Penile Dysmorphic Disorder - An Overview

Introduction:

PDD (Penile Dysmorphic Disorder) is a part of body dysmorphic disorder (BDD), where the affected person devotes so much of their time to thinking and worrying about flaws in their appearance, which others may not notice. It is also referred to as small penis syndrome. In the case of PDD, the man is preoccupied with their penis size and shape, causing consequential shame and impairment. In addition, there is very little information about men's sexual functioning and anxiety about their penis size and shape, which may lead men to try to alter the size of their penis. This article provides all the aspects and factors for men suffering from this condition.

What Is PDD?

PDD is an anxious psychological state of a man thinking his penis is too small. However, it is within the normal size range and is of normal anatomic structures and functions. It is an entirely different condition than having a true case of micropenis, where the actual size of the penis is small due to hormonal or genetic conditions.

What Are the Causative Factors for PDD?

• In men, penis size is often considered a symbol of masculinity and sexual capabilities. The importance of penis size in some social and cultural beliefs might leave men alarmed by negative evaluation when their genitals are exposed in sexual encounters resulting in hampered sexual functions.

• The onset of symptoms of PDD is chronic and generally occurs from early adulthood as a personal criticism about the esthetics and the size of their penis.

• There is a possibility that the unawareness of the normal range of penis experience in conjunction with an exasperated presentation in popular culture and media (such as pornography) may have contributed to the development of this satisfaction with their personal experience and suffering from PDD.

What Are the Symptoms of PDD?

Men suffering from PDD may have the following symptoms;

• Reduced orgasmic function.

• Erectile dysfunction.

• Feelings of insecurity.

• Lower self-esteem.

• Comparable psychological distress.

• Men suffering from PDD exhibit compulsive and repetitive behaviors such as seeking medical advice and treatment and receiving procedures to increase the size and girth of the penis in response to concerns over appearance.

How Is PDD Diagnosed?

• The Health Care provider will take a family and personal medical history and do a thorough physical examination. If the Healthcare provider suspects PDD, they may refer the person to a psychologist. This mental healthcare professional will evaluate for person's behavior, attitude, and associated symptoms.

• There are no specific characteristics for identifying men with PDD from men who are anxious about the size of the penis but do not have PDD.

• Men who are consistently ashamed, worried, and obsessed due to their penis size and shape, which is within the normal range, might suffer from PDD.

What Are the Effects of PDD on a Person's Life?

• Men suffering from PDD suffer from low self-esteem because they have constant agony about the size and appearance of the penis and are anxious about their sexual performance.

• Anxiety and associated depression attributed to their condition often lead to a lack of sexual relationships.

• Men with PDD condition are constantly preoccupied with the perceived defects in their penis that are either not observable to others or may appear only minor. Therefore, they keep on checking and comparing their penis.

• In response to the concerns and anxiety, they may also experience clinically significant distress and impairment in their occupational, social, or other salient areas of function. This constant psychological distress may lead to suicide ideation.

How Is PDD Treated?

Since PDD is a mental health-related disorder, the most commonly advised therapies are psychological, such as;

• Psychotherapy like CBT (cognitive behavior therapy) - psychiatrist counseling for PDD mostly focuses on changing the patient's cognition, which is their thinking and behavior. This approach helps change their perception of deficiency in their penis, and as a result, lower compulsive behavior is achieved.

• Anti-anxiety medications can help to lessen their anxiety and obsessive thinking.

• Antidepressant medication is required in case of depression associated with PDD.

It is a chronic condition. Symptoms are more likely to progress and may worsen if left untreated.

How to Avoid Triggering PDD?

Recent research investigating the phenomenology of men suffering from PDD reported greater shame and interference in their relationships. The shame-provoking situation may be avoided by following measures;

• Avoid displaying a flaccid penis in public Areas, for example, in changing rooms.

• Avoid displaying an erect and flaccid penis with a sexual partner, which can be done by taking some measures, such as changing one’s posture to avoid their penis being seen.

• Avoid measuring and comparing penis size.

Does an Increase in the Size of the Penis Help in the Case of PDD?

• There are very scarce studies of data available stating that this condition is psychological. Therefore, no physical augmentation can provide a satisfactory outcome and resolve one's issue.

• Men with PDD have reported doing detrimental practices such as squeezing and stroking their penis to draw blood flow to the tip of their penis, hypothetically increasing their length, and stretching exercises by tying weights to the penis. In addition, men have used a vacuum pump to force blood Into the penis tip by creating a vacuum over it. The success rate of these attempts to increase penis size is very low.

• Too many surgical case studies have described men suffering from PDD seeking phalloplasty augmentation. Panel length augmentation can include prepubic liposuction, suspensory ligament release, penile disassembly, and cartilage transplant. Girth augmentation can include dermal graft, lipo injection, saphenous vein graft, temporalis fascia transfer, And the injection of synthetic material such as vaseline jelly. Unfortunately, cosmetic phalloplasty is considered to be experimental with PDD men without any sufficient outcome measures or safe pieces of evidence.

• Moreover, in retrospective case studies, PDD diagnosis has been associated with poor outcomes regarding most cosmetic procedures.

Men suffering from PDD having dissatisfaction with their penis have become a huge source of motivation for pursuing penis augmentation procedures to increase the length and or the girth of their penis.

Considerable research has shown that most men seeking penile augmentation surgeries (surgeries to increase the length and width of the penis) have a normal size of the penis, potentially highlighting the overestimation of normal penis size. In addition, many population-based studies prove that the average flaccid length of a penis ranges from eight to ten centimeters.

Conclusion

Penis size is considered an important parameter to men regarding their sexual capabilities, immensely affecting their self-esteem. PDD is not a physical condition but a mental health disorder. Men suffering from PDD require intensive and careful psychological counseling. A surgical approach to managing this disorder has provided no or less positive outcomes on patients' symptoms.