New research has found a strong association between genital dissatisfaction and lower sexual activity in men.

The nationally-representative study of 4,198 U.S. males aged 18–65 years found less than a quarter of men reported dissatisfaction with their genitals.

Among those who did, twenty-seven percent of men were dissatisfied with the size of their flaccid penis, while 19 percent were dissatisfied with the length of their erect penis. Fifteen percent were dissatisfied with the girth of erect their penis, while 14 percent were dissatisfied with their pubic hair.

Men who reported genital dissatisfaction were less sexually active and had sex less frequently. They were also likely to report penetrative vaginal sex and receiving oral genital sex in the last year.

PsyPost interviewed the study’s corresponding author, Thomas Gaither of the University of California, San Francisco. Read his responses below:

PsyPost: Why were you interested in this topic?

Male genital satisfaction is an important aspect of psychosocial and sexual health. In urology and sexual medicine, we often see patients with conditions that affect how men may perceive their genitals (i.e. micropenis, hypospadias, Peyronie’s disease, genital cancers, etc). Even in men without such conditions, concerns surrounding what is normal and abnormal in terms of male genitalia are common. A group of researchers recently validated the Index of Male Genital Image, and we explored scores on this index with male sexual behaviors and sexual frequencies.

What should the average person take away from your study?

For one, we believe this study can normalize the fears or anxiety that men have in regards to their genitalia. Second, there is a strong relationship between male genital dissatisfaction and less sexual activity.

Are there any major caveats? What questions still need to be addressed?

This was a survey done at one time point. Thus, we cannot determine causation. we also don’t know if low sexual activity leads to poor male genital satisfaction or vice versa. We can just say right now there is a relationship between the two.

The study, “Characterization of Genital Dissatisfaction in a National Sample of U.S. Men,” was published online September 13, 2016, in the Archives of Sexual Behavior.