Surgical management of a short penis is limited to liposuction and transposition of scrotal skin in men with abnormal position of the penis. Cutting the suspensory ligament and subsequently applying a traction system has been used in some centers to elongate the penis, but this is not a commonly performed procedure. Its effectiveness is questionable in most cases, and the effects depend on accurate patient selection and lack of any postoperative scarring. Fat injection, fat flaps, and silicon injections have all been tried to increase girth of penis. Fat injections last temporarily as most adipose (fat) cells dissolve. Fat flaps have been described as a successful method of increasing girth and is occasionally performed in reconstructive surgery. Injection of silicon has often been disastrous with an uneven, "bumpy" surface of the penis, erosion through skin, and scarring of subcutaneous tissue.
Patients with a decrease in penile length and girth caused by Peyronie's disease can be successfully treated in specialized centers. A decrease in length of the penis after prostate surgery is managed by increasing the frequency of erections and sexual interactions.
Three common "home" methods are used to elongate the penis without medical supervision or proof of effectiveness: penile tape (also used in foreskin restoration), penile weight system, penile stretching using a controlled stretch device. All are based on the assumption that by applying a pulling force on the penis, the penile tissues extend and men can achieve a 0.25 to 0.75 cm increase in length. Penile stretching using adjustable devices like Fastsize has been used in the treatment of Peyronie's disease, and when supervised by a urologist, is safe. However, the unsupervised stretching treatment has resulted in bruising of the penis, vein thrombosis, and damage to nerves of the penis, especially if weights are used.
Many web sites promote and sell devices, herbal preparations, and instructional DVDs for penile enlargement. There is no convincing evidence documenting that these devices provide significant benefit. The no-device, self-exercise method recommends stretching the penis with the hand for extended times during the day. No medical literature is available to suggest that this is an effective method of penile elongation.
Jelqing (jelq) is an exercise used to increase the girth of the penis by increasing positive pressure in the penis. By rolling the fingers from the base of the penis toward the head with the penis mostly rigid, increased pressure exerted on the sides of penis is supposed to stretch the tissues. This technique, in principle, is a modification of an old technique of the penile vacuum device (penile pump), where, by placing the cylinder on the penis and by creating negative pressure, the tissues expand. There are no good medical studies evaluating the effectiveness of either jelqing or the penile pump to increase girth of the penis.
