This pubertal growth spurt, coupled with hormonal changes, signifies the completion of penile development into its adult form. The child's overall growth influences penile growth and anticipates the rapid growth that occurs during puberty. Between the ages of one and five years, there is a slow and steady growth in both the length and width of the penis, which is influenced by growth hormones (GHs) and other factors. For men with PDD, surgical procedures are likely to result in dissatisfaction, as physical change rarely resolves the underlying psychological distress. For many men seeking enlargement, the preoccupation with size relates to a distorted perception of their own body, not objective measurement. Hyaluronic acid fillers offer temporary girth gains but can result in migration, palpable nodules, or disfigurement, requiring further corrective procedures. Division of the ligament may necessitate additional procedures to stabilize the penis and prevent retraction. Accurate information about micropenis and potential treatment options must be provided. On the other hand, girth enhancement procedures aim to increase penile girth, often involving fat grafting or the injection of hyaluronic acid. Common surgical techniques may include penile lengthening, girth enhancement, visual appearance improvement, augmentation phalloplasty, or even replacement of the phallus. Surgical interventions for micropenis are typically deferred until the child reaches an appropriate age, often in late adolescence or adulthood, due to the ongoing growth and development of the genitalia. However, surgical management of micropenis in infants and children is a complex and highly specialized area of pediatric urology. Interestingly, it may be difficult to make the diagnosis of hypogonadotrophic hypogonadism in the prepubertal patient with micropenis if they are past infancy, as there is a quiescent phase of the pituitary that sees levels of FSH and LH drop precipitously. Several issues need to be addressed, including the growth potential of the penis and the etiology of the micropenis. In children less than 11 years of age, mean penile length increased significantly after hormonal treatment from 15.54 mm to 37.18 mm (Table 2). (a) A 10-year-old boy presenting with stretched penile length of 16 mm (b) Post treatment stretched penile length increased to 44 mm This comprehensive review of micropenis and its treatment options underscores the importance of multidisciplinary care, considering both medical and psychological aspects of this condition. The psychological aspects discussed in the study can introduce complexities and subjectivity in interpreting results, as the psychological impact of micropenis varies among individuals. Moreover, the scope may only encompass micropenis cases and treatment options from some demographics and regions, affecting the generalizability of the findings. Seeking resolution, individuals with micropenis may explore medical interventions such as hormone therapy, penile lengthening procedures, or psychological counseling to address the physical and psychological aspects of the condition. A smaller-than-average penis can lead to sexual difficulties, affecting sexual self-esteem and relationships due to challenges during sexual intercourse, including penetration and maintaining an erection. With penis extenders, lighter is definitely better, in our opinion, as long as the device doesn't sacrifice tension strength. Although SizeGenetics enables you to fine-tune those settings, this penis extender is one of the heavier devices we tested, likely due to the use of stainless steel over aluminum, which adds durability but also weight. If you notice discomfort during a session, you won’t have to take the penis extender off and mess with the extension rods; you can make those fine adjustments instead. One noteworthy feature SizeGenetics offers that other penis extenders could benefit from is the opportunity to make minute adjustments to your tension while wearing the device. Quality sleep is essential for hormone regulation, especially testosterone. Stronger muscles here can lead to firmer, longer-lasting erections, making the penis appear fuller during arousal. Strength training, in particular, helps raise testosterone levels naturally, while aerobic exercises promote heart health and endurance. Regular physical activity improves blood flow, boosts testosterone, reduces stress, and enhances stamina all key factors in male enhancement. In some cases, the cause of micropenis remains unknown, labeled as idiopathic micropenis. Certain medical interventions and treatments for genital disorders can also result in a smaller penis. Anatomical and structural abnormalities in the penis, such as severe hypospadias, chordee, or underdevelopment of erectile tissues, can lead to micropenis39,40. This may help explain why most men seeking surgical interventions for enlarging what they perceive to be a small penis actually have a penis that falls within a normal range . Furthermore, women tended to slightly underestimate the length of penis models after a recall delay. A related limitation is that the experimental protocol necessarily limited the sample size, and these women were recruited largely near a college campus. Less experienced women may also be less accurate in their size estimates. After the inverted V-Y incision and suspensory ligament release, a silicone sheath from a penile prosthesis was inserted in the soft tissue defect created between the base of the penis and the symphysis pubis. Division of the suspensory ligament, with or without bulking agent, fat pad excision or V-Y plasty is the most widely accepted surgical technique for penile elongation (45). This attachment prevents the penis from moving further outward and creates an arched angle to the penile base (44). Penile augmentation with fat grafts also increase the weight of the penis, which can itself increase the length by 2–3 cm (35). An interesting note is how satisfaction with sexual performance increases despite circumference gain is lost in the following months. A summary of studies reporting outcomes of soft tissue filling, grafting and biodegradable scaffolds implantation for penile girthening, in presented in Table 2. 80% of patients were satisfied postoperatively, 76% of patients managed to reach orgasm and reported an acceptable level of penile tactile and erogenous sensation. Total phalloplasty is a two-step procedure including the creation of a neophallus with an urethra that helps in urinating standing up and an acceptable esthetic size and sensation followed by penile prosthesis implantation to provide enough rigidity for sexual intercourse. This may result in fuller erections and improved sensitivity, both of which contribute to a more confident sexual experience. This natural technique, when done regularly and without strain, may increase flexibility and improve the appearance of length. Gentle, controlled stretching exercises can slightly lengthen the penis over several months. These exercises can improve erection firmness, duration, and even perceived size during arousal. Compliance and patient selection is a significant issue given the time requirements for this minimally invasive treatment. In addition to exogenous testosterone, topical applications have been studied in the micropenis population. In children with true micropenis, the first step in management is always the least invasive, which includes the application of exogenous testosterone. While genetics play the biggest role in determining size, there are practical steps men can take to improve the appearance of their penis and enhance sexual confidence. While genetics and age largely determine penis size, there are safe and natural methods that may enhance how it looks or functions. If you want to increase the size of your penis, there are several herbs or other medicinal plants you can use that may stimulate blood flow to the area and temporarily help it get fully erect. These include methods like pelvic floor exercises, designed to strengthen muscles that can affect penis size and function. Natural Ways to Increase Penis Size Topical dihydrotestosterone gel has been used to treat underutilized children with 5α-reductase deficiency or with partial AIS, an alternative to intramuscular testosterone, since 1990. They showed a significant improvement in penile length by about 20%, while no effect on height velocity and bone maturation. Additionally, testosterone therapy is used to treat scrotal hypoplasia in young children. Side effects are minimal, although temporary growth rate acceleration, advancement of bone age, premature growth spurt, and precocious puberty may occur. The overall complication rate was 71.8%, including 47 patients with erectile discomfort, 12 with delayed healing, 10 with unobvious augmentation effect, 8 with wound hematoma, 7 with prepuce edema, 4 with wound infection, and 3 patients with skin necrosis of the dorsal side. Re-surgery was needed for either de-bulking of the oversized flap, flap pedicle, or for donor site scar revision, while edema (resolved in 2–8 weeks) and dorsal shaft skin ulceration in overweight participants were also reported . An increase in flaccid girth from 9.3 cm to 14.5 cm was observed with additional improvement in flaccid non-stretched visible length. These potential complications of a larger penis suggest why the human penis has not evolved to be larger. A larger phallus would increase friction relative to a smaller phallus. Anything that increases friction during intercourse may promote genital injury, indirectly increasing infection risk. These appear finely tuned to detect variability in circumference, whereas the vagina is less sensitive to differences in other stimuli such as vibration or warmth . In fact, women were generally very accurate in identifying the same model at both immediate and delayed recall. Subcutaneous penile implant There is very little scientific support for things like jelqing, or attempting to recreate the action of a traction-based penis extender manually. There is some evidence that penis extenders can treat ED, especially in men who experience ED after undergoing a prostatectomy. And vacuum-based devices cover the glans entirely, so you’d definitely have to remove that type of penis extender to urinate. It’s possible to pee while wearing a traction-based penis extender, though we recommend removing the device to use the bathroom for safety and sanitary reasons. A high insertion of the penoscrotal junction on the penile shaft skin may be inborn or acquired from excessive removal of the foreskin during circumcision. Other described skin flaps used to lengthen the penis include the lower abdominal Z plasty and the W-flap reconstruction . The penopubic skin can be advanced onto the penile shaft by an inverted V-Y advancement flap. These procedures can also be used to manage phimosis in patients who do not wish to undergo a full circumcision. Fig 5. Recalled sizes (immediate and delayed) slightly shorter than actual model with most picking exact model. Though not typically done for size enhancement alone, inflatable penile implants used to treat severe ED can add firmness and slight fullness during erections. Girth enhancement focuses on increasing the penis’s circumference. The most common surgical technique for increasing penis length involves cutting the suspensory ligament, which anchors the penis to the pelvic bone. The two most widely accepted categories are penis pumps and traction (extender) devices. 6.4. Subcutaneous Penile Implant: “Penuma®” All measurements were taken in centimeters (cm) and weight in kilograms (kg).But I really liked the whole world of gay men and women — the scene, but not the sex.Seeking professional help for psychological distress, considering medical consultation and treatment options, and maintaining a supportive family environment are also vital.Once you have used a penis extender for several months, you can stop when satisfied with your size, knowing that the gains are now permanent.Even the kids who claimed to be very sexual didn’t really know that much.An interesting note is how satisfaction with sexual performance increases despite circumference gain is lost in the following months.Traction devices work by gently stretching the penis over extended periods. Since women’s preferences for both relationship types were slightly larger than the average male, the preferred size for the one-time partner was farther from the average. Their participants preferred phalluses 2SD above their estimated population-average penis size, whereas our participants preferred penises that were only a little above average. These data are generally consistent with Mautz et al. (2013), which asked women to rate the attractiveness of life-sized, projected, rotating drawings of male figures with flaccid penises of various sizes. While most declined to identify a penis size most likely to carry an STD, women selected even larger phallus sizes as the most likely to be infected with an STD. The goal of intervention in these patients is to restore a functional penis size in order to allow normal standing micturition, enable satisfying sexual intercourse and improve patient quality of life.Penile elongation using a dorsal V-Y incision in the congenital or acquired short penis was first described over 40 years ago.If you’re able to, we advise removing an extender if you get an erection while wearing it.I tried once to achieve the simplest, flat on the bed rear-entry penetration but my penis never got near the important area, and it never could.Shedding extra pounds, especially around the lower abdomen and pubic area, can make a significant difference in how large the penis appears.Like all DanaMedic products, MaleEDGE offers a one-year warranty on its penis extenders, equal to Quick Extender Pro but shorter than Phallosan or PeniMaster.Acellular Dermal Matrix (ADM) has also been employed to improve penile girth, after being wrapped around the degloved penile shaft.The dartos is then reapproximated with resorbable sutures, and the skin is closed with subcuticular resorbable sutures . Since then, recombinant gonadotropins have been suggested as an alternative treatment to testosterone for male infants and peripubertal boys with congenital hypogonadotropic hypogonadism. They found that six neonates experienced significant penile growth following three daily intramuscular injections of 1500 IU of hCG. The response to DHT treatment, as measured by stretched penile length, can vary depending on the underlying diagnosis and age at which therapy is started. The procedure for applying DHT transdermal gel to genital skin lacks standardization, with varying doses and durations reported in different studies. There are no other natural ways to enlarge the penis. It may take a little trial and error to determine how you like to use it, as different men will or will not fold back their foreskin based on preference. A penis pump is designed to draw blood into the penis to help men with mild-to-moderate erectile dysfunction achieve an erection.12 Some men also report dryness in the skin from the stretching process, which can be resolved with moisturizing cream. Penis extenders are mostly safe.8 There is a risk of bruising or discomfort if you use the device incorrectly. What’s the difference between a penis extender and a penis pump? In the video in the “How to use a penis extender” section below, you'll see that it's relatively easy to put together and wear, once you've figured out how each part works. It’s one of only a few penis extenders on the market you can wear overnight. Best for convenience, best for maximum comfort, and best for men with micropenis The literature reviewed shows significant variability in the methodology used for penile measurement and the environmental conditions in which it is carried out. Percentiles of penile parameters studied are summarized in Table 1 and represented in Figure 2. The arrows show the pubic bone and the tip of the glans with the foreskin retracted. Last, genetic syndromes in which micropenis may be a feature include Klinefelter and Noonan syndromes, among others. The genitalia of individuals with LH-receptor defects vary from normal female-appearing to male-appearing with micropenis. Micropenis can also occur in children with LH-receptor defects and defects in testosterone biosynthesis (e.g., 17-beta hydroxysteroid dehydrogenase deficiency). The most common cause of micropenis is abnormal hypothalamic or pituitary function. Girth augmentation of the penis using the Superficial Circumflex Iliac Artery and Vein (SCIAV) flap was reported in 52 patients. The penis shaft was degloved from its skin and the dermal graft was tailored according to the desired shape and size and applied to the degloved penis shaft from the coronal sulcus to the base. At 18 months, the mean penile girths had significantly increased in both groups and satisfaction levels were significantly higher than those at baseline in both cohorts. I could have done other sexual things, but in those days I think we were all a bit naïve. What was your first sexual experience like? As the evening went on, we would pair off, and I remember one time I was paired off with a girl and I was so worried about revealing this that I never did anything. When you were a teenager or an adolescent, did you avoid girls, or intimate situations, because you were worried about your penis? A total of 29 studies were included (3 reporting non-invasive approaches, 11 injection therapies, and 15 surgical procedures). If you feel that your penis is too small, a penis enlargement surgery may be right for you. They showed that the serum level of testosterone, positive sperm count, and testicular volume was increased significantly in the gonadotropin-injected group. Schopohl et al., reported that gonadotropin therapy with 3 × 2,500 IU hCG as a weekly intramuscular injection restored endocrine and exocrine testicular function to the normal range in male patients with IHH. Another approach is based on filling the infra-pubic space resulting after ligament release between the pubic symphysis and the base of the penis .Identifying research gaps highlights the limitations in data sufficiency and the potential lack of effective data for certain treatments.Studies have demonstrated that men who are satisfied with their penile length overestimate their size, whereas men who are dissatisfied consistently underestimate (11).For those who want more permanent solutions, professional treatments and surgeries are available.A systematic literature search of the PubMed, Web of Science, and Scopus databases was conducted in December 2023 to identify English-language papers on penile augmentation surgery published within the last 15 years.Psychological assessments are pivotal, particularly in distinguishing between individuals with genuine concerns and those experiencing small penis anxiety. Psychological Impact and Confidence It has long been known how cosmetic surgery may represent an important support to psychotherapy in mitigating or even resolving the psychological distress of patients not satisfied with their appearance 97, 98, although this way to heal psychiatric disorders could create a surgery addiction . The best patient management may result from a complete clinical pre-operatory evaluation, including a psychiatric and psychosexual assessment, especially for patients who fall within the normal range diameters. There were two cases of necrosis of the overlying skin, which was treated conservatively, whereas no alterations in erection or sensitivity were noted with high satisfaction from patients . Nowadays there are many techniques capable of earning girth, both in erect and flaccid penis, less invasive and of easier execution. Unfortunately, there are still few studies with long-term follow-up and with a complete evaluation of the sexual e psychological distress before and after treatment. Adolescents and adults with micropenis often experience lower self-esteem and increased anxiety regarding their body image and sexual performance. Surgical interventions, such as penile lengthening procedures, were identified as options for adults with micropenis who sought to increase penile length. The administration of testosterone or human chorionic gonadotropin (hCG) can lead to increased penile growth, especially if initiated during the early stages of life. According to the included studies, micropenis is defined as an erect penile length of less than 9.3 cm (3.66 inches) in adults or more than 2.5 SDs below the mean in neonates and children. Find the best treatment for erectile dysfunction and which ones to avoid. Our 2026 reviews tell you if PeniMaster Pro can make your penis bigger without discomfort and for a good price. Our 2026 reviews tell you if Phallosan Forte makes your penis bigger. Other studies have also noted the effectiveness of gonadotropin treatment in increasing stretched penile length in boys with congenital hypogonadotropic hypogonadism during their first year of life.We can confirm that estimates of the average penile measurements in Argentina are flaccid penis length of 11.4 cm, penile circumference of 10.1 cm, and stretching the penis to the maximum in flaccidity of 15.2 cm.This technique involves a peno-pubic incision up to Buck’s fascia, which is preserved, followed by complete degloving of the penis.Multiple measurements should be taken to increase accuracy, and the average should be calculated.A smaller-than-average penis can lead to sexual difficulties, affecting sexual self-esteem and relationships due to challenges during sexual intercourse, including penetration and maintaining an erection.At puberty, the HPG axis gets activated and stimulates testicular testosterone production, which subsequently leads to further penile growth into adulthood (7,8).Penile traction devices, or extenders, are the only non-surgical method with limited scientific backing, primarily for length increases. The duration of treatment is determined based on an individual's specific growth needs but often needs an extended period. Oh et al found synergetic effects of GH therapy on penile growth by enhancing the AR expression levels and reducing the testicular volume losses. Bougnères et al described continuous gonadotropin infusion by an insulin pump to treat two newborns with micropenis and congenital hypogonadotropic hypogonadism. Other factors may play into whether greater gains are possible in certain individuals, but no scientific studies have illustrated this possibility. But we have yet to encounter a credible study in which participants gained more than an inch or so in length. Most studies we've read have used traction devices for anywhere from 12 weeks to 12 months. But studies show that the gains become permanent after using a traction device for months rather than weeks. Men’s sexual function and satisfaction are affected by their discomfort with genital size, which motivates them to seek out invasive and non-invasive penis augmentation options . In recent years, the popularity of penile augmentation surgery has increased significantly . The history of penile augmentation surgery dates to ancient civilizations, where the practice of enlarging the penis through various methods, such as stretching or tying weights to the penis, was reported. The primary outcomes were changes in penile dimensions, specifically in terms of length and girth, as well as the incidence of surgical complications and the impact on quality of life. The increase in practices related to enhancing penile size can be attributed to the belief that an improved genital appearance contributes to a man’s virility, coupled with an altered self-perception of his body. Radial artery forearm free flap (RAFFF) phalloplasty was first described in 1984 and is still accepted as the standard technique for penile reconstruction worldwide .It's worth noting that it's normal for newborns to have variations in penile size and that the size will continue to develop throughout childhood.These patients may refer dissatisfaction of the appearance of their genitalia but usually present with discomfort while walking, using loose clothes, doing sports and during intercourse.The NMC group included 72 patients (29.0%) who were circumcised during the newborn period; the non-NMC group included 176 patients (71.0%) who were circumcised after the newborn period.In children less than 11 years of age, mean penile length increased significantly after hormonal treatment from 15.54 mm to 37.18 mm (Table 2).Elist et al reported outcomes of 400 patients who underwent Penuma implantation from 2009 to 2014.Indeed, one of the more common complaints among customers we've spoken to — even those who were pleased that MaleEdge works and recommend it — was the fact that the penis extender can break over time.Even a moderate fat loss of 10–15 pounds can significantly improve penis visibility and boost confidence.A smaller penis decreases sexual confidence , which may be why penis size is related to sexual function. These patients may refer dissatisfaction of the appearance of their genitalia but usually present with discomfort while walking, using loose clothes, doing sports and during intercourse. The scrotum is stretched away from the penis, two incisions are done, one parallel to the penis’ edge and the other convex to the scrotum’s edge, with the excision of excess scrotal skin. Local rhomboidal skin flaps can be used with good esthetic results , or lateral scrotal flaps, whose rotation of the base allows bilateral coverage of the corresponding dorsal penile tract . The final step is represented by the closure of any skin defect with scrotoplasty and, in case of large penile defects, with skin grafting vacuum assisted closure 25, 33. A lipectomy must then be performed, removing underlying adipose tissue and excess skin, being careful to ensure a tension-free closure, preventing the penis from telescoping back within the soprapubic tissue 28,29,30. Environmental factors can disrupt hormone levels and impact penile development. Disorders affecting hormone production, such as adrenal gland dysfunction or pituitary gland/hypothalamus dysfunction, can impact penile development35,36. AIS reduces or eliminates the response to androgens, including testosterone, leading to underdeveloped male genitalia. I tried once to achieve the simplest, flat on the bed rear-entry penetration but my penis never got near the important area, and it never could. Is masturbation your primary form of sexual activity? That was an issue for a long time. In London, we have these “Gentlemen’s” public toilets where you all stand in a row, trying to pee, trying not to notice the next guy’s penis. Regarding penile enlargement, there are no guidelines, nor a standardization of the procedures so far recounted in the literature. They can make a gain in length, but with moderate and time-limited results, although without major complications 18, 20,21,22, 102. The association between the V-Y skin advancement, the suspensory ligament release and the filling of the suprapubic space represents the best example of such synergy . On this matter it would be useful a structured follow-up based on objective measurements of outcomes and complications and based on the evaluation of patient satisfaction (eg. Sexual quality of life, Visual analogue scale, APSSI, Self-body esteem, etc.) through validated questionnaires. As the months went on, it got worse because everyone changed, but I didn’t, and by the time I was 14, I was still a very plump boy with a very small penis.In a prospective multicenter double-blind randomized trial, HA was compared to polylactic acid (PLA) in 74 patients.Low DHT with high LH and testosterone levels and a high testosterone/DHT ratio may indicate 5α-Reductase 2 deficiency (5αR2D).As the body repairs microtears in the corpora cavernosa — the spongy tissue in the shaft that collects blood — men find their erections gaining noticeable size and strength.Dermal fat grafting has also been described to increase girth and length of the penis, which may have better fat retention and decreased contour irregularities at the expense of a larger donor-site scar (37,43).Women tended to recall the size of the 3D models very well, only underestimating penis length.All research, testing, and customer interviews that we’ve done lead us to conclude that your realistic expectations for success are in the 1-inch vicinity after months of using a penis extender.Procedures may include fat grafting, where fat is transferred to increase girth, or ligament release, which allows more of the penis shaft to extend outward.The open side of the syringe is applied to the penis to exert a negative suction of the penis by pulling back the piston, causing the penis to be pulled inside the syringe.Review articles, editorials, commentaries, and letters to the editor were included if deemed to contain relevant information on cosmetic surgery of the penis. As participants for our study, we identified already circumcised young patients who visited our hospital for urological treatment. Table 6 summarizes follow-up care for various life stages of patients with micropenis. The decision to use GH therapy is made within a comprehensive treatment plan considering the patient's overall health and underlying causes of micropenis. Surgical release of this ligament changes the acute angle of the penis to the pubic symphysis to an obtuse angle which allows the penis to lie in a more dependant position and therefore gives the perception of lengthening (44). As discussed, the suspensory ligament anchors the penis to the pubic symphysis and while providing support, acts as the mobile point for the penis during erection. This technique can be combined with suspensory ligament release to further increase length. The autologous fat graft will lose 20–80% of its volume over the first year of engraftment, and thus multiple procedures are sometimes necessary to achieve the desired result (40-42). The majority of men seeking penile elongation treatment have a normal penile size, which is functionally adequate for sexual activity and micturition (14,15). After normal development, there is an LH surge at birth which stimulates an increase in testosterone production and penile growth. This paper will review the anatomy and embryology of congenital micropenis and discuss both conservative and surgical management options for men seeking penile elongation therapy. While these procedures cater to patients with true micropenis, they pose higher risks and complexities, often necessitating multiple stages for reconstruction and potential complications involving urethral anastomosis and flap survival 20,21,22,23,24,25,26,27,28,29,53. Whatever the reason and/or the medical condition driving patients to seek penile augmentation surgeries, the decision to undergo penile enhancement surgery necessitates careful consideration. Another point to discuss is whether the stretched penile length is a good estimate of the erect penile length. To measure the length of the erection, the patient was administered intracavernous drugs,9 said length may vary according to the response of each patient, not reaching its maximum length in some cases. This simple gesture considers a few hidden centimeters in the adipose tissue, thus giving more accuracy to the measurement. As to the penile measurement procedure, Habous et al.9 did not take into account sinking the prepubic fat pad when measuring penile length. Of course, intercourse can occur only with a sufficiently rigid penis . Thus, in this study, three-dimensional (3D) models were used with the hope of increasing accuracy, ecological validity, and external validity. Both sources of data are usually available in sexual interactions. Yet, humans judge sizes most accurately when visual and haptic information are available together . While women adjust their behaviors for this risk, being less likely to engage in anal sex and more likely to use condoms with one-night partners, such risky behaviors themselves are often experienced as pleasurable . Given longer surgical times (from 3 to 5 h) even in expert hands, the high risk of moderate complications and patient dissatisfaction and the overall cost of the procedure, graft implantation for male esthetic surgery is not the wisest strategy to undertake. Xu et al. reported solutions to avoid these complications in a group of 78 patients who underwent penile girth enhancement with acellular dermal matrix . Austoni et al. was the first to use bilateral corporal venous grafts to expand corporal girth on 39 patients with normal penile diameter . Who are penis extenders for? From these results the Penuma® implants could achieve both girth and length enhancement with a high long-term satisfaction rate. Penuma® is a soft silicone subcutaneous implant placed, after infra-pubic access to the subcutis, on ¾ of the back of the penile shaft and secured to the glans with a polyester mesh . They degloved the penis after subcoronal incision, and implanted scaffolds on the buck’s fascia near the urethra, without covering it. Cells are first isolated from their natural biological environment, then cultured and implanted on scaffolds, made of a protein matrix capable of promoting their growth directly and indirectly 89,90,91. Although there are already several proofs about the use of biodegradable scaffolds for reconstructive surgery of urethra and corpora cavernosa 87, 88, in male esthetic surgery’s the evidence is still limited. More masculine traits, such as lower voice pitch and (to some extent) larger penis size 51, 52 are correlated with testosterone levels, which also may influence men’s mating goals and attractiveness. Two studies of erect penis sizes provided kits for home measurement 47, 48. When flaccid and “stretched” penis sizes are characterized , largely by self-measurement , they predict erect size surprisingly poorly. Another study asked participants to indicate their preference from reading erotic passages with three qualitative penis size options (small, medium, large) . The context of the sexual relationship could influence penis size preferences. Alternatively, try 500 milligrams of Korean ginseng root per day, which has been shown in one study to improve sexual performance.The genital male organ is linked to an ancestral sense of man’s fertility and sexual performance, which are the reasons making it the main factor to affirm one’s own masculine identity and to procure pleasure in the partner .Proper diagnosis, involving comprehensive clinical evaluations, hormonal profiling, and psychiatric assessments, helps determine whether patients would benefit from medical therapy or invasive procedures .Some of these approaches, such as weight loss, can create a noticeable difference by reducing pubic fat, which is often referred to as “weight loss penile growth”.Research suggests that this may be related to the time when androgen sensitivity is at its peak.Data on flaccid, stretched, and/or erect penile length, as well as patient satisfaction and quality of life, were extracted when available. Discover the possibilities with the best cosmetic surgery in the Philippines. We ensure to provide ample guidance and regular follow-ups post surgery. For those who want more permanent solutions, professional treatments and surgeries are available. A positive mindset enhances not only confidence but also overall sexual well-being. Penile Lengthening Surgery (Ligamentolysis) Additionally, interventions to address micropenis, such as hormone therapy or surgery, should be discussed and decided upon with the individual's and their parent's full consent, when applicable. Adolescence can be incredibly challenging for those with micropenis, as it is a period of increased self-awareness and self-identity. They can also properly connect parents with pediatric endocrinologists and urologists who can assess the cause of the micropenis and recommend treatment, if necessary. Additionally, it does not exclusively focus on a specific group of interventions (surgical or non-invasive) or a particular condition or disease (e.g., PD), providing a comprehensive picture of the current landscape. The papers analyzed in this review demonstrated inconsistent approaches in evaluating changes in penile dimensions, highlighting the absence of a consensus in assessing and reporting efficacy outcomes. However, it is important to note that the scientific evidence relies heavily on studies with inadequate internal validity, such as observational designs, non-standardized methodologies, and heterogeneous populations. Girth enhancement techniques, including soft tissue fillers, grafting procedures, biodegradable scaffolds, and subcutaneous penile implants, have gained traction. This may include measuring testosterone precursors, testosterone, DHT, luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, estradiol, and other relevant hormones such as cortisol, thyroid stimulating hormone, GH, and IGF-1. When measuring or monitoring penile length, following these guidelines for accurate results is crucial. It is often used in medical settings to evaluate penile abnormalities or during the assessment of erectile dysfunction. The measurements should be recorded in both centimeters (cm) and inches (in) for reference and comparison. More permanent natural solutions to increase its length and width include making dietary changes, getting more exercise, and losing weight around your midsection. Regular practice can lead to noticeable improvements in function and potentially size. Consistency and proper technique are crucial when performing penis enlargement exercises. For those exploring a more practical approach, specific exercises designed to promote penis health and potential enlargement are options right at home. Despite the appealing promises, the effectiveness of penis enlargement pills remains largely unproven. The measurement should be from the pubic bone, which is the base of the penis, to the tip of the glans without any bends or curves. The penis should be fully extended and straight during the measurement to obtain the most accurate length. To measure a fully erect penis, a ruler or tape measure is used to measure from the pubic bone to the tip of the glans along the dorsal (top) side. It was injected into the subcutaneous tissue of the penile shaft in a linear threading technique using a small needle. No adverse reactions or need for a second surgery were reported, except for one case of nodular fat occurrence . The fat suctioned with a liposuction apparatus is divided into syringes after being filtered and is then injected into the penile tissue with the assistance of a cannula, thus ensuring equal distribution. Techniques include soft tissue fillers, grafting procedures, biodegradable scaffolds, and penile implants. Several modifications of this technique have been described regarding either the site/shape and size of tunica albuginea incisions or the closure of defects with Buck’s fascia instead of graft material 34,54,55 (techniques described in detail in Table 1). The characteristics of studies on the techniques for increased penile length are summarized in Table 1. Until now a combination of multiple surgical approaches seemed to be the most suitable solution for surgeons and patients. Surgical interventions for enhancing penile size encompass methods aimed at increasing both length and girth. Data on flaccid, stretched, and/or erect penile length, as well as patient satisfaction and quality of life, were extracted when available. The following review aims to compare surgical outcomes, quality of life, and complications of non-invasive and invasive approaches to penile augmentation surgery. The primary outcomes were changes in penile dimensions, surgical complications, and quality of life. Review articles, editorials, commentaries, and research letters were included only if deemed to contain pertinent information on penile augmentation surgery. A systematic literature search of the PubMed, Web of Science, and Scopus databases was conducted in December 2023 to identify English-language papers on penile augmentation surgery published within the last 15 years. However, men who are less satisfied with their penis report more sexual health problems . In the case of micropenis, it is important to note that the numerical value varies across countries although some may show the same. A contrastive analysis among studies on penile measures from different countries is very difficult to make because, as it was mentioned before, criteria used for measurements differ so any comparison would be unfair.