What to Know About Penis Enlargement

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.

A penis enlargement procedure may be indicated for a man who has experienced penile trauma or has a medical disorder that affects the function of the penis. In cases where penis size affects fertility or quality of life, penis enlargement may be considered under the direction of a urologist. These include surgical procedures known as penile augmentation (a.k.a. augmentation phalloplasty).

Reasons for Augmentation

There are many reasons why a man might seek penis augmentation. There may be medical reasons, such as the impairment of urinary function or fertility, or psychological ones, in which penis size triggers negative emotions such as anxiety or low self-esteem.

Physical Reasons

In some cases, a man's penis might be genuinely "smaller" due to a genetic or hormonal disorder that causes micropenis. Micropenis is defined as a stretched penis length of under three inches (when the flaccid penis is fully stretched without causing discomfort).

Having a penis this size may interfere with a man's ability to direct a urine stream. It may also make sexual intercourse difficult and decrease the amount of semen that reaches to the upper vagina.

Some men with micropenis have reduced testosterone levels and a low sperm count due to an underlying hormonal dysfunction. In such cases, increased penis size will not improve fertility as much as assisted fertility treatments.

There are other conditions associated with reduced penis size:

  • Microphallus: Microphallus is an abnormally small penis accompanied by hypospadias (a congenital defect in which the opening of the urethra is on the underside of the penis).
  • Peyronie's disease: Peyronie's disease is a condition in which the penis will suddenly develop an abnormal bend, usually later in life. Fibrosis (scarring) at the site of the bend can cause the shortening and/or narrowing of the penis, along with painful erections or erectile dysfunction.
  • Prostate cancer surgery: Radical prostatectomy in which the entire prostate is removed along with surrounding tissues is known to reduce penis size as the fibrosis causes an internal retraction of the penis and a loss of length of up to 16%.
  • Buried penis: "Buried penis" is a term used when a penis is concealed within excess pelvis fat. It is common in prepubescent boys who are obese, many of whom have normal-sized penises and will eventually outgrow the condition. Weight loss also helps.

Psychological Reasons

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

There are even some men with above-average penises who have an abnormal preoccupation with their size. When the preoccupation interferes with their quality of life, it is typically diagnosed as penile dysmorphic disorder (PDD). It is 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 size was normal and in no need of augmentation.

Home Remedies and Lifestyle

There are numerous websites that recommend penis exercises to increase the length or girth of the penis. The rationale behind these exercises is that repetitively rubbing the penis creates "micro-tears" in tissues that look engorged when healed.

There is one popular 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.

Despite claims to the contrary, there has never been any evidence that physical exercise of any sort, including jelqing, can increase penis size. In fact, the persistent rough handling of the penis can cause injury or scarring.

If you want to enhance the appearance of your penis because it makes you feel more confident, there are simpler ways to do so:

  • Lose weight: If you are overweight, those extra pounds can make your penis appear smaller. Losing weight reduces pelvic fat and allows more of the penis to be seen.
  • 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 around the penis (referred to as "manscaping") can make the penis appear larger since it is no longer buried in hair.

Over-the-Counter (OTC) Therapies

There are several options 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 for you 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. Although some people claim this helps improve erections, there is no evidence that doing so increases penis size.

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. With penile traction, a weighted 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.

Penile Clamps and Rings

These devices marketed for penis enlargement wrap around the shaft and provide a gentle squeezing pressure to "stretch out" the penis. Some are suggested for use during an erection, while others are used while the penis is flaccid. Others are meant to be used between jelqing sessions.

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

Topical Treatments

Lotions, creams, and oils advertised as being able to increase penis size by being applied directly to the organ often contain hormones, vasodilating medications that increase blood flow, and essential oils said to promote cell proliferation.

There is no evidence any of these works; some may even cause skin irritation or allergy.

Vacuums and Pumps

Penis pumps and vacuums are popularly used as sexual aids to promote erections in men. They are also used by some with the intent of increasing penis size. These devices are placed over the penis (and sometimes the scrotum) and use suction to engorge the penis with blood. 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.

Despite their popularity, there is no evidence that vacuums or pumps can increase the length of a penis.

Vacuum pumps can cause injury if the suction is too extreme or the device is worn for too long. Urethra bleeding and bruising can occur as superficial veins in the penis are ruptured.

Surgeries and Specialist-Driven Procedures

Some men seek injections of natural and synthetic fillers to increase the girth of the penis. Others seek surgery if a smaller penis size or penile abnormality (like hypospadias) is interfering with the ability to urinate or quality of life. Small penis size usually is not an indication for surgery to treat infertility. In such cases, assisted fertility procedures may be the better option.

Penile Injections

Penile injections have been around since the early 1900s, often performed by non-medical professionals and often with disastrous results. In recent years, three safe injectables have been used by aesthetic physicians to increase penile girth, each of which has its pros and cons:

  • Autologous fat injections involve the extraction of fat via liposuction, which is then injected strategically along the shaft of the penis. While safe, much of the injected fat is reabsorbed. Injecting too much fat can cause uneven absorption, leading to an abnormal curvature or shape of the penis.
  • Hyaluronic injections involve a naturally occurring, gooey compound known as hyaluronic acid (HA) or hyaluronan. While effective, it takes a high level of skill to inject HA evenly. As with autologous fat, HA can be reabsorbed by the body, albeit at a slower rate. Loss of tactile sensation is not uncommon among men who undergo the procedure.
  • Polymethylmethacrylate (PMMA) microspheres are a newer product made with tiny acrylic spheres. While longer-lasting than hyaluronic acid, with some results lasting up to seven years, PMMA injections have a higher rate of complications, including the formation of indentations, hard ridges, and nodules.

Health Warning

Some men have been known to self-inject synthetic materials, like silicone and paraffin, in an attempt to increase the girth of their penis. Practices like these are dangerous and can lead to infection, abscesses, induration (tissue hardening), tissue necrosis (skin death), and even penis loss.

Surgery

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

The most common penile augmentation procedures include:

  • 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, or the pelvic area of overweight men. The tissues are 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 final step helps prevent the irregular clumping of fat cells. Because 20% to 80% of the fat cells will be reabsorbed by the body in the 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 a 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 rejection is low.
  • V-Y plasty is a surgical technique in which the suspensory ligament that anchors the penis to the pelvic bone is severed, releasing the shaft and allowing it 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 primarily is performed on overweight men for whom weight loss has not improved the appearance of a buried penis. The procedure involves removing a trapezoid-shape piece of skin and fat from above the penis. The ends are sutured together, lifting the pelvic skin to expose the underlying penis. The procedure is relatively safe; the side effects are limited to postoperative pain, bleeding, or infection.
  • 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 surrounding the shaft is then severed, allowing the penis to straighten and lengthen. While the surgery does not involve any grafting, nerve injury is possible.
  • Penile disassembly is a more invasive form of sliding elongation surgery in which the degloved shaft is completely severed just below the head of the penis. The gap is then filled with a section of rib cartilage taken from the patient and reassembled by suturing the degloved tissues back into place. While less commonly used, the surgery can be effective for men with micropenis, congenital defects, or deformities resulting from penile cancer,
  • Penile implants generally are reserved for men with impotence as they do nothing to make the penis 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.

Complementary Alternative Medicine (CAM)

Some alternative and Ayurvedic practitioners endorse the use of medicinal herbs to increase the quality and duration of erections. Others claim that the ongoing use of the herbs can increase either the girth or length of the penis. These include plant-based medicines such as:

  • Bindii (Tribulus terrestris)
  • Golden eye-grass (Curculigo orchioides)
  • Longjack (Eurycoma longifolia)
  • Peruvian ginseng (Lepidum meyenii)
  • Red kwao krua (Butea superba)

To date, there is little scientific evidence that any herbal medicine can improve penis erections or size. It is also unknown at what dose or duration these herbs are safe.

A Word From Verywell

If you think that your penis is too small, be sure 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 sometimes helps to speak with a psychologist who can help you sort through your feelings and provide the perspective you need.

If you decide to pursue penile augmentation, meet with a urologist to discuss the benefits and risks of the procedure. Ask about the response rate and what complications are possible. If you're concerned about infertility, speak with a fertility specialist first to get an accurate picture of your sperm count and motility.

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