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The remedies persist for men who can't get their hands on prescription drugs like Viagra or who prefer "natural" cures.

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

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

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

Just ask Bob, a retail manager from New Jersey.

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.

Lamm has endorsed an herbal remedy, marketed under the Roaring Tiger label, that combines horny goat weed and other herbal extracts with the amino acid L-arginine.

"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.

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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.

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

Thousands of years before Viagra, men were consuming everything from horny goat weed to powdered rhino horn in hopes of boosting sexual performance.

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Bob, New Jersey.

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.

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.

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

Richard's wife has also been supportive.

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

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

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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.

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

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.

Sexual performance declines naturally as men age, doctors say.

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

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

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.

"I didn't feel manly enough," he tells WebMD.

"If a woman can have a breast enlargement and it makes them psychologically feel better," he reasons, "then perhaps we should have the same thing for men.

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

Then, in the back of a weightlifting magazine, he saw an ad for the FastSize Extender, a device that claims to make the penis longer and fatter through traction.

"PaginationHere's what guys should watch out for.

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.

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He has a loving wife who has always enjoyed their sex life.

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

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WebMD does not provide medical advice, diagnosis or treatment.

But ever since he was a young boy, Richard couldn't get over the feeling that his penis was too small.

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

He says he has patients who have developed Peyronie's disease due to violent stretching of the penis through jelqing.

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

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

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

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.

Chicago urologist Laurence A.

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

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

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

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"The FastSize Extender, though not extensively tested, has received some validation from mainstream medical sources.

He says he's gained over 2 inches of erect length.

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

When Boyle's patients come to her with bottles of herbal supplements, she tells them she cannot vouch for their safety or effectiveness unless the FDA has reviewed the claims on the label.

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

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

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

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And how to get out of it.

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.

A recent study found that 85% of women are pleased with their partner's penis proportions, but 45% of men say they want a larger penis.

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.

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

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

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

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.

Men who are overly preoccupied with penis length tend to have unrealistic expectations of surgery and should seek counseling instead, the authors wrote.

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

Nonpresciption methods of male enhancement and male enlargement range from the possibly effective to the downright dangerous.

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

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

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"The small blood vessels that go to the penis can become diseased much earlier than the [larger vessels that go to the heart," Karen Boyle, MD, a urologist at Johns Hopkins School of Medicine, tells WebMD.

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

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

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.

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Richard, New York.

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

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

Richard began wearing the device almost eight hours a day, every day.

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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.

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

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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.

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