The human penis is an external male intromittent organ. It sits in front of the scrotum. Outside of penis is covered with skin. Inside of it contains some muscles look like sponge. The urethra traverses the corpus spongiosum, and its opening, known as the meatus, lies on the tip of the glans penis. It is a passage both for urination and ejaculation of semen. Just like other kinds of muscle tissue, the penis can grow, shrink or stiffen itself. The penis will continue to grow throughout puberty. In the early stages of puberty, pubic hairs appear at the base of the penis to ease friction during sexual intercourse. The end of the penis, called the glans penis, has a high concentration of nerve endings, resulting in very sensitive skin that influences the likelihood of ejaculation. The penis spends most of its time flaccid, or soft and hanging loosely. An erection is the stiffening and rising of the penis, which occurs during sexual arousal, though it can also happen in non-sexual situations. A reflective erection is also caused by touch of glans penis. The foreskin drapes over the head (glans) of the penis like a hood when you are not erect. The penis head largely is not visible. When you are erect, the foreskin retracts and exposes the glans. The foreskin usually looks bunched up.

Erection Hardness Score (EHS) can be a helpful tool to evaluate erectile dysfunction (ED) that is now widely accepted in medical profession about men’s health. In addition to the EHS, there is the Quality of Erection Questionnaire (QEQ) which is a new patient-reported outcome questionnaire for evaluating satisfaction with the quality of erections. However, ESH is more applicable for daily life and the men can use on their own to assess their erection hardness. The following questionnaire use to evaluate ED from the past 4 weeks.

  1. When you had erections with sexual stimulation, how often were your erections hard enough for penetration?
    • Almost always/ always
    • Most times (much more than half the time)
    • Sometime (about half the time)
    • A few times (much less than half the time)
    • Almost never/ never
  2. When you attempted sexual intercourse, you able to maintain your erection after you had penetrated (entered) your partner until finish, how did you satisfy?
    • Very satisfied
    • Almost satisfied
    • indifferent
    • Unsatisfied
  3. When you had erections with sexual stimulation, how often were your erections hard enough for penetration?
    • Very satisfied
    • Almost satisfied
    • indifferent
    • Almost unsatisfied
    • Unsatisfied
  4. During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?
    • Very satisfied
    • Almost satisfied
    • indifferent
    • Almost unsatisfied
    • Unsatisfied
  5. How did you satisfy with your erection?
    • Very satisfied
    • Almost satisfied
    • indifferent
    • Almost unsatisfied
    • Unsatisfied
  6. Did you satisfy with the quality of your erection?
    • Very satisfied
    • Almost satisfied
    • indifferent
    • Almost unsatisfied
    • Unsatisfied

An important of size of penis

The majority of men are not confident about their penis when having sexual relation. This may cause to sexual stress and leads to erectile dysfunction. Men should satisfy with their penis. If the size still matter, you may use some techniques to support on sexual intercourse. If you do not want to depress during sexual activity and want to share your enjoyment with your partner, you should enjoy with what you have and learn to manage it for highest satisfaction. Each size of penis has distinctive advantages and disadvantages.

  1. The circumference greater than 5.18 inches: If size of the penis is large and the vagina is quite small, the sexual intercourse may hurt your partner. Therefore, male should be very careful when stepping from sexual stimulation to intercourse. The longer arousal increase virginal lubrication and more expansion. You may ask your partner to ensure the readiness before penetration. It should begin slowly and may use vaginal moisturizer for relief painful.
  2. The circumference lesser than 5.18 inches: You may not pleasure when penetrated. However, some sexual positions work great such as keeping woman’s knees close together because it shortens the vaginal canal, so penetration feels much deeper. The woman’s position is laying flat and pulling her legs close to her chest or pulling her legs with knees bending. The women may use her hands control her knee close together. The man’s position is kneeling down and spreading his knees out wider than woman’s hip then pulling his knees closer to control woman’s hip tight.
  3. The length of penis is less than 4.4 inches: During arousal, the vaginal may expand too much for allowing entry of a penis (a foreign body). After the penis is inside, the vaginal walls tighten back to accommodate things coming in. A man with length of penis is less than 4.4 inches should rub his penis around woman’s pelvis and firstly insert his fingers into vagina for 2 – 3 minutes. When the vagina tightens enough then insert the penis instead. This technique will make you and your partner more satisfaction because the man will feel tighter sensation and women will also feel of a normal size penis.
  4. The length of penis is 4.4 – 6.5 inches: The man should learn of how to control his emotion and tempo of penetration. A sensitive spot is located about 2 – 3 inches inside the vaginal on anterior wall which is an area that an average length of penis can touch with the missionary position – a sexual position in which generally woman lies on her back and a man lies on top of her.
  5. The length of penis is more than 6.6 inches: These men may think that they are superior to others. However, most of women think that long penis may hit her cervix during thrusting, which can be painful as same as pain from squeezing testicle. Therefore, men should not penetrate deeper than women’s comfortable zone. The best sex position is a man lying on his back and the women us straddling to him, so she has the freedom to move into the position that best suits her and gives her the greatest pleasure.

How to forecast the length of penis?

  1. Many scientists tried to find a correlation between length of penis and other factors such as height, weight, body mass index, waist-hip ratio, length of index finger and size of shoes.
  2. A study conducted by researcher from the United Kingdom on the length of penis in 104 volunteers, age 17 to 84 years. The research recorded length of flaccid penis at normal temperature (measure promptly after taking off their trousers) compared to the size of thier shoes. There was no significant relationship existed between these factors (Correlation coefficient = 0.012).
  3. The study that had examined the possible correlations between the length of flaccid penis and the size of man’s butt. It had conducted by measuring hip size and body mass index (BMI) in 115 Nigeria volunteers, age between 30 and 65 years old. A review of study found insignificant correlation with these three factors.
  4. A study conducted by researcher from the Greece that had examined the possible correlations between the length of flaccid penis and age, height, weight, BMI, waist-hip ratio, and length of index finger. It had conducted in 52 volunteers, age between 19 and 38 years old. . A review of study found significant correlation between the length of flaccid penis and index finger (correlation coefficient = 0.339, P = 0.014). Whereas there was no significant correlation between the length of flaccid penis and the rest factors.
  5. During development of mammals, the development along extremities (arms, legs, fingers, toes) and external genitalia are controlled by Homeobox or Hox. The morphology of extremities and external genitalia have parallel developments and relevant growths. Twelve weeks of pregnancy, baby’s external genitalia has not been developed and there is no different of the length of index fingers and middle fingers. Later on, testosterone and estrogen initiate the development of baby’s external genitalia. Also, length of index fingers and middle fingers are a result of higher exposure to testosterone and estrogen. Most of women have ring fingers longer than index fingers while most of men have ring fingers equal to or shorter than index fingers.
  6. The length of ring finger and ratio of index finger length to ring finger length had significant correlation with length of penis. The determination of length of penis with these two factors together was more accurate than the determination from length of finger index only.

Penis Enlargement

Penis sizes vary by ethnicity. Flaccid lengths average is from 9 to 12 centimeters. Erect lengths average is from 12 to 18 centimeters. Erect circumference is around 10 to 12 centimeters. Ratio of appropriate length to its circumference is 1.3:1.0

Significant Criteria for Penis Enlargement

  • The size of penis is smaller than normal range with normal male anatomy.
  • The size of erect penis is very small, less than 3 2⁄3 inches.
  • The size of penis is normal but unsatisfied.
  • The extreme penis curvature and particularly downward.
  • Pass psychological examination from psychologist prior to the treatment.

Penis Enlargement without surgery

  1. You can increase length of penis without surgery by using penile extenders or vacuum devices. However, there were no significant evidences of the successful of these devices. Moreover, it may take many years to notice the impact of these methods. Basically, there are no non-surgical treatments that can permanently increase penile circumference. Thus, these methods are usually undergone after the surgical treatment to maintain and sometime increase more length.
  2. Jelqing is a technique to exercise the flaccid penis to extend and strengthen. Before you jelq, you may put moist heading pad around your penis a while then dry it. After that, use your hand to massage the tissues along your penis to get about 75 percent erect. Well grab the base of the penis with your index finger and thumb of one hand in an O shape and slowly slide your fingers from the base to top of your penis. During the slide, you may feel the blood rush to the head of penis. The sponge-like tissues of the penis will extend and expand more every sliding. The stretched jelqing exercise requires two hands alternately. Each set of jelqing is 1 to 3 seconds; continue for 20 to 30 minutes.
  3. Kegel exercise can help build stronger pelvic floor muscles (PFMs), which can increase the tone and strength of these muscles to help with involuntary urine leakage, strengthen erection, and create more force during the emission and expulsion of semen.

Penis Enlargement with surgery

  1. Ligamentolysis: In fact, around one third of penis entire length is housed inside of the body. The suspensory ligament of the penis is attached to the pubic symphysis, which holds the penis close to the pubic bone. When you sever the ligaments there is nothing to pull you penis back up inside the body. The result is that you will tend to hang out at your full length about 2 to 5 centimetres even when flaccid. However, care should be taken to retain some of the ligaments so as to minimize changes in the erection angle. Some ligaments should be maintained especially lateral side. Standard ligamentolysis involves cutting the ligament through an incision in the pubic hair areas just above the base of the penis which can leave a scar. The surgery can result in an average gain in length to the flaccid penis but there will be no change to the size of the erect penis.
  2. Penile Dysassembly Technique: This is a radical technique as it involves completely disassembling and reconstructing the penis. By disassembling the penis to its anatomical parts, space is created between the penis glans cap and the penis shaft and cartilage harvested from the patient is inserted in this gap, leading to increased penis length. The average gain in penile length (both in the flaccid and erect state) through this technique is 2 to 5 centimetres. If you have technique associated with vacuum device will also increase 2 to 4 centimeters more. The physician usually recommends the patient to use vacuum device for 2 to 6 weeks after the surgery to maintain the length of penis.
  3. Girth Enhancement: It is a surgical technique to increase penile circumference. An autologus fat or filler injection is a safety technique. However, a significant re-absorption of fat might occur (some case may experience the re-absorption up to 50% of fat injection). A risk of unnatural shape may also be possible.
  4. An injection of some safety chemical such as collagen, hyaluronic acid, aguamis give a same outcome as fat injection but the result is temporary. On average a patient can increase 10% to 15% from this procedure.
  5. Dermal graft: It is a procedure which is to have a portion of skin removed from the patient’s own body for penis enlargement.
  6. Silicone penis enlargement sleeve: This technique is popular in Korean. The risk of this technique is a friction between silicone sleeve and tissues or fascia around silicone that may cause unnatural sensation.
  7. Stem cell: This technique use platelet-rich plasma (PRP). We start by collecting a patient’s blood.  The blood we draw is then placed into a centrifuge where the stem cells are enhanced by separating the PRP from other binding components found in your blood.  After applying a numbing component to the penile region, we then inject the concentrated PRP into your penis. When PRP cells are injected into your penis, you will more than likely experience new tissue growth.  This will lead to new blood vessels being formed.  Many patients experience a significant increase in size around the 6 months period. The penile circumference will increase about 2 to 5 centimeters.
  8. Liposuction: Removing excess fat around the pubic area can make a partly buried penis appear more prominent.

The Preparation for Surgery

  • Provide information of drug allergy.
  • Provide information of routine food supplement taken before the surgery.
  • Provide information of underlying such as diabetes, hypertension, asthma, heart disease to attending physician and surgeon.
  • Do not discontinue the medication of hypertension, diabetes and other underlying diseases.
  • Discontinue aspirin, ibuprofen and vitamin C for 2 weeks before an operation.

Common Care after an Operation

  • An operation is performed in the hospital under general anesthesia. It requires 1 to 2 days admission for monitoring possible complication and administrating of IV antibiotics.
  • The surgical drain will be removed on the discharge date.
  • The wound will be dressing by the attending physician every day before discharge. Also, the attending physician will educate how to perform wound care at home. The follow up appointment will be scheduled 7 days after discharge.
  • Protect the wound from water.
  • After 7 days, the stitch will be taken off. The scar from the operation will disappear within 3 to 5 weeks.
  • Stop alcohol drinking and smoking.
  • Stop sexual intercourse and masturbation for 6 weeks.

Possible Complications

  • Hematoma or bruising which may lead to infection
  • Non-healing wound
  • Gangrene
  • Poor penile sensation (very rare case)