Penis size and enlargement surgery

A glance though the small ads in men's magazines will reveal the following 'treatments' on offer:

• vacuum 'developers'
• weights that attach to the penis to stretch it
• magnetic or electrical devices to stimulate penis growth
• 'hormone' therapy, sometimes containing testosterone or related sex hormones (steroids)
• remedies that contain assorted herbs from around the world.

Vacuum devices and weights may produce very small, short-term increases in size, simply because the penis is elastic and can be stretched. However, like an elastic band, it snaps back with time.

More worrying are private clinics that advertise penile augmentation (enlargement) procedures, and make extravagant and misleading claims about their results. Surgery can be of benefit to some men, but certainly not all of them.

Current cosmetic surgical procedures are largely unproven by research, unreliable in their benefits, and may carry the risk of serious complications. Urologists generally consider this type of surgery to be still experimental in nature, and not a standard procedure.2 Seek advice from a trusted doctor, such as your GP or local urologist, about the nature and standards of the clinic before asking for a consultation.

Surgical treatment
Since 1971, penile-lengthening surgery has been offered to men with severe shortening due to congenital abnormalities (abnormalities present from birth), surgery (for penile cancer or Peyronie's disease) or trauma (accidental or deliberate amputation).

Cosmetic surgery to increase penile girth, or thickness, began in the USA in the late 1980s.

Techniques for cosmetic lengthening were described in 1990. More than 10,000 men have had such surgery, but reliable information about results and complications have not been published in a peer-reviewed journal (a journal where the quality and content of the research is checked by independent experts). Given the number of operations performed, this fact is both astounding and worrying.

Penile lengthening: the most common technique to lengthen the penis is to cut its suspensory ligament then perform plastic surgery to provide additional skin to cover its new length. The results are difficult to judge, as surgeons have not collected data in a systematic manner. The results of the only reliable study indicate that dividing the suspensory ligament alone results in an average increase of 0.5cm (around 0.25in) in length, while skin advancement increases the length gain to 1.6cm (around 0.75in). These figures do not compare well with the claims made by some clinics.

The suspensory ligament does have a role, in that it helps keep the penis pointing upwards during erection. After it has been divided, that support is no longer present. After surgery, some men find that they have gained a small increase in flaccid length, but the erect penis is about the same size and now points towards the floor!

Increasing penile girth (thickness): this treatment may be performed with a lengthening procedure or on its own. There are two techniques in common use:

• injection of liposuctioned fat, from the abdominal wall or thighs, into the dartos fascia, under the skin of the penile shaft.
• placing grafts of dermis (a layer of tissue from under the skin surface that is well supplied with blood vessels) and fat from the groin or buttock area within the penile shaft.

Complications following surgery
At least one person has died from bleeding after augmentation surgery. Apart from the risks of infection and bleeding, specific complications exist for each procedure.

Lengthening procedures

• Scrotalisation of the penis, in which the penis appears to arise from the scrotum instead of the abdominal wall.
• 'Dog-ears' at each end of the operation scar.
• Sloughing of the skin used to increase penile length (the skin has a poor blood supply and therefore dies, leaving a deep, ulcerated area).

Girth-increasing procedures

• Loss of girth due to fat reabsorption.
• Nodule formation, if the implanted fat does not disappear uniformly. The penis can be left with a deformed appearance, with irregular fatty lumps all over it.

Conclusions
Some men are severely anxious about their penis size and are prevented from enjoying a normal life as a result.

Men who are born with a small penis may benefit from surgical treatment, but the results are unpredictable. Without surgery, many will still be able to enjoy very satisfactory sexual relationships despite the small size of their penis.

Men that are dissatisfied with the appearance of their penis should think very carefully before requesting cosmetic surgery, especially if the size falls within the normal range.

A better option may be to seek the advice of a sexual and relationship therapist, who might be able to offer help and advice.

Using surgery to treat a psychological problem is fraught with risks. If surgery is the only way in which a man can regain his self-esteem and improve his self-image, they should seek advice from an experienced surgeon working in a reputable clinic.

Men should ask very carefully about the procedures that are offered, the surgeon's results and any possible complications.

They would also be wise to ask another trusted medical adviser for their view.

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