Body dysmorphic disorder and penis size

Body dysmorphic disorder (BDD) is equally prevalent in males and females, but the way it presents can be quite different. For example, females’ focus is often related to their body weight, and dieting is twice as common than in males. For males, concerns often relate to muscularity, with excessive exercise twice as prevalent than in females². Males are also more likely than females to be concerned about the appearance of their genitals².

Penis size perceptions and reality

The average flaccid human penis is just a bit longer than nine centimetres; 95% of men have flaccid penis lengths ranging from six to 12-and-a-half centimetres. Most men (two-thirds to three-quarters) think their penises are of average size, but it’s about 50:50 when it comes to who is content with their penis size and who would like a larger penis (almost no one wants a smaller penis).

Concerns about penis size and Body Dysmorphic Disorder

Although we have known for at least 15 years that the genitals are a common focus of BDD in males², research aimed at understanding this issue is scant, and has only been performed by one research group studying a small, selected group of men. The men were either (a) unconcerned about the size of their penis, (b) concerned and fit the criteria for BDD or (c) concerned and did not meet the criteria for BDD. These studies suggest that men with BDD relating to penis size do, in fact, have slightly smaller penises than other men (including those who are anxious about the size of their penis but do not have BDD), but their size is within the normal range.

Men who are worried about the size of their penis and have BDD are more likely to have experienced physical or emotional abuse or neglect as children than men concerned about their penis size who do not satisfy diagnostic criteria for the disorder, or men without concerns. They were also more likely than men without BDD to have been teased about their general appearance or competency. Specific genital teasing was more common for men concerned about their penis size (regardless of BDD) than those without concerns⁷. Detrimental psychological and behavioural characteristics are more common in men who are concerned about their penis size than in men who are not, and are most severe in those with BDD.

This (albeit limited) research suggests that men’s concerns about their penis size, regardless of whether they have BDD, relates more to their psychology than their anatomy.

Is surgery a solution?

Cosmetic treatments are often futile in people with BDD, and people with the disorder should be encouraged to seek psychological help, rather than pursue treatments to ‘correct’ the perceived defect. The US Urology Care Foundation (an initiative of the American Urology Association) recommends that surgery for penile augmentation be limited to cases of micropenis (a stretched penile length of less than 7.5 cm) but there is clearly a market, and provision of services, for penis augmentation among men with normal penis length (using techniques of unproven safety and efficacy).

The sensible first step

Counselling can be effective in discouraging men with concerns about penis size from having unnecessary surgery. The evidence suggests this is the most appropriate first step for men concerned about the size of their penis.