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Penis enlargement, sometimes euphemistically called male enhancement, are techniques alleged to increase the girth, length, or hardness of the human penis. Often, in the advertising of fraudulent products, the distinction between temporary enlargement, i.e. erection, and permanent enlargement, is deliberately muddied.

Procedures range from manual exercises to stretching devices and surgical procedures, with reports of successes and failures around the world. While some of these are known to be outright hoaxes, other techniques can produce some measure of success.

Little legitimate scientific research has been done specifically on penile enlargement, so any claims of significant and permanent enlargement can be biased or anecdotal. General research has been done regarding the efficacy (or lack thereof) of the contents of the pills; otherwise, one assumes, mainstream medicine would have made use of them if they indeed worked in any setting. There are also risks inherent to some of the more invasive procedures, with negative outcomes ranging from the tearing of skin and scarring, to permanent loss of sexual function. Due to the speculative nature of any hope for "improvement" and the many known cases of permanent injury involved in this endeavor, many medical professionals are sceptical of the subject.^[1]

At present, there is no proof of any non-surgical technique that permanently increases either the thickness or length of a normal penis.

A variety of options exist for treating erectile dysfunction. The cause and severity of your condition, and underlying health problems, are important factors in your doctor's recommending the best treatment or treatments for you. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner's preferences also may play a role in treatment choices.

Oral medications

Oral medications are a successful erectile dysfunction treatment for many men. They include:

• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra)

All three medications work in much the same way. These drugs enhance the effects of nitric oxide, a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation. These medications vary in dosage, how long they work and their side effects. Your doctor will take into account your particular situation to determine which medication may work best.

Possible side effects include flushing, nasal congestion, headache, visual changes and stomach upset.

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Other medications

Other medications for erectile dysfunction include:

Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject Impulse, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include papaverine, alprostadil and phentolamine. Each injection generally produces an erection that lasts about an hour. Because the needle used is very fine, pain from the injection site is usually minor. Side effects can include bleeding from the injection, prolonged erection and formation of fibrous tissue at the injection site.

Alprostadil penis suppository. Alprostadil intraurethral (Muse) therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra. The erection usually starts within 10 minutes and lasts between 30 and 60 minutes. Side effects can include pain, minor bleeding in the urethra, and formation of fibrous tissue inside your penis.

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Testosterone replacement. Some men have erectile dysfunction caused by low levels of the hormone testosterone, and may need testosterone replacement therapy.

Penis pumps, surgery and implants. Medications may not work or may not be a good choice for you. If this is the case, your doctor may recommend a different treatment. Other treatments include:

• Penis Pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis. Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device. The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation may not be as forceful. If a penis pump is a good treatment choice for you, your doctor may recommend or prescribe a specific model. That way you can be sure it suits your needs and that it's made by a reputable manufacturer. Penis pumps available in magazines and sex ads may not be safe or effective.
• Penile Implants. This treatment involves surgically placing devices into the two sides of the penis. These implants consist of either inflatable or semi rigid rods. The inflatable devices allow you to control when and how long you have an erection. The semi-rigid rods keep the penis firm but bendable. This treatment is usually not recommended until other methods have been tried first. As with any surgery, there is a risk of complications such as infection.

Psychological counseling. If your erectile dysfunction is caused by stress, anxiety or depression, your doctor may suggest that you, or you and your partner, visit a psychologist or counselor. Even if it is caused by something physical, erectile dysfunction can create stress and relationship tension.

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