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Penile size and the ?small penis syndrome?
Abstract
The male is often troubled by concerns that his penis is not large enough to satisfy his partner or himself. He is ashamed to have others view his penis, especially in the flaccid state. Such concerns might be unfounded in reality and might be a presentation of social anxiety or some other clinical problem, such as erectile dysfunction. Concern over the size of the penis, when such concern becomes excessive, might present as the 'small penis syndrome', an obsessive rumination with compulsive checking rituals, body dysmorphic disorder, or as part of a psychosis. However, it is often a worry that can be described as within the normal experience of many men. Various potential causal factors are considered. A thorough assessment, normalizing the worry and then exploring the treatment options in detail with the man, is essential to allow the matter to be consolidated satisfactorily within the male ego.
... The anxiety mentioned above is named "Small Penis Syndrome" (SPS), where the person has anxiety about the subjective perception of the size, appearance, and girth of the penis both in the flaccid and erect states despite evidence for the contrary. The anxiety can stem due to an obsessive rumination or body dysmorphic disorder (BDD) named penile dysmorphic disorder (PDD) or due to psychosis (Wylie and Eardley, 2007). ...
... Premorbid obsessive-compulsive personality traits confer an additional risk of developing PDD (Chowdhury et al., 2022). Comorbid psychiatric disorders associated with PDD include anxiety, depression, social phobia, and obsessive-compulsive disorder (Wylie and Eardley, 2007). A recent case study revealed the co-occurrence of Koro in a patient with PDD (Chowdhury, 1989a). ...
... Individuals with PDD are found to have obsessive ruminations and hypochondriacal thought processes (Chowdhury et al., 2022). Depressed affect, low self-esteem, depressive cognitions, and suicidal ideas can be present when the PDD is complicated with depression (Wylie and Eardley, 2007). The low self-esteem among the men with PDD was predicted by the maladaptive self-perception of penile size apart from body weight, muscularity, and height (Tiggemann et al., 2008). ...
Penile Dysmorphic Disorder (PDD) is the persistent anxiety and preoccupation about having a small penis combined with repetitive checking behaviors, leading to significant distress and/or impairment. Literature is scarce regarding the risk factors, clinical features, and comprehensive management of PDD in men. There is a considerable degree of uncertainty regarding the risk factors, nosological status, psychopathology, diagnosis, and management of PDD. The present review will provide an overview of risk factors, patho-clinical features, and diagnostic strategies using screening instruments specific to PDD. It also aims to summarize the multimodal treatment options involved in managing PDD. The literature review shows that though the psychopathological understanding of PDD is in its early stages, considerable knowledge has accrued over the past few years regarding the phenomenology and psychopathology of PDD, which facilitates a better understanding of the disorder and guides appropriate surgical and/or psychological interventions. Specialized psychotherapies such as psychosexual therapy involving individuals and couples have been frequently used in individuals with PDD.
... 1,[7][8][9] Further, 37,3% of respondents in a study, said that their concern regarding the penile size appeared after seeing erotic images. 10 Concerns can be focused on the penile length, circumference, or both, as well as the size when erect or flaccid. 8 Concerns about penile size are often found in men who do not have permanent jobs, do not complete university education, have a lot of spare time, do not have a partner, and often use the internet. ...
... 33 Few theories are proposed regarding this condition such as impaired neurological development (tactile stimulation and perineal sensation), dysfunction in the parietal lobe (association areas), and other contributing factors (cognition and disgust effect also cognition of parts belonging to self). 10 Normal penile measurement and adequate sexual and voiding function were found in 98% of men who were concerned about their penile size. 22,30,31 Overestimation of the average flaccid penile length of others and assuming that their flaccid penile length is much smaller, is often found. ...
... 14 For extreme anxiety, Buspirone can be used. 10 Delusional BDD can be treated with antipsychotic medication. 10 Another therapeutic option is the use of a penile traction device to extend the penis noninvasively, working by stretching the penile tissue through careful mechanical attraction to increase the length and thickness of the penis. ...
The dissatisfaction of men due to their penile size is found in a number of studies. Concerns can be focused on the penile length or width or even both, whether erect or flaccid. Men who are worried about the penile size also want to increase the size of the penis. Concerns about men’s penile size are also increasing because they think normal penile size is what is shown in pornography. These worries can affect self-esteem, sexual function, and satisfaction, to physical and mental health. Small penis anxiety is an anxiety that arises when a man observes his flaccid penile size and feels concerned that his penile size is less than the normal size. In addition, this concern persists even though it has been refuted by clinical examination. Penile dysmorphic disorder is excessive self-concern, distress, and a preoccupation with trivial or even non-existent deficiencies in penile size and shape that can lead to impaired function. Until now, there have not been effective guidelines for managing patients with complaints of penile size. Some of the treatments that can be conducted are psychosexual counseling, cognitive behavioral therapy, the use of selective serotonin reuptake inhibitors, penile traction devices, and invasive procedures. Various modalities of therapy have been tried to overcome excessive concern about penile size. Yet, so far, no good results have been obtained. Thus, clear and effective guidelines are needed to make treatment can be carried out properly.
... To establish the reference size of penis for Vietnamese men, approximately 30,000 patients who visited our clinic from January 2014 to December 2019 were screened for this study. Among them, 19,910 men had their penis size measured. To minimize the selection bias in this study, we excluded young men under 17 years old, men without the measurement of hormonal concentration, particularly with testosterone, and testicular ultrasound. ...
... This information was essential for adequate interventions in case of micro-penis, small penis anxiety, or Body Dysmorphic Disorder that can be treated properly by sex education and psychosexual counseling. 18,19 Thus, results of this present study could be useful in clinical practice, education purposes, or counsel for patient with concerns related to penile dimensions. reported that, in order to obtain a ratio of erected length to stretched length that equals to 1, a critical stretching force value of approximately 450 gram should be applied. ...
... 29 In fact, a general assessment of endocrine levels is also valuable with patient concerned about penis size because of misleading sexual conception, even when their phallus is normal in length. 18,19 Micro-penis is widely defined as flaccid length lower than 4.0 cm and stretched length lower than 7.5 cm. 24 In this present study, any man was diagnosed as having true micro-penis because of prepubertal hypogonadism or developmental abnormalities having been excluded by previous laboratory tests and physical examination. ...
Background
Penis size is a highly sensitive topic, which has often raised concerns associated with human masculinity and male sexual health. Although data regarding penile dimensions have been published worldwide, little is known about these measurements in South East Asian countries.
Objective
This study aimed to provide the reference range in penile length, circumference and diameter of Vietnamese men and their variations among men with erectile dysfunction and other diseases.
Materials and Methods
Information about flaccid length, stretched length, mid‐shaft circumference and glans diameter from the health records of 14,597 men attending the Andrology Consultation was collected. These men were classified into 3 groups being regular reproductive health screening group, sexual dysfunction group and other diseases group.
Results
We found that penile dimensions follow a non‐parametric distribution, as tested by Kolmogorov‐Smirnov test. The median values are 9.03 cm for flaccid length, 14.67 cm for stretched length, 8.39 cm for mid‐shaft circumference and 2.86 cm for unaroused glans diameter. Length and girth of the penis also changed among the different groups, especially in flaccid state; specifically, men with erectile dysfunction had a greater value in all penile dimensions except for change ratio compared with other groups. Circumcision, which rarely occurs in Vietnam, was associated with a 2 mm reduced penis length.
Discussion
Findings on correlations between penile dimensions and somatometric parameters from previous studies are questionable and some measurements, such as glans dimension, have not been thoroughly investigated so far. Nevertheless, penile dimensions provide useful insight concerning conditions affecting sexual development and might be a valuable parameter in the assessment of erectile dysfunction.
Conclusion
Results of this study provide informative materials for the assessment of penile size, including reference values drawn from a large sample of Vietnamese men that can be useful in clinical practice and sexual health education.
... Disparaging comments about the man's penis size or aesthetics (see A4 below) was common in our dataset. This is not surprising given that a 'a big, long, thick dick' 'in many cultures it has come to symbolise attributes such as largeness, strength, endurance, ability, courage, intelligence, knowledge, dominance over men, possession of women; a symbol of loving and being loved' and fertility (Hall, 2015;Wylie & Eardley, 2007, p. 1449). A3's account centers on his deceitfulness: 'This guy promised' her a large penis and her desire for sexual satisfaction; 'To be honest the sex was terrible'. ...
... First, it challenges his manhood. As we noted in our analysis of A3's text, penis size and aesthetics are important for masculine status (Wylie & Eardley, 2007). Second, in conjunction with the extreme-case formulation 'all' (Pomerantz, 1986) in ' they all must wanna feel what a square cock feel like' positions him as a sexual novelty. ...
... This works in two ways. First, like A3 and A4, claiming he has small genitals works to challenge his manhood (Wylie & Eardley, 2007). Second, it is readable as humour (Benwell, 2004). ...
... For example, Sanches et al. [25] demonstrated that self-perceived small penile size is a risk factor for erectile dysfunction. Excessive concerns over the size of penis can even lead to small penis syndrome, a type of body dysmorphic disorder that can lead to major depression with the potential for associated psychosis or suicidal ideation [26]. These unrealistic and unattainable media representations have led to a considerable number of men becoming so concerned about their penis size that they seek to undergo costly and potentially hazardous surgeries for penis augmentation and enlargement [27]. ...
... Another significant element of men's discontent with their penis size might be related to their perceptions of their partners' preferences [26]. Prause et al. [28] reported that women prefer men with a larger penis (in terms of both length and circumference) for sexual satisfaction. ...
Objectives:
To investigate alterations in depicted penis size by evaluating nude male paintings from the 15th to 21st centuries.
Subjects and methods:
Nude-male paintings were identified from various art history websites and analyzed to determine changes in penis size over time. Two observers organized the paintings according to the century in which they were created and made the calculations. Penile length to ear length (PtEL) or penile length to nose length (PtNL) were calculated to standardize the measurements using professional image analysis software. PtEL was first attempted for all paintings; if PtEL could not be ascertained, then nose length was used instead of ear, as the nose length is defined as equal to ear length according to the Golden Ratio. Thus, PtNL was ensured and both ratios were then referred to using a common term: penis depiction ratio (PDR). Further analysis was performed by dividing the paintings into three groups according to the historical development of art: Renaissance Period (1400-1599; 15th-16th centuries), Baroque-Rococo and Impressionism Period (1600-1899; 17th-19th centuries) and Contemporary Art Period (1900-2020; 20th and 21st centuries).
Results:
Of 232 identified paintings, 72 (31.1%) were excluded because they depicted images of adolescents or an erect penis. PDR was found to differ significantly between paintings created in different centuries (P < 0.001). Subgroup analysis revealed that paintings from the 21st century demonstrated significantly higher PDR than paintings from previous centuries (P = 0.001).
Conclusions:
In paintings depicting nude males, the size of the penis has gradually increased throughout the past 6 centuries, and especially after the 20th century. This observation illustrates the changing sociocultural inputs into male body image and emphasizes the need for improved understanding of the socio-cultural factors associated with the perception of penis size in men.
... This anxiety lowers men's sexual self-esteem and engenders avoidance of occasions where genitals have to be exposed in front of others. 4 Body dysmorphic disorder (BDD) might occur in some extreme cases, resulting in more psychological burdens and personal ability impairments. 5 Subsequently, a demand for penile enlargement appears. ...
... 6,7 Education and psychological consultation are recommended for patients, in order to correct their wrong perceptions about penile size and restore sexual self-esteem. 4,5 Although many studies have reported that the majority of patients seeking penile augmentation might give up after consultation, there is no consensus on ways to conduct this procedure. 3 Presence of many alternative methods, after the failure of psychological intervention, confuses the patient due to the dearth ORIGINAL ARTICLE Penile augmentation with injectable hyaluronic acid gel: an alternative choice for small penis syndrome unsatisfactory penile size; (3) strong desire for penile size alterations after initial psychological consultation; and (4) absence of congenital or acquired phallus defects, such as micropenis and Peyronie's disease. ...
There is no well-established procedure for the management of small penis syndrome (SPS), especially when psychological interventions fail. This study aimed at systematically evaluating the physical and psychological benefits of penile augmentation (PA) using injectable hyaluronic acid (HA) gel. Thirty-eight patients receiving PA with HA gel from January 2017 to March 2020 were included and followed up for 1 year. Penile size, erectile function, and psychological burden measured by the Index of Male Genital Image (IMGI), Index of International Erectile Function (IIEF), and Beliefs about Penis Size (BPAS), respectively, were assessed at the beginning and at 1, 3, 6, and 12 months postinjection. The volume of HA gel injected was 21.5 ± 3.7 ml. Compared to baseline data, flaccid penile girth and length significantly increased by 3.41 ± 0.95 cm (P < 0.01) and 2.55 ± 0.55 cm (P < 0.01) at the 1st month postinjection, respectively. At the endpoint, despite attenuations, statistically significant improvements in flaccid penis size were still obtained, namely 2.44 ± 1.14 cm in girth (P < 0.01) and 1.65 ± 0.59 cm in length (P < 0.01). Similarly, erectile penile girth statistically increased by 1.32 ± 1.02 cm (P < 0.01) at the 1st month but were only 0.80 ± 0.54 cm bigger than baseline (P < 0.01) at the endpoint. At the 1st month, the average score of IMGI and the mean score of IIEF statistically increased by 46.2 ± 10.5 (P < 0.01) and 7.6 ± 6.2 (P < 0.01), respectively; the score of BAPS significantly decreased by 18.3 ± 4.5 (P < 0.01). These alterations remained steady during follow-up. Considering the significant penile size improvement, lasting psychological benefit, and low complication rate, PA with HA might serve as an appropriate alternative for patients with SPS.
... Focusing attention on the vagina, this is an elastic muscular tube of between 7 and 10 cm in length that will lengthen further with penetration by the penis or other object. The typical erect penis is between 14 and 16 cm in length [4]. Several factors can impact on total vaginal length including hysterectomy and pelvic reconstructive surgery, contributing to a shortening of 0.63 cm and 0.22 cm, respectively. ...
... Any reduction in sexual pleasure in the partner that is experienced (or anticipated) because of the shorter penile length may accentuate sexual difficulties for the couple. For this reason, it is important that accurate information is readily available to men and their partners about normal penile (and vaginal) dimensions [4] as well as the multimodal impact of bringing about sexual pleasure for both partners. ...
The study by Veale et al. whether artificially reducing
the depth of penetration of a penis during intercourse
can impact female sexual satisfaction. The researchers
used different sizes of silicone rings as a proxy for reducing
penis length and report that reducing the depth of penetration
led to a statistically significant 18% reduction of overall sexual
pleasure following an average 15% reduction in length of the
penis. They report that the longer the erect penis the less likely
the rings were to have an impact on sexual pleasure.
... Пенільна дисморфофобія. Лікарі мають розрізняти пенільну дисморофобію та СМСЧ (занепокоєність розміром члена) [22,24], оскільки при обох цих розладах чоловіки, маючи нормальний розмір СЧ, недооцінюють розмір власного члена і завищують середній розмір інших чоловіків [13,20,21]. Згідно з Міжнародною класифікацією хвороб 10-го перегляду (МКХ-10) та Діагностичним і статистичним керівництвом з психічних розладів 5-го перегляду (Diagnostic and Statistics Manual of mental disorders, DSM-5), пенільна дисморфофобія належить до дисморфічних розладів тіла. ...
... На відміну від чоловіків із СМСЧ, пацієнти з пенільною дисморфофобією зазвичай не отримують вдоволення від збільшення фалоса, навіть зафіксовані випадки погіршення симптомів [22,23]. На сьогодні існує декілька клінічних досліджень, в яких відзначається позитивний ефект від консервативної терапії дисморфічного розладу тіла [24,[27][28][29][30] фікації чоловіків із пенільною дисморфофобією на допомогу хірургам було запропоновано анкетування [31]. ...
Review objective: to evaluate the current scientific evidence of all available injectable methods of penis enlargement, to evaluate their effectiveness.
Materials and methods. A systematic search of scientific medical information include databases MEDLINE, Embase, AMED and HMIC. A manual web search of relevant links in the found texts was performed.
Results. Conditions in which phallus thickening is used: concern with penis size or small penis syndrome, penile dysmorphophobia, penis reduction (radical prostatectomy for prostate cancer, Peyronie's disease, congenital anomalies, erectile dysfunction).
Injectable thickening of penis started using in the in the early XX century, paraffin and mineral oils were introduced. In the 1940s, safer liquid silicone and polymethyl methacrylate were used. Gel-like biodegradable materials are currently popular because they lack most of the disadvantages of permanent substances: hyaluronic acid, polylactic acid, dextran gel and mixtures of these substances. Thickening of the penis depends on the volume inserted filler and averages + 2–4 cm in circumference.
In 2003, Moon et al. for the first time proposed a method of enlarging the penis head with hyaluronic acid. Other drugs were also used: hydrogel, polyacrylamide and dextran gel. Hyaluronic acid is the most commonly used drug. Promising filler is polylactic acid, which stimulates the fibroblasts development at the injection site and is relatively safe to use. The circumference length of the penis head can be increased by an average of 1.5 cm.
Conclusion. Penis enlargement procedures are gaining popularity among men. However, there are a limited number of scientific papers that would describe the results and complications of these procedures. Further research is needed to study the impact of penis enlargement techniques on men's sex life and well-being, because it is the key motivating factor in turning to experts on this issue.
... 6,7 In society, penis size is often thought to equate to a man's sense of masculinity-the larger the penis, the more "manly" the man. 8 A seminal study involving over 25,000 cisgender men found that 45% desired a larger penis. 9 This penis size concern was particularly the case for men who considered their penis to be smaller than average (91%) or average in size (46%). ...
... These ideals tend to focus on having a more muscular or bigger body, which extends to a larger penis size too. 8 Clearly, individuals who identify as transgender are likely to be highly dysphoric about their genitalia, and cannot even attempt to achieve these appearance ideals for "feminine" and "masculine" genitalia without surgical intervention. ...
Genital focused body image concerns or negative genital self-image is a common experience across the gender spectrum, including cisgender and transgender populations. Such concerns can result in lower psychological and sexual well-being. In this article, it is proposed that the development of genital self-image concerns may be partly explained by the theoretical framework of cisgenderism. This theory proposes that there are only two genders - men and women - and these are dictated solely by the appearance of the genitals. Any deviation from these two categories can result in discrimination, which particularly impacts transgender individuals. An increasing number of cisgender and transgender people are seeking out aesthetic genital procedures to alleviate genital self-image concerns (and gender dysphoria in transgender populations). The growing body of research suggests that cisgender and transgender men and women are relatively satisfied with the results of their genital procedures. However, this research is limited by a lack of standardized and validated patient-reported measures to evaluate surgical outcomes. Furthermore, despite negative genital self-image being a key motivator for surgery, it is often not included as an outcome measure. In this article, recommendations are proposed for conducting higher quality evaluation studies of aesthetic genital procedures in cisgender and transgender populations. Moreover, future research and clinical directions are suggested to assist transgender men and women who choose not to undergo genital gender confirmation surgery. The vast majority of transgender individuals do not have this surgery and so are in great need of support in managing their gender dysphoria and negative genital self-image.
... 11. Based on one research finding that compared Korean men's penises (average 6.9 cm) with a number of other nationalities (Wylie and Eardley 2007), being the second shortest on the list. Some examples on WOMAD are at https://www.womad.life/l/889656?cacheppublic&pagep1 ...
... 17. A 2007 review article(Wylie and Eardley 2007) on penile length worldwide ranked Korean men as second to the last with a flaccid length of 6.9 cm (drawing on a study of young men in the Korean military bySon et al. [2003]). ...
... Although muscle build is important in the definition and perception of male body image as an element of sexual attraction for partners and an emblem of masculinity (Badenes-Ribera, Fabris et al., 2018;Leit et al., 2001), it is not the sole element. For many men, penis size may also be regarded as a sign of masculinity and sexual prowess (Lever, Frederick, & Peplau, 2006;Wylie & Eardley, 2007). Several men experience a sense of anxiety and a lack of satisfaction concerning the size of their penis (Lever et al., 2006;Wylie & Eardley, 2007). ...
... For many men, penis size may also be regarded as a sign of masculinity and sexual prowess (Lever, Frederick, & Peplau, 2006;Wylie & Eardley, 2007). Several men experience a sense of anxiety and a lack of satisfaction concerning the size of their penis (Lever et al., 2006;Wylie & Eardley, 2007). Some men instead may develop dysmorphic concerns, which in turn are associated with a higher level of distress (Veale et al., 2015(Veale et al., , 2016. ...
Body dysmorphic disorder (BDD) is a relatively common psychiatric condition of which the prevalence has not been fully investigated in the non-clinical population, and in particular among men having sex with men (MSM). MSM have proven to be more inclined to develop body dissatisfaction and body image disorders compared to non-MSM. Our study investigates the prevalence of BDD and the prevalence and co-occurrence of muscle dysmorphia (MD) and penile dysmorphic disorder (PDD) in a sample of 261 Italian MSM recruited online. From our data, gathered through self-report measures, the prevalence of BDD, MD, and PDD in our populations was 5.4%, 8.8%, and 4.2%, respectively. Compared to their elders, younger adults (ages 18–34) appear to be at higher risk of BDD and especially of MD. Non-significant differences have been observed for the prevalence of PDD depending on the age range. Our study shows that the risk of body image disorders among MSM is quite common, especially among young adults, and higher than what is found among heterosexual men.
... This achieves a visual lengthening of the penis. 1,17,18 In cases where the patient requires further penile lengthening, one proposed surgical technique is to detach the suspensory ligament of the penis. Dissection of the suspensory ligament enables the penis to move forward and to appear longer in the flaccid state by 1.5-2 cm. ...
Penile size is a frequently observed concern in men of all ages. The way in which some men see their personality is defined, appraised, or reflected by their penis, with the view that ‘bigger is better’, is termed ‘phallocentrism’. In this review article, we assess the literature and evaluate the evidence on what is ‘normal’ in relation to penile size, and evaluate techniques for penile lengthening and girth augmentation with emphasis on the possible benefits and complications of the procedures reviewed.
... 29,30 Diagnosis of Koro consists of both psychological evaluation and physical examination of the genital organs, the latter of which is used to rule out physical disorders such as hypospadias or measurable, sustained genital retraction. 28, 31 The major diagnostic criteria are patients' report of genital (i.e. penis) retraction despite objective evidence, subsequent fear and anxiety, and physical attempts to prevent or reverse the retraction. ...
Koro syndrome is a multi-tiered disease presenting as an overwhelming belief that one’s sex organs are shrinking into their body. Moderate to severe anxiety attacks are associated with the condition, along with a fear of imminent death. Koro is often culturally related and is most seen as an epidemic form in East and Southeast Asia, although it can present anywhere worldwide in its sporadic form. The condition typically affects young males who believe in sex-related myths, and many individuals can co-present with anxiety, depression, or even psychosis. Although most presentations of Koro are self-limiting, the condition is harmful for one’s self-esteem and quality of life, and some individuals may go through extreme, physically injurious measures to prevent genital retraction. Treatments include the use of psychotherapy that has a sex education component, especially if the patient believes in culturally rooted myths. In sporadic Koro, it is believed that if the primary psychiatric disorder is treated with anxiolytics, antidepressants, sedatives, or psychotics, the secondary Koro-like symptoms will also fade. Additional investigation on the prevalence, pathogenesis, factors that correlate with treatment efficacy are needed to fully understand Koro syndrome.
... Penis size has been a source of concern for men ever sincethe earliest history, and attempts of penile augmentation can be found throughout the history in many tribes around the world. Some of these attempts would involve deliberately exposing the penis to the bites of venomous snakes, making holes in the glans of the penis into which various objects would then be placed, as well as many similar attempts [9]. In modern times, the first use of mineral oils to fill tissue defects was performed in 1899 by a surgeon Robert Gersuny, who injected Vaseline into the scrotal sac of a boy after a bilateral orchiectomy with good results [10]. ...
Introduction: Increasing the volume of penis by injecting various substances (paraffin, silicone, mineral oils) remains a highly controversial procedure. This procedure is usually performed by patients themselves or by persons without a licensed medical education. Injecting these substances causes a local inflammatory reaction with redness, pain, swelling, thickening of penile skin, with the subsequent formation of sclerosing lipogranuloma, In more serious cases ulceration, necrosis, embolism and even death may occur. Impotence, painful erections and dysuria are the most common symptoms. The treatment is excision with subsequent reconstruction, while the conservative approach using antibiotics has a limited effect. Case report: A 45-year-old patient presents to Emergency Department due to lesions on penis. Inspection showedscarring with ulcers and signs of inflammation on ventral side of penis, and patient was referred to urologist. Part of the scar tissue with inflammation was excised, biopsy was taken, and reconstruction was made. Pathohistological analysis revealed fragments of skin and subcutaneous connective tissue. Ulcerations with inflammatory infiltrate, hyperkeratosis and parakeratosis were present on parts of epidermis. Inflammatory infiltrate rich in epithelioid histiocytes with lipid vacuoles was present in subcutaneous connective tissue, and smaller foci of necrosis and cystic changes in the form of "Swiss cheese" were observed. Based on pathohistological findings and clinical data, he was diagnosed with sclerosing lipogranuloma. Conclusion: Increasing the volume of penis by injecting substances is very dangerous. In extreme cases this procedure can even result in death, and will never provide the expected , satisfying results to the patients.
... Many men suffer from excessive anxiety and dissatisfaction with their penis size and this includes men with normal penis size [33,34]. This type of anxiety has been called "small penis anxiety" [35] and it is associated with reduced sexual intercourse satisfaction [34]. In this study, excessive worry and shame concerning penis size (i.e., a kind of body dysmorphic disorder) had a negative effect on erectile function, orgasmic function, and satisfaction with sexual intercourse [34]. ...
Premature ejaculation (PE) and erectile dysfunction (ED), which is common male sexual dysfunctions worldwide, lead to substantial distress in men as well as their partners, and decrease the quality and stability of romantic relationships, and, consequently, lead to a decreased quality of life in a large part of the population.
We investigated the associations between self-reported anatomical characteristics of the penis and PE and ED in an urban Chinese sample.
We recruited 1976 Chinese urban men aged 18 to 50 to fill out an online questionnaire regarding demographic information, anatomical characteristics of the penis, as well as PE and ED.
Participants reported their age, penile length, penile circumference, circumcision status, and foreskin characteristics as well as answered the International Index of Erectile Function-5 (IIEF-5) and Checklist for Early Ejaculation Symptoms (CHEES).
Penile length and girth were associated with less ejaculatory problems, but only penile length was associated with less erectile problems. Results showed that overall higher age was associated with less ejaculatory and erectile problems. This pattern was confirmed in the younger group (age < = 31) where higher age was associated with less ejaculatory and erectile problems. However, in the older group (age > 31), higher age was associated with more ejaculatory and erectile problems. The relationship between penile length and sexual function did not change with age whereas penile girth was associated with less ejaculatory problems in the older age group only. Male circumcision and less foreskin covering the glans penis were associated with less ejaculatory and erectile problems. The present study is the first study to investigate the association between anatomical characteristics of the penis (penis size and circumcision) and sexual function. However, the self-reported measurement of penis size is a potential limitation.
the penis size was measured by self-reported. There is a potential limitation to the reliability of such self-reports. The results indicated that the relationship between the anatomical characteristics of the penis and sexual function was complex. Also, the effects of age on sexual function were positive among younger men and negative among older men.
... This suggests that men's reasons for seeking penile augmentation are complex, and such complexity would be expected when penis size is linked with men's overall feelings of self-identity and masculinity. 38 As expected, on average, the men perceived not only their current penile girth but also their flaccid and erect penile length to be below average size. In concordance with previous research, men typically overestimate average penile size, and this has been linked with exposure to pornographic materials where male porn actors tend to have particularly large penises. ...
Background
The popularity of penile augmentation procedures is increasing, but little is known about the motivations and psychological characteristics of men who seek these procedures.
Objectives
To investigate the motivations and psychological characteristics of men seeking a penile girth augmentation using valid psychological measures.
Methods
Men seeking to undergo a penile girth augmentation (n = 37) completed an online questionnaire containing standardized measures assessing their motivations to undergo augmentation, penile size self-discrepancy, psychological distress, self-esteem, body image related quality of life, body dysmorphic disorder (BDD), and cosmetic procedure screening scale-penile focused dysmorphic disorder (PDD).
Results
Men’s motivations for seeking penile girth augmentation were characterized as “improve self-confidence”, “change penile size/appearance”, “sexual function/pleasure”, “feelings of insecurity”, and “medical issues”, with self-confidence being the most commonly reported motivation. The men perceived their actual penis size (girth, flaccid length, erect length) as significantly smaller than ideal size, the size they believed their penis should be and their expected size post-augmentation. Compared to non-clinical norms, the men seeking penile augmentation had higher PDD symptoms, lower self-esteem and lower body image related quality of life, but comparable psychological distress. In addition, four of the men met diagnostic criteria for BDD according to self-reported questionnaire (11%, n = 4/37) and clinical interview (14%, n = 4/29).
Conclusions
Men seek penile girth augmentation for a variety of reasons and perceive all their penile dimensions to be smaller than ideal sizes. They differ from non-clinical samples in some psychological characteristics and a small but sizeable portion experience BDD.
... Concern over the size of the penis, when such concern becomes excessive, might present as the 'small penis syndrome' an obsessive rumination with compulsive checking rituals, body dysmorphic disorder, or as part of a psychosis. However, it is often a worry that can be described as within the normal experience of many men (Wylie & Eardley, 2007). Many men seek medical treatments complaining that their penises are too small (short). ...
105 married women (between ages 19 and 50, with mean age of 33.01, and SD of 7.682) recruited using convenience sampling technique participated in this case study aimed at assessing the impact of penis size and anxiety on women's sexual satisfaction. Three hypotheses using ANOVA were tested at p=0.05. Result of the first hypothesis revealed that, penis size had a main effect on sexual satisfaction among married women, F (1, 97) =6.222, p=0.003; with mean scores of 67.458, 76.573 and 79.857 for small penis, medium and big penis size respectively. Result of the second hypothesis did not reveal any significant main effect of anxiety on sexual satisfaction among married women, F (1, 97) =1.864, p=0.161; with mean scores of 73.918, 75.852 and 68.250 for low, moderate and high anxiety respectively. Result of the third hypothesis, showed no significant interaction effect of anxiety and penis size on sexual satisfaction among married women, F (1, 97) = 0.608, p=0.612; with mean scores of 69.625, 68.500 and 64.250 for small penis size/low anxiety, small penis size/moderate anxiety, and small penis size/high anxiety respectively. In relation to medium penis size, the mean scores are as follows, low anxiety, 78.700, moderate anxiety 78.769 and high anxiety 72.250 respectively, while in relation to big penis size, only low and moderate anxiety were identified by the participants with the mean scores of 73.429 and 80.286 respectively. Psychologists, marriage counsellors and mothers need to psycho-educate ladies about the likely challenges associated with sexual relation in marriage.
... The penis is symbolic of masculinity and manhood. It is also an essential organ for sexual pleasure and reproduction [4]. Maslow's hierarchy of needs is a theory that depicts the basic needs of an individual that should be met in order for that person to reach self-actualisation, that is to become the most that he or she can be. ...
Background
In South Africa, penile loss is a recognised complication of ritual circumcision which has a profoundly negative effect on these men's psyches and their everyday lives. The purpose of this paper was to investigate the experiences of the first two South African penile allograft transplantation recipients in order to assess the psychosocial impact of this surgery.
Materials and methods
A qualitative descriptive phenomenology approach was used. A total of four in-depth interviews were conducted with the two South African penile transplant recipients. The interviews were transcribed verbatim while adding the field and observational notes. Thematic analysis was used to derive meaning from the collected data.
Results
After the penile loss, both participants reported feeling suicidal for the following reasons: their communities shunned them and regarded them as ‘dead,’ they felt severely ashamed of their disfigured bodies, they were unable to develop intimate relationships and could not have children. Transplantation gave them a fully functional penis, which resolved the majority of these issues. The participants were able to build relationships and satisfy their own and their partners' sexual and relationship needs. The transplant led to complete restoration of their self-image and manhood. They were, however, still persecuted by their traditional communities as they had not successfully completed the ritual circumcision ceremony.
Conclusion
This study emphasises the necessity of offering penile transplantation as treatment for penile loss as this is not only life enhancing but lifesaving, especially within the South African context.
... It may results in constant obsession to check the penis and may be part of a psychotic disorder. This condition is referred to as the small penis syndrome [1]. On the contrary, women perception of penile length depends on the type of relationship; they prefer width of penis on short term relationship and smaller penis for long term relationship because this reduces the chances of infection and trauma to their vagina. ...
Penile length varies worldwide. It is necessary to determine penile length in our region to enable adequate counselling on normal length and reduce avoidable anxiety. Two hundred and seventy-one men were recruited with 97 men in group I and 174 men in group II. Mean ages were 38.4 ± 6.9 (21-50) years and 68 ± 9.1 (51-98) years. In group I, the mean flaccid penile length (FPL)-I and stretched penile length (SPL)-I were 9.8± 2.7 and 10.6± 2.2, mean height 1.7±0.07m and body mass index (BMI) 24.1±3.1 kg/m2. While in group II, mean FPL-II and SPL-II were 13.0± 2.9 and 14.1 ± 2.1, mean height was 1.69± 0.07m and BMI 24.3± 3.2 kg/m2. There were positive correlations between the SPL-I and heights in group I; (r=0.305, p<0.002); height and FPL-I (r = 0.218, P<0.032). Similarly, in group II positive correlations of FPL-II and SPL-II with height; r = 0.166 P<0.028 and r = 0.183, P<0.015. There was negative correlation SPL-II and BMI-II r-0.224, p<0.003. FLR-II and BMI-II, -0.157, p<0.039. In conclusion, Flaccid and stretched penile length of men < 50 years was smaller than those > 50 years. In both age groups, flaccid and stretched penile lengths correlated with height. In group II, penile lengths correlated negatively with BMI.
... 3 Such concerns are reinforced by the cultural influences, wherein the male genital represents manhood in some cultures and it represents masculinity, virility, and fertility in some other cultures. 4,5 In addition to this, the men link sexual capacity, sexual functioning, as well as sexual satisfaction to the size of their penis. 6,7 The ease of access to pornography, where the large penis positively correlates with exaggerated female sexual response, adds to the concerns of these men who are already upset with their genital size. ...
Background
Many men express concerns about their penile size, with respect to its role in sexual satisfaction of their female partners. The evidence to the contrary exists in the Western literature. However, similar evidence is lacking in a conservative society like India.
Aim
This study aimed to evaluate the perception of Indian women about the size of the penis of their male partners with respect to sexual satisfaction.
Methodology
A questionnaire-based study was carried out using a 20-item questionnaire in a sample of 230 sexually active Indian women, who answered the questionnaire either using pen and paper or using social media platform such as WhatsApp. Both the univariate and multivariate regression analysis was done using GraphPad software (©2020 GraphPad Software, Inc, California, USA). A P value less than .05 was considered statistically significant.
Results
The study was conducted from January 2015 to December 2020. As per the accrued opinion of the women who participated in the study, there was no statistically significant correlation between the size of the penis and the sexual satisfaction.
Conclusion
There is hardly any literature on the perception of women from a conservative society like India about the size of the penis of their partners in relation to the sexual satisfaction. Hence, the data from this study, which is the first of its kind form the Indian subcontinent, can be the basis to allay fears of men expressing their concerns about the size of their penis in this part of the world.
... The Dayak Borneo tribe had a ritual of glans piercing followed by insertion of foreign bodies into the resultant holes for increased erogenous stimulation. The Topinama tribesmen of Brazil have a tradition of encouraging poisonous snakes to bite their penis to make it bigger (20). ...
Objective:
Sclerosing lipogranuloma of the penis is a relatively rare disorder associated with injection of illicit foreign materials for penile augmentation. We aim to report the clinical presentation, diagnosis, treatment, and outcomes of patients with this condition, and to review the most relevant literature currently available.
Background:
Injection of mineral oil into the subcutaneous tissues of the penis for augmentation has been practiced since ancient times. The potential for complications has long been known, and most doctors have abandoned the procedure. However, it is still practiced in some parts of the world. The complications may be devastating including death from embolism or sepsis. The affected area may not be restricted to the injection site, potentially involving the scrotal and suprapubic areas. Surgery with complete removal of the involved tissue followed by covering the denuded area with a graft or skin flap is the best therapeutic option.
Methods:
The literature search involved keywords such as penis, augmentation, enlargement, sclerosing, lipogranuloma, penile injection, paraffinoma, and was obtained from computerized search of databases such as PubMed, Google Search and Scopus. Personal experience of the lead author (BS) is also described. We tried arbitrarily to limit our search to articles including ≥5 patients pertaining to the subject of our review and, therefore, excluded single case reports. However, a single systematic search of PubMed and Scopus was also found and included.
Conclusions:
The treatment of choice is radical excision of all the lesions followed by skin grafting. Bearing in mind that prospective, randomized, controlled studies are considered difficult to carry out, further work will continue apparently to be based on case series by individual surgeons. It is critical to advise patients to separate the myths from the facts and use preventive measures through awareness and education to best minimize the downsides of this problem.
... Three organs particular to the male anatomy are frequently associated with "masculinity", the penis, the testes, and the prostate. Penile size has historically been symbolic of such attributes as strength, power, and fertility in many cultures dating back thousands of years [1]. The sizes of both the flaccid and erect states of their penis are an important issue to many men, and as many as 45% are reported to be unsatisfied [2]. ...
Association of organ sizes in the genitalia have long been a topic of interest for the general public. However, factors such as selection bias, embarrassment, and invasive testing have hindered studies on living individuals. We obtained measurements of penile size, testicular weight, and prostate weight, and conducted related serum testing on 63 Japanese male adults who died of unexpected reasons and underwent autopsy from 2009 to 2013. Micropenis was seen in 7 subjects (11.1%) as determined by flaccid penile length. Penile measurements were mainly correlated with body weight, testicular weight with age and body mass index, and prostate weight with age and serum prostate-specific antigen level. No correlation was detected between testosterone and any genital organ measurements. Interestingly, penile circumference showed no correlation to any of the penile length measurements. Prostate weight showed a significant positive correlation with penile circumference, penile stretched length, and testicular weight. Although the direct clinical implications are unclear, utilizing autopsy provided insight into genital organ measurements free of patient selection bias and other disadvantages of live patient testing. With a larger sample size, autopsy studies may be of use to future adjustment of nomograms.
... Mannen zijn hier echter zelf het minst tevreden over. Dit zou verklaard kunnen worden doordat in de maatschappij een grote penis geassocieerd wordt met mannelijkheid en de gemiddelde penislengte over het algemeen overschat wordt (Ozer & Grift, 2014;Wylie & Eardley, 2007). De tevredenheid over de afzonderlijke aspecten van de penis komt overeen met eerder onderzoek onder Amerikaanse mannen (Gaither et al., 2017). ...
Samenvatting Onder (jong-)volwassenen neemt de vraag naar cosmetische genitale chirurgie toe en gemakkelijk beschikbare por-nografie schetst een onrealistisch ideaalbeeld van het genitale uiterlijk. Omdat er veel onduidelijkheid is over het 'normale' genitale uiterlijk onderzochten wij de perceptie van verschillende veelvoorkomende variaties van het uitwen-dige genitaal en de tevredenheid daarmee. In dit cross-sectionele onderzoek vulden festivalbezoekers een anonieme vragenlijst in. Deze vragenlijst bestond uit drie onderdelen: 1) vragen over demografie en seksualiteit, 2) vragen over het uiterlijk van het eigen genitaal en de tevredenheid hierover aan de hand van voorbeeldafbeeldingen en 3) de-zelfde vragen over het geslachtsdeel van de laatste sekspartner. Via beschrijvende statistiek is de variatie in uiterlijk beschreven en met een multivariate analyse zijn voorspellende factoren voor (on)tevredenheid geïdentificeerd. In totaal zijn 1472 deelnemers geïncludeerd waarvan 91% onder de 41 jaar en 61% vrouw. Het merendeel was tevreden over het uitwendige genitaal (73% van de vrouwen vs. 72% van de mannen). Tevredenheid over het geslachtsdeel van de partner was hoger: 91% van de mensen met een mannelijke partner was tevreden vs. 89% van de mensen met een vrouwelijke partner. Mannen zijn het minst tevreden over de lengte van hun penis (55%) en vrouwen over de grootte van hun binnenste schaamlippen (63%). Mannelijk gender, 20+ sekspartners en een hogere waardering van het seksleven zijn positief voorspellend voor tevredenheid over het eigen geslachtsdeel. Ondanks de grote vari-abiliteit in het genitale uiterlijk zijn de meeste deelnemers tevreden over het eigen uitwendige genitaal en nog meer over dat van hun partners.
... Both male infertility and penile size are sensitive topics and remarkable sources for anxiety in men (30)(31)(32)(33). Our findings suggest a potential association between men presenting with a complaint of infertility and a shorter SPL; but it is important to understand what these findings do not mean. ...
Background:
Male infertility can be associated with secondary sexual characteristics, hypogonadism, and several findings in the examination of external genitalia. We sought to identify if stretched penile length (SPL) is associated with infertility or baseline testosterone.
Methods:
We performed a retrospective review of all males age 18-59 presenting to a Men's health clinic from 2014 to 2017. SPL of patients with infertility were compared to patients with any other complaint. Patients with Peyronie's disease, prior penile surgery, prostatectomy, on testosterone replacement, clomiphene or β-hCG were excluded from our study. Baseline characteristics were compared between the two groups (infertile vs. other). Linear regression was used to assess the association between infertility and testosterone with SPL after adjusting for patient age, BMI, and race. Scatterplot was used for correlation between testosterone and SPL.
Results:
Six hundred and sixty-four men were included in our study (161 infertile, 503 other). The unadjusted mean SPL in the infertile group was 12.3 cm compared to 13.4 cm in the other group (P<0.001). The significance remained when adjusted for age, BMI, testosterone and race (12.4 vs. 13.3, P<0.001). Mean total testosterone in the infertile group was not significantly different than the other group (414 vs. 422, P=0.68). Infertile men were younger than the other group (33.2 vs. 42.1 years, P<0.001). BMI did not significantly differ (28.9 vs. 28.9 kg/m2, P=0.57). There was a weak positive correlation between testosterone and penile size in both the infertile group (r=0.20, P=0.01) and the other group (r=0.24, P<0.001).
Conclusions:
Though SPL differed amongst our groups, adult testosterone levels did not. If developmental levels of testosterone exposure accounted for some of the differences in SPL between our two groups, these variations did not persist into adulthood. It remains unknown if reduced length is a result of genetic or congenital factors associated with infertility. Further investigation is needed to better understand the association of shorter SPL with male infertility.
... Worries about not only performance but also about the size and shape of the phallus is a common concern among men [50]. In the East, it can manifest itself as koro, fear that the penis is shrinking [51]. ...
Exhibitionism has been viewed through many lenses, from the perspectives of sexual deviance, forensic psychiatry, psychopathology, psychological dynamics, feminism, behaviorism, and psychopharmacology. Starting from the description of one psychotherapy patient, the aim of this paper is to synthesize this disparate literature. The findings of the synthesis include an estimate of the lifetime male prevalence of exhibitionism, 2–4%, peaking in late adolescence. Insecure attachment, sexual abuse in childhood, substance abuse, and sexual dysfunction are acknowledged risk factors. Motives behind the act of genital exposure remain obscure, constructed of both sexual and non-sexual impulses. The usual response of women victims is alarm and disgust. Successful treatment relies on a strong therapeutic alliance with specific psychological and psychopharmacological interventions - comparative effectiveness not yet determined. In conclusion, precedents for exhibitionism vary. The frequency of the behavior usually wanes with age and, while exhibitionists may pose a risk to others, they usually do not. There is, as yet, no gold standard treatment; the recommendation for therapists is to respond to individual facets of the patient’s circumstances and history.
Background:
Augmentative phalloplasty is a controversial issue. A safe, stable, and efficient surgical method for penile girth enlargement (PGE) was not avaliable. This paper introduces a novel autologous scrotal flap-turning procedure "scrotal dartos flap method" for males with small penis syndrome (SPS) and addresses its efficacy and safety.
Methods:
A single-centered, prospective study was conducted at the Zhongnan Hospital of Wuhan University, where 29 patients were treated with "scrotal dartos flap method". The key procedure for this technique is fully turning the scrotal dartos flap to the loose plane just between the superficial penile fascia and Buck's fascia to increase the circumference of the penis. Penile girth improvement and adverse events (AEs) were recorded.
Results:
Complete follow-up data were collected for 27/29 (93.1%) of the patients. It yielded a 3.59 ± 0.80 cm (50.8%) girth improvement. This enlargement surpassed that of most previous published surgical procedures. Additionally, there were no serious AEs (such as penile fibrosis, flap infection, sclerosis, or removal) during the 6-month follow-up. Wound infection (n = 1), hematoma (n = 2), and folding (n = 1) were all slight.
Conclusions:
This novel autologous flap-turning procedure performed better than the majority of previously published PGE methods and was accompanied by only slight and acceptable AEs. "Scrotal dartos flap method" appears to be a viable method for the PGE treatment of SPS.
Male genital regenerative surgery spans from pure male genital cosmetic surgery, where penile lengthening procedures and girth enhancement procedures are the most common, to functional problems after trauma, diseases, or congenital anomalies. The male genitals symbolize masculinity, strength, courage, endurance, and sexual health and are important for masculine identity. Tissue engineering and the therapeutic use of stem cells are emerging techniques in male genital surgery, and have a good potential for penile reconstruction. In penile augmentation, lipofilling with the effects of regenerative cells and stromal vascular fraction from fat transfer treatments are the most commonly used regenerative techniques today. We present a series of 204 patients that we operated with our cosmetic penile lengthening and girth enhancement procedure. With a good selection of patients, attention to surgical technique and follow-up, the overall satisfaction was good, and the complications were low and minor.KeywordsPenile elongationGirth enhancementRegenerative cellsBiofillingFat transferNanofatStem cellRegenerative surgeryPenile lengtheningPenile augmentationFat graftStromal vascular fraction
For many years, surgical treatment of buried penis in children has been researched by several scholars, and numerous methods exist. This study aimed to explore the clinical effect of a modified fixation technique in treating buried penis in children. Clinical data of 94 patients with buried penis who were treated using the modified penile fixation technique from March 2017 to February 2019 in Fujian Maternity and Child Health Hospital (Fuzhou, China) were retrospectively collected, compared, and analyzed. Clinical data of 107 patients with buried penis who were treated using traditional penile fixation technique from February 2014 to February 2017 were chosen for comparison. The results showed that at 6 months and 12 months after surgery, the penile lengths in the modified penile fixation group were longer than those in the traditional penile fixation group (both P < 0.05). The incidence of postoperative skin contracture and penile retraction in the modified penile fixation group was less than that in the traditional penile fixation group (P = 0.034 and P = 0.012, respectively). When the two groups were compared in terms of parents' satisfaction scores, the scores for penile size, penile morphology, and voiding status in the modified penile fixation group were higher than those in the traditional penile fixation group at 2-week, 6-month, and 12-month follow-ups after surgery (all P < 0.05). We concluded that the modified penile fixation technique could effectively reduce the incidence of skin contracture and penile retraction and improve the penile length and satisfaction of patients' parents.
Background:
To demonstrate modified technique of penile lengthening.
Methods:
We have reviewed 30 patients who underwent surgery with the use of the proposed "cross-method" and also compared with 35 patients who had surgery with the division of the suspensory ligament performed with the use of V-Y plasty method.
Results:
We have achieved better enlargement and SEAR (self-esteem and relationship) scores with the "cross-method" compared to V-Y plasty.
Conclusion:
The cross-method is a simple alternative technique for penile lengthening that can be performed safely in order to treat small penis syndrome and obtain better results.
Virility and sexual pleasure have long been associated with penile size and this, in turn, has typically been linked to some anthropometric measurements, such as foot size or height, leading to various misconceptions from both men and women. Our intention is to estimate penile size parameters in Argentina and evaluate the correlation between penile size and certain anthropometric measurements. This is a cross-sectional, descriptive, multicenter, and observational study. Male patients who underwent a urological procedure were included in four hospitals located in different regions of the country. Different anthropometric measurements were obtained: height, weight, penile circumference, flaccid and stretched length, and foot length. A total of 800 patients were evaluated. Mean left foot was 26.4 cm. Mean flaccid penile length was 11.4 (95% confidence interval [CI]: 8-14) cm, and mean penile circumference was 10.1 (95% CI: 8-12) cm. Finally, mean stretched penis was 15.2 (95% CI: 11-18.5) cm. We can confirm that estimates of the average penile measurements in Argentina are flaccid penis length of 11.4 cm, penile circumference of 10.1 cm, and stretching the penis to the maximum in flaccidity of 15.2 cm. Correlations between flaccid penis length, stretched out, penile circumference, height, weight, and length of the left foot were evaluated, finding low or no correlation between those mentioned, except for flaccid and stretched length.
A case of penile dysmorphophobia with recurrent Koro is presented. Different clinical and diagnostic issues relating to the interrelationship of obsessive-compulsive disorder-spectrum, body-dysmorphic disorders, and Koro are discussed.
Perceptual deviations in penis image are discussed about Koro perception. Different clinical examples of penis-image disturbances are also presented. A guideline for management is provided.
Koro (genital retraction syndrome) was first reported in 1895 in a Dutch medical journal. Since then, it was regarded as a culture-bound disorder of far East, especially concerning Chinese culture. There is a long historical Chinese medical reference for this disorder (since 476–221 BC), and it was pretty prevalent among the people of Chinese ethnicity. In Chinese, the illness is known by the term Suo-yang or Shook yang. Up to 2013, i.e., intervening 117 years, many arguments and counter-arguments surfaced regarding its culture-bound construct, and different researchers support or oppose this contention from many angles. In May 2013, the DSM-5 was published by the American Psychiatric Association and shifted its position from culture-bound disorders and classified Koro as an obsessive–compulsive-related disorder, thus cutting off its long-held cultural tag. This discourse will explore Koro's long academic journey, both supporting or against its culture-boundness over these past 117 years.
Introduction
Men with normal penis size sometimes mistakenly believe they have below average penile dimensions and often seek out treatment. Many men suffer from significant anxiety regarding this perceived defect. In this review, we evaluate the current literature of psychological, medical, and surgical treatment options for men with a complaint of a small penis.
Objective
To review the current practice for treatment of men presenting for penile augmentation surgery.
Methods
A literature review was conducted, using PubMed to identify current studies regarding penile enhancement. Search terms included “penile enhancement,” “small penis anxiety,” “small penis syndrome,” “body dysmorphic disorder,” and “penile augmentation.”
Results
The literature consistently reveals that men who seek out penile augmentation surgery usually have normal penile dimensions. There are limited published data on the practice of penile lengthening surgery or procedures to increase penile girth. New techniques have expanded on suspensory ligament release, such as tissue grafting and flaps. Structured psychological counseling continues to be the recommended initial standard of care for these men.
Conclusion
Many social forces have increased the perception among men that their penis size is inadequate. This increases anxiety and can lead to psychological disorders such as Penile Dysmorphic Disorder and Small Penis Syndrome. Men who undergo penile enhancement are often not satisfied with the results and may develop complications.
Soubra A, Natale C, Brimley S, et al. Revelations on Men Who Seek Penile Augmentation Surgery: A Review. Sex Med Rev 2021;XX:XXX–XXX.
The aim of this review is to describe reported techniques and to provide available scientific data on the success of penis length procedures for cosmetic purposes. Penis lengthening methods remain a controversial issue. Penis size is a matter of great interest among men who are affected by ‘small penis anxiety’’ or just believe themselves to have a small penis, even though the dimensions of the organ fall within the normal range. We performed a narrative review of the literature based on a comprehensive search in the MEDLINE database for original articles published until March 2021, referring to lengthening approaches exclusively for aesthetical reasons. Abstracts, opinion papers and case series ≤10 patients were not considered. We included the results of 14 papers in the review that gathered the experience obtained in a total of 1661 patients. Four of the studies referred to non-surgical procedures for penile length augmentation (PLA) and the remaining 10 analyzed the results of invasive (surgical) procedures. Both invasive and non-invasive techniques achieve similar improvements in penis length. These procedures vary in complexity and require specialized training and experience. However, the low scientific quality of the analyzed papers makes it difficult to establish recommendations to choose one technique over any other. However, it seems reasonable that, if possible, non-invasive techniques should be proposed as a first-line treatment. Before deciding the procedure, we must carry out a correct psychological evaluation of our patients, discuss with them the technique of choice, and adjust their expectations.
Hyaluronic acid injection is becoming a popular way for penile augmentation. However, only few studies and follow-ups have investigated the various complications of hyaluronic acid injection and their corresponding management. In this study, a total of 230 patients who had penile augmentation with hyaluronic acid injection from January 2018 to December 2019 were examined on follow-up for penile girth, complications, and their corresponding management. At 1-month, 3-month, and 6-month postoperative follow-ups, the penile circumference had increased by 2.66 ± 1.24 cm, 2.28 ± 1.02 cm, and 1.80 ± 0.83 cm, respectively. During the entire 6-month follow-up, 4.3% had complications such as subcutaneous bleeding, subcutaneous nodules, and infection. There were no systemic or local allergic reactions among all the patients. All complications were treated accordingly, and no further deterioration or severe sequelae were observed. Although complications of hyaluronic acid injections are mild and rare, these may affect the patient's satisfaction postoperatively. Preoperative redundant prepuce may increase the incidence of penile edema or postoperative gel migration. Standardization of the surgery protocol and elucidation of the effects of other injection parameters are still lacking. Nevertheless, it still highlights the importance of preoperative preparation and surgical technique.
The buried or hidden penis in adults is troublesome in males, whereas the length of the penile shaft is buried under the skin surface of the suprapubic fat to a degree that reveals the concept of a little penis. We aimed to assess a new modality of treatment to increase the apparent penile length by using the cryolipolysis in the reduction of male suprapubic fat as a noninvasive procedure. This prospective study was performed on 46 male patients complaining of buried short apparent small size penis. All patients were subjected to full medical history, body mass index and examination of penile (length, size and abnormalities). The measures of the apparent penile length from the skin to the tip of the glans penis and suprapubic skin fold thickness using (adipometer) were recorded before the three consecutive suprapubic cryolipolysis sessions. The mean apparent stretched penile length at session 1, 2 and 3 were 12.1 ± 0.5 cm, 12.66 ± 0.48 and 12.88 ± 0.72, respectively, with a statistically significant increase between three sessions (p < .001), whereas the mean skin fold suprapubic fat at session 1, 2 and 3 was 2.99 ± 0.49 cm, 2.37 ± 0.48 and 2 ± 0.37, respectively, with a statistically significant decrease (p < .001). The cryolipolysis of suprapubic fat is a safe, effective, noninvasive and applicable procedure that successfully decreases the suprapubic fat in males and increases the apparent length of the buried penises.
In order to detect abnormalities in the size of the penis, firstly, the penis length must be measured correctly. Controversies about the best technique on to be used to measure the length of the penis still persist. The hypothesis of this study is to show that penile length in children is longer than measured under normal examination conditions. A total of 155 children who applied to our institution for circumcision whose stretched penis length (SPL) measurements were performed were included in the study. The distance from the pubic bone to the tip of the glans penis, which was maximally stretched, was measured. Under normal examination conditions (SPL 1), under general anaesthesia (SPL 2) and after skin/ subcutaneous tissues were released during circumcision (SPL 3). The mean age of the patients was 4.20 ± 2.66 years. Mean SPLs were measured as 5.48 ± 1.03 and 5.96 ± 1.01 and 6.54 ± 1.01 cm in SPL 1, SPL 2 and SPL 3 respectively. The amount of increase between penis length measurements was statistically significant (p = .001). In all cases (100%), penis length measurements in SPL 3 were longer relative to SPL 1 and SPL 2.
Background:
Aesthetic augmentation phalloplasty is a set of procedures aimed at increasing penile length and/or girth; many of these procedures are investigational. This systematic review set out to summarize available literature on these procedures in patients with normal penile anatomy.
Methods:
A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The MEDLINE/PubMed, Scopus, and Cochrane Databases were used to identify articles on aesthetic augmentation phalloplasty in cis-gender men without penile deformity from 1990 to 2018. Data on outcomes, complications, and patient-reported satisfaction were collected.
Results:
Sixteen articles, involving 1192 patients, met our inclusion criteria. Mean age ranged from 23 to 44 years, and follow-up time ranged from 6 to 48 months. The quality of the studies was poor regarding methodology for patient selection and outcomes reporting. Surgical interventions included suspensory ligament incision, grafting, flaps, and penile disassembly. Augmentation was performed for length only in 16 percent of patients, girth only in 70.6 percent, and combined in 13.4 percent. Length gain ranged from 8 to 83 percent in the flaccid state and 12 to 53 percent in the erect state. Girth gain ranged from 16 to 56 percent in the flaccid state and 19 to 30 percent in the erect state. The pooled complication rate was 14.6 percent, with those undergoing combined augmentation having the highest complication rate. Patients were generally satisfied; reported satisfaction rates ranged from 50 to 100 percent.
Conclusions:
Enhancement procedures are controversial and investigational. Data point to inconsistent methodology when reporting penile dimensions, outcomes, and patient satisfaction. Despite the reportedly high satisfaction rates, patients should be counseled regarding high complication rates. Best-practice guidelines will be critical to achieve safe and reliable outcomes.
The current research summarizes three studies (Ns = 312, 584, and 176) examining genital perceptions among groups of Canadian post-secondary students. Results indicated that male participants evidenced consistently more favourable views of their genitalia in comparison to female participants. Men and women who were non-virgins (i.e., had engaged in vaginal and/or anal intercourse) also reported more favourable perceptions than their virgin counterparts. In addition, among those who were sexually experienced, the favourability of their genital perceptions correlated positively with sexual esteem, and negatively with body-image self-consciousness and sexual anxiety. Finally, item analysis suggested that, for men, the locus of genital dissatisfaction was penis size whereas for women, the loci were genital odour and pubic hair (amount and texture). Limitations of the current research and directions for future inquiry are provided. Research suggests that perceptions of physical appearance are associated with variations in sexual functioning. For example, in a large survey of female readers of Shape magazine (N = 3,627), Ackard, Kearney-Cooke, and Peterson (2000) found that those who reported being satisfied "when they looked at their body in a mirror" (p. 424) were more likely than their dissatisfied counterparts to feel comfortable undressing in front of their partner; have sex with the lights on; and initiate new sexual activities. In addition, participants satisfied with their bodies expressed greater confidence in their ability to provide sexual pleasure to their partner, and reported having sex more often and being more likely to achieve orgasm. Wiederman and Hurst (1998) similarly identified differences in sexual activity as a function of perceived attractiveness. Female participants who had experienced cunnilingus evidenced significantly higher mean scores on a single-item measure of self-rated bodily attractiveness than those who had never experienced this form of oral sex. The authors also found that participants' sexual esteem (i.e., the tendency to view oneself positively as a sexual partner) correlated positively with self-rated bodily and facial attractiveness. Finally, Cash, Maikkula, and Yamamiya (2004) examined the association between body-image and sexual functioning in samples of male and female college students. In this study, dispositional and situational body-images were measured. The former conceptualises satisfaction (or dissatisfaction) with one's physical appearance as a global trait whereas the latter focuses on body-image as it is experienced within specific contexts (e.g., during sexual intimacy). Results indicated that participants' general body satisfaction correlated negatively with their level of anxiety about exposing parts of the body during sexual activity (i.e., situational body-image). Intriguingly, multiple regression analysis revealed that situational, but not dispositional, body-image emerged as a significant predictor of sexual functioning for male and female participants. The nature of the association was negative such that greater anxiety about the body during sexual activity was associated with poorer sexual functioning. This finding suggests that perceptions of the body during sexual activity may play a more important role in sexual functioning than assessments of physical appearance that are not context specific. Although body-image and sexual functioning have received empirical scrutiny, surprisingly little research has examined the association between individuals' genital perceptions and their sexual attitudes and behaviours. Winter (1989) reported that male participants who described themselves as possessing large genitalia evidenced more favourable genital image, body image, and beliefs about their sexual abilities, as opposed to those who described their genitalia as being average or small in size. Using a small sample of female clients seeking treatment for an unspecified sexual dysfunction, Berman and associates (2003) found that participants' genital self-image correlated negatively with levels of sexual distress and depression. A non-significant correlation was obtained between genital perceptions and scores on a measure of female sexual functioning; however, the size of this correlation (.34) suggests that its non-significance is attributable to the small number of participants used (N = 31). To the authors' knowledge, only one published study provides comparative information on men and women's genital perceptions. Reinholtz and Muehlenhard (1995) found that, as hypothesized, perceptions of male college students were more favourable than those of female college students. In addition, the favourability of participants' genital perceptions correlated positively with involvement in, and self-reported enjoyment of, specific sexual activities (e.g., oral sex). Based on the findings obtained in their study, the authors concluded that "attitudes toward the genitals are an important facet of human sexual experience" (p. 164). The purpose of the current research was to expand understanding of the correlates of genital perceptions among non-clinical samples of men and women. Three studies were conducted (Ns = 312, 584, 176) with samples of university students attending institutions located in the provinces of Alberta and Saskatchewan (Canada).
O conceito de masculinidade hegemônica tem influenciado os estudos de gênero em vários campos acadêmicos, mas ao mesmo tempo tem atraído um sério criticismo. Os autores traçam a origem do conceito a uma convergência de ideias no início dos anos 1980 e mapeiam as formas através das quais o conceito foi aplicado quando os estudos sobre homens e masculinidades se expandiram. Avaliando as principais críticas, os autores defendem o conceito de masculinidade como fundamental, uma vez que, na maioria das pesquisas que o opera, seu uso não é reificador nem essencialista. Entretanto, as críticas aos modelos assentados em características de gênero e às tipologias rígidas são sólidas. O tratamento do sujeito em pesquisas sobre masculinidades hegemônicas pode ser melhorado com a ajuda dos recentes modelos psicológicos, mesmo que os limites à flexibilidade discursiva devam ser reconhecidos. O conceito de masculinidade hegemônica não equivale a um modelo de reprodução social; precisam ser reconhecidas as lutas sociais nas quais masculinidades subordinadas influenciam formas dominantes. Por fim, os autores revisam o que foi confirmado por formulações iniciais (a ideia de masculinidades múltiplas, o conceito de hegemonia e a ênfase na transformação) e o que precisa ser descartado (tratamento unidimensional da hierarquia e concepções de características de gênero). Os autores sugerem a reformulação do conceito em quatro áreas: um modelo mais complexo da hierarquia de gênero, enfatizando a agência das mulheres; o reconhecimento explícito da geografia das masculinidades, enfatizando a interseccionalidade entre os níveis local, regional e global; um tratamento mais específico da encorporação1 em contextos de privilégio e poder; e uma maior ênfase na dinâmica da masculinidade hegemônica, reconhecendo as contradições internas e as possibilidades de movimento em direção à democracia de gênero.
Venoocclusive disorder, also known as venous leak and anticipatory anxiety, are both common causes of erectile disorder. The clinical presentation and investigations using ultrasonography have some common findings during the preliminary assessment process. We present a treatment approach which may be offered in both conditions and which may require reduced doses or eventually allow withdrawal off medication. The Sheffield PDE5i and Ring Duo Technique uses maximum tolerated doses of sildenafil, tadalafil or vardenafil alongside penoscrotal rings to secure reliable and cosmetically aesthetic erections.
As part of a study investigating the adequacy of the Australian Standard for latex condoms, we arranged for self-measurement of the erect penis by a volunteer sample of 156 men, predominantly Caucasian. The kits contained illustrated instructions and paper tapes which the respondents mailed back to us marked with creases to indicate their dimensions. Mean penis length was 16.0 cm (95% confidence interval (CI) 12.2-19.8 cm) and circumferences were: base 13.5 cm (95% CI 10.7-16.2 cm); shaft just below coronal ridge 12.4 cm (95% CI 10.0-14.8 cm); glans 11.9 cm (95% CI 9.6-14.2 cm). Repeat measures of 15 men showed intraclass correlations (r) of 0.90 for length, 0.68 base circumference, 0.87 behind ridge and 0.87 glans. Non-users of condoms were more likely to have narrower penises. In a subsample of 66 men who reported on perceived condom comfort, men with wider penises (base circumference) were more likely to find condoms too tight. Men with longer penises were more likely to complain that condoms were too short. Circumcised men had shorter erect penises than uncircumcised men (p < 0.05). The paper recommends that the measurement technique described in this study should be applied to other populations, and that condoms should be manufactured and marketed in a wider range of lengths and widths.
The media equate a man's penis size with his power and masculinity. Views about penis size were assessed in an Internet survey of 52,031 heterosexual men and women. Most men (66%) rated their penis as average, 22% as large, and 12% as small. Self-reported penis size was correlated positively with height and negatively with body fat level. Whereas 85% of women were satisfied with their partner's penis size, only 55% of men were satisfied with their penis size, 45% wanted to be larger, and 0.2% wanted to be smaller. Satisfaction did not vary across age groups from 18 to 65. Men reporting a larger-than-average penis rated their appearance most favorably, suggesting a possible confidence effect of perceived large penis size. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The relation between sexual orientation and penile dimensions in a large sample of men was studied. Subjects were 5122 men interviewed by the Kinsey Institute for Research in Sex, Gender, and Reproduction from 1938 to 1963. They were dichotomously classified as either homosexual (n = 935) or heterosexual (n = 4187). Penile dimensions were assessed using five measures of penile length and circumference from Kinsey's original protocol. On all five measures, homosexual men reported larger penises than did heterosexual men. Explanations for these differences are discussed, including the possibility that these findings provide additional evidence that variations in prenatal hormonal levels (or other biological mechanisms affecting reproductive structures) affect sexual orientation development.
Does the size of the male penis, in terms of length or width, make a difference in female sexual satisfaction?
To study the effect of penis width vs. length on female sexual satisfaction, 50 sexually active female undergraduate students were asked which felt better, i. e., was penis width or length more important for their sexual satisfaction.
None reported they did not know, or that width and length were equally satisfying. A large majority, 45 of 50, reported width was more important (p < .001).
Implications are discussed, including the fact that the data seem to contradict Masters and Johnson about penis size having no physiological effect on female sexual satisfaction.
Concerns over penile size and a desire for a longer penis are common in the male population. The number of male patients seeking an andrological consultation for the problem of 'short penis' is increasing. We looked at the numbers of patients presenting to a University andrology clinic over a 2-y period and correlated their perceived penis size with the accepted norms. Sixty-seven patients were evaluated with a median age of 27 (range 16-55) complaining of 'short penis' and requesting surgical correction. Clinical history, including the IIEF-5 questionnaire and an accurate physical examination were obtained. Data concerning measures of penile length and circumference were recorded in both the flaccid and fully stretched states and compared to the normal reference range as previously described in the nomogram we recently published (Eur Urol 2001; 39: 183-186.). All patients were also asked to estimate the length of a normal sized penis.Fourty-four (65.7%) complained of a short penis only while flaccid, 22 patients (32.8%%) while both flaccid and erect, and only one patient (1.5%) was worried only by the erect length of the penis. Fifteen (22.4%) also complained about their penile circumference. Fifty-seven (85%) patients thought a 'normal' penile length should range from 10 to 17 cm (median value of 12 cm). Ten patients (15%) were not able to estimate 'normal' penile size. No patient was found to have a penile length under the 2.5 percentile according to our nomogram. Forty-two (62.7%) subjects recalled the problem starting in childhood, when they felt that their penis was smaller than their friends'. In 25 patients (37.3%) the problem started in the teenage years after seeing erotic images. Our data show that most men who seek penile lengthening surgery overestimate 'normal' penile length. In our series, none of the patients could be classified as having a severely short penis according to our nomogram and none had any anatomical penile abnormality. Most found the use of a nomgram to show them how they compared with other men helpful. We suggest that documentation of such a demonstration should be made for any man seeking an opinion on penile lengthening surgery.
Men overestimate the degree of muscularity that is attractive to women, and women overestimate the degree of thinness that is most attractive to men. Consistent with the thesis that sociocultural input influences such body type preferences and beliefs, we postulated that magazines aimed at a male audience would portray a more muscular male body ideal than would magazines aimed at a female audience. Systematic comparison of popular magazines (Cosmopolitan, Men's Health, Men's Fitness, and Muscle & Fitness) revealed that the ideal male body marketed to men is more muscular than the ideal male body marketed to women. We introduce the Physical Trait Overvaluation Hypothesis, which proposes that gender-specific media fuel emphasis on certain body parts in within-gender prestige competitions. The resulting competitive escalation creates a disconnect between the preferences of one gender and the personal aspirations of the other.
Early penile prostheses implanted for impotence are the direct descendants of stents used in the reconstruction of traumatically amputated penises that essentially served as artificial os penises for impotent men. Implanted relatively superficially beneath Buck's fascia in the dorsal intercavernosal groove, these early prostheses were plagued by numerous complications such as erosion and extrusion as we]l as functional difficulties due to proximal instability. Forty years of trial and error in design and placement, along with development of medical grade silicone, led to development of currently used intracavernosal prostheses. Despite the recent development of effective alternate therapies for impotence (i.e., intracavernosal self-injection of vasoactive agents and vacuum constriction devices), low complication rates coupled with high patient satisfaction have kept the penile prosthesis the gold standard in impotence treatment.
The concept of hegemonic masculinity has influenced gender studies across many academic fields but has also attracted serious criticism. The authors trace the origin of the concept in a convergence of ideas in the early 1980s and map the ways it was applied when research on men and masculinities expanded. Evaluating the principal criticisms, the authors defend the underlying concept of masculinity, which in most research use is neither reified nor essentialist. However, the criticism of trait models of gender and rigid typologies is sound. The treatment of the subject in research on hegemonic masculinity can be improved with the aid of recent psychological models, although limits to discursive flexibility must be recognized. The concept of hegemonic masculinity does not equate to a model of social reproduction; we need to recognize social struggles in which subordinated masculinities influence dominant forms. Finally, the authors review what has been confirmed from early formulations (the idea of multiple masculinities, the concept of hegemony, and the emphasis on change) and what needs to be discarded (onedimensional treatment of hierarchy and trait conceptions of gender). The authors suggest reformulation of the concept in four areas: a more complex model of gender hierarchy, emphasizing the agency of women; explicit recognition of the geography of masculinities, emphasizing the interplay among local, regional, and global levels; a more specific treatment of embodiment in contexts of privilege and power; and a stronger emphasis on the dynamics of hegemonic masculinity, recognizing internal contradictions and the possibilities of movement toward gender democracy.
The idea of autologous fat microtransplants has recently resurfaced because of interest by the press. Past experiments have shown that small amounts of fat may be transplanted with an expected survival rate between 10 and 50 percent without ectodermis. A great fund of knowledge exists showing that skin grafts will survive quite dependably if their thickness is up to about 0.0020 inch. For the first week or so, they live by diffusion and inosculation, and then neovascularization enables them to continue viability. I have developed a technique whereby fat is harvested through a blunt cannula with minimal vacuum to prevent explosion of the cellular fat globules. Fibrin and cellular debris are removed, and the fat globules are separated from the free fat, blood, and other constituents of the aspirate. Individual, free-floating 1- to 3-mm adipose fragments are then suspended in nutrient solution and injected through an 18-gauge needle. Multiple radial pathways, with each fat segment being separated from the other by host tissue, maximizes the host-prosthesis interface and the possibility for exchange of nutrients. I have attempted this procedure in more than 100 patients with widely varying results. In acne pits of the face, no significant improvement could be noted 6 weeks after injection. For the first few weeks, a near-perfect result was obtained, but none of these transplants in scarred areas of this kind have been of benefit. Injection of 10 to 50 cc in other areas has resulted in some cells (perhaps 10 percent) surviving over 2 years. I do not recommend autologous fat injection as a permanent transplant at this time, but I am continuing investigations to improve survival. An anonymous survey of the opinions of my patients shows a low regard by them for the results.
Introduction:
The technique most commonly used for penile lengthening is the release of the suspensory ligament in combination with an inverted V-Y skin plasty. This technique has drawbacks such as the possibility of reattachment of the penis to the pubis, a hump that forms at the base of the penis, in addition to alteration in the angle of erection.
Aim:
In this work, we describe a new technique that overrides these drawbacks and minimize the loss of gained length.
Methods:
The suspensory ligament was released through a penopubic incision. The caudal flap of the resected ligaments was reflected caudally and sutured to the Buck's fascia. The V flap was incised. The caudal half of the V was deskinned, leaving a cranial skin-covered V flap, and a caudal, rectangular fat flap. The fat flap was pulled into the gap between the base of the penis and the pubis and secured in position by suturing its deep surface and lower edge to the pubis. This maneuver filled up the gap. The V incision was closed as a Y. The penopubic incision was closed as a T shape, to avoid pulling the penis back at skin closure. A stay suture stretched from the glans to the thigh, maintaining the penis in the stretched position. A urinary catheter was inserted.
Results:
Six months after surgery, there was no loss in the length gained. The angle of erection (as reported by the patient) was similar to that prior to the procedure. The skin incisions left no hump and a faint scar that was not troublesome to the patient.
Conclusion:
"V-Y half-skin half-fat advancement flap" and "T-closure" may improve the results of suspensory ligament release for penile lengthening. The reported techniques minimize the losses compromising length gain, whether in-surgery or following it.
Purpose:
We provide guidelines of penile length and circumference to assist in counseling patients considering penile augmentation.
Materials and methods:
We prospectively measured flaccid and erect penile dimensions in 80 physically normal men before and after pharmacological erection.
Results:
Mean flaccid length was 8.8 cm., stretched length 12.4 cm. and erect length 12.9 cm. Neither patient age nor size of the flaccid penis accurately predicted erectile length. Stretched length most closely correlated with erect length.
Conclusions:
Only men with a flaccid length of less than 4 cm., or a stretched or erect length of less than 7.5 cm. should be considered candidates for penile lengthening.
Thesis (Ph. D.)--New York University, 1989. Includes bibliographical references (p. 114-118). Photocopy.
The Kama Sutra of Vatsasayana / Richard F. Burton Note: The University of Adelaide Library eBooks @ Adelaide.
Genital aesthetic and penile enlargement surgeries are relatively new. Most results are anecdotal, but some surgeons are trying to generate meaningful data. Follow-up data are often difficult to obtain because many patients travel long distances for the surgery.
Dermal-fat grafts have been successful, although some patients resist the operation primarily because of the large donor scar(s). Gluteal crease donor scars are less noticeable than groin scars. Physicians performing fat injections promise small scars and minimal morbidity but emphasize the frequent necessity for re-injections. Dermal-fat grafts do not need re-operations and appear to have good long-term results. A reasonable aesthetic proportion between the shaft and the glans should be maintained. Some men with massive fat injections, however, appreciate the greatly enlarged shaft despite the “grotesque” appearance resulting from the disproportion between the shaft and the glans. The limited size of the dermal-fat grafts does not allow for massive thickening of the shaft because circumference increase of 1 to 2 inches is reasonable even with a relatively small glans. No effective procedure for enlargement of the glans is known.
Penile lengthening operations in the normal patient remain a major question. There is no satisfactory incision for skin advancement onto the penis, but a Z-plasty or double Z-plasty may be acceptable. Z-plasty is preferable owing to the high incidence of hypertrophic scars, wound disruption, and dorsal humps with V-Y advancement flaps. Moreover, exaggerated length claims of many physicians are unrealistic; a gain of 1 inch is considered a success. The patient with the 3-inch gain may be deformed with an extended escutcheon and a low-hanging penis, while achieving minimal or no real length gain.
Malpractice is a major consideration in penis enlargement surgery. Most malpractice carriers will not insure penile fat injections. Depending on the physician and the insurance carrier, dermal-fat grafts may be covered. Liability largely depends on adequate informed consent. Patients should be advised that these operations are investigational and require an extensive consent form to be signed. They must understand that penis enhancement techniques are evolving and that results are still being compiled.
Extensive physician consultation before surgery is imperative, and a “factory” approach is unethical. No two patients are anatomically alike, and thus, a “standard” approach to penile enhancement surgery is not in the best interest of the patient. Many referred patients present with persistent pain, bizarre-appearing V flaps, penile shortening, and massive fat injections with lumps. Some men have become emotional cripples, physically and psychologically unable to perform sexually. Obviously, a man seeking penile enlargement surgery has self-esteem issues, and therefore, a disastrous result may leave him further devastated. Dissatisfied male aesthetic patients have a greater propensity towards violence, so the physician must carefully screen these patients and perform good work for the protection of both the patient and himself.
The male with the concealed penis definitely benefits from a suprapubic lipectomy, release of the suspensory ligament, and a possible Z-plasty of the penoscrotal junction. Such reconstructive cases to restore normal sexual functioning may be covered by insurance.
The necessity for understanding plastic surgical principles to achieve satisfactory results cannot be overemphasized. Knowledge of the principles of flap design and surgical technique is necessary to prevent flap necrosis, wound disruption, “dog-ear” formation, unsightly genital distortion, and poor scar formation. Urologists should study these principles and techniques before performing such operations. Meticulous, time-consuming surgery will help prevent major problems and patient dissatisfaction.
Penis enlargement surgery is effective with low morbidity and high patient satisfaction. As new techniques evolve, demand will continue to increase.
Complications of the recent cosmetic technique of penile lengthening and girth enhancement are reviewed.
During a 16-month period 12 men presented with complications of penile augmentation performed elsewhere. All 12 patients had undergone release of the suspensory ligament and 10 had received autologous fat injection.
The chief complaint was poor cosmetic appearance (irregular residual fat nodules in 7 men, skin deformity and scarring in 4 and scrotalization in 4). Reoperation was necessary in 6 patients, wound complications occurred in 6 and sexual dysfunction was reported by 4. Only 1 patient reported a subjective increase in penile length.
Although a verifiable complication rate may never be available, the morbidity of elective penile lengthening and girth enhancement is noteworthy. These cosmetic techniques should be regarded as experimental.
More than 30 patients presented for reconstruction of penile deformities secondary to penile enlargement surgery performed by other physicians. Lengthening was performed by releasing the suspensory ligament of the penis and advancing pubic skin with a V-Y advancement flap. Girth was increased by injecting autologous fat. Specific complaints relating to the lengthening procedure involve hypertrophic and/or wide scars, a proximal penile hump from a thick, hair-bearing V-Y flap, and a low hanging penis. Complications relating to autologous fat injections include disappearance of fat, penile lumps and nodules, and shaft deformities. The repair of these deformities is described.
From 1994 through October 1996, 19 men underwent 24 various combinations of reconstructive operations, such as scar revisions, V-Y advancement flap reversal, and removal of fat nodules and asymmetrical fat deposits.
Penile appearance and function were improved. Complications include 1 hematoma requiring drainage, minor wound complications and 1 inadequately reversed V-Y flap.
The methods of various repairs are discussed, including reconstructive limitations, timing and staging. Significant improvement can be achieved with proper reconstruction of penile deformities.
This study examined the effect of penis dimensions on the probability of complete condom slippage and condom breakage in actual use. Men were recruited through advertising, used the condoms supplied and completed a diary sheet for each condom used. A total of 3658 condoms were used by 184 men of which 1.34% broke and 2.05% slipped off. No significant effect was demonstrated for penile dimensions on the probability of complete condom slippage. However, condom breakage was strongly associated with penile circumference. These findings suggest that condom manufacturers may need to increase the range of condom sizes available, or some aspects of their performance, in order to ensure that condoms meet the needs of all men without unduly exposing them to risk.
PIP
Anecdotal reports suggest large penis size may be associated with condom breakage, while small penis size increases the risk of condom slippage. The effect of penis dimensions on the likelihood of both these events was investigated in 184 male volunteers recruited through advertisements and posters in Victoria, Australia. Each participant was provided with 12 condoms at a time and instructed to complete a diary sheet for each condom. According to self-measurements, men had a mean total penis length of 15.71 cm and a mean basal circumference of 13.19 cm. Of the 3658 condoms used by these men, 49 (1.34%) broke and 73 (2.05%) slipped. 30 men (16.3%) experienced at least one instance of breakage and 35 (19.0%) experienced complete slippage. There was no evidence for an effect of penis length or circumference on condom slippage. Condom breakage, on the other hand, was strongly associated with penis circumference. Each additional centimeter of penile circumference increased the risk of condom breakage by 50-100%. This finding suggests a need to increase either the range of condom sizes available or the lateral extension of currently available condoms.
Young men often complain about problems with condom use, but very little information exists about the influence of men's age on penile dimensions and therefore on possible problems in the use of the most important means of contraception in the young.
We performed a prospective measurement of penile dimensions in 111 men,18 to 19 years old (group A), and in 32 men, 40 to 68 years old (group B). We measured penile length and width in the flaccid state and after visual and manual self-stimulation in group A and after intracavernous injection of prostaglandin E(1) in group B.
The mean flaccid length in group A (8.60 cm) and group B (9.22 cm) was significantly different. The mean erect length in group A (14.48 cm) and group B (14.18 cm) was not significantly different. The mean flaccid width at the base was significantly different between group A (3.08 cm) and group B (2.87cm), but the mean flaccid width at the glans was not (group A, 3.02 cm; group B, 3.01 cm). The mean erect width at the base (group A, 3.95 cm; group B, 3.50 cm) and the erect width of the glans (group A, 3.49 cm; group B, 3.32 cm) were significantly different.
Our assumption that the problems young men experience with condom use may be because of smaller penises could not be proved. To address the problems in condom use in younger men, a larger variety of condom sizes and better information about condom use may be useful.
The knowledge of normal variations in the size of male external genitalia is of considerable interest to several disciplines. We carried out an extensive study in young Italian males to provide estimates of normal variations of penile dimensions.
The penile length in flaccid and stretched states and the penile circumference were measured in a random group of 3,300 young men aged 17-19 years and free from endocrine disorders and from congenital or acquired abnormalities of the penis. In a random sample of 325 subjects of the same set of people, penile length and circumference were also correlated with weight and height. Statistical analysis was performed with the Sperman test, because our data were not normally distributed as tested by the Kolmogorov-Smirnov test (p < 0.01).
The median values of penile dimensions recorded in the present study are flaccid length 9.0 cm, flaccid circumference, at the middle of the shaft, 10.0 cm, and stretched length 12.5 cm. We also observed that the penile dimensions are highly correlated with height and weight.
Since penile length and circumference correlate with anthropometric parameters such as weight and height, we suggest to consider themselves as two bodily measures which display a wide extent of normal variability along the general population.
Using evidence based methods we prospectively evaluated the impact of a new surgical procedure on penile deformity caused by severe cavernous fibrosis.
In 10 patients with severe penile curvature, shortening and impaired penile rigidity due to fibrosis of the corpora cavernosa we made multiple relaxing incisions of the tunica albuginea and subsequently placed a 3-piece inflatable penile implant. Patients were evaluated before and after the procedure by the International Index of Erectile Function and several general assessment questions. Preoperatively and postoperatively we measured flaccid and erect penile length.
At the 6-month followup all International Index of Erectile Function domains were significantly improved compared with preoperative values. Average penile length was increased 2.3 and 3 cm. while flaccid and erect, respectively, compared with before surgery. Complete penile straightening was achieved in 9 of 10 cases (90%). Surgical reoperation was performed in 1 patient (10%) in whom the implant was removed due to scrotal infection and in another (10%) in whom a further single relaxing incision of the fibrotic plaque was needed to attain complete penile straightening.
Patients with severe penile curvature, shortening and impaired penile rigidity due to penile fibrosis may be offered this surgical alternative, which proved to be effective and safe in our preliminary series.
Research on the pharmacotherapy of body dysmorphic disorder (BDD), a common and often disabling disorder, is limited. Available data suggest that this disorder may respond to serotonin reuptake inhibitors. However, no placebo-controlled treatment studies of BDD have been published.
Seventy-four patients with DSM-IV BDD or its delusional variant were enrolled and 67 were randomized into a placebo-controlled parallel-group study to evaluate the efficacy and safety of fluoxetine hydrochloride. After 1 week of single-blind placebo treatment, patients were randomized to receive 12 weeks of double-blind treatment with fluoxetine or placebo. Outcome measures included the Yale-Brown Obsessive Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) (the primary outcome measure), the Clinical Global Impressions Scale, the Brown Assessment of Beliefs Scale, and other measures.
Results of the BDD-YBOCS indicated that fluoxetine was significantly more effective than placebo for BDD beginning at week 8 and continuing at weeks 10 and 12 (F(1,64) = 16.5; P<.001). The response rate was 18 (53%) of 34 to fluoxetine and 6 (18%) of 33 to the placebo (chi(2)(1) = 8.8; P=.003). The BDD symptoms of delusional patients were as likely as those of nondelusional patients to respond to fluoxetine, and no delusional patients responded to the placebo. In the sample as a whole, treatment response was independent of the duration and severity of BDD and the presence of major depression, obsessive-compulsive disorder, or a personality disorder. Fluoxetine was generally well tolerated.
Fluoxetine is safe and more effective than placebo in delusional and nondelusional patients with BDD.
There are only a few reports that investigate the measurement of functional penile length and compare the methods used for this purpose. The aim of this study was to determine the correlation between the measurement techniques and to determine an appropriate method that correlates the erect state most closely. Measurements of penile length in 200 healthy men were made during three different states--flaccid, erect, and stretched--of the penis. The results were evaluated using descriptive statistics, paired t-test, correlation coefficients, and regression equations. The correlation between the flaccid and the erect lengths was 71.2%, and it was 80.2% between the stretched and the erect lengths (p < 0.01). Using regression equations, the degree of accuracy in estimating the erect length by using the stretched length was 65.3% (R2 = determination coefficient; p < 0.01) and was 50.8% by using the flaccid length (p < 0.01). When both the flaccid and the stretched lengths were considered together, the predictability of erect length was R2 = 65.5%. The results obtained using different statistical methods showed that the most accurate results can be obtained by considering stretched penile length, whereas flaccid length had little importance in determining erect penile length. In conclusion, the stretched penile length measurement technique is highly recommended for the accurate prediction of the erect penile length.
To establish if the 'myth' about whether the size of a man's penis can be estimated from his shoe size has any basis, in fact.
Two urologists measured the stretched penile length of 104 men in a prospective study and related this to their shoe size.
The median stretched penile length for the sampled population was 13 cm and the median UK shoe size was 9 (European 43). There was no statistically significant correlation between shoe size and stretched penile length.
The supposed association of penile length and shoe size has no scientific basis.
Penile augmentation surgery is a highly controversial issue due to the low level of standardisation of surgical techniques. The aim of the study is to illustrate a new technique to solve the problem of enlarging the penis by means of additive surgery on the albuginea of the corpora cavernosa, guaranteeing a real increase in size of the erect penis.
Between 1995 and 1997, 39 patients who requested an increase in the diameter of their penises underwent augmentation phalloplasty with bilateral saphena grafts. The patients considered eligible for surgery were patients with either hypoplasia of the penis or functional penile dysmorphophobia. All the patients included in our study presented normal erection at screening. The average penis diameter in a flaccid state and during erection was found to be 2.1cm (1.6-2.7 cm) and 2.9 cm (2.2-3.7 cm), respectively. Before surgery the patients were informed of the experimental nature of the surgical procedure. The increase in volume of the corpora cavernosa was achieved by applying saphena grafts to longitudinal openings made bilaterally in the albuginea along the whole length of the penis.
No major complications and specifically no losses of sensitivity of the penis or erection deficiencies occurred during the post-operative follow-up period. All the patients resumed their sexual activity in 4 months. A measurement of the penile dimensions was carried out 9 months after surgery. No clinical meaningful increases in the diameter of the flaccid penis were documented. The average penis diameter during erection was found to be 4.2 cm (3.4-4.9) with post-surgery increases in diameter varying from 1.1 to 2.1cm (p<0.01).
The penile enlargement phalloplasty technique with albuginea surgery suggested by the authors definitely is indicated for increasing the volume of the corpora cavernosa during erection. Albuginea surgery with saphena grafts has been found to be free from aesthetic and functional complications with excellent patient satisfaction.
A great deal of men consider that the size of the penis is directly proportional to its sexual power. Some men, who are worried that their penis is too small, wish to be considered for surgical lengthening or thickening procedures. The argumentation for this chiefly points in the direction of women. However, have women actually been asked about the extent to which they consider the size of the penis to be of importance from a sexual point of view? Or asked what they think about ideas surrounding the size of the penis in relation with actual sexual functioning?
To address these questions, 375 sexually active women who had recently given birth at the University Hospital Groningen were asked a number of questions about sexual functioning and the importance they attach to the size of their partner's penis.
A total of 170 questionnaires were returned (response rate 45%); 20% of the women found the length of the penis important and 1% very important; 55% and 22% of the women found the length of the penis unimportant and totally unimportant, respectively. Opinions about the girth of the penis followed the same trend. Length was less important than girth: 21% and 32%, respectively. The women who found the girth of the penis important had the same opinion about the length of the penis (correlation 0.71, p=-0.001). Median division into two subgroups (girth important/unimportant; t-test) did not reveal any significant differences in relation with demographic data. Correlation analysis did not reveal any significant correlation between sexual functioning (measured with the NSF) and opinions about the girth of the penis.
Although clearly in the minority, a nevertheless considerable percentage of the women respondents attached substantial importance to the size of the male sexual organ.
To investigate the flaccid and stretched penile sizes of young Korean men and their complexes or pride about their penile size.
After an explanation and agreement to the purpose and methods of this study, 123 Korean men in their early 20's visiting the Jinhae Military General Hospital were included in the study. The flaccid penile length, flaccid mid-shaft circumference, stretched length and pre-pubic bone fat pad depth were measured in a warm comfortable environment. The accuracy the subjects assessed their penile size was investigated by asking them to rate their penile size, as 'very small', 'small', 'normal', 'large'or 'very large', All subjects were asked to complete the Minnesota multiphasic personality inventory (MMPI) test.
The mean flaccid length, flaccid circumference, stretched length and fat pad depth of the 123 subjects were (6.9+/-0.8) cm, (8.5+/-1.1) cm, (9.6 +/-0.8) cm and (1.1 +/-0.4) cm, respectively. The answer distribution on penile size was 1 (0.8 %) 'very small', 29 (23.6 %) 'small', 86 (69.9 %) 'normal', 6 (4.9 %) 'large' and 1 (0.8%) 'very large'. Subjects who underestimated their penile size showed significantly higher scores on the hypochondriasis (Hs), depression (D) and psychasthenia (Pt) subscales of the MMPI than those in the Unbiased Group (P<0.05).
In consultation, with a patient requesting penile augmentation, the urologist should consider the psychologic attitude of the patient to his penile size.
Although augmentation phalloplasty is not an established procedure, some patients still need enlargement of their penis. Current penile augmentation is girth enhancement of penile body by dermofat graft. We performed this study to identify the efficacy and the patient's satisfaction of human glans penis augmentation with injectable hyaluronic acid gel. In 100 patients of subjective small penis (Group I) and 87 patients of small glans after dermofat graft (Group II), 2 cm(3) of hyaluronic acid gel was injected into the glans penis, subcutaneously. At 1 y after injection, changes of glandular diameter were measured by tapeline. Patient's visual estimation of glandular size (Gr 0-4) and patient's satisfaction (Grade (Gr) 0-4) were evaluated, respectively. Any adverse reactions were also evaluated. The mean age of patients was 42.2 (30-70) y in Group I and 42.13 (28-61) y in Group II. The maximal glandular circumference was significantly increased compared to basal circumference of 9.13+/-0.64 cm in Group I (P<0.01) and 9.49+/-1.05 cm in Group II (P<0.01) at 1 y after injection. Net increase of maximal glandular circumference after glans augmentation was 14.93+/-0.80 mm in Group I and 14.78+/-0.89 mm in Group II. In patient's visual estimation, more than 50% of injected volume was maintained in 95% of Group 1 and 100% of Group II. The percentage of postoperative satisfaction (Gr 4, 5) was 77% in Group 1 and 69% in Group II. There was no abnormal reaction in area feeling, texture, and color. In most cases, initial discoloration by glandular swelling recovered to normal within 2 weeks. There were no signs of inflammation and no serious adverse reactions in all cases. These results suggest that injectable hyaluronic acid gel is a safe and effective material for augmentation of glans penis.
Some patients report that the penis is smaller after radical retropubic prostatectomy for prostate cancer. We performed a prospective study which measured penile length before and after radical retropubic prostatectomy.
A total of 124 men consented to penile measurements before radical prostatectomy performed by the same surgeon. Repeat measurements were performed at 3-month intervals following surgery. Penile measurements (cm.) consisted of flaccid length, stretched length, depth of prepubic fat pad and circumference. Statistical analysis of penile measurements was performed using the paired samples and independent Student's t test, Pearson's correlation and analysis of variance.
Mean patient age was 59.1 (range 42 to 76). No patient had a penile abnormality, for example Peyronie's disease, or history of penile or urethral surgery. The size of the penis was significantly smaller after prostatectomy, and there was a significant difference for flaccid (p <0.001), stretched (p <0.001), prepubic fat pad (p = 0.02) and circumference measurements (p <0.01). Twelve patients (19%) had a 15% or greater decrease in stretched penile length. When dichotomizing groups at the cut point of 15% decrease, the independent t test of prostate size was not significant (t[df 36.7] = -1.83, p = 0.076). Nerve sparing was not significant in relation to change in penile stretched length, (F[df 2, 62] = 0.501, p = 0.609).
Our findings support observations of decreased penile length after radical prostatectomy. Men should be counseled before radical prostatectomy that penile shortening may occur.
To report on the efficacy and safety of augmentation phalloplasty procedures in physically normal young men, to introduce a patient selection and outcome evaluation questionnaire as well as, to propose a surgical technique modification.
Eleven (11) out of 28 psychosomatically normal men (25-35 years) who presented complaining of penile dysmorphophobia (subjective perception of small penis), were subjected to: (a) penile lengthening (suprapubic skin advancement--ligamentolysis): n=5, (b) penile lengthening and shaft thickening (free dermal-fat graft shaft coverage): n=3 and (c) panniculectomy--suprapubic lipectomy and penile lengthening: n=2. A self administered questionnaire was employed in order to facilitate selection of the patients qualifying for the operation as well as to evaluate the outcome. In addition, a technical modification regarding dermal-fat graft handling was applied.
The postoperative course was uneventful with minor complications. The mean penile length gain (flaccid--stretched penis) was 1.6 cm (1-2.3 cm) [p=0.0014], the mean circumference gain was 2.3 cm [p=0.003] at the base and 2.6 cm [p=0.0012] subcoronaly. Significant (20%-53%) [p<0.0001] sexual self-esteem and functioning improvement was reported by the majority (91%) of patients.
Although penile size alteration was not spectacular or satisfying the patients' "great" expectations, the substantially uneventful clinical course coupled with the significant improvement in sexual self-esteem and function and the highly accepted outcome by the patients, render augmentation phalloplasty reasonable treatment modality for the management of strictly selected and thoroughly informed young adults who suffer from penile dysmorphophobia.
To evaluate in a multicenter, prospective study preliminary aesthetic and functional results of autologous ex-vivo tissue engineering for penile girth enhancement.
From July 1999 to January 2004, 204 men of mean age 26.77 (range 19-54 years) underwent this procedure. Indications for penile girth enhancement were penile dysmorphic disorder and previous failed surgery for penile girth enhancement. Fibroblast cells harvested from 1 cc of biopsied scrotal dermal tissue were expanded in culture until the total cell number of at least 2x10(7) was reached. Suspended cells in culture medium were then seeded on pretreated tube-shaped PLGA scaffolds and incubated for 24 hours. After penile degloving, scaffolds were shape adjusted and transplanted between dartos and Buck's fascia when the skin was compliant or under the neurovascular bundle when the skin was not compliant.
A total of 84 randomly selected patients were followed 1 to 5 years postoperatively (median 24 months). The gain in girth ranged from 1.9 to 4.1cm (mean 3.15 cm). Postoperative complications occurred as infection in three, penile skin pressure necrosis in two and seroma formation in five patients and were all treated conservatively. Surgical intervention was appraised by patients on a scale from 1 to 5 as follows: the best mark (5) was given by 44.05%, very good (4) by 36.90%, good (3) by 19.05% and only one patient gave the mark 2 judging general penile appearance as dissatisfactory; mean score was 4.25.
Autologous tissue engineering by using biodegradable scaffolds as a carrier is a new and safe therapeutic approach for penile girth enhancement. The outcome of this study points out the necessity for its expanded clinical applicability in the future.
Current girth augmentation techniques rely either on liposuction/injection or on the use of dermal fat grafts. These procedures have serious disadvantages, including regression in gained size, deformities, irregular contour, and asymmetry. Ideally, the augmentation technique should ensure durability and symmetry. This case report describes the first application of a flap (superficial circumflex iliac artery island flap) in penile girth augmentation.
The superficial circumflex iliac vessels were identified and the groin flap was elevated from lateral to medial, rotated toward the penis, and tunneled into a penopubic incision. It was wrapped around the penis short of the corpus spongiosum and insinuated under the glans.
Six months after surgery, the patient had an erect girth of 19.5 cm and a flaccid girth of 16.5 cm, compared with 11 cm and 7 cm, respectively, before surgery, thus maintaining the intraoperative girth gain. The outer surface felt smooth with no lobulation. The size of the glans was proportionate to the shaft's girth.
This case report shows that the application of flaps in penile girth augmentation may provide a reliable alternative to the currently applied techniques. Glans flaring promotes the aesthetic results and is applicable with other techniques of penile girth augmentation.
Genital size has been a source of anxiety for men throughout history. It has various social and psychological ramifications, such as social maladjustment, fear of relationships, and lack of self-confidence.
To assess the efficacy of a vacuum device as a noninvasive method for penile elongation.
Between September 2003 and November 2004, 37 sexually active men with a stretched penis length of <10 cm were given vacuum treatment three times a week, for 20 min on each occasion, for 6 months.
After 6 months, the mean penile length had increased from 7.6 cm to 7.9 cm (no significant difference). The efficacy of vacuum treatment was approximately 10%, and the patient satisfaction rate was 30%. There was one case of haematoma of the penis and one of glans numbness, both resolved spontaneously without any intervention.
Vacuum treatment of the penis is not an effective method for penile elongation, but provides psychological satisfaction for some men.
Until 20 years ago, penis size (either nonerected or erected) was not mentioned, discussed, or defined even in serious books of human anatomy. The need of some men to enlarge and elongate their penile size is equivalent to the need of some women to ask for breast augmentation. The same method of transferring autologous fat into other parts of the body can be used in male patients for augmentative phalloplasty. The circumference of the penis increases 2 to 3 cm, and before of a heavier penis, the length increases 1 to 2 cm. If more lengthening is desired, subtotal dissection of the ligament fundiforme penis below the symphysis could be done, pull the corpus cavernosus out, and fix the tunica albuginea at the periost. At the root of the phallus, the skin can be elongated by V-Y-plasty, and the scrotal skin can be released by 1 or 2 Z-plasties. Combining both autologous fat transfer and ligament release allows for penis elongation of 3 to 5 cm. The authors have performed augentative phalloplasty on 88 patients since 1996. They have transplanted 40 to 68 ml of pure fat. Of the 88 patients, 57 underwent autologous fat transfer only, and 31 received additional ligament release. Penis length increased 1.5 to 4.8 cm (average, 2.42 cm), and circumference increased 1.4 to 4.0 cm (average, 2.65 cm). The initial penis lengths were 6.5 to 10.0 cm (average, 8.72 cm), and the circumference were 8.0 to 10.1 cm (average, 9.18 cm) not erected. This article details a simple operative procedure to enlarge the penis and simple postoperative bandages. Patients are advised to obstain from sexual activity for 5 weeks after the surgery. Two patients who disregarded this advice had an unsatisfactory result. In one patient too, much of the grafted fat had to be removed from the preputium. No other serious complications were observed.
We present 2 techniques of enhancement and sculpturing of a small and/or deformed glans.
The small glans in primary or re-do hypospadias repair was enhanced by longitudinal double-faced island flaps incorporated onto the ventral side of the glans between the glans wings. The deformed glans, of small or normal size (with normal urethra or well functioning neourethra), was enlarged and sculptured by injection of hydrogel. Between May 1997 and March 2002, 27 patients underwent glans enhancement and sculpturing. Small deformed glans occurred after failed hypospadias repair in 10 patients, penile trauma in 3, hemangioma sclerozation in 2, primary hypospadias in 8 and normally developed penile body in 4. A double-faced island flap was performed in 14 patients, glans was enhanced by hydrogel injection in 9 and both procedures were performed in 4.
Mean followup was 34 months for the double-faced flap technique 17 months for hydrogel injection. Satisfactory enlargement and esthetic appearance were achieved in 13 of the 14 patients who underwent the double-faced flap technique and 1 required surgical correction. Of the 9 patients who underwent either single or multistage hydrogel injection 8 had good results and 1 required partial removal of hydrogel after hypercorrection. The combination of these 2 techniques provided satisfactory results in all 4 cases.
Enlargement and sculpturing of a small deformed glans are challenging and difficult. A double-faced island flap and/or injection of hydrogel resolves this problem satisfactorily.
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Efficacy of daily penis stretching technique to elongate the 'small penis
- G M Colpi
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- F I Scroppo
- M Mancini
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Mancini M, Castiglioni F. Efficacy of
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