Plastic and reconstructive surgery of the male genitals

Plastic and reconstructive surgery of the male genitals comprises a set of procedures that correct malformations, functional problems and acquired conditions of the penis. They range from frenulum surgery to circumcision, from straightening a curved penis to procedures on penile size. Some are simple day-case procedures; others require careful patient selection and, in certain cases, a preliminary psychological assessment.

Frenulum surgery (frenulotomy)

The frenulum is the thin fold of skin joining the glans to the foreskin. It is a highly sensitive tissue, rich in blood vessels: during intercourse, being particularly stressed, it can undergo partial tears with sometimes considerable bleeding.

In some men, even after puberty, the frenulum remains too short (short frenulum) and prevents the foreskin from fully retracting over the glans, or it causes discomfort and tension during erection. In these cases a frenulotomy (frenulum plasty) is performed: a small incision of the frenulum under local anaesthesia, which lengthens it. Healing takes one to two weeks.

Circumcision (foreskin surgery)

The foreskin is the sliding fold of skin covering the glans. When the foreskin prevents the glans from being fully uncovered, the condition is called phimosis. Phimosis has varying degrees of severity and is usually treated with circumcision.

• Tight (complete) phimosis: the foreskin entirely blocks the glans, preventing intercourse; in severe forms it can even obstruct the passage of urine
• Partial phimosis: the most common form. The glans emerges only partly and pain is felt during intercourse

Beware of paraphimosis: if the glans is forced out, the foreskin can become trapped behind it, causing a dangerous strangulation that requires urgent surgery. Circumcision is usually performed under local anaesthesia as a day-case procedure.

Straightening a curved penis

Straightening procedures (penile plasty) are possible when the erection is valid and the only problem is the curvature. They apply to two distinct conditions.

Congenital penile curvature (CPC)

Congenital penile curvature is a malformation due to asymmetry of the corpora cavernosa: from the very first erections the young man notices an abnormal curve. Its incidence is around 0.6%. Curvatures greater than 30 degrees are considered clinically significant; those over 60 degrees can seriously interfere with the mechanics of penetration and with sexual satisfaction. Plastic surgery procedures exist to straighten these curvatures.

Peyronie's disease (Induratio Penis Plastica)

In Peyronie's disease the curvature is acquired, caused by a fibrous plaque. Here too, surgical straightening is possible provided the erection is valid and the problem is limited to the curvature. See the dedicated page for details.

Penile lengthening and girth enhancement

This is the area where honesty about real outcomes matters most. In every patient requesting this type of surgery, a preliminary psychological, psychiatric and sexological counselling must always be arranged: very often the request arises from a distorted perception of one's own size, in the presence of an entirely normal penis.

Lengthening: division of the suspensory ligament

In patients with a true micropenis — stretched penile length under 9 cm — division of the suspensory ligament of the penis may be proposed. It is essential that the patient understands one point: the length of the erect penis does not change. The procedure produces only an apparent increase in length in the flaccid state.

Girth enhancement: unsatisfactory results

As for penile girth enhancement, the techniques currently available — autologous fat injection, vein or dermal grafts — do not deliver satisfactory results. This must be stated clearly to the patient before any decision is taken.

Frequently asked questions about male genital plastic surgery

What is a short frenulum and how is it treated?

A short frenulum is a condition in which the fold of skin joining the glans and foreskin is too short, preventing full retraction over the glans or causing discomfort and tears during intercourse. It is treated with frenulotomy, a small incision under local anaesthesia that lengthens the frenulum, healing in one to two weeks.

When is circumcision necessary?

Circumcision is the usual treatment for phimosis, when the foreskin does not allow the glans to be uncovered. It is indicated above all in tight forms, which prevent intercourse or urination, and in painful partial forms. It is performed under local anaesthesia as a day-case procedure.

What is paraphimosis, and is it an emergency?

Yes, paraphimosis is an emergency. It occurs when the foreskin, forced beyond the glans, becomes trapped behind it and causes strangulation with obstruction of venous return. It requires prompt surgery. This is one reason a tight foreskin should never be forced.

Do penile lengthening procedures work?

Division of the suspensory ligament, offered in cases of true micropenis, does not increase the length of the erect penis: it produces only an apparent lengthening in the flaccid state. Girth enhancement procedures (autologous fat, vein or dermal grafts) do not give satisfactory results. This is why psychological and sexological counselling always precedes any surgery: the request often concerns a penis of entirely normal size.

What is a true micropenis?

A true micropenis is defined as a stretched penile length under 9 cm. It is an objective and rare condition, to be clearly distinguished from the subjective perception of having a small penis, which affects many men of normal size. Only a true micropenis can justify considering surgery.

Would you like an assessment for one of these conditions? Ask Prof. Natali for a consultation or book an appointment at his practices in Florence and Empoli, Italy.

The information on this page is provided for general educational purposes and does not replace a medical examination, which remains the only diagnostic tool for correct and effective treatment.