Alexander Gittinger, ASW, ASAT
Alexander Gittinger is an associate clinical social worker and primary therapist at Center for Healthy Sex. His approach to therapy is based on trauma informed care and exploring the underlying issues that… read more.
An enterprising L.A. surgeon has invented a silicone penis implant, which, because we’re sure you have a friend who’ll want to know, costs 13 grand and can nearly double your size. Amy Wallace grills the good doctor on how it works—and asks a few of his very satisfied customers (and their mostly satisfied wives) how it’s working
The world’s most girth-tastic penis implant is available in three sizes: L, XL, and XXL. “Nobody wants a small,” says James Elist, M.D., the Beverly Hills urologist who calls his invention the Penuma. “So we don’t have a small, we don’t have a medium. We start from large.”
Nobody wants a small. If there’s one global, irrefutable truth, it’s that all men dream of being enormous—even the ones who are already big. Among the many patients I interviewed for this story were several well-hung gentlemen who’d nonetheless paid Elist $13,000 to slice them open and enhance their penises with a sheath of silicone. Consider the 39-year-old accountant from outside L.A. who had trouble explaining precisely what led him to get his Penuma in 2014. His wife had no complaints. (“He was very well-off,” she told me; his pre-surgery erections were eight inches long.) When I pushed him, repeatedly, about his motivation, he finally stammered, “I don’t know. I think I just wanted it bigger.”
Another guy, a 43-year-old mechanic from Arizona, told me he got an XL Penuma inserted two years ago because “I realized, well, nothing about me is average or normal, and I didn’t want my sexuality to be average or normal anymore.” After the surgery, he said, his boners increased from six and a half inches to eight and a half inches, and the Penuma “gave me this crazy amount of stamina. Like, I can go for two hours. And I have more control over my orgasms. I mean, I can be going like a Mack truck and still hold back.”
And then there’s the 43-year-old plumber from Northern California whose six-inches-plus, his wife says, “had never been an issue for me.” And yet her husband was convinced that he wasn’t satisfying her: “I didn’t feel like I was doing my job like I was supposed to.” This feeling of inadequacy led to bouts of erectile dysfunction that tormented him until he was fitted last July with an XL Penuma. Now the plumber and his wife get busy four or five times a week. “He’s been a sexual maniac,” the wife told me. “He has erections all day long every day now. We haven’t had this much sex since when we first got together.” And that was 20 years ago. Getting the Penuma, the plumber said, “basically saved our marriage. I wish I had done it sooner.”
The average erect penis is about five inches long and four and a half inches in circumference, according to a 1996 Journal of Urology study. (Feel better?) Yet by one estimate, nearly half of all men think their packages are smaller than average. Blame porn if you want, or our cultural predisposition to always think bigger is better, or some hardwired Darwinian impulse. Whatever the cause, it’s hardly news that men obsess about the relative size of their members and what that size says about them, physically but also socially. Beyond its sexual function, the penis plays an undeniable, if subtle, role in establishing pecking order, whether at the urinal or in a locker room. Size matters, and not just in bed.
But until Elist—an affable Iranian-born father of three with a mischievous, slightly goofy laugh—got FDA clearance for his implant in 2004, the only procedures available for growing a man’s manhood were temporary, or potentially damaging, or disgusting, or all three. To this day, some surgeons cut the suspensory ligament in the groin so the penis will hang lower, potentially giving the appearance of greater length (but sometimes making stand-at-attention erections tricky). Other doctors inject collagen gel, or your own fat, or insert cadaver cells into the penis, leading to temporary gains (but sometimes to misshapen, lumpy results).
In Tijuana, there’s a doctor who will inject a Brazilian product called Metacrill, which is not approved for use in the U.S. (one doctor I talked to compared it to liquid plexiglass), and there’s a surgeon in Cairo who’s developed a procedure to rotate a flap of groin fat into the penis to make it larger. Still, even as breast implants have become a $300-million-a-year business in the U.S., men have largely been left to make the best of what God gave them. In a world that has always devoted greater resources to diseases affecting more men than women, elective cosmetic surgery has long been an industry focused on females.
That’s begun to change. Especially over the past five years, procedures such as calf and cheekbone implants have increased as men shake off the stigma and embrace the prime drivers of such surgeries in women: vanity and self-affirmation. Without exception, the Penuma patients I interviewed said that their lives had improved since getting the implant. And it wasn’t just about sex. To have continued to settle for the status quo, they said, would have been to deny their potential in every area of life.
By this point you may be wondering: How have I not heard about this? The answer: Elist is currently the only doctor authorized by the FDA to insert the Penuma, and he has all the patients he can handle without doing any marketing other than a basic website. A 66-year-old surgeon with 13 patents to his name, Elist has inserted about 1,300 of his implants in men from all over America and from other countries around the world. The procedure has a 95 percent success rate, according to a five-year clinical study Elist commissioned and presented at an industry conference. That study is part of an ambitious expansion effort spearheaded by his son, a Harvard man who took a leave from his job at a top consulting firm to help his dad make Penuma huge. Elist is petitioning the FDA for clearance that would enable him to begin selling the devices to other doctors and teaching them how to perform the procedure. But until that happens, he’s the only game in town.
Elist’s urological career began in 1976, when he came to the U.S. as a medical resident from Tehran. Back in the ’80s, he was the lead author on the first scientific paper that linked cigarette smoking to impotence. Today, in addition to his Penuma surgeries, he is one of L.A.’s go-to guys for prepping adult ritual circumcisions. (Men who want a bris must be conscious to receive the mohel’s blessings, and Elist has a reputation for his skill at administering local anesthetic.) He is also an infertility expert. In his office on Wilshire Boulevard, he has a bulletin board labeled mission accomplished that is covered with photos of babies born with his help. Still, it was the nagging sense that he’d failed to accomplish another mission that led Elist to invent the Penuma.
Since 1980, the doctor had been inserting inflatable penis prostheses (5,000 of them to date) into impotent men, including Hustler publisher Larry Flynt. The devices, which were invented by a Texas surgeon in the early ’70s, re-invigorated these men’s sex lives, and they were grateful—at least at first. But as time went by, many of Elist’s patients came back with a not-small complaint: It seemed their penises were shrinking. It turned out they were right. Because the prosthetic is inserted into the spongy tissue in the core of the penis, as the body encapsulates the foreign object, the tissue constricts. (The opposite happens with the Penuma, because it is inserted under the skin and moves freely, preventing encapsulation. Men report that they actually gain length over time with the Penuma, thanks to the pull of gravity.)
The bottom line: Elist felt that as he solved one problem, he had unintentionally created another. And he wanted to fix that. He knew that silicone was the obvious material to use, because it had been proven safe (and was FDA-approved) for breast implants and because it does not affix to tissue (thus allowing removal, if necessary, with minimal complications). Design-wise, he did not want to encircle the penis completely, because it needed to be able to expand; he envisioned an implant that would envelop about 80 percent of the organ, leaving a gap along the length of the underside.
The more he got into the logistics, the more Elist realized that the potential market for such an implant was far larger than the number of men who’d experienced shrinkage from inflatable prostheses. Elist’s “dream,” he told me, was to enhance the quality of life of men and their partners—like one gay couple he told me about, both of whom got the procedure done in the hopes of bettering their relationship. For the doctor, this wasn’t just about maximizing patients’ manhood, he said earnestly. This was about making the world a genuinely more joyful place. His original name for the implant? The Hap-penis.
The penis—we’ll call him Slim—was lying on his side, asleep, when Dr. Elist began to wash and irrigate him. Underneath Slim, keeping him warm, was an unconscious 52-year-old man, face up, his arms outstretched and his naked body draped in blue tenting but for an opening at the crotch. The man, a pipe fitter (!) from the Pacific Northwest, had traveled 1,100 miles to be here.
His problem? “His wife can’t feel him,” Elist said flatly. “When he is erect, he is very thin—like a pencil.” The doctor squirted some Betadine into Slim’s urethra to flush out any malingering bacteria. “His main goal: girth.”
Elist then ticked off Slim’s stats: about four and a quarter inches long when flaccid, which made him just about average. Slim’s circumference, however, was four inches flaccid—also about average—but that didn’t change much when he got hard. This was apparently a problem for the man’s wife.
I watched with fascination as Elist tugged gently at some excess skin that made Slim appear to be wearing a wet suit two sizes too big. But all that roominess was a good thing today, Elist declared, because it made Slim an ideal candidate for the implant. A nurse ripped open a sterile pouch and plopped the Penuma—imagine a translucent, hollowed-out hot-dog bun—into a dish of hydrogen peroxide. Then the doctor drew a line across the patient’s lower abdomen and made a single incision, about two inches long, cauterizing as he went. “We are washing with holy water,” he joked as he flooded the opening with antibiotic fluid, adding impishly: “There is a lot of prayer here.”
Slim’s owner certainly would have prayed if he’d been conscious. Because Elist then reached in and pulled the body of his circumcised penis—circumcision is a prerequisite—out of its skin. You know the way a condom turns inside out when you peel it off after sex? The skin of your penis, which is attached only at the glans, can be rolled off just like that. (Party trick!) Once Elist had the inner penis exposed, he wrapped the implant around it, added a layer of surgical mesh, and used a fishhook-shaped needle to attach it, right under the head of the penis. Then he rolled the skin back on, making sure the implant was positioned correctly, rinsed everything with antibiotic fluid, and closed up the incision. The whole thing took 45 minutes.
The effects of the procedure are immediate. The still-groggy (and flaccid) Slim, for example, was six inches long after surgery and five and a half inches around: an increase of one and a half inches in girth. Patience is required during the healing process—no sex for at least four months—but once healed, the enhancement is essentially permanent (and basically undetectable). The patients I talked to said they weren’t inclined to tell their new sexual partners about the surgery. The Penuma had become part of them, they said, both physically and mentally.
Of course, as with any surgery, there can be complications. While Elist’s infection rate (3.3 percent) is far below the average for other implants, infections happen, and when they do, they’re a drag. Other potential (though rare) negative outcomes, according to that clinical report Elist and his son commissioned: detachment of sutures (experienced by two out of 400 patients surveyed), implant breakage (one out of 400), and implant perforation of the skin (four out of 400). Elist acknowledges that because his procedure is so new, he has needed to refine it over time. But in each problematic case—many that resulted from men not being able to wait to try out the merchandise—he has fixed what went wrong for free.
Every once in a while, the doctor is asked to remove an implant. One patient fell in love with a small woman who didn’t enjoy his mammoth proportions. And then there are cases when the wife doesn’t want the damn Penuma in the first place—but her husband goes ahead with it anyway. The spouse of that L.A. accountant I mentioned earlier told me that from the start, she was a little queasy about the whole thing. First of all, she was “bummed” that her husband had to get circumcised first, which meant she had to change her nickname for his penis: Kenny, after the hoodie-wearing character on South Park. Moreover, she didn’t think eight-inch Kenny needed enhancing. The prospect of her husband getting larger was intimidating, she said. In the wake of the surgery, the couple have had to learn how to make love all over again.
“It is definitely a lot thicker,” she said, not altogether admiringly. “I do have to say that it has been a little bit more painful. There may be times when I say, ‘You know what? Don’t touch me with that thing!’ ” Lube is essential in a way it never was before, and fellatio has proved challenging, as the size of her mouth hasn’t changed. (She has, however, come up with a new nickname: “Mr. Grey, because he likes to punish me.”)
And yet she understands the desire for self-improvement, having gotten plastic surgery herself—a breast reduction and lift—after having her third child. “He didn’t have any complaints, either, but he supported me when I did mine,” she said. “And I do see he has more confidence.”
Ah, yes. The confidence factor. This came up with every man I spoke to. (According to Elist’s clinical report, 72 percent of patients reported a significant uptick in general self-confidence.) One guy, while thrilled with the physical effects—he says he doubled his girth and now calls his penis Schlongo—seemed even happier about this side benefit. His post-op swagger is attracting hotter women, he says, and he claims he’s even noticed men paying him more deference. “Now I show when I wear my blue jeans, and I catch women and men looking. Their attitude is like, ‘Oh, this guy is an alpha male.’ As shallow as it sounds, first impressions are what we go off of.” The Bionic Manhood
The question isn’t so much: Is the age of the supersized penis upon us? The question is: In the age of supersized everything, how the hell did this take so long?