What are the indications for penis enlargement?
Men have genitals of different sizes. Most are satisfied with the size of their own penis, others find their symbol of male strength rather too small.
About 80% of men suffer from inferiority complexes towards their members simply because of a lack of information about the size of the male sex organs.
When the length of the penis is less than 2 cm, this condition is called micropenis and implies that the length of the erect penis is insufficient for normal sexual function.
If a man has a penis length of 2 to 9. 5 cm when stretched or erect, then he does not have a micropenis, but a small penis. The value of 9. 5 cm is to be regarded as the lower limit of the average penis size.
Based on the generalized literature, it can be concluded that an adult male with an erect penis longer than 9. 5 cm can be absolutely certain that he has a statistically average sized penis. A penis that is less than 3. 75 inches long should be called a small penis. The term micropenis means that the length of the stretched penis is no more than 2 cm.
What are the social aspects of the small penis?
In the late 20th century, the public's open attitude to family issues, men's health, and of course, sexual issues, helped many paramedical, sexually oriented advertisers to popularize the idea of increasing the size of male genitalia, including through surgery. Currently, more and more information is appearing in both the medical and popular literature about the possibility of enlarging the penis in various ways, including surgery. Many medical and popular websites have been created, entire sections devoted to penile surgical procedures are published. They detail the benefits of these techniques and the complications associated with penis enlargement surgery.
Often this organ is functionally and anatomically completely normal for many men who want to enlarge the penis. At the same time, dissatisfaction with the appearance and size of their own penis can trigger feelings of inferiority or even depression in some men. This circumstance prompts a man to look for ways to enlarge his penis, which is completely normal in terms of anatomical parameters. And if someone has convinced himself that his sex organ is too small, then no medical assurance will bring anything else. In the psyche of this man, a feeling of inferiority and low self-esteem dominates, which sometimes requires the need for treatment by a psychotherapist. However, it does not always bring the desired emotional improvement.
You can draw an analogy with penis enlargement with the effect of increasing female breasts. Scientists have proven that after breast augmentation, women significantly increased their self-esteem and got rid of long-term mental disorders and depression. In this case, if a woman undergoes breast prosthesis implantation or liposuction for aesthetic reasons to increase her own importance and the admiration of others, why can't a man choose penis enlargement surgery for the same reasons?
In addition, it is known that more than 70% of women, when answering an anonymous question: "Of several similar and outwardly equally attractive men, but with different lengths of genitals, who would you prefer? "" for a man would choose a large penis.
What penis enlargement methods are there?
All methods of increasing the penis can be conditionally divided into three groups - vacuum, traction and surgery. The first two groups are non-surgical in nature and consist of long-term "training" of the organ's tissues for stretching.
vacuum devices (VU)- consist of two main components: a cylinder with an open end, into which the penis is inserted, and a vacuum pump. WU works on the principle of a pressure gradient - air is removed from the cylinder by a pump, a vacuum is created in the cylinder, as a result of which blood flows from the body to the penis, causing it to increase in size.
External stretching devicesare different extenders for permanent lengthening of the penis. For 4-6 months of regular daily training, it is possible to increase the length of the penis from 1. 5 to 3 cm (without surgery). However, it is highly recommended to use these devices after penis enlargement surgery. In this case, the effect will be much greater.
Surgical intervention. The possibility of lengthening the penis with the help of surgical intervention lies in the peculiarity of fixing the erectile tissue of the penis with a supporting band on the pubic joint. The brace is the main object of intervention in penis enlargement surgery. This triangular sail of fibrous tissue is connected to Buka's deep fascia. The ligament extends from the linea alba and the tip of the pubic symphysis along the midline to the middle of the penis. Furthermore, the ligament diverges laterally like a fan, curves at the edges and, so to speak, covers the base of the penis in its proximal part at the level of the transition from the cavernous bodies to the hanging part of the penis.
All surgical methods of penis enlargement have multiple goals: penis lengthening, penis thickening, a combination of penis lengthening and thickening, correction of erectile deformity with penis size correction, correction of erectile dysfunction with penis enlargement.
Are there indications for surgical penis enlargement?
Yes there is. Medical indications include: micropenis, epispadias, hypospadias, Peyronie's disease, cavernous fibrosis, penile injury consequences. "Aesthetic indications" - a hidden penis, an excess of fatty tissue in the pubic area.
Surgical penis lengthening is not a new topic, as it has been an additional goal in the treatment of various penile disorders. However, penis lengthening has only recently been performed as an aesthetic procedure for an anatomically correct and functioning penis.
In most cases, men want to enlarge the penis for the following reasons: to increase external attractiveness, to improve the quality of sexual relations, to increase self-esteem due to "locker room syndrome", when a man is embarrassed to be in a jointshower room, in a sauna, etc. being naked because he thinks he has a small penis.
The medical and functional indications for augmentation are clear. However, it should be emphasized that the last group (aesthetic indications) is the most numerous and at the same time the most controversial. In this group, the aesthetic wishes of the patients become the indication for surgery.
In 1986 scientists believed that "the capacity for all-consuming hypochondriacal fixation on one's genitals is the exclusive property of men and is absolutely not characteristic of women". This condition can be interpreted as penile dysmorphophobia. In other words, penile dysmorphophobia is a man's dissatisfaction with the appearance, shape, and size of his penis.
However, penile dysmorphophobia as an indication for surgical treatment does not contradict the principles of aesthetic surgery, the purpose of which is to improve the shape of a normal organ. A man's desire to enlarge the penis is one of the main indications for surgery.
How is the penis enlarged?
Methods of surgical penis enlargement:
Dissection of the suspensory ligament of the penis– Ligamentotomy (long operation). In 1990, a Chinese surgeon developed a penis lengthening operation called ligamentotomy, which is the most important and versatile method of penis lengthening. The principle of the procedure is based on eliminating the physiological curvature of the penis by crossing the supporting ligament and relieving the pressure on the corpora cavernosa up to the level of entry into the deep arteries and then fixing the corpus cavernosum in a new position at the level of the severed supporting ligament. The technique allows the penis to be lengthened by 3-5 cm.
Implantation of prostheses with simultaneous transverse incision of the albuginea.It should be emphasized that the isolated implantation of prostheses in the erectile tissue of the penis does not result in lengthening of the penis. The prostheses were designed to provide organ rigidity for successful insertion in men with erectile dysfunction. The principle of the lengthening method with simultaneous implantation is to place prostheses of obviously greater length in the intracavernosal space and perform transverse corporotomies to lengthen the organ.
Implantation + lengthening with full mobilization of the penile legs.The effect is achieved due to the maximum removal of the proximal part of the cavernous bodies due to their full mobilization, movement forward and fixation in the pubic region. Such a significant displacement of the penis implies the overlapping of deep arteries and the actual shutdown of the hemodynamic mechanism of erection. The blood supply to the erectile tissue is provided by the dorsal vascular bundle and the spongy body of the urethra.
It must be emphasized that full mobilization of the cavernous bodies leads to erectile dysfunction due to the inevitable damage to the pudendal nerves and deep cavernous arteries. Therefore, this method is only suitable for men with erectile dysfunction.
Decoupling operation (Perovic operation).The author of this technique recommends carrying out a complete separation of the organ into components - the separation of the cavernous bodies as much as possible along the entire length of the hanging part of the penis from the spongy body and head with complete mobilization of the spinal neurovascular bundle. Pieces of the patient's costal cartilage or a plastic implant are then implanted between the ends of the cavernous bodies and the head, taking into account the free distance obtained and previously measured. The stretching effect is achieved due to the natural elasticity and ability to stretch the spongy body of the urethra and elements of the neurovascular bundle. A penis lengthening can be achieved by up to 3-5 cm.
Methods of surgical penis thickening:
Microsurgical tissue autotransplantation, subcutaneous injection of free autologous fat, use of a free deep epidermal skin fat flap, corporotomy with replacement autograft and allograft, use of rotated pedicle flaps, use of a synthetic implant
Microsurgical tissue autotransplantation. The method of microsurgical autografting of fascio-muscle or fascio-fat flaps on a supplying vascular pedicle consists in subcutaneously enveloping the penis with a selected fragment of the latissimus muscle, followed by its revascularization (making vascular anastomoses to maintain blood supply in the penis). Graft).
Subcutaneous injection of free autologous fat.Most commonly, adipose tissue for implantation is harvested from the suprapubic region during liposuction. After special preparation of the extracted fat, it is gradually inserted with a syringe along the entire shaft part of the penis through an incision in the subcoronary zone. In this case, manual modeling is required, during which the adipose tissue is evenly smoothed along the organ.
The use of a free deep epidermal skin fat flap.Cut out one or two grafts in the donor area. Usually these are the gluteal creases or, less commonly, the groin creases. Depending on the size of the penis, each graft should be approximately 12-15 cm long and 5-12 cm wide, depending on whether one or two lobes are used. These flaps are then implanted under the skin of the penis along the entire length of the shaft.
Longitudinal corporotomies with replacement autograft (Austoni operation).The principle of the operation is to make longitudinal incisions of the albuginea on the bilateral surfaces of the cavernous bodies of the penis, followed by replacement of defects with inserts from an autovein or other materials.
Application of rotated pedicled flaps. The widespread use of autologous tissue for penile thickening limits the lack of blood supply to the transplanted tissue. Free vascularized flaps cannot always and everywhere be used due to the technical circumstances of the operation. In this regard, for penile thickening, it seems very promising to isolate an autograft with preserved blood flow without the need to perform microsurgical vascular anastomoses.
Used to thicken an organTechnique for isolating a fragment of the rectus abdominis muscle. The principle of the operation is to isolate a twisted flap of muscle from the anterior abdominal wall on a feeding leg with a base at the base of the penis. The free end of the autograft on the vascular pedicle is guided under the skin of the penis and fixed to the coronary sulcus.
The principle of another operation is to isolate two (Dabees operation) or one twisted fascial fat flap from the subcutaneous tissue of the anterior abdominal wall.
The use of synthetic implants. A new direction of penis thickening, which consists in implanting a specially designed synthetic implant under the skin of an organ, is considered very promising. The principle of the operation and the materials used are similar to those used in breast augmentation in women. A shell or solid hydrogel implant is used to thicken the penis. The operation is characterized by a programmed thickening result, a short stationary period, the absence of additional incisions for graft extraction and the almost absence of complications.
In addition, a thickening process has now been developed that is based on the technique of transplantation of "grown" autologous tissue onto a soluble biopolymer carrier (matrix). The method is completely new and there are not enough clinical observations.
What are the results of penis enlargement?
The results of surgical penis enlargement. The degree of stretching is not a uniform criterion, since the reasons that lead to a reduction in the size of the penis are fundamentally different from each other. An organ lengthening of 2. 5-3 cm or more should be considered a usual and successful result of the operation.
There are no standard criteria for assessing the effect of penile thickening as much depends on the patient's desire and the possibility of the surgical technique. Uniform thickening of the shaft of the penis without deforming the contours and bulging of the graft is considered satisfactory and a good outcome.
Are There Any Complications From Penis Enlargement Surgery?
Since any surgical intervention can be accompanied by various negative consequences, operations on the penis are not without the risk of developing specific complications.
It is well known that aesthetic surgery has two equal goals: good anatomical and functional results and patient satisfaction with the operation. The main obstacle to this is the development of various complications and the patient's negative assessment of the final result of the operation. The frequency of complications in aesthetic surgery of the penis depends on many factors, the determining factors of which are the following: the formation of a realistic attitude of the patient to the possibilities of surgical intervention; experience and skill of the operator; application of standard methods; Compliance with all prescribed recommendations by the patient after the operation.
At the same time, a very unfavorable prognostic result of the operation is the discrepancy between the patient's preoperative expectation of a "miracle" from the surgeon's scalpel and the result actually achieved during this operation. This can be due to an unrealistic expectation or a deliberately negative assessment of possible resultsAt the same time, the postoperative result from the surgical point of view can be described as excellent.
In conclusion, it must be emphasized that the penis is a unique organ that performs 3 main functions: copulative (ensuring sexual intercourse), reproductive (ensuring childbirth) and providing urination. For a man, he is inherently singular and excellent. Therefore, paraphrase the well-known phrase: ". . . live with the fact that they need it lest it become excruciatingly painful later. . . ". And if in the future men can freely correct the size of their reproductive organs if necessary, as we are now correcting ugly teeth, then in the future there will be much fewer disappointed, embittered and simply unhappy men, since a harmonious intimate life is one of the constituent factorsa healthy and socially active person.