The Truth About Penis Enlargement

What Works, What Doesn't, and What to Avoid

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Penis size can be a sensitive subject for many men. Although pills, injections, traction devices, and surgery are regularly marketed to men in search of larger penises, some are more effective than others. Moreover, the risk of certain procedures, particularly surgery, can significantly outweigh any presumed benefits.

Generally speaking, penis enlargement devices and procedures are indicated for men who have experienced penile trauma or have a medical disorder affecting the function of the penis. In cases where penis size is affecting fertility or the man's quality of life, penis enlargement may be considered (ideally under the care of a urologist). These may include surgical procedures known as penile augmentation or augmentation phalloplasty.

Penis Function and Concerns

The penis is a complex organ with multiple important functions. Structures within the penis allow it to perform urination, erection, and ejaculation:

  • The urethra is a thin tube running through the penis that carries urine out of the bladder. The urethra is part of the corpus spongiosum which leads to the glans (head) of the penis.
  • The erectile body of the penis is also known as the corpus cavernosum. It quickly fills with blood to achieve an erection.
  • The corpus cavernosum surrounds the corpus spongiosum, extends from just behind the glans to the pelvis. It splits into two chambers that attach to the right and left ischial tuberosity (the bones that men sit on).

The penis grows throughout puberty in response to a male hormone called dihydrotestosterone (DHT). Although men continue to make DHT throughout life, the penis stops growing toward the end of puberty. The flaccid penis size can also decrease with age. These natural changes are simply a fact of life.

Any procedure designed to make the penis larger can damage the vital structures of the penis, increasing the risk of erectile dysfunction and urination problems.

Why Men Seek Augmentation

There are a number of reasons why a man would want to seek penis enlargement. There may be developmental or medical reasons for such interventions and/or psychological concerns that trigger negative emotions, both reasonable and abnormal.

Physical Reasons

In some cases, a man might be genuinely smaller due to a genetic or hormonal disorder that causes micropenis (a penis under three inches in length when stretched). Having a penis of this size may not only affect a man's self-esteem but interfere with his ability to urinate or conceive.

The term microphallus is typically used when the penis is abnormally small and accompanied by hypospadias (a congenital defect in which the opening of the urethra is on the underside of the penis).

Another condition for which men seek penis enlargement is Peyronie's disease. This is a condition that develops later in life in which the penis will suddenly develop an abnormal bend. Fibrosis (scarring) at the site of the bend can cause a visible shortening and/or narrowing of the penis, along with pain and a loss of erectile function.

Prostate cancer surgery is also known to reduce penis size in some men as internal scarring causes a retraction of the penis at the base and a loss of length of up to 16%.

Not everyone seeking penis enlargement do so because of less-than-average penis size. "Buried penis" is one such condition in which the penis is concealed beneath excessive subcutaneous fat in the pelvis. It is common in prepubescent boys who are obese, many of whom have average-size penises and will eventually outgrow the condition. If they don't, interventions may be considered if weight loss doesn't help.

Psychological Reasons

Other men seek penis enlargement out of the belief that they are "smaller than average." Many such men fail to realize that the typical erect penis is around 5 to 6 inches long with a circumference of 4 to 5 inches.

Even so, there are men who will develop a preoccupation with their penis size even if they are above average. When this preoccupation interferes with the quality of life, it is typically diagnosed as penile dysmorphic disorder (PDD), a condition that may benefit more from psychological counseling that penile enlargement.

According to a 2019 review in Sexual Medicine Review, counseling was effective for the majority of men who felt inferior about their penis size, with most coming to understand that their penis was normal and in no need of augmentation.

Treatment Options

There are several options that are advertised to men who are dissatisfied with the size of their penis. While these may be tempting, don't be misled by false claims or anecdotal evidence. Speak with a urologist for insights on what may work and what won't.

Supplements

There are many companies that claim their supplements can enhance penis size. At best, they will do nothing more than waste your money. At worst, they may contain traces of Viagra (sildenafil) or other drugs dangerous to men with heart disease.

Supplements like L-citrulline or L-arginine are said to increase nitric oxide levels in the blood, which may improve circulation to the penis. While this may improve erections, there is no evidence that doing so increases penis size.

Topical Products

You may see advertisements for lotions, creams, and oils that can increase penis size. Products like these often contain hormones, vasodilating medications that increase blood flow, and essential oils said to promote cell proliferation. There is no evidence that any topical product can increase the size of your penis. Some may even cause skin irritation or allergy.

Exercises

There are physical exercises said to promote penile enlargement. The idea behind these exercises is that repetitively rubbing the penis increases blood flow and creates "micro-tears" in tissues that loo engorged when healed.

There is a specific technique called jelqing in which the thumb and forefinger are wrapped around the penis to repetitively stretch the shaft from the base to the tip for 20 minutes every day.

There is no physical exercise, including jelqing, that has been shown to increase penis size. In fact, rough exercise can cause injuries or scarring.

Penile Clamps and Rings

There are a number of devices that wrap around the penis and provide a squeezing pressure to "stretch" the penis out. Some are suggested for use during an erection, and others for when you are not. A number of these devices marketed for use during jelqing.

There is no evidence that wrapping anything around your penis will lengthen it. In fact, devices like these can cut off the blood flow, causing bruising, hematomas, and nerve damage.

Penile Traction

While there has never been an FDA-approved device for a penile extension, there has been growing interest in products that may help increase penis length using traction.

Traction involves the application of weights to a limb or other body part to provide steady pressure. With penile traction, the device is connected to the shaft of the penis and worn for a specific amount of time each day to gradually stretch the penis.

A medical device called "The Extender" has been shown to improve penile length in men with Peyronie's disease but has not been well studied in men without Peyronie's.

Vacuums and Pumps

Penis pumps and vacuums are popularly used as a sexual aid to promote erections in men. They are also used by some to increase penis size. These devices are placed over the penis and use suction to fill the penis will excess blood, causing swelling. If used consistently over a long period of time, they can cause the skin of the penis to become "spongy" and have a thicker appearance.

There is no evidence that they can increase the length of a penis. However, there is a chance that they can cause injury, particularly if the suction is too extreme or is worn for too long a period of time. Urethra bleeding has been known to occur as well as the rupture of superficial veins in the skin.

Surgery

There are no FDA-approved surgical treatments for penis enlargement, but that has not stopped men and cosmetic surgeons from embarking on such procedures. The procedures can be broadly categorized as penis-lengthening (elongation) surgeries and penis-widening (circumference) surgeries and are frequently used in combination.

Among the 7 most common penile augmentation procedures:

  • Free fat grafting (FFT) starts with the extraction of adipose (fat-storing) tissue from the thighs of thin men, lower abdomen of normal-weight men, the pelvic area of overweight men. The tissues are then centrifuged (spun at a high rate) to break the cells apart and injected into the penis with a syringe or flexible tube called a cannula. This step helps prevent the irregular clumping of fat cells. Because 20% to 80% of the fat cells will be reabsorbed by the body in its first year, multiple procedures may be needed.
  • Dermal fat grafting (DFG) involves the extraction of a patch of skin from the patient's own body (usually the lower back, lower abdomen, or buttocks) along with the underlying layer of fat. After the skin is removed from the penis, the extracted tissue is grafted in its place. Because the extracted skin is thicker, it will increase the circumference of the penis. By taking tissue from the patient's own body, the risk of tissue rejection is low.
  • V-Y plasty is a surgical technique used to sever the suspensory ligament that anchors the penis to the pelvic bone. By doing so, the penis is released and allowed to extend forward. The procedure is so-named because it involves a triangular incision, the edges of which are pulled together and sutured in a "Y" shape. While effective in elongating the penis, it also makes the penis less stable when erect.
  • Suprapubic lipectomy is primarily used in overweight men in whom weight loss has not improved the appearance of a buried penis. The procedure involves the removal of a trapezoid-shape piece of skin and fat from above the penis. The ends are sutured together, lifting the skin to expose the underlying penis. The procedure is relatively safe with post-operative pain, bleeding, infection being the greatest risks.
  • Sliding elongation is sometimes used in men who have experienced a shortening of the penis due to Peyronie's disease. The procedure involves the temporary "degloving" of skin and underlying tissues from the shaft of the penis. The constricted sheath around the shaft is then severed, allowing the penis to straighten and lengthen. While the surgery does not involve grafting, nerve injury is possible.
  • Penile disassembly is a more invasive form of sliding elongation surgery in which the degloved shaft is completely severed below the head of the penis. The gap is filled with a section of rib cartilage taken from the patient and reassembled by suturing the degloved tissues (including the urethra) back into place. While less commonly used, the surgery can be effective for men with micropenis, congenital birth defects, or deformities resulting from penile cancer,
  • Penile implants are generally reserved for use in men with impotence as they don't make the penis any bigger. With that said, they are often used with V-Y plasty, sliding elongation, or penile disassembly to help stabilize the penis and increase girth.

Some men have been known to self-inject synthetic materials, like silicone and paraffin, to increase the girth of their penis. Practices like these are highly discouraged as they risk infection, deformity, and the loss of penile function.

Men who have undergone self-injections have experienced severe abscesses, edema (swelling), induration (tissue hardening), visible lumps and nodules, and tissue necrosis (skin death).

Self-Help Tips

If you think your penis is "too small," take the time to measure it accurately. Even if it is shorter than average, it's important to place the size of your penis in context and ask yourself why it is causing you such distress. It often helps to speak with a psychologist who can help you sort through your feeling and provide the perspective you need.

If you simply want to enhance the appearance of your penis because it makes you feel more confident, there are things you can do:

  • Lose weight. If you are overweight, those extra pounds can make your penis appear smaller. Losing weight can make your penis appear relatively larger.
  • Get in shape. A muscular physique may add to this visual effect and make you feel more confident about the size of your penis.
  • Groom your pubic area. Shaving some of the hair around the penis (referred to as "manscaping") can make the penis appear larger as well.

A Word From Verywell

Penis enlargement is possible but usually only with extreme surgical measures. Nonsurgical measures are uncertain at best, and, with no regulatory body governing the sale of these products, there is always a risk of harm.

Avoid any product that "guarantees results" or says that it is "clinically proven." This is patently untrue and a red flag of a marketing scam.

If you feel compelled to pursue penile augmentation surgery, meet with a urologist and listen to the benefits and risks with an open mind. Ask about the response rate and what complications are possible. The doctor or surgeon should try to "sell" you on the surgery but rather provide you with objective, unbiased information from which to make an informed choice.

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Article Sources

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