From dysmorphia to disasters: What it’s really like to be a penis surgeon

Gordon Muir is a consultant urological surgeon at London Bridge Hospital in the UK who helps patients with prostate and testicle problems, erectile problems and other men's health issues.

“The majority of men think it’s smaller than it is,” says Gordon Muir, a consultant urologist who has travelled the world fixing penis enlargements gone wrong. Is there any safe way to enhance your size, and do you even need to?

“If a young man washed up on a desert island as a baby, and all he had with him was a picture book about NBA basketball, he’d be convinced he was a dwarf by the time he got rescued,” says Muir. “It’s the same with penises.”

Muir, a consultant urologist, has spent a large part of his career thinking about men’s genitals. After graduating with a degree in medicine from the University of Glasgow in 1984, he served as a medical officer in the army, and later completed his post-graduate training in surgery and urology at the Royal Marsden and St George’s Hospitals.

Since 1996 he’s been a consultant at King’s College Hospital and a senior lecturer in surgery at King’s College London, where he has published over 100 scientific papers focused on penile size problems and genital anxiety in men. In 2016, he published the largest review of penis size ever conducted (on average 3.6 inches flaccid, 5.2 inches erect, in case you’re wondering).

In short, for men who are worried about measuring up, Muir is the person to ask. And if his work is any indication, there are more than a few.

“The majority of men tend to think their penis is smaller than it is because they don’t know how to measure it, or they think the average penis is much bigger than it is,” says Muir. “That became worse during lockdown because a lot of younger men were sitting at home, not seeing any other human beings, except on Pornhub [a pornography website]. You don’t get a job as a porn actor unless you have an abnormally long, straight penis. Men get a false idea of what is normal.”

Of course, the average man might well simply shrug and make the most of what nature gave him. But for an increasingly large number of others, alternative options do present themselves.

Penis enlargement surgeries are as old as the field of aesthetic surgery itself. But while the offer of bigger genitals might tempt some, Muir contends it has never been achieved.

‘There is no safe way to make the penis bigger’

“There’s a reason it sounds too good to be true: it’s not true. There is no safe way to make the penis bigger,” says Muir, who has travelled the world fixing penis enlargements gone wrong, doing hundreds of surgeries in the process, and helping counsel men whose lives have been devastated by the “charlatans” he says still promote the practice.

“It’s desperately sad. The majority of these men have nothing wrong with them, their partners are happy with them, but they feel they are smaller than average and these avaricious, disreputable clinics encourage that.”

The practice hit the headlines in Britain earlier this year after a Harley St doctor – who was offering such surgeries – became embroiled in a public row with a patient who claimed a £3500 ($7815) “penis filler” operation had left him with a “misshapen” penis.

While £3500 ($7815) might sound expensive, Muir has met patients who’ve paid upwards of £40,000 ($89,310) to surgeons offering a solution to their “problem”.

‘These clinics will try to get as much as they can out of you’

“In most of these clinics, you see a salesman who gauges how gullible you are, how much money you’ve got, and they take that off you,” he says. “There’s no price list. They will try to get as much as they can out of you and offer finance plans if you’re not wealthy enough.”

Patients come from all walks of life, though Muir says they tend to be younger, slightly introverted and struggling to form relationships, which they often blame on their penis.

Men who’ve put on weight are also often at risk of penile dysmorphia, sometimes thinking their manhood has “shrunk” when in reality, the fat around the base of it has just grown.

“Educating men on what is normal and what partners actually want – both subjects of my research – is the first step and usually helps men realise they don’t have a problem,” says Muir. “I just hope those men will come to someone like me before they go to a high-street clinic which will confirm their fears and hustle them into surgery.”

The surgeries themselves come in many different forms.

A recent phenomenon is the “penuma”. Approved by the Food and Drug Administration in the USA, the device is a silicon ring which is inserted into the penis just above the scrotum. “A horror story,” says Muir. “How anyone was ever able to get approval for that, I do not know. It’s not licensed in Europe, thank God. But they’re a fairly predatory bunch – they threaten patients and doctors who’ve spoken out against it with lawsuits, and pay unhappy patients to shut up with NDAs.”

‘Fillers make the penis look swollen and misshapen’

The most common surgery in the UK is fillers. “The most-used are absorbable fillers, which is what they use for lips,” explains Muir. “They’re uneven, they make the penis look swollen and misshapen, but they don’t normally cause any massive harm – except financial – as they’re usually absorbed back into the body.”

Other fillers aren’t so easy to deal with. “I’ve seen people using industrial silicon, vaseline and fat injections, which are nightmares,” says Muir. “Polymers, in particular, crystallise and become impossible to remove. With the rest, you get allergic reactions and scar tissue.”

“All of these things give a very bad appearance,” Muir says. “The fillers look lumpy and odd; they coagulate in the foreskin, making it bulbous. That usually requires circumcision.”

But if those “treatments” make male readers cross their legs, the other common method – suspensory ligament release – is worse still.

‘I’ve seen men getting horrible infections’

The “treatment” sees surgeons cut the penile suspensory ligament – essentially a cord which attaches the penis to the pubic region. The theory is that it will make the penis drop lower when the man doesn’t have an erection. “It doesn’t make the penis bigger, it just means more of it is showing,” explains Muir.

The penile suspensory ligament is in the pubic area, which is “prone to developing severe scarring”, says Muir. “That means the man will often end up with a penis which may look a bit longer (though usually only 1.5cm at most). But it often retracts backwards again, so they have to put in silicone implants to hold it in place. It’ll also change the angle of erection so that the penis points downwards rather than up when erect, and becomes unstable, so it can twist around during penetrative sex, which can be extremely painful.”

Muir says in his experience, suspensory ligament release has a high likelihood of going wrong. “I’ve seen men getting horrible infections, which lead to the nerves at the end of the penis being damaged so they have no sensation at all,” says Muir. “I’ve even seen a guy where the surgeon managed to cut the arteries at the head of his penis and he lost his organ entirely. In fact, I’ve seen a number of patients who’ve lost their penises to these surgeries.”

While experts like Muir can ameliorate some of the issues for these men, in the majority of cases, they end up with shorter penises than they had originally.

“It depends on the level of damage that’s been done,” admits Muir. “Absorbable fillers will usually disappear in about nine months, though they usually require circumcisions. If it’s silicon or, God help us, Vaseline, then we have to try to take as much of the bad stuff out while leaving the organic material. It’s an immensely difficult surgery and men often need skin grafts to cover the whole of the penis, which leads to reduced sensation.”

In the case of suspensory ligament release surgeries, Muir says doctors can reattach the ligament using artificial grafts. “But the success rate isn’t great,” he adds.

‘The patients I see are probably the tip of the iceberg’

The patients Muir sees are probably the tip of the iceberg, he thinks. “We don’t usually see them unless they’re total disasters. It’s already a sensitive subject and when men are unhappy with the results, they are ashamed and don’t come forward.”

Men are generally dissatisfied with the results of the so-called enlargement surgeries. Researchers at King’s College published a study in 2019, asking 1192 men who’d had such procedures if they were happy with the outcome. 80% said they weren’t.

Ultimately, Muir doesn’t blame the men who fall victim to the con, but reserves his fury for the practitioners who offer it up and the General Medical Council, the independent regulator of doctors in the UK.

“I don’t think these surgeons and doctors should be allowed to practise medicine: they lie to their patients, they perform unnecessary procedures which all the evidence shows do not work, so I don’t understand why the GMC doesn’t strike them off,” he says. “It’s charlatanism and defrauding the patients. [And] the GMC has a terrible history of managing charlatans.”

“If a plastic surgeon or some random GP says, ‘This is a great treatment’, you have to wonder why the academic urologists are not making money out of it as well,” Muir says. “The answer is: We’ve tried it, we’ve looked at it, and it doesn’t work.”