I’ve seen several patients recently with concerns about the suspensory ligament of the penis.  What is the penile suspensory ligament – it’s a rubber-like tissue that “suspends” the erect penis similar to a suspension bridge. It extends from the base of the penis to the pubic bone. Its main function is to support the penis when it is erect to provide the appropriate angle for sexual intercourse. 

Some cosmetic and aesthetic surgeons offer “penile suspensory ligament release” and rearrangement of the skin around the base of the penis as a simple procedure to improve penile length. I’ve said this before, but I will say this again – there is no simple way to improve penile length. These surgeons offer to release or cut the fundiform and suspensory ligament proper to increase the length of the flaccid penis by 1-3 cm. This alone will not affect the length of the penis when erect. Although this procedure sounds very intuitive to improve the length of the flaccid penis (cut the “leash” of the penis as one of my patients described it as), the truth is we often see a paradoxical effect long-term. What tends to happen is that the cut edges of the ligament will often reconnect and scar together. Since this dense scar tissue is not like the rubbery, elastic-like tissue that described the ligament initially, the scar can adhere the base of the penis to the pubic bone leading to penile shortening. Additionally, patients often report a lack of penile support during erection, where you may need to support the base of the penis with your hand with vaginal or anal penetration to avoid injury.  

Highly experienced genitourinary surgeons like myself may offer a release of the fundiform ligament of the penis alone in select patients either alone or at the time of another surgical procedure in the same area. I do not recommend releasing the penile suspensory ligament proper as a penile enhancement procedure for the two reasons 1) long-term penile shortening 2) unstable penis during penetrative intercourse. 

On the flip side, as men get older the suspensory ligament itself gets more laxity and you may notice that although the penis gets very firm with an erection, the angle of the erect penis is more parallel to the floor rather than pointing up at the ceiling. This also can be related to gaining a few extra pounds, where the fat from the belly drapes over the penis and can also make it difficult for the erect penis to provide the appropriate angle for sexual intercourse. For these patients, I always recommend weight loss as one of the first-line options. I do sometimes perform procedures to “repair” the suspensory ligament or remove the double belly that drapes over the penis, however, these always involve a detailed discussion of the realistic expectations after surgery.  

So can you have a bigger penis? The address is yes, but a penile suspensory ligament release surgery alone is not the answer. Stay tuned for my next entry about proven ways to improve penile length.     

-Dr. Patel