International Journal of Impotence Research (2003) 15, Suppl 7, S44–S45
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Chapter 12
Penis enlargement: current status
Reporters and participants of the 1st Latin American Erectile Dysfunction Consensus Meeting
International Journal of Impotence Research (2003) 15, Suppl 7, S44–S45. doi:10.1038/sj.ijir.3901137
Introduction
Not rarely do men associate their virility to the size
of their penis and its erectile capacity. The psycho-
logical trauma triggered by dissatisfaction about
one’s penis size originates in many cases in child-
hood, from comparing one’s own penis with other
children’s the same age or from parents’ anxiety
with regard to their children’s genitalia. Penis
hypoplasia, as a negative sign of sexual identity,
can cause an important psychological impact.
What is observed in the physician’s daily office
practice is that most patients complaining about a
small penis have the sexual organ within the
measurements deemed normal for an adult male.
Some are obese individuals with their penis par-
tially covered with prepubic fat; others are tall, with
a proportionally small penis. The increasing infor-
mation disclosed in the media on techniques for a
possible penile enlargement causes an increasing
number of men to seek doctors, wishing to enlarge
their sexual organ.
Penile anthropometry
Papers in the literature show that an adult male’s
penis is on average 8.5–9.4 cm long, in the flaccid
state, and 12.9–14.1 cm long, in erection,3,4 depend-
ing on the anthropometrical techniques used. Some
authors characterize an adult ‘micropenis’ as being
shorter than 4 cm in the flaccid state or 7.5 cm in the
erect state.3,4 Those patients could be offered some
type of surgical correction. Penile measurement is
taken from the pubis to the tip of the glans with the
organ stretched. The patient should be examined
both in the upright position and lying down to better
have his prepubic fat assessed.
Surgical indication
Currently, the penile enlargement surgery may be
indicated in some situations, in which the penis
functional restoration is sought:
 bladder exstrophy,
 significant shortenings due to Peyronie’s disease,
 severe epispadias and hypospadias,
 partial sequels from surgical or trauma amputa-
tions,
 micropenis, and
 sequels from penile infections.
Enlargement techniques used:
 section of the suspensory ligament of the penis,
forward extension of the organ and refixation,
 lipectomy or liposuction of prepubic fat,
 zetaplasty or VY plasty of the prepubian regions
skin fold,
 skin flap rotation from the lower abdomen to the
penis, and
 muscle–cutaneous flaps for penile reconstruc-
tions.
All of the above-mentioned methods provide a
1–2 cm lengthening, however, only when the penis
is in the flaccid state, and no gain in the erect state
has been reported.
In the reconstruction surgeries this augmentation
may be greater, not preserving the physiological
erection, and they are usually performed in patients
who have undergone amputation or mutilation.
Complications
Lengthening surgeries are followed by a high rate of
complications:
 Following sectioning of the suspensory ligament,
if not duly refixed, the penis may drop and, even
if rigid, it points downwards, with loss of the
erection angle.
 Penile scar retractions following zetaplasty or VY
plasty.
 Penile ‘scrotalization’ with an inadequate esthetic
outcome, causing a ‘dog ears’— shaped penis.
 Hypostasis, infections, abscesses, fistulas and
chronic edema.
Extensors
A few penile enlargement-oriented devices are
available on the market. There is no scientific

evidence on the efficacy or safety of those techni-
ques.
Conclusions
Despite particularly appealing, penile esthetic aug-
mentation surgeries fail to provide a satisfactory
outcome and are followed by a high rate of
complications. As a result, surgeries for purely
esthetic purposes should not be performed.
References
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Penis enlargement: current status
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International Journal of Impotence Research