Penis Enlargement Surgery Is Risky--And There's Little Evidence That It Works

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Penis size is a common body concern among men. While most guys report being satisfied with the size of their genitals, a sizable minority say they’re unhappy. For example, in a survey of 4,198 US men aged 18-65 who were asked to rate their satisfaction with 14 different aspects of their manhood [1], 85.9% were categorized as being satisfied overall. The remaining 14.1% (or about 1 in 7 men) were dissatisfied. Perhaps not surprisingly, their most common concerns revolved around flaccid and erect penis length as well as penile girth.

Why are so many guys unhappy with their penis size? Perhaps because they’ve internalized the “bigger is better” message perpetuated in the popular media and in porn. This social pressure to be large is problematic, and it appears to be leading many guys who actually have normal sized penises to go under the knife in order to enhance their size. But do these surgeries even work?

Before we get to the evidence, let’s review some of the different surgical options that have been advertised. The most common lengthening procedure involves cutting the suspensory ligament, the structure the anchors the penis to the pubic bone. Theoretically, this allows more of the penis to hang outside of the body. There are also various girth/width enhancing surgeries, such as injecting fat from the patient’s abdomen into the shaft of the penis, placing donor tissue grafts underneath the skin of the penis, or injecting dermal fillers into the shaft. All of these procedures are expensive—I’ve seen them advertised for as much as $5,000-$10,000 each, which means that people who want “the works” can easily pay tens of thousands of dollars.

So do these surgeries actually work? According to the doctors who offer such procedures, they sure do. Many surgeons’ websites talk about high success rates, include glowing patient testimonials, and show impressive before-and-after pictures. However, those websites don’t tell the full story. According to a recent review of the literature on this subject published in the journal Sexual Medicine Reviews, these procedures are very risky and should almost never be performed [2].

This review looked at the results of 17 different studies, which involved 21 different procedures and over 1,000 male patients. The conclusions? The quality of these studies overall is “poor” in terms of methodology, the surgical techniques used have not been validated, and complications were “not infrequent.” In fact, the authors of the review go as far as to say that penis enlargement surgeries have such scant evidence behind them and carry so many potential risks that they should be “considered unethical outside of clinical trials.” That’s a very strong statement and should give anyone considering these surgeries great pause.

What kinds of risks are we talking about? Some studies report on various penile deformities following enlargement surgery, including prominent scarring, penile humps and lumps, as well as a disappearance of injected fat [3]. Many of these men need to have reconstructive surgery afterward in order to fix the deformities.

The full extent of complications arising from these operations remains unknown. They continue to be performed despite a lack of supporting data. Consider what was said in a review paper on this subject more than 10 years ago:

“Penile enhancement surgery is a highly risky procedure. There is no standard surgical technique, and much of the performed procedures are experimental with minimal objective pre- and postoperative data.” [4]

There was very little data back then, and there still isn’t much now, so these continue to be largely “experimental” procedures. What this tells us is that when someone signs up for one of these operations, they don’t necessarily know what they’re going to get. If you or someone you know is thinking about pursuing penile enlargement, it is vital to be informed of the risks and to really think about why you want the procedure.

If it’s because you don’t feel good about yourself, remember that cosmetic surgery of any type isn’t necessarily going to fix that. Many people have visited a plastic surgeon thinking that if they can just fix one thing about their body (e.g., getting a nose job, breast implants, penile augmentation, etc.) they will be happy; however, many find that happiness remains elusive afterwards. Research tells us that the outcomes of cosmetic surgery in general are quite mixed; further, the factors that predict worse outcomes include being young, male, thinking that cosmetic surgery will save your relationship, and having a history of depression and anxiety [5]. In other words, a lot of the characteristics of people seeking penile augmentation are predictive of poor outcomes.

If you’re concerned about penis size, here’s a good place to start: stop comparing yourself to porn stars and get educated about what the average penis actually looks like (stats available here). It turns out that most of the guys who think they’re small (and most of the guys seeking penis enlargement) are actually well within the normal range. You might also consider counseling, because research finds that—unlike penis enlargement surgery—counseling actually works, and it carries a heck of a lot less risk [2].

Want to learn more about Sex and Psychology ? Click here for previous articles or follow the blog on Facebook (facebook.com/psychologyofsex), Twitter (@JustinLehmiller), or Reddit (reddit.com/r/psychologyofsex) to receive updates. You can also follow Dr. Lehmiller on YouTube and Instagram.

[1] Gaither, T. W., Allen, I. E., Osterberg, E. C., Alwal, A., Harris, C. R., & Breyer, B. N. (2017). Characterization of genital dissatisfaction in a national sample of US men. Archives of Sexual Behavior46(7), 2123-2130.

[2] Marra, G., Drury, A., Tran, L., Veale, D., & Muir, G. H. (2019). Systematic Review of Surgical and Nonsurgical Interventions in Normal Men Complaining of Small Penis Size. Sexual Medicine Reviews.

[3] Alter, G. (1997). Reconstruction of deformities resulting from penile enlargement surgery. The Journal of Urology, 158, 2153-2157.

[4] Dillon, B.E., Chama, N.B., & Honig, S.C. (2008). Penile size and penile enlargement surgery: A review. International Journal of Impotence Research, 20, 519-529.

[5] Honigman, R. J., Phillips, K. A., & Castle, D. J. (2004). A review of psychosocial outcomes for patients seeking cosmetic surgery. Plastic and reconstructive surgery, 113, 1229.

Image Source: Photo by Charles 🇵🇭 on Unsplash

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