Jelqing: The latest in a long history of attempts to enlarge the male member

Advice about a penis-enlargement method called jelqing (also "jelquing") is being widely shared online. Posts advise that stretching a semi-erect penis could add up to an inch in length and girth by exploiting the body's repair mechanisms.

Jelqing is just the latest in a long line of dubious penis enlargement techniques stretching (sorry) back millennia.

The ancient Greek method of lengthening the foreskin with a kynodesme (dog leash) seems positively mild compared with ancient Indian methods. A Sanskrit text on medicine and surgery, called the Sushruta Samhita, advises rubbing the penis with bristled insects, then oils and then more bristled insects, which probably caused short-term enlargement due to infection or inflammation.

Then there are the men of the Brazilian Topinamá tribe who, in the 16th century, allowed poisonous snakes to bite their penises to increase size.

These days, pills are more likely to be proffered as a method of penis enlargement. They are far less painful than bristled insects and poisonous snakes, but equally as ineffective.

Most penis-enlargement pills are probably nothing more than vitamins. Although there are drugs, such as Viagra, that enhance the stiffness of the penis, they treat erectile dysfunction.

Penis pumps are also used for erectile dysfunction, but unlike some online claims, they don't lengthen the penis. And persistent or incorrect use of these devices can lead to bruising, bleeding or penile tissue death.

Penis stretching devices require significant daily time investment over prolonged periods. There are small studies that show some improvement, but these are over ten years old and haven't led to larger studies or a revolution in treatments.

Surgical interventions

Penoplasty or phalloplasty surgeries are most effective for lengthening the penis. They are typically used for men with a decreased penis length following prostatectomy (removal of the prostate gland) or other conditions where the length of the penis is affected by structural factors, such as being buried by skin.

Fillers are increasing in popularity, particularly hyaluronic acid (HA) injections. HA is popular because it is doesn't generate an immune response. Injections with this substance increase penis volume and draw water in. Some trials have shown "significant enhancement of girth".

However, HA is broken down over several months and requires top-ups. And incorrect administration can have serious side-effects, from infection to preventing urination.

Surgery to cut the suspensory ligament anchoring the penis is the most widely accepted surgical elongation method. This surgery alters the angle that the penis hangs from the body, increasing the appearance of length. It can also be combined with liposuction to reduce pubic fat, but these surgeries have poor satisfaction rates.

Fat transplantation from another region can enhance girth, with some success. However, about 30% of the fat is lost in the first two months, and scar tissue and infections are common, which can cause longer-term complications and, occasionally, even death when the fat breaks free and causes an embolism.

Implants, which come as inflatable and non-inflatable, are used to treat erectile dysfunction. But they are also used cosmetically for penis enlargement. The results, though, are not great. There have been various reports of lack of satisfaction for the patient and their partner, infection, damage to internal organs, complications such as "floppy glans syndrome" and, in some cases, death.

A recent review concluded that evidence for supporting surgical procedures for penis enlargement is weak and the complications are under-reported.

Not needed, in most cases

Penis enlargement surgery is the second most sought after cosmetic surgery in men. But only men with a micropenis may need treatment.

A micropenis, usually diagnosed at birth, is where the penis is 2.5 standard deviations less than the average stretched penis length (2.3 to 2.5cm depending on ethnicity). It is typically caused by a deficiency or imbalance of hormones such as testosterone or human chorionic gonadotropin (hCG), or genetics.

Micropenis usually responds to hormone therapy in childhood, bringing size to the normal range.

Other than a man's desire for a larger penis, is there any anatomical benefit?

The average male penis is between 5.1 and 5.5 inches in length, with a recent study showing the latter value is a 24% increase on three decades ago. The female vagina is on average 2.5 to 3.8 inches deep, but lengthens during sexual arousal to accommodate a penis longer than this.

Research studies also show that penile girth is a more important characteristic than length for sexual satisfaction and there is no definite consensus on length correlating with sexual satisfaction—at least for heterosexual couples. The female genitalia have multiple erogenous structures that can result in orgasm, so penile length isn't the key characteristic.

A closer look at jelqing

The penis consists of three cylindrical structures. Two corpus cavernosum and a corpus spongiosum. The top two consist of numerous spaces that are surrounded by smooth muscle, which keeps most blood out of the spaces.

During an erection, the muscles relax allowing blood to flow in, filling these spaces, and enlarging penile volume. This enables penetration to occur. Among and around these structures are various bundles of connective tissue, primarily collagen.

Jelqing appears to try and exploit the body's repair mechanisms to heal microtears in the penile tissues, in the same way microfractures in bone and microtears in skeletal muscle heal bigger and stronger.

While the theory sounds good, smooth muscle cells in the penis don't respond in the same way skeletal muscle does. Smooth muscle increase in size is usually due to disease or damage, and more importantly, when the penis is erect, the smooth muscle cells are actually relaxed and not working, so are not going to increase in size.

Jelqing also increases the risk of developing Peyronie disease where scar tissue formation under the skin of the penis causes excessively curved erections and pain, particularly in the acute phase where the scar is still growing.

Scar tissues are weaker and not well aligned, jeopardizing normal function. Penile scar tissue reduces penile blood flow causing inability to get or maintain an erection. Developing this condition will also result in a shortening of the penis.

If jelqing, or any other trend, was really that effective, we would have seen evidence of it in medical journals, and the sale of extra-large underwear would be making the headlines.

This article is republished from The Conversation under a Creative Commons license. Read the original article.