Penile enlargement: 5 things you need to know

For men living with anxiety and shame over the size and shape of their penis, searching for answers online about how to enlarge it may lead down a rabbit hole of half-truths and false promises.

Adding to the pressure are stats like those from a Stanford University study showing that the average erect penis increased 24% in length over three decades (from 4.8 inches in 1992 to almost 6 inches in 2021). But as some plastic surgeons explain to Yahoo Life, while these stories make for good clickbait headlines, they often encourage men to seek dangerous measures in efforts to grow their penis size.

Such anxieties are at the heart of a recent and buzzy story featuring several men who received a popular penile implant called the Penuma, a piece of silicone that gets surgically implanted under the skin to make the penis longer and wider. According to that ProPublica feature, the procedure left some men with an appearance similar to that of "a beer can with a mushroom sticking out on the top." Other stories of men who've taken similar measures — including with what's called traction, a penis-stretching technique involving a device to help extend its length, leaving some with irreversible skin tears — have also been the subject of fascination.

Horror stories aside, penile enlargement procedures are largely shrouded in misinformation and myth. Here, physicians specializing in such procedures explain what it all means.

1. 'Nobody is happy with what they start with'

As Dr. David Shafer, double board-certified New York City plastic surgeon and inventor of SWAG, a penile enlargement injection procedure, tells Yahoo Life, society places unfair pressure on men to "always search for ways" to gain inches, even when they don't necessarily need them.

"Nobody is happy with what they start with," he explains. "I have people coming in who are larger than average but who feel that they're smaller than average because that's their perception."

Indeed, decades of studies on the topic show that most men either want a larger penis or have exaggerated the length of their organ to gain social acceptance or to feel more masculine — despite the fact that most have a penis of average length (meaning between 5 and 6 inches, per a 2020 study). According to one recent survey, 74% of millennials say that penis size is important, while 85% of Gen Z respondents say the same, with almost 1 in 5 straight men saying porn's influence was the biggest reason for body insecurity during sexual interactions.

These messages, Shafer notes, create a false idea among men that "unless they're bigger," they're always going to feel inadequate.

And for men with what's actually called micropenis — a diagnosable medical condition referring to a penis that's less than 2.8 inches long when erect (affecting only around 1% of the American male population) — surgical and nonsurgical interventions are pretty much impossible. "The patients who are the best candidates are actually slightly smaller than average, average or even larger, because there's already space there to put the filler," says Shafer.

2. Nonsurgical fillers are rising in popularity

With this approach, penis fillers are injected into the shaft of the penis to instantly increase its girth and overall volume. They're usually made of either hyaluronic acid (a natural compound typically used for chin or cheek fillers) or biostimulators (a synthetic compound used to stimulate collagen and improve skin quality).

Injections can cost anywhere from $1,000 to $15,000 and typically last about a year. They are reversible with a special enzyme called hyaluronidase, which doctors can administer at the patient's request.

Still, while injections are FDA-approved for cosmetic purposes — such as for lip, chin or cheek fillers — they've yet to be approved for penis injections, so procedures are typically off-label. Regardless, "it's the safest out of all procedures," says Shafer, whose clinic has seen a 200 percent increase year over year in penis fillers, with over 30 men coming in to receive penis injections per week.

Similarly, Dr. Douglas Steinbrech, a Beverly Hills plastic surgeon who specializes in penis injections, has seen a growing number of male patients opting for injections, largely due to convenience. "You can get an instant increase in girth with injectables in 15 minutes. There's no longer a need to have a big surgery with a lot of downtime," he tells Yahoo Life, stressing that it's important for fillers to be administered by a trained and accredited medical professional and not "in somebody's basement."

Such injections, both doctors have observed, have led many men to more enjoyable orgasms.

3. The truth about Penuma and other surgical methods

Penuma is the only FDA-approved penile implant on the market, and results have been mixed: Per a 2018 study, 81% of patients reported feeling elated about the implant years after having the procedure. Meanwhile, many others have spoken out about experiencing various disfigurements and problems (like difficulty urinating and orgasming) after the fact.

"Once this goes in, these men are never going to be the same again, because their penis is never the same again," Dr. Mark Solomon, a Philadelphia-based plastic surgeon, told ProPublica about the Penuma implant.

That hasn't stopped some Texas doctors from attempting to reinvent the device, which its creator, famed Beverly Hills urologist Dr. James Elist (often cited as "the Thomas Edison of penis surgery"), has tried to stop, according to Texas Monthly. Meanwhile, Elist insists that Penuma is safe and effective.

"There is a myth that with the implant, one might have difficulty with some activities," Elist tells Yahoo Life. "The truth is that after the healing period, patients typically go back to all their activities such as exercise, sexual activity, scuba diving, etc."

In response to the ProPublica article, a spokesperson for Dr. Elist tells Yahoo Life, “Dr. Elist is a highly-skilled, world-renowned surgeon and inventor who pioneered the Penuma implant and penile enhancement procedure. Thousands of men have traveled from around the globe to his Beverly Hills clinic to undergo cosmetic surgery. As a result, men have regained their self-confidence in and out of the bedroom. As with any cosmetic surgery, there are potential risks and rare complications. Pro Publica cherry-picks and sensationalizes those few and conveniently ignores the vast majority of Dr. Elist's highly satisfied patients."

Besides implants, other surgical measures include ligamentolysis (a procedure severing the ligament that anchors the penis to the pubic bone, giving the illusion of length without actually increasing it) and fat grafting (in which fat is removed from one part of the body and injected into the penis to increase length), which, like implants, are not reversible.

"Surgery requires an incision, and once you have an incision, you always have an incision; there's no way to erase that," Shafer says, noting that with fat grafting, you never know how the fat cells will integrate with the surrounding tissue in their new location, which may affect appearance down the road.

4. Diet, supplements and other devices are mostly futile

Myths have floated around for years that certain foods — like spinach, olive oil, tomatoes and garlic — can help with penis growth, largely because of their supposed benefits to increase blood flow toward the genitals. Steinbrech says it's wishful thinking.

"All myths," he says. "There's nothing clinically shown that diet helps with growth, except that overweight pelvic tissue might shroud the base of the penis and make it appear shorter." Maintaining a healthy weight and exercise regimen are always going to help with pelvic circulation and a positive mindset, which he says is never a bad thing.

Also without merit, he adds: pills and supplements, like the kind seen in gas stations or in porn advertisements, which the FDA points out contain active ingredients that may interact poorly with certain medications. Similarly, vacuum pumps and lotions traditionally used to combat erectile dysfunction, but sometimes used to make the penis look larger temporarily, may cause permanent damage.

5. Some health conditions could make enlargement procedures more challenging

In general, the ideal candidates are healthy men with no active diseases or medical problems, Steinbrech explains.

"Comorbidities to avoid are diabetes, vascular disease, patients on aspirin or other blood thinners," he says, noting that doctors should be careful when deciding the best path forward for their patients.

Even though injections are safe procedures, Shafer adds, "you need to choose the patients wisely. You don't want to have a patient with brittle diabetes or a patient that's a heavy smoker, which is going to put you at higher risk for infections." That includes "somebody with active STDs," he stresses, as doing any kind of procedure during that time will "risk giving them an infection or making the infection worse, or spreading."

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