Penitox
Treatment

More penis volume and firmer erections — without surgery

What many men don't know: Botulinum toxin — the active ingredient that has been smoothing wrinkles and relaxing muscles for decades — can be injected specifically into the erectile bodies of the penis, where it achieves two measurable effects: more penis volume at rest and during erection, as well as harder, more intense, and longer-lasting erections.

The treatment is called Penitox. It is minimally invasive, outpatient, takes about 30 minutes, and requires no downtime. Dr. med. Timo A. Spanholtz and colleagues have been performing the Penitox treatment for years at the Praxisklinik am Rosengarten — with many years of experience in male intimate surgery and andrology.

Penitox treatment at the AndroKlinik

Consultation initially via video · procedure at the private clinic K61 · discreet and professional.

Book a consultation now

What is Penitox — and how does it work?

Penitox describes the targeted injection of a neuromodulator (botulinum toxin A) directly into the erectile bodies of the penis (corpora cavernosa). The active ingredient relaxes the smooth muscle cells in the walls of the penile arteries — the blood vessels dilate, allowing more blood to flow into the erectile bodies.

The result is twofold: On the one hand, the penis becomes visibly larger and fuller in its flaccid state due to the permanently improved blood circulation. On the other hand, the erectile bodies respond more strongly during sexual arousal — erections become harder, fuller, and last longer.

Penitox:
At a glance

Active ingredient:

Botulinum toxin A (neuromodulator) — no filler, no implant
Mechanism of action:

Relaxation of the smooth vascular muscles → more blood flow into the erectile bodies
Onset of effect:

First effects after 2–3 weeks · maximum after approx. 4–6 weeks
Duration of effect:

approx. 4–7 months · then declining · easily repeatable
Duration of procedure:

approx. 30 minutes outpatient
Downtime:

None — normal daily life possible immediately · sport/sex after 24 hours
Repetition:

Recommended after approx. 6 months

Who is Penitox suitable for?
The two indications

At the AndroKlinik, Penitox is used for two clearly defined groups — both benefit from the same mechanism of action, but have different starting situations:

Men with erectile disorders
(medical indication)

In the case of vascular erectile dysfunction — when the erectile body vessels can no longer allow sufficient blood in due to arteriosclerosis, diabetes, or age-related changes — Penitox addresses the cause directly. The relaxation of the vascular muscles improves blood flow structurally, not just symptomatically like PDE-5 inhibitors.

Vascular ED in which PDE-5 inhibitors no longer work sufficiently
Erection problems in the context of andropause — as a supplement to hormone therapy
Men who cannot take PDE-5 inhibitors for medical reasons
As a supplement to P-Shot or shockwave therapy for a synergistic effect

Men without a medical indication
(aesthetic-functional desire)

Many men without a clinical erectile disorder wish to improve their sexual performance, gain more penis volume at rest, or achieve a more intense erection quality. Penitox is also suitable for this group — as a non-surgical alternative to surgical penis enlargement procedures.

Desire for more penis volume (flaccid and erect) without surgery
Desire for a more intense, harder erection and improved sexual experience
Men who wish to functionally optimize the results after a surgical procedure

The effects of the Penitox treatment in detail

Due to the improved permanent blood circulation of the erectile bodies, the following effects appear — which have been documented in several clinical publications, including by El-Shaer et al.:

Effect	What happens / What patients report
Larger penis at rest	Due to the permanently relaxed vascular muscles, the penis in its flaccid state has continuously better blood circulation and is therefore visibly fuller and more voluminous
Harder, firmer erections	More blood flow into the erectile bodies → stronger filling → harder, firmer erection · particularly noticeable with a vascular component
Longer-lasting erections	Due to the improved arterial supply, the erection pressure remains more stable · the erection lasts longer without rapid flaccidity
More intense sexual sensation	More blood filling = more intense erection sensation · many patients report an improved sexual experience and enhanced orgasm
More penis volume during erection	Due to the stronger filling of the erectile bodies, the erect penis appears and is more voluminous · a measurable increase in circumference is possible
More self-confidence	Positive side effect: more reliable function and an improved sense of one's body reduce performance anxiety · a more relaxed sex life

Note: The effects vary individually depending on age, initial situation, pre-existing conditions, and genetic predisposition. A Penitox treatment cannot work miracles — but it is scientifically proven to be effective with consistent use.

Important note

Penitox cannot work miracles — and it is important to have realistic expectations.

The enlargement effects are temporary and vary individually in their extent.

Those who wish for more permanent or more pronounced results should discuss surgical penis enlargement (PHALLOMAX®, AlphaFill®) as an alternative.

Dr. Spanholtz will honestly advise you in the initial consultation on which approach is best suited to your situation.

Is shockwave therapy the right option for you?

The specialist assesses this based on your laboratory values and medical history — in a 30-minute initial consultation.

Book a consultation now

Penitox vs. PDE-5 inhibitors: Two different approaches

Both methods improve erection quality — but through fundamentally different mechanisms and with very different time profiles:

Criterion	Penitox (botulinum toxin)	PDE-5 inhibitors (e.g. sildenafil)
Mechanism of action	Permanent vascular relaxation in the tissue	Enzyme inhibition — temporarily improved vasodilation
Onset of effect	2–3 weeks · maximum after 4–6 weeks	30–60 minutes after intake
Duration of effect	4–7 months continuously	4–36 hours depending on the active ingredient
Application	Once every 6 months at the clinic	Orally before each act of intercourse
Penis volume	Improved even at rest	No effect at rest
Spontaneity	Fully preserved — no tablet required	Timing of intake required
Combinable with	P-Shot, ESWT, AlphaFill®, PDE-5 inhibitors	Penitox, ESWT, P-Shot

The P-Shot 100 combination:
Penitox + P-Shot in one session

The combination of Penitox and P-Shot is particularly effective — known at the AndroKlinik as P-Shot 100 and possible to perform in a single treatment session.

More about the P-Shot and P-Shot Pro

P-Shot 100: The synergy explained

Penitox relaxes the vascular muscles → maximum blood flow and opened capillaries in the erectile body tissue.
P-Shot (PRP stem cell therapy) injects growth factors directly into this optimally perfused tissue.
Result: The growth factors of the P-Shot work more intensely in a better-perfused tissue.
Both treatments reinforce each other — immediately (Penitox relaxation) and long-term (PRP regeneration).
Procedure: Both treatments are carried out in one session of approx. 45–60 minutes.
→ More about the P-Shot: P-Shot and P-Shot Pro (/andropause/p-shot)

Transparency: Off-label use

Off-label means: There is no official approval for this specific indication.
Off-label does NOT mean: The active ingredient is unsafe or untested.

Botulinum toxin has been used medically for decades, is comprehensively documented, and is very well tolerated.

Off-label uses are common in medicine and legally permissible when the evidence supports them.
Clinical studies (including El-Shaer et al.) prove the effectiveness and safety of the Penitox treatment.

At the AndroKlinik, you will be fully informed about the off-label status before the procedure.

The treatment procedure at the AndroKlinik

Consultation (possible via video)

In the initial consultation — via video consultation or at the clinic — Dr. Spanholtz discusses your wishes, your medical history, and expectations. He explains what Penitox can and cannot achieve, and discusses, where applicable, the combination with the P-Shot or other treatments. Before the procedure, complete medical information is provided, including a note about the off-label status.

The procedure (approx. 30 minutes)

The treatment is outpatient at the private clinic K61. Procedure:

Cleaning and disinfection of the treatment area
If desired: application of a local anesthetic cream for additional comfort
Short-term throttling of the blood supply with a tourniquet tube (approx. 20 minutes) — so that the botulinum toxin remains concentrated in the target tissue
Precise injection of botulinum toxin with a fine needle at several points into the corpora cavernosa
Removal of the tourniquet band · treatment completed

After the procedure

Daily life can be resumed immediately after the treatment. For the first 24 hours, it is recommended to avoid strenuous physical exertion and sexual intercourse — after that, there are no restrictions.

The first effects appear after 2–3 weeks; the maximum effect is reached after 4–6 weeks.

Frequently asked questions about shockwave therapy

How much penis enlargement is achieved with Penitox?

The enlargement is individual and not exactly predictable. It depends on the initial blood circulation, age, and the anatomical situation. On average, patients report a noticeable increase in penis circumference and volume — both in the flaccid state and during erection. Those who wish for more pronounced or permanent results are better advised with AlphaFill® (hyaluronic penis thickening) or a surgical procedure. Dr. Spanholtz will honestly advise you on this in the initial consultation.

Is Penitox painful?

The procedure is almost pain-free. If desired, a local anesthetic cream is applied. The pressure sensation of the tourniquet band and the injection itself are well tolerable for most patients. After the treatment, slight sensitivity at the injection sites may occur for a few days.

Is sensitivity preserved?

Yes, completely. Botulinum toxin acts specifically on the smooth muscles of the blood vessels — nerve sensitivity and the ability to feel remain fully preserved. Orgasm and ejaculation are unchanged. Many patients even report a more intense experience due to the improved erection quality.

How does Penitox compare to AlphaFill®?

Penitox improves blood circulation and erection quality — the penis size in the relaxed state increases due to the better blood filling. AlphaFill® (hyaluronic penis thickening), on the other hand, increases the volume directly through the incorporation of hyaluronic acid — independent of blood circulation. Both treatments can be excellently combined and complement each other physically and aesthetically. Dr. Spanholtz will advise you on which option or combination makes more sense for your goals.

What does the Penitox treatment cost?

Penitox is an individual health service (IGeL) and is billed as a private service — the statutory health insurance (GKV) does not cover the costs. The exact costs will be communicated after the consultation and individual assessment of the treatment effort. Guideline prices can be found on our services page.

Get in touch
with Dr. Spanholtz

Penitox — discreet, minimally invasive, performed with many years of experience.

About the author

Dr. med. Timo A. Spanholtz
Specialist in Plastic and Aesthetic Surgery - Specialist for men's health and intimate surgery

Dr. Spanholtz is the founder and chief physician of the AndroKlinik. With many years of clinical experience in men's health, andrology, and reconstructive urology, he supports patients from the entire German-speaking region.

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