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Therapeutic strategies for patients with micropenis or penile dysmorphic disorder

Nature Reviews Urology volume 9, pages 499–507 (2012)Cite this article

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Abstract

Micropenis in adults is defined as a stretched length of <7.5 cm. Many aetiologies exist, including congenital and endocrinological causes as well as pathological conditions, such as penile lichen sclerosus, trauma and genital cancer. The resulting reduction in functional penile length can lead to considerable psychosexual morbidity. Furthermore, the subset of patients with micropenis who also suffer from penile dysmorphic disorder require careful and intensive psychological counselling. Corrective surgery for micropenis can be performed in patients with realistic expectations. Total phalloplasty using radial-artery-based forearm skin flaps can offer restoration of normal penile length in selected patients. More-conservative surgical techniques to improve length or girth are limited by minimal enhancement but associated with a significantly lower rate of complications and comorbidity compared to total phalloplasty. Emerging tissue engineering techniques might represent a suitable alternative to penile replacement surgery in the future.

Key Points

  • Micropenis is defined as a stretched penile length of <7.5 cm based on population studies

  • True micropenis can manifest as a result of congenital abnormalities of testosterone production or function; other causes of micropenis include trauma, surgery, infection and cancer

  • Avoidance of micropenis can be achieved by using contemporary reconstructive techniques in order to maintain penile length

  • Patients with penile dysmorphic disorder require careful and intensive psychological counselling

  • Corrective surgery can be performed in patients with realistic expectations; total phalloplasty using radial-artery-based forearm flaps can offer restoration of normal penile length to selected patients

  • Penile-sparing surgical techniques to improve length or girth are limited by minimal enhancement but associated with a significantly lower rate of complications and comorbidity compared to total phalloplasty

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Figure 1: Glans resurfacing.
Figure 2: Buried penis after radiotherapy.
Figure 3: Buried penis owing to genital malignancy.
Figure 4: Radial artery forearm flap phalloplasty.

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  1. Department of Andrology, University College London Hospital, 250 Euston Road, London, NW1 2PG, UK

    Oliver Kayes, Majid Shabbir, David Ralph & Suks Minhas

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O. Kayes researched data for the article. M. Shabbir and D. Ralph made substantial contribution to the discussion of content. O. Kayes and S. Minhas wrote and reviewed the manuscript before submission.

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Kayes, O., Shabbir, M., Ralph, D. et al. Therapeutic strategies for patients with micropenis or penile dysmorphic disorder. Nat Rev Urol 9, 499–507 (2012). https://doi.org/10.1038/nrurol.2012.150

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