In this episode we discuss penile enlargement. A recent study revealed that 45% of men wish that their penises were larger. That desire is further confirmed by the multitudes of creams, medications, and procedures promising to increase the length and/or the girth of the penis. But is it actually possible to increase the size of the penis? Do any of these treatments actually work? And, if so, to what extent? What are the risks of these penile enhancement treatments? And are there trade offs involved? To answer these questions, we are fortunate to be joined by Dr. Matthew Ziegelmann.
Matthew Ziegelmann, MD
Dr. Ziegelmann is an Assistant Professor specializing in male sexual dysfunction and infertility (Andrology) in the Department of Urology at the Mayo Clinic. He obtained his medical degree from the University of Minnesota and then completed a residency in urology at Mayo Clinic in Rochester, MN. He then continued his sub-specialty training in male sexual dysfunction and infertility (Andrology) at Rush University Medical Center in Chicago, IL. He is an active member of the American Urological Association, North Central Section, and Sexual Medicine Society of North America. He has published extensively in male sexual dysfunction and speaks nationally on topics related to male sexual dysfunction and other urologic conditions.
Better Man Clinics
What is a normal penis size? How long is a typical penis?
Dr. Ziegelmann
Yeah, that’s a great question, one that a lot of different studies have tried to answer. There was a systematic review done maybe six years ago, something like that. The review looked at 20 different studies that looked at populations of men and tried to identify what is an average penis size? And some of that gets a little complicated. Is it a flaccid penis? Is it a flaccid (non erect) penis that is put on stretch? Is it the erect penis? It gets a little bit complicated but, ultimately, the number that came about was that the stretched, flaccid penis (the non-erect penis), on average, for males was about 12 to 12.5 centimeters. If you think about that in inches, that’s roughly five inches, give or take. Again, that’s the penis on stretch as opposed to just the penis sitting there without the stretch.
Better Man Clinics
What does that translate into in terms of an erect penis?
Dr. Ziegelmann
So that’s another tough one. There is this concept of the “grower” versus the “shower”.
Better Man Clinics
That was going to be my next question. Can you help explain that to us? What is the “grower” penis versus the “shower” penis?
Dr. Ziegelmann
In general, the concept is that, essentially, there are some men who have flaccid penises that tend to hang out the majority of their length. They don’t perceive that their penis gets substantially longer with an erection. In comparison, there are many men that feel that their penis does get substantially longer as it fills with blood during an erection. There are, again, a lot of complicating factors. When we are talking about the size of the flaccid penis, we have to think about the ambient temperature outside. Remember the Seinfeld episode with George after the pool? A cold ambient temperature essentially causes the body to cause contraction of muscles. The penis has muscles on it. The pelvis is full of muscles that pull the organs into the body to conserve heat. That can change the appearance of the penis. If a man is under stress, his penis can be pulled in tighter because of something called a sympathetic or an adrenergic response. All of these things can factor into the appearance of the flaccid penis. But, yes, that classic grow versus show refers to whether someone feels that their penis gets substantially longer with an erection versus what we see is what we get : what we see when the penis is flaccid is what we get when it is erect.
Better Man Clinics
How does that even work physiologically, Men’s penises are kind of all built the same way. Why does one stretch during an erection and the other one doesn’t?
Dr. Ziegelmann
Well, some of it probably has to do with the inherent elasticity of the penis or the ability of the fibers of the erectile bodies of the penis to stretch. Some men likely have some intrinsic enhanced elasticity that’s just present at baseline in the flaccid state, whereas other men have more elasticity that’s present as the erectile body fills with blood. For some men who experience length loss of the penis as a result of different conditions, it is usually that loss of the elasticity of the penis that’s the main driver of that length loss in a lot of conditions.
Better Man Clinics
Is there a size or length of the penis that is considered abnormally small or short from a medical perspective?
Dr. Ziegelmann
Yes, there is a condition called micro penis. That is a medical condition. That is a diagnosis. There’s a code for that. Oftentimes, that is even identified in pediatric patients, in young children. Some of that has to do with anatomic abnormalities that people are born with, some of that has to do with hormones in children. However, the true definition of micro penis is a little in the weeds – micropenis is defined as being about two and a half standard deviations below the average. So, essentially, in measurement terms, I think some of the studies have suggested a cut off of around seven to 7.5 centimeters (roughly about three inches) of that stretched penile length would be considered the micro penis,
Better Man Clinics
Do certain conditions cause the penis to get shorter in men?
Dr. Ziegelmann
Yes, absolutely. Some of them are not specific to the penis. They are specific to your body changing over time. For some men, especially in the United States, we gain weight as we get older. One of the places that we can accumulate fat is the area above the penis. It is called the suprapubic skin. And beneath that, we can develop what’s called the suprapubic fat pad. That fat pad can give the appearance that the penis is shorter, but it may not actually be shorter. Some men can also accumulate swelling or fluid in the scrotum, the tissue that houses the testicles, and that can give the appearance of the penis being shorter as well. Those are just two examples of conditions where the penis isn’t, per se, anatomically changed but the tissue around it would give that appearance.
Some conditions could actually cause shortening of the penis. Men, as we age, tend to report penile length floss, but that’s probably more of a representation of other conditions going on. One notorious condition is just erectile dysfunction: difficulty achieving and maintaining an erection. The theory there is that if you’re not sort of “cycling” the penis with erections, if you’re not stretching those fibers (those elastic fibers) as the penis fills with blood, then you are essentially losing that, that stretch-ability or that elasticity over time. You know, there’s sort that old adage that “if you don’t use it, you lose it.” And it may be that you don’t want to stop using it. Rather, it’s just that it’s not working as well as it should. So erectile dysfunction is a classic cause of penile shortening. Another condition that many urologists who specialize in sexual dysfunction, see commonly is called Peyronie’s disease, which is a condition in which men develop scar tissue on the penis. We think it’s a result of injury. That condition can lead to loss of the ability of the penis to stretch with an erection because that scar tissue acts like a piece of tape. It causes restriction that can absolutely cause penile shortening. That is one of the most common, extremely bothersome symptoms of that condition that we see with men.
Better Man Clinics
Does the size of the penis affect the sexual satisfaction of partners? Have any studies been conducted to evaluate this?
Dr. Ziegelmann
Well, in one of the studies that you mentioned earlier, about 45% of men reported dissatisfaction with their penis size. I believe it was the same study or a study around the same time that said that only about 15% of their female partners were dissatisfied with the penis size of their partners. So,there is a disconnect there. If you do look at the literature, most of the literature would support that, outside of very special circumstances, the size of the penis does not correlate very well with sexual satisfaction. Now, we also have to take into account that, over time, women’s bodies (presuming a male and female, heterosexual sexual relationship) change as well. Those changes can affect them both from a physiologic and from an anatomical perspective and that can affect the satisfaction with sex as well. Female partners may suffer from vaginal dryness or pain with penetrative sexual intercourse, which can take away from the pleasure regardless of penile size. If the partner is overweight, and the person who’s concerned about their penile size is overweight, that can obviously throw in some difficulties as well.
Better Man Clinics
Are there any lifestyle changes in terms of diet, exercise or anything that can be done at home without actually buying anything that might help increase at least the appearance of the penis to be larger.
Dr. Ziegelmann
So basically, when I’m talking to anybody who’s coming in with any concerns regarding the genitalia, whether its size or function in general, I like to start out by explaining the fact that the penis is a vascular organ. And so, if we’re thinking about what can make my penis healthier- basically anything that enhances heart health or vascular health is going to help the penis health. That would include good dietary habits. So, that includes avoiding processed sugars and excessive calorie intake and enjoying lots of healthy fruits and vegetables. That also includes regular exercise and good sleep hygiene. Also, one of the most important things that can affect how high and tight things get pulled into your body is stress. If we can enhance stress control, oftentimes, we will see some relaxation of that pelvic floor. That relaxation can then actually enhance the appearance of the penis. None of these are magic bullets, but they all can be useful lifestyle modifications. The only other thing I’ll mention is doing simple, manual stretching of the flaccid penis. Actually, just gently pulling. For example, if they’re sitting down to read the newspaper or watch a television program, just gently pulling out on the penis to try to enhance some of the elasticity may enhance the ability of the muscles in the skin of the penis to stretch. Some guys have found that to be useful. But that’s purely anecdotal.
Better Man Clinics
Is what your are describing jelqing? What is jelqing? Can jelqing increase the size of the penis?
Dr. Ziegelmann
That is different. Jelqing is this phenomenon where men are essentially trying to, very aggressively, almost injure the penis when they have a partial erection to try to essentially cause some micro tears in the penis in hopes that they will enhance the length of the penis. There’s no evidence that that works. There are, you know, horror stories that you hear about as far as outcomes with that. I would certainly not recommend jelqing. Rather, just some gentle manual traction of the fully flaccid penis shouldn’t hurt. That should be the big thing. I don’t ever want anybody to purposefully cause any tearing or discomfort when they’re doing that. No injury.
Better Man Clinics
Does “manscaping” or waxing the pubic hair increase the size of the penis in terms of appearance?
Dr. Ziegelmann
I guess that makes good sense. I’ve never personally recommended that to a patient. However, I certainly think that, especially for men who have more prominent pubic hair around their penis, waxing away the hair can potentially enhance the appearance of the penis. And that would be pretty safe as long as you’re doing it the right way.
Better Man Clinics
Can weight loss increase the size of the penis in terms of appearance?
Dr. Ziegelmann
I’m a huge proponent of weight loss. That goes along with heart health and diet and exercise. The challenge is that a lot of men can lose significant amounts of weight, especially if they’re morbidly obese, but they may still maintain that fat pad- that suprapubic fat pad above their penis. That can be very bothersome. And you know, there are interventions we can do to address that. But that is one of those challenges where, a lot of times, people who are visiting with their clinicians who may not have a lot of experience in treating this will say “Oh, that’ll get better, just lose weight.” But, sometimes, losing weight in that specific area of the body can be really tough.
Better Man Clinics
Next, I want to talk about the potential therapies we see very prominently through Google searches for penile enhancement. What comes up really prominently are potential miracle cures in the form of everything from creams to pills to supplements which promise things like 6 inches of growth after 30 days. Obviously, that’s an exaggeration. But is there any reliable data to suggest that any of these creams or pills or supplements really work to increase the size of the penis?
Dr. Ziegelmann
I don’t know if that’s such an exaggeration. So, the short answer to this is that there is no data. There is no data to support any oral therapy or any vitamin or any mineral any topical cream reliably enhancing penile length and girth. Regardless of what type of intervention you are talking about, you’re always going to find someone who has some sort of an anecdote. However, there is no reliable study that I know of that’s ever shown that these therapies were effective. The concern we have with any of these therapies being offered is that a lot of these sort of vitamins and creams aren’t necessarily regulated in the same way that some of our other treatments are. So, they may be touted as having a certain quantity or percentage of a certain mineral or vitamin and they may not actually have that. That can be dangerous on rare occasions but, also, it can be pretty frustrating because it’s just another hit to the pocketbook, sort of taking advantage of people who are already in a situation where they just feel like there aren’t a lot of great options,
Better Man Clinics
What is a vacuum erection device? Can a vacuum erection device help with increasing the size of the penis?
Dr. Ziegelmann
The vacuum erection device is a cylinder that gets placed on the penis and it essentially creates a vacuum. It creates a negative pressure that pulls blood into the penis. The theory is that it can pull blood into those erectile bodies of the penis and, also, into the skin and tissues around that area. We frequently use the device to treat erectile dysfunction in men that don’t respond to Viagra and don’t want to move on to more invasive treatments. They can also use a little band at the base of the penis to trap blood in the penis. The theory behind how the vacuum erection device can increase penile length and girth is that by routinely cycling the penis, you are pulling blood into the penis and stretching that penile tissue. Through that stretching, you’re enhancing the length and girth of the penis. I would say that from a mechanism standpoint, that makes very good sense. That said, I don’t know that there is a lot of data on the vacuum erection device outside of treating erectile dysfunction or treating men who have had a prostatectomy and want to optimize erectile function afterwards. But, just anecdotally, we have patients who use the vacuum reaction device and report that they feel that their penis is able to expand more in terms of length and girth. And, so, I think it makes sense. There are some downsides to the vacuum erection device. First, it’s not very comfortable. For a lot of men, when they’re actually using it, sometimes the penis can get black and blue and even feel kind of cool to the touch for a period of time. However, that tends to go away and is self-limited. So, as long as you’re using the appropriate technology the right way, it tends to be very safe. And it does not have a lot of downsides. It’s just that, again, we don’t have a lot of data to say that, if a man is just frustrated with his penis size, the vacuum erection device is really going to make a difference
Better Man Clinics
What is a penile traction therapy? Can penile traction help with increasing the size of the penis?
Dr. Ziegelmann
Penile traction therapy is a noninvasive treatment that involves using a mechanical stretching device that men wear which essentially holds the flaccid penis, the non-erect penis, on stretch. The theory behind penile traction therapy is that it is actually causing the body to come in and remodel tissue. The most common reason we use penile traction is for Peyronie’s diseases for scar tissue that is built up in the penis. There is good data that says that when stretching forces are continuously applied to scar tissue, the body comes in and upregulate certain enzymes, certain proteins that break down that scar tissue, and hopefully the body remodels or lays down new tissue that’s more normal and more elastic. And there is also data that says that using traction can improve curvature. For men with Peyronie’s disease, the traction therapy can actually enhance the length of the penis. For example, we did a study of a traction device at Mayo Clinic a couple of years ago. We found that if men wear a traction device for 30 minutes at a time, two or three times a day, for three months, 95% of them had an improvement in stretched flaccid penile length of an average about 1.5 – 2 centimeters, which is not insignificant. For most of those men, that increase in the length of the penis was extremely meaningful because a lot of those men had experienced severe loss of penile length as a result of their Peyronie’s disease. What we don’t know with this treatment is whether those results extend to men without Peyronie’s disease. Does it apply to men with a normal anatomy of the penis but who are frustrated about the size of their penis? We just don’t have those studies. It is certainly something I’m interested in and others are interested in. But the data is pretty sparse.
Better Man Clinics
How does the penile traction therapy actually work? What does the device look like? How does someone use a penile traction device?
Dr. Ziegelmann
There are different traction devices on the market. In the context of Peyronie’s Disease, these have been around for a couple of decades, and they have undergone some modifications. The original devices consisted of a ring, essentially, that would be placed at the base of the penis, and then some type of mechanism (like a strap) that would be placed at the head of the penis and that would hold the penis, because you need to be able hold the head of the penis to be able to pull on it. The mechanism for pulling the penis would actually be a series of bars and rods essentially that you would screw together at various lengths. You would strap the penis in at the head of the penis, and it would pull and you would leave that device on for up to six or eight hours at a time. Usually, people would take it off every couple of hours and give their penis a rest but they would keep it on for six or eight hours a day. There are newer models also available. For example, there is a model where you can have a suction cup to the head of the penis. That is a different way of just holding the penis, but it’s still that same “bars and rods” mechanism. The newest traction system that’s on the market uses a spring loaded mechanism. So, again, it still has the ring at the base and it still has a clamp at the head of the penis. That spring is what constantly allows the penis to stretch. The study we performed showed that the outcomes were pretty darn good with 60 minutes of traction a day as opposed to several hours. There has never been a head to head comparison, comparing one device to another. So, the jury is still out as far as which one makes the most sense.
Better Man Clinics
Are these penile traction devices something you could just pull your pants over and go to work with?
Dr. Ziegelmann
There are a couple of models that have little apparatuses that you could potentially hide under your pants, but for the most part, these are devices that you would be using at home.
Better Man Clinics
Is there a lot of pain involved with these penile stretching devices?
Dr. Ziegelmann
I usually tell guys that the penile traction therapy is not that comfortable. And it probably shouldn’t be, right? I mean, you’re trying to get some results. If you don’t feel anything, it’s probably not doing anything. But, it shouldn’t be exquisitely painful. I mean, if you’re pulling to the extent that you’re gritting your teeth for 30 minutes, then that is not a good thing. So, it’s a balance. But, I would say that the vast majority of men who we recommend this treatment to tolerate it and, thankfully, most of them get some results.
Better Man Clinics
Aside from this discomfort, are there any significant risks with using a penile traction device. Have there been injuries reported with the traction devices?
Dr. Ziegelmann
So, I think as long as you use it safely, and under the guidance of a clinician, we haven’t seen any severe injuries. The biggest issue is just discomfort on the head of the penis. Sometimes, the traction device can cause some skin irritation and the skin can change colors temporarily. However, all of that tends to resolve pretty darn quickly once the device is removed, and usually doesn’t impact the person from being able to use it long term.
Better Man Clinics
Generally speaking, with these devices, whether it be the vacuum erection device or the penile traction devices, is this something that you would potentially use for a few months and maybe gain a centimeter or two in length and you’re happy and you stop? Or is it that, if you stop, the penis will retract back and go back to its baseline size? Do you have to keep using the vacuum erection device or penile traction device indefinitely to maintain their effects on the size of the penis?
Dr. Ziegelmann
That is an extremely important question to which I don’t think we have a good answer. But, it is something I get asked a lot. My thought is that we you probably see diminishing marginal returns. Over time, you are going to see benefit. We did a study of treatment up to three months and we saw a benefit. And then, we extended treatment for an additional three months and we saw some additional benefit. However, it wasn’t quite as robust for those men who got good results during the first three months. The question is, how long are you going to see any benefits? And what if you just stopped cold turkey? Are you going to lose it? So, I usually say, “I don’t know. I honestly don’t know the answer to that. But I think you don’t need to use these things for four hours a day indefinitely.” Maybe the key is maintenance, meaning use it every day for three months or even six months and, then, cut back to maybe once or twice a week for a couple of months and, then, maybe cut back further to once a week and then maybe even further to once every other week. A lot of men can tolerate saying “okay, I’ll find an hour a couple of times a month to wear this”. And so far, again, purely anecdotally, the results have suggested that the benefits are maintained. But we just we just don’t have any good studies to answer that question long term.
Better Man Clinics
Are the vacuum erection devices and the penis traction devices something guys can just go and buy online on their own or they need to see a doctor to get a prescription?
Dr. Ziegelmann
They can buy these devices. You don’t need a prescription. You can purchase the device online. There are resources available for most of these devices that can help you troubleshoot if you have any concerns. That said, I would encourage people, if they really are interested in a therapy like that, to think about having a conversation with an expert. Either way, I think you just should go into therapies like these with the right expectations. Don’t go into it expecting that it’s going to change your life
Better Man Clinics
Are injections of fillers effective in increasing the size or girth of the penis?
Dr. Ziegelmann
These injections are called soft tissue fillers and there are actually hundreds of products that are available worldwide. The injections are usually performed by plastic surgeons for cosmetic purposes. Over two and a half million soft tissue filler procedures(of all kinds) were done in the US back in 2018. So, it’s a pretty common thing. The theory here is that you’re injecting material into the soft tissue. For the penis, that would be under the skin and within those tissues, to enhance its size and appearance. These fillers are less invasive than a surgical procedure and, hopefully, less expensive. I think the ideal product would be something that has low risk for side effects, is easy to administer, and persists. There are a bunch of different agents that have been looked at on the penis. Examples would even include using the patient’s own tissue such as autologous fat. You can do liposuction, take fat from the abdomen, and then inject it directly under the skin of the penis or within the penis. There are techniques to do this as well. You can also use off the shelf soft tissue fillers. One of the most common ones is called hyaluronic acid, which is a natural occurring agent that’s been modified. Some of these agents are long acting but not permanent. Additionally, there are even additional agents that are permanent, like collagen or silicone. There are issues with these agents, however. First, the results are pretty inconsistent. For example, when you inject fat into the penis, the majority of those fat cells actually die pretty quickly. As a result, the bulk of tissue may look different as far as the girth of the penis. Over time, that is going to change as well. Same thing with the nonpermanent agents like the hyaluronic acid. The other problem is that if you start injecting foreign bodies like silicone or collagen, your body may have an inflammatory reaction to them. And the problem is, that’s a hard thing to control. Some people have a really robust inflammatory response, others not so much. And, so, you can actually get these foreign body reactions. You can get these lumps, bumps and masses and they can be painful, they can look unsightly, and they can get infected. If you look at the urology literature, there’s a lot of reports of the negative consequences of these injections including skin loss or pain or abnormal feeling on the penis. So, as of right now, I would say that this isn’t a treatment intervention that is recommended or encouraged by any governing body. But there’s a lot of it being done, and not necessarily by experts who know the anatomy and physiology of the areas of the body that they’re working on. I should back up and say one more thing. With these injections, the only enhancement you would get is with regards to girth. To my mind, aside from maybe the extra weight of the filler within the tissue causing the penis to hang down a little bit more, there is no mechanism that makes sense to me of why the penis would get longer.
Better Man Clinics
Are these potential disfiguring masses that can develop from injections possible to reverse?
Dr. Ziegelmann
There are surgeons who made their entire career out of fixing those types of problems, like very skilled reconstructive surgeons who have done that. So, it’s a problem and a big concern. So, I would just certainly encourage people to really take a pause before going down that pathway. When you see these treatments being advertised on a website, for example, you are going to hear about the good outcomes. However, you have to take a pause and think about it, because the risks outweigh the benefits in a lot of these circumstances.
Better Man Clinics
How do surgical procedures like Penuma work to increase the size of the penis? Are they effective in increasing penile size?
Dr. Ziegelmann
Penuma is a sleeve that gets implanted under the skin of the penis on the top and the sides. And it was developed by a single urologist in California who’s done 1000s of these. And really, the goal is to enhance the cosmetic appearance of a penis, specifically, girth. There are now certain other surgeons who are starting to do this under very careful guidance, in with the appropriate technique throughout the country, I don’t personally do these procedures. There are probably just like everything else, pros and cons and people who are in favor of, of doing this and not in favor. But it’s certainly a hot topic within our field. And again, one that we should just give careful consideration to and encourage patients to do their due diligence, do their research before they go down a pathway like that. Because there are potential downsides. I mean, anytime you’re having a surgical procedure, you just want to carefully consider those options,
Better Man Clinics
Another surgical option for increasing the length of the penis that has been described involves cutting the suspensory ligament to let the penis drop a bit more. Can you explain how that works? And what type of outcomes you might get with that?
Dr. Ziegelmann
Yeah, so that’s a great question. There is a ligament that’s attached to the midline of the pubic bone, which is front of your pelvis, and it anchors the penis. When it is not erect, when the penis hangs flaccid, it usually hangs down and points to the ground or points out a little bit. When you get a good, strong erection, like a 10 out of 10, that erection (as the penis fills), will essentially often point, not even straight out, but at an angle, This is because a significant portion of your penis is actually inside your body, below the skin and anchored to the bottom of your pubic bone on the on the sides and then in the middle. Your penis is anchored by this ligament called the suspensory ligament. The theory behind doing what’s called a suspensory ligament release is that, by cutting that ligament, the penis would then hang down lower which would give the appearance (almost like a trick of the eye so to speak) of the penis being longer, particularly in the flaccid condition. If you think about it from an anatomic perspective, that surgery is not changing the length of the erectile body, it is not changing the elasticity or the ability of the erectile body to stretch, it is simply changing the position of the penis, which theoretically enhances the appearance of the flaccid penis. Now, the problem with that is that if you get an erection, and you’re used to having a penis that points either straight or up, you’re probably to see that change, because that part of the orientation of the erect penis is due to that suspensory ligament. So, we actually have patients who come in with concerns of some type of trauma to the suspensory ligament on occasion, and one of their symptoms is that their penis hangs differently when they are erect. It’s not as vertical or parallel to the ground.
Better Man Clinics
How much perceived gain in length of the penis can be achieved by cutting the suspensory ligament?
Dr. Ziegelmann
I think it’s extremely variable. Because of the small numbers, I don’t think that you can put a lot of weight into the literature. A lot of it, again, comes down to the skin around the area. If you have a large suprapubic fat pad and you have prominent scrotal skin, releasing the ligament is probably not going to do much to that perceived length of the penis. Whereas if you were extremely thin and you had a tight ligament, that could possibly make a difference.
Better Man Clinics
Can liposuction of the fat over the pubic bone (suprapubic fat) also increase the perceived length of the penis?
Dr. Ziegelmann
Yes. I think for men who do have truly prominent suprapubic fat, that sometimes actually can cause concealment of the penis, sometimes called a buried penis or retractile penis, to the extent where hygiene can be affected. Maybe when they urinate, they find it troublesome to grab the penis, and they spray urine and maybe they get an infection or their skin gets inflamed. Also, on rare occasions, that skin can get so inflamed that it develops scar tissue. And that’s a big issue. So, I do think that whether it’s liposuction or even surgical procedures (where we cut out a segment of that fat and the overlying skin and reconstruct the tissue there), there’s some merit to them because you can improve function and hopefully improve the appearance of the penis. I think that can be an important thing to keep in the back of our toolbox as far as treating men with concerns about the length of their penis.
Better Man Clinics
Can penile implants be used to increase the size of the penis in men with erectile dysfunction?
Dr. Ziegelmann
I think that, first and foremost, the goal of the penile implant is reliable rigidity. The implant is addressing the inability of the patient to achieve and maintain firmness of the penis for their desired sexual activity. It is not to restore their penis to what it was before the erectile dysfunction started. The implant will not enhance the size of the penis beyond what it is. I have a lot of patients who joke about it a little bit like “oh, you’re going to give me two inches back, right doc?” And then I have some patients who, actually, do expect that or have read that. So, resetting that expectation is so important because, if you look at the studies, most men report loss of erection length after the penile implant. So, we should be setting that expectation. Men should understand that the goal of the penile implant surgery is to not make your penis longer. In fact, many men perceive shortening. Why is that? A couple of reasons. One is that the last time many of these men saw their erect penis was a long time ago. They’ve tried meds, they’ve tried injections. They have been suffering from ED in silence for years. And their penis, like we talked about earlier, has undergone changes. It is shorter, it does not expand to the same extent. After the implant surgery, they have that firmness but they’re going, “Wait a minute, this isn’t what I remember.” So that’s one reason. The second reason is that, with a natural, sexually induced erection, there’s often in engorgement of the head of the penis, and of the skin and the tissues surrounding the erectile bodies that you don’t necessarily get when you inflate the penile prosthesis. So, the implant gives you great rigidity, it gives you lots of satisfaction, and it restores intimacy for couples. It is an amazing treatment. But it doesn’t recreate that same 10 out of 10 erection because those tissues aren’t necessarily filling in the same way. Sometimes they do. And, sometimes, we’ll use pills and creams and things like that to help enhance blood flow to the penis, but it’s just different. So, as far as the length of the goes, that’s important to talk about with men interested in a penile prosthesis. As far as girth goes, prosthetics do have great birth, and they fill that space. So, girth concerns are less common. I mean, some men still have them. But I think they’re a lot less common after the prosthetics and some men even report enhanced girth. So that that is less of an issue as opposed to the length.