A YEAR ago Dr Hennie Roos, a South African plastic surgeon, received a patient who desperately wanted to have his penis enlarged. He was on the point of suicide, he said, his deficiency in this department having chronically hampered his capacity to engage in lasting relationships with women. The patient urged Dr Roos, who works out of Johannesburg's Millpark Hospital, to read a magazine article about a surgeon in China who had perfected a technique for lengthening the penis by up to 50 per cent of its natural size.

Dr Roos and a urologist colleague, Dr Irving Lissoos, spent six months trying to establish the whereabouts of the Chinese doctor. Eventually, they tracked him down to Hubei province in central China. The doctor's name, incredibly enough, is Dr Long - Dr Dao-Chou Long. In March, the two South Africans travelled to Hubei, where they spent a week studying Dr Long's methods. 'We were the first Westerners ever to visit him,' Dr Roos said. They attended some of his operations and after a few days performed a few themselves.

According to Dr Roos, Dr Long, a professor of plastic surgery, has carried out more than 1,000 of these operations. 'He receives 1,000 requests a week from all over China.'

Since his return home, Dr Roos has studied plastic surgery in Paris and Taiwan, and has successfully carried out 73 'penis elongation operations', as he describes them. For an all-in price of 10,000 Rand (pounds 2,000) he promises an average growth in penis length of 50 per cent, or 4-7cm. 'The sexual, reproductive and urinary functions are in no way hampered by the operation. At no point is the basic connection to the blood supply and the nerves cut. Therefore, there is no effect on the patient's capacity to have erections and lead a normal sexual life.'

The operation itself, conducted under a general anaesthetic, takes approximately an hour and involves three stages. First, a triangular skin flap is cut upwards in the pubic hair area from the base of the penis in the direction of the belly button. This allows access to the root of the penis, 40 per cent of which is hidden from view inside the pelvis. Later it will be used to close the wound and cover the newly exposed part of the shaft of the penis.

The second stage involves dissecting the root of the penis from the pubic bone. This means cutting the connecting 'superficial suspensory ligament'. All the time the penis is erect, tumescence having been artificially induced. This is necessary for the vital part of the operation, which involves pushing out a substantial part of the penis from inside the pelvis and then 'restabilising' it, as Dr Roos put it, by a special stitching process. The effect of the stitches is also to prevent retraction of the penis to its pre-operative dimensions.

The third stage requires that the wound be closed by shifting part of the skin of the pubic area over the penis, accommodating it to the new size. Here, Dr Roos said, lay the fundamental difference between earlier attempts to lengthen the penis by dissecting the pubic bone ligament. Previously, doctors had been unable to solve the problem of how to provide the necessary additional skin cover. In Dr Long's method, the skin flap cut at the start of the operation meets this requirement.

The patient is kept in hospital for one day and, after five days' recommended rest at home, is able to resume normal work. Sexual activity, however, is prohibited for three weeks, during which erections are, by chemical means, discouraged. The wounds will take up to six months to settle completely, but after the initial three-week period, the patient is able to engage in as hectic a sex life as he desires.

What are the down sides of the operation? Complications, Dr Roos said, could occur during the surgery itself. 'As in any other operation the possibility exists of infection or bleeding, but there is no special, intrinsic difficulty attached to the procedure. This is not a high-risk operation.'

As to the after-effects, one is that pubic hair will grow on the front part of the penis, in 2-3cm of the penile base. 'This can be removed by electrolysis,' Dr Roos said, 'although most of our patients' partners see this as a sexual stimulant.' Another is that the angle of erection diminishes from 45 to 60 degrees. 'But the penis is still stable in erection, giving no problems with sexual function.'

Dr Roos said that his patients, 20 per cent of whom were homosexual, fell within the 20-38 age bracket. 'I did have a man of 73 who increased his penis size by 100 per cent through the operation. His wife, he said, was very excited by this.'

Patients' needs could be accommodated into three distinct categories. 'First, there are the genuinely underendowed - those we call microphallic - either because of congenital abnormalities or trauma to the penis. For example, an amputated penis or a circumcision that went wrong.

'Another third suffer from severe psychological problems due to the perception that they have a small penis even though they are normal sized. Often they will have been mocked at some stage of their lives.

'The third category belong to what I call 'the macho man syndrome'. They don't have a small penis nor do they have a psychological problem. They just want a big penis.'

Would he ever turn down a patient's request for the operation? 'On psychological grounds, no. That is not my area. I will do it unless it causes an abnormally long penis.' Abnormally long? 'An erection of more than 20cm I will not do. You also have to think of the woman in such cases.'

The benefits for those who undergo the operation lie chiefly in the mind, Dr Roos believes. 'The whole thing about penis size not counting is all crap. It is important in male sexuality. I read a study on breast enlargement recently (an operation Dr Roos also performs, as well as facial reconstruction) and it showed that sexual satisfaction for a woman increased after the operation because of her improved self-perception. I think the same goes for men after they have their penis enlarged.

'In China, Dr Long has found that 800 of his patients have shown a significant general improvement in their sexual function. Of course, it is completely psychological. Physiologically, the operation does not improve sexual function.'

Dr Roos has made a 20-minute video that explains his operational procedure and answers questions patients normally ask. He may be reached by fax in Johannesburg on 010 2711 482 1298.

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