Male-enhancement products that won't spice up your Valentine's Day.

Health and medicine explained.
Feb. 12 2009 6:53 AM

Growth Industry

Male-enhancement products that won't spice up your Valentine's Day.

Note: Some links in this article go to Web sites advertising the products and procedures described, including photographs. These sites might not be appropriate for viewing at the workplace.

Still from an Enzyte commerical.
Enzyte's Smilin' Bob

Male enhancement and the Internet are inextricably linked, as anyone with an unfiltered e-mail account knows. Promises of instant expansion appear daily, seeming to inhabit that happy area of infomercials and self-sharpening knives with limited-time offers that lies just outside the real world.

Even though the big promises have a shady pedigree, are all attempts at enlargement futile? If we can fly a man to the moon, split the atom, and flatten our abs, can't we stretch things another measly inch or two? As a Valentine's Day exercise, let's examine the facts about male enhancement to see if it is all snake oil (of a very literal sort) or whether there actually are things a guy can do to improve.

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Broadly speaking, there are two promised pathways to more bigness: the surgical and nonsurgical. And because you will need a little time to prepare yourself before we pull out the scalpel, let's start with nonsurgical approaches. First come pills and tonics, the distant region patrolled by Smilin' Bob, Enzyte's very pleased pitchman. Enzyte is one of many herbal approaches to enhancement; the products vary widely in price and composition. (Most contain ginseng, saw palmetto, horny goat weed, and a handful of other remedies.) Bob has had a tough time recently—Enzyte's founder, Steve Warshak, and Steve's mom, Harriet, were sentenced to the slammer in 2006 and fined $500 million for conspiracy to commit mail fraud, bank fraud, and money laundering. (How, you might ask, could this be a $500 million business? Welcome to America, buddy.) Do these pills work? The FDA can't regulate herbals because—well, because they probably don't work, so they don't need oversight, see? As very little supports the effectiveness of these herbal offerings, I suggest you look elsewhere.

Another nonsurgical approach is very low tech and centuries if not millennia old: You just stretch the damn thing. Try tying a weight (like a rock or something more elaborate) around the glans, or sink a few bucks into a Procrustean device (there are lots), or, for a more yogic experience, jelq. Jelqing one's wanger is device-free, not unlike stretching salt-water taffy, and, though painful-appearing, has an ardent following. The Internet is awash with jelqing videos and sworn testimonials. Finally, Austin Powers' old friend the vacuum pump promises to work its magic by the disturbing method of sucking ever more blood into the penis and then … actually, I'm not sure what happens next—maybe your blood stalls in there for a while and you can impress someone. But any size that might appear will wash away soon enough.

That was the easy part. Now prepare for the wide world of surgical improvement. Proponents of the male-domination theory of everything should take note of the fact that cosmetic breast enhancement has been around for 100 years. In 2007, 350,000 such surgeries were performed, some as part of post-mastectomy reconstruction, others for nonmedical reasons. If the voracious male gaze is driving much of this (advantage, male supremacy theorists), why is the state of surgical penile enlargement still in its infancy? (Besides castration anxiety, the risk of disfiguring scars, and the fact that it is such a stupid idea.)

Whatever the explanation, here are the options. The simplest, least bloody thing to sign on for is something called a suspensory ligament release. Normally, the base of the penis is connected to the pubic bone by a ligament to anchor the entire enterprise. But this stabilization comes with a substantial cost: a precious inch or so. Surgeons reviewing the situation figured the top of the base of the penis doesn't have to be that close to the navel, so with a little snip here and a little snip there, the penis is released to reclaim the valuable real estate. Sounds easy enough, so why not hurry out and get it done before Valentine's Day? For one thing, ligament release adds length only to the flaccid penis. You'll hang a little lower, but once erect, you'll have what you've always had—not a micrometer more. Plus, any surgery comes with risks (a wildly swinging, unanchored erection among them). Indeed, the American Urologic Association does not consider suspensory ligament release safe or efficacious.

Finally, there is the major league of penis surgery. The simplest procedure is akin to what is done with lips, breasts, and other area in need of a little puffing up: inject collagen, a person's own fat (aka a dermal fat graft), or a pricy product like AlloDerm, which is something of an all-purpose human putty. This approach can address the all-important girth problem but, alas, does nothing for length.

If length is what you're after, you'll have to endure the gruesome. For example, you may need Triple Augmentation Phalloplasty, which includes the suspensory ligament release and a nip and tuck elsewhere. Be aware that phalloplasty, a mostly made-up term referring to surgery to reshape the penis, is a bit of a new surgical discipline. That said, its practitioners already have their own society (the American Academy of Phalloplasty Surgeons), which in turn underwrites the International Phalloplasty Institute, and they hold conferences. They even have a manifesto that (guess what?) concludes that cosmetic penis surgery is a safe and medically accepted procedure. Best of all, they offer a course open to "all surgeons" to learn the techniques—a course that covers soup to nuts in just three days. If you do visit these Web sites, prepare to see photos of men sporting unusually vigorous moustaches.

The most radical approach to lengthening is pioneered by surgeons at the University of Belgrade. They simply unpack the penis, add a little rib, and sew him back up. Here is the method of Drs. S.V. Perovic and M.L.J. Djordjevic:

The penis is completely disassembled into its anatomical parts; the glans cap [head] remains attached dorsally to the neurovascular bundle and ventrally to the urethra and corporal bodies. A space is created between glans cap and the tip of corpora cavernosa [the shaft]; this space is used to insert autologous cartilage previously harvested from the rib [yes, your rib], the space being measured beforehand when the corpora cavernosa are erect. The anatomical entities and inserted cartilage are joined together to form a longer penis.

See how simple that was? Those still interested should peruse the accompanying pictures (you may need to click the link twice to open it) and illustrations before booking a ticket to Belgrade.

Maybe surgery isn't ready for prime time, at least for most people, and the pills don't work, and the thought of tying a stone to the head of your penis seems Neanderthal. But do not let hope perish—the dream must never die. There's plenty of good news in the field (OK, not that much). Important research is being done even as we speak. In Thailand, scientists are working long hours, sometimes in difficult circumstances, with a single goal in mind: to elongate the penises of rats. Yes, friends, a technique to enhance our rodent neighbors may be only years away. The approach is so elegantly simple: The investigators inject cells from the small intestine of pigs into the rat penis (of course!), and, bingo, those lucky rats have the biggest members in their colony. But, guys, until this research has matured a bit more, may I suggest that this Valentine's Day you show up with the usual—flowers and chocolates—and keep the big news on well-hung rats to yourself.

Kent Sepkowitz is a physician in New York City who writes about medicine.

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