Sitting in a urology office in Beverly Hills, I’m handed a butterflied cylinder of white silicone. It’s around six inches in length, surfaced inside and out with a fine mesh, and over 3,000 like it have been inserted into bodies of over 3,000 men since 2004. “With this, we’ve made a lot of people very happy,” says avuncular urologist James Elist. “In some cases, we’ve saved some lives.” The “this” he refers to is the Penuma, a penile implant he invented in the year 2000 to add girth to the penises of his patients.
Prior to Y2K, Elist’s main gig was outfitting guys with erectile dysfunction with penile prosthetics—he tells me that the newly launched Viagra didn’t alleviate the problem for some 45 percent of his patients. “What Viagra did for them however, was make them feel more comfortable talking about what other improvements could be made to their sex lives,” he says. “A very common concern I heard was about the size of the penis.”
“Small Penis Syndrome”—a type of body dysmorphia that feels a bit like the opposite of BDE—is a thing and it’s prevalent. The majority of men who are unhappy with the size of their penises are actually within what’s referred to as the normal range and many are actually larger than average. Having a micropenis means having a penis that has an erect penile length of at least 2.5 standard deviations smaller than the mean human penis size. That comes out to a penis that’s around 2.75” for an adult when compared with an average 5.17”. While Elist says that many Penuma recipients do end up being in the normal range—only 0.6 percent of men have a micropenis—he prefers to align himself with the “if it ain’t broke, don't fix it” maxim.
When he talks about saving lives, Elist is talking both figuratively and literally. “We can help men feel confident again and enjoy life again but there have been some cases in which men have considered suicide,” he says. “I think it’s true to say that there are people alive today because of our attention to this matter.”
Around the time he invented Penuma, Elist spent more of his time on addressing the penis’s form and not just the function. Up until then, men’s attempts to get a thicker penis mainly entailed the injection of organic and inorganic materials which often yielded lumpy, sometimes gangrenous results. Taking cues from breast implants, Elist started to develop an idea for a solid and shelf-stable prosthesis.
“I knew that the FDA would not approve a prosthesis that covered the urethra so I came up with a device that surrounds 270 degrees of the shaft,” he says. As I hold it in my hand, Elist explains that as the penis becomes erect, the Penuma opens up—a little like the doors of a Tesla Model X. Not only did this hot dog bun-like design solve the urethra snag (the FDA cleared his patented device in 2004), it also enabled the device to move with the penis’s countless ups and downs. The Penuma is sutured both at the base of the penis and behind the ridge of the glans or head of the penis. In 2018, Elist’s trademarked procedure accounts for 90 percent of his work load.
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“It’s actually quite a simple operation,” Elist says, explaining how, under twilight anesthesia, a lateral incision is made about an inch or two above the point at which the penis attaches the body, into which his squid-like brainchild is slid until it ensconces the penis. “But this a procedure that didn’t previously exist. Many improvements have been made to the way it’s done and to the Penuma itself over the years.”
Something Elist didn’t foresee was that in many of his patients, the weight of the device lengthened the penis over time. While on the face of it that might appear to be a nice bonus, early patients found that their penises had become longer than the prostheses and were now sporting a gully where the penis meets the body. In anticipation of what gravity often does to Penuma recipients’ dongs, Elist began laying a deeper foundation, placing two inches of the device inside the body. “I need to stress though that while an increase in erect length often happens, it’s not something I can guarantee,” Elist tells me. “The girth, however, is a certainty.”
Penuma comes in three sizes: large, extra large and extra extra large. Depending on the size patients opt for, the circumference can increase substantially. An IRB (the FDA of biomedical research) approved, retrospective clinical study of 400 of Elist’s patients over a five-year period was presented to the American Urological Association and the Society for Sexual Medicine. The data showed an average increase in erect circumference of 4.9 cm (or ~2 in). The Penuma also provides gains in flaccid girth and length which—according to Elist—is a selling point among folks known as growers as opposed to showers.
Despite being in the same “normal” range as the overwhelming majority of penis owners, it didn’t take sitting in Elist’s clinic to make me wonder what life would be like if I was sporting a penis thicker than my wrist. “I wouldn’t advise somebody get a penile prosthesis of this type,” says New York City-based plastic surgeon Andrew Jacono, when I press him for his take. Though Jacono says that he wasn’t very familiar with the Penuma, he asserts that because this is fairly new—the first Penuma recipient got his just 14 years ago—the longer term risks are unknown. “Erectile dysfunction and a loss of sensitivity could be among these risks,” he says.
Elist maintains that so far, no loss of sensation has been reported and that around 95 percent of operations are successful. Complications that arise in the 5 percent, he tells me, often arise from patients not following post operative care guidelines. And those complications generally include infection and damage from trying to have sex too soon after the operation.
It’s understandable that you’d want to play with your new toy ASAP, but Elist recommends exercising patience while dissolvable sutures break down and what he calls a “capsule” forms between the skin and the prosthesis. This capsule both holds the prosthesis in place and makes its presence less detectable to the touch over time. He recommends six to eight weeks of down time.
“Painful erections are quite common for the first few weeks,” Elist says, explaining that new patients are prone to waking up at night, every 90 minutes, as their engorged penises tug on the new sutures anchoring the Penuma in place.
Elist, who performs his procedure for $15,000 on patients from around the world, has recently struck a deal with a distributor that will enable other urologists to lighten his workload. “I’ve been doing this for 14 years and we’re now in a place where the outcomes are consistent,” he says. At this point, he’s comfortable with other highly qualified urologists performing the procedure under his tutelage.
While I really do love my penis and would hate anything to happen to it, I have to admit that I am rather tantalized by the prospect of having a penis that is 2” bigger around and quite possibly a little longer too. My girlfriend, however, is less enthused at the prospect. The six-to-eight week sex strike aside, she’s concerned that a change in the size and shape of my penis might not feel as good as the two hands I was dealt. In a way, it’s almost enough to know that, should I ever feel the an overwhelming urge for my pump to be plumped, I have the option.
Correction: A previous version of this article is titled There's an Implant to Make Penises Thicker, Lot Longer. The current title reflects a correction to the inaccuracy that this implant does not increase the length of a penis, which it often does.
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