Multiple studies have explored intervention with testosterone replacement either early during development and/or at pubarche. There is a high prevalence of psychogenic erectile dysfunction and lack of sexual satisfaction in men with BDD, despite their normal libido (11). Men are so preoccupied with their penis size and length, they may develop depressive episodes associated with social, occupational, and sexual dysfunction. PDD lies within the body dysmorphic disorder (BDD) spectrum, which is defined in the Diagnostic and Statistical manual of Mental Disorder, Fifth edition as a ‘somatoform disorder presented by preoccupation with an imaginary or trivial flaw in the physical appearance that causes impairment in various areas of functioning’ (17). In both of these disorders, men consistently underestimate the size of their own penis and overestimate the mean size for other men (16). Men complaining of small penis, despite adequate length, typically suffer from either penile dysmorphophobia disorder (PDD) or small penis anxiety (SPA). ![]() ![]() The majority of men seeking penile elongation treatment have a normal penile size, which is functionally adequate for sexual activity and micturition (14,15).
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