Vacuum and Traction Devices for Penile Enlargement (2005–2025 Literature Review)

Penile Traction Devices (Extenders) for Penis Enlargement

Penile traction devices (mechanical extenders) have been more extensively studied for penile lengthening. These devices apply gentle, chronic stretching force to the penis over many hours per day, aiming to stimulate tissue elongation. From 2005–2025, multiple clinical trials and studies assessed extenders in men seeking a larger penis (often those with a perceived “short” penis, but within normal size range) as well as in specific medical contexts (e.g. Peyronie’s disease and post-surgical penile shortening). 

Extender Studies in Men with Perceived “Short Penis” (Cosmetic Lengthening)

• Gontero et al., 2009 (BJU Int) – Pilot Prospective Trial: Fifteen men complaining of a “short penis” used a commercial penile extender device ≥4 hours daily for 6 months. Baseline mean flaccid length was ~7–8 cm. After 6 months, average flaccid length increased by 2.3 cm and stretched (flaccid stretched) length by 1.7 cm (both significant gains). Notably, erectile function (assessed by IIEF scores) improved modestly post-treatment, and patient-reported satisfaction was “acceptable to good.” The study concluded that traction therapy is a safe, minimally invasive method to significantly elongate the penile shaft. No major side effects were reported aside from mild discomfort from prolonged use.

• Nikoobakht et al., 2011 (J Sex Med) – Prospective Study: 23 young men (mean age ~26) with “short penis” concerns were instructed to wear the “Golden Erect®” extender 4–6 hours per day for 2 weeks, then ~9 hours per day up to 3 months. Mean flaccid length increased from 8.8 cm at baseline to 10.5 cm at 3 months (≈1.7 cm gain), and mean stretched length from 11.5 cm to 13.2 cm (≈1.7 cm gain), both statistically significant improvements. There was no significant change in mid-shaft or proximal penile girth. However, they noted a slight increase in glans circumference (from 8.8 cm to 9.3 cm, ~0.5 cm gain, p<0.05). No serious adverse events occurred. The authors concluded the extender was effective for increasing penile length, with a possibility of glans girth enhancement, and recommended further study.

• Nowroozi et al., 2015 (J Sex Med) – Observational Study: This larger study focused on men with penile dysmorphophobia (men overly concerned about having a small penis despite normal size). Out of 163 men seeking enlargement, 54 chose to undergo traction after counseling. They used the AndroPenis® extender for 4–6 hours daily over 6 months. Outcomes: At 6 months, mean gains were +1.7 cm in flaccid length, +1.3 cm in stretched length, and +1.2 cm in erect length (all p<0.001). These length gains remained stable at a 9-month follow-up (3 months after stopping device use), indicating a lasting effect. A subset of men with mild baseline erectile dysfunction reported improved erections after therapy (9 of 13 men’s mild ED resolved), presumably due to improved psychosexual confidence or increased penile blood flow. Overall, patient satisfaction was modest – many were pleased with some length gain, though expectations were often higher. The investigators emphasized that extenders are safe and provide modest but measurable benefits for men seeking non-surgical enhancement. No major complications occurred; mild pain or inconvenience led a few participants to reduce daily usage, underscoring that compliance and patience are crucial (the device must be worn for many hours daily for months).

Side effects and safety: Across these studies, penile extenders were generally well tolerated. Some men reported mild discomfort, bruising or skin irritation from prolonged stretching or from the device straps, but no long-term injuries. Importantly, no study observed worsening of erectile function; in fact, some noted slight improvements in erectile scores. 

Traction Therapy in Peyronie’s Disease (Curvature) and Length Loss

Penile traction has also been studied as a treatment for Peyronie’s disease (PD) – a condition of penile curvature and often shrinkage due to fibrous plaques. In PD, traction’s goals are to reduce curvature and restore lost length by stretching the scar tissue. Key studies include:

• Gontero et al., 2009 (J Sex Med) – Phase II Trial in PD: This pilot study applied an extender in men with chronic stable Peyronie’s disease (average curvature ~31°). Patients used the device ~4–6 hours daily for 6 months (similar protocol to the “short penis” study). Results: Mean curvature improved slightly (31° to 27° at 6 months), but this change was not statistically significant (p=0.056). Importantly, penile length increased despite the fibrosis: stretched length gained ~1.3 cm (flaccid length +0.8 cm) over 6 months, and these gains were maintained at 12 months. No girth changes were noted. Although curvature reduction was minimal, patients reported a reasonable level of satisfaction – likely due to the recovered length and a subjective improvement in penile straightness (even if small). The authors concluded that in PD, extenders offer **minimal curvature correction but can increase penile length, improving patient satisfaction. They also noted traction is safe and could be combined with other therapies for better results.

• Martínez-Salamanca et al., 2014 (J Sex Med) – Controlled Trial in Acute PD: This study in Spain evaluated traction in the early (acute) phase of Peyronie’s. Fifty-five men with PD (<6 months onset) used an extender for 6 months, compared to 41 men who received no treatment (controls). After 6 months, the traction group had a significant reduction in curvature (from ~33° to 15°, an average improvement of ~20°) and a decrease in penile pain, along with improved erectile function and rigidity scores. In contrast, the no-treatment group tended to worsen: their penile curvature increased on average and their stretched penile length actually decreased over the 6 months (a consequence of progressing PD). While this study’s primary focus was curvature/pain, it demonstrated that traction can prevent length loss in acute PD and even yield some length gain, whereas untreated PD often leads to further shortening. By 9 months, some additional curvature improvement was noted in the traction group, and nearly half of treated patients had plaque softening or regression on ultrasound. No significant adverse events were reported. The authors concluded that early use of traction in PD appears effective in reducing curvature progression and preserving (or modestly increasing) penile length, with the caveat that patient compliance for many hours daily is challenging.

• Ziegelmann et al., 2019 (J Urol) – Randomized Controlled Trial in PD: A notable RCT from Mayo Clinic evaluated a newer traction device (RestoreX®) that requires much less daily wear time. 110 men with PD were randomized 3:1 to traction vs no therapy for 3 months. The traction regimen was only 30–90 minutes per day (a departure from the multi-hour protocols of older extenders). Despite the shorter daily use, outcomes were significantly better in the traction group: after 3 months, men using traction had a +1.5 cm increase in penile length on average, versus essentially 0 cm change in controls (p<0.001). Curvature also improved significantly with traction (mean decrease ~11.7°) whereas controls had a slight increase in curve (+1.3°, p<0.01). Additionally, in men who had concomitant erectile dysfunction, those in the traction arm reported improved erectile function scores while the control group worsened. In total, 94% of treated men had some degree of length improvement (though only ~11% gained ≥1.6 cm, reflecting that many gains were small). About 77% of treated patients saw curvature reduction of at least 10°. No significant adverse events occurred; only mild, transient erythema or discomfort were noted. This trial was significant as it demonstrated, under level-1 evidence, that traction can produce measurable lengthening and curvature improvement in just 3 months with relatively low daily usage, thanks to an improved device design. Participants who had used older extenders overwhelmingly preferred the new device. A follow-up phase of this RCT extended traction therapy to 6 months: men who continued using the device achieved further length gains, with total increases averaging about 2.0–2.3 cm in penile length after 6+ months of traction. In fact, 95% of men treated for 6 months had a net length gain (≈2 cm mean) with no serious side effects. These results represent some of the largest length improvements reported for any nonsurgical method, and notably it was achieved with only ~30 minutes of daily use (high compliance due to convenience). The consensus from this and similar studies is that traction therapy can reliably increase penile length in PD patients (typically on the order of 1–3 cm) and also aid in reducing curvature, improving penile morphology without surgery.

Summary of Traction in PD: Traction devices in Peyronie’s disease are safe and can improve penile length (often restoring length lost to disease) and mildly reduce curvature, especially when used in early disease or in combination with other treatments. The magnitude of length gain in PD tends to be slightly less than in men without fibrosis (due to inelastic scar tissue), but still significant for patients experiencing penile shortening. All studies emphasize the need for consistent daily use and patient motivation. Side effects remain minor (transient soreness or skin irritation). Traction is now considered a valid nonsurgical option to conservatively manage PD-related deformity while enhancing length.

Traction Therapy After Prostatectomy or Penile Surgery

Another application of traction is in men who have lost penile length due to surgery (e.g. radical prostatectomy for prostate cancer, which often causes fibrosis and shortening, or men with indwelling penile prostheses). Recent literature suggests traction can help maintain or increase length in postoperative settings:

• Case Report – Post-Prosthesis Lengthening (Chung et al., 2011, J Sex Med): This case involved a man unhappy with penile length after a prior inflatable prosthesis placement (his implant was shorter than his original erection, causing difficulty with penetration). The patient undertook an intensive combined regimen of vacuum therapy (2×10 minutes daily) plus penile extender use (a remarkable ~8 hours daily) for 8 months. After 6–8 months of therapy, his stretched penile length increased by 2.3 cm. He then underwent revision surgery to replace his implant: surgeons were able to upsize the prosthesis from 15 cm to an 18 cm length device (20% longer). Post-revision, his erect penile length increased by 4.4 cm compared to before, and he reported greatly improved sexual function (successful penetration). This single-patient experience illustrates that aggressive traction (with adjunct vacuum use) can significantly lengthen the penile tissues over time, enough to permit a longer implant and a large functional gain. The report’s conclusion was that penile traction can increase corporal length even years after surgery, offering a non-invasive way to enhance penile dimensions in men with prosthetic or post-surgical shortening. (It should be noted this level of commitment – 8 hours daily for months – is exceptional and may not be tolerable for all; however, it demonstrates the upper limit of what traction might achieve in select cases.)

• Zganjar et al., 2023 (BJU Int) – Randomized Trial Post-Prostatectomy: In men who have undergone radical prostatectomy (RP), penile shrinkage and erectile dysfunction are common. This recent RCT evaluated the RestoreX® traction device in men starting therapy one month after RP. Participants were assigned either to daily traction (30 minutes, 5–7 days/week) or to no treatment, for 5 months, followed by a crossover/open-label phase. The results at 5–6 months were encouraging: men in the traction group had a median increase of ~1.5–1.7 cm in stretched penile length, whereas control patients had minimal change or slight losses (0 cm to –0.1 cm on average). This difference was statistically significant. Traction patients also showed better erectile function outcomes – the treatment group had much smaller drops in IIEF scores than controls (almost preserving baseline function), and notably, far fewer men in the traction group needed injection therapy for ED. After stopping traction, the gained length was maintained at a 9-month follow-up. Men who initially had no treatment and later crossed over to traction did see some improvement, but significantly less than those who started early, suggesting a potential benefit to early post-op intervention. No significant adverse events were recorded; compliance was good due to the short daily use requirement. The authors concluded that postoperative traction therapy can prevent penile shortening and even add length after prostatectomy, while also aiding erectile rehabilitation. This is the first RCT to show a post-surgery therapy that improves penile length (and possibly erectile function) in prostatectomy patients. These findings align with earlier, smaller studies and case reports, reinforcing a trend: traction can be a valuable tool in penile rehabilitation, mitigating the atrophy and fibrosis that otherwise occur after surgeries.

Vacuum Devices (Penis Pumps) for Penile Size Enhancement

Aghamir et al. (2006, BJU Int) : Enrolled 37 men with stretched penile length <10 cm (micropenis criteria) who underwent vacuum therapy three times weekly (20 minutes per session) for 6 months. After 6 months, mean stretched length increased from 7.6 cm to 7.9 cm.