Paul H. Byerly
Penis enlargement products are big business. No longer relegated to the back of pornographic magazines, these products are being marketed on late night TV, in mainstream magazines, and in the e-mail in-box of every person on the planet. Do they work? Are they safe? Does a man need to worry about the size of his penis? This article will examine these issues.
How big is the average penis? In one Internet poll, 69% of men over estimated the size of the average penis, some by several inches. For a long time studies done by Kinsey in the late 40s were quoted, but there are some serious problems with these studies. The Kinsey studies were based on self-reporting of men who responded to a post card mailed to them by the Kinsey institute. This results in several problems, only men who “opted in” were included, the men could have exaggerated, and the sample is not demographically valid. It has since been found that, surprise, a man with a big penis is more likely to volunteer for measurement than is a man with a small penis.
Web sites trying to convince men they need to be bigger give the average at 6 inches (15.25 cm) and larger, but science says otherwise. In the last fifteen years, there have been a number of statistically and scientifically well done studies on penis size. The most famous of these studies, done by the University of California School of Medicine and reported in the Journal of Urology in 1996, found the average erect penis to be 5.1 inches (13cm) in length and 4.9 inches (12.5) in circumference. Studies done by the Department of Urology, University of Florence, Italy, and St. Mary's Hospital, London, as well as at other medical institutions, have given very similar results that range from 5.03 to 5.3 inches (12.78 to 13.46 cm) for the average erect length of the penis.
It is interesting to note that penile dysmorphophobia, or small penis syndrome is now a recognised psychiatric disorder. Much as with anorexia, the man does not see his penis as it really is, but rather as smaller than it is.1 If you think you have a small penis, odds are you do not!
First, let’s get a good understanding of how the penis is constructed, and how it works. The penis is composed of three chambers, the two cavernous bodies (or corpora cavernosa) which lie side by side on the top of the penis, and the spongy body (or corpus spongiosum) which is centered below the other two. The spongy body surrounds the urethra, and extends out the end of the shaft to form the glans. All three chambers contain small hollow areas that can fill with blood to produce an erection. Surrounding all three bodies is a semi-elastic membrane called the tunica albuginea. The arteries that feed blood to the penis are surrounded by smooth muscle fibers that normally limit blood flow to the penis. During sexual arousal the muscle fibers relax and blood flow to the penis increases. The spongy tissue of the penis fills with blood, causing the penis to swell. The veins that drain the penis lie close to the surface, and these are compressed by the erection, slowing flow of blood from the penis. The size of the erect penis is limited by the tunica albuginea membrane, just as a bicycle tire limits the expansion of the inner tube inside it. As with a bike tire, once the limit of the membrane is reached, further pressure results in greater firmness but no increase in size.
Making it bigger
There is no exercise that will enlarge the penis. The only muscle in the penis is the smooth muscle fibers that controls erection and these muscles cannot be built up in the same way skeletal muscles can be. Even if this muscle could be strengthened, doing so would only serve to reduce blood flow to the unerect penis, making it smaller.
In order to enlarge the size of the erect penis the tunica albuginea would have to be increased. The tunica albuginea is flexible to a point, but repeated stretching does not lengthen it the way the ear lobes can be lengthened.
No FDA oversight
The FDA does not regulate penis enlargement products in any way. The Dietary Supplement Health and Education Act of 1994 says that "dietary supplements" are not regulated so long as they do not make "disease or health claims." However, a supplement can claim that it affects the "structure or function of the body." What this means is that a company can claim a product enlarges the penis (body structure) or increases the amount of time a man can have intercourse (body function) without having to worry that the FDA will examine the claims. If I put ground up parsley in a capsule, and sold it as an "ancient Oriental" penis enlargement formula, I would not be breaking any laws in the United States.2 Devices and exercises that claim to enlarge the penis are also essentially free from government supervision.
Fake before and after images on penis enlargement sites are common. Some images are “photoshoped”, while others use semi-erect “before” images and fully erect “after” images.3
Given these things, "buyer beware" is vital when looking at products that claim to enlarge the penis. There is no way to guarantee you are getting what you are told, no proof it works, and no legal recourse if it does not work. Even worse, there is no guarantee the device, exercise, or product is safe. Herbs are unregulated, even though some have been proven to have nasty side effects, so harm is possible.
- Pills: It only takes a bit of reasoning to understand why these could not work. What kind of drug could enter the blood stream and affect only the two specialized tissues in the penis? This would be like creating a pill that made the nose bigger!
- Creams: These seem a bit more reasonable, as they are applied to the penis, but anything rubbed onto the penis will be carried away from the penis by the blood stream before it could get to the tunica albuginea or the spongy bodies. In fact, this has been a major hurdle for drug companies trying to find an impotence cure that can be rubbed on rather than injected. So far, the best solution the drug companies have found is to insert the drug into the urethra (ouch).
Surgery and Injections: There are two techniques that doctors can perform that do actually add size, but both have risks.For more length, a doctor can cut the ligaments that attach the penis to the pelvic bone, and then move the penis outward some (the penis has an internal “root” that is about as long as what is on the outside). This gains a man only about an inch, but risks infection, and can leave the penis less stable because it is no longer anchored as well as it was.4For more width, fat can be injected into the penis. Unfortunately, the fat does not stay put well, and it can become lumpy, gradually leave the penis, or cause scaring.4 Others have injected things such as mineral oil, paraffin, silicone, vaseline, cod liver oil, and hydrocarbon gel to enlarge the penis. There are a number of reports of disfigurement5,6, impotence, and even death7 from these procedures.
- Pumping: Pumps, which are successfully used for impotence, have been claimed to increase penis size. While there can be a temporary enlargement due to drawing extra fluid into the penis, studies have found no long term change in erect size. Many men do have permanent increases in unerect size. When a proper pump is used according to the directions, there is no safety issue.
- Weights, and traction (stretching) devices: Those promoting these techniques offer a variety of explanations for how they work, but most of these explanations are contrary to the facts about how the penis is constructed. A few urologist monitored studies have shown small gains in size. The best study to date was done by the British Journal of Urology. They found that using a traction device for six hours a day, for six months, resulted in a gain of about half an inch (1.25 cm). Most growth was in the first months, suggesting that longer use will not add more length. The size gains were about a third of what the devices manufacture claimed was “normal”.8 On the other hand, there are many reports of injury from do it yourself attempts. What has also not been determined is if these methods can cause any permanent harm. Urologists have voiced concerns about scaring, nerve damage, damage to the blood vessels, and Peyronie's disease (bent penis syndrome).
Jelqing: The Jelq is the most common method of penis enlargement touted today. Jelqing consists of a "milking" motion down the penis that is supposed to gradually increase both length and circumference. A study of sites advocating this technique sends up several red flags:The technique is said to be something used by men in the Middle East for centuries. However, no one can back that claim up, and when WebMD.com researched jelqing they reported that "Sex historian Vern Bullough says he has never heard of it, and queries to the Kinsey Institute and professors of Middle Eastern studies at several universities shed no more light on the matter."9Some Jelqing sites suggest that enlargement is cause by breaking down and building up the tissues of the penis just as you exercise to make you biceps larger. However, there are no tissues in the penis that respond this way to any kind of manipulation.The specifics of how to jelq vary widely from site to site. Some insist it will not work unless done with a full erection, while others warn that doing it with a full erection will cause damage.Most urologists have seen damage caused by jelqing. This includes erection problems, numbness, scar formation, bruising, and swelling.10 There is also growing discussion that jelqing with an erection can lead to venous leakage, which results in a form of impotence in which the penis becomes erect but does not stay erect.Urologists who will comment on size increases from Jelqing say the most they have seen is 2 cm (3/4 of an inch). Such a small change does not seem worth the potential damage.
The bottom line is this - pills and creams cannot possibly work, and surgery which does work can leave a man disfigured or impotent. Other methods can give very small gains in size, but they also have a very real chance of doing long term and permanent harm. In the end, each couple (it is hers too, guys) must weigh the possible risks against the possible benefits. We have looked at the risk side of that equation, what about the benefits side?
Does she want more?
So, does size really does matter, and can a penis be too big? We have heard from several men and women who have problems enjoying sex because his penis is large - it may be a rare problem, but it does happen. The book "The Kinsey Institute New Report on Sex" (1990) says that more women report concerns and apprehension about too large a penis than report being unhappy with a smaller penis. Our own poll was similar, with 11% saying big was important, and 15% saying too much is worse than too little. Comments from members of The Marriage Bed Message Boards when penis enlargement was discussed show a similar concern (paraphrased to prevent identification):
- “I do not EVER care to see my husband larger than he is now.”
- “I am 6.25 by 6.25 and my wife says if I make it bigger I won't be having sex with her.”
- “I agree about not wanting my husband to get bigger. He is a 6 and 3/4 and that's as big as I care to go. ”
- My wife wants me to get a reduction. She said she was impressed at first but, now says I am too big. ”
- "My first husband's penis was larger, but my current husband satisfies me far more often than the first husband ever did." This woman was not saying the smaller penis was better, rather she was saying her second husband was better because he was more loving. A loving caring man is the most important thing for a woman's sexual pleasure, and skill at what he does in bed is far more important than the size of his penis. A dozen extra kind words each day and a few more minutes of foreplay will do more to increase a woman's sexual desire and pleasure than an extra inch or two of penis ever could.
A study done a few years ago sizes the issue up well. It starts by stating that the vast majority of men seeking enlargement have, “normal-sized and fully functional penis but visualize their penises as small” and concludes by saying, “There is a lack of any standardization of all described procedures. Indications and outcome measures are poorly defined, and the reported complications are unacceptably high.”11 It seems to us that the whole thing is a big fuss about problem that does not exist outside the mind of many men.
1 Penile size and the ‘small penis syndrome’ | BJU International Volume 99, Issue 6, pages 1449–1455, June 2007 Abstract
3 Penis Size and Penis Enlargement – From Cornell Urology http://bit.ly/RK2IGx
4 Penile Enlargement Surgery and Phalloplasty Complications - Center for Reconstructive Urology
5 Penis invalidating cicatricial outcomes in an enlargement phalloplasty case with polyacrylamide gel (Formacryl) | International Journal of Impotence Research (2006) 18, 318–321
6 Mineral Oil-induced Sclerosing Lipogranuloma of the Penis | J Clin Aesthet Dermatol. 2010 September; 3(9): 41–44.
8 A pilot phase-II prospective study to test the ‘efficacy’ and tolerability of a penile-extender device in the treatment of ‘short penis’ | BJU International Volume 103, Issue 6, pages 793–797, March 2009 Abstract
10 Penis-enlargement products: Do they work? - MayoClinic.com
11 A Critical Analysis of Penile Enhancement Procedures for Patients with Normal Penile Size: Surgical Techniques, Success, and Complications | Eur Urol 2008;54:1042–50 Abstract