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 towards their member just because of the lack of information about the size of the male genitals.
If the length of the penis is less than 2 cm in length, this condition is called micropenis and implies that the length of the erect penis will not be sufficient for normal sexual function.
If a man has a stretched or erect penis length of 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 data in the literature, it can be concluded that an adult male who has an erect penis of 9. 5 cm or more in length can be absolutely certain that he has a penis of a statistically average size. A penis less than 9. 5 cm in length should be called a 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 the public consciousness to family problems, men's health and, of course, sexual problems, contributed to many paramedical media, of sexual orientation, popularizing the idea of increasing the size of patients. male genital organs, including by surgery. Currently, both in specialized and popular medical literature, there is more and more information about the possibility of increasing the size of the penis in various ways, including surgery. Many medical and popular Internet sites were 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 their 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 leads a man to look for ways to increase the size of his perfectly normal penis, in terms of anatomical parameters. And if a person has convinced himself that his sexual organ is too small, no medical guarantee to the contrary will bring results. In this man's mind, a feeling of inferiority and low self-esteem prevails, which sometimes necessitates the need for treatment by a psychotherapist. However, it does not always give the desired emotional improvement.
You can make an analogy of penis enlargement with the effect of increasing female breast size. Scientists proved that women after breast augmentation significantly increased their sense of self-esteem and got rid of psychological disorders and long-term depression. In this case, if a woman, for aesthetic reasons, undergoes breast implants or liposuction to increase her own importance and the admiration of others, then why can't a man, for the same reasons, decide to have a penis enlargement operation??
Furthermore, it is known that more than 70% of women, when answering an anonymous question: "Of several similar and apparently equally attractive men, but with different lengths of genitals, which would they prefer? ", would opt for a man with a penis. great.
What are the penis enlargement methods?
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 inherently non-surgical methods and consist of long-term "training" of the organ's tissues for stretching.
Vacuum Devices (VU)- consist of two main components: a cylinder with an 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 blood from the body rushes to the penis and increases in size.
External stretching devicesare several extenders for permanent lengthening of the penis in length. For 4-6 months of regular daily training, it is possible to increase the length of the penis by 1. 5-3 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 ligament supporting the pubic joint. The supporting ligament is the main object of intervention in penile enlargement 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. In addition, the ligament diverges laterally like a fan, bends at the edges and, as it were, covers the base of the penis in its proximal part at the level of the transition from the corpora cavernosa to the hanging part of the penis.
All surgical methods of penis enlargement have several goals: penis lengthening, penis thickening, a combination of penis lengthening and thickening, erectile deformity correction with penis size correction, erectile dysfunction correction with penis enlargement.
Are there indications for surgical penis enlargement?
Yes I have. Medical indications include: micropenis, epispadias, hypospadias, Peyronie's disease, cavernous fibrosis, consequences of penile injury. "Aesthetic indications" - a hidden penis, an excess of fatty tissue in the pubic area.
Penile lengthening by surgery is not a new topic, as it was previously an additional objective in the treatment of various diseases of the penis. However, only recently has penis elongation been performed as an aesthetic procedure for an anatomically correct and functional penis.
In most cases, men want to increase their penis size for the following reasons: increase external attractiveness, improve the quality of sexual relations, increase self-esteem, due to "locker room syndrome", when a man is embarrassed to stay naked in a common bathroom, sauna, etc. believing he has a small penis.
The medical and functional indications for augmentation are clear. But it should be noted that the last group (aesthetic indications) is the most numerous and at the same time the most controversial. In this group, the aesthetic desires of patients become indications for surgery.
In 1986, scientists believed that "the capacity for hypochondriacal attachment to their 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 cosmetic surgery, whose aim is to improve the shape of a normal organ. A man's desire to increase his penis size is one of the main indications for surgery.
How is the penis enlarged?
Surgical penis lengthening methods:
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 of lengthening the penis. 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 cavernous bodies to the level of entry into them of the deep arteries and subsequent fixation of the cavernous bodies in a new position at the level of the ruptured supporting ligament. . The technique allows to achieve the lengthening of the penis up to 3-5 cm.
Implantation of prostheses with simultaneous transverse incisions of the albuginea.It is noteworthy 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 elongation method with simultaneous implantation consists of placing prostheses of obviously greater length in the intracavernous space and performing transverse corporotomies to elongate the organ.
Implantation + stretching 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 pubic joint area. Such a significant displacement of the penis implies the intersection of deep arteries and the real shutdown of the hemodynamic mechanism of erection. The blood supply to the corpora cavernosa is provided by the dorsal vascular bundle and the spongy body of the urethra.
It should be noted that 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.
Decoupling operation (Perovic operation).The author of this technique recommends performing a complete separation of the organ into components - separation of the cavernous bodies as far as possible along the entire length of the hanging part of the penis from the corpus spongiosum and head, with complete mobilization of the dorsal neurovascular bundle. Between the ends of the cavernous bodies and the head, pieces of the patient's costal cartilage or a synthetic implant are then implanted, taking into account the free distance obtained and previously measured. The stretching effect is achieved due to the natural elasticity and ability to stretch the spongy body of the urethra and the neurovascular bundle elements. Penis elongation 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 skin-fat free flap of deep epidermis, corporotomy with autotransplantation and allotransplantation replacement, use of rotated pedicled flaps, use of synthetic implant
Microsurgical tissue autotransplantation. The method of microsurgical autotransplantation of fasciomuscular or fasciofatty flaps in vascular feeding pedicle consists of subcutaneous involvement of the penis with a selected fragment of the latissimus dorsi muscle, followed by its revascularization (application of vascular anastomoses to maintain the blood supply in the graft ).
Subcutaneous injection of free autofat.In most cases, adipose tissue for implantation is obtained during liposuction of the suprapubic region. After a special preparation of the evacuated fat, it is introduced gradually through a syringe along the entire part of the shaft of the penis through an incision in the subcoronary area. In this case, it is necessary to carry out manual shaping - straightening the fatty tissue evenly along the organ.
Use of a deep epidermal fat-free flap.Cut one or two grafts in the donor area. These are usually the gluteal folds or, less commonly, the 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 corporotomies with replacement autotransplantation (Austoni operation).The principle of operation is to make longitudinal incisions of the albuginea on the bilateral surfaces of the corpora cavernosa of the penis, followed by the replacement of defects with insertions of an autovein or other materials.
Application of rotated pedicled flaps. The widespread use of autologous tissue for penile thickening limits the lack of blood supply to the transplanted tissue. Free vascularized flaps are not always and everywhere possible to be used, due to the technical characteristics of the operations. In this sense, 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, based on the root of the penis. The free end of the autograft in the vascular pedicle is held under the skin of the penis and fixed in the coronal sulcus.
The principle of another operation is to isolate two (Dabees operation) or a 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 of implanting a specially designed synthetic implant under the skin of an organ. The principle of operation and the materials used are similar to those of breast augmentation in women. A shell or solid hydrogel implant is used to thicken the penis. The operation is distinguished by a programmed thickening result, 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 transplanting "cultured" own tissues in a soluble biopolymer carrier (matrix) was developed. The method is completely new and there are still not 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, as the reasons that lead to penis reduction are fundamentally different from each other. The standard and successful result of the operation should be considered a lengthening of the organ of 2. 5-3 cm or more.
There are no standardized criteria to assess the effect of penile thickening, as much depends on the patient's wishes and the possibility of the surgical technique. Uniform thickening of the shaft of the penis, without contour deformities and bulging of the graft, is considered satisfactory and has a good result.
Are there complications from penis enlargement surgery?
As any surgical intervention can be accompanied by several negative consequences, operations on the penis are not without the risk of developing specific complications.
It is known that cosmetic surgery has two equivalent objectives: good anatomical and functional results and patient satisfaction with the operation. The main obstacle to 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 cosmetic surgery of the penis depends on many factors, the determinants being the following: the formation of a realistic attitude of the patient in relation to the possibilities of surgical intervention; surgeon's experience and skill; application of standard methods; patient compliance after the operation of all prescribed recommendations.
At the same time, a very unfavorable prognostic result 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 considered excellent.
In conclusion, it should be noted that the penis is a single organ that performs 3 main functions: copulative (ensuring sexual intercourse), reproductive (ensuring pregnancy) and providing urination. therefore, to paraphrase the well-known phrase, ". . . live with them they need so that it is not terribly painful afterwards . . . ". And if in the future men can, if necessary, freely correct the size of their reproductive organs, as we now correct ugly teeth, then there will be men who are much less disappointed, embittered and simply unhappy in the future, for a harmonious intimate life is one of the factors. constitutive elements of a healthy and socially active person.