Penis enlargement procedures (sometimes euphemistically referred to as male enhancement procedures in spam email and television advertisements) are techniques alleged to make the human penis larger in width and/or length. Often, in the course of advertising fraudulent products, the distinction between temporary enlargement, i.e. erection, and permanent enlargement, is deliberately muddied.
Procedures range from manual exercises to stretching devices and surgical procedures, with reports of successes and failures around the world. While some of these are known to be outright hoaxes, other techniques seem to have some measure of success.
Very little legitimate scientific research has been done on penile enlargement, so any claims of significant and permanent enlargement can be biased or anecdotal. Conversely, there is an element of risk to most all of the procedures, with negative outcomes ranging from the tearing of skin and scarring, to permanent loss of sexual function. Due to the speculative nature of any hope for "improvement" and the many known cases of permanent injury involved in this endeavor, many medical professionals are skeptical of the subject.
At present there is no consensus in the scientific community of any non-surgical technique that permanently increases either the thickness or length of the erect penis that already falls into the normal range (4.5" to 7").
 Surgical methods
Surgical techniques used for penis lengthening (enhancement phalloplasty) and penis widening (girth enhancement) have been in the urologic literature for many years. In a study conducted at St. Peter's Andrology Centre and Institute of Urology in London, it was determined that most patients who underwent penis-lengthening surgery were unsatisfied with the results. (September 2006).
 Penis enlargement (length) surgery
Approximately one-third to one-half of the penis is inside the body, and is internally attached to the undersurface of the pubic bone. Penis lengthening involves the release of the fundiform ligament and the suspensory ligament that attaches the two erectile bodies to the pubic bone (ligamentolysis). The suspensory ligament makes the penis arch under the pubic bone. Release of this ligament allows the penis to protrude on a straighter path, further outward to give a longer physical appearance. With the penis on stretch, the ligament is divided close to the pubic bone until all midline attachments have been freed. Once these ligaments have been cut, part of the penile shaft (usually held within the body) drops forward and extends out, enlarging the penis by 2–3 cm (0.78–1.18 in.). After surgery, part of the postoperative treatment includes stretching of the penis to prevent the severed suspensory ligament from healing shorter than it was previously. The article "Penile Suspensory Ligament Division for Penile Augmentation: Indications and Results" discussed the subject. According to Nim Christopher, a urologist at St. Peter's Andrology Center in London, among men who have had the surgery, "the dissatisfaction rate was in excess of 70 percent".
Real penile lengthening (i.e., lengthening of corporal bodies vs. ligamentolysis) is not a routine or safe procedure because of high risk of losing the ability to have an erection. It can only safely be done during implantation of penile prostheses in patients with erectile dysfunction or Peyronie's disease. The world's leading urologists specializing in the field of penis enlargement surgery use only ligamentolysis, liposuction of the pubic area, and skin redistribution. They state clearly that surgeons can only expose the penis more outside the body with especially visible results in obese patients and ones with different deformities of penile skin where the penis is layered.
 Inflatable implants
A further method is to replace the two corpora cavernosa with inflatable penile implants. This is performed primarily as a therapeutic surgery for men suffering from complete impotence; an implanted pump in the groin or scrotum can be manipulated by hand to fill these cylinders from an implanted reservoir in order to achieve an erection. The replacement cylinders are normally sized to be direct replacements for the corpus cavernosa, but larger ones can be implanted.
One advantage to this surgery is that an erection can be created whenever desired, for as long as is desired and as firm as desired. However, this surgical procedure can never be reversed.
 Self-applied methods
Rather than attempt to change the actual size of the penis, one may make it appear bigger, by trimming the pubic hair or by losing weight.
"Penis enlargement pills", "penis patches" or ointments are commonly offered over the Internet. This is one of the most common topics for spam email messages. Analyses performed by Flora Research of California and by the University of Maryland have uncovered harmful contaminants in a number of "penis enlargement" pills. Contaminants found included mold, yeast, dangerous E. coli bacteria, pesticides, and lead. Dr. Michael Donnenberg of the University of Maryland has described herbal pills marketed as having "heavy fecal contamination", possibly from animals grazing near the plants harvested for herbal ingredients.
Dr. Ira Sharlip, a spokesman for the American Urological Association, has said, "There is no such thing as a penis pill that works. These are all things that are sold for profit. There's no science or substance behind them."
 Penis pump
A penis pump is a cylinder that is fitted over the penis, with a manual or motorized pump to create suction. As the apparatus creates a partial vacuum around the penis, blood is drawn into the penis, helping it to become engorged. As vacuum increases, the difference between the inner blood-pressure and the pump pressure increases as well; excessive pressure causes vascular damage rather than a harder penis.
A penis pump with a translucent cylinder
Penis pumps, usually described in this context as vacuum pumps, have use in conventional treatment of impotence. The pump itself is essentially as described above, although often made to higher standards of quality with a much higher price, and arrangements for distribution by suppliers of medical equipment.
Flexible compression rings, commonly called cock rings, can be added. Fitted on the open end of the cylinder, then an erection is created by pumping. Then the rings are pushed by hand onto the base of the erect penis before releasing the vacuum. This restricts blood flow out of, but not into the penis, enabling the erection to be held even in the presence of problems of the vascular or nervous system which would otherwise lead to immediate loss of erection. In the best circumstances erections can be maintained for a considerable time, but manufacturers' literature recommends that, for safety, rings should be removed after no more than 30 minutes.
Pumping must be done very carefully, if done incorrectly serious injury may result. Over-enthusiastic pumping can burst blood vessels and form blisters. In some cases the testicles can be unexpectedly pulled into the cylinder and cause severe pain and injury. It is also believed that the rim of the cylinder can cut into the skin and over time cause damage to the ligaments surrounding the penis. Impatiently pumping without reading explanatory material can produce too much suction (any pressure lower than 10 torr/1,333 Pa) and cause permanent and irreparable injury. Attempts at using vacuum cleaner units for this purpose have resulted in extremely severe injuries because the machine produces far too much suction. However, scientists Graham Rutherford and Anne Henke have also undertaken significant research in this area, being funded by some of the major names in sexual pleasure toys, such as Ann Summers. Mild pumping has led to the strengthening and increased durability of penis muscles and also, for psychosomatic reasons, has led to decreased masturbatory rates in later life.
The effectiveness of penis pumps was examined by Kazem, Hosseini and Alizadeh. They studied 37 men with penis length less than 10 cm and found no significant change in penile length after using pumps for six months, although the follow-up have found 30% satisfaction with the method..
A further 31 patient study conducted by the Department of Urology at St Peter's Hospitals and the Institute of Urology in London investigating the usefulness of pumps to correct the penile curvature associated with Peyronie's disease found that "There was a clinically and statistically significant improvement in penile length, angle of curvature and pain after 12 weeks of using the vacuum pump". In this study, subjects with Peyronie's undertook two ten minute pumping sessions per day for twelve weeks. The additional penis length was an unexpected side effect and not one of the intended aims of the study, but large enough to be statistically significant.
Stretching consists of attaching a penis stretcher or "extender" device to the penis for set periods of time. The device exerts a constant traction on the penis, which, in theory, lengthens and widens the penis. The traction supposedly causes the cells in the penis to divide and expand. In 2002 a study published in the International Journal of Impotence Research concluded that penis extender devices are effective at elongating the penis and furthermore the increases in length correlate with the amount of time the device is worn. A study conducted at the University of Turin and published in 2009 in the British Journal of Urology showed similar results, using a penile extender exerting a continuous and gradually increasing traction force on the penis. The device consists of a plastic ring, where the penis is introduced, with two dynamic metallic rods which produce the traction. After using the device at least 4 h daily for 6 months, the mean gain in length in flaccid state was 2.3 cm, with significantly improved erectile function scores and treatment satisfaction scores of "acceptable" to "good improvement" in all items, except for penile girth, where there was no significant measurable or subjective changes. However, the study population only included patients with inadequate penile dimensions, so it remains uncertain whether people with usual dimensions would have the same effects.
Jelqing is a penis enlargement method intended to make the penis larger by exercising the smooth muscle and other tissues in the penis, with the goal of permanently increasing the maximum erect size of the penis. This technique, also called "milking", involves wrapping the thumb and index finger around the penis while semi-erect and repeatedly drawing them away from one's body to force blood into the glans, thus encouraging more vascularity in the corpus cavernosum and associated tissues.
There are many products (tools, instructions, etc.) that one can buy; however, much of what they offer (instructions) is available on forums and free websites.
Jelqing is typically preceded by a warm-up with a hot compress on the genitals, and concluded the same way. The reasoning behind the 'warm-up' mimics the normal operation of the biological processes of the penis during the four stages of arousal. The third stage is heat. At this stage the smooth muscles of the 'glans' can easily expand to their present greatest potential size.
Clamping is a risky and dangerous technique. The goal of clamping is to increase the girth of the penis. This enlargement technique uses a constricting device, such as a shoe string, cable clamp, or a tight cock ring. The device is firmly tied, clamped, or put, respectively, on the base of the erect penis while "edging" (extended masturbation) with a firmly erect penis. Use of a metal cock ring is not advised because trapped blood engorging the penis can make it impossible to remove without amputation or emergency intervention such as sawing the ring off. Clamping is considered extremely dangerous by both practitioners and the medical community as it can cause permanent catastrophic damage to the penis.
Hanging is perhaps the oldest self-applied method of penis enlargement, with evidence suggesting it was practiced by certain African tribes as much as 2,000 years ago. Weight hanging consists of attaching a device (usually a rope or a strap) that grips the glans or just behind the glans and allows a weight to be suspended for a specific amount of time. Then a conscious effort is made to exercise the penis by raising the weight in repetitions (lasting no more than 5 to 10 minutes at a time) starting with the smallest and lightest weight 1/16 pound to the heaviest usually 1/4 pound or more, to increase the strength and stamina as well as elongation of the penis.
Weight hanging, however, can also carry serious risks, which include nerve damage, chronic pain, scarring and impotence. The potential for these risks is dramatically increased if the patient is not directly trained by a qualified certified therapist. The idea behind weight hanging is to stretch the tunica albuginea and other various tissues of the penis. The general effect is to elongate the penis, although widening can also occur, commonly at the base of the penis.
Hanging carries additional health risks due to the restriction of blood flow to the glans, including possible erectile dysfunction. Many tribal practitioners of weight hanging are impotent, although urination is unaffected.
 See also
- ^ Fox News. Most Men Unsatisfied With Penis Enlargement Results
- ^ European Urology: Is Penile Enlargement an Ethical Procedure for Patients with a Normal-Sized Penis? http://europeanurology.com/article/S0302-2838(05)00873-0/fulltext
- ^ Pharmacist.Com:Performance' pills offer men something unexpected
- ^ www.metrotimes.com
- ^ 'No Science' Behind Male Pill's Claims / Best bet? Deal with it, Newsday
- ^ , Sexual Health and Penis Enlargement, Anne Henke and Graham Rutherford.
- ^ Kazem, M., Hosseini, R. & Alizadeh, F. (2005). "A vacuum device for penile elongation: fact or ﬁction?". BJU International 97 (4): 777–778. doi:10.1111/j.1464-410X.2006.05992.x. PMID 16536772.
- ^ Raheem AA, Garaffa G, Raheem TA, Dixon M, Kayes A, Christopher N, Ralph D. (2010). "The role of vacuum pump therapy to mechanically straighten the penis in Peyronie's disease". US National Library of Medicine.
- ^ "Efficacy on Daily Penis Stretching Technique to Elongate the "Small Penis"". International Journal of Impotence Research. http://www.nature.com/ijir/journal/v14/n4s/pdf/3900961a.pdf. P155
- ^ a b c "A pilot phase-II prospective study to test the ‘efficacy’ and tolerability of a penile-extender device in the treatment of ‘short penis’". British Journal of Urology. http://www.andromedical.com/pdf/en/study_penile_extender_regarded_as_effective_treatment_for_short_penis.pdf. Authors: Paolo Gontero, Massimiliano Di Marco, Gianluca Giubilei, Riccardo Bartoletti, Giovanni Pappagallo, Alessandro Tizzani and Nicola Mondaini
- ^ "The dangers behind an advanced technique like penis clamping". Canadian Male Sexual Health Archives. http://growyerpenis.com/advanced_penis_clamping.html.