Penis surgery--lots of pain, dubious gain

Penile Enlargement Surgery-Fact or Illusion?

Yoram Vardi; Lior Lowenstein

Genital size has been a source of anxiety for men throughout history. It has various social and psychological ramifications, such as social maladjustment, fear of relationships, and lack of self-confidence. Many men feel a need to enlarge their penis in order to improve their self-esteem, or to satisfy and impress their partners. 'Phallic identity'—the tendency of males to seek their identity in their penis, with an emphasis on the belief that bigger is better—and 'phallocentrism'—the idea that the penis is central to identity and symbolically empowered—are deeply embedded myths that are likely to persist.

In recent years, surgery to augment penile length or girth has become increasingly common, especially in private settings. Lack of standardization of this controversial procedure has led to a wide variety of poorly documented surgical techniques, with unconvincing results. Since the early 1970s, when it was first described by pediatric urologists in boys with microphallus and bladder exstrophy, media attention, increased demand for cosmetic surgery, and widespread advertising have contributed to the rising popularity of penile augmentation. The fact that, between 1991 and 1998, 10,000 men underwent penile augmentation in the US alone, is evidence of this phenomenon.

Interestingly, the main concern of the majority of men having this kind of surgery is flaccid penile size, the so-called 'locker room syndrome', when men feel considerably inadequate despite normal penile length and girth. Standard penile length and girth in the flaccid state range from 8.2 to 9.7 cm, and 1.6 to 2.7 cm, respectively. It is important that a distinction be made between surgery with the esthetic aim of improving penile appearance, and surgery for functional abnormalities. In this Viewpoint, we will discuss only cosmetic penile procedures.

There are three main procedures for elongation of the penile shaft. Pubis liposuction entails the reduction of pubic fat and is performed primarily in obese persons when the protruding belly conceals the penis. Pubis liposuction can virtually increase penile length by 2 cm when measured from the pubis bone to the end of the glans penis. Another technique involves release of the suspensory ligament, a very controversial procedure in which the suspensory ligament of the penis is detached from the symphisis pubis and both corpora are advanced by traction of the penis using various methodologies, such as vacuum devices, weights, or specialized traction devices. It is important to emphasize that the release of the suspensory ligament does not itself cause length gain. Another common procedure for penile elongation is the advancement of an infrapubic skin flap onto the penis. The rationale for this technique is to protrude the external portion of the penis via a skin flap, or via a VY plasty at the base of the penis....

Unfortunately no reliable data are available regarding the criteria for success or complication rates of these techniques....

It is our conviction that men who are dissatisfied with the appearance of their genital organ should think very carefully before requesting procedures that are experimental and high risk, especially in cases where the penis is normal. A better option might be to seek the counsel of psychologists: often men simply need to be reassured that they are 'normal', or need advice on how to better satisfy their partner without resorting to cosmetic surgery.....