Do penis enlargement procedures work or is it a myth? In this article we talk about the myths and dangers of penile enhancement, and scientific evidence (if any) behind them.
A few days ago as one of our team members was scrolling on the Arabic-speaking part of TikTok, he came across an account in a neighboring Arab country that spoke about penis enlargement being a possible solution for penis enlargement. The Doctor speaking sounded like a guy you meet at the shisha bar telling you crazy unbelievable stories. Penis enlargement was always a snake oil salesman pitch, but to see it now in Arabic, and on TikTok was alarming. So we dug deeper to understand this trend and the dangers surrounding it.
To start the discussion about what penis enlargement surgery is, we first need to discuss the anatomy of this organ. If you are a man, with the probability of 99% you have seen a penis in your life and know what it is usually used for: urination and reproduction. But if you look beyond the surface, it is quite a complex system of interconnected elements.
Any penis (that definitely includes yours) consists of three parts [1]:
When you get aroused, and sometimes spontaneously, your brain releases some substances that make the blood vessels in your penis relax. When they relax, blood flows into your penis and it gets hard (erect). Unlike an on/off switch (or “100% ready for action” and “I don’t want anything” in case of your reproductive organ), in real life your penis has more than just the two states. It can be anywhere between fully erect and not erect at all (this state is often called “flaccid” in scientific publications). This bit will be important for understanding how some of the “penis enlargement devices” we discuss below work. [1]
And don’t forget that your urethra goes through your penis as well, helping you to get rid of excess liquid and some of the products of your metabolism. [1]
We discussed it in extremely simplistic terms, but even with this you can clearly see how complicated your reproductive organ is. Nerves, vessels, muscles, connective tissue, skin - all these parts you need to keep in mind when you think about penis enlargement methods and their effectiveness.
Let us start with stating it straight away: there is no such thing as “normal penis size”. We have a separate post about the penis size in Arab countries where we discussed it in detail, go and check it out. But to summarise, the vast majority of erect penises fall within 11.46-14.78cm range. [2] But keep in mind that you cannot 100% rely on population studies and that the real average size is likely smaller. It also doesn’t mean that having a smaller penis is not normal. For a large proportion of women the width is more important. [3] And there are other ways to make your partner happy in bed.
Now that we know a bit more about the anatomy and the sizes of penises, let’s talk about why we think about our penis size so much. A lot of men fix their minds on it, constantly asking themselves (and sometimes people around): “Is it too small? Is it too big? Can I make it bigger? Should I?” Let's get the elephant out of the room: you are reading this blog, so most likely you asked these questions at some point of your life, or maybe you saw an ad for penis enlargement and wanted to check if it actually works.
But why are we so curious about it? A lot of this comes from societal expectations shaped by media and pornography. Media often associates masculinity with penis size. To start with, a smaller penis is often thought of as a reason for mockery. There are countless memes and jokes that imply that having a smaller-than-average organ is bad, that people try to compensate for that etc etc etc. Secondly, when young people watch pornography (and you can’t stop them from doing that, even if you try), they often get unrealistic expectations of how big an average penis should be. [4]
Unrealistic expectations create uncertainty about men’s perception of the size of their own penis. That often turns into insecurities. And these insecurities are often expressed in men as not accepting their body and wanting to change it so that it looks more like this “ideal” image they have in their head.
The penis enlargement industry generates millions of dollars in selling dreams and "solutions" for the essentially false urge for male enhancement or enlargement year after year. But what is it exactly?
All methods of penis enlargement can be divided into two groups:
Let us start with various pills and lotions that promise you to double your length, triple your girth, and “hundr-uple” your confidence. They might include vitamins, minerals, herbs, hormones, or some mystery powerful components. When you think about the anatomy of the male penis we discussed above, it is hard even to imagine what possible mechanism of action there is for such remedies. Scientists seem to agree: to date, there is no scientific evidence that any of these work. And the risks of taking such meds can be quite high, and even life threatening sometimes. Read our post about herbal Viagra to learn more.
Other non-surgical choices include vacuum devices, sometimes called penis pumps, penis rings and penis stretchers. Vacuum pumps work by creating suction in your penis. That attracts the blood to the penis and erection happens. Since you know the anatomy of the penis already, you would also logically conclude that these pumps actually help to create an erection, and not enlarge your penis. And indeed, penile pumps are one of effective and safe (when used correctly) ways to treat erectile dysfunction. [5] If your erections were not completely hard, you will also see an increase in size compared to your erections when you don’t use such a pump, but it would be insignificant.
Penis rings work similarly to vacuum pumps. Put at the base of the penis, they block the flow of the blood from it, thus increasing the strength of an erection. Again, they do not lengthen your penis, they might just help with the strength of your erection. And you have to be very cautious when using them, as incorrect usage can lead to severe medical emergencies, like penis strangulation.
Another group of gadgets that is often advertised for men who want to enlarge their penis are so-called penis extenders(stretchers). These gadgets work by stretching the non-erect penis and work at increasing the length of the penis. Usually you put or tie your penis to a device and then stretch it with the help of such a device. This seems to be the only non-invasive option on the market that actually has at least some scientific evidence. [6, 7] At the same time, the scientists themselves admit that more evidence-based research is needed to say it with 100% certainty. And, when applied incorrectly, these gadgets can have some serious side effects like penis raptures, swelling and pain.
There are also articles about stretching exercises that do not involve any external gadgets, but those have little to no evidence that they work.
Invasive methods of penis enlargement are the most extreme ones and mostly targeted at increasing the girth of the penis rather than its length (apart from the ligament surgery). They include manipulations with the suspensory ligament, fat injection, tissue grafting and penis implants. Usually these methods involve a doctor and a hospital environment, so a lot of men assume it must be legit. So let’s discuss each of these separately.
Cutting the suspensory ligament of a penis is one of the most common surgical procedures that claims to lengthen your reproductive organ. Suspensory ligament is one of the ligaments that attach your penis to your body. By cutting it, the penis can hang down more, making it seem bigger. This is sometimes accompanied by some manipulation with skin around the penis to make it look even bigger. Whilst this can help it look bigger, it adds instability to penis when it is erect, which can cause trauma during the act and scarring. [8] There are techniques that aim to improve the safety and efficiency of such a surgery, but unless you have clear indications for such a procedure, the wisest thing would be to avoid it.
Next, let’s have a look at fat injection. Fat injection is exactly what it sounds like: you take fat elsewhere in your body, and you inject it into your penis to make it seem thicker. Whilst theoretically this could sound like a good idea, quite often this procedure does not produce the desired outcome. Some of that fat can be reabsorbed, and the fat that stays can be distributed unevenly, creating a non-desired aesthetic appearance of the penis body. And all that not taking into consideration more serious complications that can occur, including edema, curvature, scar tissue and others. [9] Major urology organisations, such as American Urological Association, advise against fat injection. [10]
Tissue grafting is another technique in the realm of penis enlargement surgeries. Graft is a piece of skin with an underlying fat layer that is taken from other parts of your body. It is then sewn into the body of the penis to make the girth of the penis bigger. Whilst it can make the penis look bigger, surgeons report a 50% complication rate, meaning every other man that did it, faced severe consequences. [11] Some of these consequences included skin loss, urinary obstruction, fat necrosis and others.
Finally, penis implants. Let’s clarify one thing straight away though: we are not talking about penile implants for erectile dysfunction here. Such types of penile implants are a safe and tested method of treating erectile dysfunction that is not responsive to the medications and vacuum pumps. They can also help men that sustained injuries to their penis to restore the reproductive function of it.
Penis implants for penis enlargement is a different type of beast. They are one and many, each different from another, and you can see the ads for penille implants as a way to make your penis larger. Since there are quite a few of them, it is hard to define just one mechanism of action, but they usually either inject something other than fat (so-called fillers) to make your penis thicker, offer some sort of tubes to straighten it, or use some techniques to make the part of the penis below the surface of the skin look bigger. While some may claim that these methods are effective, both science and real-live patient feedback question this. [9, 12]
Please remember, that unless you have a micro-penis (a condition with penis being shorter than 9.3cm/3.67in stretched, it affects 0.6% of the people worldwide [14]), you do not need penis enlargement. A much better option would be to start communicating with your partner to find out more about what they like, as penis size often has little to do with this. Additionally, a consultation with a therapist, who can suggest to you how to accept and love yourself the way you are, might change your life in the bedroom much more drastically than a penile implant would.
Well, taking everything above into consideration, most of the penis enlargement methods do not work. Numerous scientific reviews and meta-analyses question the efficiency of these methods and say they are at best not helpful, at worst dangerous for your health. [9,13,15] Remember, than when you see ads regarding the penile enlargement, someone makes money out of them. Be skeptical about everything you see on the internet, double check everything against scientifically-backed sources, talk to your doctor, and mainly - talk to your partner about what is bothering you. Learning how to use what you have would bring you much more satisfaction than trying to achieve the image that is sold to you by ads and unrealistic depictions of sex in the media.
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References:
[1] Sam P, LaGrange CA. Anatomy, Abdomen and Pelvis, Penis. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482236/
[2] Veale D, Miles S, Bramley S, Muir G, Hodsoll J. Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15,521 men. BJU Int. 2015 Jun;115(6):978-86. doi: 10.1111/bju.13010. Epub 2015 Mar 2. PMID: 25487360.
[3] Eisenman R. Penis size: Survey of female perceptions of sexual satisfaction. BMC Womens Health. 2001;1(1):1. doi: 10.1186/1472-6874-1-1. PMID: 11415468; PMCID: PMC33342.
[4] Sharp G, Oates J. Sociocultural Influences on Men's Penis Size Perceptions and Decisions to Undergo Penile Augmentation: A Qualitative Study. Aesthet Surg J. 2019 Oct 15;39(11):1253-1259. doi: 10.1093/asj/sjz154. PMID: 31107944.
[5] Lee M, Sharifi R. Non-invasive Management Options for Erectile Dysfunction When a Phosphodiesterase Type 5 Inhibitor Fails. Drugs Aging. 2018 Mar;35(3):175-187. doi: 10.1007/s40266-018-0528-4. PMID: 29464656.
[6] Oderda M, Gontero P. Non-invasive methods of penile lengthening: fact or fiction? BJU Int. 2011 Apr;107(8):1278-82. doi: 10.1111/j.1464-410X.2010.09647.x. Epub 2010 Sep 24. PMID: 20868389.
[7] Nikoobakht M, Shahnazari A, Rezaeidanesh M, Mehrsai A, Pourmand G. Effect of penile-extender device in increasing penile size in men with shortened penis: preliminary results. J Sex Med. 2011 Nov;8(11):3188-92. doi: 10.1111/j.1743-6109.2009.01662.x. Epub 2010 Jan 19. PMID: 20102448.
[8] B Cook, J Rubin, M Brennan, (052) Penile Length Enhancement with Suspensory Ligament Release, Corporal Advancement, and Periosteal Stabilization, The Journal of Sexual Medicine, Volume 21, Issue Supplement_1, February 2024, qdae001.048, https://doi.org/10.1093/jsxmed/qdae001.048
[9] Furr J, Hebert K, Wisenbaugh E, Gelman J. Complications of Genital Enlargement Surgery. J Sex Med. 2018 Dec;15(12):1811-1817. doi: 10.1016/j.jsxm.2018.10.007. Epub 2018 Nov 13. PMID: 30446473.
[10] https://www.urologyhealth.org/urology-a-z/p/penile-augmentation
[11] Adhikari S. Penis Girth Augmentation Using SEPA Flap and Dermofat Grafts. J Cutan Aesthet Surg. 2023 Jul-Sep;16(3):198-204. doi: 10.4103/JCAS.JCAS_174_22. PMID: 38189069; PMCID: PMC10768958.
[13] Hehemann MC, Towe M, Huynh LM, El-Khatib FM, Yafi FA. Penile Girth Enlargement Strategies: What's the Evidence? Sex Med Rev. 2019 Jul;7(3):535-547. doi: 10.1016/j.sxmr.2018.11.003. Epub 2019 Jan 4. PMID: 30612977.
[14] https://my.clevelandclinic.org/health/diseases/17955-micropenis
[15] Giancarlo Marra, Andrew Drury, Lisa Tran, David Veale, Gordon H. Muir. Systematic Review of Surgical and Nonsurgical Interventions in Normal Men Complaining of Small Penis Size. Sexual Medicine Reviews, Volume 8, Issue 1, 2020, Pages 158-180, ISSN 2050-0521, https://doi.org/10.1016/j.sxmr.2019.01.004
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