From the Research
Penile dysmorphic disorder (PDD) is best treated with a combination of psychological interventions, rather than surgical approaches, to improve morbidity, mortality, and quality of life outcomes. Cognitive behavioral therapy (CBT) is considered the first-line treatment, typically delivered in 12-20 weekly sessions, helping patients challenge distorted beliefs about their appearance and reduce checking behaviors 1. Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (20-80mg daily), sertraline (50-200mg daily), or escitalopram (10-20mg daily) may be prescribed for 12 weeks initially, with treatment often continuing for 6-12 months if effective 1. These medications help reduce obsessive thoughts and anxiety associated with the condition.
Some key points to consider in the management of PDD include:
- Psychoeducation about normal penile size variation and the ineffectiveness of surgical interventions for psychological distress is crucial 2, 3, 4.
- Surgery is generally discouraged as it rarely resolves the underlying body image concerns and may worsen psychological symptoms 2, 3, 4.
- A multidisciplinary approach involving mental health professionals is recommended, as PDD is fundamentally a psychological condition characterized by excessive preoccupation with a perceived flaw that is minimal or non-existent to others, causing significant distress and functional impairment 1, 5.
- The use of a screening scale, such as the Cosmetic Procedure Screening Scale for PDD (COPS-P), can help identify men with PDD and differentiate them from men with small penis anxiety or no penile concerns 2.
Overall, the goal of treatment is to reduce the symptoms of PDD, improve quality of life, and minimize the risk of morbidity and mortality associated with this condition. A comprehensive treatment plan that incorporates psychological interventions, medication, and psychoeducation is essential for achieving these outcomes.