In a survey of 42 men who underwent penile enlargement surgery, urologist Nim Christopher and colleagues at St. Peter’s Andrology Center in London found that over 70 percent were dissatisfied with the results, with the men often requesting another surgery. The results of this study were reported in the February 2006 European Urology Journal. Dr. Christopher believes that spam email advertisements for penile enlargement surgery give men unrealistic expectations about surgery, and that men with psychological concerns about the size of their penis, especially those with normal size penises, gain little from surgery and should instead be referred for psychological counseling. The average increase in penis length among men in this survey was 1.3 cm.