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"The small blood vessels that go to the penis can become diseased much earlier than the [larger vessels that go to the heart," Karen Boyle, MD, a urologist at Johns Hopkins School of Medicine, tells WebMD.
But ever since he was a young boy, Richard couldn't get over the feeling that his penis was too small.
"I didn't feel manly enough," he tells WebMD.
WebMD Medical News: "Penis-Lengthening Surgery Questioned," "Small-Penis Syndrome Questioned.
Steven Lamm, MD, assistant professor of medicine, New York University and author, The Hardness Factor.
And how to get out of it.
(Have you tried or considered trying a male enhancement product? Talk about it on the Men's Health: Man to Man message board.
Just ask Bob, a retail manager from New Jersey.
Does working out give it a boost?You will receive your first newsletter with our next scheduled circulation!© 2005 - 2019 WebMD LLC.
The group also refuses to endorse surgeries that inject fat cells in the penis with the goal of increasing penile girth.
After four months of wearing the device, he says his flaccid penis has stretched from 3 inches to over 5 inches; erect, he has gone from less than 6 inches to over 7 inches.
Lamm has endorsed an herbal remedy, marketed under the Roaring Tiger label, that combines horny goat weed and other herbal extracts with the amino acid L-arginine.
Sometimes men with erection problems or a diminished libido have low levels of testosterone, Boyle says.
Richard began wearing the device almost eight hours a day, every day.
What men don't know about it.
At the end of the six-month study, which was funded by the maker of the FastSize Extender, Levine found increased penile length and reduced curvature in every man and increased girth in seven of the men.
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Nonprescription testosterone, such as the kind used by some bodybuilders, is dangerous, she warns.
"In younger or younger middle-aged men, ED is often the first sign of atherosclerosis.
For men with performance issues who are physically healthy, Boyle often prescribes counseling, such as marriage counseling for men with relationship issues or psychiatric help for men who are preoccupied with a problem in penile appearance.
Instead of furtively turning to untested methods, men with persistent concerns should consider opening up about them with their doctors.
The FastSize Extender device promises results, but it's far from quick and easy.
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Most are a waste of money, and some are downright dangerous, doctors say.
Calling the results "remarkable," Levine now prescribes the device to many of his Peyronie's patients and reports no significant complications.
So there should be plenty of ways to satisfy your partner that have nothing to do with pills, creams, surgery, or devices.
Men who are overly preoccupied with penis length tend to have unrealistic expectations of surgery and should seek counseling instead, the authors wrote.
"For men with ED who are at risk of heart disease, prescribing Viagra or its cousins isn't enough, Boyle says.
"In some cases, men are harming themselves in the pursuit of a bigger penis.
(Levine has also worked as a paid consultant to FastSize Extender.
Atherosclerosis, a condition in which fatty deposits build up inside arteries, may restrict blood flow to the penis and cause erection difficulties.
The remedies persist for men who can't get their hands on prescription drugs like Viagra or who prefer "natural" cures.
Our email inboxes fill up every day with advertisements for pills, ointments, supplements, and contraptions aimed at enhancing penis size, sexual stamina, or libido.
WebMD does not provide medical advice, diagnosis or treatment.
Evidence shows that these changes in themselves can have a positive effect on sexual function, Boyle says.
He says he has patients who have developed Peyronie's disease due to violent stretching of the penis through jelqing.
"Penis-lengthening surgery is also an option for men, but it is a highly controversial procedure.
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Nonpresciption methods of male enhancement and male enlargement range from the possibly effective to the downright dangerous.
"I see a more confident man in front of me from using this product," she says.
"The FastSize Extender, though not extensively tested, has received some validation from mainstream medical sources.
Most importantly, erectile dysfunction may be an early predictor of heart disease.
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WebMD archives content after 2 years to ensure our readers can easily find the most timely content.
It's a testimony to men's abiding insecurities about sexual performance.
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Then, in the back of a weightlifting magazine, he saw an ad for the FastSize Extender, a device that claims to make the penis longer and fatter through traction.
These men should be also be controlling their weight and cholesterol level, limiting their alcohol intake, and quitting smoking.
"All the pills, topical creams, and gels are worthless.
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) SOURCES: Karen Boyle, MD, assistant professor of urology and director of reproductive medicine and surgery, Johns Hopkins University School of Medicine.
Levine, MD, professor, Rush University Medical Center and director of male sexual function and fertility, Chicago.
But a rapid or severe decrease in performance or libido can be a red flag.
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He was shocked to notice a difference within a few days.
But many doctors are wary of traditional medicines.
A 2006 study found that only 35% of men were satisfied with the outcome of surgery, which added only half an inch, on average, to length.
And there's plenty of debate on whether size matters at all.
Testosterone deficiencies can also affect mood and energy levels.
The American Urological Association says a common form of lengthening surgery (involving cutting the suspensory ligament of the penis) has not been shown to be safe or effective.
He has a loving wife who has always enjoyed their sex life.
Richard's wife has also been supportive.
Boyle tests for testosterone levels and prescribes it as a topical gel, though she warns it is only safe when prescribed and monitored by a physician.
Many doctors question whether the benefits of lengthening surgery outweigh the risks.
Given that the vast majority of men fall within a certain penis size -- about 5 to 2 inches long when erect -- most men fall within the normal range.
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"I was afraid my girlfriend would think I was a freak, but she was supportive because she felt a difference in her satisfaction and I felt more confident in myself," Bob tells WebMD.
Levine cites "jelqing," a technique involving hours and hours of intense stroking.
When Boyle's patients come to her with bottles of herbal supplements, she tells them she cannot vouch for their safety or effectiveness unless the FDA has reviewed the claims on the label.
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)Could FastSize work on men of normal penile length? Levine says it might.
Richard, the mechanic from New York, got results faster than Bob, but still wore the device under his clothes for about eight hours a day.
The most sensitive nerves in the vagina are found close to the surface, Lamm notes, and the clitoris is found on the vagina's outside.
)The Internet is rife with scammers who seek to prey on men's insecurities, Levine says.
Levine, MD, director of the male fertility program at Rush University Medical Center, tested the FastSize Extender on 10 men afflicted with Peyronie's disease, which can cause bending and shrinkage of the penis.
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That's because performance problems sometimes act as an early warning signal for serious health problems.
Richard, New York.
"They need reassurance from a physician that everything is OK," she says.
But Lamm says these remedies may be appropriate for men who have experienced a decline in sexual performance but do not suffer from a diagnosable sexual problem.
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For young men with sexual performance problems and no signs of physical problems, Boyle may prescribe counseling and a low dose of Viagra as they work out issues of insecurity.