Management of buried penis syndrome: The novel therapeutic DJ- SAM (Deepak Jumani-Sesame Arginine Metformin) approach

Objectives

Buried penis (hidden penis) is a congenital or acquired condition in which the penis is partially or completely hidden below the surface of the skin. It is an unusual, difficult-to-treat condition that presents a unique clinical challenge. It is an acquired condition in adulthood, most commonly due to predisposing factors such as morbid obesity and diabetes mellitus which are becoming increasingly prevalent, which suggests a potential increase in the incidence of this condition. Although no specific approach is applicable to all patients, a combination of various techniques may be applied. The use of L-arginine gel for erectile dysfunction is well documented, however the use of sesame seed oil applied topically for penile lengthening has not been reported. Both the ingredients are routinely used and have no known side-effects and are being studied for penile lengthening.

Methods

24 patients in age group 31-45 years, BMI ≥ 36 were administered Metformin SR 1gm/OD, L Arginine 3gm OD along with Sesame seed oil (food grade) and 5% L arginine for local application on the shaft of the penis for 12 weeks (DJ-SAM regime). The treatment for the comorbid diseases like diabetes, dyslipidaemia, hypertension, Vitamin D deficiency, COPD, UTI continued as per current standard of care.

Results

The patients were on low carbohydrate, high protein diet and exercise, but were unable to adhere to the exercise regimen. The patients were motivated and adhered to the DJ-SAM therapeutic regimen. Patients reported an increase of penile length to an extent of 2.5±0.56 inches. The changes in the BMI were statistically insignificant.

Conclusion

We postulate that sesame oil along with L-arginine for its topical properties could account for the lengthening of the penis in obese subjects with buried penis. The results of this pilot study as proof in concept highlights the concept of pharmacological modulation in penile lengthening. Metformin in high BMI patients would have a role as a metabolic hormonal regulator which needs further exploration. Although the exact mechanism of action of sesame seed oil for penile lengthening, is still not known, this is the first study that demonstrates the use of sesame seed oil as a therapeutic agent along with L-arginine gel for topical application.