The last decade has seen a new openness about male sexuality, but rather than boosting men’s confidence it appears to have created a surge in “imagined inadequacy”.

American male sexual health expert Dudley Danoff, who has more than 30 years of experience as a urologist, says he has seen a dramatic rise in otherwise healthy men who imagine they are sexually inadequate in some way.

Through the internet, television, advertising and pornography, these men are being exposed to images that subtly erode their confidence and prompt them to reassess their performance.

“There is an enormous prevalence of material available around the clock. It is on their screens, on their smartphones, it’s at sporting events: they can’t watch American football on television without seeing advertisements for drugs like Viagra, Cialis and Levitra,” he says.*

They are also bombarded with a range of pills, potions and lotions that have never been approved by the Food and Drug Authority and are a billion-dollar industry in the United States.

The launch of Viagra some 15 years ago sparked a change in the way male sexuality was discussed in public. Within a few years, it was being talked about openly and at a level of detail previously unimaginable.

Danoff, founder of the Cedars-Sinai Medical Centre Tower Urology Group in Los Angeles, says it is now not unusual for men to consult him for an apparent urologic problem about a kidney, bladder or prostate issue when the real agenda is to dispel anxieties about their penis.

They may come in with a minor complaint like a blemish or an irritation but at the last moment, as they are reaching for the door, they’ll say “By the way, Dr Danoff . . .” and out will come their real concern.

While some are troubled by size and want an expert opinion on enlargement – Danoff is dead-against this – the questions are more frequently about performance.

There are worries about libido. Older men fear they have lost it while younger men fear they compare poorly with the reported prowess of their peers.

Then there are perennial issues about rigidity. What is sufficient? How to sustain it.

Concern about ejaculation is common too, particularly about its speed and volume.

After examining 200,000 penises in his career, Danoff says only a small number of men who complain have a genuine medical condition.

EXPRESSIONS OF INSECURITY

What he is really hearing are expressions of insecurity, mainly variations on one fundamental anxiety: “Am I normal?” In most cases, his answer is unequivocally yes.

Danoff disagrees with Freud’s famed theory that women suffer penis envy. He says men have the envy. They are obsessed with the metrics of their member.

In the locker room they look around and covet what others have. But looks can be deceptive.

Ignore the flaccid size, says Danoff. “If one man’s penis is five inches long when soft and another’s is three inches long, that two-inch size difference is likely to shrink to near zero when they become erect. It is even possible for the smaller penis to be bigger when erect.”

And the size of a man’s hands, feet or nose is not indicative of penis size.

Danoff says the variation in men’s sexual functionality and capacity has little to do with the anatomy of their penis or with their level of success, wealth, or status in the world.

Rather, it is tied to how they perceive what they have. “What gives a penis its power is much more than the condition of its blood vessels and nerves.”

Much power comes from attitude, from being positive and from what is in the man’s heart. Negativity and anger draw power away from potency.

Danoff’s latest book, Penis Power, the ultimate guide to male sexual health, is described as “a meticulous examination of the essentials of male sexual health, arousal and anatomy”.

It aims to help men overcome what he calls penis weakness. One of the first steps is self-acceptance. “You’ve got to look down and love it,” he says.

“The majority of men have perfectly normal apparatus and often the problem they have, or think they have, originates in their mind.”

“The brain is the ultimate controller of the penis and self-doubt is its enemy. I see the brain/penis axis like a high-tension wire.”

FEAR SELF-FULFILLING

The connection is direct: it is easily disturbed and a fear of failure can quickly become self-fulfilling.

”If you think you are abnormal, if you are anxious about performing adequately, if you are afraid that your partner might be disappointed, then chances are you have already worried yourself into creating the very problems you fear.”

He tells men sex is not an Olympic sport but is about passion, sharing and tenderness, and he exhorts them not to consider trying to change what they were born with.

“There is no legitimate and safe way to make a penis larger,” he says: as it is a dynamic organ that grows and shrinks, there is no safe way to make it fatter with a graft.

“Procedures that increase girth or length are ineffective and highly risky. To believe otherwise is to subject your penis to gross disfigurement.”

“Rather, just take a good look in the mirror and be happy with what you have. If it functions well, then you have nothing to worry about.”

“In all my years of practice no woman has ever come in with her partner and asked if I could make his penis longer, fatter or wider. But they have said ‘Could you make it a little firmer please, and perhaps attach it to a nicer guy?’”

Danoff’ says the secret of a good relationship for a woman is not only to know the man’s needs and his desires but to understand that “a man with an erection is a mindless baby”.

But he also notes that modern, powerful women can be intimidating, and a successful sexual relationship requires a delicate dance. “For the average man, a woman with big set of balls can be a threat. I am not suggesting she cut them off, but she needs to be balanced in her approach.”

While the brain is a major driver of potency and performance, Danoff says there are several medical conditions that prevent normal sexual function. If a man of 50 reports difficulty over the past few months, he will have a battery of tests to check for an underlying systemic condition.

Chronic sexual dysfunction can also originate from deep psychological conditions such as depression, past sexual abuse or a debilitating inner conflict. Danoff says these men need a different help.

Impairment caused by alcohol and drugs needs to be ruled out too. Prescription or recreational drugs can impair performance temporarily and can do so over the long term too.

Some recreational drugs create the illusion of enhanced sexuality because they lower inhibitions and produce a heightened sensitivity – but that’s all it is, an illusion, Danoff says.

While a little alcohol can lessen reticence and loosen reserve, which may be sexually helpful, too much alcohol adds to desire but takes away from performance.

*Prescription drugs are not advertised to the public in Australia.