Penile enhancement or penis enlargement procedures (sometimes euphemistically referred to as male enhancement procedures in spam email and television advertisements) are techniques used to make the human penis increase in girth, length, or hardness. Procedures range from manual exercises to stretching devices and surgical procedures, with reports of successes and failures around the world. While some of these are known to be outright hoaxes, other techniques have some measure of success. The media is filled with advertisements offering male enhancement pills. This resembles the craze ten years ago over penile enlargement surgery. These so called new discoveries are disappointing due to the fact that most men want their organ to be twice the size. It is difficult to imagine how a pill could enlarge the penis other than improving with erection. Penile enhancement surgery involves two procedures. Penile lengthening can be achieved by a small incision placed above the base of the penis. Ligaments anchoring the penile shaft to the pubic bone above are divided. The internal aspect of the penis is thus externalized. The skin is advanced as well producing an increase in length between 1 and 2 inches. Surgery lasting less than two hours is performed under sedation with local or full anesthesia. This procedure must be accompanied by the use of an external traction device to prevent scar tissue from retracting the externalized shaft. Men may return to work in as little as 2 days. I suggest that patients begin using a device to make sure they can comfortably wear it for up to 4 hours per day. Use of a device alone may result in gains up to 1/2 inch.