Posts Tagged ‘penile shrinkage’

10 Common Penile “Flaws” You May Have That Are Actually Quite Normal

October 14, 2017

 Andrew Siegel MD   10/14/17

A penis is a special organ—a man’s joy, if not pride—and certainly one of his most prized, appreciated and cherished possessions, to which he has a significant attachment. As multifunctional as a Swiss Army knife, it allows him to stand to urinate (an undervalued capability), rises and firms to the occasion to allow for sexual penetration, and ejaculates genetic material–the means to perpetuate the species. A marvel of hydraulic engineering, within nanoseconds of sexual stimulation it is uniquely capable of increasing its blood flow 50 times over baseline, transforming its shape and size. Penis magic!

Each and every penis is unique.  As variable as snowflakes, they come in every size, shape and color. Beyond “size matters”—often a source of male preoccupation—men are often obsessed, if not preoccupied, with the appearance of their genitals.  In my interactions with patients, concerns are often voiced about symmetry, color, pigmentation, angulation, spots, blemishes, vein patterns, shrinkage and other oddities. Unless you are in the habit of closely inspecting other men’s genitals (as urologists are), you are unlikely to realize how common and completely normal most of these genital variations are.

 10 Common Penile “Flaws” You May Have That Are Actually Quite Normal

  1. Penis leans to one side

left or right

No human is perfectly symmetrical and the flaccid penis rarely hangs perfectly centered. Wherever your penis naturally lies when you are clothed—whether left or right—is not indicative of your political leaning or left vs. right-sided brain predominance and is of absolutely no significance or consequence whatsoever!

Interesting trivia: “Throckmorton’s sign” is a term used jokingly by medical students, residents and attending physicians. A positive Throckmorton sign is when the penis points to the side of the body where the pathology is, e.g., if a man is getting surgery for a right groin hernia and the penis points to the right side. The Throckmorton sign indicates the proper side of the pathology at least 50% of the time!  Operating room humor! 

  1. Slight penile curvature when erect

pixabay banana

Thank you Pixabay, for image above

Again, although perfect symmetry may be desirable, the norm for the erect penis is not to be perfectly straight. There is often a subtle bend to the left, right, up or down.  Some men have a penis that has a banana-like curvature. Slight bends—considered totally normal—are to be distinguished from Peyronie’s disease, a condition in which there is significant angulation due to scarring of the sheaths of the erectile chambers. It is a potentially serious condition that can cause painful erections and erectile dysfunction.

  1. One testicle hangs lower

pixabay plumsThank you Pixabay, for image above

If you ever wondered why one of your testes is slightly bigger or heavier and hangs lower than the testes on the other side, you are in good company. Paralleling women with breast asymmetry, the vast majority of men have testes asymmetry, so your mismatched gonads are perfectly normal.

  1. Dark genital skin

Hyperpigmentation (darkening) of the median raphe (the line running from anus to perineum to scrotum to undersurface of penis) and other areas of the penis is extremely common.  In fact, it is normal for the penile skin color to be darker than other areas of the body, because of the effect of sex hormones on the cells that produce pigment (melanocytes).  The circumcision line, as well, is often deeply pigmented.

  1. Freckles, moles and skin tags

pixabay spottedThank you Pixabay, for image above

The penis is covered by skin–just like the rest of the body–and is therefore subject to common benign skin growths, including moles, freckles and skin tags. These are generally harmless and usually do not require any treatment unless desired for cosmetic reasons. However, if you have a growth that changes in size, color or texture, you should have it checked out because penile cancers do occur on occasion.  Skin tags are small fleshy protuberances and can be confused with genital warts, so if you have any doubt, get checked.

  1. Other penis and scrotal bumps and lumps

Pearly penile papules are raised “pearly” bumps that appear around the corona (the base of the head of the penis). They consist of one or more rows of small, fleshy, yellow-pink or transparent, smooth bumps surrounding the penile head. They are benign and do not cause harm, but sometimes are treated for cosmetic reasons, usually with freezing or lasering.


Pearly penile papules, By AndyRich48 (Own work) [CC BY-SA 4.0 (, via Wikimedia Commons

Sebaceous glands produce oil that nourishes the hair follicles of the genitals. These glands appear as numerous small yellowish bumps on the scrotum and penile base.  In some men, they are prominent and referred to as sebaceous gland hyperplasia.  At times, they can exist without a hair follicle even being present.  Regardless, they are a normal occurrence.  See public domain image below–a.k.a. Fordyce spots.

Fordyces_spot_closeup.public domain. jpg

  1. Scattered scrotal spots

Angiokeratomas are benign purplish skin growths with a scaly surface that are not uncommonly present on the scrotum. They consist of dilated thin-walled blood vessels with overlying skin thickening. These skin lesions can occasionally bleed and also cause fear and anxiety since they can resemble more serious problems such as melanoma. If in any doubt, get it checked out.


Scrotal angiokeratomas, By Jlcarter2 (Own work) [GFDL ( or   CC BY-SA 3.0 (, via Wikimedia Commons

  1. Veiny vanity

Every man has a unique penile venous pattern, the anatomy as unpredictable as the distinctive venous anatomy of the hand and wrist. In some men, the veins are twisted and prominent and in other men they are barely noticeable.  No matter what the pattern, venous anatomy is highly variable and individualized and is normal.

  1. Loose skin

Unlike most other skin on the body that is more tightly attached, penile skin is loosely attached to underlying tissues, allowing for expansion with erections. Since the physical state of the penis can vary from totally flaccid to totally rigid, when the penis is fully deflated, the skin may appear to be somewhat floppy and redundant, which is absolutely normal.  Scrotal skin often becomes increasing lax with the aging process, such that the testicles typically hang quite low in the elderly male, paralleling the common situation of pendulous breasts of the elderly female.

10. Shrinkage

Penile size in an individual is quite variable, based upon penile blood flow. The more blood flow, the more tumescence (swelling); the less blood flow, the less tumescence. “Shrinkage” can be provoked by exposure to cold (weather or water), the state of being anxious or nervous, and participation in sports. The mechanism in all cases involves temporary reduced blood circulation.  Don’t worry, that sorry and spent looking penis can magically be revived with some TLC!

Bottom line: If you have an imperfect penis…welcome to the club!  No penis or scrotum is perfect.  Far from being an object of beauty, genital imperfections are the norm, so there is no need for feeling self-conscious. Just be happy that your little “fella” can function properly and enjoy his own happiness from time to time! Function over form!

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.



“Welcome To The Club”

June 20, 2015

Andrew Siegel MD 6/20/15


(Thank you Pixabay for above image)

“Welcome to the club.” These four words have become my favorite response to a variety of the presenting complaints of my middle-age patients. As a fifty-something year-old male, I am a member of this club, the one in which things are not necessarily bad or problematic, but certainly different from the way they used to be.

I find that this sentence—gently stated in a heartening manner with a smile on my face—is calming and reassuring to my patients who are uncertain if they have a genuine medical issue that they might need to be concerned about. By being told that they are “members of the club,” they immediately understand that their complaint is not only common and shared by many of their peers, but also is to be expected and is not a major concern.

“Things fall apart, the center cannot hold.” –Chinua Achebe

Things change. We get older and we look and function differently…again, not necessarily badly, but differently. Unfortunately, humans do not come with a “user manual” that explains what to expect as we age, which could help us make the distinction between the normal expectations of aging as opposed to problems that demand medical attention. On my bucket list is to write such a “Manual of Man,” at least from a urology perspective, discussing the urinary, genital and sexual changes to be expected with the aging process. The challenge is to recognize the difference between “normal aging” and “pathological aging.”

On Becoming A Slack In The Sack

Sex Drive

After age 40, you are still interested in sex, but not nearly with the all-consuming passion you had decades before. Testosterone levels fall ever so gradually, resulting in this decrease in sexual appetite. That stated, libido seems to be the element of male sexuality that survives the longest, intact to some extent long after the penis functions only to allow you to stand to urinate. However, what was once a raging “fire” may now be mere “embers.”  It can be a source of great frustration to have functioning software but poorly functioning hardware!


You still may be able to get a respectable erection, but now it probably requires a bit more effort—often demanding touch for full arousal, whereas at one time it took only a smidgeon of erotic stimulation. Although the penis may be capable of getting hard enough for penetration, it has probably lost some of the rock-star majestic rigidity of yesteryear. Although the erection still can defy gravity, it might not have quite the angle it used to. On occasion the erection may soften before the sex act is completed. Nighttime and morning erections are fewer and farther between. Getting a second erection after climax is difficult, and you probably have more interest in going to sleep rather than pursuing a sexual encore.

Ejaculation and Orgasm

Ejaculation becomes noticeably different. The volume of semen is diminished and you question why you are “drying up.” Climax happens with less force and arc, sometimes just a mere dribble; your once “high-caliber rifle” is now a “blunt-nosed handgun.” Orgasms are unquestionably different with loss of some kick and intensity. At times, it may feel like nothing much happened—more “firecracker” than “fireworks.” Sperm quality also tends to go by the wayside with aging, but who really cares since procreation is for the next generation!

The penis often becomes less sensitive, not only making it more difficult to achieve and maintain an erection, but also at times giving rise to difficulty achieving climax, with delayed ejaculation. Perhaps this is an improvement over the premature ejaculation that may have been an issue when you were younger.

Changes In Genital Anatomy


Not a day goes by in my urology practice when I don’t hear the words: “Doc, my penis is shrinking.” The truth of the matter is that the penis can shrink from a variety of circumstances, but most of the time it is a mere illusion—a sleight of penis. Weight gain causes a generous pubic fat pad—the male equivalent of the female mons pubis—making the penis appear shorter. However, penile length is usually intact, with the penis merely hiding behind the fat pad, what I call the “turtle effect.”

There are genuine reasons for penile shrinkage such as treatments for prostate cancer including radical prostatectomy and testosterone deprivation as well as “disuse atrophy,” penile “wasting” resulting from not using the penis as nature intended. Additionally, with aging there is often a fatty plaque buildup within the penile arteries, loss of erection chamber smooth muscle and elastic tissue (replaced with scar tissue) and weakening of the pelvic floor muscles. This results in less elastic and expansive erection chambers that do not fill up and trap blood properly.  It also causes a loss in penile length, girth and the ability to maintain the high penile blood pressures that cause bone-hard rigidity. If scar tissue forms on the sheath of the erectile chambers, it can cause penile curvature and pain with erections, a.k.a. Peyronie’s disease.

On Becoming Slack In The Sac

While the penis may shrink, the scrotal sac expands, time and gravity being cruel conspirators. This smaller penis and larger and looser scrotum–appearing like the genitals of an old hound dog snoozing on the veranda–is not a particularly appealing sight! While the sac expands, the testicles often shrink in size. One of the complaints voiced not infrequently by middle-aged and older men is that their testicles hang down loosely, similar to pendulous breasts in older women. At times, men complain that when they sit on the toilet, their scrotum touches the toilet water. Ouch! The scrotum may hang so low that when you pass wind, your testicles may become airborne like a kite flying erratically in a sudden gust.

Urinary Woes

The only male organs that get bigger with age are our noses, ears, scrotums and prostate glands. Unfortunately, the prostate is wrapped precariously around the urethral channel and as the prostate enlarges it can constrict the flow of urine. You may observe a weaker stream that hesitates to start, takes more time to get going and longer to empty, starts and stops and the sensation that you have not emptied completely. You might notice that you urinate more often, get up one or more times at night to empty your bladder and when you have to go, it comes on with much greater urgency than it used to. Almost universal with aging is post-void dribbling, that annoying dribble that occurs after emptying your bladder.

Bottom Line: If you are a middle-aged male and are experiencing some of these symptoms, “Welcome to the club.” If these symptoms become annoying and interfere with your quality of life, it is time to check in with your friendly urologist!

Wishing you the best of health,

2014-04-23 20:16:29


A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback:

Co-founder of Private Gym:

available on Amazon and Private Gym website

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to properly strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic strength and tone. This FDA registered program is effective, safe and easy-to-use: The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximum opportunity for gains through its patented resistance equipment.


Use Your X or Lose It

November 1, 2014

Andrew Siegel, MD

Use X or lose it…X can be anything–you fill in the blank–your muscles, your brain, your bones, your sexual function.

The cells and tissues of our bodies—including muscles, bones, brains, and every other organ—are endowed with a remarkable capacity for “plasticity,” the quality of being able to be shaped and molded in an adaptive response to the environment they are exposed to. What it comes down to is that our human body is an “adaptation machine.”   Our composition is “fluid” as opposed to “static,” and our tissues are constantly being remodeled, restructured and refashioned in adaptive responses that occur in accordance to the forces, stresses, resistances and demands placed upon them. This plasticity is an amazing phenomenon that can be tapped into by purposely challenging our tissues with the appropriate resistances to enable them to perform at extreme high levels of function.

Today’s blog is a discussion of use X or lose it in the context of male sexual function.

Hard Fact: If you go for too long without an erection, smooth muscle and other tissues within the penis may be damaged, resulting in a loss of penile length and girth and negatively affecting your ability to achieve an erection.

Your penis needs to be utilized the way nature intended, just like every other body component…and that means not just to direct your urinary stream with laser-like precision! Your penis is a marvel of engineering, uniquely capable of increasing its blood flow by a factor of 40-50 times over baseline, this surge of blood flow happening within seconds and accomplished by relaxation of the smooth muscle within your penile arteries and erectile tissues. When your penis is erect, not only is rigidity achieved, but the erection also serves to keep your penile muscles and tissues richly oxygenated, elastic and functioning well. The dramatic increase in penile blood flow that occurs with an erection enhances subsequent erectile performance via the release of nitric oxide, one of the important chemical mediators of erections.

In the absence of regular sexual activity, disuse atrophy (wasting away with a decline in anatomy and function) of your penile smooth muscle and erectile tissues can occur. In a vicious cycle, the poor blood flow resulting from lack of use produces a state of poor oxygen levels in the penile tissues, that, in turn, can induce scarring, which can further compound sexual dysfunction.

Scientific studies have found that sexual intercourse on a regular basis protects against ED and that the risk of ED is inversely related to the frequency of intercourse. Men reporting intercourse less than once weekly had a two fold higher incidence of ED as compared to men reporting intercourse once weekly.  (Am J Med 2008 July;121(7): 592-596).

Radical prostatectomy, the surgical removal of the prostate gland for treatment of prostate cancer, can cause penile shortening. The gap in the urethra (because of the removed prostate) is bridged by sewing the bladder neck to the urethral stump, with a consequent loss of length thought to be on the basis of a telescoping phenomenon. Erectile dysfunction associated with damage to the nerves that are responsible for erections further compounds the shortening by causing disuse atrophy and scarring. For this reason, getting back in the saddle as soon as possible after surgery will help “rehabilitate” the penis by preventing disuse atrophy.

A Few Words on Adaptation

Your muscles and other tissues are capable of hypertrophy (growth) or atrophy (shrinkage), depending upon the environment to which they are subject to. Exposure to a stimulating and active “environment” on a long-term basis can positively affect not only your external appearance, but also more importantly, your internal health. Conversely, exposure to a non-stimulating, sedentary environment on a long-term basis can negatively affect your external appearance and internal health.

Every cell, tissue and organ of your body is endowed with a remarkable capacity for “plasticity,” the quality of being able to be shaped and molded in an adaptive response to environmental changes. It deserves repeating that your body and its parts are “fluid” as opposed to “static” and are constantly being remodeled, restructured and refashioned in adaptive responses occurring in accordance to the forces, stresses, resistances and demands placed upon it.

Use It or Lose It

Our bodies demand physical activity in order to function optimally. For example, our bones require weight bearing and biomechanical stresses in order to stay well mineralized and in peak functional condition, as bone mineralization is stimulated by the stresses brought on by a variety of movements. The same holds true for every organ in our body—to maintain maximal functioning they need to be put into the service for which they were designed. As much as our bodies adapt positively to resistance, so they will adapt negatively to a lack of resistance. For example, after wearing a cast on one’s arm for 6 weeks, there is noticeable wasting of the arm muscles, nothing other than disuse atrophy. This phenomenon will occur to any body part not used in the manner for which it was designed.

Beyond Using It

The magic of plasticity and adaptability can be tapped into by challenging your body to adapt to resistances to enable it to perform at extreme levels of function. Exercise is about the adaptation—in neuromuscular, mechanical, and metabolic terms—to the specific demands that are placed on it. As your body is subjected to gradual and progressive “overload,” adaptation occurs and a “new normal” level of fitness is achieved.

Your pelvic floor muscles play an important role during erections, activating and engaging to help maintain penile rigidity and a skyward angling erection. There is good reason that the 1909 Gray’s Anatomy labeled one of the pelvic floor muscles the “erector penis.” Numerous studies have documented the benefits of male Kegel exercises in the management of ED.

Participating in a pelvic floor muscle training program can be a very useful tool to improve ED. It will sharpen your awareness of your pelvic floor muscles and enable you to isolate them and increase their strength, tone, and endurance. As your pelvic floor muscles become more robust, erections will improve accordingly. A comprehensive program such as the Private Gym includes a basic series of progressive male Kegel exercises without resistance followed by the use of resistance equipment to maximize pelvic floor muscle strengthening and performance. The pelvic muscles—like any other muscle in your body—will gradually and progressively adapt to the load placed upon them and will strengthen in accordance with the resistance.



Elston Howard was a New York Yankee who invented the batting “donut,” a circular lead weight that slides onto baseball bats and is used by on-deck batters. This added weight during practice swings is useful for stretching, enhancing bat speed and strength training; additionally, it makes the bat feel very light once it comes time to step up to the plate and remove the weight. Howard employed the resistance principle to heighten power—use the weighted bat in practice and when it comes time to step up to the plate, you’re going to perform better.


batting donut on bat


This principle will work on your “bat,” too—utilize resistance training in practice and when it comes time to “step up to the plate,” you’re going to perform better. Resistance training turns conditioning into a weapon that is capable of producing “outstanding” erections, maximizing endurance, and  boosting one’s confidence.

Bottom line: You can lose it, maintain it, or optimize it by not using it, using it, or subjecting it to exercise and resistance training, respectively. You are bestowed with an amazing and magical capacity for plasticity and adaptation, which can be transformative when used to your advantage and benefit.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Note: As Arnold Kegel popularized pelvic floor muscle exercises in females in the late 1940’s, so I am working towards the goal of popularizing pelvic floor muscle exercises in males. This year I published a review article in the Gold Journal of Urology entitled Pelvic Floor Muscle Training in Men: Practical Applications to disseminate the importance and applications of these exercises to my urology colleagues. I wrote Male Pelvic Fitness: Optimizing Sexual and Urinary Health, a book intended to educate the non-medical population. I, along with my partner David Mandell and our superb pelvic floor team, co-created the Private Gym male pelvic floor exercise DVD and resistance program.

For more info on the book:

For more info on the Private Gym: