The impact of male genital self-image on depression, anxiety and sexual functions

Abstract

Aim

This study aims to examine the relationship between male genital self-perception and sexual functioning and depression anxieties.

Method

The study included male patients who were referred to the andrology outpatient clinic between March 2022 and June 2022. Demographic data of the patients were recorded. Cigarette and alcohol consumption was also noted. The Male Genital Self Image Scale (MGSIS) questionnaire was used for the Genital Self Image(GSI) assessment, which consists of 7 questions. The International Index of Erectile Function (IIEF), composed of 15 questions, was used to evaluate sexual function. STAI-I, STAI-II, and BECK scales were used for depression and anxiety. The penis size of the patients was measured in a flask and stretched condition, and the midpenile circumference was recorded. Patients were compared with respect to GSI, depression, anxiety, and sexual functioning.

Results

A total of 75 patients were included in the study. The mean age of the patients was 46.69 ± 11.32 (26–72), and the mean BMI was 27.82 ± 3.79 (22.46–40.40) kg/m². A slightly positive correlation was found between the patients’ flask penis size and MGSIS-total scores (r = 0.260, p = .024) and IIEF-SF scores (r = 0.240, p = .038). There was a moderately positive correlation between the stretched penis size and IIEF-OS (r = 0.403, p < .001) and IIEF-SF (r = 0.354, p = .002). While the MGSIS-total score and the STAI-I and STAI-II scores had a moderate negative correlation, there was an advanced negative correlation between the MGSIS-total score and the BECK score.

Conclusion

Disruption of men’s genital self-perception is moderately related to their susceptibility to depression and anxiety. This situation affects the person’s sexual performance and causes orgasm problems to increase.

Keywords:

• Male genital self-image
• orgasm
• erection
• penis size
• penis thickening

Introduction

Body image is an important component of quality of life and is associated with the satisfaction one feels from one’s own body [1]. A negative body image can lead to depression, low self-esteem, anxiety, social isolation, and decreased sexual activity [2]. In some men, the size and appearance of the penis may be necessary for self-confidence and is considered an important factor for pleasure received during sexual activity [3]. While several studies have tried to reveal the aspects related to penis size, there is a limited number of studies available on men’s genital self-perception.

The genital self-image (GSI), which is an important part of body image and a significant matter in terms of sexuality, consists of the attitudes and behaviors related to the genitals of the person [4]. It has been observed that the pleasure received during sexual intercourse changes with this self-perception. It is thought that dissatisfaction with the genital appearance reduces a person’s sense of pleasure. A strong genital self-perception preserves sexual function, while a poor perception can lead to sexual dysfunction and even sexual unresponsiveness [5]. A previous study has found a significant relationship between GSI and sexual performance, frequency of sexual intercourse, and quality of orgasm [6].

Several questionnaire forms have been developed for GSI measurement. These include the female genital self-image scale, the genital perception scale, the genital self-image scale, and the male genital self-image scale [7,8]. Although many forms are related to the genital appearance of women, it is also considered appropriate for men to use before hypospadias surgery and before penile prosthesis implantation [9,10]. Recently, due to the fact that men who are not satisfied with their penis length seek penis extension and thickening operations, these forms are used to evaluate these patients objectively [11]. Most of the studies available are about women; however, more recently, studies about men have also appeared in the literature [12].

With GSI, a person’s quality of life can change. Although there are studies showing the impact of GSI reduction on sexual functioning, there are no studies examining the depression and anxiety conditions of these patients. This study aims to examine the correlation between male genital self-perception and sexual functioning and depression concerns and the consequences of this correlation.

Materials and methods

The study included male patients who applied to the Andrology outpatient clinic between March 2022 and June 2022. The ethics board approval for the study was obtained from the ethics committee of Izmir Katip Celebi University (no: 70/2022). The study has been designed in accordance with the Declaration of Helsinki, with written consent obtained from each participant.

Patients with a previous history of pelvic surgery, patients who had undergone penis enlargement or thickening surgery, patients with previously registered psychiatric disorder, and patients who refused to participate in the study were excluded from the study.

Demographic data of the patients were recorded. Smoking and alcohol consumption was also noted. The Male Genital Self Image Scale (MGSIS) questionnaire was used for the GSI assessment, which consists of 7 questions. The International Index of Erectile Function (IIEF), composed of 15 questions, was used to evaluate sexual function. BECK questionnaire was completed for the scale of depression, and while STAI-I and STAI-II questionnaires were filled to evaluate anxiety.

The penis size of the patients was measured as standard by a single urologist at appropriate room temperature (21 °C). First, the flask penis size was measured using a flexible ruler, from the pubic symphysis to the tip of the glans penis. Then, after stretching the penis 3 times, stretched penis length was measured again from pubic symphysis to the tip of the penis. Penis circumference was measured from the midpenile region and measurements were recorded [12].

MGSIS is a validated test that consists of 7 questions and measures men’s genital self-perception. The total score obtained from the test prepared on the four-Likert scale is obtained by the sum of the scores from 7 questions [13]. The higher the score received, the higher the male genital self-perception. Its language validation was done by Kocak et al. [14]. The MGSIS correlation coefficient was considered to be mild up to 0.3, moderate between 0.3 and 0.5, and high from 0.5 to 0.7.

The IIEF is a questionnaire of male sexual function with 15 questions and different subdimensions [15]. The total score obtained from questions 1–5 and 15 yields the erectile function (EF) score, and other sub-dimensions such as sexual function (SF), orgasmic function (OF), sexual satisfaction (IS), and overall satisfaction (OS) are evaluated.

For depression, the BECK depression scale was used with 21 questions [16]. The higher the number of points obtained from the questions, the higher the degree of depression.

For anxiety, STAI-I and STAI-II tests were performed [17]. Higher scores from the questionnaires were high was considered to indicate anxiety.

Statistical analysis

Statistical analysis of the study was done with SPSS 25.0 (IBM, Armonk, USA). It was planned to include at least 70 patients in the study by calculating at least 10 times the number of items in the questionnaire. The case distribution was assessed with the Kolmogorov–Smirnov test. Average, standard deviation, minimum-maximum and percentage values were used. Pearson’s correlation test was applied to evaluate relations. Significant p-value was taken as <.05.

Results

A total of 75 patients were included in the study. The mean age of the patients was 46.69 ± 11.32 (26–72), and the mean BMI was 27.82 ± 3.79 (22.46–40.40) kg/m². In total, 80% of the participants were married and 40 were smokers.

Under the same suitable conditions and measured by a single urologist for each patient, the average flask penis length of the patients was 8.67 ± 2.16 (5–13) cm, stretched penis length average was 11.68 ± 2.34 (7.70–16.2) cm, and mid penile circumference average was 6.53 ± 1.18 (4.5–9.2) cm (Table 1).

Table 1. Demographic characteristics.

		Mean ± SD	Min-Max	n	%
Age		46.69 ± 11.32	26–72
BMI		27.82 ± 3.79	22.46–40.40
Marital Status	Single			15	20
	Married			60	80
Chronic Disease	No			47	62.7
	Yes			28	32.3
Surgery	No			67	89.3
	Yes			8	10.7
Smoking	No			35	46.7
	Yes			40	53.3
Alcohol	No			63	84
	Yes			12	16
Penis Length(Flask)		8.67 ± 2.16	5–13
Penile Length(Streched)		11.68 ± 2.34	7.70–16.2
Penile girth		6.53 ± 1.18	4.5–9.2

The MGSIS total score mean of the patients was 15.75 ± 3.80, IIEF-EF mean was 17.09 ± 8.52, IIEF-IS mean was 7.43 ± 4.12, IIEF-OS mean was 6.37 ± 3.05, IIEF-SF mean was 6.60 ± 2.21 and IIEF-OS mean was 4.49 ± 2.79. In addition, the BECK depression scale average score was 14.05 ± 8.58, the STAI-I average was 50.57 ± 10.55, and the STAI-II average was 48.21 ± 9.56 (Table 2).

Table 2. Mean and standart deviation of the questionnaires.

	Mean	Std. Deviation
MGSIS-Total	15.75	3.796
IIEF-EF	17.09	8.522
IIEF-IS	7.43	4.124
IIEF-OS	6.37	3.053
IIEF-Cİ	6.60	2.206
IIEF-OS	4.49	2.792
BECK	14.05	8.577
STAI-I	50.57	10.554
STAI-II	48.21	9.564

A slightly positive correlation was found between the patients’ flask penis size and their MGSIS-total score (r = 0.260, p = .024) and IIEF-SF score (r = 0.240, p = .038). There was a moderate correlation between flask penis size and IIEF-OS.

Also, there was a slightly positive correlation between the patients’ stretched penis size and their MGSIS-total score (r = 0.237, p = .041), IIEF-EF (r = 0.297, p = .010), and IIEF-SF (r = 0.232, p = .045). There was a moderately positive correlation between the stretched penis size and IIEF-OS (r = 0.403, p < .001) and IIEF-SF (r = 0.354, p = .002) (Table 3).

Table 3. Relationship between penile measurements and MGSIS, IIEF, BECK, STAI-I and STAI-II questionnaires.

		MGSIS-Total	IIEF-EF	IIEF-IS	IIEF-OS	IIEF-Cİ	IIEF-OS	BECK	STAI-I	STAI-II
Penile Length-Flask	r	0.260*	0.207	0.139	0.350**	0.240*	0.086	0.047	−0.091	0.104
	p	.024	.074	.234	.002	.038	.465	.691	.438	.376
Penile Length Streched	r	0.237*	0.297**	0.232*	0.403**	0.354**	0.189	−0.055	−0.175	0.072
	p	.041	.010	.045	.000	.002	.104	0640	.134	.537
Midpenile Girth	r	0.305**	0.177	0.064	0.181	0.193	0.131	−0.121	−0.262*	0.040
	p	0.008	.129	.587	.119	.098	.263	.300	.023	.732
MGSIS-Total	r	1	0.299**	0.207	0.312**	0.120	0.358**	−0.533**	−0.432**	−0.432**
	p		.009	.074	.007	.305	.002	.000	.000	.000

Bold values are statistically significant and p < 0.05.

While a moderate positive relationship was found between the penis circumference and the MGSIS-total score (r = 0.305, p = .008), there was a slightly negative correlation with the STAI-I (Table 3).

The MGSIS-total score and the STAI-I and STAI-II scores had a moderate negative correlation, and there was an advanced negative correlation between the MGSIS-total score and the BECK score (Table 3).

Discussion

At the end of the study, it was observed that as the flask and stretched penis length decreased and the penile circumference decreased, there was a decrease in the MGSIS score. This condition affects sexual functioning, especially the orgasmic functions. In particular, the level of the midpenile circumference has been shown to be associated with anxiety. The thoughts that patients develop about their genital image are associated with depression and anxiety.

When men see their genital organs as sufficient with no complaining, this contributes to a non-deteriorated quality of life [18]. They also do not experience difficulty because of their self-confidence during sex [19]. Their most affected organ in the genital area is the penis. Many studies have shown that men who are not satisfied with their penis do not like the thickness of their penis [20,21]. In our study, it was found that as the penis thickness decreased, the perception of GSI decreased, and this was associated with the problem of erection and orgasmic dysfunction.

One’s being at peace with their genital area includes the satisfaction of the partner. It is known that individuals with adequate GSI enjoy sex more and reach satisfaction more easily [22]. People who have problems with GSI particularly have difficulty reaching orgasm. In our study, it was observed that as both penis length (flask and stretched) and penile circumference decreased, there was an impairment in orgasmic function in individuals.

MGSIS, which is a very useful and conveniently administered test for the evaluation of GSI in men, can inform the clinician in many ways [13]. Depending on the decrease of the total score from MGSIS, the person may develop feelings such as inability to satisfy the sexual partner, shame, contempt, etc. [14]. This condition causes increased depression and anxiety and, consequently, sexual dysfunction. In our study, as the MGSIS score decreased, depression and anxiety states in patients increased moderately. The relationship between these two conditions affects a man’s sexual performance, reduces his satisfaction with sex and causes him to have difficulty reaching orgasm. Especially when evaluating male sexual health, one’s self-perception and the results of this perception should also be evaluated. The findings obtained in our study also support this conclusion.

Limitations

There are certain limitations to this study. The first is that the female partners of the patients were not evaluated. Studies in which female partners will be included may be useful to ensure partner participation and obtain more objective interpretations when examining sexual life. In addition, only heterosexual men were evaluated in the study. Homosexual men were not evaluated. The small number of patients participating in the study is another limitation. Again, the number of partners, fantasies, and masturbation habits can be examined in further studies with respect to sexual evaluation. Despite all such limitations, our study shows that men’s perception of GSI, depression anxiety, and sexual function are impacted, and will shed light on future studies.

Conclusion

As men’s genital self-perception deteriorates, their susceptibility to depression and anxiety increases. This condition affects a person’s sexual performance and causes increased orgasmic problems.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.