Penis enlargement

Editors-In-Chief: Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org]; Michel C. Samson, M.D., FRCSC, FACS [mailto:samsonm1@ccf.org]; and Joel Gelman, M.D. [mailto:jgelman@uci.edu],   Director of the Center for Reconstructive Urology and Associate    Clinical Professor in the Department of Urology at the University of    California, Irvine

Overview
Penis enlargement procedures (sometimes referred to as "male enhancement procedures" in spam email and television advertisements) are techniques alleged to make the human penis larger.

Surgical methods
Surgical techniques used for penis lengthening (enhancement phalloplasty) and penis widening (girth enhancement) have been in the urologic literature for many years. In study at St. Peter's Andrology Centre and Institute of Urology in London, men who got penis-lengthening surgery, most patients weren't satisfied with the results.

Penis enlargement (girth) surgery
A related method involves injection of silicone, PMMA and other materials into the penis and scrotum, to achieve girth enlargement. The results of the study into penile augmentation surgery mentioned above confirm that surgical techniques used to thicken the penis are far more effective than those designed to increase penile length. In the research sample of men studied, flaccid circumference following the above procedure had increased from an average of 3.1 inches to an average of 4.1 inches, whilst erect penile circumference increased from an average of 4.1 inches before surgery to 4.8 inches after surgery., but is effectively irreversible and may have side effects including loss of sensation, inability to perform penetrative intercourse, scarring and deformation.

Injections of other substances, including collagen, mineral oil, and even KY Jelly may have similar effects, but also may cause extreme scarring and permanent disfigurement. These may include a bump, permanent or temporary, on the stem of the penis itself, which would actually be the collected collagen or silicone introduced in the erectile tissues. This forms an unsightly lump around the base of the penis where it settles down and may inhibit the flow of the blood itself. Other effects may be the slight decrease of the glans width as compared to the overall stem of the penis.

In 2006 the journal of European Urology reported autologous tissue engineering using biodegradable scaffolds as beneficial not only for men with penile dysmorphic disorder and for correcting severe penile shaft deformity after lipofilliing but also an advanced, well-proven therapeutic approach for penile girth enhancement with remarkable safety, reproducibility, superior cosmetic results, low morbidity and low incidence of post-operative complications. Unlike the high level of disatisfaction with lengthening cited in the opening paragraph of this article, 81% of patients scored the results of autologous tissue engineering as "excellent" and "very good" with most experiencing a 4 cm (1.6 inches) permanent flaccid girth gain. Unlike the injection or implantation of foreign substances into the penis such as AlloDerm®, silicone, and other substances, tissue culture leaves no residual foreign tissue around the penis after scaffold reabsorption by the body.

Although AlloDerm® (treated cadaver flesh) is currently being used by some plastic surgeons, its manufacturer does not recommend it for penis enlargement phalloplasty. The USA Food and Drug Administration (FDA) regulates its use and has specifically not approved AlloDerm® as a “void filler” nor for “cosmetic augmentation”. The manufacturer warns phalloplasty surgeons that it is: “important to clarify ... cosmetic augmentation phalloplasty does not fall within approved procedures for which LifeCell can promote AlloDerm®”. The articles Penis enlargement Surgery: Myths and Facts and Penile Suspensory Ligament Division for Penile Augmentation: Indications and Results do a good revision about the subject.

Penis enlargement (length) surgery
Approximately one-third to one-half of the penis is inside the body, and is internally attached to the undersurface of the pubic bone. Penis lengthening involves the release of the fundiform ligament and the suspensory ligament that attaches the two erectile bodies to the pubic bone (ligamentolysis). The suspensory ligament makes the penis arch under the pubic bone. Release of this ligament allows the penis to protrude on a straighter path, further outward to give more functional length. With the penis on stretch, the ligament is divided close to the pubic bone until all midline attachments have been freed. Once these ligaments have been cut, part of the penile shaft (usually held within the body) drops forward and extends out, enlarging the penis by 20-30 mm (0.78-1.18 in.). After surgery, part of the postoperative treatment includes stretching of the penis to prevent the severed suspensory ligament from healing shorter than it was previously. The article "Penile Suspensory Ligament Division for Penile Augmentation: Indications and Results" discussed the subject. According to Nim Christopher, a urologist at St. Peter's Andrology Center in London, among men who have had the surgery, "the dissatisfaction rate was in excess of 70 percent".

Real penile lengthening (i.e.; lengthening of corporal bodies vs. ligamentolysis) is not a routine and safe procedure because of high risk of losing the ability to have an erection. It can be done safely only in patients with erectile dysfunction or Mb Peyronies concomitantly with implantation of penile prosthesis. The world's leading urologists specializing in the field of penis enlargement surgery use only ligamentolysis, liposuction of the pubic area, and skin redistribution. They state clearly that surgeons can only expose the penis more outside the body with especially visible results in obese patients and ones with different deformities of penile skin where the penis is covered.

Inflatable implants
A further method is to replace the two corpora cavernosa with inflatable penile implants. This is performed primarily as a therapeutic surgery for men suffering from complete impotence; an implanted pump in the groin or scrotum can be manipulated by hand to fill these cylinders from an implanted reservoir in order to achieve an erection. The replacement cylinders are normally sized to be direct replacements for the corpus cavernosa, but larger ones can be implanted.

One advantage to this surgery is that an erection can be created whenever desired, for as long as is desired and as firm as desired. The major negative to it is that this surgical procedure can never be reversed.

Self-treatment methods
No scientific research supports the use of any nonsurgical method to enlarge the penis, and no reputable medical society endorses penis-enlargement surgery performed for purely cosmetic reasons.

Cosmetic
Rather than attempt to change the actual size of the penis, one may make it appear bigger, by trimming the pubic hair or by losing weight, which may be of particular use if one is overweight.

Pills
"Penis enlargement pills" or ointments are commonly offered over the Internet. Analyses performed by Flora Research of California and by the University of Maryland have uncovered harmful contaminants in a number of "penis enlargement" pills. Contaminants found included mold, yeast, dangerous E. coli bacteria, pesticides, and lead. Dr. Michael Donnenberg of the University of Maryland has described herbal pills marketed as having "heavy fecal contamination", possibly from animals grazing near the plants harvested for herbal ingredients. There may however be a placebo effect i.e. a psychological effect of making the user think he has a larger penis, and increasing his confidence, when there is no actual change to his penis size. Some people have also reported that such pills make them feel sexually aroused, and give them harder erections, but again, without any actual growth of the penis.

Penis pump
A penis pump is a cylinder that is fitted over the penis, with a manual or motorized pump to create suction. As the apparatus creates a vacuum around the penis, blood is drawn into the penis, helping it to become engorged. As vacuum increases, the difference between the inner blood-pressure and the pump pressure increases as well; excessive pressure causes vascular damage rather than a harder penis.

Penis pumps, usually described in this context as vacuum pumps, have use in conventional treatment of impotence. The pump itself is essentially as described above, although often made to higher standards of quality with a much higher price, and arrangements for distribution by suppliers of medical equipment.

Flexible compression rings, commonly called cock rings, can be added. Fitted on the open end of the cylinder, then an erection is created by pumping. Then the rings are pushed by hand onto the base of the erect penis before releasing the vacuum. This enables the erection to be held even in the presence of problems of the vascular or nervous system which would otherwise lead to immediate loss of erection. In the best circumstances erections can be maintained for a considerable time, but manufacturers' literature recommends that, for safety, rings should be removed after no more than 30 minutes. Having rough sex can also result in the bursting of a blood vessel. Pumping must be done very carefully to avoid injury. Over-enthusiastic pumping can burst blood vessels and form blisters. In some cases the testicles can be unexpectedly pulled into the cylinder and cause severe pain and injury. It is also believed that the rim of the cylinder can cut into the skin and over time cause damage to the ligaments surrounding the penis. Impatiently pumping without reading explanatory material can produce too much suction (any pressure lower than 10 torr) and cause permanent injury. Attempts at using vacuum cleaner units for this purpose have resulted in severe injury as the machine produces far too much suction.

Penis pumps are also used for masturbation. In August 2006, Oklahoma district court judge Donald Thompson was sentenced to four years in prison for repeatedly having masturbated with a penis pump while presiding over court cases.

In an episode of the Five (channel) documentary series A Girl's Guide to 21st Century Sex, the penis pump was one of the methods that, when used between 30 minutes to 1 hour each day for the course of 30 days, resulted in a 1-inch increase in penis length. This outcome caught one of the medical consultants by surprise, as he expected an improvement only within a few millimeters.

Jelqing and clamping
Jelqing is a method intended to enlarge the penis by increasing the blood pressure in the penis, with the goal of permanently increasing the maximum erect size of the penis. This technique, also called "milking", involves wrapping the thumb and index finger around the penis while semi-erect and repeatedly drawing them away from one's body to force blood into the glans, thus encouraging more vascularity in the corpus cavernosa and associated tissues. Whether jelqing actually works or not is a subject of controversy.

Risks that exist from this exercise are; burst blood vessels, sometimes causing bleeding from the urethra (which can lead to infection and other complications if not taken care of), temporary erectile dysfunction and, in the very extreme cases, bursting of the penis itself.

There are many products (tools, instructions, etc.) that one can buy; however, much of what they offer (instructions) is available on forums and free websites. Before beginning an enlargement regimen, one should contact someone experienced with the technique.

Jelqing is typically preceded by a warm-up with a hot compress on the genitals, and concluded the same way.

Clamping is a technique that uses a constricting device, such as a shoe string, cable clamp, or a tight cock ring. The clamp is firmly tied, clamped, or put, respectively, on the base of the erect penis while "edgeing" (extended masturbation) with a firmly erect penis.

Stretching and hanging
Stretching consists of attaching a penis stretcher or "extender" device to the penis for set periods of time. The device exerts a constant traction on the penis, which, in theory, lengthens and widens the penis. The traction supposedly causes the cells in the penis to "split" and then reform and expand. Whether or not penis extenders actually work is subject to debate - much like all methods of penis enlargement.

In an episode of the Five (channel) documentary series A Girl's Guide to 21st Century Sex, stretching by means of a plastic-and-nylon penis extender resulted in no penile enlargement. A 30-day test was conducted whereby three participants had their peak erection lengths measured before the experiment. One of the participants was given a penis extender and was told to use it for 30 minutes to 1 hour each day for 30 days. After 30 days, the test subject who was assigned the penis extender was the only one who turned up no improvement whatsoever. The subjects who used a penis stimulating cream for penile massage and a penis pump, on the other hand, each gained 1 inch (25 mm) in length after 30 days. There is a high likelihood that penis enlargement only takes effect with regular expansion and stretching of the corpus cavernosum. The penis will have to be engorged and stretched. Passive stretching such as the use of a penis extender did not aid penis enlargement in any way.

Hanging is perhaps the oldest self-treatment method of penis enlargement, with evidence suggesting it was practiced by certain African tribes as long as 2000 years ago. Weight hanging consists of attaching a device (usually a rope or a strap) that grips the glans or just behind the glans and allows a weight to be suspended for specific amount of time.

The idea behind weight hanging is to stretch the tunica albuginea and other various tissues of the penis. The general effect is to elongate the penis, although widening can also occur. Weight hanging, however, can also carry serious risks, which include chronic pain, scarring, and impotence.