As men age, they experience various changes in their bodies, and the penis is no exception. These changes can affect both the physical appearance and the function of the penis. Common changes include a decrease in testosterone levels, which can lead to reduced libido and erectile function.

The penis itself may experience changes in size and shape, often becoming slightly shorter and less firm. Blood flow to the penis may decrease, contributing to difficulties in achieving and maintaining erections. Additionally, the skin of the penis may lose some of its elasticity, and sensitivity can diminish over time. Understanding these changes can help men manage their sexual health and seek appropriate medical advice when necessary.

Changes in the penis with aging

As men age, several changes can occur in the penis, impacting both its appearance and function. Here are the key changes:

Size and Shape:

• Reduction in Size: The penis may become slightly shorter and thinner due to the reduction in elasticity and loss of collagen in penile tissues.
• Curvature: Some men may develop a curvature, known as Peyronie’s disease, due to the formation of fibrous plaques within the penile shaft.

Erectile Function:

• Erectile Dysfunction (ED): Difficulty in achieving or maintaining an erection becomes more common due to decreased blood flow and reduced testosterone levels.
• Erection Quality: Erections might be less firm and less frequent.

Sensitivity:

• Reduced Sensitivity: There can be a decrease in penile sensitivity, making sexual arousal and orgasm more challenging.

Appearance:

• Skin Changes: The skin of the penis may lose its elasticity and become more wrinkled.
• Discoloration: Changes in pigmentation might occur, with the skin appearing darker or lighter.

Testosterone Levels:

• Decrease in Testosterone: Lower levels of testosterone can lead to reduced libido, affecting sexual desire and performance.

Health of Penile Tissue:

• Loss of Muscle Tone: The smooth muscle within the penis may weaken, contributing to changes in erectile function.
• Reduced Blood Flow: Vascular changes can lead to reduced blood flow, impacting the ability to achieve and sustain erections.

Understanding these changes can help men address concerns related to sexual health and seek appropriate medical care or lifestyle adjustments to maintain their sexual well-being as they age.

Causes of changes in the penis with aging

As men age, various changes can occur in the penis due to natural physiological processes and the effects of aging on different body systems. Here are some key causes and types of changes in the penis with aging:

Reduced Blood Flow:

• Atherosclerosis: Aging can lead to the hardening and narrowing of arteries, reducing blood flow to the penis and affecting erectile function.
• Reduced Nitric Oxide Production: With age, the body produces less nitric oxide, a molecule essential for relaxing blood vessels and facilitating erections.

Hormonal Changes:

• Decreased Testosterone Levels: Testosterone levels tend to decline with age, leading to reduced libido, erectile dysfunction, and changes in penile tissue.

Muscle and Tissue Changes:

• Loss of Smooth Muscle: The smooth muscle in the penis may decrease, leading to less rigid erections.
• Changes in Collagen: Aging affects collagen in the penile tissue, which can result in less elasticity and firmness.

Nerve Function Decline:

• Neuropathy: Conditions such as diabetes can cause nerve damage, affecting penile sensation and erectile function.
• General Nerve Degeneration: Aging can naturally affect nerve sensitivity and function.

Peyronie’s Disease:

• Scar Tissue Formation: This condition, which causes curved and painful erections, becomes more common with age due to the accumulation of scar tissue in the penile shaft.

Changes in Skin and Appearance:

• Thinning Skin: The penile skin may become thinner and less elastic with age.
• Reduced Pubic Hair: Hormonal changes can lead to a decrease in pubic hair density.
• Penile Shrinkage: A combination of decreased blood flow, muscle atrophy, and tissue changes can result in a slight reduction in penis size.

Medications and Health Conditions:

• Medications: Drugs for conditions such as hypertension and depression can have side effects that impact erectile function.
• Chronic Health Conditions: Diabetes, cardiovascular disease, and other chronic conditions common in older adults can affect penile health and function.

Lifestyle Factors:

• Smoking: Smoking can accelerate vascular damage and reduce blood flow to the penis.
• Alcohol Consumption: Excessive alcohol can impair erectile function.
• Sedentary Lifestyle: Lack of physical activity can contribute to overall poor vascular health.

Prevention of changes that occur in the penis with age

While it is not possible to completely prevent all changes in the penis that occur with age, there are several strategies that can help minimize or manage these changes, promoting overall penile health and function. Here are some key approaches:

Healthy Lifestyle:

• Regular Exercise: Engaging in regular physical activity helps maintain cardiovascular health, which is crucial for good blood flow to the penis.
• Balanced Diet: A diet rich in fruits, vegetables, lean proteins, and whole grains can support overall health and help manage weight, reducing the risk of conditions like diabetes and cardiovascular disease that can affect erectile function.

Avoiding Risk Factors:

• Smoking Cessation: Smoking damages blood vessels and can impair blood flow to the penis, contributing to erectile dysfunction.
• Limiting Alcohol: Excessive alcohol consumption can lead to ED and other health issues.

Regular Medical Check-ups:

• Monitoring Health Conditions: Regular check-ups can help manage conditions like hypertension, diabetes, and high cholesterol, which can affect penile health.
• Hormone Levels: Monitoring and managing testosterone levels can help maintain libido and erectile function.

Sexual Health:

• Regular Sexual Activity: Engaging in regular sexual activity or erections can help maintain penile tissue health and erectile function.
• Pelvic Floor Exercises: Strengthening the pelvic floor muscles through exercises like Kegels can improve erectile function and urinary control.

Mental Health:

• Stress Management: Chronic stress and anxiety can negatively impact sexual performance, so practices like mindfulness, meditation, and therapy can be beneficial.
• Addressing Mental Health Issues: Seeking help for depression, anxiety, or other mental health concerns can improve overall well-being and sexual health.

Medical Treatments:

• Medications: For men experiencing erectile dysfunction, medications like sildenafil (Viagra), tadalafil (Cialis), and others can be effective.
• Hormone Replacement Therapy: In cases of significantly low testosterone, hormone replacement therapy may be an option under medical supervision.

While aging is inevitable, these proactive steps can help maintain penile health and function, improving quality of life and sexual health in later years.

Treatment

Treating the changes in the penis that develop with age involves a combination of lifestyle modifications, medical treatments, and sometimes psychological support. Here are some common approaches:

Erectile Dysfunction (ED):

• Medications: Phosphodiesterase type 5 (PDE5) inhibitors such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) can help improve blood flow to the penis and facilitate erections.
• Vacuum Erection Devices: These devices create a vacuum around the penis, drawing blood into it and causing an erection. A constriction ring is then placed at the base of the penis to maintain the erection.
• Penile Injections: Medications such as alprostadil can be injected directly into the penis to induce an erection.
• Penile Implants: Surgical implants, either inflatable or semi-rigid, can provide a permanent solution for severe ED.

Hormonal Changes:

• Testosterone Replacement Therapy (TRT): For men with significantly low testosterone levels, TRT can help restore libido and improve erectile function. This can be administered via injections, patches, gels, or implants.

Peyronie’s Disease (Penile Curvature):

• Medications: Oral medications, injectable collagenase (Xiaflex), or topical treatments can help reduce plaque formation and improve curvature.
• Surgery: In severe cases, surgical options such as plaque excision, grafting, or penile prosthesis implantation may be necessary.

Reduced Sensitivity and Other Functional Changes:

• Lifestyle Changes: Regular exercise, a healthy diet, and quitting smoking can improve overall vascular health and penile function.
• Pelvic Floor Exercises: Strengthening the pelvic floor muscles through exercises like Kegels can enhance erectile function and control over ejaculation.

Psychological Support:

• Therapy: Counseling or therapy can address psychological factors contributing to ED, such as stress, anxiety, or depression.
• Sex Therapy: Working with a sex therapist can help address sexual dysfunction and improve intimacy and sexual satisfaction.

General Health Measures:

• Manage Chronic Conditions: Keeping conditions like diabetes, hypertension, and high cholesterol under control is crucial for maintaining penile health.
• Regular Check-ups: Routine medical exams can help catch and manage potential issues early.

Summary

As men age, the penis undergoes various changes affecting its appearance and function. Common changes include a reduction in size and firmness, decreased sensitivity, and changes in skin elasticity. Erectile function may also decline due to reduced blood flow and lower testosterone levels. These changes can lead to difficulties in achieving and maintaining erections. However, lifestyle modifications, medical treatments, and psychological support can help manage and mitigate these effects, maintaining penile health and sexual function. Regular exercise, a healthy diet, quitting smoking, and seeking medical advice for appropriate treatments are key strategies in addressing these age-related changes.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE