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.
1 Schneider et al., 2017. Prevalence and correlates of body dysmorphic disorder in a community sample of adolescents. Australian & New Zealand Journal of Psychiatry
2Phillips et al., 2006. Gender similarities and differences in 200 individuals with body dysmorphic disorder. Comprehensive Psychiatry
3Malcolm et al., 2021. An update on gender differences in major symptom phenomenology among adults with body dysmorphic disorder. Psychiatry Research
4Veale et al., 2015. Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15 521 men. BJU International
5Lever et al., Does size matter? Men’s and Women’s views on penis size across the lifespan. Psychology of Men & Masculinity
6Mansfield, 2020. Genital manifestations of body dysmorphic disorder in men: a review. Fertility and Sterility
7Veale et al., 2015. Environmental and physical risk factors for men to develop body dysmorphic disorder concerning penis size compared to men anxious about their penis size and men with no concerns: A cohort study. Journal of Obsessive-Compulsive and Related Disorders
8Veale et al., 2015. Phenomenology of men with body dysmorphic disorder concerning penis size compared to men anxious about their penis size and to men without concerns: A cohort study. Body Image
9Bowyer et al., 2016. A critical review of cosmetic treatment outcomes in body dysmorphic disorder. Body Image
10 Phillips, 2009. Understanding body dysmorphic disorder. Oxford University Press
11 Littara et al., 2019. Cosmetic penile enhancement surgery: a 3-year single-centre retrospective clinical evaluation of 355 cases. Scientific Reports
12 Ghanem et al., 2007. Structured management and counselling for patients with a complaint of a small penis. The Journal of Sexual Medicine