A client came to the Center for Marital and Sexual Studies for a one time therapy session as requested by Dr. C. The doctor refused, at the time, to do a revision surgery but suggested counseling among other things. Patient set up an appointment with Dr. Marilyn Fithian and Dr. William Hartman while he was in Los Angeles. Upon arrival at the Center, they asked the new client if he would be comfortable with their intern, the researcher, joining them. He had no problem with the new arrangement and seemed anxious to share his problems with someone who is researching penile augmentation surgeries. The therapy session involved an interview and sex history, a sexological exam and body image exercises.
The client was 28 years old, tall, good looking, virgin, and works as a teacher's assistant. He is very intelligent, highly self conscious and extremely critical of his body. The client's presenting problem was poor body image especially regarding the size of his penis and testicles. During the interview portion of our meeting, he had a very difficult time staying focused on the question. He could not answer the straight forward question of why he had a penile augmentation without lecturing us on his entire life history. Dr. Hartman had to interrupt him in order to get back to the issue at hand.
The client's sex history revealed a recent prescription for testosterone shots in order to raise his hormonal levels. He blamed his inactive sex life on his “underdeveloped body and genitals” that had led one woman to flee when she saw him naked. He felt he lacked muscular development and had wide hips. He has never had sexual intercourse but had exchanged sensual caresses with one woman. The client masturbates approximately once every three days.
During the sexological exam, Dr. Fithian and this researcher educated the client on his genitals and assured him that his penis and testicles were average, if not above average, in size. He had undergone a poor penile enlargement, lengthening and autologous fat injections, eight months prior. The fat had since reabsorbed and he was left with a few fatty nodules. The nodules were soft mounds hidden at the base of the penis and were not visible to the eye. The releasing of the suspensory ligament was accomplished with the use of a Y-plasty which left a thick, reddish pink, raised scar that felt like wax. The unsightly scar was very visible through his pubic hair. The client also had a testicular enlargement that involved injecting fat into the scrotum. The fat had almost completely reabsorbed, leaving only a small well hidden nodule at the bottom of the scrotal sac.
During the body image exercises, the client was asked to rate his body on a scale from one to one hundred. As he stared into the large three sided mirror, he proclaimed his body a “55.” When asked what his body lost points for, he claimed 15 points for the unsightly, pubic scar, 10 points for lack of muscles, 10 points for wide hips, and 10 points for penis size.
In one day, the client tripled the number of women who had seen his genitals and both proclaimed that his penis and testicles were above average in size. Even so, he said he planned to have scar revision surgery with Dr. C and possibly a dermal fat graft six months after that. Dr. C had told the client that he must lose his virginity before he would perform any surgical procedure. This may seem like an odd request but it is also perfectly reasonable.
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