Penile Dysmorphic Disorder: When Penis Size Concerns Get Out Of Control

The penis tends to be the most common part of the body that men are dissatisfied with and wish they could change. Consider this: one online survey of over 25,000 men found that nearly half of the participants were unhappy with their current size, with 45% wanting to be larger and 0.2% wanting to be smaller [1]. Thus, among those guys who aren’t happy with their penises, there is almost a universal desire to be bigger. However, when looking at the actual penile measurements of guys who think that they aren’t big enough, very few of them have objectively small penises—the vast majority fall well within the normal range [2]. In other words, almost all of the guys who think that they’re too small are actually perfectly normal. 

The degree of penis anxiety that men have can certainly vary a lot, but for some of them it gets entirely out of hand and reaches a point where it becomes an obsessive preoccupation that significantly interferes with their quality of life. What we’re talking about here are men with something that has been referred to as “penile dysmorphic disorder” (PDD). PDD is not an actual diagnosis in the DSM (the Diagnostic and Statistical Manual that psychiatrists and psychologists use for diagnosing mental disorders); rather, it is better considered as a subtype of body dysmorphic disorder (BDD) that focuses exclusively on the penis. BDD refers to a condition in which individuals have a persistent and distressing belief that they have some major physical defect or flaw that, in reality, is only very slight or not noticeable by others.

Better understanding and identifying PDD is an important goal for psychiatrists and psychologists because PDD can have potentially serious consequences. For instance, body dysmorphic disorder more generally has been linked to increased thoughts of suicide and suicide attempts. In addition, body dysmorphia is associated with seeking repeated cosmetic treatments for one’s perceived flaw, often with disastrous consequences (e.g., they may continue to have surgery after surgery without ever being happy with the outcome, and in some cases those surgeries can make the perceived flaws even worse). This concern is especially significant for persons with PDD, given that most available treatments for enhancing penis size remain experimental. In fact, such treatments are generally regarded as risky and reports of penile deformities following penile augmentation surgeries are not uncommon. Thus, those with PDD who seeks surgical treatment may end up feeling much worse about themselves than they did before the procedure.

So what does it mean to have PDD? A study published earlier this year in the Archives of Sexual Behavior created a screening tool that that can potentially be used to identify the most extreme cases of penis anxiety [3]. The 9 items on this survey included the following, each rated on a 9-point scale ranging from not at all/never to extremely/always:

1.) To what extent do you feel the size or appearance of your penis is defective or unattractive?
2.) To what extent does the size or appearance of your penis currently cause you distress?
3.) How often does the size or appearance of your penis currently lead you to avoid situations or activities?
4.) To what extent does thinking about the size or appearance of your penis currently preoccupy you? That is, you think about it a lot and it is hard to stop thinking about it.
5.) If you have a regular partner, to what extent do your concerns about the size or appearance of your penis currently have an effect on an existing sexual relationship? (e.g. enjoyment of sex, frequency of sexual activity). If you do not have a regular partner, to what extent do your concerns about your penis currently stop you from developing a sexual relationship?
6.) How much do your concerns about the size or appearance of your penis currently interfere with your ability to work or study?
7.) To what extent do your concerns about the size or appearance of your penis currently interfere with your social life? (with other people, e.g. going to parties, pubs, clubs, outings, visits)
8.) To what extent do your concerns about the size or appearance of your penis currently interfere with leisure activities? (for example being in a public changing room).
9.) How much do you feel the size or appearance of your penis is the most important aspect of who you are?

The researchers administered this scale to three groups of men: those who had PDD, those who thought that they had a small penis but did not have PDD, and those who were not concerned with the size of their penis. Those with PDD scored highest on this scale, those with small penis anxiety but no PDD scored somewhere in the middle, and those without penis anxiety concerns scored the lowest. Thus, the scale was able to distinguish among these groups.

For most individuals in the PDD group, their point total for all 9 items on the scale above exceeded 40. In other words, those who find themselves answering above the midpoint of the scale for most of these items are likely to have PDD.

More research validating this scale and exploring the nature of PDD and its outcomes is certainly needed. However, this scale is an important step in helping clinicians and researchers to distinguish between minor and severe forms of penis anxiety.

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[1] Lever, J., Frederick, D. A., & Peplau, L. A. (2006). Does size matter? Men’s and women’s views on penis size across the lifespan. Psychology of Men and Masculinity, 7, 129–143.

[2] Ghanem, H., Shamloul, R., Khodeir, F., El Shafie, H., Kaddah, A., & Ismail, I. (2007). Structured management and counseling for patients with a complaint of a small penis. Journal of Sexual Medicine, 4, 1322–1327

[3] Veale, D., Miles, S., Read, J., Troglia, A., Carmona, L., Fiorito, C., ... & Muir, G. (in press). Penile dysmorphic disorder: Development of a screening scale. Archives of Sexual Behavior. 

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