One of Those Porno King Kong Dongs

Taking a Hard Look at Penis Implants

A few weeks ago, my mother asked what I was working on, and I told her I was writing an article on penis size for a client. “We’re still worried about that?” she groaned, referring to the royal we. Unfortunately we are, and some men are going to extraordinary lengths to augment what nature gave them (yes, I did that on purpose).

Proof of this very concern came a few days later in the form of a fabulous article from ProPublica/The New Yorker that took a hard look at the Penuma implant and procedure (yes, I did that on purpose) developed by Beverly Hills Urologist James Elist. It’s a great piece of investigative journalism that weaves patients’ stories with the surgeon’s story with the stories of other urologists who say they’ve been hired to clean up his work. It includes information on intellectual property lawsuits and medical malpractice suits; discussions of online communities that popped up to share negative experiences (there I go again); and the writer’s first-hand account of watching a Penuma implant surgery. It’s the kind of investigative journalism that I admire, and Ava Kaufman should know she did a great job.

I won’t try to summarize it because there’s so much nuance, and you should all read it, but I am going to list a few of the many things that stood out to me. Presented here without comment (feel free to imagine my response to each):

1. It has the most impact on the flaccid penis which can gain length and girth. The erect penis may gain a little girth but won’t be longer.

2. Mick, whose story is the thread that ties the article together, lost most of the sensation in the head of his penis after surgery.

3. The basic operation costs $15,000.

4. Mick says his consultation lasted five minutes and happened on the same day as the surgery. Despite this, Mick signed a document that said the consultation lasted an hour and another that was essentially an NDA promising not to “disclose his relationship with Dr. James Elist.”

5. In lawsuits three men said they’d been given the informed consent papers after they were given Demerol, some men said they were given forms in English despite not being English speakers, and some of those same men said they went under expecting to have a different procedure. (Elist denies these allegations.)

6. Some men have said the corners of their implant protruded out of their skin.

7. Penuma’s monthly newsletter is called “Inching Toward Greatness.”

8. Other surgeons have signed on to do the Penuma procedure and believe it is revolutionary.

9. One surgeon who studied with Elist released his own version of an implant, and Elist successfully sued him for violating intellectual property rights.

10. One man had his implant break into pieces in his penis.

11. Other urologists have said they frequently do surgery to repair the damage caused by the Penuma. One doctor who does this has his patients wear condoms with weights in the tips for 6 hours a day as part of penis rehabilitation. 

12. Men who have the implant removed may lose erectile length or see a change in the shape of their penis because of the scar tissue that formed.

13. The Penuma has FDA approval for the “cosmetic correction of soft tissue deformities,” but, according to the article, the word “penis” did not appear in its indications for use.

14. The procedure involves a step called “degloving the penis.”

15. Dr. Elist has written a book called Operating with God, a collection of parables for the spiritually minded surgeon.

16. One man who actually liked his extra-large implant had it taken out anyhow because it was uncomfortable for his wife: she was getting micro-tears in her vagina.

17. Some men say their post-implant penis is always in a semi-erect state. One man put it this way, “I couldn’t let my kids sit on my lap. I couldn’t jump on the trampoline with them. I even felt like a pervert hugging my friends.”

18. Surgeons use a piece of mesh to attach the implant to the inside of the penis, and scar tissue forms around the mesh. The doctor who removed Mick’s implant said, “I feel like it’s sacrilege, wrapping a man’s neurovascular bundle in mesh.”

19. Late in the article Kaufman writes, “The great irony — lost on few — was that, after getting surgery to stop thinking about their penises, these men were now thinking about their penises all the time.”

As I was reading the article, I realized that I’d been getting press pitches about something similar for months. I’d mostly dismissed the pitches as quackery and had not considered interviewing the offered expert, but I went back to look wondering if they would discuss Penuma. As it turned out, that the expert in my in-box was Dr. Elist himself. Now, I had some questions.

There was some back-and-forth with his publicist in which I was totally honest about my position (I’m a sex educator who thinks penis size issues should be addressed with education and counseling and not plastic surgery, but I’m also a firm believer in bodily autonomy), my intention (this isn’t “gotcha” journalism, I just wanted to get answers to some lingering questions I had), and my style (there will be snark and really bad penis puns). Ultimately, Dr. Elist agreed to answer my questions in writing, and I agreed to quote them verbatim.

Some of my friends and colleagues suggested I ask Dr. Elist about the size of his own member, but I decided to keep it above-board. The resulting exchange is actually kind of boring. I asked a few clarifying questions, and he answered in the driest, most I’ve-just-been-burned-by-the-media-and-my-lawyer-is-looking-over-my-shoulder way possible. To keep my promise, I have cut and pasted the whole thing at the end of this issue, so you can read all of his answers in his own words.

But I also promised snark and bad puns, so here’s an annotated explanation of what I asked, why I asked it, and what I learned, in my own words.

How does it work?

Penises have complicated hydraulic systems that allow blood in and out so that they can be soft sometimes and hard other times. This has been cited as the underlying reason why classic plastic surgery implants—like those that offer a sharp chin where there once was just neck or turn someone into a 32DD overnight—have not traditionally been applied to the male member.

The article describes the procedure in detail, but I was still confused about whether this procedure cracked the code on changing the size of an appendage that is already designed to change size. I wanted to know where amongst the internal structures of the penis (the corpus cavernosa, the corpus spongiosum, and the urethra) the implant goes and how erections work with it in.

I may not have been detailed enough in my question, however, because the only part of the response that addressed it was, “It is designed to maintain penis function the same way it functioned before the procedure, only bigger.” I’m still not sure where exactly the implant goes after the penis has been degloved (sorry, but I can’t get that visual out of my head).  

What’s different about the rebranded Himplant, and what is its FDA status?

A rebrand that comes on the heels of negative press seemed a little too convenient, so I wondered whether it was nothing more than a name change. Dr. Elist’s answer to that was clear: the procedure is different and the mesh is gone. Moreover, the documents seeking FDA approval for this model (which was granted last year) do, in fact, mention penises.

I didn’t ask why they chose Himplant as the new name, and nobody asked for my opinion on it, but I see it as a marketing misstep; it sounds like himbo and is even harder to take seriously (oops, I’m back at it) .

Did he ever turn anyone away?

The article mentioned that Mick’s penis was 6.5 inches long when erect before the surgery which makes him far longer than average (the average erect penis is 5.16 inches). Similarly, the client whose surgery was described in the article was 4 inches long and 4 inches around when flaccid which is also bigger than average (the average soft penis is 3.6 long by 3.6 wide).

What I really wanted to know was whether Dr. Elist ever told a guy to drop his pants, took one look and said, “Dude, go home, your cock is big enough.” He said he had (though neither of us used those words in our Q&A).   

He referred me to a journal article about the screening procedure which includes an interesting exercise in which men are shown pictures of penises of varying sizes and asked to pick out their current dick and their dream dong. If either varies from reality, they could be referred to therapy or disqualified from the surgery. That article did not say how many men were turned away, but as you’ll see below, Elist says they frequently turn men away for a whole host of reasons.

Elist also told me that prospective patients had to attest to having watched a YouTube video before they are allowed to even schedule a surgery date. I watched the 12-minute animated video and found that it focused mainly on post-operative instructions and potential issues. While it did remind patients at least twice that they could choose not to have surgery, it did not educate viewers on average penis size or suggest that their image of what a penis should be was likely widely off-base and clouded by porn.

Why did he think so many men had bad experiences?

Finally, I asked Dr. Elist about the number of men who talked to the New Yorker and posted in online communities saying they hated their new dick. His answer, which you should read below, essentially had two themes; there are more satisfied patients out there who aren’t talking to reporters, and the people who had problems probably didn’t follow the post-operative advice.

I’ll give him part of the first one. It’s like Yelp reviews in that you only hear from the people who want to excoriate a restaurant for its tasteless food and piss-poor service or diners who had the best meal of their entire lives. But in this case, it’s a Yelp review of a restaurant people may have been embarrassed to eat at in the first place. Why publicly celebrate that you used to have a small penis?

Dr. Elist said “Over 5,000 Penuma procedures, have been performed to date, and only a small number of patients have experienced complications.” Then he cited a study that was also mentioned in the New Yorker piece which included only 400 patients. The samples seems suspiciously small, and it’s findings of an 81% satisfaction rate does not seem particularly impressive (and yes, I might still be doing it).

The second part of his answer focused on post-operative procedures and borders on blaming the victim. The instructions—which are spelled out in the video—discuss stitches near the pubic hair that you may need to remove yourself, says spontaneous erections during recovery will likely be painful, and basically tells you to leave your dick alone for 6-8 weeks. The video says, “you must avoid examining, manipulating, or bending your penis until you’ve received clearance for sexual activity.” (I’ve never had a penis, but leaving it entirely alone seems really difficult given that one must pee multiple times a day, and doesn’t it have to bend to fit into pants?) Dr. Elist’s answer to the question also seems to suggest that some men use penis stretchers during recovery which sounds excruciating.

Body Autonomy or Quackery

Again, I invite you to read the original article and Dr. Elist’s answers to my questions, and perhaps to listen to Macklemore’s “Penis Song,” because all week I’ve been singing “This is my penis song, I wish I had a bigger schlong, one that is quite a bit more thick and way more long.”

I’ve talked about penis size a lot in my career. We last talked about it here when discussing the statue of David. We learned that in David’s day having a big penis was actually not desirable because the well-endowed were looked down upon as unserious and frivolous. Clearly, we don’t live in the days of David and marble statues with tiny dicks anymore. Ours are the days of Ron Jeremy and, to quote Macklemore, those porno King Kong dongs. It is easy to understand why men worry that they don’t measure up.

Still, I’m not sure this implant is the answer. At best (taking only what Elist and his materials have said themselves), this surgery increases the size of your flaccid penis, requires a potentially painful recovery that includes two months of total abstinence, and only has an 81% satisfaction rate. At worst (adding in what the men told the New Yorker), it can lead to loss of sensation, may not be appreciated by sex partners, and could end in additional surgeries and “penile rehabilitation.”  

I’m still for bodily autonomy, but I will keep reminding people that most penises are smaller than you think, that studies show women don’t want want a partner who has an enormous schwanzstucker, and that the most important thing about a penis is its ability to provide pleasure to its owner and maybe a few good friends.

Complete Q&A With Dr. Elist

1. Can you explain the mechanics of how the penis functions after the Penuma/
Himplant is implanted? How do erections change?  

The Penuma/Himplant has been cleared for penile augmentation after extensive review and clinical work. It is designed to maintain penis function the same way it functioned before the procedure, only bigger. The erect penis tends to have more girth after the procedure, and the flaccid penis typically has more girth and length. Part of our qualification and consent process entails ensuring the patient has a thorough understanding that erect length changes, if any, should not be the driving factor for this procedure as erect length changes are unpredictable and may not happen.

2. Does the implant increase size both in the flaccid and erect state or just when flaccid? 

An extensive clinical study showed that the implant increased the girth and length of a flaccid penis. Clinical experience shows that the implant also increases girth in an erect state. Erect length changes, if any, are unpredictable and a critical component of our qualification and consent process requires the patient to understand that erect length changes, if any, should not be the driving factor for this procedure.

3. What are the differences between the Penuma and Himplant both in terms of the implant itself and the surgery?

Himplant is designed to have the reinforcing sheeting fully embedded within the silicone implant. No external mesh is needed to secure the implant in place. The implant is now surgically placed through a scrotal incision (instead of a suprapubic one), which appears to reduce post-operative healing time and minimize scarring. 

4. What is the FDA status of the Himplant?

Himplant is FDA-cleared for penile augmentation and is currently available to appropriate patients who undergo an extensive screening and consent process. 

5. There seem to be a lot of men for whom the surgery is not a success, why do you think that is? 

Over 5,000 Penuma procedures have been performed to date, and only a small number of patients have experienced complications. For example, a 400 person, 5 year study found that infection happened in 3.3% of cases, scar formation in 4.5%, and seroma in 4.8%. The vast majority of patients did not experience any issues. In fact, 81% of patients in the extensive study stated they were highly or very highly satisfied by the procedure. Every surgery, ranging from an appendectomy, cesarean section, or cosmetic procedures like breast augmentation, carries with them potential risks and complications.  In the Penuma case, published studies evidence that the likelihood of risks and complications following this procedure drop significantly provided the patient follows the post-operative instructions and stays in close communication with the clinic.  Similar to other responsible practitioners in the medical field, we make it a priority to take steps to minimize those risks by requiring follow-up visits, care, and check-ins.  Most importantly, we require the patients to refrain from any sexual activity or stimulation of the penis for a period of 6 to 8 weeks following the procedure. The critical factor to a patient’s success is following the post-operative instructions, and this includes maintaining scheduled follow-up appointments, refraining from additional cosmetic procedures immediately following the penile procedure, disregarding explicit advice to refrain from using penile stretchers within weeks of a procedure or having a family member pursue an at-home procedure of sticking needles in the penis.  All of these unadvised actions subsequent to the procedure introduce unnecessary risks to the ultimate success of the Penuma procedure.

6. Some men described a pretty short screening/ education session with you and seemed to suggest that they did it on the same day they had their surgery. What is the process? 

This is patently false and contradicts our objective of only working with appropriately qualified patients. The time between an initial inquiry and the surgery is typically several weeks if not months. During this timeframe, prospective patients receive several documents that answer questions about Himplant/Penuma, describe the pre and post-op insurrections, and list out the potential risks and complications such as infection, scarring, seroma (fluid formation), suture loosening, and pain, amongst others. In addition, Prospective patients are screened for body dysmorphic disorder, among other disqualifying reasons, such as psychological issues, unrealistic expectations, and large size, among others. Prospective patients are also required to attest that they watched this video before they’re even allowed to schedule a surgery date.

Following this initial qualification period and immediately prior to the procedure, there is a final consent process which lasts at a minimum of over 60 minutes, where we again go over the potential risks and complications with the prospective patient and answer any questions the patient might have to their full satisfaction. The patient is allowed to reschedule or cancel at any point. After this consent process, patients are also required to acknowledge the consent process. 

7. Do you ever turn men away and tell them their penis is big enough as is? 

Our objective is to only work with appropriately qualified patients.  Consequently, we routinely turn away patients who are not qualified for a whole host of reasons, which we’ve published in a peer-reviewed journal article. Reasons include unrealistic expectations, exhibiting psychological issues such as body dysmorphic disorder (for which we screen), large size, and refusal to follow all post-operative instructions, amongst others.