What are the safe and effective methods for a male patient to enlarge his penis?

Penile Enlargement: Evidence-Based Recommendations

There are no safe, effective, evidence-based methods for penile enlargement in men with normal-sized penises, and most men seeking enlargement have physiologically normal penile dimensions but suffer from psychological concerns about size. 1

Initial Assessment and Counseling

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

• The vast majority of men seeking penile enlargement have normal penile dimensions (within the 5th-95th percentile range), and their concerns stem from penile dysmorphophobic disorder rather than actual anatomical abnormality. 2, 1
• When structured counseling is provided, the majority of men come to understand their penis is normal and become unwilling to pursue further treatment. 1
• Referral to a mental health professional with expertise in sexual health should be considered for men with persistent concerns despite reassurance. 3

Non-Surgical Options (If Counseling Fails)

Penile Traction Devices (Extenders)

If patients still seek enlargement after counseling, penile extenders represent the only evidence-based non-surgical option and should be offered as first-line treatment. 4, 5

• Penile extenders show average length increases of approximately 1 cm, but require prolonged daily use of 2-8 hours per day for at least 3 months. 4
• The European Association of Urology supports penile extender therapy as an adjunct treatment with documented safety (no serious adverse events reported, only transient mild discomfort or redness). 4
• Results with extenders are not inferior to surgery, making them the ideal first-line treatment option. 5
• Realistic expectations are critical: improvements are modest (1-1.5 cm in length) and require strict adherence to the treatment protocol. 4

Ineffective or Dangerous Non-Surgical Methods

Pills, vacuum pumps for enlargement, and injectable fillers should NOT be recommended. 6, 2, 1

• Vacuum devices do not increase penile size. 1
• Injectable materials (including silicone, hyaluronic acid, and other fillers) for girth enhancement are associated with high complication rates including penile fibrosis, sexual dysfunction, and devastating outcomes. 2, 1
• Penile enlargement pills lack any scientific evidence of efficacy. 6

Surgical Options

Surgical penile enlargement should be considered experimental and unethical outside of clinical trials. 1

• Surgery is the only proven method for penile enlargement, but it lacks standardized indications and carries unacceptably high complication rates. 6, 5
• Surgical techniques include suspensory ligament incision (most common), tissue grafting, and flaps, but none have been externally validated and complications are frequent. 1
• Girth augmentation procedures show increases ranging from 0-4.9 cm but may result in devastating complications including penile fibrosis, sexual dysfunction, device infection, and even death. 2
• Clinical guidelines are lacking, and complications are likely underreported in the literature. 2

Important Clinical Caveats

• Patient selection is critical: Sexological counseling and detailed explanation of risks and complications are mandatory before any operative intervention. 6
• Most men seeking enlargement have normal penile anatomy and would benefit more from psychological intervention than physical treatment. 2, 1
• The quality of evidence for all penile enhancement interventions is poor, with inadequate methodology for patient selection and outcomes assessment. 1
• Until more rigorous investigation with accurate reporting of complications is achieved, penile augmentation procedures should remain experimental. 2