What are the indications for penis enlargement?
Men have genitals of various sizes. Most of them are satisfied with the size of their own penis, others tend to think that their symbol of male prowess is too small.
About 80% of men suffer from an inferiority complex about their member solely because of the lack of information about the size of the male genital organs.
If the length of the penis is less than 2 cm in length, then this condition is called a micropenis and implies that the length of the erect penis will not be sufficient for normal sexual function.
If a man has a penis length in a stretched or erect state from 2 to 9. 5 cm, then he does not have a micropenis, but a small penis. In this case, the value of 9. 5 cm should be considered as the lower limit of the average size of the penis.
Based on the generalized literature data, it can be concluded that an adult man who has an erect penis of 9. 5 cm or more in length can be absolutely sure that he has a penis of statistically average size. A penis less than 9. 5 cm long should be called the 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?
At the end of the 20th century, the open attitude of public consciousness to family problems, men's health and, of course, to sexual problems, contributed to the fact that many paramedical, sexually oriented advertising media popularized the idea of increasing the size of male genital organs, including by surgery. Currently, both in specialized medical and popular literature, more and more information appears about the possibility of increasing the size of the penis in a variety of ways, including surgery. A lot of medical and popular Internet sites have been formed, entire sections devoted to surgical interventions on the penis are published. They describe in detail the advantages of these techniques and the complications associated with surgical penis enlargement.
Often, for many men who want to enlarge the penis, this organ is functionally and anatomically completely normal. At the same time, in some men, dissatisfaction with the appearance and size of their own penis can cause a feeling of inferiority or even depression. This circumstance prompts a man to look for ways to increase the size of his perfectly normal, in terms of anatomical parameters, penis. And if a person has convinced himself that his sexual organ is too small, then no medical assurances to the contrary will bring results. The consciousness of this man is dominated by a feeling of inferiority and low self-esteem, which sometimes requires the need for treatment by a psychotherapist. However, it does not always give the desired emotional improvement.
It is possible to draw an analogy of the increase in the size of the penis with the effect of increasing the size of the female breast. Scientists have proven that women after breast augmentation significantly increased their sense of self-esteem and they got rid of long-term psychological disorders and depression. In this case, if a woman, for aesthetic reasons, undergoes implantation of breast prostheses or liposuction to increase her own importance and the admiration of others, then why can't a man, for the same reasons, decide on a penis enlargement operation?
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 genitals of different lengths, who would they prefer? ", Would opt for a man with a large penis.
What are the methods of penis enlargement?
All methods used to increase the size of the penis can be conditionally divided into three groups - vacuum, traction and surgical. The first two groups are essentially non-surgical methods and consist in a long-term "training" of the tissues of the organ for stretching.
Vacuum devices (VU)- consist of two main components: a cylinder with one 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 the blood from the body rushes to the penis and it increases in size.
External stretching devicesare various extenders for permanent stretching of the penis in length. 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 surgical penis lengthening. 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 peculiarities of fixing the cavernous bodies of the penis with a supporting ligament to the pubic joint. The supporting ligament is the main object of intervention in penile augmentation surgery. This triangular sail of fibrous tissue connects to Buka's deep fascia. The ligament extends from the linea alba and the top of the symphysis along the midline to the center of the penis. Further, the ligament diverges like a fan laterally, bends around the edges and, as it were, covers the base of the penis in its proximal part at the level of the transition of the cavernous bodies into the hanging part of the penis.
All penis enlargement surgical methods have several goals: penis lengthening, penis thickening, a combination of penis lengthening and thickening, correction of erectile deformity with correction of penis size, correction of erectile dysfunction with penis enlargement.
Are there any indications for surgical penis enlargement?
Yes, I have. Medical indications include: micropenis, epispadias, hypospadias, Peyronie's disease, cavernous fibrosis, consequences of penile trauma. "Aesthetic indications" - a hidden penis, an excess of adipose tissue in the pubic area.
Penile lengthening through surgery is not a new topic, as it has previously been an additional goal in the treatment of various diseases of the penis. However, only recently has penis lengthening been performed as an aesthetic procedure for an anatomically correct and functioning penis.
In most cases, men want to increase the size of the penis for the following reasons: to enhance external attractiveness, to improve the quality of sexual relationships, to increase self-esteem, due to the "locker room syndrome", when a man is embarrassed to be naked in a common shower room, sauna, etc. believing that he has a small penis.
The medical and functional indications for augmentation are clear. But 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 indications for surgery are the aesthetic wishes of patients.
In 1986, scientists believed that "The ability to all-consuming hypochondriacal fixation on one's genitals is the exclusive property of men, and is absolutely not characteristic of women. "It is this condition that 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. The desire of a man to increase the size of the penis is one of the main indications for surgery.
How is the penis enlarged?
Methods of surgical penis lengthening:
Dissection of the suspensory ligament of the penis– ligamentotomy (Long operation). In 1990, a Chinese surgeon developed a penis lengthening operation, ligamentotomy, which is the main and most versatile method for penis lengthening. The principle of the method is based on the elimination of the physiological curvature of the penis by crossing the supporting ligament and releasing the corpora cavernosa to the level of entry into them of the deep arteries and subsequent fixation of the corpora cavernosa in a new position at the level of the severed supporting ligament. The technique allows to achieve lengthening of the penis up to 3-5 cm.
Implantation of prostheses with simultaneous transverse incisions of the albuginea. It should be emphasized that the isolated implantation of prostheses in the cavernous bodies of the penis does not lead to an increase in the length of the penis. The prostheses are designed to provide organ rigidity for successful introjection in men with erectile dysfunction. The principle of the lengthening method with simultaneous implantation consists in placing prostheses of obviously greater length in the intracavernous space and performing transverse corporotomies in order to lengthen the organ.
Implantation + lengthening with total mobilization of the legs of the penis.The effect is achieved due to the maximum removal of the proximal part of the cavernous bodies due to their complete mobilization, moving anteriorly and fixing in the area of the pubic joint. Such a significant displacement of the penis implies the intersection of deep arteries and the actual shutdown of the hemodynamic mechanism of erection. The blood supply of the cavernous bodies is carried out by the dorsal vascular bundle and the spongy body of the urethra.
It must be emphasized that the complete mobilization of the corpora cavernosa 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.
Uncoupling operation (Perovic operation).The author of this technique recommends carrying out a complete separation of the organ into components - 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 dorsal neurovascular bundle. Between the ends of the cavernous bodies and the head, pieces of the costal cartilage of the patient or a synthetic implant are then implanted, taking into account the obtained and previously measured free distance. The elongation effect is achieved due to the natural elasticity and ability to stretch the spongy body of the urethra and elements of the neurovascular bundle. Penis lengthening can be achieved up to 3-5 cm.
Methods of surgical thickening of the penis:
Microsurgical tissue autotransplantation, subcutaneous injection of free autofat, use of a free deep-epidermal skin-fat flap, corporotomy with replacement autotransplantation and allotransplantation, use of rotated pedicled flaps, use of a synthetic implant
Microsurgical tissue autotransplantation. The method of microsurgical autotransplantation of fascio-muscular or fascio-fat flaps on a feeding vascular pedicle consists in subcutaneous wrapping of the penis with a selected fragment of the latissimus dorsi muscle, followed by its revascularization (applying vascular anastomoses to maintain blood supply in the graft).
Subcutaneous injection of free autofat.Most often, adipose tissue for implantation is obtained during liposuction from the suprapubic region. After special preparation of the evacuated fat, it is gradually introduced through a syringe along the entire stem part of the penis through an incision in the subcoronary zone. In this case, it is necessary to perform manual modeling - straightening the adipose tissue evenly 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 or, less commonly, inguinal folds. 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 flaps are used. These flaps are then implanted under the skin of the penis along its entire shaft.
Longitudinal corporotomy with replacement autotransplantation (Austoni operation).The principle of the operation is to perform 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 tissues for penile thickening limits the lack of blood supply to the transplanted tissue. Free vascularized flaps are not always and everywhere possible for use, due to the technical features of the operations. In this regard, to thicken the penis, 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 rotated muscle flap from the anterior abdominal wall on a feeding leg, with a base at the root of the penis. The free end of the autograft on the vascular pedicle is carried out under the skin of the penis and fixed at the coronal sulcus.
The principle of another operation is to isolate two (Dabees operation) or one rotated fascial fat flap from the subcutaneous tissue of the anterior abdominal wall.
The use of synthetic implants. A new direction of penis thickening is considered very promising, which consists in implanting a specially designed synthetic implant under the skin of an organ. The principle of the operation and the materials used are similar to those for breast augmentation in women. A shell or solid hydrogel implant is used to thicken the penis. The operation is distinguished by a programmed result of thickening, a short stationary period, the absence of additional incisions for graft sampling, and the virtual absence of complications.
In addition, a thickening method based on the technique of transplantation of "grown" own tissues on a soluble biopolymer carrier (matrix) has now been developed. The method is completely new and there are not yet enough clinical observations.
What are the results of penis enlargement?
The results of surgical penis enlargement. The degree of elongation is not a unified criterion, since the reasons leading to a reduction in the penis are fundamentally different from each other. The standard and successful result of the operation should be considered an organ lengthening of 2. 5-3 cm or more.
There are no standard criteria for evaluating the effect of penile thickening, since much depends on the desire of the patient and the possibility of surgical technique. Uniform thickening of the shaft of the penis, without deformities of the contours and bulging of the graft, is considered satisfactory and a good result.
Are there any complications of penis enlargement surgery?
Like any surgical intervention can be accompanied by various negative consequences, so operations on the penis are not without the risk of developing specific complications.
It is known that aesthetic surgery has two equivalent goals: good anatomical and functional results and patient satisfaction with the operation. The main obstacle to achieving this is the development of various complications and the patient's negative assessment of the final results 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 in the patient to the possibilities of surgical intervention; experience and skill of the surgeon; application of standard methods; compliance by the patient after the operation of all prescribed recommendations.
At the same time, a very unfavorable prognostic outcome of the operation is the discrepancy between the patient's preoperative expectations of a "miracle" from the surgeon's scalpel and the result actually achieved during this operation. This may be due to an unrealistic expectation or a deliberately negative assessment by the patient of any possible outcomes. At the same time, from a surgical point of view, the postoperative result can be regarded 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 childbearing) and providing urination. For a man, he is singled out by nature in the singular and therefore, paraphrasing the well-known phrase, ". . . live withthey need it so that it would not be excruciatingly painful later . . . ". And if in the future men will be able, if necessary, to freely correct the size of their reproductive organs, as we now correct ugly teeth, then there will be much less disappointed, embittered, and simply unhappy men in the future, since a harmonious intimate life is one of the constituent factors of a healthy and sociallyactive person.