From the Guidelines
Penile retraction can occur naturally with aging in male patients, but treatment is not always necessary unless it causes significant urinary problems or sexual dysfunction. This phenomenon, sometimes called "buried penis" or "hidden penis," occurs due to hormonal changes, decreased blood flow, increased fatty tissue in the pubic area, and weakening of the suspensory ligament that supports the penis, as noted in the context of erectile dysfunction management 1. Additionally, conditions like erectile dysfunction and Peyronie's disease can contribute to this change. When treatment is needed, options include:
- Weight loss for overweight men
- Testosterone replacement therapy for those with low testosterone levels
- Vacuum devices to improve blood flow
- In some cases, surgical procedures to remove excess fatty tissue or repair the suspensory ligament. Regular exercise, maintaining a healthy weight, avoiding smoking, and managing chronic conditions like diabetes can help minimize these age-related changes, which is in line with the approach to managing lower urinary tract symptoms in older men, emphasizing shared decision making and consideration of individual benefits, risks, and costs of treatment strategies 1. Men experiencing significant penile retraction that affects urination or sexual function should consult a urologist for proper evaluation and personalized treatment recommendations.
From the Research
Penile Retraction and Aging
- Penile retraction is not directly addressed in the provided studies, but Peyronie's disease, which can cause penile curvature and retraction, is discussed in several studies 2, 3, 4, 5, 6.
- Peyronie's disease is an acquired inflammatory condition that can cause fibrotic, nonexpansile thickening of the corpora tunica, resulting in focal bend, pain, or other functional or structural abnormalities of the erect penis 3.
- The disease primarily affects men between 45 and 60 years of age, although it can occur in men as young as 18 or as old as 80 3.
Treatment of Penile Retraction and Peyronie's Disease
- Treatment options for Peyronie's disease include medical therapies, such as antioxidants and corticosteroids, but these lack adequate scientific support 3.
- Surgery is a mainstay of treatment when conservative measures fail, and penile traction therapy (PTT) has gained interest as a novel nonsurgical treatment option 3, 4, 5, 6.
- PTT has been shown to be safe and well-tolerated, and can result in increased penile length and reduction of penile deformity in selected cases of Peyronie's disease 4, 5.
- However, patient compliance is critical, and new devices and traction protocols are needed to maximize the benefit of PTT 6.
Penile Traction Therapy
- Penile traction therapy devices, such as the RestoreX device, have been developed to treat Peyronie's disease and have shown significant improvements in penile curvature and length, as well as erectile function in men with erectile dysfunction and Peyronie's disease 4.
- The use of PTT as a primary or adjunctive treatment for Peyronie's disease, as well as its use in the perioperative period, has been reviewed in the literature 6.
- While PTT appears beneficial, the true magnitude of effect is difficult to discern due to the lack of randomized controlled trials and varying traction protocols 6.