REVIEW Penile Girth Enlargement Strategies: What’ s the Evidence? Marah C. Hehemann, MD, 1 Maxwell Towe, BS, 2 Linda My Huynh, MSc, 2 Farouk M. El-Khatib, MD, 2 and Faysal A. Yafi, MD, FRCSC 2 ABSTRACT Introduction: Most men seeking penile girth augmentation have physiologically normal penises but may suffer from severe preoccupation with penis size known as penile dysmorphophobic disorder. Aim: To describe the medical, procedural, and reconstructive techniques available for penile girth enhancement and to review the success and complications of each modality. Methods: A comprehensive review of peer-reviewed publications on the topic was performed through a PubMed search. Key search terms included penis, enhancement, enlargement, phalloplasty, reconstruction, girth, and augmentation. Main Outcome Measure: We wanted to summarize the motivations behind penile girth enhancement and review the outcomes for girth augmentation treatments. Results: Various medical, traction, injection, prosthetic, and reconstructive modalities have been studied for penile girth enhancement, with increases in girth ranging from 0-4.9 cm. Complications were reported in a minority of patients, but they may be devastating and include penile fibrosis, sexual dysfunction, device infection, and death. Conclusion: A variety of penile girth augmentation techniques have been studied. Clinical guidelines are lacking, and complications of penile girth enhancement are likely underreported. Until more rigorous investigation with accurate reporting of complications is achieved, penile girth augmentation procedures should be considered experimental. Hehemann MC, Towe M, Huynh LM, et al. Penile Girth Enlargement Strategies: What’s the Evidence? Sex Med 2019;XX:XXXeXXX. Copyright Ó 2018, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved. Key Words: Penile Augmentation; Penile Enhancement; Penile Girth; Phalloplasty; Penile Dysmorphophobic Disorder INTRODUCTION Throughout history, the penis has been regarded as the domi- nant symbol of masculinity, engendering significant anxiety about penile length and girth in many men. 1,2 Although the average erect penile length and girth are 13.1 and 11.65 cm, respectively, men who perceive their penis to be smaller than average account for as much as 91% of the general population. 3,4 Because this precon- ception is further proliferated by mainstream media, men are increasingly seeking medical solutions for “inadequate” size. 5 Although numerous indications and strategies exist for penile lengthening, there is neither clinical recommendation nor current literature that adequately describes motivations or strategies solely for penile girth enlargement. 5,6 In distinction to girth restoration (eg, in those undergoing surgical treatment for Peyronie’s disease [PD]), girth enhancement is typically performed only for cosmetic and psychological reasons—similar to that seen with breast augmentation. 7 In this review, we highlight potential motivations behind penile girth enlargement, as well as the various medical, traction, injection, prosthetic, and reconstructive modalities commonly used in urologic and plastic specialties (Table 1). PENILE DYSMORPHOPHOBIA Most men who seek penile augmentation have a normal-sized penis by clinical standards. 21,22 These men may suffer from penile dysmorphophobic disorder (PDD), a subtype of body dysmorphic disorder (BDD) that is defined in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, as a pre- occupation with a minor or non-existent flaw in body image that Received September 6, 2018. Accepted November 11, 2018. 1 University of Washington, Department of Urology, Seattle, Washington, USA; 2 University of California Irvine, Department of Urology, Irvine, California, USA Copyright ª 2018, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.sxmr.2018.11.003 Sex Med Rev 2018;-:1e13 1