Penile erection depends on a valvular mechanism in which the blood vessels at the base of the penis dilate and allow massive blood flow. Along with this, the musculature at the base of the penis contracts and allows pressurized blood to be held inside the penis.
During penile enlargement and thickening surgery, the erectile mechanisms of the penis are not usually affected, although it is true that we act directly on two structures intimately linked to erection: the suspensory ligament of the penis and the musculature of the base of the penis.
At the level of the suspensory ligament, we are going to release it during surgery. Specifically, we partially release the ligament from its attachment to the pubis. This ligament does not help the erection but it does determine, together with the patient’s own anatomy, how the erection is produced with regard to the angle formed by the penis and the pubis, and therefore by the penis and the shaft.
When we perform the surgery we create a pharmacological penile erection by puncturing the base of the penis with substances that allow us to recreate it. During the surgery we progressively release the supensory ligament, which allows us to remove the penis that was attached to the pubis. The amount of penis we can remove depends on how the erection angle behaves. So we stop dissection of the suspensory ligament when the angle of erection approaches eighty degrees with respect to the abdomen.
This allows the erection to be optimal for penetration and even better than before surgery.
The greatest difficulty lies in patients with significant anatomical asymmetries in the pubis or who have pre-existing deviated erections in which we must perform internal rotation vectors by means of penile anchor points to achieve an optimal erection in terms of position.
The muscular region that we modify in the surgery involved in the erection is not very important since we are only going to make approximation points between the homologous muscular zones of each side to push the penis with greater force towards the external region and make it more visible in this way.
As far as the valvular mechanism of penile erection is concerned, we do not intervene in that region, so it is not affected. Therefore, erection should not be affected by it.
In summary, the alteration of the erection is infrequent in penile enlargement and thickening surgery, although it is true that the erection mechanism depends absolutely on the psychological state of the patient and factors such as stress or insecurity are determinant in the correct functioning of the penile erection.