LAUSR

Since the appearance of the first civilizations in Mesopotamia 12 millennia ago [1], male genitals have been subjects of art, culture, and religion. Priapus, an ancient Greek and Roman deity, is one of the most famous examples of the sexual instinct symbols. Similar to ancient times, the symbology attributed to the penis and the idea that male genitals play a fundamental role in defining male identity are still strong in today’s culture. Therefore penis size and shape are still important concerns for many men [2]. The self-esteem of a man can be jeopardized if he perceives that his genitals size and shape are below the ideal standards. Unfortunately, boosted exposure to sexually explicit Internet material in the recent years [3, 4] has created unrealistic expectations about “ideal penis”. This phenomenon caused sense of inadequacy and discomfort among young men who increasingly feel body dissatisfaction [5]. Several surveys have demonstrated that almost half of adult men are not satisfied with the size of their penises and are willing to have larger ones, even though they met normal parameters from a physical and anatomical point of view [6–8]. Tendency of men to underestimate their penis size and shape in the recent years resulted in an increased demand for penile length [9] and girth [10] enhancement procedures, frenuloplasty (or frenulotomy) [11], scrotoplasty (reconstructive surgery of the scrotum) [12], preputioplasty (surgical correction of foreskin) [13], and glans penis augmentation [14]. Although the majority of men seek male aesthetic genital surgery for self-satisfaction (especially those who are not satisfied with length, girth, or shape of their penises), some others require these procedures for real discomfort caused by congenital or acquired anomalies of the genitals. Of note, female—to—male transgender individuals are commonly seeking sex reassignment surgeries and willing to have a phallus which looks like a real penis as well. Considering the fact that there is not sufficient data about the efficacy and safety of the male genital aesthetic surgeries, healthcare professionals must think twice before applying these procedures. Preliminary psychiatric evaluation is recommended in identifying patients who suffer from “penile dysmorphophobia” which is a type of body dysmorphic disorder [8]. Some of these men may benefit from medical therapy or minimally invasive treatments without the need of invasive surgeries. Surgeons may keep in mind that most of these irreversible surgical procedures may be associated with poor patient satisfaction and serious complications [15, 16]. In this special issue of IJIR: Your Sexual Medicine Journal, worldrenowned experts have shared their experiences regarding male aesthetic genital surgery. Edited by Javier Romero-Otero and Celeste Manfredi, this special issue is exploring the topics related to the surgical and non-surgical interventions for male genital aesthetic procedures, including penile length augmentation, frenuloplasty, scrotoplasty, preputioplasty, glans penis augmentation, vascularized composite allotransplantation of the penis, penile girth enhancement procedures, regenerative treatments, and implants for penile rejuvenation. The authors of this issue underline that men who are willing to undergo aesthetic genital surgeries (especially penile augmentation procedures) usually have normal penile dimensions and may have psychological problems (also known as Penile Dysmorphic Disorder that is classified according to DSM-5 within Body Dysmorphic Disorders) [8]. In particular, concern about penis size could present itself as “small penis syndrome”, when that anxiety becomes excessive. Therefore, an attentive psychological evaluation may be necessary prior to any surgical intervention in the majority of the cases. Moreover, most of the male genital aesthetic procedures are still considered “experimental” and further multicenter studies must be conducted before these surgeries can be routinely recommended. We would like to invite the readers of IJIR: Your Sexual Medicine Journal to read the special issue “New Trend in Medicine: Aesthetic Genital Surgery” which is prepared by the leading experts in this field. With this issue, we encourage the researchers and the surgeons to put more efforts for the development of evidence-based research to enrich the literature and to enhance the clinical knowledge related to genital aesthetics.