Penile augmentation procedures have attracted growing interest within both reconstructive urology and cosmetic medicine, driven by increased patient awareness, sociocultural influences, and expanding technical options. Despite rising demand, the safety, efficacy, psychological implications, and ethical considerations of these interventions remain controversial, with heterogeneous practices and variable outcomes reported across the literature. The Fifth International Consultation on Sexual Medicine (ICSM 2024) represents the first international consensus document to specifically address aesthetic penile augmentation and cosmetic penile surgery, providing structured guidance on patient selection, psychological screening, and evidence-based positions on non-surgical and surgical augmentation techniques. This chapter integrates the ICSM 2024 consensus with existing European Association of Urology (EAU) and Sexual Medicine Society of North America (SMSNA) guidance to present an updated framework for ethical and evidence-based clinical decision-making in penile augmentation practice.