Archive for August, 2019

The Quest for A Mightier Penis: What You Should Know

August 31, 2019

Andrew Siegel MD  8/31/19


A wood carving I picked up in Jamaica a number of years ago

The adages “It’s not the size of the ship, but the motion of the ocean” and as expressed on a poster hanging in the boarding gateway of an airplane: “Size should never outrank service” make the point that size is not always the most important priority. However, when it comes to penis size, many men feel insecure—despite having adequate dimensions—particularly so with our super-sized American bigger-is-better culture: cars, homes, breasts, soft drinks, etc. Furthermore, the porn industry and mainstream media have not helped the plight of the average-endowed male. 

The penis represents way more than what it presents at “face” value. Transcending sexuality, the penis is a literal “totem pole” that is symbolic of confidence and swagger; it is no wonder why the words “cocksure” and “cocky” mean possessing self-assurance. Some men desire to be alpha males with a substantial locker room presence. Other men desire only to possess a formidable bedroom presence. Still others desire to be mighty under all circumstances. Interestingly, women in general are considerably less concerned with penile size than men. 

Many a man who is quite ordinary in genital dimensions perceives his penis to be smaller than average, a condition in which his image of his penis is at odds with reality.  Some men with this perceptual distortion are motivated to search for the means to a mightier penis, the topic of today’s entry.  

Penis art

Penis art, photo taken at Icelandic Phallological Museum, Reykjavik

Although micro-penis is a rare but real medical entity, the vast majority of men who have the perception that their penises are of sub-optimal dimensions do in fact have adequate penises in terms of size, anatomy and function. Many of these men have a psychological issue that parallels body dysmorphic disorder – defined as “a preoccupation with a minor or non-existent flaw in body image that causes marked functional impairment.” This preoccupation with penile size and/or shape is known as penile dysmorphic disorder.  This perceived inadequacy and obsessive focus can engender feelings of shame, embarrassment, psychological stress and self-esteem issues as well as acting as an impediment and handicap to relationships, resulting in some of these men seeking solutions to the perceived problem.

With all biological parameters—including penile size—there is a bell curve with a wide range of variance. Outliers may be phallically-endowed or phallically challenged, but most men are clustered in middle range. In a study of 3500 men published by Alfred Kinsey, the average flaccid penis length was 3.5 inches and the average erect penis length ranged between 5-6 inches. The average circumference of the erect penis measured 4.75 inches.

Penises of handball team

The penises of the Icelandic National Handball Team, photo taken at Icelandic Phallological Museum, Reykjavik



Enhancement supplements

Pervasive on the Internet, there are a multitude of “natural male enhancement” products available with no scientific data to support their effectiveness.  Moreover, these products are unregulated, lack FDA approval, and many have been found to have undeclared and potentially dangerous additive substances. My vote: An affirmative NO! Do not waste your money on snake oil from charlatans!

Viagra Family of Medications

The PDE5 class of medications used for ED (Viagra, Cialis, Levitra, Stendra) increase penile arterial inflow, decrease venous outflow and enhance penile length, girth and erectile rigidity.  These meds are commonly prescribed to the ED population and are often used as part of the penile rehabilitation program after radical prostatectomy to help maintain penile tissue integrity and facilitate the resumption of erections. For a man who has issues with genital size, a daily dose of one of these medications can induce more “tumescence” (blood flow to penis resulting in some filling and plumpness as opposed to full rigidity) than would occur otherwise, perhaps improving one’s perception and body image. My vote: YES, when used selectively and appropriately.

Testosterone Therapy

The penis depends on the male sex hormone testosterone to maintain tissue integrity.  Although men on androgen deprivation therapy (a pharmacological means of reducing testosterone levels) for prostate cancer may have penile tissue atrophy, the use of testosterone in men who do not have low testosterone levels does not appear to enhance penile dimensions.  My vote: YES, but only in the face of low testosterone levels in conjunction with symptoms of low testosterone.

Staying Sexually Active   

Keep your penis fit by using it on a regular basis for the purpose it was designed for. In other words, stay sexually active as nature intended! Sexual activity is vital for maintaining the ability to have ongoing satisfactory sexual intercourse. Regular sexual activity increases pelvic and genital blood flow and optimizes penile tissue health and elasticity, while ejaculation tones and strengthen the pelvic floor muscles“Disuse atrophy” is a genuine condition that occurs when the genitals adapt to not being used, with tissue wasting, shrinkage and weakness of the pelvic floor muscles. Use it or lose it! My vote: A Resounding  YES!

Staying in Good Physical Shape and Maintaining a Healthy Weight

Weight gain and obesity will cause a prominent pubic fat pad, the male equivalent of the female mons pubis, which will make the penis appear shorter. However, penile length is usually intact, with the penis merely hiding behind the fat pad, what I call the “turtle effect.”  Lose the fat and presto…the penis reappears. Having a plus-sized figure is just not a good thing when it comes to penis metrics. It is estimated that for every 35 pounds of weight gain, there will be a one-inch loss in apparent penile length.  My vote: An Affirmative YES!

Pelvic Floor Muscle Training

The pelvic floor muscles play a vital role with respect to all aspects of sexual function, from arousal to climax. Numerous scientific studies have documented the benefits of pelvic exercises (Kegels) in improving sexual function. Pelvic floor muscle training will help maintain penile tissue integrity and optimize the strength and endurance of the hidden muscles that are vital for erectile rigidity. My vote: An Affirmative YES!

Vacuum Therapy

Penile vacuum devices are mechanical means of producing increased penile blood flow and tissue expansion.  The penis is placed within a plastic cylinder that is connected to a manual or battery-powered vacuum. Negative pressure draws blood into the erectile chambers of the penis, engorging the penis with blood and temporarily increasing penile dimensions as well as causing an erection.  However, the ability to result in durable changes in penile size is debatable. The vacuum devices are at times used for several weeks prior to penile prosthesis implantation to optimize the size of the prosthesis.  My vote: May be useful on a very selective basis.

Traction Therapy

Traction devices result in tissue expansion via mechanical pulling forces, lengthening and/or straightening the penis. They are sometimes used in Peyronie’s disease to manage or prevent penile shortening and angulation. In the absence of Peyronies, studies have demonstrated that these devices can increase penile length, but have minimal effect on penile girth.  My vote: May be useful on a very selective basis.

Injection of Bulking Agents

Fat, silicone and soft tissue fillers can be injected subcutaneously to bulk up the penis. Fat injections can certainly increase penile girth, but with potential complications including irregular fat nodules, skin deformity, scarring, sensory disturbances, and fat embolism. Similar complications have resulted from subcutaneous silicone injections, some catastrophic. Dermal fillers, including hyaluronic acid, PMMA, and others have been shown to be capable of augmenting girth, but with major side effects such as nodularity, ridges, irregularity, indentations, voids in tissue filler, sensory issues, etc. My vote: An affirmative NO!  Not ready for primetime.

Grafts and Flaps

Many materials can be used for grafting– dermal fat, fascial-cutaneous arterial island flaps, dermal acellular matrix grafts, etc., to fatten up the penis and augment girth.  There are numerous complications associated with these, including edema, ulceration, infection, loss of skin sensation, penile shortening, etc. My vote: An affirmative NO! 

Subcutaneous Penile Implants

The Penuma device is a silicon sheath shaped like a hot dog bun that is placed under the skin of the penis, wrapped around and encircling about 80% of the penis, leaving an area of the underside of the penis unexposed. The device immediately expands the penis by about 2-2.5 inches in length and girth. The device is available in three sizes—large, extra-large and extra-extra-large (doesn’t that just say it all?!). As with implantations of all foreign devices into the body, there is the potential for infections, device breakage, skin perforation, pain and other issues. My vote: Leave the hot dog buns for hot dogs and not for penises!

Sliding Technique

This is a complex surgical technique for penile enlargement.  After the penis is degloved (releasing the skin to expose the underlying tissues), the penile erectile chambers are exposed and incised horizontally at the 3 and 9 o’clock positions, and additional incisions are made at the upper part of the chambers proximally and the lower part of the chambers distally. The distal erectile chamber is slid off the proximal erectile chamber and a penile prosthesis is inserted. My vote: Complex surgical procedure with many potential complications useful only on an extremely selective basis.

Other Surgical Techniques

There are many “sleight of penis” procedures including cutting the penile suspensory ligaments, disconnecting and moving the attachment of the scrotal sac to the penile base, and liposuction of the pubic fat pad. These procedures unveil some of the “hidden” (inner) penis, but do nothing to enhance overall length, nor girth. My vote: May be useful on a very selective basis.

Penile Transplantation

The world’s first penis transplant was performed at Guangzhou General Hospital in China. Microsurgery was used to transplant a donor penis to the recipient, whose organ was damaged beyond repair in an accident.  Penis transplantation has been used selectively for men after surgery for penile cancer and for traumatic injuries, particularly among veterans with IED-induced genital trauma. It certainly would be nice to look at a catalog of penis possibilities and pick out the penis of one’s choice, but this is not a possibility at this time!  My vote: May be useful on a highly selective basis for traumatic penile injuries and deformities resulting from penile cancer surgery.

Bottom Line:  If there were truly an effective, safe and simple means to increase penile size, you would know about it.  Realistically, to optimize your genetic endowment maintain a healthy weight, pursue a healthy lifestyle, remain physically fit and sexually active, and keep your pelvic floor muscles fit.  Oral medications, testosterone replacement, vacuum and traction therapy may have a role on a very selective and individualized basis. Stay clear of nonsense enhancement supplements, and especially avoid invasive procedures, which are fraught with an array of complications including an unsightly, lumpy, discolored, painful and perhaps poorly functioning penis.

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.  Dr. Siegel is the author of Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.  The first section of the book provides abundant information on the prostate and prostate cancer, while the second and third sections address male urinary and sexual concerns, respectively.

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Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

Prostate Cancer 20/20 on Apple iBooks

Dr. Siegel’s other books:

FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health