The 2026 Winter Olympics in Milano Cortina, Italy, were shaken by a controversy quickly dubbed “Penisgate” by international media. At the center of the discussion was an accusation as unusual as it is scientifically plausible: Some ski jumpers may have received injections of hyaluronic acid into their genitals to manipulate the measurements of competition suits and gain an aerodynamic advantage.

Initial reports surfaced in January 2026 in the German tabloid Bild, prompting an immediate response from the World Anti-Doping Agency (WADA). At a press conference in Milan during the Olympic opening ceremonies, WADA Director General Olivier Niggli admitted his concerns: “I’m not aware of the details of ski jumping and how it could enhance performance. If anything comes to light, we will examine it to see if it can be considered doping.”

Witold Bańka, WADA president, promised to personally investigate the matter.

Aerodynamic Basis

As odd as the premise may sound, it rests on solid physics. In ski jumping, the surface area of the suit is crucial to performance. As Sandro Pertile, the International Ski and Snowboard Federation (FIS) ski jumping men’s race director, explained, “Every extra centimeter on a suit counts. If your suit has a 5% bigger surface area, you fly further.”

The hypothesized mechanism works like this: Athletes are measured with three-dimensional body scanners at the start of each season, and their suits must conform to their measurements within a tolerance of 2-4 cm. A temporary increase in penile circumference through hyaluronic acid injections during measurement could therefore result in a suit that is slightly wider in the groin area, providing greater aerodynamic surface area during flight.

The potential impact would be significant. A study published in October 2025 in Frontiers in Sports and Active Living found that adding just 2 cm of fabric to a ski suit’s circumference increased jump distance by about 2.8 m, a difference that, in a sport where medals are decided by fractions of a meter, could prove decisive.

It’s important to note, however, that the FIS has categorically denied any concrete evidence of such a practice. FIS communications director Bruno Sassi told BBC Sport, “There has never been any indication, let alone evidence, that any competitor has ever made use of a hyaluronic acid injection to attempt to gain competitive advantage.” No athlete has been formally accused, and the “scandal” remains largely hypothetical and speculative.

Hyaluronic Acid Beyond the Face

Beyond sporting implications, the controversy has drawn attention to a procedure that remains relatively little known: the use of hyaluronic acid to increase penile girth.

Hyaluronic acid is a glycosaminoglycan naturally present in the human body and a key component of the extracellular matrix. Composed of glucuronic acid and N-acetylglucosamine, hyaluronic acid is found in joints, skin, eyes, and connective tissue, where it plays essential roles in hydration and lubrication.

The US FDA approved it as a dermal filler in 2003. Since then, it has become one of the most widely used materials in cosmetic dermatology, mainly to fill facial wrinkles. Its popularity stems from its ideal characteristics: good biocompatibility, a low risk for allergic reaction, reversibility, and predictable duration.

Over the past two decades, applications of hyaluronic acid have expanded well beyond the face. In ophthalmology, it is used during cataract surgery; in orthopedics, it is used for intra-articular injections in osteoarthritis; and more recently, it has been used in andrology. It is in this latter field that the substance has generated growing interest, offering a less invasive alternative to traditional surgical procedures for penile augmentation.

“It is wrong to consider hyaluronic acid injections into the penis as doping,” said Gabriele Antonini , MD, PhD, urologist and andrologist in Rome, Italy, who began using it for penile injections about a decade ago. “Hyaluronic acid is not a pharmacological doping substance and does not affect metabolism, endurance, or muscle strength. The technique is primarily for aesthetic and local functional purposes and always requires a specialist evaluation, appropriate patient selection, and dedicated clinical follow-up.”

Clinical Indications in Andrology

Medical literature identifies three main areas of use of hyaluronic acid in andrology, each with scientific evidence of varying efficacy.

Penile girth enhancement (PGE) is by far the most common indication. The procedure is mainly sought by men with what is known as small penis syndrome, a psychological condition characterized by excessive anxiety about penis size despite measurements that fall within clinical norms.

As documented in several psychological studies, many men tend to underestimate their own size and overestimate female preferences in this area, generating anxiety that can lead to mood disorders and sexual dysfunction.

Evidence on the procedure’s effectiveness is increasingly robust. A Chinese study of 230 patients who underwent PGE with hyaluronic acid between January 2018 and December 2019, published in the Asian Journal of Andrology, reported progressive but predictable increases in penile circumference: 2.66 ± 1.24 cm at 1 month after the procedure, 2.28 ± 1.02 cm at 3 months, and 1.80 ± 0.83 cm at 6 months. The overall complication rate was 4.3%, a rate considered acceptable for a cosmetic procedure.

A 2023 systematic meta-analysis published in Annals of Medicine and Surgery reviewed four randomized clinical trials with a total of 283 participants, comparing hyaluronic acid with polylactic acid, another filler used in this context. The results confirmed hyaluronic acid’s superiority not only for increasing circumference but also for improving patient-reported sexual satisfaction.

Injection of hyaluronic acid into the glans has been studied as an alternative treatment for premature ejaculation in patients who do not respond to conventional drugs. However, this indication remains more controversial and less well supported by evidence than PGE.

Although hyaluronic acid is generally considered safe, complications are not negligible. Reported rates range from 4.3% to 20%.

Early complications (0-30 days) include subcutaneous bleeding (1%-2%), penile edema (3%-5%), and infections (1.5%-2%). Late complications (more than 30 days) include subcutaneous nodules (4%-6%), filler migration (7%-8%), asymmetry (6%), and rarely phimosis and paraphimosis.

Management ranges from simple observation for minor complications to the use of hyaluronidase to dissolve the filler and up to surgical excision in refractory cases.

WADA’s Position

WADA experts have already stated that hyaluronic acid is not currently included in the list of prohibited substances. The fundamental question they must address is whether its use should be considered doping or equipment manipulation. Its hypothetical effect would be indirect, mediated through a slightly looser suit.

In 2025, Norwegian Olympic Champions Johann Andre Forfang and Marius Lindvik received 3-month suspensions for reinforcing the seams at the crotch of their suits. This precedent suggests that manipulation of the groin area could be considered an ethical violation.

Clinically, the “Penisgate” scandal has exposed a relatively little-known procedure in contemporary aesthetic medicine. Physicians should be prepared to manage unusual requests arising at the intersection of medicine, aesthetics, and human performance — even if the entire Olympic episode ultimately proves to have been, in the end, a false alarm.

This story was translated from Univadis Italy, part of the Medscape Professional network.