The Winter Olympics are a bewildering spectacle at the best of times, particularly for causal quadrennial viewers of alpine sports such as myself. Personal highlights of this year’s iteration in Milano-Cortina included the superhuman performance of the Norwegian Johannes Klaebo whose six gold medals in the cross-country skiing froze him into the history books; the dominant Dutch racking up the medals chasing milliseconds clad in their characteristic orange around the speed skating oval; and the British skeleton champion Matt Weston carving his way down the bobsleigh track face-down head-first, essentially on a glorified tea tray.
Amid this formidable display of sporting prowess, one headline leapt off the page prior to any medal being thrust around a neck; the rumour that ski jumpers may have been dabbling in penile augmentation to gain an aerodynamic edge. Ski-jump suits are evidently tight, and tightly regulated for that matter, and the suggestion was that even a marginal increase in suit volume could theoretically improve lift whilst airborne. A case of every inch mattering. The International Ski and Snowboard Federation (FIS) were quick to state that there was no evidence of athletes using penile injections to garner an advantage. The unsubstantiated hearsay nonetheless generated quite the talking point.
Given the growing conversation, the recent consensus statement on penile augmentation from the BAUS Section of Andrology and Genital Surgery provides a timely opportunity to refocus attention on evidence, patient safety and appropriate clinical governance in this evolving area.
Much like all things winter sports, I am admittedly more of an armchair observer when it comes to andrological matters. Thankfully I have been joined by two rather more authoritative figures to give us the long and short of penile augmentation in the context of their new consensus document. Professor Vaibhav Modgil, amongst his various roles, is Secretary of BAUS Andrology, Chief Editor of Trends in Urology and Men’s Health and Consultant Andrologist based in Manchester; and Mr Mohamed Mubarak, who is the current Andrology Rep for the BAUS Section of Trainees, and registrar colleague from the North-East of England.
Many thanks to the pair of you for sharing your perspectives on this rather topical subject.
Firstly, what prompted BAUS to produce a consensus statement on penile augmentation?
Vaibhav Modgil (VM): BAUS produced the consensus statement because penile augmentation procedures are increasing rapidly in the UK despite limited evidence, inconsistent regulation and growing reports of complications. The document aims to provide clinicians, patients and policymakers with a balanced, evidence-based framework for counselling, safety and governance in this emerging area of men’s health.
Are you able to elaborate on the various techniques that have been published to date?
Mohamed Mubarak (MM): Broadly speaking, the techniques fall into two groups: injectables and surgery. Injectables include substances such as hyaluronic acid, polylactic acid (PLA), combination fillers or fat taken from the patient’s own body used mainly to increase penile girth. Surgical approaches include procedures that release the suspensory ligament, remove fat from the pubic area, or insert grafts or implants to change the appearance of length or thickness.
Do you feel that demand for penile augmentation procedures is increasing and if so, what factors do you think are driving this phenomenon?
VM: One major driver is simply increased awareness of available procedures. Injectable fillers, fat grafting and other techniques are now widely marketed online and through cosmetic clinics. Many men are encountering these options for the first time through advertising or social media, where procedures are often presented as quick, minimally invasive and low risk. The BAUS consensus notes that much of the information about these procedures is disseminated by non-experts via social media and informal platforms, which can shape expectations and demand.
There is growing recognition that body-image concerns in men are increasing with social media and changing body-image pressures. Online imagery, pornography and social media comparisons can create unrealistic perceptions of what is “normal.” Importantly, the BAUS review highlights that many men seeking augmentation have anatomically normal penile dimensions but perceive themselves to be inadequate.
Psychological drivers and genital self-image are another factor. Research cited in the consensus statement shows a large mismatch between perception and reality: while the majority of partners report satisfaction with penile size, a substantial proportion of men remain dissatisfied with their own size. In surveys, almost half of men who consider themselves “average” still want a larger penis, illustrating how self-image rather than anatomy often drives consultations.
There is the expansion of the cosmetic and aesthetic industry; therefore, penile augmentation has increasingly moved into the wider cosmetic medicine sector. As minimally invasive aesthetic procedures have become more mainstream, genital cosmetic treatments have followed a similar trajectory, particularly injectable fillers that promise relatively quick recovery and reversible outcomes.
It’s a money maker! Another important factor discussed in public health conversations – such as the BBC programme – is the highly commercial environment in which these procedures are marketed. Clinics often promote them directly to consumers with strong claims about confidence and sexual performance, sometimes without robust long-term evidence or balanced risk discussions.
Ideally, how should this patient population be approached, whose concerns may reflect body dysmorphic disorder and/or unrealistic expectations?
MM: A careful and structured assessment by a qualified genital surgeon is essential. Many men seeking these procedures have normal penile dimensions but significant anxiety about size, sometimes related to body dysmorphic disorder. A thorough history, physical examination and objective measurements are essential. Where appropriate, validated screening tools such as the Body Dysmorphic Disorder Questionnaire (BDDQ) and the Cosmetic Procedure Screening Scale for PDD (COPS-P) should be utilised. This structured approach can often redirect management away from invasive interventions towards reassurance and appropriate psychological support.
Who is currently performing penile augmentation procedures in the UK? Is there a need for clearer oversight in this area?
VM: One of the key issues highlighted in the BAUS consensus statement is that we simply do not have a clear picture of who is performing penile augmentation procedures in the UK. Many of these treatments – particularly injectable fillers used for penile girth enhancement – are delivered in the private aesthetic sector rather than within traditional urological practice. As a result, procedures may be performed by a range of practitioners with varying levels of training and oversight, and there is currently no central registry or reporting system to capture how many procedures are being done, by whom, and with what outcomes. This lack of transparency makes it difficult to fully understand the scale of the practice, evaluate complication rates or ensure consistent standards of patient counselling and safety.
What are the outcomes that have been reported in terms of girth, durability, and patient satisfaction?
MM: Patient satisfaction is often reported as high, but this must be interpreted with caution as most studies have small patient volumes, are single centre and utilise non-validated outcome measures for satisfaction.
What are the most important complications clinicians should be aware of?
MM: Historically, non-absorbable injections such as silicone or paraffin have been associated with severe complications, including tissue necrosis and deformity requiring reconstructive surgery. While contemporary techniques may appear safer, complications remain procedure-dependent and, in some cases, may require re-intervention or surgical correction. With injectable fillers, reported complications include infection, granuloma or nodule formation, contour irregularities, migration and rarely skin necrosis. Surgical approaches carry risks such as infection, wound dehiscence and scarring or contracture. In addition, more complex interventions, including bioscaffolds and implantable devices, have been associated with complications such as erosion, revision procedures and device removal.
Are we seeing more patients presenting with complications from procedures performed outside of regulated medical settings, and how prepared should urologists be to manage them?
VM: In practical terms, urologists should be prepared to assess and manage complications such as infection, nodules, migration, deformity, inflammatory reactions and psychosexual distress, while also recognising that some of these men may present first to NHS services after treatment in the private aesthetic sector.
What do you see as the key messages clinicians should take away from the BAUS consensus?
VM: The key message from the BAUS consensus on penile augmentation is one of caution, transparency and patient safety. BAUS doesn’t advocate penile augmentation. Clinicians should recognise that demand for penile enlargement procedures is increasing, but the evidence base supporting many of these interventions remains limited and heterogeneous, with relatively little robust long-term outcome data. As a result, the consensus emphasises that clinicians should prioritise careful patient assessment, including evaluation of expectations and psychological factors such as genital body-image concerns, and ensure that men are counselled about normal penile size and realistic outcomes. The statement also highlights that many procedures – particularly injectable fillers – are being offered outside specialist urological settings, and therefore stresses the importance of clear, balanced informed consent and awareness of potential complications. Overall, the central message is that penile augmentation should be approached cautiously, within appropriate clinical governance, and with the patient’s long-term wellbeing as the primary focus.
The consensus highlights the limited quality of evidence in this field. Are there any research priorities that should be addressed over the next few years?
MM: The main priority is the generation of high-quality reproducible evidence. Future research should focus on robust, standardised protocols conducted across multiple centres, incorporating consistent girth and length measurement techniques and validated patient-reported outcomes, including quality of life and psychological impact. This is essential to accurately define the safety, efficacy, and overall patient impact of these procedures.
During the recent Winter Olympics in Italy there were widely reported rumours about ski jumpers altering genital measurements to gain an aerodynamic advantage. From an andrological perspective, what was your reaction to the story?
VM: From an andrological perspective, my reaction was that the story was largely sensationalist nonsense. There is no credible physiological or aerodynamic evidence to suggest that altering genital size would meaningfully affect ski-jump performance. The factors that determine performance in ski jumping are overwhelmingly related to technique, body position, equipment, ski length, and overall aerodynamics of the body-suit system, not minor anatomical variations. From a medical standpoint, any attempt to alter genital measurements for such a purpose would be both unnecessary and potentially harmful. It is a good example of how discussions about male genital size can sometimes drift into myth and speculation rather than evidence-based science.
Well, that certainly clears that up!
Unsurprisingly, I leave our conversation with my understanding of penile augmentation significantly more enhanced. No doubt our readers will also agree. Your valuable work on producing this consensus document reminds us that unlike Olympic rumours, patient safety, evidence and professional standards should always take the gold.
Reference
1. Mubarak M, Kalejaiye O, Kumar V, et al. British Association of Urological Surgeons (BAUS) consensus document on male genital augmentation and enhancement procedures. Journal of Clinical Urology 2026;19(2):149–66.
