Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

History and future perspectives of male aesthetic genital surgery

Abstract

Since ancient times, men have tried to change the size and shape of their genitals. Bites from insects or poisonous snakes and weights were among the first methods used for this purpose. In the first half of the 1900s, the scientific push regarding male genital aesthetic surgery began. Scrotoplasty, penile suspensory ligament release, injection of hyaluronic acid as filler, use of several types of grafts, lipofilling, and liposuction are techniques currently used. The Penuma® implant has recently been described with promising results. We are living in the era of tailored surgery and regenerative medicine. Shortly the surgeons will have to know several surgical techniques and adapt them to the patient. New fillers with ideal characteristics, innovative prosthetic devices, and stem cells will probably be the protagonists of future aesthetic surgery. The main effort of the scientific community should be directed towards the design of new randomized controlled trials to increase the evidence on the efficacy and safety of the topic, with the ultimate aim of allowing clear recommendations from scientific societies.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

This is a review; therefore, the availability of the reported data does not depend on the authors.

References

  1. Hait P. History of the American Society of Plastic and Reconstructive Surgeons, Inc. 1931-1994. Plast Reconstr Surg. 1994;94:1A–109A.

    Article  CAS  PubMed  Google Scholar 

  2. Arab K, Barasain O, Altaweel A, Alkhayyal J, Alshiha L, Barasain R, et al. Influence of social media on the decision to undergo a cosmetic procedure. Plast Reconstr Surg Glob Open. 2019;7:e2333.

    Article  PubMed  PubMed Central  Google Scholar 

  3. International Society of Aesthetic Plastic Surgery (ISAPS). Global Survey on Aesthetic/Cosmetic Procedures. 2019. https://www.isaps.org/wp-content/uploads/2020/12/global-survey-2019.pdf.

  4. Kim WW. History and cultural perspective. In: Park N, Kim S, Moon D (eds). Penile augmentation. Berlin, Heidelberg: Springer; 2016.

  5. Romero-Otero J, Manfredi C, Ralph D, Osmonov D, Verze P, Castiglione F, et al. Non-invasive and surgical penile enhancement interventions for aesthetic or therapeutic purposes: a systematic review. BJU Int. 2021;127:269–91.

    Article  PubMed  Google Scholar 

  6. Serefoglu EC. New trend in medicine: aesthetic genital surgery. Int J Impot Res. 2022.

  7. Fischer N, Hauser S, Brede O, Fisang C, Müller S. Implantation of artificial penile nodules–a review of literature. J Sex Med. 2010;7:3565–71.

    Article  PubMed  Google Scholar 

  8. Lee KC, Brock GB. Strategies for maintaining penile size following penile implant. Transl Androl Urol. 2013;2:67–73.

    PubMed  PubMed Central  Google Scholar 

  9. García Gómez B, Alonso Isa M, García Rojo E, Fiorillo A, Romero Otero J. Penile length augmentation surgical and non-surgical approaches for aesthetical purposes. Int J Impot Res. 2021.

  10. Manfredi C, Romero Otero J, Djinovic R. Penile girth enhancement procedures for aesthetic purposes. Int J Impot Res. 2021.

  11. Califano G, Arcaniolo D, Ruvolo CC, Manfredi C, Smarrazzo F, Cilio S, et al. Glans penis augmentation: when, how, and why? Int J Impot Res. 2021.

  12. Schifano N, Castiglione F, Cakir OO, Montorsi F, Garaffa G. Reconstructive surgery of the scrotum: a systematic review. Int J Impot Res. 2021.

  13. Parker RM. The paraffin injection treatment of Gersuny, with a report of cases. Q Bull Northwest Univ Med Sch. 1903;4:482–4.

    PubMed Central  Google Scholar 

  14. Arthaud JB. Silicone-induced penile sclerosing lipogranuloma. J Urol. 1973;110:210.

    Article  CAS  PubMed  Google Scholar 

  15. Zyderm Collagen Implant, approval by Food and Drug Administration. 1981. https://www.accessdata.fda.gov/cdrh_docs/pdf/P800022S050b.pdf.

  16. Restylane gel, approval by Food and Drug Administration. 2003. https://www.accessdata.fda.gov/cdrh_docs/pdf2/P020023b.pdf.

  17. Sculptra, approval by Food and Drug Administration. 2004. https://www.accessdata.fda.gov/cdrh_docs/pdf3/p030050b.pdf.

  18. Radiesse, approval by Food and Drug Administration. 2006. https://www.accessdata.fda.gov/cdrh_docs/pdf5/P050052b.pdf.

  19. Kang DH, Chung JH, Kim YJ, Lee HN, Cho SH, Chang TH, et al. Efficacy and safety of penile girth enhancement by autologous fat injection for patients with thin penises. Aesthetic Plast Surg. 2012;36:813–8.

    Article  PubMed  Google Scholar 

  20. Alter GJ. Augmentation phalloplasty. Urol Clin North Am. 1995;22:887–902.

    Article  CAS  PubMed  Google Scholar 

  21. Li CY, Kayes O, Kell PD, Christopher N, Minhas S, Ralph DJ. Penile suspensory ligament division for penile augmentation: indications and results. Eur Urol. 2006;49:729–33.

    Article  PubMed  Google Scholar 

  22. Shishido S, Natsume O. Scrotoplasty. Geka Chiryo. 1967;16:347–52.

    CAS  PubMed  Google Scholar 

  23. Zhang P, Wang B, Zhang X, Song Z, Bai W, Li Q, et al. Suprapubic liposuction with a modified devine’s technique for buried penis release in adults. Plast Surg. 2020;28:172–8.

    Article  Google Scholar 

  24. Perovic SV, Djordjevic ML. Penile lengthening. BJU Int. 2000;86:1028–33.

    Article  CAS  PubMed  Google Scholar 

  25. Austoni E, Guarneri A, Cazzaniga A. A new technique for augmentation phalloplasty: albugineal surgery with bilateral saphenous grafts-three years of experience. Eur Urol. 2002;42:245–53.

    Article  CAS  PubMed  Google Scholar 

  26. Panfilov DE. Augmentative phalloplasty. Aesthetic Plast Surg. 2006;30:183–97. https://doi.org/10.1007/s00266-004-0153-y

    Article  PubMed  Google Scholar 

  27. Elist JJ. The Penuma® Silicone Implant A new implantable device improving penile appearance and adding additional girth and length of penis outside the body. VJPU. 2018;2:119.

    Google Scholar 

  28. Elist JJ, Valenzuela R, Hillelsohn J, Feng T, Hosseini A. A single-surgeon retrospective and preliminary evaluation of the safety and effectiveness of the Penuma silicone sleeve implant for elective cosmetic correction of the flaccid penis. J Sex Med. 2018;15:1216–23.

    Article  PubMed  Google Scholar 

  29. Angulo JC, García-Díez M. Male genital representation in paleolithic art: erection and circumcision before history. Urology 2009;74:10–4.

    Article  PubMed  Google Scholar 

  30. Rempelakos L, Tsiamis C, Poulakou-Rebelakou E. Penile representations in ancient Greek art. Arch Esp Urol. 2013;66:911–6.

    CAS  PubMed  Google Scholar 

  31. Neto FTL, Bach PV, Lyra RJL, Borges Junior JC, Maia GTDS, Araujo LCN, et al. Gods associated with male fertility and virility. Andrology. 2019;7:267–72.

    Article  CAS  PubMed  Google Scholar 

  32. Mendonca S, Pan J, Brandes S. FR01-16 Festival of the “steel phallus” and the “bourani” carnival of Tynavos: Phallic festivals of contemporary Japan and Greece. J Urol. 2020;203:S4:e289–e290.

    Article  Google Scholar 

  33. Mautz BS, Wong BB, Peters RA, Jennions MD. Penis size interacts with body shape and height to influence male attractiveness. Proc Natl Acad Sci USA. 2013;110:6925–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Jacobs T, Geysemans B, Van Hal G, Glazemakers I, Fog-Poulsen K, Vermandel A, et al. Associations between online pornography consumption and sexual dysfunction in young men: multivariate analysis based on an international web-based survey. JMIR Public Health Surveill. 2021;7:e32542.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Francken AB, van de Wiel HB, van Driel MF, Weijmar Schultz WC. What importance do women attribute to the size of the penis? Eur Urol. 2002;42:426–31.

    Article  CAS  PubMed  Google Scholar 

  36. Mosse HL. The influence of mass media on the sex problems of teenagers. J Sex Res. 1966;2:27–35.

    Article  Google Scholar 

  37. de Boer ML. Virile infertile men, and other representations of in/fertile hegemonic masculinity in fiction television series. J Med Humanit. 2021;42:147–64.

    Article  PubMed  Google Scholar 

  38. Murtagh J. The ‘small’ penis syndrome. Aust Fam Physician. 1989;18:218. 220

    CAS  PubMed  Google Scholar 

  39. Lever J, Frederick DA, Peplau LA. Does size matter? Men’s and women’s views on penis size across the lifespan. Psychol Men Masculinity. 2006;7:129–43.

    Article  Google Scholar 

  40. Veale D, Miles S, Read J, Troglia A, Wylie K, Muir G. Sexual functioning and behavior of men with body dysmorphic disorder concerning penis size compared with men anxious about penis size and with controls: a cohort study. Sex Med. 2015;3:147–55.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Vardi Y. Is penile enlargement an ethical procedure for patients with a normal-sized penis?. Eur Urol. 2006;49:609–11. https://doi.org/10.1016/j.eururo.2005.12.053.

    Article  PubMed  Google Scholar 

  42. Mondaini N, Ponchietti R, Gontero P, Muir GH, Natali A, Caldarera E, et al. Penile length is normal in most men seeking penile lengthening procedures. Int J Impot Res. 2002;14:283–6.

    Article  CAS  PubMed  Google Scholar 

  43. DSM-IV to DSM-5 body dysmorphic disorder comparison. From: DSM-5 child mental disorder classification. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t19/.

  44. Veale D, Miles S, Read J, Troglia A, Carmona L, Fiorito C, et al. Penile dysmorphic disorder: development of a screening scale. Arch Sex Behav. 2015;44:2311–21.

    Article  PubMed  Google Scholar 

  45. Kamel I, Gadalla A, Ghanem H, Oraby M. Comparing penile measurements in normal and erectile dysfunction subjects. J Sex Med. 2009;6:2305–10.

    Article  PubMed  Google Scholar 

  46. Lue TF, El-Sakka AI. Lengthening shortened penis caused by Peyronie’s disease using circular venous grafting and daily stretching with a vacuum erection device. J Urol. 1999;161:1141–4.

    Article  CAS  PubMed  Google Scholar 

  47. Cohen S, Tennenbaum SY, Teitelbaum A, Durst R. The koro (genital retraction) syndrome and its association with infertility: a case report. J Urol. 1995;153:427–8.

    Article  CAS  PubMed  Google Scholar 

  48. Brosig B, Kupfer J, Niemeier V, Gieler U. The “Dorian Gray Syndrome”: psychodynamic need for hair growth restorers and other “fountains of youth”. Int J Clin Pharm Ther. 2001;39:279–83.

    Article  CAS  Google Scholar 

  49. Bettocchi C, Checchia AA, Falagario UG, Ricapito A, Busetto GM, Cormio L, et al. Male esthetic genital surgery: recommendations and gaps to be filled. Int J Impot Res. 2022.

  50. Sexual Medicine Society of North America. Position statements. Penile lengthening and girth enhancement surgery. www.smsna.org/resources/position-statements.

  51. American Urological Association. Policy statements. Penile Augmentation Surgery. https://www.auanet.org/guidelines/guidelines/penile-augmentation-surgery.

  52. Wilson SK, Picazo AL. Update on the Penuma® an FDA-cleared penile implant for aesthetic enhancement of the flaccid penis. Int J Impot Res. 2022.

  53. Israeli JM, Lokeshwar SD, Efimenko IV, Masterson TA, Ramasamy R. The potential of platelet-rich plasma injections and stem cell therapy for penile rejuvenation. Int J Impot Res. 2021.

Download references

Author information

Authors and Affiliations

Authors

Contributions

CZ drafting the manuscript; DS, ILD, and JPAV organization of topics and supervision; CM scientific and grammatical correction; IMI critical review and final approval of the paper.

Corresponding author

Correspondence to Celeste Manfredi.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zaccaro, C., Subirà, D., López-Diez, I. et al. History and future perspectives of male aesthetic genital surgery. Int J Impot Res 34, 327–331 (2022). https://doi.org/10.1038/s41443-022-00580-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-022-00580-6

This article is cited by

Search

Quick links