Regardless of the definition, drug counterfeiting has become a global problem. For the purposes of this paper, the term “counterfeit” will be used to encompass all forms of SSFFC medications. This can include products with bona fide ingredients, but with insufficient or excessive quantities, products with the wrong ingredients, or products with deceptive packaging. Furthermore, PDE-5i can have potentially dangerous interactions with other pharmaceuticals that are rarely warned against with counterfeit PDE-5i. Results DisclaimerThe above collection of results was obtained from various sources, including the products main website. We may receive a commission from products we endorse, in the form of affiliate sales. We are not affiliated with any of these products, except for products that we endorse. Learn about my results, side effects, and more in my comprehensive review. While it will get you hard relatively quickly, sometimes the side effects are simply not worth it. The mean increase in girth was 22.74 ± 12.60 and 20.23 ± 8.73 mm in the HA and control groups, respectively. The pleasure from anal sex involves the stimulation of nerve endings and the stimulation of prostate gland, and is related to penis size. In summary, the penis is crucial in sexual function through stimulation and pleasure during heterosexual interactions. 4. Penile prosthesis implantation This adjuvant technique studied by the authors succeeded in increasing the circumference at the same location of the simulated cavernous corpus cavernosum tissue through a new material with negative Poisson's rate properties (i.e., it becomes wider when stretched). The remaining 20 men formed the control group and received only penile implants. Of these, 15 (enhancement group) also underwent venous ligation of the posterior coronary plexus, deep dorsal veins, and cavernous veins. In one study, the ingredients of 58 products available for the treatment of ED without a prescription were analyzed. In an analysis of 24,708 patients receiving a PDE-5i, 70% had an underlying medical diagnosis, with 50% of these patients having vasculogenic disease. There is also an indirect risk of missing potential medical conditions in patients that bypass the healthcare system to purchase illicit PDE-5i. Over a 6-month period, the second study followed 54 patients who received traction therapy 6 hours a day for 4 months.Even if your penis is smaller than average, it may not matter to your partner.Now the problem I have is now that that problems fixed my penis is very sensitive and can’t really last worth a damn.” NewWarOrder, Comment On YoutubeIn 2012, Alei et al. performed a procedure to increase penile girth in 69 patients utilizing porcine dermal decellularized grafts.In a recent survey, Spyropoulos et al. conducted a study on the microscopic ultrastructural examination and surgical benefits of biodegradable scaffolds used to expand the penile circumference.This trial demonstrated that autologous fat is suitable for penile enlargement and has few adverse effects.Various medical, tractional, injectable, and surgical modalities have been investigated for penile augmentation. Therefore, when receiving patients with penile thickening, a thorough physiological and psychological evaluation must be performed. Many unproven methods to increase penis size are available on the Internet; these include lotions, pills, stretching devices, vacuum pumps, and home massage techniques. This was true across all age categories but was most pronounced among males who thought their penis was average-sized (46%) or smaller than the average (91%) (18–65 years). Summary of clinically relevant studies on different penile girth augmentation methods. However, even in these well-regulated countries, the market for counterfeit PDE-5i has grown. It is largest in poor and developing countries, with the size of the market being inversely proportional to the amount of regulation. Some sources estimate that the market for counterfeit medications ranges between 75 and 200 billion dollars (5,6). In addition to the intellectual property rights that counterfeiters violate, the products they make can place consumers in danger. Currently, the WHO is using the term “Substandard, Spurious, Falsely labeled, Falsified, and Counterfeit (SSFFC)” for medical products until a new definition is agreed upon (1). Repeated penile girth enhancement using biodegradable scaffolds employing biopsy of previously formed tissue. Based on the noted results and complications, the scrotal dartos flap approach seems to be a viable treatment for penile girth enlargement. A 2021 study by Lei et al. used a novel autologous scrotal flap (scrotal flap method) reversal to increase penile girth by rotating the scrotal flap to a loose plane between the superficial penile fascia and Buck's fascia. Optimal prostate health At long-term follow-up (mean, 4 years), 72% of the patients still showed improvement, and 81% of the subjects reported “high” or “very high” satisfaction. In 2018, Elist et al. reported both satisfaction and adverse events in 400 patients who participated in a postoperative questionnaire. The growing market for male genital esthetics has brought new surgical procedures, devices, and implants. My Results From Taking Zyrexin With these advancements, penis enlargement surgery might become safer and more effective, benefiting from new technologies such as gene editing, stem cell therapy, nanotechnology, 3D printing, and mature biotissue engineering. Moreover, the application of fat, polylactic acid, HA, and dermal transplantation during the preparatory stages of penile enlargement surgery laid the foundation for emerging materials and technologies. Postoperative penile girth relaxation and erectile enhancement improved by 1.1 and 1.0 cm, respectively. Autologous tissue engineering on a biodegradable scaffold is a novel, safe, and effective treatment for penile enlargement. In 2014, Shaeer used a spin superficial circumflex iliac artery and vein flap for penile girth augmentation, with a mean increase of 5.6 cm. It also contains Xanthoparmelia Scarbosa and cnidium monnier, common ingredients found in many male enhancement pills. Zyrexin is an over the counter male enhancement pill that is a natural alternative to prescription drugs like the big V and others. Zyrexin is an all natural male enhancement pill that can be found in local stores such as Walmart, CVS, GNC, and many others. Penis-enlargement products Therefore, the superficial circumflex iliac artery and vein flap is a reliable option for penile girth lengthening, and flap enlargement helps preserve the intrinsic blood supply, thereby improving viability and tissue thickness. In 2018, Antonini et al. conducted a study of postoperative vacuum therapy after AMS™ LGX 700® inflatable penile prosthesis placement in 74 patients with medically refractory erectile dysfunction. Penile implant surgery does not reduce penile size compared with presurgical stretching measures, instead preserving or increasing penile size for most patients. The 2 types of studies both suggest that Penuma results in a rapid, durable increase in penile girth and generally improves the flaccidity of the penis. Regarding injectable treatments for penile girth enhancement, perhaps the foremost area of historical and contemporary research is penile subcutaneous injection therapy. With advances in technology, tissue engineering may be helpful in penile enlargement (Fig. 7). Perovic et al. also performed a second penile widening among 12 patients using a biodegradable scaffold containing enlarged autologous scrotal sarcolemma cells. In penile augmentation, surgery involving tissue engineering with biodegradable scaffolds is a novel technique. However, penile prosthesis surgery does not affect the size of the penis but may indirectly help the penis grow larger. In a 2014 study by Hsu et al., 35 patients underwent extensible penile implantation. Therefore, penile prosthesis surgery does not decrease penile size and may indirectly help the penis grow larger. 1. Autologous fat augmentation and dermal fat grafting Perovic et al. performed the surgery on 204 men with a mean age of 26.77 years. This enlargement exceeded that of most previously published surgical procedures. The adjuvant incision enlarged the penile circumference by 50% (from 8.0 to 12.0 cm). This is mainly because they are typically less likely to produce side effects. You also don’t need to get a doctor’s prescription before you can get natural male enhancers. While these drugs are known to be effective, their use tends to come with more side effects. Popular erectile dysfunction (ED) medications such as Viagra and Cialis are considered examples of synthetic male enhancers. Although HADM is becoming a common modality for penile enlargement, relatively few descriptions of its complications exist. At the 1-year follow-up, the mean flaccid and erect penile circumferences were 11.3 cm (8.2–13.2 cm, mean increase of 3.1 cm) and 13.2 cm (8.8–14.5 cm, mean increase of 2.4 cm), respectively. Given less trauma, a simpler operation, a precise effect, and fewer complications, day surgery and outpatient surgery can be performed. The aforementioned studies using autologous fat augmentation and dermal fat grafting demonstrated considerable changes in the average penile circumference. At 6 months postoperatively, penile circumference enlarged by 2.29 ± 0.82 cm, with only 1 patient developing nodularity. Collaboration is crucial to comprehensively understand a patient's condition and effectively manage their expectations. This approach should involve experts from different fields such as psychology, urology, and sexual medicine. Any treatment method for SPA must encompass significant psychological components, because the treatment of SPA is not merely physiological, but a complex interplay of psychological and physical factors. These technologies aim to achieve enhancements in precision and durability. Therefore, addressing these issues is crucial for any treatment protocol. Although complications of HA injection are minor and rare, they emphasize the importance of preoperative preparation and surgical techniques and that these complications can affect postsurgical patient satisfaction. This concludes that HA is a safe and effective method for penile body enlargement. Satisfaction with penile appearance and sexual life was significantly higher in the HA groups. There is also an indirect risk of missing potential medical conditions in patients that bypass the healthcare system to purchase illicit PDE-5i.During intercourse, the penis helps remove foreign bodies and bacteria from the vagina, thereby improving the ability of a woman to withstand infections.Many factors are contributing to the rapid growth of the illicit market, such as the low risk of prosecution, potentially high financial reward, and ease of distribution via Internet pharmacies.We are not affiliated with any of these products, except for products that we endorse.One case of penile hematoma and one case of glans numbness were reported, both of which resolved without medical intervention.Repeated penile girth enhancement using biodegradable scaffolds employing biopsy of previously formed tissue.Currently, the WHO is using the term “Substandard, Spurious, Falsely labeled, Falsified, and Counterfeit (SSFFC)” for medical products until a new definition is agreed upon (1).Regardless of the definition, drug counterfeiting has become a global problem. Several studies have identified an increase in similar augmentation operations performed by medical experts, even though acceptability ratings for such surgeries are rarely recorded in the literature. An increasing number of men are self-conscious about the size of their penis given the constant media promotion of the penis' relationship with masculinity and manhood and the widespread cultural opinion that bigger penises are better. However, limited scientific evidence is available to support the effectiveness of these uncontrolled medicines, elongation devices, or surgical therapies in increasing penile size. Furthermore, female sexual dysfunction is an increasingly prevalent occurrence in young women, with a prevalence rate as high as 18.3%. Specifically, during intercourse, penile insertion into the vagina can lead to a gratifying sexual experience by rubbing and stimulating sensitive areas within the vagina, such as the G-spot and clitoris, thereby promoting vaginal lubrication and orgasms in women. A study including 15,521 men noted that, on average, penises in the flaccid and erect states were 9.16 and 13.12 cm long, respectively. Veale et al. conducted a systematic review pooling data from 20 studies measuring penile length and girth during flaccidity and erection, and subsequently derived nomograms for men of all ages and races (Fig. 1). PDE-5i products purchased from Internet pharmacies rarely contain the stated amount of active ingredient (17). As stated, counterfeit PDE-5i rarely are packaged with the appropriate warning labels. The effects of widely variable amounts of active ingredient range from low efficacy at a minimum to severe side effects and negative drug interactions at the worst. In Indonesia, 100% of “Viagra” sold by street peddlers, 56% purchased in “drug stores”, and 13% acquired from legitimate pharmacies was counterfeit Viagra marked as authentic (29). Similar results were found in an analysis of counterfeit ED drugs sold in Italy, Austria, and Canada (28). According to scientists, autologous sarcolemma cell implantation on biodegradable scaffolds is a novel and promising therapeutic strategy for a realistic increase in penile circumference. In addition, the repeat surgical technique resulted in a considerable improvement in peripenile enhancement, with a mean follow-up period of 38 months. In a recent survey, Spyropoulos et al. conducted a study on the microscopic ultrastructural examination and surgical benefits of biodegradable scaffolds used to expand the penile circumference. The term “small penis syndrome” describes this illness in the medical literature. Although most of these men had normal-sized penises, they tended to worry excessively and overestimate the average penises of other men. The first group of men experienced pain because they were insecure and unhappy with the size of their penis, fearing that it was not big enough to satisfy their spouses or themselves. Table 1. Common medications and dietary supplements with interactions with phosphodiesterase-5 inhibitors (PDE-5i). The blood then flows into the penis and is prevented from flowing out using a constriction ring at the base of the penis, thereby facilitating the maintenance of an erection during sexual activity. Notably, most of the literature on penile enhancement comes from China, Korea, and Mexico. None of the patients reported any pain after the anesthetic effect had worn off. Injectable implants designed to increase penile circumference are becoming more widely utilized (Fig. 4). Psychological distress, diminished quality of life, and impaired sexual function are crucial components of comprehensive SPA assessment. Given the increasing emphasis on physical appearance, “small penis anxiety” (SPA) must be recognized and treated appropriately. This therapeutic advantage is due to the steady remodeling of neovascularization, fibroblast-like proliferation, and collagen accumulation, which are characteristics of highly vascularized normal connective tissue in the adult sarcolemma. However, taking illicit PDE-5i may harm consumers directly, as many illicit products contain detrimental contaminants and inaccurate amounts of the active ingredient without the appropriate warnings. Many factors are contributing to the rapid growth of the illicit market, such as the low risk of prosecution, potentially high financial reward, and ease of distribution via Internet pharmacies. Already in widespread use, the market for PDE-5i is steadily growing as the population ages. This procedure injects excess fat cells from any part of the body into the area to be filled, and the fat cells regrow and fuse with the tissue at the site. In recent decades, autologous fat injections have been widely used for cosmetic, breast augmentation, and enhancement procedures. The International Index of Erectile Function scores indicated that device satisfaction was generally favorable, with only 4 patients discontinuing use due to mild and reversible adverse outcomes. The third group of male patients undergoes cosmetic penile contour surgery and repair for congenital and acquired causes of penile damage.22,26,32 These men seek various enlargement methods to increase the size and girth of their penises. In 2017, among 23 patients who underwent single-treatment PLA injections with a mean volume of 20 mL for penile girth enhancement, the mean circumference increased by 2.2 ± 0.2 cm at 3 months. In a recent pilot study of acellular collagen matrix grafts, Xu et al. observed 78 patients treated with prostaglandin E and ADM. At the 3-month follow-up, the mean increase in penile girth was 1.1 cm. Furthermore, 11.5% of patients being evaluated for a PDE-5i prescription had a new underlying disease detected (26). Before PDE-5i are prescribed, patients must be evaluated for potential drug interactions and warned of the absolute contra-indications. This strategy could help ease patient concerns and re-invigorate the PDE-5i market. Furthermore, as mentioned earlier, embarrassment with potency issues leads patients to avoid physician visits. This refined approach is essential for advancing the field and ensuring effective and patient-centric care of patients with SPA. In summary, SPA treatment must adopt a holistic strategy that prioritizes psychophysical assessment, patient selection, and counseling. This is key to achieving patient satisfaction and reducing the risk of post-treatment dissatisfaction. Thigh (A) and/or abdominal fat (B) suction was performed in a fan-like pattern by moving the harvesting cannula back and forth. The harvesting cannula was moved back and forth in a fan-like motion to aspirate fat from the thigh and/or abdomen. However, serious complications were not noted in the dermal fat grafting cohort (Fig. 5). The maximum circumference of the glans increased by 16.6% and 14.2% at the initial and final (10–12 months) follow-ups, respectively. In 2012, Shaeer selected 10 men who underwent a dermal fat grafting procedure. Various medical, tractional, injectable, and surgical modalities have been investigated for penile augmentation. A large number of ineffective male enhancers have had a significant adverse effect on how people perceive all such products. Ask medical experts, and most of them will write off male enhancers as scams and a waste of money. Of all these products available on the market today, pills are arguably the most popular ones due to their convenience in use. During intercourse, the penis helps remove foreign bodies and bacteria from the vagina, thereby improving the ability of a woman to withstand infections. The micropenis is defined as less than 2.5 standard deviations from the average stretched length for age, mainly due to congenital endocrine dysfunction. These men were embarrassed to have others look at their penis, especially when flaccid. It’s not recommended that you take Zyrexin with alcohol, as the depressing effects of alcohol will lower the pills effectiveness. It can also be found in a number of other products, including stamina rx. Yohimbe is somewhat controversial because of its potential side effects, which have been linked to men suffering from heart attacks. It usually stops working after a few hours, however, it is marketed to work up to 24 hours. It is labeled as the “Worlds Strongest Sexual Enhancer”, and has been on the market for a few years now. In addition, a Canadian study found that penis size tends to be larger in gay than in heterosexual men, with a preference for larger sizes noted within the gay community. A study conducted in the United States in 2011 revealed that mutual masturbation, oral sex, and anal sex were the preferred sexual behaviors among gay and bisexual men.23,39 In male-male anal intercourse, the penis is inserted into the partner's rectum. In male-male sexual activity, which primarily involves oral (mouth-to-genital) and anal (anal-genital) sex, the size of the penis is closely linked to sexual satisfaction. By creating new functional tissues from somatic cells, the circumference of the penis can be enlarged. Considering the preservation structure that prevents degradation and fragmentation of the transferred tissue, they are superior to the granular fat used in injections. The aforementioned novel combined technologies show that adjunctive solutions for penile enhancement and the restoration of penile volume exist. The counterfeit drug market is a nebulous and constantly evolving entity that has become increasingly difficult to define and quantify. This communication reviews the literature regarding counterfeit PDE-5i, and summarizes both the scope and dangers of the illicit PDE-5i market. Consumers of illicit PDE-5i often do not realize they are using counterfeit products and placing themselves at an unnecessary health risk. The solution to your concerns about penis size may be as easy as talking with your partner or getting in shape. This approach is performed through a short dorsal incision at the base of the penis such that the scar is hidden in a pubic hair–covered fold; therefore, the incision is virtually invisible. Human acellular dermal matrix (HADM) is an extracellular matrix and 3-dimensional framework structure of the human dermis used in the treatment of various urologic diseases. (D) A cannula for fat injection with an 18-gauge blunt tip was placed into the Colles' fascia layer, and 1 mL of fat was injected slowly and evenly into the superficial, medium, and deep layers of the Colles' fascia by sliding the cannula back and forth. (C) A suction pump–assisted liposuction equipment was used to extract fat (Dominant 50; MedelaAG, Baar, Switzerland). Of all these products available on the market today, pills are arguably the most popular ones due to their convenience in use.Surgery is typically reserved for men whose penises don't work because of a problem present at birth or an injury.Non-declared pharmaceuticals can have drug interactions and side effects such as gastrointestinal symptoms and nausea when combining metronidazole and alcohol.The physiological and psychological evaluations must be considered with patients' attitudes toward surgery to analyze the feasibility and effects of surgery and determine whether these can be achieved (Fig. 2).In 2006, the WHO estimated that 10% of drugs worldwide were counterfeit, with the figure at 25% in developing countries, and as high as 50% in certain African and Asian countries (3).In addition, the repeat surgical technique resulted in a considerable improvement in peripenile enhancement, with a mean follow-up period of 38 months.Furthermore, as mentioned earlier, embarrassment with potency issues leads patients to avoid physician visits.In all the cohorts, patients with below-average penises were extremely rare, and most patients had normal penises.1,2 The second group of male patients seeks surgery because their penis is physiologically too small. Besides the high profit margins, the underlying characteristics of consumers of PDE-5i make it a prime target for counterfeiters. According to the Massachusetts Male Aging Study, 52% of men aged 50–70 have some degree of ED, a number that increases to upwards of 70% in men older than 70. Erectile dysfunction (ED) is a common problem and increases in incidence as men age (10). Studies have been published worldwide to evaluate and establish normal penile sizes. The normal penis size and the methods of determination of the normal penis size must be defined. Findings in patient presenting to the clinic with complaints of a small penis. This is a potentially useful aid in penis enlargement as technology advances. Similarly, men with inflatable penile prostheses may see a greater increase in length compared with extensible penile prostheses. After prosthetic implantation, 72% of patients reported a decrease in length. General penile prosthesis implantation involves prosthesis insertion into the cavernous body of the penis. These extensively utilized methods for penile enlargement demonstrate effectiveness and yield high patient satisfaction. In 2012, Kang et al. reported 52 patients who underwent phalloplasty, including autologous fat injection. During the nontreatment period, significant changes in penis length and girth were not observed. Over a 6-month period, the second study followed 54 patients who received traction therapy 6 hours a day for 4 months. Two different studies have shown significant changes in mean penile length but not penile girth. Signs of inflammation and serious adverse effects were absent in all cases. Available injectable soft tissue fillers include hyaluronic acid (HA), poly l-lactic acid (PLA), polymethyl methacrylate (PMMA), calcium hydroxyapatite, and synthetic polymers such as silicone. In homosexual relations, gay men predominantly achieve sexual climax through oral and anal sex. The pleasure of anal sex primarily comes from stimulating the densely packed nerve endings in the anus and rectum of the receptive partner, as well as indirect stimulation of the male prostate, leading to pleasure and potential climax. In studies regarding female orgasms, 62% thought vaginal intercourse was the best trigger for orgasm. In one study attempting to estimate illicit sildenafil use, concentrations of sildenafil and sildenafil metabolites were measured in sewage treatment centers in the Netherlands. Between 2004 and 2008, 35.8 million counterfeit sildenafil tablets were seized in Europe, which is 7 times greater than the amount of all other counterfeited Pfizer products combined. In fact, for PDE-5i, the illegal market in industrialized countries approaches the size of that in developing countries. Unsuspecting patients often seek alternative treatments of ED due to embarrassment and lower cost, but also because of the perception that “all natural” products are somehow safer than synthetic medications. At best, surgery may give a slight increase in girth to the penis. Dave Walker founded BestEnhancementReviews.com back in 2009, and has since become one of the largest male enhancement review websites on the internet. Innovations such as Penuma and assistive technology for the penile tunica albuginea, along with their potential for tissue engineering, are steering the field toward more promising directions. These advancements, which are characterized by fewer complications, more effective results, shorter operation time, and higher patient satisfaction, are pivotal for the development of treatment options. Developments in skin flap procedures, the introduction of products such as Penuma, and breakthroughs in tissue engineering have redefined the landscape. Ingenuity and device innovation are vital to technological surgical advances that can produce a more sustainable improved quality of life for patients. Most (96.4%) patients who underwent cosmetic procedures for SPA reported worsened or unchanged SPA symptoms. Pro Solution Pills are designed to help increase your sexual stamina and drive. Zyrexin contains all natural ingredients which help to create this temporary boost in size and girth. It is intended to start working within 1 hour, and gives an all natural boost in sexual stamina, vigor, and size. In conclusion, this newly developed PLA filler caused significant penile enlargement for up to 18 months and was well tolerated without serious adverse effects. Among these patients who received HA treatments, 4.3% experienced complications such as subcutaneous bleeding, subcutaneous nodules, and infection throughout the 6-month follow-up period. Although HA injections are becoming a popular modality for penile enlargement, relatively few reports of their side effects are available. Low testosterone levels are also believed to increase the risk of several medical issues, including osteoporosis and bone fractures. It describes several benefits that pertain to male sexual health for the most part. Male enhancement is a thing of particular interest to men who are having issues in their sexual lives. Physicians who treat ED should warn patients against purchasing PDE-5i via alternative means, especially the Internet. By bypassing the legitimate healthcare system, users of counterfeit PDE-5i bypass screening for concurrent medical comorbidities, as well as proper education and warnings of PDE-5i use. A 2002 study surveying perceptions of penis size among 375 sexually active women found that 32% of women thought penis length was less significant than penis girth. Meanwhile, a 2014 Mexican study regarding sexual dysfunction in young women highlighted that partner penile thickness/size was significant for female sexual dysfunction. In all the cohorts, patients with below-average penises were extremely rare, and most patients had normal penises.1,2 The second group of male patients seeks surgery because their penis is physiologically too small. As a matter of fact, most male enhancement products have not been evaluated by the FDA. He has personally tested over 100 different types of male enhancement pills, extenders, pumps, creams / ointments, and an array of other products. Other outcomes accompanying this physical change were significant improvements in self-confidence and self-esteem, as well as high levels of long-term patient satisfaction with minimal and manageable adverse events (Fig. 6). However, unlike Siegal's study, Elist et al. did not apply a triple-antibiotic or rifampin solution to the implants. Elist et al. reported an infection rate of 3.3%, similar to that of inflatable and noninflatable penile implants (4.6%). The penis is then bent, and additional sharp stripping is performed to expose the surface of the suspensory ligament. Surgery is typically reserved for men whose penises don't work because of a problem present at birth or an injury. At worst, surgery can cause complications such as infection, scarring, and loss of sensation or function. But it does not change the actual length of the penis. And these products may have potentially dangerous ingredients not listed on the label. A penis is considered small only if it measures less than 3 inches (about 7.5 centimeters) when erect. In 2021, Khalil et al. investigated a new adjuvant surgical technique for graft-less penile girth restoration and thickening through assisted expansion of the tunica albuginea. As such, AMS™ LGX 700® IPP insertion and postoperative vacuum device treatment is a safe and highly satisfactory combination approach to maintain penile size. At the end of the study, the median penile length and girth were 17 and 11 cm, respectively. One of the most common complaints of patients after penile prosthesis implantation is that their erection is perceived as smaller than their natural erectile memory. The most common postoperative complications were seroma (4.8%), scar formation (4.5%), and infection (3.3%), whereas no patients reported any change in sexual function, erection, or ejaculation. While the market for counterfeit pro-erectile medications is partially driven by the cost of prescription drugs, this reality could soon change. With such significant profits to be made at a relatively low risk, there is a tremendous incentive for counterfeiters to tap into the growing market for PDE-5i. Many factors contribute to the disproportionately large market of counterfeit PDE-5i. Mayo Clinic does not endorse companies or products. If you are a Mayo Clinic patient, we will only use your protected health information as outlined in our Notice of Privacy Practices. Even if your penis is smaller than average, it may not matter to your partner. There's no guaranteed safe and proven way to enlarge your penis. When the suspensory ligament is cut, the non-erect penis may look longer because more of it hangs outside the body. In summary, the penis is crucial in sexual function through stimulation and pleasure during heterosexual interactions.Two different studies have shown significant changes in mean penile length but not penile girth.By bypassing the legitimate healthcare system, users of counterfeit PDE-5i bypass screening for concurrent medical comorbidities, as well as proper education and warnings of PDE-5i use.Already in widespread use, the market for PDE-5i is steadily growing as the population ages.Research by Bogaert and Hershberger corroborated this finding in which a sample of 4000 men, those in the gay community generally had larger penises than their heterosexual counterparts.Therefore, the primary purpose of this review was to conduct a literature search to evaluate the efficacy of surgical and nonsurgical treatments for penile enlargement.Some might assume that a particular male enhancement product or technique delivers the same benefits as any other. Given the seemingly high rates of complications with ADM grafting, grafting does not appear to be viable despite the successful enhancement of penile girth. However, one disadvantage of HADM is that penile girth increases significantly in the flaccid state, but less significantly during erection. The authors highlighted several advantages of decellularized dermal matrix grafts for penile girth augmentation over autologous dermal fat grafts. This trial demonstrated that autologous fat is suitable for penile enlargement and has few adverse effects. This study demonstrated the efficacy of the penile stretching device in increasing penile length, but significant evidence of greater penile girth was not noted. As for natural products, while some ingredients show potential, many claims remain anecdotal. The others merely contribute to enhancing sexual functions and are not primarily targeted at promoting stronger erections. It is certainly helpful to do your research before buying these products. As we noted earlier in this article, many people usually have natural supplements in mind when they talk of male enhancers. You may be disappointed to learn that the assertion is often true if you are already contemplating using one of these products. The ease and convenience of purchasing counterfeit PDE-5i products via the Internet have contributed to the growth of the illicit market. Of these users, 68% did so without a prescription, as patients often do not realize that they are getting false and possibly dangerous products, and 60% of these users believed they received the same product as from a legitimate pharmacy (13). These patients with higher socioeconomic statuses having the resources to pay for pharmaceuticals out-of-pocket, combined with the stigma of ED, creates an environment ripe for an illicit market. The large market for counterfeit medications is not equally distributed in size or class of medications worldwide. Numerous studies have shown that men who believe their penis is small are not only unhappy with their physical appearance but also have a lower sense of self, which manifests itself in their relationships. Among 25,592 surveyed men, most respondents wanted a larger penis, and around a third wanted a longer penis. A large penis has long been celebrated as an indication of masculinity, power, prestige, fertility, and stamina. Penis enlargement medications, elongation devices, surgical procedures, and other methods are widely accessible, but many lack the necessary oversight and are thus illegal. The market is filled with unregulated supplements, and some may be ineffective—or worse, unsafe.It also contains Xanthoparmelia Scarbosa and cnidium monnier, common ingredients found in many male enhancement pills.These products, especially the herbal ones, contain ingredients that are thought to increase testosterone levels.In a well-known example, 150 non-diabetic patients were hospitalized with hypoglycemia in Singapore.The impact of the penis on female sexual function is predominantly through the stimulation and sexual pleasure from intercourse.For the purposes of this paper, the term “counterfeit” will be used to encompass all forms of SSFFC medications.Erectile dysfunction (ED) is a common problem and increases in incidence as men age (10).If your penis is about 5 inches (13 cm) or longer when erect, it's of typical size. The common link between these patients was the use of an ED supplement that contained glyburide (a sulfonylurea used to treat diabetes), as well as illicit PDE-5i (31). In a well-known example, 150 non-diabetic patients were hospitalized with hypoglycemia in Singapore. Perhaps even more dangerous than the counterfeit PDE-5i that is marketed as legitimate pharmaceuticals, however, are those marketed as “natural” supplements. Given the mixed results of cosmetic procedures for SPA, clear communication about the potential effects, risks, and psychological impacts of these treatments is vital. Given the complexity of SPA, a multidisciplinary approach is essential for a thorough evaluation of a patient's eligibility for treatment. This comprehensive approach ensures the adoption of more ethical, effective, and patient-centered treatment plans for managing SPA. In the future, more precise and efficient surgical and nonsurgical therapies may be developed, thereby expanding the range of options for patients with SPA. They also explicitly state that you should consult a physician prior to use, and not use their product if you have a medical condition. Several men have suggested side effects including headaches and abdominal pain while ingesting more than 1 pill. When compared to some other products in the same category, it is actually very cheap, and you can buy a one months supply for only $33 in GNC. Now the problem I have is now that that problems fixed my penis is very sensitive and can’t really last worth a damn.” NewWarOrder, Comment On Youtube What I found with ZYREXIN- is it mirrors viagra side effects to a tee except times 3, for some reason.” Joel, email we received You can see an image of most of the products on the list. The products, which are often sold on the internet, can be dangerous to health, and we therefore warn consumers against using them. We are also informed about such products through our cooperation with the drug regulatory authorities in other countries. At the Danish Medicines Agency, we routinely analyse products that we suspect contain active pharmaceutical ingredients which are not declared in the product information. The datasets generated during and/or analyzed during the current study are publicly available. Recognizing the limitations of the current evidence and employing a multidisciplinary approach is crucial for better assessment of patient eligibility and meeting patient expectations. Regarding expectations and patient satisfaction, the former must be managed realistically. An increasing number of men with healthy and normal penises want to enlarge their penis. Whether you choose a medical or herbal route, managing expectations is key. Always verify the source and look for transparent, third-party tested products. The market is filled with unregulated supplements, and some may be ineffective—or worse, unsafe. Therefore, the primary purpose of this review was to conduct a literature search to evaluate the efficacy of surgical and nonsurgical treatments for penile enlargement. Men are more concerned with their penis size and girth, and they seek methods to enhance their erections. Over the past 2 decades, the “The bigger the penis, the better” mentality has been reinforced by an explosion of media content focused on expanding the size and thickness of the male penis. Some might assume that a particular male enhancement product or technique delivers the same benefits as any other. Furthermore, counterfeit PDE-5i often contain improper dosing and contaminants that may place patients at direct risk. Strategies to limit counterfeiting should be multi-faceted and target prescribing healthcare professionals, pharmaceutical companies, regulatory authorities, and patients. Or surgery may add a slight appearance of increased length to the non-erect penis. Companies offer many types of nonsurgical penis-enlargement treatments. Understanding your partner's needs and desires is more likely to improve your sexual relationship than changing the size of your penis. And no trusted medical organization endorses penis surgery for purely cosmetic reasons. Ads for penis-enlargement products and procedures are everywhere. Some have male enhancement, especially stronger, longer-lasting erections, as their focal point. Numerous offerings on the market are targeted at helping to improve male sexual health and performance. Herbal male enhancement supplements not only aim to work the same way as ED drugs do, but they also do other great things, too. Men who have fertility issues may also benefit from male enhancement. There are different types of approaches and products for male enhancement. Another benefit that some male enhancement products are said to offer is greater satisfaction. We will discuss some common benefits or functions of male enhancement products below. Consequently, evidence-based clinical guidelines regarding dermal fillers for penile girth enhancement are non-existent. The average penile girth measured before and after treatment was 9.5 and 12.1 cm, respectively. The authors noted that both HA and PLA fillers had significantly enhanced effects in patients with micro penile syndrome 24 weeks after HA and PLA injections, and encephalitis was a severe side effect without serious adverse effects. At 24 weeks, the average increase in penile girth was 2.1 ± 1.0 cm in the HA group and 1.6 ± 0.9 cm in the PLA group. Additionally, the researchers propose that the importance of penis size is further magnified by its prominence in the prevailing male gay culture, highlighting its role in shaping sexual dynamics and identity within this community.” Globally, antibiotics comprise the largest class of counterfeit medications, but in Europe, PDE-5i are the most commonly counterfeited medicines (7). The proportion of falsified drugs ranges from 1% in industrialized countries that have a well-regulated and controlled drug market to as high as 60% in some developing countries (6). In a private study, 2,177 incidents of pharmaceutical crime involving seizures or police raids were reported in 2015, with 53% of them classified as commercial involving greater than 1,000 dosage units (4). Regardless, it is clear that counterfeit medications have reached an industrial level scale. In 2006, the WHO estimated that 10% of drugs worldwide were counterfeit, with the figure at 25% in developing countries, and as high as 50% in certain African and Asian countries (3). However, products meant for this purpose often have specific goals or benefits in focus. Such issues tend to be more common as males get older in age and can be quite frustrating or embarrassing. The use of dietary supplements for treatment of ED should be screened for and given due precautions. As the population ages, and the market for PDE-5i grow, so does the illicit market for PDE-5i. Similarly, the FDA has launched significant public education campaigns through magazine public service announcements, education leaflets, news articles, a consumer website (/counterfeit), and a pharmacist education program (36). Among 23 patients with a mean age of 26.5 years, the mean flaccid penile length increased from 8.8 ± 1.2 cm to 10.1 ± 1.2 cm and 10.5 ± 1.2 cm, respectively, in the first and third months of follow-up. In a 2005 study by Aghamir et al., 27 patients received vacuum erection device treatment. The off-label use of these products in patients who want to enhance their penile function should be approached with caution. They argue that this emphasis is rooted in the eroticization of the body within various gay cultures, along with the ‘dual presence’ of the penis in homosexual relationships and encounters. Drummond and Filiault examine the increasing significance of penis size among men who have sex with men. Research by Bogaert and Hershberger corroborated this finding in which a sample of 4000 men, those in the gay community generally had larger penises than their heterosexual counterparts. The penis is vital in sexual function and also significantly affects homosexual interactions. Similarly, some women may experience more stimulation and pleasure with a larger penis, which may enhance their libido and sexual function. However, limited scientific evidence is available to support the effectiveness of these uncontrolled medicines, elongation devices, or surgical therapies in increasing penile size.There are numerous known side effects of PDE-5i, some of which may be life threatening.Such issues tend to be more common as males get older in age and can be quite frustrating or embarrassing.This study demonstrated the efficacy of the penile stretching device in increasing penile length, but significant evidence of greater penile girth was not noted.Furthermore, the manufacturing conditions of counterfeiters cannot match the sterile processing conditions of legitimate pharmaceuticals.What I found with ZYREXIN- is it mirrors viagra side effects to a tee except times 3, for some reason.” Joel, email we receivedPenile traction therapy (PTT) controls penile stretching using mechanical traction.As the population ages, and the market for PDE-5i grow, so does the illicit market for PDE-5i.Additionally, the researchers propose that the importance of penis size is further magnified by its prominence in the prevailing male gay culture, highlighting its role in shaping sexual dynamics and identity within this community.” Patients embarrassed by their condition or seeking less expensive alternatives to legitimate pharmaceuticals have fueled the market, and the growth of Internet pharmaceuticals have made counterfeit pharmaceuticals easy to obtain. However, by doing so, many of these patients are unknowingly subjecting themselves to significant health dangers. Recently, in January of 2016, the FDA announced warnings against 40 products marketed as dietary supplements that contained undeclared PDE-5i (33) (Table 3). I would recommend Zyrexin to any guy looking for a quick boost in sexual confidence.” Josh, Texas However, when I was sexually stimulated, I did feel a succinct different in my energy and stamina. Namely, while it says it will make you a beast in bed for a prolonged period of time, I noticed that it only worked for about an hour or two before the effects wore off. Vacuum treatment of the penis is likely an ineffective method for penile lengthening and thickening but provides psychological satisfaction for some men. Most patients (52%) reported nodularity, ridges, irregularities, indentations, or voids in the tissue fillers. Beginning in 2007, Casavantes et al. administered PMMA injections to enhance penile girth in 752 men and conducted follow-up reports over 7 years. Furthermore, for the first time, they demonstrated significant improvement in psychological distress among patients with micro penile syndrome. In 2003, Yacobi et al. employed a series of subcutaneous injections of liquid silicone as the primary enhancement procedure in 324 men under local anesthesia. Circumcised patient before and 3 months after 1 session with 20 mL of polymethylmethacrylate. Polymethyl methacrylate microspheres are suspended in a vehicle such as bovine collagen or fibrin and are one of the safest non-absorbable soft tissue fillers. Representative figures of polylactic acid filler injection for penile augmentation. The study also reported 5 cases of mild, transient acute encephalitis, but no severe acute cerebrovascular accidents. The erection of the penile prosthesis simulates the physiological erection of the penis, thus allowing patients with erectile dysfunction to achieve coitus and treat severe erectile dysfunction. In a 2022 study by Siegal et al., 49 patients who received Penuma implants found that the mean preoperative and postoperative flaccid girths were 9.3 ± 1.2 and 13.1 ± 1.1 cm. The Penuma implant is a medical-grade silicone implant surgically implanted subcutaneously in the penile shaft to improve the girth of the penis. These aspects are unique to penile enlargement surgery for the treatment of female sexual dysfunction. Table 2 shows patients who present for medical treatment due to small penis size. In addition, the advent and refinement of artificial intelligence, various surgical techniques, and products are anticipated not only to improve male SPA and small penis syndrome but also to enhance treatments related to female sexual function and satisfaction. Prostate enlargement is an issue that is more common among older men. Male enhancement is also believed to have a positive effect on the prostate gland, including cancer prevention. There are certain ingredients in some of these products that boost sperm count. Some are also said to enhance the sensitivity of the penis, thus making a man enjoy the activity more. It is typical for older men to have a lower interest or desire for sexual activity. Contamination with either adulterants or bacteria poses risks to consumers of counterfeit PDE-5i. Many laboratories of counterfeiters are exposed to the open air and use unsterile water that would not be safe for drinking. These results are not surprising, when considering the strict regulations and inspections that legitimate pharmaceutical producers must pass, compared with the unsterile conditions in which counterfeiters may work. Furthermore, the manufacturing conditions of counterfeiters cannot match the sterile processing conditions of legitimate pharmaceuticals. Non-declared pharmaceuticals can have drug interactions and side effects such as gastrointestinal symptoms and nausea when combining metronidazole and alcohol. The length of a non-erect penis doesn't consistently predict length when the penis is erect. The fear that your penis looks too small or is too small to satisfy your partner during sex is common. But, there's little scientific support for nonsurgical methods to enlarge the penis. Therefore, this review evaluated the mental health status of men who complained of a small penis and examined the state of nonsurgical and surgical treatments for male patients seeking penile enlargement, along with a risk assessment for each. In 2018, Habous et al. explored whether penis size measured preoperatively and penile erections after penile implant surgery were linked in 133 patients undergoing penile implant surgery. In 2012, Alei et al. performed a procedure to increase penile girth in 69 patients utilizing porcine dermal decellularized grafts. Poor erection is an indication of poor blood circulation to the male organ. Some products are more targeted in their approach, meaning that they have specific benefits. People also refer to this sometimes as “male menopause.” Another description for it is “androgen decline in the aging male” (ADAM). Male enhancement can mean different things to different men. Essentially, the fat cells grow in a different place, and because the fat cells are transplanted autologously, rejection does not occur, which fundamentally guarantees the safety of the procedure. However, the effect was different for the circumference of the penile head (9.3 ± 0.86 vs. 8.8 ± 0.66 cm). No significant differences were observed in the circumference of the proximal penis. Penile traction therapy (PTT) controls penile stretching using mechanical traction. The vacuum erection device involves inserting the penis into a cylinder and applying a vacuum to create negative pressure. Despite these potential dangers, the market for counterfeit products has grown astronomically. Counterfeiters are taking advantage of this growing market by developing illicit and counterfeit PDE-5i products. There aren't enough studies of penis-enlargement surgery to give an accurate picture of risks and benefits. Manufacturers often claim that these products will restore the sexual endurance of older men to a level comparable to that of a younger man. The improved circulation that often results from the use of male enhancers can also help men to perform better sexually. These products, especially the herbal ones, contain ingredients that are thought to increase testosterone levels. High-quality male enhancers aim to help by improving the blood flow to the penis. In the 400 patients, the medial circumference increased from a mean of 8.5 ± 1.2 to 13.4 ± 1.9 cm. However, 47, 12, 10, 8, 7, 4, and 3 patients experienced erectile discomfort, delayed healing, insignificant enhancement, wound hematoma, foreskin edema, wound infection, and dorsal skin necrosis, respectively. Acellular dermal matrix (ADM) can replace autologous tissues, which can reduce secondary trauma to patients, while simultaneously reducing operation difficulty and time. Therefore, penile size has additional significance for both heterosexual and homosexual relationships. In addition, in the context of gay culture, penile size may influence sexual attractiveness, particularly among men who have sex with men. A 2020 study evaluating orgasm and overall sexual function and habits among 303 American women noted that 41% of women with stable sexual partners were at risk for female sexual dysfunction. The impact of the penis on female sexual function is predominantly through the stimulation and sexual pleasure from intercourse. But chances are your penis is within the typical size range. Many men believe that increasing the size of their penises will make them a better lover or make them more attractive. But there are a few things you can do if you're concerned about your penis size. Some surgeons offer cosmetic penis enlargement using many techniques. Most advertised penis-enlargement methods don't work. Advertisers would have you believe that your partner cares deeply about penis size. If your penis is about 5 inches (13 cm) or longer when erect, it's of typical size. Many men also have an exaggerated idea of what is considered a "typical" penis size. But most men who think their penises are too small actually have penises that are considered typical size. Many pumps, pills, weights, exercises and surgeries claim to increase the length and width of your penis.