Does underestimated penile size impact erectile function in healthy men?

The impact of male genital self-image on depression, anxiety and sexual functions

AIM

This study aims to examine the relationship between male genital self-perception and sexual functioning and depression anxieties.

METHOD

The study included male patients who were referred to the andrology outpatient clinic between March 2022 and June 2022. Demographic data of the patients were recorded. Cigarette and alcohol consumption was also noted. The Male Genital Self Image Scale (MGSIS) questionnaire was used for the Genital Self Image(GSI) assessment, which consists of 7 questions. The International Index of Erectile Function (IIEF), composed of 15 questions, was used to evaluate sexual function. STAI-I, STAI-II, and BECK scales were used for depression and anxiety. The penis size of the patients was measured in a flask and stretched condition, and the midpenile circumference was recorded. Patients were compared with respect to GSI, depression, anxiety, and sexual functioning.

RESULTS

A total of 75 patients were included in the study. The mean age of the patients was 46.69 ± 11.32 (26-72), and the mean BMI was 27.82 ± 3.79 (22.46-40.40) kg/m2. A slightly positive correlation was found between the patients' flask penis size and MGSIS-total scores (r = 0.260, p = .024) and IIEF-SF scores (r = 0.240, p = .038). There was a moderately positive correlation between the stretched penis size and IIEF-OS (r = 0.403, p < .001) and IIEF-SF (r = 0.354, p = .002). While the MGSIS-total score and the STAI-I and STAI-II scores had a moderate negative correlation, there was an advanced negative correlation between the MGSIS-total score and the BECK score.

CONCLUSION

Disruption of men's genital self-perception is moderately related to their susceptibility to depression and anxiety. This situation affects the person's sexual performance and causes orgasm problems to increase.

Reasons for Genital Dissatisfaction in a Sample of Brazilian Men

Genital self-image (GSI) involves subjective perceptions, experiences, and feelings of individuals regarding their genitalia. A negative GSI contributes to lower sexual esteem and, consequently, negative sexual experiences and sexual dysfunction. In men, self-perception may be influenced by several factors, including penis size or shape, personal experiences, body image, general health status, sex education, and even the media they consume. This study aimed to understand the reasons that lead to dissatisfaction with GSI among Brazilian men. With a mixed approach, we present male perceptions regarding dissatisfaction with GSI captured from the following question: "If you are dissatisfied with your genitals, tell us for what reason(s)? (Optional)," which integrated the last questionnaire element of the original survey. Brazilian men over 18 years of age from different Brazilian states were eligible. In this analysis, 376 responses were obtained. The data were analyzed using thematic content analysis. The participants expressed the reasons for dissatisfaction, which were grouped into two categories: (1) anatomical aspects and beliefs in the construction of GSI and (2) functional aspects. The results offer an understanding of men's perceptions of their genitals and may aid in clinical practice and research on how Brazilian men perceive their genitals. It is possible to improve knowledge about sexual health and increase positivity regarding genital perception by providing information about the reasons that lead to dissatisfaction with the genitals.

Worldwide Temporal Trends in Penile Length: A Systematic Review and Meta-Analysis

PURPOSE

Normative male genital measurements are clinically useful and temporal changes would have important implications. The aim of the present study is to characterize the trend of worldwide penile length over time.

MATERIALS AND METHODS

A systematic review and meta-analysis using papers from PubMed, Embase, and Cochrane Library from inception to April 2022 was performed. PRISMA guidelines were used for abstracting data and assessing data quality and validity. Pooled means and standard deviations for flaccid, stretched, and erect length were obtained. Subgroup analyses were performed by looking at differences in the region of origin, population type, and the decade of publication. Metaregression analyses were to adjusted for potential confounders.

RESULTS

Seventy-five studies published between 1942 and 2021 were evaluated including data from 55,761 men. The pooled mean length estimates were flaccid length: 8.70 cm (95% CI, 8.16-9.23), stretched length: 12.93 cm (95% CI, 12.48-13.39), and erect length: 13.93 cm (95% CI, 13.20-14.65). All measurements showed variation by geographic region. Erect length increased significantly over time (QM=4.49, df=2, p=0.04) in several regions of the world and across all age groups, while no trends were identified in other penile size measurements. After adjusting for geographic region, subject age, and subject population; erect penile length increased 24% over the past 29 years.

CONCLUSIONS

The average erect penis length has increased over the past three decades across the world. Given the significant implications, attention to potential causes should be investigated.

Factors Associated with Satisfaction with Male Genital Self-Image in Brazil

Male genital self-image (GSI) refers to how men feel about their genitals. Studies suggest that GSI is influenced by several psychosocial and physical factors, such as frequency of sexual activities, anxiety, and sexual dysfunctions. In Brazil, no studies have investigated the factors associated with satisfaction with male GSI. This is a cross-sectional and online study conducted with Brazilian men over 18 years of age. The Male Genital Self-Image Scale (MGSIS), Body Appreciation Scale-2 (BAS-2), and International Index of Erectile Function (IIEF) were used. Body appreciation and frequency of sexual activity were included as confirmatory variables and other variables were explored as factors associated with GSI. Data were analyzed by binary logistic and multiple linear regression, according to the MGSIS cut-off point for satisfaction with male GSI and total score of MGSIS, respectively. A total of 1,235 men (M = 26.14, SD = 7.28 years) participated in the study. The mean of the total MGSIS score was 23.02 (SD = 4.45; absolute range, 7-28) points, with 62.11% of men being classified as satisfied with GSI. Men satisfied with GSI were more likely to have a partner, higher body appreciation, lower body mass index (BMI), and not have phimosis (excess skin covering the penis, making it difficult to expose the glans). Satisfaction with GSI of Brazilian men was associated with relationship status, body appreciation, BMI, and phimosis.

European Association of Urology Guidelines on Penile Size Abnormalities and Dysmorphophobia: Summary of the 2023 Guidelines

CONTEXT

Recommendations regarding the management of penile size abnormalities and dysmorphophobia are important in guiding evidence-based clinical practice.

OBJECTIVE

To present a summary of the 2023 European Association of Urology sexual and reproductive health evidence-based recommendations for the management of penile size abnormalities and dysmorphophobia.

EVIDENCE ACQUISITION

A broad and comprehensive scoping exercise covering all areas of the guidelines was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. A level of evidence and a strength of recommendation were assigned for each recommendation according to the evidence identified. The evidence cutoff date for the 2023 guidelines is June 1, 2022.

EVIDENCE SYNTHESIS

Well-structured studies reporting high level of evidence, with standardized PROMS were deficient on penile size abnormalities and dysmorphohobia. A shared definition for short penis/micropenis was also lacking. Categorisation of penile abnormalities according to congenital, acquired, and dysmorphophobic aetiology is deemed compulsory. A detailed medical and psychosexual history and precise measurements of penile size are essential in the diagnostic pathway. Patients with normal penile size who are seeking penile augmentation should be referred for psychological evaluation for potential dysmorphophobic disorders. Penile length and girth enhancements can be achieved via a multitude of treatments, but a personalised management plan is crucial for satisfactory results. Endocrinological therapies, when indicated, are effective in the prepubertal setting only. Vacuum therapy has a limited evidence base in treatment protocols, although acceptable outcomes have been reported for penile traction therapy. Surgical techniques to enhance penile length and girth have limited evidence and should only be proposed after extensive patient counselling.

CONCLUSIONS

Management of penile abnormalities and dysmorphophobia is a complex issue with considerable ethical concerns. The adoption of a structured diagnostic and therapeutic pathway is crucial, as recommended in the guidelines.

PATIENT SUMMARY

Requests for medical/surgical treatments to increase penis size have increased dramatically worldwide. Several conservative and surgical treatments are available. However, few patients receive clear information on the benefits and possible harms of these treatments. These guidelines aim to provide a structured path to guide both physicians and patients in the selection of appropriate treatment(s) to increase penis size.

Male Genital Self-Image Scale (MGSIS): Cutoff Point, Cultural Adaptation and Validation of Measurement Properties in Brazilian Men

BACKGROUND

Concerns about genital self-image (GSI) can influence sexual function and quality of life, and instruments that assess male GSI, such as the Male Genital Self-Image Scale (MGSIS), need to be adapted and validated in different cultures.

AIMS

To culturally adapt and validate the measurement properties of MGSIS in Brazilian men, according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline, and to create a cutoff point for satisfaction with male GSI.

METHODS

We assessed the validity of content through a committee of experts and cognitive interviews. The internal consistency and test-retest reliability were assessed using Cronbach's α and Intraclass Correlation Coefficient (ICC). We also calculate measurement errors using the Bland and Altman graph. The structural validity was investigated through exploratory and confirmatory factor analysis. The hypothesis test for construct validity was assessed using Spearman correlation from MGSIS with the International Index of Erectile Function (IIEF), Body Appreciation Scale (BAS-2) and Rosenberg Self-Esteem Scale (RSES). To create a cutoff point for satisfaction with the GSI, the item response theory and the classic test theory were used.

OUTCOMES

Male's (i) GSI, (ii) sexual function, (iii) body appreciation, and (iv) self-esteem were assessed.

RESULTS

In this study, 518 men with a mean age of 33.90 (±13.83) years participated. The Brazilian version of MGSIS demonstrated good content validity and a single factor that explained 64.57% of the variance. Cronbach's α and ICC values were 0.905 and 0.806, respectively. By assessing measurement errors, we found no systematic bias in the sample. MGSIS showed a moderate to weak correlation with IIEF, BAS-2 and RSES. A cut-off point of 23 in the MGSIS total score was found to rate satisfaction with the GSI.

CLINICAL TRANSLATION

MGSIS is a valid and reliable measurement instrument for measuring male GSI in Brazil.

STRENGTHS AND LIMITATIONS

This study evaluated the measurement properties of MGSIS according to COSMIN, which is a powerful and useful guideline for measurement properties. However, due to the lack of a gold standard for measuring the GSI, we have not assessed the criterion validity.

CONCLUSION

MGSIS is valid, reliable and can be useful to assess the GSI and classify the satisfaction with the GSI of Brazilian men. de Arruda GT, da Silva EV, Braz MM. Male Genital Self-Image Scale (MGSIS): Cutoff Point, Cultural Adaptation and Validation of Measurement Properties in Brazilian Men. J Sex Med 2021;18:1759-1767.

A Meta-Analysis of Erectile Dysfunction and Alcohol Consumption

PURPOSE

The purpose of the study was to evaluate the association between alcohol consumption and risk of erectile dysfunction (ED).

METHODS

PubMed was searched for reports published before June 2019. Data were extracted and combined odds ratios (ORs) calculated with random-effects models.

RESULTS

Finally, 46 studies were included (216,461 participants). The results of our meta-analysis indicated that there was a significant association between regular alcohol consumption and ED (OR 0.89, 95% confidence interval [CI]: 0.81-0.97). There was no indication of publication bias (Egger's test, p = 0.37). In the stratified analysis, the pooled OR of ED for light to moderate and high alcohol consumption was 0.82 (95% CI: 0.72-0.94) and 0.82 (95% CI: 0.67-1.00), respectively. No variable related to the source of heterogeneity was found in univariate and multivariate meta-regression analyses. A dose-response meta-analysis suggested that a nonlinear relationship between alcohol consumption and risk of ED was observed (p for nonlinearity <0.001).

CONCLUSION

A J-shaped relationship between alcohol consumption and risk of ED was observed. Alcohol should be taken in moderate quantities in order to obtain the dual effect of disinhibition and relaxation. If taken chronically, it could provoke vascular damages.

Penile length and circumference dimensions: A large study in young Italian men

The aim of the present study was to evaluate the size of the penis in flaccidity and in erection of Italian men. A total of 4,685 men living in Italy and who have been visited at the Italian urology operating units were involved in the study between January 2019 and January 2020. Each patient was given details on how to measure their penis (erect length and circumference) in flaccidity and in erection, from the lower base to the distal penile tip. Mean (standard deviation [SD]) flaccid penis length was 9.47 (2.69), mean (SD) flaccid penis circumference was 9.59 (3.08), mean (SD) erect penis length was 16.78 (2.55) and mean (SD) erect penis circumference was 12.03 (3.82). At the linear regression analysis, height was associated with flaccid penis length (β = 0.04; p-value = .01), and erect penis length was (β = 0.05; p-value < .01) and erect penis circumference was (β = 0.06; p-value < .01). Height is proportional to the length of the penis in flaccidity and in erection, and to the circumference in erection. The increase in BMI leads to a reduction in the length of the erect penis, as well as weight gain reduces the length of the flaccid penis.

Penile Size Dissatisfaction

BACKGROUND

Men concerned about their penis size often consult professionals working in urology, andrology, surgery, and sexual medicine.

AIM

To inform professionals in the sexual medicine field about small penis syndrome as a clinical syndrome and to provide recommendations for treatment.

METHODS

This was an overview of the existing literature combined with our extensive clinical experience.

RESULTS

Small penis syndrome is a syndrome with psychiatric comorbidities and social consequences that impair life. Men with these concerns tend to be susceptible for treatment that is not evidence based and potentially harmful.

CLINICAL IMPLICATIONS

Treatment of men with concerns about penis size should start with a thorough biopsychosocial assessment, followed by extensive psychoeducation, counselling, and psychological interventions, even if surgery is being considered.

STRENGTHS & LIMITATIONS

The strength of this study is the concise overview of the existing literature combined with clinical experience which leads to important recommendations. Limitation is that this is not a systematic review.

CONCLUSION

Complaints about penis size should be taken seriously, and a thorough biopsychosocial and multidisciplinary assessment is required.

Penile Girth Enlargement Strategies: What's the Evidence?

INTRODUCTION

Most men seeking penile girth augmentation have physiologically normal penises but may suffer from severe preoccupation with penis size known as penile dysmorphophobic disorder.

AIM

To describe the medical, procedural, and reconstructive techniques available for penile girth enhancement and to review the success and complications of each modality.

METHODS

A comprehensive review of peer-reviewed publications on the topic was performed through a PubMed search. Key search terms included penis, enhancement, enlargement, phalloplasty, reconstruction, girth, and augmentation.

MAIN OUTCOME MEASURE

We wanted to summarize the motivations behind penile girth enhancement and review the outcomes for girth augmentation treatments.

RESULTS

Various medical, traction, injection, prosthetic, and reconstructive modalities have been studied for penile girth enhancement, with increases in girth ranging from 0-4.9 cm. Complications were reported in a minority of patients, but they may be devastating and include penile fibrosis, sexual dysfunction, device infection, and death.

CONCLUSION

A variety of penile girth augmentation techniques have been studied. Clinical guidelines are lacking, and complications of penile girth enhancement are likely underreported. Until more rigorous investigation with accurate reporting of complications is achieved, penile girth augmentation procedures should be considered experimental. Hehemann MC, Towe M, Huynh LM, et al. Penile Girth Enlargement Strategies: What's the Evidence? Sex Med 2019;7:535-547.