He married, had children and learned to live with his unease. Then, four years ago, after separating from his wife, he asked a new partner how he measured up to her ex-husband. “It was a stupid question,” Alistair admits. “It’s pathetic that I cared at my age – but I did. To start with she told me it was fine, but I kept pushing and, eventually, she just told me: his was bigger.”
Richard, a mechanic from upstate New York, is a muscular, athletic guy. He has a loving wife who has always enjoyed their sex life. But ever since he was a young boy, Richard couldn't get over the feeling that his penis was too small. In public bathrooms, he'd use the handicapped stall. He felt embarrassed in gym locker rooms and when standing naked before his wife. "I didn't feel manly enough," he tells WebMD.
As the name implies, the traction method involves the phallus being placed in an extender and then stretched daily. One team of researchers quoted in the study reported average growth of 0.7 inches (flaccid) in participants who used the method for four to six hours each day over four months. Another team reported an average increase of nearly an inch (0.9 inches, flaccid) plus some slight improvement in girth after similar treatments lasting a course of six months.
Something extraordinary was also taking place at Berkeley Nutraceuticals, the Cincinnati, Ohio, startup behind Enzyte. The company, founded by Steven Warshak, eventually sold 13 different herbal products with vaguely medical-sounding names like Rovicid (allegedly enhanced sex), Ogoplex (allegedly intensified orgasms), and Keflex (allegedly masked drug traces in urine), but it was Enzyte that became the corporate gold mine.
"They're a complete waste of time," says Professor Wylie. "Pills and lotions have no proven benefit. If they were effective, they would be on sale at chemists. Using a lotion may help a man become more familiar with his penis, which some men shy away from. So lotions can help a man become more comfortable with his penis but they certainly won't make it any bigger."
At his Harley Street clinic, Dr Roberto Viel is explaining how a typical enlargement works. First, surgeons sever the organ’s suspensory ligament, causing it to hang an inch or two lower, giving the impression of extra length. They then extract fat from the patient’s stomach and inject it into the penis shaft, increasing girth by around two inches. Erect, it’s worth noting, it remains roughly the same size, suggesting the motives for many men are not necessarily to enhance either their – or a partner’s – sexual experience.
• Exercise regularly. Exercise improves arterial health, allowing more blood into the penis. But exercising the penis itself is pointless. The sex media sometimes refer to the penis as the "love muscle," implying that like the biceps, certain exercises can buff it up. But there are different kinds of muscle tissue. The penis contains smooth muscle, not the kind that gets bigger with exercise.
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Performed on the halfway tumescent penis, jelqing is a manual manipulation of simultaneous squeezing and stroking the shaft from base to corona. Also called "milking", the technique has ancient Arab origins. Despite many anecdotal reports of success, medical evidence is absent. Journalists have dismissed the method as biologically implausible, or even impossible, albeit unlikely to seriously damage the penis. Still, if done excessively or harshly, jelqing could conceivably cause ruptures, scarring, disfigurement, and desensitization.
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Not all operations leave happy customers – infections and scarring are both potential side-effects (“This is the same as an operation of any kind,” Viel says). Some men report a decline in angle after the suspensory ligament is cut, but according to David Ralph, a professor of urology at UCL, “By and large, patients don’t complain about that. The operation doesn’t change the erect length at all – this is only for men who have anxiety about how they look in the changing rooms. The average increase in size is 1.3cm, less than the diameter of a 1p coin. In my clinics, I show patients one of these and ask if they still think it is worth it. Less than 5% decide to, and of those who do, the satisfaction rate is just 20%.”
Sometimes men with erection problems or a diminished libido have low levels of testosterone, Boyle says. Testosterone deficiencies can also affect mood and energy levels. Boyle tests for testosterone levels and prescribes it as a topical gel, though she warns it is only safe when prescribed and monitored by a physician. Nonprescription testosterone, such as the kind used by some bodybuilders, is dangerous, she warns.