Medical Oncologist
CION Cancer Clinics
Penile shortening after prostatectomy: why it happens and what helps | CION Cancer Clinics
Yes, many men notice some loss of length after a radical prostatectomy, and it is a real change. It is usually small, of the order of a centimetre, and part of it recovers over the first year or two as erections return. Nothing is cut from the penis. The join between bladder and urethra pulls it slightly inward, and months without erections let the tissue shrink. This page explains both causes and what may limit them. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Does the penis get shorter after prostatectomy?
- What exactly is making the penis shorter?
- How does it change over the first two years?
- Four things men tell us, and what is actually true
- Words your doctor may use, in plain language
- What may help, who it does not suit, and what this page cannot tell you
- Common questions about penile shortening after prostatectomy
The short answer
Does the penis get shorter after prostatectomy?
Yes, many men notice some loss of length after a radical prostatectomy, and it is a real change rather than imagination. The loss is usually small, measured in a centimetre or so rather than more, and part of it recovers over the first year or two as erections return. Nothing is cut from the penis during the operation.
Why it happens
Two things are going on. First, when the prostate is removed, the urethra is joined directly to the bladder, and that join pulls the inner part of the penis a little further up into the body. Second, the months without erections mean less oxygen-rich blood reaching the tissue, and tissue that is not stretched regularly tends to shrink and stiffen. The first change is fixed. The second is partly reversible.
Why it is rarely mentioned beforehand
Surgeons focus on the cancer, on continence and on erections, and this comes further down the list. Many men only discover it when they notice the change themselves and wonder whether something went wrong. Nothing did.
Who notices it more
Men whose erections take longer to return, men who had no rehabilitation programme, and men who also had hormone therapy tend to notice more change. Men whose nerves were spared and whose erections recover early tend to notice less, and some notice none.
The causes
What exactly is making the penis shorter?
Four separate things contribute. Knowing which apply to you tells you what can be done about it.
The join pulls it upward
Removing the prostate leaves a gap between bladder and urethra. The surgeon closes it by bringing the two together, and that draws the hidden part of the penis slightly further inside. This is mechanical and permanent, but it is small.
No erections, so less blood
A healthy penis has several erections a night during sleep, which keep the tissue supplied with oxygen. After surgery these stop for months. Without them the tissue gets less blood and slowly loses its stretch.
This is the part rehabilitation aims at.Scar tissue inside the penis
When smooth muscle inside the penis is starved of oxygen for long enough, some of it is replaced by scar tissue, which does not stretch. Doctors call this fibrosis. It is the least reversible cause, and the reason early rehabilitation matters.
Hormone therapy, if given
Lowering testosterone shrinks the penis and testicles in its own right and removes desire, so there are even fewer erections. Men who have both surgery and hormone therapy usually notice the most change. Some of it returns after the therapy ends.
Not sure whether this applies to you?
Ask an oncologistOver time
How does it change over the first two years?
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The first weeks
Swelling, a catheter and a healing wound. The penis often looks smaller and retracted at this stage, and some of that is bruising and swelling that settles on its own.
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The first few months
This is when most men notice the change and worry. There are no erections yet, the tissue is under-used, and the loss of length is at its most obvious. Rehabilitation, if it is going to happen, should have started by now.
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Six months to a year
As erections begin to return, with or without help, the tissue is stretched again and some length comes back. Men using a vacuum device regularly often report this earlier than men who are not.
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The second year and after
What is left by now is usually what stays. For most men it is a small difference. If it is more than that, or if a curve has appeared, ask your surgeon, because there are treatments for both.
Commonly believed
Four things men tell us, and what is actually true
"The surgeon must have cut some of it away."
No part of the penis is removed or cut during a prostatectomy. The operation is entirely inside the pelvis. The change in length comes from the join pulling inward and from the tissue shrinking during months without erections.
"It is permanent and there is nothing to be done."
Part of it is fixed and part is not. The tissue shrinkage from lack of blood flow responds to regular erections, whether natural, from tablets, or from a vacuum device. Men who start early tend to lose less and recover more of it.
"This only happens to older men."
It happens at every age, because the causes are mechanical and to do with blood flow, not with age. Younger men often notice it more, because they are more likely to be sexually active and to compare with how things were.
"A vacuum device will stretch it back to exactly how it was."
A vacuum device helps keep the tissue supple and may limit the loss, and some men regain most of what they lost. It cannot undo the mechanical change from the join, and nobody can promise a particular result. Use it for what it does, not for what it cannot.
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In clinic
Words your doctor may use, in plain language
- Anastomosis
- The join the surgeon makes between the bladder and the urethra after the prostate is removed.
- Fibrosis
- Scar tissue replacing the stretchy muscle inside the penis. The cause of shortening that is hardest to reverse.
- Penile rehabilitation
- A planned programme of tablets, a vacuum device or injections to keep blood flowing into the penis while the nerves heal.
- Vacuum erection device
- A clear cylinder and pump that draws blood into the penis. Used without the ring, it is a way of stretching the tissue regularly.
- Peyronie's disease
- A curve or hard lump in the penis caused by scar tissue. It can appear after prostatectomy and is treatable, so mention it if you notice a bend.
Being straight with you
What may help, who it does not suit, and what this page cannot tell you
The single most useful thing is regular blood flow into the penis, started early. That means a rehabilitation programme agreed with your surgeon: tablets on a set pattern, a vacuum device used most days, or injections if those do not work. Traction devices are sometimes suggested; the evidence for them after prostatectomy is thin.
Who this does not suit
Men on nitrate heart medicines cannot use the tablets. Men with a bleeding disorder need advice before using a vacuum device. Men on hormone therapy may find the effort discouraging while desire is low. A man who is not troubled by the change does not need to do anything about it.
When to ask for help
If the change is more than you expected, if a curve or a hard lump has appeared, or if it is affecting how you feel about yourself or your marriage, say so at your review. These are ordinary questions for a surgical oncologist or a urologist.
What this page cannot tell you
It cannot tell you how much length you will lose or regain. That depends on the nerve-sparing, your erections before surgery, hormone therapy and what you do in the first year. Your surgeon can tell you what was found and what to expect in your case.
Did you know
The part of the penis you can see is only about half of it. The rest runs back inside the body, which is why a join that pulls the inner part upward by a small amount shows as a small loss of length outside.
Questions we are asked
Common questions about penile shortening after prostatectomy
How much shorter does the penis get after prostate surgery?
For most men it is a small change, of the order of a centimetre, and some notice none at all. A few notice more, usually men whose erections took a long time to return or who also had hormone therapy. Part of the loss recovers over the first year or two as erections come back.
Is the change permanent?
Partly. The small mechanical change from the join between bladder and urethra is fixed. The larger part, from tissue shrinking during months without erections, responds to regular blood flow and often improves as erections return. Starting rehabilitation early limits how much becomes permanent.
Will a vacuum pump bring the length back?
It can help. Used regularly without the ring, it stretches the tissue and keeps blood flowing, and many men who use one find they lose less and recover more. It cannot promise a return to exactly how things were. Ask your surgeon before buying one, and ask to be shown how to use it.
Does it affect the ability to have sex?
Not by itself. A small change in length does not stop intercourse or orgasm. What affects sex far more is whether erections have returned, and that is where rehabilitation is aimed. Couples who talk about the change openly find it matters less than they feared.
My penis has developed a bend. Is that related?
It may be. Scar tissue inside the penis can cause a curve or a hard lump, sometimes called Peyronie's disease, and it is seen more often after prostatectomy. It is treatable, especially early, so mention it at your next review rather than waiting to see if it settles.
Does hormone therapy make the shortening worse?
Usually yes. Low testosterone shrinks the penis and testicles in its own right and removes desire, so there are even fewer erections to keep the tissue stretched. Some of this returns after the therapy ends. Ask how long the hormone therapy is planned for and what can be done during it.
Should I have been warned about this before surgery?
Ideally, yes, alongside continence and erections. It is often missed because it is lower on the list than the cancer. If you were not told, that is a fair thing to raise with your surgeon, and it does not mean the operation was done badly.
Who do I talk to about this at CION?
Your surgical oncologist at any follow-up visit, or a urologist if you are referred on. It is a routine question and nobody will be surprised by it. If you would rather not raise it with family in the room, ask for a few minutes alone or call the helpline beforehand.
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Sources
- American Cancer Society — Surgery for prostate cancer
- Cancer Research UK — Surgery for prostate cancer
- National Cancer Institute — Sexual health issues in men with cancer
- NHS — Prostate cancer: treatment
- Macmillan Cancer Support — Prostate cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Penile Rehabilitation After Prostate SurgeryThe programme aimed at the part of this that is reversibleErectile Dysfunction After ProstatectomyWhy erections stop, and the timeline for their returnDry Orgasm and Changed SensationThe other changes to sex after this operationTalking to Your Wife About Life After ProstatectomyRaising this as a couple
Talk to us
Noticed a change and want to ask about it?
Tell us where you are since surgery and we will arrange time with a surgical oncologist. It is a routine question and you can ask it without family in the room. One helpline serves every CION centre.