Method for locating participants and doctors.
Advertisements and articles for and about doctors who perform penile enlargements were found in a variety of magazines and newspapers. Penthouse and Playboy often run large ads. In the Los Angeles Times sports section, a variety of local doctors can be found sporting their unproven results. A letter of intent and explanation was sent internationally to urologists and plastic surgeons who have performed penile augmentation surgeries. The letter asked for the doctors' cooperation in distributing the research questionnaire to benefit the field of sexology and urology. The letter was accompanied with a copy of the questionnaire for their perusal and a request for any comments or suggestions they may have.
After two weeks, the researcher called or faxed each doctor to see if they had any questions or comments regarding the questionnaire and to persuade them to accept the responsibility of distribution. Some doctors did not feel that they could participate because they felt it may breach the confidentiality of the patient.
The doctors who agreed to help with distribution were sent a package that contained the desired number of questionnaires, each with an attached cover letter, a stamped return envelope addressed to the Center for Marital and Sexual Studies, all in a non-addressed five by seven inch envelope. Postage stamps were placed on the envelope by the researcher in order to save any costs for the doctors and make distribution as easy as possible. Each side of the 5 x 7 envelope was stamped with a red "Personal and Confidential" imprint. This was done to protect the privacy of each patient. Foreign based patients were sent an international coupon for return postage to the United States.
The subjects were asked by their doctor or doctor's staff in person, usually in the doctor's office or waiting room, or through a mailing that included a cover letter on the doctor's letterhead and a questionnaire, if they would be willing to participate in this study. The two means of contacting subjects indicates that there may be a variation in answers due to the way they found out about the study. The men who agreed in person to fill out the nine page questionnaire were very helpful and would possibly have returned the questionnaire if it was sent to them.
Qustionnaire development
A pilot questionnaire was given to three men who had not undergone a penile enlargement surgery to determine how long it would take to fill it out and to uncover any ambiguity. One man had planned on getting a penile enlargement but declined just prior to doing so because he claimed he felt uncomfortable in the doctor's office. A few changes were made, some questions being combined and others being added to fill potential gaps in the research.
The revised questionnaire was then sent to a few doctors and other active people in the field of penile augmentation to be distributed as the pretest. The pretest included five respondents. A personal note was sent along with each batch of questionnaires to inform the patients to feel free to write any suggestions or misunderstandings directly on the questionnaire. The returned questionnaires served as an additional pilot study to make sure that the questions were understandable to the general population.
The pilot study consisted of five returned questionnaires. Three were obtained at the offices of Dr. Gary Rheinschild whose staff allowed me to give the questionnaire to men who were about to undergo a revision surgery that was originally done by other doctors. The other two questionnaires were returned via U.S. Mail to the Center for Marital and Sexual Therapy. Overall, the answers were quite diverse. The pilot study revealed the need for some alteration in questioning and the addition of new questions. The new questions dealt with other enhancing procedures used, the importance of length or girth, acquaintances who have undergone or are considering penile augmentation and any other elective surgeries they have considered.
Questions about the patient's prime motives and deciding factors regarding the surgery were combined into a simple, more direct question asking why they had undergone penile augmentation surgery. Their answers were compared to Roos and Lissoos' results from their study in 1994. Questions regarding dates of past penile surgeries were altered to incorporate men who have had multiple surgeries with different doctors. The question regarding counseling in relation to penis size was altered to read, "What percentage of the counseling time was spent regarding penis size?" This will allow for a numerical response versus the simple "yes" or "no" requested previously.
The revised penile augmentation questionnaire (Appendix
1) is composed of 92 items. The questionnaire was designed to
gather data on eight broad variable categories:
(1) Biographical and Demographic - 21 items
(2) Physical characteristics and Health - 5 items
(3) Sexual Preference and Sexual Education - 6 items
(4) Surgical Procedure (including Effects of) and Medical Professionals
- 26 items
(5) Mental State and Self Concept - 8 items
(6) Sexual Satisfaction and Sexual Interactions - 2 items
(7) Type and Frequency of Sexual Behaviors - 14 items
(8) Specific Body Traits (Genital) - 10 items
Securing a Sample
Twelve doctors or other professionals involved with penile augmentation surgeries had responded positively to the idea of a research study in their field. (They are identified in this paper by letter only, to preserve their confidentiality, and that of their patients.) They approved the questionnaire that was sent to them and requested between five and two hundred packets to pass or send to their patients or clients. The researcher was planning on advertising in magazines and newspapers but the doctors' requests for questionnaires were overwhelming and soon after the U.S. mail was delivering a returned questionnaire about once a day to the Center for Marital and Sexual Studies. No advertisements were ever bought.
In order to obtain as unbiased a sample as possible, the researcher distributed to a one hundred percent sample from Dr. C. with the help of his staff. Dr. A and the researcher decided to distribute to all patients who had a penile enlargement during two separate full months except those who had specifically requested not to be contacted again. The months that were chosen were exactly one year prior to the time of distribution. It was assumed that after one year the patient will have recovered fully and will have resumed normal sexual patterns.
According to fifty-six responses, the average amount of time since surgery was 12.2 months.
Approximately six hundred questionnaires were distributed and fifty-eight questionnaires were returned by the researcher's cut-off date. The return rate was 9.7%.
Confidentiality
The questionnaires were coded according to how they were acquired but remained completely anonymous. The coding included the initials of the doctor and the number of the questionnaire as it is returned. The confidentiality of the doctor is also important. The purpose of this study is not to make any doctor stand out but to understand the surgery. The doctors will be able to review their patient's anonymous results along with the final results of the entire study.
Respondents were advised on the questionnaire to call the Center for Marital and Sexual Studies and leave their address if they wished to be sent results. They were then told to send a formal written request separate from their respective questionnaire. Some respondents did not read the instructions and obviously had no regard for their own privacy because they wrote their full address and desire for results right on the last page of their questionnaire.