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Small penis anxiety: a case study of its effect on a gay man

Kunelaki, R1

1: Chelsea and Westminster Hospital, London, United Kingdom

Objectives: This is a case study that demonstrates the overwhelming experience that small penis anxiety can have on a gay man. The existing literature mainly focuses on heterosexual men. It is a case of a 25- year- old white –Caucasian man, raised in a Catholic society, who was referred for psychosexual therapy by a specialist (sexual medicine) doctor, who treated his erectile dysfunction with Sildenafil, to address the impact of his anxiety in his sex life. At the time of the assessment, the patient presented with low mood (no suicidal ideation) and sense of self -worth, traits of self- harming behaviour such as ChemSex (sex under the influence of drugs) and barebacking (condomless sex) and he was on antidepressants. The patient presented as too timid and spoke with a low voice. He experienced humiliating comments by other gay men in sex clubs for the size of his penis. The patient was having sex with men he did not find attractive as he perceived they are more likely to accept his penis size. He also occasionally received money for sex which he understood as a way of validation. The goal for the psychosexual therapy was to gain self -acceptance over his penis size and thus sexual confidence.

Methodology: Patient was initially recommended to start a regular mindfulness practice. This approach provided a neutral/safe way to start connecting within his body without pressure. Issues were addressed around masculinity and impact on his existence about his life focus and ways he presents himself. He was advised on creative ways to express himself, such as participating in amateur theatre. Recommendations were also made to address fear, with the practice of martial arts and bibliotherapy.

Result: Lowered alcohol consumption and the use of MDMA (Methylenedioxymethamphetamine) by the end of the sessions. Martial arts helped with expressing his inner voice. Took part in a burlesque (naked) charity event and felt confident about showing his body. He got himself a career that increased his job satisfaction and sense of self-worth. He started PreP (pre- exposure prophylaxis) as a way to manage his condomless sex. He was referred for ongoing psychotherapy.

Conclusion: This case demonstrates that the complexity of gay men’s lives has to be carefully considered when treating a penis size anxiety.


Work supported by industry: no.

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