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A very common concern among patients contemplating penile implant surgery is, What happens to the head of the penis?

What is "cold glans"?

Now, let’s talk about it.

Hello everyone, My name is Jonathan Clavell, and I am a urologist and penile implant specialist in Houston, Texas. Today, I want to discuss what happens to the glans (head) of the penis when you get a penile implant. But before we get into that, let’s first understand the anatomy.

This here is a side view of a penis and its blood vessels. You can see the corporal bodies here on the top and the urethra, or urinary channel, here on the bottom. The glans, or head of the penis, is connected to the urethra. When we place a penile implant, we occupy the space inside the corporal bodies. But let’s take a closer look at the blood vessels.

The blood supply that goes into the penis comes from an artery called the internal pudendal artery. This artery then divides into several branches, and, if you look closely, the blood flow that goes into the corporal bodies, or corpus cavernosum (the chambers where the implant is placed), is called the cavernosal artery. On the other hand, the blood supply to the urethra comes from the bulbourethral artery, which supplies the urethra all the way up to the glans penis. But that’s not all—there’s a second artery supplying the glans penis, which comes from the dorsal artery of the penis. This artery lies close to the skin.

To give you a better perspective, let’s imagine that the pelvic bone is somewhere in this area, so part of your penis is inside your body, and the other part is on the outside. When we place an implant via the penoscrotal approach, we make an incision away from the urethra, close to this spot on the bottom of the penis. With the infrapubic approach, the incision is made underneath the pubic bone (hence the name infrapubic), staying away from the dorsal artery. We then dilate the tissues inside the corpus cavernosum, which may affect the cavernosal artery.

But look closely: the end of the cavernosal artery does not reach the glans penis. I’ll repeat that—the cavernosal artery does not reach the glans penis. We need to remember that blood flow to the glans penis, supplied by the urethra via the bulbourethral artery and the skin via the dorsal artery, remains intact.

What does this all mean in layman's terms? This anatomy reveals that the blood supply to the head of the penis is different from the one going into the shaft. Therefore, men with erectile dysfunction who can still bring blood flow to the glans penis may retain that function after the implant. However, that depends on the health of your blood vessels. If your arteries are blocked due to diabetes, high cholesterol, smoking, atherosclerosis, radiation therapy for prostate cancer, etc., there is no guarantee that blood flow can reach the glans penis.

Now, you might ask, How can I know if I will have that problem? Remember, the only way men without erectile dysfunction see glans engorgement is when aroused. Think about it: the head of the penis engorges with blood only when you’re aroused. Without sexual stimulation, the glans is very unlikely to engorge. Therefore, the only way a man with a penile implant can appreciate if he has blood flow to the glans will be when aroused. I’ll repeat that—the head will engorge only when aroused.

This concept is also important when a man measures his penis after implant surgery. Measuring your penis in the first few days post-surgery—when you’re not aroused and are mostly dealing with post-operative pain and discomfort—is not a good idea. You have swelling around the tissues, and the glans is not aroused. So when you wake up after surgery, try not to focus on your size because things may change and improve as you recover. Swelling will go down, you’ll start cycling regularly, and, when aroused, the glans may also engorge, making your penis look larger.

Now, what if I get an implant and don’t have good blood flow to the glans? What can I do?

The term "cold glans" describes a man with a penile implant who is unable to engorge the head of the penis, even when aroused. Since blood flow to the glans is separate from that to the shaft, there is a possibility that oral medications like Sildenafil or Tadalafil (Viagra or Cialis) might help with glans tumescence. Other options men have tried include Trimix urethral gel or a vacuum erection device with a constriction ring. These medications—be it oral pills or Trimix gel (not the injection but the gel)—can sometimes help bring blood flow to the urethra. If you have issues with blood flow to the glans, you can discuss these options with your surgeon.

What if those treatments don’t help? Not to worry, because many men who are unable to get the glans engorged are still able to enjoy sexual activity with a penile implant. As mentioned in previous videos, you can still have enough sensation to reach orgasm without glans engorgement.

In summary, as you saw in today’s video, in many cases, the blood supply to the glans penis is different from that to the shaft. Therefore, if you get a penile prosthesis, although not guaranteed, there is a possibility that your penis will still feel warm and engorged with blood, which may increase pleasure during sexual activity. If you have an implant and feel like you have cold glans, there are treatments you can try. If you’re considering an implant and the fear of cold glans is holding you back, ask yourself this: Are you satisfied with your ability to gain and maintain an erection firm enough for penetration with your current treatment option? If the answer is no, then a penile implant might be a viable solution for you. Discuss it with your urologist, and if you’re seeking an expert, we’re here for you.

Remember to like and subscribe if you haven’t, and check out the other videos on our channel. I wish you the best of luck on your journey.

LastHope wrote:A good video that addresses this topic.

How to Treat Cold Glans after Penile Implant Surgery - Dr. Clavell

https://youtu.be/FwAvz1IucSU?si=SD8cB77-_1U93egG

Transcript:

A very common concern among patients contemplating penile implant surgery is, What happens to the head of the penis?

What is "cold glans"?

Now, let’s talk about it.

Hello everyone, My name is Jonathan Clavell, and I am a urologist and penile implant specialist in Houston, Texas. Today, I want to discuss what happens to the glans (head) of the penis when you get a penile implant. But before we get into that, let’s first understand the anatomy.

This here is a side view of a penis and its blood vessels. You can see the corporal bodies here on the top and the urethra, or urinary channel, here on the bottom. The glans, or head of the penis, is connected to the urethra. When we place a penile implant, we occupy the space inside the corporal bodies. But let’s take a closer look at the blood vessels.

The blood supply that goes into the penis comes from an artery called the internal pudendal artery. This artery then divides into several branches, and, if you look closely, the blood flow that goes into the corporal bodies, or corpus cavernosum (the chambers where the implant is placed), is called the cavernosal artery. On the other hand, the blood supply to the urethra comes from the bulbourethral artery, which supplies the urethra all the way up to the glans penis. But that’s not all—there’s a second artery supplying the glans penis, which comes from the dorsal artery of the penis. This artery lies close to the skin.

To give you a better perspective, let’s imagine that the pelvic bone is somewhere in this area, so part of your penis is inside your body, and the other part is on the outside. When we place an implant via the penoscrotal approach, we make an incision away from the urethra, close to this spot on the bottom of the penis. With the infrapubic approach, the incision is made underneath the pubic bone (hence the name infrapubic), staying away from the dorsal artery. We then dilate the tissues inside the corpus cavernosum, which may affect the cavernosal artery.

But look closely: the end of the cavernosal artery does not reach the glans penis. I’ll repeat that—the cavernosal artery does not reach the glans penis. We need to remember that blood flow to the glans penis, supplied by the urethra via the bulbourethral artery and the skin via the dorsal artery, remains intact.

What does this all mean in layman's terms? This anatomy reveals that the blood supply to the head of the penis is different from the one going into the shaft. Therefore, men with erectile dysfunction who can still bring blood flow to the glans penis may retain that function after the implant. However, that depends on the health of your blood vessels. If your arteries are blocked due to diabetes, high cholesterol, smoking, atherosclerosis, radiation therapy for prostate cancer, etc., there is no guarantee that blood flow can reach the glans penis.

Now, you might ask, How can I know if I will have that problem? Remember, the only way men without erectile dysfunction see glans engorgement is when aroused. Think about it: the head of the penis engorges with blood only when you’re aroused. Without sexual stimulation, the glans is very unlikely to engorge. Therefore, the only way a man with a penile implant can appreciate if he has blood flow to the glans will be when aroused. I’ll repeat that—the head will engorge only when aroused.

This concept is also important when a man measures his penis after implant surgery. Measuring your penis in the first few days post-surgery—when you’re not aroused and are mostly dealing with post-operative pain and discomfort—is not a good idea. You have swelling around the tissues, and the glans is not aroused. So when you wake up after surgery, try not to focus on your size because things may change and improve as you recover. Swelling will go down, you’ll start cycling regularly, and, when aroused, the glans may also engorge, making your penis look larger.

Now, what if I get an implant and don’t have good blood flow to the glans? What can I do?

The term "cold glans" describes a man with a penile implant who is unable to engorge the head of the penis, even when aroused. Since blood flow to the glans is separate from that to the shaft, there is a possibility that oral medications like Sildenafil or Tadalafil (Viagra or Cialis) might help with glans tumescence. Other options men have tried include Trimix urethral gel or a vacuum erection device with a constriction ring. These medications—be it oral pills or Trimix gel (not the injection but the gel)—can sometimes help bring blood flow to the urethra. If you have issues with blood flow to the glans, you can discuss these options with your surgeon.

What if those treatments don’t help? Not to worry, because many men who are unable to get the glans engorged are still able to enjoy sexual activity with a penile implant. As mentioned in previous videos, you can still have enough sensation to reach orgasm without glans engorgement.

In summary, as you saw in today’s video, in many cases, the blood supply to the glans penis is different from that to the shaft. Therefore, if you get a penile prosthesis, although not guaranteed, there is a possibility that your penis will still feel warm and engorged with blood, which may increase pleasure during sexual activity. If you have an implant and feel like you have cold glans, there are treatments you can try. If you’re considering an implant and the fear of cold glans is holding you back, ask yourself this: Are you satisfied with your ability to gain and maintain an erection firm enough for penetration with your current treatment option? If the answer is no, then a penile implant might be a viable solution for you. Discuss it with your urologist, and if you’re seeking an expert, we’re here for you.

Remember to like and subscribe if you haven’t, and check out the other videos on our channel. I wish you the best of luck on your journey.