Inside the Secretive World of Penile Enlargement — ProPublica
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They wanted it because they’d just gone through a bad breakup and needed an edge in the volatile dating market; because porn had warped their sense of scale; because they’d been in a car accident, or were looking to fix a curve, or were hoping for a little “software upgrade”; because they were not having a midlife crisis; because they were, “and it was cheaper than a Bugatti Veyron”; because, after five kids, their wife couldn’t feel them anymore; because they’d been molested as a child and still remembered the laughter of the adults in the room; because they couldn’t forget a passing comment their spouse made in 1975; because, despite the objections of their couples therapist, they believed it would bring them closer to their “sex obsessed” husband (who then had an affair that precipitated their divorce); because they’d stopped changing in locker rooms, stopped peeing in urinals, stopped having sex; because who wouldn’t want it?
他们之所以想要它，是因为他们刚刚经历了一次糟糕的分手，需要在动荡的约会市场中占据优势；因为色情扭曲了他们的尺度感；因为他们遭遇过车祸，或者正在寻求修复弯道，或者希望进行一点“软件升级”；因为他们没有经历中年危机；因为它们是，“而且它比布加迪威龙便宜”；因为在生了五个孩子之后，他们的妻子再也感觉不到他们了；因为他们小时候被猥亵过，还记得房间里大人的笑声；因为他们无法忘记配偶在 1975 年说过的一句话；因为，尽管他们的夫妻治疗师反对，但他们相信这会让他们更接近“性痴迷”的丈夫（后来丈夫有外遇，导致他们离婚）；因为他们不再在更衣室换衣服，不再在小便池里撒尿，不再做爱；因为谁不想要它？
Mick (his middle name) wanted a bigger penis because he believed it would allow him to look in the mirror and feel satisfied.
米克（他的中间名）想要一个更大的阴茎，因为他相信这会让他照镜子时感到满意。
He had trouble imagining what shape the satisfaction would take, since it was something he’d never actually experienced.
他很难想象这种满足会是什么样的，因为这是他从未真正经历过的事情。
Small and dark haired, he’d found his adolescence to be a gantlet of humiliating comparisons: to classmates who were blond and blue-eyed; to his half brothers, who were older and taller and heterosexual; to the hirsute men in his stepfather’s Hasidic community, who wore big beards and billowing frock coats.
他身材矮小，头发黑黑，发现自己的青春期充满了羞辱性的比较：与金发碧眼的同学进行比较；与金发碧眼的同学进行比较；与金发碧眼的同学进行比较；与金发蓝眼睛的同学进行比较；与金发蓝眼睛的同学进行比较；与金发蓝眼睛的同学进行比较；与金发蓝眼睛的同学进行比较；与金发蓝眼睛的同学进行比较；与金发碧眼的人进行比较；与金发蓝眼睛的同学进行比较；与金发碧眼的人进行比较；与金发蓝眼睛的同学进行比较；与金发碧眼的人进行比较；与金发蓝眼睛的同学进行比较；与金发碧眼的人进行比较等。给他同父异母的兄弟，他们年纪更大，更高，而且是异性恋；他继父的哈西德派社区里留着大胡子，穿着飘逸的礼服大衣的多毛男人。
After he reached puberty — late, in his estimation — he grew an impressive beard of his own, and his feelings of inadequacy concentrated on his genitals.
在他进入青春期后——据他估计，他已经长出了令人印象深刻的胡须，而他的不足感集中在他的生殖器上。
None of Mick’s romantic partners ever commented on his size, but his preoccupation had a way of short-circuiting the mood.
米克的恋人都没有评论过他的身材，但他的专注却让气氛变得短路。
He tried several kinds of self-acceptance therapy, without success; whenever he went to the bathroom, there it was, mocking him.
他尝试了多种自我接纳疗法，但都没有成功。每当他去洗手间时，它就在那里嘲笑他。
“Like an evil root,” he said of the fixation.
“就像邪恶的根一样，”他谈到这种痴迷时说道。
“It gets in there and grows like a tree.
“它进入那里并像树一样生长。
But I think everybody has that on some level about something.”
但我认为每个人都在某种程度上对某些事情有这样的看法。”
After high school, Mick decided to study art and moved to Berkeley, California, where his mother had spent her hippie years.
高中毕业后，米克决定学习艺术，并搬到加利福尼亚州伯克利，他的母亲在那里度过了嬉皮士时光。
Eventually landing in Seattle, he supported his life as an artist by working in the hospitality industry.
最终抵达西雅图，他通过在酒店业工作来维持自己的艺术家生活。
His paintings often depicted a human body glowing, as if transfigured, in a geometric landscape.
他的画作经常描绘在几何景观中发光的人体，仿佛变形了。
Over the years, Mick kept up with advances in male augmentation but wasn’t thrilled by the options.
多年来，米克一直在关注男性增强技术的进步，但对这些选择并不感到兴奋。
The gains from a vacuum pump were fleeting; hanging weights from the end of his shaft seemed like a painful investment for an uncertain result; and having a surgeon snip his suspensory ligament, which promised an additional inch or so, could lead to wobblier erections.
真空泵带来的好处转瞬即逝；在杆身末端悬挂重物似乎是一项痛苦的投资，但结果却不确定。让外科医生剪断他的悬韧带，这可能会增加一英寸左右的长度，可能会导致勃起更加不稳定。
It wasn’t until the spring of 2019, when he was 36, that he came across something appealing: a silicone implant shaped like a hotdog bun that could be inserted just under the skin of the penis to increase its girth and flaccid length.
直到 2019 年春天，当时他 36 岁，他才发现了一些吸引人的东西：一种形状像热狗面包的硅胶植入物，可以插入阴茎皮下，以增加其周长和松弛长度。
The device, called the Penuma, had been invented by James Elist — a silver-haired urologist who has been described on TMZ as “the Thomas Edison of penis surgery.” Elist’s procedure was touted as reversible, and, according to a rapturous article in GQ, more than a thousand men had already undergone it.
该设备名为 Penuma，由银发泌尿科医生 James Elis 发明，他被 TMZ 称为“阴茎手术界的托马斯·爱迪生”。埃利斯特的手术被吹捧为可逆的，据《GQ》杂志一篇令人兴奋的文章称，已有一千多名男性接受过该手术。
It was also, as far as Mick could tell, the only genital enhancement on the market to have received the blessing of the Food and Drug Administration.
据米克所知，这也是市场上唯一获得美国食品和药物管理局批准的生殖器增强产品。
The basic operation would cost $15,000 — roughly half of Mick’s life savings — though he added in a pair of discounted testicular implants, at seven grand more.
基本手术将花费 15,000 美元——大约是米克一生积蓄的一半——不过他还加上了一对打折的睾丸植入物，价格多了七块钱。
He put down a deposit, told his long-distance boyfriend that he was taking a work trip and, on a sunny morning in September, arrived at Elist’s office, in Beverly Hills.
他付了押金，告诉远距离男友他要去出差，并在九月一个阳光明媚的早晨到达埃利斯特位于比佛利山庄的办公室。
A framed copy of the GQ story — cover line: “We Have Huge News About Your Manhood” — hung on the wall of the exam room.
考场的墙上挂着一份镶在镜框里的《GQ》故事，封面是：“我们有关于你的男子气概的大新闻”。
Elist strode in, directed Mick to drop his pants and rolled Mick’s scrotal sac appraisingly between his fingers, as though it were a piece of fruit at a market stall.
埃利斯特大步走进来，指示米克脱掉裤子，并用手指欣赏地滚动米克的阴囊，就好像它是市场摊位上的一块水果一样。
Elist’s hands seemed reassuringly delicate, but Mick wanted to see the implant before it was put inside him.
埃利斯特的手看起来娇嫩得让人放心，但米克想在植入物被植入他体内之前先看看它。
The surgeon clicked open a briefcase containing three translucent sheaths: Large, Extra Large and Extra Extra Large.
外科医生点击打开一个公文包，其中包含三个半透明护套：大号、特大号和特特特大号。
The device felt stiff to Mick’s touch, but Elist told him that over time it would soften to the consistency of a gummy bear.
米克触摸该设备时感觉很僵硬，但埃利斯特告诉他，随着时间的推移，它会软化成小熊软糖的稠度。
The consultation lasted about five minutes, Mick recalled.
米克回忆说，咨询持续了大约五分钟。
He signed a stack of consent forms and releases, including one that said his consultation had lasted more than an hour, and another promising “not to disclose, under any circumstance,” his “relationship with Dr. James J.
他签署了一堆同意书和声明，其中一份称他的咨询持续了一个多小时，另一份承诺“在任何情况下都不会透露”他“与詹姆斯·J·肯尼迪博士的关系”。
Elist.” The operation took place the same morning in an outpatient clinic up the street.
埃利斯特。”手术于当天早上在街上的一家门诊诊所进行。
In the preop room, awaiting his turn, he watched “Rush Hour” in its entirety on a flat-screen TV.
在准备室里，等待轮到他时，他在平板电视上完整地观看了《尖峰时刻》。
When the surgery was over, Mick, still groggy from the general anesthesia, took an Uber to a Motel 6 near the airport, where he spent the next five days alone on his back, his penis mummy-wrapped in gauze.
手术结束后，米克仍然因全身麻醉而昏昏沉沉，他乘坐优步前往机场附近的 6 号汽车旅馆，在那里他独自仰卧度过了接下来的五天，他的阴茎裹着纱布。
Morning erections were excruciating.
早晨的勃起令人难以忍受。
Sharp jolts seized his crotch whenever he peed, which he could do only by leaning over the bathtub.
每当他撒尿时，他的胯部就会剧烈震动，而他只有靠在浴缸上才能做到这一点。
He’d anticipated some discomfort, but when he changed his gauze, he was startled to see the corners of the implant protruding under the skin, like a misplaced bone.
他预料到会有些不适，但当他更换纱布时，他惊讶地发现植入物的角突出在皮肤下，就像一根错位的骨头。
Back in Seattle, the Penuma’s edges continued to jut out, particularly on the right side, although the testicular implants looked fine.
回到西雅图，尽管睾丸植入物看起来不错，但 Penuma 的边缘仍然突出，特别是在右侧。
He decided not to tell his boyfriend about the operation: talking to him would only make it seem more real, and he wasn’t yet prepared to entertain the possibility that he’d made a terrible mistake.
他决定不告诉男友手术的事：与他交谈只会让事情看起来更真实，而且他还没有准备好接受自己犯了一个可怕错误的可能性。
When he emailed Elist’s clinic the staff urged patience, counseling him that he was “continuing to heal as we expect.” Then he began to lose sensation.
当他给埃利斯特的诊所发电子邮件时，工作人员敦促他保持耐心，并建议他“正如我们预期的那样，正在继续康复”。然后他开始失去知觉。
“I know it’s been just three weeks and I’m following by the letter all the instructions but I’m a bit concerned about the look of it as you have seen in the pictures,” he wrote Elist.
他在给埃利斯特的信中写道：“我知道这才过了三个星期，我正在按照信中的所有说明进行操作，但我有点担心它的外观，就像你在照片中看到的那样。”
“It’s been 70 days since surgery and yet it feels like a shrimp,” he wrote in November.
“手术已经 70 天了，但感觉就像一只虾，”他在 11 月写道。
“I’m so sorry for another email,” he wrote in December, “but I am freaking out about the fact I have zero sensitivity in my penis!”
“我很抱歉又收到一封电子邮件，”他在 12 月写道，“但我对我的阴茎敏感性为零这一事实感到害怕！”
“Being totally numb is normal as mention[ed] in the past correct?” he asked later that month.
“正如过去提到的那样，完全麻木是正常的，对吗？”当月晚些时候他问道。
“It will pass correct?”
“会过去的吧？”
For much of the 20th century, urologists devoted themselves to the prostate, testes, kidneys and bladder.
在 20 世纪的大部分时间里，泌尿科医生致力于前列腺、睾丸、肾脏和膀胱的研究。
A man’s sexual function, or lack thereof, was largely considered a matter for psychoanalysts to puzzle over.
男性的性功能或缺乏性功能在很大程度上被认为是精神分析学家困惑的问题。
It wasn’t until the late 1970s that a handful of researchers began demonstrating that erectile troubles, though occasionally psychogenic, were primarily vascular in cause.
直到 20 世纪 70 年代末，一些研究人员才开始证明，勃起问题虽然偶尔是心因性的，但主要是由血管引起的。
Their discoveries transformed the mercurial penis — John Updike’s “demon of sorts ...
他们的发现改变了善变的阴茎——约翰·厄普代克所说的“某种恶魔……”
whose performance is erratic and whose errands seem, at times, ridiculous” — into a tamable medical object.
他们的表现不稳定，他们的差事有时看起来很荒谬”——变成一个可驯服的医疗对象。
It was at this moment of upheaval that Elist entered the clannish, hypermasculine world of American urology.
正是在这个剧变的时刻，埃利斯特进入了美国泌尿科的宗族主义、超级男性化的世界。
Raised in a Sephardic family in Iran, he completed a residency in Washington, D.C., just before the 1979 Islamic Revolution.
他在伊朗的一个西班牙裔家庭长大，于 1979 年伊斯兰革命之前在华盛顿特区完成了居住。
Instead of going home, he remained in the States and went into private practice in Beverly Hills.
他没有回家，而是留在美国并在比佛利山庄开始私人执业。
There, he joined the vanguard of physicians who were treating impotence with a suite of novel procedures, such as injections and inflatable penile prostheses.
在那里，他加入了通过注射和充气阴茎假体等一系列新颖手术治疗阳痿的医生先锋行列。
“If the penis is the antenna to a man’s soul, then James Elist must be the Marconi of medicine,” Hustler announced in a 1993 profile.
“如果阴茎是男人灵魂的天线，那么詹姆斯·埃利斯特一定是医学界的马可尼，”哈斯特勒在 1993 年的简介中宣称。
Larry Flynt, the magazine’s publisher, was among his celebrity clientele.
该杂志的出版商拉里·弗林特 (Larry Flynt) 是他的名人客户之一。
With the blockbuster launch of Viagra, in 1998, Elist feared that demand for surgical cures for erectile dysfunction would fall, and decided it was time to diversify.
1998 年，随着伟哥的轰动上市，埃利斯特担心手术治疗勃起功能障碍的需求会下降，并决定是时候进行多元化经营了。
Over the years, many of his patients had asked if he could make them bigger while he was down there.
多年来，他的许多病人都问他是否可以在他在那里的时候让它们变大。
Walking around the 90210 ZIP code, where the median breast size seemed to balloon by the day, Elist realized that his next move was staring him in the face.
埃利斯特在邮编 90210 的地区走来走去，那里的乳房尺寸中位数似乎与日俱增，他意识到自己的下一步行动就在眼前。
As he toyed with an early prototype for the Penuma, other doctors were dismissive.
当他摆弄佩努玛的早期原型时，其他医生对此不屑一顾。
The penis — a tentacle that shrinks and swells with an exquisite sensitivity — was nothing like the breast; it wouldn’t be possible, they told him, to put something static under its elastic skin.
阴茎——一根以极其敏感的方式收缩和膨胀的触手——与乳房完全不同。他们告诉他，不可能在其弹性皮肤下放置静态的东西。
Because the FDA requires the pharmaceutical industry to conduct clinical studies of new drugs, it is often assumed that the same is required of medical device manufacturers.
由于 FDA 要求制药行业对新药进行临床研究，因此人们通常认为医疗器械制造商也有同样的要求。
However, a loophole known as the 510(k) process allows companies to implant untested products in patients as long as they can demonstrate that the devices are “substantially equivalent” to those already on the market.
然而，一个被称为 510(k) 流程的漏洞允许公司将未经测试的产品植入患者体内，只要他们能够证明这些设备与市场上已有的设备“基本相同”。
In September 2004, not long after Elist convinced the U.S. Patent and Trademark Office of the novelty of his invention, he informed the FDA that his “silicone block” was comparable to calf and butt implants.
2004 年 9 月，埃利斯特让美国专利商标局相信他的发明具有新颖性后不久，他就通知 FDA，他的“硅胶块”可与小腿和臀部植入物相媲美。
A month later, when the agency cleared the device for the “cosmetic correction of soft tissue deformities,” the word “penis” did not appear in its indications for use.
一个月后，当该机构批准该设备用于“软组织畸形的美容矫正”时，“阴茎”一词并未出现在其使用说明中。
Despite the FDA imprimatur, persuading men to get the implant was a challenge, even after one of his patients, Bryan, a 20-something with biceps the size of porterhouse steaks, began modeling it for prospective customers.
尽管获得了 FDA 的认可，说服男性接受植入物仍然是一项挑战，即使在他的一位患者 Bryan（20 多岁，二头肌有上等腰肉牛排大小）开始为潜在客户建模之后也是如此。
Bryan, who later referred to himself as Elist’s “spokespenis,” told me he also moderated content on My New Size, an online forum for male enhancement, where Elist’s invention was often extolled.
布莱恩后来称自己为埃利斯特的“代言人”，他告诉我，他还主持了 My New Size 的内容，这是一个男性增强在线论坛，埃利斯特的发明经常在该论坛上受到赞扬。
Still, by 2014, the doctor was averaging barely 100 implant surgeries a year.
尽管如此，到 2014 年，医生平均每年仅进行 100 例种植手术。
It wasn’t until the 2016 GQ article that his device — newly christened the Penuma, an acronym for Penis New Man — was propelled from the margins to the mainstream.
直到 2016 年《GQ》的文章，他的设备——新命名为 Penuma（Penis New Man 的缩写）——才从边缘推向主流。
(The New Yorker, like GQ, is owned by Condé Nast.) By the end of the year, Elist was doing roughly 60 Penuma procedures a month, and his oldest son, Jonathan, left a job at McKinsey to become the CEO of International Medical Devices, as they called their family firm.
（《纽约客》和《GQ》一样，属于康泰纳仕集团旗下。）到年底，埃利斯特每个月要做大约 60 例 Penuma 手术，他的大儿子乔纳森 (Jonathan) 辞去了麦肯锡的工作，成为国际医疗器械公司 (International Medical Devices) 的首席执行官，国际医疗器械公司称之为他们的家族公司。
Prominent urologists had long seen penile enlargement as the remit of cowboys and regarded Elist as such, insofar as they regarded him at all.
杰出的泌尿科医生长期以来一直将阴茎增大视为牛仔的职权范围，并认为埃利斯特也是如此，就他们对他的看法而言。
As part of Penuma’s gentrification campaign, Elist got the FDA to explicitly clear his implant for the penile region in 2017, noting in his application that the “unique anatomy, physiology, and function of the penis does not increase the overall potential risks.” At conferences of the Sexual Medicine Society of North America, his company also began to recruit “key opinion leaders,” as Jonathan put it, to advise the company and join its new board.
作为 Penuma 中产阶级化运动的一部分，Elist 在 2017 年让 FDA 明确批准了他的阴茎区域植入物，并在申请中指出“阴茎独特的解剖结构、生理学和功能不会增加总体潜在风险”。在北美性医学协会的会议上，他的公司还开始招募乔纳森所说的“关键意见领袖”，为公司提供建议并加入新董事会。
Among the KOLs in the field of sexual medicine are those who install the highest number of prostheses to restore erectile function, typically in prostate cancer patients or in men with diabetes.
在性医学领域的 KOL 中，安装最多假体以恢复勃起功能的人通常是前列腺癌患者或糖尿病男性。
So entrenched is this hierarchy that specialists to whom I spoke frequently rattled off their colleagues’ stats.
这种等级制度如此根深蒂固，以至于我采访过的专家经常滔滔不绝地讲述他们同事的统计数据。
“It’s all about who has the biggest whatever and who has the bigger numbers,” Faysal Yafi, the director of Men’s Health at the University of California, Irvine, and himself a high-volume implanter, explained.
加州大学欧文分校男性健康中心主任费萨尔·亚菲（Faysal Yafi）解释说：“这取决于谁拥有最大的东西以及谁拥有更多的数量。”他本人也是一名大批量植入者。
Elist’s first big catch was Steven Wilson, formerly a professor of urology at the University of Arkansas, who, until his apparent unseating by Paul Perito, a spirited upstart in Miami, was feted as the highest volume implanter in the country.
埃利斯特的第一个大收获是史蒂文·威尔逊（Steven Wilson），他曾是阿肯色大学的泌尿外科教授，直到他被迈阿密一位精力充沛的新贵保罗·佩里托（Paul Perito）明显取代之前，他一直被誉为全国植入量最高的植入者。
(“Our Tom Brady,” Yafi said of Wilson, admiringly.) Wilson, a paid consultant for Elist’s company, helped vet skilled surgeons around the country who could be trained to perform the Penuma procedure.
（“我们的汤姆·布雷迪，”亚菲钦佩地谈到威尔逊。）威尔逊是埃利斯特公司的付费顾问，帮助审查全国各地的熟练外科医生，这些外科医生可以接受培训来执行佩努玛手术。
“The cosmetic revolution of the flaccid penis,” Wilson said, is urology’s “last frontier.”
“松弛阴茎的美容革命，”威尔逊说，是泌尿学的“最后前沿”。
On the conference circuit, where the goals of the revolution were the subject of fervid debate, Penuma surgeons argued that urologists were at a crossroads.
在巡回会议上，革命的目标成为激烈辩论的主题，佩努马外科医生认为泌尿科医生正处于十字路口。
They could cede the augmentation market to quacks and overconfident plastic surgeons, or they could embrace their vocation as the so-called champions of the penis, and in their hygienic, well-lit clinics provide patients with what they’d been asking for and might otherwise find an unsafe way to secure.
他们可以将阴茎增大市场让给庸医和过于自信的整形外科医生，或者他们可以拥抱自己作为所谓的阴茎冠军的职业，并在他们卫生、光线充足的诊所为患者提供他们一直要求的东西，否则可能会找到一种不安全的方式来获得。
When the tabloids reported in March 2019 that a Belgian Israeli billionaire had died on a Parisian operating table while getting an unknown substance injected into his penis, it seemed to prove their point.
2019 年 3 月，当小报报道称一名比利时以色列亿万富翁在巴黎手术台上接受不明物质注射时死亡，这似乎证明了他们的观点。
A month later, Laurence Levine, a past president of the Sexual Medicine Society of North America and a professor at Chicago’s Rush University Medical Center, successfully performed the first Penuma procedure outside Beverly Hills, kicking off the implant’s national expansion.
一个月后，北美性医学学会前任主席、芝加哥拉什大学医学中心教授劳伦斯·莱文 (Laurence Levine) 在比佛利山庄外成功实施了首例 Penuma 手术，拉开了植入物在全国范围内推广的序幕。
Soon afterward, the pandemic began fueling a boom in the male augmentation market — a development its pioneers attribute to an uptick in porn consumption, work-from-home policies that let patients recover in private and important refinements of technique.
不久之后，这种流行病开始推动男性增强市场的繁荣——其先驱者将这一发展归因于色情消费的增加、允许患者私下康复的在家工作政策以及技术的重要改进。
The fringe penoplasty fads of the ’90s — primitive fat injections, cadaver-skin grafts — had now been surpassed not just by implants but by injectable fillers.
90 年代的边缘阴茎成形术时尚——原始的脂肪注射、尸体皮肤移植——现在不仅被植入物超越，还被注射填充剂超越。
In Las Vegas, Ed Zimmerman, who trained as a family practitioner, is now known for his proprietary HapPenis injections; he saw a 69% jump in enhancement clients after rebranding himself in 2021 as TikTok’s “Dick Doc.” In Manhattan, the plastic surgeon David Shafer estimates that his signature SWAG shot — short for “Shafer Width and Girth” — accounts for half of his practice.
在拉斯维加斯，Ed Zimmerman 接受过家庭医生培训，现在因其专有的 HapPenis 注射而闻名。 2021 年，他将自己重新命名为 TikTok 的“Dick Doc”，之后，他的增强型客户数量猛增了 69%。在曼哈顿，整形外科医生 David Shafer 估计他的标志性 SWAG 镜头（“Shafer Width and Girth”的缩写）占了他一半的手术时间。
The treatment starts at $10,000, doesn’t require general anesthesia and can be reversed with the injection of an enzyme.
该治疗起价为 10,000 美元，不需要全身麻醉，并且可以通过注射酶来逆转。
In Atlanta, Prometheus by Dr. Malik, a fillers clinic, has been fielding requests from private equity investors.
在亚特兰大，填充诊所 Prometheus by Dr. Malik 一直在回应私募股权投资者的请求。
In a business that’s often reduced to a punchline, enhancement entrepreneurs are unusually vocal about the perceived or actual chicanery of their rivals, whom they see as posing a threat to their fledgling legitimacy.
在一个经常被简化为笑点的企业中，增强型企业家对竞争对手的感知或实际的欺骗行为异常直言不讳，他们认为竞争对手对他们刚刚起步的合法性构成了威胁。
“What can we do to keep patients out of the hands of these charlatans?” Paul Perito, who developed a popular filler named UroFill, asked colleagues at a recent webinar attended by doctors across the world.
“我们能做些什么来让病人远离这些江湖骗子的手呢？” Paul Perito 开发了一种名为 UroFill 的流行填充剂，他在最近一次由世界各地医生参加的网络研讨会上向同事询问。
He displayed a slide highlighting an ad by Victor Loria, an osteopath and erstwhile hair transplant specialist headquartered in Miami, whose permanent penile filler injections were on sale for $14,950.
他展示了一张幻灯片，突出显示维克多·洛里亚 (Victor Loria) 的一则广告。维克多·洛里亚是一位整骨医生，也是一名头发移植专家，总部位于迈阿密，其永久性阴茎填充剂注射剂的售价为 14,950 美元。
Loria’s concoction, mixed in-house, includes liquid silicone oil, which is typically used to refill damaged eyeballs.
洛里亚的混合物在内部混合，其中含有液体硅油，通常用于补充受损的眼球。
Perito described Loria’s methods as “practically criminal,” but Loria, who self-identifies as the highest volume permanent penile filler administrator in the nation, denies unethical conduct, defends the safety record of his product and told me that Perito and his “bandits” were just upset that he’d stepped into the urologists’ sandbox.
佩里托将洛里亚的方法描述为“实际上是犯罪”，但洛里亚自认为是全国数量最多的永久性阴茎填充剂管理员，他否认不道德行为，为他的产品的安全记录辩护，并告诉我佩里托和他的“强盗”只是对他踏入泌尿科医生的沙箱感到不安。
What the Penuma promised the urologists was effectively what it promised patients: the chance to make it even bigger.
Penuma 向泌尿科医生承诺的实际上也是它向患者承诺的：有机会让它变得更大。
Even as costs soar, physician reimbursement rates from Medicare for complex operations have declined .
尽管成本飙升，但医疗保险对复杂手术的医生报销率却下降了。
Inserting an inflatable penile prosthesis to treat erectile dysfunction brings a surgeon around $800.
插入充气阴茎假体来治疗勃起功能障碍会给外科医生带来大约 800 美元的费用。
For the Penuma procedure, which is not covered by insurance, that same surgeon can pocket six times as much.
对于不在保险范围内的 Penuma 手术，同一位外科医生的收入是原来的六倍。
During a call in January 2020, four months after Mick’s Penuma surgery, Elist told him that the sensation in his penis would return in time.
2020 年 1 月，米克接受 Penuma 手术四个月后，埃利斯特在一次电话中告诉他，阴茎的感觉会及时恢复。
Having invested so much, financially and psychologically, in the implant, Mick felt grateful for the doctor’s assurances and tried to focus on his paintings, producing several large acrylic canvases in which forlorn human figures appeared to be tossed about by waves.
米克在经济和心理上为植入物投入了如此多的资金，他对医生的保证感到感激，并试图专注于他的绘画，创作了几幅大型丙烯酸画布，其中孤独的人物似乎被海浪翻腾着。
But the numbness of his penis reminded him of having a limb fall asleep, indefinitely.
但阴茎的麻木让他想起自己的肢体陷入了无限期的沉睡。
In the paperwork Mick had initialed on the day of the surgery, a clause said, “The clinic highly discourages seeking information elsewhere as the information provided can be false, misleading, and inaccurate.” One day, though, Mick opened Google and searched “Elist,” “Penuma,” “numb.”
在米克在手术当天草签的文件中，有一项条款称：“诊所强烈反对在其他地方寻求信息，因为所提供的信息可能是虚假的、误导性的和不准确的。”然而有一天，米克打开谷歌并搜索“Elist”、“Penuma”、“numb”。
“I was looking for people to tell me, ‘Oh, yeah, I waited three months, and now everything’s fine, I am very happy,’” he said.
“我一直在寻找人们告诉我，‘哦，是的，我等了三个月，现在一切都很好，我很高兴，’”他说。
Those people were hard to find.
那些人很难找到。
A truck driver whose device dug into his pubic bone told me that he felt like a “prisoner in my own body.” An executive at an adhesive company, who hid his newly bulging crotch behind a shopping bag when walking the dog, began to have nightmares in which he castrated himself.
一名卡车司机的装置刺入了他的耻骨，他告诉我，他感觉自己就像“自己身体里的囚犯”。一家粘合剂公司的高管在遛狗时将新隆起的胯部藏在购物袋后面，他开始做噩梦，梦见自己阉割了自己。
A sales specialist at an industrial supply store sent me his diary, which imagined Elist as its addressee.
一家工业用品商店的销售专家给我寄来了他的日记，其中将埃利斯特想象为收件人。
“I wish you would have told me I would lose erect length,” he wrote.
“我希望你能告诉我，我会失去勃起长度，”他写道。
“I wish you would have told me it could shift and pinch my urethra and make it difficult to urinate.”
“我希望你能告诉我，它可能会移动并挤压我的尿道，导致排尿困难。”
It was tricky to bend over to tie the laces of winter boots, tricky to slip on a condom, tricky to sleep in a comfortable position, tricky to stretch, tricky to spoon.
弯腰系冬靴鞋带很困难，戴避孕套很困难，以舒适的姿势睡觉很困难，伸展很困难，用勺子舀也很困难。
“It makes you look like you’re always semi-erect,” a health-spa vice president said of his Penuma.
“它让你看起来总是半直立的，”一位健康水疗中心的副总裁在谈到他的 Penuma 时说道。
“I couldn’t let my kids sit on my lap.
“我不能让我的孩子坐在我腿上。
I couldn’t jump on the trampoline with them.
我不能和他们一起跳蹦床。
I even felt like a pervert hugging my friends.
我什至觉得自己像个变态拥抱我的朋友。
And God forbid you get an actual erection, because then you have to run and hide it.”
上帝禁止你真正勃起，因为那样你就必须跑开并隐藏它。”
Not everyone minded.
不是每个人都介意。
Kaelan Strouse, a 35-year-old life coach, was thrilled by both the “restaurant-size pepper mill” between his legs and the kilts he began wearing to accommodate it.
35 岁的生活教练凯兰·斯特劳斯 (Kaelan Strouse) 对他双腿之间的“餐厅大小的胡椒磨”和他开始穿的适应它的短裙感到兴奋。
Richard Hague Jr., a 74-year-old pastor at a Baptist church in Niagara Falls, said his implant made him feel like “a wild stallion.” Contented customers told me they were feeling better about their bodies and having better sex, too.
尼亚加拉瀑布市一座浸信会教堂的 74 岁牧师小理查德·黑格 (Richard Hague Jr.) 表示，他的植入物让他感觉自己像“一匹野马”。满意的顾客告诉我，他们对自己的身体感觉更好，性生活也更好。
But even they acknowledged that getting a Penuma could require adjusting not just to a different appendage but to a different way of life.
但即使他们也承认，获得佩努玛不仅需要适应不同的附肢，而且需要适应不同的生活方式。
As one pleased Elist patient counseled others, “You have to treat your penis like a Rolex.”
正如一位埃利斯特病人所建议的那样，“你必须像对待劳力士一样对待你的阴茎。”
For dozens of Penuma patients who spoke to me, the shock of the new was the prelude to graver troubles.
对于与我交谈的数十名佩努玛患者来说，新的震惊是更严重麻烦的前奏。
Some, like Mick, lost sensation.
有些人，比如米克，失去了知觉。
Others said they experienced stabbing pains in the shower or during sex.
其他人则表示，他们在洗澡或做爱时感到刺痛。
Seroma, or excess fluid, was not uncommon.
血清肿或过多的液体并不罕见。
When a defense-and- intelligence contractor’s girlfriend, a registered nurse, aspirated his seroma with a sterile needle, a cup of amber fluid oozed out.
当一名国防和情报承包商的女朋友（一名注册护士）用无菌针吸出他的血清时，一杯琥珀色的液体渗出。
The one time they tried to have sex, she told me, the corners of his implant felt like “someone sticking a butter knife inside you.”
她告诉我，有一次他们试图做爱时，他的植入物的角落感觉就像“有人在你体内插了一把黄油刀”。
Some implants got infected or detached.
一些植入物被感染或脱落。
Others buckled at the corners.
其他人则在角落里弯曲。
Occasionally these protrusions broke through the skin, forming holes that would fester.
有时，这些突起会刺破皮肤，形成溃烂的洞。
The hole of the health-spa vice president was so tiny that he originally mistook its fermented odor for an STD.
这位健康水疗中心副总裁的洞太小了，以至于他最初将其发酵的气味误认为是性病。
An engineer with gallows humor played me a video of the snorting crunch his penis made when air moved through a hole.
一位幽默的工程师给我播放了一段视频，视频中空气流过一个洞时，他的阴茎发出嘎吱声。
He had two holes, and the skin between them eventually eroded so that a corner of the implant emerged, pearlescent.
他有两个洞，洞之间的皮肤最终被侵蚀，使得植入物的一角露出来，呈现出珍珠般的光泽。
Later, doctors unaffiliated with the Penuma would compare such penises to “a torpedo,” “a penguin,” “a pig in a blanket,” “a beer can with a mushroom sticking out on the top” and “the tipped-down nose of the Concorde.” But the imperturbable assistants at Elist’s clinic, besieged by photographs documenting these phenomena, told patients that they were “healing as expected” and “continuing to heal well!” It was only after months had passed and the men insisted they weren’t healing well at all that Elist would sometimes suggest that an “upgrade” to a bigger size would resolve their problems.
后来，与佩努马无关的医生将这种阴茎与“鱼雷”、“企鹅”、“毯子里的猪”、“顶部有蘑菇伸出的啤酒罐”和“协和式飞机的倾斜机头”进行比较。但埃利斯特诊所镇静的助理被记录这些现象的照片包围，告诉患者他们“正如预期的那样康复了”并且“继续康复得很好！”直到几个月过去了，这些人坚称自己的康复情况根本不好，埃利斯特有时才会建议“升级”到更大的尺寸才能解决他们的问题。
(Elist said in a deposition that upgrades are “part of the process of the procedure,” noting that some patients “might need the upgrade with the larger implant or the longer implant, and that happens often.”) Faced with the prospect of more surgery, some men began, quietly, to seek other advice.
（埃利斯特在一份证词中表示，升级是“手术过程的一部分”，并指出一些患者“可能需要使用更大的植入物或更长的植入物进行升级，这种情况经常发生。”）面对更多手术的前景，一些男性开始悄悄地寻求其他建议。
The subculture of penile enhancement remains shrouded in stigma, because for a man to admit that he wants to be bigger suggests that he isn’t big enough.
阴茎增大的亚文化仍然笼罩在耻辱之中，因为一个男人承认他想变得更大就意味着他还不够大。
In February, the rapper 50 Cent settled his claims against the Shade Room, a gossip blog he’d sued for falsely insinuating that he’d had work done on his penis and subjecting him “to ridicule.” Only six of the 49 enlargement patients I spoke to agreed to have their last names printed, also fearing ridicule.
今年 2 月，说唱歌手 50 Cent 就其对 Shade Room 提出的诉讼达成和解。他起诉八卦博客 Shade Room，理由是该博客错误地暗示他已经对自己的阴茎做过手术，并让他“受到嘲笑”。在我采访的 49 名增大患者中，只有 6 名同意打印自己的姓氏，因为他们也担心遭到嘲笑。
In such a taboo and information-poor environment, anonymous testimonials can take on the authority of peer-reviewed journal articles.
在这样一个禁忌和信息匮乏的环境中，匿名推荐可以具有同行评审期刊文章的权威。
Elist understood this dynamic.
埃利斯特了解这种动态。
In addition to encouraging Bryan, the spokespenis, to post positive comments on My New Size, Elist tracked his own mentions on PhalloBoards and Thunder’s Place, other online forums for male enhancement, demanding that their moderators stop harboring “defamatory” statements.
除了鼓励代言人布莱恩在《My New Size》上发表积极评论外，埃利斯特还在其他男性增强在线论坛 PhalloBoards 和 Thunder’s Place 上追踪了自己的提及情况，要求其版主停止发表“诽谤性”言论。
He offered a PhalloBoards user, after an abscess had formed, $5,000 for deleting his posts about the procedure and releasing the clinic from liability, according to a settlement agreement I reviewed.
根据我审阅的一份和解协议，在脓肿形成后，他向 PhalloBoards 用户支付 5,000 美元，要求其删除他有关手术的帖子，并免除诊所的责任。
(Elist said through a spokesperson that the patient didn’t follow post-op advice, and that, while he was not able to respond to some of the accounts in this story because men had requested anonymity, complications were rare.)
（埃利斯特通过发言人表示，患者没有遵循术后建议，虽然由于男性要求匿名，他无法对本文中的一些说法做出回应，但并发症很少见。）
A sign in Elist’s waiting room instructed patients not to speak to one another about medical issues (the better to protect their privacy, Elist said through the spokesperson).
埃利斯特候诊室里的一块标牌指示患者不要互相谈论医疗问题（埃利斯特通过发言人表示，这是为了更好地保护他们的隐私）。
But Elist could only do so much to disrupt the communities of unhappy men coalescing online.
但埃利斯特只能做这么多来扰乱网上聚集的不满人群的社区。
As Mick pored over hundreds of posts, he was horrified to discover that he had been acting out a well-worn script.
当米克仔细研究数百个帖子时，他惊讶地发现自己一直在表演一个陈旧的剧本。
The others had also read the GQ article about the Penuma, learned that the implant was “reversible” and, heartened by the FDA’s clearance, put down their deposit.
其他人也阅读了《GQ》杂志上有关 Penuma 的文章，了解到植入物是“可逆的”，并因 FDA 的许可而受到鼓舞，并支付了押金。
They, too, felt that their consultations were rushed and that they hadn’t had enough time to review the cascade of consent forms they’d signed alerting them to potential complications.
他们也觉得他们的咨询很仓促，而且他们没有足够的时间来审查他们签署的一系列同意书，提醒他们潜在的并发症。
Emmanuel Jackson, then 26, was a model who had grown up in foster homes outside of Boston.
当时 26 岁的伊曼纽尔·杰克逊 (Emmanuel Jackson) 是一位模特，在波士顿郊外的寄养家庭中长大。
He won a free Penuma in a contest in 2013, as part of a marketing campaign involving the rapper Master P.
他在 2013 年的一场比赛中赢得了免费的 Penuma，这是由说唱歌手 Master P. 参与的营销活动的一部分。
According to a complaint by the Medical Board of California, Jackson said he was given scripted answers for a promotional video, which later appeared on Elist’s YouTube channel.
根据加州医疗委员会的投诉，杰克逊表示，他收到了一段宣传视频的脚本答案，该视频后来出现在埃利斯特的 YouTube 频道上。
(Elist’s spokesperson said Jackson volunteered his positive comments in the video, and Master P, who once featured Elist on his Playboy Radio show, said through his own spokesperson that he was not involved with any YouTube testimonials for the implant.)
（埃利斯特的发言人表示杰克逊在视频中自愿发表了积极的评论，而曾在花花公子广播节目中介绍过埃利斯特的 P Master 通过他自己的发言人表示，他没有参与任何 YouTube 植入物的推荐。）
Jackson didn’t find the other men online until 2018, around the time a doctor at the Cleveland Clinic told him his implant had fractured into pieces that were floating under his skin.
杰克逊直到 2018 年才在网上找到其他人，当时克利夫兰诊所的一名医生告诉他，他的植入物已经断裂成碎片，漂浮在他的皮肤下。
A young Iraq War veteran whom Jackson met through PhalloBoards warned him that having the implant out could be even worse than having it in.
杰克逊通过 PhalloBoards 认识的一位年轻的伊拉克战争老兵警告他，取出植入物可能比植入更糟糕。
“He told me, ‘Manny, you’re going to lose your mind,’” Jackson recalled.
“他告诉我，‘曼尼，你会失去理智的，’”杰克逊回忆道。
“He was right.” Medical records show that, not long after the fragments were removed, Jackson attempted suicide.
“他是对的。”医疗记录显示，碎片被取出后不久，杰克逊就试图自杀。
“I’ve been threatened for saying the things I’m telling you,” Mark Solomon said when I visited him in his waiting room, in Los Angeles, this spring.
“我因为说了我告诉你的事情而受到威胁，”今年春天，当我在洛杉矶的候诊室拜访马克·所罗门时，他说道。
A plastic surgeon with an elegant Roman nose and a crisp white lab coat over a brown cashmere sweater, he’d learned the techne of male enhancement in Vienna in the ’90s.
他是一名整形外科医生，有着优雅的罗马鼻子，穿着清爽的白色实验室外套，外面套着棕色羊绒毛衣，他在 90 年代的维也纳学会了男性增强技术。
But he never imagined that, one day, nearly half his male practice would involve fixing the handiwork of other practitioners.
但他万万没有想到，有一天，他的男性实践中近一半的工作都涉及到修理其他练习者的手工作品。
Now, as much as he liked to joke that the last thing Beverly Hills needed was another plastic surgeon, he was doing such brisk business repairing Penuma complications that he’d relocated his practice from Philadelphia to an office down the street from Elist’s clinic.
现在，尽管他喜欢开玩笑说比佛利山庄最不需要的就是另一位整形外科医生，但他修复佩努马并发症的业务非常活跃，以至于他将自己的诊所从费城搬到了埃利斯特诊所附近的一间办公室。
As the number of Penuma procedures increased, a cottage industry emerged to treat what Solomon describes as a new class of “penile cripples.” William Brant, a reconstructive urologist in Salt Lake City, who told me he sees about 10 Penuma patients a month, noted “the deep despair of men who can’t unring the bell.” Gordon Muir, a urologist in London, said that he’s been taking out Penumas “all the way across the bloody pond.” But other reconstructive surgeons asked to speak confidentially, because they were afraid of being sued.
随着 Penuma 手术数量的增加，出现了一个家庭手工业，用于治疗所罗门所说的新一类“阴茎残障者”。盐湖城的重建泌尿科医生威廉·布兰特 (William Brant) 告诉我，他每个月会接诊大约 10 名佩努玛 (Penuma) 患者，他指出“无法按铃的男人感到深深的绝望”。伦敦的泌尿科医生戈登·缪尔 (Gordon Muir) 表示，他“一直在血淋淋的池塘里”取出佩努马斯。但其他重建外科医生要求保密，因为他们担心被起诉。
Solomon had received a cease and desist letter from Elist’s lawyers arguing that the mere mention of Penuma on his website infringed on the implant’s trademark.
所罗门收到了埃利斯特律师发出的停止令，称在他的网站上仅仅提及 Penuma 就侵犯了植入物的商标。
(Solomon now notes his expertise in treating complications from “penis enlargement implants” instead.)
（所罗门现在指出他在治疗“阴茎增大植入物”并发症方面的专业知识。）
From his satchel, Solomon produced a couple of biohazard bags.
所罗门从他的书包里拿出了几个生物危害袋。
One held two sheaths of silicone stitched together with a blue thread: an early edition of the Penuma that he’d removed from a patient.
其中一个拿着两个用蓝色线缝合在一起的硅胶护套：他从病人身上取下的早期版本的 Penuma。
The other contained a modern Penuma, a single piece with a built-in crease.
另一个包含一个现代的佩努玛，一个带有内置折痕的单件。
“Once this goes in, these men are never going to be the same again, because their penis is never the same again,” he said.
“一旦进入，这些男人就再也不会一样了，因为他们的阴茎再也不会一样了，”他说。
When a foreign object is placed in the body, the body reacts by forming an envelope of tissue around it.
当异物放入体内时，身体会做出反应，在其周围形成组织包膜。
In the penis, a retractable organ, this new tissue can distort shape and mobility, causing the penis to shorten and curve.
在阴茎这个可伸缩的器官中，这种新组织会扭曲形状和活动性，导致阴茎缩短和弯曲。
The disfigurement can be exacerbated if the Penuma is removed, Solomon explained, since the penis can contract to seal up the vacuum of space — a phenomenon that patients have called the “mini-dick” or “dicklet” phase.
所罗门解释说，如果阴茎被移除，畸形可能会加剧，因为阴茎会收缩以封闭空间的真空——这种现象被患者称为“迷你阴茎”或“阴茎”阶段。
To counteract retraction and scarring after removal, some men engage in an elaborate penile rehab regimen.
为了对抗切除后的回缩和疤痕，一些男性进行了精心设计的阴茎康复方案。
Solomon directs his patients to wear a condom with a metal weight at its tip six hours a day.
所罗门指导他的病人每天六个小时佩戴尖端有金属重物的避孕套。
Other doctors who remove the device — explanters, in the parlance — prescribe RestoreX, a contraption whose painful clamp and extension rods its users compare to a medieval rack.
其他移除该装置（用术语来说是外植机）的医生会开出 RestoreX，这是一种装置，它的夹子和延长杆让使用者感到痛苦，就像中世纪的架子一样。
These daily stretching routines are sometimes accompanied by further revision procedures, as well as by prescriptions for Viagra and antidepressants.
这些日常伸展运动有时会伴随着进一步的修正程序，以及伟哥和抗抑郁药的处方。
The great irony — lost on few — was that, after getting surgery to stop thinking about their penises, these men were now thinking about their penises all the time.
最具讽刺意味的是，在接受手术以不再考虑自己的阴茎后，这些男人现在一直在考虑自己的阴茎，这一点很少有人注意到。
At conferences and in case reports, urologists across the country cautioned that, although they were seeing only the subset of patients unhappy enough to seek them out, the complications those patients presented ( “significant penoscrotal edema,” severe erectile dysfunction “necessitating placement of an inflatable penile implant during removal”) could be “devastating” and “uncorrectable.” Penuma surgeons, meanwhile, were collecting their own data , which showed that the complication rate was both low and comparable to that of other procedures.
在会议和病例报告中，全国各地的泌尿科医生警告说，尽管他们只看到一小部分患者不满意去寻求治疗，但这些患者出现的并发症（“明显的阴茎阴囊水肿”、严重的勃起功能障碍“在切除过程中需要放置充气阴茎植入物”）可能是“毁灭性的”和“无法纠正的”。与此同时，Penuma 的外科医生正在收集自己的数据，这些数据表明，并发症发生率很低，并且与其他手术相当。
In the largest study to date , published in The Journal of Sexual Medicine, Elist’s clinic surveyed 400 of the 526 patients who’d received a Penuma between 2009 and 2014.
在《性医学杂志》上发表的迄今为止最大规模的研究中，Elist 的诊所对 2009 年至 2014 年间接受过 Penuma 的 526 名患者中的 400 名进行了调查。
Eighty-one percent of the subjects who responded to the questionnaire indicated “high” or “very high” levels of satisfaction.
百分之八十一的受访者对问卷的满意度表示“高”或“非常高”。
Other surgeons told me they wouldn’t be associated with Elist’s invention if most of their patients (some of whom, they added, were urologists themselves) weren’t similarly pleased.
其他外科医生告诉我，如果他们的大多数患者（他们补充说，其中一些人本身就是泌尿科医生）没有同样的高兴，他们就不会与埃利斯特的发明联系在一起。
On his website, one of the Penuma doctors dismissed PhalloBoards as being populated by patients who ignored post-op instructions and said it was propped up by “opportunistic” competitors.
在他的网站上，佩努马的一位医生驳斥了 PhalloBoards 的说法，称其上充斥着无视术后指示的患者，并表示它是由“机会主义”竞争对手支撑的。
(Solomon is among a dozen doctors who sponsor PhalloBoards.)
（所罗门是赞助 PhalloBoards 的十几位医生之一。）
Elist’s consent forms included a provision releasing the clinic from “any liability” if a patient receives post-op treatment elsewhere, but Mick, confused about whom to trust, online or off, decided to seek out a second professional opinion — and then a third, a fourth and a fifth.
埃利斯特的同意书包括一项条款，如果患者在其他地方接受术后治疗，诊所将不承担“任何责任”，但米克对在线或线下该信任谁感到困惑，决定寻求第二个专业意见——然后是第三个、第四个和第五个。
Some of the physicians he consulted were, as Elist had forewarned, baffled by the alien device.
正如埃利斯特预先警告的那样，他咨询的一些医生对这种外星装置感到困惑。
But Thomas Walsh, a reconstructive urologist and director of the Men’s Health Center at the University of Washington, was not.
但华盛顿大学男性健康中心主任、泌尿重建专家托马斯·沃尔什 (Thomas Walsh) 则不然。
He was struck that Mick, like other Penuma patients, had the misapprehension that the device was easily “reversible,” as Elist and his network had advertised.
令他惊讶的是，米克和其他佩努玛患者一样，误认为该设备很容易“逆转”，正如埃利斯特和他的网络所宣传的那样。
“To fully consent to a procedure, the patient needs someone to tell him everything,” Walsh said.
“要完全同意手术，患者需要有人告诉他一切，”沃尔什说。
“He doesn’t need a salesman.
“他不需要推销员。
The problem here is that you’ve got someone who is inventing and manufacturing and selling the device.
这里的问题是有人正在发明、制造和销售该设备。
That personal investment can create a tremendous conflict of interest.” (Elist, through his spokesperson, said his expertise with the device outweighs the conflict, which he freely discloses.)
这种个人投资可能会造成巨大的利益冲突。” （埃利斯特通过他的发言人表示，他在该设备方面的专业知识超过了他自由披露的冲突。）
Before removing Mick’s implant, in May 2020, Walsh ordered an MRI, which suggested that the device was impinging on the nerves and arteries at the head of his penis.
2020 年 5 月，在移除米克的植入物之前，沃尔什要求进行核磁共振检查，结果表明该装置正在影响他阴茎头部的神经和动脉。
Walsh also sent Mick to a neurologist, who, after prodding Mick’s shaft with a sharp metal tool, declared the glans to have lost “total” sensation.
沃尔什还把米克送到了一位神经科医生那里，这位神经科医生用锋利的金属工具刺了一下米克的阴茎后，宣布龟头已经“完全”失去了知觉。
There was no guarantee it would return.
无法保证它会回来。
The challenge of removing a Penuma, Walsh told Mick, can lie in the detachment of a rectangular piece of mesh from the tip of the penis.
沃尔什告诉米克，移除阴茎的挑战可能在于从阴茎尖端分离一块矩形网片。
Mesh prompts the body to create scar tissue, which binds together everything in its vicinity; to help the implant adhere, Penuma doctors stitched some near the head, an area dense with arborized nerves and blood vessels.
网格会促使身体产生疤痕组织，将其附近的所有物体粘合在一起；为了帮助植入物粘附，佩努玛医生在头部附近缝合了一些植入物，该区域布满了树枝状神经和血管。
Despite carefully planning the explantation, Walsh found himself disconcerted in surgery by the sight of his patient’s erogenous zone ensnared by the patch of plastic.
尽管仔细计划了移植手术，沃尔什还是发现自己在手术中因看到病人的性感区被塑料片所困而感到不安。
“I feel like it’s sacrilege, wrapping a man’s neurovascular bundle in mesh,” Walsh later said.
“我觉得用网状包裹一个人的神经血管束是一种亵渎，”沃尔什后来说。
“How would anyone want to do that?”
“怎么会有人愿意这么做呢？”
It has been hypothesized that a longer penis confers an evolutionary edge in launching the reproductive payload into the vaginal canal.
据推测，较长的阴茎在将生殖有效载荷发射到阴道管方面具有进化优势。
But, as the journalist David Friedman recounts in “ A Mind of Its Own ,” a cultural history of the male sex organ, some primatologists who have seen male apes brandish their genitals during a fight have posited that its purpose, if any, is simpler: to impress and intimidate rivals.
但是，正如记者大卫·弗里德曼（David Friedman）在男性性器官文化史《自己的想法》中所叙述的那样，一些灵长类动物学家在目睹雄性猿类在战斗中挥舞生殖器后，认为其目的（如果有的话）更简单：给对手留下深刻印象和恐吓。
“They notice the penis of a brother or playmate, strikingly visible and of large proportions, at once recognize it as the superior counterpart of their own small and inconspicuous organ, and from that time forward fall a victim to envy for the penis,” Freud wrote in 1925.
弗洛伊德在 1925 年写道：“他们注意到兄弟或玩伴的阴茎，引人注目且比例巨大，立即认识到它是自己小而不起眼的器官的高级对手，从那时起，他们就成为嫉妒阴茎的受害者。”
He was referring to the “momentous discovery which little girls are destined to make” about their lack of a phallus, but his description more precisely captures the “penis envy” that some men told me they’d felt after catching a glimpse of the competition.
他指的是“小女孩注定要做出的重大发现”，因为她们缺乏阴茎，但他的描述更准确地捕捉到了“阴茎嫉妒”，一些男人告诉我，他们在瞥见比赛后感受到了这种感觉。
As John Mulcahy, a clinical professor of urology at the University of Arizona, put it, “It’s more of a locker room thing than a bedroom thing.”
正如亚利桑那大学泌尿科临床教授约翰·马尔卡希（John Mulcahy）所说，“这更像是更衣室的事情，而不是卧室的事情。”
Yet, after biological explanations for impotence triumphed and urologists wrested the penis away from the psychoanalysts, they seemed to overlook the man and the society to which it was attached.
然而，在对阳痿的生物学解释取得胜利并且泌尿科医生将阴茎从精神分析学家手中夺走之后，他们似乎忽视了人和它所依附的社会。
Critics of male enhancement said they had no desire to body shame men in search of something extra, noting that women who get breast implants can do so without provoking a moral panic.
男性增强的批评者表示，他们不想为了寻求额外的东西而羞辱男性，并指出接受隆胸手术的女性可以这样做，而不会引发道德恐慌。
But, especially in the case of men with an unrealistic self-image, the critics worried that doctors seemed too eager to pitch a risky surgical procedure for what is a cultural, and, in some instances, a psychiatric, phenomenon.
但是，特别是对于自我形象不切实际的男性，批评者担心医生似乎太急于为这种文化现象（有时甚至是精神现象）推销一种危险的外科手术。
What surgeons continually emphasized — the implanters with pride, the explanters with dismay — was that most of the men they were seeing had been of at least average size before going under the knife.
外科医生们不断强调的——植入者自豪，外植者沮丧——他们看到的大多数男性在接受手术之前至少具有平均身材。
(The photographic evidence men sent to me over text and email supported this contention.) “Most don’t have anything physically wrong with them at all, so what they don’t need is vultures preying on them, which is almost always a disaster,” Muir, the London urologist, said.
（人们通过短信和电子邮件发送给我的照片证据支持了这一论点。）“大多数人根本没有任何身体问题，所以他们不需要秃鹫捕食他们，这几乎总是一场灾难，”伦敦泌尿科医生缪尔说。
Along with other urologists and psychiatrists, at King’s College and the University of Turin, Muir conducted a literature review called “Surgical and Nonsurgical Interventions in Normal Men Complaining of Small Penis Size.” The research showed that men dissatisfied with their penises respond well to educational counseling about the average size, which is 3.6 inches long when flaccid, and 5.2 inches erect.
缪尔与其他泌尿科医生和精神病学家一起，在国王学院和都灵大学进行了一项文献综述，题为“抱怨阴茎尺寸过小的正常男性的手术和非手术干预”。研究表明，对阴茎不满意的男性对平均尺寸的教育咨询反应良好，阴茎松弛时长 3.6 英寸，勃起时长 5.2 英寸。
(The average girth is 3.5 inches flaccid, and 4.6 inches erect.) For men who have an excessive and distorted preoccupation with the appearance of their genitals — a form of body dysmorphic disorder — Muir said that cognitive behavioral therapy and medications may also be necessary.
（松弛时的平均周长为 3.5 英寸，直立时的平均周长为 4.6 英寸。）缪尔表示，对于过度关注生殖器外观（一种身体变形障碍）的男性，认知行为疗法和药物治疗可能也是必要的。
Penuma surgeons told me they use educational videos, intake surveys and sexual-health therapists to make sure that the men they operate on have realistic expectations and to screen for those with body dysmorphia, though only a handful of the patients I spoke to recalled being referred to a therapist before their surgery.
佩努马的外科医生告诉我，他们使用教育视频、摄入量调查和性健康治疗师来确保接受手术的男性有切合实际的期望，并筛查那些患有身体畸形的人，尽管只有少数与我交谈过的患者回忆起在手术前被转介给治疗师。
Shortly before the pandemic, Elist received a Google alert for “penile implant” and noticed something strange: a Houston urologist, Robert Cornell, had been issued a patent for the Augmenta, a device that bore an uncanny resemblance to his own.
疫情爆发前不久，埃利斯特收到了谷歌关于“阴茎植入”的警报，并注意到了一些奇怪的事情：休斯敦泌尿科医生罗伯特·康奈尔获得了 Augmenta 的专利，这种设备与他自己的设备惊人地相似。
The previous year, Cornell had asked to learn about the Penuma “expeditiously,” saying that he saw a “real opportunity to expand the level of service” he offered to patients.
去年，康奈尔大学曾要求“迅速”了解 Penuma，并表示他看到了为患者提供的“扩大服务水平的真正机会”。
Run Wang, a Penuma board member and a professor at the University of Texas MD Anderson Cancer Center, in Houston, had cautioned Elist that Cornell could be a bit of a snake, according to Jonathan Elist.
据乔纳森·埃利斯特称，Penuma 董事会成员、休斯敦德克萨斯大学 MD 安德森癌症中心教授 Run Wang 曾警告埃利斯特，康奈尔大学可能有点像蛇。
But father and son chalked up Wang’s warning to the machismo of the Texas urological market, and Elist invited Cornell to shadow him as he performed four Penuma procedures.
但父子俩将王的警告归咎于德克萨斯州泌尿外科市场的大男子主义，埃利斯特邀请康奈尔在他进行四次佩努玛手术时跟随他。
Now, as Elist thumbed through Cornell’s patent, he was startled to see his future plans for the Penuma, which he said he recalled discussing with Cornell, incorporated into the Augmenta’s design.
现在，当埃利斯特翻阅康奈尔大学的专利时，他惊讶地发现自己对 Penuma 的未来计划，他说他记得与康奈尔大学讨论过该计划，并将其纳入 Augmenta 的设计中。
In April 2020, Elist and his company sued Cornell, alleging that his visit to Beverly Hills was “a ruse” to steal trade secrets.
2020年4月，埃利斯特和他的公司起诉康奈尔大学，指控他访问比佛利山庄是窃取商业机密的“诡计”。
Later that year, when Elist discovered that Wang was listed as the Augmenta CEO and had assisted the penile startup with its cadaver studies, Elist and his company added Wang as a party to the suit.
同年晚些时候，当埃利斯特发现王被列为 Augmenta 首席执行官并协助这家阴茎初创公司进行尸体研究时，埃利斯特和他的公司将王列为诉讼当事人。
(Cornell and Wang did not comment for this story, though Wang denied through his counsel that he’d called Cornell a snake and said in court filings that he’d been named CEO without his consent.)
（康奈尔大学和王没有对这篇报道发表评论，尽管王通过他的律师否认他称康奈尔为蛇，并在法庭文件中表示，他在未经他同意的情况下被任命为首席执行官。）
When deposed, Cornell said that he’d talked to Elist about marketing strategies, not proprietary specifics, and that his invention had been spurred by potential hazards he’d observed during the surgeries, particularly the use of mesh.
康奈尔被罢黜后表示，他与埃利斯特讨论了营销策略，而不是专有细节，并且他的发明是由他在手术期间观察到的潜在危险（特别是网状材料的使用）激发的。
As both teams began conscripting high-volume implanters as allies and expert witnesses, the fraternity of sexual medicine was sundered into warring camps.
当两个团队开始征召大量植入者作为盟友和专家证人时，性医学界分成了交战阵营。
“This is a tiny smear of people, and they are fucking cutthroat,” one high-volume implanter told me of the intellectual property dispute.
“这是一小群人的污点，他们真是太残酷了，”一位大批量植入者向我讲述了知识产权纠纷。
“It’s vicious because there’s so much money to make.”
“这很邪恶，因为有这么多钱可以赚。”
Augmenta’s team endeavored to put the safety record of the Penuma on trial, securing Elist’s confirmation in a deposition that 20% of the patients in his 2018 study had reported at least one adverse post-surgical event.
Augmenta 的团队努力对 Penuma 的安全记录进行试验，并确保 Elist 在一份证词中确认，在他 2018 年的研究中，20% 的患者报告了至少一项术后不良事件。
Foster Johnson, one of the Augmenta attorneys, also tracked down some of the patients who’d posted horror stories online.
Augmenta 的律师之一福斯特·约翰逊 (Foster Johnson) 也找到了一些在网上发布恐怖故事的患者。
In 2021, he reached out to Mick.
2021 年，他联系了米克。
A year had passed since Mick’s explant, and he’d entered a serious depression.
米克接受外植体手术已经一年了，他陷入了严重的抑郁症。
He’d barely noticed when pandemic restrictions were lifted, because he’s continued to stay in his bed.
他几乎没有注意到流行病限制何时取消，因为他继续躺在床上。
Originally six and a half inches erect, he had lost an inch of length.
原本直立的六英寸半，他的身长却减少了一英寸。
Whenever he caught sight of himself in the mirror, he felt desperate.
每当他看到镜子里的自己时，他都会感到绝望。
So did other post-removal patients.
其他切除后的患者也是如此。
An FBI agent in his early 30s said that he was afraid he would never date again, let alone start a family, because his penis had shrunk to a stub.
一名 30 岁出头的联邦调查局特工表示，他担心自己再也不会约会了，更不用说组建家庭了，因为他的阴茎已经萎缩成一根短截。
A Hollywood executive who’d undergone multiple surgeries with Elist told me, “It’s like he also snipped the possibility of intimacy away from me.” The defense-and-intelligence contractor, who’d traveled the country to consult six reconstructive surgeons, said he’d tucked a Glock in his waistband before one appointment, thinking he might kill himself if the doctor couldn’t help.
一位曾与埃利斯特一起接受过多次手术的好莱坞高管告诉我，“就好像他也断绝了我亲密关系的可能性。”这位国防和情报承包商曾前往全国各地咨询六名重建外科医生，他说在一次就诊之前，他在腰带里塞了一把格洛克手枪，认为如果医生无法提供帮助，他可能会自杀。
Mick had come to believe that the only thing more humiliating than being a satisfied penile enhancement patient was being a dissatisfied one.
米克开始相信，唯一比成为一名满意的阴茎增强患者更丢脸的事情就是成为一名不满意的患者。
Still, he tried to alert local news stations, the Better Business Bureau, the FBI, the district attorney, malpractice lawyers, the California medical board.
尽管如此，他还是试图向当地新闻台、商业改善局、联邦调查局、地区检察官、医疗事故律师和加州医疗委员会发出警报。
No one returned his calls — “Who could blame them when it almost sounds like a joke?” — apart from an investigator with the medical board, who didn’t treat his distress as a laughing matter.
没有人回复他的电话——“当这听起来几乎像个笑话时，谁能责怪他们呢？” ——除了医学委员会的一名调查员，他并没有把他的痛苦当作笑料。
Neither did Johnson, who decided to tip off a Houston-based firm that specializes in class-action complaints.
约翰逊也没有这样做，他决定向一家专门处理集体诉讼投诉的休斯顿公司举报。
Last year, a Texas man accused International Medical Devices of falsely advertising the Penuma as FDA cleared for “cosmetic enhancement” when it was, until recently, cleared only for cosmetic correction of soft-tissue deformities.
去年，一名得克萨斯州男子指控国际医疗器械公司为 Penuma 进行虚假广告，因为 FDA 批准其用于“美容增强”，而直到最近，Penuma 还只批准用于软组织畸形的美容矫正。
Jonathan Elist called the lawsuit, which awaits class certification, meritless.
乔纳森·埃利斯特称这起等待集体认证的诉讼毫无根据。
“It’s not medical malpractice,” he said.
“这不是医疗事故，”他说。
“And it’s not a product-liability case, either, which is what one might expect from something like this.” His expectations proved prescient when, in March, a personal injury law firm in Ohio brought the first of what are now eight product-liability suits against the company.
“而且这也不是产品责任案件，而这正是人们对此类案件的期望。”事实证明，他的期望是有先见之明的。三月份，俄亥俄州的一家人身伤害律师事务所对该公司提起了目前已有八起产品责任诉讼中的第一起诉讼。
The lawsuits, all of which Elist’s spokesperson called “frivolous,” feature 10 John Does.
埃利斯特的发言人称所有这些诉讼都是“无聊的”，其中包括 10 名约翰·杜斯 (John Does)。
Every surgical revolution is bloody by definition.
从定义上来说，每一次外科手术革命都是血腥的。
When I met Elist, earlier this year, he underscored how many taken-for-granted medical breakthroughs had emerged from tweaks and stepwise developments.
今年早些时候，当我见到埃利斯特时，他强调了许多被视为理所当然的医学突破是通过调整和逐步发展而实现的。
The breast implant had been dogged by ruptures and leaks in its early days.
乳房植入物在早期曾遭受破裂和渗漏的困扰。
Even the celebrated penile pump — the object around which the egos of many eminent urologists now orbit — had taken years to overcome high rates of removals.
即使是著名的阴茎泵——现在许多著名泌尿科医生的自尊心都围绕着它——也花了数年时间才克服了高去除率。
Two decades of innovation had led to the current Penuma procedure, he noted, and during that time nearly everything about it had improved, from the deployment of a drain to the placement of the incision.
他指出，二十年的创新催生了目前的佩努玛手术，在那段时间里，从引流管的部署到切口的放置，几乎所有方面都得到了改进。
“This procedure is like any other procedure,” he told me.
“这个程序就像任何其他程序一样，”他告诉我。
“It has its own evolution.”
“它有自己的演变。”
Recently, the Penuma procedure evolved again.
最近，Penuma 手术再次发展。
Elist had got rid of the vexing patch of mesh, and the company was shipping out a new model.
埃利斯特已经摆脱了令人烦恼的网格片，公司正在推出一种新型号。
He invited me to shadow him as he implanted it.
他邀请我在他植入时跟随他。
The first operation of the day complete, Elist was in a giddy, expansive mood.
当天的第一次手术完成后，埃利斯特心情愉悦、心情舒畅。
As his next patient was put under anesthesia, Elist sat behind an imposing desk in a borrowed office and spoke about his forthcoming book, a collection of parables for spiritually minded surgeons titled “Operating with God.” His ghostwriter had rendered his voice so skillfully, he said, that he’d found himself moved to tears while reading it.
当他的下一个病人接受麻醉时，埃利斯特坐在借来的办公室里一张气派的桌子后面，谈论他即将出版的书，这是一本为有灵性的外科医生准备的寓言集，书名为《与上帝一起手术》。他说，他的代笔人非常巧妙地呈现了他的声音，以至于他在阅读时发现自己感动得热泪盈眶。
Beside a gilt statue of a jaguar in the corner of the room, someone had propped a mirror with an image of Jesus etched at its center.
房间角落里有一尊镀金的美洲虎雕像旁边，有人撑着一面镜子，镜子的中心刻着耶稣的图像。
As Elist recounted passages from his book, his merry face, crowned by a hairnet, hovered next to Christ’s.
当埃利斯特讲述他书中的段落时，他带着发网的快乐的脸盘旋在基督的旁边。
The surgery, which Elist said was supposed to take approximately 35 minutes, lasted twice as long.
埃利斯特说，手术预计需要大约 35 分钟，但实际持续了两倍的时间。
A surgical technician had covered the patient’s body in sheets until only his penis, gleaming beneath the overhead lamp, was visible.
一名外科技术人员用床单盖住了病人的身体，直到只能看到他的阴茎，在头顶灯下闪闪发光。
With a purple marker, Elist drew a dotted line close to where the scrotum met the shaft.
埃利斯特用紫色记号笔在靠近阴囊与轴的交汇处画了一条虚线。
A clamp pulled the skin taut, and he began to cut along the line.
一个夹子将皮肤拉紧，然后他开始沿着线切割。
The scrotal skin gave easily, like something ripe, and a few seconds later, the man on the table let out a high-pitched sound.
阴囊皮肤轻易地就软了，就像熟透了的东西一样，几秒钟后，桌上的男人发出了尖锐的声音。
To stop the bleeding, Elist applied a cautery pencil that beeped each time it singed the skin, giving off smoke and a whiff of burned flesh.
为了止血，埃利斯特使用了一支烧灼笔，每次烧焦皮肤时，它就会发出嘟嘟声，散发出烟雾和烧焦的肉味。
Alternating between his cautery tool and a pair of scissors, he deepened the incision, centimeter by centimeter, revealing the chalky tissue below, until he approached the pubic bone.
他交替使用烧灼工具和剪刀，一厘米一厘米地加深切口，露出下面的白垩组织，直到接近耻骨。
Then, in a stage known as “degloving,” he began to flip the penis inside out through the hole he’d created at its base.
然后，在一个被称为“脱手套”的阶段，他开始将阴茎从里面翻出来，穿过他在阴茎根部挖的洞。
Wearing the marbled interior flesh around his fingers, he trimmed the soft tissue and cauterized a series of superficial blood vessels, speckling the interior of the shaft with dark dots.
他将大理石状的内部肉包裹在手指上，修剪软组织并烧灼一系列浅表血管，在轴的内部布满黑点。
For a few moments, a quivering red sphere popped up like a jellyfish surfacing at sea — an inverted testicle, he explained.
他解释说，有一会儿，一个颤抖的红色球体突然出现，就像浮出海面的水母一样——一个倒置的睾丸。
A nurse unwrapped an Extra Large implant from its box and handed it to Elist, who used curved scissors to smooth its top corners.
一名护士从盒子中打开一个超大植入物，并将其交给埃利斯特，埃利斯特用弯剪刀将其顶角磨平。
With a hook-shaped needle, he began to sew the implant into the inverted penis, and he asked his surgical tech to tie a “double lateral” knot.
他开始用钩形针将植入物缝入内翻的阴茎，并要求外科技术人员打一个“双侧”结。
He barked the word “lateral” several times and sighed.
他多次喊出了“横向”这个词，然后叹了口气。
“She’s never seen this procedure,” he told me.
“她从未见过这个手术，”他告诉我。
When he asked for wet gauze a few minutes later, she handed him a piece they’d discarded.
几分钟后，当他要湿纱布时，她递给他一块他们丢弃的纱布。
“You know that it’s dirty,” he reprimanded her in Farsi.
“你知道这很脏，”他用波斯语斥责她。
“It was on the skin.
“它在皮肤上。
And you bring it for me?”
那你还给我带来？”
I recalled that Zimmerman, the “Dick Doc” of Las Vegas, had compared his own visit to Elist’s operating theater to being “in the presence of a master conductor who can bring the whole orchestra together.” But as Elist chided his tech for being “a troublemaker” — she’d handed him the wrong size of sutures, an unnecessary needle, the wrong end of the drain, the wrong kind of scissors — it felt like watching the stumble-through of a student ensemble.
我记得齐默尔曼，拉斯维加斯的“迪克医生”，曾将自己对埃利斯特手术室的访问比作“在一位可以将整个乐团聚集在一起的指挥大师面前”。但当埃利斯特斥责他的技术人员是“麻烦制造者”时——她给了他错误尺寸的缝线、不必要的针、错误的引流管末端、错误类型的剪刀——感觉就像是在看着一个学生合唱团跌跌撞撞地前进。
Elist cauterized more tissue by the pubic bone to make sure the implant would fit there, and at this the patient’s breaths rose into a moan.
埃利斯特烧灼了耻骨附近的更多组织，以确保植入物适合那里，此时病人的呼吸变成了呻吟。
Elist regloved the penis with the Penuma tucked under its skin.
埃利斯特重新戴上阴茎，将佩努玛塞在皮肤下。
Too long, he decided.
太长了，他决定。
He slid the implant out part way and snipped a bit off the bottom.
他将植入物滑出一部分，并从底部剪掉了一点。
Pushing it into the shaft, he wagged it back and forth.
他把它推入竖井，来回摇晃它。
“OK,” he said.
“好吧，”他说。
It was done.
事情完成了。
The patient, who had arrived that morning average sized — four inches in length by four inches in girth — was now six by five.
那天早上到达的病人的平均尺寸是四英寸长乘四英寸围，现在是六乘五英寸。
Later, through his spokesperson, Elist would say that the patient’s outcome was excellent.
后来，埃利斯特通过他的发言人说，病人的结果非常好。
In the room, talk turned to preparing the table for the next man.
房间里，谈话转向为下一个人准备桌子。
Elist has always been keen to distance himself from other purveyors of controversial penile enhancement techniques — “gimmick” surgeons, he has called them.
埃利斯特一直热衷于与其他有争议的阴茎增强技术的提供者保持距离——他称他们为“噱头”外科医生。
At one point during our conversations, which were punctuated by lively digressions, he said that some of his unscrupulous rivals reminded him of Josef Mengele, the Nazi doctor who conducted lethal experiments on prisoners at Auschwitz.
在我们的谈话中，他说，他的一些肆无忌惮的竞争对手让他想起约瑟夫·门格勒，一位在奥斯威辛集中营对囚犯进行致命实验的纳粹医生。
“How do you allow yourself to put something on the patient’s body that you know gets infected?” he asked, as though addressing them directly.
“你怎么能让自己把一些你知道会被感染的东西放在病人身上？”他问道，仿佛是在直接对他们说话。
Sections of his website and of a book he self-published in 2015, “ A Matter of Size ,” are devoted to chronicling the macabre complications that can result from skin grafts and fat injections to the penis.
他的网站和 2015 年他自行出版的书《大小问题》的部分内容专门记录了阴茎皮肤移植和脂肪注射可能导致的可怕并发症。
When I reviewed old files in an underground archive for the Los Angeles County courts, however, I saw that, a decade before the Penuma came into being, Elist had been part of a coterie of LA surgeons promoting the very methods he now decried, with coverage in Hustler, Penthouse, Penis Power Quarterly and local newspapers like the Korea Central Daily and the Korea Times.
然而，当我查阅洛杉矶县法院地下档案中的旧档案时，我发现，在 Penuma 诞生的十年前，埃利斯特曾是洛杉矶外科医生小圈子的一员，他们提倡他现在谴责的方法，并在《Hustler》、《Penthouse》、《Penis Power Quarterly》以及《韩国中央日报》和《韩国时报》等当地报纸上进行了报道。
One ad, in Korean, for the surgery center where Elist operated sounded a familiar note, promising a “life changing” procedure with no complications and “guaranteed results,” performed by “the Highest Authority in Urology in Beverly Hills,” “approved by the state government” and “authorized by the FDA.”
埃利斯特经营的手术中心的一则韩语广告听起来很熟悉，承诺一种“改变生活”的手术，没有并发症，并且“有保证的结果”，由“比佛利山泌尿外科最高权威”进行，“得到州政府批准”和“FDA 授权”。
At least 23 malpractice lawsuits have been filed against Elist in Los Angeles since 1993.
自 1993 年以来，洛杉矶至少有 23 起针对埃利斯特的医疗事故诉讼。
(He has also been named as a defendant in product liability lawsuits regarding inflatable penile prosthesis brought by plaintiffs Dick Glass and Semen Brodsky.) The dockets indicate that some of the complaints were settled confidentially out of court, a few were dismissed and in one of two trials a jury ruled in Elist’s favor.
（他还在原告迪克·格拉斯（Dick Glass）和塞门·布罗德斯基（Semen Brodsky）提起的有关充气阴茎假体的产品责任诉讼中被列为被告。）案卷显示，一些投诉在庭外秘密解决，少数被驳回，在两次审判中，陪审团在其中一次做出了对埃利斯特有利的裁决。
It is not unusual for a doctor practicing for more than 40 years to be accused of malpractice, and it is not unusual, either, for patients to be self-serving in their recollections of informed consent, but as I scrolled through the microfilm I was surprised to see how many of Elist’s past patients — who’d received cosmetic surgeries, medical procedures or both — described the same MO.
执业超过 40 年的医生被指控医疗事故并不罕见，患者在回忆知情同意书时出于自私也并不罕见，但当我滚动浏览缩微胶卷时，我惊讶地发现埃利斯特过去的患者中有多少——接受过整容手术、医疗程序或两者兼而有之——都描述了同样的行为模式。
Three men alleged that they’d been asked to sign consent forms after being injected with Demerol, a fast-acting narcotic.
三名男子声称，他们在注射速效麻醉剂杜冷丁后被要求签署同意书。
A number of foreign-born patients seeking treatment for erectile dysfunction alleged that they were given forms in English, which they couldn’t read, and some of those same patients, who said they’d thought they were undergoing a vein-cleaning procedure, alleged that they awoke from surgery to find themselves implanted with a penile prosthesis for erectile dysfunction.
一些寻求勃起功能障碍治疗的外国出生的患者声称，他们收到了英文表格，但他们看不懂，其中一些患者表示，他们以为自己正在接受静脉清洁手术，但他们声称，他们从手术中醒来，发现自己植入了用于勃起功能障碍的阴茎假体。
Multiple patients who said they’d turned to Elist for a functional issue alleged that they’d been upsold enhancement procedures that resulted in their disfigurement.
多位自称因功能问题而求助于 Elist 的患者声称，他们被推销了增强手术，导致他们毁容。
Ronald Duette, a 65-year-old property manager and auto detailer who filed a malpractice case in 2021, told me that a consultant at Elist’s clinic had encouraged him to get the Penuma by reassuring him that Elist had one himself.
罗纳德·杜埃特 (Ronald Duette) 是一位 65 岁的物业经理兼汽车美容师，他于 2021 年提起了一起医疗事故案件，他告诉我，埃利斯特诊所的一位顾问向他保证埃利斯特自己也有一台，从而鼓励他购买 Penuma。
Elist’s spokesperson told me that Duette’s allegations and the claims in the other lawsuits are false; that Elist does not have a Penuma; and that Elist is a gifted, responsive and exacting surgeon, supported by conscientious employees, who does not rush his patients and performs additional surgery only when medically appropriate.
Elist 的发言人告诉我，Duette 的指控以及其他诉讼中的指控都是虚假的；埃利斯特没有佩努玛；埃利斯特是一位才华横溢、反应灵敏、要求严格的外科医生，在尽职尽责的员工的支持下，他不会催促病人，只在医疗条件允许的情况下才进行额外的手术。
The spokesperson said Elist was not aware of any patients suffering extreme dissatisfaction or sleeplessness or mental health crises as a result of Penuma surgery, and noted that complications were more likely when patients failed to comply with post-op instructions.
该发言人表示，Elist 并不知道有任何患者因 Penuma 手术而遭受极度不满、失眠或心理健康危机，并指出，当患者未能遵守术后指示时，更有可能出现并发症。
The spokesperson disputed some particulars of Mick’s account (Mick waived his medical privacy rights so that Elist could discuss his records) and said this article “cherry-picks and sensationalizes” outlier cases.
该发言人对米克账户的一些细节提出了质疑（米克放弃了他的医疗隐私权，以便埃利斯特可以讨论他的记录），并表示这篇文章“挑选并耸人听闻”异常案例。
Elist told me that what his critics failed to grasp, whether by dint of envy or closed mindedness, was that for every dissatisfied customer there were many more whose lives had improved immeasurably.
埃利斯特告诉我，他的批评者未能理解的是，无论是出于嫉妒还是封闭的思想，对于每一个不满意的顾客，都有更多的人的生活得到了不可估量的改善。
Nobody hears about the happy implantees, he said, because “unfortunately people are not willing to come out and talk about penile enlargement.”
他说，没有人听说植入者快乐的事，因为“不幸的是，人们不愿意出来谈论阴茎增大。”
All nine deeply satisfied Penuma patients I spoke to, several on the recommendation of Elist and his associates, said they would do it again.
我采访过的所有九名非常满意的佩努玛患者（其中几位是在埃利斯特及其同事的推荐下）表示他们会再次这样做。
“I can give someone pleasure and see it in their eyes,” an industrial designer said.
“我可以给别人带来快乐，并在他们的眼中看到它，”一位工业设计师说。
“That’s the part that makes me almost cry.” But hearing some of their stories I found myself wondering whether the difference between happy and unhappy customers was less a matter of experience than of its interpretation.
“这就是让我几乎哭了的部分。”但听了他们的一些故事后，我发现自己想知道快乐和不快乐的顾客之间的区别是否与其说是经验的问题，不如说是其解释的问题。
Two men said they’d needed a second surgery to replace their implants when complications arose, and one continued to volunteer as a patient advocate even though he’d had his Extra Extra Large removed.
两名男子表示，当出现并发症时，他们需要进行第二次手术来更换植入物，其中一名男子继续自愿担任患者倡导者，尽管他已经移除了特大号植入物。
He explained: “It was very uncomfortable for my wife.
他解释说：“这对我的妻子来说非常不舒服。
She was getting microtears and was considering getting a procedure done to enlarge that opening.”
她出现了微泪，正在考虑进行手术以扩大开口。”
Elist emphasized to me that “the best advantage of Penuma over any other procedure” was how easy it was to remove.
艾利斯特向我强调，“Penuma 相对于任何其他手术的最大优势”是它很容易去除。
He said that some patients even gained length upon removal.
他说，有些患者在移除后甚至变长了。
Last year, Penuma’s monthly newsletter, “Inching Towards Greatness,” featured the YouTube testimonial of a man who, after his removal, said that the procedure had still been “worth every cent.” This patient — who described his Penuma to me as a “life-ruiner” — said that he’d been under the influence of drugs the clinic had prescribed at the time.
去年，Penuma 的月刊《迈向伟大》在 YouTube 上刊登了一名男子的感言，这名男子在被免职后表示，该手术仍然“值得每一分钱”。这位患者向我描述他的佩努玛是“生命的毁灭者”，他说他当时受到了诊所开出的药物的影响。
Elist, through his spokesperson, declined to comment on the matter; the video is no longer available.
埃利斯特通过他的发言人拒绝对此事发表评论；该视频不再可用。
In April, Mick received a letter from the office of California’s attorney general, notifying him of a hearing this October on Elist’s conduct.
4 月，米克收到了加州总检察长办公室的一封信，通知他今年 10 月将就埃利斯特的行为举行听证会。
Since Mick had filed his complaint, the California medical board had investigated the surgeon’s treatment of 10 other Penuma patients, including the contest winner Emmanuel Jackson and other men I interviewed.
自从米克提出申诉以来，加州医疗委员会调查了该外科医生对其他 10 名佩努马患者的治疗情况，其中包括竞赛获胜者伊曼纽尔·杰克逊和我采访的其他人。
Alleging gross negligence and incompetence, the board accused Elist of, among other lapses, recommending that patients treat what appeared to be post-op infections with Neosporin, aloe vera and a bloodflow ointment; asking them to remove their own sutures; and deterring them from seeking outside medical care.
委员会指控埃利斯特存在严重疏忽和无能，除其他失误外，还建议患者使用新孢菌素、芦荟和血流软膏治疗似乎是术后感染的情况；要求他们拆掉自己的缝线；并阻止他们寻求外部医疗护理。
Elist said through his attorney that innovative procedures like his are routinely reviewed by regulators; that many specifics in the complaint are false; and that a previous medical board complaint against him was resolved in 2019, when he agreed to improve his recordkeeping.
埃利斯特通过他的律师表示，像他这样的创新程序会定期受到监管机构的审查。投诉中的许多细节都是虚假的；此前医疗委员会对他提出的投诉已于 2019 年得到解决，当时他同意改进记录保存。
Reading the letter from the attorney general’s office dredged up “dark thoughts from the ditch where I’d been burying them,” Mick said.
米克说，读了总检察长办公室的这封信，“从我埋葬它们的沟里挖出了黑暗的想法”。
In the three years since his Penuma removal, he estimates that he’s regained about 80% of the sensation in his penis, but his anger and sense of powerlessness have remained.
在切除 Penuma 后的三年里，他估计自己的阴茎恢复了约 80% 的感觉，但他的愤怒和无力感仍然存在。
In one of his last emails to Elist’s office, he wrote that he’d felt like “a testing mouse.” Given a recent expansion of Elist’s empire, the possibility that the surgeon might be censured, fined or lose his license now seemed to Mick beside the point.
在他给埃利斯特办公室的最后一封电子邮件中，他写道，他感觉自己像“一只测试老鼠”。鉴于埃利斯特帝国最近的扩张，在米克看来，外科医生可能受到谴责、罚款或吊销执照的可能性现在似乎无关紧要。
“They should have cut down the tree before it grew,” he said.
“他们应该在树长出来之前就把它砍掉，”他说。
“It’s too big now.”
“现在太大了。”
In Times Square, a billboard recently appeared: “MANHOOD REDEFINED,” it said, beside the URL for the Penuma website.
在时代广场，最近出现了一个广告牌：“MANHOOD REDEFINED”，在 Penuma 网站的 URL 旁边。
A few weeks after Elist and his lawyer were served by the office of the California attorney general, Elist was traveling on the East Coast, training new recruits to his network.
在埃利斯特和他的律师接受加州总检察长办公室的服务几周后，埃利斯特正在东海岸旅行，为他的网络培训新成员。
He has also been pitching interested parties in the United Arab Emirates, Qatar, Kuwait and South Korea, the world capital for cosmetic surgery.
他还一直在向阿拉伯联合酋长国、卡塔尔、科威特和世界整容手术之都韩国的感兴趣的各方进行推介。
Colombia was already a go.
哥伦比亚已经是一个尝试。
“The Penuma is going to be the only procedure that surgeons not just in the United States but worldwide are going to accept,” Elist told me.
“Penuma 将成为美国乃至全世界外科医生唯一接受的手术，”埃利斯特告诉我。
In June, his company rebranded the updated Penuma as the Himplant, and the Augmenta trial unfolded in a federal courthouse in downtown Los Angeles.
6 月，他的公司将更新后的 Penuma 更名为 Himplant，Augmenta 审判在洛杉矶市中心的联邦法院进行。
Elist testified with brio about his victimization at the hands of Cornell, who’d violated “the sanctuary” of his operating theater; the judge ruled with Penuma’s attorneys that the negative experiences of patients like Mick were irrelevant to the question of theft at hand.
埃利斯特热情地作证，讲述了他在康奈尔大学手中受害的情况，康奈尔大学侵犯了他手术室的“庇护所”。法官与佩努玛的律师一起裁定，像米克这样的患者的负面经历与当前的盗窃问题无关。
On June 16, the jury returned a verdict in Elist’s favor and invalidated Cornell’s patents.
6月16日，陪审团做出了对埃利斯特有利的裁决，并宣布康奈尔大学的专利无效。
Not long ago, I met Bryan, Elist’s former penis model, at a coffee shop in Orange County.
不久前，我在奥兰治县的一家咖啡店遇到了埃利斯特的前阴茎模特布莱恩。
He had undergone multiple surgeries with Elist, with two different iterations of the implant.
他在 Elist 的帮助下接受了多次手术，并进行了两次不同的植入物迭代。
He said he’d experienced complications and, in 2011, he’d had his second implant removed.
他说他经历了并发症，并于 2011 年移除了第二个植入物。
The following year, Bryan ended up flying to Philadelphia for the first in a series of revision and enhancement procedures with Solomon, whom he’d learned about on PhalloBoards.
第二年，布莱恩最终飞往费城，与所罗门进行了一系列修改和增强程序中的第一次，他是在 PhalloBoards 上了解到所罗门的。
This spring, he was released from prison, where he’d served time for participating in a car theft ring that a prosecutor described as highly sophisticated and that Bryan described to me as a matter of “incorrectly filled-out paperwork.” When he returned home, he got back into the enlargement scene.
今年春天，他从监狱获释，当时他因参与一个汽车盗窃团伙而服刑，检察官称该团伙非常复杂，布莱恩向我描述这是“文件填写不正确”的问题。回到家后，他又回到了放大的场景。
He now works as a paid patient advocate for Solomon — a role that involves fielding inquiries from men struggling with the fallout from unsatisfactory operations.
他现在是所罗门的一名有偿患者权益倡导者，负责回答那些因手术效果不佳而苦苦挣扎的患者的询问。
The week before we met, Bryan had spent hours on the phone with Kevin (his middle name), an aspiring actor.
在我们见面的前一周，布莱恩花了几个小时与有抱负的演员凯文（他的中间名）通电话。
Kevin said that he had undergone five surgeries with Elist, including two upgrades, a revision and a removal, and his penis no longer functioned.
凯文说，他已经在埃利斯特的帮助下接受了五次手术，包括两次升级、一次修正和一次切除，他的阴茎不再起作用。
Still, Kevin had always found the surgeon to be caring, if a little preoccupied.
尽管如此，凯文总觉得这位外科医生很关心人，尽管有点心不在焉。
“He reminded me of Doctor Frankenstein — the intensity of him wanting this thing to come to life,” Kevin told me.
“他让我想起了弗兰肯斯坦博士——他对这件事的强烈渴望，”凯文告诉我。
It sounded strange, he acknowledged, but before each operation he’d been filled with excitement.
他承认，这听起来很奇怪，但在每次手术之前他都充满了兴奋。
“You just feel relieved that you’re fixing something,” he said.
“你会因为正在修复某些东西而感到如释重负，”他说。
At an appointment earlier this year, Kevin said, Elist promised to fix him again with a sixth procedure, but one of the surgeon’s assistants discreetly advised against it.
凯文说，在今年早些时候的一次预约中，埃利斯特承诺通过第六次手术再次修复他，但外科医生的一位助手谨慎地建议不要这样做。
Kevin thought he could spot “the other experiments” in the clinic from their loose-fitting sweatpants and the awkward way they walked.
凯文认为他可以从诊所里宽松的运动裤和笨拙的走路方式中发现“其他实验”。
There were so many men waiting to see the doctor that they spilled into the hallway.
等待看医生的人太多了，他们涌到了走廊里。
Rounding up migrants.
围捕移民。
Lists of “friendly” sheriffs.
“友好”警长名单。
Debating political assassinations.
辩论政治暗杀。
Internal messages reveal AP3's journey from Jan.
内部消息揭示了 AP3 从 1 月 1 日起的旅程。
6 through the tumultuous lead-up to the 2024 election.
6 经历 2024 年大选前的动荡。
One member predicts: “It’ll be decided at the ammo box.”
一名成员预测：“这将在弹药箱上决定。”
A Spotlight PA, ProPublica and Butler Eagle investigation found the process for securing campaign events was susceptible to attack for years.
Spotlight PA、ProPublica 和 Butler Eagle 的一项调查发现，确保竞选活动安全的流程多年来很容易受到攻击。
by Danielle Ohl , Spotlight PA ; and Jessica Lussenhop , ProPublica; and Irina Bucur , Tracy Leturgey and Eddie Trizzino , Butler Eagle , Aug.
作者：丹妮尔·奥尔 (Danielle Ohl)，聚光灯 PA；和 Jessica Lussenhop，ProPublica；和 Irina Bucur、Tracy Leturgey 和 Eddie Trizzino，Butler Eagle，8 月
20, 5 a.m.
20日凌晨5点
EDT
东部夏令时间
With millions in expanded tax credits and direct state funding going to anti-abortion groups, the nonprofit Coalition Life has expanded its operations beyond Missouri and into states where the procedure is still legal.
随着数百万美元扩大税收抵免和国家直接资金流向反堕胎团体，非营利组织“联盟生活”已将其业务扩展到密苏里州以外的地区，并进入了堕胎程序仍然合法的州。
The “King of Debt” promised to reduce the national debt — then his tax cuts made it surge.
“债务之王”承诺减少国家债务——然后他的减税措施使得国家债务激增。
Add in the pandemic, and he oversaw the third-biggest deficit increase of any president.
再加上新冠疫情，他的赤字增幅在所有总统中排名第三。
by Allan Sloan , ProPublica, and Cezary Podkul for ProPublica , Jan.
作者：Allan Sloan、ProPublica 和 Cezary Podkul，ProPublica，1 月
14, 2021, 5 a.m.
2021 年 14 月 14 日凌晨 5 点
EST
东部时间
On Monday, the GOP-controlled State Election Board is poised to adopt the rule, which would potentially allow county officials, including one who secretly backed the rule, to throw the election results of the swing state into chaos this fall.
周一，共和党控制的州选举委员会准备通过这项规则，这可能会让县官员，包括秘密支持该规则的官员，让这个摇摆州今年秋天的选举结果陷入混乱。
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