Filling the Void: A Case of Sepsis Following the Injection of a Penile Bulking Agent

Many cosmetic procedures are now performed by non-medical personnel. Owing to the wide coverage of aesthetic procedures by the media, patients may be less informed of the serious complications that can be seen when impure materials are injected by less-skilled practitioners. The authors present a case of sepsis following the injection of a non-medical grade penile bulking agent. Although penile augmentation is under-reported in the literature, public interest in such procedures is increasing. The growing demand for such procedures needs to be addressed by the medical community.

Injectable dermal fillers have become an increasingly popular cosmetic procedure. However, due to their commercial potential and aesthetic popularity, these procedures are also now being performed in non-clinical settings, where regulation of the injectable materials is less stringent. The nature of cosmetic surgery has meant that non-surgical cosmetic procedures are often trivialised by the media. While many procedures are generally quite safe, even non-surgical procedures carry potential risks and problems, especially where there are uncertainties regarding the purity of the injected material. The general demedicalisation of cosmetic procedures has compromised patient safety, as these procedures are now performed at lower costs by unskilled or poorly trained practitioners who are often working in non-medical environments. It should be noted that the majority of adverse case reports, including our patient, had procedures which were performed by non-medical personnel using silicone-based fillers of unknown purity or volume…^1–3

Full article at:   http://goo.gl/nAzJym

By:  Elaine Redmond,1 James C Forde,2 and Hugh D Flood2

¹University Hospital of Limerick, Limerick, Ireland

2

²Department of Urology, University Hospital of Limerick, Limerick, Ireland

1University Hospital of Limerick, Limerick, Ireland

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The Role of the Illusion in the Construction of Erotic Desire: Narratives from Heterosexual Men Who Have Occasional Sex with Transgender Women

Little is known about men's sexual desire for and erotic attraction to male-to-female transgender women. To better understand how erotic desire is constructed, this study examined the narratives of a sample of heterosexual men who had had an occasional sexual encounter with a transgender woman. 

Open-ended qualitative interviews were conducted with 16 heterosexual men who reported at least one sexual encounter with a transgender woman in the previous 12 months. Using principles of Grounded Theory, three themes emerged: 

1. the erotic desire that transpired from a transgender woman's construction of her femininity, 
2. the sexual act that dictated the specific navigation of a transgender woman's penis and 
3. the sexual dissonance that resulted from being a heterosexually identified man having sex with a partner who had a penis. 

These themes reflected how the participants defined and negotiated their sexual encounters, both psychologically through their understanding of sex with a transgender woman with a penis, and physically through the navigation of specific sex acts. 

The role of the 'illusion' was central to the meaning and construction of erotic desire. These narratives provided another framework for continuing discourse on the complexity of erotic desire.

Purchase full article at:   http://goo.gl/ruljKP

By:  Reback CJ1,2, Kaplan RL1,3, Bettcher TM4, Larkins S2.

• 1 Friends Research Institute, Inc. , Los Angeles , USA.
• 2 Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior , University of California at Los Angeles , California , USA.
• 3 Department of Obstetrics, Gynecology and Reproductive Sciences; Bixby Center for Global Reproductive Health , University of California at San Francisco , San Francisco , USA.
• 4 Department of Philosophy , California State University , Los Angeles , USA. 
• Cult Health Sex. 2016 Mar 11:1-13. 

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Sexual Function after Partial Penectomy: A Prospectively Study From China

The Purpose of this study was to evaluate the sexual function after partial penectomy for penile carcinoma patients. 

Between January 2010 and May 2013, patients treated with partial penectomy at our institution were prospectively enrolled in this study. Sexual function (IIEF-15), age, body mass index, penile length in the flaccid state after partial penectomy (PL), treatment, having a partner and psychological factors (SAS scores and SDS scores) were assessed. Univariate and multivariate linear regression analyses were performed. 43 patients were included in our study. 

The median age was 56 years, and the median PL was 4 cm. The preoperative IIEF-15, SAS, SDS scores were significantly different from the postoperative scores. There was no statistically significant difference between the patients treated with partial penectomy and partial penectomy+ lymphadenectomy on IIEF-15 scores. Age was negatively associated with erectile function, sexual desire, and overall satisfaction; PL was positively associated with intercourse satisfaction; SAS score was negatively associated with erectile function, orgasmic function, sexual desire, and intercourse satisfaction. 

Our preliminary findings suggest that the sexual function after partial penectomy was significantly reduced. The sexual function was negatively affected by age and anxiety but positively affected by PL.

Full article at:  http://goo.gl/PO8ZMV

By:  Cui Yu,1 Chen Hequn,1 Liu Longfei,1 Chen Minfeng,1 Chen Zhi,1 Zeng Feng,1 Chen Jinbo,1 Qi Lin,1 and Zu Xiongbinga,1

¹Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China

^aEmail: moc.621@yxbxuz

Sci Rep. 2016; 6: 21862.

Published online 2016 Feb 23. doi:  10.1038/srep21862

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The Prevalence of Peyronie's Disease in the United States: A Population-Based Study

Peyronie’s disease (PD) is a connective tissue disorder which can result in penile deformity. The prevalence of diagnosed PD in the United States (US) has been estimated to be 0.5% in adult males, but there is limited additional information comparing definitive and probable PD cases. 

We conducted a population-based survey to assess PD prevalence using a convenience-sample of adult men participating in the ResearchNow general population panel. Respondents were categorized according to PD status (definitive, probable, no PD) and segmented by US geographic region, education, and income levels. 

Of the 7,711 respondents, 57 (0.7%) had definitive PD while 850 (11.0%) had probable PD. Using univariate logistic regression modeling, older age (18–24 vs 24+), Midwest/Northeast/West geographic region (South vs Midwest/Northeast/West), and higher income level (<25K vs 25K+) were each significantly associated with reduced odds of having a definitive/probable PD diagnosis compared with no PD diagnosis. When all three variables were entered in a stepwise multivariable logistic regression, only age and region remained significant. 

This study is the first to report PD prevalence by geographic region and income, and it advocates that the prevalence of PD in the US may be higher than previously cited. Further, given the large discrepancy between definitive PD cases diagnosed by a physician and probable cases not diagnosed by a physician, much more needs to be done to raise awareness of this disease.

Below:  PD prevalence by demographic subgroups

Full article at:  http://goo.gl/RBcG5m

By:  

Mark Stuntz, Anna Perlaky, Dan Glass 
Deerfield Institute, New York, New York, United States of America

Franka des Vignes 

Formerly at Deerfield Institute, New York, New York, United States of America

Tassos Kyriakides 

Yale Center for Analytical Services, Yale School of Public Health, New Haven, Connecticut, United States of America 

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The Decline of Inpatient Penile Prosthesis over the 10-Year Period, 2000–2010

AIMS:

Our aims were to analyze national trends of penile prosthesis (PP) surgery and to examine patient and hospital characteristics, and perioperative complications in the inpatient setting.

METHODS:

We analyzed data from National Inpatient Sample. Patients in NIS who underwent PP insertion between 2000 and 2010 were included.

MAIN OUTCOME MEASURES:

Our main outcomes were the number of inpatient PP procedures, type of prosthesis, patient demographics, comorbidities, hospital characteristics, and immediate perioperative complications.

RESULTS:

There was a progressive and dramatic decline by nearly half in the number of both inflatable (IPP) and noninflatable (NIPP) inpatientinsertions performed from 2000 to 2010 (P = 0.0001). The overall rate of inpatient complications for PP insertion was 13.5%. Patients with three or more comorbidities were found to have a higher risk of complications than patients with no comorbidities (OR = 1.45, 95% CI = 1.18-1.78) (P = 0.0001). Surgeries performed in high-volume hospitals (10 or more PP cases per year) were associated with reduced risk of complications (OR = 0.6) (P < 0.0001). There was a dramatic decrease in inpatient setting for PP placement in high-volume hospitals (32% in 2000 compared with 6% in 2010; P < 0.0001), and when compared with lower volume hospitals. NIPP was more likely performed in younger patients and in community hospitals, and less likely in white patients. Medicaid health insurance was associated with much higher rate of NIPP insertion than other types of insurance.

CONCLUSIONS:

The number of PP procedures performed in the inpatient setting declined between 2000 and 2010, likely reflecting a shift toward increasing outpatient procedures. Our data also suggest a better outcome for patients having the procedure done at a high-volume center in terms ofinpatient complications

Below:  Volume of inpatient PP in the United States from 2000 to 2010. IPP, inflatable penile prosthesis; NIPP, noninflatable penile prosthesis

Below:   Patient comorbidities of inpatient PP from 2000 to 2010. 0, no comorbidity; 1, one comorbidity; 2, two comorbidities; 3+, three or more comorbidities

Below:  Hospital volume of inpatient penile prosthesis from 2000 to 2010. 1, one case/year; 2–9, two to nine cases/year; 10+, 10 or more cases/year

Full article at:   http://goo.gl/VmGOEU

By:  Alwaal A1, Harris CR2, Hussein AA2, Sanford TH2, McCulloch CE3, Shindel AW4, Breyer BN2.

• 1 Department of Urology, University of California San Francisco, San Francisco, CA; Department of Urology King Abdul Aziz University Jeddah Saudi Arabia.
• 2 Department of Urology University of California San Francisco San Francisco CA USA.
• 3 Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA USA.
• 4 Department of Urology University of California at Davis Sacramento CA USA.

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Why Are Men Satisfied or Dissatisfied with Penile Implants? A Mixed Method Study on Satisfaction with Penile Prosthesis Implantation

Introduction

Studies have demonstrated high levels of satisfaction with penile prosthesis implantation (PPI). However, qualitative research exploring the experience of PPI through men's narratives is scarce.

Aim

The main goals were to analyze (i) the level of sexual satisfaction (quantitatively), and (ii) the reasons for satisfaction and/or dissatisfaction with PPI (qualitatively).

Method
Participants were 47 men with erectile dysfunction who underwent surgery between 2003 and 2012, placed by a single surgeon. Structured telephone interviews were carried out.

Main Outcome Measures

Satisfaction with PPI was a qualitative and quantitative measure assessed through the following four items: (i) “Would you repeat the PPI surgery?”; (ii) “Would you recommend the PPI surgery?”; (iii) “How satisfied are you with the PP?”; and (iv) “Could you explain the motives of your satisfaction/dissatisfaction?”.

Results

The majority of men (79%) reported to be satisfied with PPI. Content analysis revealed four main themes for men's satisfaction with the PPI: (i) psychological factors were reported 54 times (n = 54) and included positive emotions, self-esteem, confidence, enhancement of male identity, major live change, and self-image; (ii) improvement of sexual function was reported 54 times (n = 54) and referred to achievement of vaginal penetration, increase of sexual desire, sexual satisfaction, penis size, and improvement of erectile function; (iii) relationship factors were reported 11 times (n = 11) and referred to relationship improvement and the possibility of giving pleasure to the partner; and (iv) improvement in urinary function (n = 3).

Conclusions

The level of satisfaction with the implementation of penile prostheses is very high, therefore constituting a treatment for erectile dysfunction with a positive impact on the experience of men at sexual, psychological and relational level.

Full article at: http://goo.gl/y1erz8

By:   Ana Carvalheira PhD^1,,Rita Santana MA²and Nuno M. Pereira PhD³

William James Center for Research, ISPA—University Institute, Lisbon, Portugal

ISPA-University Institute, Lisbon, Portugal

iSex-Association of Advanced Study of Human Sexuality, Lusófona University, Lisbon, Portugal

*Corresponding Author: Ana Carvalheira, PhD, William James Center for Research, ISPA—University Institute, R. Jardim do Tabaco 34, 1149-041 Lisbon, Portugal. Tel: +351 919 253 757; Fax: +351-218-860-954; E-mail: acarvalheira@ispa.pt  

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Penile Prosthesis Implantation in Patients with a History of Total Phallic Construction

INTRODUCTION:

Outcomes following penile prosthesis implantation in patients with a history of total phallic construction are not well described.

AIM:

The aim of this study was to evaluate outcomes following neophallus penile prosthesis placement.

METHODS:

Retrospective review penile prosthesis placement in patients with prior total phallic construction. GORE-TEX® (Gore Medical, Flagstaff, AZ) sleeve neotunica construction was utilized in all patients.

MAIN OUTCOME MEASURE:

Success defined as patient sexual activity with a functioning prosthesis.

RESULTS:

Thirty-one patients underwent neophallic prosthesis implantation at a mean 35.6 years of age. Prosthesis placement occurred at an average 56.3 months following phallic construction and follow-up was a mean of 59.7 months. Malleable prostheses were placed in 21 patients and inflatable in 10; implants were bilateral in 94%. Six percent experienced operative complications including a bladder injury (1) and phallic flap arterial injury (1). Postoperative complications occurred in 23% at a median 5.5 months following placement. Five prostheses were explanted secondary to infection or erosion and two additional required revisions. Of the explanted prosthesis two were later replaced without further complication. Eighty-one percent of patients were sexually active following prosthesis placement.

CONCLUSIONS:

Penile prosthesis placement is possible in patients with prior penile reconstruction/phallic construction. Although complications rates appear to be elevated in this population compared with historic controls of normal anatomic men, the majority of patients in this series were sexually active following prosthesis placement. This demonstrates the utility of prosthesis implantation in these difficult patients. 

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By:   Zuckerman JM1, Smentkowski K2, Gilbert D3, Storme O2, Jordan G2, Virasoro R2, Tonkin J2, McCammon K2.

• 1Department of Urology, Naval Medical Center San Diego, San Diego, CA, USA.
• 2Department of Urology, Eastern Virginia Medical School, Norfolk, VA, USA.
• 3Department of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, VA, USA. 

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Cancer of the Penis Associated with HIV: A Report of Three Cases Presenting at the CHU Cocody, Ivory Coast

We describe three cases of advanced penile cancer associated with HIV infection.

Advanced penile cancer associated with VIH infection were discovered in three patients aged respectively 47, 56 and 40. The prognosis was extremely poor. Two patients died without receiving any treatment and one patient was lost to follow-up after refusing all treatment proposed.

There appears to be a link between HIV infection and penile cancer with concomitant HIV infection worsening the prognosis of the disease.

Cancer of the penis is extremely rare. In Europe and the USA, the incidence of this form of cancer is estimated as 1.0 per 100,000 men [1]. The incidence varies between different countries worldwide with a higher incidence in Hispanic individuals, in Brazil and in Uganda [2]. Circumcision in the perinatal period or before puberty has a preventative role, but not circumcision carried out in adulthood. Early circumcision decreases the risk 3–5-fold [3], probably by improving local hygiene. Cancer of the penis is usually a disease of older men and its incidence increases with age. The peak in frequency occurs between 60 and 70 years of age [1], [2], [4]. In 95 % of cases penile tumours are squamous cell carcinomas [5]. Penile cancer may present as a flat or ulcerated exophytic papillary lesion, with the latter having a worse prognosis. The most common locations are the glans (48 % of cases) and the foreskin (25 % of cases). Penile cancer patients with advanced disease have a poor prognosis. Grades 2 and 3 disease, T3 stage and positive lymph nodes are adverse prognostic factors for cancer-specific survival in penile squamous cell carcinoma [6], [7]. In a study of eight patients with metastatic penile cancer, the longest and shortest survival times (from diagnosis of the primary cancer to death) were 16 years and 9 months, respectively [8]. Other, rarer histological forms of penile cancer such as melanoma and sarcoma may also occur [9].

There is a higher risk of penile cancer in patients with AIDS although it is not possible to conclude formally about a causal link with immunosuppression [10]. An increasing number of cases of penile cancer associated with HIV are being reported in the literature [1], [10], [11]. The aim of this report is to describe three cases of penile cancer associated with HIV that presented at the Urology Department of the CHU Cocody and to review the literature...

Below:  Cancer of the penis (patient 1), view 3

Below:  Cancer of the penis (patient 2)

Below:  Paraphimosis seen in patient 3 on admission, view 2

Full article at: http://goo.gl/832GHc

By:  P. G. Konan^*, C. C. Vodi, A. H. Dekou, A. Fofana, E. E. Gowé and K. Manzan

Service d’Urologie, CHU de Cocody, Abidjan, Ivory Coast, Africa

 

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Metastatic Tumors of the Penis: A Report of 8 Cases and Review of the Literature

The purpose of this study was to report the clinical characteristics, treatments, and outcomes of secondary penile cancers and review the literature of this rare condition.

The records of 8 patients with metastatic penile cancer treated at our hospital from 2006 to 2013 were analyzed. A search of medical databases was conducted.

Patient symptoms included penile mass (n = 7, 5 had concomitant pain) and acute urine retention (n = 1). The primary cancers included bladder, lung, gastric, liver, and prostate malignancies and 1 case of pulmonary epithelioid hemangioendothelioma. The longest time from diagnosis of the primary cancer to metastatic penile cancer was 16 years and the shortest was 7 months. Six patients were treated with phallectomy, 1 with resection of the mass, and 1 with only a biopsy because of advanced metastatic disease. Five patients are deceased at the time of this report, and the longest and shortest survival times (from the diagnosis of primary cancer to the death) were 16 years and 9 months, respectively. The literature review identified 17 cases reported since 2011, bringing the total number of reported cases to 480. Genitourinary cancer, primarily bladder and prostate, account for approximately 70 of the primary cancer sites and gastrointestinal cancers account for approximately 21%. Approximately half of the patients had died of their disease within 1 year of the diagnosis of penile metastasis.

The prognosis of metastatic penile cancer is poor. Most primary cancers are in the urologic or gastrointestinal systems. Surgery and adjunctive therapy may improve symptoms, but fail to prolong survival.

Below:  Penile metastasis from lung squamous cell carcinoma. (A) Longitudinal section of the corpora cavernosum of the penis after phallectomy. The cancer invaded the full-length penis (from balanus to root, red circle), and superficial skin ulceration was also observed. (B) Histological examination with hematoxylin and eosin stain (magnification ×200) showed squamous cell carcinoma of the corpora cavernosum of the penis, moderately to poorly differentiated cells, with massive necrosis and cancer thrombus in the vasculature (red arrows).

Below:  Representative histopathological images of penile metastases with different primary tumors. All images are hematoxylin and eosin stained, ×200 magnification. (A) Epithelioid hemangioendothelioma, primary lung. (B) Advanced urothelial cancer, primary bladder. (C) Advanced urothelial cancer, primary bladder. (D) Angiosarcoma, primary liver. (E) Adenocarcinoma, primary prostate. (F) Poorly differentiated adenocarcinoma, primary stomach. (G) Invasive papillary urothelial carcinoma, primary bladder.

Full article at: http://goo.gl/IJt9B6

By: Ke Zhang, MD, MS, Jun Da, MD, MS, Hai-jun Yao, MD, MS, Da-chao Zheng, MD, MS, Zhi-kang Cai, MD, Yue-qing Jiang, MD, Ming-xi Xu, MD, MS, and Zhong Wang, MD, PhD

Department of Urology and Andrology (KZ, JD, HY, DZ, ZC, YJ, MX, ZW), Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Correspondence: Zhong Wang; Ming-Xi Xu, Department of Urology and Andrology, Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhizaoju Road, Shanghai 200011, China (e-mail: moc.anis@0102gnawgnohz).

  

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Beliefs About Penis Size: Validation of a Scale for Men Ashamed About Their Penis Size

No measures are available for understanding beliefs in men who experience shame about the perceived size of their penis. Such a measure might be helpful for treatment planning, and measuring outcome after any psychological or physical intervention. Aim: Our aim was to validate a newly developed measure, called the Beliefs about Penis Size Scale (BAPS). Method: 173 male participants completed a new questionnaire consisting of 18 items to be validated and developed into the BAPS, as well as various other standardised measures. An urologist also measured actual penis size. Main outcome measures: The BAPS was validated against six psychosexual self-report questionnaires as well as penile size measurements. Results: Exploratory factor analysis reduced the number of items in the BAPS from 18 to 10, which was best explained by one factor. The 10-item BAPS had good internal consistency and correlated significantly with measures of depression, anxiety, body image quality of life, social anxiety, erectile function, overall satisfaction and the importance attached to penis size. The BAPS was not found to correlate with actual penis size. It was able to discriminate between those who had concerns or were dissatisfied about their penis size and those who were not. Conclusions: This is the first study to develop a scale for measurement of beliefs about penis size. It may be used as part of an assessment for men who experience shame about the perceived size of their penis and as an outcome measure after treatment. The BAPS measures various manifestations of masculinity and shame about their perceived penis size including internal self-evaluative beliefs; negative evaluation by others; anticipated consequences of a perceived small penis and extreme self-consciousness.

Full PDF article at: https://goo.gl/qoQYyf

By: David Veale1 , Ertimiss Eshkevari1 , Julie Read1 , Sarah Miles1 , Andrea Troglia1 , Rachael Phillips1 , Lina Carmona2 , Chiara Fiorito2 , Kevan Wylie3 , Gordon Muir2

1 NIHR Specialist Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and The Institute of Psychiatry, Kings College London 

2 King's College Hospital, London 

3 Porterbrook Clinic, Sheffield

  

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Sexual Functioning and Behavior of Men with Body Dysmorphic Disorder Concerning Penis Size Compared with Men Anxious about Penis Size and with Controls

Little is known about the sexual functioning and behavior of men anxious about the size of their penis and the means that they might use to try to alter the size of their penis.

To compare sexual functioning and behavior in men with body dysmorphic disorder (BDD) concerning penis size and in men with small penis anxiety (SPA without BDD) and in a control group of men who do not have any concerns.

An opportunistic sample of 90 men from the community were recruited and divided into three groups: BDD (n = 26); SPA (n = 31) and controls (n = 33).

The Index of Erectile Function (IEF), sexual identity and history; and interventions to alter the size of their penis.

Men with BDD compared with controls had reduced erectile dysfunction, orgasmic function, intercourse satisfaction and overall satisfaction on the IEF. Men with SPA compared with controls had reduced intercourse satisfaction. There were no differences in sexual desire, the frequency of intercourse or masturbation across any of the three groups. Men with BDD and SPA were more likely than the controls to attempt to alter the shape or size of their penis (for example jelqing, vacuum pumps or stretching devices) with poor reported success.

Men with BDD are more likely to have erectile dysfunction and less satisfaction with intercourse than controls but maintain their libido. Further research is required to develop and evaluate a psychological intervention for such men with adequate outcome measures.

Table 2

Sexual history of BDD, SPA, and control participants

Measure	BDD group	Small penis anxiety group	Control group	Comparison
	n = 26	n = 31	n = 33	ANCOVA/Fisher's Exact Test
Previous sexual experience, n (%)	23 (88.5)	30 (96.8)	32 (97)	Fisher's Exact Test P = 0.432
Mean age at first sexual experience (SD)	17.17 (5.80)	19.13 (5.78)	18.66 (2.77)	n/a
Mean number of previous sexual partners (SD)	22.15 (29.37)	35.90 (94.15)	36.16 (105.00)	F (2, 86) = 1.60, P = 0.209
Median number of previous sexual partners	12.50	6.00	12.50
Mean number of long-term sexual partners (SD)	3.12 (2.76)	2.13 (1.50)	2.94 (2.95)	F (2, 86) = 0.823, P = 0.443
Mean frequency of sexual intercourse per month (SD)	2.88 (4.66)	5.29 (7.78)	6.58 (6.58)	F (2, 86) = 0.700, P = 0.499
Mean frequency of pornography access per month (SD)	11.69 (11.45)	13.87 (12.94)	15.00 (12.12)	F (2, 86) = 0.219, P = 0.804
Mean age at first masturbation (SD)	14.46 (5.84)	12.58 (3.01)	12.76 (2.17)	F (2, 86) = 2.73, P = 0.071
Mean frequency of masturbation per month (SD)	14.54 (11.63)	16.68 (9.91)	20.58 (15.73)	F (2, 86) = 1.21, P = 0.304
Belief penis damaged through masturbation, n (%) (0 “not at all”—10 “convinced”)	3 (11.5)	5 (16.1)	4 (12.1)	Fisher's Exact Test P = 0.859
Sexual Orientation, n (%)
Heterosexual	19 (73.1)	22 (71.0)	26 (78.8)	Fisher's Exact Test P = 0.790
Homosexual	7 (26.9)	9 (29.0)	7 (21.2)

Table 4

Interventions tried to alter the size or appearance of the penis, and their success rates

Measure	BDD group	Small penis anxiety group	Control group	Comparison
	n = 26	n = 31	n = 33
Previous attempt to alter the shape or size of the penis, n (%)	11 (42.3)	10 (32.3)	0 (0)	Fisher's Exact Test P < 0.001
Mean number of procedures tried (SD)	1.75 (0.75),	1.36 (0.67)	n/a	t (20) = .−1.29, P = 0.211
Type of procedure n (%)
Exercises	2 (18.2)	8 (80)
Pump	2 (18.2)	0 (0)	n/a	Fisher's Exact Test P = 0.083
Elastic stretching device	1 (9)	0 (0)
Viagra	1 (9)	0 (0)
Multiple procedures	5 (45.5)	2 (20)
Mean cosmetic success of procedure (0–8) (SD)	2.67 (2.31)	5.00 (1.87)	n/a	t (20) = 1.58, P = 0.166
Mean reduced preoccupation with size concern following the procedure (0–8)(SD)	1.67 (2.08)	4.17 (2.40)	n/a	t (20) = 1.53, P = 0.170

Full article at: http://goo.gl/8HIR4D

By: David Veale,* Sarah Miles,* Julie Read,* Andrea Troglia,* Kevan Wylie,† and Gordon Muir‡

*Institute of Psychiatry, Psychology and Neurosciences, Kings College London, South London and Maudsley NHS Foundation Trust, London, UK

†Porterbrook Clinic, Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK

‡King's College Hospital, NHS Foundation Trust, London, UK

  

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