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That's because performance problems sometimes act as an early warning signal for serious health problems.

"They need reassurance from a physician that everything is OK," she says.

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"Penis-lengthening surgery is also an option for men, but it is a highly controversial procedure.

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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.

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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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"For men with ED who are at risk of heart disease, prescribing Viagra or its cousins isn't enough, Boyle says.

To find the most current information, please enter your topic of interest into our search box.

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.

"In younger or younger middle-aged men, ED is often the first sign of atherosclerosis.

Atherosclerosis, a condition in which fatty deposits build up inside arteries, may restrict blood flow to the penis and cause erection difficulties.

(Levine has also worked as a paid consultant to FastSize Extender.

But a rapid or severe decrease in performance or libido can be a red flag.

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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.

WebMD Medical News: "Penis-Lengthening Surgery Questioned," "Small-Penis Syndrome Questioned.

"I see a more confident man in front of me from using this product," she says.

In public bathrooms, he'd use the handicapped stall.

Many doctors question whether the benefits of lengthening surgery outweigh the risks.

But many doctors are wary of traditional medicines.

) SOURCES: Karen Boyle, MD, assistant professor of urology and director of reproductive medicine and surgery, Johns Hopkins University School of Medicine.

)Could FastSize work on men of normal penile length? Levine says it might.

"All the pills, topical creams, and gels are worthless.

Calling the results "remarkable," Levine now prescribes the device to many of his Peyronie's patients and reports no significant complications.

But that makes it a true rarity among the nonprescription methods of male enhancement.

The group also refuses to endorse surgeries that inject fat cells in the penis with the goal of increasing penile girth.

Nonprescription testosterone, such as the kind used by some bodybuilders, is dangerous, she warns.

These men should be also be controlling their weight and cholesterol level, limiting their alcohol intake, and quitting smoking.

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Many men would clearly rather spend $20, $50, $100 on the Internet than go to the doctor and get real information.

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The device cost $298, but Richard says the effect on his self-confidence has been priceless: "It made a world of difference to me.

He felt embarrassed in gym locker rooms and when standing naked before his wife.

Just ask Bob, a retail manager from New Jersey.

Sexual performance declines naturally as men age, doctors say.

All it took was 25 months and over 2,600 hours wearing the device, typically five hours a day, seven days a week.

(Have you tried or considered trying a male enhancement product? Talk about it on the Men's Health: Man to Man message board.

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Levine cites "jelqing," a technique involving hours and hours of intense stroking.

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Most are a waste of money, and some are downright dangerous, doctors say.

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.

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.

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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.

Your doctor might be able to prescribe something that can really help, or least provide a valuable dose of perspective about what constitutes "normal" sexual performance.

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.

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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.

Bob, New Jersey.

It's a testimony to men's abiding insecurities about sexual performance.

Levine, MD, professor, Rush University Medical Center and director of male sexual function and fertility, Chicago.

Richard, New York.

It's ironic that the male preoccupation with enhancement seems to be independent of the needs of women, the supposed benefactors of improved sexual performance.

Steven Lamm, MD, assistant professor of medicine, New York University and author, The Hardness Factor.

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.

The FastSize Extender device promises results, but it's far from quick and easy.

WebMD does not provide medical advice, diagnosis or treatment.

She also says the lengthening has enhanced their sex life, though she had no complaints before.

And there's plenty of debate on whether size matters at all.

Testosterone deficiencies can also affect mood and energy levels.

He was shocked to notice a difference within a few days.

"In some cases, men are harming themselves in the pursuit of a bigger penis.

Does working out give it a boost?You will receive your first newsletter with our next scheduled circulation!© 2005 - 2019 WebMD LLC.

(The supplements are made by the same company that makes the FastSize Extender.

Most importantly, erectile dysfunction may be an early predictor of heart disease.

No herbal remedy can restore erections like Viagra and its prescription counterparts, says Steven Lamm, MD, an assistant professor of medicine at New York University and author of The Hardness Factor.

"PaginationHere's what guys should watch out for.

Evidence shows that these changes in themselves can have a positive effect on sexual function, Boyle says.

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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.

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Instead of furtively turning to untested methods, men with persistent concerns should consider opening up about them with their doctors.

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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.

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.

Richard's wife has also been supportive.

)The Internet is rife with scammers who seek to prey on men's insecurities, Levine says.

The question is, do any of these "male enhancement" techniques really work?Richard, a mechanic from upstate New York, is a muscular, athletic guy.

Sometimes men with erection problems or a diminished libido have low levels of testosterone, Boyle says.

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