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Key takeaway: Proceed carefully, prioritizing psychological evaluation and specialist care over unproven methods.
This illustrates why viable fat grafting demands precise technique, as seen in facial procedures, but failed here due to inconsistent "take" rates.
Penis pain sensitivity: The shaft is relatively insensitive to pain (test pinch test: requires hard pinch vs. thigh), unlike testicles; sensitivity is more erotic/psychic than nociceptive (pain-sensing).
penis shaft cross section labeled diagram
As shown above, the shaft's structure explains low pain response—dermal layers tolerate procedures better than expected.
Permanent fillers (silicone, methyl methacrylate) risk unevenness and deformity; removal is arduous (e.g., 2.5-hour surgery under local anesthesia to excise adherent material).
Mechanism: Fillers add volume subcutaneously, mimicking fat but dissolving predictably. Risks include lumps if poorly placed; ideal candidates are psychologically stable, prepared for imperfections. Recovery: Minimal soreness, but intercourse timing post-injection varies (unset period needed).
Average sizes (measured erect/stretched):
This mindmap highlights why most seeking enhancement are statistically normal, underscoring counseling's role.
Cutting the ligament releases hidden shaft, increasing flaccid length (hangs lower) and slightly aiding erect length via lower angle. Adds "floppiness" but stability unstudied long-term; often combined with implants for erectile dysfunction.
penis suspensory ligament anatomy diagram labeled
The diagram illustrates anchorage—severing frees basal shaft without full detachment.
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In this episode, Dr. Morgentaler and Dr. Brandon talk about various cosmetic penile enhancement procedures as outlined in a recent SMSNA (Sexual Medicine Society of North America) position statement.
They highlight the benefits, risks, and the importance of consulting qualified specialists for these procedures, emphasizing the need for careful consideration and realistic expectations.
Chapters
0:17 - Introduction to the article Cosmetic Penile Enhancement Procedures, an SMSNA Position Statement from the Journal of Sexual Medicine.
4:29 - Discussing the idea that body enhancements, like cosmetic penile procedures, can improve self-confidence and should be viewed with an open mind, similar to breast augmentation.
10:29 - Mention of silicone and methyl methacrylate use; sharing a case where methyl methacrylate injections led to uneven results.
14:56 - Emphasizing the importance of being prepared for potential complications and less-than-ideal outcomes.
23:34 - Question about recovery time and possible soreness after procedures.
SMSNA Position Statement Overview
The Sexual Medicine Society of North America (SMSNA), a group of physicians and psychologists, issued a 2023 position statement in the Journal of Sexual Medicine titled "Cosmetic Penile Enhancement Procedures." This provides guidelines for practitioners on controversial, under-researched genital surgeries, emphasizing evidence-based approaches to help patients seeking changes due to dissatisfaction. Position statements like this arise when experts volunteer time to synthesize data, advising caution since many techniques lack robust safety data or standardization—multiple options exist because none dominate as clearly safe and effective.Key takeaway: Proceed carefully, prioritizing psychological evaluation and specialist care over unproven methods.
Historical and Cultural Context of Penile Enhancement
Penile modification has ancient roots across cultures, including implanting objects like "hard little balls" (e.g., steel shot) under the penile shaft skin near the glans to alter appearance. A modern example involved autologous fat transfer: surgeons performed abdominal liposuction, processed the fat, and injected it into the penile shaft for girth enhancement. Fat cells require neovascularization (new blood supply) to survive; uneven absorption led to lumpy, irregular results, resembling the "Michelin Man" post-surgery, with poor long-term outcomes causing license revocations.This illustrates why viable fat grafting demands precise technique, as seen in facial procedures, but failed here due to inconsistent "take" rates.
| Implanted beads (e.g., steel shot) | Subcutaneous placement for girth/texture | Aesthetic concerns; unclear satisfaction |
| Autologous fat injection | Liposuction harvest, shaft injection for girth | Uneven reabsorption, lumpiness, high dissatisfaction |
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Technique
[/th][th]Mechanism
[/th][th]Outcome Issues
[/th]penis shaft cross section labeled diagram
As shown above, the shaft's structure explains low pain response—dermal layers tolerate procedures better than expected.
Injectable Fillers for Girth Enhancement
Current buzz surrounds dermal fillers (e.g., hyaluronic acid, poly-L-lactic acid) injected into the shaft for girth (thickness), not length. Administered evenly like facial fillers, they last 1-2 years before absorption, avoiding permanence.Permanent fillers (silicone, methyl methacrylate) risk unevenness and deformity; removal is arduous (e.g., 2.5-hour surgery under local anesthesia to excise adherent material).
Mechanism: Fillers add volume subcutaneously, mimicking fat but dissolving predictably. Risks include lumps if poorly placed; ideal candidates are psychologically stable, prepared for imperfections. Recovery: Minimal soreness, but intercourse timing post-injection varies (unset period needed).
Psychological Factors and Normal Penis Size
Candidates often perceive inadequacy despite average/above-average size, influenced by pornography featuring outliers ("freaks of nature"). Not pathological—like breast augmentation in women—body dissatisfaction can boost confidence if addressed mindfully. Preoperative screening ensures realistic expectations, as complications (e.g., asymmetry) occur in elective surgery.Average sizes (measured erect/stretched):
- Flaccid: ~3.2 inches
- Erect: just over 5 inches
This mindmap highlights why most seeking enhancement are statistically normal, underscoring counseling's role.
Suspensory Ligament Division for Length
The erect penis anchors via a "tripod": two corpora cavernosa (erectile chambers) attach to ischiopubic rami (sit bones/pelvic extensions), plus the suspensory ligament under the pubic bone.Cutting the ligament releases hidden shaft, increasing flaccid length (hangs lower) and slightly aiding erect length via lower angle. Adds "floppiness" but stability unstudied long-term; often combined with implants for erectile dysfunction.
penis suspensory ligament anatomy diagram labeled
The diagram illustrates anchorage—severing frees basal shaft without full detachment.
Grafts, Flaps, and Silicone Devices
- Grafts/flaps: Surgeons like Dr. Douglas Whitehead used acellular tissues (e.g., irradiated cadaver pericardium) for partial shaft wraps under skin, aiding girth/stability. Complications possible (e.g., post-op bleed from anticoagulation after pulmonary embolus on long flight).
- Silicone sleeve (e.g., Pommu): ~80% circumferential implant under skin, prevents retraction for apparent length/girth gain; outpatient under anesthesia.
Recommendations and Future Directions
Consult SMSNA members via smsna.org directory—avoid non-specialists (e.g., dermatologists with fillers). No procedure universally endorsed; data gaps persist, but improvements expected in ~10 years with safety-proven standards. Elective genital surgery demands psychological readiness for suboptimal results, mirroring any cosmetic work.In this episode, Dr. Morgentaler and Dr. Brandon talk about various cosmetic penile enhancement procedures as outlined in a recent SMSNA (Sexual Medicine Society of North America) position statement.
They highlight the benefits, risks, and the importance of consulting qualified specialists for these procedures, emphasizing the need for careful consideration and realistic expectations.
Chapters
0:17 - Introduction to the article Cosmetic Penile Enhancement Procedures, an SMSNA Position Statement from the Journal of Sexual Medicine.
4:29 - Discussing the idea that body enhancements, like cosmetic penile procedures, can improve self-confidence and should be viewed with an open mind, similar to breast augmentation.
10:29 - Mention of silicone and methyl methacrylate use; sharing a case where methyl methacrylate injections led to uneven results.
14:56 - Emphasizing the importance of being prepared for potential complications and less-than-ideal outcomes.
23:34 - Question about recovery time and possible soreness after procedures.
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