Penile Dysmorphophobia and Small Penis Anxiety

Most men seeking penile lengthening treatment actually have a normal penile size, sufficient for sexual activity and urination. Men who complain about having a small penis, despite having an adequate length, often suffer from penile dysmorphia disorder (PDD) or small penis anxiety (SPA). In both conditions, men tend to underestimate the size of their own penis and overestimate the average size of other men’s.
Penile dysmorphia disorder falls within the spectrum of body dysmorphic disorder, defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a “somatoform disorder characterized by a preoccupation with an imagined or minor physical defect that causes impairment in various areas of functioning.” Men with penile dysmorphia disorder are so obsessed with the size and length of their penis that they may develop depressive episodes, associated with social, occupational, and sexual dysfunction. It is common for these men to experience psychogenic erectile dysfunction and lack of sexual satisfaction, despite having a normal libido.
In contrast, small penis anxiety is an anxiety disorder related to the fear that the genital organs, observed directly or indirectly when clothed, may appear smaller than normal for an adult man. The anxiety persists despite clinical evidence showing otherwise. Small penis anxiety may manifest as obsessive rumination or be a feature of psychosis, causing significant emotional distress and impairing behavior. Several scales and nomograms have been created to reassure patients about the normality of their length, but unfortunately, due to the nature of their anxieties, these tools are only minimally helpful for this patient population.