http://www.popline.org/node/317539 [accessed: 2013-01-15].

WHO. 1998. The Male Latex Condom: Specification & Guidelines for Condom Procurement. WHO & Joint UN Programme on HIV/AIDS. http://whqlibdoc.who.int/hq/1998/ WHO_RHT_FPP_98.15_spec&guidelines.pdf [accessed: 2012-01-23].