Penile enhancement involves injections, modeling, exercises, or surgery to increase a penis’s length or girth. Historically, penile augmentation (PA) or penile girth enhancement (PGE) has involved inserting fat tissue implants under the skin. In more recent years, men may find ads for penile growth medications not approved by the U.S. Food and Drug Administration (FDA) on questionable websites that promise “3 inches in just 3 days!”
Patients who are dissatisfied with penile size may seek out these products before discussing their concerns with a healthcare professional. Providers should be prepared to discuss the risks and available options and refer patients for appropriate treatment. This article intends to explain these things.
Who is an Appropriate Candidate?
The Fifth International Consultation on Sexual Medicine (ICSM 2024) has released the most recent set of recommendations regarding penile augmentation and cosmetic surgery. They note that it is important to have a deep understanding of the difference between a micropenis, adult-acquired buried penis (AABP), and penile dysmorphic disorder (PDD). Understanding a patient's motivation for seeking penile enhancement is an important part of the evaluation. Cosmetic intervention may not be appropriate for every patient.
Patients with PDD are unlikely to benefit from PA or PGE and should be referred for appropriate psychological evaluation and treatment before cosmetic intervention is considered. The treatments for micropenis and AABP also differ. Additionally, providers should take into account existing conditions such as Peyronie’s disease, which may also require separate treatments.
Injectable Fillers
Injectable fillers, such as hyaluronic acid (HA), polylactic acid (PLA), and polymethylmethacrylate (PMMA), are the most common off-label FDA-approved options for penile enhancement. HA is the safest of these three, with a relatively low complication rate. PLA, as a foreign material, may be rejected more easily. PMMA, primarily used as a bone glue, may also react poorly. Potential complications of injectable fillers include infection and migration.
Patients who have received HA injections have reported satisfaction with both aesthetic and sexual function results. Be aware that patients may attempt to implant their own DIY filler, and that this can cause infection.
Fat Transfer and Silicone Implants
Fat transfer and silicone implants are practiced across North America; however, they are typically not approved by the FDA and are not recommended by the American Urological Association (AUA). This is due to many accounts of infection and a risk of necrosis. The only FDA-approved silicone penile implant is the Penuma, which has higher rates of post-operative penile curvature and deformation.
Patients who have received the Penuma silicone implant have reported satisfaction with their penis’s appearance and function.
Counseling Patients about Penile Enhancement
Patients should be aware of the complications associated with each option, including potential sexual dysfunction and setting realistic expectations for aesthetic outcome. For example, the shape may not be what is desired, and length or girth may only increase by a few inches.
Key Takeaways
- Several penile enhancement procedures are available, but evidence, regulatory status, and complication rates vary.
- Injectable fillers are commonly used off-label, with HA having a higher safety profile.
- Providers should be aware of and ask about any procedures their patients may have found online, including unapproved or self-injected substances.
- Evaluation should differentiate between cosmetic concerns and existing psychological or physical conditions.
- Patients with PDD require psychological evaluation and treatment before considering penile enhancement.
- Pre-treatment counseling should include setting realistic expectations for aesthetic and sexual outcomes, as well as any complications that may occur.
Resources
Chung, E., Jenkins, L., Moon, Du G., Ziegelmann, M., Deveci, S., Lin, H. C., Broderick, G., Seyam, R., Morey, A., & Levine, L. (2025). Penile augmentation and cosmetic surgery: Recommendations from the fifth international consultation on sexual medicine (ICSM 2024). Sexual Medicine Reviews, 14(1). Oxford Academic. https://doi.org/10.1093/sxmrev/qeaf067
Pearlman, A. M., Tatem, A., Zorn, K. C., & Moore, W. A. (2024, August 14). OFFICE & SURGICAL TECHNOLOGIES The Evolving Landscape of Penile Girth Enhancement. American Urological Association. Auanews.Net. https://www.auanews.net/issues/articles/2024/august-extra-2024/office-and-surgical-technologies-the-evolving-landscape-of-penile-girth-enhancement
Pignanelli, M., Williams, J. M., Crespo, R. E. F., Britt, J., Parker, J., & Carrion, R. (2025). Complications and management of penile enhancement procedures. Translational Andrology and Urology, 14(10), 3367–3376. PubMed. https://doi.org/10.21037/tau-23-519
Salkowski, M., & Levine, L. A. (2024). Outcomes and patient satisfaction after Penuma silicone implant surgery via two surgical approaches. Therapeutic Advances in Urology, 16, 17562872241280021. PubMed Central. https://doi.org/10.1177/17562872241280021You may also be interested in...
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