Participants

The research sample includes 58 men who have undergone at least one penile augmentation surgery.  The ages ranged from 22 to 67 years old (Mean = 39.3).  The majority of the ethnic backgrounds were White (86%), Hispanic (7.0%), Asian (5.3%) and one "Mix" (1.7%).

According to the 1990 Census (1993), 77.2% of the American population is White or Caucasian, 11.6% is Black, 8.5% is Hispanic and another 2.8% is Asian or of the Pacific Islands.  Comparing these national percentages to the racial breakdown of the men in this study, the percentages of Whites and Asians were slightly higher in this study than in the American population recorded during the 1990 census.

The religious orientations in this study were closely divided between Protestants (35.6%) and Catholics (32.2%).  Trailing far behind were those who declare no religion (6.8%) and Jews (5.08%), with no other group over 5%.

The National Health and Social Life Survey (NHSLS) (Laumann, Gagnon, Michael & Michaels, 1994) results of religious affiliations were quite different.  The majority of the people interviewed were Protestant  (56.0%) with Catholics making up another significant proportion at 28.8%.  Those who declared no religion were 10.7% of the interviewed population, 2.6% were categorized as "other" and 1.8% were Jewish.  The 1990 Census did not question the American population on religious affiliation.

The religiosity of the sample population that underwent at least one penile augmentation was divided into four categories and defined by how often they attend religious services.  The NHSLS study questioned religiosity and the table below compares this group of men who have had penile augmentations and the results of the NHSLS survey.

Table 5.1
COMPARISON OF RELIGIOSITY
 

	NHSLS %	P. A. Study %
Never attends services	15.0	29.8
Attends 1-2 times per year	39.4	35.1
Attends 1 time per month	16.6	24.6
Attends 1 or more time per week	29.0	10.5

The general health of the men who opt to undergo an elective surgery  is very important when predicting recovery, scarring and overall results.  Some problem cases (see Appendix 3) have resulted from men not being truthful during intake interviews given by doctors or their staff.  They often lie about their medical histories or current unhealthy practices like cigarette smoking, drug abuse or alcohol intake.  The procedures can be performed under a local or general anesthesia which may be dangerous to men who may not be in good health.

A Likert scale was used to determine personal health ratings in which one was "great" and five was "very poor."   The respondents  (n = 57) were to circle the number that best describes their general health.  Two thirds of the sample (66.7%) rated themselves a "one" and another 29.8% rated themselves a "two."  Only one man rated himself a "three" and another man a "four."

The NHSLS used a four point Likert scale to measure personal health ratings.  Their categories included excellent, good, fair, and poor. Over 90% rated themselves "excellent" or "good."  Only 8.3% rated themselves in "fair" health and a mere 1.6% rated themselves as "poor."

The comparative health ratings among this study and the NHSLS's study obtained similar results.  Most men in both studies consider themselves to be in above average health.

Kinsey's occupation scale (Kinsey et al., 1948) outlines ten major levels ranging from dependents to the extremely wealthy.  The researcher divided the men from this sample population using these guidelines.  Appendix 4 lists the occupation or profession of the patients in this sample.  Table 5.1.2 illustrates the breakdown of this sample using Kinsey's guidelines.

Table 5.2
OCCUPATIONAL CLASS
 

Occupational Class	N	%
Dependents/Students	2	3.5
Illicit Behavior/Underworld	0	0.0
Day Labor	6	10.5
Semi-skilled Labor	3	5.3
Skilled Labor	6	10.5
Lower white collar	4	7.0
Upper white collar	35	46.9
Professional	8	14.0
Business Executive	3	5.3
Extremely Wealthy	0	0.0

The Census bureau uses a system different from Kinsey's.  The categorical breakdown is listed below along with the percentages of the 1990 census population and this study's population as they fit into each category.  The occupations of the men in this study were assigned to a category by the researcher.

The top three occupational groups of the men who had a penile augmentation were: 1) Executive, Administrative and Managerial, 2) Technicians and Related Support Occupations, and 3) Service Occupations (not Household or Protective).

Table 5.3
OCCUPATIONAL CATEGORIES
 

	Census %	This study %
Executive, Administrative and Managerial	12.3	20.7
Professional Specialties	14.1	6.9
Technicians and Related Support	3.7	19.0
Sales	11.8	6.9
Administrative Support (inc. Clerical)	16.3	3.4
Private Household	0.45	0
Protective Service	1.7	3.4
Service, except Protective and Household	11.0	15.3
Farming, Forestry, Fishing	2.5	5.2
Precision Production, Crafts, Repair	11.3	1.7
Machine Operators, assemblers, inspectors	6.8	0
Transportation and Material moving	4.1	1.7
Handlers, equipment, cleaners, helpers, laborers	3.9	6.9
Self-employed	*	3.4
Students	*	3.4
Miscellaneous	*	1.7

* Not in census data

The average yearly income of the patients in this study was $84,568.  The 1990 census (United States Department of Commerce, 1993) found the average per capita income for caucasians in the United States was  $15,687.  The average household earned $30,056 in 1989.  The census also found that only 5.1% of households earned between $75,000 and $99,999 in 1989.  In non-family households only 1.8% earned between $75,000 and $99,999.

The annual income is high for a group whose mean occupational class according to Kinsey's scale would be lower white-collar.  The probable reason is the vague answers that refer to the respondent's occupation or profession and the creation of new jobs since Kinsey published his data.  For example, the man who claimed to have a yearly income of one million dollars wrote that he is a roofer.  He did not write that he was the owner of a roofing company or the supervisor, just a roofer.  The other kind of example would be a computer programmer.  They may not need more than a high school or college degree to know how to program but they are often paid quite well.

Sexual Orientation

Two separate measurements of sexual orientation were investigated.  First, a revised Kinsey scale was used that had a range of 1 - 7 instead of 0 - 6.  The revision was made to eliminate the anxiety a man might encounter if he rates his sexuality with a zero.    Table 5.4 provides the data from 57 of these men.  The second sexual orientation question asked the respondent to circle either "Heterosexual," "Bisexual," "Homosexual," or fill in an "Other."  The majority of the 58 respondents to this question were heterosexual (79.3%), 5.2% were bisexual and 15.5% considered themselves homosexual.

According to the NHSLS study (Laumann et al., 1994) only 2.8% of their male sample population "reported level of homosexual or bisexual identity."

Table 5.4
REVISED KINSEY SEXUAL ORIENTATION SCALE
 

Description of both fantasies and behavior	#	N	%
Opposite sex interests only	1	30	50.8
Mostly opposite sex, rare same sex interests	2	14	23.7
Both opposite sex and same sex interests, with more opposite	3	4	6.8
Equal same and opposite sex interests	4	0	0
Both opposite sex and same sex interests, with more same	5	1	1.7
Mostly same sex, rare opposite sex interests	6	3	5.1
Same sex interests only	7	7	11.9

Education

The education level of each respondent was divided into three questions.  The first, number three, asked how many years of high school completed.  Of the fifty-one respondents, the mean grade levels completed were 11.9 with a standard deviation of .36.  The range was from 10th grade to 12th grade.

Question number four asked, "How many years of undergraduate schooling did you complete?"  Thirty nine respondents, over sixty- seven percent, had some undergraduate experience ranging from one semester to seven years.  The mean was 3.6 years of undergraduate schooling and the standard deviation 1.4.  Eleven people answered "zero" when asked how many years of college they attended.

Question number five asked, "How many years of graduate school did you complete?"  Twenty respondents, 34.5 percent, had some graduate school experience ranging from one year to eight years.  The mean was 3.3 (2.2) years of graduate school (and the standard deviation was 2.2).  Eighteen people responded that they had not attended graduate school.

Thirty-four respondents shared fifty-five degrees or certifications in a wide variety fields and levels.  There were six A.A. or A.S's which are the degrees given by two-year junior colleges.  Four-year bachelor's degrees were attained by twenty-seven men, fifteen Bachelors of Science, nine Bachelors of Arts and three Bachelors of Business Administration.  Ten masters level degrees were completed and three Ph.D.s.  The dentist (D.D.S.) and psychiatric registered nurse were the only men with medical oriented degrees.  Seven other miscellaneous degrees or certifications were also earned.

The 1990 Census (USDOC, 1993) and the NHSLS study (Laumann et al., 1994) inquired about their subjects' educational attainment.  Of the census respondents who were at least 25 years old, 75.2% graduated high school or passed the high school equivalency exam.  Over 20% of the white/caucasion population in the 1990 Census, the bulk of the respondents who had penile augmentations, attained a Bachelor's degree or higher.  Approximately 13% attained an advanced degree.

The NHSLS survey also inquired about the educational attainment of their subjects.  Sixty-three percent had graduated high school or passed the high school equivalency exam and 15.6 % graduated college.  Another 6.9% attained advanced degrees of some kind.

Approximately 83% of the men who returned their penile augmentation questionnaire graduated high school or passed the high school equivalency exam and 57% had attained a Bachelor's degree or higher.  Approximately, 24% received advanced degrees.  Overall, the fifty-eight men included in this study on penile augmentation were much more educated than the 1990 general census population.  The table below compares all three sample populations and their educational attainment.

Table 5.5
COMPARISON OF EDUCATIONAL ATTAINMENT - in percent of population
 

	1990 Census	NHSLS	This study
High school grad. or equiv.	75.2	63.0	83
College graduate	20.3	15.6	57
Advanced Degree	13.1	6.9	24

Sex Education

Most (57.9%) of the sample (n = 57) had never received any formal sex education in school.  Twenty-four men (42.1%) had some formal sex education from elementary school to university/college.  Of the men who had at least one sex education course (n = 26), 19.2% took it in elementary school (kindergarten - 6th grade), 26.9% in junior high school (grades 7-9), 38.5% in high school (grades 10-12), 11.5% in junior college, and 3.85% in university/college.  Two respondents circled more than one level of schooling, indicating more than one human sexuality class. The next question is what percent of the information learned in the class was new to the respondents.  Eighteen men responded,  with a mean of 39.7% of the information was new.  The range went from 5% to 95%.

The sample population was questioned about when they first learned of sexual behaviors, vocabulary and enlargement surgeries.  Masturbation (n = 57) was learned between the ages of five and eighteen with an average of 12.0 (2.2) years old.  Knowledge of orgasm (n = 54) was acquired during the same time with a mean that was only slightly higher at 12.4 years old and the same standard deviation.  The mean age regarding when knowledge of pregnancy occurred was 11.1 (2.9) years.  The knowledge of menstruation may depend on a boy's mother, sisters or girlfriends especially if they were involved in sexual relations at a young age.  The range of first knowledge regarding menstruation (n = 51) spread from eight to twenty-one years old, with a mean of 13.5 (2.9) years.  Another female-oriented question asked for the men's first knowledge of what a clitoris was.  Some men (n = 48) learned as early as ten or as late as twenty-two years old with a mean of 15.4 (3.1) years.

The knowledge of sexual intercourse (n = 56) was gained as early as five to eighteen years old.  The question was not aimed to find out when the patients had sexual intercourse for the first time but merely when they learned of it. The mean age was 11.8 (2.7) years.  The first knowledge of homosexuality (n = 55) had the widest range.  There was a twenty-year gap, from five to twenty-five, between the acquisition of knowledge of homosexuality.  The mean age was 14.3 (3.7) years.

The first knowledge of penile lengthening (n = 57) and later penile enlargement surgery (n = 56) corresponds with the average age of the patients at the time of their surgery (M = 39.4) and how long before their surgery they were considering the procedure (M = 10 months).  The mean age of when this population sample (n = 57) learned of the lengthening procedure was 37.5 years old.  The mean age for knowledge of enlargement surgeries was about six months later with a mean age of 38.1 years old.  If you add the ten months of consideration before surgery to the mean ages of first knowledge, the data is quite consistent.

Exercise

The doctors and staff whom the researcher interviewed clearly stated that homosexuals or body builders undergo the highest percentages of penile augmentations.   Penis Power Quarterly (P.P.Q.) is a phallocentric publication.  Supposedly, a significant percentage of men who subscribed to this magazine were homosexual or had undergone or considered a penile enlargement of some kind.  According to this research, only one man had learned of the procedure and the recommended doctors from P.P.Q.  The staff of P.P.Q. has since found that readers were mostly heterosexual, much to their surprise.

There is no way to know through a questionnaire whether or not a man looks like a body builder.   How often they exercise, and what types of exercises they do, can be investigated.  The statistics regarding the number of times the respondents work out per week were high, but there were no indications that any of the men were professional or amateur body builders.  The mean number of times the sample population exercised was 3.8 (2.2) times per week.  The range went from zero to seven times per week.  The most common physical activities included weights, running/jogging, cycling, cardiovascular/aerobics, walking, swimming sports and surfing.  The intense workout schedules of most of these men reflect a sincere appreciation for the ideal body and the desire to do everything it takes to achieve it.  A penile enlargement seems to be the next necessary step towards that goal.

Other Cosmetic Surgeries Considered by Subjects

Customer satisfaction is delicate in the area of plastic surgery. Sixteen men in this sample had undergone other cosmetic surgeries before their penile augmentation.  Some procedures may or may not be considered cosmetic surgeries by all, but these are the respondents' comments so they must all be recognized in order to understand the population.  The "other cosmetic surgeries" included hair transplantation, dermabrasion, liposuction/liposculpture, rhinoplasty, RK eye surgery, electrolysis, jaw correction, mole removal and braces.  Thirty-three men reported never having any other cosmetic surgeries performed.

Reasons Why Subjects Had Surgery

Cosmetic surgeries often have subjective results because they are most often done for vanity. The following quotes are in the order in which the questionnaire was received.
  "To provide more pleasure for my mate."
  "Improve nude appearance and ability to satisfy wife."
  "The fact that it was available."
  "I wanted at least an average size penis."
  " Because the curvatur (sic) was being straighted (sic) so decided why not since it was being worked on."
  "Why not."
  "To feel average, thought I was smaller than most."
  "Wanted it larger."
  "It was to (sic) small + I could not satisfy a woman + I was also  very self conscious about my size."
  "I thought it would look better."
  "To have more confidence at the gym, at the beach or pool in a  swimsuit."
  "For my own feeling of satisfaction."
  "To feel better pshycologically (sic) and pshysically (sic). To  please my partner.  My past girlfriends would mention to me  about their past boyfriends who had a bigger penis than me."
  "Prior experiences with girlfriends stressing the importance of a large penis or larger than average."
  "I have always felt my penis size was extremely small and  inadequate."
  "Desire."
  "Feel adequate."
  "Cosmetic reasons."
  "1) Increase my sexual desirability. 2) Increase partner's  pleasure. 3) Partner's heigtened (sic) pleasure increases my  pleasure and fulfillment. 4) Increased sexual confidence. 5)  Increase sexual ‘hold' on partner."
  "Self-conscious of penis size, especially flaccid.  Although my size been within normal range, it was smaller than average."
  "To correct penile curvature only."
  "More sexual satisfaction."
  "Did not like the small look and did not feel like it was big enough during intercourse."
  "Better sex satisfaction for partner + self."
  "My wife of 14 years died 6 months prior to my decision.  This  was something I did for myself."
  "No special reason."
  "Always felt I could be bigger than I was.  Just waiting for the  cure"
  "Self improvement, more aesthetically pleasing to opposite sex."
  "Wife had a child, I thought would help with her orgasms."
  "To bring it up to the size I felt was equal to my friends at the  gym."
  "Self-image improvement.  Wanted to look better nude + fill out  clothes better."
  "I felt it small and could make sex better for my wife and my self astein (sic)."
  "To satisfy women.  To avoid embarrassment."
  "Because I felt small compared to friends."
  "Was not satisfied with it."
  "Seemed like an interesting possibility."
  "Because I thought it would increase my self confidence, and help me in getting involved in a relationship."
  "I thought my wife would enjoy sex better."
  "When I saw the advertisement in the paper."
  "I though (sic) few extra inches might not be a bad idea.  Phsycologically (sic) and maybe the wife would like it better."
  "Wanted to be closer to normal."
  "Low self concept regarding penis size - specifically."
  "To be more attractive to my partners."
  "Self consciousness due to smallness."
  "Self-confidence."
  "Confidence."
  "More self confidence."
  "Hope satisfaction mentally."
  "Because I felt mine was too small, and I though (sic) this could  improve my overall lifestyle."
  "Because I felt I was to (sic) small."
  "Wanted to look in the mirror and view myself larger."
  "Self image."
  "All way wanted." (SIC)
  "Ego, image, providing increased sexual pleasure to partner."
  "Vanity."
  "Peyronie's had altered my normal penis size from 6 3/4 inches erect to 5.25 inches erect."
  "I thought I would look better naked."

These quotes can only be compared to the percentages referred to earlier by Roos and Lissoos (1994) that categorize the reasons their patients revealed for undergoing a penile augmentation.  Their categories included self-image (79%), functional (14%), congenital (6%) and trauma (1%).  Three new categories, "for partner," "availability/no special reason," and "personal satisfaction" were added by this researcher to accommodate this population's reasons for the surgery.

This researcher found that 44% of this sample reported improvement of their self-image or self-concept as the reason they had a penile enlargement.  Increased pleasure for partner accounted for 20.6%.  Personal satisfaction sought through a penile enlargement accounted for 17.6%.   Mere availability of the procedure or "no special reason" accounted for 11.8% of the sample population.  One man (1.4%) felt his new, larger penis would function better sexually without mentioning a partner.  Three men (4.4%) had Peyronie's disease that had shortened their penises.  Their doctors suggested a penile enlargement be performed while the curvature was being corrected.

Overall, many of these quotes represent myths that could be cleared in sessions with a sex therapist.   The issues about self-esteem and self-confidence that these men have related to the size of their penis could be the topic of another large study but are also worthy of a few talk-therapy sessions with a sexologist.  It would be interesting to note how many of the men who are about to undergo a penile augmentation could become educated enough during a short lecture on male and female sexuality to understand that penis size does not make the man.  Communication between partners and a little education could eliminate the need for surgery for a large portion of future patients.

The questionnaire asked the respondents to circle "length" or "girth" depending on which one they thought was the most important or ideal.  Length was most important to 72.4% of the sample (n = 58) and girth most important to 27.6%.  Nine respondents circled both length and girth.  Two of those nine were very clear that they felt length was more important for them but girth more important for women.

Actual and Ideal Penis Sizes

The penile measurements taken by the subjects (n = 44) found the mean flaccid length before surgery to be 2.6 inches long.  After surgery, the mean flaccid penis length was extended to 3.8 inches.  This is a significant increase (t = 8.3, p < .000) in flaccid length.

The flaccid circumference (n = 22) was also increased significantly (t = 5.14, p < .000) from a mean of  3.1 inches to a mean of 4.1 inches.  Many men mentioned problems they encountered when measuring penile circumference.  The before and after pictures (Patient 9) clearly show the flaccid results attained by penile augmentation.

Erect penile length (n = 46) did not significantly change.  The method of cutting the suspensory ligament simply releases the hidden, internal penis to hang outside of the body when flaccid.  When the penis is erect, the internal penis naturally extends to its full length.  This was not clearly understood by some of the patients in this sample because they expressed their discontent with a lack of increased erect length.  The mean before surgery was 5.4 inches and afterwards the mean was 5.7 inches.

The addition of fat and skin grafts to the penis increases the circumference of the penis in all stages (n = 27).  There was a significant increase  (t = 5.3, p < .000) in erect circumference.  The mean circumference before surgery was 4.1 inches whereas after surgery it was 4.8 inches.

Table 5.6
AVERAGE PENILE LENGTH BEFORE AND AFTER SURGERY
 

Length	Before	After
Flaccid	2.6"	3.8"
Erect	5.4"	5.7"

Table 5.7
AVERAGE PENILE CIRCUMFERENCE BEFORE AND AFTER SURGERY
 

Circumference	Before	After
Flaccid	3.1"	4.1"
Erect	4.1"	4.9"

A major problem that doctors who are performing penile enlargements have encountered is the patient's unrealistic expectations.  Men with an above average penis often undergo a penile enlargement (photos 2.1- 2.3 and 5.1 - 5.2).  Even after their first lengthening and girth enlargement many men still want more.  To investigate this problem, the questionnaire included questions regarding ideal penis length and circumference.  It was not specified as to whether the ideal measurements should be flaccid or erect.  It was up to the respondent.  Some men were very concise and wrote both flaccid and erect ideals. The results of these questions were very interesting.  The average length of the respondents' ideal penis was 7.9 inches with a range from 5 inches to 12 inches.   There was a 2.2" difference in the actual erect length of the patient's penises after surgery and their ideal length.  According to Kinsey's data, the average erect penis length is 6.2 inches with a standard deviation of 0.77 inches.  The ideal length of this sample is above two standard deviations from the mean which may be interpreted as this research population's desire to be in the top 2.5 percent of men's penis sizes on a normal bell curve.

According to Kinsey's data of 3500 adult male penises measured (Jamison & Gebhard, 1988), the mean circumference was 4.85 (.71) inches.  The ideal circumference is 5.2 inches, which is only slightly larger than their current size.  Some respondents wrote on their questionnaires that they had a difficult time measuring circumference.  Some penis circumferences were related according to items the respondent could visualize.  For example, one man said his penis was the size of a quarter and another the size of a magic marker.  Ideal penis circumferences ranged from two (a magic marker) to nine inches (a soda can) in circumference. It is possible that the circumference results would be more accurate if a scale was assigned common household objects for each gradation.

Perceived Penis Sizes

No matter what the actual size of a man's penis is, the feelings or anxiety he attaches to its size may have more to do with how he perceives the size of his penis.  If a penile enlargement increases the length of the penis by one inch, that may not be considered worthwhile investment for some.  For others, the biggest difference could be in how that man perceives his new penis.  Their feelings regarding their penis may increase their self-esteem or sexual confidence which may help them start new relationships, have better sex, or earn respect by other men.  A new perception of a man's penis may change his life without it ever being seen by others.

The researcher asked the respondents to rate their perceived penis length and circumference before and after surgery.  The  5-item Likert scale was assigned values from 1 = "much smaller than average" to 5 = "much larger than average."  The mean rating (n = 58) before surgery for flaccid length was 4.00, or "somewhat smaller than average."  After surgery, the mean perceived flaccid length changed significantly (t = 11.8, p < .000) to 2.7, which is slightly above average.  Over 75% of the sample felt their flaccid penis was somewhat smaller or much smaller than average before surgery whereas after surgery only 14% felt they were somewhat smaller than average.

The erect size of the penis technically only changes in circumference with a penile enlargement because cutting of the suspensory ligament will not add erect length.  With fat injections, dermal grafts (pictures 7.1-7.9) or pedical grafts (pictures 8.1-8.2) the circumference can be markedly increased.  According to the respondents in this sample (n = 58), they had a mean rating of their erect penis before surgery as a 3.45, which is between "average" and "somewhat smaller average."   Approximately 14% of the sample felt their erect penis was "somewhat larger" or "much larger than average."  "Average" ratings were assigned by 32.7% of the men about their erect penises.  Approximately 53% of the sample felt they had a "somewhat smaller" or "much smaller than average" erect penis.

The perceived erect size after surgery had a mean rate of 2.8 which is slightly above average.  There was a significant increase (t = 4.4,  p < .000) in the perceived erect size.  One third of the sample (33.4%) felt that after surgery they were "somewhat larger than average" or "much larger than average" and another 38.6% felt "average."  Even after a penis enlargement, 22.8% still felt "somewhat smaller than average" or "much smaller than average."

Expectations

The questionnaire asked whether or not the penile expectations of the patients were met.  When asked if the overall surgical procedure matched what they expected, eighteen (32.1%) of the respondents (n = 56) circled "yes," whereas thirty-eight (67.9%) circled "no."

Table 5.8
DID THE PENILE ENLARGEMENT LIVE UP TO YOUR EXPECTATIONS?
In percent of 58 participants.
 

	YES	NO
Length	27.6	69.0
Thickness	48.3	41.4
Proportion	32.8	48.3
Asthetics*	17.2	77.6
Function	62.1	22.4

*Aesthetics include scarring, curvature, angle, and lumpiness from a subjective perspective.

The expectations of the patient and the doctor include other important issues besides increased length and circumference.  The doctors also predict the length of recovery.  This is an important issue considering the delicacy and privacy levels involved in penile enlargements.  Men need to know how long they need to take off from work, when they can return to the gym, and when sexual activity may be resumed. The doctors who were interviewed had suggested at least four to six weeks of recovery before any attempts at masturbatory or penetrative sexual activities.  According to the patients, they were told to wait an average of 1.1 months before attempting masturbation, oral sex or vaginal sex and an average of 1.2 months before attempting anal sex.  Two respondents indicated that they were never told to wait any specific length of time.

The respondents reported how long after surgery they attempted masturbation.  The researcher found a mean of 1.6 months or approximately six weeks and a standard deviation of 1.0 (n = 54). The range was five days to six months after surgery. Four men had not attempted masturbation since their surgery.

Fifty respondents had resumed sexual intercourse between six days and eighteen months after surgery.  Eight men had never had sexual intercourse since the penile augmentation surgery when they filled out the questionnaire.  The average man in this sample population waited 2.9 (3.2) months.

Physical Changes Due to Surgery

The questionnaire asked about unwarranted physical changes, other than actual penis size, such as erection, ejaculation and penile sensation with bipolar answers and adequate room for explanation.  Changes in erection occurred in 60.3% of the sample population, whereas 24.1% felt there was no change.  Nine people did not answer this question. Twenty men explained their likes or dislikes with their penis after surgery.

Quotes regarding erectile changes:
  "Angled up."
  "Hung in the lower RT (right) quadrant"
.  "It is much softer than before."
  "Lumps from fat."
  "After the first 2 surgeries, my erection was slightly lower and because of the scar I had slight pain after intercourse."
  "Straighter"
  "It is just a little bigger and fatter than before surgery."
  "Scarring is quite visible.  The excess tissue at the base makes the penis appear unnaturally ‘puffy' with a strange tapering to the shaft.  Quite unappealing."
  "Penis doesn't point straight up.  Now about 20-30 degrees. Also penis is more easily pivoted."
  "Cons: ridge on penis-unable to wear condom, odd shape, scarring visible, etc. Pros: more flexible at base."
  "Does not become as hard."
  "The head is tilted upward all the time."
  "Slight decrease in angle,  It feels larger to me, larger than the actual increase would indicate."
  "Fatter, very difficult to put condom on."
  "Big ball of fat on my penis."
  "Angled slightly downward as opposed to nearly vertical."
  "Angle dropped 40 degrees, less firm (40%), too lumpy."
  "Thickness augmentation is lumpy."
  "I am not pleased with the scarring."
  "Bad scaring (sic) also fat injected into penis makes it impossible to wear a condom as it digs into the erect penis and won't go on thus makeing (sic) it impossible to have sex with a condom."

The investigator was invited to watch doctors perform check ups for pre-operative and post-operative care.  She was also given the opportunity to help perform a sexological exam on a client (Appendix #6, Case A), who had issues regarding the scarring above his pubic bone and fatty lumps on his penis shaft and in his scrotum.  The quotes regarding erectile changes due to surgery repeat many of the complaints this client had.

The researcher feels that many of the complaints regarding erectile changes could be eliminated if the patients were given a more indepth explanation of possible results.  The doctors, nurses and staff members who answer office phones often do not always know the answers to the variety of hard questions asked daily.

The patients should understand that there will be scarring that may be visible through pubic hair.  Minimal scarring occurs even if a laser or orthroscopic surgery is performed.  The men should also be warned that there is also a good chance that by cutting a suspensory ligament the erect penis may lose some of its vertical angle.  Explanation of fat transplantation should be described to future patients so they understand that fat does become reabsorbed by the body, often unevenly.  During an erection the transplanted fat will be softer than engorged tissue that hardens the penis.

Changes in Ejaculation

Changes in ejaculation only occurred in 10.3% of the patients. Over 86% found no difference in their ejaculatory pattern from before to after surgery.  Two men did not answer this question.  Below you will find quotes from the sample population that explain any changes.

 Quotes regarding changes in ejaculation:
  "Not as forceful or powerful as before."
  "Not sure, don't think there is any difference."
  "Many times cannot ejaculate."
  "Ejaculate is frequently not expelled- about 50% of the time. Pleasure/sensation is unchanged."
  "Doesn't seem to be any difference."
  "Seem to retain fluid - doesn't all come out."
  "It was stronger and the semen is thicker."
  "No feeling."

These quotes regarding changes in ejaculation reveal that four cases (7%) may have experienced retrograde ejaculations after recovery.   This is a problem because many of the men who have penile enlargements are young and may be planning on having children.  A researcher has to consider any change in ejaculation a concern because the patients and doctors do not expect ejaculation to be affected.

Changes in Sensitivity

The researcher feels that few would choose to undergo a surgery that would decrease genital sensitivity.  Of the 57 respondents to this question, 31% felt their sensitivity had changed whereas 67.2% did not feel any difference.

Quotes regarding changes in penile sensitivity:
  "More sensitive."
  "Numbness along the shaft.  Less sensitive."
  "Less sensitive at the base, and at scarred areas."
  "Diminished sensitivity for 2 months."
  "Less sensation."
  "Head area same, shaft felt distant."
  "Not as sensitive."
  "Greatly diminished sensitivity- especially top of shaft."
  "Maybe a dull sensation for about 2 months."
  "A little more contact with vagina."
  "If you have intercourse for a long period of time you have pain on the upper shaft afterwards."
  "Was very very sensitive during the first month due to removing tape from the penis which was used to hold weights."
  "Penis is more sensitive requiring gentler treatment."
  "Lost sensation, because of getting thicker."
  "Slightly less sensation."
  "Less feeling at the base."
  "Seemed to be slightly less sensation haveing (sic) intercorse (sic)."

Loss of penile sensitivity seemed to concentrate on areas of the shaft whereas increased sensitivity related to pain.  The quotes above were generally negative.  Hopefully, doctors will begin to experiment with less invasive enlargement techniques that may save sensitivity.

Importance of Sex and Recovery

The importance of sex relates closely to changes in penile sensitivity in a man's life.  These are both of great concern for most men.   One question included four choices in order to determine the importance they put on sex.  The majority of this population (71.9%) revealed that sex was "very important" to them.  Another 29.8% picked "somewhat important" as how they would define sex in their lives.  Two men claimed sex was merely "slightly important" for them.  Nobody felt that sex was not a significant part of their lives.

Resuming a sexual pattern after a surgery can be a very important factor in the definition of a full recovery and of life being considered "back to normal."  A sexually painless or low-pain encounter is also important.  The respondents reported how long after surgery they attempted masturbation, whether or not they experienced any pain, and how long it took the pain to go away.  Masturbation was attempted after an average of 1.6 (1.0) months, or approximately six weeks.  These fifty-four respondents waited between five days and six months before attempting masturbation with four others continuing to refrain at the time they filled out the questionnaire.  Of the fifty-four men who answered the question about their experience with pain during masturbation, 27.6% said they had pain and 65.5% had not.   Fifteen men reported that the pain during masturbation ceased between one and five months with a mean time of 2.4 (1.0) months.  This is considerably longer than the one month suggested by the doctors.

The same questions were asked regarding sexual intercourse.  Fifty respondents waited between six days and eighteen months after surgery to resume sexual intercourse but another eight men were still refraining from intercourse at the time they filled out the questionnaire.  The average man in this sample population waited 2.9 (3.2) months.  Out of the entire sample, 25.9% had experienced pain during sexual intercourse and 62.1% had not.  Seven men (12.1%) did not answer this question.  When asked how much time passed before the pain ceased, the answers ranged from one month to ten months.  The mean months spent in pain during intercourse was 3.1 (2.6) months.  Many men wrote comments about how they were not prepared for the pain they endured.

The patients were questioned on whether or not their recovery time matched their doctor's expected time of recovery.  The answers were split almost in half.  Out of the fifty-eight potential responses, 46.5% felt their recovery matched their doctor's expectations whereas 48.3% did not.  Three respondents (5.2%) did not answer.  According to fifty-one respondents, their mean length of recovery was 2.3 months.  "Recovery" was explained in the questionnaire as the time in which life returned to normal.  Two people did not answer and five others responded with "never was" or "not yet."

Self-Concept and Sexuality

Fifty-seven subjects rated their self-concept, before and after surgery on a Likert scale, one being best and five being worst.   The mean rating before surgery was 2.21 whereas after surgery it improved a mere 0.05 to 2.16.  If you read the reasons why the sample population decided to undergo a penile augmentation, 44% chose the surgery ‘to improve their self-image.'  The discrepancy is apparent in the non-significant results regarding self-concept versus the large number of self-concept or self-image related reasons given for having the surgery.

Other popular reasons for having a penile augmentation included hopes of improving sexuality.  Sexual satisfaction (n = 56) was measured on a Likert scale from very much above average (1) to very much below average (5) both before and after surgery.  Before surgery, the respondents rated their sexual satisfaction with a mean of 2.6 (1.1).  After surgery, the mean satisfaction was significantly worse at 3.1 (1.2).

According to the NHSLS study (Laumann et al., 1994), 46.6% of the males interviewed were extremely physically satisfied with their partner and 41.8% were extremely emotionally satisfied with their partner. The wording used by the NHSLS, "extremely" satisfied, could only be compared to the men in the penile augmentation study as those who rated themselves "very much above average."   Unfortunately, the percentages show that sexual satisfaction among the men who answered the researcher's questionnaire dropped from before to after penile augmentation surgery.  Only 17.2% of the men, before their surgery, were very satisfied sexually.  That percentage dropped to 6.9% after surgery.

Frequent Sexual Activities

The respondents were asked to list their three most frequent sexual activities.  Intercourse was mentioned thirty-seven times, masturbation thirty-one times and oral sex nineteen times.  Less frequent activities included frottage, anal sex and mutual masturbation.  Frequencies of masturbation, sexual relations and overall sexual activities with or without a partner were compared before and after surgery.

There was a significant decrease (t = 3.1 p < .01) in the masturbation patterns.  Before surgery the men (n = 53) were masturbating an average of 14.5 times per month whereas after surgery they were only masturbating 9.8 times per month. Three subjects wrote "not applicable" or "never" in reference to how often they masturbate.

The NHSLS study questioned their subjects on their frequency of masturbation.  The published results show that out of the total male population, 36.7% of the men claimed to not masturbate at all.   This percentage is very high compared to the 5.7% of men in the penile augmentation study who do not masturbate.  Another 26.7% of the men masturbated once a week.  No other categories were listed in the NHSLS study, making these percentages hard to compare to the sample population of men who had penile augmentations.

Frequency of "sexual relations" was divided into opposite sex and same sex encounters.  Both before and after surgery, the population sample (n = 48) had sexual relations 10.6 times per month with members of the opposite sex.  The range before surgery spread from zero to 90 times per month and afterwards spread from zero to 60 times per month.   Ten subjects (17.2%) answered "not applicable" in response to their frequency of sexual intercourse before surgery, and 14 subjects (24.1%) responded with either a zero, "never", or "not applicable" regarding after surgery.  No significant change was found  between the amount of sexual relations before and after surgery.

The questions about sexual activities in the NHSLS study were answered via a self-administered questionnaire.  According to the study, 9.8% of their total male sample population had not had sex in the last year.  Another 17.6% had sex a few times in the last year, 35.5% had sex a few times per month, and 29.5% had sex two to three times per week.  Only 7.7% had sex four or more times per week.  No higher frequencies such as times per day were reported.  The mean frequency of sex per month for the total male sample was 6.5, which is just below twice per week.  The mean frequency of "sexual relations" in this study was much higher (M = 10.5 times per month).

Homosexual relations also found no significant change in frequency, with an average of  4.5 times per month (n = 11) before surgery and an average of 3.7 times per month (n = 12) after surgery.

Overall frequency of "sexual activities" with or without a partner significantly decreased (t = 3.9, P < .001) from a mean of 17.2 (14.4)  times per month (n = 58), to a mean of 12.9 (12.5)  times per month (n = 56).  The range dropped from 0 - 90 to 0 - 60 times per month.  Unfortunately, the men who were hoping for an improved sex life as a result of surgery are, on average, not satisfied.

Doctors and Demographics

Approximately six hundred questionnaires were sent to men who had undergone at least one penile augmentation surgery with a doctor who is currently performing or has performed this experimental procedure.  Four letters were returned as "undeliverable."  The researcher made contacts through phone calls, facsimiles, and letters with twenty-seven doctors, two innovators and one author to help in the distribution of  questionnaires.

The fifty-one respondents wrote down the name of the doctor who performed their first penile augmentation.  The fifty-one men had been seen by ten different doctors.  Seven men did not answer or did not remember the name of their doctor.  The doctors have been assigned letters A through J to protect their privacy.  Dr. A's twenty-four responses made up 47.1% of the total population sample.  Dr. B had performed a penile augmentation on 12 patients (23.5%) from the sample population.  Dr. C's patients made up 11.8% of the sample population, even though his office staff claims to have sent out approximately one third of the total mailed questionnaires.  Dr. D had only three returns which amounted to 5.9% of the sample.  Drs. E through J each received only one response.  Four out of the six doctors who only received one response were never given any questionnaires by the researcher.  The patient may have received a questionnaire because he had revision work or a second enlargement performed at a later date by a doctor who did participate.

Of the 56 men who responded as to where they had their penile augmentation performed, 94.6% said theirs were done in California.  Only 36.8% of the sample (n = 57) lived in California at the time of their surgery.  Five men (8.8%) were from the state of Washington and another five (8.8%) from Texas.  Three men (5.3%) came from each of the following states: New York, Minnesota, and Oregon.  Twelve other states were represented but none had more than two respondents.  Two men (3.5%) flew from Australia to Los Angeles to have their penile augmentation.  With the use of widespread advertising by doctors and the importance of privacy issues, men will travel far distances to undergo this type of surgery.

This figure shows the breakdown of how the patients found their doctor.

Types of Surgeries

Penile augmentation surgeries are continually being improved and altered, so it was important to find out exactly which surgery was performed on each patient.  At the time the questionnaire was being created, there were five main techniques being used.   The patients (n = 58) could circle one of the procedures that were offered, circle "don't know" or "other" and write in the specialized technique.  Ten respondents (17.2%) had only the penile lengthening otherwise known as the cutting of the suspensory ligament.  One man (1.7%) only had fat injected into his penis.  Most of the men (60.3%) had the combination of these procedures:  They had the suspensory ligament cut and their own fat liposuctioned out, usually taken from the abdomen, and replaced into their penis.  The second most common procedure was the dermal fat graft and lengthening which was performed on six men (10.3%) in this sample.  Dermal fat grafts (photos 7.1 - 7.9) are skin and fat that are removed from under the gluteal folds of the buttocks and inserted into each side of the penis.  Four men (6.9%) underwent lengthening and  used pedical fat grafts (photos 8.1 - 8.2), which are removed from the abdomen and replaced in the penis.  One man did not know what surgery had been performed and the only "other" was correction of penile curvature and lengthening.

Costs

The costs of the different types of penile augmentations this sample (n = 54) had performed ranged from $3000.00 to $9000.00 with a mean of $5580.  Some men only had the lengthening done whereas others had the lengthening and girth enlargement.  One man was excluded from the calculations because he was having surgery to correct curvature caused by Peyronie's disease when his urologist suggested an enlargement at the same time.  He did not incur any personal costs because his insurance company paid in full.  No other subjects mentioned that their medical insurance covered their costs.

Besides the actual cost of the surgery, the respondents (n = 54) were questioned about how much they spent on extra costs such as airfare,  hotel accommodations, taxis, prescriptions, etc.  The range of extra costs was from zero to $5000. The mean extra cost was $870.

Total costs (surgery + extra costs) ranged from $3030 to $12000 with a mean of $6413.  The total costs were compared with each respondent's annual income to find what percent was spent on an elective surgery.  These percentages allow readers to understand the scope of the issue and future augmentation patients to evaluate how much they would be willing to spend for an extra few inches.  The range of annual percentage of income spent started at 1.2% to as high as 55.1%, with an average of 14.4%.

No matter which surgery a man has had performed, doctors often suggest post-surgical techniques to improve results.  The suspensory ligament can repair itself and actually shorten the penis, so an inventor, Roland Clark, created a weights system (photo 10.1- 10.2) called P.L.D. (Penile Lengthening Device) that allows the penis to heal at its maximum new length.  Twenty two men (44.9%) out of this sample had used weights to enhance their results.  Four men (8.2%) used manual stretching (photos 9.1 - 9.3) and another four (8.2%) used a vacuum pump (photo 11.1).  Sixteen men (32.65%) did not do anything else to improve their results.  Other methods (6.1%) included corrective surgery, regular exercise and general good health.

Time Spent With Patients

A surgeon's time is very valuable.  It is very common for the patients to spend more time with the staff or nurses than the doctor.   Penile surgery is a very sensitive topic and often the men want to talk with the predominantly male urologists before the surgery.  Some doctors spend a long time with each patient, explaining their procedure and the possible results.  The questionnaire asked for the number of minutes each patient spent with his surgeon before the day of the surgery and then again on the day of surgery.  The researcher found the mean time the patients (n = 58) spent talking with the surgeon before the day of the surgery to be 33.9 minutes.  On the actual day of the surgery, the doctors spent an average of 22 minutes with each patient.  These numbers imply responsible doctors who care for their penile augmentation patients and spend adequate amounts of time with each one.

Each respondent rated their doctor on their initial contact, the interview, the actual surgery and the follow up procedures.  Four Likert scales with the same one (very satisfied) to five (very unsatisfied) range was used to uncover the overall, combined doctor's ratings.  The initial contact rating (n = 56) was found to have a mean of 2.6 (1.2) which is slightly above neutral.  The interview stage was rated by all 58 respondents with a mean of 2.7 (1.2).  The actual surgical rating (n = 58) given to the doctors had a mean of 2.9 (1.4).  Following the trend downwards, the doctor's follow up ratings (n = 56) had a mean of 3.4 (1.5).  These calculations show the clear trend in which the patients became more and more frustrated with their treatment.

Separate ratings were also taken regarding the quality of pre-operative and follow-up procedures as they relate to the content and the entire staff.  A Likert scale ranging from one (best) to five (worst) was used.  Examples of pre-operative procedures include meetings with staff, videos shown, medical testing and informational packets.  Of the 55 cases that rated their pre-operative procedures, the mean was 2.9 (1.3), which is just barely above neutral.  The following are quotes regarding the pre-operative procedures the patients experienced:

 "I was rushed with little information."
 "The doctor shows care - but no eye contact and appears not to ‘really' listen to concerns."
 "Average as I expected; counsellor (sic) could have been more  informative.  His job was only to be sure that I was okay  mentally."
 "I was shown a 15 min. video, then had a 15 min. interview with Dr. ______ before surgery."
 "Pictures (before & after) left alot (sic) to be desired - should  have been taken several months after procedure."
 "Photos, measuring, planing (sic) surgery."
 "Did not have one."
 "No blood work up."
 "Very informal all around.  I was shaved then I was put under."
 "I felt very unsure, scared.  They didn't seem to care much."
 "Verbal consultation with M.D. on phone was excellent."
 "Watched a video, spoke with physician, treated well by nursing  staff."
 "Meet with nurse for 10 mn., shown video, meet with doctor 15  mn."
 "Saw a video, talked briefly to a doctor, had surgery."
 "Lengthy phone calls, complete blood testing, lengthy examination & discussion of surgery, 1/2 hour discussion with  anesthesiologist."
 "Misleading, dishonest promises."
 "Meeting with doctor, video."
 " Many introductions."
 "Initial sales consultation, questionaire (sic), video, pre-op consultation."
 "Non-chalant, brief, misleading."
 "Info through mail was O.K. & phone conversations adequate -  but actual office meeting was quick - & not as reassuring as it could have been."
 "They quickly put me to sleep with very little explanation of the procedure."
 "Short talk, video."
 "Sent a packet of procedures to follow."
 "Discussion/film"
 "Very misleading."
 "Seen video, signed papers, that was it."
 "O.K."
 "Videos, counseling."
 "Where's your money?"
 "Information package, met with Dr. ______ the morning prior to surgery."
 "Interview, description with pictures."
 "Showed video, didn't mention scar."
 "Conversation with doctor and video."
 "Questionaire (sic), video, meeting doctor."

These quotes explaining procedures before surgery seem quite bleak.  Some of the patients were not comfortable with the situation but they went ahead with the surgery anyway.   Some men admitted that they did not shop around and merely went to the first doctor they found.  The information received seemed minimal considering the risks involved in such an invasive procedure.

Follow-up procedure examples include correspondence with staff, prescriptions, perceived levels of concern or interest, and medical check-ups.   Fifty-three cases rated their follow-up, which faired slightly worse than pre-operative procedures.  The mean was 3.3 (1.2).  The following are quotes regarding the patients' experiences with their follow-up:

 "I kept opening up and required to be restitched on several  occasions."
 "The doctor shows care - but no eye contact and appears not to ‘really' listen to concerns."
 "Doctor showed sincere interest in how I was doing and agreed to do follow-up procedure."
 "Dr. ____ didn't ask to see me for 8 days after surgery."
 "Very good follow."
 "Review of healing, photos."
 "2 min. ck. up sent me home to N.Y."
 "Again, I felt very alone & alienated.  Nurses were bad &  Dr._____  never came to see me."
 "Wasn't given enough information up front."
 "Doctor was extremely concerned and helpful w/ post-op care."
 "There wern't (sic) any."
 "3 days post-op I had a 5 mn. check up with nurse, then 3 or 4 telephone consults with nurse for next weeks"
 "Not very good."
 "Constant post-op attention until well enough to be driven to motel, phone call from Dr. @ 9 P.M. that night, 5 days of post-op observation & change of bandages, phone calls every 3 days for  month."
 "Would call or write after being contacted by myself."
 "Phone in follow-up."
 "Non-existent."
 "Fat refill in Nov. ‘95 did not fill in all depressions.  Excess fat area near lower head of penis."
 "There were none - except a check up the next days (3) & then I flew home."
 "There were none.  I would call and get a return call later  (maybe)."
 "Short exam."
 "Very wishey-washey (sic) on what I should do, no one to talk to about what I went thought (sic)."
 "Was none."
 "No follow up procedures were done."
 "2 more fat injections and scar reduction."
 "None offered."
 "Met with technician the day following surgery & phone calls (initiated by me) post surgery."
 "None."
 "None."
 "I had refilled, because the shape did look right."
 "Stayed in room & back to my hotel room."
 "There wasn't any."
 "None."

Follow-up procedures ranged from none at all to deep concern and very helpful.  They also ranged from moments after the surgery to many months later.  Much of the follow-up was rushed because most men had flights home.  Phone calls to the doctor and assistants were a very common means of follow-up.  During a visit to a doctor's office, the researcher was present when a physician's assistant instructed a patient, over the phone, how to take out his stitches.  To be safe doctors often suggest the patients stay close to the doctor's office for two weeks, when the stitches can be removed.  One man from Australia was on a flight home within 24 hours of his surgery.

Surgical Success

The patient's feelings regarding successfulness of the surgery sum up many aspects into one rating that defines the overall worthiness of the penile enlargement to them.  The researcher used a Likert scale ranging from one (best) to five (worst).  The mean success rating was leaning slightly to the negative side with a numerical value of 3.3 (1.3).  Three respondents did not answer this question.

One of the medical cross-reference questions asked whether the patient experienced an infection or other problem after their penile augmentation surgery.  Twenty-six respondents (44.8%) experienced an infection or problem, whereas 28 (48.3%) did not.  Four people (6.9%) did not answer this question.  The below-average successfulness rating and the even split of infections or problems are clear warning signs to future patients.  There can be many different meanings to "infections or problems" by non-medical laypersons, so the questionnaire asked for explanations of the ‘yes' or ‘no' response.  The following are quotes from the sample population in the order they were received.

 "I'm sure I had a little since I kept opening up."
 "Buttocks kept tearing at dermal graft sight.(sic)"
 "The whole incision area was infected w/ puss."
 "My penis got smaller & the injected fat got all lumpy after 6 months. It was hell!"
 "Incision around penis head reopened twice."
 "Slight infection."
 "Scarring, development of foreskin."
 "Lumps, scarring, hair requiring electrolysis, odd shape, difficult to put on condom, 2 (degree) ridge in penis."
 "Difficulty healing around incisions & sarcomas requiring draining and re-closure."
 "3 days after procedure penis became inflamed & sore!  Should give all its 12 days therapy of antibiotic instead of 5."
 "I was doing squat and the wound cracked open (approx. 3-4 weeks after the surgery)."
 "Rather than improvement, I am scarred- probably for life.  The procedure left no redeeming or desirable results, biggest  mistake of my life."
 "Other than needing a second refill after only eight  months."
 "Bad infection, with a bad oder (sic) which held up the healing."
 "There was an infection about 2 weeks following the surgery that required further antibiotics."
 "Stitches pulled out - partially my fault for not following directions."
 "Stiches (sic) broke loose had to bandage my self."
 "My wound did not close completely in one area because I removed the sutures too soon due to the discomfort they  caused."
 "The suture lines opened up causing wide scarring."
 "I thought there was infection on the suture line (puffy-colored  matter) & consulted my doctor (who was interested but knew  nothing of the procedure) & what prescribed 2 more courses of  antibiotics."
 "Stitches ripped out of one side."
 "Stitches did not hold well."
 "Scared (sic) because hard bumpy where stitches was."
 "Side wall of penis exploded leaving large dent."
 "Swelling at sutures."
 "Extreme pain which caused great problems with sleep,  walking, sitting, and getting out of bed. Other problems  resulting from surgery: 1) The fat for the first surgery was taken from only one side of my abdomen and left it asymmetrical after healing.  2) It is more difficult to expell (sic) all of my urine and therefore requires me to press on my  perineum to force residual urine forward and out.  I also have to do this more forcefully following ejaculation to force all of the  semen out.  3) Even one year following surgery, my penis exits my pubic area horizontally (when I am standing) for ~ 3/4"  before it curves downward."
 "Broken sutures, heavy scarring on left side of penis."
 "Bleeding and reopening of wound."

Due to the unrealistic expectations of the patients and lack of indepth information, surgical successfulness has suffered greatly.  Problems regarding surgical results cover all aspects of the surgery including scarring, swelling, torn sutures, infections and antibiotics.

The questionnaire devoted three questions to find out whether the respondent would have the surgery again if they had life to live over, if they would suggest their procedure to a friend, and what advice they would give to future patients.  These questions were very descriptive as you will see by the quotes.

If the sample population (n = 55) had life to live over again, 26 (44.8%) would have a penile enlargement but 29 (50%) would not.  Three people (5.2%) left the question blank.

Nineteen men (32.8%) said they would suggest the enlargement procedure to a friend whereas 33 (56.9%) would not.  Six men (10.3%) did not answer.  The respondents (n = 54) were asked why they would or would not suggest the procedure.  The following are their quotes.

  "Privacy reasons."
  "Not enough results for financial investment."
  "Too much scarring."
  "Most persons don't need the procedure."
  "Maybe now with Dr. ____ but only him."
  "Too personal."
  "If his penis was thin and I believed he wanted to thicken it."
  "I would let him know the expense involved & the results far less than expected."
  "This procedure is reliable and gives better results."
  "Would never discuss."
  "I would only suggest the lengthening procedure, not the girth procedure."
  "Too much scarring not enough results for financial investment."
  "Only an increase in flacid (sic) length is attained.  There is no improvement in erect length.  The resulting scarring is highly visible and quite unattractive, as is the apparent disformation (sic)."
  "If someone confided in me his disappointment with his penis size and asked my advice, I would suggest this procedure."
  "I see that other people have had good results."
  "If asked.  I would not offer up information that was unsolicited."
  "I don't know."
  "_____ Medical Group did not make any promises of high expectations.  Every was self-explanatory."
  "I'd suggest a procedure that didn't leave such bad scars on the buttocks."
  "But I think I would explain things to him better so he would have a better understanding of what to expect before and after."
  "Because I value my privacy."
  "I haven't seen any advantage."
  "Expen$ive (sic), painful, mixed results."
  "Hell no."
  "If I knew anybody that was going to have this surgery I would tell and show them my results."
  "Not with Dr. ______."
  "No I don't think I would as the lack of guarantees outweigh the costs."
  "It's their business if they want it."
  "To (sic) painful and it did not work for me."
  "Maybe but I would ask to see his penis erect before I would make that decision."
  "I don't think it was worth all the money or the pain."
  "Not willing to discuss the procedure with a friend."
  "Self image."
  "Yes, if has Peyronies. It is an approach to masking Peyronies - there are not many.  No, if has normal penis."
  "Because the surgery would make them look worse even deformed like myself."

Most men did not think the procedure was worth the pain or expense for results received.  The lack of information about the procedure would make these men valuable to future patients but unfortunately some patients felt their privacy and the privacy of the men who are considering the procedure to be too valuable.

The following are quotes from men who have advice for future patients:

  "Do enough research and don't just go to the first place you see."
  "Proceed w/ caution."
  "Try it if you want to."
  "Choose your surgeon carefully."
  "Pubic skin will make up part of penile shaft which  means you'll have to shave it off or else a part of penis covered in hair.  Don't expect erection gains but if flaccid gain all you want then you'll be satisfied. You must  keep pulling penis down otherwise tends to take odd  shape."
   "Consult the doctor thoroughly, the results of the surgery, and what to expect (not going to get a salami)."
  "Pick a good doctor."
  "Let Dr. _____ do it- ck (sic) out doctor very carefully talk to others who have had it done."
  "Don't go to Dr. ____, Dr. ____, Dr. ____ for any procedure. Do some serious investigation first."
  "Too much scarring not enough results for financial investment."
  "Talk to people who have had the surgery."
  "Deal with your small penis.  A 1/2 inch gain in flacid (sic) penis length isn't worth $3900.00.  The scarring and unattractive appearance resulting from the procedure can ruin your sex life forever."
  "Be realistic in your expectations.  Don't be disappointed if things don't turn out perfect.  Some improvement is better than none and better than having nothing done."
  "Go to surgery with your wife or a close friend. I went alone."
  "Make sure you receive accurate information and good follow through."
  "Lower expectations."
  "Take careful measurements and a picture of your penis before the surgery."
  "Select physician carefully."
  "Not worth it.  Results too poor to justify."
  "Very painful."
  "Talk to someone who had the surgery."
  "Be happy with nature."
  "Allow/prepare for physical limitations due to discomfort/pain."
  "No advice."
  "Follow thru (sic) on after care yourself."
  "Don't do it you'll regret it."
  "Pain."
  "Do not expect any change in erect length."
  "Don't rush into surgery.  Interview more than one physician."
  "Don't expect too much."
  "Don't."
  "The pain is much more intense than they tell you.  Avoid erections at all cost right after surgery."
  "Don't do it."
  "Do you really need this?"
  "Don't do it, if you think you have problems having a small dick, wait till (sic) you have a big scare (sic) and a little dick."
  "Don't its an expensive misstake (sic)."
  "Unless your penis size is very small and ugly don't do this procedure."
  "Do not remove sutures before you are sure wound is closed completely - Perhaps do not expect an increase in the erect size."
  "Expect potential problems with scar, lumpiness and hair growth on shaft."
  "Use a different Dr."
  "Be very sure its what you want.  Talk to someone who has had the operation (if you can).  Take counseling before and after the operation."
  "Don't do it."
  "Natural is the best."
  "Make sure you got minimal scarring and lay low for a while."
  "They should really think about it before doing, or talk to me so I can explain what they will go through."
  "Check doctors track record- i.e. numbers of law suits and references."
  "Be realistic."
  "To think!"
  "Balance the importance of modest penile enlargement with the high monetary costs, inconvenience of possible repeat visits, high levels and long duration of pain, and the likelihood of disappointments due to smaller than expected length increase and disappearance of injected fat leading to odd shapes."
  "Have to make up their own mind."
  "Don't have it done just don't do it.  This operation should be banned and the people performing them put in jail."

These final quotes sum up the entire procedure very clearly.  Overall the quotes were disappointing and negative.  The future patient is the only one to decide whether or not the procedure is right for him.  Shopping around for a doctor you feel comfortable with is very important.  A future patient must weigh the best and worst possible results with their expectations and expenses.

This extensive list of advice usually goes to waste because the men in this sample knew very few people who had already undergone an enlargement and knew even fewer people who are considering one.  Thirty-eight (74.5%) of the fifty one respondents did not know anyone who had had a penile enlargement. The range for those who did was from zero to six people.

Counseling

Therapists often ask how much counseling the men who decide to have a penile enlargement had before and after the surgery.  It is also important to ask what percent of the counseling or therapy regarded penis size.  As a sexologist and a researcher, these questions were posed to this sample.

Only nine men had been to any type of counseling the year before their surgery.  Of those nine the average was 1.7 times per month.  The range was from two times a week to once a year.  Over fifty percent (51.7%) of the time was spent talking about penis size.  The range of percentages went from 10 - 100%.

In the year after surgery, only seven men went for counseling.  Of those, the average frequency was .76 times per month and the range was from one time per week to twice a year.  Five men reported a percentage of time that was regarding penis size.  The average was 42% with a range from 5-100%.

Counseling is often an option if a man does not feel like he could tell anyone else his problems.  Many of the men in this sample were married or had significant others who knew about the surgery.  Forty-eight men revealed their penis to someone other than a medical professional within months.  The average time spent after surgery before showing their penis to another person was 1.5 months.  The range went from "immediately" to "still haven't" but only numerical answers were calculated.   Remember, the average length of time from surgery to when each man filled out his questionnaire was 12.2 months.

The respondents were asked whom, specifically, they showed their penis to first.   Ten men first showed another man whereas twenty three showed a woman first.  Twenty-nine men showed their lovers first.  Twelve showed their fiancées or wives.  Eight people showed a friend and another six showed a relative.   Three miscellaneous people were shown: an electrolysis technician, a date and a man at the gym.  Many men wrote more than one description of the same person so it is not clear how many each of the men had as a support system.

The questionnaire also asked the men who else knew of their plans to get a penile augmentation.  Sixteen men (25.8%) had shared with their wife and another six (9.7%) with their girlfriend.  Six men (9.7%) had shared with a partner or boyfriend.  Eight friends (12.9%) were told by the respondents as to their plans.  Two men told their brothers and one man shared with his mother.  Seven men had told more than one person.  The men revealed that they had been considering a penile enlargement for an average of 10 months before they went through with it.

Through all the good and bad experiences this sample had with this elective surgery, the final question asked what other cosmetic surgeries they had considered.  The following are their quotes:

 "Scar revision."
 "Arthroscopic knee" surgery.
 "Another dermal fat graft, eye wrinkle removal."
 "Facial plastic surgery"
 "Liposuction on chin"
 "Lazer (sic) surgeries to remove scare (sic)"
 "Thickening"
 "Liposuction, fat refill"
 "Scar removal"
 "Dermal fat graft"

Go to Chapter 6