I have never used the small grip. I started with the medium because it felt the most comfortable. Then I was reading a blog from someone who liked the feel of the medium but shot better with the large, so I tried it. The large made a noticeable difference in my accuracy so I've stuck with it. I intend to go back to the medium eventually simply because I'm a relatively new pistol shooter and know that shooting better may be just a result of progress in my shooting ability.