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On the biomedicalisation of the penis: the commodification of function and aesthetics.

This paper explores contemporary understandings and representations of the penis. It presents an overview of recent trends which re-frame long-standing penile anxieties within a new hybrid world of health and aesthetics. It explores these apparent changes through the lens of biomedicalisation. By focusing on constructions of masculinities in crisis, changes in the representability of the penis and the effects of Viagra, it suggests that contemporary penile pathologies and anxieties are being constructed and commodified. In the past medical discourse has focused primarily upon the 'traditional 'functionality of the penis, more recently it has focussed upon pharmaceutical innovations such as Viagra. However, we suggest that now there appears to be the emergence of a new penile discourse, a penile aesthetic that focuses upon penile appearance as much as function. This shift has been facilitated by the Internet, the deregulation of pornography and changes in sexual mores.

Keywords: penis, aesthetics, pathology, masculinities, biomedicalisation


Given its cultural significance as a key marker of both masculinity and men's corporeality, there is a relative dearth of historical work relating to men and their penises within the social sciences (for a notable exception see Friedman, 2003); yet within both the medical field and within broadly psychoanalytic work there is extensive literature. Partiality and specificity resonate with wider sociocultural penile discourses. For example, it has been said that the penis is simultaneously everywhere yet also seemingly nowhere, culturally salient but equally invisible or hidden (Stephens, 2007). In this paper we critically examine the variety of discourses concerning the penis and through this argue that the historic inviolability of the male penis is now changing. Whilst the penis has traditionally fallen under the gaze of discourses of medicalisation, with a focus on function over personal meaning, it is apparent that new discourses are emerging, which whilst broadly within the realm of the biomedical, and therefore enmeshed with technoscientific developments, also require an extension of biomedicalisation theory (Clarke et al., 2003) to incorporate discourses of the aesthetic. Our aim in this paper is twofold: (1) to detail the extant medicalised discourse of the penis in the context of hegemonic masculinity and (2) to highlight the emergence of a new aesthetic discourse of the penis, which operates at the boundaries of both the "new paradigm of health" (Beck & Beck-Gersheim, 2001; Becker, 1986; Nettleton, 2006) and "biomedicalisation" (Clarke et al.). This case offers up another example of the changing landscape concerning men's bodies and the consequent new challenges facing men in the context of biomedicalisation and the feminization of health (Moore, 2010).

Biomedicalisation offers a conceptual framework within which complex networks and agents constitute, and are constituted by, novel, and often highly technologically mediated, processes of medicalisation (see Clarke et al., 2003). It is arguably the most worked through theoretical perspective within the context of what has been called the new paradigm of health (Beck & Beck-Gersheim, 2001; Becker, 1986; Nettleton, 2006). It captures the fluid, technological and expanding repertoire of processes, structures and disciplines now appropriated into the exercise of what could be called biopower (Foucault, 1980), and what has been described as the production of the biosocial (Rabinow, 1992), wherein the psychosocial and the sociocultural are increasingly constituted through the biomedical. Central tenets of biomedicalisation, as opposed to medicalisation, are a focus upon medicalising health (as opposed to illness), the central involvement of commerce and industry and what has been termed technoscience. The pursuit of health presents one major and critically lucrative aspect of biomedicalisation; its necessary un-attainability representing a key driver for both commodification and governmentality.

Biomedicalisation provides a context in which to understand relationships between bodies and health. Within this framework an account is made of the ways in which the biomedical now also incorporates the transformation of bodies and the production of new identities. This is further reflected within literature on the sociology of the body, with the development of concepts such as "somatic individuality" (Rose, 2001), the "somatic society" (Turner, 1984) and "body projects" (Giddens, 1991; Nettleton & Watson, 1998). Moreover, digital technologies such as the internet have added to and facilitated the decoupling of biomedical discourse from its traditional professional and regulatory bodies and structures; now technoscience and biomedicine leach into, and construct, everyday life with a proliferation of risk and uncertainty. This "everyday medicalization," the disconnection from traditional medical power and the (re) problematisation of often traditional ideas or values, is indicative of the complexity, expansion, and entrepreneurship associated with biomedicalisation. A range of "normative" phenomena can be repackaged and rebranded as pathological and the solutions, treatments, or care packages sold back to us, often via the technologies of self diagnosis and self care and increasingly through the technologies of the digital era. Through biomedicalisation the normative becomes denatured, technologised and managed by the self.

Critically for this paper, whilst striving for health, men and male bodies have come under increasing scrutiny. Public health, health promotion, the social sciences and feminism have all in theft own ways shaped new forms of gendered surveillance (Moore, 2010). Dividing practices (ways of monitoring and measuring a population) have focussed upon the pathologisation of both the male body and associated masculinities. Similarly, the pathology and mutability implied within both gender dysmorphia and gender-reassignment surgery literally have pathologised the male body: masculinities are arguably in crisis (e.g., Horrocks, 1994). Simultaneously and relatedly, within popular culture there has been an associated exponential explosion of images and representations of "men" as visibly gendered masculine bodies (e.g., see Pope et al., 2001). Thus biomedicalisation helps illuminate two distinct yet clearly related areas of academic investigation: firstly, the critical exploration of men and masculinities (e.g., Connell, 1995; Connell & Messerschmidt, 2005), and secondly, the examination of the (gendered) body as a new identity project (Featherstone, 1991; Giddens, 1991; Jones, 2008; Shilling, 1993). Given the uncertainties that characterise contemporary Western society, for example, the increasingly provisional nature of relationships (Giddens, 1993), employment and career (Beck & Beck-Gernsheim, 1995), the fragility of family units (Beck-Gernsheim, 2002; Smart & Neale, 1998), communities and religious faith (Bauman, 2001; Turner, 2010), and of most relevance to this paper, gendered ideals and practices (Delamont, 2001; Horrocks, 1994)--the body can be understood as representing both a refuge of stability and certainty yet also, given the promise of biomedicalisation, an opportunity for fundamental rather than superficial transformation.

The body can be understood as a possible site to secure a sense of an enduring, authentic self, yet also, or perhaps because, it represents a key locus for self transformation and the embodiment of biomedicalised identities (for example, healthy/beautiful subjectivities, such as being "fit at 50," "being well adjusted," managing to live "slowly"). Similarly, in an era of forensic surveillance and identity theft, Gies (2008, p. 312) argues that through the increasing use of bio-informatics "the body is rapidly establishing itself as the ultimate measure of truth and authenticity." Body projects and associated identity work form a psychosocial and sociocultural corollary, stressing the body's potential status as guarantor of authentic personhood and highlighting why customization, and the individualisation, of bodies through a plethora of means has such contemporary currency and cultural capital (most often under the auspices of biomedicalisation). As ontological uncertainty increases, the biomedical ostensibly offers an increasing sense of truth, or "facticity" (Sartre, 2003) with the consequence that the "natural," "biological" and/or "genetic" operate as foundational and arguably fundamentalist forms of understanding. Yet, as the reach of biomedicalisation increases (e.g., in terms of discipline, technology and commodification), new regimes of truth emerge. Concomitantly, a wealth of new subjectivities emerge, each bringing the challenge of managing both authenticity and selfhood in increasingly diverse ways. The idea that diagnosis can transform the self has become an accepted, even comfortable idea (e.g., "Person Living With HIV" or "Cancer Survivor"), yet biomedicalisation suggests that the exercise of bio-power is now palpable within a far wider variety of health behaviours such as, for example, striving to be a good parent and accessing on-line peer support for parenthood, attaining a good work/life balance, the purchase of protein powders to attain the gym-fit-body or being an active retiree.

There is a clear historical sense of the interrogation of women's bodies and subjectivities as a central aspect of medicalisation (Bartky, 1991; Bordo, 1993; Davis, 1995; Wolf, 1991) and now more clearly biomedicalisation (Moore, 2010). Moreover, the vagina in particular has often been subject to considerable critical investigation (for example, see advice on vaginal self-examination: Boston Women's Health Book Collective, 1976; men's vagina-phobia: Kristeva, 1984; Creed, 1993; female genital cutting--for a sensible summary see Pedwell, 2008; designer vaginas: Braun, 2005; Jeffreys, 2005). Yet arguably the appropriation of gender (as dividing practice) in relation to the male body is more recent with a rapid shift in recent years from medicalisation to biomedicalisation (see Clarke et al., 2003, for detailed discussion of the distinction). A range of domains and stake-holders continue to scrutinise the male gender (for example, public health, health promotion, psychology, sociology, gender studies) and produce diverse discourses of gendered health, risk and identity. Subsequent subjectivities proliferate; the new man, the coronary candidate, the Type A personality, or the alpha male, for example. It is within the context of these wider biosocial trends that an emerging psychosocial focus upon men and their bodies has been forged, with research covering body image concerns (Grogan, 2007), body modifications (Gill, Henwood, & McLean, 2005), and various men's health issues (Gough & Robertson, 2009), often with a clear focus upon the retention or refashioning of and/or resistance to hegemonic masculinities across different social contexts. Men's (dis-)engagement with embodiment occurs in an overarching consumerist context, which often idealises the muscular, lean and hairless body (Gill, Henwood, & McLean, 2005; McCreary et al., 2007; Miller, 2005, 2008; Tiggemann, Martins, & Churchett, 2008). It is within this maelstrom of the biosocial and its appropriation of masculinity as pathology, and the associated problematisation of the male body that the current paper explores emerging ideas concerning the heightened construction and commodification of penile anxieties and vulnerabilities for men. That is, we seek to signal the potential impact of biomedicalisation on men, masculinities and the penis, revealing key ways in which such constructions may offer up new challenges for men in these late modern times. Through an overview of discourses of the penis, from functional to a new aesthetic, we demonstrate the power of biomedicalisation to denature and trouble the male body with the result that we now witness the emergence of new "health" problems, new challenges to masculinities and new anxieties for men. However, our review and analysis also points up limits to the biomedicalisation framework as we witness the emergence of a new discourse of bodily aesthetics. We argue that this new aesthetics requires an extension of the biomedical framework so that it better represents the rapidly evolving landscape concerning men's bodies and offers up an appropriate theoretical framework within which to understand socio-cultural change.


In contrast to the penis-related literature that is concerned with the symbolism of the penis (the "phallus") rather than its corporeality, the largest extant body of work can be characterised as clinical, invariably concerned with explicit and traditionally medical pathology, for example, within the contexts of erectile dysfunction or urology (e.g., see Monstrey et al., 2005). This medical penis-related literature typically addresses the regulation, "fixing" or "normalising" of the "broken penis;" it continues to represent the mainstay of penile discourse. The apparent dominance of medical constructions of the penis is perhaps not too surprising: the physiological aspects of the penis as appendage or organ are commonly emphasised and a range of interventions are designed to ensure that the penis remains "fit for purpose." These understandings tend to construct the penis in terms of its "function" and can usefully be thought of as bolstering particular everyday discourses which construct the penis as "tool." These ideas stress how the penis is important as the principal means to achieving particular ends, predominantly penetration and very rarely micturition (the penis as "tool" also brings with it additional connotations of traditional masculinity and manual labour).

The traditional focus upon the functionality of the penis is highlighted across both academic and popular discourse. The cultural consumption of Viagra has both emphasised and contested this central means to understanding the penis; it represents a pivotal moment in what we think of as the biomedicalisation of penile masculinities. The logic of the drug itself, and the literature associated with its ascendency, demonstrates that the "natural" functionality of the penis has been both reinforced yet simultaneously undermined. On the one hand we see the way that the drug acts "invisibly" to restore "normal function" and thus reinforce the naturalness of the penis and associated hegemonic masculinity. On the other hand, however, we now have greater attention focused on the penis and particularly the functional erection than ever before. This has resulted in a new discourse of "erectile quality" and penile aesthetics that moves beyond the merely functional and also undermines any notion of sex beyond the penetrative. The "Sexual Health Inventory for Men (SHIM)" (Cappelleri & Rosen, 2005; Rosen, 1999), for example, constructs sexual health across a limited number of primarily physiological and functional dimensions (rather than more normative constructions of sexual health which focus upon infectious disease). These measures conceptualise and construct sexual health and the function of the penis in terms of confidence in maintaining an erection, having an erection hard enough to penetrate a partner, maintenance of erection within a partner, maintenance to completion of intercourse and satisfaction with sexual intercourse (; for review of its use see Rosen, Cappelleri, & Gendrano, 2002).

In terms of Viagra undermining functional discourses relating to the penis, two key areas are important. Primarily, the very function of Viagra problematises the "natural" erection. The novel notion of erection "quality" and the ability to "improve" an erection renders normative erectile changes across the life span as problematic and as pathological. Moreover, the emergence and blossoming of critical Viagra studies with its close scrutiny, and deconstruction, of the functional and often patriarchal ideologies relating to the penis equally undermine and contest functional discourses relating to the penis (e.g., Asberg & Johnson, 2009; Brubaker & Johnson, 2008; Haiken, 2000; Mamo & Fishman, 2001; Marshall, 2006, 2009; Tiefer, 2006; Vares & Braun, 2006) and in turn equally invoke the pathology of male bodies and many masculinities.

Moreover, the functional, medical and clinical perspectives outlined here also stress a sense of dualism (i.e., the man and his penis as separate), reinforcing dominant images of the penis as disembodied, or exteriorised. In a literal sense, there is a focus upon the mechanics of a man's "equipment" that may need to be assessed and fixed to continue with normative function, although this mechanised metaphor extends to male bodies in general within much men's health discourse (see Gough, 2009). In terms of managing clinical interactions (between health care workers and male "patients"), these ways of talking and thinking about the penis may be valuable as they potentially reduce the stigma and embarrassment of discussing penis-related problems through facilitating some distance and objectivity. However, writing in the pre-Viagra period, Boyle (1993) notes how the differential aetiology of gendered sexual dysfunctions (i.e., physical explanations for men and psychological for women) functioned to stigmatise women yet enable men to maintain their rationalist integrity while experiencing sexual problems.

A series of other constructions exist which focus on the penis as exteriorised but also as relating to some miniaturised, yet often agentic, version of masculinity; in other words, constructions which understand the penis as having a mind of its own to some extent (probably deriving from involuntary erections and nocturnal emissions). These ideas (e.g. "wee man") can also be useful in managing accounts of culpability for sexual misdemeanour, or for explaining premature ejaculation or erectile dysfunction, for example, through attributing blame to the penis rather than self (Potts, 2001). Disconnecting the penis from the man is also reported as a strategy for heterosexual male viewers of pornography, who can thereby look at the penis, even assess it, without this being read as desire for the man it is attached to (Sorensen, 2009). Buchbinder (2013) discusses such constructions of the penis in the context of the Baktinian distinction between the classical and grotesque. Here, the penis falls into the category of the grotesque as natural, corporeal and unruly. However, the above ideas stand in marked contrast to the understandings of the penis which address it as representing a man's "essential" "man-hood," or "member" (these ideas seeming to stress the centrality of the penis to masculinity and sense of self). The penis (and male body as a whole) is thus ambiguous, natural and cultural, and therefore a perfect example of Derridean brisure for Buchbinder (2013, p. 134), "a site on which nurture and nature meet, or hinge together ... always-already conceptually divided, yet (organically at least) unified."


In addition to the contested functional penile discourse outlined above, we suggest that, post-Viagra there are now new, primarily aesthetic, discourses relating to the penis and masculinities. These discourses and their associated subjectivities stem from an array of developments, some very clearly aligned with the ideas of the new paradigm of health and biomedicalisation, others clearly not. We explore the effects of consumerist culture where men and male bodies are either products or the means to market products; developments in the internet which have forged new distributed visual sexualities; the deregulation of pornography and the spectacular penis; the prominence of the gay-male gaze and the centrality of the homosocial; and finally, the problematisation of sex and the corresponding sexualisation of everyday life.

As outlined earlier, at the end of the twentieth century, in the context of the rise of the new paradigm of health and/or biomedicalisation, we have witnessed both the problematisation of the male body and an increase in representations of the idealised male body within popular culture, one which invited the onlooker to observe and desire while presenting a new series of possibly unattainable hybrid health and beauty goals for men to aspire to and strive for. As Gill, Henwood and Maclean note, "men's bodies as bodies have gone from near invisibility to hyper visibility in the course of a decade" (2005, p. 39). The muscular, lean, youthful and hairless body has emerged as a new ideal (McCreary, Hildebrandt, Heinberg, Boroughs & Thompson, 2007). This ideal form is closely associated with both selling products and being a product itself, a host of new identities and subjectivities map out a series of bodily related pathologies and identities which arguably did not exist a generation ago, for example, the degree and colour of bodily hair, "love handles," having "a belly," mens' wrinkles or having a six pack. Although, it is important to remember that this body also has a very long history, being represented in Egyptian Hieroglyphics as well as Greek statuary (Holliday & Cairnie, 2007), we believe the specific place of the penis within these recent representations is changing and still unclear, yet its potential "visibility" appears increasingly significant for understandings of men and masculinities.

Growth in pornography has been facilitated in the UK by exponential growth of the internet and the British Board of Film Classification's decision to consider and rate pornography. This has been described as the "mainstreaming" or "normalisation" of pore, and has been associated with the intensification of anxiety that is so closely associated with the performance of Western heterosexual masculinity (Cook, 2006). For most heterosexual men in the West, primary engagement with other men's penises is visual. Thus these constructions do not relate to the functional discourse outlined earlier; instead they signal the salience of the visibility of the penis within contemporary culture. Until recently, censorship laws embedded in the UK in the Obscene Publications Act have prevented the erect penis from being represented in any mainstream media. The women-run pornographic magazine For Women, for example, suffered from a prohibition on erections, and it seems that little has really changed. When contemporary porn magazine for women, Filament, attempted to depict erections their printer refused to print it and lawyers advised the owners it would be a legally risky step. This was despite protestations from readers (Lloyd & Madden, 2009). This is in stark contrast to representations of women's vaginas for men's consumption (or indeed men's penises for male consumption within gay pornography). Stephens (2007) nonetheless identifies and examines media representations of the penis, such as the Bobbitt trial, and performance such as the Puppetry of the Penis, noting that the turn of the last century witnessed a change in the "representability" of the penis, with depictions now often rendering the penis as "humiliated, tortured or laughed at" (Stephens, 2007, p. 96). "Mainstream" movies have begun to include occasional depictions of the erect penis, too--for example In The Cut (2003), Nine Songs (2004) and Antichrist (2009).

The Internet, of course, is now a key site for encountering, displaying and interacting with embodied images. It is emerging as a site of exponential growth in relation to representations of the penis and the marketing of solutions to penis problems (e.g. "penis enhancement" products). Gies (2008) argues that the internet, with all its non-corporeal potential, paradoxically re-emphasises embodiment and the material body through the senses of sight and sound, but also through the somatic motivation to go online, for example, seeking pleasure, or peer support for bodily discomfort. This distinction makes considerable sense if we accept Heidegger's (2001) distinction between the body (Leib) and corporeality (Korper), wherein the corporeal stops and is bounded by the skin whilst embodiment may be experienced beyond this "bodily limit" and thus be experienced intersubjectively and indeed even virtually. Most understandings of the body concern the body as Leib but Heidegger suggested that our sense of embodiment may extend beyond this, beyond the boundary of our skin. If we think of the footballer moving to curve the ball that has left their boot, or the person playing the videogame feeling physically trapped in a corner as their character is surrounded, then we have a sense of this extended notion of embodiment. Clearly, this is highly relevant to understanding the expansion of sex on the Internet with both the body (as Leib) and the corporeal (as Korper) providing multiple opportunities for entrepreneurship and commercial exploitation. Gies (2008) also highlights that recent developments on the Internet have focussed on video-sharing and increasing exposure of the body. This is also true with regard to the sexual. The Internet represents an increasingly public domain of bodily sexuality (e.g. Cam4, Redtube, Xtube, ICU2, Arguably, the Internet has disrupted and inverted traditional divisions of the public and the private. What once only happened "behind closed doors" now may also be broadcast to potentially thousands of other people. This development, we argue, may heighten men's anxieties about their "privates" either via comparison or by exposing oneself to real and direct feedback. Given the centrality of intersubjective corporeality within the consumption of pornography a man's relationship to his penis, although still firmly rooted in the personal and private, is now simultaneously exposed and under real, and critically imagined, surveillance. The penis has been denatured, deprived of its natural character through increasing surveillance and critical interrogation.

Concern with penile appearance should also be considered in relation to the proliferation of pornographic representations of exaggerated penile size (i.e. the spectacular penis, see Stephens, 2007). Because pornography is currently limited to visual and aural depictions of sex, it must compensate for its lack of other sensual pleasures through the over-representation of extended vigorous fucking and other visual strategies to heighten intersubjective corporeality and to authenticate the "realness" of the sex being depicted. The visual must thus be exaggerated via extended movement, duration and therefore penis size. Porn stars themselves, however, notoriously have extreme difficulties maintaining their over-sized and over-hard erections for the duration of shoots. These penises may look impressive but rarely live up to their promise. "Behind-the-scenes" documentaries about the porn industry, now a staple of late-night multi-channel TV, have to some extent revealed the artifice behind achieving this "realness," though this has been countered by greater appeals to "reality" through, for example, an emphasis on "amateur" porn depicting "real sex" (Barcan, 2004). One effect of the "realitization" of porn has arguably been to expose viewers to a wider variety of body types, though arguably it has done little to address the "performance anxieties" of its audiences.

Changes in sexual norms at the population level mean an average increase in the turnover of sexual partners and a new sexual contract that encourages self-scrutiny and analysis of all aspects of relationships (e.g. Johnson et al, 2001; Giddens, 1993). There is some evidence to suggest that for heterosexual women the importance of penis length and girth is associated with number of sexual partners, with women having higher numbers of partners more likely to pay attention to penis size (Stulhofer, 2006). Thus heterosexual men are potentially exposed to the reality, or, at the very least, the "fantasy," of "the comparator penis" in relatively new and perhaps challenging ways and thus exposing them to anxieties that previously may have been more commonly associated with gay men. This shift in penile visibility and associated cultural norms, and the self-scrutiny they engender for many men, represents a novel development in the gendered and pathologised male body and associated masculinities. This increased visibility might represent the queering of hegemonic masculinity, with a radical transformation of the relationship between men, their bodies and the bodies of other men. What was previously private is now increasingly public and subject to the gaze of the Other. Simpson (1994, p. 4) describes it thus:
   Men's bodies are on display everywhere; but the grounds of men's
   anxiety is not just that they are being exposed and commodified but
   that their bodies are placed in such a way as to passively invite a
   gaze that is undifferentiated: it might be female or male, hetero
   or homo. Traditional male heterosexuality ... is now inundated with
   images of men's bodies as passive, masochistic and desired.

This shift, alongside changing power dynamics with women who are more likely to have had multiple partners, access to pornography and therefore greater knowledge of comparator penises, might very well result in the wholesale queering of normative masculinity and embodiment.

As well as liberalisation of pornography controls, changes in legislation and societal attitudes concerning both homosexuality and "Gender Identity Disorder" (GID) (itself a problematic diagnostic category) have also changed understandings of the penis, and present a valuable lens through which to examine contemporary understandings of the penis. Whilst homosexuality is no longer a disease category and no longer regulated in a simplistic way by medicine and psychiatry (see Flowers and Davis, in press), GID still is (see DSM-IV-TR). The greater acceptability of gay sexuality has perhaps increased an awareness of the "gay male gaze" and added to the pre-existing locker room dynamics of many other homosocial interactions (for example, the ways men check each other out at urinals, in showers and in changing rooms has potentially expanded; see Cover, 2003). Constructions of ethnic diversity in penis size and shape (such as the "supersized Black penis") also invite comparisons and court perceived inadequacies (Fung, 1991). In contrast to the solely visual nature of heterosexual men's engagement with other men's penises, sex between men necessarily involves at least two men and two penises and thus there is a constant comparator penis. Moreover, for the receptive partner within penetrative anal sex, a hard and erect penis is not "essential" for sexual pleasure. Equally, to some extent, the salience of gay sexuality has the potential to de-centre the penis as the unitary "male" sexual organ. Potts (2000), for example, has described how within heterosex, the "functional" discourses of the penis centralise sex and limit "what counts as enjoyable male sexual experience" (Ports, 2000, p. 89). Along the same lines, Waldby (1995, p. 271) writes how "full identification with the phallic, proprietal imago of masculinity demands a kind of de-eroticisation of most of the body." Yet, for all people, particularly men because of the erogenous nature of the prostate gland (and perhaps for gay men especially), the rectum and surrounding anal areas are also often explicitly thought of as sexual organs. In fact, within sexualised gay cultures discourses exist which speak of anal agency, for example within personal adverts on line, identities such as "aggressive bottom" and "hungry hole" are tangible. And in terms of thinking about gender identity and gender re-assignment, the changing awareness of trans-people, and the associated mutability of genitals and gender also perhaps is affecting both cultural representations and men's understandings of their penises.

It has been suggested that we are now living in an era defined by creeping sexualisation of everyday life (Gill et al., 2005; McNair, 2002), as evidenced by recent concern over sexualised images of young girls within mass media and marketing sites (see, for example, the Bailey review, 2011, and its endorsement by the UK government). There has also been a huge resurgence in "popular feminism" fuelled by concerns over the rise in "sex industries" integral to the night-time economy and the imagined effects of this on "ordinary" young women (see for instance Levy, 2006 & Walter, 2010; for a more nuanced critique see Holliday & Sanchez Taylor, 2006). The developments outlined within this section speak to the pathologisation of sex and sexuality; the lens of biomedicalisation means that the sexualisation of everyday life will continue to come under increasing scrutiny. Sex itself is problematised, pathologised and commodified. The pursuit of healthy sex and healthy sexuality already represents a key focus for both governance and governmentality. It seems likely that these ever increasing and diversified aspects of sexuality will be under continued biomedicalised scrutiny (by biomedicine, the social sciences and the humanities).

Penile Pathologies, Penile Treatments and Penile Products

The biomedicalisation of the penis has pathologised and problematised both the function (exacerbated by the effects of Viagra) and appearance of the penis (the aesthetic penile discourse). It provides both an increased range of penile problems and pivotally, as we shall see below, a plethora of new treatments and interventions regarding their amelioration. Moreover, it demands the self-management of penile anxieties. In this section we provide illustrations documenting new penile pathologies and briefly outline how these are commodified. Detailed examination and analysis of these products is beyond the scope of the current paper but the following should be sufficient to highlight the possible emergence of a new industry of penile aesthetics.

Non-pornographic aspects of the Internet have further facilitated the commodification of men's anxieties about the aesthetics and perceived inadequacies of their penises, for example, sites on Facebook, and a plethora of small-penis support sites. "Size med" offers a fairly typical example, it delivers both ostensible support and information ("the best advice") but also a range of products and women's personal testimonies outlining the inadequacy of the "small penis," e.g. "Do you like penises? A lot of women are repulsed by them." Response: "I am repulsed by small, wimpy little things. But a hard, large thick penis is the sexiest thing in the world, nothing gets me going more. They make me feel so horny and in the mood" (see A variety of solutions are advertised and offered, for a price.

Existing evidence and cultural norms suggest that penile anxieties are relatively commonplace (Wylie & Eardley, 2006; Oderda & Gontero, 2010) but there is very little systematic research charting its prevalence. However, Lever, Frederik, & Peplau (2006) report that 45% of men are dissatisfied with their penis size and wish it to be larger, while more recently Tiggemann, Martins and Churchett (2008) report from an Australian study that over 60% of their self selected convenience sample wanted a larger penis. A study from Italy (Mondaini et al., 2002) examining the accounts of men presenting for penile lengthening procedures at a clinic indicates that these men were primarily concerned with flaccid appearance rather than erect state, and that they also systematically overestimated the size of an average penis. In addition, about a quarter of their sample also had concerns about penile girth. With regards to the homosocial, amongst this pre-clinical sample, 63% had begun being concerned about their penis in childhood when comparisons between boys took place. However, a further 37% reported their anxieties emerged within their teenage years as a result of their consumption of pornography and the penises they witnessed therein. A systematic review of the literature concerning the overall effects of penile cancer and treatment (i.e. mostly partial penectomy, but also some glansectomy and laser therapy) emphasises the centrality of the penis to sexual and social functioning and indeed to quality of life. Maddineni et al. (2009) suggest that up to 40% of those treated for penile cancers show psychiatric symptoms, and approximately 50% present with indications of post-traumatic stress syndrome. These factors may begin to explain the spectrum of dissatisfaction with penis size that includes "small penis syndrome" (see Wylie & Eardley, 2006).

Penile enhancement (or treatment for penile anxiety) occurs in several ways, ranging from the decidedly low tech to the complex and surgical (see Oderda & Gontero, 2010). It is occurring in ways which are quite distinct from some on-going cultural practices such as penile adornment (e.g., see Fischer et al., 2010). In terms of low tech treatments, trends such as the styling or removal of pubic hair for men signal the increased visibility of male genitals and a new, primarily visual genital aesthetic (Ramsey et al, 2009; for a comparable discussion about women's genitals and pubic hair, see Barcan, 2004). Equally a range of low-tech solutions exist which focus upon herbal remedies, penile lengthening pills, penile workout regimes, penile extenders or penile vacuum pumps (for review see Nugteren et al., 2010). A range of more traditional and pharmaceutical treatments now exist, through oral means as tablets (e.g., Viagra), also as gels (e.g., Cialis), alongside injected drugs (such as Caverject--"alprostadil") or injected liquid silicone. Moreover, the range of surgical techniques now available has expanded. Haiken (2000) shows that it was only within the 1990s that cosmetic penile surgery appeared and proliferated. These surgical procedures range from taking fat from another part of the body to enhance girth to phalloplasty and even penectomy (usually within gender reassignment). Interestingly, as outlined above, most surgery is only associated with how the penis looks in a flaccid state rather than the appearance of the erect penis or how the penis feels or functions, paralleling wider debates about the symbolic capital associated with contemporary body projects (e.g., Bourdieu, 1984; Gill, Henwood, & McLean, 2005).

The medical discourses found in many of these enhancement procedures emphasise the rhetorical power of biomedicalisation and the "call-to-disease" they elicit amongst the worried well within the context of a new discourse of penile aesthetics. For example, conspicuous displays of chemical formulas and unsubstantiated comparison charts between bio-medically regulated drugs and the herbal product advertised sit comfortably with personal testimonies and expert recommendations and bright colourful sexualised imagery in many sites of information concerned with improving the appearance of the penis (see


The penis was once described as "the most visibly mutable of body parts" (Bordo, 1994, p. 226). However, this changeability referred to the temporal aspects of the erection rather than to the array of more contemporary penile modifications or "enhancements." In very visceral ways the penis is fundamentally amenable to change in ways that it wasn't in the past. Moreover, the possibility of changing the penis and the idea that men can and indeed should change their penis is increasingly ubiquitous. New possibilities in penile enhancement mean that new and usually private concerns and worries over the penis are potentially becoming additional problems that men didn't know they had. A decade ago, Potts (2000) highlighted the predominantly "chemical or prosthetic solutions" relating to functional and primarily physical penile pathologies; these continue. Yet now, due to the increasing representability of the penis, and the market forces which now capitalise upon these changes, there has been a diversification of penile pathologies to include aesthetic as well as functional shortcomings. Moreover, the range and modalities of solutions to these new penile problems have also grown (e.g. unregulated enhancement products on the internet).

It could be argued that the increasing presence of the male body and the penis within mass media and consumerist sites presents a critical challenge to the "naturalness" of the male body and an undermining of symbolic masculinity and male power. The male gaze is troubled and forced to examine itself and like whiteness, heterosexuality or able bodied-ness, the tacit and implicit is problematised, deconstructed and the workings of power are rendered visible. This argument is supported by the problematisation of the penis at these sites (e.g., erectile dysfunction), which for Stephens (2007, p. 91) often has a punitive element; "the penis which becomes visible, and is seen in the public sphere, becomes an object of ridicule, evidence of lack of control over the body." When we consider that historically it has been the relative invisibility of the penis that has helped secure male status, security and superiority (over women), the current tendency towards exposing and troubling the penis could work to destabilise and deconstruct such male privilege. Yet things appear more complicated, in the words of Stephens (2007, p. 87): "although the materiality of the penis provides a direct model for the phallus, the construction of the phallic ideal requires the disappearance of the physical penis it replaces and supersedes." Thus it has also been proposed that there is no new crisis in masculinity; that, in fact, Western patriarchal culture is reliant upon an enduring culture of crisis in masculinity, and the concomitant and continual quest for hierarchy, dominance and control that it engenders (see Thompson & Holt, 2004). Of course classic psychoanalytic accounts construe men as fundamentally defensive in their denouncement of femininity and restless striving after (an illusory) sense of control and wholeness (Ireland, 2004; Lacan, 1977). Notwithstanding these arguments, we would suggest that the increasing representability of the penis in the contemporary sex-saturated age will likely engender further new brands of "old crises" within masculinities which will, in-turn, require carefully crafted, beguiling, income-generating and health-maximising solutions. To what extent such crises affect men differently positioned with regards to age, race/ethnicity, sexuality, socio-economic status and dis-ability remain to be seen and is an empirical question worthy of investigation. We might expect to find differences between different generations of men, as much as between men of different sexualities or socio-economic status. The technologically mediated nature of the emergence of a new aesthetic discourse is particularly salient and likely to mediate any effects, at least until we reach global technological saturation.

In this paper we have contextualised these changes within the broad and inclusive framework of biomedicalisation (see Clarke et al., 2003), but must note that this framework is at present inadequate to account for the emergence of a new aesthetic discourse concerned with embodiment. Whilst the new paradigm of health and biomedicalisation recognise the technoscientific transformation of bodies, to date they have not adequately accounted for this within the context of a new aesthetics of the body. Our analysis suggests that the biomedicalisation framework needs expansion in the light of this emerging discourse so that it can fully account for this rapid cultural shift in men's understandings of embodiment and account for the intersection of bodily aesthetics and the biomedical. The new aesthetics of the penis in many ways represents the growing feminization of health discussed by Moore (2010), with the visual superseding the functional. The traditional medical discourse of the male body as machine, with mind and body clearly separable (Annandale & Clark, 1996; Connell, 1990; Lupton, 2003; Turner, 1984), remains a potent discourse concerning the functional nature of the penis. However, we argue that this must now also be augmented by an expanded notion of the biomedical, in which discourses of bodily aesthetics and the visual occupy as powerful a place in men's consciousness as medical understandings. Self-surveillance must now extend beyond the penis as effective tool for penetration to the penis as comparator body part with the penis of the Other. This shift not only represents a move in men's understandings of embodiment but also a significant shift in our understanding of hegemonic gender norms.

The complex processes of biomedicalisation are pervasive and pernicious; perhaps it even makes sense to identify phenomena that resist it, rather than those which exemplify it. However, as social scientists interested in embodiment, health and illness and committed to the promise, and outcomes, of interdisciplinary research and indeed demonstrable impact, it is difficult for us to ignore. Biomedicalisation offers a framework within which we can contextualise our respective disciplines, the regulation of research assessment and indeed the drivers for contemporary research funding and publication. We are part of the technoscientific network regulating increasingly diverse discourses of health, illness, pathology and intervention. Moreover with a reflexive twist we can also see that even as critical researchers we are still centrally concerned with identifying, or diagnosing, problems. Rather than reducing illness and death, concepts such as quality of life, well-being and health inequalities chart the ever-expanding topography of biomedicalisation. Moreover, the diversification of digital technologies as key modalities through which we engage with the world add to the challenges of examining how health and well-being are similarly being commodified, experienced and theorised.

DOI: 10.3149/jmh.1202.121


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(1) Department of Psychology and Allied Health Sciences, Institute for Applied Health Research, Glasgow Caledonian University, Scotland.

(2) Faculty of Social Sciences, The Open University, UK.

(3) School of Social, Psychological & Communication Sciences, Leeds Metropolitan University, UK.

(4) Centre for Interdisciplinary Gender Studies University of Leeds, UK.

Correspondence concerning this article should be addressed to Paul Flowers, Department of Psychology and Allied Health Sciences, Institute for Applied Health Research, Glasgow Caledonian University, Scotland, G4 OBA. Email:
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Author:Flowers, Paul; Langdridge, Darren; Gough, Brendan; Holliday, Ruth
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Date:Jun 22, 2013
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