Penis size is highly important for many men, who associate length and girth with virility and masculinity. Generally, penile length does not affect sexual or urinary function, but a smaller-than average penis (or the perception that one’s penis is smaller) can negatively affect a man’s self-esteem.
Unfortunately, some medical procedures can result in penile shortening. In a recent paper published by Sexual Medicine Reviews, researchers looked at various studies on penile size and the effects of surgical treatments for Peyronie’s disease, erectile dysfunction (ED), and prostate cancer.
The findings, they explained, can help clinician help patients undergoing such procedures develop realistic expectations.
Methods for Measuring
Penises are measured for monitoring and research using several methods, from the basic plastic ruler that measures length (in flaccid, stretched flaccid, and erect states) to 3-dimensional photography that measures volume. To assess curvature, the gold standard method is using a goniometer after inducing an erection with medication.
Inflatable Penile Prostheses
Penile prostheses, or implants, are a common treatment for men with ED who do not respond to other medical therapies. A man can achieve an erection when he wishes to by activating the implanted device.
Studies suggest that most men who receive implants have penile shortening afterward, either perceived or actual. This may occur because of corporal fibrosis or scarring, a lack of glanular engorgement, inaccurate recollection of previous penis size, or an increase in fat tissue leading to “buried penis.”
Many patients incorrectly assume that penile implantation will lengthen their penis, the authors said. With that in mind, clinicians should make sure patients know they may lose some length.
Penile shortening is a common symptom of Peyronie’s disease, affecting about one third of patients. Surgical treatments, such as plication procedures and tunica lengthening procedures (plaque incision or excision with grafting) can also lead to loss, although tunica lengthening procedures appear to have lower risk.
Men who have radical prostatectomy for treatment of prostate cancer may also experience penile shortening. Some proposed explanations involve the surgical attachment of the bladder neck and the development of penile fibrosis [such as from penile hypoxia (oxygen deficiency in the penis) or injury to the cavernous nerve].
Research shows that penile shortening can occur with other prostate cancer treatments as well, including combination androgen suppression and radiation therapy. Men who undergo androgen ablation may also have penile length loss.
It’s essential for urologists to understand the importance of penile size to men and the potential for length loss from various procedures, the authors noted, adding that “devastating psychological consequences” could occur in patients who are not prepared. Whether penile shortening is real or perceived, clinicians should counsel their patients accordingly.
Sexual Medicine Reviews
Davoudzadeh, Ethan P., BS, et al.
“Penile Length: Measurement Technique and Applications”
(Full-text. Published online: December 27, 2017)