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Hello Frank Board,

I am a 35yo man.

Two life-long issues I've had ongoing:
1. My erections have never in my lifetime been hard enough to penetrate.
FOR THIS, A PENILE-IMPLANT IS BEING EXPLORED
2. In addition, the base of the penis has remained too loose and floppy – and so unable to hold the penis rigidly in-place to enable any sort of penetration. As a consequence, my angle of elevation has never been above 20-30 degrees.
FOR THIS, A SUSPENSORY-LIGAMENT TIGHTENING/STITCHING MAY BE NEEDED.

So I am now considering penile-implant + suspensory-ligament-tightening in a single procedure. I would be having this done in London by Mr David Ralph.

[I have already in the past tried less invasive cures, such as Cialis, Muse, caverject, psychosexual counselling, rings, vacuum pumps - all to no avail].

My questions for the Franktalk board:
1. Has anyone out there also had their suspensory-ligaments tightened simultaneously to having a penile-implant inserted? Is this a common occurrence for people to have both issues?
2. What has been people’s success of having their suspensory ligaments tightened – has it helped achieve the rigidity at the base needed for penetration? And has it raised their angle of elevation to above 90 degrees?
3. Would people recommend having suspensory-ligament tightening done at same time to penile-implant, or is it better to do them in separate operations?
4. Has anyone out there had their penile-implant/suspensory-ligament-repair done by Mr Ralph before in London? Was it success?

Your help and opinions appreciated!

Hi. Ralph did my implant December 2017. Feel free to get in touch.

The issue of not being hard enough probably causes the low erection angle. Not the ligament. Just something to think about.

i have had susp. ligament repair. Feel free to ask questions as well

Thank you for posting this. I would like to know more about this. With my implant fully pumped I am just able to make 45 degrees. If I pull up on my pubic fat pad I will go to 90 degrees. I thought of having the fat lipo'd and my skin trimmed and reattached at the belt line but was concerned it would just stretch back down. Might be that I was looking at this wrong.

newbie443 - have you ever in your life had great than 45 or 90 degrees elevation? If you have, my guess would be that it's not suspensory-ligament issue (but that's coming from another newbie here).

From my understanding, it's more the firmness-at-the-base that drives the decision rather than angle-of-elevation itself.

For me, I've never actually had a decent enough erection - so the confusing bit for me has always whether the lack of angle is driven by the lack-of-hardness or suspensory-ligaments. (I've not had penile-implant yet).

My suggestion might be to see a surgeon and try inflating infront of them so they can try ascertain what's going on. The other alternative would be a "general-anaesthetic-erection-test" (I don't know the proper medical name for it hence my putting it in inverted commas) - whereby you're artifically-induced under general-anaesthetic, so they can see the angle-of-elevation for themselves.

At my latest consultation with the surgeon, it turns out I infact had this "general-anaesthetic-erection-test" years back - which according to the medical notes suggest that my suspensory-ligaments are infact okay (which I of course wouldn't know as I've never had decent-erection). So the decision made for me is to do penile-implant and leave the suspensory-ligaments untouched.

livinglarge - interested to hear if the procedure worked well for you - whether it increased your angle-of-elevation / rigidity - and what was the process of determining you needed your suspensory-ligaments repaired as opposed to/before penile-implant.

I experienced a low angle after my first surgery. After the revision, it was clear that it was caused by underdilated/undersized on the proximal part, so it was a typical case of hinge effect.

All this recent talk on FT of pointing up when inflated makes me think I might need a suspensory ligament repair (lift). They do an infrapubic incision and use a non-absorbable monofilament suture between the tunica and the pubis symphysis to repair a slack, damaged PSL (penile suspensory ligament). I might have to wait for the PSL repair until I need a revision though, since it involves placing sutures into the proximal dorsal tunica albuginea which I would think would be risky to the cylinders.

One thing I read about a study of 35 patients who underwent this procedure included two men who had venogenic ED (ED caused by venous leakage), the PSL repairs resolved their ED. They surmised that "a functional PSL might be part of the veno‐occlusion mechanism required for the process of erection". This goes back to the technique I employed on many occasions to relieve myself of painful morning wood in the past 10 years - PRESSING DOWNWARD at the top of the base of my penis until I heard a CLICK. No doubt I was damaging the PSL each time I did that, thus adding to my ED and my low angle of erection now.

(Citation added): https://onlinelibrary.wiley.com/doi/ful ... 07.06551.x