A penile implant (prothesis) is a device that is surgically inserted into the penis as a treatment for erectile dysfunction (ED). There are two main types of penile implants: the malleable implant that contains semirigid rods and is therefore always firm, and the more commonly used inflatable implant that is manually filled with fluid to achieve an erection.

Many men who suffer from permanent ED could benefit from getting a penile implant, particularly those for whom conservative treatment options have failed. Still, it is natural to have a lot of questions about the procedure. Perhaps unsurprisingly, one of the most frequently asked questions about penile implants is: Will I lose length after my surgery?

In short, it depends. Several peer-reviewed studies have documented cases of decreased penile length after penile implant surgery, but others assert that penile length is not significantly affected by this procedure. This may be because penile length is subject to a number of different factors, some of which may not even be related to the placement of a penile implant. Here are some of reasons why penile length may be objectively (or subjectively) decreased after getting an implant:

Penile atrophy may occur before the surgery.

Body cells and tissues atrophy (deteriorate or waste away) when they are not used. The tissues of the penis are no exception. On average, men who decide to pursue penile implant surgery wait 6.2 years to do so, while struggling with ED throughout this time period. Since ED makes it difficult to get and maintain erections by definition, chances are that the patient is not getting regular erections during this timeframe, leading to the atrophy of the penile tissues and possible shortening of the penis.

Other conditions and medical treatments may decrease penile length.

Often, ED is linked to other medical conditions that may also contribute to decreased penile length such as Peyronie’s disease (PD) and hypogonadism (low testosterone). Some medical treatments such as pelvic radiation and/or radical prostatectomy (the removal of the prostate) for prostate cancer can cause penile atrophy and impact penile length as well.

PD occurs when plaques of scar tissue form under the skin of the penis, causing it to bend or create an abnormal shape (e.g., an hourglass deformity), especially during erections. It can contribute to ED and decrease the length of the penis due to the curve it creates. On the other hand, hypogonadism occurs when the testes do not produce enough sex hormones, which can affect the length and girth of the penis.

The surgeon may be conservative when selecting penile implant size.

Distal erosion is a rare but serious complication of a penile implant procedure in which the implant begins to erode through the body’s tissues or skin. This complication is not as common with inflatable implants as it was with malleable implants, which are used less frequently these days. Nevertheless, surgeons may still decide to select an implant that is 1-2 cm less than the measured size of the penis to avoid this complication. Naturally, a smaller implant could reduce penis length.

Men may perceive a loss of penile length, even if it is not objectively so.

Some studies have shown that men who perceive their penises as shorter after penile implant surgery actually have the same penile measurements as they did before surgery. Therefore, it is a good idea to take measurements of the penis before and after surgery to confirm that length has not been lost. Also, while an implant will make the shaft of the penis hard, it does not engorge the glans penis (the head of the penis), so this situation may lead to a perceived loss of length that is not due to the implant itself.

How can one prevent the loss of penile length before and after getting a penile implant?

There are several proven ways to preserve penile length before and after the placement of a penile implant. If you are considering getting a penile implant, talk to your health care provider about which of these methods might be best for you.

• Use a vacuum erection device (VED) consistently before and after surgery. A VED can help expand the corpora cavernosa, which are the two columns of spongy tissue in the penis that fill with blood to create an erection.
• Cycle the implant as soon as possible after surgery, even if you do not plan to use the erection for sex. Using the implant helps preserve penile length. Some surgeons recommend inflating the device twice a day for at least 30 minutes starting a week after surgery, but consult your surgeon about what is right for you.
• Follow a penile rehabilitation plan, as outlined by your provider. Rehabilitation plans including oral ED medications, intraurethral suppositories, and/or intracavernosal injections may also help support penile length.

No matter what you decide with regard to getting a penile implant, keep in mind that penile length is usually not the biggest contributor to relationship and sexual satisfaction. Spending time with a partner and nurturing intimacy with this person is likely a more effective way to improve a relationship and sexual connection.

Resources:

• Habous, M., Giona, S., Tealab, A., Aziz, M., Sherif, H., Abdelwahab, O., Binsaleh, S., Ralph, D., Bettocchi, C., Mulhall, J.P., & Muir, G. (2019). Penile length is preserved after implant surgery. BJU international, 123(5), 885-890. DOI: 1111/bju.14604
  
  
• Mani, S. B., Henry, G. D., & Karpman, E. (2022). Penile Length Loss After Penile Implant Surgery. The Journal of Sexual Medicine, 19(6), 887-889. DOI: https://doi.org/10.1016/j.jsxm.2022.02.009