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Penis Enlargement

Normal anatomy of the penis
Sexual self-conciousness and dysfunction
Penis enhancement
Penile lengthening
Penile girth enhancements

Normal anatomy of the penis
The penis forms part of the male external genitalia and is the common outlet for urine and semen. It consists of an internal root, and the externally visible body and glans.

The root of the penis is composed of three erectile tissues: the bulb, and the right and left crura. These are partially surrounded by muscular tissue. As the erectile tissues continue into the body of the penis, the crura become the corpora cavernosa and the bulb becomes the corpus spongiosum. The corpus spongiosum then expands, forming the glans. The body of the penis is surrounded by loose skin, which is reflected upon itself to form the foreskin covering the glans. The urethra enters the penis via the erectile tissue of the bulb and continues in the corpus spongiosum until it ends at the external urethral orifice.
Each of the erectile tissues contain tiny spaces that can fill with blood. When the penis is flaccid, these spaces are collapsed. When a man is sexually stimulated, a reflex triggers the relaxation of the blood vessels supplying these tissues. This allows greater blood flow and as a result the erectile tissues fill with blood, causing penis enlargement and erection.
The external portion of the penis (the body and glans) typically measures 7.6–13 cm in length and approximately 8.5–10.5 cm in circumference when flaccid. When erect, this increases to 12.7–17.7 cm in length and 11.3–13.0 cm in circumference

Sexual self-consciousness and dysfunction
Sexual self-consciousness has the potential to negatively impact our sexual experiences. It is believed that sexual self-consciousness:
Increases appearance-related anxieties;
Interferes with attention, focus and concentration;
Impairs physical performance; and
Reduces awareness of our own arousals, leading to sexual dysfunction.
While studies are limited, it has been shown that male sexual dysfunction can negatively impact the sexual function of female partners. One study showed that women who had partners with erectile dysfunction had significantly lower sexual arousal, lubrication, orgasm, satisfaction, pain and total sexual function scores than those who had partners without erectile dysfunction. Later in that study, a large proportion of the men with erectile dysfunction underwent treatment. Following treatment, sexual arousal, lubrication, orgasm and satisfaction were all significantly increased. It was concluded that female sexual function is impacted by male erection status, which may improve following treatment of male sexual dysfunction.

Penis enhancement

It seems that penis size has been a source of male anxiety throughout history and across cultures. Weights have been used by the Sadhus holy men of India and by the males of the Cholomec tribe in Peru in order to increase penile length. Members of the Dayak tribe in Borneo pierced their penises and used decorative items to increase their partners' pleasure. Topinama tribesmen in Brazil used poisonous snake bites to enlarge their penises.
Today in our society, the only consensus regarding such procedures is for the surgical correction of a micropenis – a smaller than average penis than is structurally normal. However, most men requesting penile enhancement surgery have a penis of normal size and function. Typically, these patients interpret normal appearances as abnormal; this is known as psychological dysmorphism.
The indications for enhancement surgery are ill defined and the measures for success are still unclear, but the procedures are frequently performed, often in private settings.

Penile girth enhancements
Some consider penile girth enhancement to be even more controversial than penile lengthening. Indications for the use of these procedures are lacking in the medical literature. Increased symmetry and uniform girth would provide an optimal result, though this is often a significant challenge given current techniques.

Injectable materials
Fat injection
This procedure involves collecting fat cells from the abdomen and then injecting them into several areas of the penis. An increase in circumference of 2.6 cm has been reported with the injection of 40–68 mL of fat. During the injection process, a large number of fat cells rupture or are resorbed, so that only ~10% of the fat cells remain intact.
There is often a trade off between increased size and side effects. If smaller amounts of fat are injected into multiple locations the side effects are minimal; however, only a small increase in girth is gained. As larger amounts are injected, the risk of side effects increases. Complications include the formation of nodules, increased curvature of the penis, unsymmetrical results and other rare conditions. If large volumes of fat cells survive, patients can complain of decreased erectile stiffness as the increased fat overwhelms the firmness of the erectile tissues.

Silicone injection
The use of liquid injectable silicone has not been recommended for penile girth enhancement due to reports of severe complications. Some of these are related to the large volumes required, and others to drifting or distant migration, swelling and distortion, and other reactions. There is also an increased likelihood of damaging the blood supply and nerves, resulting in loss of sensation and erectile dysfunction.
In a recent study involving 324 patients, large volumes of silicone were injected to achieve an increase in penile circumference of 2.6 cm without any reported short-term complications. All patients were reported as fully satisfied; some reported increased erectile function and prolonged time to ejaculation. However, this is only one small study and the results should be evaluated further.

Hyaluronic acid gel injection
The use of this injectable material was reported to increase the size of the glans penis; the injection of 2 cm3 results in a 1.5 cm increase in glanular circumference after one year. Post-operative satisfaction was high with no serious adverse events. However, some believe that glanular enhancement as a separate procedure may be problematic.

Graft procedures
Dermal fat grafts
This procedure involves grafting skin and subcutaneous tissue from the abdomen or folds near the buttock onto the penis. The results are largely dependent on the amount of fat tissue that remains intact. Published studies show inconsistent results one year after the operation, though a 2.5–5.1 cm increase in girth is generally achieved.
Grafting is quite a long procedure; it takes roughly seven hours and has high rates of post-operative complications. Some of the complications include persistent penile swelling, skin injury, increased penile curvature, shortening of the penis and asymmetry, as well as cosmetically unpleasant scarring. There is also a significant risk that the grafted skin may be rejected by the new site, leading to impaired healing.

Allografts
The use of alloderm, a substance created from donated human skin, has several benefits compared to dermal fat grafting. There is greater success in achieving penile symmetry and a lower incidence of adverse effects. However, this procedure is still associated with some adverse events, including fibrosis, infection, and skin and graft loss.

Venous grafts
Venous grafting involves enlargening the corpora cavernosa using segments of a vein normally found in the leg. The penile girth is increased in the erect state only; hence it is more suitable for those men with dysmorphophobia related to the erect state.
In the first report of this procedure, there were no signs of post-operative complications in any of the 39 men who underwent the procedure. However the results have not yet been reproduced, and the technique is still considered experimental.

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