Clinical Conditions

Penile size differs between men of different ethnic backgrounds and large studies of penis girth and length have been conducted by condom manufacturers. What many men perceive as a short penis actually falls into normal range size. Based on many published charts, scientific articles, and self reported web based surveys, 95 % of caucasian men will fall into one of the following categories of size:

  • Average length of flaccid penis is between 3.4 inches and 3.7 inches (8.6 cm and 9.3 cm)
  • Average length of erect penis is between 5.1 inches and 5.7 inches (12.9 cm and 14.5 cm)
  • Average circumference of an erect penis is between 3.5 inches and 3.9 inches (8.8 cm and 10.0 cm)

Shortening of the penis can be a result of weight gain and the deposition of fat pubic area. This results in the visual shortening of penis. Obesity increases the risk of erectile dysfunction and heavy men who complain of loss of length may simply have inadequate blood flow to achieve adequate rigidity.

Less common reasons for shortening of the penis are inborn defects in response to a male hormone (testosterone), congenital cordae (tethering of penis), chromosomal abnormalities (rare), or a scar from Peyronie's disease (development of scars – plaques in the penis). Penile length may slightly decrease with age because of atrophy related to a decrease in testosterone level and the decreased frequency of erections. Prostate surgery may also damage the nerves and result in shortening of the penis. Thus, men who are concerned about penile size should be fully evaluated by a urologist specializing in sexual medicine, to exclude medical reasons for a change in penile size.

From our experience, a majority of men who are concerned about penile size are younger men in their late teens, 20s and early 30s, and men older than 60.

There is no "one for all" approach to evaluate and manage men concerned about penile size. However, if penile size and a decrease in girth is caused by a variant of Peyronie's disease, a so called "hour glass deformity", it can be successfully treated in specialized centers. A decrease in length of the penis after prostate surgery is managed by increasing the frequency of sexual interactions, corrections of underlying hormonal problems, and supplementation with antioxidants as shortening of the penis after prostatectomy is believed to be secondary to "free radicals", an active damaging form of oxygen which is produced in any part of the body after nerve injury.

Surgical management of a short penis is limited to liposuction and transposition of scrotal skin in men with abnormal position of the penis. Cutting the suspensory ligament with a traction system has been used in some centers to elongate the penis, however it is not a commonly performed procedure as its effectiveness is questionable in most cases, and the effects depend on accurate patient selection and lack of any postoperative scarring. Fat injection, fat flaps, and silicon injections have all been tried to increase girth of penis. Fat injections last temporarily as most adipose (fat) cells dissolve. Fat flaps have been described as a successful method of increasing girth and is occasionally performed in reconstructive surgery. Injection of silicon has often been disastrous with an uneven, "bumpy" surface of the penis, erosion through skin, and scarring of subcutaneous tissue.

Three common "home" methods are used to elongate the penis without medical supervision or proof of effectiveness:

  • penile tape (also used in foreskin restoration)
  • penile weight system
  • penile stretching using a controlled stretch device.

All are based on the assumption that by applying a pulling force on the penis, the penile tissues extend and men can achieve 0.25 to 0.75 cm increase in length.

The penile stretching using adjustable devices like Fastsize has been used in the treatment of Peyronie's disease (curvature of penis). Results of a study published in the Journal of Sexual Medicine showed a mild increase in penis length after daily use of Fastsize for treatment of Peyronie's disease. Subjectively, all men noted reduced curvature estimated at 10–40 degrees, increased penile length (1–2.5 cm), and enhanced girth in areas of indentation or narrowing. Objective measures demonstrated reduced curvature in all men from 10–45 degrees; average reduction for the group was 33% (51–34 degrees). There were no adverse events including skin changes, ulcerations, hypoesthesia, or diminished rigidity. When supervised by a urologist with a sexual medicine specialty, the stretching method using FastSize may be safe. However, the unsupervised stretching treatment has resulted in bruising of the penis, vein thrombosis, and damage to nerves of the penis, especially if weights are used.

Many web sites promote and sell devices, herbal preparations, and instructional DVDs for penile enlargement. We have reviewed some of the sites and it is almost universal that the pictures taken before treatment are taken with semi rigid penises. The trained eye of a sexual medicine specialist can recognize the arousal and rigidity of penises in pictures without much of difficulty, and we have not seen the convincing photographic documentation that those devices provide significant benefit.

The no-device self-exercise method recommends stretching the penis with the hand for extended times during day. However, no medical literature is available to suggest that this is an effective method of penile elongation.

Jelqing (jelq) is a type of exercise to increase girth of the penis by increasing positive pressure in the penis. By rolling the fingers from the base of the penis toward the head with the penis mostly rigid, the blood flow pushes on the side of penis and is supposed to stretch the tissues. This technique, in principle, is a modification of an old technique of the penile vacuum device (penile pump), where, by placing the cylinder on the penis and by creating negative pressure, the tissues get expanded. There are not medical studies evaluating the effectiveness of either jelqing or the penile pump to increase girth of the penis. The penile pump is occasionally used in our practice as part of the treatment of an hour glass deformity (narrowing of penis shaft). It is always combined with other medications and performed after an evaluation and training by a urologist.

Penis size is an import issue for many men and men of all ages are concerned about length and thickness of their penises.

Penile growth and development is a complex process regulated by genes, hormones, and enviromental factors. As with any health concern, men who are worried about their penis size should consult with a urologist trained in sexual medicine.

The Department of Urology at Weill Cornell Medical College is one of the top rated urology programs in United States. Dr. Darius A. Paduch, who runs Sexual Medicine in the Department, is a fellowship trained urologist with expertise in male sexual and reproductive health and will be happy to address concerns and evaluate any man who is concerned about the size of the penis.