Penis enlargement

Technique aimed to increase the size of a human penis

Not to be confused with erection.

Penile enlargement procedures are designed to increase the size of the cavernous cylinders of the penis or to stimulate blood flow to increase hardness.

Penis enlargement, or male enhancement, is any technique aimed to increase the size of a human penis. Some methods aim to increase total length, others the shaft's girth, and yet others the glans size. Techniques include surgery, supplements, ointments, patches, and physical methods like pumping, jelqing, and traction.

Surgical penis enlargement methods can be effective; however, such methods carry risks of complications and are not medically indicated except in cases involving a micropenis. Noninvasive methods have received little scientific study, and most lack scientific evidence of effectiveness. However, limited scientific evidence supports some elongation by prolonged traction.[1] Some quack products may improve penis erection, mistaken by consumers for penis enlargement.

## Surgical methods

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Such advertisements are common in South Africa.

There are several surgical penis enlargement treatments, most of which carry a risk of significant complications.[2] Procedures by unlicensed surgeons can lead to serious complications.[3]

Surgical penis enlargement methods include penile augmentation and suspensory ligament release. Penile augmentation involves injecting fat cells into the penis or grafting fat cells onto the penis. Injecting fat cells into the penis can cause swelling and deformity; in some instances, removal of the penis may be necessary. Grafting fat cells onto the penis can be effective; however, the increase in size may disappear over time. Suspensory ligament release increases flaccid penis length, but does not increase the length of an erect penis[4] and can create problems with sexual function.[5]

The American Urological Association (AUA) and the Urology Care Foundation "consider subcutaneous fat injection for increasing penile girth to be a procedure which has not been shown to be safe or efficacious. The AUA also considers the division of the suspensory ligament of the penis for increasing penile length in adults to be a procedure which has not been shown to be safe or efficacious."[6] Both statements were first published in January 1994 and re-affirmed ever since.[6] Complications from penis enlargement procedures include scarring that may lead, ultimately, to penis shrinkage or erectile dysfunction.[7][8]

Other surgical treatments include the injection of dermal fillers, silicone gel, or PMMA.[9][10] Dermal fillers are also not approved by the US Food and Drug Administration (FDA) for use in the penis.[11] Injectables such as hyaluronic acid and polyactic acid have shown some limited efficacy, however the Sexual Medicine Society of North America (SMSNA) "strongly recommends against" permanent fillers such as paraffins and silicone.[12]

Because of great risk and uncertainty, medical professionals are generally skeptical of penile enlargement and avoid attempting it.[8][13] A 2019 study in Sexual Medicine Reviews found that surgical methods of penis enlargement are typically ineffective and can be damaging to both physical and mental health.[14] The authors found that such treatments are "'supported by scant, low-quality evidence... Injectables and surgery should remain a last option, considered unethical outside of clinical trials'".[15] According to the study, "'overall treatment outcomes were poor, with low satisfaction rates and significant risk of major complications, including penile deformity, shortening, and erectile dysfunction'".[14]

Medical doctors do treat micropenis with surgical procedures.[5] In such cases, surgery can improve urinary or sexual function.[16]

## Supplements

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Penis-enlargement pills, patches, and ointments are sold online. Such products are generally considered ineffective.[17]

## Physical techniques

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Physical techniques involve extension devices, hanging weights, and vacuum pressure. There is also significant overlap between techniques intended to enlarge the penis and techniques intended to achieve other, related objectives, such as reversing impotence, extending the duration of erections, or enhancing sexual climax.

### Pumping

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A water-based penis pump

Commonly called a "penis pump", a vacuum erection device, or VED, creates negative pressure that expands and thereby draws blood into the penis.[18][19] Medically approved VEDs, which treat erectile dysfunction, limit maximum pressure, whereas the pumps commonly bought by consumers seeking penis enlargement can reach dangerous pressure, damaging penis tissue.[20] To retain tumescence after breaking the device's airtight seal, one must constrict the penis' base, but constriction worn over 30 minutes can permanently damage the penis and cause erectile dysfunction.[21] Although vacuum therapy can treat erectile dysfunction sufficiently to prevent penis deterioration and shrinkage,[19] clinical trials have not found it effective for penis enlargement.[22][23]

### Jelqing

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The latinized name "jelqing" is the corrupt form derived from the Persian jalq zadan (جلق زدن), jalq meaning "to masturbate" followed by an auxiliary verb zadan meaning "to strike, hit or throb". Performed on the halfway tumescent penis, jelqing is a manual manipulation of simultaneous squeezing and stroking the shaft from base to corona. Also called "milking",[24] the technique has ancient Arab origins.[25] Despite many anecdotal reports of success, medical evidence is absent.[26] Journalists have dismissed the method as biologically implausible,[27] or even impossible, albeit unlikely to seriously damage the penis.[28] Still, if done excessively or harshly, jelqing could conceivably cause ruptures, scarring, disfigurement, and desensitization.[26][27]

### Traction

[edit]

Main article: Penis extender

One type of traction device

Traction is a nonsurgical method to lengthen the penis by employing devices that pull at the glans of the penis for extended periods of time. As of 2013, the majority of research investigating the use of penile traction focuses on treating the curvature and shrinkage of the penis as a result of Peyronie's disease, although some literature exists on the effects on men with short penises.[29]

Scientific evidence supports some elongation by prolonged traction.[1] There are also medical studies that indicate that the lengthening effects can be negligible.[30]

## Society and culture

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Some doctors say that most men seeking penis enlargement have normal-sized penes, and many may experience penile dysmorphophobia by underestimating their own penis size while overestimating the average penis size.[16]

Products purported to enlarge one's penis were frequently promoted via spam email in the late 1990s and early 2000s.[31] In 2003, a log file from an e-commerce site used by one such spammer was accidentally exposed on the public Internet. It showed that they received around 6,000 orders for their herbal supplement product "Pinacle"  [sic] in a period of four weeks, with most orders being for $100 worth of product. The US Federal Trade Commission said at the time that "there is no proof the pills work as advertised".[32]

In 2013 in Vietnam, many Vietnamese men attempted to enlarge their penises by injecting liquid silicone into them. They were hospitalized for complications such as infections, necrosis, tumors, swelling, deformities, and sexual dysfunction.[33]

## See also

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* Clitoral enlargement methods
* Penis reduction
* Peyronie's disease
* Plastic surgery
* Tissue expansion

## References

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1. ^ a b Oderda M, Gontero P (April 2011). "Non-invasive methods of penile lengthening: fact or fiction?". BJU International. 107 (8): 1278–1282. doi:10.1111/j.1464-410X.2010.09647.x. PMID 20868389.
2. ^ Levine LA, Becher EF, Bella AJ, Brant WO, Kohler TS, Martinez-Salamanca JI, et al. (April 2016). "Penile Prosthesis Surgery: Current Recommendations From the International Consultation on Sexual Medicine". The Journal of Sexual Medicine. 13 (4): 489–518. doi:10.1016/j.jsxm.2016.01.017. PMID 27045255.
3. ^ Blatchford C (May 2, 2001). "The beauty butchers". National Post. Retrieved July 14, 2014.
4. ^ Neligan PC, ed. (2013). Plastic Surgery. Vol. 6 (3d ed.). Elsevier Health Sciences. p. 657\. ISBN 978-1-4377-1733-4.
5. ^ a b Barrell A (12 January 2020). "Does penis enlargement work? Methods and effectiveness". Medical News Today. Retrieved 1 March 2020.
6. ^ a b "Penile Augmentation Surgery". American Urological Association. Retrieved 1 March 2020.
7. ^ Nugteren HM, Balkema GT, Pascal AL, Schultz WC, Nijman JM, van Driel MF (2010). "Penile enlargement: from medication to surgery". Journal of Sex & Marital Therapy. 36 (2): 118–123. doi:10.1080/00926230903554453. PMID 20169492. S2CID 39984361.
8. ^ a b Vardi Y (April 2006). "Is penile enlargement an ethical procedure for patients with a normal-sized penis?". European Urology. 49 (4): 609–611. doi:10.1016/j.eururo.2005.12.053. PMID 16439051.
9. ^ Shamsodini A, Al-Ansari AA, Talib RA, Alkhafaji HM, Shokeir AA, Toth C (December 2012). "Complications of penile augmentation by use of nonmedical industrial silicone". The Journal of Sexual Medicine. 9 (12): 3279–3283. doi:10.1111/j.1743-6109.2011.02563.x. PMID 22145947.
10. ^ Fukuda H, Endo H, Katsuzaki J, Mukai H (August 2016). "Development of nodules on the glans penis due to hyaluronic acid filler injection". European Journal of Dermatology. 26 (4): 416–417. doi:10.1684/ejd.2015.2600. PMID 26081014. S2CID 41634996.
11. ^ Center for Devices and Radiological Health. "Dermal Fillers (Soft Tissue Fillers)". www.fda.gov. Retrieved 2018-03-14.
12. ^ Trost, Landon; Watter, Daniel; Carrier, Serge; Khera, Mohit; Yafi, Faysal; Bernie, Helen; Ziegelmann, Matthew; Köhler, Tobias (April 23, 2024). "Cosmetic penile enhancement procedures: an SMSNA position statement". The Journal of Sexual Medicine. 21 (6): 573–578. doi:10.1093/jsxmed/qdae045. PMID 38654638.
13. ^ Griffin RM (2010). "Penis enlargement: Does it work?". WebMD. Retrieved July 28, 2011.
14. ^ a b Ratan NM (July 9, 2020). "Penis enlargement surgery ineffective and potentially dangerous". News-Medical.net.
15. ^ Kashmira G (May 10, 2019). "Penis enlargements are "ineffective and risky" and leave men at mercy of charlatans, study finds". Newsweek.
16. ^ a b Campbell J, Gillis J (February 2017). "A review of penile elongation surgery". Translational Andrology and Urology. 6 (1): 69–78. doi:10.21037/tau.2016.11.19. PMC 5313298. PMID 28217452.
17. ^ Nugteren HM, Balkema GT, Pascal AL, Schultz WC, Nijman JM, van Driel MF (2010). "Penile enlargement: from medication to surgery". Journal of Sex & Marital Therapy. 36 (2): 118–123. doi:10.1080/00926230903554453. PMID 20169492. S2CID 39984361.
18. ^ Stein MJ, Lin H, Wang R (February 2014). "New advances in erectile technology". Therapeutic Advances in Urology. 6 (1): 15–24. doi:10.1177/1756287213505670. PMC 3891291. PMID 24489605.
19. ^ a b Qian SQ, Gao L, Wei Q, Yuan J (May–June 2016). "Vacuum therapy in penile rehabilitation after radical prostatectomy: review of hemodynamic and antihypoxic evidence". Asian Journal of Andrology. 18 (3): 446–451. doi:10.4103/1008-682X.159716. PMC 4854102. PMID 26289397.
20. ^ Engber D (29 June 2006). "Do penis pumps work?". Slate.
21. ^ Lehrfeld T, Lee DI (2009). "The role of vacuum erection devices in penile rehabilitation after radical prostatectomy". International Journal of Impotence Research. 21 (3): 158–164. doi:10.1038/ijir.2009.3. PMID 19225465.
22. ^ Min KS (2016). "Chapter 20: Penile traction therapy (penile lengthening device". In Park NC, Kim SW, Moon DG (eds.). Penile Augmentation. Springer. p. 162\. ISBN 9783662467534.
23. ^ Hecht SL, Hedges JC (2016). "Chapter 13: Vacuum therapy for erectile dysfunction". In Köhler TS, McVary KT (eds.). Contemporary Treatment of Erectile Dysfunction: A Clinical Guide (2nd ed.). Humana Press. p. 181\. ISBN 9783319315874.
24. ^ Salvini M (12 April 2005). "Size matters". Salon. Retrieved 6 January 2013.
25. ^ Wylie KR, Eardley I (June 2007). "Penile size and the 'small penis syndrome'". BJU International. 99 (6): 1449–1455. doi:10.1111/j.1464-410X.2007.06806.x. PMID 17355371.
26. ^ a b Mayo Clinic Staff. "Penis-enlargement products". Mayo Clinic. Retrieved 6 January 2013.
27. ^ a b Wanjek C (February 20, 2007). "Penis enlargement products come up short". livescience.com. Tech Media Network. Retrieved 6 January 2013.
28. ^ Johanson S (2011). "Jelqing". Talk Sex with Sue Johanson. Retrieved 14 June 2013.
29. ^ Chung E, Brock G (February 2013). "Penile traction therapy and Peyronie's disease: a state of art review of the current literature". Therapeutic Advances in Urology. 5 (1): 59–65. doi:10.1177/1756287212454932. PMC 3547530. PMID 23372611.
30. ^ Usta MF, Ipekci T (June 2016). "Penile traction therapy for Peyronie's disease-what's the evidence?". Translational Andrology and Urology. 5 (3). AME Publishing Company: 303–309. doi:10.21037/tau.2016.03.25. PMC 4893512. PMID 27298777.
31. ^ Herrman J (20 August 2019). "Is Spam Trying to Tell Us Something?". The New York Times. Retrieved 8 October 2021.
32. ^ McWilliams B. "Swollen Orders Show Spam's Allure". Wired. Retrieved 8 October 2021.
33. ^ "More Vietnamese men using silicone to enlarge their penises". Thanh Nien News. August 31, 2013. Retrieved July 14, 2014.

## Further reading

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* Tealab AA, Maarouf AM, Habous M, Ralph DJ, Abohashem S (June 2013). "The use of an acellular collagen matrix in penile augmentation: A pilot study in Saudi Arabia". Arab Journal of Urology. 11 (2). Elsevier: 169–173. doi:10.1016/j.aju.2013.02.001. PMC 4442917. PMID 26558077.
* Austoni E, Guarneri A, Gatti G (27 April 2009). "Penile elongation and thickening--a myth? Is there a cosmetic or medical indication?". Andrologia. 31 (1). Wiley-Blackwell: 45–51. doi:10.1111/j.1439-0272.1999.tb01450.x. PMID 10643519.
* Romero-Otero J, Manfredi C, Ralph D, Osmonov D, Verze P, Castiglione F, et al. (March 2021). "Non-invasive and surgical penile enhancement interventions for aesthetic or therapeutic purposes: a systematic review". BJU International. 127 (3). Wiley-Blackwell: 269–291. doi:10.1111/bju.15145. PMID 32575166.
* Marra G, Drury A, Tran L, Veale D, Muir GH (January 2020). "Systematic Review of Surgical and Nonsurgical Interventions in Normal Men Complaining of Small Penis Size". Sexual Medicine Reviews. 8 (1). Elsevier: 158–180. doi:10.1016/j.sxmr.2019.01.004. PMID 31027932.
* Wilson SK, Wen L, Egydio PH (December 2020). "Evolution of techniques for aesthetic penile enlargement during prosthesis placement: a chronicle of the Egydio non-grafting strategy". International Journal of Impotence Research. 35 (4). Springer Nature: 1–8. doi:10.1038/s41443-020-00379-3. PMID 33273716.
* Hehemann MC, Towe M, Huynh LM, El-Khatib FM, Yafi FA (July 2019). "Penile Girth Enlargement Strategies: What's the Evidence?". Sexual Medicine Reviews. 7 (3). Elsevier: 535–547. doi:10.1016/j.sxmr.2018.11.003. PMID 30612977.
* Vardi Y, Har-Shai Y, Harshai Y, Gil T, Gruenwald I (November 2008). "A critical analysis of penile enhancement procedures for patients with normal penile size: surgical techniques, success, and complications". European Urology. 54 (5). Elsevier: 1042–1050. doi:10.1016/j.eururo.2008.07.080. PMID 18760874.

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