SUMMARY :
A survey questionnaire completed by 39 users of penile prosthesis shows that
complaints related to the size of the implanted penis involve a decrease in
satisfaction towards the prosthetic device.
However, a reduced penile size is not necessary considered as a problem by all
patients.
Beyond functional considerations, the disappointment concerning the length of
the penis is mostly related to the representation of a virility debased by the
notions of artifice and assistance which are associated to the penile implant.
Strong correlations are actually reported between a lower satisfaction, complaints
related to the length of the implanted penis, feelings of shame, a lower self-esteem
due to the idea of an "artificial virility" and a trend to attribute
a negative attitude towards penile implant to the partner. On the whole, these
variables appear to be the expression of a global castration experience that
makes the psychosexual assimilation of the prosthesis rather precarious. This
castration experience is derived from a certain representation of male erotic
quality which requires long, natural and spontaneous erections. From this point
of view, the injurious impact of reduced erections seems inseparable from an
injurious representation of prosthetic sexuality globally perceived as a “parodic”,
“reduced” virility.
It is remarkable that none of these variables correlates with the partners'
actual opinions concerning prosthesis and sexuality permitted by penile implant.
Parallel questionnaires completed separately by 27 partners show that part of
the men's injurious representation partakes of projective mechanisms.
Such observations underline the relevance of a psychosexological approach of
the couple in addition of the surgical approach.