Small penis - surgical penis enlargement - Causes, symptoms and treatment. MF.
Men have different genitalia. Most of them are satisfied with the size of their own penis, others tend to believe that their symbol of male prowess is too small.
About 80% of men suffer from an inferiority complex about their penis due to the lack of information on the size of the male genital organs.
There are three dimensions for measuring dimensions: at rest, at maximum stretching and with erection. The penis is measured at room temperature, immediately after stripping the man, to exclude the factor of spontaneous tissue contraction in response to the cold. For maximum stretching, the penis is pulled out by the head. Of course, the size of the elongated penis depends on how much tension is being applied. Measurement should be carried out on the back of the penis, from the pubis to the edge of the head, with the angle between the anterior abdominal wall and the penis should be equal to 90Gy.
The measurement results are mediated by the age and general health of patients, the presence of pathological changes and diseases of the penis, the thickness of the suprapubic subcutaneous fat layer. In these situations, both the true and functional shortening of the penis occurs.
If the penis length in the elongated state is 2.5 times smaller than the standard deviation from the average length, then it fits into the definition of the micropenis [Aaronson I., 1994].This definition means the penis is no more than 2 cm in length and implies that in the future the length of the erect penis will be critical for normal sexual function.
If a man has a penis length in the stretched or erect state of at least 2 cm but not more than 9.5 cm, then he does not have a micropeniasis, and the has a small penis .In this case, the value of 9.5 cm should be considered as the lower limit of the average penis size.
Based on the general literature data, it can be concluded that an adult male having a penis erectile 9.5 cm long and more than , can be absolutely sure that he has a penis of statistically average size. Sexual member less than 9.5 cm long should be called a small penis. The term micropenias means that the length of the penis is no more than 2 cm.
Some authors give certain characteristics of the size of the genital organ in men of different races. For example, in black people, the penis is an average of a centimeter more at rest, while in the erect penis, it is comparable in size to the genitalia of white men and Caucasians [Da Ros C, et al., 1994;Porst H., 1997].According to other authors, the average length of the erect member of a black man is 2-3 cm larger than that of a white man [Grifin G., 1995].
The smallest penis size in Asia, on average 11-12 cm in erect condition. This fact is even taken into account in the production of condoms and falloprostheses.
Social aspects of the small penis
One of the distinguishing features of modern medicine is the improvement of the quality of life. And an integral part of this concept is a full-fledged sexual function, which depends on the quality of the erection, and on the appearance of the genitals.
Masters W. H. and Johnson V.( 1966) wrote that "the size of the male organ, both at rest and in a state of erection, in many cultures was a reflection of man's sexual valor".Representatives of early cultures were very frank in expressing their admiration for a great member.
At the end of the twentieth century, the open attitude of public consciousness to family problems, male health and, of course, to sexual problems, contributed to the fact that many paramedical, sexually targeted advertising media popularized the idea of increasing the size of male genital organs, including surgically. Currently, both in specialized medical and popular literature, more and more information appears on the possibility of increasing the size of the penis in a variety of ways, including surgical intervention. A lot of medical and popular Internet sites are formed, whole sections devoted to surgical interventions on the penis are published. They detail the advantages of these techniques and the complications associated with the surgical enlargement of the penis. Excessive excitement around this topic is fueled by a certain commercial interest of doctors working in the field of plastic and genital surgery.
Patients wishing to change their penis, the most common people-workers, employees, businessmen, etc. In many of them, genital organs are functionally and anatomically perfectly normal. At the same time, in some men, dissatisfaction with the type and size of their own sexual organ, can cause feelings of own inferiority or even depression. This circumstance prompts the man to search for opportunities to increase the size of his completely normal, from the point of view of anatomical parameters, penis. And if a person convinces himself that his sexual organ is too small, then no medical assurances in the opposite, will not bring a result. In the mind of this man dominated by a sense of inferiority and low self-esteem, which sometimes requires the need for treatment with the therapist. However, it does not always give the desired emotional improvement. The patient is forced to contact the surgeon.
You can draw an analogy of increasing the size of the penis with the effect of increasing the size of the female breast. Schlebush L. and Mahrt I.( 1993) proved that women after breast augmentation significantly increased their sense of self-esteem and they got rid of prolonged psychological disorders and depression. In such a case, if a woman, for aesthetic reasons, subjects herself to the operation of implanting mammary gland prostheses or liposuction to enhance her own worth and admiration for others, then why can not a man from the same considerations decide to have an operation to enlarge the penis?
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 length, what would they prefer?", Would have opted for a man with a largemember.
Methods for enlarging the penis
For the elongation of the penis, the method of suspending various weights has long been known, which has been used in various cultures. The descriptions and notes of travelers provide observations of the facts of the ritual process of stretching the penis, carried out by constant or periodic suspension of weight to the genital organs of men, beginning with adolescence. This training was supposed to last for a lifetime, but it promoted a significant increase in the length of the penis.
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 a long "training" of organ tissues for stretching.
Vacuum devices( AS) - consist of two main components: a cylinder with one open end, into which the penis and a vacuum pump are introduced. VU works on the principle of pressure gradient - the pump removes air from the cylinder, creates a vacuum in the cylinder, resulting in blood from the body rushes to the penis and it increases in size.
External stretching devices .They represent various extenders for the permanent stretching of the genital organ 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 particularly recommended to use these devices after surgical elongation of the penis. In this case, the effect will be much larger.
Surgical intervention. The possibilities of elongating the penis with the help of surgical intervention are laid in the features of fixation of the cavernous bodies of the penis by a supporting ligament to the articulation. Supportive ligament is the main object of intervention in the enlarging surgery of the penis. This triangular sail fibrous tissue connects to the deep fascia of the beech. The ligament extends from the white line of the abdomen and the upper part of the symphysis along the midline to the center of the penis. Then the bundle diverges laterally, 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 to the hanging part of the penis.
All surgical methods for increasing the size of the genital organ have several purposes:
Elongation of the penis, Penis enlargement, Combination of elongation and thickening of the penis, Correction of erectile deformity with correction of penis size, Correction of erectile dysfunction with increase in penis size,
Indications for surgicalincreased penis
Elongation of the penis with surgical intervention is not a new topic, as it was previously an additional goal of treating various diseases of the penis. However, only recently elongation of the penis has been performed as an aesthetic procedure for an anatomically correctly formed and normally functioning penis.
Most patients referring to a plastic surgeon for an operation to increase penis size, mature age. This indicates that the surgeon is not primarily addressed to young adults, but adult men who have a previously inferiority complex due to the small size of the penis, leads them already in adulthood to a conscious desire to increase their penis.
In most cases, men want to increase the size of the penis for the following reasons:
to enhance the external appeal, to improve the quality of sexual relationships, to increase self-esteem, due to the "locker room syndrome", when a man hesitates to uncover himself in a common shower room, sauna,etc., considering that he has a small penis.
The following main groups of indications for enlargement of the penis are available:
INDICATIONS FOR OPERATION OF INCREASE OF THE SEXUAL MEMBER
| Medical indications | Functional indications | Esthetic indications |
| epispadia, hypospadias, Peyronie's disease, cavernous fibrosis, injury consequences, micropeniasis | excess of subcutaneous fat in the genital area, buried, concealed penis, membranous penis | penile dysmorphophobia |
Medical and functional indications for increase are obvious. 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 aesthetic wishes of patients become indications for surgery.
In 1986, V.D.Topolyansky and M.V.Strukovskaya believed that "The ability for an all-absorbing hypochondriac fixation on their genitals is the exclusive property of men, and absolutely not characteristic of women."It is this condition that can be treated as penile dysmorphophobia. In other words, penile dysmorphophobia is dissatisfaction with the male 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 surgical intervention. However, we deem it compulsory to observe the following conditions:
is a mental health condition, assessed by a psychiatrist if necessary( any abnormality in the psyche is an absolute contraindication for the operation), sufficient sexual experience and the presence of a constant sexual partner, a patient's persistent desire to increase the size of the penis, mandatory sexological examination.
Methods of surgical lengthening of the penis
Dissection of the supporting ligament of the penis - ligamentotomy( Long operation).
In 1990, the Chinese surgeon Long developed an operation for lengthening the penis - Ligamentotomy, which is the main and most universal method of lengthening the penis. The principle of the method is based on eliminating the physiological curvature of the penis by crossing the supporting ligament and releasing the cavernous bodies to the level of deep arteries entering into them and then fixing the cavernous bodies in a new position at the level of the cut off supporting ligament. The technique allows to achieve penis extension to 3-5 cm
There are several options for performing the operation depending on the type of access( suprapubic, over-the-subocoronary, subcoronary), although the main stage( ligamentotomy) remains unchanged.
Implantation of prostheses with cross-sectional transection of the gall-stone shell( corpotomy).
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. Prostheses are designed to provide rigidity of the organ for successful introjection in men with ED.The principle of the method of lengthening with one-stage implantation consists in placing in the intracavernous space of prostheses of obviously longer length and performing transverse corporatomies with the purpose of lengthening the organ.
Implantation + lengthening with total mobilization of the legs of the penis.
The effect is achieved due to the maximum excretion of the proximal part of the cavernous bodies due to their complete mobilization, anterior movement and fixation in the region of the pubic articulation. Such a significant displacement of the penis implies the intersection of deep arteries and the actual deactivation of the hemodynamic mechanism of erection. Blood supply of cavernous bodies is carried out due to the dorsal vascular bundle and the spongy body of the urethra.
It should be emphasized that full mobilization of cavernous bodies leads to erectile dysfunction( ED), due to the inevitable damage to the pudend nerves and deep cavernous arteries. Therefore, this method is not recommended for absolutely sexually healthy men, without concomitant ED.
Disconnection operation( Perovic operation).
The author of this technique, Sava Perovic, recommends conducting a complete dissociation of the organ into its components-the separation of cavernous bodies along the entire length of the hanging member from the spongy body and head, with the full mobilization of the dorsal vascular-neural bundle. Between the ends of the cavernous bodies and the head are then implanted patches of the patient's costal cartilage or synthetic implant, taking into account the obtained and previously measured free distance. The effect of elongation is achieved due to the natural elasticity and the ability to stretch the spongy body of the urethra and the elements of the neurovascular bundle. Elongation of the penis can be achieved up to 3-5 cm
Methods of surgical thickening of the penis:
Microsurgical autotransplantation of tissues Subcutaneous injection of free auto-fatigue Application of free de-epidermalized skin-fat flap Corporotomy with replacement autotransplantation and allotransplantation Application of rotated flaps on the feeding leg Application of the synthetic implant
Microsurgical autotransplantationtissues.
The method of microsurgical autotransplantation of the fascial-muscular or fascial-fat flaps on the feeding vascular pedicle consists in subcutaneous wrapping of the penis with an isolated fragment of the latissimus muscle of the back followed by its revascularization( application of vascular anastomoses to preserve blood supply in the transplant).
Subcutaneous injection of a free auto-fat. The most common adipose tissue for implantation is obtained during liposuction from the suprapubic region. After the special preparation of the evacuated fat, step-by-step introduction of it through the syringe along the entire trunk of the penis through the incision in the subcoronary zone. In this case, it is necessary to perform manual modeling - the fatty tissue is spread evenly along the organ.
Use of free de-epidermal skin-fat flap.
Cut one or two transplants in the donor area. Usually it is the gluteal or, more rarely, inguinal folds. Depending on the size of the penis, each transplant should be approximately 12-15 cm in length and 5-12 cm in width, depending on whether one or two flaps are used. These grafts are then implanted under the skin of the penis along its entire trunk portion.
Longitudinal corotorotomy with replacement autotransplantation( operation Austoni).
The principle of the operation is to perform longitudinal incisions of the gallbladder on the bilateral surfaces of the corpora cavernosa of the penis with subsequent replacement of defects with inserts from the autovene or other materials.
Application of rotated flaps on the feeder leg.
The extensive use of autothytes for thickening the penis limits the lack of blood supply to the transplanted tissue. Free vascularized grafts are not always and not always possible to 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 a preserved blood flow, without the need for microsurgical vascular anastomoses.
For thickening of the body, a technique is used to isolate a fragment of the rectus abdominis muscle. The principle of operation is to isolate from the anterior abdominal wall a rotated muscular flap on the feeding stem, with a base at the root of the penis. The free end of the autograft on the vascular pedicle is carried 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 fasciculo-fat flap from the subcutaneous tissue of the anterior abdominal wall( Kurbatov's operation).
Application of synthetic implants. Very promising is the new direction of thickening of the IF, which consists in implanting a specially designed synthetic implant under the skin of the organ. The principle of operation and the materials used are similar to the operation of increasing the volume of the breast in women. To thicken the penis, a hull or integral hydrogel implant is used. The operation is differentiated by the programmed result of thickening, short-term stationary period, the absence of additional incisions for sampling the transplant, and the practical absence of complications.
In addition, a thickening method based on the technique of transplantation of "grown" native tissues on a soluble biopolymer carrier( matrix) has now been developed. The method is completely new and there are not enough clinical observations yet.
Results of a surgical enlargement of the penis. The degree of elongation is not a unified criterion, since the causes leading to a decrease in the penis are fundamentally different. The standard and successful result of the operation is to consider the elongation of the body at 2.5-3cm.and more.
There are no standard criteria for assessing the effect of thickening of the penis, as much depends on the patient's desire and the possibility of surgical technique. It is considered satisfactory and good result uniform thickening of the penis shaft, without deformation of the contours and bulging of the graft
Errors, dangers and complications in the enlarging surgery of the penis
As with any surgical intervention can be accompanied by various negative consequences, and the operations on the penis are not without the danger of developing specificcomplications.
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 a patient's negative evaluation of the final results of the operation. The frequency of complications in the aesthetic surgery of the penis depends on many factors, the defining ones of which are the following:
formation of a realistic attitude in the patient to the possibilities of surgical intervention;
experience and mastery of the surgeon;
application of standard techniques;
compliance with the patient after surgery all the prescribed recommendations.
At this very prognostically unfavorable outcome of the operation is the discrepancy between the patient's pre-operative expectations of the "miracle" from the scalpel of the surgeon and the actual result achieved in the course of this operation. This may be due to an unrealistic expectation or a deliberately negative assessment by the patient of any possible outcomes. From the surgical point of view, the postoperative result can be regarded as an excellent
. In conclusion, it should be emphasized that the penis is a unique organ that performs 3 main functions: copulatory( ensuring sexual intercourse), reproductive( ensuring procreation) and ensuring urination. For a man, he is identified by nature insingular, and therefore, to paraphrase a well-known phrase, "... it is necessary to live with it so that it is not painfully painful afterwards. ..".And if in the future men can, if necessary, freely adjust the size of their reproductive organs, as we are now correcting ugly teeth, then the disappointed, embittered, and simply unfortunate men in the future will be significantly less, since harmonious intimate life is one of the components of healthy and social factorsactive person.
pages from the book Shcheplev PA.and Kurbatova DG
"Small penis - correction methods"
Definition of a normal and a small penis