The (dubious) science of penis enlargementS

You've seen the spam. You've heard legends. But is there any actual science behind the promise of penis enlargement? Quite a lot, it turns out. Here's what we've learned from thousands of years of experiments that have attempted to address whether life would be better if that special organ were just a little bit bigger.

A couple of medical drawings below might be NSFW.

First, a few facts. Unless you have a rare condition that produces a "micropenis," or an organ that's 2.5 standard deviations smaller than the average penis size, your penis is not unusually small. There is some debate over what an "average penis size" is, but most sources agree that a typical penis size when flaccid is 1-4 inches, and a typical erect penis is 5-7 inches.

A lot of factors can make a typical penis appear smaller, such as carrying extra fat in the pubic region, or simply having a large frame with an average-sized penis. Whether responding to cosmetic issues like these or just social pressure, a huge number of men every year try to enlarge their rods of delight. And they've been trying to do it for a really long time.

A very brief history of lengthening the third leg

An article in the journal European Urology notes that there is a long, global history of men attempting to extend their reaches, as it were:

The Sadhus holy men of India and males of the Cholomec tribe in Peru used weights to increase their penile lengths. Males of the Dayak tribe in Borneo mutilated their penises by forming holes and then sticking decorative items through them for their partner's pleasure. In the 16th century, men of the Topinama tribe of Brazil allowed poisonous snakes to bite their penises in order to enlarge them.

The first medical procedures intended to lengthen human penises were probably performed in the early twentieth century, but many were covert. In his autobiography Memoirs of a Sexologist, doctor Ludwig Levy-Lenz describes doing operations similar to vasectomies in the 1920s to restore "vitality" to his patients' sex lives. He admits that usually the operation had no effect, and he eventually stopped performing it on older men who complained of impotence.

It wasn't until the late twentieth century that medical procedures to lengthen the penis became more common.

Surgery for a bigger stick

Currently there are three main ways that surgeons can lengthen a penis.

The (dubious) science of penis enlargementS

The first involves cutting the suspensory ligament in the penis, and then using weights or suction to pull the penis further from the body as it heals. The suspensory ligament holds the penis suspended comfortably in your body, but also (as this Beverly Hills plastic surgery practice explains) it could be said to hold part of the penis shaft inside the body. Severing the ligament allows patients to see a few extra centimeters of shaft, though complications can arise. As a group of researchers comment in a Nature Urology article:

A few reports indicate that release of the suspensory ligament can decrease the angle of elevation of the erect penis. Paradoxical penile shortening can also occur, as a result of spontaneous reattachment of the ligament to the pubis bone.

In other words, your erections may point at the floor, or the ligament may reattach in such a way that it pulls even more of the shaft into your body cavity.

The (dubious) science of penis enlargementS

Another way to create the appearance of a larger penis is often called the "skin flap" surgery. Often it's paired with suspensory ligament surgery. The doctor essentially takes skin from the abdomen and attaches it to the base of the penis so more of the organ's shaft can protrude from the body. This surgery has many drawbacks, for the few centimeters of extra penis you'll get. One of the main problems is that the skin grafted to the penis often has hair on it. In European Urology, a group of surgeons write:

Other reported forms of skin flaps that are used in penile lengthening surgery are the lower abdominal Zplasty which probably gives the best results due to a low risk of scrotal skin sliding onto the penile surface and the W-flap reconstruction. Unfortunately, most of these flaps cause unattractive hair-bearing tissue that covers the penis and causes pubic deformation.

A simpler method of increasing the size of the penis is just to use liposuction on the fatty pubic area. Removing this padding from around the base of the penis can make the organ appear larger.

Widening the weapon

There are also surgeries for expanding the girth of the penis. Most involve injecting fat or other tissues into the shaft, and nearly all these surgeries result in unwanted side-effects ranging from impotence to extremely deformed organs. Often the fat injected into the shaft will migrate, creating a lumpy-looking organ. In the best case scenario, the fat simply dissolves and leaves you no worse for wear.

The Journal of Urology devoted an entire article to surgeries that doctors could use to correct the deformities caused by girth-widening procedures, as well as penis-lengthening operations gone wrong.

Hormones that add heft to the hammer

While most penis-enhancing treatments are looked upon with gimlet eyes by doctors who are not plastic surgeons, hormone treatments are in fact a standard way to deal with micropenis conditions. Let me emphasize that injections or creams containing testosterone and HGH are recommended only for people who have suffered hormone deficiencies that caused a micropenis. Children who are born with a micropenis, or whose penises do not develop during puberty, are prescribed a course of testosterone and HGH with generally good results.

The (dubious) science of penis enlargementS

As early as 1978, an article in the Journal of Urology reported positive results of hormone in young men:

Five patients were treated with gonadotropin and topical testosterone for micropenis associated with hypothalamic hypogonadotropic hypogonadism. All patients received 1,000 units of gonadotropin weekly for 3 weeks, with a 6-week interval followed by 10% topical testosterone cream twice daily for 3 weeks . . . Average penile growth response with gonadotropin was 14.3% increase in length and 5.0% increase of girth. Topical testosterone produced an average increase of 60% in penile length and 52.9% in girth. The greatest growth response occurred in prepubertal male subjects with a minimal response in postpubertal male subjects. This study suggests that 10% topical testosterone cream twice daily will produce effective penile growth. The response appears to be greater in younger children, which is consistent with previously published studies of age-related 5 reductase activity.

In other words: this works on children, but not adults.

Another article, published twenty years later in the Journal of Pediatrics, suggests that hormone treatment is still deemed effective. In addition to affirming that testosterone could aid in cases of micropenis, the authors also argue that there is no need to transform boys with micropenises into girls:

We conclude that 1 or 2 short courses of testosterone therapy in infancy and childhood augment penile size into the normal range for age in boys with micropenis secondary to fetal testosterone deficiency; replacement therapy at the age of puberty results in an adult size penis within 2 SD of the mean. We found no clinical, psychologic, or physiologic indications to support conversion of affected male infants to girls.

Why would they argue such an odd thing? For many years, one accepted treatment for boys born with micropenises was to give them sex changes at birth, supplementing the surgeries with female hormones as they neared puberty. You can read about the tragic life of one person who went through this treatment in John Colapinto's book As Nature Made Him: The Boy Who Was Raised as a Girl. (The boy in Colapino's book was the victim of an accident that gave him a micropenis, but others are born with the condition.) "Sex reinforcement" surgery for infants born with ambiguous genitals is no longer recommended by most doctors, and is definitely not recommended by the people who had such surgeries imposed on them.

Pumping up the pestle and stretching the snake

"Penis Pumps" (and their analogue, clitoral pumps) consist of a cylinder with a vacuum, creating suction around the base and thus increasing bloodflow into the penis, causing an erection. Penis pumps are generally used for impotence treatment rather than an enlargement method, and continued use can cause extreme damage.

Interestingly, in a study observing the use of penis pumps for the treatment of Peyronie's disease, (a disease of the connective tissues of the penis that can cause divets, indentations, and curvature of the penis) did note a statistically significant increase in penis length over time for those individuals in the study who did twice daily pumping sessions for three months.

The (dubious) science of penis enlargement

One study suggested that men might expect to see as many as 2.7 centimeters of added length from using "penis extenders," which stretch the penis tissues using two rings — one at the base of the shaft and one at the base of the tip — connected to extendable rods. This study looked specifically at a product called the Andro Penis, but study has never been duplicated so your results may vary.

Home remedies for adding another stage to the rocket

Among the many methods of penis enlargement that are not validated by any scientific studies, we can include strategies like jelqing (basically tugging on the penis with fingers), "ligament stretching" exercises, and the old ancient standby, hanging the organ with weights.

So the surgeries are dubious, the hormones are only for people with medical conditions, and the penis pumping and stretching methods aren't dependable (not to mention uncomfortable). There are a few easy things you can do if you want to get an extra booster on your own personal Soyuz rocket. Why not invest in a nice, latex penis extender (link is seriously NSFW)? Or, if you are really worried that your penis isn't large enough, considering visiting both a medical doctor and a therapist.

Just remember, it's not the size of the vessel - it's whether you can get it deep into space, if you know what I mean.

Additional reporting by Keith Veronese.