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Address correspondence to: Sriram V. Eleswarapu, M.D., Ph.D., David Geffen School of Medicine at UCLA, 10945 Le Conte Avenue, Suite 3361, Los Angeles, CA 90024.
Currently, the medical literature suggests there is objective benefit to penile stretching and traction therapy in Peyronie's disease, in postprostatectomy patients to prevent penile shortening, in erectile dysfunction prior to placement of an inflatable prosthesis, and for men concerned about penile length.
While this evidence in the literature regarding the medical benefit of penile traction therapy is quite recent, penile stretching practices are not new from a historical perspective.
There is a long history of obsession with penile size as a marker of strength, virility, and masculinity. Cave drawings from 8,000 years ago in present day Turkey depict a man with a penis as long as his leg.
Even though most men who currently seek penile augmentation have normal penile length, men persist in their search for options to increase penile length and girth.
Across history, penile and foreskin stretching practices have been used by many peoples and cultures to achieve the “ideal” male penis.
The idea of stretching or shaping the body permanently to achieve a desired shape is prominent throughout history. There is robust literature regarding ear shaping via gauges, neck extending, head flattening, and constriction of feet.
This review is concerned with the historical and cultural practices of penile and foreskin stretching.
METHODS
To identify literature detailing the practices of penile and foreskin stretching and traction throughout history, we performed focused search for textual sources through the National Library of Medicine (www.pubmed.gov), Google Scholar (scholar.google.com), and the Internet Archive (www.archive.org), through August 28, 2022. A combination of the search terms “penile stretching,” “penile traction,” “penile augmentation,” “history,” and “culture” were used to identify books, journal articles, and texts that could elucidate different practices.
Separately, we sought to evaluate the origin of jelqing by accessing Empire Online (primary source materials for British Empire and colonialism, www.empire.amdigital.co.uk), JSTOR (www.jstor.org), and Archives of Sexuality and Gender (historical primary source materials on the study of sex and sexuality, www.gale.com/primary-sources/archives-of-sexuality-and-gender).
Finally, we aimed to evaluate contemporary, colloquial discussions of penile stretching practices by examining anonymous internet forums. Reddit was chosen because it is the most popular forum website in the world and is publicly accessible without the need for membership. We accessed the two largest forums on Reddit (www.reddit.com) dedicated to penile lengthening: “r/jelq” and “r/penissize.” These Reddit forums have a combined user base of >10,000 distinct users. Posts included in our results were from January 2015 through August 2022 and were filtered for popularity based on view counts.
RESULTS
Review of the literature revealed five textbooks, one encyclopedia, and one primary journal article related to penile stretching in tribal cultures, ancient Rome and Greece, and ancient India. We evaluated four different companies that design both vacuum and traction devices utilized for penile enhancement. Two Reddit forums were evaluated for discussions on theories and techniques around penile enhancement.
Tribal Cultures
Margaret Mead in her studies of Polynesian males described a woven device of plant fiber that was used to help men to stretch their penises. Working in a similar fashion to a Chinese finger trap, the penis is inserted into one end of the device while a weighted object is hung from the other end.
Similarly, the Cholomec tribe from Peru, some African tribes, and certain Holy Men from Sadhu tribes in India have used the direct hanging of weights on their penis in attempts to increase penile length.
This method of traction does not increase girth. In fact, some have hypothesized that the direct use of weights may decrease girth and cause tissue damage.
Foreskin stretching has long been described in Roman and Greek medical literature as a method to treat lipodermos – a disorder of the penis characterized by an externalized glans penis or a deficient prepuce.
The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme.
Literally translating to “lacking skin,” lipodermos could be treated with herbal remedies such as honey and the plant Thapsia garganica or with traction therapy.
The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme.
The physician Soranus of Ephesus, who practiced medicine from 98 to 138 CE, discusses in his treatise Gynecology a technique involving stretching the foreskin of a newborn to improve the length and appearance of a lipodermic penis:“If the infant is male and it looks as though it has no foreskin she [the wet nurse] should gently draw the tip of the foreskin forward or even hold it together with a strand of wool to fasten it for if gradually stretched and continuously drawn forward it easily stretches and assumes its normal length covers the glans and becomes accustomed to keep the natural good shape.”
To achieve a longer prepuce in adults, ancient Greeks also utilized the kynodesme, a leather thong wrapped around the portion of the prepuce distal to the glans penis that pulled the penis upwards (Fig. 1).
Attributed to the Triptolemos Painter - Available at: http://Www.Cirp.Org/Library/History/Hodges2/Hodges16.Jpg Munich 2314, Antikensammlungen; Beazley, ARV (n. 3), 1: 362, No. 14; Illustrated in Reinhard Lullies, Ed., Corpus Vasorum Antiquorum. Deutschland. München Museum Antiken Kleinkunst 4 (Munich: Beck, 1956), Plate 197.
Similarly, the physician Galen of Pergamon (129 to ca 216 CE) describes in his collection De method medendi the application of traction and tension to treat individuals lacking a large amount of posthē, the part of the prepuce covering the glans penis.
The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme.
The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme.
Although the present-day correlates for lipodermos and deficient posthē are unclear, these practices provide insight that foreskin stretching practices have long existed.
Ancient India
Penile and foreskin stretching practices have also been documented in the Sanskrit texts Kama Sutra (circa the 4th-6th century AD) and Sushruta Samhita (circa the 3rd-4th century AD).
The Kama Sutra describes a method of enlarging the lingam, or penis, by rubbing it with the bristles of insects, then oils for 10 nights, and finally the bristles once again. During this process, the man should lie on a cot and allow his lingam to hang through a hole in the cot. Enlargement of the lingam can also be achieved by rubbing items such as the plant Physalis flexuosa and boiled oil. These techniques likely result in an immune-mediated reaction, causing swelling and penile organomegaly.
The Sushruta Samhita discusses the application of foreskin stretching for the treatment of parivartiká, retroflexion of the prepuce. The treatment involves rubbing clarified butter and medicated lotions onto the glans penis and stretching the prepuce over the glans penis, while bathing it in warm poultices.
Although the modern-day correlate of parivartiká is unclear, there seems to be a preference for a longer prepuce, similar to the values of ancient Rome and Greece.
Jelqing
Jelqing is a penile stretching technique that purportedly dates back to Sudanese tribes in the Middle East. Although multiple online sources claim that it originated in ancient Sudanese tribes, no original sources were identified that demonstrate the legitimacy of these claims. Nonetheless, the Sudanese origin story of jelqing is a commonly held and disseminated idea among online sources. Some of these sources even claim that it was a tradition by which Sudanese fathers prepared their sons for marriage.
In the modern day, jelqing is commonly discussed on various online forums for its use in increasing penis size. The technique involves manually stroking the penis forward in a semierect state for a given period of time and is meant to be performed consistently. The technique is described in an SMSNA article titled “What Is Jelqing, and Does It Actually Work?”
These articles highlight the history of the technique and offer various expert opinions on the issue.
The theory behind jelqing is most consistent with the concept of tissue remodeling. The mechanism highlighted involves manually massaging blood into the penis, effectively stretching the cavernosal tissue and skin to induce growth. Unfortunately, there have been no robust clinical trials evaluating the efficacy of this technique. Some clinicians caution against its routine use, including excessive or aggressive manipulations, due to concerns of potential fibrosis and plaque formation.
Vacuum and Traction Devices
Some of the first penile stretching devices and pumps were invented in the mid-20th century. In 1959, Freddie W. Sell obtained a patent for the Erector, a vacuum pump device invented for the purpose of penile stretching (Fig. 2).
The device involved a manual plunger mechanism that created a vacuum to draw blood into the penis. Since then, there have been a variety of vacuum-and nonvacuum-based traction devices aimed towards increasing penile length.
Figure 2Sketch of Erector device from original 1957 patent.
An online search for “penile stretching device” generates hundreds of options for devices promising increases in penile length. These options include traction devices, vacuum devices, and hanging weight devices aimed at maintaining constant traction or providing increased blood flow to the penis. The traction devices typically involve a clamp mechanism that attaches at 2 points-usually at the base and corona of the penis. A ratcheting, elastic, or locking mechanism is then used to obtain optimal retraction and positioning. Theoretically, the resulting stress from persistent retraction of the penis into a stretched position leads to adaptation and changes to penile length.
The vacuum devices offer similar promises with a slightly different mechanism. These devices consist of a vessel that is placed around the penis with adequate seals around the proximal and distal aspects of the penis. A plunger or suction component is then attached distally to create a vacuum, effectively increasing blood flow to the penis.
In the modern era, multiple companies exist dedicated to these devices. Some of the most popular companies based on prevalence in Google searches and medical literature include RestoreX (traction), Phallosan (vacuum), QuickExtender (traction) and PeniMasterPro (traction). The PeniMasterPro, for example, offers a unique mechanism involving a vacuum bulb suction component that sits around the glans of the penis and attaches to an extender that sits at the base of the penis for sustained traction. These devices cost anywhere from $150 to $500 and offer result guarantees on their websites.
Although there is limited literature on the efficacy of these devices, consumer interest remains high among young men who desire to increase penis size, especially for those with body dysmorphic disorder or small penis syndrome.
Sexual functioning and behavior of men with body dysmorphic disorder concerning penis size compared with men anxious about penis size and with controls: a Cohort Study.
Social media is an avenue through which men may seek help for erectile dysfunction. Online platforms allow individuals to ask questions free of judgment, under the guise of anonymity. Reddit (https://www.reddit.com/) is a popular medium for online consumers to find advice about penile lengthening and stretching. Two of the largest forums dedicated to increasing penile length are “r/penissize” (https://www.reddit.com/r/penissize/) and “r/jelq” (https://www.reddit.com/r/jelq/), which have 7700 and 420 members, respectively. The forum “r/penissize” is dedicated to the discussion of penis size. Its most popular posts discuss methods of penile lengthening and offer members an avenue to discuss their experiences.
There are large online communities that offer opportunities to explore the topic of penile lengthening. Unfortunately, most of these users are not experts and are only able to offer anecdotal ‘“evidence’” and advice on how to ‘“correctly’” perform penis lengthening techniques. Because of the potential for these penile enlargement techniques to cause injury, individuals should consult with their urologists and sexual health providers before attempting these practices. Clinicians should consider asking patients about their interest in these techniques, especially if there is a history of body dysmorphic disorder or small penis syndrome, to provide guidance and minimize the potential for adverse effects.
CONCLUSION
There is a long-standing use of penile and foreskin stretching and traction practices across many cultures and historical time points. Only recently has the medical literature begun to elucidate best practices and objective benefits that men have been seeking for many years.
References
Usta MF
Ipekci T
Penile traction therapy for Peyronie's disease: what's the evidence?.
The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme.
Attributed to the Triptolemos Painter - Available at: http://Www.Cirp.Org/Library/History/Hodges2/Hodges16.Jpg Munich 2314, Antikensammlungen; Beazley, ARV (n. 3), 1: 362, No. 14; Illustrated in Reinhard Lullies, Ed., Corpus Vasorum Antiquorum. Deutschland. München Museum Antiken Kleinkunst 4 (Munich: Beck, 1956), Plate 197.
Sexual functioning and behavior of men with body dysmorphic disorder concerning penis size compared with men anxious about penis size and with controls: a Cohort Study.
Financial Disclosures:Dr. Jesse Mills is a speaker for Boston Scientific, Endo Pharmaceuticals, and Antares Pharma. The remaining authors have no conflict of interest to disclose.
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