Andrew Siegel MD 5/22/2021
“Doc, my penis is shrinking.”
“I can barely find it at times.”
“When I pee, it sprays all over the place so I have to sit like a woman.”
“Sex is out of the question.”
The aforementioned complaints are frequently voiced by many patients who consult urologists. The long and the short of it is that aging, weight gain, poor lifestyle habits and other factors may result in men with penises that are shrunken or recessed, unreliable in terms of ability to urinate straight– often requiring sitting to urinate, and deficient with respect to sexual function. Sadly, this combination of shrinkage, the necessity to sit like a female and erection issues can make a man feel emasculated, deprived of his male role and identity.
TEMPORARY SHRINKAGE FROM COLD, STRESS OR EXERCISE
Penile dimensions are quite variable, depending upon circumstances. A temporary contraction often occurs with exposure to cold, stress (causing fight-or-flight response that decreases blood flow to the penis via adrenaline release), and exercise (by shunting blood to the muscles in demand and away from the penis). In addition to the decreased blood flow that deflates the penis, cold, stress and exercise cause additional penile shrinkage via contraction of the muscle fibers within the dartos layer of the penis, further concealing the penis by retracting it inwards.
CAUSES FOR THE DISAPPEARING PENIS
The Turtle Effect
The most common reasons for penile shrinkage and the typical complaints voiced above are the ravages of weight gain, gravity and time. The enlarging “apron” of abdominal fat (“pannus” in medical speak) that occurs with weight gain that hangs in accordance with gravity obscures the penis and causes it to lose apparent length. Additionally, weight gain and obesity, in particular, cause a bulging of the rounded mound of fatty tissue overlying the pubic bone, the male equivalent of the female mons pubis, further concealing the penis within the mass of fatty tissue. Penile length is usually reasonably intact, with the penis merely buried. Lose the fat and the penis will reappear.
Trivia tidbit: For every 35 lbs. of weight gain, there is about a one-inch loss in apparent penile length.
Disuse Atrophy
In the absence of sexual activity, the erectile tissues can atrophy, resulting in a loss of penile length and girth and contributing to progression of erectile dysfunction. Erections and sexual activity serve to keep the penile tissues (collagen, smooth muscle, elastin, etc.) richly oxygenated, supple, and healthy. Use it or lose it.
Low T (testosterone)
T plays a pivotal role in maintaining penile erectile tissue anatomy and function. Low levels can adversely affect penile dimensions. This is particularly the case with markedly diminished levels, as seen with androgen deprivation therapy, a form of treatment for prostate cancer that aims to achieve the same levels of testosterone as surgically removing the testes.
Low T may also be caused by testicular damage from: failure of testicular descent, twisting, injuries, infections, surgical removal, chemotherapy, toxic damage from alcohol or heavy metals, Klinefelter’s syndrome, and pituitary-hypothalamic issues. If T is low and one presents with a disappearing penis, replacement T may be in order.
Surgical Removal of the Prostate
Removing the prostate as treatment for prostate cancer (robotic assisted laparoscopic prostatectomy) may result in penile shortening. The gap in the urethra after prostate removal is bridged by sewing bladder neck to urethral stump, with a consequent loss of urethral length that can create a “telescoping” phenomenon. Furthermore, traumatized and impaired nerves and blood vessels vital for erections result in less oxygen delivery to erectile tissues that may give rise to disuse atrophy. To prevent disuse atrophy, penile rehabilitation is key.
The French surgeon de la Peyronie first described this disease in 1743–an acquired penile deformity due to scarring of the sheath surrounding the erectile chambers. It may result in a hard lump, penile shortening and narrowing, curvature with erections, a visual indentation (“hour-glass” deformity), pain with erections and erection issues. The penile shortening occurs because the scarring of the erectile cylinders prevents them from expanding properly.
MEANS OF PREVENTING VANISHING PENIS SYNDROME
- Healthy lifestyle: wholesome nutrition, weight management, exercise including core and pelvic floor muscle training, tobacco cessation, moderation of alcohol intake, stress management.
- Stay lean: lose the pannus, regain the penis.
- Stay sexually active: Use it or lose it. If erections cannot be achieved, check with your urologist who can certainly help.
- Testosterone replacement under the circumstance of symptoms of low T and lab testing confirming low T levels.
- For shortening issues after prostate surgery or from Peyronie’s, management options include oral medications, traction therapy, vacuum suction therapy, injection therapy, penile implants, etc.,…check with your urologist for assistance.
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States. His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
PROSTATE CANCER 20/20 is now available at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
Our Greatest Wealth Is Health 