Commentary on Bhat A., Upadhyay R., et al. Penile anthropometry in north Indian children. Indian J Urol 32;106-10.

Nomograms are an essential part of medical science. Without the knowledge about the “normal” variations in a population, it is difficult to evaluate the “abnormal.” In most underdeveloped countries, in the absence of region- or race-specific nomograms for various parameters, there is a tendency to follow the western standards.[1] However, this may not be representative. Bhat and co-workers in this simple study have demonstrated the normal variation in penile dimensions seen in north Indian children.

The authors recruited 250 children with age ranging from birth to 10 years in a study period of 3 months, with 25 children in each year-group. They were fortunate to recruit a uniform sample size for each age group as it is sometimes difficult to get an equal sample size for each age range. They found an expected association between the child's age and penile size. However, they could not find any association between the height and body mass index of the child and his penile length and have not been able to explain the reason of this finding. They have also correlated the measured penile dimensions with those published from other countries.

Another issue addressed in the article is the problem of different methods used to measure the penile dimensions in various studies. This was because of the differences in the degree of stretching the penis and the different instruments used for measurement. These differences could account for the minor variations seen between the various studies.

Nomograms, although important for research purposes, are rarely used in routine clinical practice. Nomograms may also change after few years because it is expected that physical growth of Indian children may improve with better nutrition; the present Indian nomograms will gradually tilt toward those seen in the western world today. The world is like a global village today and there is a mixing of races and making different nomograms may then become futile.