I love The New Yorker because the magazine exposes me to great writing about important issues (I skip the fiction, preferring the non-fiction articles). But sometimes what I read is so disturbing, yet so eloquently described, I'm torn between finishing an article or putting it aside.
That was my dilemma with Ava Koffman's piece in the July 3, 2023 issue, The Perils and Promises of Penis-Enlargement Surgery: One doctor's Promethean quest to grow the male member is leaving some men desperate and disfigured.
I'll share a PDF file of the story in case that link doesn't work for non-subscribers.
Download The Perils and Promises of Penis-Enlargement Surgery | The New Yorker
I ended up reading the entire article, which was fascinating and terrifying in equal measure. Until the article came along I knew nothing about this sort of surgery. The first paragraph drew me in, making me want to learn more about why men entrust such a vital and sensitive organ to a surgeon's knife.
They wanted it because they’d just gone through a bad breakup and needed an edge in the volatile dating market; because porn had warped their sense of scale; because they’d been in a car accident, or were looking to fix a curve, or were hoping for a little “software upgrade”; because they were not having a midlife crisis; because they were, “and it was cheaper than a Bugatti Veyron”; because, after five kids, their wife couldn’t feel them anymore; because they’d been molested as a child and still remembered the laughter of the adults in the room; because they couldn’t forget a passing comment their spouse made in 1975; because, despite the objections of their couples therapist, they believed it would bring them closer to their “sex-obsessed” husband (who then had an affair that precipitated their divorce); because they’d stopped changing in locker rooms, stopped peeing in urinals, stopped having sex; because who wouldn’t want it?
Well, nine New Yorker pages later my question became, who would want it?
For while there are plenty of men who are satisfied with their penis-enhancement surgery, there's also plenty who are trapped in a doom loop of seeking help to undo the surgery, which typically isn't easy to accomplish. For the procedure is much more complicated than breast-enhancement surgery.
James Elist is a urologist who is the centerpiece of the article. He developed a silicone implant "shaped like a hot-dog bun which could be implanted just under the skin of the penis to increase its girth and flaccid length."
With the blockbuster launch of Viagra, in 1998, Elist feared that demand for surgical cures for erectile dysfunction would fall, and decided it was time to diversify. Over the years, many of his patients had asked if he could make them bigger while he was down there. Walking around the 90210 Zip Code, where the median breast size seemed to balloon by the day, Elist realized that his next move was staring him in the face.
As he toyed with an early prototype for the Penuma, other doctors were dismissive. The penis—a tentacle that shrinks and swells with an exquisite sensitivity—was nothing like the breast; it wouldn’t be possible, they told him, to put something static under its elastic skin.
Because the F.D.A. requires the pharmaceutical industry to conduct clinical studies of new drugs, it is often assumed that the same is required of medical-device manufacturers. However, a loophole known as the 510(k) process allows companies to implant untested products in patients as long as they can demonstrate that the devices are “substantially equivalent” to those already on the market.
In September, 2004, not long after Elist convinced the U.S. Patent and Trademark Office of the novelty of his invention, he informed the F.D.A. that his “silicone block” was comparable to calf and butt implants. A month later, when the agency cleared the device for the “cosmetic correction of soft-tissue deformities,” the word “penis” did not appear in its indications for use.
The article describes how many of Elist's patients were not at all happy with the penis implant they got, to put it mildly. Here's a sample of the gory details.
For dozens of Penuma patients who spoke to me, the shock of the new was the prelude to graver troubles. Some, like Mick, lost sensation. Others said they experienced stabbing pains in the shower or during sex. Seroma, or excess fluid, was not uncommon. When a defense-and-intelligence contractor’s girlfriend, a registered nurse, aspirated his seroma with a sterile needle, a cup of amber fluid oozed out. The one time they tried to have sex, she told me, the corners of his implant felt like “someone sticking a butter knife inside you.”
Some implants got infected or detached. Others buckled at the corners. Occasionally these protrusions broke through the skin, forming holes that would fester. The hole of the health-spa vice-president was so tiny that he originally mistook its fermented odor for an S.T.D. An engineer with gallows humor played me a video of the snorting crunch his penis made when air moved through a hole. He had two holes, and the skin between them eventually eroded so that a corner of the implant emerged, pearlescent.
Later, doctors unaffiliated with the Penuma would compare such penises to “a torpedo,” “a penguin,” “a pig in a blanket,” “a beer can with a mushroom sticking out on the top,” and “the tipped-down nose of the Concorde.” But the imperturbable assistants at Elist’s clinic, besieged by photographs documenting these phenomena, told patients that they were “healing as expected” and “continuing to heal well!” It was only after months had passed and the men insisted they weren’t healing well at all that Elist would sometimes suggest that an “upgrade” to a bigger size would resolve their problems.
A sad part of Kofman's article was these passages.
What surgeons continually emphasized—the implanters with pride, the explanters with dismay—was that most of the men they were seeing had been of at least average size before going under the knife. (The photographic evidence men sent to me over text and e-mail supported this contention.) “Most don’t have anything physically wrong with them at all, so what they don’t need is vultures preying on them, which is almost always a disaster,” Muir, the London urologist, said.
Along with other urologists and psychiatrists, at King’s College and the University of Turin, Muir conducted a literature review called “Surgical and Nonsurgical Interventions in Normal Men Complaining of Small Penis Size.”
The research showed that men dissatisfied with their penises respond well to educational counselling about the average size, which is 3.6 inches long when flaccid, and 5.2 inches erect. (The average girth is 3.5 inches flaccid, and 4.6 inches erect.) For men who have an excessive and distorted preoccupation with the appearance of their genitals—a form of body dysmorphic disorder—Muir said that cognitive-behavioral therapy and medications may also be necessary.
Which would be a heck of a lot wiser thing to do than get a penis implant.