An argument to screen for body dysmorphic disorder prior to penile augmentation procedures

The field of sexual medicine sits at the complex intersection of identifying patients seeking legitimate therapeutic care and those whose psychological distress drives requests for cosmetic intervention. This distinction has become more pressing as the demand for penile enlargement procedures continues to rise. The Sexual Medicine Society of North America’s (SMSNA) 2024 Position Statement designates penile enlargement procedures (inclusive of ligament division procedures, injection of fillers and insertion of subcutaneous implants) as lacking sufficient safety and efficacy data and thus experimental in nature.1 A recent report from the Fifth International Consultation on Sexual Medicine on penile augmentation and cosmetic surgery similarly expresses caution, “Due to the controversies and lack of longer-term data regarding penile augmentation and cosmetic procedures, comprehensive assessments and careful patient counseling weighing the pros and cons, as well as potential complications, are mandatory before embarking on any treatment.”2 This report also emphasizes the need to assess for any underling psychological concerns prior to proceeding with any augmentation procedure. In this context, the absence of routine psychological screening places vulnerable patients at risk of inappropriate medical interventions. As such, it is pivotal to recognize body dysmorphic disorder (BDD), particularly its genital-focused presentation, penile dysmorphic disorder (PDD), in patients who exhibit excess worry or anxiety with penile length and shape.