Recovery After Penile Curvature Surgery: The First Weeks, Returning to Sexual Activity and Follow-Up

Many men who have had, or are preparing for, surgery for penile curvature find that most of their questions concern not the operation itself but what comes afterwards: how long the swelling lasts, whether night-time erections can harm the stitches, and when and how sexual activity can resume. These questions apply both to corrective surgery for Peyronie's disease and to surgery for congenital curvature.

Setting realistic expectations from the outset reduces unnecessary anxiety and helps to preserve the correction achieved. This article explains the first days after surgery, daily life in the first weeks, returning to sexual activity, rehabilitation options, realistic expectations and the signs that need attention.

Which operations are we talking about?

Recovery depends largely on the method used. As the techniques are covered elsewhere, only their effect on recovery is discussed here:

• Plication (correction with sutures): The longer side, opposite the curve, is shortened with sutures; the plaque is not touched. It is used in congenital curvature and in suitably selected cases of Peyronie's disease; recovery is usually shorter and more predictable.
• Plaque incision and grafting: In Peyronie's disease, the plaque on the shorter side is released or partly removed, and the opened area is covered with a patch (graft). As this is a more extensive procedure, recovery may take longer and rehabilitation is considered more often.

What happens on the day of surgery and in the first days?

Surgery is usually performed under general or spinal anaesthesia; most patients go home the same day or after one night in hospital. Most of what happens in the first days is normal:

• Dressing: A lightly compressive dressing is applied to limit swelling and oozing. The surgeon decides when it is removed.
• Urinary catheter: Some patients have a catheter for a short time, usually removed the next day.
• Pain: This is generally mild to moderate and is controlled with the recommended painkillers.
• Swelling and bruising: Swelling and bruising of the penile skin, sometimes spreading towards the scrotum, are common. They tend to increase in the first days and fade over the following weeks; although they may look alarming, they are usually normal.
• Cold application and support: If the surgeon recommends it, ice wrapped in a cloth can be applied for short periods. Snug underwear that holds the penis upwards, towards the abdomen, helps the swelling settle.

What should daily life look like in the first weeks?

The timings below are a general framework; the individual schedule is set by the surgeon:

• Showering and bathing: A short shower is usually possible once the dressing is off; the wound is washed without rubbing and patted dry. Baths, pools, the sea and hammams are postponed until it has healed.
• Returning to work: Most people with desk jobs can return within a few days to a week; for physically demanding work this may take longer.
• Driving: This is usually possible after the first few days, once painkillers no longer cause drowsiness and braking is not painful.
• Heavy lifting and sport: Gentle walking is encouraged early on; heavy lifting and strenuous sport are generally postponed for several weeks.
• Cycling: Because of saddle pressure, cycling, motorcycling and horse riding are postponed for longer.

Why can night-time and morning erections be painful?

Erections that occur spontaneously during sleep continue after surgery. This is a positive sign for blood supply; in the first weeks, however, they stretch the suture line and swollen tissue, so they can be painful and may wake a man from sleep. In most patients this eases with time. The following may help:

• Getting up to empty the bladder on waking; a full bladder can make morning erections more pronounced
• Avoiding large amounts of fluid in the hours before bed

A night-time erection on its own does not mean that the stitches will come apart. If the pain keeps disrupting sleep, the surgeon should be informed; additional measures can be planned if needed.

When can sexual activity resume?

A return to sexual activity, including masturbation, is generally advised after a break of several weeks and once healing has been checked at a follow-up visit; after grafting this period may be longer. During the first attempts:

• Being gentle: Avoiding sudden bending of the penis and starting with comfortable positions in which the partner controls the movement
• Using a lubricant: This reduces friction and irritation of the healing skin
• Accepting mild tenderness as normal: A slight pulling sensation along the suture line may be felt and fades with time

Feeling anxious before the first time is entirely natural, and the thought “what if something goes wrong?” can itself affect erections. Talking openly with one's partner and not treating the first attempt as a test make this period easier.

When is penile rehabilitation considered?

For some patients, penile rehabilitation is recommended to support recovery. Particularly after grafting, the aim is to limit contraction of the graft as it heals, and the resulting loss of length, and to support blood flow to the erectile tissue. Not everyone needs it; after plication it is not routine in most patients.

• Penile traction device: By stretching the penis with a controlled force, it aims to help the healing tissue mature in a lengthened position. It is started after the wound has healed, at a time set by the surgeon.
• Vacuum device: It may help to maintain tissue elasticity; because premature or incorrect use can cause harm, it is used only on medical advice.
• Medicines that support erections: These may be used under medical supervision in patients whose erections are weak, or to support blood flow to the tissue.

Rehabilitation does not restore length already lost; its aim is to preserve the current situation and limit further loss. Its effect depends largely on regular use.

Length, sensation and curvature: what should you expect?

Realistic expectations have a direct bearing on satisfaction after surgery:

• Length: Because the longer side is shortened in plication, there may be some reduction in erect length. Grafting techniques aim to limit loss of length, but a sense of shortening may still occur. Shortening caused by Peyronie's disease before surgery is not reversed by the operation.
• Change in sensation: Numbness or reduced sensation in the head of the penis may occur; it is usually temporary.
• Palpable stitches: After plication, small firm spots may be felt under the skin; these are usually suture knots and become less noticeable with time.
• Residual angle: The penis may not be completely straight; a small residual angle does not usually prevent intercourse.
• Erection strength: Particularly after grafting, some patients may notice weaker erections; this can be treated.
• Recurrence of curvature: Peyronie's disease can become active again. In congenital curvature this is less likely, although some recurrence may be seen as the sutures loosen.

This is why follow-up visits matter: wound healing is checked at the first visit, and in the following months the erect axis, erection strength and sensation are assessed.

When should you see a doctor?

Medical advice should be sought without waiting for the scheduled check-up in the following situations:

• Fever, shivering or feeling generally unwell
• Swelling that keeps growing and becomes tense, with rapidly spreading bruising (a collection of blood, haematoma)
• Pus-like or foul-smelling discharge from the wound, spreading redness or the wound opening
• Being unable to pass urine, or marked difficulty passing urine
• Pain that keeps getting worse despite painkillers
• Sudden pain with a cracking sound during an erection
• No erections at all once the recovery period has passed
• A marked return of the curvature, or a new, painful hardening

In most patients, recovery after penile curvature surgery moves through the first weeks, in which the swelling settles,, a gradual return to sexual activity and a maturation period lasting months. Following the advice given, rehabilitation where needed and regular check-ups help to preserve the correction achieved. Assoc. Prof. Zülfü Sertkaya practises in urology and andrology in Istanbul; assessment and treatment planning for recovery and follow-up after penile curvature surgery are carried out with individual assessment and confidentiality.

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