Dear Dr. G,I am a 25-year-old man who is experiencing lockdown like everyone else.Out of boredom (and a great deal of courage), I have decided to confront one of my biggest challenges in life, the size of my manhood.I am sexually inexperienced. So far, I have had two sexual partners during my university days.Sadly, both of them commented that I am “not so blessed down south” and not match up to expectation. Therefore, both relationships had no happy endings.During the movement control order, as I have more free time, I began to look into medical literature on “how small is small” and investigate the “shortchanged remedies”.While doing all the investigations, I have come across numerous operations, lotions and potions on penile enlargement.For the benefit of your other “shortchanged” readers, I am hoping to put Dr. G on the spot on issues regarding penile enlargementFirst of all, how small is small?Do penis enlargement supplements really work?What are the risks and side effects of these supplements?What operations are done for men with small penis?When should a person see a doctor or consider surgical procedures?Yours truly,Shortchanged Steven Penile enlargement is the application of any technique aimed to increase the length or girth of the human penis. These can generally be divided into surgery, physical traction, pills and lotions. Surgical methods are the most scientifically robust ways to enlarge the male genitalia. All the other methods are generally considered unproven. The surgical techniques to enhance the penile sizes include the release of penile suspensory ligaments and penile bulking injections. The suspensory ligament of human penis is the structure at the base of the pubic bone that plays a role to hold the penis steady. This tends to refract the penis inwards during a flaccid state. Cutting the ligaments is proven to increase the flaccid length of the penis, but the overall increase in erect length is less pronounced. The operation is also well known to cause difficulties in stabilising the penis during penetration. Some even reported weaker erection and loss of sensation after the operation. Other penile augmentation is the injection technique to engorge the girth of the penis by infiltrating bulking materials or grafting fat cells into the shaft of the penis. Although the bulking agents such as silicon and fat can make the penis look and feel more engorged, the injected penis may look deformed and out of shape. Moreover, the transient increase in size tends to disappear with time. The American Urological Association considers the division of suspensory ligament and the injections of fat, dermal fillers, silicone gels non-efficacious and even unsafe. In fact, all the procedures are reported to be associated with scarring, leading to penile shrinkage and erectile dysfunction. The other technique of utilising traction to increase the length of the penis is also considered unproven and dangerous, and the excessive traction may induce irreversible traumatic injury to the penis. To date, no lotion or potion that claims to induce penile enlargement can stand the scrutiny of science. The penile supplements available online can come in pills, patches and ointment. Recent analysis of the products revealed the ingredients of standards vitamins, minerals, hormones and herbs. The claim of penile size increase has no scientific basis. The testimonial evidence may be placebo in nature and generally anecdotal. The consumption of the supplements that contain vitamins and harmless herbs are generally risk-free. However, adulterated supplements with steroids, hormones or medicines such as Sildenafil will have the risks to patients with contraindications. Patients with heart disease or certain cancers such as, prostate cancer are certainly at risks. The 2019 International Society of Sexual Medicine Reviews found that men with micropenis are the only group of men whom may benefit from the surgical intervention. Micropenis is only diagnosed for men with penile length that is at least 2.5 standard deviations smaller than the normal human penis. It is generally acceptable to have the measurement of less than 7cm long, as compared to the average erect penis of 12.5cm. This is believed to affect 0.6% of the general population. In the same report, it revealed men with average, or below average size penis to undergo surgical intervention can be “damaging both to physical and mental health”. According to the study, “the overall surgical treatment outcomes were poor, with low satisfaction rates and significant major complications including penile deformity and shortening!” My all time favourite quote from the American humorist, Mark Twain states: “It’s not the size of the dog in the fight. It’s the size of the fight in the dog!” Of course, it is always possible to keep up with the Joneses when it comes to the size of your car, house or even bank accounts. When it comes to God being unkind and not offering his blessing down South, it is simply impossible for the reversal of fortune. 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