Loss of Penile Girth

What loss of girth looks like

Men usually notice one of two patterns:

• Focal narrowing (indentation, hourglass, bottleneck): a band or dent in one part of the shaft when erect. The rest of the penis keeps its normal thickness. This is typical of Peyronie's disease.
• General thinning: the whole erect penis seems thinner, often with shortening and softer erections. This is more typical of loss of erectile tissue from long-term erectile dysfunction, surgery or low hormones.

Loss of girth is easiest to see in the erect penis. A flaccid penis varies in size with temperature, stress and arousal, so a smaller-looking flaccid penis is not by itself a sign of disease.

Causes of loss of penile girth

Peyronie's disease (most common)

In Peyronie's disease, fibrous scar tissue (a plaque) forms in the tough sheath (tunica albuginea) around the erectile chambers. The plaque does not stretch during erection, so the penis bends, narrows or shortens at that point. It affects an estimated 3 to 9% of adult men, most often between 40 and 70.

It has two phases:

• Active phase (first 6 to 18 months): pain with erections, changing curvature or narrowing, and a plaque you may feel as a lump.
• Stable phase: pain settles, and the deformity stops changing.

The cause is thought to be small, repeated injuries to the penis during sex in men with a tendency to abnormal scarring. Risk factors include diabetes, smoking, prostate cancer surgery, and Dupuytren's contracture of the hand.

Erectile dysfunction and tissue atrophy

Erections bring oxygen-rich blood into the penis. When erections are rare for months or years, the smooth muscle in the erectile tissue can be replaced by stiffer collagen, called corporal fibrosis or atrophy of the corpus cavernosum. The penis becomes thinner and shorter and erections weaken further. Erectile dysfunction and loss of girth reinforce each other.

Prostate cancer treatment

Radical prostatectomy and radiation often reduce penile length and sometimes girth, partly from nerve injury and reduced erections, and partly from shrinkage of the erectile tissue. Hormone (androgen deprivation) therapy also reduces size. Early penile rehabilitation, using medicines or vacuum devices to bring in blood flow, may help preserve tissue.

Low testosterone

Low testosterone can reduce erectile function and sexual desire, and may reduce erectile tissue health over time. Adult penile size does not usually increase with testosterone treatment, but treating a true deficiency can improve erections.

Injury and priapism

• A penile fracture, a tear in the tunica during sex, can heal with scarring that narrows or bends the penis.
• Priapism, an erection lasting more than 4 hours, can damage the erectile tissue and cause fibrosis if not treated quickly.

Weight gain

Weight gain does not shrink the penis, but fat in the pubic area buries the base, making the visible penis look shorter and sometimes thinner. Losing weight restores visible length.

How loss of girth is diagnosed

A urologist will ask when you noticed the change, whether there was pain or injury, and about erection quality, diabetes, smoking and prostate treatment. They will feel the shaft for plaques. Because deformity is best seen when erect, you may be asked to bring photographs taken from the side and from above. Some clinics give an injection to produce an erection for measurement.

Penile Doppler ultrasound shows plaques, calcification and blood flow, and helps plan treatment. Blood tests may check testosterone, blood sugar and cholesterol.

Treatment

In the active phase of Peyronie's

• Penile traction therapy: a device worn for several hours a day for months can modestly improve length and curvature and may help narrowing.
• Pain relief with NSAIDs for painful erections.
• Oral supplements such as vitamin E have not been shown to work and are not recommended by the AUA.

In the stable phase

• Collagenase injections into the plaque, combined with stretching, reduce curvature in men with a 30 to 90 degree curve. They are less clearly effective for hourglass narrowing.
• Verapamil or interferon injections are sometimes used.
• Surgery for significant deformity that prevents sex: plication (tightening the opposite side), plaque incision or partial removal with a graft (which can improve narrowing), or a penile prosthesis for men who also have erectile dysfunction.

For thinning from erectile dysfunction

• PDE5 inhibitor medicines (such as sildenafil or tadalafil) prescribed by a doctor improve erections and blood flow.
• Vacuum erection devices used regularly can help maintain tissue.
• Penile prosthesis for severe ED, which restores rigidity but not lost size.

Avoid girth-enhancing injections (fillers, silicone, oils) offered outside medical settings. They can cause disfigurement, infection and tissue loss.

Frequently asked questions

Why is my penis getting thinner?

The most common reasons are Peyronie's disease, which causes scar tissue that narrows part of the shaft, and long-term erectile dysfunction, which reduces the elasticity of the erectile tissue. Prostate cancer treatment and low testosterone can also contribute. A urologist can examine you and recommend treatment.

What is an hourglass deformity of the penis?

It is a narrowing or dent around part of the shaft during erection, making the penis look pinched in like an hourglass. It is usually caused by a Peyronie's plaque. It may cause the penis to hinge or buckle during sex.

Can loss of girth be reversed?

Sometimes partly. Traction devices, vacuum therapy and treating erectile dysfunction can improve length and shape in some men. Surgery with grafting can correct significant narrowing from Peyronie's disease. Girth lost from long-term tissue scarring is rarely fully restored.

Does Peyronie's disease go away on its own?

Pain usually goes away within 12 to 18 months. The curve or narrowing improves on its own in only a small minority of men, stays the same in about half, and worsens in others. Early evaluation helps you choose treatment at the right time.

Can a lack of erections make the penis smaller?

Yes. Regular erections keep the erectile tissue supplied with oxygen. Months without erections, for example after prostate surgery, can cause scarring and shrinkage. This is why doctors encourage penile rehabilitation with medicines or a vacuum device after prostate cancer treatment.