"Doctor, my penis is small. Please give treatment to increase size of penis."

This is a recurring question for the clinical research Specialists in Andrology. In effect, it often represents a frequent reason for a medical visit to Sex Therapist, mostly for men of young age.

In most cases, small size of penis is perceived due to mistaken notion of how much the size should be. It constitutes false problem arising due to UNREALISTIC EXPECTATIONS.

True hypo development of penis that cause inability to do satisfactory sexual intercourse is indeed rare.

Frequently, there are a series of cases in which the development of the penis is not considered truly pathological though it causes lowered self esteem, profound psychological (anxiety-depression) discomfort, which sometimes deeply affect the patient's relationships and may generate disturbance in sexual functioning. In conditions of TRUE reduced development of the penis anatomical correction signifies a clear improvement in the quality of the life of the subject.

What are the therapeutic possibilities?
The necessary beginning before deciding on a treatment is obviously to discard false problems. In cases where, rather, a reduced development is truly present, there are both pharmacological and surgical types of treatment.

Hormonal Therapy is reserved solely for cases of phyogonadism, that is, conditions in which the development of primary sexual characteristics (testicles) and secondary characteristics (the penis, facial hair, prostate, etc.) are insufficient: in general, after six months of therapy, excellent results can be obtained.

Surgical Therapy
Penis enlargement surgery
Surgical techniques used for penis enlargement (enhancement phalloplasty) -- penis lengthening and penile widening (girth enhancement) -- have been in the urologic literature for many years.

There two basic ways of enlarging the penis:
1. Penis lengthening surgery involves the release of the fundiform ligament and the suspensory ligament that attaches the 2 erectile bodies to the pubic bone. Once these ligaments have been cut, part of the penile shaft (usually held within the body) drops forward and extends out, enlarging the penis in 2-3 cm.
2. Penis widening with PMMA injection. This method involves injection of silicone, PMMA and other materials into the penis and scrotum, to achieve girth enlargement.

How to know whether surgical method of increasing in the size of penis is required?

Counseling by Sex Therapist has to be done before Surgical Procedure. Medical Facts about what is normal size of penis, natural difference in sizes of penis in detumescence (normal/flaccid penis) and tumescence (erect penis), the cost and consequences and risks of surgery are to be clearly explained to the patient and to a responsible adult family member who has to accompany the patient.
It is important to check whether the expectations of the patient regarding size of penis are realistic.

(Confirmation for this method of surgery is required)
It consists in removing pubic fat and cutting into the suspension ligaments to the penis, in this way causing a major extension of the penis during flaccidity; in the erection there are no significant variations.

Very recently, there has been a fine-tuning of the special penile devices called extensors; these are based on the principle that when the human tissue is subjected to a force of traction, the tissue reacts by an augmentation of its dimensions due to cellular growth. It deals with the well-noted principle already profited on in medicine on simple tissue such as the cutis. It is enough to think of the example of subcutaneous expansors which obtain a growth of the strips of skin from transplants on burnt areas or in plastic surgery operations

Regarding therapy of extensors, at the moment we have no international literature available; in case the treatment with extensors be undertaken autonomously, it should be done under a specialist's control with periodic penile scans (ecographs) to survey possible damaging effects of the trauma to the covering of the corpi carnervosis of the penis. It requires, therefore, maximum caution.

There are other conditions of anomalous curvatures of the penis called "recurvatum" which may be congenital, due to asymmetric development of the corpus cavernous, or acquired after a trauma or fibrosis: in these cases, one may carry out surgical procedures for the straightening of the penis (Nesbit's surgical intervention).

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