Psychologists need to develop an effective therapy for men who are excessively worried about their penis size, according to scientists from King’s College London who recently conducted research on the sexual functioning and behavior of such men.

There are two psychological concepts used to describe men’s concerns about their penis size. One is small penis anxiety, in which men with a normal penis are excessively worried about its size. The second is Body Dysmorphic Disorder involving the penis, also known as Penile Dysmorphic Disorder, a more serious condition in which men’s preoccupation with their penis size causes significant distress or social impairment.

“This is the first study to investigate the sexual functioning and behavior of men with BDD related to their penis size in comparison with men with SPA and controls in the community,” David Veale and his colleagues wrote in their research article, which was published in the journal Sexual Medicine.

The study included 26 men with Body Dysmorphic Disorder involving the penis, 31 men with small penis anxiety and 33 men with no penis size concerns. It included both heterosexual and homosexual men. All of the participants had a normal sized penis.

Veale and his colleagues found that concerns about penis size tended to begin in adolescence. Most men with Body Dysmorphic Disorder and small penis anxiety first started to think their penis was too small around the age of 15 or 16. These men said their penis size became a significant problem for them a few years later, when they were 18 or 19.

Men with Body Dysmorphic Disorder tended to wait longer to seek help for their size-related concerns than men with small penis anxiety. Most men with Body Dysmorphic Disorder sought help around age 30, while men with small penis anxiety sought help around age 24.

Many men with size concerns attempted to alter the length or width of their penis. The most commonly reported procedure was a milking-like exercise known as “jelqing,” but the men also said they had tried using stretching exercises, vacuum pumps, and in one case a mechanical penile-extender device.

“Of note is that the success rates of the attempts were low and this supports previous research,” Veale and his colleagues said. “A simple search on Google will give hundreds of results for ‘solutions’ to increase penis size; however the evidence for their efficacy is unproven and unlikely. However, such ‘solutions’ are often risky, and clinicians should educate their patients to avoid any ‘solutions’ that have no evidence base and develop an effective psychological therapy for such men.”

There were no significant differences between the three groups regarding their number of sexual partners, frequency of sex, the age they lost their virginity, or their level of sexual desire. But men with penis size concerns reported lower sexual satisfaction than controls. Men with Body Dysmorphic Disorder also reported significantly more erectile dysfunction.

“Our sample judged their own interventions of exercises and vacuum pumps to be unsuccessful. Further research is now needed to consider specific interventions that may help such men,” Veale and his colleagues wrote.

There are treatments for men suffering Body Dysmorphic Disorder, such as cognitive behavior therapy, “but they have not been adapted or evaluated for men with penis size concerns,” the researchers added. “Men with SPA might be helped by psycho-education and counselling but again there are no randomized controlled trials to evaluate any [treatment].”