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When weighing results against risk, be aware that, not only can some solutions be a hazard to men with...

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Dan Salas had obsessed over the smaller-than-average size of his penis for most of his adult life. He avoided joining the Marines for fear that he wouldn't "measure up" to other guys in the shower, and he stayed in unhealthy relationships because he was afraid his penis size would be a turn off to new sex partners. He became so preoccupied with his phallic dimensions that he gave up his los angeles apartment, and began sleeping in his car in order to save $12,000 for penis enlargement surgery.

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At last, Salas put down the cash for a phalloplasty procedure, only to discover the financial burden was just one of the downsides. For the first three weeks during his recovery he was awakened two to three times a night from unwelcome, nocturnal erections. Also, the operation he had sacrificed so much for cost him inches as well-- his penis shrank from five to four inches.

"Most websites and doctors downplay the negative side-effects and complications of penile surgery," claims Salas.

So he consulted with a medical doctor who informed him that for several months after his surgery his penis would actually retract and that excessive scar tissue could permanently shorten it. After the doctor introduced him to a device that was designed to stretch his organ back to size, Salas began the long-term process of trying to regain his original length, and then some.

Fixations on penis size and doubts about size-related sexual performance have become almost universal male preoccupations.

"For some reason, men equate size with manhood," says psychotherapist Dr. Ana Robles. "Even men of adequate size often feel there's something wrong, that they're small. But size definitely matters, because it builds self-confidence. A man feels more like a man, more sexual prowess, with a larger penis."

Dr. Richard Wineland, with the Anaheim Urologic Medical Group in Anaheim, California, says he's seen an increase during the past several years in the number of men seeking some form of phallic enhancement. "I would say we get four inquiries a week from men interested in surgery and other options," he notes.

Whether the goal is to increase penis length or girth, there are a number of effective methods (and even more ineffective ones). However, the matter should never be approached without extensive research and careful consideration of the hazards and expenses.

Interestingly, it's not those brandishers of below-average penises that attempt such modifications, but rather men who are already of average size. One has to wonder then, if some men are seeking to fill the phallic shadow of their blue-movie idols. The following information is offered as a reality check for those who are considering such a quest.

Ups and downs of penile augmentation

We live in an ever more pharmaceutical-dependent society, in which people assume there's a magic pill for every biological, physical, and mental malady. Factor in the desperation of men who feel they don't measure up, and it's no wonder companies are able to market truckloads of drugs that are about as productive as placebos.

"There are a variety of pills and creams that can give a man short-term-- less than one day-- enlargement of the penis," says pharmacist Dana Nelson. "But the duration is four-to-six hours only, and all medications have the potential for negative side effects, especially with people who have high blood pressure or diabetes."

Regardless of the poor results and high risks, these short-term solutions are so popular they account for a good portion of the billion-dollar penile-enlargement industry. The idea of making such an important, private decision based on claims-- neither scientifically nor medically validated-- by corporations that are trying to sell penis-growth pills is downright scary.

Drugs such as Enzyte, for example, don't actually do anything to permanently magnify your manhood. Makers of the popular supplement boast of its ability to enhance the penis to its fullest, but it's necessary to delineate between enhancement and actual growth. In the case of Enzyte, that means the smiling Bob character in the drug's TV commercial is the recipient of a firmer, fuller penis, not a bigger one.

Penis enlargement pills are made up of a number of herbal ingredients, including a sexual stimulant called yohimbe, and gingko biloba (a stimulant/vasodilator that changes blood flow by relaxing blood vessel walls). While these ingredients may temporarily harden erections, Viagra-style, and amplify energy, there's no evidence they contribute to permanent changes in penis length or girth. Penile upsizing solutions such as creams or patches are just as ineffective.

Some experts attribute the popularity of these supplements to a placebo effect. A man might feel better about himself thinking his penis has undergone permanent growth, even though there's no real physical change, save a harder hard-on.

Another misconception is that pumps are an effective tool for permanently increasing penis size. Negative-pressure vacuum pumps were originally introduced to draw blood into the penis capillaries, creating an otherwise impossible erection for men who suffer from chronic insulin-dependent diabetes or circulatory disorders. A temporary degree of length and girth enlargement can be obtained, but after the pressure is released, the swollen member will quickly return to its original size.

With catchy names such as Blue Veiner, Bull Fighter, Fireman's Pump, and Big Bazooka, the fact is that penis-pumpers provide more comic relief than increased phallic dimensions.

Gaining through gravity

Hanging weights from the penis is a practice that has withstood the test of time and has crossed many cultural barriers. Such rituals have been in place for an estimated 2000 years and are still popular in some African tribes. But be careful what you ask for! Stretching has a side-effect that might make you think twice before attaching anything heavy to your love hammer.

Along with length increase, some men have experienced a decrease in thickness. Also, depending upon the device used, there's the possibility of restricting blood circulation, which can lead to necrosis (death) of the tissue

One of the most successful, yet limited, methods for increasing penis length is done by carefully stretching tissue in a controlled manner over long periods of time with so-called "traction devices." Doubtless there are some insane solutions offered on the internet, so one should seek only medically-approved techniques. Dr. Wineland favors the "Fastsize Extender," a device developed and medically-approved in Europe. The secret to the success of the Extender, which has given users a one-to-two-inch gain, is in the unique design and the timed periods of recovery before resuming tension.

Surgical solutions: a cut above the rest?

While surgery is the most immediate solution to size concerns, it's expensive and has the highest risks of complications.

"Surgery does work, but should not be a man's first choice on his way to a larger penis. It's too traumatic," claims Dr. Nelson.

The most common penile surgery doesn't change the size or structure of the penis; it only makes it appear longer by cutting the abdominal ligaments that anchor it to the body, and extruding the part of the penis that usually runs inside the abdomen (mini-abdominoplasty). The disconcerting drawback to this process is that during intercourse, because of the dissected ligament, the penis can slip and shift, resulting in a "jarring" sensation.

To prevent shrinkage during the healing process, the patient must hang weights from his penis on a daily basis for a few months following the procedure. In order to increase girth, another operation involves the transfer of skin from other parts of the body, or tissue from cadavers, to the penis. As with any surgery, though, all of these methods carry the risk of infection, but most unnerving is the possibility of ugly results from complications.

The now severed ligament, which normally serves as a kind of erection crane, can lose its ability to fully hoist up the excited member. Although inconvenient, a southern-pointing penis might not be as aesthetically undesirable as yet another syndrome. After surgery the flaccid penis can sink even further into the nut-sac pillow, creating an effect known as "scrotal dog ears" and looking like the long snout of man's other best friend.

But wait, it gets worse! Since body fat doesn't reabsorb evenly, a man could very well end up with a knot-lined, contorted cock that seems, well, Frankensteinian. To their horror men have reported post-surgical monstrosities that look more like twisted ginger roots than sex organs.

Modesty prevents many men from exposing their damaged dicks (and the surgeons who are responsible for the blunders), but some have taken their cases to court and won. A total of $6 million was rewarded to two men in one 1998 case against a Toronto surgeon.

Patients are not the only ones making hindsight decisions based on the negative outcomes of penile surgical procedures.

At one time, Gary Alter was one of the top phalloplasty surgeons in the country. Not willing to deal with the complications of his handiwork any longer, Alter has abandoned the procedure and spends a great deal of his time reversing the damage done by past operations.

The charge of discovering safer, more effective surgical techniques for phallic enlargement is one of never-ending trial and error. Recently, specialists in the phalloplasty field thought they had found a solution to problems with trying to increase girth.

The procedure involves taking strips of skin from the patient's buttocks and other areas and slipping them under the skin of the penis. The risk of lumpiness is decreased because-- unlike fat-- dermis doesn't reabsorb into the body unevenly. One can still end up with nasty scars however, and when all is said and done, you're still robbing Paul to pay Peter.

The decision to make below-the-belt alterations could be the most important one you'll ever make. So whether you choose to grab a tape measure and start popping pills, begin a regimen of stretching, pulling and prodding, or take the riskiest of routes and go under knife, let patience and common sense be your guide in making that choice.