What can we do for our sex life after Peyronies gave me a 90 degree curved penis?

I was diagnosed by Dr. Levine about 7 years ago with Peyronies disease when I was 51 years old. When I told him I did not want to be cut on he politely told me he could not do anything more for me. I have read way too many horror stories about Peyronie surgery. Like I think I read on your website it does not make sense to operate on something that has already shown it is going to heal with an abnormal amount of scar tissue.

What I want to know is what can we do for our sex life after Peyronies has left me this way? My wife and me have had to be very careful about our sex life because my upward curve is close to 90 degrees, so there is a lot we can't do any more. We have learned to be satisfied with limited contact because my bent penis prevents complete entry. I am a lucky guy to have a wife who has stayed with me in spite of all this.

Thanks for all that you do.

W.

Greetings W.,

What I have written many times on the PDI website is that a man should be extremely careful and reluctant to undergo Peyronies surgery because of the increased risk of developing even more scar tissue and a worse case of Peyronie's disease after being cut on.  I have warned that before agreeing to undergo penis surgery it is very prudent to first use all of the possible non-surgical and non-drug options possible for at least a year before even thinking about being cut on to remove the PD scar tissue.  I am not against Peyronies surgery; I am against hasty and premature surgery as though it is the only option, and as though it is a simple and sure-fire cure for this terrible problem.  It is not. 

You ask for advice about your limited sex life, but I must back you up a bit and suggest that you might not have a limited sex life if your curve was improved or reduced.  This is a good place to start to help your sex life, by working to improve your Peyronie's disease.  It sounds like you have not tried to increase or support your ability to get rid of your PD on your own.   I suggest that you read How to start Peyronies treatment.

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The subject of sexual problems when Peyronies is in the bedroom is huge, and the subject of possible solutions is complicated.  There is so much to be said about improving sexual performance and compatibility in spite of a curved penis that must refer you to the book, “Peyronie's Disease and Sex.”   I wrote this book a few years back to address this problem that affects most couples who deal with Peyronies;  few couples are exempt; sex problems are common and just a matter of degree.  What I can tell you since writing this book is that almost all people who read it and follow the ideas in it will improve their sexual ability and regain either a small or large degree of their lost sexual pleasure.  As an outside observer in this area I can tell you that I have yet to find a couple whose sex life is not helped by using this book; some to a great degree and some to a small degree but everyone seems to gain something.   TRH      

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Can my congenital penis curvature be fixed by surgery or is there some other way to get help?

Hello Dr Herazy I am 34 years old and my penis bends down and left like a hook I have really hard erections and was wondering what can be done I don't think I have a plaque I have had this all my life . When my penis is flaccid if I stretch it out I can feel my left corpora cavernosa like a tight string and the right loose. Can I be fixed by surgery ? Thank you for your time.

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Greetings,

Of course, I cannot answer you in any direct or meaningful way since I have not examined your curved penis.

Your question has been asked and answered several times.  Please review the post Questions about straightening a congenital penis curvature and Stretching a congenital penis curvature. There are several other posts on this topic, all you have to do is enter “congenital penis curvature” in the search box and read all that comes up.

In doing this work this 2002 I have been surprised that many men report back to me that they have used the PDI gentle manual penis stretching method with success.   It is always used in conjunction with a variety of other therapies for best results.  I am not saying to forgo penis surgery, but if you do that as a first method of correction there is absolutely no way to undo bad results. (Surgery to correct bad surgery usually results in in worse results.)   I suggest to anyone that usually the best results occur while using conservative measures first, since there are little to no adverse consequences; if they are not effective you can always try more aggressive methods later.  TRH     

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Will this surgery work to correct my Peyronie’s disease?

I have peyronies a year and a half now with a 45 degree bend when erect.i have consulted my doctor.i have seen a surgeon and I am not satisfied with his straightening method.he just wants to put a slit in it and sew it back.i don't believe this would would work.i need a second opinion.i am on medical card and live in county roscommon in the west region of Ireland. i need a surgeon who is prepared to carry out the full and proper treatment I would be very thankful for your assistance doctor and advice.i am only 39 and this is ruining my relationships and I am depressed. please help me.


Greetings,

Are you sure you heard and understood everything that was told to you about this penis surgery?

I cannot directly comment about what your surgeon explained about the Peyronie's surgery he or she proposed because I was not there to hear the explanation you were given, and you were. However, as I understand penis surgery to correct a penile curvature caused by PD, the typical procedure is much more complex than simply putting a slit in the shaft and closing it up.  

If you are positive you were given this exact explanation, I suggest you contact another urology surgeon who will take your case more seriously for a second opinion.  Using the information that follows I propose that this next time around you be prepared to ask many questions and demand answers.  You should fully understand what is being proposed to you so you can make an intelligent and informed decision.  I also suggest that you spend some time on the Peyronie's Disease Institute website to learn about the possibility of using non-drug and non-surgical treatment to increase your ability to eliminate the Peyronie's plaque naturally.

I am sensitive to what you are asking and I understand your concern about penis surgery.  However, I have no way to know what is the full and proper surgical treatment for your particular problem, and frankly neither do you.  Something as vitally important and final as surgery requires a great deal of trust in the skill and competence of the surgeon in an area that a layperson does not have enough knowledge or skill to judge what needs to be done. Having said that, I think you might be correct to want to talk to another surgeon if only because it is not correct or proper that you were allowed to leave that office without a better understanding of the proposed surgery.  In my opinion, a half-hearted explanation is no explanation, and does not bode well for the kind of surgery that a doctor like that would provide.

There is always the possibility you misunderstood what was explained to you, but it is still the responsibility of the doctor to make sure you do fully understand so you can give informed consent to a surgical procedure.  There is also the possibility the doctor did not want to give you all the (somewhat gruesome) details of the surgery, since it might scare off someone with a squeamish stomach. Another possibility is that the doctor simply did not want to take the time from a busy office schedule to explain what would happen in the proposed surgery.  It has been my observation that many times a surgeon will greatly limit or modify the truth about some aspect of a proposed surgery (risks, chances for recurrence, changes for failure, degree or frequency of complications or side effects) so that the patient is more inclined to accept the idea of the surgery, and agree to have the surgery done.  It is somewhat of a "selling job" that is done.  It is not appropriate, it is not correct, and it is not legal, but it is done.  Perhaps something like this happened in your case.  Whatever was the reason that you thought the doctor was going to "put a slit in it and sew it back," it is the fault of the doctor for that notion and possible misunderstanding to remain.

More than likely, and I could be completely wrong since I was not there, the doctor proposed to do a Nesbit procedure for your curved penis.

For the most men the Nesbit procedure is the most common, easiest and most direct way that a surgeon can address the penile curvature of  Peyronie’s disease. However, it causes shortening of the erect penis by 2.5 to 6 cm (one to two and a half inches), and this is the greatest drawback of it.  The operation is performed under a general anesthetic and takes 40 to 60 minutes.  Men usually go home the day after surgery, or even the same day.

Basically, in the Nesbit operation the main idea is to make an elliptical incision to remove some of the shaft tissue and tunica albuginea from the long side of the bent penis (on the side opposite the inner curve of the bend), in an effort to straighten the curvature.  This tissue removal is responsible for the overall effect of penis shortening when the long side is reduced. The rule of thumb is that for every 25-30 degree of curvature that is present, a loss of approximately 1 to 1.5cm penis (about half to one inch) length at erection will occur.

An incision is made all the way around the shaft, a few millimeters behind the edge of the head (glans) of the penis.  The cut skin of the penis is rolled back down (like rolling or peeling your socks down off your leg), exposing the two corpora cavernosae so the one corpora cavernosa that is opposite the bend and the Peyronie's plaque can be shortened.  This is done by either removing tissue of the corpora with removal using an elliptical incision or simply by drawing it tighter with internal stitches.  After this is done the foreskin usually has to be shortened also so that it matches the new shorter length of the penis.  As in any operation, infection of the incision lines can be a problem and the foreskin, if left behind, sometimes becomes swollen after surgery; for this reason many surgeons will also perform a complete circumcision to prevent this complication. Otherwise direct surgical complications are not common, but occasional to infrequent side effects after surgery of erectile dysfunction, permanent numbness and penile pain can occur.

Hopefully, this explanation of the Nesbit procedure is helpful.  Keep in mind that this is the simplest Peyronie's surgery.  You can see Peyronie's surgery is a lot more complex than what you thought.  TRH

Is there any penis surgery procedure you could recommend?

Greetings,

I must admit that I am very embarrassed to send this message.

I'm 52 years old with what could be a fairly long 4.5 to 5" penis, but the curvature is painful and very very frustrating for my lover and me. I keep my pubic hair shaved to give the appearance of more mass, but he is not satisfied, nor am I.

Is there any penis surgery procedure you could recommend? I have been too embarrassed to mention this to our family practitioner (female).

What first steps can I do to improve my condition?

In His name, Peter

 

Greetings Peter,

After reading your email a few times I am not sure if you are more concerned about the pain and distortion of your Peyronie's disease, or by your loss of penile size since you developed PD. 

We live in a strange culture in which personal self-worth and value as a human being is based on penis size.  Your penis is attached to you; you are not attached to your penis. Think about that a bit. 

There is no need for embarrassment since developing PD is not a personal character flaw or a deliberate act that suggests an imperfection of who you are as a person; it is just an unfortunate  health problem.  No one should feel embarrassed for having glaucoma or asthma, not should you feel that way because of your PD.

From my experience in communicating with many hundreds of men since 2002 about penis enlargement surgery, I hear far too many horror stories of failed surgery.  Learn to enjoy what you have and who you are, or you might be left with little to enjoy.

If you want to actually treat your real problem I suggest that your go to the PDI website to learn how to increase your ability to heal and repair your Peyronie's disease – which in turn could result in return of lost penile length and girth.   TRH

Penis Surgery to Treat Peyronie’s Plaque

Peyronie’s surgery from correction to amputation

It is not uncommon for a man to learn that he has Peyronie’s disease and to have his doctor immediately recommend penis surgery to attempt to remove the Peyronie’s plaque or straightened his curved penis.

When faced with even a mild degree of penis curvature someone might think that penile surgery is the only treatment option.   It seems to me from my perspective in talking to a dozen men each week about their history with Peyronie’s disease that many of them are given strong pressure to have surgery far too early in the process.

It seems they are not being told that many who undergo penis surgery end up with numerous side effects like pain, numbness or loss of all sensation of the penis, additional loss of length and girth greater than their PD gave to them, greater curvature than their PD gave to them, and total impotence or inability to develop an erection.   I frequently communicate with men who have more pain, distortion and loss of sexual ability after penile surgery than before it.

In a desperate effort to satisfy their sexual partner, and under false expectation of how easy and safe the surgery will be, men sometimes make matters worse with Peyronie’s disease surgery.  Worse yet, it often happens that a man will have a second Peyronie’s surgery to correct the errors and problems created by the first Peyronie’s surgery – only to have even greater problems after the second surgical attempt.

For information about the Leriche surgery technique for Peyronie’s disease.

Peyronie’s surgery to the extreme

The worse case of failed Peyronie’s disease surgery I ever spoke to occurred sometime in 2006.  I received a phone call from a man who asked if I guaranteed the treatment we present in the PDI website.  I told him that no medical procedure or therapy is ever guaranteed – even aspirin.  I said there is no such thing as a medical guarantee provided anywhere in the world because of the complexity of human physiology.  I asked him why he was interested in a guarantee.  He said he was desperate for something to help his terribly curved penis that had gotten progressively worse after each of three separate penis surgeries.  He said he was scheduled to have his fourth penis surgery in two weeks, but he would cancel that surgery if I could give him a guarantee that the PDI process would correct his problem.  I told him I was sorry that I could not make such a guarantee, and said I doubted his surgeon was going to guarantee the next operation.  He corrected me.  He told me that the next surgery was going to “fix’ his problem because the next operation was for the surgeon to amputate – completely cut off – his penis!

He went on to explain that his penis was now just a tiny two inch mass of twisted scar tissue; he had no feeling in his penis; for the last two years when he urinated he would get his abdomen wet; his wife was long gone and he felt that suicide was his only other option, so having his penis cut off made sense to him.

I was shocked.   Just as I was starting to explain that I could not guarantee his results at this late stage in his problem I heard a click, and the phone was silent.  The entire conversation took less than five minutes, but it was the most powerful discussion I have ever had with any of my Peyronie’s men.  I will never forget the empty and desperate tone of his voice.

Penis surgery for a man who already has Peyronie’s disease presents a greater risk than for someone who does not have a Peyronies problem:

  1. High degree contracture due to fibrous tissue buildup, resulting in greater curvature than prior to surgery.
  2. Greater chance for numbness or total loss of sensation, or Peyronie’s pain,
  3. Greater chance for impotence.

Start with conservative Peyronie’s treatment, then penis surgery if necessary

I am not saying that a bad outcome will happen to all men who have Peyronie’s surgery, but it can and does happen so the possibility should be clearly kept in mind before rushing into surgery.    Every day I hear from men who tell me their doctor on the first visit suggested penis surgery to “correct” their Peyronie’s disease.

It is my opinion that it is safer and wiser to take a more conservative route of care using the Alternative Medicine form of natural Peyronie’s treatment options that have been presented here since 2002, before considering surgery.

Leriche Technique for Peyronie’s Surgery

Peyronie’s disease surgery with Leriche method carries risk

The Leriche technique is a new surgical treatment of the stable phase of Peyronie’s disease.  At this time 10 cases are reported in the literature, and they were followed for only three months post-surgically.  While many more Leriche surgeries have taken place, primarily in France, they have not been reported in the literature for review. For this reason any man considering this technique must realize not much historical data has been collected to prove the effectiveness of this new procedure to reduce the curved penis of Peyronie’s disease, or evaluate for complications.  If a man wishes to volunteer to be one of the first for a new surgical approach, this would be that opportunity.

It is important to remember the Leriche technique is a different kind of penis surgery, but it is surgery nonetheless.  In all other Peyronie’s disease surgery techniques – like Nesbitt – there is ALWAYS more scarring that occurs as a result of surgical intervention.  In this new technique patients are operated on an outpatient basis under local anesthesia, after identification of the Peyronie’s plaque is made by ultrasound examination.  In the Leriche technique multiple tears (plication) of the PD plaque are made with an 18 gauge needle almost as though the surgeon was trying to shred the plaque, with the idea that it will be enlarged, spread out and flattened.

Leriche surgery by comparison to the Nesbit technique is minimally invasive, and solely for this reason might have a better range of outcomes. It is suggested following the Leriche surgery that the patient must engage in early and daily sexual activity for at least one month to obtain a good outcome.  Early reports suggest 30 percent of men who undergo the Leriche procedure are cured; however this opinion is based on limited post-surgical follow up of three months.  Another 50 percent gain sexual function after two or more additional Leriche surgeries.  For the 20 percent of men who do not respond well to the Leriche approach, the technique will not interfere with additional surgery or penile implant.

Time will tell how truly effective the Leriche technique is for correction of the Peyronie’s problem.

Penis surgery always carries risk

Most other types of Peyronie’s surgery are performed on an outpatient basis under general anesthesia, and can last up to two and a half hours. A second doctor, a plastic surgeon, may be needed when specialized grafting techniques are used. Surgery for Peyronie’s disease is a major event to a very sensitive part of the body with a large nerve supply, so there is never an easy walk in the park no matter what kind of surgery is performed.

Martin K. Gelbard, MD, world-renown Peyronie's disease expert, states, “Unfortunately, surgery does not offer a cure for Peyronie’s disease. The scarring in men with deformity severe and persistent enough to warrant an operation represents an irreversible loss of connective tissue elasticity. Though surgical restoration of sexual function can be both effective and reliable, potential candidates need to understand the compromise inherent in this approach.” Compromise means that after surgery some degree of the old problem and limitation usually remains, and new problems (more scarring, reduced sensation or numbness, new bends, more pain) will occur in spite of the best effort of the Peyronie’s disease surgeon.

Every surgical procedure has risk; none are totally safe or foolproof.   No Peyronie’s disease surgery can restore the penis to its former condition. Some surgery shortens the penis more than others. Some are more effective in straightening curvature. Every surgery carries the risk of less than perfect straightening, and sometimes the curvature is worse after corrective penile surgery because excess scar formation can occur from the trauma of surgery. Lastly, surgical side-effects are possible resulting in loss of rigidity (hardness) or inability to maintain an erection (impotence), due to permanent surgical alteration of blood flow in the penis, pain greater than before surgery, as well as permanent loss of sensation (numbness) that makes sexual pleasure a thing of the past.

Please keep this in mind:  You have PD because your body made a foreign scar in your penis as an over-reaction process – usually to some type of trauma.  Any surgery – like the Leriche technique – involves cutting holes into and tearing the internal tissue of the penis.  This kind of trauma often results in more scars in a man who has already shown he is capable of creating excess scar formation after any level of injury to the penis.

What will probably happen is that the researches will find 6-12-24 months after the Leriche surgery that men will develop more scars, like they do after other penis surgeries when done to men who already make too much scar material after injury, and the technique will fall out of favor.

Please ask a lot of questions and be very slow to submit to penile surgery if you already know you make more scar than the average man.  For this reason it might be worthwhile considering using a more conservative Peyronie’s disease natural treatment with Alternative medicine.