Does the penis get thinner with age?
The European guideline does not describe a loss of penile girth as a normal part of ageing. It gives reference values, with a mean erect circumference of 11.66 cm, and shows how far size worries differ from reality. In one study, 84% of women were satisfied with their partner's size, while only 55% of men were satisfied with their own.
What is a normal penile girth?
The mean circumference of the penis is 9.31 cm when flaccid and 11.66 cm when erect. When a man is concerned about penile size, accurate measurement is a mandatory step in the assessment, and girth is measured in every man who reports a short penis, both near the head and at the middle of the shaft.
The European guideline gives no figures for girth loss with age. Conditions that become more common later in life can still change the shape or size of the penis. Peyronie's disease, for example, typically begins between 50 and 60, and its assessment includes length and girth.
When does worry about penis size need attention?
Worry about size is far more common than dissatisfaction from partners.
"In the real-life setting, 84% of females report being satisfied with their male partner's penile size, whereas only 55% of male partners were satisfied with their penile size and 45% reported that they would like to have a larger penis." Source 1, p. 92
Men who place a high value on social approval are more likely than others to report having a larger penis. The subjective impression of penile size can harm sexual function and quality of life in about 10% of men.
Body dysmorphic disorder is strong distress about a perceived flaw in appearance that others cannot see or that is only slight. It affects about 2.2% of men in the USA and 1.8% in Germany, and it is expected in 3% to 16% of people having cosmetic surgery. Small penis anxiety, by contrast, describes excessive anxiety about a penis of normal size.
Some men do not reach reasonable satisfaction after enlargement procedures, so a tailored psychological evaluation is part of the assessment. Psychotherapy is recommended when psychological conditions are found or when relationship problems may lie behind a request for enlargement.
Do girth enhancement treatments work?
Men increasingly ask urologists about girth enhancement to feel more confident, to like how the penis looks or to satisfy a partner. There are no precise definitions or indications for girth enlargement, either in the literature or in international guidelines. The evidence supporting these procedures in clinical practice is low, and surgery in this vulnerable group raises ethical concerns.
Injected fillers can come from the man's own fat, from biological materials or from synthetic materials. Penile traction can lengthen the penis but is not effective for increasing girth.
What else can change penile size later in life?
Treatment for prostate cancer can change penile size, and men having such treatment are told about this risk beforehand, together with other sexual changes. A newer traction device preserved penile length after prostatectomy better than no treatment.
Erectile dysfunction, which becomes more common with age, also changes how firm the erection is, and that can make the penis seem smaller. A penile implant is unlikely to restore size lost through scarring of the erectile tissue, and Peyronie's disease, which can scar and shorten the penis, is more common in men with erectile dysfunction and diabetes.