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Suspensory ligaments: why are they ligaments?

Suspensory ligaments: why are they ligaments?


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Don't ligaments connect bone to bone? In the eye for example, the suspensory ligaments connect the ciliary muscle to the lens, which obviously aren't bones. Is this just one of those instances where the terminology isn't that precise and you just have to memorize the exception?


"… The suspensory ligaments connect the ciliary muscle to the lens… "

You must be referring to the Zonule of Zinn (Such a great name).

You are absolutely correct, the definition of Ligament varies across texts which can create confusion.

For example:

Merriam-webster: A tough fibrous band of tissue connecting the articular extremities of bones or supporting an organ in place.

Wikipedia: A ligament is the fibrous connective tissue that connects bones to other bones.


Here's The Anatomical Secret That Lets Giraffes' Spindly Legs Support All That Weight

The average giraffe weighs a ton -- literally. How do giraffes' spindly legs stand up to that immense weight without buckling?

Researchers at the Royal Veterinary College in London may have found the answer.

"It turns out that the suspensory ligament plays an important role," Dr. John Hutchinson, a professor of evolutionary biomechanics at the college, told BBC News.

A suspensory ligament is a strip of elastic tissue that supports an organ or bone in the body. In humans there are a number of suspensory ligaments, including the ligament that connects the ovary to the pelvic wall and the one that helps position the lens of the eye.

Suspensory ligaments are found in large animals, including horses and giraffes, too. But this is the first time scientists have studied the ligament in giraffes.

Anatomy of the forelimb of a horse, indicating location of suspensory ligament.

For the study, researchers took the legs of captive animals that had died of natural causes and tested their strength by using a hydraulic press to apply weights of up to 550 pounds (250 kilograms). The legs remained upright and stable even without the support of living muscle tissue. The scientists concluded that the suspensory ligament located along the lower leg bones explains the legs' great strength.

Future studies may reveal how this ligament has evolved.

"I'd like to link modern giraffes with fossil specimens to illustrate the process of evolution," researcher Christopher Basu, a Ph.D. student in biomedical sciences at the college, said in a written statement. "We hypothesize that the suspensory ligament has allowed giraffes to reach large sizes that they otherwise would not have been able to achieve."

The research was presented on July 2, 2014 at the annual meeting of the Society for Experimental Biology in Manchester, England.


Penis Injury of the the Suspensory Ligament: What Men Need to Know

A painful penis injury is just about every guy’s worst nightmare, and one of the primary motivating factors for keeping a close eye on one’s penis health. Although many men know about the rare but painful penis fracture, very few are aware that damage to the suspensory ligament of the penis can also be a cause for serious pain and discomfort – as well as an impediment to positive erectile function.

The suspensory ligament

The name “suspensory ligament” is a mouthful, which may be one reason most non-physicians are not familiar with it. A ligament is fibrous connective tissue that generally connects one bone to another. Ligaments are found throughout the body, including in the pelvis. The suspensory ligament is basically what connects the penis to the left and right pubic bones. It also plays a big role in providing maximum support for the penis when it is erect, helping it to stretch up and out as the blood flows in and fills up the penis during times of sexual excitement.

Penis injury

It’s easy to see the important role that the suspensory ligament plays in proper penis functioning and why it is important to avoid injury to this connective tissue. Fortunately, damage to the suspensory ligament is not an everyday occurrence in humans. (Interestingly, it does happen rather more frequently in animals, especially horses.)

The most common cause of a problem with the suspensory ligament is trauma to the penis, especially if it occurs when the organ is engorged. For example, if the erect penis is pushed down hard, it may cause the ligament to tear, either partially or fully. This can cause a significant degree of pain in the moment, and lingering lesser amounts of pain. The pain is likely to increase during periods of excitement. Because of the role that the ligament plays in supporting erection, it also means that a man’s erection may not be as full or as intense as is normal.

This “pushing down” on the erect penis may occur when a partner accidentally handles the penis incorrectly, or if a man is thrusting during intercourse at an incorrect angle. Sometimes this can occur during sleep, when a man is experiencing an erection and rolls over on it. It can also be the result of an object, such as a baseball, hitting the erect penis with great force.

If a man sustains a penis injury, he should contact a doctor as soon as possible seeing a urologist is generally a better first step than seeing a general practitioner, who is likely to recommend a visit to a urologist anyway.

If the damage to the suspensory ligament is minor – meaning, the ligament has been strained but not actually torn or detached – the doctor is likely to recommend pain relievers, application of soothing compresses and rest. However, in cases in which there is tearing or detachment, surgery is often recommended. Ligaments do not have the same propensity to heal naturally as many other parts of the body, and so “re-sewing” the suspensory ligament is often necessary in order to correct the penis injury.

Treating damage to the suspensory ligament, or any type of penis injury, is easier if the manhood is already in its best possible health. Regular use of a top drawer penis health crème (health professionals recommend Man1 Man Oil) can help in this area. Vitamin C is well known for its role in collagen production and the resulting penile tissue firmness, so most men will wisely gravitate toward a crème that includes this all-important vitamin. Since trauma can also result in de-sensitization of the penis, a crème that also contains acetyl L carnitine is recommended. Why? Because acetyl L carnitine is neuroprotective it helps prevent peripheral nerve damage to the penis due to rough handling, thereby protecting the degree of pleasurable sensitivity which men associate with the penis.


Ligament

Our editors will review what you’ve submitted and determine whether to revise the article.

Ligament, tough fibrous band of connective tissue that serves to support the internal organs and hold bones together in proper articulation at the joints. A ligament is composed of dense fibrous bundles of collagenous fibres and spindle-shaped cells known as fibrocytes, with little ground substance (a gel-like component of the various connective tissues).

Some ligaments are rich in collagenous fibres, which are sturdy and inelastic, whereas others are rich in elastic fibres, which are quite tough even though they allow elastic movement. At joints, ligaments form a capsular sac that encloses the articulating bone ends and a lubricating membrane, the synovial membrane. Sometimes the structure includes a recess, or pouch, lined by synovial tissue this is called a bursa. Other ligaments fasten around or across bone ends in bands, permitting varying degrees of movement, or act as tie pieces between bones (such as the ribs or the bones of the forearm), restricting inappropriate movement.

The Editors of Encyclopaedia Britannica This article was most recently revised and updated by Kara Rogers, Senior Editor.


Traditional suspensory ligament injury treatments

In many cases, there is nothing abnormal to feel and the vet will have to use a nerve block to eliminate the lower limb as a source of pain and also determine that the pain is coming from just below the back of the knee.

Scanning is essential, too. Sometimes an obvious black hole in the ligament shows up on the scan sometimes the changes are more subtle. The ligament may be slightly enlarged, with a tiny disruption of its fibre pattern.

The vet’s aims are to eliminate any predisposing causes such as poor foot balance or inappropriate shoes, to reduce inflammation by the use of cold therapy, laser treatment or therapeutic ultrasound and to encourage good quality repair of the damaged fibers.

Small lesions at the top of the suspensory ligament often resolve with around three months’ box rest, combined with a controlled exercise program. Scanning can be used to monitor healing. Larger injuries in the body or branch may need surgery to remove any blood clots. Prolonged rest combined with an ascending exercise program is an essential part of any treatment regime.

Prognosis depends on many factors including:

  • the site of the injury
  • the severity of the injury
  • the duration of the injury
  • the future athletic expectations for the horse

Most horses are able to return to some level of work, but there is also a big chance of reoccurring injury.

With appropriate early treatment most horses with a sprain around the origin of the ligament make a complete recovery however, the chance of repeat damage to injuries on the body of the ligament is quite high if the horse returns to its former workload. The prognosis for branch injuries is between the other two.

Some factors may predispose the suspensory ligament injury in horses or injury’s recurrence:

  • conformation can play a role. A horse with a crooked lower limb will overload one side of the fetlock and predispose it to a branch injury
  • poor foot balance is commonly seen in horses that injure the origin of the ligament. If the shoes are too short and offer little support to the back of the heel region, this can cause an overload of the ligament
  • fast work: there is also no doubt that suspensory ligament injuries are an occupational hazard for some horses, particularly those which jump at speed
  • a previous suspensory injury also places a horse at increased risk of repeat injury since, particularly with body and branch injuries, the repair tissue is never as strong as before

Anatomy of the Pelvis

The pelvis is made up of four bones, the two large innominate bones, the sacrum which is wedge-shaped and fits between the two innominates posteriorly. As well as the coccyx, a small "tail" like bone attaching to the underside of the sacrum. The joining of the sacrum and innominate bones forms the two sacroiliac joints of the pelvis, hence the joint&aposs name.

The sacrum is a solid bone, which was once thought to be a continuation of the spinal joints. It&aposs thought that it was once separated into multiple vertebral joints with an intervertebral disc in between each. Evolution seems to have found more use for a stable bone used to support the rest of the pelvis and act as an anchorage for ligaments and muscles. The bones have therefore fused over time.

The innominate bones are interesting, as before the age of about 15, each innominate is actually made up of three bones which begin to fuse together during the early teenage years. The ilium, the posterior-most bone which articulates with the sacrum. The ischium which forms part of the acetabular fossa where the acetabulum head sits to form the hip joint. The third bone is the pubis, which forms the rest of the acetabular fossa and joins the medial anterior cartilage that makes the pubic symphysis. The pubic symphysis has an important role in pregnancy which will be discussed later.


Suspensory ligament transection can increase the flaccid length of the penis, though it will have no effect on the length of the erect penis. Here is a quick guide for what to expect before, during, and after a suspensory ligament transection procedure.

Before Treatment

  • Stop taking blood thinning medications for 4 weeks
  • Stop taking diet pills 1 month before
  • Do not take diabetic medication the morning of surgery
  • No eating or drinking for 8 hours before the procedure

During Treatment

  • General anesthesia
  • Upside down V-shaped incision made on the pubic area
  • Suspensory ligament severed
  • Buffer placed between penis and pubic symphysis to help prevent reattachment
  • Incision closed in a Y-shape to further lengthen appearance of the penis

Immediately After Treatment

1-4 Weeks After Treatment

  • Avoid excessive walking, prolonged standing, and heavy lifting for at least 1 week
  • Bruising and swelling can last for up to 2 weeks
  • Light exercise can be gradually resumed after 4 weeks

1-4 Months After Treatment and Beyond

  • Normal sexual activity is permitted after 4-6 weeks
  • Strenuous activity can be resumed as tolerated after 1 month
  • Penis stretching exercises begin after 1 month
  • Final results after 3-6 months

Result Notes

  • Improvement noticeable immediately after treatmen
  • Possibility of reoccurrence of ligament attachment which can cause shortening of the penis
  • There is no penis enlargement procedure or technique that is widely recognized as effective with sustained results

NHS – Penis Length Surgery

The most common technique involves cutting the ligament that attaches the penis to the pubic bone and performing a skin graft at the base of the penis to allow for the extra length. Professor Wylie says the surgery can result in an average gain in length to the flaccid penis of 2cm, but there will be no change to the size of the erect penis.

Furthermore, the erect penis won’t point as high as before the operation because the ligament which was cut no longer offers support.

“A lot of men who have this treatment don’t truly appreciate this loss of angle,” says Professor Wylie. “It can make sex quite uncomfortable. You’ve got to do a lot more manoeuvring with your partner. The advantage of a 2cm gain in flaccid length is far outweighed by the loss of angle of erection.”

The ligaments that stabilise your penis are partially cut.

These ligaments function to lift and stabilise your penis when erect.

After lengthening surgery the penis can be less stable horizontally and vertically.

There can also be scarring and infection.

To access the penis suspensory ligaments an incision has to be made, as shown below.

When all healed the scarring is partially covered by the pubic hair, however some of the scarring will always be visible.

Examples of scarring from penis lengthening surgery are below.

Scarring may not be an issue to you, for example, if you are married or in a long-term relationship and your partner knows about your penis lengthening surgery.

In this case, the scarring is unlikely to cause you any embarrassment.

If you are a young man and expect to have numerous sexual partners during your lifetime, then it would be worth considering whether you will feel comfortable explaining the scars under your pubic hair to current and future sexual partners.

The most common complication is Penile Shortening.

Unfortunately penile shortening is the most common complication of penis lengthening surgery (ligamentolysis).

“Penile shortening is a major complication of penile lengthening surgery, usually resulting from the freely hanging penis reattaching to the pubic bone located higher on the corporal bodies. The likelihood of this complication can be minimised by the placement of surrounding soft tissues, fat tissues, silicone, polytetrafluoroethylene, Gore-Tex, and other artificial materials.” [Emphasis added].

The risk of ligaments reattaching can be lowered by inserting a silicone buffer to help prevent ligaments from reattaching and the penis shortening.

In a small number of cases, the silicone buffer can become infected and may need to be surgically removed.

Wearing a penis extender for 8 hours per day for 1 year after surgery can also help to prevent retraction and penis shortening after surgery.

It is worth purchasing and wearing a penis extender for an extended time before your surgery, to see how it feels and to make sure that wearing one after surgery will not be too uncomfortable for you, or disrupt your normal routine.

Explanation:

If you don’t wear a penis extender after penis lengthening surgery, the ligaments are likely to reattach to the penis shaft, further down towards the head, making your penis shorter than before surgery.

Surgeons have tried to prevent penile shortening and reattachment by inserting plastic or Gore-tex into the gap between the penile base and the pubis, with varying levels of success.

Before having penis lengthening surgery, first buy a penis extender, to make 100% sure you can wear it for 8-10 hours per day, as part of your normal everyday routine. You’ll need to wear an extender every day after lengthening surgery.

Infection is a major risk of penis lengthening surgery.

In some cases the results can be severe.

Penis lengthening surgery is not popular among mainstream doctors and Urologists.

As it has not been shown to be safe or effective, and as it is cosmetic surgery, it is not available from the NHS.

American Urological Association statement of Penis Lengthening Surgery (division of the suspensory ligament).

The American Urological Association considers the division of the suspensory ligament of the penis [penis lengthening surgery] for increasing penile length in adults to be a procedure which has not been shown to be safe or effective.

Board of Directors, January 1994
Board of Directors, January 1995 (Reaffirmed)
Board of Directors, September 1995 (Revised)
Board of Directors, January 2001 (Reaffirmed)
Board of Directors, February 2006 (Reaffirmed)
Board of Directors, October 2008 (Revised)
Board of Directors, October 2013 (Reaffirmed)

Board of Directors, October 2018 (Reaffirmed)

NHS: “A lot of men who have this treatment don’t truly appreciate this loss of angle,” says Professor Wylie. “It can make sex quite uncomfortable. You’ve got to do a lot more manoeuvring with your partner. The advantage of a 2cm gain in flaccid length is far outweighed by the loss of angle of erection.”

In the field of medicine, penis enlargement surgery remains controversial.

It has among the highest rates of reported complications, and, among the lowest rates of long-term patient satisfaction when participants are questioned about their outcomes over a long-term horizon. Some of the reasons not to go ahead with penis enlargement surgery are outlined in the following links provided by the NHS and various Urology Journals.

“…the use of cosmetic surgery to enlarge the penis remains highly controversial. There is a lack of any standardization of all described procedures. Indications and outcome measures are poorly defined, and the reported complications are unacceptably high. In our opinion, until new, reliable, and more objective and reproducible data are available, these procedures should be regarded as investigational and patients should be discouraged from undergoing these invasive treatments.”

There is an inordinate amount of misinformation regarding penis enlargement surgery on the internet and in popular culture. We have sought to address some of the most common misconceptions on the page Penis Enlargement Fact vs Fiction.

Penoplasty surgeons will often neglect to inform patients of some risks and limitations of penis enlargement surgery.

In many instances it is not explained to the patient that penis lengthening by suspensory ligament division is only effective in achieving increased flaccid penis length: in the erect state, no gain in length is s possible.

All prospective patients should read widely on the subject of penis enlargement, particularly the surgical approaches, before committing to a procedure. Our non-surgical procedures may be a better option for those who do not wish to accept the risk of higher than normal levels of reported complications the invasive aspect of surgery, and the lengthy recovery time.

Information from government sources or industry associations is worth considering, as the information often provides an independent perspective on the pros and cons of penis enlargement surgery. We recommend searching online for cases in which penis enlargement surgery has not been successful, in order to be fully informed of the risks and limitations. The possible downside risks to surgery are real, potentially severe, and occur not infrequently.

Penis enlargement has become safer and more effective in recent years. It is possible to undergo a lower risk enlargement procedure for penis thickening using dermal fillers proven in facial aesthetics, and supported by peer-reviewed research, such as those based on Hyaluronic Acid. This procedure is available at our London Harley Street address.

There is a wealth of information available to those considering undertaking penis enlargement surgery, including in our medical literature section. Our surgeons are experienced in dealing with all aspects of male genital surgery and will clarify any questions you may have.


Reattaching the PSL after surgery?

I had the lengthening surgery done in 1996 by a surgeon in Ontario.The penile suspensory ligaments were identified then divided.We didn’t have access to much information other than what was offered by the surgeon.As this was a fairly new procedure,there wasn’t a lot of information from medical boards or databases regarding the safety and the lack of success with this procedure.My over zealousness had gotten the best of me,although I did put off the surgery for 2 months when he told me he was at patient#30 and was not using any type of weight or traction exercises yet!
I never realized at the time,the importance of the psl for anchorage and stability during sex! Arghh I guess hindsight is 20/20
So I present myself with frustration,depressing regrets and anxiety on a regular basis.Especially lately being involved with a girl I love for the last 9 months.
It was a V-Y plasty with a forward advancement flap.Weights were used as indicated, but I still feel as if I experienced some degree of re-contraction in spite of my 0.5” length gain :rolleyes: :mad:
I have less prominence of the superficial dorsal vein and my erections have not been the greatest since the surgery.I dont think the SDV was compromised or any other emisary veins.Flow voids have been demonstrated to be normal when performed through my urologist.
PE has kept me relatively in good function and has maintained my sanity for the most part.
My medical chart can and will be obtained for medical and legal purposes,as there are a few actions against this retired surgeon.

There is a palpable gap between the penis and pubic symphysis.Would there be a way for surgeons to re-attach the suspensory ligaments? or if not,would there be ligament type of material with similar elasticity they can use to attach from buck’s fascia to the pubic symphysis coupled with proper reconstructive plasty to give stability in that area once again? I wonder what the most efficient solution would be at this point in order to give me more stability and continual PE gains?
Thanks to all in advance for any and all information and advice :D

Hope I’m in the right forum area Mods? thanks

The thread is fine in this forum Snake. I don’t ever remember anyone mentioning reattachment surgery.

Make a Donation This place runs on donations, help out if you can. Thanks.

I dont either Thunder but any knowledge that you or the other members are aware of or come across would greatly be appreciated. I dont know if my suspensory ligaments can be saved.They might have been severed from the surface of the penis and that is where unfortunately the blood supply comes from.Especially the fact that it’s been 14 years.An MRI or ultrasound? is warranted. Thanks.

Here is something that I found that sounds promising.

Hope it helps and let us know what you find out!

The Penile Suspensory Ligament: Abnormalities And Repair
Main Category: Urology / Nephrology
Also Included In: Erectile Dysfunction / Premature Ejaculation Men’s health
Article Date: 05 Feb 2007 - 8:00 PST

Visitor Ratings:
Healthcare Professional:
General Public:

The penile suspensory ligament (PSL) supports and maintains the erect penis in an upright position during sexual intercourse. The suspensory apparatus of the penis consists of the fundiform ligament, the suspensory ligament proper and the arcuate subpubic ligament. The fundiform ligament is superficial and not adherent to the tunica albuginea, whilst the suspensory ligament proper bridges between the symphysis pubis and the tunica albuginea of the corpus cavernosum and circumscribes the dorsal vein of the penis. The arcuate subpubic ligament runs a similar course to the suspensory ligament proper it is a slightly denser structure and lies further posterior. Functionally, the PSL maintains the base of the penis in front of the pubis and acts as a major point of support for the erect penis during intercourse.

A group from St. Peter’s Hospital in London, UK led by Chi-Ying Li report on a group of 35 men with abnormalities of the PSL who subsequently underwent repair. The report is published in the January 2007 issue of BJU International.

The surgical technique of repair included identifying the PSL via a transverse suprapubic incision. Once identified, the PSL was reinforced or repaired using nonabsorbable no. 1 Nylon sutures placed from the midline of the tunica to the pubic symphysis, until the optimal functional penile position was achieved as documented by an artificial erection test. The mean number of sutures required was 4. When there was also penile curvature present (21 men), the curvature was corrected at the same time using a variety of techniques such as Nesbit’s procedure or plaque incision and grafting. After surgery, men were asked to delay sexual intercourse for 6 weeks.

This report describes the often overlooked problem of an abnormality of the penile suspensory ligament. The diagnosis is largely clinical and can be elicited by physical exam findings. This problem can be induced iatrogenically after the penile suspensory ligament is divided in penile lengthening surgery and the technique for repair described here can be useful in that clinical condition and those that are described in this report.

BJU Int. 2007 Jan. 99(1): 117-20

Reviewed by UroToday.com Contributing Editor Michael J. Metro, M.D

How in the world would you find a urologist who is an expert in that procedure in the US or Canada, since the study was done in the UK just a year ago is probably the next good question. Hopefully someone here has a clue on that. I guess price would also be a great question too! That likely won’t be cheap :( but well worth it!

OK, hold on buddy! I kinda feel like I’m talking to myself, but I found out some more info. That info was reviewed by UroToday.com Contributing Editor Michael J. Metro, M.D. Who it looks like happens to practice in the US, and if he is not practicing I bet he can tell you who is the best to handle your case!

Did a quick search and came up with this:

Michael J. Metro, MD serves as Clinical Assistant Professor of Urology at Albert Einstein Medical Center, Philadelphia, an affiliate of Thomas Jefferson Health System and has done so since 2001. He also serves in a similar capacity at Temple University Medical Center.

Dr. Metro received his undergraduate degree in Biology and received his medical degree from the University of Pittsburgh in 1992 and 1996. He completed his surgical training and urologic residency at the Hospital of the University of Pennsylvania in 2001. He went on to complete a fellowship in Traumatic and Reconstructive urology at the University of California, San Francisco under the direction of Dr. Jack W. McAninch in 2002. He also served as clinical instructor at San Francisco General Hospital during this time.

He has authored several peer-reviewed journal articles and book chapters and is a co-editor of an upcoming book on Urologic emergencies. He has presented at regional, national and international meetings on such topics as erectile dysfunction, urethral reconstruction and urologic trauma.

I didn’t try to dig up the Dr. Contact Info, yet, :) but here is UroToday’s info:

UroToday, 1802 Fifth Street, Berkeley CA 94710
510.540.0930 (fax), [email protected]

I’m sure they would refer you to him if it is possible.

OK, sorry for the multiple posts. It is probably getting old. Anyway, here is the Doctors info, or I’m pretty sure it is his:

Contact Information for Dr. Michael Metro

A.5401 Old York Road Klein Building Suite 500
Philadelphia, PA 19141
(215) 456-1177

B.9880 Bustleton Avenue
Philadelphia, PA 19115
(215) 677-0667

I’m hoping your sleeping and you’ll wake up in the morning and find this and be the happiest guy in the world filled with hope!

Let us know how things go. K, bye. Last post I swear!

Thank you so much! I really appreciate it 8 Works :) I have that article but not the contact info.Great work done ! and I owe you big time. I just pray to god that the surgeon didn’t cut right to the bone,so that there is some ligament tissue to suture to.

I think this also might be helpful to anyone who has had the lengthening surgery and is considering correction………

ORIGINAL RESEARCH—SURGERY
Minimizing the Losses in Penile Lengthening: “V-Y Half-Skin Half-Fat Advancement Flap” and “T-Closure” Combined with Severing the Suspensory Ligament

* Osama Shaeer, MD**Department of Andrology, Faculty of Medicine, Cairo University, Egypt

Introduction. The technique most commonly used for penile lengthening is the release of the suspensory ligament in combination with an inverted V-Y skin plasty. This technique has drawbacks such as the possibility of reattachment of the penis to the pubis, a hump that forms at the base of the penis, in addition to alteration in the angle of erection.

Aim. In this work, we describe a new technique that overrides these drawbacks and minimize the loss of gained length.

Methods. The suspensory ligament was released through a penopubic incision. The caudal flap of the resected ligaments was reflected caudally and sutured to the Buck’s fascia. The V flap was incised. The caudal half of the V was deskinned, leaving a cranial skin-covered V flap, and a caudal, rectangular fat flap. The fat flap was pulled into the gap between the base of the penis and the pubis and secured in position by suturing its deep surface and lower edge to the pubis. This maneuver filled up the gap. The V incision was closed as a Y. The penopubic incision was closed as a T shape, to avoid pulling the penis back at skin closure. A stay suture stretched from the glans to the thigh, maintaining the penis in the stretched position. A urinary catheter was inserted.

Results. Six months after surgery, there was no loss in the length gained. The angle of erection (as reported by the patient) was similar to that prior to the procedure. The skin incisions left no hump and a faint scar that was not troublesome to the patient.

Conclusion. “V-Y half-skin half-fat advancement flap” and “T-closure” may improve the results of suspensory ligament release for penile lengthening. The reported techniques minimize the losses compromising length gain, whether in-surgery or following it.

My mistake, sorry. I believe it’s just a better technique for those considering the surgery..but do NOT consider the surgery! stick to hard work-huge reward from PE . :up:

Your welcome! I’m glad I could help.

I’m in a rather similar situation to yours. I also had the lengthening surgery in 1996, but in California. I was 19. Basically I was young, stupid, low self-esteem, you name it and armed with a credit card. Hopefully guys who are considering this will hear us saying: I WOULD NOT RECOMMEND!! So far as I can tell I got nothing as far as gains, and honestly even if I did, I still would not be happy with the functionality issues of a cut PSL. Thankfully, I wasn’t mutilated or anything like that, but your absolutely right about the value of the PSL. Many sexual positions are impossible without it. Having a girl or guy (what ever your taste is) on top I find to be pretty much next to impossible. I’ve only been with 2 chicks who have been able to work with it in this position, which was awesome, but I wasn’t exactly at ease. Every other time, it simply doesn’t work and usual results in a lost erection and some feelings of frustration and regret on my part. Missionary and such are ok (not certainly as good as it could be), cause I know how to work with it. I also feel, like it may have effected my erection quality to. Perhaps screwed with my blood supply or something, but I have not had a doctor check it out as of yet.

Anyway, what I’m trying to say, is I feel your pain, bro! I’m considering surgical means for repair, but I haven’t researched it extensively and I’m probably going to wait for a while before I go that route. However, I think it is inevitably something that I will do if it can be done with a high degree of certainty that it won’t make matters any worse. So, PLEASE keep me, and the rest of us on Thunders up to date with what you find out! I’m certain there are a lot more men who are in the same situation as us. One is never alone!

Did the surgeon use the old V-Y forward advancement flap? Reversing the V-Y advancement usually gives more stability. Yes girl on top is next to impossible and the fear/anxiety of buckling causes loss of erection.

You should have an ultrasound doppler done through your urologist to make sure that you have normal venous integrity and occlusion in your dick. Is the top vein still there or does it fade off closer to the base?

Who was your surgeon if you dont mind me asking? It’s just a huge effort now to get things fixed properly but I’m sure huge improvement can be obtained, so stay focus and positive. Are you looking into legal action?

Did the surgeon use the old V-Y forward advancement flap? Reversing the V-Y advancement usually gives more stability. Yes girl on top is next to impossible and the fear/anxiety of buckling causes loss of erection.

You should have an ultrasound doppler done through your urologist to make sure that you have normal venous integrity and occlusion in your dick. Is the top vein still there or does it fade off closer to the base?

Who was your surgeon if you don’t mind me asking? It’s just a huge effort now to get things fixed properly but I’m sure huge improvement can be obtained, so stay focus and positive. Are you looking into legal action?

No. I believe my incision was at that time the “newer” transverse incision (that is the straight line one, right) and is less than 2” long hidden under my pubes. The scar really isn’t noticeable unless I trim my pubes too far, and I think it would have healed even better, but stretching post surgery in the downward angle didn’t help in the healing process. So, it is a little wider and more noticeable than I’m sure it could have been.

I’m trying to remember the Doctor’s last name, but off the top of my head all I can remember is that it started with an R. Looking online is seems that it would either be Dr. Melvyn Rosenstein or Dr. Gary Rheinschild. I want to say it was the later, but I’d have to search for some record of that to be sure. I know that I stayed in Anaheim, CA when I had the surgery done in 󈧀 and it was close to where the clinic was.

As far as legal action. I haven’t though about it. I kinda figured that all the paperwork that I signed released the Dr of pretty much all Liability. Plus I think that there are some guys out there who got pretty screwed up so they would probably look at me and my situation and think nothing of it. Additionally it has been so long, and I’m not sure what the statue of limitations is on a lawsuit like that. Honestly I just wouldn’t know where to start on legal action and I don’t have a lot of cash to make it happen. That is if cash is necessary to do it. In the end, though if there were a means to sue and I had a good case I’d do it. Justice and some cash to pay for fixing things up!

I hear you on the buckling thing. It’s like my dick is hard enough to go in, but unless I have the right angle or stabilize it will not penetrate further, instead it will buckle, bent or arc like a bow. Not cool. One way around it, which I haven’t tried with anyone because I’d feel stupid, is to have sex with your underwear on, but the waistband in the front pulled down to just under the base of your shaft. This provides the proper leverage or anchoring that is necessary. But, who wants to have sex in their underwear, right! “Ah, yeah, take off all your close so I can fuck the crap out of you, but I’m gonna go ahead and keep on my underwear. OK?” No go!

I must say, it is good to discuss this with someone and figure out some of the details and possible avenues towards recovery. Well, best of luck to you, and do keep me posted and let me know if I can help ya in any way. I’ll do what I can.


Suspensory ligament?

Good thinking! feeling sorry for ourselves will only waste time and energy. I am convinced that there's a solution as well, and will keep you updated of any progress.

Good idea in quitting, I hope many more will realize that PE is too much of a gamble and a waste of time really. Instead of pulling on your unit, one should learn how to communicate better with women (you'll end up boning chicks everyday trust me), that beats any extra inch that carries huge risks.

Why should men break their balls to please women who focus on dick sizes, women with loose morals and loose tunnels. PE is inflating smooth muscles with excess blood, this can and will cause some scar (your gains) tissue and can burst blood vessels, and you risk having a loose penis with little sensitivity.

smooth muscles are not like musculoskeletal muscles (dont exercise that thing), in other words there are no muscles in the penis, the only muscles near are your bc,pc and ic muscles (pelvic muscles).

If you pull the ligaments out, all you'll really get is instability and a little extra flaccid length, and who cares about flaccid length really? if you stretch a nerve passed its 12%, you risk nerve damage, so for those that increased by an inch, beware.

And finally as my biology teacher told me in college, a man with a smaller penis has more chance of knocking boots at 70 than one with a long dong, and he has more chance of sexing more women since he'll recover faster and needs less blood to fill. This can explain why India and China are so populated (not to discriminate on my asian brothers lol).

So now I'll focus on recovering from hard flaccid, and I think that the ligament damage included vascular damage which explains the erectile dysfunction. The pain at the base can be anything really since nerves veins and ligaments pass through there.

so marshmallow my advice to you is to keep doing your cold or hot (or both) therapy, and to look into what obitoo has suggested like you said earlier. also don't apply any pressure on the base and make sure that you have good bloodflow down there. If you do masturbate/sex than do it with moderation, once per 2-3 days, not more for now, and if your erections have been the same I'm sure you'll be perfectly fine if in a few weeks.

You guys are all going down the wrong path. Let me explain a few extremely basic medical facts:

1. If you had a leaking vein, you would have a whole bunch of very obvious symptoms besides these. Your skin would look like a violent bruise, you would have blood pooling, all kinds of swelling and adema, the works.

2. Your erectile dysfunction is caused by the same exact thing that is causing your hard flaccid. How would you expect the penis to fill with blood properly when the arteries that feed it are all being pressed upon by muscle tension? It's a simple problem, with a simple fix.

3. You all have classic symptoms of pelvic muscle dysfunction. Classic. There isn't a single thing special or unusual about any of your issues.

4. The only symptom of suspensory ligament injury is an erection which will not stand upright. That's it. No more, no less.

You could all use some mental help. I mean that sincerely. The ideas you have in your minds about yourselves and women are really, really far from reality. Honestly just sounds like your entire perspective comes from nothing but porn. Sad stuff. I hope you guys can become normal human beings someday. You are all missing out on real life.

There are tons of things you can do to completely rid yourself of all these problems, and none of them are on this moronic website.

1. Go to professional physical therapy with a pelvic floor specialist.

2. Get psychological counseling.

This happened to me when I was a bored teenager with little sexual experience. And unfortunately the experiences I had was with two size queens.

what i've done so far is leg stretches, reverse kegels, not sitting too much, eating healthy,masturbation 1-2 a week, and hot baths every two days. All of this seemed to have helped, and also I tend to wear loose underwear, feels more confortable but not sure if it plays a role in hard flaccid.

Here is what I've observed from the ligaments. My suspensory ligament is visible, it is there and not sore as it used to be. What is missing is the fundiform ligament, the triagular ligament that encircles the shaft around the scrotum. Before my injury, I would flex the bc muscle and the base would pull down, making the tip of the penis go up, at the same time the fundiform ligament would resist the force of the bc muscle which would then result in increase bloodflow due to the opposing tension between the fundiform and the bc muscle. this event would make my glans engorge with blood. Now if i flex the bc muscle the base simply goes down and there is no resistance so the penis just flops around, and I lose all the blood from the head and the rest of the shaft quickly empties. this is why i suspected the fundiform ligament to have more than just the role of keeping the penis up, but again this is only speculation.

Sad to hear you also are in pain.
I have not improved greatly to be honest and it's been 2 and a half months for me.
I am going back to the GP tomorrow as my next appointment with the urologist is not until the end of the month (where I know he will tell me nothing is wrong with my penis) and the anxiety is building up. Not knowing is not a good thing. I wake up at night in pain and with chest pain, which is provoked by my constant thinking about this, and I could do with some relaxing pills. As I mentioned in a previous post, I have practiced loads of sports and have injured myself many times, but this is the only occasion where a pain is starting to get the better of me.
Dick pain is not the same thing as ankle pain.

About CPPS:
I have contacted the only person that seems to deal with Chronic Pelvic pain in Madrid, and he recommended that I went to see him when I had the results from the urologist as that would help him assess my situation faster. I'll have to wait and see. CPPS seems complex and includes quite a few possible symptoms. I don't have many of them but Obitoo could be right, and I sure will investigate that route as soon as I get the results from the urologist.

What I know is that my symptoms have changed quite a lot. From the pain at the base of the penis I had originally, I now feel a pain in the rectum and in between the anus and the beginning of the penis. It's a burning pain. And it's present especially when I sit down.
I used to have penis pain when sitting or walking as if the trousers where literally burning my dick, but that is not happening anymore. I also felt like my penis was ripping whenever I had an erection. That's no longer the case. I feel a little sharp pain at the base of the penis where the dorsal vein is which I did not really have before.
Sometimes I feel like I have gone from a kind of pain to a completely different one. Not even sure they are related anymore, honestly!

- As Obitoo says STOP Pe and NEVER try it again. Also, it can't be suspensory ligament damage. The penis would just not get erect in its natural angle. I started this thread as "Suspensory ligament?", but I know now that my pains have absolutely nothing to do with that.

- I would stay away from searching the net. You may find answers, but you will not find the answer. What I have may be different from what you have. A specialist is the only person that can help. Plus searching and finding answers that have nothing to do with your conditions can create more anxiety. I WISH I HAD NOT READ THAT MUCH!! No one will really help you in PeGym.

- Try to stay active. If you are out partying, and not thinking I guarantee you that the pain will not be there. Sometimes, I wake up pain free, and the second I think "Is the pain there?", I start feeling pain. not thinking about it makes it definitely more tolerable.

Any questions, ask me. I am happy to help whichever way I can.

@marshmallow: Your entire ordeal could be explained in a single word you have already said yourself. anxiety.

Anxiety is why your problem persists. It's why it has worsened. It's why it has spread to other areas. It's also probably got a lot to do with why you got it in the first place.

What you need more than any physical therapy is to dramatically reduce your stress and anxiety levels, and keep them that way. For a lot of guys, simply eliminating or learning to properly cope with stress and anxiety is enough to get rid of their entire CPPS and/or HF problem completely.

You need to better understand your body and mind, how they work together. You need emotional counseling. I would start there if I were you. I couldn't have gotten rid of HF without it. You will literally never, ever, ever get better if you continue to be under stress like that. Not a chance in hell.

There is no need to try and figure out HF any more. We have already figured it out. It is a cramp of the Ischiocavernosus muscle. That's it. Now, why yours is cramped is for you to figure out. Number one causes for guys with HF are: stress/anxiety, CPPS/muscle dysfunction, muscular weakness, postural defects (like tilted pelvic etc).

I know people THINK they broke your penis doing PE, but the truth is that your body has been setting itself for this injury for probably your entire life. Emotional Counseling + Physical Therapy = no hard flaccid. That's the answer. Now, stop looking and start doing.

Obitoo is absolutely right, the IC muscle is cramping and treating it has greatly improved my situation. I still believe that ligament damage can decrease rigidity since theres less of a pull/tug at the base but it should not stop you from getting an erection.

Obitoo thank you for your devoted time in giving us advice, I think now that I have achieved my goal of feeling like a normal man again.


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