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During the nontreatment period, significant changes in penis length and girth were not observed. The other American-related studies were from the USA. In terms of race and ethnicity of American men, the study by Barboza, et al,11 was conducted on Brazilians, ≥18 years old who self-declared as having black or white skin color. The PRISMA diagram shows the number of articles that are included (Figure 1). 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