Characterization of Genital Dissatisfaction in a National Sample of U.S. Men

Reasons for Genital Dissatisfaction in a Sample of Brazilian Men

Genital self-image (GSI) involves subjective perceptions, experiences, and feelings of individuals regarding their genitalia. A negative GSI contributes to lower sexual esteem and, consequently, negative sexual experiences and sexual dysfunction. In men, self-perception may be influenced by several factors, including penis size or shape, personal experiences, body image, general health status, sex education, and even the media they consume. This study aimed to understand the reasons that lead to dissatisfaction with GSI among Brazilian men. With a mixed approach, we present male perceptions regarding dissatisfaction with GSI captured from the following question: "If you are dissatisfied with your genitals, tell us for what reason(s)? (Optional)," which integrated the last questionnaire element of the original survey. Brazilian men over 18 years of age from different Brazilian states were eligible. In this analysis, 376 responses were obtained. The data were analyzed using thematic content analysis. The participants expressed the reasons for dissatisfaction, which were grouped into two categories: (1) anatomical aspects and beliefs in the construction of GSI and (2) functional aspects. The results offer an understanding of men's perceptions of their genitals and may aid in clinical practice and research on how Brazilian men perceive their genitals. It is possible to improve knowledge about sexual health and increase positivity regarding genital perception by providing information about the reasons that lead to dissatisfaction with the genitals.

Factors Associated with Satisfaction with Male Genital Self-Image in Brazil

Male genital self-image (GSI) refers to how men feel about their genitals. Studies suggest that GSI is influenced by several psychosocial and physical factors, such as frequency of sexual activities, anxiety, and sexual dysfunctions. In Brazil, no studies have investigated the factors associated with satisfaction with male GSI. This is a cross-sectional and online study conducted with Brazilian men over 18 years of age. The Male Genital Self-Image Scale (MGSIS), Body Appreciation Scale-2 (BAS-2), and International Index of Erectile Function (IIEF) were used. Body appreciation and frequency of sexual activity were included as confirmatory variables and other variables were explored as factors associated with GSI. Data were analyzed by binary logistic and multiple linear regression, according to the MGSIS cut-off point for satisfaction with male GSI and total score of MGSIS, respectively. A total of 1,235 men (M = 26.14, SD = 7.28 years) participated in the study. The mean of the total MGSIS score was 23.02 (SD = 4.45; absolute range, 7-28) points, with 62.11% of men being classified as satisfied with GSI. Men satisfied with GSI were more likely to have a partner, higher body appreciation, lower body mass index (BMI), and not have phimosis (excess skin covering the penis, making it difficult to expose the glans). Satisfaction with GSI of Brazilian men was associated with relationship status, body appreciation, BMI, and phimosis.

Happiness with Circumcision Status, Not Status Itself, Predicts Genital Self-Image in a Geographically Diverse Sample

Research exploring the impact of penile circumcision on aspects of body image is scarce and few studies have considered the potential roles of attitudinal factors toward one's own circumcision status. The purpose of the present study was to assess the potential relationship between one's circumcision status, happiness with circumcision status, genital self-image, and sexual functioning. The present study also examined how happiness with circumcision status varied across geographic regions. A total of 205 participants (102 circumcised, 103 not circumcised) completed a study through online recruitment methods. Participants reported being born in the United States (n = 80), Canada (n = 23), and various countries within Latin America (n = 22), Europe (n = 49), Asia (n = 13), Africa (n = 11), and Oceania (n = 7). Participants who were not circumcised reported significantly greater happiness with their circumcision status than participants who were circumcised. However, genital self-image, sexual body image, and sexual functioning did not significantly differ by circumcision status. Instead, participants who reported being happier with their circumcision status reported better genital self-image and less body exposure avoidance during sex, but sexual function did not differ by happiness. Although researchers hypothesized that happiness with circumcision status would depend on whether one fits in with the majority circumcision status within their region of origin, results did not support this. Participants who were circumcised tended to have less happiness with their circumcision status than non-circumcised participants regardless of region of birth. These findings support a small body of the literature which suggests that the psychosexual impact of penile circumcision may rely more on attitudinal factors toward circumcision status than actual circumcision status.

Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease

INTRODUCTION

Across many cultures, penis size has been associated with virility, and concerns about penile length are commonplace. Peyronie's disease (PD) is a known acquired cause of penile shortening.

OBJECTIVES

This paper describes the psychosocial impacts of penile length on men and their partners, both generally and in men with PD, and evaluates the effect of PD treatments (eg, collagenase clostridium histolyticum , surgery, mechanical therapy) on this outcome measure.

METHODS

A PubMed database search was performed for English language articles through July 2021. Main outcome measures were association of penile length with emotional well-being, selfesteem, and relationship satisfaction in men with PD, and change from baseline penile length after treatment.

RESULTS

Shortened penile length caused by PD can negatively impact patient and partner quality of life, including effects on body image, emotional well-being, sexual function, and interpersonal relationships. In men with PD, studies have demonstrated an association between loss of penile length and emotional problems, reduced satisfaction with sexual performance, poor self-esteem, depression, and relationship difficulties. Loss of penile length can frequently occur after surgery for PD (including plication, plaque incision/excision with grafting, and penile implant). Advanced surgical techniques may preserve/increase penile length, but the increased risks associated with these complex procedures must be carefully considered. Treatment with collagenase clostridium histolyticum does not appear to negatively impact penile length, and 5-year follow-up data suggest potential longterm posttreatment improvements in this outcome measure. Penile traction therapy, either alone or as adjunctive therapy, may increase penile length in men with PD, but nonadherence may limit improvement.

CONCLUSION

Changes in penile length are important to many men, particularly those with PD, and should be considered during PD treatment selection. Penile length should be measured objectively before and after treatment for PD and should be included as an outcome measure in future studies on treatment effectiveness. Goldstein I, Gelbard MK, Lipshultz LI. Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease. Sex Med Rev 2022;10:409-420.

Data from 14,597 penile measurements of vietnamese men

BACKGROUND

Penis size is a highly sensitive topic, which has often raised concerns associated with human masculinity and male sexual health. Although data regarding penile dimensions have been published worldwide, little is known about these measurements in South-East Asian countries.

OBJECTIVE

This study aimed to provide the reference range in penile length, circumference, and diameter of Vietnamese men and their variations among men with erectile dysfunction and other diseases.

MATERIALS AND METHODS

Information about flaccid length, stretched length, mid-shaft circumference, and glans diameter from the health records of 14,597 men attending the Andrology Consultation was collected. These men were classified into three groups being regular reproductive health screening group, sexual dysfunction group, and other disease groups.

RESULTS

We found that penile dimensions follow a non-parametric distribution, as tested by Kolmogorov-Smirnov test. The median values are 9.03 cm for flaccid length, 14.67 cm for stretched length, 8.39 cm for mid-shaft circumference, and 2.86 cm for unaroused glans diameter. Length and girth of the penis also changed among the different groups, especially in flaccid state; specifically, men with erectile dysfunction had a greater value in all penile dimensions except for change ratio compared with other groups. Circumcision, which rarely occurs in Vietnam, was associated with a 2 mm reduced penis length.

DISCUSSION

Findings on correlations between penile dimensions and somatometric parameters from previous studies are questionable and some measurements, such as glans dimension, have not been thoroughly investigated so far. Nevertheless, penile dimensions provide useful insight concerning conditions affecting sexual development and might be a valuable parameter in the assessment of erectile dysfunction.

CONCLUSION

Results of this study provide informative materials for the assessment of penile size, including reference values drawn from a large sample of Vietnamese men that can be useful in clinical practice and sexual health education.

Average-Size Erect Penis: Fiction, Fact, and the Need for Counseling

Most men believe that the average length of an erect penis is greater than 6 inches (15.24 cm). This belief is due, in part, to several often-cited studies that relied on self-reported measurements, with means of about 6.2 inches (15.75 cm) for heterosexual men and even greater for gay men. These studies suffered from both volunteer bias and social desirability bias. In this review, the combined mean for 10 studies in which researchers took measurements of erect penises was 5.36 inches (13.61 cm; n = 1,629). For 21 studies in which researchers measured stretched penises, the mean was approximately 5.11 inches (12.98 cm; n = 13,719). Based on these studies, the average length of an erect penis is between 5.1 and 5.5 inches (12.95-13.97 cm), but after taking volunteer bias into account, it is probably toward the lower end of this range. Studies show that a majority of men wish they were larger, with some choosing penile lengthening surgery. These surgeries are considered by the American Urological Association to be risky. Most men seeking surgery have normal sized penises. Counseling with factual information about penis size might be effective in alleviating concerns for the majority of men who worry about having a small penis.

Application of Botulinum Neurotoxin in Male Sexual Dysfunction: Where Are We Now?

INTRODUCTION

Botulinum neurotoxin (BoNT) is a recognized therapeutic agent of modern medical care, routinely used to treat medical conditions affecting a variety of organ systems including the musculoskeletal, integumentary, and urological domains. Ongoing research is exploring BoNT's potential role as a therapeutic agent for a variety of male sexual pathologies.

OBJECTIVE

To review and analyze the literature regarding BoNT as a treatment option for male sexual dysfunction.

METHODS

A PubMed search was performed for English-language articles in peer-reviewed journals between 1970 and 2019 (with one article from 1897). Relevant articles referenced within these texts were also included. One article did not have an accompanied English full-text available. The following search terms were used: "Botox", "Botulinum toxin", "Botulinum toxin A", "Onabotulinum A", "Abobutlinum A", "BoNT", "BoNT-A", "Male sexual health", "Male sexual pathology", "Peyronie's disease", "Premature ejaculation", "Scrotal Pain", "Penile Retraction", "Scrotox", "Erectile Dysfunction", and "Botox in Urology".

RESULTS

There is interest in the potential role of BoNT in the treatment of male sexual pathologies. We identified studies that used BoNT to treat chronic scrotal content pain, premature ejaculation, erectile dysfunction, Peyronie's disease, penile retraction, and more. However, despite preclinical/clinical data indicating some potential efficacy and safety in these settings, a lack of robust clinical trial data has resulted in no current Food and Drug Administration-approved indications for the use of BoNT in the treatment of male sexual pathology. As a result, much of the current use of BoNT by today's providers is "off-label," and ongoing clinical trials aim to further elucidate the potential role of this therapeutic agent.

CONCLUSION

Current data suggest that BoNT could have a potential role as a treatment option for certain types of male sexual pathologies. However, more randomized controlled trial data regarding its long-term safety and efficacy are necessary before a widespread clinical adoption can take place. Reddy AG, Dick BP, Natale C, et al. Application of Botulinum Neurotoxin in Male Sexual Dysfunction: Where Are We Now?. J Sex Med 2021;9:320-330.

Penile dimensions: What are surgeons measuring?

Penile dimensions and related dissatisfaction, may have significant impact upon patients whom undergo andrological surgeries. Whilst penile dimension assessment is performed as part of the andrological evaluation, little is known regarding the surgeons' opinions nor contemporary practices. This study was designed to gain further insights into the opinions and practices of clinicians regarding penile measurement and is the first paper in the literature of its kind. The study was performed by inviting clinicians at andrological/urological conferences to participate in a voluntary 10 point survey concerning penile dimensions. Of 126 responses recorded, 56% (71/126) were andrologists. Of the responders, 45% (56/122) did not routinely perform penile measurement prior to treatment nor were they aware of the standardised method (93/123). The majority 64%(81/126) would measure the penile length from the pubic bone to the tip (79/123) with the penis in a stretched position (99/125). A goniometer was the most common way of assessing penile curvature (37/73) and the length would be measured mostly on the convex side (46/119). Responders felt that, from the patients perspective, a combination of length, girth and shape (51/123), or length only (50/123), were the more important aspects of penile dimensions. As responders were recruited based on their interest in andrological aspects of urology, it may not be representative of the general urological community. In conclusion, attitudes and methods of penile measurement are quite varied amongst surgeons, thus further discussion and investigation of this aspect of andrological care ought to occur.

Male Body Image Self-Consciousness During Physical Intimacy (M-BISC): Validating the M-BISC With Gay Men

INTRODUCTION

An expanding area of research within the realm of body image is its role in human sexual functioning, which denotes people's overall satisfaction with their performance during a specific sexual encounter. Traditionally, studies investigating the association between body image and sexual functioning have focused on women. The Male Body Image Self-Consciousness Scale (M-BISC) was developed to exclusively assess male body image self-consciousness during sexual activity using a sample consisting primarily of heterosexual men.

AIM

The purpose of the current study is to evaluate the dimensionality, reliability, and validity of the M-BISC with a sample of gay men. Research suggests that sexual difficulties and body image concerns can overlap and interrelate. Therefore, 2 subscales (erectile difficulties and body embarrassment) from the Gay Male Sexual Difficulties Scale (GMSDS) were used to assess the validity of the scale.

METHODS

1,930 men self-identifying as "exclusively gay" completed an online survey consisting of demographics, the M-BISC, and the GMSDS (erectile difficulties and body embarrassment subscales).

MAIN OUTCOME MEASURE

The replicability of the M-BISC factor structure with a gay male sample was determined using an exploratory and confirmatory factor analysis. Additionally, the GMSDS (erectile difficulties and body embarrassment subscales) was used to determine the validity of the M-BISC.

RESULTS

Exploratory and confirmatory factor analyses revealed that, following the removal of 3 items, the M-BISC was unidimensional. Scale score reliability for the 14-item M-BISC was good. Finally, as predicted, scores on the M-BISC correlated with scores on the GMSDS (ie, greater sexual difficulties).

CLINICAL IMPLICATIONS

The results indicate that assessment scales developed using samples consisting primarily of heterosexual men may not be appropriate for use with gay men in their original form. Thus, limiting the accuracy of the measurement and increasing the risk of misdiagnoses.

STRENGTH & LIMITATIONS

Strengths of this study include a large sample of exclusively gay men and the utilization of best-practice statistical analysis for assessing factor structure, validity, and reliability of measures. Limitations include the assumption that the M-BISC should be used in lieu of a novel scale developed exclusively for gay men. Further, the study utilizes an Internet sample consisting primarily of Caucasian gay men.

CONCLUSION

Results of the current study illustrate that the M-BISC is a valid tool to measure gay men's body concerns during intimacy. More importantly, it also highlights gay men's elevated body concerns during intimacy and the need to understand the etiology of these apprehensions. Currently, there is a noticeable gap in the literature regarding the cause of gay male body concerns that have potential clinic implications. Kiss MJ, Morrison TG, McDonagh LK. Male Body Image Self-Consciousness During Physical Intimacy (M-BISC): Validating the M-BISC With Gay Men. J Sex Med 2018;16:307-315.

Patient Decision-making and Predictors of Genital Satisfaction Associated With Testicular Prostheses After Radical Orchiectomy: A Questionnaire-based Study of Men With Germ Cell Tumors of the Testicle

OBJECTIVE

To better understand patient decision-making and genital satisfaction associated with postorchiectomy testicular prosthesis (TP) implantation in patients with germ cell tumors of the testicle.

MATERIALS AND METHODS

An electronic survey to assess TP decision-making and genital satisfaction was distributed to patients via an institutional database (n = 70) and social media outlets (n = 167). Statistical analyses were performed using chi-square tests for categorical variables, Wilcoxon-Mann-Whitney tests for continuous variables, and multivariate regression analyses to identify independent predictors of receiving a prosthesis, genital satisfaction, and prosthesis satisfaction.

RESULTS

24.9% of respondents elected to receive a TP, but 42% of men without a prosthesis reported never being offered one. Identifying as a heterosexual man (2.86) and receiving a TP (odds ratio = 3.29) were both positive predictors of overall genital satisfaction. Having the orchiectomy performed at an academic institution (odds ratio = 2.87) was a positive predictor of testicular prosthesis TP placement. 89.8% of TP recipients were satisfied with the look of their prosthetic, but only 59.3% of respondents were satisfied with prosthetic feel.

CONCLUSION

There are high levels of genital satisfaction in those who elect to receive a TP postorchiectomy. Associations between TP placement, genital satisfaction, and sexuality merit further investigation. Our results also indicate that patients who pursue an orchiectomy at an academic institution are more likely to receive a TP. The use of social media to recruit study participants in urology should be explored further.

Growers versus showers: a meaningful (or useful) distinction?

Yafi et al. have conducted a study that will be of great interest to the lay community and also of import to practicing urologists who routinely encounter patients with concerns about the appearance of their phallus [1]. In one study 14% of men expressed dissatisfaction with their genitals with flaccid penile length being the most common source of dissatisfaction [2]. The concerns of such men tend to be the perception that their penis is small, or at least smaller than the penises of other men.

Attitude Toward One's Circumcision Status Is More Important than Actual Circumcision Status for Men's Body Image and Sexual Functioning

Research exploring the impact of circumcision on the sexual lives of men has failed to consider men's attitudes toward their circumcision status, which may, in part, help to explain inconsistent findings in the literature. The current study explored the potential relationship between attitudinal factors toward one's circumcision status, timing of one's circumcision, and sexual correlates. A total of 811 men (367 circumcised as neonates, 107 circumcised in childhood, 47 circumcised in adulthood, and 290 intact) aged 19-84 years (M = 33.02, SD = 12.54) completed an online survey. We assessed attitudes toward one's circumcision status, three domains of body image (Male Genital Image Scale, Body Exposure during Sexual Activities Questionnaire, Body Image Satisfaction Scale), and self-reported sexual functioning (International Index of Erectile Function). Men who were circumcised as adults or intact men reported higher satisfaction with their circumcision status than those who were circumcised neonatally or in childhood. Lower satisfaction with one's circumcision status-but not men's actual circumcision status-was associated with worse body image and sexual functioning. These findings identify the need to control for attitudes toward circumcision status in the study of sexual outcomes related to circumcision. Future research is required to estimate the number of men who are dissatisfied with their circumcision status, to explore the antecedents of distress in this subpopulation, and to understand the extent of negative sexual outcomes associated with these attitudes.

Negative Body Attitudes and Sexual Dissatisfaction in Men: The Mediating Role of Body Self-Consciousness During Physical Intimacy

Previous research indicated that negative attitudes about the body and appearance are common among men and demonstrated that negative body attitudes are associated with negative sexual experiences. The present study investigated the association between body attitudes and sexual dissatisfaction and the mediating role of body self-consciousness during physical intimacy. In a cross-sectional design, 201 Dutch men completed an online survey regarding body attitudes toward muscularity, body fat, height, and genitals, body self-consciousness during physical intimacy, and sexual dissatisfaction. Hypotheses were tested using correlation analyses and a mediation analysis with body attitudes as predictors, body self-consciousness as mediator, and sexual dissatisfaction as outcome. Correlation analyses showed that negative body attitudes and body self-consciousness during physical intimacy were significantly related to sexual dissatisfaction. The mediation analysis revealed that negative attitudes toward muscularity, body fat, and genitals had indirect effects on sexual dissatisfaction through body self-consciousness during physical intimacy. Negative attitudes toward genitals additionally had a direct effect on sexual dissatisfaction. These findings indicate that body image interventions focused on male body attitudes may be beneficial in improving men's body image, which may ultimately increase sexual satisfaction.