Does Penile Girth Change With Age?

The 2025 EAU Guidelines on Sexual and Reproductive Health acknowledge that age is one of the risk factors associated with erectile dysfunction¹. While the guidelines don’t specifically quantify normal age-related changes in penile girth, they recognize that certain conditions and treatments, such as Peyronie’s disease and prostate cancer treatment, can shorten the penis. A recent study cited in the guidelines demonstrated that reducing the depth of penetration led to a statistically significant 18% reduction of overall sexual pleasure with an average 15% reduction in length of the penis, highlighting the importance of penile dimensions in sexual satisfaction². Age-related vascular changes, such as reduced blood flow, can contribute to decreased erectile function³. Additionally, hormonal changes, particularly declining testosterone levels associated with aging, may influence penile tissue composition and size⁴. The guidelines cite a study in which 45% of men said they would like to have a larger penis, even though 84% of women were satisfied with their partner’s penile size⁵.

For men experiencing significant erectile dysfunction with age, the guidelines discuss several types of penile implants that can restore erectile function, although they note implants do not increase penile length⁶. These include inflatable (two-piece and three-piece) and malleable (semi-rigid) implants. The three-piece inflatable implant consists of a pair of cylinders implanted in the corpora cavernosa, a pump placed in the scrotum, and a reservoir containing fluid placed in the retropubic space⁷. This type provides the most natural erection with significant control over both rigidity and girth⁸.

The guidelines emphasize that patient satisfaction rates with penile implants are high, at 92-100% for patients and 91-95% for partners with appropriate counseling.⁹ However, the guidelines caution that proper patient selection and counseling are essential, as some men with body dysmorphic disorder focused on penile size may not benefit from penile augmentation procedures¹⁰. For men concerned about age-related changes in penile girth without erectile dysfunction, a sensible general step is addressing modifiable risk factors that may contribute to vascular health, including smoking cessation, regular physical exercise, and management of conditions like diabetes and hypertension¹¹. The guidelines also note that certain medications for cardiovascular disease may have a detrimental effect on erectile function, whereas newer drugs have exhibited a neutral or even beneficial effect¹². It’s important to understand that the subjective impression of penile size may have a negative effect on sexual functioning and quality of life, impacting sexual life in about 10% of men¹³. This prevalence sharply rises in patients seeking penile augmentation procedures¹⁴. The guidelines emphasize that clinicians should be able to recognize psychologically vulnerable men through a tailored psychological evaluation, and should consider psychotherapy when psychological conditions underlie a request for penile enlargement¹⁵.