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Penis enlargement procedures (sometimes euphemistically referred to as male enhancement procedures in spam email and television advertisements) are techniques alleged to make the human penis larger. Often, in the course of advertising fraudulent products, the distinction between temporary enlargement, i.e., erection, and permanent enlargement, is deliberately muddied. For those instances, see Confidence tricks, Patent medicine, Quackery.
Alleged permanent procedures range from manual exercises to devices and medical interventions, with reports of successes and failures around the world, and while some are known to be hoaxes, there is no popularly known scientific proof about their effectiveness in general.
However, for small penises ("microphallus"), stretching exercises have been shown to increase length after 4-6 months.
Surgical techniques used for penis lengthening (enhancement phalloplasty) and penis widening (girth enhancement) have been in the urologic literature for many years. In a study conducted at St. Peter's Andrology Centre and Institute of Urology in London, it was determined that most patients who underwent penis-lengthening surgery were unsatisfied with the results. (September 2006).
Penis enlargement (length) surgery
Approximately one-third to one-half of the penis is inside the body, and is internally attached to the undersurface of the pubic bone. Penis lengthening involves the release of the fundiform ligament and the suspensory ligament that attaches the two erectile bodies to the pubic bone (ligamentolysis). The suspensory ligament makes the penis arch under the pubic bone. Release of this ligament allows the penis to protrude on a straighter path, further outward to give a longer physical appearance. With the penis on stretch, the ligament is divided close to the pubic bone until all midline attachments have been freed. Once these ligaments have been cut, part of the penile shaft (usually held within the body) drops forward and extends out, enlarging the penis by 2-3cm (0.78-1.18 in.). After surgery, part of the postoperative treatment includes stretching of the penis to prevent the severed suspensory ligament from healing shorter than it was previously. The article "Penile Suspensory Ligament Division for Penile Augmentation: Indications and Results" discussed the subject. According to Nim Christopher, a urologist at St. Peter's Andrology Center in London, among men who have had the surgery, "the dissatisfaction rate was in excess of 70 percent".
Real penile lengthening (i.e., lengthening of corporal bodies vs. ligamentolysis) is not a routine and safe procedure because of high risk of losing the ability to have an erection. It can be done safely only in patients with erectile dysfunction or Mb Peyronies concomitantly with implantation of penile prosthesis. The world's leading urologists specializing in the field of penis enlargement surgery use only ligamentolysis, liposuction of the pubic area, and skin redistribution. They state clearly that surgeons can only expose the penis more outside the body with especially visible results in obese patients and ones with different deformities of penile skin where the penis is layered.
As a result penile surgery is strongly discouraged in all patients with normal, functional penises. Such individuals should not engage in penile enlargement surgery, in addition such a surgery is encouraged only for men born with a congenital abnormality, who have suffered an injury, or who have severe erectile dysfunction.
A further method is to replace the two corpora cavernosa with inflatable penile implants. This is performed primarily as a therapeutic surgery for men suffering from complete impotence; an implanted pump in the groin or scrotum can be manipulated by hand to fill these cylinders from an implanted reservoir in order to achieve an erection. The replacement cylinders are normally sized to be direct replacements for the corpus cavernosa, but larger ones can be implanted.
One advantage to this surgery is that an erection can be created whenever desired, for as long as is desired and as firm as desired. However, this surgical procedure can never be reversed.
No scientific research supports the use of any nonsurgical method to enlarge the penis, and no reputable medical society endorses penis-enlargement surgery performed for purely cosmetic reasons.
Rather than attempt to change the actual size of the penis, one may make it appear bigger, by trimming the pubic hair or by losing weight, or by applying on the penis an adult lotion for men containing Arginine. "In highly vascularized tissues such as lips, gums, genitalia, etc, vasodilation leads to transient, reversible increases in tissue mass and sensitivity. A method for enhancing vasodilation in these tissues would therefore lead to a tissue with enlarged appearance for the duration of vasodilation. "
"Penis enlargement pills", "penis patches" or ointments are commonly offered over the Internet. This is one of the most common topics for spam email messages. Analyses performed by Flora Research of California and by the University of Maryland have uncovered harmful contaminants in a number of "penis enlargement" pills. Contaminants found included mold, yeast, dangerous E. coli bacteria, pesticides, and lead. Dr. Michael Donnenberg of the University of Maryland has described herbal pills marketed as having "heavy fecal contamination", possibly from animals grazing near the plants harvested for herbal ingredients.
Dr. Ira Sharlip, a spokesman for the American Urological Association, has said, "There is no such thing as a penis pill that works. These are all things that are sold for profit. There's no science or substance behind them."
Though evidence suggests no penis pill currently marketed can increase the physical size of the penis, they can cause an increase in the quality of erection which can result in firmer erections, particularly from men with weak erections, which can result in a larger size than normal for the duration of the pill's effectiveness.
A penis pump is a cylinder that is fitted over the penis, with a manual or motorized pump to create suction. As the apparatus creates a partial vacuum around the penis, blood is drawn into the penis, helping it to become engorged. As vacuum increases, the difference between the inner blood-pressure and the pump pressure increases as well; excessive pressure causes vascular damage rather than a harder penis.
Penis pumps, usually described in this context as vacuum pumps, have use in conventional treatment of impotence. The pump itself is essentially as described above, although often made to higher standards of quality with a much higher price, and arrangements for distribution by suppliers of medical equipment.
Flexible compression rings, commonly called cock rings, can be added. Fitted on the open end of the cylinder, then an erection is created by pumping. Then the rings are pushed by hand onto the base of the erect penis before releasing the vacuum. This restricts blood flow out of, but not into the penis, enabling the erection to be held even in the presence of problems of the vascular or nervous system which would otherwise lead to immediate loss of erection. In the best circumstances erections can be maintained for a considerable time, but manufacturers' literature recommends that, for safety, rings should be removed after no more than 30 minutes.
Pumping must be done very carefully to avoid injury. Over-enthusiastic pumping can burst blood vessels and form blisters. In some cases the testicles can be unexpectedly pulled into the cylinder and cause severe pain and injury. It is also believed that the rim of the cylinder can cut into the skin and over time cause damage to the ligaments surrounding the penis. Impatiently pumping without reading explanatory material can produce too much suction (any pressure lower than 10 torr/1,333 Pa) and cause permanent injury. Attempts at using vacuum cleaner units for this purpose have resulted in severe injury as the machine produces far too much suction. However, scientists Graham Rutherford and Anne Henke have also undertaken significant research in this area, being funded by some of the major names in sexual pleasure toys, such as Ann Summers. Mild pumping has led to the strengthening of penis muscles and also, for psychosomatic reasons, has led to decreased masturbatory rates in later life.
The effectiveness of penis pumps was examined by Kazem, Hosseini and Alizadeh. They studied 37 men with penis length less than 10 cm and found no significant change in penile length after using pumps for six months, although the follow-up have found 30% satisfaction with the method. 
Jelqing is a method intended to enlarge the penis by exercising the smooth muscle and other tissues in the penis, with the goal of permanently increasing the maximum erect size of the penis. This technique, also called "milking", involves wrapping the thumb and index finger around the penis while semi-erect and repeatedly drawing them away from one's body to force blood into the glans, thus encouraging more vascularity in the corpus cavernosa and associated tissues. There is no scientific evidence that this technique actually works.
Risks that exist from this exercise are: burst blood vessels, sometimes causing bleeding from the urethra (which can lead to infection and other complications if not taken care of), and temporary or even permanent erectile dysfunction.
There are many products (tools, instructions, etc.) that one can buy; however, much of what they offer (instructions) is available on forums and free websites.
Jelqing is typically preceded by a warm-up with a hot compress on the genitals, and concluded the same way. The reasoning behind the 'warm-up' mimics the normal operation of the biological processes of the penis during the four stages of arousal. The third stage is heat. At this stage the smooth muscles of the 'glans' can easily expand to their present (not future) greatest potential size.
Clamping is a technique designed to increase the girth of the penis which uses a constricting device, such as a shoe string, cable clamp, or a tight cock ring. The device is firmly tied, clamped, or put, respectively, on the base of the erect penis while "edging" (extended masturbation) with a firmly erect penis. Use of a metal cock ring is not advised because trapped blood engorging the penis can make it impossible to remove without amputation or emergency intervention such as sawing the ring off. Clamping is considered extremely dangerous by both practitioners and the medical community as it can cause permanent catastrophic damage to the penis.
Stretching and hanging
Stretching consists of attaching a penis stretcher or "extender" device to the penis for set periods of time. The device exerts a constant traction on the penis, which, in theory, lengthens and widens the penis. The traction supposedly causes the cells in the penis to "split" and then reform and expand. In 2002 a study published in the International Journal of Impotence Research concluded that penis extender devices are effective at elongating the penis and furthermore the increases in length correlate with the amount of time the device is worn.  A similar study conducted by Paolo Gontero of the University of Turin was published in 2009 in the British Journal of Urology. 
Hanging is perhaps the oldest self-applied method of penis enlargement, with evidence suggesting it was practiced by certain African tribes as much as 2,000 years ago. Weight hanging consists of attaching a device (usually a rope or a strap) that grips the glans or just behind the glans and allows a weight to be suspended for a specific amount of time. Then a conscious effort is made to exercise the penis by raising the weight in repetitions (lasting no more than 5 to 10 minutes at a time) starting with the smallest and lightest weight 1/16 pound to the heaviest usually 1/4 pound or more, to increase the strength and stamina as well as elongation of the penis.
One must be completely healed after circumcision before attempting hanging. Weight hanging, however, can also carry serious risks, which include nerve damage, chronic pain, scarring and impotence. The potential for these risks is dramatically increased if the patient is not directly trained by a qualified certified therapist. The idea behind weight hanging is to stretch the tunica albuginea and other various tissues of the penis. The general effect is to elongate the penis, although widening can also occur.
Hanging carries additional health risks due to the restriction of blood flow to the glans, including possible erectile dysfunction. Many tribal practitioners of weight hanging are impotent, although urination is unaffected.
- ↑ Fox News. Most Men Unsatisfied With Penis Enlargement Results
- ↑ Penile Suspensory Ligament Division for Penile Augmentation: Indications and Results
- ↑ Mayo Clinic. Penis-enlargement scams: You're more normal than you think. (September 2006).
- ↑ Pharmacist.Com:Performance' pills offer men something unexpected
- ↑ www.metrotimes.com
- ↑ 'No Science' Behind Male Pill's Claims / Best bet? Deal with it, Newsday
- ↑ , Sexual Health and Penis Enlargement, Anne Henke and Graham Rutherford.
- ↑ (2005). A vacuum device for penile elongation: fact or ﬁction?. BJU International 97: 777–778.
- ↑ Efficacy on Daily Penis Stretching Technique to Elongate the "Small Penis". International Journal of Impotence Research. URL accessed on 2009-03-27. P155
- ↑ A pilot phase-II prospective study to test the ‘efficacy’ and tolerability of a penile-extender device in the treatment of ‘short penis’. British Journal of Urology. URL accessed on 2009-07-01.
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