For Providers/ Provider Newsletters/ Navigating the Landscape of Penile Girth Enhancement: A Practitioner’s Perspective

Navigating the Landscape of Penile Girth Enhancement: A Practitioner’s Perspective

Written by Dr. Amy Pearlman

1341 Words. 5 minute 39 second Read.

I love the art and science of medicine and, in my practice, penile girth enhancement is at the heart of this intersection.

Many of my patients walk in the door feeling self-conscious and walk out with just a little more pep in their step.

This transformation isn’t just about physical changes. It’s about restoring a sense of self-esteem and well-being. And that’s why it’s crucial for us, as healthcare providers, to stay informed about the latest developments in this field.

Let’s dive into the current landscape of penile girth enhancement, exploring the methods available, safety considerations, patient counseling, and future directions.

Current Methods for Penile Girth Enhancement

When it comes to girth enhancement, we’ve come a long way. Today, we have options that prioritize safety and reversibility.

Let’s break them down:

Hyaluronic or Polylactic Acid Injections

Hyaluronic acid (HA) is currently my go-to option for patients seeking girth enhancement. The reasoning is simple: we have HA naturally in our bodies, and it’s been used for years in facial treatments. We know it’s safe when injected, making it an excellent choice for penile enhancement. It is also easily reversible, using a medication called hyaluronidase.

We know it’s safe when injected, making it an excellent choice for penile enhancement.

In our own retrospective review of 471 men receiving HA injections under the PhalloFill® protocol at a single clinic, which includes a post-procedural penile sleeve (PhalloSleeve™), no men required a trip to the operating room, reported worsening erectile function, or reduced penile sensation. Our results are consistent with those in the published literature, as well. Risks may include poor cosmetic outcome, infection, filler migration, and granuloma formation.

In my own practice, I’ve also had success using HA filler for patients with existing inflatable penile implants (IPP). The technique is slightly different so as to reduce risk of injuring the implant. Interestingly, these patients are some of the most satisfied patients I’ve treated and may be a safe and effective way to increase satisfaction post IPP.

Polylactic acid (PLA) is another temporary filler option that offers comparable results to HA. Non-inferiority studies have shown that these two options perform similarly, giving patients another viable choice.

The Sexual Medicine Society of North America (SMSNA) recently published a position statement on cosmetic penile enhancement procedures acknowledging that the limited data suggest benefit and acceptable safety profile using temporary fillers, though recommended these procedures should be studied for safety and efficacy under Institutional Review Board (IRB)-approved protocols. The American Urological Association (AUA) Urology Care Foundation’s recommendations on penile enhancement do not comment on the use of temporary fillers.

Risks associated with temporary fillers are arguably less risky compared to those associated with permanent fillers. The scant published literature on permanent fillers mainly involves small, single-institution studies with limited follow up. There are also several case reports describing more significant treatment-related adverse events. Injectable materials include liquid silicone, paraffin, autologous fat injections, Lipen-10® (75% cross-linked dextran, 15% polymethyl methacrylate (PMMA), and 10% Hypromellose), and Metacrill (PMMA microspheres in carboxymethyl-cellulose).

Treatment-related adverse events include irregularities, nodules, sexual dysfunction, pain, swelling, penile deformity, some of which required surgical intervention. Life-threatening complications including filler-induced non-thrombotic pulmonary embolism have also been reported and have resulted in deaths. The AUA Urology Care Foundation’s recommendations simply state injection of fat cells for girth enhancement have not been shown to be safe or effective. The SMSNA position statement strongly recommends against the use of permanent fillers.

Silicone Implants

A permanent, surgical approach currently used for penile girth enhancement is the Penuma implant, recently rebranded as the Himplant™ (International Medical Devices). This solution involves a subcutaneous silicone sleeve.

Published results show a substantial increase in penile girth. However, reported complications can be more serious compared to the non-surgical/temporary solutions including infection, erosion, device flaring, erectile dysfunction, reduced penile sensitivity, and scar tissue formation.

Some surgeons around the country are placing these implants, and it’s crucial to note that many of them are highly skilled and experienced. I always recommend my patients to surgeons who are actively studying and improving their techniques in this area if they’re interested. In my opinion, a great deal of surgical skill is required when dealing with this procedure. Of note, my recommendation would be the same when it comes to fillers.

Some highly skilled and experienced surgeons are placing silicone implants around the country.

The SMSNA position statement recommends silicone sleeve surgery under IRB oversight with evaluation of long-term safety endpoints and placement by experienced surgeons after discussion of potentially significant complications. The AUA Urology Care Foundation’s recommendations do not discuss silicone sleeves.

Post-procedure care and complications

Just as important as filler placement is the post-procedural protocol to keep the filler in place and to reduce risk for migration as the penis retracts and expands. I use the (PhalloSleeve™) with all of my patients. Patients I’ve seen who have had filler elsewhere and were instructed to wear a wrap for a very short period of time or no wrap at all have had concerns with poor cosmetic outcomes.

In our retrospective study of 471 patients, 2 experienced superficial infections treated with oral antibiotics due to noncompliance.

In our retrospective study of 471 patients, 2 experienced superficial infections treated with oral antibiotics due to noncompliance with post-procedural protocol. Superficial infections can be easily avoided with a comprehensive discussion on post-procedural protocol which includes sexual activity restrictions.

Patient Selection and Counseling

Selecting the right patients and providing comprehensive counseling is half the battle in ensuring successful outcomes.

I always start by laying out all the options, both surgical and non-surgical. This includes vacuum devices and traction therapy. I will postpone filler injection in patients interested in trial of vacuum therapy as I suspect using a vacuum device post filler leads to more rapid filler loss. I’ve had patients use traction therapy RestoreX® post filler and have not had patients report any concerns.

Future Directions and Research Needs

As exciting as the current options are, there’s still so much to explore.

Longevity of results beyond 18 months

The longest study we have on hyaluronic acid fillers only goes out to 18 months. We desperately need longer-term studies to provide accurate information about the durability of these results.

Factors affecting filler retention

I’m really curious about whether there are supplements, dietary choices, or lifestyle factors that could help prolong filler retention. If we could find ways to extend the longevity of fillers like hyaluronic acid, it would be a game-changer for our patients. It’s equally important for us to understand factors that may result in more rapid absorption of filler. For example, I’ve had patients ask about the impact of cold plunges, red light therapy, and saunas.

Glans engorgement techniques

Currently, our injections focus on the penile shaft. There’s some research on glans enhancement, but it’s limited and results may not last as long. We need to develop more effective and lasting techniques for glans enhancement to achieve proportional results.

Patient and partner satisfaction metrics

We need to develop better ways to capture patient outcomes. I’d like to see us adapt questionnaires from the cosmetic and plastic surgery fields that look at genital image and overall satisfaction. We should be assessing not just the patient’s satisfaction, but their partner’s, as well.

Effects on erectile function and penile sensation

It’s crucial that we track any changes in erectile function and penile sensation related to these interventions. We’re altering a highly sensitive organ, so we need to understand fully how these procedures might impact sexual function and sensation in both the short and long term.

Closing thoughts

Within urology, I can’t think of a more polarizing topic than penile enhancement, and there’s definitely a lot of controversy. The SMSNA’s position statement emphasizes this same idea. It’s our responsibility to navigate these waters carefully, always putting our patients’ well-being first.

Overall, I believe we need to embrace cosmetic urology as a legitimate field of study and practice.

Overall, I believe we need to embrace cosmetic urology as a legitimate field of study and practice. It’s not about promoting the idea that every man needs a larger penis, but about acknowledging that for some men, this is a significant concern that affects their quality of life.

That being said, there’s a pressing need for more standardized guidelines and further research in this field. We’ve made significant strides, but there’s still so much to learn and improve.