The lack of cost information was a significant hole in the story, and there was no discussion of the limitations of the study or alternatives to treatment, especially given that the consensus in this story appears to be that most men with dissatisfaction about their penis size are suffering from a perception problem, not a physical problem. With some of these improvements, the story could have provided a much better service to readers.
There’s a lesson in this story for journalists to do a better job checking conflicts of interests in sources. The story didn’t disclose that one of the authors has conducted research on a penile traction device and is quoted on the company’s advertising materials.
Penile enhancement — along with hair replacement — is one of the most popular medical interventions targeted at men, and it is often the purview of medical providers outside the mainstream. Because men who perceive themselves as being sexually inadequate are particularly vulnerable to aggressive marketing about ostensible cures, it is especially important to evaluate the claims being made by plastic surgeons and the like. This story does a decent job doing just that. Several of our grades for different criteria were toss-ups, but we hope that our comments – far more important than the overall “star score” – will help guide journalists and consumers in evaluating the evidence.
No cost information was provided, leaving a big hole in the story. The range in costs here is wide, and some of the more invasive procedures would be quite costly. None would be covered by insurance unless necessitated by a medical condition.
The benefits are discussed but not adequately quantified.
Harms are mentioned here, and we appreciate that. We do think, though, that some hard numbers should have been put to the risks associated with more of the enhancement procedures. We give it a pass, though, for at least providing harms data for the penile extenders that are touted as the method with the biggest benefit. It says, “More than 70 of them used penile extenders, with six experiencing minor problems such as bruising, pain and itching. These devices yielded average flaccid length increases of between 0.2 inches and 1 inch, Gontero said, and men achieving better results noted their satisfaction.”
The story provided some information about the study design (a retrospective review of the literature), and the way it examined various aspects of penile enhancement. But the story lacked any discussion of the study’s limitations, including the methods for choosing studies to review, the homogeneneity of the populations studied and the like. Importantly, none of the studies examined actually compared treatment approaches, and the authors concluded that comparative studies need to be performed.
The story does an adequate job avoiding disease-mongering, explaining that most men who seek penile enhancement are, in fact, quite average. It quotes one of the urologist-authors: “most men complaining of inadequate penile size do have associated sexual problems even if their penile dimensions fall within the normal range — so-called dysmorphophobic penis.” The story also notes this “is a condition consisting of an imaginary flaw in the physical appearance”.
Some authors have addressed the medicalization of dysmorphophobias in general, not the specific “dysmorphophobic penis” referred to in the story:
Given all of the concern about past editions of the DSM (Diagnostic & Statistical Manual – the psychiatry tome that names and categories psychiatric disorders) and the current DSM redrafting underway, the story could have done more on this point. But we’ll give it a satisfactory score, nonetheless, since it at least used terms such as “average…normal… imaginary flaw.”
The story uses independent sources, and we applaud that. We wish that the second independent source quoted had not been a penile enhancement practitioner. The story did not, however, note that the co-author of the study has conducted research for a European company that produces a penile traction device and is a member of the company’s medical advisers (http://www.andromedical.com/medical-committee/committee-members/). This was not included in the conflict of interest statement that was published with the study, but this is a reminder that reporters should perform basic background checks when covering research and quoting experts.
Given that so much of the story comes back to the idea that men don’t really “need” these procedures, it would have been worth discussing whether there are any other ways to help men feel better about their body type or their perceived sexual inadequacy. Obviously people seek therapy for sexual disorders, but that was addressed only briefly: “Gontero noted that cognitive behavioral therapy might help build confidence in some men.” After all of the attention the story gave to medical/physical interventions, the cognitive behavioral work seemed to deserve more attention.
The story suggests but does not makes it clear that many “treatments” are available. It implies that surgical procedures are performed by urologists and plastic surgeons. We would have liked to have seen some additional comments about the availability of and a definition of traction methods. A comment on the frequency of these procedures from one of the plastic surgery societies would have been a good addition.
Besides the comment, “urologists are constantly approached by men concerned about their penis size,” we are not given any idea about how widespread or available are the methods to address these concerns.
And cognitive behavioral therapy isn’t given much attention at all.
Because the story adequately explained that it was reporting on a retrospective review of the medical literature – by definition it was not reporting on novel conclusions – only the overview of past studies.
The story does not rely on a news release.