Is it time for a penile implant?

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dsafsadfi

First time poster, long time reader.

As you can see in my profile, I've struggled with Erectile Dysfunction since 2018. I started having difficulty getting sufficient erections. I was single in 2020 until March 2021. I was masturbating but in hindsight my penis was often not fully hard. Fast forward to April 2021 - in a new dating relationship I realized my Erectile Dysfunction is full blown.

Current status:
- 31 years old
- No known physical cause for Erectile Dysfunction (doppler ultrasound was performed)
     Note: I was given an injection for the ultrasound but it produced only a chub for the test (4/10 on erection scale). I walked back to my car and then had a hard erection that lasted 20-30
     minutes, but it was concerning that the injection really did not do much
- I do have a flaccid and erect curve to the right and up. I believe this is something new but urologist said there's no scar tissue
- I can have sex basically 10/10 times with sildenafil (100mg + 3,000mg l-arginine)
- I was previously (May 2021) taking 20mg sildenafil. It worked astonishingly well, but by June I was needing 60-100mg and was not seeing as much success. In May I got granite-hard from 20mg and had a brief refractory period. Now I get 80-90% with 100-120mg and cannot have sex multiple times
- Without pills, I get some erections during foreplay/kissing but they can be weak or I lose them quickly. Sometimes I get ZERO erection even when my partner urges me to f--- her
- I cannot get ANY erection with masturbation by myself. I just do not get hard
- My nocturnal erections are weak and sometimes non-existent

Some internet research shows that there is "PIED - Porn Induced Erectile Dysfunction." I did use porn from around 13 years old into my early 20s. I picked it up again in 2020 but stopped in February 2021.

I'm in a serious dating relationship. My partner knows I use pills and is supportive of them. She also has an enormous sex drive, as do I. She would love sex 2-4x/day, every day. I would be in heaven if I could give her that.

We want to get married. I'd like to propose to her by Christmas this year. The problem is, I'm severely depressed by my Erectile Dysfunction. Although the pills are allowing me to have sex, it is NOT satisfactory. I hate the non-spontaneity. Every single night we're together, I mentally "log" what time I finish dinner so I know when I can take the pill and have sex. I also hate that I can't dominate/initiate/assert with her whenever I damn well feel like it (she LOVES this kind of thing).

I will not consider injections or VED.

What I want, more than anything, is to leave Erectile Dysfunction in the dust and move on with life. I want this haunting depression of Erectile Dysfunction gone. I want spontaneity back. Confidence back. Anxiety-free sex back. I believe an implant can provide that.

I know the implant is not magic, and know I can't place all my hope in it for improving my life. But truly, my life outside of Erectile Dysfunction is incredible. This girl is the girl of my utter dreams. I just cannot imagine bringing Erectile Dysfunction (and pills) into a new marriage, especially with a highly sexual wife.

My questions are these:
- Am I crazy to get an implant for "psychological Erectile Dysfunction"? (As no physical cause has been found)
- If you were me, would you get an implant?
- How could I explain implants to my girlfriend in a way that is honest but also doesn't weird her out completely into thinking I'll have an artificial dick?

Thank you in advance.  
32 years old
Recently married
ED started 2018, gradually getting worse
Cannot have sex without pills
Pills only give 75% erection
Implant seems to be next step

porterrobinson

if i were you which i kind of am in a similar position then i would not get an implant
single, mid 20
diagnosed early 2020
indentation 20 degree bent to left, recurrence with new indentation below glans
tried vacuum device with no success

Benraycamp0

Hey!

This sudden extreme erectile dysfunction at your age probably has another cause. Have you checked you testosterone levels? Do you have Hard Flaccid?

As you know, your issue isn't a Peyronie's Disease issue but it's an Erectile Dysfunction problem. I'd suggest getting to the best ED doctor you can get to and find out what happened.

How is your overall health? Any other medical issues?

As far as implants, leave that for the final resort once you have ruled out everything. But just know that most men are satisfied with their implants and if you need it, you will get it and give that lovely girl of yours the experience of her lifetime  (Hint: implants will keep you going as long as she wants  ;) )  
26 years old. 20 degree upward curve with slight clockwise twist. Symptoms onset Dec 20.
Dr. Levine says it's not Peyronie's Disease but a slow healing wound. Saw him Mar 21 and May 21.
Traction (PMP) and supplements per Dr. Levine's recommendation.

GaussRifle

No, this is not the time for an implant for you based on your description where you are able to have sex using medication. Try switching to daily cialis instead of viagra for more spontaneity. It lasts longer in blood stream upto 36 hours per dose. Implant should only be reserved if you are unable to have sex. Also, having sex 2 to 4 times a day with erectile dysfunction seems a bit too much expectation from a man. If your woman is so sexual, try using toys on her for half of your sexual encounters.
26 year old
45-50 degree downward curve with an indentation on one side when erect.
Using RestoreX and Xiaflex injections
Taking coq10 with daily Cialis 5mg.

Hawk

If you are taking maximum Viagra and L-Arginine every day (you suggest you both want sex every day). That is a lot of Viagra.  You seem to suggest even that is not totally satisfying to you and your fiancee.

I would try the daily Cialis.

Keep in mind the relationship is new.  A year from now maybe you will end up having sex 4 times a week and you are very functional for that.

After trying daily Cialis and Arginine and other approaches, IF you are still not unsatisfied enough to face a potential 5 revisions in your lifetime then I guess that is a choice you have to make.

In the end, only you and your woman can decide if you are having satisfying sex.  

As far as explaining it, I think that is the easy part but you are not at that stage yet.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

dsafsadfi



Hawk,

Thank you. I have been taking the Daily Cialis and stacking the 100mg Viagra and L-Arginine on top. I have a feeling the Daily Cialis is not enough.

In the event I'm not able to have satisfying sex with just Daily Cialis, would I be irrational to want the penile implant? If the Daily Cialis allowed me to be spontaneous throughout the day, I'd be very satisfied. But needing an on-demand pill (Viagra) just to have sex is not satisfactory at my age and my partner and my desire for spontaneity and frequency of sex. I will not consider injections or VED. I just can't see sustaining this program of daily 100mg Viagra + L-Arginine because my girlfriend and I are highly sexual.

Thank you.  
32 years old
Recently married
ED started 2018, gradually getting worse
Cannot have sex without pills
Pills only give 75% erection
Implant seems to be next step

GaussRifle

Does it occur to you that maybe you don't have erectile dysfunction  and just maybe you're having sex so many times that your body is not able to recover completely.

You do realize that if you starve yourself of sex/masturbation for a day or take a break, the next time your penis will be more sensitive and you will get a stronger erection. You are not exactly 16 lol, you can't compare your dick to a 16 year old who is half your age.

You also did not respond to my suggestion of using sex toys and not using your penis in every single sexual encounter if your girlfriend is so sexual. You are not a machine lol


Also in case you are wondering.. failing cialis 5mg is not strong enough for some people... it establishes a baseline... but you need a booster of 5mg as needed.
26 year old
45-50 degree downward curve with an indentation on one side when erect.
Using RestoreX and Xiaflex injections
Taking coq10 with daily Cialis 5mg.

dsafsadfi



I have Erectile Dysfunction. Night time erections are weak. I can't get hard from masturbation. I struggle to get an erection for sex without pills. I do notice improvement when I take a break from sex, but I also certainly have Erectile Dysfunction.

Maybe the question/point I'm driving to is: I don't want to be reliant on pills. I hate the lack of spontaneity. Hate that I can't just have sex whenever I damn well please. Hate going out to eat dinner with my girlfriend and mentally "logging" when the last bite was, so that I know when I can take my pill (and then waiting 1 more hour). Yes, the pills help me have sex. And for a lot of men, that would be enough. For me, I just can't stop the depression/anxiety of "I have Erectile Dysfunction." I think about it 24/7. I'm anxious around my partner, not the same person I used to be.

At the same time, at this point there has been no physical cause found. So I'm currently left to assume my Erectile Dysfunction is "psychological." But it's still Erectile Dysfunction, and I want it fixed.

Am I being extreme for thinking about an implant?
32 years old
Recently married
ED started 2018, gradually getting worse
Cannot have sex without pills
Pills only give 75% erection
Implant seems to be next step

Benraycamp0

If you can reliably have mutually satisfying sex with Erectile Dysfunction pills, you are being extreme for thinking about an implant. Especially being younger.

I get this is taking a psychological toll on you (we all understand that here ❤️), but remember that an implant has its own complications. For a man who cannot get erections satisfactory for sex, an implant is an AWESOME solution and the risks/complications are warranted because he could NOT have sex before. If you right now can have sex with Erectile Dysfunction pills and get an implant which ends up having complications, you'd wish you never went the implant route because you had the choice to just continue having normal, albeit less spontaneous sex.

You also know that you'll need several revisions throughout your life for implants. What if Viagra keeps you going strong another few years? That could save you on a revision. The thing is bud, you are still having sex. I know its less spontaneous and not ideal for a 31 year old with a high sex drive and a partner with a high sex drive, but it is something you and your partner can work together on. And in the meantime, you can find peace in the back of your mind that your sex life will NEVER stop because when the time is right (your Erectile Dysfunction gets too severe), you get the implant then and continue having sex.

QuoteI have a feeling the Daily Cialis is not enough.
You seem to suggest that you have not experimented with just daily Cialis + L-arginine. Can you first try and see if that works?

The anxiety you have over sex with your girlfriend that you have intentions of proposing to may be helped by discussing this with her. You mentioned already that she's supportive that you are on pills, but would talking to her about the performance anxiety you have with her help your anxiety over the situation? Just like she's already being supportive with the pills, maybe you two can work out something together that alleviates some of the stress you've been having?

The point is to try to explore all routes before thinking about implants. You aren't at the implant stage yet, so try everything to make the best of your situation now.
26 years old. 20 degree upward curve with slight clockwise twist. Symptoms onset Dec 20.
Dr. Levine says it's not Peyronie's Disease but a slow healing wound. Saw him Mar 21 and May 21.
Traction (PMP) and supplements per Dr. Levine's recommendation.

Hawk

I have to say I find your situation pretty interesting.  Ben said: "If you can reliably have mutually satisfying sex with Erectile Dysfunction pills, you are being extreme for thinking about an implant."

I understand his point, BUT I seem to hear you saying you are NOT having mutually satisfying sex because at least you are not satisfied with it.  It is interesting because most of us would probably refer to that a mutually satisfying, but to you, it isn't.  The standard is NOT if you can have sex that would be satisfying to me or Ben :)

That makes this interesting and difficult.  Also, you are putting one hell of a load of NO enhancers in your body.  Enough so that I suspect most physicians would not recommend or prescribe that amount or that frequency.

It is also interesting because we can't answer your question.  How can we know your level of satisfaction or dissatisfaction and depression?  How can we know how much of this depression has nothing to do with Erectile Dysfunction?  How can we know if the depression is the result of Erectile Dysfunction or the Erectile Dysfunction resulting from your depression?  How can we know if you are a little obsessive and would find something about an implant dissatisfying?  If so, then what?

This is what I get:
1.  You are taking a risky amount of vasodilators, and you are doing so at a risky frequency.
2. You still seem dissatisfied
3. You would need 3 - 6 revisions in your life unless you die young or unless there is some new development in your lifetime.
4.  You have some depression and anxiety issues that need direct treatment rather than trying to treat them by way of treating your penis and hoping they improve.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

TDix

47 yrs old, 3 yrs diagnosed
Xiaflex w/original uro resulted in a fracture
Excision/grafting by Dr Faysal Yafi 3/26/19
Implanted by Dr Yafi 8/11/20, Titan 20cm + 1cm RTE

porterrobinson

so how i understand it and correct me if i am wrong is that when you have done the proper tests, doppler US and have normal values for arterial in and venous outflow and there is no fibrosis and nerve damage, then it MUST be psychological does it not? orherwise something would have picked up by these tests right? it cant be this dubious where some magical force is at play that andrological researchers cant figure out. i am not suggesting that its in your head however, these are just questions i am posing in part to myself as well. it cant always be complicated?  
single, mid 20
diagnosed early 2020
indentation 20 degree bent to left, recurrence with new indentation below glans
tried vacuum device with no success

Benraycamp0

@porterrobinson:

That's a great question. I'm also curious and in my discussion with the OP, he also wants to know this so it is very relevant to this post.

I wonder if someone can share what are all the tests we have that should be completed in determining physical causes of Erectile Dysfunction?

The obvious ones are:
1. Doppler Ultrasound (bloodflow and scarring detection)
2. Testosterone levels
3. Biothesiometry (nerve test) - yes I know that this isn't the most reliable test by far, but Dr. Levine and others do use it for Peyronies Disease/Erectile Dysfunction for one more data point
4. Nocturnal penile tumescence test

What other tests are there?
And doubling down on @porterrobinson's question, is it possible for someone to pass all these tests and still have physical ED? I'm guessing it isn't common, but I'm also guessing that we don't have all the tests to rule out physical ED 100%.
26 years old. 20 degree upward curve with slight clockwise twist. Symptoms onset Dec 20.
Dr. Levine says it's not Peyronie's Disease but a slow healing wound. Saw him Mar 21 and May 21.
Traction (PMP) and supplements per Dr. Levine's recommendation.

dsafsadfi

I just want to provide some more insights from a recent urologist visit (Mayo Clinic).

The injection did not produce a good erection while in the office. It was 4/10 - a chub. I was given 0.07 mL's of Trimix. Below are the results. When I got back to my car after (2 block walk), I had a strong erection. But the measurements below were taken with a 4/10 erection (6 is the minimum for penetration).

VASCULAR ASSESSMENT:
Right peak systolic velocity:31.84 cm/s
Right end diastolic velocity: 2.80 cm/s
Right resistive index: 0.91
Left peak systolic velocity: 35.95 cm/s
Left end diastolic velocity: 2.87 cm/s
Left resistive index: 0.92

My testosterone levels were within the healthy range.

My doctor wrote in my visit summary: "possibility of high adrenergic tone and possibly pelvic floor dysfunction."

I've not gotten a satisfactory response via email as to what "high adrenergic tone means."
32 years old
Recently married
ED started 2018, gradually getting worse
Cannot have sex without pills
Pills only give 75% erection
Implant seems to be next step

porterrobinson

so it appears that there is no vascular reason for the ED based on the values you posted. andrenergic tone could refer to your muscle tonus, he probably supsefts a chronic tightening of the pelvic floor muscles. you could try pelvic floor exercises. i cant think of anythjng else causing ED  
single, mid 20
diagnosed early 2020
indentation 20 degree bent to left, recurrence with new indentation below glans
tried vacuum device with no success

Hawk

I have ED primarily from nerve damage very common to prostatectomy, including the so-called "nerve-sparing" prostatectomy which I had.  I was treated by a world-renowned Surgeon at Memorial Sloan Kettering in Manhatten and a well-known male sexual health specialist in Manhattan.  

1. No one ever suggested I be tested for nerve function.
2. Also, NTE's are very unreliable as an indicator of physiological ED because NTE's are known to use different nerve pathways than stimulated erections.
3. Even if it is psychological ED, it has the same effect as ED from nerve damage or vascular issues. Therefore, psychological ED might be more treatable, but there is no guarantee.  In addition, I have never known a case where a doctor conclusively determined psychological ED from an absence of other evidence.

Also, to dsafsadfi, It is not uncommon to not get a full erection in the office after injection but then get one when you leave. .  When Dr. Eid injected me, I got a weak erection in his office then drove through Manhattan with a raging erection.  I actually called him after 2 hours about concerns.

Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

RichardWilson99

The real big issue here is how much PDE5 + NO supplements you are taking.  Be careful, that is quite a lot.  I completely understand your situation, with the time constraint you've put on yourself for proposing by Christmas.  Why don't you want to try VED? You don't need to use the VED to have sex, but you can use the VED to promote good blood flow.  

Do you have any idea why you think you're having ED? Do you notice any physical changes in your penis?

I think you need to give yourself a bit of time.  Daily cialis can take up to 24 months to help promote good erectile function. Proposing after 9 months seems a bit soon IMO, but if that's what you want to do, go for it.  Just don't jump into getting an implant until you've given yourself 24 months of using daily cialis.

31/Single
Injury Nov 2019, bend 15deg, loss of erections, dent and hard-flaccid
VED, cialis 5mg on/off
EQ medium (with pills), no NTE.  Lost 1+ inches length, lots in girth. Some loss of sensation. Considering implant to restore full sexual function

Hawk

Why should he time his proposing with his treatment?  If he is honest and she is aware of his issues, they can work on this together.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

GaussRifle

Yeah... if you're proposing, she ought to be your support. If she backs off, you know you're making a mistake proposing if she runs away the moment your dick stops working.  
26 year old
45-50 degree downward curve with an indentation on one side when erect.
Using RestoreX and Xiaflex injections
Taking coq10 with daily Cialis 5mg.

dsafsadfi

Guys,

Thank you for your thoughts. It really helps.

I guess at the end of the day, this is more core question: What do you think of an implant as a solution for psychological ED that is not getting better and is causing serious quality-of-life issues?

- I can't keep taking 100mg sildenafil every day
- I will not use injections or VED (except for penile health)
- My ED is affecting every aspect of my life; I think of it every minute of every day. No, I don't have serious mental issues -- I have a successful career, friends, family, hobbies -- but the fact is that I just need a damn solution, and pills don't seem to be providing it, at least not sustainably.

Thank you, gentlemen.  
32 years old
Recently married
ED started 2018, gradually getting worse
Cannot have sex without pills
Pills only give 75% erection
Implant seems to be next step

GaussRifle

I mean at the end of the day, if you can't get at erection, no matter what the root cause may be, the result is the same. I think you need to schedule another ultrasound with a doctor, I don't simply think it's physiological with you if you take such copious amounts of viagra and are atttracted to your partner and don't feel clinical depressed all the time and are not nervous . This will only help you make a decision easier or earlier but if you truly and I mean TRULY feel it's physiological only then you can wait a year or two , sometimes the body just goes through a rough phase and doesn't work the way you want it to work. If it turns out there is a physical problem instead , it will make your decision a lot easier.

You mention you cannot get any erection with masturbation in your own time when you have no performance anxiety , that is a big red flag to me that something is wrong physically and an implant could be for you. Also do you take any other medicines like finasteride or blood pressure pills or antidepressant? They all cause Ed as side effect.
26 year old
45-50 degree downward curve with an indentation on one side when erect.
Using RestoreX and Xiaflex injections
Taking coq10 with daily Cialis 5mg.

dsafsadfi

Quote from: GaussRifle on August 03, 2021, 01:07:25 PM
I mean at the end of the day, if you can't get at erection, no matter what the root cause may be, the result is the same. I think you need to schedule another ultrasound with a doctor, I don't simply think it's physiological with you if you take such copious amounts of viagra and are atttracted to your partner and don't feel clinical depressed all the time and are not nervous . This will only help you make a decision easier or earlier but if you truly and I mean TRULY feel it's physiological only then you can wait a year or two , sometimes the body just goes through a rough phase and doesn't work the way you want it to work. If it turns out there is a physical problem instead , it will make your decision a lot easier.

You mention you cannot get any erection with masturbation in your own time when you have no performance anxiety , that is a big red flag to me that something is wrong physically and an implant could be for you. Also do you take any other medicines like finasteride or blood pressure pills or antidepressant? They all cause Erectile Dysfunction as side effect.

Thanks, Gauss.

I take no other medications -- no anti-depressants, hair-loss pills, etc.

The closest I've been able to get to a "cause" is PIED (Porn Induced ED). I have used porn intermittently (at times daily) for quite a bit of my life since 13-14 years old. Supposedly that can make it difficult to get aroused to a real person anymore. However, this is not a medically recognized condition and sometimes seems more like "bro science." I have not watched porn for 6 months.

I also have lost almost all nocturnal erections, even when taking 100mg sildenafil before bed.

Again, I'm not mentally imbalanced. I just want my dick to work so I can get back to life and have a healthy sex life. I've landed the absolute girl of my dreams, but the ED is consuming my thoughts and making me a shell of the person I once was. I want this fixed so I can enjoy a wonderful sex life with her.  
32 years old
Recently married
ED started 2018, gradually getting worse
Cannot have sex without pills
Pills only give 75% erection
Implant seems to be next step

westerntown

Quote from: Hawk on July 29, 2021, 11:12:50 PM

After trying daily Cialis and Arginine and other approaches, IF you are still not unsatisfied enough to face a potential 5 revisions in your lifetime then I guess that is a choice you have to make.


What's wrong with getting 5 revisions ?
20, late 2020 masturbation injury leads to semi erect hourglass, then try manual stretching leads to pudendal neuralgia like symptoms, corpus spongiosum and glans do not fill, severe ed- floppy unstable erections that feel like water balloon .

Hawk

5 revisions mean 5 recoveries, 5 expenses, and 5 chances for complications including infections that ALWAYS require the removal of an implant for months.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

Hawk

dsafsadfi,

Have you had a complete workup by an andrologist or even an interest to assess hormone levels and other medical concerns?  I would not consider a general urologist for this.  

If you have not had a complete investigation then you have not thoroughly pursued this issue.  I am pro-implant in many cases but if they find the real problem is hormonal or a heart issue it would be wreckless to rush into an implant.  If you are as emotionally stable as you indicate then you know this already.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

Stepone

I certainly understand your frustration.
I know you want this problem fixed.
It seems like your only choice is an implant.
However, before you decide I agree with Hawk.
Go to a urologist that treats men issues. They are hard to find. It seems every urologist says they treat "men issues", but in actuality they do not.
I went to 5 urologists, before they figured out the problem, and it was actually this forum that pointed me to a solution.
Please, find a real expert ED mens issues doctor and I hope they will help you towards a solution that will fix this problem.
Best wishes
StepOne  
Nesbit surgery 2015, 66 years young, Titan Implant 4/25/19, 22cm, Dr. Lentz, Duke University NC

westerntown

Hawk I may need to go through more than 5 revisions in my lifetime. Should I just go dormant for 10+ years instead? Doesn't seem plausible. Of course maybe some don't really need it, but for the ones who do, what other option do they realistically have. Hourglassing and denting with ED is a dealbreaker man.
20, late 2020 masturbation injury leads to semi erect hourglass, then try manual stretching leads to pudendal neuralgia like symptoms, corpus spongiosum and glans do not fill, severe ed- floppy unstable erections that feel like water balloon .

Hawk

Quote from: westerntown on January 05, 2022, 02:49:52 AM
Hawk I may need to go through more than 5 revisions in my lifetime. Should I just go dormant for 10+ years instead? Doesn't seem plausible. Of course maybe some don't really need it, but for the ones who do, what other option do they realistically have. Hourglassing and denting with Erectile Dysfunction is a dealbreaker man.

Obviously only you can answer that question.  No one can answer it for you.  To me, it makes sense to start by asking if you would rather "go dormant for ten years" now, or at the end of your life (assuming you live in to your 70's - 80's)

First you need to make sure there are not acceptable solutions that can make intercourse a viable option.  
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

GaussRifle

Have you tried switching from sildefanil (viagra) to tadalafil(cialis). The action of tadalfil stays in the system for 36 hours and gives a sustained release. Young men are typically prescribed 5mg daily tadalafil with or without sex. This allows spontaneity. And you ca take a 5mg booster when you initiate sex.

If it's possible for you to have sex with cialis reasonably well without hinging deformity and your erection is hard and stays up to please your partner for about 10-15 minutes atleast then you don't need an implant now.

If not you can try using cock ring and see if you like it. If you don't like that or it doesn't work, next step is an mplant. Do not do injections, they only cause scarring long term and more deformity.

Moreover, make sure you lead an active lifestyle before judging your erections. If you sit on your chair all days and lead a sedentary life or have a pot belly... chances are you will have lifestyle based Erectile Dysfunction for sure.

If these steps fail... only option is to get in touch with a world class implant surgeon and start considering it.  
26 year old
45-50 degree downward curve with an indentation on one side when erect.
Using RestoreX and Xiaflex injections
Taking coq10 with daily Cialis 5mg.

AlohaPete

Hey Gausrifle,

I totally understand where you are coming from. I have been dealing with performance anxiety all my life. The irony is I am a 6'2" handsome man, with elite fitness genetics, before Peryonies had a big thick cock with over 6 in. in girth and over 6.5 in length and the icing on the cake own the top modeling agency in my state. Thanks to pills I worked through it in most cases however with women I really liked and saw a future with dating was quite difficult as the anxiety would show through in nervous behavior (major turn off) especially if they made me wait which most quality women do and many times lead to situation where pills didn't work or I would be too overly focused on my erection which would make for an awkward sexual experience or inabilty to climax/maintain erection. One night stands after a few drinks or whores where typically not a problem as I didn't really give a crap nor did the anxiety have time to build and the stakes were not that big in my mind. However, at 45 and now recovering from Peyronies while in a committed relationship with a wonderful woman my anxiety is minimal. Funnily enough it is somewhat due to my Peyronies as I now have an excuse as well as my age if things don't work out. Plus, in committed relationships where we have had sex successfully many times there is a reduction in the anxiety however from time to time it would be there, but not these days. I have been approved for an implant due to my Peyornies however have been recovering better than expected and if I do get one the prominent reason would be to try life without anxiety. My psychologist would recommend going into sexual situations without the expectation of sex and focus on pleasing her in other ways and if an erection comes then great. However, as you know all too well, that is easier said then done. I would go for it and enjoy life they way you should and not miss out on the quality women I did.  
44 Years old - Diagnosed with Peyronie's in 7/20. First signs 7 months prior. 35 degree upward curve, slight ED and length lost. Taking cialis, co-Q-10, Kanchanar guggulu and using restorex for three weeks. Seeing some slight positive results already

Stepone

AlohaPete,
Thanks for posting such a personal caring story. I hope this will help others realize they are not alone, when it comes to sexuality. Many men tend to gloss over the psychology of Peyronie's Disease, you did not.
Thanks again for sharing.
Best wishes for your surgery.
StepOne  
Nesbit surgery 2015, 66 years young, Titan Implant 4/25/19, 22cm, Dr. Lentz, Duke University NC