Urological Science

LETTER TO THE EDITOR
Year
: 2020  |  Volume : 31  |  Issue : 2  |  Page : 85--86

Penile dysmorphic disorder: A secret obsession in men


Chidiebere Emmanuel Okechukwu1, Abdalla Ali Deb2, Shady Emara3, Sami A Abbas4,  
1 Department of Biomedicine and Prevention, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
2 Department of Urology, Manchester University NHS Foundation Trust (MFT), UK
3 Department of Urology, Western General Hospital, Edinburgh, Scotland
4 Department of Urology, National Institute of Urology and Nephrology, Cairo, Egypt

Correspondence Address:
Chidiebere Emmanuel Okechukwu
Department of Biomedicine and Prevention, Faculty of Medicine and Surgery, University of Roma Tor Vergata, Via Montpellier, 1, 00133 Roma
Italy




How to cite this article:
Okechukwu CE, Deb AA, Emara S, Abbas SA. Penile dysmorphic disorder: A secret obsession in men.Urol Sci 2020;31:85-86


How to cite this URL:
Okechukwu CE, Deb AA, Emara S, Abbas SA. Penile dysmorphic disorder: A secret obsession in men. Urol Sci [serial online] 2020 [cited 2020 Jul 8 ];31:85-86
Available from: http://www.e-urol-sci.com/text.asp?2020/31/2/85/283251


Full Text



Dear Editor,

Penile dysmorphic disorder (PDD), also known as “small-penis syndrome,” is a form of body dysmorphic disorder that refers to a gross obsession and worry over one's penis size that is within the normal range. Patients with PDD usually have upsetting concerns about their penile size, and they usually exhibit repetitive and compulsive behaviors (medical seeking and receiving procedures) in response to the appearance concerns. Patients with PDD have normal penile size and should be differentiated from men with truly small penis (micropenis).[1] Men who are usually worried, obsessed, and ashamed because of the size of their penis, which falls within the normal range may be suffering from PDD.[2] Men with PDD are more likely to suffer from erectile dysfunction, orgasmic dysfunction, and less sexual satisfaction than normal controls but maintain their libido.[3] Obsession over one's penis size could be associated with frequent pornography use. The size of an average flaccid penis is below 4 cm at birth, and some changes occur during puberty. The flaccid penile circumference is a poor indicator of erect circumference, and there are variations among individuals depending on genetic factors, lifestyle behaviors, and psychological well-being.[4] A lot of men are worried about their penis size with regard to the erect and flaccid condition of the penis. Obsession and anxiety kindle the desire in these men to increase the size of their penis. Majority of women do not believe that a small penis is ineffective or that a larger penis is better; rather, they lay emphasis on the ability of men to use their penis effectively during coitus, and a lot of women preferred a wide penis to a long penis.[5]

Men who are suffering from PDD tend to exhibit low self-esteem because of the size and appearance of their penis and are often worried about their sexual performance. The anxiety and depression associated with PDD often lead to a lack of relationship with the opposite sex. Individuals with PDD usually undergo cosmetic and surgical treatments to increase their penis size which consequently helps boost their self-esteem. Examples of surgical procedures that are carried out to increase the penis size are phalloplasty, which includes suspensory ligament release, prepubic liposuction, cartilage transplant, and girth augmentation, which includes dermal graft, temporalis fascia transfer, and vein grafts.[6] However, penile augmentation surgery on men with sphincter-preserving surgery is still controversial, and undergoing cosmetic surgery such as implant surgery on these men requires professional psychiatric evaluation preoperatively. Apart from the cosmetic and surgical approach, regular physical activity, smoking cessation, reduced intake of alcohol, weight loss, and dietary modification can help to improve penile appearance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Wylie KR, Eardley I. Penile size and the 'small penis syndrome'. BJU Int 2007;99:1449-55.
2American Psychiatric Association. Diagnostic & Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
3Veale D, Miles S, Read J, Troglia A, Wylie K, Muir G. Sexual functioning and behavior of men with body dysmorphic disorder concerning penis size compared with men anxious about penis size and with controls: A cohort study. Sex Med 2015;3:147-55.
4Ryu DS, Cho WY, Chung JM, Kang DI, Lee SD, Park S. Comparison of penile length at 6-24 months between children with unilateral cryptorchidism and a healthy normal cohort. Investig Clin Urol 2018;59:55-60.
5Francken AB, van de Wiel HB, van Driel MF, Weijmar Schultz WC. What importance do women attribute to the size of the penis? Eur Urol 2002;42:426-31.
6Ghanem H, Glina S, Assalian P, Buvat J. Position paper: Management of men complaining of a small penis despite an actually normal size. J Sex Med 2013;10:294-303.