Male esthetic genital surgery: recommendations and gaps to be filled

Abstract

The reason behind the spread of penis enlargement practices over time is rooted in the virility that the appearance of the genitals can give a man, as well as an altered perception of his own body. The approach should be to modulate the interventions on the real needs of patients, carefully evaluating the history, the psychological picture, and possible surgical advantages. The aim of this study was to shed light on cosmetic surgery of male genitalia through minimally invasive and more radical techniques, with the purpose of laying the foundation for possible indications and recommendations for the future. A non-systematic literature review using the PubMed and Scopus databases was conducted to retrieve papers written in English on cosmetic surgery of the penis published over the past 15 years. Papers discussing cosmetic surgery in patients with concomitant pathologies associated with sexual dysfunction were excluded. The main outcomes recorded were change in penile dimensions in term of length and girth and surgical complications.

Penile Distortion Caused by a Large Epidermal Cyst after Augmentation Penoplasty: A Case Report

“…As a man's perception of his penis has a significant effect on sexual identity and self-esteem, some male patients undergo aesthetic genital surgery to change the appearance of the penis or scrotum [9]. Therefore, various options for penile augmentation have been developed, including surgical methods such as lipoplasty, suspensory ligament release, flaps, or grafting, in addition to non-surgical methods of injecting silicone, fat, and fillers [10][11][12]. After penile augmentation, major complications such as wound dehiscence, infection, hematoma, adhesion, and glans numbness and minor complications such as paradoxical shortening due to adhesion and erectile malfunction can be observed.…”

“…After penile augmentation, major complications such as wound dehiscence, infection, hematoma, adhesion, and glans numbness and minor complications such as paradoxical shortening due to adhesion and erectile malfunction can be observed. Rare complications such as foreign body reactions and epidermal cyst formation due to implantation of epithelium after incomplete de-epithelization have been reported after injection, implantation, and grafting [10,13,14].…”

Clinical recommendations on penile reconstructive and prosthetic surgery: a consensus statement from the Asia-Pacific Society of Sexual Medicine

“…Furthermore, there are no clear guidelines or standardization of the procedures in this vulnerable subgroup. A buried penis is a medical condition in which the overlying prepubic skin and fat obscure a normal-sized penis, making it appear smaller or less visible 86 , 87 . It is important to distinguish this condition from micropenis, which is defined by an erect penile length of at least 2.5 standard deviations smaller than the mean human penis size 88 .…”

“…While advances in surgical techniques and the development of novel agents in this field have made possible aesthetic improvements in the male genitalia, it is important to address any underlying psychological and physical issues before consenting these patients for aesthetic penile surgery 60 , 86 , 87 . Clinical evaluation should include a detailed examination of the male genitalia (such as penile stretched length, size, plaque, and prepubic fat pad) while digital photographs and penile CDU can be useful to document relevant clinical findings pertaining to the proposed aesthetic surgery 60 , 74 .…”

“…Evaluation of the patient’s reason(s) for the aesthetic surgery, exclusion of psychiatric problems, and documentation of the patient understanding of the realistic expectations are critical factors to ensure satisfactory outcomes for both the patient and surgeon 60 , 89 . Many of these penile aesthetic procedures, which are often promoted as relatively safe surgeries with minimal risks, can have poor long-term aesthetic outcomes and importantly, significant complications such as altered sensation, ED, and loss of the penis 74 , 86 , 87 , 89–92 .…”