New surgical procedure enables men born with a very small penis to acquire an average-sized one

Dec 6 2004

A surgical procedure being pioneered by University College London (UCL) urologists is enabling men born with a very small penis to acquire an average-sized, functioning penis which not only allows them to urinate normally, but for many, to enjoy a full sex life for the first time.

In a talk to be given on Wednesday 8 December at the European Society for Sexual Medicine conference in London , Dr David Ralph will present the results from recent operations performed at UCL to correct the condition known as micropenis, which is though to affect 0.6 per cent of the population. Whereas the average size of the human penis is around 12.5 cm or 5 inches, a micropenis spans less than 7 cm or just over two inches.

A micropenis can develop from inadequate testosterone in the 2nd and 3rd trimester of fetal growth, although there may be other causes such as genetic make-up or androgen insensitivity, where the fetus begins as a male but is insensitive to the male hormone testosterone during growth. A number of treatments are available or alternatively gender reassignment may be considered.

Phalloplasty or penile enlargement involves cutting a flap of skin from the patient's forearm and shaping it into a penis four or five inches long. To maintain erogenous sensation, the original penis is incorporated into the surface of the transplanted skin. Patients receive a urethra to enable them to urinate, and an inflatable penile prosthesis to allow an erection to engage in sexual intercourse.

UCL surgeons performed the operation on nine men aged 19 to 43 with a range of medical backgrounds, including three hermaphrodites and two men who had problems with androgen (the group of hormones which includes testosterone), one of whom became deficient in androgen after chemotherapy.

Following surgery, all patients were found to be satisfied with the cosmetic appearance of their penis, with four patients able to urinate standing up and four able to have regular sexual intercourse. However, in several cases multiple complications arose, such as an infection or a shift in the cylinder position, with subsequent revision operations needed.

Dr David Ralph of UCL's Institute of Urology says: “This operation can change the life of young men, improving their self-esteem and quality of life and allowing many of them to have sexual intercourse, sometimes for the first time in their life. However, patients should be aware of the high risk of complications from this procedure.”