Shortened penile length after radical prostatectomy: what’s new?


The fact that there is a significant degree of risk for a reduction in penile length after radical prostatectomy for the treatment of localized prostate cancer is very definitely not news (despite the fact that all too few surgeons advise their patients of such a risk). However, an accurate assessment of the probability of this risk has never been well established.

A new paper by Parekh et al. in Urology (“the gold journal”) is — unsurprisingly — getting a lot of media coverage. The paper describes data from 948 patients in the so-called COMPARE registry regarding the incidence of patient complaints about reduced penile size after first-line treatment of localized prostate cancer.

Here are the core findings:

  • The patients were assessed at an average (median) of 5.53 years after first-line treatment.
  • Their treatments included radical prostatectomies, external beam radiation therapy, or brachytherapy, with or without androgen deprivation therapy (ADT).
  • 25/948 patients (2.6 percent) complained of reduced penile size psot-treatment (but no data on penile size before or after therapy were actually available allowing objective evaluation of the accuracy of this complaint).
  • Among these 25 patients, the incidence of reduced penile size stratified by treatment was
    • 19/510 (3.7 percent) for those treated by radical prostatectomy for surgery
    • 6/225 (2.7 percent) for those treated by any form of radiation therapy plus ADT
    • 0/213 (o percent) for those treated by any form of radiation therapy without ADT
  • The perception of a reduction in penile size was signifciantly associated with
    • Interference with close emotional relationships (odds ratio [OR] =2.36)
    • Increased treatment regret (OR = 3.37)

The authors conclude that:

Complaints about a reduced penile size were more common with [radiation therapy] plus ADT or surgery than [radiation therapy] alone and were associated with greater interference with close emotional relationships and increased treatment regret. Physicians should discuss the possibility of this rarely mentioned side effect with their patients to help them make more informed treatment choices.

The “New” Prostate Cancer InfoLink is in complete agreement with Parekh et al. that patients should be clearly advised of the “possibility” of this side effect of treatment. However. it is worth noting some other facts about this side effect that are addressed in a media release from the Dana-Farber Cancer Institute that is directly related to this new study:

  • Patients’ physicians did not specifically ask their patients about this side effect in the COMPARE study; the issue was brought up by patients in conversations with their doctors. Parekh et al. suggest that this problem is, in fact, more common than reported in the survey.
  • According to one of the surgeons who was a co-author of this paper, “Previous studies have concluded that there is shortened penis length following prostatectomy. This is most common with non-nerve sparing surgery, as this may result in fibrosis and atrophy of erectile tissue due to damage to nerve and vascular structures.” However, this study did not find much difference on that score.
  • This is the first time that there has been any mention (that we are aware of) of risk for penile size reduction associated with first-line treatment by radiation therapy and ADT.

Another reason for loss of penile size post-surgery is, quite simply, poor surgical technique, leading to shortening of the length of the urethra when it is reattached to the bladder neck after removal of the prostate.

What is the bottom line here?

It seems to The “New” Prostate Cancer InfoLink that it is high time that a careful study was conducted to accurately correlate risk for loss of penile size with specific types of first-line treatment for localized prostate cancer, and with related factors affecting sexual function. (For example, if the patient already has erectile dysfunction prior to surgery or a couple is sexually inactive for other reasons, how important is it that there is any loss of penile size?)

Sexually active men and their partners need and are entitled to full information on how any form of first-line treatment for localized prostate cancer might affect their intimate interpersonal relations (however embarrassed their surgeons and radiation oncologists may feel about bringing this subject up). Without such information, the patient and his partner are in real danger of having to live with a consequence that, if known of beforehand, might have changed their decision about treatment.

33 Responses

  1. Mike,

    Quite frankly, you are too kind. The industry meme that big macho, braggadocio surgeons — men (and women) willing to hold a beating prostate in their hands — are too “embarrassed” to talk about shrinking men’s genitals, a very likely effect of prostatectomy, is a total and complete red herring. They’re not “embarrassed”! They don’t want to lose market share. Period. They like selling a “pig in a poke” — all puns intended.

    If they were honest about all the likely outcomes of the procedures they proffer, one or more of several good things would happen: We’d have a fully articulated, widely-adopted, evidenced-based, active surveillance protocol that most men with low-grade, early stage prostate cancer would choose until their disease progressed, requiring more intensive treatment to truly preserve their lives. And/or, if they were honest about the outcomes of their current wares, we would have already “redefined” low grade prostate “cancer” as something else, so that patients didn’t have to deal with the psychological weirdness of “not treating cancer.” And/or, we’d use prostate cancer as an example to enhance the public’s health literacy about the complexity, diversity, and range of risks presented by “cancers” and we’d quit treating every small speck of irregular prostate cells as the equivalent of late stage pancreatic cancer.

    The dearth of authentic informed consent of men subjected to current prostate “cancer” “treatments” is shameful. Lies of commission and omission run rampant, unabated, and unchallenged by peers. Where are the moral actors in this field? The very idea that trained physicians — who spend every day with their gloved fingers exploring urethrae and rectums — are such delicate flowers that they can’t honestly explain to potential patients all the likely outcomes of their work requires too great a suspension of disbelief to continue to play along with. It’s time to have an honest conversation about what is and what is not life-threatening “cancer” and what are the totality of risks and benefits of treatment. We’re nowhere close to doing that. And the folks — the clinicians, researchers, and advocates ultimately responsible for facilitating that conversation are the most resistant to having it because of vested financial and political interests.

    As an aside, the hypothesis and methodology used by Parekh et al. is like a public service announcement for understanding how to avoid crap science as well as the imperative of calling it out when it flounces about the ballroom masquerading as knowledge — truly a humiliation to the western canon of scientific endeavor.

    Really!?! A sample of less than a 1,000 pulled from a registry (we all know how good those data are) for a retrospective, self-reported study of men with failed first-line treatment using “multivariate” (which didn’t include any actual empirical evidence) regression analysis on psychosocial perceptual data, hand-fed to respondents. It’s hard to imagine a more self-rationalizing exercise in manufacturing evidence to blame the victim, I mean “patient”, than this kind of “So, Mr. Smith, do you still beat your wife in the morning or only in the afternoon?” It is a mockery of clinical research that this was published after peer-review and the very idea that this pro-invasive treatment propaganda is about improving patient incomes is a sick joke.

  2. Why be mealy mouthed about this? If a prostate is removed, about 1.75 inches of urethra goes. When the two ends are rejoined, something has to give. The bladder neck might stretch a bit but it is 100% likely that some if not all that 1.75 inches will go in terms of penis length. It has nothing to do with surgical skill, it is a simple matter of mechanics!

  3. Dear Ed:

    Respectfully, the amount of urethra that can be retained in order to minimize loss of this tissue depends a great deal on the skill of the surgeon and the anatomy of the individual prostate. There is always loss of some of the urethra, obviously, but just how much is important for a number of reasons, as is the fact that the bladder can be moved downward to fill some of the space previously occupied by the prostate.

    Yes, there is loss of some of the urethra, but it would be mechanically inaccurate to imply that loss of 1 or 1.5 inches of urethra was necessarily correlated to loss of 1 or 1.5 inches of penile length.

  4. Clearly it is not going to get any longer, that pretty much leaves one answer.

    Tracy, well said. There is far too much truth in your statements. The motivation may not be as self-serving as you feel it is, the outcome is not far off.

    Take that same list of patients and blind poll them on the results, and then take their partners and blind poll them.

    TV show “House”: “All patients lie.”

  5. Well, this article confirms that, as a past prostate cancer patient, I am on the wrong forum. To suggest “shrinkage” is possible after surgery is “not news” may sound great to all of the urologists who don’t find it convenient to share said fact, but I only learned of penile “shrinkage” 2 years ago from a past surgery patient who insists he lost nearly 2 inches and is livid he wasn’t warned about it. I have not spoken with any prostate cancer patients who have been informed of that risk and I’ve interviewed dozens in my research.

    As I’ve shared with the Sitemaster in the past, prostate cancer patients are truly at risk when it comes to treatment with few or no side effects. Ninety percent have a very difficult time researching the treatment choices and it is no wonder why.

    Continuing discussions of “lack of data” from every single procedure … is just one more nail in the credibility coffin of prostate cancer treatment in the US, where urologists play the CYA card more than transparent contrition.

    It ain’t just “patients” that lie …

  6. Dear Elucidated1:

    Perhaps another way to look at this is that it only emphasizes the value of joining on-line or physical patient support groups for newly diagnosed patients before they make any decisions about treatment. My guess would be that there isn’t a prostate cancer support group leader in the country who hasn’t regularly come across the issue of loss of penile size after radical prostatectomy … but we still have very little data on the real incidence or “size” of this problem.

  7. It has been a while since I saw the show; isn’t it “Everybody lies.” More lies are from being polite or embarrassed than any other reason.

    The more you truly like or respect the physician, the harder it is to look them in the eye and say not everything is all right.

  8. Sitemaster, you bring up a good point. I think the common path is to be told you have cancer and walk out of that first appointment with at least a tentative plan if not a referral. That is so wrong.

    Cancer is not going to kill you in a week or a month. People take more time to decide about their IRA than their treatment.

  9. Oh … and Elucidated1 … This web site is not a “forum” … We have a whole separate discussion forum if you click here. please feel able to join it. This web site is a news service with background information.

  10. Forum by definition. I understand. But the only reason I am following this site is to help share edifying data with friends who are at risk.
    What I believe to be true is that the large majority of prostate cancer patients do what their doctors suggest, are intimidated by having cancer, wanting to elimidate it immediately despite the fact that they are not going to die tomorrow. They want to believe their doctor … they don’t want to believe that professional fees play into a urologist’s recommendations.

    And it is happening to hundreds of thousands Americans every year. Any posts of my opinion to the “forum” will probably not amount to a hill of beans anyway.

  11. It is a rational, political, and economic act to choose not to fully measure the impact of one’s (and one’s profession’s) actions.

  12. This certainly is old news, but vastly underestimates the percentage of men who experience decreased penile dimensions after prostate cancer treatment. I have written extensively about this on my website. To begin with, approximately 17% who undergo a radical prostatectomy develop Peyronie’s disease (penile curvature) and almost all of these men experience penile shrinkage. An even greater percentage (even those who don’t develop Peyronie’s) find that their penis will shrink. There is ample evidence</a? to support this.

    In one study discussed on my site, the percentage of men who were informed by their physicians of this potential adverse event was exactly zero. Finally, these studies always — and I mean always — leave out another important issue … decrease in penile girth. This is another common event, but never discussed. Physicians routinely fail to provide enough information to their patients so they can give informed consent prior to treatment.

    If anyone would like to spend an hour or so reading about prostate cancer treatment and Peyronie's disease and penile shrinkage, just go to my site and type in prostate cancer in the search box.

  13. Beautifully expressed comment by Tracy, in my opinion. Here in the UK, with the National Health Service, there is much less financial/career incentive for quick radical treatment, although there remains the effect that radiation oncologists tend to want to irradiate, and da Vinci surgeons tend to operate, etc.

    Just as one data point, I was not warned of penile shrinkage before my RP, but fortunately, nor has it occurred.

  14. As a patient, I find Tracy’s comment compelling, but I don’t understand it. Would she please explain? Does it mean CYA is a rational way to protect one’s profession and incompetence?

  15. “Another reason for loss of penile size post-surgery is, quite simply, poor surgical technique, leading to shortening of the length of the urethra when it is reattached to the bladder neck after removal of the prostate.”

    Apparently this is what Tracy suggests to protect: Questioniable competence of physicians resulting in rest of life compromises to the patient.

  16. My penis in its flaccid state (which it was permanently until I had a pump installed), seemed much smaller, but because I never had measured it in that state, I can’t say how much. As a young man, I had, however measured it in an erect state, and the loss was 2 inches in length. Also seemed to have a smaller girth. And, I wasn’t informed about this prior to surgery.

  17. Dear Elucidated1:

    I don’t think Tracy is seeking to “protect” anything on behalf of physicians. My suspicion is that she would might think that any urologist who wanted to carry out radical prostatecomies for a living be required to have one himself before he was allowed to do one!

  18. In my opinion, professional accountability should include a subversive hit squad of patients to deal with physicians who refuse to police their own or who completely screw up. Published exposure of professional incompetence is one place to start.

  19. And how would you suggest that patients became qualified to act as such “subversive” judges and jurists? Your suggestion sounds to me rather like a potential lynch mob.

    As I have noted a number of times before, there are plenty of patients who absolutely insist on having unnecessary treatment despite professional guidance not to do so. Some of those patients quite certainly then complain vociferously about their side effects after the fact.

    Should we also have a “subversive hit squad” of physicians to deal with patients who refuse to deal with the realities of their clinical situation? Patients have a good deal of accountability for their actions too (in my opinion).

  20. I stand by my statements. In my opinion, for the most part, medicine in the US is quite good. And you have been very tolerant of my stupidity over the last few months.

    But in my personal research, after discussing prostate cancer side effects and mistakes with a few dozen patients as well as those on websites like YANAnow, more than one patients feels that professional accountability is an oxymoron in many facets of medicine. In fact, there are many patients who are fighting mad about their results. Why do you think I chose HIFU over other treatments once I found out the chance of side effects? Why do you think I chose Dr. Scionti for HIFU instead of surgery or radiation? For me, everything went like clockwork. But there are way too many horror stories that are not shared with patients before treatment.

    I play golf with doctors who sheepishly talk about issues just this side of malpractice. Physicians like you know it. Few call out their own, though. It is an incestuous community in my opinion when things don’t go well. The head urologist for S. Cal Kaiser told me in person about a scrap heap of patients that need major corrective treatments after prostate cancer mistakes. It is apparently not easily remedied and can be life threatening. It seems the field of urology is so difficult that mistakes are magnified big time. Do we blame the patients for a urologist overselling RALP because that is what he does?

    You can go on multiple websites to find out good and bad information about suspect restaurants and businesses or a Congressman’s voting record. You can easily find out about suspect teachers at schools, but just try and find any specific data on success and failures of specific doctors in the US.

    Apparently you might have a database to share. I don’t. Please share here a quanitifiable database of US physician successes and failures.

    90% of patients don’t know Jack Diddly and appear to be incapable of figuring out their choices. They depend on the doctor.

    Do we really expect 240,000 newly diagnosed prostate cancer patients to actually figure out how to research the most successful treatments like radiation or surgery, then subcategories like brachytherapy, proton therapy, etc., of each, and then find capable urologists on their own? How do those patients meander through the formidable medical lexicon and changing treatments and medications?

    Even agreements within the urological community of “Do we give patients PSA tests” (or not) is a problem. These issues cloud understanding for almost all of the patients. I have advanced degrees and for me, it took me month of research … so how does the guy who is a plumber (pun intended) figure it out?

    No one is defending patients who come in demanding costly proton therapy or magnifying side effects. They are part of the problem too. But at what point in time do we call out the radiation community that once seemed to oversell proton therapy as the next best thing?

    Lastly, if all physicians played the game straight up … as the Hippocratic oath suggests, then we wouldn’t be having this discussion. But too many physicians are swayed by having financial interests in certain treatments as we have previously discussed.

    If you find it troubling that I am suggesting a metaphorical asskicking of those doctors who screw up, so be it. The urological community can call out their own, but so far, they don’t.

  21. In regards to the remark “Another reason for loss of penile size post-surgery is, quite simply, poor surgical technique, leading to shortening of the length of the urethra when it is reattached to the bladder neck after removal of the prostate.” Not so. My take following research is explained here: http://tinyurl.com/artg62p

  22. Dear Elucidated1:

    It seems to me that there are multiple and very different things going on here:

    (a) I completely agree with you that organized medicine — pretty much worldwide — does a lousy job of protecting patients from the “bad actors” within the medical profession. Actually that is true of many, if not most, professions. Furthermore, organized healthcare as a whole tends to be supportive of organized medicine in this respect. This is far from exclusive to the field of prostate cancer. There are databases in some countries (including the USA) that could theoretically be used by independent arbiters (inclusive of members of the patient community) to assess and report on the quality of care provided by individual physicians. However, these databases are (largely) inaccessible without specific approval by those who control them. Is that a good thing? I don’t think so. However, I will also tell you from what little I know about those databases that they would need to be used with great caution because the data included is limited and largely non-objective.

    (b) The fact that there are patients who do well and patients who do poorly in response to specific treatments can be extremely complex. It is neither appropriate or accurate to point one’s finger at a physician when a patient has a poor outcome to a perfectly reasonable clinical procedure and make the inevitable assumption that this necessarily is the physician’s fault. There may be all sorts of reasons why the clinical procedure didn’t work well in an individual patient, and many of them are completely unpredictable (such a an unusual anatomic feature in an individual patient). Medicine is not an accurate science … just as using Google doesn’t necessarily lead to its users receiving accurate information through the web.

    (c) The idea that we could develop a system through which all patients could be thoroughly and accurately informed about all their options with respect to their treatment for localized prostate cancer (or indeed many other forms of localized cancer such as early stage breast cancer or early stage sarcomas) is idealistic — no one has worked out how to do it so far despite millions of dollars invested in this area by thousands of organizations around the world. Humans are human … They do not agree about all sorts of things … Therefore (sometimes rightly and sometimes wrongly) there are differences of opinion and differences in the interpretation of available data. This is hardly exclusive to the field of medicine. Plenty of intelligent people make bad medical choices despite doing weeks and even years of research.

    (d) Do I think that most physicians fail to give their patients a really thorough understanding of all the potential risks associated with specific treatments (again, this is not exclusively to prostate cancer)? Of course I do. However, I am not sure what you think we could do about this. It would take considerably longer to give the average, individual patient a sound grounding in all of the options for the treatment of localized prostate cancer and how each of them might apply to him than it does to treat him by any one of the available options (inclusive of 40 sessions of external beam radiation therapy).

    Just as an example, for most of the past 25 years, I — and others like Terry Herbert, the founder of Yananow — have been advising selected older (and some younger) men with low-risk forms prostate cancer that careful monitoring of their disease (all it what you will) was and is a perfectly reasonable option. Until comparatively recently, this idea was rejected by a vast majority of the medical community, let alone the patient community. Even today, most men with low-risk prostate cancer (including men in their 70s with two or more co-morbid conditions) will reject this idea out of hand.

    I would love it if we lived in an ideal world in which people were much better educated about issues related to their health and their medical care, starting in early childhood (which is when they really need to start understanding these issues). However, most educational systems in the world aren’t set up to focus on things like this. Where would you like to begin?

  23. Dear Chuck:

    Respectfully, I think your research misses a number of key issues, including the fact that how penile size is assessed before and after surgery is crucial (erect, flacid, flacid but extended, etc.); that the key source you quote does not address the issue of poor surgical technique at all; and other factors.

    I certainly agree with you that good penile rehabilitation can help to minimize any risk for loss of penile size post-surgery — if the surgery was well conducted in the first place. However, a poorly conducted procedure can most certainly have loss of penile size as one of its consequences if the surgeon does not leave a sufficient “stump” of the urethra attached to the bladder or if the surgeon removes more of the urethra with the prostate than is actually necessary (and if the degree of trauma to the internal organs cannot be reversed by penile rehabilitation).

    As I stated in the original commentary, the problem is that we have very little accurate information on the extent of this problem. A single paper from Brazil on 105 patients is not exactly a compelling database.

  24. There is an interesting discussion of penile shortening at this website. In particular, the author of the article (presumably a urologist) says, “One such theory that has been debunked (for the most part) is that of tension from the urethra. It was thought that because the prostate is removed, tension is created in bringing together the bladder and urethra. As a result, the urethra is pulled up towards the bladder, simultaneously pulling the penis into the body and shortening it. This theory does not make much anatomic sense as the urethra is tethered to the part of the pelvic muscles called the urogenital diaphragm. As a result, the urethra cannot really get pulled much in either direction, limiting its ability to shorten the penis.”

    From my own experience, I have not noticed any penile shortening as a result of a nerve-sparing prostatectomy performed in November 2011. However, I have been actively pursuing penile rehabilitation because I was well aware from the outset that the short-term ED resulting from nerve damage could turn into long-term ED due to atrophy of the erectile tissues. I have been using a vacuum pump, oral drugs, and even injections. At this point, I have quit using the pump and am about to stop using injections because I’m getting a good response to the oral drugs. Whether I’ll ever be able to stop using the oral drugs remains to be seen, but I’m relatively content with my progress to date.

  25. All:

    I am a 6-year veteran after RP via DaVinci in 2007.

    I was not foretold of penile shrinkage and actually never thought about that possibility. Post surgery and following several weeks, flaccid state was small but perhaps no smaller than experienced for the previous 63 years even after rehab penis messages. As having lost all of my normal erectile functionality post surgery, I found my shrinkage issue by accident upon attempting intercourse with the help of injections and found I was not very successful as my penis kept slipping out. First I thought it was us not remembering what it was like after 10 months. But it did not take much thought to realize what the problem was. This has been very frustrating and cannot seem to find a way around this unfortunate reoccuring issue. Girth is also smaller over time. Overcoming these issues would be desirable.

    Yes, I wish I had known about this issue as well as other issues that were minimized or not discussed at those critical mental decision times prior to surgery. It is what it is and I do appreciate all of the subject matter discussed above with intensity and seriousness. This is enlightening and can only be good in educating all prostate cancer candidates. I’ll be back to learn and offer if I can.

    Thanks for the forum. Any and all support is welcome.

    Marc

  26. Marc

    I understand your frustration. After my RP in 2006 my penis shrank in both length and girth. Added to that, I was very incontinent. The result — a small, limp, and soggy penis. My penis was smaller both when flaccid and when pumped up with injections. Eventually I had a penile implant and a side benefit was that my penis while in a flaccid state felt full and is, in fact, as big as it was before — maybe larger. It is still smaller while erect, but there is enough. Lovemaking, while absent that wonderful unfolding of an erection, has been great. Last year I also received a male sling, which handled 95% of the incontinence and I am pretty happy with it all. Hang in — there is more coming.

  27. It would seem that all of us are having this shrinkage side effect. Some may not realize it, some may be too ashamed to admit it, and many are aware but are thinking, “What is the use, done is done and I am still alive”. (Those of you who were mourning the loss of your foreskin at birth should be happy, as having a prostatectomy will give you that effect immediately as your member backs up into its own skin covering.)

    It sounds like all urologists are sworn to some code of silence about this side effect. Don’t know why they would be; maybe they figure many would choose not to fight the cancer knowing of this one final insult. I can think of nothing positive that comes from treating this cancer other than the unknown and non-guaranteed hope that it might prolong your life. There seem to be very few things known for sure about the treatment of this cancer other than there will be side effects that will haunt you for the rest of your life. Even the necessity of treatment is a grey area. There are no experts, just statistics. I am sure that in 50 years the medical community will look back on these methods as barbaric, maiming, and shameful. For now, it is profitable for the medical industry and just might be helping some of us live without dying from the cancer. I do think the medical industry for some reason finds this side effect minor to the point that they aren’t trying very hard to alleviate it. It is not minor by the way! It is an insult to one’s self-esteem and a constant reminder of the tragedy you have endured. Maybe a by-pass, like they do for one’s heart, as part of the procedure would bring more life-saving blood and oxygen to this now deprived organ.

    JR

  28. JR,

    You have said what so many men have been afraid to say. I agree with all of it. And yet RP and radiation seem to be the du jour treatments in the US and the side effects are well documented.

    And that is why the sitemaster here is entirely correct: active surveillance should be the first line of suggested treatment with surgery as a last resort.

  29. Just to be clear, there was no association found with radiation alone, only with radiation + ADT. Most people who study this, like Mulhall, believe that penile shrinkage begins during surgery when tissues are deprived of oxygenation, and they begin to atrophy and become fibrotic. ADT may indirectly cause atrophy because the reduced libido discourages use of “the equipment.” A propos of your suggestion to do a by-pass, Ash Tewari has developed a surgical technique that monitors and maintains penile oxygenation throughout. It would be interesting to see if that maintains penile size.

    I agree that it’s tragic that patient perceptions of penile shrinkage are not routinely monitored in the same way that erectile function is monitored. To my knowledge, it is not included in any of the routine questionnaires urologists use to monitor quality of life. Unless they start looking at it, I am not hopeful that they will ever really address it.

  30. Stumbled upon this discussion … I know it is now a few years old.

    I too am post-RP (open) … 4 years … Prior to surgery my surgeon, after being asked specifically about penile shrinkage, advised me “none at all”.

    In fact I lost almost 3 in in length and girth. I also have curvature, though my urologist says it is not Peyronie’s.

    My ED still requires injections but I have recently had some effect with sildenafil, though inconsistent. I have pre-op measurements and images of my penis which my wife and I took as we had heard from other sources of the chance of this side effect. Little did we know it would be a bad case.

    My brother had RP (da Vinci) a year prior to me, from which his recovery took 2-3 months — to full function and no loss of length/girth.

    I am bitterly disappointed as I am only 54 and my wife and I rarely have sexual relations now. I masturbate once or twice a week in which I climax with only a partial erection that could not be used for successful intercourse.

    In discussion with my surgeon a few years ago and with the sexual health clinic doctor about my ED they both said it was all in my head. When I put it to them about the lost length/girth they looked at the images and both disbelieved me.

    Rod (Australia)

  31. This all convinces me that the medical field is generally just a bunch of highly skilled mechanics with very little compassion for what their treatments cause their patients. (As is the case with a car mechanic who fixes the main problem but in doing so is careless about causing little scratches and other “minor” damage as he works on your car.)

    These minor problems are minor and acceptable to the surgeon, but to the patient they are constant visual reminders of the tragedy he has endured and, while healed on the inside and accepting the results of that, he now lives with the constant and visible “minor” damage inflicted from fixing the main problem. I do not think the medical field has a good understanding of the effect that this prevalent but down-played issue has on their patients and until they are forced to recognize it as a major problem, they will continue to not address it and even deny it. It is an unnecessary tragedy piled on top of another.

    JR

  32. Based on my own experience with urologists and with the outcome of my own RP, the criticism of those specialist physicians as a group is well earned. They are not straight with their patients, and they protect one another at their patients expense.

  33. Paul,

    You are exactly correct. It appears that physicians are not well trained in dealing with the emotions of losing penile length, or for that matter the discussion of incontinence/impotence with their patients, pre- and post-treatment.

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