By Dr. Jonathan Clavell, Urologist Specializing in Sexual Medicine and Penile Implant Surgery
Have you ever wondered how we measure the penis for a penile implant—or how we decide what size to use? You’re not alone. One of the most common concerns men have before surgery is about size. If you’ve noticed your penis looks shorter due to erectile dysfunction (ED), you’re probably wondering: is there a way to restore or even maximize that length?
Let’s talk about what really happens—before, during, and after penile implant surgery—and what can be done to help you get the best possible outcome.
This blog is intended for educational purposes only and is not a substitute for professional medical advice. Always speak with your urologist or surgeon about your specific situation.
Why Does Erectile Dysfunction Cause Shrinkage?
Many men with long-standing ED experience a gradual loss of length over time. Here’s why: the penis is an elastic organ that needs regular blood flow and stretching to maintain its natural size. If you’re no longer having nighttime erections (which are common during healthy sleep), that natural “stretching” stops. Over time, this can lead to shortening of the penile tissue.
What You Can Do Before Surgery to Help Maximize Size
Use ED Medications—If Appropriate
If your doctor approves, taking a low daily dose of Tadalafil (2.5–5mg) can help increase oxygen-rich blood flow to the penis. Even partial erections can help keep the penile tissue healthy and stretched.
Just make sure to stop ED medications in the 24–48 hours before surgery to avoid complications with anesthesia.
Train with a Vacuum Erection Device (VED)
A vacuum pump can help you preserve and possibly increase your length before surgery by stretching the penile tissues.
Here’s how to use it effectively:
- Apply lubrication to the base.
- Seal the pump against the pubic bone.
- Create suction until you feel a firm but not painful stretch.
- Hold for 10–15 seconds, release, and repeat 10–15 times.
- On the last repetition, hold the stretch for 2–3 minutes.
Do this exercise 2–3 times daily for several weeks—like training your penis for “race day” (surgery day).
🚫 Avoid using the pump for 2–3 days before surgery to prevent bruising.
⚠️ Don’t compare your penis size in the vacuum pump to your post-op size. The pump compresses the fat pad, making the penis look longer than it will visually appear after surgery. However, what you see in the pump may be close to what you’ll functionally use during sex.
What Happens During Surgery to Determine Implant Size?
Patients often ask if their penis is measured before surgery. In reality, we determine the implant size during the procedure.
Here’s what happens in the operating room:
- Once you’re asleep, we inject sterile saline into the penis to induce an artificial erection, fully stretching the tissue.
- We then measure from the pubic bone (proximal) to the tip of the penis (distal)—covering the entire internal length.
- The implant cylinders are selected to match that exact measurement.
We don’t oversize. Forcing a larger implant than your anatomy allows can lead to:
- Pain
- Penile curvature or deformity
- Cylinder erosion (implant pushing through the skin)
Our goal is always to maximize size safely, based on your anatomy at the time of surgery.
What You Can Do After Surgery to Improve Outcomes
Give It Time
It takes time for your penis to heal, swelling to go down, and the tissues to relax around the implant. You won’t see your final result right away—just like recovery from plastic or orthopedic surgery, it may take up to a year to see the full benefit.
Understand the Role of Arousal
When you cycle your implant without arousal, the penis might not look as full. Arousal brings blood flow, which can enhance the glans (head of the penis), tighten the skin, and give a more natural, fuller appearance.
Start Implant Cycling (When Cleared by Your Surgeon)
Cycling = inflating and deflating your implant daily. This helps stretch the penile tissues from the inside out, increasing both length and girth over time.
I typically recommend:
- Once or twice per day
- For at least 6 months
Want more detail? I cover the full cycling process in a separate video—just ask at your consultation for resources.
Final Thoughts: Trust the Process and Take the Next Step
From preparation to recovery, every step of the penile implant process offers an opportunity to help maximize your results—before, during, and after surgery.
The path to restoring sexual function and confidence is a journey—and choosing the right surgeon makes all the difference. At our practice, we’re committed to providing expert care, tailored solutions, and the support you need every step of the way.
👉 If you’re considering a penile implant or want to learn more about optimizing your results, schedule a consultation with Dr. Clavell today. We’re here to answer your questions and help you make informed, confident decisions about your care.
This article was authored by Dr. Jonathan Clavell. Dr. Clavell is a board-certified urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.