Can penile shortening be treated or reversed?
Penile traction is the one lengthening approach the European guideline supports, as a conservative option. In one study, wearing a traction device for at least four hours a day for six months added 1.7 cm to stretched length. The guideline recommends against implants, penile disassembly and the sliding technique for lengthening, and against hormones after puberty.
How well does penile traction work?
Penile traction therapy uses a device that stretches the penis for several hours a day. In one study, men who wore a device for at least four hours a day for six months gained 2.3 cm in flaccid length and 1.7 cm in stretched length. In another, stretched length rose from 11.5 cm to 13.2 cm after three months.
"Consider the use of penile traction therapy as a conservative treatment to increase penile length." Source 1, p. 99
Traction seems effective for both flaccid and stretched length with minimal side effects, but it does not increase girth. The quality of evidence is poor, because there are no randomised trials and the studies are small.
Which lengthening treatments are not recommended?
A penile implant does not increase penile length, and the evidence for penile disassembly and the sliding technique, two operations that try to add length, is limited. A strong recommendation in the European guideline advises against offering any of these three to men who are seeking a longer penis.
It also warns against the sliding technique because of a significant risk of life-changing complications. Vacuum devices, which are used to treat erectile dysfunction, are an ineffective way to lengthen the penis.
Testosterone treatment does not increase penile size in adult men, including men with late-onset testosterone deficiency. Using testosterone or any other hormone to increase penile size after puberty is also advised against, as a strong recommendation.
Hormonal treatment has a role only earlier in life. Testosterone, a gel form of dihydrotestosterone and gonadotropin hormones can restore penile size in boys with micropenis or disorders of sex development, which is a different situation from an adult seeking more length.
What if shortening follows prostate surgery or Peyronie's disease?
Traction has also proved effective in restoring length or correcting deformity caused by several conditions, including Peyronie's disease and changes after radical prostatectomy. A newer traction device preserved penile length after prostatectomy better than no treatment.
Men who have an implant for erectile dysfunction often feel the penis is shorter. Measured losses are small, averaging 0.74 cm at one year in one study, and in some men with Peyronie's disease stretched length increased after an implant. An implant is still not a lengthening operation, because it does not increase penile length.
When is psychological support part of treatment?
The subjective impression of penile size can harm sexual function and quality of life in about 10% of men, and this proportion rises sharply among men seeking enlargement procedures. Some men do not reach reasonable satisfaction even after such procedures.
For this reason, a tailored psychological evaluation is part of the assessment. Psychotherapy is a strong recommendation when psychological conditions are found or when relationship problems may lie behind a request for enlargement. Clinicians are also asked to consider cultural standards so that they understand what the man expects.