Category Archive Men’s Health

Penis size and enlargement surgery

This article includes information about the size of a so-called ‘normal penis’, about the abnormally small penis, and about treatment.

Problems with judging penis size

Men generally fall into two groups regarding their penis size and appearance. Some men have a short, fat, rather elastic penis when flaccid that stretches and expands very considerably during erection.

Others have a long, impressive-looking flaccid penis that barely changes in size when erect, and simply becomes more rigid. Men in the first group who see men from the second group naked in the showers incorrectly think that they have an abnormally small penis.

Both are normal, just different.

Obesity and very thick growth of pubic hair may make the penis appear smaller. Obese men develop a pad of fat in the pubic area and the flaccid penis becomes buried in it. Weight reduction will improve appearance, as will neatly trimming excessive pubic hair.

Very obese men might not be able to see their penis at all, because of their large and pendulous abdomen.

Men should also remember that their penis will always look shorter when they look down at it, compared with looking straight at their penis in a mirror or across the changing room at another man’s penis. This is a simple optical illusion.

What is a normal penis?

When measuring penis size, it is important to distinguish between the respective sizes of the flaccid, stretched flaccid and erect penis.

Many men are concerned about the apparent size of their flaccid (‘soft’) penis, and worry that other men will laugh at them in the shower, or that sexual partners will ridicule them when they see them naked.

The flaccid penis varies considerably in size, ranging from less than 5cm to over 10cm (2 to 5 inches). The size of the flaccid penis does not determine the size of the erect penis.

Research1 suggests that the average size, measured from the pubic skin (precisely where the penis joins the body) to the opening (urinary orifice) at the tip, is about:

unstretched, flaccid length 8.8cm (3.9 inches)

stretched (pulled firmly out from the body), flaccid length 12.4cm (4.8 inches).

Fewer men seek medical advice about the length of their erect penis. Masters and Johnson (1966) found that the size of the erect penis ranges from 12.5 to 17.5cm (5 to 7 inches). They also demonstrated that men with a smaller flaccid penis had a proportionally greater increase in size on erection. The average size of the erect penis, measured in the same way as above, is around 12.9cm (5.2 inches).

What is an abnormally small penis?

No widely accepted definition of what is an abnormally small penis exists, but guidelines for selection of men for penis enlargement (penile augmentation surgery) recommend that only those with a flaccid length of less than 4cm (1.6 inches) or erect length of less than 7.5cm (3 inches) should be considered for surgery.

Does penis size matter?

The answer to this question rather depends upon your perspective. If you believe that you have a small penis, it may matter very much to you, however unimportant the issue might seem to others.

Some men become quite obsessed by the size of their penis and will consider almost anything, including surgery, to enlarge it. Most of these men will have a penis that falls within the suggested normal size range, but that does not always make them feel normal or better about themselves. Both they, and their doctor, should recognise that this is primarily a psychological problem, connected to physical and sexual self-image, rather than a physical handicap.

Researchers have repeatedly shown that penis size does not affect partner satisfaction during sexual intercourse. Some men born with a severely shortened and malformed penis, even less than 5cm (2 inches) long when erect, enjoy very satisfactory sex with their partners.

Women are much more likely to be bemused by men’s anxieties surrounding penis size, than amused by its actual size.

Penis enlargement treatments

  • Treatments aimed at increasing penile length or girth can be divided into two groups:
  • non-surgical treatments
  • surgical treatments.

Non-surgical treatment

From ancient times, men have tried a wide variety of treatments to enlarge the penis. Because of the sensitive nature of the problem, and because of the surrounding shame and embarrassment, concerned men are very vulnerable to exploitation by the unscrupulous.

While most doctors and other healthcare professionals act in a highly ethical manner, a few individuals will sell remedies and even perform surgery that they know has no evidence of long-term benefit. Some of them have been barred from practice as a consequence of their unethical behaviour. Others are still in practice, waiting to exploit the unsuspecting by relying on the fact that they are likely to be too embarrassed to complain to the authorities about an unsatisfactory outcome.

A glance though the small ads in men’s magazines will reveal the following ‘treatments’ on offer:

  • vacuum ‘developers’
  • weights that attach to the penis to stretch it
  • magnetic or electrical devices to stimulate penis growth
  • ‘hormone’ therapy, sometimes containing testosterone or related sex hormones (steroids)
  • remedies that contain assorted herbs from around the world.

Good-quality research evidence has not been published showing that any of these treatments produce a sustained increase in penis size.

Vacuum devices and weights may produce very small, short-term increases in size, simply because the penis is elastic and can be stretched. However, like an elastic band, it snaps back with time.

More worrying are private clinics that advertise penile augmentation (enlargement) procedures, and make extravagant and misleading claims about their results. Surgery can be of benefit to some men, but certainly not all of them.

Current cosmetic surgical procedures are largely unproven by research, unreliable in their benefits, and may carry the risk of serious complications. Urologists generally consider this type of surgery to be still experimental in nature, and not a standard procedure.2 Seek advice from a trusted doctor, such as your GP or local urologist, about the nature and standards of the clinic before asking for a consultation.

Surgical treatment

Since 1971, penile-lengthening surgery has been offered to men with severe shortening due to congenital abnormalities (abnormalities present from birth), surgery (for penile cancer or Peyronie’s disease) or trauma (accidental or deliberate amputation).

Cosmetic surgery to increase penile girth, or thickness, began in the USA in the late 1980s.

Techniques for cosmetic lengthening were described in 1990. More than 10,000 men have had such surgery, but reliable information about results and complications have not been published in a peer-reviewed journal (a journal where the quality and content of the research is checked by independent experts). Given the number of operations performed, this fact is both astounding and worrying.

Penile lengthening: the most common technique to lengthen the penis is to cut its suspensory ligament then perform plastic surgery to provide additional skin to cover its new length. The results are difficult to judge, as surgeons have not collected data in a systematic manner. The results of the only reliable study indicate that dividing the suspensory ligament alone results in an average increase of 0.5cm (around 0.25in) in length, while skin advancement increases the length gain to 1.6cm (around 0.75in). These figures do not compare well with the claims made by some clinics. Some people, undoubtedly, do better than average, while others do worse.

The suspensory ligament does have a role, in that it helps keep the penis pointing upwards during erection. After it has been divided, that support is no longer present. After surgery, some men find that they have gained a small increase in flaccid length, but the erect penis is about the same size and now points towards the floor!

Increasing penile girth (thickness): this treatment may be performed with a lengthening procedure or on its own. There are two techniques in common use:

injection of liposuctioned fat, from the abdominal wall or thighs, into the dartos fascia, under the skin of the penile shaft.

placing grafts of dermis (a layer of tissue from under the skin surface that is well supplied with blood vessels) and fat from the groin or buttock area within the penile shaft.

The results following injection of liposuctioned fat can be deeply disappointing. Up to 90 per cent of the fat can disappear within a year. Grafts seem to do rather better, but there is no reliable published data on long-term results.

Complications following surgery

At least one person has died from bleeding after augmentation surgery. Apart from the risks of infection and bleeding, specific complications exist for each procedure.

Lengthening procedures

Scrotalisation of the penis, in which the penis appears to arise from the scrotum instead of the abdominal wall.

  • ‘Dog-ears’ at each end of the operation scar.
  • Sloughing of the skin used to increase penile length (the skin has a poor blood supply and therefore dies, leaving a deep, ulcerated area).
  • Girth-increasing procedures
  • Loss of girth due to fat reabsorption.

Nodule formation, if the implanted fat does not disappear uniformly. The penis can be left with a deformed appearance, with irregular fatty lumps all over it.

Conclusions

Some men are severely anxious about their penis size and are prevented from enjoying a normal life as a result.

Men who are born with a small penis may benefit from surgical treatment, but the results are unpredictable. Without surgery, many will still be able to enjoy very satisfactory sexual relationships despite the small size of their penis.

Men that are dissatisfied with the appearance of their penis should think very carefully before requesting cosmetic surgery, especially if the size falls within the normal range.

A better option may be to seek the advice of a sexual and relationship therapist, who might be able to offer help and advice.

Using surgery to treat a psychological problem is fraught with risks. If surgery is the only way in which a man can regain his self-esteem and improve his self-image, they should seek advice from an experienced surgeon working in a reputable clinic.

Men should ask very carefully about the procedures that are offered, the surgeon’s results and any possible complications. They would also be wise to ask another trusted medical adviser for their view.

References

1. Wessells H, Lue TF, McAninch JW. Penile length in the flaccid and erect states: guidelines for augmentation. Journal of Urology. 156(3):995-7, 1996 Sep.

2. Carson C, Kirby R, Goldstein I. Textbook of Erectile Dysfunction. p513. Isis Medical Media, Oxford 1999.