The SMSNA’s Position on Cosmetic Penile Enhancement Procedures

The SMSNA’s Position on Cosmetic Penile Enhancement Procedures

Penile cosmetic enhancement procedures aim to increase the length and girth of the penis, both when flaccid and erect. These treatments range from less invasive filler injections to more invasive surgeries. However, mainstream medical societies, like the International Society for Sexual Medicine, generally do not recommend these procedures due to a lack of published data on their safety and efficacy. Unlike treatments for medical conditions, penile enhancements are purely cosmetic and are therefore judged by stricter standards.

None of the current enhancement procedures have undergone rigorous testing for safety and efficacy, unlike approved medical devices and medications. Furthermore, many men seeking these procedures may have psychological conditions such as body dysmorphic disorder, which is a mental health condition where a person becomes excessively preoccupied with perceived flaws or defects in their appearance.

Studies on average penile sizes show that most men seeking these procedures have normal-sized penises. Given the potential risks, the Sexual Medicine Society of North America (SMSNA) advises careful consideration and psychological assessment before proceeding with these treatments. While the SMSNA supports scientific research and innovation in sexual health, the society cautions against illegitimate therapies and false claims.

Injection Procedures

Injectable fillers, such as hyaluronic acid (HA) and polyactic acid (PLA), can temporarily increase penile girth with moderate safety. Studies report HA and PLA can increase girth by 2-2.5 cm but may reduce over time, with some men experiencing mild adverse effects like pain and inflammation, effects that usually resolve on their own. Still, data are limited, and the SMSNA urges more safety and efficacy studies under approved research protocols. Permanent fillers like silicone and paraffin, on the other hand, are strongly discouraged due to severe long-term complications. These fillers can cause serious issues requiring complex surgical removal.

Suspensory Ligament Division

Suspensory ligament division (SLR) is a surgery to lengthen the flaccid penis. It may involve placing a silicone spacer in the penis to prevent ligament reattachment. Results show an average length increase of 2.5 cm (flaccid) and 1.9 cm (stretched). Potential complications include infection, pain, and penile instability. The SMSNA recommends psychological assessment before surgery and finds SLR to be reasonable when offered by experienced surgeons to select patients who have been properly informed about the potential risks of the surgery.

Graft-and-Flap Procedures

Graft-and-flap procedures aim to increase penile girth using various tissues. These methods show girth increases of 1.5-5 cm but carry risks such as scarring, infections, and variable satisfaction. Due to limited and diverse data, the SMSNA advises against these procedures outside of research settings.

Silicone Sleeve Implants

Silicone sleeve implants increase penile girth and length. Initial results show satisfaction and size increases, but complications include infection, erosion, and severe long-term issues like erectile dysfunction. The SMSNA recommends these be done as investigational procedures under research oversight due to unclear long-term risks.

Sliding/Slicing Techniques

Sliding/slicing techniques aim to lengthen the penis during prosthesis implantation. While effective in increasing length, they can cause severe complications like glanular necrosis. These procedures are considered by the SMSNA to be experimental and should be performed only by experienced surgeons under research protocols.


A major issue with penile cosmetic procedures is the lack of high-quality studies, making it hard to understand the true risks and benefits. This lack of data means informed consent is limited, so some treatments must be considered experimental.

The SMSNA recommends multicenter, long-term studies to track complications of cosmetic penile enhancement procedures. They also suggest that the Food and Drug Administration (FDA) re-evaluate some of these treatments as experimental due to their potential for severe long-term issues. In the end, better data would help patients and doctors make informed decisions about these cosmetic procedures.


Trost, L., Watter, D. N., Carrier, S., Khera, M., Yafi, F. A., Bernie, H. L., Ziegelmann, M., & Köhler, T. (2024). Cosmetic penile enhancement procedures: An SMSNA position statement. The Journal of Sexual Medicine, 21(6), 573-578.

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