Prostate Cancer in Gay, Bisexual, and Other Men Who Have Sex with Men: A Review

Purpose:

Prostate cancer in gay, bisexual, and other men who have sex with men (GBM) is an emerging medical and public health concern. The purpose of this review is to summarize the literature on prostate cancer in GBM, including its epidemiology, clinical studies, and anecdotal reports.

Methods:

In 2015, we undertook a structured literature review of all studies from 2000 to 2015.

Results:

Despite prostate cancer being the most common cancer in GBM, the main finding of this review is that prostate cancer in GBM is very under-researched. With only 30 published articles in English (a rate of 1.9 articles per year), most of the literature is limited to case studies or anecdotal reports. There is some evidence of a link between human immunodeficiency virus (HIV)-positive status and prostate cancer, with early studies showing HIV infection as a risk factor and more recent studies as it being protective. Antiretroviral treatment appears protective. Globally, only four quantitative studies have been published. Based on this admittedly limited literature, GBM appear to be screened for prostate cancer less than other men and are diagnosed with prostate cancer at about the same rate, but have poorer sexual function and quality-of-life outcomes.

Conclusion:

Methodological challenges to advancing research include challenges in subject identification, recruitment, heterocentric definitions of dysfunction based on vaginal intercourse and penetrative sex, and inappropriate measures. Six future directions, to advance the study of the effects of prostate cancer in GBM and to improve treatment, are detailed...

[H]eterocentric definitions of functioning limited to penetrative sex are problematic. While DSM-5¹¹⁵ defines “sexual dysfunction” as “a clinically significant disturbance in a person's ability to respond sexually,” erectile functioning in prostate cancer treatment is typically operationalized as “sufficient for vaginal penetration.”^5,116,117 This gold standard is irrelevant for sex between men. Physiologically, anal penetration requires a greater degree of penile rigidity than vaginal penetration,^28,30 which potentially explains the poorer outcomes of prostate cancer treatment for GBM. Population-appropriate measures and definitions need to be developed before the effects of prostate cancer treatment in GBM can be enumerated.

Six directions for future research are identified. First, methodological research is needed to identify ways to locate, recruit, and retain GBM with prostate cancer in studies and to develop population-appropriate definitions and measures. Second, more formative research is needed. In particular, in-depth examination of the effects of treatment on sexual functioning behavior and identities will advance a comprehensive sexological understanding of the experience of prostate cancer in GBM. Third, empirical studies to quantify the prevalence and incidence of sexual problems and effects of treatment by treatment type will be critical to informing clinical care. Fourth, comparative studies of treatment preferences for GBM and heterosexual men should confirm whether GBM are more, as, or less likely than heterosexuals to choose surgical intervention. Fifth, intervention studies to address the rehabilitation needs of GBM with prostate cancer are needed to develop evidence-based interventions tailored for this population. Finally, the training needs of urologists, surgeons, oncologists, and other specialists providing services to GBM with prostate cancer need to be identified and curricula developed to ensure culturally competent providers capable of addressing the sexual health needs and care of this population...

Full article at:   http://goo.gl/Y7ItUl

By:  B.R. Simon Rosser, PhD, MPH, ¹ Enyinnaya Merengwa, MD, MPH, CPH,² Benjamin D. Capistrant, ScD,¹ Alex Iantaffi, PhD,¹ Gunna Kilian,¹ Nidhi Kohli, PhD,³ Badrinath R. Konety, MD, MBA,⁴ Darryl Mitteldorf, MSW, MPA,⁵ and William West, PhD⁶

¹Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.

²Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota.

³Department of Educational Psychology, University of Minnesota, Minneapolis, Minnesota.

⁴Department of Urology, University of Minnesota, Minneapolis, Minnesota.

⁵Malecare Cancer Support, New York, New York.

⁶Department of Writing Studies, University of Minnesota, Minneapolis, Minnesota.

Corresponding author.

Address correspondence to:, B.R. Simon Rosser, PhD, MPH, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454

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Sexual Anatomy and Function in Women With and Without Genital Mutilation

INTRODUCTION:

Female genital mutilation (FGM), the partial or total removal of the external genitalia for non-medical reasons, can affect female sexuality. However, only few studies are available, and these have significant methodologic limitations.

AIM:

To understand the impact of FGM on the anatomy of the clitoris and bulbs using magnetic resonance imaging and on sexuality using psychometric instruments and to study whether differences in anatomy after FGM correlate with differences in sexual function, desire, and body image.

METHODS:

A cross-sectional study on sexual function and sexual anatomy was performed in women with and without FGM. Fifteen women with FGM involving cutting of the clitoris and 15 uncut women as a control group matched by age and parity were prospectively recruited. Participants underwent pelvic magnetic resonance imaging with vaginal opacification by ultrasound gel and completed validated questionnaires on desire (Sexual Desire Inventory), body image (Questionnaire d'Image Corporelle [Body Image Satisfaction Scale]), and sexual function (Female Sexual Function Index).

MAIN OUTCOME MEASURES:

Primary outcomes were clitoral and bulbar measurements on magnetic resonance images. Secondary outcomes were sexual function, desire, and body image scores.

RESULTS:

Women with FGM did not have significantly decreased clitoral glans width and body length but did have significantly smaller volume of the clitoris plus bulbs. They scored significantly lower on sexual function and desire than women without FGM. They did not score lower on Female Sexual Function Index sub-scores for orgasm, desire, and satisfaction and on the Questionnaire d'Image Corporelle but did report significantly more dyspareunia. A larger total volume of clitoris and bulbs did not correlate with higher Female Sexual Function Index and Sexual Desire Inventory scores in women with FGM compared with uncut women who had larger total volume that correlated with higher scores.

CONCLUSION:

Women with FGM have sexual erectile tissues for sexual arousal, orgasm, and pleasure. Women with sexual dysfunction should be appropriately counseled and treated.

Below:  Vulvar appearance of (A) a woman without female genital mutilation (arrow = glans of clitoris) and (B) a woman with female genital mutilation type IIb (arrow = palpable clitoral stump hidden under the scar). Panel C shows a corresponding sagittal proton density-weighted fat-saturated magnetic resonance image of the woman without female genital mutilation. Depicted are the clitoral crus (white arrowhead), bulb (black arrowhead), intact clitoral glans (short black arrow), ultrasound gel in the distal vagina (black spherical mark), and symphysis pubis (long black arrow). Panel D shows a T2-weighted magnetic resonance image of the woman with female genital mutilation. The distal part of the clitoral body (white arrows) is covered by the scar. The clitoris is not in direct contact with the ultrasound gel in the distal vagina (black spherical mark). Also depicted is the symphysis pubis (white arrowheads)

Full article at:   http://goo.gl/f4D99t

By:  Abdulcadir J1, Botsikas D2, Bolmont M3, Bilancioni A4, Djema DA5, Bianchi Demicheli F4, Yaron M4, Petignat P4.

• 1Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland. Electronic address: jasmine.abdulcadir@hcuge.ch.
• 2Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland; Division of Radiology, Department of Imaging, Geneva University Hospitals, Geneva, Switzerland.
• 3Faculty of Psychology and Educational Science, University of Geneva, Geneva, Switzerland.
• 4Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland.
• 5Division of Radiology, Department of Imaging, Geneva University Hospitals, Geneva, Switzerland. 
• J Sex Med. 2016 Jan 27. pii: S1743-6095(15)00058-2. doi: 10.1016/j.jsxm.2015.12.023.

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Sexual Excitation & Sexual Inhibition as Predictors of Sexual Function in Women

To date no longitudinal studies have evaluated the predictive value of the two factors of the Dual Control Model-sexual excitation (SE) and sexual inhibition (SI)-for future sexual function. 

The aims of the present study were to investigate the associations between SE/SI and sexual function and estimate their predictive value for future sexual function in a sample of women. Overall, 2,214 women participated in a web-based survey that assessed SE, SI, and sexual function as well as symptoms of depression. The one and two-year follow-up surveys included 396 and 380 participants, respectively. Correlational analyses and hierarchical regression analyses were conducted to analyze the relationships between predictor and outcome variables. 

Four factors of SE (Arousability, Partner Characteristics, Sexual Power Dynamics, and Setting) and two factors of SI (Concerns about Sexual Function and Arousal Contingency), as well as symptoms of depression and partnership status were significant predictors of concurrent and future sexual function. Several subscales of SE and SI contributed to the prediction of future sexual function above and beyond prior sexual function levels. 

Our study provides the first supportive evidence for the assumptions of the Dual Control Model that propensities for low SE and high SI influence future sexual function.

Purchase full article at:   http://goo.gl/hxlU8z

By:  Velten J1, Scholten S1, Graham CA2, Margraf J1.

• 1 Mental Health Research and Treatment Center, Ruhr-Universität Bochum , Bochum , Germany.
• 2 Department of Psychology , University of Southampton , Southampton , UK. 
• J Sex Marital Ther. 2016 Jan 6:0. 

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Sexual Functioning & Sexual Well-Being in People with a Limb Amputation: A Cross-Sectional Study in the Netherlands

PURPOSE:

This study aimed to: (a) investigate whether, and if so which, sexual problems are present in people with a limb amputation; (b) analyze how they experience their sexuality; and (c) investigate whether sexuality was discussed with them during their rehabilitation process.

METHOD:

In total, 301 participants completed a survey consisting of a questionnaire on participant characteristics, the Hospital Anxiety and Depression Scale (HADS), the Maudsley Marital Questionnaire (MMQ), the Amputee Body Image Scale (ABIS), the Questionnaire about SexualCounselling, the Questionnaire about Sexuality and the Short Sexual Functioning Scale (SSFS).

RESULTS:

Overall, 20% of the participants experienced one or more sexual dysfunction(s). Participants who had at least one sexual dysfunction were more likely to be male, had an amputation more recently, and had a more negative body image. Moreover, sexuality was only scantly discussed by rehabilitation professionals.

CONCLUSIONS:

Sexual problems and sexual dysfunctions do occur in people with a limb amputation, but these problems are not discussed during the rehabilitation process. Justice for a person's "whole body" can only be served when sexuality is taken seriously in rehabilitation care in order to avoid cutting sexuality out of an amputee's life. Implications for Rehabilitation People with a limb amputation may be confronted with sexual problems and/or sexual dysfunctions. It is therefore important that sexuality is taken seriously as a part of standard rehabilitation care and that professionals bring up the issue of sexuality during the rehabilitation process.

Purchase full article at:   http://goo.gl/Lu02BZ

By:  Verschuren JE1, Geertzen JH1, Enzlin P2,3, Dijkstra PU1,4, Dekker R1.

• 1 Department of Rehabilitation Medicine , Center for Rehabilitation, University of Groningen, University Medical Center Groningen , The Netherlands .
• 2 Department of Neurosciences , Institute for Family and Sexuality Studies , KU Leuven , Belgium .
• 3 Context - Center for Couple, Family and Sex Therapy , Department of Psychiatry , UPC KU Leuven , Belgium , and.
• 4 Department of Oral and Maxillofacial Surgery , University of Groningen, University Medical Center Groningen , The Netherlands.
• Disabil Rehabil. 2016 Feb;38(4):368-73. doi: 10.3109/09638288.2015.1044029. Epub 2015 Jun 1. 

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Sexual Function of Women Practicing Sex in Nonconventional Settings - Conjugal Visits

The quality of sexual intercourse in the context of conjugal visits by women to their jailed partners is unknown. This study aimed to assess the quality of the sex lives and psychological conditions of women attending conjugal visits with their jailed inmate partners. 

This controlled study involved 124 women between the ages of 18 to 40 years who engaged in sexual relations with their inmate partners (conjugal visit group) or with their partners at home (control group). Sexual function was assessed using a semi-structured questionnaire and the Female Sexual Function Index, and psychological parameters were evaluated using the Hospital Anxiety and Depression scale. The total Female Sexual Function Index scores was similar in the 2 groups. The percentage of women reporting good quality of the relationship was significantly higher in the conjugal visit group. 

Also, the Hospital Anxiety and Depression scale scores were higher in the conjugal visit group. Depression was a risk factor for sexual dysfunction and had a negative effect on scores in the desire, excitement, lubrication, and sexual satisfaction domains, whereas anxiety was associated with lower sexual desire scores. 

A regular + poor quality of the relationship and being religious were factors associated with sexual dysfunction. Sexual practices in jail were not a risk for sexual dysfunction in this sample.

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

By:   Silveira LR1, Romão AP, Vieira CS, de Sá Rosa E Silva AC, Reis RM, Ferriani RA, Navarro PA, Lara LA.

• 1a Sexual Medicine Service of the Sector of Human Reproduction, Department of Gynaecology and Obstetrics, Faculty of Medicine of Ribeirão Preto , São Paulo University , Ribeirão Preto , Brazil. 

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Health-Related Quality of Life and Sexual Functioning of HIV-Positive Men Who Have Sex with Men Who Are Treated for Anal Intraepithelial Neoplasia

BACKGROUND:

The impact of the treatment of precursor lesions of anal cancer (anal intraepithelial neoplasia) on health-related quality of life has not been investigated.

OBJECTIVE:

This study aimed to evaluate the impact of 3 treatment options for anal intraepithelial neoplasia on health-related quality of life and sexual functioning in HIV-positive men who have sex with men.

DESIGN:

The prospective cohort was embedded in a randomized clinical trial evaluating the optimal treatment of anal intraepithelial neoplasia.

SETTING:

This study was performed at the HIV outpatient clinic of the Academic Medical Center, Amsterdam, the Netherlands.

PATIENTS:

Included in the study were HIV-positive men who have sex with men with anal intraepithelial neoplasia.

INTERVENTION:

Treatment with imiquimod (n = 54), topical fluorouracil (n = 48), or electrocautery (n = 46) was given for 16 weeks.

MAIN OUTCOME MEASURES:

Health-related quality of life and sexual functioning were assessed before, during, and 4 weeks after treatment. Health-related quality of life was assessed using the EQ5D, sexual functioning was assessed using items derived from the International Index of Erectile Function, and the female sexual function index adapted for anal intercourse.

RESULTS:

One hundred forty-five patients (98%) completed at least 1 questionnaire. There was a significant different pattern of change over time in health-related quality of life among the 3 treatment groups. Patients in the imiquimod group were more likely to report pain/discomfort at week 8 than patients in the electrocautery group. Patients in the electrocautery group were more likely to report anxiety/depression and were less satisfied with their overall sex life at week 16 than patients in the imiquimod and fluorouracil groups, and patients in the electrocautery group were also more likely to report pain/discomfort and problems with usual activities at week 20 than patients in the fluorouracil group.

LIMITATIONS:

The follow-up method differed slightly among treatment groups. There is no standardized, validated sexual functioning questionnaire for HIV-positive men who have sex with men.

CONCLUSIONS:

All treatment options have a negative impact on aspects of health-related quality of life. Electrocautery has significantly more negative effects on health-related quality of life than imiquimod and fluorouracil and also has a negative effect on sexual functioning.

Purchase full article at:   http://goo.gl/hA6niq

By:   Siegenbeek van Heukelom ML1, Richel O, Nieuwkerk PT, De Vries HJ, Prins JM.

• 11 Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands 2 Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands 3 Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands 4 Department of Psychology, Academic Medical Center, Amsterdam, The Netherlands 5 Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands. 

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Effectiveness of a Low Dose Testosterone Undecanoate to Improve Sexual Function in Postmenopausal Women

Background

Adding testosterone to hormonal therapy could improve sexual function and general well-being among women during climacteric. We evaluated the effectiveness of testosterone undecanoate on sexual function in postmenopausal women utilizing the standardized questionnaire FSFI score.

Methods

Postmenopausal women with sexual complaints and Female Sexual Function Index (FSFI) ≤ 26.5 were enrolled in to this randomized, double-blinded, placebo-controlled trial. Participants were randomly assigned to 8-week treatment with either oral testosterone undecanoate 40 mg or placebo twice weekly with daily oral estrogen. The FSFI scores before and after treatment were compared to assess any improvement of sexual function.

Results

Seventy women were recruited of which each group had 35 participants. The baseline characteristics and baseline FSFI scores were comparable between both groups. After 8 weeks of treatment, the FSFI scores significantly improved in both groups when compared to the baseline but the FSFI scores from the testosterone group were significantly higher than in the placebo group post-treatment (28.6 ± 3.6, 25.3 ± 6.7, respectively, p = 0.04). There was no difference in adverse effect between the two groups.

Conclusions

The twice weekly addition of testosterone undecanoate to daily oral estrogen was associated with a significant improvement in sexual function among postmenopausal women than the use of the estrogen alone.

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

By:  Reuthairat Tungmunsakulchai^1*, Sukanya Chaikittisilpa¹, Thiti Snabboon², Krasean Panyakhamlerd¹, Unnop Jaisamrarn¹ and Nimit Taechakraichana¹

¹Menopause Research Unit, Reproductive Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok 10330, Thailand

²Endocrinology and Metabolism Unit, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok 10330, Thailand

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Sexual Functioning in Men Living with a Spinal Cord Injury–A Narrative Literature Review

Background:

Sexual dysfunction is a major concern for Indian men living with a spinal cord injury

Objectives:

To examine the literature related to sexuality traumatic cord injury and its impact on sexual functioning.

Materials and Methods:

Databases using Cumulative Index to Nursing and Allied Health Literature (CINAHL) 2000–2012, Medline 1989–2012, Applied Social Sciences Index and Abstracts (ASSIA) 1989–2012 and Google Scholar were the search engines used used for literature review.

Results:

The search yielded a total of 457 articles and only 75 of them were found relevant. The minimum number of articles required to meet the inclusion criteria for this review was 25–30 articles. Out of the 75 articles, 33 were considered relevant or related to the topic of sexual functioning, spinal cord injury, and paraplegia. Six areas were identified: Sexual stigmatization, physiological barriers to sexual satisfaction, clinical aspects of sexual functioning, biomedical approaches to sexual dysfunction, partner satisfaction, and lack of accessibility to sexual education.

Conclusion:

Spinal cord injury and sexual functioning affects a large segment of the male Indian population, yet most current research focuses on quantitative measurement with the emphasis on ejaculatory dysfunction, orgasm impairment, incontinence, and other physiological dysfunction. Further research is needed to address the subjective accounts of patients themselves with respect to the emotional and social impact of sexual disability. This would help to identify the best possible outcomes for both treatment and rehabilitation.

Full article at:   http://goo.gl/QcTM1b

By:  MM Sunilkumar, Patricia Boston,1 and MR Rajagopal

Department of Research and Training, Trivandrum Institute of Palliative Sciences, Trivandrum, Kerala, India

¹Department of Family Practice, Faculty of Medicine, University of British Columbia, University Boulevard, Vancouver, British Columbia, Canada

Address for correspondence: Dr. Sunilkumar MM; E-mail: moc.liamffider@mmramuklinusrd

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Sexual Functioning and Cognitions During Sexual Activity in Men with Genital Pain: A Comparative Study

Male genital pain is frequently associated with sexual dysfunction and some studies suggest it is influenced by cognitive factors. However, there is little evidence on how these factors discriminate male genital pain from other sexual problems. 

This study intends to explore differences on sexual functioning and self-reported cognitions during sexual activity between men with genital pain, men with sexual dysfunction, and sexually healthy men. A total of 134 men divided in three groups based on their clinical condition (i.e. genital pain, sexual dysfunction or no sexual/pain complaints) and matched for demographic variables completed measures of sexual functioning (IIEF) and thoughts during sexual activity (SMQ). 

Findings showed that men with genital pain and men with sexual dysfunctions reported significantly lower levels of overall satisfaction with sexual life, compared to men without sexual problems. Additionally, men with genital pain and men with sexual dysfunctions presented significantly more failure anticipation thoughts in comparison to sexually healthy men. 

Overall, findings emphasize the role of negative cognitions as a common factor associated with male genital pain and sexual dysfunctions, suggesting that genital pain should be regarded as a sexual problem and that clinical interventions should include sex therapy techniques as well as cognitive-behavioral procedures.

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By:  Pereira R1, Oliveira CM2, Nobre P3.

• 1 Universidade do Porto, Faculdade de Psicologia e de Ciências da Educação , Rua Alfredo Allen, 4200-135 , Porto , Porto , Portugal.
• 2 Universidade do Porto, Faculdade de Psicologia e Ciências da Educação , Porto , Portugal.
• 3 Universidade do Porto, Faculdade de Psicologia e Ciências da Educação , Porto , Portugal.

 

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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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