posted 29th October 2025
Concerns about the shape, size and condition of your genitals brings up strong emotions: crushing anxiety, sadness, frustration, or hopelessness. Even if others don’t see any problem, the distress feels very real. BDD doesn’t mean you are vain or selfish. It is a mental health condition that causes your brain to focus obsessively on perceived flaws. With genital concerns, the impact is often very severe because this area is tied to identity, sexuality, and intimacy.
If you are living with BDD focused on your genitals, you may feel compelled to check that part of your body repeatedly, looking in mirrors, measuring, taking photos, or touching to see if something has “changed.” Some individuals start potentially dangerous activities designed to change the appearance of their genitals, for example, tugging, stretching or extreme use of devices Some may consider risky surgical procedures such as fat transfer. All of these serve to further compound and entrench their concerns and can carry risks of unintended harm to the genitals.
You may feel unable to have sex, start a relationship, or even undress in front of a partner and you may experience devastating hopelessness about this. You may also conceal your concern from your partner who in turn may misunderstand your avoidance behaviours. Anxiety about the appearance of one’s genitals can make arousal or erections difficult, or cause loss of desire.
People whose partner silently suffers with BDD about their genitals may mistakenly believe that there is another reason for the lack of intimacy in the relationship. In which case frustrations and sometimes relationship breakdowns may occur. Even when they are aware of the situation, lack of intimacy can be extremely challenging within the relationship.
Alternatively the sufferer of genital BDD may engage in compulsive and repetitive reassurance seeking about their genitals which can also cause distress between couples. As with many forms of BDD seeking reassurance can be a significant reinforcing behaviour: asking a partner or doctor if things are “normal,” but never feeling fully reassured.
If you have BDD about your genitals it’s common to engage in comparing your body to others, for example, measuring yourself against images online, in pornography, or against others and often feeling inadequate.
Sometimes BDD develops after trauma, in the case of BDD relating to the genitals, this may be a sexual assault or abuse, a relationship breakdown or difficulties with dating or an accident or injury. The trauma may not be easy to pinpoint, for example a single comment made when you were a vulnerable adolescent or the impact of longstanding low self-esteem.
There is some emerging literature and discussion about the relationship between female genital mutilation / cutting (FGM/C) and body image, self-perception, shame, and possibly BDD or BDD-like features, although this is under- researched and a matter that may be shrouded in secrecy.
BDD relating to genitals can stem from long-term worries about size or appearance that gradually start to dominate one’s thoughts. Such concerns may become more severe because there may be no way to reality test these worries, because genitals are hidden. This may be compounded by comparison with the genitals presented in pornography.
Some people with BDD about their genitals., may indeed have an actual difference. In this case we define BDD not as to whether there is a literal difference in the structure, appearance, function or size of the genitals, but by the distress caused and the degree to which this impacts the individual’s life. Where there is no possible cosmetic or surgical fix, psychological support may be the only path.
For some people, BDD may arise or escalate after surgery to rectify a medical issue such as Hypospadias (repair to correct urethral opening placement), Epispadias repair, (the correction of urethral malformation), or skin grafting or fat replacement following burns, trauma, or tumour removal. Many men with Peyronie’s disease worry about cosmetic appearance, loss of length, or disfigurement as well as experiencing erectile dysfunction, all of these can cause intense shame. Sometimes this overlaps with BDD-like concerns, where the distress about appearance may be greater than the physical impairment.
Another risk category are people seeking Cosmetic / Aesthetic Genital Procedures. Each of the following come with potential for dissatisfaction leading to the onset of BDD but there’s every possibility that people who have BDD may not know that this is the root of their concerns; some may know that they have significant appearance anxiety or BDD and conceal this from surgeons. They then slip through screening for BDD, have the procedure and then experience exacerbated BDD symptoms post operatively. Examples of such surgeries include: Labiaplasty, Clitoral hood reduction, Monsplasty, Penile girth enhancement (which involves fat transfer, dermal fillers, or grafting to increase circumference) and Penile lengthening surgery.
We have encountered individuals, who having had surgery have experienced significant pain, which has created a ‘feedback loop’ whereby the pain prevents them from shifting their attention away from the area of concern. Whilst they suffer from pain emanating from their genitals, that is where they focus.
The good news is that BDD is treatable. Many people recover and go on to live fulfilling, connected lives. However entrenched BDD is not an easily treatable disturbance.
Support may include: talking to a therapist trained in BDD, who can help you manage obsessive thoughts and rebuild self-confidence. Medication is sometimes helpful to reduce obsessive thinking and ease depression or anxiety. Doctors and therapists can work together in multidisciplinary teams to address both physical and emotional needs, this is especially helpful if there is physical trauma, pain, or scarring.
Self-help includes compassionate approaches, learning to relate to your body with kindness rather than criticism and a variety of other trauma focused, somatic (body) therapies.
Talking openly with a partner, a trusted friend, or a support group can reduce shame and isolation. With the right support, it is possible to reduce obsessive thoughts, reconnect with your body, and build closeness in relationships again.
Recovery is not about reaching some idea of “perfect” – it’s about regaining freedom, dignity, and peace of mind and learning that the object of one’s BDD is not all of who we are. We are valuable for who we are, far more than for the attributes of a physical characteristic or body part.