It is estimated that about 250,000 men worldwide have undergone some type of penile-enlargement procedure, majority of which occurred in North America. Conventional penile-enlargement procedures involve two basic procedures.

The first procedure increases the length and involves making an incision at the base of the penis and cutting off the ligament that anchors it to the pubic bone. This allows the part of the penis that is normally inside the pubic mound to fall outside. It increases the length by about 2-4 cm. The second procedure is done to widen or add girth to the penis. This usually requires insertion of a filler material under the skin of the penis and can widen the girth by at least 30 percent.

The Small Penis

Men in general have a vague perception of what a normal penis size is. Most men feel they have a small penis. The explosion of sex on TV, the internet and pornographic magazines has made almost all males feel sexually inferior.

Size of the genitalia has been a common source of apprehension and preoccupation in men throughout history. The preoccupation with genitalia size has led to lack of confidence, social withdrawal and psychological embarrassment among men. Some men believe that the size of the phallus is important for ego, identity, symbolic power and when pleasing women. Like all things American, "bigger is better" is a deeply embedded myth.

However, men should not fear. After decades of controversy, it is now accepted that the average flaccid penile length is 8.8 cm (3 1/2 inches) and average erect length is 12.8 cm (5 inches). Surveys of women indicate that size is irrelevant and most women believe that quality is what counts, not quantity. However, most men remain fixated on the ideal of an 8- to 10-inch penis.

Penile enlargement

Everyday, there are numerous ads claiming to increase the size of the penis and a glorious sex life afterwards. These ads seldom offer any scientific evidence, yet men spend millions on such unknown products hoping for penile nirvana. Men fall prey to a few misconceptions believing that they have a smaller-than-average penis and that non-surgical penile enlargement methods are safe, effective and cheap or that surgery is cure for a small penis and the results are excellent.

The history of penile-enlargement surgery

Penile enlargement is not recent. Many cultures in the past have made an attempt to change the phallus. The Sadhus (holy men) of India and the Peruvian Cholomecs used weights as traction on the penis. Reports indicate that the penis did elongate about 10-18 inches. Unfortunately, the penises were only symbolic. Whether they could have been used for sexual purposes or even if an erection occurred remains unknown. The Dayaks of Borneo mutilated their penises with needles for their partner's pleasure. The mutilated penis had colorful ornaments placed in them. The man with the most decorations was said to be the best lover and all the women pursued him.

During the 16 th century, the Topinama Indians of Brazil enlarged their penis by encouraging poisonous snakes to bite their penis. The snake poisons deformed the penis and caused excruciating pain. At the end of six months, the men had largely deformed and swollen penises that delighted their women.

In the Kama Sutra, men are encouraged to use Apadravyas, which are metal bands put on or around the penis to supplement its length or its thickness for intercourse. It's similar to modern-day cock rings that are used to sustain a man's erection. One of the principal Hindu gods is named Siva, who is always represented by an erect phallus. Siva is worshipped for his phallic representation that can be as small as a fist or as tall as a tree.

However, these cultural techniques of penile enlargement never caught on in North America and so we had to wait until the l980s when surgery came into vogue.

The technique of penile-enlargement surgery was developed 20 years ago by the Chinese surgeon Long Daochao. In the early 90s, penile-enlargement surgery flourished, partly due to the growth of the Internet, partly because of a great male clientele population and partly due to the chance to make money. To date, the technique of penile enlargement is not recognized by a formal surgical society and the procedure is practiced without any standards or monitoring.

Over the last decade, cosmetic surgeons have come up with novel methods of penile enlargement, which includes increasing the width. This surgery usually involves cutting the ligaments which hold the base of the penis up against the pubic bone. The width of the penis is increased by harvesting fat from the abdomen and then injecting it into the penile skin to add mass. Despite a decade of such surgeries on numerous patients, this technique is still considered experimental and risky. Serious complications have been reported and the results are still difficult to reproduce and hard to predict. Like the beginnings of any new surgical procedure, penile enlargement is still in its infancy and fraught with unchartered results. Lack of standardization of this controversial procedure has led to a wide variety of poorly accepted surgical techniques with unpersuasive results

The Surgery

The surgery is by no means cheap and can cost anywhere from $6,000 to $10,000. As with all cosmetic surgery, one should never forget that it is not medically necessary. Elongation of the penis can be done in various ways. In obese individuals, the excess fat in the pubic mound usually conceals the penis. Pubic liposuction can remove this fat and make the penis appear longer. It is claimed that by this procedure alone, the length of the penis is increased by 1-3 cm. Another more controversial procedure involves release of the suspensory ligaments at the base of the penis. The base of the penis is usually attached to the pubic bone via a couple of ligaments. These ligaments are cut, thus elongating the penis by a few centimeters. One has to remember that in this technique it is the base of the penis which has been extended. Another related procedure for penile elongation is the advancement of an infrapubic skin flap onto the penis. The rationale for this technique is to protrude the external portion of the penis via a skin flap.

Girth enlargement

Penile-width enlargement is another controversial procedure. There are absolutely no health reasons for doing it. Penile width is usually increased by injection of various substances just below the penile skin. Fat taken from the abdomen (or where there is excess fat) is then injected into the skin of the penis. The results at best are mediocre. Distorted penile shape and bumpy penis have been reported. Other surgeons have advocated more aggressive surgery by slicing the penis and placing a piece of vein in the muscle to increase the width. This procedure is known to increase the penis diameter but is way too aggressive for a cosmetic procedure which has no medical indications to begin with.

Results

Unfortunately, no reliable data are available regarding the criteria for success or complication rates of these techniques. A few reports indicate that release of the suspensory ligament can decrease the angle of elevation of the erect penis. Paradoxical penile shortening can also occur as a result of spontaneous reattachment of the ligament to the pubic bone. Skin advancement can cause severe deformities, including unnatural hair growth near the penile stump. Utilizing a large flap can impair blood supply, leading to poor wound healing, possible rupture and in some cases, abnormally large tissue growth which leads to scarring.

Plastic surgery for the penis is here to stay and men will continually seek surgeons to increase the length and width of their penises. In the majority of these men, they have a distorted perception of their genitalia.

So far, most reports on penile-enlargement surgery have been anecdotal. The safety and the durability of the surgery still remain in question. In the end, we need to understand why men want their penises enlarged and decide whether the problems are psychological or physical.

These men would be best served by psychological counseling before undertaking surgery. In an environment where medicine and money go hand-in-hand, the surgeon is not the appropriate person to seek advice on the reasons for surgery.

Penile enlargement is not a simple undertaking and is usually not medically necessary. If you choose to obtain surgical penis enlargement, be sure to check the credentials of your surgeon (e.g., board certification) and carefully weigh the risks and potential benefits.

Penis enlargement surgery, whilst having advanced a great deal over the last 10 years, is still not without risks. Penis disfigurement and sexual dysfunction are just two of the reasons to be vigilant if considering this treatment.

The cost and procedure

The costs of penile enlargement vary from $4,000 to $10,000. Penile widening is more expensive because of the filler material. Most penile-enlargement procedures are done on an out-patient basis. The majority are performed in the surgeon's office or clinic. The procedures are done under general anesthesia and take about 2-3 hours. Lengthening of the penis requires release of the suspensory ligaments from the base of the penis. The skin from the pubic area is used to cover this extra length of the penis. After surgery, traction is maintained to lessen the risk of retraction. Penis widening is done in several ways and may involve free fat transfer of tissue grafting. Alloderm (human collagen) and dermal fat are the most common substances used as fillers. Ideally, uncircumcised patients should be circumcised at least six weeks before girth enhancement is undertaken. Length and girth enhancement and circumcision can be done at the same time, but discomfort is greater and healing may be slower. If lengthening only is desired, circumcision is not necessary.

Potential side effects

As with any surgery, there are risks. Aside from the general risk of anesthesia, the surgical side effects include swelling, bruising, mild discomfort, infection, altered sensation or numbness, inability to develop erection, abnormal angle of erection, delayed wound healing, scarring and blood may collect beneath the skin and require another procedure to drain it. It is highly recommend that people who want penile enlargement stop smoking and wait at least 2-3 months before surgery. Nicotine is known to narrow the blood vessels and decrease the blood supply. This results in poor healing and skin necrosis which often results in scarring.

The results of penile enlargement are not immediate and the exact length and width is almost never assured. The shape, size and its function may all vary and the final result is not seen for at least a few months. If not satisfied, another surgery is required which is even less predictable of a good result. After surgery, it is recommended that you wear jockey shorts and keep the area clean and dry. The penile area is usually bruised and tender for about 2-3 weeks. Sutures are generally removed at the first post surgery visit which is about 7-10 days

Manual stretching at one week and a weight program is highly recommended. Various light traction devices are available and used for 2-3 weeks. Some patients go overboard and place traction for 3-6 months to further lengthen the penis. Masturbation and sexual intercourse is avoided for 4-8 weeks. Playing of sports or any heavy physical activity is not recommended during this time.

Are you a good candidate?
As with any cosmetic surgery, it is important to have realistic expectations. Penile-enlargement procedures are usually performed by plastic surgeons and urologists. But with the envy of money, you never know who is doing the procedure. So if in doubt, ask.