TOPIC: 5 Proven Fixes for Turtling Syndrome

Many men have talked about “turtling” — when the penis retracts inward in a flaccid state, resembling a turtle pulling into its shell. While some degree of retraction is normal, persistent or exaggerated shrinkage (what we call Turtling Syndrome) usually has an underlying physical cause. The good news is, it’s almost always treatable.

Here are 5 of the most common causes of chronic turtling and the solutions our urologists at Rejuvall use to fix them:

1. Repairing Scar Tissue or Skin Problems from Circumcision
One of the most frequent causes of chronic turtling is scar tissue or skin tethering from neonatal circumcision. In these cases, surgical revision or skin resurfacing can release the restriction and allow the shaft to hang more naturally.

2. Reducing a Hidden (Genetically Engorged) Fat Pad
Some men inherit a Genetically Engorged Suprapubic Fat Pad (GEFP), which buries part of the shaft and makes the penis look shorter when flaccid. Even lean men can have this condition. Monsplasty (fat pad reduction) or liposuction can restore visible length and prevent further retraction.

3. Calming Overactive Retraction Muscles
The cremaster muscle is designed to pull the penis and testes inward during cold exposure or stress. For some men, this reflex is overactive and causes chronic turtling. Options include pelvic floor therapy or anxiety management which reduces sympathetic nerve triggers that keep the cremaster contracted.

4. Reattaching the Dartos
When the dartos muscle detaches, the penis retracts inward like a loose sock. Reconstructive surgery can re-anchor the dartos, often combined with ligament release and monsplasty, to restore proper support and visible length.

5. Improving Blood Flow
Poor circulation makes it harder for the penis to maintain healthy tissue volume in the flaccid state. A few contributing factors include diabetes, vascular disease, and prostate surgery. Treatments range from lifestyle changes and daily low-dose tadalafil, to vacuum therapy, and in some cases, External Counterpulsation (ECP) Therapy.

Takeaway
Turtling Syndrome is more than just “shrinkage” or being "a grower vs a shower." It’s usually a correctable condition with a specific mechanical or vascular cause. Identifying the root problem is the key to successful treatment.

For those who want a deep dive into the medical details, here’s a full resource: Rejuvall’s Definitive Guide to Turtling Syndrome

Regarding “ Monsplasty (fat pad reduction) or liposuction” what is the minimum fat pad thickness that should be left in place?….thanks

Regarding “ Monsplasty (fat pad reduction) or liposuction” what is the minimum fat pad thickness that should be left in place?….thanks

Great question, @Alittlebigger ! There should be basically zero fat and/or sagging skin left behind after fat pad removal since there shouldn't really be any fat pad there in the first place. The weight of the fat is what bears down on the dartos and strains it to the point of detachment. Once the dartos detaches, the body begins absorbing the penile shaft.

If you're young enough and depending on the size of the fat pad, we can usually just do liposuction to remove it. However, if the fat pad is larger and has been there a while and you're older with less skin elasticity, we wouldn't be able to just lipo it away since the residual sagging skin would continue to hide the penis. In this case the fat pad would need to be surgically removed and the leftover skin contoured and tightened surgically as well.

Thanks for the reply. Let me ask a follow up question or two.

Is there a way to estimate the amount of penis that will become visible from the moneplasty procedure?

For example, if the non bone pressed Flaccid penis length is 3 1/2 inches and the bone pressed Flaccid length is 4 1/2 inches how much of the difference can expected to become visible?

Thanks

Is there a way to estimate the amount of penis that will become visible from the moneplasty procedure?

For example, if the non bone pressed Flaccid penis length is 3 1/2 inches and the bone pressed Flaccid length is 4 1/2 inches how much of the difference can expected to become visible?

Yes. So when you push all the way in on that fat pad into the pubic bone, that's a good indicator of how much more visible length you'll have post-surgically. For Rejuvall-specific outcomes, you would actually get about another extra Inch or more of length on top of that since Dr. Carney would also be performing our penile repositioning technique as well. So using your example, that person could expect to see a NBP Flaccid length of around 4 1/2 inches or longer post-surgery.

That is, unless your dartos has become detached and your body has begun reabsorbing the penile shaft. Dr. Carney would have to first perform the fat Removal and Repair the detached dartos before we would be able to look at getting any extra length in addition to what would be regained after the fat Removal. Even so, after dartos Repair, your only option for adding cosmetic length would be a non-surgical lengthening program since the dartos Repair requires use of the structure we usually work with to create more length as a new anchor for the reattached dartos.

I hope that helps answer your questions! I'm happy to explain further if needed.