‘ I wanted a truncheon in my gasps ‘: the rise of the penis extension

CPR and COVID-1 9

More and more men are opting for surgical penis expansion. Is it a confidence boost, or a con?

It has been more than a year since the operation, but Alistair is still furious about the results.” I paid PS8, 000 and they mutilated me ,” he says.” It was butchery. My partner said it looked like a war meander. My erection is basically ruined .”

In July 2017, the 55 -year-old decorator, from London, became one of a growing number of British humen to have a surgical penis expansion. Talk of improvement was once the conserve of promotional spam mail for bizarre-looking pills and pumps; now, it is serious clinical business. British clinics, which have taken consultancy rooms in Harley Street and in UK cities including Manchester, Sheffield, Birmingham and Leeds, report record numbers of patients calling on their services. One practice, the London Centre for Aesthetic Surgery, has gone from performing a handful of penis procedures annually when it opened in 1990 to more than 250 in 2017. Between 2013 and 2017, members of the International Society of Aesthetic Plastic Surgery carried out 45,604 penis enhancements worldwide. Previous numbers are unknown; the procedure was considered such a minority concern that it wasn’t included in surveys. This increase in demand apparently caters to a growing anxiety about penis size, but it is by no means a risk-free procedure. For Alistair, dreams of a larger penis were overtaken by infections, lumps and an erection that no longer rises above a 45 -degree angle. And he is not alone. In recent years, the General Medical Council has recorded stories of” wonky penis” and erectile dysfunction following surgery. In Stockholm, last summertime, a 30 -year-old man died after suffering a cardiac arrest following an operation to enlarge his penis.

***

At his Harley Street clinic, Dr Roberto Viel is explaining how a typical enlargement works. First, surgeons sever the organ’s suspensory ligament, causing it to hang an inch or two lower, giving the impression of extra duration. They then extract fat from the patient’s stomach and inject it into the penis shaft, increasing girth by around two inches. Erect, it’s worth noting, it remains roughly the same size, indicating the motives for many men are not inevitably to enhance either their- or a partner’s- sex experience.

The procedure, which can cost more than PS5, 000, lasts a little over an hour, but causes enough residual inconvenience that doctors recommend patients take a week off run. The penis remains bandaged for 10 days. Sex is off the cards for a few months. Erection suppressants are prescribed to avoid stitches being rent open.

” Operations are very safe ,” says Viel, who founded the London Centre for Aesthetic Surgery with his twin brother Maurizio.” Perhaps 95% of our patients are happy. Where they are not, it is often to do with expectations. Some men want 10 inches when nature gave them four or five. I have to say, gently,’ This is not possible. I am not a miracle worker .'”

Photograph
Photograph: Ilka& Franz for the Guardian

William O’Connor, a 38 -year-old mechanic from Northampton, is one of his fulfilled clients- and it’s easy to understand why. Think of a large can of aerosol deodorant and you have, roughly enough, his new dimensions.” There was one woman who took one look at it and simply went,’ That thing is coming nowhere near me ,'” he says.” But largely it goes down very well. I’ve seen a lot of eyes light up .”

Though generously endowed by nature and confident enough in his body to have appeared in some adult movies in his 20 s, O’Connor decided to enhance his circumference in 2013.” It was just something I imagination ,” he says with a shrug.” Some humen have hair transplantings or belly tucks. I wanted a truncheon in my gasps. My whole life I’ve enjoyed impressing girls; this was just an extension of that. You could call it a gentlemanly thing to do .”

O’Connor says he had no concerns beforehand (” My main worry was having the anaesthetic- I’m scared of needles “) and no unhappiness afterwards. The ache was manageable and there were no complications. He views the procedure as akin to working out.” I’m not preoccupied by my body- I have too many other things going on in my life ,” O’Connor says.” But I’m proud of it and I like that it’s in good shape- every part of it .”

The surgery should have no impact on fertility; O’Connor has since married and parent two children( he also has four from a previous relationship ).” I met her after the op, but she was a family friend and knew I’d had it done. I’ve never asked if it was a plus point .”

***

Amr Raheem is an andrology specialist( meaning his focus is on medicine relating to men) at University College London Hospital, as well as a surgeon at International Andrology, a private clinic in the capital city. Over the past 15 years, he has carried out more than 250 expansions.” It is not possible to typical patient ,” Raheem says.” All professions, all ethnicities, married, single, lesbian, straight, rich, poor. It’s across the board. And all ages. I’ve worked on humen in their 60 s- I don’t know if they go out and use it afterwards. Early 20 s, I won’t do. These are still boys. They must get to know it before they change it .”

Patients come in all shapes and sizes:” I’ve had men who are already large enough. I had one say he wanted to be like a milk bottle. Impossible .”

If there is one unifying factor, it is a lack of confidence about what nature has provided. The average length of a British penis is, are consistent with a 2016 King’ s College London study, 5.16 in erect and 3.67 in flaccid. Merely 0. 14% of men have what one University of California study defined as a “micropenis”- that is, less than 2.5 inches when erect. Nonetheless, study after study proves displeasure remains widespread among men.

” These are the men who come to us ,” Raheem says.” They are not necessarily small, but they want to feel more confident. In front of women, yes, but in front of other humen, too, down the gym, that sort of thing .”

Many of his patients, he adds, has also already” avoided sex or situations where they would be exposed, out of embarrassment. So this constructs them happier .”

Not all operations leave happy clients- infections and scarring are both potential side-effects (” This is the same as an operation of any kind ,” Viel says ). Some humen report a decline in angle after the suspensory ligament is cut, but according to David Ralph, a professor of urology at UCL,” By and big, patients don’t complain about that. The operation doesn’t alteration the erect length at all- this is only for men who have anxiety about how they look in the changing rooms. The median increase in size is 1.3 cm, less than the diameter of a 1p coin. In my clinics, I show patients one of these and ask if they still think it is worth it. Less than 5% decide to, and of the individuals who do, the gratification rate is just 20% .”

Occasionally, the cut ligament leaves genitals lopsided when flaccid, and pointing off to the left or right when erect, as Francis Tilley, director of London clinic Androfill, explains.” Ligaments are there for a reason ,” he says.” If you start cutting at them, the stability of the penis will be reduced: the erection will be lower and less straight .” Tilley’s practise offers the operation, but its website clearly identifies it as high risk.

One Stockport-based surgeon, Ravi Kant Agarwal, was hit off( though later allowed to practise again) after botching two procedures. One of his patients, the General Medical Council hear, was left with a penis” bent like a boomerang “. Agarwal was criticised for failing to explain potential complications and misinforming patients about the possible outcome, as well as for not having anaesthetic backup during the operations.

Alistair decided to have the operation after 40 years of nervousnes.” I played Sunday football and dreaded the changing rooms ,” he says.” It’s not so much the duration as how thin and scrawny it was .”

Six
Photograph: Ilka& Franz for the Guardian

He married, had children and learned to live with his unease. Then, four years ago, after separating from his wife, he asked a new partner how he measured up to her ex-husband.” It was a stupid question ,” Alistair acknowledges.” It’s pathetic that I cared at my age- but I did. To start with she told me it was fine, but I kept pushing and, eventually, she simply told me: his was bigger .”

Alistair took out a PS5, 000 loan to add to PS3, 000 of savings, and paid to go under the knife.( Surgery is difficult to obtain on the NHS, though it can be offered for psychological reasons, or to correct a true micropenis .)” It was the worst thing I’ve ever done ,” he says.” The ache afterwards … I couldn’t sit, I couldn’t stand. It was beyond anything they told me to expect. The wound get infected, and when they gave me antibiotics, it kept oozing pus. The scarring has barely faded even now .” He says the fat injection became lumpy, while his erecting no longer stands straight.” It just doesn’t look right. It’s deformed .”

Not long after the operation, he and his partner- who had repeatedly insisted he should not have it done- split up. As we speak, he is preparing for one of his first dates since their separation.” I’m already remain concerned about what she might think if we get intimate ,” he admits.

***

Thomas Modecai, 37, a educator from Crewe, has fought with the size of his penis for most of his life.” When I was 14, I shot up to 6ft but my penis stayed the same ,” he says.” I felt like a man with a child’s penis. And it’s affected everything: my relationships, my confidence, even my desire to have children. I fretted they might have the same issue .”

The only person who has ever seen him without clothes is his wife.” But even with her- we’ve been married 14 years- I was still anxious .”

After being rejected twice by physicians (” One said,’ Don’t worry about your penis, but you’re overweight ‘”), Modecai contacted Andrology International and, in August last year, paid PS6, 800 for a duration and girth boost.

” My spouse didn’t like the idea ,” he says.” But this had been bothering me for 20 years. I’d already tried pills and potions- useless stuff you assure advertised in spam- and I was depleted. I needed it fixing .”

Since the surgery, he has felt happier and more confident.” I’m not exactly skipping round the house naked but, you know, maybe once I lose that weight ,” he says.” And we’re now thinking about children .”

I ask for his pre-op dimensions. He doesn’t want his exact measurings reported, but they are surprising: while flaccid, he was smaller than most men; erect, his penis grew significantly. Modecai, it seems, experienced two decades of stress despite the fact that, fully extended, he was bigger than the UK average. This apparent contradiction does not surprise Angela Gregory, a psychosexual therapist based at Nottingham University Hospitals NHS Trust.” Penis expansions can be about a lot of things ,” she says.” But the amount of anxiety a man experiences rarely, in my experience, correlates with his actual size .”

The sheer symbolism of what’s in a man’s gasps may be a factor. As Harrison Pope and Katharine Phillips write in their volume on male body obsessions, The Adonis Complex, genitals have been equated with” masculinity, procreative potency, and power” throughout history. This has been further compounded by an apparent rise in general masculine vanity. Figures from the British Association of Aesthetic Plastic Surgeons show the number of members of male procedures doubled between 2005 and 2015, with breast reduction, rhinoplasty and neck lifts especially popular. For those in need of rejuvenation, surgery is cheaper and more easily available than ever.

Eric
Eric Bell, 68, is preparing for his third enlargement:’ It stimulates me happy knowing I have something eye-opening down there .’ Photograph: Richard Baybutt

Furthermore, Gregory highlights two other most recent developments: the proliferation of pornography and the rise of TV shows where brutal physical objectification has become, for the first time, an equal-opportunities phenomenon.

” Young humen generally become preoccupied with the size of their genitals when they compare with others ,” she says.” Historically, this was limited to changing rooms or the odd top-shelf magazine. But now there is this almost routine exposure to porn via smartphones. And that is creating a generation of men whose expectations of what they should look like are entirely unattainable .”

Added to that, she says, is the popularity of displays such as Love Island where objectification comes as standard. In the summer of 2017, one male contestant was described as having” a penis like a baseball bat “; it was, unequivocally, a compliment. None of this objectification is new, of course: it’s just new for men.” But that doesn’t minimized the impact ,” Gregory says.” For the individual who is going through the trauma of fearing his penis is too small, this is still devastating .”

All this might be leading to more than simple image anxiety; some have pointed to a new mental-health issue they words penile dysmorphic ailment.” It is a minority of men- and we don’t know how many- but it certainly exists and it’s as damaging as any other body dysmorphia ,” says Professor David Veale, of King’s College London, an authority on health nervousness.” These men might seek out surgery, and for a few months they will be happy with the results. But then the same nervousness reappear. So, they seek out further surgery. It becomes a circle. But you cannot maintain building your penis bigger. This requires therapy .”

Largely, he says, these cases remain undisclosed.” Those who suffer don’t inevitably realise themselves, and rarely acknowledge it. It is an invisible illness .”

So how can we be sure it really exists?” Because the number of men seeking surgery, or the growth of this strange industry selling pills and other so-called enlargement remedies, these numbers do not map up with the numbers of men who actually have a significantly smaller penis than average ,” Veale says.” So, these men are worrying about- and trying solutions for- a problem they do not have .”

Veale’s hypothesi chimes with the experience of a retired marketings manager I gratify in a drab Sheffield consultancy room. A lifelong bachelor, Eric Bell, 68, is charming and well-dressed, if, with a beard tinted blue, a touch eccentric. He is also preparing for his third penis expansion- an operation that, judging from the sizeable member already between his legs, is unnecessary.” I’d just like it a bit fatter here ,” he explains, circling thumb and middle finger around the top of his rod.” I’m single, but it stimulates me happy knowing I have something eye-opening down there .” We spend five minutes discussing the merits of this before he asks his own question:” Can I put it away now ?”

Bell says he had his first enlargement in 2015, a year after agony the trauma of his brother drowning in York’s River Foss.” I suffered severe depression ,” he says.

Are the two things linked? “Possibly,” he says.” I don’t know. I don’t think about it .”

Bell is a patient at Moorgate Aesthetics, which has head offices in Doncaster. When I ask managing director David Mills if this may be one client who doesn’t need any more girth, he waves away the concern. Bell, he says, knows his own mind, and now passed a psychological evaluation. The operation goes ahead.

This evaluation is something all clinics I speak to insist on. It involves a patient meeting with a surgeon or psychologist to have their general mental wellbeing assessed. If there is any hint of underlying concerns, problems or mental health issues, the operation does not go ahead. But, given that such a refusal would mean clinics losing PS5, 000 a pop, one does wonder how rigorous these assessments are. Is the entire industry merely profiting off insecurity bordering on dysmorphia?

Dr Roberto Viel supposes not.” I tell my patients we can give you a bigger penis, but we cannot construct you happy ,” he says.” You must be happy first, in your heart and head. If not, this operation is not for you. All it would mean is you are still unhappy – you just have a somewhat bigger penis .”

Professor Ralph at UCL believes that some clinics are feeding patients’ unrealistic expectations.” Initially, they don’t see doctors, they ensure marketings people. It’s a hard sell:’ We can get you an extra inch or two .’ I’ve been practising in the NHS for 30 years: if it was that easy to increase the length of a normal penis, I’d be in the Mediterranean on my cruise liner now .”

Ralph thinks that” penile stretchers”, marketed under the name Andropenis, can be just as effective; but few men are prepared to make the commitment of wearing a traction device for six hours a day for six months. He also points out that, for men with an unhealthy BMI, weight loss can be enough to induce the penis appear bigger.

In a last brief dialogue with Alistair, he asks if I would ever consider going under the knife. I tell him I’ve seen such a bewildering array of shapes and sizes over the past few weeks, I don’t even know what normal is any more. If it does the job nature aimed, I say, that should be enough. For many humen wanting an expansion, it’s probably not so much about what’s in their gasps as what, somewhere along the way, has got into their minds- and that can’t be fixed by a fat injection and a severed ligament.

Alistair thinks about this and appears to agree:” Once it’s in your head, it’s difficult to let it go- even after you’ve had surgery .”

* Alistair’s name has been changed.

Read more: www.theguardian.com

‘ I wanted a truncheon in my gasps ‘: the rise of the penis extension

More and more men are opting for surgical penis expansion. Is it a confidence boost, or a con?

It has been more than a year since the operation, but Alistair is still furious about the results.” I paid PS8, 000 and they mutilated me ,” he says.” It was butchery. My partner said it looked like a war meander. My erection is basically ruined .”

In July 2017, the 55 -year-old decorator, from London, became one of a growing number of British men to have a surgical penis enlargement. Talk of improvement was once the preserve of promotional spam mail for bizarre-looking pills and pumps; now, it is serious clinical business. British clinics, which have taken consultancy rooms in Harley Street and in UK cities including Manchester, Sheffield, Birmingham and Leeds, report record numbers of patients calling on their services. One practise, the London Centre for Aesthetic Surgery, has gone from performing a handful of penis procedures annually when it opened in 1990 to more than 250 in 2017. Between 2013 and 2017, members of the International Society of Aesthetic Plastic Surgery carried out 45,604 penis enhancements worldwide. Previous numbers are unknown; the procedure was considered such a minority concern that it wasn’t included in surveys. This increase in demand seemingly caters to a growing anxiety about penis size, but it is by no means a risk-free procedure. For Alistair, dreams of a larger penis were overtaken by infections, lumps and an erection that no longer rises above a 45 -degree angle. And he is not alone. In recent years, the General Medical Council has recorded stories of” wonky penis” and erectile dysfunction following surgery. In Stockholm, last summer, a 30 -year-old man died after suffering a cardiac arrest following an operation to enlarge his penis.

***

At his Harley Street clinic, Dr Roberto Viel is explaining how a typical expansion works. First, surgeons sever the organ’s suspensory ligament, causing it to hang an inch or two lower, giving the impression of extra duration. They then extract fat from the patient’s belly and inject it into the penis rod, increasing circumference by around two inches. Erect, it’s worth noting, it remains roughly the same size, suggesting the motives for many humen are not inevitably to enhance either their- or a partner’s- sex experience.

The procedure, which can cost more than PS5, 000, lasts a little over an hour, but causes enough residual inconvenience that doctors recommend patients take a week off run. The penis remains bandaged for 10 days. Sex is off the cards for a month. Erection suppressants are prescribed to avoid stitches being rent open.

” Operations are very safe ,” says Viel, who founded the London Centre for Aesthetic Surgery with his twin brother Maurizio.” Perhaps 95% of our patients are happy. Where they are not, it is often to do with expectations. Some men want 10 inches when nature dedicated them four or five. I have to say, gently,’ This is not possible. I am not a miracle worker .'”

Photograph
Photograph: Ilka& Franz for the Guardian

William O’Connor, a 38 -year-old mechanic from Northampton, is one of his satisfied customers- and it’s easy to understand why. Think of a large can of aerosol deodorant and you have, roughly enough, his new dimensions.” There was one woman who took one look at it and just ran,’ That thing is coming nowhere near me ,'” he says.” But mostly it goes down very well. I’ve seen a lot of eyes light up .”

Though liberally endowed by nature and confident enough in his body to have appeared in some adult films in his 20 s, O’Connor decided to enhance his girth in 2013.” It was just something I imagination ,” he says with a shrug.” Some men have hair transplants or belly tucks. I wanted a truncheon in my gasps. My whole life I’ve enjoyed impressing girls; this was just an extension of that. You could call it a gentlemanly thing to do .”

O’Connor says he had no concerns beforehand (” My main worry was having the anaesthetic- I’m scared of needles “) and no sadness afterwards. The ache was manageable and there were no complications. He views the procedure as akin to working out.” I’m not obsessed by my body- I have too many other things going on in my life ,” O’Connor says.” But I’m proud of it and I like that it’s in good shape- every part of it .”

The surgery should have no impact on fertility; O’Connor has since married and fathered two children( he also has four from a previous relationship ).” I gratify her after the op, but she was a family friend and knew I’d had it done. I’ve never asked if it was a plus point .”

***

Amr Raheem is an andrology specialist( meaning his focus is on medicine relating to men) at University College London Hospitals, as well as a surgeon at International Andrology, a private clinic in the capital. Over the past 15 years, he has carried out more than 250 enlargements.” There is no typical patient ,” Raheem says.” All professions, all ethnicities, married, single, homosexual, straight-out, rich, poor. It’s across the board. And all ages. I’ve worked on humen in their 60 s- I don’t know if they go out and use it afterwards. Early 20 s, I won’t do. These are still boys. They must get to know it before they change it .”

Patients come in all shapes and sizes:” I’ve had men who are already large enough. I had one say he wanted to be like a milk bottle. Impossible .”

If there is one unifying factor, it is a lack of confidence about what nature has provided. The average length of a British penis is, according to a 2016 King’ s College London study, 5.16 in erect and 3.67 in flaccid. Merely 0. 14% of men have what one University of California study defined as a “micropenis”- that is, less than 2.5 inches when erect. Nonetheless, study after study shows displeasure remains widespread among men.

” These are the men who come to us ,” Raheem says.” They are not inevitably small, but they want to feel more confident. In front of women, yes, but in front of other humen, too, down the gym, that sort of thing .”

Many of his patients, he adds, have previously” avoided sexuality or situations where they would be exposed, out of embarrassment. So this attains them happier .”

Not all operations leave happy clients- infections and scarring are both potential side-effects (” This is the same as an operation of any kind ,” Viel says ). Some humen report a decline in angle after the suspensory ligament is cut, but according to David Ralph, a prof of urology at UCL,” By and big, patients don’t complain about that. The operation doesn’t alteration the erect duration at all- this is only for men who have anxiety about how they look in the changing rooms. The median increase in size is 1.3 cm, less than the diameter of a 1p coin. In my clinics, I present patients one of these and ask if they still think it is worth it. Less than 5% decide to, and of those who do, the satisfaction rate is just 20% .”

Occasionally, the cut ligament leaves genitals lopsided when flaccid, and pointing off to the left or right when erect, as Francis Tilley, director of London clinic Androfill, explains.” Ligaments are there for a reason ,” he says.” If you start cutting at them, the stability of the penis will be reduced: the erecting will be lower and less straight .” Tilley’s practise offers the operation, but its website clearly identifies it as high risk.

One Stockport-based surgeon, Ravi Kant Agarwal, was struck off( though later allowed to practise again) after botching two procedures. One of his patients, the General Medical Council hear, was left with a penis” bent like a boomerang “. Agarwal was criticised for failing to explain potential complications and misleading patients about the possible outcome, as well as for not having anaesthetic backup during the operations.

Alistair decided to have the operation after 40 years of anxiety.” I played Sunday football and dreaded the changing rooms ,” he says.” It’s not so much the length as how thin and scrawny it was .”

Six
Photograph: Ilka& Franz for the Guardian

He married, had children and learned to live with his unease. Then, four years ago, after separating from his wife, he asked a new partner how he measured up to her ex-husband.” It was a stupid question ,” Alistair admits.” It’s pathetic that I cared at my age- but I did. To start with she told me it was fine, but I maintained pushing and, eventually, she merely told me: his was bigger .”

Alistair took out a PS5, 000 loan to add to PS3, 000 of savings, and paid to go under the knife.( Surgery is difficult to obtain on the NHS, though it can be offered for psychological reasons, or to correct a true micropenis .)” It was the worst thing I’ve ever done ,” he says.” The ache afterwards … I couldn’t sit, I couldn’t stand. It was beyond anything they told me to expect. The wound got infected, and when they gave me antibiotics, it kept seeping pus. The scarring has barely faded even now .” He says the fat injection became lumpy, while his erection no longer stands straight.” It just doesn’t look right. It’s deformed .”

Not long after the operation, he and his partner- who had repeatedly insisted he should not have it done- split up. As we speak, he is preparing for one of his first dates since their separation.” I’m already remain concerned about what she might think if we get intimate ,” he admits.

***

Thomas Modecai, 37, a teacher from Crewe, has fought with the size of his penis for most of his life.” When I was 14, I shot up to 6ft but my penis stayed the same ,” he says.” I felt like a human with a child’s penis. And it’s affected everything: my relationships, my confidence, even my desire to have children. I fretted they might have the same issue .”

The only person who has ever seen him without clothes is his wife.” But even with her- we’ve been married 14 years- I was still anxious .”

After being dismissed twice by physicians (” One said,’ Don’t worry about your penis, but you’re overweight ‘”), Modecai contacted Andrology International and, in August last year, paid PS6, 800 for a duration and girth boost.

” My wife didn’t like the idea ,” he says.” But this had been bothering me for 20 years. I’d already tried pills and potions- useless stuff you insure advertised in spam- and I was depleted. I needed it fixing .”

Since the surgery, he has felt happier and more confident.” I’m not exactly skipping round the house naked but, you are aware, maybe once I lose that weight ,” he says.” And we’re now thinking about children .”

I ask for his pre-op dimensions. He doesn’t want his exact measurings reported, but the issue is surprising: while flaccid, he was smaller than most men; erect, his penis grew significantly. Modecai, it seems, experienced two decades of stress despite the fact that, fully extended, he was bigger than the UK average. This apparent contradiction does not surprise Angela Gregory, a psychosexual therapist based at Nottingham University Hospitals NHS Trust.” Penis expansions can be about a lot of things ,” she says.” But the amount of anxiety a man experiences rarely, in my experience, correlates with his actual size .”

The sheer symbolism of what’s in a man’s gasps may be a factor. As Harrison Pope and Katharine Phillips write in their volume on male body obsessions, The Adonis Complex, genitals have been equated with” virility, procreative effectivenes, and power” throughout history. This has been further compounded by an apparent rise in general masculine vanity. Figures from the British Association of Aesthetic Plastic Surgeons indicate the total number of male procedures doubled between 2005 and 2015, with breast reduction, rhinoplasty and neck lifts especially popular. For those in need of rejuvenation, surgery is cheaper and more easily available than ever.

Eric
Eric Bell, 68, is preparing for his third enlargement:’ It constructs me happy knowing I have something eye-opening down there .’ Photograph: Richard Baybutt

Furthermore, Gregory highlightings two other recent developments: the proliferation of pornography and the rise of TV shows where brutal physical objectification has become, for the first time, an equal-opportunities phenomenon.

” Young men generally become preoccupied with the size of their genitals when they compare with others ,” she says.” Historically, this was limited to changing rooms or the odd top-shelf magazine. But now there is this almost routine exposure to porn via smartphones. And that is creating a generation of men whose expectations of what they should look like are entirely unattainable .”

Added to that, she says, is the popularity of indicates such as Love Island where objectification comes as standard. In the summer of 2017, one male contestant was described as having” a penis like a baseball bat “; it was, unequivocally, a compliment. None of this objectification is new, of course: it’s just new for men.” But that doesn’t lessened the impact ,” Gregory says.” For the individual who is going through the trauma of fearing his penis is too small, this is still devastating .”

All this might be leading to more than simple image anxiety; some have pointed to a new mental-health issue they term penile dysmorphic ailment.” It is a minority of men- and we don’t know how many- but it certainly exists and it’s as damaging as any other body dysmorphia ,” says Professor David Veale, of King’s College London, an authority on health nervousness.” These humen might seek out surgery, and for a few months they will be happy with the results. But then the same anxieties reappear. So, they seek out further surgery. It becomes a circle. But you cannot keep making your penis bigger. This necessitates therapy .”

Largely, he says, these cases remain undisclosed.” Those who suffer don’t inevitably realise themselves, and rarely admit it. It is an invisible illness .”

So how can we be sure it really exists?” Because the number of men attempting surgery, or the growth of this strange industry selling pills and other so-called enlargement redress, these numbers do not map up with the numbers of men who actually have a significantly smaller penis than average ,” Veale says.” So, these men are worrying about- and seeking answers for- a number of problems they do not have .”

Veale’s theory chimes with the experience of a retired marketings administrator I fulfill in a drab Sheffield consultancy room. A lifelong bachelor, Eric Bell, 68, is charming and well-dressed, if, with a beard tinted blue, a touch eccentric. He is also preparing for his third penis expansion- an operation that, judging from the sizeable member already between his legs, is unnecessary.” I’d just like it a bit fatter here ,” he explains, circling thumb and middle finger around the top of his shaft.” I’m single, but it stimulates me happy knowing I have something eye-opening down there .” We expend five minutes discussing the merits of this before he asks his own question:” Can I put it away now ?”

Bell says he had his first enlargement in 2015, a year after suffering the trauma of his brother drowning in York’s River Foss.” I suffered severe depression ,” he says.

Are the two things linked? “Possibly,” he says.” I don’t know. I don’t think about it .”

Bell is a patient at Moorgate Aesthetics, which has head offices in Doncaster. When I ask managing director David Mills if this may be one client who doesn’t need any more girth, he waves away the concern. Bell, he says, knows his own intellect, and has passed a psychological evaluation. The operation goes ahead.

This evaluation is something all clinics I speak to insist on. It involves a patient meeting with a surgeon or psychologist to have their general mental wellbeing assessed. If there is any hint of underlying concerns, problems or mental health issues, the operation does not go ahead. But, given that such a refusal would entail clinics losing PS5, 000 a pop, one does wonder how rigorous these assessments are. Is the entire industry merely profiting off insecurity bordering on dysmorphia?

Dr Roberto Viel believes not.” I tell my patients we can give you a bigger penis, but we cannot stimulate you happy ,” he says.” You must be happy first, in your heart and head. If not, this operation “re not for” you. All it would entail is you are still unhappy – you just have a slightly bigger penis .”

Professor Ralph at UCL believes that some clinics are feeding patients’ unrealistic expectations.” Initially, they don’t see doctors, they consider sales people. It’s a hard sell:’ We can get you an extra inch or two .’ I’ve been practising in the NHS for 30 years: if it was that easy to increase the length of a normal penis, I’d be in the Mediterranean on my cruise liner now .”

Ralph thinks that” penile stretchers”, marketed under the name Andropenis, can be just as effective; but few humen are prepared to build such commitments of wearing a traction device for six hours a day for six months. He also points out that, for men with an unhealthy BMI, weight loss can be enough to build the penis appear bigger.

In a last brief conversation with Alistair, he asks if I would ever consider running under the knife. I tell him I’ve seen such a bewildering array of shapes and sizes over the past few weeks, I don’t even know what normal is any more. If it does the job nature intended, I say, that should be enough. For many men wanting an enlargement, it’s probably not so much about what’s in their pants as what, somewhere along the way, has got into their intellects- and that can’t be fixed by a fat injection and a severed ligament.

Alistair thinks about this and appears to agree:” Once it’s in your head, it’s difficult to let it go- even after you’ve had surgery .”

* Alistair’s name has been changed.

Read more: www.theguardian.com

‘ I wanted a truncheon in my pants ‘: the rise of the penis extension

More and more men are opting for surgical penis enlargement. Is it a confidence boost, or a con?

It has been more than a year since the operation, but Alistair is still furious about the results.” I paid PS8, 000 and they mutilated me ,” he says.” It was butchery. My partner said it looked like a war meander. My erection is basically ruined .”

In July 2017, the 55 -year-old decorator, from London, became one of a growing number of British humen to have a surgical penis expansion. Talk of improvement was once the conserve of promotional spam mail for bizarre-looking pills and pumps; now, it is serious clinical business. British clinics, which have taken consultancy rooms in Harley Street and in UK cities including Manchester, Sheffield, Birmingham and Leeds, report record numbers of patients calling on their services. One practice, the London Centre for Aesthetic Surgery, has gone from performing a handful of penis procedures annually when it opened in 1990 to more than 250 in 2017. Between 2013 and 2017, members of the International Society of Aesthetic Plastic Surgery carried out 45,604 penis enhancements worldwide. Previous numbers are unknown; the procedure was considered such a minority concern that it wasn’t included in surveys. This increase in demand seemingly caters to a growing nervousnes about penis size, but it is by no means a risk-free procedure. For Alistair, dreams of a larger penis were overtaken by infections, lumps and an erection that no longer rises above a 45 -degree angle. And he is not alone. In recent years, the General Medical Council has recorded tales of” wonky penis” and erectile dysfunction following surgery. In Stockholm, last summertime, a 30 -year-old man died after agony a cardiac arrest following an operation to enlarge his penis.

***

At his Harley Street clinic, Dr Roberto Viel is explaining how a typical enlargement works. First, surgeons sever the organ’s suspensory ligament, causing it to hang an inch or two lower, giving the impression of extra length. They then extract fat from the patient’s stomach and inject it into the penis rod, increasing girth by around two inches. Erect, it’s worth noting, it remains roughly the same size, suggesting the motives for many men are not necessarily to enhance either their- or a partner’s- sex experience.

The procedure, which can cost more than PS5, 000, lasts a little over an hour, but causes enough residual discomfort that physicians recommend patients take a week off work. The penis remains bandaged for 10 days. Sex is off the cards for a month. Erection suppressants are prescribed to avoid sews being rent open.

” Operations are very safe ,” says Viel, who founded the London Centre for Aesthetic Surgery with his twin brother Maurizio.” Perhaps 95% of our patients are happy. Where they are not, it is often to do with expectations. Some humen want 10 inches when nature dedicated them four or five. I have to say, gently,’ This is not possible. I am not a miracle worker .'”

Photograph
Photograph: Ilka& Franz for the Guardian

William O’Connor, a 38 -year-old mechanic from Northampton, is one of his satisfied clients- and it’s easy to understand why. Think of a large can of aerosol deodorant and you have, roughly enough, his new dimensions.” There was one woman who took one look at it and only went,’ That thing is coming nowhere near me ,'” he says.” But mostly it goes down very well. I’ve seen a lot of eyes light up .”

Though liberally endowed by nature and confident enough in his body to have appeared in some adult movies in his 20 s, O’Connor decided to enhance his girth in 2013.” It was just something I fancied ,” he says with a shrug.” Some humen have hair transplants or belly tucks. I wanted a truncheon in my gasps. My whole life I’ve enjoyed impressing females; this was just an extension of that. You could call it a gentlemanly thing to do .”

O’Connor says he had no concerns beforehand (” My main worry was having the anaesthetic- I’m scared of needles “) and no regrets afterwards. The ache was manageable and there were no complications. He views the procedure as akin to working out.” I’m not obsessed by my body- I have too many other things going on in my life ,” O’Connor says.” But I’m proud of it and I like that it’s in good shape- every part of it .”

The surgery should have no impact on fertility; O’Connor has since married and parent two children( he also has four from a previous relationship ).” I satisfy her after the op, but she was a family friend and knew I’d had it done. I’ve never asked if it was a plus phase .”

***

Amr Raheem is an andrology specialist( meaning his focus is on medicine relating to humen) at University College London Hospitals, as well as a surgeon at International Andrology, a private clinic in the capital city. Over the past 15 years, he has carried out more than 250 expansions.” There is no typical patient ,” Raheem says.” All professions, all ethnicities, married, single, homosexual, straight-out, rich, poor. It’s across the board. And all ages. I’ve worked on humen in their 60 s- I don’t know if they go out and use it afterwards. Early 20 s, I won’t do. These are still boys. They must get to know it before they change it .”

Patients come in all shapes and sizes:” I’ve had men who are already large enough. I had one say he wanted to be like a milk bottle. Impossible .”

If there is one unifying factor, it is a lack of confidence about what nature has provided. The average duration of a British penis is, according to a 2016 King’ s College London study, 5.16 in erect and 3.67 in flaccid. Merely 0. 14% of men have what one University of California study defined as a “micropenis”- that is, less than 2.5 inches when erect. Nonetheless, study after study indicates frustration remains widespread among men.

” These are the men who come to us ,” Raheem says.” They are not necessarily small, but they want to feel more confident. In front of women, yes, but in front of other humen, too, down the gym, that sort of thing .”

Many of his patients, he adds, has already been” avoided sex or situations where they would be uncovered, out of embarrassment. So this builds them happier .”

Not all operations leave happy clients- infections and scarring are both potential side-effects (” This is the same as an operation of any kind ,” Viel says ). Some men report a decline in angle after the suspensory ligament is cut, but according to David Ralph, a professor of urology at UCL,” By and big, patients don’t complain about that. The operation doesn’t change the erect duration at all- this is only for men who have anxiety about how they look in the changing rooms. The median increase in size is 1.3 cm, less than the diameter of a 1p coin. In my clinics, I demonstrate patients one of these and ask if they still think it is worth it. Less than 5% decide to, and of those who do, the gratification rate is just 20% .”

Occasionally, the cut ligament leaves genitals lopsided when flaccid, and pointing off to the left or right when erect, as Francis Tilley, director of London clinic Androfill, explains.” Ligaments are there for a reason ,” he says.” If you start cutting at them, the stability of the penis will be reduced: the erection will be lower and less straight .” Tilley’s practice offers the operation, but its website clearly identifies it as high risk.

One Stockport-based surgeon, Ravi Kant Agarwal, was hit off( though later allowed to practise again) after botching two procedures. One of his patients, the General Medical Council heard, was left with a penis” bent like a boomerang “. Agarwal was criticised for failing to explain potential complications and misleading patients about the possible outcome, as well as for not having anaesthetic backup during the operations.

Alistair decided to have the operation after 40 years of anxiety.” I played Sunday football and dreaded the changing rooms ,” he says.” It’s not so much the length as how thin and scrawny it was .”

Six
Photograph: Ilka& Franz for the Guardian

He married, had children and learned to live with his malaise. Then, four years ago, after separating from his wife, he asked a new partner how he measured up to her ex-husband.” It was a stupid question ,” Alistair admits.” It’s pathetic that I cared at my age- but I did. To start with she told me it was fine, but I maintained pushing and, eventually, she only told me: his was bigger .”

Alistair took out a PS5, 000 loan to add to PS3, 000 of savings, and paid to go under the knife.( Surgery is difficult to obtain on the NHS, though it can be offered for psychological reasons, or to correct a true micropenis .)” It was the worst thing I’ve ever done ,” he says.” The pain afterwards … I couldn’t sit, I couldn’t stand. It was beyond anything they told me to expect. The wound get infected, and when they gave me antibiotics, it maintained oozing pus. The scarring has barely faded even now .” He says the fat injection became lumpy, while his erection no longer stands straight.” It simply doesn’t look right. It’s deformed .”

Not long after the operation, he and his partner- who had repeatedly insisted he should not have it done- split up. As we speak, he is preparing for one of his first dates since their separation.” I’m already remain concerned about what she might think if we get intimate ,” he admits.

***

Thomas Modecai, 37, a teacher from Crewe, has fought with the size of his penis for most of his life.” When I was 14, I shot up to 6ft but my penis stayed the same ,” he says.” I felt like a human with a child’s penis. And it’s affected everything: my relationships, my confidence, even my desire to have children. I fretted they might have the same issue .”

The only person who has ever seen him without clothes is his wife.” But even with her- we’ve been married 14 years- I was still anxious .”

After being dismissed twice by physicians (” One said,’ Don’t worry about your penis, but you’re overweight ‘”), Modecai contacted Andrology International and, in August last year, paid PS6, 800 for a length and girth boost.

” My wife didn’t like the idea ,” he says.” But this had been bothering me for 20 years. I’d already tried pills and potions- useless stuff you consider advertised in spam- and I was exhausted. I needed it fixing .”

Since the surgery, he has felt happier and more confident.” I’m not exactly skipping round the house naked but, you know, maybe once I lose that weight ,” he says.” And we’re now thinking about children .”

I ask for his pre-op dimensions. He doesn’t want his exact measurings reported, but they are surprising: while flaccid, he was smaller than most men; erect, his penis grew significantly. Modecai, it seems, experienced two decades of stress despite the fact that, fully widened, he was bigger than the UK average. This apparent contradiction does not surprise Angela Gregory, a psychosexual therapist based at Nottingham University Hospitals NHS Trust.” Penis expansions can be about a lot of things ,” she says.” But the amount of anxiety a man experiences rarely, in my experience, correlates with his actual size .”

The sheer symbolism of what’s in a man’s gasps may be a factor. As Harrison Pope and Katharine Phillips write in their book on male body preoccupations, The Adonis Complex, genitals ought to have equated with” masculinity, procreative effectivenes, and power” throughout history. This has been further compounded by an apparent rise in general masculine vanity. Figures from the British Association of Aesthetic Plastic Surgeons present the total number of male procedures doubled between 2005 and 2015, with breast reduction, rhinoplasty and neck lifts especially popular. For those in need of rejuvenation, surgery is cheaper and more easily available than ever.

Eric
Eric Bell, 68, is preparing for his third expansion:’ It induces me happy knowing I have something eye-opening down there .’ Photograph: Richard Baybutt

Furthermore, Gregory highlightings two other recent developments: the proliferation of pornography and the rise of TV shows where brutal physical objectification has become, for the first time, an equal-opportunities phenomenon.

” Young humen generally become preoccupied with the size of their genitals when they compare with others ,” she says.” Historically, this was limited to changing rooms or the odd top-shelf magazine. But now there is this almost routine exposure to porn via smartphones. And that is creating a generation of men whose expectations of what they should look like are entirely unattainable .”

Added to that, she says, is the popularity of reveals such as Love Island where objectification comes as standard. In the summer of 2017, one male contestant was described as having” a penis like a baseball bat “; it was, unequivocally, a compliment. None of this objectification is new, of course: it’s just new for men.” But that doesn’t mitigated the impact ,” Gregory says.” For the individual who is going through the trauma of dreading his penis is too small, this is still devastating .”

All this might be leading to more than simple image anxiety; some have pointed to a new mental-health issue they words penile dysmorphic disorder.” It is a minority of men- and we don’t know how many- but it certainly exists and it’s as damaging as any other body dysmorphia ,” says Professor David Veale, of King’s College London, an authority on health anxieties.” These men might seek out surgery, and for a few months they will be happy with the results. But then the same anxieties reappear. So, they seek out further surgery. It becomes a circle. But you cannot keep making your penis bigger. This requires therapy .”

Largely, he says, these cases remain undisclosed.” Those who suffer don’t inevitably realise themselves, and rarely acknowledge it. It is an invisible illness .”

So how can we be sure it really exists?” Because the number of men seeking surgery, or the growth of this strange industry selling pills and other so-called enlargement redress, these numbers do not map up with the numbers of men who actually have a significantly smaller penis than average ,” Veale says.” So, these men are worrying about- and trying answers for- a problem they do not have .”

Veale’s theory chimes with the experience of a retired marketings director I satisfy in a drab Sheffield consultancy room. A lifelong bachelor, Eric Bell, 68, is charming and well-dressed, if, with a beard tinted blue, a touch eccentric. He is also in preparations for his third penis expansion- an operation that, judging from the sizeable member already between his legs, is unnecessary.” I’d just like it a bit fatter here ,” he explains, circling thumb and middle thumb around the top of his shaft.” I’m single, but it induces me happy knowing I have something eye-opening down there .” We expend five minutes discussing the merits of this before he asks his own question:” Can I put it away now ?”

Bell says he had his first enlargement in 2015, a year after agony the trauma of his brother drowning in York’s River Foss.” I suffered severe depression ,” he says.

Are the two things linked? “Possibly,” he says.” I don’t know. I don’t think about it .”

Bell is a patient at Moorgate Aesthetics, which has head offices in Doncaster. When I ask managing director David Mills if this may be one client who doesn’t need any more girth, he waves away the concern. Bell, he says, knows his own mind, and has passed a psychological evaluation. The operation goes ahead.

This evaluation is something all clinics I speak to insist on. It involves a patient meeting with a surgeon or psychologist to have their general mental wellbeing assessed. If there is any hint of underlying concerns, problems or mental health issues, the operation does not go ahead. But, given that such a repudiation would entail clinics losing PS5, 000 a pop, one does wonder how rigorous these assessments are. Is the entire industry merely profiting off insecurity bordering on dysmorphia?

Dr Roberto Viel supposes not.” I tell my patients we can give you a bigger penis, but we cannot build you happy ,” he says.” You must be happy first, in your heart and head. If not, this operation “re not for” you. All it would mean is you are still unhappy – you just have a slightly bigger penis .”

Professor Ralph at UCL believes that some clinics are feeding patients’ unrealistic expectations.” Initially, they don’t see doctors, they watch marketings people. It’s a hard sell:’ We can get you an extra inch or two .’ I’ve been practising in the NHS for 30 years: if it was that easy to increase the length of a normal penis, I’d be in the Mediterranean on my cruise liner now .”

Ralph thinks that” penile stretchers”, marketed under the name Andropenis, can be just as effective; but few humen are prepared to stimulate the commitment of wearing a traction device for six hours a day for six months. He also points out that, for men with an unhealthy BMI, weight loss can be enough to induce the penis appear bigger.

In a last brief conversation with Alistair, he asks if I would ever consider running under the knife. I tell him I’ve seen such a bewildering array of shapes and sizings over the past few weeks, I don’t even know what normal is any more. If it does the job nature intended, I say, that should be enough. For many humen wanting an expansion, it’s probably not so much about what’s in their pants as what, somewhere along the way, has got into their minds- and that can’t be fixed by a fat injection and a severed ligament.

Alistair thinks about this and appears to agree:” Once it’s in your head, it’s difficult to let it go- even after you’ve had surgery .”

* Alistair’s name has been changed.

Read more: www.theguardian.com

‘ I wanted a truncheon in my gasps ‘: the rise of the penis extension

More and more men are opting for surgical penis enlargement. Is it a confidence boost, or a con?

It has been more than a year since the operation, but Alistair is still furious about the results.” I paid PS8, 000 and they mutilated me ,” he says.” It was butchery. My partner said it looked like a war meander. My erection is basically ruined .”

In July 2017, the 55 -year-old decorator, from London, became one of a growing number of British men to have a surgical penis enlargement. Talk of improvement was once the preserve of promotional spam mail for bizarre-looking pills and pumps; now, it is serious clinical business. British clinics, which have taken consultancy rooms in Harley Street and in UK cities including Manchester, Sheffield, Birmingham and Leeds, report record numbers of patients calling on their services. One practice, the London Centre for Aesthetic Surgery, has gone from performing a handful of penis procedures annually when it opened in 1990 to more than 250 in 2017. Between 2013 and 2017, members of the International Society of Aesthetic Plastic Surgery carried out 45,604 penis enhancements worldwide. Previous numbers are unknown; the procedure was considered such a minority concern that it wasn’t included in surveys. This increase in demand apparently caters to a growing anxiety about penis size, but it is by no means a risk-free procedure. For Alistair, dreams of a greater penis were overtaken by infections, lumps and an erection that no longer rises above a 45 -degree angle. And he is not alone. In recent years, the General Medical Council has recorded narratives of” wonky penis” and erectile dysfunction following surgery. In Stockholm, last summertime, a 30 -year-old man died after suffering a cardiac arrest following an operation to enlarge his penis.

***

At his Harley Street clinic, Dr Roberto Viel is explaining how a typical expansion runs. First, surgeons sever the organ’s suspensory ligament, causing it to hang an inch or two lower, giving the impression of extra length. They then extract fat from the patient’s belly and inject it into the penis rod, increasing circumference by around two inches. Erect, it’s worth noting, it remains approximately the same size, indicating the motives for many men are not inevitably to enhance either their- or a partner’s- sex experience.

The procedure, which can cost more than PS5, 000, lasts a little over an hour, but causes enough residual discomfort that physicians recommend patients take a week off run. The penis remains bandaged for 10 days. Sex is off the cards for a few months. Erection suppressants are prescribed to avoid stitches being rent open.

” Operations are very safe ,” says Viel, who founded the London Centre for Aesthetic Surgery with his twin brother Maurizio.” Perhaps 95% of our patients are very happy. Where they are not, it is often to do with expectations. Some men want 10 inches when nature gave them four or five. I “re saying”, gently,’ This is not possible. I am not a miracle worker .'”

Photograph
Photograph: Ilka& Franz for the Guardian

William O’Connor, a 38 -year-old mechanic from Northampton, is one of his satisfied clients- and it’s easy to understand why. Think of a large can of aerosol deodorant and you have, roughly enough, his new dimensions.” There was one woman who took one look at it and merely went,’ That thing is coming nowhere near me ,'” he says.” But largely it goes down very well. I’ve seen a lot of eyes light up .”

Though generously endowed by nature and confident enough in his body to have appeared in some adult cinemas in his 20 s, O’Connor decided to enhance his girth in 2013.” It was just something I imagination ,” he says with a shrug.” Some humen have hair transplants or belly tucks. I wanted a truncheon in my gasps. My whole life I’ve enjoyed impressing women; this was just an extension of that. You could call it a gentlemanly thing to do .”

O’Connor says he had no concerns beforehand (” My main worry was having the anaesthetic- I’m scared of needles “) and no unhappiness afterwards. The ache was manageable and there were no complications. He views the procedure as akin to working out.” I’m not preoccupied by my body- I have too many other things going on in my life ,” O’Connor says.” But I’m proud of it and I like that it’s in good shape- every part of it .”

The surgery should have no impact on fertility; O’Connor has since married and parent two children( he also has four from a previous relationship ).” I fulfill her after the op, but she was a family friend and knew I’d had it done. I’ve never asked if it was a plus phase .”

***

Amr Raheem is an andrology specialist( meaning his focus is on medicine relating to humen) at University College London Hospital, as well as a surgeon at International Andrology, a private clinic in the capital. Over the past 15 years, he has carried out more than 250 enlargements.” There is no typical patient ,” Raheem says.” All professions, all ethnicities, married, single, gay, straight-out, rich, poor. It’s across the board. And all ages. I’ve worked on men in their 60 s- I don’t know if they go out and use it afterwards. Early 20 s, I won’t do. These are still boys. They must get to know it before they change it .”

Patients come in all shapes and sizes:” I’ve had men who are already large enough. I had one say he wanted to be like a milk bottle. Impossible .”

If there is one unifying factor, it is a lack of confidence about what nature has provided. The median duration of a British penis is, according to a 2016 King’ s College London study, 5.16 in erect and 3.67 in flaccid. Merely 0. 14% of men have what one University of California study defined as a “micropenis”- that is, less than 2.5 inches when erect. Nonetheless, study after study indicates frustration remains widespread among men.

” These are the men who come to us ,” Raheem says.” They are not inevitably small, but they want to feel more confident. In front of women, yes, but in front of other men, too, down the gym, that sort of thing .”

Many of his patients, he adds, have previously” avoided sex or situations where they would be exposed, out of embarrassment. So this attains them happier .”

Not all operations leave happy clients- infections and scarring are both potential side-effects (” This is the same as an operation of different kinds ,” Viel says ). Some men report a decline in angle after the suspensory ligament is cut, but according to David Ralph, a professor of urology at UCL,” By and large, patients don’t complain about that. The operation doesn’t alter the erect length at all- this is only for men who have anxiety about how they look in the changing rooms. The average increase in size is 1.3 cm, less than the diameter of a 1p coin. In my clinics, I prove patients one of these and ask if they still think it is worth it. Less than 5% decide to, and of all the persons who do, the gratification rate is just 20% .”

Occasionally, the cut ligament leaves genitals lopsided when flaccid, and pointing off to the left or right when erect, as Francis Tilley, director of London clinic Androfill, explains.” Ligaments are there for a reason ,” he says.” If you start cutting at them, the stability of the penis will be reduced: the erection will be lower and less straight .” Tilley’s practice offers the operation, but its website clearly identifies it as high risk.

One Stockport-based surgeon, Ravi Kant Agarwal, was struck off( though later allowed to practise again) after botching two procedures. One of his patients, the General Medical Council hear, was left with a penis” bent like a boomerang “. Agarwal was criticised for failing to explain potential complications and misleading patients about the possible outcome, as well as for not having anaesthetic backup during the operations.

Alistair decided to have the operation after 40 years of anxiety.” I played Sunday football and dreaded the changing rooms ,” he says.” It’s not so much the duration as how thin and scrawny it was .”

Six
Photograph: Ilka& Franz for the Guardian

He married, had children and learned to live with his unease. Then, four years ago, after separating from his wife, he asked a new partner how he measured up to her ex-husband.” It was a stupid question ,” Alistair acknowledges.” It’s pathetic that I cared at my age- but I did. To start with she told me it was fine, but I kept pushing and, eventually, she simply told me: his was bigger .”

Alistair took out a PS5, 000 loan to add to PS3, 000 of savings, and paid to go under the knife.( Surgery is difficult to obtain on the NHS, though it can be offered for psychological reasons, or to correct a true micropenis .)” It was the worst thing I’ve ever done ,” he says.” The pain afterwards … I couldn’t sit, I couldn’t stand. It was beyond anything they told me to expect. The wound get infected, and when they gave me antibiotics, it kept seeping pus. The scarring has barely faded even now .” He says the fat injection became lumpy, while his erection no longer stands straight.” It just doesn’t hanging in there. It’s deformed .”

Not long after the operation, he and his partner- who had repeatedly insisted he should not have it done- split up. As we speak, he is preparing for one of his first dates since their separation.” I’m already worried about what she might think if we get intimate ,” he admits.

***

Thomas Modecai, 37, a teacher from Crewe, has struggled with the size of his penis for most of his life.” When I was 14, I shot up to 6ft but my penis stayed the same ,” he says.” I felt like a human with a child’s penis. And it’s affected everything: my relationships, my confidence, even my desire to have children. I fretted they might have the same issue .”

The only person who has ever seen him without clothes is his wife.” But even with her- we’ve been married 14 years- I was still anxious .”

After being rejected twice by doctors (” One said,’ Don’t worry about your penis, but you’re overweight ‘”), Modecai contacted Andrology International and, in August last year, paid PS6, 800 for a duration and girth boost.

” My wife didn’t like the idea ,” he says.” But this had been bothering me for 20 years. I’d already tried pills and potions- useless stuff you insure advertised in spam- and I was depleted. I needed it fixing .”

Since the surgery, he has felt happier and more confident.” I’m not exactly skipping round the house naked but, you are aware, maybe once I lose that weight ,” he says.” And we’re now thinking about children .”

I ask for his pre-op dimensions. He doesn’t want his exact measurings reported, but they are surprising: while flaccid, he was smaller than most men; erect, his penis grew significantly. Modecai, it seems, experienced two decades of stress despite the fact that, fully extended, he was bigger than the UK average. This apparent contradiction does not surprise Angela Gregory, a psychosexual therapist based at Nottingham University Hospitals NHS Trust.” Penis enlargements can be about a lot of things ,” she says.” But the amount of anxiety a man experiences rarely, in my experience, correlates with his actual size .”

The sheer symbolism of what’s in a man’s gasps may be a factor. As Harrison Pope and Katharine Phillips write in their volume on male body obsessions, The Adonis Complex, genitals ought to have equated with” virility, procreative potency, and power” throughout history. This has been compounded by an apparent rise in general masculine vanity. Figures from the British Association of Aesthetic Plastic Surgeons demonstrate the total number of male procedures doubled between 2005 and 2015, with breast reduction, rhinoplasty and neck lifts especially popular. For those in need of rejuvenation, surgery is cheaper and more easily available than ever.

Eric
Eric Bell, 68, is preparing for his third enlargement:’ It induces me happy knowing I have something eye-opening down there .’ Photograph: Richard Baybutt

Furthermore, Gregory highlightings two other recent developments: the proliferation of pornography and the rise of TV shows where brutal physical objectification has become, for the first time, an equal-opportunities phenomenon.

” Young humen generally become preoccupied with the size of their genitals when they compare with others ,” she says.” Historically, this was limited to changing rooms or the odd top-shelf magazine. But now there is this almost routine exposure to porn via smartphones. And that is creating a generation of men whose expectations of what they should look like are entirely unattainable .”

Added to that, she says, is the popularity of depicts such as Love Island where objectification comes as standard. In the summer of 2017, one male contestant was described as having” a penis like a baseball bat “; it was, unequivocally, a compliment. None of this objectification is new, of course: it’s just new for men.” But that doesn’t mitigated potential impacts ,” Gregory says.” For the individual who is going through the trauma of dreading his penis is too small, this is still devastating .”

All this might be leading to more than simple image anxiety; some have pointed to a new mental-health issue they term penile dysmorphic disorder.” It is a minority of men- and we don’t know how many- but it certainly exists and it’s as damaging as any other body dysmorphia ,” says Professor David Veale, of King’s College London, an authority on health nervousness.” These humen might seek out surgery, and for a few months they will be happy with the results. But then the same anxieties reappear. So, they seek out further surgery. It becomes a circle. But you cannot keep stimulating your penis bigger. This requires therapy .”

Largely, he says, these cases remain undisclosed.” Those who suffer don’t necessarily realise themselves, and rarely acknowledge it. It is an invisible illness .”

So how can we be sure it really exists?” Because the number of men seeking surgery, or the growth of this strange industry selling pills and other so-called enlargement remedies, these numbers do not map up with the numbers of men who actually have a significantly smaller penis than average ,” Veale says.” So, these men are worrying about- and trying answers for- a problem they do not have .”

Veale’s theory chimes with the experience of a retired marketings manager I fulfill in a drab Sheffield consultancy room. A lifelong bachelor, Eric Bell, 68, is charming and well-dressed, if, with a beard tinted blue, a touch eccentric. He is also preparing for his third penis enlargement- an operation that, judging from the sizeable member already between his legs, is unnecessary.” I’d just like it a bit fatter here ,” he explains, circling thumb and middle thumb around the top of his shaft.” I’m single, but it constructs me happy knowing I have something eye-opening down there .” We expend five minutes discussing the merits of this before he asks his own question:” Can I put it away now ?”

Bell says he had his first expansion in 2015, a year after agony the trauma of his brother drowning in York’s River Foss.” I suffered severe depression ,” he says.

Are the two things linked? “Possibly,” he says.” I don’t know. I don’t think about it .”

Bell is a patient at Moorgate Aesthetics, which has head offices in Doncaster. When I ask managing director David Mills if this may be one client who doesn’t need any more girth, he waves away the concern. Bell, he says, knows his own intellect, and has passed a psychological evaluation. The operation goes ahead.

This evaluation is something all clinics I speak to insist on. It involves a patient meeting with a surgeon or psychologist to have their general mental wellbeing assessed. If there is any hint of underlying concerns, problems or mental health issues, the operation does not go ahead. But, in recognition of the fact that such a repudiation would mean clinics losing PS5, 000 a pop, one does wonder how rigorous these assessments are. Is the entire industry simply profiting off insecurity bordering on dysmorphia?

Dr Roberto Viel supposes not.” I tell my patients we can give you a bigger penis, but we cannot construct you happy ,” he says.” You must be happy first, in your heart and head. If not, this operation “re not for” you. All it would entail is you are still unhappy – you just have a slightly bigger penis .”

Professor Ralph at UCL believes that some clinics are feeding patients’ unrealistic expectations.” Initially, they don’t see physicians, they consider sales people. It’s a hard sell:’ We can get you an extra inch or two .’ I’ve been practising in the NHS for 30 years: if it was that easy to increase the length of a normal penis, I’d be in the Mediterranean on my cruise liner now .”

Ralph thinks that” penile stretchers”, marketed under the name Andropenis, can be just as effective; but few humen is now ready to build such commitments of wearing a traction device for six hours a day for six months. He also points out that, for men with an unhealthy BMI, weight loss can be enough to build the penis appear bigger.

In a last brief dialogue with Alistair, he asks if I would ever consider going under the knife. I tell him I’ve seen such a bewilder array of shapes and sizes over the past few weeks, I don’t even know what normal is any more. If it does the job nature aimed, I say, that should be enough. For many humen wanting an expansion, it’s probably not so much about what’s in their pants as what, somewhere along the way, has got into their intellects- and that can’t be fixed by a fat injection and a severed ligament.

Alistair thinks about this and appears to agree:” Once it’s in your head, it’s difficult to let it go- even after you’ve had surgery .”

* Alistair’s name has been changed.

Read more: www.theguardian.com

Goal! The football league that helped me lose five stone

Sick of being overweight and worried about his health, Andy Welch knew it was time for drastic action. Then he stumbled across Man v Fat

I have always been overweight. I was 10 lb( 4.5 kg) when I was born and it kind of ran from there. I was 10 stone( 64 kg) by the age of 10, 13 st (8 3kg) at 13 and 16 st( 102 kg) by 16. My age and weight matching was a worry- and lasted until I was 21.

There were diets along the way. When I was younger, my parents tried various approaches to get me to lose weight- gentle persuasion, desperate pleas, even financial bribes. I was referred to a hospital dietitian who had a go, too. When I was a bit older, I joined a gym, and throughout my teens and at university I tried whatever fad was going: SlimFast, the Atkins, the GI diet and its closely related Low GL version. I went through a phase of drinking grapefruit juice after every meal because I had read it stopped any fat eat being absorbed, and I once spent a hungry fortnight eating nothing but Rice Krispies after vaguely recollecting the Olympic sprinter John Regis explaining how he had managed his weight by eating only cereal. Unsurprisingly, it did not work.

When I was 21, a friend at university told me he was concerned about my weight, that I was attaining life difficult for myself. I wasn’t offended, but those words were a kicking-off point. I lost almost four stone over the course of that summer.

Yet the manner in which I had lost it- walking eight to 10 miles a day in my summer task as a hospital porter and going to the gym most days- couldn’t last and, within two years, the weight had returned. I made countless resolutions to slim down over the next few years, but nothing stuck.

At 30, I tried Weight Watchers for the first time. Again, I lost 4st in a matter of months but, happy in a new relationship, I took my eye off the ball, enjoying eating out and cosy, snack-filled nights in. The weight crept back on. By the middle of 2016, aged 35, I reached my heaviest ever- 21 st 4lb( 135 kg ).

Something felt different this time. I was unhappier than ever about my weight and, as I marched towards 40( sweating and out of breath ), I felt I was being stalked by the twin spectres of diabetes and heart disease. A lifestyle overhaul was needed , not just a diet.

In my youth, despite my sizing, I had always been active. I was in the school and town football and rugby squads and I was a county tennis player. But that was a long time ago. According to a 2017 report by the European Commission, 37% of people in the UK don’t do any exert, and I was among them. I softly longed to get back to sport but had convinced myself that my knees couldn’t take it, or that I should lose some weight first, then run operating, or that I would let the side down and no one would play football with a big fat man. There’s always an excuse when you are trapped in a cycle of remorse, self-hatred and emotional overeating. Much easier to buy another container of wine gums, fire up Netflix and promise to start afresh on Monday.

Andy
Andy Welch in 2008:’ I made countless resolutions to slim down over the years, but nothing stuck’

Then I stumbled upon Man v Fat, a weight-loss football league where overweight humen can play against each other, safe in the knowledge some skinny wunderkind isn’t going to show up and run rings around them. Players are rewarded for weight lost with goals added to their team’s score on the pitching. There are hat-trick bonuses for losing three weeks in a row, and further rewards for reaching 5% and 10% weight-loss milestones.

I signed up in January 2017, unsure what to expect and having not kicked a ball since my late teens. The enrollment meeting was heartening for a number of reasons: I was far from the biggest man in the room- a rare feeling- and most of the players returning for their second run had lost 10% of their body weight during the previous season, depicting me that change was possible. After the initial introductions, we began swapping tales of our struggles with weight and our reasons for wanting to lose some. It felt more like a therapy group than a Sunday-morning kickabout.

At my first weigh-in, the scales read 20 st 7lb( 130 kg ). Six seasons later, I have, as of last week, broken through the 100 kg barrier for the first time since I was about 15. My blood pressure has dropped( from 140/90 to 120/80 ); I am in 34 in jeans, whereas I once wore 44 in, and I have a resting pulse of about 50. I also bought the Baracuta G9 Harrington jacket I had lusted after since my teens but could never squeeze myself into without looking like a explode sausage.

I now play football three times a week, have taken up operating, go to boxing class and have started playing tennis again, 20 years after I stopped because get around the court was too difficult. Another new pastime is, when I’m in a supermarket, piling up sacks of potatoes so I can lift my missing 35 kg and try to remember what it was like lugging it around. I’m sure the staff members detest me, but at least I am enjoying myself.

Gaining control of my diet greatly improved my mental health, too, boosting my confidence, resilience and previously nonexistent self-esteem. It was tested to the extreme during a devastating 10 -week period last year that assured the breakup of a long-term relationship and the deaths of a grandparent and a dear friend. The more life events spiralled beyond my control, the tighter my grip on the double distractions of meal planning and exercise. In traumatic hours of old, I reached for drink and ice-cream. Now, I feed fruit and play football.

Andy
Andy Welch in 2019, having been playing in Man v Fat for the past two years. Photograph: Graeme Robertson/ The Guardian

Exercise is, of course, important to weight loss, but controlling intake is vital. For that, I use Weight Watchers’ app to track my food, double-checking calorie consumption with MyFitnessPal. I rarely drink alcohol and, despite a sweet tooth that could shame Augustus Gloop, waved goodbye to my beloved pick’n’mix. I am not yet at a healthy weight( my goal is 13 st 5lb, or 85 kg ), and whether I will achieve that is another matter. I know I’d like to.

Andrew Shanahan set up the first Man v Fat league in Solihull in 2016. Two years previously, after losing 6st, he had written a book, Man v Fat: The Weight Loss Manual, which grew into an online forum on which male dieters swapped tips and supported each other.( The forum is still thriving and is among the most heartening corners of the internet. If you don’t feel something watching a group of burly dieters cheering on a fellow calorie-counter who has lost his way, swapping tips on getting rid of stretch marks or advising how best to navigate a pending journey to a carvery without ruining his progress, there is something very wrong with you .) But participants were eager for a face-to-face component to their dieting.

” When I was losing weight, I could never understand why something didn’t exist specifically for men ,” he says.” I’d tried Weight Watchers and Slimming World but fought with their approach. Not that they weren’t welcome but, institutionally, they weren’t suited to me. I was often the only man in the meetings, which wasn’t conducive to opening up about my weight.

A paper published in the periodical Obesity Research and Clinical Practice in 2016 found that men and women dieted more successfully in single-sex groups. A study of more than 2,000 people published last year in the journal Diabetes, Obesity and Metabolism also reported that humen typically lose weight faster and in greater quantities than girls. There are differing attitudes regarding intake and exert, too, with humen by and large preferring to work out more in order to eat more, while women would rather eat less to avoid lengthy sessions of exercise.

“Culturally,” adds Shanahan,” having a big appetite as a man has historically been seen as a positive thing, whereas for women, that hasn’t been the case. Men and women face different challenges when dieting, and Man v Fat reflects that .”

The first league comprehend 1,000 men apply for 80 league places, with about 90% of those participants losing weight over the course of the 14 -week season. That is a figure Man v Fat has more or less maintained in the three years since launching, with more than 70 leagues now operating all over the UK. The Australian franchise is in its second season, while talks are under way to launch Man v Fat in the US. Players have so far lost a blended 188,000 lb. That’s 85 tonnes.

” It’s quite unusual for men to go into any situation admitting some kind of weakness ,” says Shanahan.” Being fat is quite a good one because we can all see it. And when we’re in that group, it undoes any machismo around that dialogue. With that comes this positivity that you’re all doing it together and it opens up all sorts of dialogues you’d never commonly have. It’s an odd dynamic, but it’s very empowering .”

Suhal Miah is an immigration officer from north London. He joined Man v Fat in June 2017 weighing 22 st 7lb( 143 kg ). He has now almost halved his body weight. Miah says he was always” the fat kid at school”, but his weight shot up after his dad passed away in 2013.” I was suffering from depression and I began constantly feeing junk food. I simply remember looking in the mirror one day and thinking:’ What the hell have you done to yourself ?'”

Players
Players at the Man v Fat summer tournament in 2018. Photograph: Richard Blaxall

He signed up to the league on the relevant recommendations of a friend, and within two seasons he had lost 4st 10 lb( 30 kg ). By far the most motivating factor for him was Man v Fat’s squad component.” I don’t like letting people down, and on other diets it’s only yourself that you’re letting down if you don’t stick to it. With Man v Fat, it’s everyone on your team that’s affected if you fail and that helped me stick to my plan .”

As for his mental health, he is in a much better place than he was two years ago.” I was very close to my father and he died very suddenly, so it came as a real shock. We always had good food together, that was our thing- I guess me eating after he died was me trying to connect with him. But I look in the mirror now and I feel so much better about myself. I think my dad would be very proud .”

It’s a familiar tale for the Man v Fat coach Michael Falloon. After losing 8st himself in 2016, he qualified as a personal trainer, got a job with Man v Fat and now employs his personal experience and expertise to help others. “Losing weight gave me so much confidence,” he says.” I got to the point where I wouldn’t go to interviews because I guessed no one would devote person of my sizing a undertaking, so I know what the players are going through and the effects being overweight can have.

Matthew Maksimovic is a mental health worker from the outskirts of Cardiff. At 22, he was signed to the Welsh semi-professional team Merthyr Town until a contravene leg ended his dreams of playing at such a high level. It was then that he first started suffering from depression and gained weight. He carried on playing, though, until another serious injury a couple of years ago saw him stop playing altogether. His depression worsened and he put on even more weight.

He has now lost 3st 4lb( 21 kg) since signing up to Man v Fat last May, while his doctor has significantly lowered his antidepressant dosage. In addition, despite being 37, he is playing more football, and at a higher level, than ever before.

” I credit Man v Fat with giving me the belief to play again ,” he says.” Losing weight has changed not just my life, but that of my family, too. A day out with my daughter might have been jumping in the car and going to McDonald’s, but now we’ll head out for a walk and play in the park.

” I’m only sorry Man v Fat wasn’t around when I was 22 and I first started struggling with my weight. Who knows what I’d have achieved ?”

* To find out about your nearest Man v Fat football league, go to manvfat.com

Read more: www.theguardian.com

‘ I wanted a truncheon in my pants ‘: the rise of the penis extension

More and more men are opting for surgical penis enlargement. Is it a confidence boost, or a con?

It has been more than a year since the operation, but Alistair is still furious about the results.” I paid PS8, 000 and they mutilated me ,” he says.” It was butchery. My partner said it looked like a war wound. My erection is basically ruined .”

In July 2017, the 55 -year-old decorator, from London, became one of a growing number of British humen to have a surgical penis enlargement. Talk of enhancement was once the preserve of promotional spam mail for bizarre-looking pills and pumps; now, it is serious clinical business. British clinics, which have taken consultancy rooms in Harley Street and in UK cities including Manchester, Sheffield, Birmingham and Leeds, report record numbers of patients calling on their services. One practice, the London Centre for Aesthetic Surgery, has run from performing a handful of penis procedures annually when it opened in 1990 to more than 250 in 2017. Between 2013 and 2017, members of the International Society of Aesthetic Plastic Surgery carried out 45,604 penis improvements worldwide. Previous numbers are unknown; the procedure was considered such a minority concern that it wasn’t included in surveys. This increase in demand apparently caters to a growing nervousnes about penis size, but it is by no means a risk-free procedure. For Alistair, dreams of a greater penis were overtaken by infections, lumps and an erection that no longer rises above a 45 -degree angle. And he is not alone. In recent years, the General Medical Council has recorded narratives of” wonky penis” and erectile dysfunction following surgery. In Stockholm, last summer, a 30 -year-old man died after suffering a cardiac arrest following an operation to enlarge his penis.

***

At his Harley Street clinic, Dr Roberto Viel is explaining how a typical expansion works. First, surgeons sever the organ’s suspensory ligament, causing it to hang an inch or two lower, giving the impression of extra duration. They then extract fat from the patient’s stomach and inject it into the penis shaft, increasing girth by around two inches. Erect, it’s worth noting, it remains roughly the same size, suggesting the motives for many men are not inevitably to enhance either their- or a partner’s- sex experience.

The procedure, which can cost more than PS5, 000, lasts a little over an hour, but causes enough residual discomfort that physicians recommend patients take a week off work. The penis remains bandaged for 10 days. Sex is off the cards for a month. Erection suppressants are prescribed to avoid sews being rent open.

” Operation are very safe ,” says Viel, who founded the London Centre for Aesthetic Surgery with his twin brother Maurizio.” Perhaps 95% of our patients are happy. Where they are not, it is often to do with expectations. Some humen want 10 inches when nature dedicated them four or five. I “re saying”, gently,’ This is not possible. I am not a miracle worker .'”

Photograph
Photograph: Ilka& Franz for the Guardian

William O’Connor, a 38 -year-old mechanic from Northampton, is one of his satisfied customers- and it’s easy to understand why. Think of a large can of aerosol deodorant and you have, roughly enough, his new dimensions.” There was one woman who took one look at it and only ran,’ That thing is coming nowhere near me ,'” he says.” But largely it goes down very well. I’ve seen a lot of eyes light up .”

Though liberally endowed by nature and confident enough in his body to have appeared in some adult movies in his 20 s, O’Connor decided to enhance his circumference in 2013.” It was just something I imagination ,” he says with a shrug.” Some men have hair transplantings or belly tucks. I wanted a truncheon in my gasps. My whole life I’ve enjoyed impressing girls; this was just an extension of that. You could call it a gentlemanly thing to do .”

O’Connor says he had no concerns beforehand (” My main worry was having the anaesthetic- I’m scared of needles “) and no sadness afterwards. The ache was manageable and there were no complications. He views the procedure as akin to working out.” I’m not obsessed by my body- I have too many other things going on in my life ,” O’Connor says.” But I’m proud of it and I like that it’s in good shape- every part of it .”

The surgery should have no impact on fertility; O’Connor has since married and fathered two children( he also has four from a previous relationship ).” I fulfill her after the op, but she was a family friend and knew I’d had it done. I’ve never asked if it was a plus phase .”

***

Amr Raheem is an andrology specialist( meaning his focus is on medicine relating to men) at University College London Hospitals, as well as a surgeon at International Andrology, a private clinic in the capital. Over the past 15 years, he has carried out more than 250 expansions.” There is no typical patient ,” Raheem says.” All professions, all ethnicities, married, single, gay, straight-out, rich, poor. It’s across the board. And all ages. I’ve worked on men in their 60 s- I don’t know if they go out and use it afterwards. Early 20 s, I won’t do. These are still boys. They must get to know it before they change it .”

Patients come in all shapes and sizes:” I’ve had men who are already large enough. I had one say he wanted to be like a milk bottle. Impossible .”

If there is one unifying factor, it is a lack of confidence about what nature has provided. The median duration of a British penis is, according to a 2016 King’ s College London study, 5.16 in erect and 3.67 in flaccid. Merely 0. 14% of men have what one University of California study defined as a “micropenis” – that is, less than 2.5 inches when erect. Nonetheless, study after study presents discontent remains widespread among men.

” These are the men who come to us ,” Raheem says.” They are not inevitably small, but they want to feel more confident. In front of women, yes, but in front of other men, too, down the gym, that sort of thing .”

Many of his patients, he adds, has already been” avoided sex or situations where they would be uncovered, out of embarrassment. So this makes them happier .”

Not all operations leave happy customers- infections and scarring are both potential side-effects (” This is the same as an operation of any kind ,” Viel says ). Some humen report a decline in angle after the suspensory ligament is cut, but according to David Ralph, a professor of urology at UCL,” By and large, patients don’t complain about that. The operation doesn’t alteration the erect duration at all- this is only for men who have anxiety about how they look in the changing rooms. The average increase in size is 1.3 cm, less than the diameter of a 1p coin. In my clinics, I prove patients one of these and ask if they still think it is worth it. Less than 5% decide to, and of those who do, the satisfaction rate is just 20% .”

Occasionally, the cut ligament leaves genitals lopsided when flaccid, and pointing off to the left or right when erect, as Francis Tilley, director of London clinic Androfill, explains.” Ligaments are there for a reason ,” he says.” If you start cutting at them, the stability of the penis will be reduced: the erection will be lower and less straight .” Tilley’s practise offers the operation, but its website clearly identifies it as high risk.

One Stockport-based surgeon, Ravi Kant Agarwal, was struck off( though later allowed to practise again) after botching two procedures. One of his patients, the General Medical Council heard, was left with a penis” bent like a boomerang “. Agarwal was criticised for failing to explain potential complications and misinforming patients about the possible outcome, as well as for not having anaesthetic backup during the operations.

Alistair decided to have the operation after 40 years of nervousnes.” I played Sunday football and dreaded the changing rooms ,” he says.” It’s not so much the duration as how thin and scrawny it was .”

Six
Photograph: Ilka& Franz for the Guardian

He married, had children and learned to live with his malaise. Then, four years ago, after separating from his wife, he asked a new partner how he measured up to her ex-husband.” It was a stupid question ,” Alistair admits.” It’s pathetic that I cared at my age- but I did. To start with she told me it was fine, but I maintained pushing and, eventually, she simply told me: his was bigger .”

Alistair took out a PS5, 000 loan to add to PS3, 000 of savings, and paid to go under the knife.( Surgery is difficult to obtain on the NHS, though it can be offered for psychological reasons, or to correct a true micropenis .)” It was the worst thing I’ve ever done ,” he says.” The pain afterwards … I couldn’t sit, I couldn’t stand. It was beyond anything they told me to expect. The wound got infected, and when they gave me antibiotics, it maintained oozing pus. The scarring has barely faded even now .” He says the fat injection became lumpy, while his erecting no longer stands straight.” It simply doesn’t look right. It’s deformed .”

Not long after the operation, he and his partner- who had repeatedly insisted he should not have it done- split up. As we speak, he is preparing for one of his first dates since their separation.” I’m already worried about what she might think if we get intimate ,” he admits.

***

Thomas Modecai, 37, a teacher from Crewe, has struggled with the size of his penis for most of his life.” When I was 14, I shot up to 6ft but my penis stayed the same ,” he says.” I felt like a man with a child’s penis. And it’s affected everything: my relationships, my confidence, even my desire to have infants. I worried they might have the same issue .”

The only person who has ever seen him without clothes is his wife.” But even with her- we’ve been married 14 years- I was still anxious .”

After being dismissed twice by doctors (” One said,’ Don’t worry about your penis, but you’re overweight ‘”), Modecai contacted Andrology International and, in August last year, paid PS6, 800 for a length and girth boost.

” My wife didn’t like the idea ,” he says.” But this had been bothering me for 20 years. I’d already tried pills and potions- useless stuff you see advertised in spam- and I was exhausted. I needed it fixing .”

Since the surgery, he has felt happier and more confident.” I’m not exactly skipping round the chamber of representatives naked but, you are aware, maybe once I lose that weight ,” he says.” And we’re now thinking about children .”

I ask for his pre-op dimensions. He doesn’t want his exact measurements reported, but they are surprising: while flaccid, he was smaller than most men; erect, his penis grew significantly. Modecai, it seems, experienced two decades of stress despite the fact that, fully widened, he was bigger than the UK average. This apparent contradiction does not surprise Angela Gregory, a psychosexual therapist based at Nottingham University Hospitals NHS Trust.” Penis enlargements can be about a lot of things ,” she says.” But the amount of anxiety a man experiences rarely, in my experience, correlates with his actual size .”

The sheer symbolism of what’s in a man’s pants may be a factor. As Harrison Pope and Katharine Phillips write in their volume on male body obsessions, The Adonis Complex, genitals have been equated with” masculinity, procreative effectivenes, and power” throughout history. This has been further compounded by an apparent rise in general masculine vanity. Figures from the British Association of Aesthetic Plastic Surgeons depict the total number of male procedures doubled between 2005 and 2015, with breast reduction, rhinoplasty and neck lifts especially popular. For those in need of rejuvenation, surgery is cheaper and more easily available than ever.

Eric
Eric Bell, 68, is preparing for his third expansion:’ It stimulates me happy knowing I have something eye-opening down there .’ Photograph: Richard Baybutt

Furthermore, Gregory highlights two other recent developments: the proliferation of pornography and the rise of TV shows where brutal physical objectification has become, for the first time, an equal-opportunities phenomenon.

” Young humen generally become preoccupied with the size of their genitals when they compare with others ,” she says.” Historically, this was limited to changing rooms or the odd top-shelf magazine. But now there is this almost routine exposure to porn via smartphones. And that is creating a generation of men whose expectations of what they should look like are entirely unattainable .”

Added to that, she says, is the popularity of reveals such as Love Island where objectification comes as standard. In the summer of 2017, one male contestant was described as having” a penis like a baseball bat “; it was, unequivocally, a compliment. None of this objectification is new, of course: it’s just new for men.” But that doesn’t minimized potential impacts ,” Gregory says.” For the individual who is going through the trauma of dreading his penis is too small, this is still devastating .”

All this might be leading to more than simple image anxiety; some have pointed to a new mental-health issue they words penile dysmorphic ailment.” It is a minority of men- and we don’t know how many- but it certainly exists and it’s as damaging as any other body dysmorphia ,” says Professor David Veale, of King’s College London, an authority on health nervousness.” These men might seek out surgery, and for a few months they will be happy with the results. But then the same anxieties reappear. So, they seek out further surgery. It becomes a circle. But you cannot keep attaining your penis bigger. This requires therapy .”

Largely, he says, these cases remain undisclosed.” Those who suffer don’t inevitably realise themselves, and rarely acknowledge it. It is an invisible illness .”

So how can we be sure it really exists?” Because the number of men seeking surgery, or the growth of this strange industry selling pills and other so-called enlargement redress, these numbers do not map up with the numbers of men who actually have a significantly smaller penis than average ,” Veale says.” So, these men are worrying about- and attempting answers for- a problem they do not have .”

Veale’s hypothesi chimes with the accomplishments of a retired marketings manager I fulfill in a drab Sheffield consultancy room. A lifelong bachelor, Eric Bell, 68, is charming and well-dressed, if, with a beard tinted blue, a touch eccentric. He is also in preparations for his third penis enlargement- an operation that, judging from the sizeable member already between his legs, is unnecessary.” I’d just like it a bit fatter here ,” he explains, circling thumb and middle finger around the top of his rod.” I’m single, but it builds me happy knowing I have something eye-opening down there .” We expend five minutes discussing the merits of this before he asks his own question:” Can I put it away now ?”

Bell says he had his first expansion in 2015, a year after agony the trauma of his brother drowning in York’s River Foss.” I suffered severe depression ,” he says.

Are the two things linked? “Possibly,” he says.” I don’t know. I don’t think about it .”

Bell is a patient at Moorgate Aesthetics, which has head offices in Doncaster. When I ask managing director David Mills if this may be one client who doesn’t need any more girth, he waves away the concern. Bell, he says, knows his own intellect, and has passed a psychological evaluation. The operation goes ahead.

This evaluation is something all clinics I speak to insist on. It involves a patient meeting with a surgeon or psychologist to have their general mental wellbeing assessed. If there is any hint of underlying concerns, problems or mental health issues, the operation does not go ahead. But, in recognition of the fact that such a refusal would entail clinics losing PS5, 000 a pop, one does wonder how rigorous these assessments are. Is the entire industry simply profiting off insecurity bordering on dysmorphia?

Dr Roberto Viel thinks not.” I tell my patients we can give you a bigger penis, but we cannot construct you happy ,” he says.” You must be happy first, in your heart and head. If not, this operation is not for you. All it would entail is you are still unhappy – you just have a somewhat bigger penis .”

Professor Ralph at UCL believes that some clinics are feeding patients’ unrealistic expectations.” Initially, they don’t see doctors, they ensure marketings people. It’s a hard sell:’ We can get you an extra inch or two .’ I’ve been practising in the NHS for 30 years: if it was that easy to increase the length of a normal penis, I’d be in the Mediterranean on my cruise liner now .”

Ralph thinks that” penile stretchers”, marketed under the name Andropenis, can be just as effective; but few humen are prepared to attain the commitment of wearing a traction device for six hours a day for six months. He also points out that, for men with an unhealthy BMI, weight loss can be enough to stimulate the penis appear bigger.

In a last brief dialogue with Alistair, he asks if I would ever consider running under the knife. I tell him I’ve seen such a bewildering array of shapes and sizes over the past few weeks, I don’t even know what normal is any more. If it does the job nature intended, I say, that should be enough. For many men wanting an enlargement, it’s probably not so much about what’s in their pants as what, somewhere along the way, has got into their intellects- and that can’t be fixed by a fat injection and a severed ligament.

Alistair thinks about this and appears to agree:” Once it’s in your head, it’s difficult to let it go- even after you’ve had surgery .”

* Alistair’s name has been changed.

Read more: www.theguardian.com

‘ I wanted a truncheon in my gasps ‘: the rise of the penis extension

More and more men are opting for surgical penis enlargement. Is it a confidence boost, or a con?

It has been more than a year since the operation, but Alistair is still furious about the results. “I paid £8,000 and they mutilated me,” he says. “It was butchery. My partner said it looked like a war wound. My erection is basically ruined.”

In July 2017, the 55-year-old decorator, from London, became one of a growing number of British men to have a surgical penis enlargement. Talk of enhancement was once the preserve of promotional spam mail for bizarre-looking pills and pumps; now, it is serious clinical business. British clinics, which have taken consultancy rooms in Harley Street and in UK cities including Manchester, Sheffield, Birmingham and Leeds, report record numbers of patients calling on their services. One practice, the London Centre for Aesthetic Surgery, has gone from performing a handful of penis procedures annually when it opened in 1990 to more than 250 in 2017. Between 2013 and 2017, members of the International Society of Aesthetic Plastic Surgery carried out 45,604 penis enhancements worldwide. Previous numbers are unknown; the procedure was considered such a minority concern that it wasn’t included in surveys. This increase in demand seemingly caters to a growing anxiety about penis size, but it is by no means a risk-free procedure. For Alistair, dreams of a larger penis were overtaken by infections, lumps and an erection that no longer rises above a 45-degree angle. And he is not alone. In recent years, the General Medical Council has recorded stories of “wonky penises” and erectile dysfunction following surgery. In Stockholm, last summer, a 30-year-old man died after suffering a cardiac arrest following an operation to enlarge his penis.

***

At his Harley Street clinic, Dr Roberto Viel is explaining how a typical enlargement works. First, surgeons sever the organ’s suspensory ligament, causing it to hang an inch or two lower, giving the impression of extra length. They then extract fat from the patient’s stomach and inject it into the penis shaft, increasing girth by around two inches. Erect, it’s worth noting, it remains roughly the same size, suggesting the motives for many men are not necessarily to enhance either their – or a partner’s – sexual experience.

The procedure, which can cost more than £5,000, lasts a little over an hour, but causes enough residual discomfort that doctors recommend patients take a week off work. The penis remains bandaged for 10 days. Sex is off the cards for a month. Erection suppressants are prescribed to avoid stitches being ripped open.

“Operations are very safe,” says Viel, who founded the London Centre for Aesthetic Surgery with his twin brother Maurizio. “Perhaps 95% of our patients are very happy. Where they are not, it is often to do with expectations. Some men want 10 inches when nature gave them four or five. I have to say, gently, ‘This is not possible. I am not a miracle worker.’”

Photograph
Photograph: Ilka & Franz for the Guardian

William O’Connor, a 38-year-old mechanic from Northampton, is one of his satisfied customers – and it’s easy to understand why. Think of a large can of aerosol deodorant and you have, roughly enough, his new dimensions. “There was one woman who took one look at it and just went, ‘That thing is coming nowhere near me,’” he says. “But mostly it goes down very well. I’ve seen a lot of eyes light up.”

Though generously endowed by nature and confident enough in his body to have appeared in some adult films in his 20s, O’Connor decided to enhance his girth in 2013. “It was just something I fancied,” he says with a shrug. “Some men have hair transplants or belly tucks. I wanted a truncheon in my pants. My whole life I’ve enjoyed impressing women; this was just an extension of that. You could call it a gentlemanly thing to do.”

O’Connor says he had no concerns beforehand (“My main worry was having the anaesthetic – I’m scared of needles”) and no regrets afterwards. The pain was manageable and there were no complications. He views the procedure as akin to working out. “I’m not obsessed by my body – I have too many other things going on in my life,” O’Connor says. “But I’m proud of it and I like that it’s in good shape – every part of it.”

The surgery should have no impact on fertility; O’Connor has since married and fathered two children (he also has four from a previous relationship). “I met her after the op, but she was a family friend and knew I’d had it done. I’ve never asked if it was a plus point.”

***

Amr Raheem is an andrology specialist (meaning his focus is on medicine relating to men) at University College London Hospitals, as well as a surgeon at International Andrology, a private clinic in the capital. Over the past 15 years, he has carried out more than 250 enlargements. “There is no typical patient,” Raheem says. “All professions, all ethnicities, married, single, gay, straight, rich, poor. It’s across the board. And all ages. I’ve worked on men in their 60s – I don’t know if they go out and use it afterwards. Early 20s, I won’t do. These are still boys. They must get to know it before they change it.”

Patients come in all shapes and sizes: “I’ve had men who are already large enough. I had one say he wanted to be like a milk bottle. Impossible.”

If there is one unifying factor, it is a lack of confidence about what nature has provided. The average length of a British penis is, according to a 2016 King’s College London study, 5.16in erect and 3.67in flaccid. Only 0.14% of men have what one University of California study defined as a “micropenis” – that is, less than 2.5 inches when erect. Nonetheless, study after study shows dissatisfaction remains widespread among men.

“These are the men who come to us,” Raheem says. “They are not necessarily small, but they want to feel more confident. In front of women, yes, but in front of other men, too, down the gym, that sort of thing.”

Many of his patients, he adds, have previously “avoided sex or situations where they would be exposed, out of embarrassment. So this makes them happier.”

Not all operations leave happy customers – infections and scarring are both potential side-effects (“This is the same as an operation of any kind,” Viel says). Some men report a decline in angle after the suspensory ligament is cut, but according to David Ralph, a professor of urology at UCL, “By and large, patients don’t complain about that. The operation doesn’t change the erect length at all – this is only for men who have anxiety about how they look in the changing rooms. The average increase in size is 1.3cm, less than the diameter of a 1p coin. In my clinics, I show patients one of these and ask if they still think it is worth it. Less than 5% decide to, and of those who do, the satisfaction rate is just 20%.”

Occasionally, the cut ligament leaves genitals lopsided when flaccid, and pointing off to the left or right when erect, as Francis Tilley, director of London clinic Androfill, explains. “Ligaments are there for a reason,” he says. “If you start cutting at them, the stability of the penis will be reduced: the erection will be lower and less straight.” Tilley’s practice offers the operation, but its website clearly identifies it as high risk.

One Stockport-based surgeon, Ravi Kant Agarwal, was struck off (though later allowed to practise again) after botching two procedures. One of his patients, the General Medical Council heard, was left with a penis “bent like a boomerang”. Agarwal was criticised for failing to explain potential complications and misleading patients about the possible outcome, as well as for not having anaesthetic backup during the operations.

Alistair decided to have the operation after 40 years of anxiety. “I played Sunday football and dreaded the changing rooms,” he says. “It’s not so much the length as how thin and scrawny it was.”

Six
Photograph: Ilka & Franz for the Guardian

He married, had children and learned to live with his unease. Then, four years ago, after separating from his wife, he asked a new partner how he measured up to her ex-husband. “It was a stupid question,” Alistair admits. “It’s pathetic that I cared at my age – but I did. To start with she told me it was fine, but I kept pushing and, eventually, she just told me: his was bigger.”

Alistair took out a £5,000 loan to add to £3,000 of savings, and paid to go under the knife. (Surgery is difficult to obtain on the NHS, though it can be offered for psychological reasons, or to correct a true micropenis.) “It was the worst thing I’ve ever done,” he says. “The pain afterwards… I couldn’t sit, I couldn’t stand. It was beyond anything they told me to expect. The wound got infected, and when they gave me antibiotics, it kept seeping pus. The scarring has barely faded even now.” He says the fat injection became lumpy, while his erection no longer stands straight. “It just doesn’t look right. It’s deformed.”

Not long after the operation, he and his partner – who had repeatedly insisted he should not have it done – split up. As we speak, he is preparing for one of his first dates since their separation. “I’m already worried about what she might think if we get intimate,” he admits.

***

Thomas Modecai, 37, a teacher from Crewe, has struggled with the size of his penis for most of his life. “When I was 14, I shot up to 6ft but my penis stayed the same,” he says. “I felt like a man with a child’s penis. And it’s affected everything: my relationships, my confidence, even my desire to have children. I worried they might have the same issue.”

The only person who has ever seen him without clothes is his wife. “But even with her – we’ve been married 14 years – I was still anxious.”

After being dismissed twice by doctors (“One said, ‘Don’t worry about your penis, but you’re overweight’”), Modecai contacted Andrology International and, in August last year, paid £6,800 for a length and girth boost.

“My wife didn’t like the idea,” he says. “But this had been bothering me for 20 years. I’d already tried pills and potions – useless stuff you see advertised in spam – and I was exhausted. I needed it fixing.”

Since the surgery, he has felt happier and more confident. “I’m not exactly skipping round the house naked but, you know, maybe once I lose that weight,” he says. “And we’re now thinking about children.”

I ask for his pre-op dimensions. He doesn’t want his exact measurements reported, but they are surprising: while flaccid, he was smaller than most men; erect, his penis grew significantly. Modecai, it seems, experienced two decades of stress despite the fact that, fully extended, he was bigger than the UK average. This apparent contradiction does not surprise Angela Gregory, a psychosexual therapist based at Nottingham University Hospitals NHS Trust. “Penis enlargements can be about a lot of things,” she says. “But the amount of anxiety a man experiences rarely, in my experience, correlates with his actual size.”

The sheer symbolism of what’s in a man’s pants may be a factor. As Harrison Pope and Katharine Phillips write in their book on male body obsessions, The Adonis Complex, genitals have been equated with “virility, procreative potency, and power” throughout history. This has been compounded by an apparent rise in general masculine vanity. Figures from the British Association of Aesthetic Plastic Surgeons show the total number of male procedures doubled between 2005 and 2015, with breast reduction, rhinoplasty and neck lifts especially popular. For those in need of rejuvenation, surgery is cheaper and more easily available than ever.

Eric
Eric Bell, 68, is preparing for his third enlargement: ‘It makes me happy knowing I have something eye-opening down there.’ Photograph: Richard Baybutt

Furthermore, Gregory highlights two other recent developments: the proliferation of pornography and the rise of TV shows where brutal physical objectification has become, for the first time, an equal-opportunities phenomenon.

“Young men generally become preoccupied with the size of their genitals when they compare with others,” she says. “Historically, this was limited to changing rooms or the odd top-shelf magazine. But now there is this almost routine exposure to porn via smartphones. And that is creating a generation of men whose expectations of what they should look like are entirely unattainable.”

Added to that, she says, is the popularity of shows such as Love Island where objectification comes as standard. In the summer of 2017, one male contestant was described as having “a penis like a baseball bat”; it was, unequivocally, a compliment. None of this objectification is new, of course: it’s just new for men. “But that doesn’t lessen the impact,” Gregory says. “For the individual who is going through the trauma of fearing his penis is too small, this is still devastating.”

All this might be leading to more than simple image anxiety; some have pointed to a new mental-health issue they term penile dysmorphic disorder. “It is a minority of men – and we don’t know how many – but it certainly exists and it’s as damaging as any other body dysmorphia,” says Professor David Veale, of King’s College London, an authority on health anxieties. “These men might seek out surgery, and for a few months they will be happy with the results. But then the same anxieties reappear. So, they seek out further surgery. It becomes a circle. But you cannot keep making your penis bigger. This requires therapy.”

Largely, he says, these cases remain undisclosed. “Those who suffer don’t necessarily realise themselves, and rarely admit it. It is an invisible illness.”

So how can we be sure it really exists? “Because the number of men seeking surgery, or the growth of this strange industry selling pills and other so-called enlargement remedies, these numbers do not map up with the numbers of men who actually have a significantly smaller penis than average,” Veale says. “So, these men are worrying about – and seeking solutions for – a problem they do not have.”

Veale’s theory chimes with the experience of a retired sales manager I meet in a drab Sheffield consultancy room. A lifelong bachelor, Eric Bell, 68, is charming and well-dressed, if, with a beard tinted blue, a touch eccentric. He is also preparing for his third penis enlargement – an operation that, judging from the sizeable member already between his legs, is unnecessary. “I’d just like it a bit fatter here,” he explains, circling thumb and middle finger around the top of his shaft. “I’m single, but it makes me happy knowing I have something eye-opening down there.” We spend five minutes discussing the merits of this before he asks his own question: “Can I put it away now?”

Bell says he had his first enlargement in 2015, a year after suffering the trauma of his brother drowning in York’s River Foss. “I suffered severe depression,” he says.

Are the two things linked? “Possibly,” he says. “I don’t know. I don’t think about it.”

Bell is a patient at Moorgate Aesthetics, which has head offices in Doncaster. When I ask managing director David Mills if this may be one client who doesn’t need any more girth, he waves away the concern. Bell, he says, knows his own mind, and has passed a psychological evaluation. The operation goes ahead.

This evaluation is something all clinics I speak to insist on. It involves a patient meeting with a surgeon or psychologist to have their general mental wellbeing assessed. If there is any hint of underlying concerns, problems or mental health issues, the operation does not go ahead. But, given that such a refusal would mean clinics losing £5,000 a pop, one does wonder how rigorous these assessments are. Is the entire industry just profiting off insecurity bordering on dysmorphia?

Dr Roberto Viel thinks not. “I tell my patients we can give you a bigger penis, but we cannot make you happy,” he says. “You must be happy first, in your heart and head. If not, this operation is not for you. All it would mean is you are still unhappy – you just have a slightly bigger penis.”

Professor Ralph at UCL believes that some clinics are feeding patients’ unrealistic expectations. “Initially, they don’t see doctors, they see sales people. It’s a hard sell: ‘We can get you an extra inch or two.’ I’ve been practising in the NHS for 30 years: if it was that easy to increase the length of a normal penis, I’d be in the Mediterranean on my cruise liner now.”

Ralph thinks that “penile stretchers”, marketed under the name Andropenis, can be just as effective; but few men are prepared to make the commitment of wearing a traction device for six hours a day for six months. He also points out that, for men with an unhealthy BMI, weight loss can be enough to make the penis appear bigger.

In a last brief conversation with Alistair, he asks if I would ever consider going under the knife. I tell him I’ve seen such a bewildering array of shapes and sizes over the past few weeks, I don’t even know what normal is any more. If it does the job nature intended, I say, that should be enough. For many men wanting an enlargement, it’s probably not so much about what’s in their pants as what, somewhere along the way, has got into their minds – and that can’t be fixed by a fat injection and a severed ligament.

Alistair thinks about this and appears to agree: “Once it’s in your head, it’s difficult to let it go – even after you’ve had surgery.”

Alistair’s name has been changed.

Read more: www.theguardian.com

‘ I wanted a truncheon in my pants ‘: the rise of the penis extension

More and more men are opting for surgical penis expansion. Is it a confidence boost, or a con?

It has been more than a year since the operation, but Alistair is still furious about research results.” I paid PS8, 000 and they mutilated me ,” he says.” It was butchery. My partner said it looked like a war meander. My erection is basically ruined .”

In July 2017, the 55 -year-old decorator, from London, became one of a growing number of British men to have a surgical penis enlargement. Talk of improvement was once the conserve of promotional spam mail for bizarre-looking pills and pumps; now, it is serious clinical business. British clinics, which have taken consultancy rooms in Harley Street and in UK cities including Manchester, Sheffield, Birmingham and Leeds, report record numbers of patients calling on their services. One practise, the London Centre for Aesthetic Surgery, has gone from performing a handful of penis procedures annually when it opened in 1990 to more than 250 in 2017. Between 2013 and 2017, members of the International Society of Aesthetic Plastic Surgery carried out 45,604 penis enhancements worldwide. Previous numbers are unknown; the procedure was considered such a minority concern that it wasn’t included in surveys. This increase in demand apparently caters to a growing nervousnes about penis sizing, but it is by no means a risk-free procedure. For Alistair, dream of a larger penis were overtaken by infections, lumps and an erection that no longer rises above a 45 -degree angle. And “hes not” alone. In recent years, the General Medical Council has recorded narratives of” wonky penises” and erectile dysfunction following surgery. In Stockholm, last summer, a 30 -year-old man died after suffering a cardiac arrest following an operation to enlarge his penis.

***

At his Harley Street clinic, Dr Roberto Viel is explaining how a typical expansion runs. First, surgeons sever the organ’s suspensory ligament, causing it to hang an inch or two lower, giving the impression of extra duration. They then extract fat from the patient’s belly and inject it into the penis rod, increasing circumference by around two inches. Erect, it’s worth noting, it remains approximately the same size, suggesting the motives for many humen are not necessarily to enhance either their- or a partner’s- sex experience.

The procedure, which can cost more than PS5, 000, lasts a little over an hour, but causes enough residual discomfort that doctors recommend patients take a week off run. The penis remains bandaged for 10 days. Sex is off the cards for a month. Erecting suppressants are prescribed to avoid sews being ripped open.

” Operations are very safe ,” says Viel, who founded the London Centre for Aesthetic Surgery with his twin brother Maurizio.” Perhaps 95% of our patients are very happy. Where they are not, it is often to do with expectations. Some men want 10 inches when nature gave them four or five. I have to say, gently,’ This is not possible. I am not a miracle worker .'”

Photograph
Photograph: Ilka& Franz for the Guardian

William O’Connor, a 38 -year-old mechanic from Northampton, is one of his satisfied clients- and it’s easy to understand why. Think of a large can of aerosol deodorant and you have, approximately enough, his new dimensions.” There was one woman who took one look at it and simply went,’ That thing is coming nowhere near me ,'” he says.” But mostly it goes down are you all right. I’ve seen a lot of eyes light up .”

Though liberally endowed by nature and confident enough in his body to have appeared in some adult films in his 20 s, O’Connor decided to enhance his girth in 2013.” It was just something I fancied ,” he says with a shrug.” Some men have hair grafts or belly tucks. I wanted a truncheon in my pants. My whole life I’ve enjoyed impressing girls; this was just an extension of that. You could call it a gentlemanly thing to do .”

O’Connor says he had no fears beforehand (” My main fret was having the anaesthetic- I’m scared of needles “) and no sadness afterwards. The ache was manageable and there were no complications. He views the procedure as akin to working out.” I’m not preoccupied by my body- I have too many other things going on in my life ,” O’Connor says.” But I’m proud of it and I like that it’s in good shape- every part of it .”

The surgery should have no impact on fertility; O’Connor has since married and parent two children( he also has four from a previous relationship ).” I satisfied her after the op, but she was a family friend and knew I’d had it done. I’ve never asked if it was a plus point .”

***

Amr Raheem is an andrology expert( entailing his focus is on medication relating to humen) at University College London Hospitals, as well as a surgeon at International Andrology, a private clinic in the capital city. Over the past 15 years, he has carried out more than 250 expansions.” “There hasnt” typical patient ,” Raheem says.” All professions, all ethnicities, married, single, homosexual, straight, rich, poor. It’s across the board. And all ages. I’ve worked on men in their 60 s- I don’t know if they go out and use it afterwards. Early 20 s, I won’t do. These are still boys. They must get to know it before they change it .”

Patients come in all shapes and sizes:” I’ve had men who are already large enough. I had one say he wanted to be like a milk bottle. Impossible .”

If there is one unifying factor, it is a lack of confidence about what nature has provided. The average duration of a British penis is, according to a 2016 King’s College London study, 5.16 in erect and 3.67 in flaccid. Only 0. 14% of men have what one University of California study defined as a “micropenis”- that is, less than 2.5 inches when erect. Nonetheless, study after study shows discontent remains widespread among men.

” These are the men who come to us ,” Raheem says.” They are not necessarily small, but they want to feel more confident. In front of women, yes, but in front of other humen, too, down the gym, that sort of thing .”

Many of his patients, he adds, have previously” avoided sex or situations where they would be uncovered, out of shame. So this stimulates them happier .”

Not all operations leave happy clients- infections and scarring are both potential side-effects (” This is the same as an operation of any kind ,” Viel says ). Some men report a decline in angle after the suspensory ligament is cut, but according to David Ralph, a professor of urology at UCL,” By and big, patients don’t complain about that. The operation doesn’t change the erect duration at all- this to be for men who have anxiety about how they look in the changing rooms. The average increase in sizing is 1.3 cm, less than the diameter of a 1p coin. In my clinics, I prove patients one of these and ask if they still think it is worth it. Less than 5% decide to, and of those who do, the gratification rate is merely 20% .”

Occasionally, the cut ligament leaves genitals lopsided when flaccid, and pointing off to the left or right when erect, as Francis Tilley, director of London clinic Androfill, explains.” Ligaments are there for a reason ,” he says.” If “youre starting” cutting at them, the stability of the penis will be reduced: the erection will be lower and less straight-out .” Tilley’s practice offers the operation, but its website clearly identifies it as high risk.

One Stockport-based surgeon, Ravi Kant Agarwal, was struck off( though afterward allowed to practise again) after botching two procedures. One of his patients, the General Medical Council heard, was left with a penis” bent like a boomerang “. Agarwal was criticised for failing to explain potential complications and misleading patients about the possible outcome, as well as for not having anaesthetic backup during the operations.

Alistair decided to have the operation after 40 years of anxiety.” I played Sunday football and dreaded the changing rooms ,” he says.” It’s not so much the length as how thin and scrawny it was .”

Six
Photograph: Ilka& Franz for the Guardian

He married, had children and learned to live with his unease. Then, four years ago, after separating from his wife, he asked a new partner how he measured up to her ex-husband.” It was a stupid question ,” Alistair acknowledges.” It’s pathetic that I cared at my age- but I did. To start with she told me it was fine, but I maintained pushing and, eventually, she simply told me: his was bigger .”

Alistair took out a PS5, 000 loan to add to PS3, 000 of savings, and paid to go under the knife.( Surgery is difficult to obtain on the NHS, though it can be offered for psychological reasons, or to correct a true micropenis .)” It was the worst thing I’ve ever done ,” he says.” The ache afterwards … I couldn’t sit, I couldn’t stand. It was beyond anything they told me to expect. The wound got infected, and when they “ve been given” antibiotics, it kept oozing pus. The scarring has barely faded even now .” He says the fat injection became lumpy, while his erecting no longer stands straight.” It simply doesn’t look right. It’s deformed .”

Not long after the operation, he and his partner- who had repeatedly insisted he should not have it done- split up. As we speak, he is preparing for one of his first dates since their separation.” I’m already worried about what she might think if we get intimate ,” he admits.

***

Thomas Modecai, 37, a teacher from Crewe, has struggled with the size of his penis for most of their own lives.” When I was 14, I shot up to 6ft but my penis stayed the same ,” he says.” I felt like a man with a child’s penis. And it’s affected everything: my relationships, my confidence, even my desire to have children. I worried they might have the same issue .”

The only person who has ever seen him without clothes is his wife.” But even with her- we’ve been married 14 years- I was still anxious .”

After being dismissed twice by physicians (” One said,’ Don’t worry about your penis, but you’re overweight ‘”), Modecai contacted Andrology International and, in August last year, paid PS6, 800 for a length and girth boost.

” My spouse didn’t like the idea ,” he says.” But this had been bothering me for 20 years. I’d already tried pills and potions- useless stuff you ensure advertised in spam- and I was depleted. I needed it fixing .”

Since the surgery, he has felt happier and more confident.” I’m not exactly skipping round the house naked but, you know, maybe once I lose that weight ,” he says.” And we’re now thinking about children .”

I ask for his pre-op dimensions. He doesn’t want his exact measurements reported, but they are surprising: while flaccid, he was smaller than most men; erect, his penis grew significantly. Modecai, it seems, experienced two decades of stress despite the fact that, fully widened, he was bigger than the UK average. This apparent contradiction does not astound Angela Gregory, a psychosexual therapist based at Nottingham University Hospitals NHS Trust.” Penis enlargements can be about a lot of things ,” she says.” But the amount of anxiety a man experiences rarely, in my experience, correlates with his actual sizing .”

The sheer symbolism of what’s in a man’s gasps may be a factor. As Harrison Pope and Katharine Phillips write in their book on male body obsessions, The Adonis Complex, genitals have been equated with” virility, procreative potency, and power” throughout history. This has been compounded by an apparent rise in general masculine vanity. Figures from the British Association of Aesthetic Plastic Surgeons indicate the total number of male procedures doubled between 2005 and 2015, with breast reduction, rhinoplasty and neck lifts especially popular. For those in need of rejuvenation, surgery is cheaper and more easily available than ever.

Eric
Eric Bell, 68, is preparing for his third enlargement:’ It builds me happy knowing I have something eye-opening down there .’ Photograph: Richard Baybutt

Furthermore, Gregory highlightings two other recent developments: the proliferation of pornography and the rise of TV indicates where brutal physical objectification has become, for the first time, an equal-opportunities phenomenon.

” Young men generally become preoccupied with the size of their genitals when they compare with others ,” she says.” Historically, this was limited to changing rooms or the odd top-shelf magazine. But now there is this almost routine exposure to porn via smartphones. And that is creating a generation of men whose expectations of what they should look like are altogether unattainable .”

Added to that, she says, is the popularity of proves such as Love Island where objectification comes as standard. In the summer of 2017, one male contestant was described as having” a penis like a baseball bat “; it was, unequivocally, a compliment. None of this objectification is new, of course: it’s just new for men.” But that doesn’t lessen the effects ,” Gregory says.” For the individual who is going through the trauma of fearing his penis is too small, this is still devastating .”

All this might be leading to more than simple image anxiety; some have pointed to a new mental-health issue they word penile dysmorphic ailment.” It is a minority of men- and we don’t know how many- but it surely exists and it’s as damaging as any other body dysmorphia ,” says Professor David Veale, of King’s College London, an authority on health anxieties.” These humen might seek out surgery, and for a few months they will be happy with the results. But then the same nervousness reappear. So, they seek out farther surgery. It becomes a circle. But you cannot maintain making your penis bigger. This necessitates therapy .”

Largely, he says, these cases remain undisclosed.” Those who suffer don’t necessarily realise themselves, and rarely acknowledge it. It is an invisible illness .”

So how can we be sure it really exists?” Because the number of men trying surgery, or the growth of this strange industry selling pills and other so-called enlargement remedies, these numbers do not map up with the numbers of men who actually have a significantly smaller penis than average ,” Veale says.” So, these men are worrying about- and seeking solutions for- a problem they do not have .”

Veale’s theory chimes with the experience of a retired sales director I fulfill in a drab Sheffield consultancy room. A lifelong bachelor, Eric Bell, 68, is charming and well-dressed, if, with a beard tinted blue, a touch eccentric. He is also preparing for his third penis expansion- an operation that, judging from the sizeable member already between his legs, is unnecessary.” I’d just like it a bit fatter here ,” he explains, circling thumb and middle finger around the top of his rod.” I’m single, but it attains me happy knowing I have something eye-opening down there .” We spend five minutes discussing the merits of this before he asks his own question:” Can I put it away now ?”

Bell says he had his first enlargement in 2015, a year after suffering the trauma of two brothers drowning in York’s River Foss.” I suffered severe depression ,” he says.

Are the two things linked? “Possibly,” he says.” I don’t know. I don’t think about it .”

Bell is a patient at Moorgate Aesthetics, which has head offices in Doncaster. When I ask managing director David Mills if this may be one client who doesn’t need any more girth, he waves away the concern. Bell, he says, knows his own mind, and has passed a psychological evaluation. The operation goes ahead.

This evaluation is something all clinics I speak to insist on. It involves a patient meeting with a surgeon or psychologist to have their general mental wellbeing assessed. If there is any hint of underlying fears, problems or mental health issues, the operation does not go ahead. But, given that such a repudiation would entail clinics losing PS5, 000 a pop, one does wonder how rigorous these assessments are. Is the entire industry merely profiting off insecurity bordering on dysmorphia?

Dr Roberto Viel supposes not.” I tell my patients we can give you a bigger penis, but we cannot construct you happy ,” he says.” You must be happy first, in your heart and head. If not, this operation is not for you. All it would mean is you are still unhappy – you just have a slightly bigger penis .”

Professor Ralph at UCL believes that some clinics are feeding patients’ unrealistic expectations.” Initially, they don’t see physicians, they watch sales people. It’s a hard sell:’ We can get you an extra inch or two .’ I’ve been practising in the NHS for 30 years: if it was that easy to increase the length of a normal penis, I’d be in the Mediterranean on my cruise liner now .”

Ralph thinks that” penile stretchers”, marketed for the purposes of the name Andropenis, can be just as effective; but few men are prepared to build the commitment of wearing a traction device for six hours a day for six months. He also points out that, for men with an unhealthy BMI, weight loss can be enough to stimulate the penis appear bigger.

In a last brief conversation with Alistair, he asks if I would ever consider going for the purposes of the knife. I tell him I’ve seen such a bewildering array of shapes and sizes over the past few weeks, I don’t even know what normal is any more. If it does the job nature intended, I say, that should be enough. For many humen wanting an enlargement, it’s probably not so much about what’s in their pants as what, somewhere along the way, has got into their intellects- and that can’t be fixed by a fat injection and a severed ligament.

Alistair thinks about this and appears to agree:” Once it’s in your head, it’s difficult to let it go- even after you’ve had surgery .”

* Alistair’s name has been changed.

Read more: www.theguardian.com

The men who look for help online for erectile dysfunction might surprise you

Jake is in urgent need of assistance. The 20 -year-old posted on an online forum for MedHelp.org that his “penis is dead“most of the time and particularly around the girl hes currently dating, and yet perfectly erect around his ex. He’s desperate to find a solution and, in his own terms, is at his wits aim. Jakes on this forum, like so many men before him, to try to find comfortand answers.

In his online posting, Jake wonders if his problem is mental or medical. He acknowledges to having tried popular erectile dysfunction( ED) medications like Cialis and Viagra to no avail. So he’s turning to the other men who have experienced similar symptoms for answers. Much like amateur sleuths trying to solve cold instances from their mother’s basement, he is trying to look for clues he may have missed.

A few weeks later, another forum user chimes in, telling Jake he had a similar problem in his twenties. He asks Jake if he’s gotten an ultrasound? Could his masturbation frequency or technique have caused a blocked artery?

It may sound strange, a 20 -year-old fretting about extreme ED: after all, most commercials for treatment present a septuagenarian with blinding white veneers hanging off the side of a sailboat as he gazes seductively at a woman who looks like his wife of 40 years. But the data paints a much different painting about the type of men suffering from ED.

According to a 2013 examine from the International Society for Sexual Medicine, one in four new ED patients are humen under 40. The analyse also showed that nearly half of the younger men in such studies suffered from severe ED, “with comparable rates in older patients.”A 2012 study estimated that half of men from 40 to 70 have some sort of ED.

Analysis of these ever-growing online forums depicts a similar and surprising skewed toward the youngbut to a much more dramatic degree. According to the analysis to be undertaken by U.K. online pharmacy Superdrug Online Doctor with data from 3,962 unique posters spanning July 2007 to October 2015, more than 58 percent of men posting on this particular forum were 24 -years-old or younger. Only 31 percent, in fact, were 30 and above.( While these men may seem disproportionately young, it’s important to bear in mind that more than half of Internet users worldwide are 34-years-old or younger .)

Not all of the men turning to MedHelp, and forums like it, are in dire straights. Some are there to discussminor problems and others are there to compare the effectiveness of different drugs, like the more popular Viagra, Cialis and Levitra. In a post titled “Cant get hard, does Cialis run? ” a 33 -year-old man describes his difficulty keeping an erecting during sex because of a beta blocker he takes called Metoprolol. “Will it counter-act the effects of the metoprolol and allow me to get and maintain a hard erecting? ” he asks the forum.

The doc told I could also try switching to Diltiazem a calcium channel blocker, he writes. I may do that too but I suspect that I’m going to need the Cialis anyway. I never even get spontaneous erections in the morning any more either. It’s ruined my self esteem because I’ve been too scared to have a sex life because I know my penis won’t being carried out in spite of me was intended to.

He closes by asking “Does this medication genuinely work? ” Even after speaking to medical doctors, hes not convinced of the advice hes been given. He’s seeking what so many other Internet users are seeking: positive affirmation.

Perhaps because of their anonymity online, these men speak openly about very personal sex-related problems. “One of the most surprising things we find was the transparency of these issues and how candidly they were speaking to online communities, ” Erin Hogg, representatives to Superdrug Online Doctor, told the Daily Dot via phone. “Its a very private issue and guys dont want to talk to their friends about this stuff. are anonymous, safe places to get things off their chests.”

Some of the language is, well, quite blunt. In another post on MedHelp.org called Penis is bent, a human describes, well, exactly what it sounds like.

MedHelp.org

Tristan Harris, the project administrator/ researcher on the Superdrug study told the Daily Dot in a phone interview that these type of freak traumata that people described were the one of the most surprising parts: “A lot of the posts were mentioning different types of injuries. Its definitely kind of terrifying to see.”

Scrolling through the hundreds of posts on MedHelp, you’ll insure ones like “Severe accident to testicles, ” “Penis fractured/ broken/ snapped, ” and “Leaking veins.” It’s enough to make even the most macho man recoil in his leather recliner.

While ED is a physical issue for some patients, for many its a mental issue. And the study showed that the word most often associated with ED and mental health was porn. One forum user, after explaining that hes unable to sustain an erection with his new girlfriend, surmises that its probably due to all the porn he watched before they were together.

I am thinking that it is porn induced ED, I can usually climax after watching porn, but I am having real troubles in even biding erect for sex. I was thinking about taking Panax Ginseng, in hopes of helping me stay erect during sex. Ive been reading on the whole rebooting therapy for porn induced ED( which would take 2 months at minimum ), but again I am quite afraid of losing her due to a non existent or only extremely awkward sexuality life .

Porn was far and away the most popular term associated with how these men self-diagnosed their mental ED, with variations including “Internet porn” and “porn addiction.” Some also attributed it to “performance anxiety.”

While it’s encouraging to see men reaching out to other men while experiencing a number of problems, there is some concern that humen may seek this sort of anonymous, private counsel instead of from a professional. “There are plenty of good and bad resources online, naturally. You can get lousy advice about everything from selecting the perfect wine for your dinner to changing your motor oil, ” Fred Wyand of the American Sexual Health Association told the Daily Dot via email. “So of course the potential for misinformation regarding health issues is ever present and is also the reason why one should not allow forums or any website to replace the advice and guidance of their health care professional.”

Wyand assures forums like MedHelp, and others like Daily Strength and Reddits various subreddits on the subject, principally as places for community but certainly not for expert opinions. “Forums are especially good at providing support, a sense of understanding from others “re going through” something similar, ” he continued. “But of course one should always consider the source and go back to the doctor or nurse with questions.”

The Internet can be a resource for people “re going through” more or less current problems under the sunshine. From dealing withsobriety, to going throughweight loss, communities exist to help people stay the course and learn from the experience of others. What is perhaps most interesting about the ED forums is that it paints a very different picture of the type of human who is experiencing the questions: hes not only just old, white and rich. This human is oftentimes young, scared and alone, and other humen are there to lift him upso to speak.

Photo via torbakhopper/ Flickr( CC BY ND 2.0 )

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