Male intimate aesthetics with injectables: clinical evidence, safety, and ethical considerations

Abstract

Introduction: Male intimate aesthetics has experienced significant growth over the past decade, driven by the increasing demand for minimally invasive procedures. In this context, injectable treatments such as hyaluronic acid, platelet-rich plasma, and botulinum toxin type A have emerged as therapeutic alternatives, although with varying levels of scientific evidence and safety.

Objective: To critically analyze the available evidence regarding the efficacy, safety, and ethical considerations of the main injectable procedures used in male intimate aesthetics.

Materials and Methods: A narrative review of the literature was conducted using major biomedical databases (PubMed/MEDLINE, Scopus, Cochrane Library, and Google Scholar), including studies published up to June 2025. Clinical trials, observational studies, reviews, and consensus documents were selected based on clinical relevance, methodological quality, and conceptual contribution.

Results: Hyaluronic acid emerges as the current gold standard, with consistent evidence demonstrating significant increases in penile girth, improvement in sexual function, and high patient satisfaction, along with a favorable safety profile. Platelet-rich plasma shows variable outcomes and limited evidence, being considered an adjunctive or experimental therapy. Botulinum toxin type A lacks robust clinical evidence, with support mainly derived from theoretical and anecdotal reports. Procedural safety largely depends on anatomical knowledge, injection technique, and appropriate patient selection.

Conclusion: Hyaluronic acid is currently the only injectable modality supported by sufficient scientific evidence for clinical use in male intimate aesthetics. PRP and botulinum toxin should be restricted to research settings. Psychosexual assessment and adherence to ethical principles are essential for safe and evidence-based practice.