Written by Finlay Mead

An American urologist’s controversial treatment has revealed a dark side to one of the most infamous quick fixes for men’s greatest insecurity. In a recent investigation, James Elist MD and his highly lucrative enhancement device known as the ‘Penuma’ — an unimaginative acronym for ‘Penis New Man’ — take centre stage in a drama populated by men who experienced grotesque complications following the implant.

There are average penises, perfect penises, fractured penises, and then, at the very top of the tree, are enormous penises. Given this almost universally accepted hierarchy, whereby bigger is undoubtedly perceived as better, it will come as no surprise to hear that men are flocking for penis enlargements in unprecedented numbers, especially in some of the world’s most cashed-up neighbourhoods. What may come as a surprise — and an unwelcome one at that — are the horror stories these men are telling about their experience…

James Elist MD is one of Los Angeles’ foremost plastic surgeons, with a speciality in this Holy Grail of male cosmetic surgeries. However, despite Elist’s promotional literature suggesting that the implantation of the Penuma — a block-like silicone device inserted through an incision in the penis shaft — is “reversible”, numerous examples of extreme complications such as excruciating pain during urination and sex alike suggest that the reality is far from straightforward.

WATCH: This woman explains why a penis enlargement is totally unnecessary anyway.

From broken implants to amber-coloured fluid emerging from all sorts of holes, the horror stories surrounding Penuma implants are enough to turn anyone’s stomach, particularly if you happen to be carrying a set of the affected implements yourself. Unfortunately for those who have suffered at the hands of Elist, the doctor has a proven knack for building good publicity around his name — including in widely-read publications like GQ — supposedly cementing Elist’s reputation as a standout surgeon in a competitive West Coast market and making the task of exposing his shortcomings even harder.

Thomas Walsh — a reconstructive urologist who has the wholly unenviable job of treating patients with post-Penuma implantation complications — argues that patients require comprehensive and honest information in order to provide informed consent for a procedure such as this. However, the problem arises when the person creating, manufacturing, and selling the device becomes the sole source of information:

“To fully consent to a procedure, the patient needs someone to tell him everything… He doesn’t need a salesman. The problem here is that you’ve got someone who is inventing and manufacturing and selling the device. That personal investment can create a tremendous conflict of interest.”

Thomas Walsh

The result of that conflict of interest? Stories saturated with male misery and regret. One patient — listed simply as “Mick” by ProPublica, the authors of this investigation, to better protect his identity — had the implant removed by Walsh after losing all sensation in his penis. Contrary to Elist’s stern warning against seeking advice from other doctors, Mick discovered that a swathe of similarly dissatisfied customers had experienced even more severe complications.

Perhaps the most disheartening aspect of Mick’s story — and one that has apparently resonated with many others that have endured Elist’s treatment — is that following the removal of the implant, he discovered that his penis had actually decreased in length. More than the obvious physical and financial losses bound up in this discovery, the real loss for Mick was the resulting forfeiture of intimacy with his loved ones, which became increasingly difficult after the surgery. A Hollywood executive who underwent multiple surgeries with Elist echoed Mick’s sentiments:

“It’s like he snipped the possibility of intimacy away from me”

Anonymous Hollywood Executive

Despite Dr. Elist’s insistence that his roster of satisfied customers vastly outweighs the dissatisfied ones, the real problems extend far beyond the implant itself. Concerns regarding the consent process have emerged, including instances where unknowing patients were given forms to sign after receiving unsolicited narcotic shots and non-English speaking patients being presented with unintelligible forms written in English. Perhaps most disturbingly, some patients report waking up from anesthesia after what they believed was a simple vein-cleaning procedure, only to discover a foreign object had been implanted in their shafts.

This entire debacle serves as a grim reminder of the potential risks associated with any cosmetic procedure, highlighting the extreme lengths people are willing to go to in order to “improve” or “enhance” their bodies. While it’s easy — and right — to isolate Dr EList and his seemingly dodgy dealings, we also have to ask what this says about society as a whole: in a world where masculinity is changing shape quicker than many could have ever imagined, is the emergence of burly billionaires and widespread penis enlargement a worrying but predictable effort to shore up the male identity?