An answer to a thick question

Dear Dr. G,

I read with interest the last few articles you published regarding body modifications, implants and piercings.

Technically, I am not enquiring about genital implants or piercings. However, I am somewhat curious about certain injectables for penile enlargement.

Since I was a young lad, I always had this inferior complex about a small penis.

Having been to boarding school, I have been rather embarrassed when I compare my assets in the pants with the rest of the boys.

I started looking up the internet about the definitions of an average size penis.

Don’t get me wrong, the length of my penis is normal.

I am just somewhat concerned with the girth of my penis, which is somewhat deficient.

I have read somewhere the girth of the penis can be augmented with some injectable bulking agents.

In the spirit of Christmas, I wonder if you can humour me by being put on the spot for clarifications on bulking implant injections in the pants.

Firstly, can you clarify what is the normal length and girth of the penis?

Can you also tell me what the bulking agents that have been used for girth augmentations are? What sort of results have been reported?

Are there risks involved in the injections of bulking agents into the penis?

Of course, I will not go for it. However, I can be tempted if the science is solid in the bulking injectables for girth enhancement.

Regards,

Bulking Ben

A 2014 review looked at measurements taken by healthcare professionals of 15,521 males aged 17 years and older. According to the team’s analysis, the average flaccid, pendulous penis is 9.16 cm (3.61in) in length; the average erect penis is 13.12 cm (5.16in) long. The corresponding girth measurements are 9.31 cm (3.66in) for a flaccid penis and 11.66 cm (4.59 in) for an erect penis. Another publication observing 1,600 men in the United States revealed the average dimensions for an erect penis were 14.2 cm (5.6 in) in length and 12.2 cm (4.8 in) in circumference. Both studies also found that the size of a person’s erect penis did not correlate with their flaccid penis size. In other words, a penis may have different lengths when flaccid but similar lengths when erect. They also found no link between age and penis size.

Throughout history, penile size has been a major concern for men as a symbol of masculinity. Many men are dissatisfied with their penile size and desire a larger penis. Therefore, various types of surgical penile augmentation have been introduced to correct medical, psychological, or aesthetic problems. In recent years, these have gained more and more attention in mainstream medicine.

Soft tissue filler injections have become the main treatment for soft tissue in various aesthetic interventions, as they are relatively safe, effective, less invasive, and less expensive than most surgical procedures. Although fillers have been comprehensively studied for use in the face. The penile anatomy, function, and injection techniques are different from those of the face. Furthermore, the amount of fillers injected in the penis is much larger than that injected in the face. The clinical utility of such fillers has not yet been demonstrated for penile augmentation. To date, no filler has been approved in the United States.

One off-labelled study published in the Journal of Clinical Medicine compared two common types of fillers, namely Hyaluronic acid and Polylactic acid. In both groups, the mean penile girth increased to a maximum, at one month, of 2.30 to 2.50cm. However, the mean girths of both fillers gradually decreased for up to 18 months. Although patient satisfaction was recorded for up to 6 months, the satisfaction weans off as the girth returns.

Hyaluronic acid fillers are known to have direct and passive effects, whereas polylactic acid fillers have delayed and bio-stimulatory effects. After the injection of Hyaluronic acid, it binds with water, and the same volume can be maintained for a few months. Polylactic filler becomes absorbed over a few days and gradually degrades by hydrolysis, while the injected site undergoes subtle volume expansion by a fibrous tissue response with collagen deposition. The augmentative effect of Hyaluronic Acid lasts up to 18 months; however, that of Polylactic Acid can last up to three years. Common complications such as oedema, bleeding and skin infections are observed in the first few days of injections. However, scarring, painful fibrosis and penile retraction are also reported in patients who received Polylactic Acid filler injections.

In the fast-paced Internet of instant gratification, it is not surprising for those with an inferior “Locker Room Syndrome” complex to be tempted by interventions that can provide instant satisfaction. Many men who worry about their penile size not measuring up to their peers may opt for filler injections that can provide that temporary security. Although the bulking fillers are generally safe, some injectables may cause significant damage beyond repair. When Dr. G is put on the spot by men contemplating bulking fillers in the pants for the Christmas stocking fillers this year, the response is, “the gratification is really action between the sheets, and don’t waste time with transient results in the pants.”