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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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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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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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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Women's Preferences for Penis Size: A New Research Method Using Selection among 3D Models

Women’s preferences for penis size may affect men’s comfort with their own bodies and may have implications for sexual health. Studies of women’s penis size preferences typically have relied on their abstract ratings or selecting amongst 2D, flaccid images. This study used haptic stimuli to allow assessment of women’s size recall accuracy for the first time, as well as examine their preferences for erect penis sizes in different relationship contexts. Women (N = 75) selected amongst 33, 3D models. Women recalled model size accurately using this method, although they made more errors with respect to penis length than circumference. 

Women preferred a penis of slightly larger circumference and length for one-time (length = 6.4 inches/16.3 cm, circumference = 5.0 inches/12.7 cm) versus long-term (length = 6.3 inches/16.0 cm, circumference = 4.8 inches/12.2 cm) sexual partners. 

These first estimates of erect penis size preferences using 3D models suggest women accurately recall size and prefer penises only slightly larger than average.

Below:  Penile Models. A) Computer graphic representation of one of the ‘print files’ used to produce the 3D penis models. B) Examples of (4 of 33) 3D models showing length in inches. A and D represent the largest and smallest models in the set, respectively; B and C represent the two models (counterbalanced) used to test recall for size.

Read more at:  http://ht.ly/Sg7Bn

By: Nicole Prause,#1,* Jaymie Park,1,‡ Shannon Leung,1,‡ and Geoffrey Miller#2

1Department of Psychiatry, University of California Los Angeles, Los Angeles, California, United States of America

2Department of Psychology, University of New Mexico; Albuquerque, New Mexico, United States of America

2Department of Psychology, University of New Mexico; Albuquerque, New Mexico, United States of America

1Department of Psychiatry, University of California Los Angeles, Los Angeles, California, United States of America

2Department of Psychology, University of New Mexico; Albuquerque, New Mexico, United States of America

Knox College, UNITED STATES

#Contributed equally.

An Unusual Delayed Complication of Paraffin Self-Injection for Penile Girth Augmentation

Below:   Massively enlarged and deformed penile shaft with phymotic foreskin. Physical examination revealed a penile shaft enlarged, deformed and fibrotic, with phymotic foreskin; the scrotum was normal.

Below:  Midline dorsal penile shaft incision. The operation started with a midline dorsal penile shaft incision to access and remove the scarred tissue between dartos and Buck’s fascia dorsally.

Below:  Fibrotic ring occluding the urethra. Following complete subcoronal incision and midline ventral penile shaft incision, the scarred tissue of the ventral penile shaft, including a fibrotic ring occluding the urethra, was accessed and removed.

Penile self-injection of various oils is still carried out among Eastern Europe people for penile girth augmentation despite the potential destructive complications of this practice are well known. Penile reactions to such foreign bodies include scarring, abscess formation, ulceration, and even Fournier’s gangrene; voiding problems due to mineral oil self-injection have been reported only once. To our knowledge, we describe the first case of paraffin self-injection for penile girth augmentation presenting with acute urinary retention.

A 27-year-old Romanian man presented with severe penile pain and acute urinary retention five years after having practiced repeated penile self-injections of paraffin for penile girth augmentation. The penile shaft was massively enlarged, fibrotic and phymotic; urethral catheterization failed due to severe stricture of the proximal pendulum urethra. The patients refused placement of a suprapubic catheter and underwent immediate penile surgical exploration. The scarred tissue between dartos and Buck’s fascia and a fibrotic ring occluding the urethra were removed and the penile skin reconstructed. Pathology confirmed the diagnosis of paraffinoma. The patient resumed normal voiding immediately after catheter removal on second postoperative day; he was very pleased with cosmetic, sexual and voiding results at six weeks, six months and 1 year follow-up.

The present report describes a novel complication of penile self-injection for penile girth augmentation. Because of the increasing number of patients seeking penile augmentation, physicians dealing with sexual medicine should pay more attention to such request to prevent the use of non medical treatments that can turn into medical disasters.

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