In recent years, there has been an increase in genital plastic surgery among both sexually active men and women. Penis enlargement (penile augmentation) surgeries are among the most frequently requested surgeries among men. Penis enlargement surgeries are generally performed in the form of penile lengthening and diameter thickening. In this article, I will talk about penis enlargement surgery in the light of my experiences and current literature.
What is the normal penis size?
Normal penis size is found by measuring the length between the lowest tip of the penis and the part where it attaches to the pubic bone (the pelvis) while it is stretched. Penis diameter or thickness is measured from the middle of the penis body with a tape measure.
Penis size varies according to races and from person to person. The average penis length in African men is 15-18 cm at erection in an adult male, 13-15 cm in European men and Turks, and around 10 cm in Asian men.
What does micropenis mean?
It is not always accurate to estimate the erected length of the penis relative to its normal size. If the penis is 13 cm or longer when erect, it is normal in size. If it is 7.5 cm or less while erect, then there is a micro-penis. Micropenis occurs in 6 out of 1000 men.
What is penis enlargement surgery?
Penis enlargement surgeries are surgical interventions performed to make the penis larger. Men often want to have this surgery because they believe their penis is too small or not big enough to make their partner happy. Penis enlargement surgery is a combined surgery for penile lengthening and diameter thickening. It is done in the same session.
Is the head of the penis enlarged in penis enlargement surgeries?
No, the glans penis is not enlarged in penile enlargement surgeries. There are those who inject synthetic fillers into the head, but we do not do this. This application can damage the head of the penis, there is no scientific basis for this.
Who can have penis enlargement surgery?
Medically, penile enlargement surgeries are rarely needed. Most of the men who apply to the Urologist for penis enlargement surgery have normal penis sizes. Our own observations are like this. While this is the case, there has been an increasing desire for penis enlargement surgeries in recent years among sexually active young men. Penis enlargement surgery is required in the following cases;
- Micropenis: In medical terms, penile enlargement surgery is necessary in cases where the penis is very small (small penis, micro penis) or buried penis. Micropenis is a very small and congenital disease. A buried penis means a penis hidden in the surrounding structures. Buried penises are small when viewed from the outside, and it is possible to enlarge them by surgical procedure.
Surgery has 2 purposes in patients with micro-penis or buried penis discomfort:
- To enable the person to urinate normally while standing
- Allowing the penis to enter the vagina during sexual intercourse
- Penis dysmorphophobia disease: Some people have the idea that some parts of their body are sick or inadequate. This is called general body dysmorphism. Some people also have an obsession with having a disease in their penis. In these people, the penis is actually normal. The person can urinate standing up and have normal intercourse, but they want a longer and thicker penis. If this situation disturbs the person psychologically, causes familial problems and erection problems, surgery is required.
- Small penis anxiety: Although the urologist says that the penis is normal in the examination, some people think that their penis is smaller than normal. This condition becomes chronic over time and negatively affects the mood of the person. This is called “small penis anxiety”. In these patients, surgery can be performed even though there is no medical need for surgery.
What should be done before the operation?
Penis enlargement surgeries are performed under general or spinal anesthesia and operating room conditions. The surgery takes about 2 hours on average. These patients undergo a general evaluation before surgery;
- Patients’ lifestyles should be questioned: alcohol, smoking and chronic drug habits, etc.
- Routine tests: Routine tests are performed for anesthesia as in other surgeries.
- Psychological evaluation: Psychiatric consultation is requested in order to evaluate the mental health of the patients when needed. All risks are explained to the patient and suitable patients are taken into surgery.
- Drugs used: Blood thinners, drugs that will affect anesthesia, etc. must be asked and blood thinners must be discontinued one week before the operation.
- Chronic diseases: Diabetes, blood pressure, heart disease, etc. are investigated
- Previous operations: Previous operations that will affect this operation, pelvic operations, penile operations, etc. should be asked.
What are the penis enlargement surgery methods?
Various surgical methods are used for penis enlargement and thickening. Generally, lengthening and thickening surgeries are performed in the same session. In this way, both elongation and thickening of the penis are provided. We do both surgeries at the same time. We have been successfully performing all current surgeries on this subject for a long time. The main penile enlargement surgeries are:
- Cutting the suspensory ligament of the penis: In this procedure, the ligament that suspends the penis from the root of the penis to the pubic bone (pelvis bone) is cut. This is called “pubectomy” surgery. This procedure is a penis lengthening method. Patients’ expectations are usually too high in such surgeries. At the end of this, the penis grows by 2-3 cm.
- V-Y plasty: Suspending the penis to the pubic bone and the ligament (suspensor ligament) is opened and cut with a V-Y plasty incision, and the penis root part moves away from the pubis bone, resulting in an elongation of approximately 2-3 cm in penis length. This length is the length obtained by pubectomy, that is, an additional lengthening cannot be achieved with V-Y plasty.
- Free fat graft: It is the process of transferring the fat tissues taken from the lower abdomen of the patient to the penis in the form of a patch. These fat tissues, which are taken with the “liposucntion” method by entering through a small incision, are passed through special processes and given under the penile skin with a thick injector (cannula) regularly. Since 20-80% of the given oils will be absorbed within a year, it may be necessary to repeat the same procedure over time. After this procedure, irregularities due to sagging of the injected fat in the penis may occur in the long term.
- Dermal fat graft: In this procedure, it is taken together with the subcutaneous patch of adipose tissue taken from the patient’s lower abdomen and thighs. This material is placed under the skin of the penis all around.
- Suprapubic lipectomy: It is the process of removing excess fat in the groin, in the lower abdomen, at the root of the penis. This method is mostly applied when overweight patients lose weight and the penis is still buried in fat. As a result, since the excess fat in the root of the penis is removed, some lengthening is achieved.
- Opening of the penoscrotal band: Sometimes there is a thin band or curtain that extends from the underside of the penis to the scrotum (the bag in which the testicles are located) and pulls the penis down during erection. With the correction of this band, a certain amount of elongation is achieved in the length of the penis. In normal people, doing this procedure does not contribute to the length of the penis.
- Use of skin fillers: Fillers that are specially used for cosmetic purposes are used to wrap the penis under the skin of the penis. In this way, thickening of the penis is provided. The amount to be given varies from patient to patient.
- Special synthetic materials: Synthetic materials, which are wrapped around the penis under the skin for the purpose of thickening the penis, have been used recently. These are substances used in the treatment of other diseases in the body, but the long-term results are not yet known as they are newly used products for penis enlargement.
- Cellular therapy/tissue engineering: With this method, “fibroblast cells” are produced in a cell culture medium from the biopsy material taken from the patient’s scrotum under the skin. After these cells reach a certain number, they are planted on tissue-engineered molds (PLGA) and placed under the penile skin all around.
What should be considered after the operation?
Patients start to take liquid food orally 4-5 hours after the surgery. Painkillers for pain and antibiotic prophylaxis against infection are administered intravenously.
- Patients stay in the hospital for one day after the operation.
- The catheter inserted during the surgery is removed the next day.
- Penis bandage stays up to 1 week
- Painkillers and preventive antibiotics are started to the patients.
- Sexual intercourse is started 6 weeks after the operation.
What are the complications of penis enlargement surgeries?
As with any surgery, there may be some complications in this surgery. Extremely few complications occur in experienced hands. In many surgeries we have performed, no serious complications have developed or revision (correction) has been required so far.
Common complications are:
- Anesthesia-related complications: Extremely few, reactions to drugs, etc. may occur.
- Infection: Serious infections can be prevented in a suitable environment and with antibiotic treatment.
- Scar reaction: A scar (scar) may develop at the surgery site depending on the body.
- Irregularity in the penis: Irregularities and deformities may be seen in the penis after surgery.
- Loss of sensation: There may be numbness in the penis as a result of stretching or injury of the penile nerve during surgery.
- Erection problems: It is extremely rare.
- Chemical reactions: Such reactions are mostly seen as a result of applying injection materials under the skin. These substances are distributed unevenly and cause deformities.
Penis enlargement by non-surgical methods
Non-surgical penis enlargement procedures have also been tried. It can be dangerous for people to use these procedures without the advice of a Urologist. Creams, pills, etc., which do not have a doctor’s recommendation and do not have the approval of the Ministry of Health, are not sold in pharmacies. The products should never be used. Especially the use of products sold on the internet and whose content is not clear can cause serious problems. There is no herbal or similar product in the world that lengthens or thickens the penis. Some of the methods that have been tried for the purpose of penis enlargement without surgery, but most of them cannot be proven scientifically, are as follows;
- Testosterone therapy: Testosterone is a male hormone. It is important in the development of the penis. It should be used with a doctor’s prescription in cases of micropenis and low hormone levels in children. This is a scientific form of treatment.
- Creams, lotions: Such products should be used in consultation with the doctor. There is no cream or lotion that actually enlarges the penis yet.
- Supplementary products: Herbal supplements are used for this purpose, but their effectiveness has not been scientifically proven.
- Weight application to the penis: Although there are such studies, it has been shown that there is no serious benefit. Unconscious practices can damage the penis.
- Vacuum pumps: Vacuum pumps specially designed for the penis create an erection by increasing blood flow to the penis. Long-term and unconscious use of these can damage the penis.
- Penile exercise: Exercises are performed by taking the penis downwards from the root part between the thumb and forefinger and massaging it. This process is called “jelqing”. It is not a widely accepted practice scientifically. It should not be done too traumatic. Otherwise, it may damage the penis.
Recommendations to patients
Penis lengthening and thickening surgeries are unnecessary for most people. They do not have much scientific validity. We will have some suggestions for patients before deciding on this surgery;
- Dialogue with their spouses and partners: Before deciding on this operation, the couples should discuss the issue among themselves. If there is a happy sexual relationship and the urologist said that the penis is medically normal, such an operation is not necessary.
- Losing weight: Fat people think that their penis is small, but it is normal. With the weight loss of these people, it is seen that the penis is of normal size. For this reason, we recommend our patients who apply for penis enlargement surgery to lose weight first if they are overweight. In this way, after losing weight with a suitable diet and exercise program, it will be revealed that the penis size is normal.
- Psychiatric consultation: It is beneficial for those who are obsessed with small penis to get psychiatric support if necessary. In some of these patients, penis size can become an obsession.
- It is not a cosmetic surgery: Penis enlargement is not a cosmetic surgery. On the contrary, there may be some deformities after this surgery. Patients should be told that penis enlargement surgery is not an aesthetic surgery.
In conclusion: The interest in penis enlargement surgeries is increasing day by day. Most of them do not really have a medical indication for surgery. Penis enlargement surgery is medically necessary for patients with “micro penis”. Apart from this, in cases of “penile dysmorphophobia” and “penile anxiety”, side effects can be explained and penis enlargement surgery can be performed, although it is normal.
Prof. Dr. Emin ÖZBEK