Is nonsurgical penile enhancement possible?

Tue Jan 25 2022

tags: research exploration draft public

Key questions

  1. Are there nonsurgical methods that (semi-)permanently increase flaccid length?
  2. Are there nonsurgical methods that (semi-)permanently increase erect length?
  3. Are there nonsurgical methods that (semi-)permanently increase penile girth?
  4. If any of 1 to 3 hold, how do these methods work mechanistically/what is their anatomical basis?
  5. What are the potential gains and risks of these methods?

Motivation

Introduction

Good study by Moncada et al. (2022). RCT. n=93 patients with Peyronie's (curved penis): penile traction devices are effective at decreasing curvature and increasing stretched penile length: "SPL increased significantly in the PG compared to baseline and compared with the NIG, ranging from 0.5 to 3.0 cm (mean 1.8 cm; P < 0.05)"

Not so good study: Nikoobakht et al. (2011). n=23 patients who complained of "short penis" were given their "Golden Erect" (lmao) penile traction device. Mean stretched penile length also significantly increased from 11.5 ± 1.0 cm to, respectively, 12.4 ± 1.3 cm and 13.2 ± 1.4 cm during the first and second follow-up (P < 0.05).

Mechanism of penile growth

Initial length gains come from loosening of the suspensory ligament; further gains come from tunica stretching.

Reddit post

Length gains are caused by a few things.

Erection quality improvements, loosening the suspensory ligaments and stretching of the tunica and increase in blood vessel volume.

Erection Quality is perhaps the easiest and quickest way to gain. Simply put, erection quality is determined by much blood a penis holds during an erection. The more blood it can hold, the stronger the erection.

Gains from EQ typically are about .25 of an inch for a man with okay EQ. Bad EQ can be as much as .5 of an inch

EQ improvements happen in the first 4 weeks of PE. Most PE techniques improve EQ passively over time but for active develop, I recommend using an angion method for 2-3 weeks. (A post on angion method is TBD)

The suspensory ligaments connect at the base of the pubic bone. They are what attach the penis to the body. They play a role in erection angle as well as length. Loosening the Suspensory ligaments allow more of the chambers of the penis to stick out of the body, as the chambers start much farther back into pelvic region(3-6 inches)

Gains from loosening of the suspensory ligaments usually happens within two months. Depending on how tight they were at the beginning the average man can expect to gain .25-.5 of an inch Targeting the suspensory ligaments.

Stretching the tunica takes much more time compared to EQ gains or suspensory gains. The tunica surrounds the shaft like a wrapper. This is what gives the penis it's hardness during an erection, otherwise it would be very spongy, like the glans/head. What causes growth in this fashion is the healing of micro damage from stretching the penis in multiple ways. Daily length sessions cause the microtears generated to heal in an elongated state leading to a longer shaft.

Blood vessel expansion will be covered more with girth

Gains from tunica stretching are about .5 of inch every 6 months given commitment and correct use of progress overload.

Given all three of the of the ways to a gain a man new to PE can gain 1 inch in as little as 6 months but typically it is about 4 -14 months, depending on their bodies response to the stimulus, their starting size, where larger men tend to grow faster, proper techniques, and personal commitment.

evidence for suspensory ligament loosening: see Protogerou et al. (2019).

Still-unanswered questions

How does tension actually induce growth? Is it actually microtears? It's possible. We know that isn't the mechanism in muscular hypertrophy. but the tunica is fibrous tissue that is made up of elastin and collagen. But is it microtearing that causes the lengthening or some other mechanism causing the plastic deformation?

Bibliography

Most helpful article so far: Protogerou V, Anagnostopolou S, Venierates D, Troupis T, Plagou M, Vlassis K, Skandalakis P. Penis ligaments: their use in "increasing" the size of the penis in penile augmentation procedures. Anatomical description in human cadavers and clinical results of a phalloplasty series. Ann Ital Chir. 2010 May-Jun;81(3):199-204. PMID: 21090558.

Zhang X, Huang Z, Xiao Y, Kuang L, Zhang M, Zhang G, Li Q, Bai W, Xu T. Suspensory ligament release combined with acellular dermal matrix filler in infrapubic space: A new method for penile length augmentation. Andrologia. 2019 Oct;51(9):e13351. doi: 10.1111/and.13351. Epub 2019 Jul 2. PMID: 31264245. https://pubmed.ncbi.nlm.nih.gov/31264245/

Moncada I, Krishnappa P, Romero J, Torremade J, Fraile A, Martinez-Salamanca JI, Porst H, Levine L. Penile traction therapy with the new device 'Penimaster PRO' is effective and safe in the stable phase of Peyronie's disease: a controlled multicentre study. BJU Int. 2019 Apr;123(4):694-702. doi: 10.1111/bju.14602. Epub 2018 Nov 22. PMID: 30365247.