Micropenis: Gender, erotosexual coping strategy, and behavioral health in nine pediatric cases followed to adulthood

In nine cases of micropenis followed from pediatric age until adulthood (aged 22 to 31) the adult penis size was 2.5 SD below the mean or smaller, with one exception. Pubertal virilization was inadequate in six cases, in five of which there was also a history of neglecting follow-up and androgen-replacement therapy. In six cases there was a low incidence of erotosexual activity. In three there was a long-term pair-bonded attachment. There was one case of homosexual hustling, one of homosexual pair-bondedness, and one of homosexual attraction frustrated by the concealment of a skin-grafted phalloplasty. In the latter two cases, there was a history of agonizing over the option of possible sex reassignment and contemplating death by suicide. In one other case there was a history of paraphilic sadomasochism, in fantasy only, with a woman victim. The juvenile experience of micropenis in the family, the clinic, and the community may dislocate what should be the normal juvenile erotosexual rehearsal play and fantasy of uncomplicated heterosexual differentiation.