Vasectomy Does Not Cause Penile Shrinkage
Vasectomy does not cause penile shrinkage. The comprehensive AUA guidelines on vasectomy make no mention of penile size changes as a complication or consequence of the procedure, and this concern is not supported by medical evidence 1.
What Actually Happens After Vasectomy
Anatomical Changes Are Limited to the Vas Deferens
- The only documented anatomical change after vasectomy occurs in the vas deferens itself—the lumen on the testicular side dilates due to internal pressure from accumulation of spermatic fluid, with approximately 70% increase in internal diameter within the first postoperative year 2
- This dilation causes thinning of the vas wall without significant increase in external diameter, and importantly, this change is confined to the vas deferens, not the penis 2
- The procedure involves only occlusion or removal of a small segment (typically 1 cm or less) of the vas deferens, which is located in the scrotum and has no anatomical connection to penile tissue 1
Hormonal Function Remains Normal
- There are no major short- or long-term changes in the pituitary-testicular axis due to vasectomy, meaning testosterone production and other hormonal functions remain intact 3
- The secretory functions of the prostate and epididymis may be transiently altered but return to normal, and these changes do not affect penile size 3
Recognized Complications of Vasectomy
What the AUA Guidelines Actually Document
The documented complications that should be discussed with patients include 1:
- Hematoma and infection: 1-2% occurrence rate
- Chronic scrotal pain: Affects 1-2% of men with negative impact on quality of life, with few requiring additional surgery 1, 4
- Sperm granuloma: Can occur as a post-vasectomy complication 4
- Occlusion failure: Less than 1% when proper techniques are used 1
Common Pitfall to Avoid
- Do not confuse scrotal changes with penile changes. Patients may experience temporary scrotal swelling, bruising, or discomfort, but these are localized to the scrotum and do not affect the penis 5, 6
- The no-scalpel technique has particularly low complication rates, with hematoma occurring in only 0.09% of 179,741 men in large Chinese studies 6
Patient Counseling Points
- Reassure patients that penile size is not affected by vasectomy, as the procedure is anatomically isolated to the vas deferens in the scrotum 1
- The penis and its blood supply, nerve supply, and erectile tissue remain completely untouched during the procedure 5
- Most patients return to regular physical and sexual activity after 1 week, with no long-term changes to sexual function or anatomy 5