I’m going through a really difficult time, and I could really use some perspective. I’m a gay 47-year-old man with a husband of 25+ years. We have two young children in the house. My husband and I are monogamish, and our relationship is okay. Not great, not terrible. Up until about three years ago, I was a big bearish/chub guy, and carried all the self-loathing and insecurities that can be associated with that. I had stomach surgery to lose weight, and I started to feel like maybe I was getting a handle on my body issues. Given the fact that I grew up in the ’80s, I’ve never been big on casual sex. But after my surgery I started to feel like this was something I wanted to experience. At least to a minimal extent. That was until last year when I was diagnosed with Peyronie’s disease. I’m sure you’re familiar with it, but it’s essentially an autoimmune disease where your body causes inflammation in your dick, and that inflammation causes scar tissue to develop. Aside from making your dick bend in strange ways, it can cause weird hour-glass deformations and erectile dysfunction, both of which I’ve developed.
This situation has kind of destroyed me. I’ve done everything my doctors have told me — I did the painful daily stretches with a device which crushes your dick head and stretches you — and I did the excruciating Xiaflex injections to try and break up the scar tissue. Believe me when I tell you that you don’t know pain until you’ve experienced those shots. Nothing has helped. I’m absolutely crushed by this. I’m disgusted by my body, and I find my penis repugnant to the point that I don’t even want to touch it. I have no interest in sex with anyone, not even myself. I’m not jerking off. Fortunately, I live within travel distance of the ONLY Peyronie’s clinic in the United States, and have had appointments with probably the foremost expert in the subject on this continent. But even he has failed to give me any hope. There’s a chance that after a few years the scar tissue will break down and my penis will be more normal, but that’s not a guarantee.
To be blunt, I’m suicidal. The knowledge that I’m never going to have a normal sex life again has ruined me. I’ve seen therapists, I’ve tried multiple anti-depressants, and I’ve even been doing daily ketamine therapy. Nothing has helped. I’m never going to get a chance to experience a fulfilling sex life. The only things keeping me from killing myself are my kids and the fact that I make substantially more money than my husband, and my family is dependent on me to be the main breadwinner. I’m out of ideas about how to navigate this situation. None of my doctors seem overly concerned about the severity of my depression. Or maybe they just realize there’s nothing they can do for me, and have given up trying. I’ve tried to broach the subject with some friends, but none of them want to talk about it. I don’t know what to do. I need someone who can appreciate the severity of waking up one day to find out that your penis is now a malformed monstrosity, and it won’t ever work for you the same way again. I also understand if this is way too fucked up for you, and you don’t want to get involved.
A Broken Man
“This is a really sad case,” said Dr. Joshua Gonzalez, a board-certified urologist and sexual medicine specialist who specializes in treating sexual dysfunctions in men and women.
“Without knowing the details of what potentially could’ve caused this and how severe his deformity is — whether or not he’s experiencing a curvature or just the hour-glass indentation he’s describing — it’s a little hard for me to provide specifics on treatments,” said Dr. Gonzalez. “But it sounds like this guy has really been suffering with what he’s been experiencing in relation to his Peyronie’s.”
Dr. Gonzalez has been in private practice in Los Angeles for more than ten years, ABM, and has treated hundreds of Peyronie’s patients. And some of the men he’s treated were just as distraught when they walked into his office as you are now.
“It also sounds like ABM has already pursued a lot of the most common treatments, including injections with Xiaflex, which is the only FDA-approved drug for this condition,” said Dr. Gonzalez. “And it sounds like he’s going to a Peyronie’s specialty practice, so I’m assuming he’ll be seeing someone who knows what they’re doing and has experience treating these conditions.”
But there is something that can be done for you — something you haven’t mentioned in your letter — that Dr. Gonzalez thinks you should explore with your doctor.
“Penile implant surgery can often be a godsend for patients who suffer from Peyronie’s disease who do not seem to respond to Xiaflex or traction devices and who also have erectile dysfunction,” said Dr. Gonzalez. “A lot of guys don’t like the idea of a penile implant when they first hear about it, but for someone who’s really been suffering like this, both in terms of the deformity that he sees in his penis and his inability to get and maintain an erection, a penile implant can treat both of those conditions and provide the rigidity he would need to have sexual activity.”
But first things first.
“Given ABM’s overall mental state currently, with his admitting to having suicidal thoughts, he should definitely work with a mental health professional and try to get that under control before considering surgery,” said Dr. Gonzalez. “But I want him to know that for men who ultimately pursue penile implant surgery, the satisfaction rate with that surgery is over 90%, which is pretty unheard of in terms of medical interventions. Working with a mental health professional and a urologist — the physician who would perform this procedure — and talking to them about how pleasurable sex can be after this surgery, especially in the context of a monogamish relationship, could be really, really helpful for him and get him back to being functional and enjoying sex.”
P.S. To say I’m familiar with Peyronie’s disease would be an understatement.
I’ve gone back and forth about whether to include this postscript, ABM, because my readers — most of them — don’t wanna think about my dick. But nearly one in ten men develop Peyronie’s disease at some point in their lives, ABM, and I was one of them. Like some men who suffer from Peyronie’s disease, it was an injury that led to the buildup of a fibrous plaque on one side of my dick, which caused it to bend at a weird angle. I wish I could say it was an interesting injury — getting kicked in the dick in a sex dungeon in Berlin or something — but it was boring (but extremely painful) fall on my bike, sadly, and not anything that happened to me in a sex dungeon in Berlin.
My case wasn’t disabling ABM, but it was extremely depressing, especially as it got worse over the course of the first year. While I never stopped having sex, I lived in constant fear that one wrong move — one misdirected thrust — could make things much worse. So, I got creative. With topping off the menu, ABM, I leaned into other things I enjoyed (oral, toys, mutual masturbation, my cherished collection of standard-issue-Catholic-schoolboy kinks). It wasn’t a “normal” sex life (not my normal, anyway), but it wasn’t a bad one either.
I recognize that my PD wasn’t as bad as what other men have had to endure — my erections were never painful — and I was extremely fortunate in the end. Two years after my PD diagnoses in 2021, ABM, I experienced the kind of spontaneous resolution you describe: the plaque in my dick began to break down on its own, the bend in my dick became less pronounced and then disappeared altogether, and my dick returned to normal.
If it could happen for me, ABM, it could happen for you, too, whether you’re lucky enough to see your Peyronie’s disease resolve spontaneously or you ultimately find an effective treatment. But it can’t happen for you — you’ll never get your dick back — if you kill yourself now. Think about your husband, think about your kids, and — if it helps — think about my dick. And don’t lose hope.
P.P.S. If your erections aren’t painful, ABM, you don’t have to wait until your Peyronie’s disease magically goes away to be sexually active — just like you didn’t have to wait until after weight-loss surgery to have some monogamish fun. Just as there were always men out there who were into bigger guys, there are men out there right now who don’t give a shit about your cock. There are guys standing in front of glory holes who just wanna get sucked off, ABM, which you can do for them; there are tops waiting in front of empty slings who wanna fuck hot middle-aged daddies, ABM, and you’re a hot middle-aged daddy. Toys, fisting, strap-ons, kink, no-recip oral, JO parties: You have lots of options, ABM, even now. Live a little.
I’m a cis man in his late 40s married to a cis woman. Long story short, after months of collaborative fantasizing and open communication — all the while observing the “best practices” we learned from you — my wife and I hired a bisexual male escort for our first threesome experience. It went great and was incredibly hot! It was also my first serious same-sex encounter. While I did not penetrate the escort or get penetrated by him, we did just about everything else and I loved all of it (as did my wife!), and we would definitely plan to do more next time. My question for you is what’s up with this kind of mid-life expansion or shifting of my desires and maybe even my sexual orientation? On the one hand, I feel like these kinds of things would have come up for me by now. On the other hand, I am very glad to know that I can still surprise myself. Either way, I’m curious about how you would make sense of it, as I typically think of core desires forming much earlier in life. Am I an outlier?
Been Exploring New Dimensions Sexually
P.S. We used the Tryst to find an escort, which I first heard about in your column or on the podcast. Had a great experience with him. We also followed all the advice you gave —(hiring local, communicating a lot in advance, etc. Thank you so much! I love your work and think you are doing such a great service to humanity.
I ran across a social-media post recently — don’t remember where — from a bisexual guy claiming that, deep down, everyone is bisexual. If people weren’t so sexually repressed, the argument goes, no one would be gay or straight. Now, if bisexual erasure is not okay (and it’s not), then I would argue that homosexual erasure and heterosexual erasure are not okay either. Gay and straight people — like bisexual people — actually do exist. In fairness, the bisexual OP was most likely taking the piss and/or punching up (clueless monosexuals are much more likely to assert that bisexuality doesn’t exist), but I’ve encountered this sentiment a million times since I came out as gay. And while people can learn more about themselves and can surprise even themselves, I don’t think everyone would be bisexual if we weren’t pressured to pick a team. No one would be gay if that kind of pressure actually worked… and some people are actually gay.
But it sure sounds like you could be bisexual, BENDS, or pan or omni or heteroflexible. You could also be one of those straight-or-close-enough guys who, under the right circumstances — for instance, an MMF threesome — can enjoy having sex with other men. (I’ve lost count of the number of straight-identified/straight-defaulting guys I’ve spoken to over the years who were surprised to learn that they loved sucking cock in the context of an MMF threesome.) Our sexual identities aren’t necessarily finalized during puberty. Some of us discover new desires, capacities, attractions, etc., later in life, and new data might require/inspire us to reassess how we identify sexually. And sometimes a particular person, relationship, or set of circumstances (see: MMF threesomes) surfaces a desire that was lurking in there somewhere.
In other words: It’s complicated — but complications make life interesting.
And here’s the good news: You don’t have to figure out what exactly happened that night or what might be happening with you. You had a great experience, your wife enjoyed seeing you enjoy it, you enjoyed seeing her enjoy it, and you’re both interested in enjoying it again. That’s plenty of information to work with for the time being. If you decide you need a new label, BENDS, you can get one tattooed on your ass at a later date. For now, keep exploring — and here’s hoping there are more surprises (and maybe some butt stuff) in your future.
P.S. I hope you kept that escort’s number — he sounds like a keeper.
Want to read the rest? Subscribe now to get every question, every week, the complete Savage Love archives, special events, and much more!
Subscribe Now GiftGot problems? Yes, you do! Email your question for the column to [email protected]!
Or record your question for the Savage Lovecast at savage.love/askdan!
Podcasts, columns and more at Savage.Love