How can I increase penis girth and length?

Penile Enhancement: Evidence-Based Recommendations

There is no safe, effective, evidence-based medical or surgical intervention that can be recommended for increasing penis girth or length in men with anatomically normal penises, and most men seeking these procedures have normal-sized penises but suffer from penile dysmorphophobic disorder. 1, 2

Initial Assessment and Counseling

Structured psychological counseling should be the first-line intervention for all men requesting penile enhancement. 1

• The vast majority of men seeking penile enhancement have physiologically normal penile dimensions but may suffer from severe preoccupation with penis size known as penile dysmorphophobic disorder 2
• When counseling is provided, the majority of men come to understand that their penis is normal and become unwilling to undergo any further treatment 1
• This counseling approach is effective and should always be performed before considering any intervention 1

Non-Surgical Options (If Counseling Fails)

Penile Extenders (Traction Devices)

If patients still seek enhancement after counseling, penile extenders are the only non-surgical option with any supporting evidence, though gains are modest. 1

• Extenders increased flaccid length by less than 2 cm in available studies 1
• One study showed mean flaccid length increased from 8.8 cm to 10.5 cm and stretched length from 11.5 cm to 13.2 cm after 3 months of use (4-6 hours daily for 2 weeks, then 9 hours daily) 3
• No significant increase in penile girth was demonstrated with extenders 1

Injectable Treatments

Injectable treatments for girth enhancement should be avoided due to high complication rates despite some reported size increases. 1, 2

• Injectables increased girth in some studies (ranging from 0-4.9 cm across various modalities) but were associated with high complication rates 1, 2
• Complications include penile fibrosis, sexual dysfunction, and devastating outcomes 2
• These procedures lack standardized recommendations and have limited outcome data with likely underreported complications 2, 4

Vacuum Erection Devices

Vacuum devices do not increase penile size and should not be used for enhancement purposes. 1

Surgical Options

All surgical interventions for penile enhancement should be considered experimental and unethical outside of clinical trials. 1, 2

Surgical Techniques and Their Limitations

• Suspensory ligament incision is the most commonly used surgical method (n=12 studies), but lacks external validation 1
• Tissue grafting (autologous, dermal fat, ex vivo) and flaps have been studied but show inconsistent results 1
• Complications are not infrequent and may include infection, sexual dysfunction, penile fibrosis, and even death 2
• The quality of available studies is poor in terms of methodology for patient selection and outcomes assessment 1

Newer Techniques

• New products and surgical techniques such as Penuma and tissue engineering approaches are being developed, but require rigorous investigation before recommendation 5

Critical Pitfalls to Avoid

• Do not proceed with injectable or surgical interventions outside of ethical board-approved clinical trials 1
• Do not assume patient dissatisfaction is based on actual anatomic abnormality—measure and document that penile dimensions are within normal range 1
• Do not underestimate the psychological component—most men have normal anatomy but distorted body image 2
• Be aware that complications are likely significantly underreported in the literature 2

Treatment Algorithm

1. Measure penile dimensions to confirm normal anatomy 1
2. Provide structured psychological counseling as first-line intervention 1
3. If patient still desires intervention after counseling, consider penile extender devices as the only option with modest evidence 1
4. Avoid injectables and surgery except in the context of ethical board-approved clinical trials 1, 2