Position Paper: Management of Men Complaining of a Small Penis Despite an Actually Normal Size

Abstract

Introduction With the worldwide increase in penile augmentation procedures and claims of devices designed to elongate the penis, it becomes crucial to study the scientific basis of such procedures or devices, as well as the management of a complaint of a small penis in men with a normal penile size. Aim The aim of this work is to study the scientific basis of opting to penile augmentation procedures and to develop guidelines based on the best available evidence for the management of men complaining of a small penis despite an actually normal size. Methods We reviewed the literature and evaluated the evidence about what the normal penile size is, what patients complaining of a small penis usually suffer from, benefits vs. complications of surgery, penile stretching or traction devices, and outcome with patient education and counseling. Repeated presentation and detailed discussions within the Standard Committee of the International Society for Sexual Medicine were performed. Main Outcome Measure Recommendations are based on the evaluation of evidence-based medical literature, widespread standards committee discussion, public presentation, and debate. Results We propose a practical approach for evaluating and counseling patients complaining of a small-sized penis. Conclusions Based on the current status of science, penile lengthening procedure surgery is still considered experimental and should only be limited to special circumstances within research or university institutions with supervising ethics committees.

Composite augmentation phalloplasty: personal experience after 275 patients

“…The racial controversy introduces more variables, which can influence decisions about justifying augmentation phalloplasty. [5,6] The enhancement of penis size can be achieved using surgical or nonsurgical procedures. Unfortunately the uses of unproven techniques or synthetic fillers have made these treatments notorious for their sequelae or bad results.…”

Perceptions about penis size among supposedly healthy 40 to 60-year-old Brazilian men: a cross-sectional pilot study

“…In a review by Ghanem et al, average penis length was reported as being 12.3 cm stretched and 12.7 cm erect. 6 However, most of the men (or parents bringing children) seeking help for "small penises" do not really present abnormal penis sizes. 6,7 They are just esthetically dissatisfied, 6 and many surgery clinics (urology and plastic) are probably profiting from this dissatisfaction.…”

“…6 However, most of the men (or parents bringing children) seeking help for "small penises" do not really present abnormal penis sizes. 6,7 They are just esthetically dissatisfied, 6 and many surgery clinics (urology and plastic) are probably profiting from this dissatisfaction. While this is an issue still under investigation, this complaint has already being named in the literature as "penis dysmorphophobia", 3,6,7 a condition in which men seek medical treatments believing that their penises are too short.…”

“…6,7 They are just esthetically dissatisfied, 6 and many surgery clinics (urology and plastic) are probably profiting from this dissatisfaction. While this is an issue still under investigation, this complaint has already being named in the literature as "penis dysmorphophobia", 3,6,7 a condition in which men seek medical treatments believing that their penises are too short. 3,7 Some studies have shown that, on measurement, their penises are in fact found to be normal.…”

“…3,7 Some studies have shown that, on measurement, their penises are in fact found to be normal. 3,[6][7][8][9] Once informed that they have no abnormality, approximately 70% of these men give up treatment. 7,8 The fact is that their penises are not impairing sexual activity (intercourse), because they are normal sized.…”