For many US office workers, the day begins with deleting spam. These days, a lot of electronic junk mail hits below the belt by seeking to profit from many men's deepest fear -- that their penises are too small.
From the vague "Expand your horizons" to the blunt "Want to increase your penis size?" the hard sell of penis-enlargement products plays on men's insecurity, experts say.
Virtually anyone with an e-mail address is bombarded daily with messages touting penis pills, herbal supplements and the latest rage, penis patches, all with the same inflated promise that they will enlarge a man's sexual organ.
Herbal supplements marketed as "penis pills," which contain ingredients ranging from soy protein and damiana leaf to ginkgo biloba and ginseng root, and dermal applications like the "penis patch," claim to be capable of lengthening men's penises by up to 10cm in as many months.
But no peer-reviewed studies comparing men who used the products to a placebo group have ever been conducted. Since the products have disclaimers stating they are not intended to treat medical problems, they fall outside the US regulatory process. The Federal Trade Commission says there is no evidence the products have any effect.
Psychiatrists say the marketers sending out such messages are hoping to take advantage of a primal obsession.
"The penis is a primary symbol of male sexuality and dominance," said Dr. Frank Muscarella, a clinical and evolutionary psychiatrist at Barry University in Miami Shores, Florida.
Muscarella, co-author of Psychological Perspectives on Human Sexuality, said the size of a man's penis "is indicative of masculinity, prowess and dominance."
Big is best?
"On a psychological level, men buy into that. And even if they don't, advertising does," he added, citing a recent truck billboard that showed a sexy cowboy crouching with a pick-up between his legs.
Muscarella said men tend to focus on the more "concrete" aspects of sexual attributes like shape, form and size. He likened it to the male attraction to, and often obsession with, women's breasts.
An obsession with penis size is not a uniquely US phenomenon, said Virginia Sadock, a psychiatrist at New York University Medical Center.
"This is not limited to the United States by any means," Sadock said, noting that in Japan there is a condition known as "koro," in which a man suffers from delusions that his penis is actually shrinking back into his stomach.
And Muscarella said that the French are known for trading rumors about men with small penises, often accompanied by jokes and derision. At the heart of the problem, Sadock said, is that since men don't see many penises other than their own, they have little basis for comparison.
The exception, she said, is pornography, which gay men view more that straight men. And comparing one's penis size to a porn star's could lead even a well-endowed man to feel inadequate.
So perhaps it's not surprising that New York's gay community self-help arena has expanded beyond problems such as alcoholism and over eating to the affliction of a small penis.
"What is Small, Anyway," is the working name of a support group in Greenwich Village, which acts as a safe haven for gay men who have small penises, or feel as though they do.
Participants complain about a gay community in which men brag about being bigger than they are and a country where big is king. Like at other support groups, most in this group are grateful just to be in a room together with people trying to confront the same problem.
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