SPECIAL MEDICAL ARTICLE
Arnaud Pontin (Image : AI / Gay Globe)
There are countless forms of dysmorphia that we hear more or less about. The most famous is gender dysmorphia, which refers to a condition in which a person experiences a significant discrepancy between the gender assigned to them at birth and their gender identity. This situation can cause psychological distress, particularly when physical appearance, sexual characteristics, or the way the person is perceived by those around them do not correspond to their lived identity. Such people are then referred to as trans.
Dysmorphia is widely discussed, but the term encompasses several different realities. In everyday language, it is often used to describe a deeply negative perception of one’s own body. In medicine and psychology, however, certain distinctions must be made, because not every concern about appearance necessarily constitutes a disorder.
The best-known form is body dysmorphic disorder, formerly called dysmorphophobia. The person is obsessed with a real or imagined physical defect, sometimes extremely minor or even invisible to those around them. This concern can become overwhelming and lead to repetitive behaviors, such as constantly looking in the mirror, trying to conceal certain parts of the body, or repeatedly seeking medical and cosmetic consultations.
Muscle dysmorphia is another particularly important manifestation. A person may have highly developed muscles while being convinced that they are not muscular enough. This perception can lead to excessive physical training, highly controlled eating, and a constant preoccupation with muscle mass and body appearance.
Other concerns may focus on specific parts of the body. Some people may develop an obsession with their nose, teeth, hair, or skin. They may consider their nose disproportionate, their smile unattractive, their hair insufficient, or their skin excessively imperfect. When these concerns become persistent and cause significant distress, they may fall within the framework of body dysmorphic disorder.
What Is Genital Dysmorphia?
Genital dysmorphia is not, strictly speaking, a distinct diagnosis recognized as such. Rather, it is a dysmorphic preoccupation focused on the genitals, which may fall within body dysmorphic disorder.
The person may be convinced that their genitals are too small, too large, asymmetrical, deformed, or abnormal, even though their appearance is normal or presents only a minor variation. In men, the concern may focus in particular on penis size, its shape, or the appearance of the testicles.
This concern can become particularly overwhelming: comparing oneself with other men, repeatedly viewing pornographic or medical content, frequently checking oneself in the mirror, seeking measurements, avoiding sexual relationships or locker rooms, and resorting to treatments or cosmetic surgery. The problem therefore does not necessarily lie in the organ itself, but in the obsessive perception and the distress it causes.
It must also be distinguished from simple dissatisfaction. Many people may be concerned about the size or appearance of their genitals without suffering from a dysmorphic disorder. Diagnosis is based in particular on the intensity of the preoccupation, the amount of time it occupies, and its consequences for daily life.
What Are the Symptoms?
Concern about the appearance of the genitals can take up a considerable amount of space in some people’s lives. When it becomes persistent, overwhelming, and disproportionate to the physical reality, it may fall within the framework of body dysmorphic disorder, even though “genital dysmorphia” is not a distinct diagnosis recognized as such.
The person may be convinced that their penis, testicles, or entire genital area has an abnormality. They may believe that they are too small, too large, asymmetrical, or different from other men. In some cases, this perception persists even when a healthcare professional confirms that the anatomy is completely normal.
Comparison with others can then become constant. Locker rooms, public restrooms, sexual relationships, or exposure to pornography can reinforce the feeling of not being “normal.” The person may also frequently measure themselves, look in a mirror, or examine their anatomy from different angles in an attempt to determine whether their fears are justified.
This preoccupation can also lead to a constant search for reassurance. A partner or doctor may say that everything is normal, but the relief often lasts only a few moments before the doubt returns. The person may then conduct increasingly numerous searches on the Internet, seek repeated medical consultations, or ask for opinions about the size and appearance of their genitals.
Avoidance is another important manifestation. Some people may avoid sexual relationships, locker rooms, beaches, swimming pools, or any situation in which they might be seen naked. Others may have difficulty being fully present in an intimate relationship because they are constantly focused on what their partner might think about their body.
Over time, this preoccupation can cause significant shame, anxiety, reduced self-esteem, and difficulties in sexual or relational life. The person may feel that the appearance of their genitals determines their worth, masculinity, or ability to be desired.
There is nevertheless an important distinction between occasional dissatisfaction and a genuine dysmorphic problem. Many people may have insecurities about their bodies without suffering from a disorder. What characterizes dysmorphic preoccupation above all is its obsessive, repetitive, and overwhelming nature, as well as the consequences it has on daily life.
A genuine change in the appearance of the genitals, pain, a lump, a new deformity, or any other unusual change should not automatically be attributed to dysmorphia. In such circumstances, a medical evaluation is necessary to rule out an actual physical condition.
How Is Male Genital Dysmorphia Treated?
Treatment first depends on what is meant by “dysmorphia.” When a man is deeply concerned about the size or appearance of his penis or testicles even though the anatomy is normal or has only a minor variation, this is generally referred to as genital dysmorphic preoccupation, which may be part of body dysmorphic disorder.
Treatment therefore does not necessarily involve changing the organ. Rather, the goal is to change the relationship the person has with their body image.
Psychotherapy, particularly cognitive behavioral therapy (CBT), is generally one of the most important approaches. It helps identify obsessive thoughts about the body, constant comparisons, mirror checking, or avoidance behaviors. The patient gradually learns to reduce these behaviors and question the beliefs that maintain their anxiety.
In some situations, a doctor or psychiatrist may also consider medication, particularly certain antidepressants in the SSRI family. They may be used in the treatment of body dysmorphic disorder, particularly when obsessive symptoms are significant. The choice of medication and dosage must, of course, be determined individually by a healthcare professional.
It is also important to conduct an initial medical evaluation. Before concluding that dysmorphia is involved, a doctor can determine whether there is an actual anatomical, hormonal, dermatological, urological, or sexual problem. This step can also help reassure the patient through objective findings rather than simply through comments about their appearance.
Interventions aimed directly at changing the penis, such as certain cosmetic surgeries, injections, or enlargement techniques, should be approached with great caution when dysmorphia is suspected. An intervention may not resolve the concern and, in some cases, the person may simply transfer their anxiety to another physical characteristic.
Treatment can therefore be particularly effective when it combines medical evaluation, psychotherapy, and, when necessary, pharmacological treatment. The goal is not to convince the man that he is “beautiful” or that his body is perfect, but to ensure that the appearance of his genitals no longer occupies a disproportionate place in his life.
If this concern leads to avoidance of sexual relationships, repeated consultations, compulsive measurements, or significant distress, it would be appropriate to discuss it with a doctor, psychologist, or psychiatrist familiar with body dysmorphic disorder.
Quebec
In Quebec, a first step can be taken by contacting Info-Social 811, option 2, which allows people to speak free of charge and confidentially with a psychosocial intervention professional. The service is available 24 hours a day and can direct the person to appropriate resources.
Gouvernement du Québec — Mental Health
The Primary Care Access Point (GAP) can also direct people who do not have a family doctor to appropriate health or psychosocial services.
To find a psychologist, psychotherapist, or other professional, Quebec’s public healthcare network is also an entry point. The government recommends CLSCs, family doctors, and mental health professionals in particular.
Canada
In Canada, the CAMH — Centre for Addiction and Mental Health, in Toronto, is an important medical resource concerning obsessive and related disorders. CAMH classifies body dysmorphic disorder among conditions related to obsessive-compulsive disorder and describes excessive concerns about appearance as well as the repetitive behaviors that may accompany them.
CAMH — Centre for Addiction and Mental Health
For Canadians, the International OCD Foundation (IOCDF) is also a particularly useful resource because its directory allows people to search for therapists, clinics, programs, and support groups specializing in BDD, including outside the United States.
IOCDF — Body Dysmorphic Disorder
United States
In the United States, one of the most important resources is the International OCD Foundation, which has an entire section devoted to Body Dysmorphic Disorder. Its directory allows people to search for specialized professionals and programs. The foundation also emphasizes that effective treatments include cognitive behavioral therapy and certain medications.
The BDD Foundation is also a major international resource. Although it is based in the United Kingdom, it provides information, educational resources, support groups, and tools for people living with body dysmorphic disorder around the world.
Europe
In the United Kingdom, the Body Dysmorphic Disorder Foundation is probably the most directly relevant European resource. It offers an email helpline, support groups, and information about accessing BDD treatment through the NHS. It also provides advice on finding a therapist specializing in the disorder.
BDD Foundation — Support in the UK
The foundation also has a general resources section containing self-assessment tools, books, personal stories, expert videos, and the Beating BDD podcast.
For continental Europe, the IOCDF is particularly useful because its network includes international partners and its directory allows people to search for specialized resources beyond the United States.
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