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State of the Art in Phalloplasty

Introduction: After Sigmund Freud “opened the bedroom door,” significant shifts in social attitudes, behaviors, and institutional regulations concerning male and female body images and the understanding of human sexuality began to occur. Today, male cosmetic genital enhancement surgery, or phalloplasty, has become the subject of recent surgical achievements that are gaining significant popularity in the United States and abroad. Appropriate methodology and surgical techniques have been developed to fulfill the demand in this field of cosmetic surgery. The objective of this study is to review the state of the art in phalloplasty and provide information about the availability of the techniques to the medical community and the public to inform them of surgical treatments that may improve unsatisfactory sexual performance, relationships, intimacy, and love by increasing the size of a man's penis. Material and Methods: Two surgeons performed phalloplasty on 594 patients at multiple surgical facilities over a 2-year period. Phalloplasty procedures include penile lengthening, penile girth enhancement, dual augmentation (combined lengthening and girth enhancement), penile glanular enhancement, scrotal web resection, and reconstruction. The patients' own satisfaction with the results of their surgeries was analyzed by using the Penis Image Assessment Scale Questionnaire. The assessment was based upon questions related to penis size, satisfaction of sexual experiences, and the psychological perspective of patients regarding their penises before and after phalloplasty. Results: Patient scores on the Penis Image Assessment Scale Questionnaire were higher before surgery (almost twice as high) than they were after surgery, showing an increase in patient satisfaction with penis size and performance after enhancement. Seventeen patients required subsequent surgery to treat local infection. Twenty-nine patients experienced localized swelling 3–7 days after surgery. The results showed enormous patient satisfaction with the cosmetic surgical procedures performed. Discussion: Penis size has always symbolized strength, virility, power, and domination in relationships. Although this subject was taboo some years ago, today many men are interested in learning about how phalloplasty may improve their self-confidence, sexual relationships, and female partners' satisfaction. Consequently, phalloplasty has acquired wide acceptance and tremendous popularity.