FOR most men the idea of letting someone loose on their penis with a scalpel sounds like a fear-inducing nightmare.
But in a luxurious private medical clinic on London's prestigious Harley Street an increasing number of blokes are volunteering for the terrifying procedure - and paying thousands for the privilege.
Average penis sizes from around the world 
Business is booming for Italian andrology surgeon Giulio Garaffa, 42 - one of Europe’s most experienced penis consultants.
And he says the range of problems he sees every day is mind-blowing.
Some guys have Peyronie's disease, where scar tissue called "plaque" builds up inside the penis making it bent when erect — some extreme cases bending it to a full right-angle.
CAN'T MAKE AN ERECT PENIS LONGER
Others want prosthetic testicles inserted, and not always to replace missing ones.
One patient had two huge silicone balls inserted into his scrotum to sit alongside his two existing testicles, just for the hell of it.
But while the crack team at International Andrology can make some fantasies come true, Mr Garaffa says there’s one thing medicine can’t do — make an erect penis longer.
He explains: "The type of procedure that has to be done needs to be tailored to the anatomy of the patient, and also to patient expectations.
"You have to appreciate there is no procedure that actually increases the real length of the penis.
“What the procedures do, all of them, they make the penis appear longer by repositioning it in relation to the structures around it."
Penis enlargement injections explained by doctors at Moorgate Andrology in London
The vast majority of patients come here because they’re not confident with their flaccid penis size
Giulio GaraffaSurprisingly it's not blokes with micropenises - smaller than 2.8in - or below average members who come to Mr Garaffa.
Although his patients vary in size, many are comfortably within the average for British men of around 5in to 7in when erect, or 3.75in when flaccid.
And the reasons for wanting a larger penis are often nothing to do with sexual performance.
SMALL PENIS CAUSED DIVORCE
“The reasons people want to do it can be various: from the dancer who wants to have a bigger looking penis in his pants to the person who goes and attends the gay sauna and wants to look good in the flaccid state.
"Men that go to the communal locker room, or urinals. It could be anything. The vast majority is self-esteem.
"It can be any age. You would expect people to be young, but you have also people in middle-life crisis who are divorced, or people in their 60s who say: ‘I’m a big guy, muscular, but I never felt very comfortable down there.’"
The surgeon has also treated men whose penis size has been a problem in their marriage - and even led to divorce.
Mr Garaffa said: "I had a couple that came here because the wife was not happy with the size of the penis of the husband.
"Or there are other people who have been in a marriage and their partner was making fun of their penis size and they divorce, and before finding a new partner they want to have that problem fixed.
"The majority of patients want a combination of length and girth. And the vast majority of patients come here because they’re not confident with their flaccid penis size.
"These are patients who avoid going into public urinals, or who avoid going in communal showers because they’re concerned.
"They’re not concerned about sexual activity and have normal penetrative sex."
£15K FOR AN ERECTION HE COULDN'T FEEL
One patient, who was paraplegic and had no feeling in his genitals at all, forked out £15,000 to have a penile implant so he could get an erection for his partner.
The incredibly invasive procedure, which means you can inflate your penis using a pump inserted into your scrotum, needs repeating every ten to 15 years.
And all of that pain and effort was undertaken by a man who would never actually feel anything during the sex the surgery allowed him to have.
CUTTING LIGAMENT TO MAKE IT 'LONGER'
The range of procedures Mr Garaffa offers can be broadly split between those that give penises more length when flaccid, or more girth.
One thing you can do is use liposuction on the fat around the base of the penis — if you've got four inches of fat there, your penis will look four inches bigger when the fat is surgically sucked out.
But most people who go to the clinic want to push things even further — and there are different methods surgeons use to do this.
Mr Garaffa explains: "The lengthening procedure involves making an incision at the base of the penis in an area that can be easily covered by the hairline, and dividing a ligament which is called the 'suspensory ligament' which connects the penis to the pubic bone."
Once the ligament is cut, the penis will permanently come further out of the body.
Cutting the ligament means the angle of your erection will change so it's not as upright — but a skilled surgeon can keep this change to a minimum so you don't end up with a downward-pointing erection.
As for the girth procedures, surgeons used to use skin grafts from the patient's body and wrap it around the penis.
But this had problems, not least the fact the penis had to be first "degloved" (in which the skin below the tip is peeled off the shaft) before the graft was stitched on, leading to considerable scarring and sometimes contractions which could ultimately make the penis shorter.
NO SEX FOR A MONTH
Mr Garaffa says: "The preferable option is to inject material into the soft tissue underneath the skin on the penis. And this can be fat, harvested from the patient himself — usually from the abdominal area — or it can be a synthetic filler like hyaluronic acid, which is what women use to enhance the lips or fill gaps in cosmetic surgery."
The complete length and girth package will set punters back £7,300, or £5,500 for just one option.
Patients can start having sex again about four weeks after the op, and although many blokes don't get it done to spice things up in the bedroom, Mr Garaffa says an increase of girth will lead to an improvement in the sheets.
He adds: “There will be an improvement because although the length does not increase, the girth does increase, even in erection.
“So obviously penetrative sex will be more pleasurable for both partners.”
INJECTING UNTIL THE FAT COMES OUT
Despite the price and month out of action, some men keep going back for more.
Mr Garaffa said: "There are some patients who are happy with the result, but they would like to gain extra girth.
"The lengthening procedure is done one off — once you divide the ligament, that’s it divided.
"But for the girth, potentially there is room to inject more and more adipose tissue [fat].
"We try to inject a quantity that will increase the size of the penis to the standard desired by the patient, but you don’t want something that looks unrealistic.
"But there are some patients, especially when I do this procedure in the Middle East, they want me to push the limit.
"The skin will expand, but there is a limit beyond which the skin doesn’t expand, and at that point everything that you keep on injecting will come out around the injection area.
"The fat will come out — at that stage, you know you are to stop."
Animation shows silicone implant penis enlargement 
Earlier this year, a study by the University of Sheffield of 50,000 men found that 45 per cent would like a larger penis.
Between 2013 and 2017, members of the International Society of Aesthetic Plastic Surgery carried out 45,604 enhancements worldwide.
Figures before that are unknown because the procedure was considered such a minority concern that records weren't kept.
Mr Garaffa sees around 20 patients a week who enquire about the op, with around a quarter of those going ahead.
Those who don't go ahead normally have unrealistic expectations, or are not good candidates for surgery - such as a risk going under anaesthetic.
Men are very ashamed of their genitalia
Giulio GaraffaMr Garaffa admits one of the main reasons blokes choose to go under the knife is comparing themselves to the guys they see in porn.
He explains: "I always say to patients, ‘Listen, in pornography they will always show big penises. It’s like if you go in an underwear shop, you will see that all men that wear underwear have six-packs, but that’s not the normal representation.’
"The thing is, it’s not very common for men to see other erect penises, while in porn now you can.
"There are some patients who have been addicted to porn, but that’s a minority.”
A study by the clinic even found that the more porn you watch, the more likely you are to be dissatisfied with your penis size (and women who watch more were more likely to be dissatisfied with their partner's).
DON'T RISK DOING IT ON THE CHEAP
And if you are planning on having a penile enlargement, you should be careful to avoid becoming one of the operation’s horror stories by cutting corners.
Mr Garaffa recently had a family of several brothers who flew to Turkey for cheap enlargements, and all of them came back with complications.
They each ended up needing to have skin removed from their penises and having the area reconstructed with skin from their scrotums.
Ultimately, Mr Garaffa thinks a lot of the hassle men put themselves through because of their penises could be avoided by tackling taboos around the male sex organ.
MOST READ IN SUN MEN
He said: "Men are very ashamed of their genitalia. Most of the patients that come to me with erectile dysfunction, for example, or penile deformities, when they sit in front of me they are very ashamed.
"Men associate their penis with their manhood and virility, which is obviously something which is very debatable.
"In reality, in history, there is no man who is remembered because of the strength of his erection or the size of his penis. But unfortunately, this is how men perceive themselves."
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