Penile Trauma - now loose at base

[Nightfox]

I'm a 31 year old healthy male who has never had problems with erections.  2 months ago I woke up on my stomach with a full erection, except it was facing downward toward my feet pressed between my leg and the bed, and it was twisted 180 degrees.  It was not exceptionally painful, just uncomfortable so I moved and thought nothing of it.  I felt noticeable but not severe pain at the base for the next 3 days.  Since that day, it is very flexible at the base when I have an erection, almost as if it is dangling there when shaken from left to right.  Before this, my erection would move back to center mast immediately if ever moved left or right.  It still stands up straight at times, but only if I’m standing or kneeling, never if I’m on my back.  Even when it’s as erect as I can get it, it can always be bent upward half way up the shaft – in other words it isn’t as strong as it used to be.  It dangles downward and hangs lower when not erect.  

Also, I’m having difficulty getting and maintaining an erection.  Even when I get one it isn't nearly as powerful as it was before.  To me, this is the most serious issue.

A urologist gave me levitra to see if that changes anything.  I haven't started using it seriously yet, but I will soon.  If you ask me, it's definitely damage to the suspensory ligament, as well as some damage to the vascular system.  

Questions

(please make your best attempt at answering these rather than recommending me to a urologist – I’ve come to you as I already have a urologist who really doesn’t sound knowledgeable when he speaks to me.)

1) Does this sound like damage to the suspensory ligament?

2) Would damage to a suspensory ligament cause blood flow problems, or did I likely damage both the ligament and the blood flow system?

3) In theory, if I only damaged the suspensory ligament shouldn’t I still be able to get a full erection?  The reason I ask this is because I could live with a stretched ligament if I could maintain the same strength in erection as before.  However, the lack of strength/blood in the erection is not working for me.

4) How are damaged suspensory ligaments typically treated and how long to they take to heal?  

5) When I using my hand/fingers to clamp some pressure around the top of the base of the penis and the bottom of the scrotum during masturbation, the strength of the erection greatly increases.  Does this sound like a venous leakage to you?  

6) How is a venous leakage typically treated?  I really don’t want to wear a ring everytime.  Sounds like a great way to cause even more damage.

7) Any other thoughts on what this is or what I can do??


Thank you.

[Kevin Pho, MD]

To answer your questions:
1) Damage to the suspensory ligament is possible with all forms of penile trauma.  

2) The damaged ligament itself should not cause blood flow problems, but damage from the trauma can.  A doppler ultrasound can be considered to evaluate penile blood flow.

3) It would depend on the extent of the damage.  Again, imaging studies can be considered to look for vascular or structural damage.

4) Again, depends on the severity of damage.  Surgical therapy can be considered if conservative therapy is not helping.  This needs to be evaluated by a urologist for a more concrete answer.

5) The pressure can impede vascular flow, leading to changes in erectile quality.  The ultrasound can further evaluate the vascular system.  

6) Surgical therapy with implantation with balloons and coils are one way to treat venous leakage.  Other surgical options can be considered, based on the severity of leakage.

7) Another urological opinion can be obtained, preferably at a major academic medical center.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

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