Locker room syndrome or penile dysmorphophobia

Locker room syndrome or penile dysmorphophobia
Summary

• Introduction and Definition
• Epidemiology
• Etiology
• Psychosexological Therapy
• medical therapy
• Physiotherapeutic techniques of elongation

Introduction and Definition
The size and morphology of the penis can vary from person to person and between different ethnicities.
Penile dysmorphophobia consists of a distorted perception of the genital organ which, despite having appropriate sizes and shapes, is seen by the person as too small or too large or too curved or to have abnormalities of the foreskin and / or glans. In the event that the physical anomalies are real, the problem is experienced by the patient in an exaggerated way. This worry has the characteristics of an obsessive idea and the behaviors associated with it are those of compulsions. Concerns about the size and appearance of your penis are a source of distress and can persist persistently or recur for several hours a day.
This pathology can cause anxiety, depression and lead to a condition of social isolation in which the subject refuses contact with women and / or partners and to the onset of a marked sensitivity to the reference issues. These patients feel ridiculous, misshapen, and mirror checks only confirm their beliefs.
There is talk of locker room syndrome as those who suffer from it are ashamed of taking a shower with other men after sporting activity for fear of being subjected to judgment because of the size or shape of their genitals. Therefore resorting to medical consultations and / or surgery for lengthening and / or enlargement although the dimensions were found to be normal. EpidemiologyIt is estimated that 3.3% of requests for andrological examinations are motivated by the suspicion or belief that they have a small penis.
A belief often associated with an erroneous perception of the genitals and under which a penile dysmorphophobia can be hidden, a phenomenon that seems to be constantly increasing.
People with this disorder can also perform do-it-yourself interventions to correct the perceived physical defect by injecting Vaseline, oils or glue into the penis, the so-called paraffinoma.
The size of the penis is considered important above all for homosexual men: for how they build their sense of themselves, for their sense of virility, which is often based on “the bigger the better” when defining an ideal partner male. It has been seen that homosexual men suffering from this problem often accept the anal receptive position. It has also been seen that homosexual men feel dissatisfied with their bodies more often than heterosexual men. Etiology
The causes may be the following:

• Presence of sexual disorders (erectile deficit, premature ejaculation).
• Lack of knowledge of one’s body and genitals.
• The end of a relationship
• Psychological causes, such as a series of unconscious emotional conflicts.
• Neurobiological factors, in particular from alterations in the functioning of the serotoninergic system or from dysfunctions of the brain areas responsible for controlling the body image.
• Socio-cultural reasons, such as the enormous value attributed by the mass media to a standardized physical beauty devoid of even the slightest imperfection.

1. Penile size and diagnosis

In a British study involving a total of over 15,000 men, the measurements of the male organ were reported in different situations: flaccid, stretching and erect.
Comprehensive data analysis showed that the average length of a penis at rest was 9.16 centimeters; the average length of a penis at rest but tense is 13.24 cm and, finally, the average length of an erect penis is 13.12 cm. The circumference also varies according to the situations: the average one of the penis at rest is 9.31 cm, while the average circumference when erect is 11.66 cm.
There was no correlation between penis size and other physical characteristics (height, body mass index, foot size).
To obtain the measurement, it is necessary to strictly adhere to the standard method: it starts from the pubic bone and ends on the glans, at the end of the penis, compressing any abdominal fat that protrudes forward. The circumference, on the other hand, can be measured indifferently at the base or at the middle of the organ.
We speak instead of micropenis (pathological condition), when its length, in a state of erection, is less than 7 centimeters.
Therefore, all penile dysmorphisms associated with a reduced shaft size (such as hypospadias) are excluded from this definition.
The causes of congenital micropenis are attributable to a low level of testosterone in the fetal blood with an imbalance in the androgen / estrogen ratio in progress after the 14th week of pregnancy.
Diagnosis is made mainly by measurement. It is possible to evaluate the existence or not of this pathology from the first years of life. As we will see, discovering as soon as possible that you are suffering from micropenia is important because treatments started at a very young age bring much more satisfactory results than treatments whose beginning occurs in the period from adolescence onwards.
Another road that is taken to evaluate the presence of this pathology is that of the differential diagnosis with other pathologies, such as the hidden penis syndrome, a pathology that affects subjects suffering from obesity, the webbed penis and penile dysmorphophobia . Psychosexological Therapy
When the discomfort is mainly of a psychological nature, a psychosexual intervention is necessary to reduce the catastrophic experience, which manifests itself in the expression of a precise physical inadequacy. The possibility of re-educating and re-appropriating some men of their self-confidence and self-esteem is at the basis of a modification and a better perception of some parts of their body. As far as the genital organ is concerned, it is probably a question of regaining possession of a status of “power” necessary for proper intimate and above all “relational” functioning. The therapy is therefore aimed at improving the perception of the body self, through sessions that document to the subject how he is in a normal condition. Medical therapy
Pharmacological treatment obtains results only if performed in the pre-pubertal period. Medical therapy aims to raise serum androgenic values ​​through testosterone replacement therapy and gonadotropic stimulation and is reserved for cases of hypogonadism.
Sometimes, however, the penis can be hidden in the suprapubic fat, in this case the therapy consists of physical activity and reducing the food intake associated with a new local slimming cream recently marketed in Italy (Ylorah®). Physiotherapeutic techniques of elongation
These techniques are inspired by primitive cultures and are reflected in other disciplines such as orthopedics (lengthening of bone diaphysis) and plastic surgery (skin flaps). . There are currently no results declared.

• Vacuum device requires associated gymnastics of the pelvic muscles and massage of the corpora cavernosa The declared results are +0.25 cm in 6 months of constant use of the device for at least 2 hours a day (Figure 1)

Figure 1: Vaccum device, Osbon ErecAid® model

• GRIP Leg Strap / Tension System and an elastic cable anchored on one side to the end of the penis and on the other to the subject’s thigh, thus allowing you to adjust the tension to be exercised daily (900 – 3600 grams). vacuum allowing it to be used even during daily activities.
• Traction by gravitational force consists of a weight attached to the penis in order to maintain constant stress.
  The principle is the same as used by some African ethnic groups. Results declared length: +0.5 cm after 6 months of constant use.
• Penis extender consisting of two rings joined by adjustable lateral metal rods that allow the penis to be stretched, adjusting the traction force. 6 hours a day) circumference: + 1 cm in about 4-6 months (Figure 2)

Figure 2: Andropenis® Penile Extender

1. Surgical therapy

According to Wessells, subjects with a penile length are considered candidates for surgical therapy

• The lengthening of the penis in flaccidity involves the section of the suspensory ligament which causes the penis to slide forward with a consequent elongation of the genital organ in the flaccid state. This technique represents the most widespread, safe and effective type of intervention for the purpose of lengthening the penis. It is performed under local or spinal anesthesia through an inverted V incision in the skin of the prepubic region. The ligament is dissected near its insertion on the pubic symphysis. A silicone prosthetic spacer is placed in the space formed as a result of the section of the ligament and fixed with a point at the base of the pubis. This technical device allows a further gain in length of the penis and avoiding the re-approach. In obese patients it is also possible to remove suprapubic fat. At the end of the operation, the skin incision is closed with an inverted VY plastic. This last maneuver also allows an increase in the length of the organ of about 2-3 cm. Suprapubic lipectomy with skin plastics (eg Z) confers an increase of a few centimeters depending on the amount of fat present.

• The “real” lengthening of the penis in erection is possible with the Perovic technique which involves the grafting of cartilage between the glans and apexes of the corpora cavernosa. The elongation obtained (2-4 cm) depends on the elasticity of the urethra and the neurovascular bundle. The series: includes 19 patients aged between 18-52 years and a follow-up: 3.3 years. In 15 patients the reports were satisfactory and painless, with no placement of the cartilage graft in the remaining 4 patients the data are not available.

The classic surgical therapy to increase the circumference can be performed by inserting adipose tissue
in the subcutaneous of the penis .

• There are various lipoenosculpture techniques: the choice of the technique depends on various parameters. If the individual is of normal weight and / or overweight, as often happens, an autologous transplant can be performed (in Day-Hospital). It is performed by taking excess fat with a needle-cannula (liposuction), often at the pubic or abdominal-pubic level, and then it is re-injected under the preputial skin, so that the penis becomes about 30% larger. The aesthetic result in flaccidity is that of a longer penis (being heavier) and thicker having a greater circumference. In erection the penis is further wider as it is combined with the physiological increase in diameter that occurs in this state. It should be emphasized that in a large number of subjects the fat can be reabsorbed (especially in smokers), where the micro-circulation is altered, so this method is not recommended for severe chronic smokers, who have no intention of quitting smoking. There is a reabsorption of fat of about 30%.
• The dermal-fat is taken from the gluteal or abdominal area. The superficial layer of epidermis is removed to facilitate engraftment. Usually 2 grafts are taken and inserted laterally to each of the corpora cavernosa through a small incision at the base of the penis and fixed at the level of the balanopreputial sulcus by another small incision.
• Cross-linked hyaluronic acid is used by performing micro-infiltrations on an outpatient basis that ensure homogeneous distribution without imperfections and / or deformities. Cross-linked hyaluronic acid is hydrophilic and bioelastic and is capable of promoting natural tissue expansion. It is also very stable and long lasting for up to 24 months
• With the advent of tissue engineering, scaffolds are being used. After taking samples of the dartoic fascia at the scrotal level and transferred to the laboratory together with 100 ml of blood in order to obtain fibroblasts that will be cultured for their growth and proloferation. Patients undergo degloving for implantation of scaffolds between Buck’s fascia and dartos. The average increase is 2.1 cm.
• Enlargement is also possible by placing an autologous graft (saphenous vein) or heterologous graft above the Buck fascia, a prosthetic material provided by modern tissue engineering, such as bovine pericardium, porcine intestine or porcine dermis.

The vast majority of interventions (almost 100%) are requested by subjects with “small penis” and not by micropenis, with often unrealistic expectations since surgical techniques are not able to lengthen the corpora cavernosa but only to make them “more visible “.
Therefore, correct counseling is essential to clearly define both the expectations of the subject and the real therapeutic possibilities. Bibliography

1. Silberstein LR1, Mishkind ME, Striegel-Moore RH, Timko C, Rodin J. Men and their bodies: a comparison of homosexual and heterosexual men. Psychosom Med. 1989 May-Jun;51(3):337-46
2. David Veale, Sarah Miles, Sally Bramley, Gordon Muir and John Hodsoll. 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 Volume 115, Issue 6, pages 978–986, June 2015
3. Wessells H, Lue TF, McAninch JW. Penile Length in the Flaccid and Erect States: Guidelines for Penile Augmentation. J Urol 156:995-7, 1996
4. Perovic SV & Djordjevic ML.Penile lengthening.
   BJU Int 86: 1028-1033, 2000
5. Perovic SV, Byun JS, Scheplev P, Djordjevic ML, Kim JH, Bubanj T. New perspectives of penile enhancement surgery: tissue engineering with biodegradable scaffolds. Eur Urol 2006; 49: 139-147.

FAQ Is it possible to really lengthen the penis
Yes. Currently it is possible with an lengthening technique through the use of costal cartilage between the glans penis and apexes of the corpora cavernosa, which is not risk-free and therefore reserved only in highly selected cases. The sensitivity of the penis is altered after enlargement with fat
No. Because the nerve endings responsible for sensitivity are not damaged in any way. The enlargement operation will improve my sexual performance
No. Since the operation does not alter the quality of the erection, if a subject had good sexual performance he will continue to have them, and vice versa those who suffer from erectile deficit will not find any benefit.How many centimeters can the penis be stretched?
The number of cm depends on the extension of the urethra and the neurovascular bundle, therefore it is difficult to make a prediction, as it varies from subject to subject and in different pathologies.