Peyronie’s Disease, Viagra and Sexual Performance

Assist sexual vitality safely when you have Peyronie’s disease

It seems that well over half of the men with Peyronie’s disease suffer moderate to severe problems with sexual performance.   While the sexual problems peculiar to Peyronie’s disease might be especially frustrating and limit the enjoyment of life, that is not the real issue why a weak erection is important to a man with PD.  The most compelling problem with a weak erection is that it increases the risk that the penis will buckle, bend or collapse during intercourse, resulting in greater injury and worsening of his Peyronie’s disease.

If this kind of sexual injury happens to a man who already has PD, his currently weak erection can possibly deteriorate to no erection in the future.  His currently mild curve that still allows for sexual penetration can possibly deteriorate to such a terrible distortion that no sexual entry is possible.

I hear these stories weekly in which a man has a mild case of PD that is not much more than a minor inconvenience and annoyance.   His erections are weak, or he has a small deformity that makes a small area of the penis weak.  During insertion or during active sexual intercourse he experiences a sudden buckling, bending or collapse of his penis that makes a small problem much worse.   This kind of thing is avoidable in two ways:

1.    Use of a non-drug sex booster that firms up the erection

2.    Use of a reusable girth ring enhancer that supports the penis at the area of greatest weakness, and also adds important girth to the penis if this has been lost due to PD.

Review some of the information on the PDI website about these natural sex boosters and the girth ring enhancer. Go to the PDI Products Store Front and scroll down to learn more about these important tools that can protect you from worsening your PD, and add enjoyment to your life.

For those who are unfamiliar with my opinion about the use of erection producing drugs (Viagra, Cialis, Levitra) for a man with  Peyronie’s disease – or any man without Peyronie’s disease, for that matter – please go to my blog post titled, Viagra, Cialis and Levitra Use with Peyronie’s disease.

What follows is a copy of an email exchange I had with someone who had a question about using Cialis for improving his erection.   From it I believe you will learn some valuable information about treating and living with Peyronie’s disease.

—–Original Message—–

From: RXXXXXX

Sent: Saturday, August 02, 20XX 3:51 PM

To: herazy@sbcglobal.net

Subject: follow-up

Hello again,

I was about to place an order when I saw that you have a few erection boosters you recommend.  The Male X Booster product  for instance. I’ve found that I cannot do without some Cialis when using the Stimulin that I get from your at the PDI store front.

The other day three natural Stimulin plus about a quarter of the Cialis pill (5-7 mg) worked pretty well.  Without the Stimulin I’d need at least twice that much Cialis. (By the way, even taking a full 20 mg does not give me the kind of killer erection you warn about.)  Given all this, I’d like your suggestion re whether one of these other products is worth trying.  It seems you favor the Male X Booster.

RXXXXXXX

My response to RXXXXXX follows:

From: Theodore Herazy <herazy@sbcglobal.net>
Subject: follow-up
To: RXXXXXX [[mailto:rxxxxxxxxx@earthlink

.net

] Date: Saturday, August 2, 20XX, 4:14PM

Greetings RXXXXXXX,

This is an area where the opinion and experience of others means very little.  My preference for Male X Booster is based on my observation that most men do best with it most of the time.  It is one of our best sellers.  After all, it is popular for a good reason.   Regardless of how well it works for others, the question is, are you like these other men?  Stimulin helps a lot of men with their sex problems related to PD, but you must learn if you are one of them, and how to use it.  It all comes down to playing the odds I suppose.

However, even if Male X Booster does work as well for you as it does for others, could another product work better?  I have seen this happen.  It does not cost much to find out.  Once you find the best product for you, it will always cost much less than the drug products that can be dangerous and they will often work just as well.

And, if Male X Booster works well for you, is there a variation of the way you have been using it that will make it work even better?  I have also seen this happen.  Those who experiment a bit will often see much better results than they got from their first use.  If you write back to me and tell me exactly how you are using the Stimulin I can suggest some variations of use that could make it even more effective for you.

Just because of the many variables involved, I would like to think the most logical and prudent action is to go through the smorgasbord of sex boosters other men have had good experience with, and take on the pleasant task of determining which one works best for you.   Our list of sexual booster products is simply a collection of products that many PD Warriors have said gives them a lift – sorry for the pun, I could not resist.

I hope you see this answer is not a cop-out, as much as it is honestly the best answer I can offer at this time.  I do not know any way of determining a successful response to these herbal sex boosters ahead of time.  You just have to try a few to learn how you will respond.  Of course, the same is true of any drug your doctor prescribes for you.  While he/she might have a good idea of what kind of response you should experience, the fact is that no doctor knows ahead of time exactly how or if a patient will react to any drug that is prescribed.

By the way, thanks for sharing your personal observation about how Stimulin allows you to use less Cialis.  That is a good way to reduce your exposure to potential injury.  I am still very concerned about anyone using any of these PDE5 drugs (Viagra, Cialis, Levitra) because of the horror stories I hear frequently.

Concerning your observation of not getting a killer erection even with 20 mg of Cialis:  My conversations and communications with men from around the globe tells me that a man can use an erection enhancing drug many times without an adverse or unexpected reaction over a long time.  Then without warning, one day he can get the monster erection of his life that tears up a lot of internal tissue.   Just because it hasn’t happened yet with your Cialis, doesn’t mean it cannot happen the next time.  That drugs are unpredictable and risky, no one will argue.  As I said above, “It all comes down to playing the odds I suppose.”

Then again there is the issue that many men who have never been warned about the dangers involved with these erection drugs.  They keep on experimenting with their dosage until they intentionally get a super-erection.  Sometimes it is the last normal erection they will ever have.  You can only play with fire so often before you get burned.

Have a good one.

Regards,

Theodore R. Herazy, DC, LAc

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Peyronie’s Surgery

Finding a surgeon for your Peyronie’s surgery

There are those times when Peyronie’s disease surgery must be done. If you sincerely feel you have faithfully and honestly used all possible drug and non-drug options to avoid Peyronie’s surgery, and they have all been unsuccessful, and now you cannot continue with the pain and limited sexual ability that started with Peyronie’s disease, then you should carefully consider penis surgery.

From my experience in talking and emailing to many hundreds of men each year since 2002, I have only occasionally found men who are happy with the results of their Peyronie’s surgery. Am I saying that most Peyronie’s operations are failures? Not necessarily. All I can say is that of those men to whom I speak, the great majority are not pleased with their results to restore the penile curvature of Peyronie’s disease.

When I get to speak to someone who has good things to say about his Peyronie’s surgeon and the results of the operation, I always make it a point to ask a lot of questions about the surgeon’s name and location, his credentials, and the interpersonal issues and insights that develop while working with the surgeon.

Here is some advice in helping you select a Peyronie’s surgeon, or any surgeon, because it all comes down to the same traits and characteristics that make someone a good surgeon:

1. Do your research. While many physicians can claim to do surgery, or be someone who specializes in being a Peyronie’s doctor, you should only consider using a doctor who is a board certified surgeon in the area of specialty you need the care. You definitely do not want to have surgery performed by someone who comes to you randomly, without experience in working with Peyronie’s disease. The need to have experience and site-specific and disease-specific training cannot be emphasized too much. After all, it is your penis that is going to be cut on, and you want the best you can find holding the knife above you.

2. There is no need to rush into anything. Plan on spending at least six months doing your research. No need to rush into anything. The more time you spend the fewer mistakes you will likely make when you must decide. If it takes you a full year to collect information, all the better you will feel and all the better your results will occur.

3. Your doctor should be a Board Certified Urologist with a sub-specialty in genitourinary surgery, or a Board Certified Urologist with a sub-specialty in surgery that does exclusively genitourinary surgeries. For example, a surgeon might be a board certified urologist with a subspecialty in genitourinary surgery, but might also further specialize in operating only on male patients. Whether this surgeon might do male urogenital surgery on the elderly (geriatrics) or male children (pediatrics) only makes his experience more valuable.

4. Generally, using a plastic surgeon is not a good idea. While a plastic surgeon might be skillful in facial work, and have a good technique and a good hand for

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doing the fine details around the face, that does not mean these skills will carry over into removal of the PD scar material. If your primary Peyronie’s or genitourinary surgeon wants to use a plastic surgeon for one particular phase of the PD surgery, and that primary surgeon will stay at the operating table the entire time, that is fine. It all comes down to training and experience in the area of the penis, especially removal of the PD scar.

5. Your surgeon should have vast experience with Peyronie’s disease, having performed at least 25 prior surgeries of the specific type you need – usually the Nesbit plication, or others. The larger this number, compared to others, the more likely you should consider this doctor. Someone who has done 10 Nesbit surgeries does not know as much as someone who has done over 100. You want someone who has seen it all, done it all, knows what to do in all circumstances, and will not be surprised while you are under the knife – or later.

6. While this might seem to be a small and superficial consideration, I suggest you employ a surgeon with a meticulous office and very neat appearance, and a clean non-cluttered desk –you want someone who is really meticulous and highly motivated for fine detail work to be doing your Peyronie’s surgery for you. You want a neat-freak, someone who is “anal” doing this kind of work, cutting into your one and only manhood.

7. Good eye contact and warm personality – two reasons: not only will this be what he/she will be like when you are under his/her knife, but how you will be treated in discussions and after surgery care – not ignored or forgotten. You want someone who will be open and friendly and a good communicator before surgery, because these are great doctor skills after the surgery when you need it the most.

8. If you have a friend that is a nurse in area, ask her to ask around for you about the surgeon you are thinking about using. I worked for orthopedic surgeon who was the rave of the hospital and all the nurses who worked in that hospital brought their kids for broken bones and for their husband’s bad backs. Nurses are more likely to know, and talk about, the bad stuff and the good stuff concerning doctors in your area. It is a high recommendation when you know that nurses like work of the doctor you want to use.

9. Go to the internet to Google your surgeon professional work history with your state board of medical review to see if any disciplinary actions have been taken against this doctor. This is important because it will give you a strong indictor about the skill and ability he/she possesses. If your doctor has been sued three times for malpractice, and there are two others who have never been sued, the decision becomes much easier to make.

However, it is always best to avoid any surgery, especially Peyronie’s surgery, if at all possible. That is what the Peyronie’s Disease Institute is all about. Helping you to naturally treat Peyronie’s disease by helping your body to heal and repair so you can eliminate the scar and avoid getting cut on in the first place. Look at a few of the testimonials about our Alternative Medicine treatment for Peyronies.

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Peyronie’s Disease and Intercourse

Peyronies and problems with sexual intercourse

Sexual intercourse can be a problem in Peyronie’s disease due to the penile distortion that occurs because of the presence of fibrous scar tissue, or Peyronie’s plaque, within the shaft of the penis.  The presence of this fibrous plaque can cause the penis is bend in any direction to a minor degree that is hardly noticeable, up to and even beyond a 90 degree curve.  In addition to a significant bend, Peyronies disease can also cause distortions that are described as “bottle neck” and “hour glass” for their resemblance, as well as simple dents or dings along the side of the shaft. Click here for Peyronie’s pictures.

The cause of Peyronie’s disease has not yet been determined even thought the condition has been known for almost 500 years.  Some researchers theorize the distortion forms as a result of trauma to the penis, or when minor contact causes an indirect micro-trauma shearing force that can result in minor bleeding into the wide area of tissue.   While healing is taking place certain growth factors that appear to be genetically determined cause an abnormal amount of scar tissue (or plaque) to form at the site of injury.

The penis is composed of three cylindrical cavities, with two of these at the top and one below.  The top two are wider and thicker, and are called the corpus cavernosa, while bottom cylinder is the corpus spongiosum and contains the urethra or the tube through which urine flows.  During erection the two top corpora cavernosa expand to trap and hold the blood that produces the pneumatic force that results in enlargement and rigidity.   Each of these paired cylinders is surrounded by a very elastic covering called the tunica albuginea, similar to the casing of a sausage.

In a case of Peyronie’s disease the elastic tissue of the tunica is replaced by scar tissue, so it lacks flexibility and the ability to stretch.  Because the plaque is not elastic, but rather hard, it will not stretch with erection.  When this happens the erection that occurs is not even or symmetrical, and often smaller than before.

What starts out as a small nodule or constriction on the penile shaft just below the skin surface, eventually expands to form a flat plaque or deposit that can sometimes extend along the entire length of the shaft.  This plaque invades and replaces the elastic tunica albuginea covering of the internal tissue of the penis, leaving a mass of inflexible material. In some patients the penis beyond the plaque will not become as rigid. When a man with this degree of extensive Peyronie’s has an erection, the scar or plaque material cannot expand, resulting in a curved or bent penis, or one that exhibits a bottle neck or hour glass deformity – or a combination of these distortion patterns.

Often the plaque is located on the top surface of the penis, causing an upward curvature.  However, plaques can occur anywhere on the penis; the scar or plaque will always be worse on the concave portion of the distortion pattern.

Many men with Peyronie’s disease complain not only about their curved or distorted erection, but also about the loss of length and girth. These are all results of the inelastic tissue within the substance of the penile body.

Peyronies curved penis and sexual intercourse

One-third of men with Peyronie’s have pain when erect, and a smaller number become impotent. In some cases, the head of the penis does not fill with blood, resulting in a penis that is erect on the bottom near the pubic area, and soft or flaccid toward the top part of the penis – this is called a bottle neck deformity.  This type of distortion would make intercourse difficult due to penetration problems.  About half of men with Peyronie’s disease continue to function sexually when their curving penis is gradual and minor.  But as the curvature becomes abrupt and large the amount of sexual difficulty also increases.   Half of men with Peyronies experience frequent to constant problems with intercourse due to their distortion pattern.

For in-depth solutions and discussion of the sexual problems related to Peyronie’s disease please review the contents of Peyronie’s Disease & Sex, a one-of-a-kind book written by a man who completely cured his PD using the Alternative Medicine treatment principles found on the Peyronie’s Disease Institute website.

Disorders of the Penis besides Peyronie’s Disease

Penile conditions, other than the curved penis of Peyronie’s disease

There are additional problems of the penis that can develop while a man treats his Peyronie’s disease.  There are not many additional problems, but all can complicate your life more than you need at this time.

Priapism

Priapism is a persistent, often painful erection that is not associated with sexual activity and is not relieved by orgasm, lasting from a few hours to a few days.  In priapism blood enters the penis but does not leave, thus the erection is maintained.   The more common causes of priapism:

  • Penile injections, as verapamil, collagenase, steroids or interferon-alpha-2b
  • Drugs, such as anesthetics, antidepressants and blood pressure medications
  • Alcohol or drug abuse, especially cocaine
  • Spinal cord disease
  • Injury to the genitals
  • Blood diseases, including leukemia and sickle cell anemia

Rapid treatment for priapism is important, even without Peyronie’s disease present, because a prolonged erection can result in tissue destruction by reducing blood flow and lead to scar formation. Treatment involves removing trapped blood with a needle placed in the corpora cavernosae, as well as treating any underlying medical condition or substance abuse problem that might be present.

Balanitis

Balanitis is an inflammation of the foreskin, or skin covering the head of the penis.   Symptoms are redness, swelling, itching, rash, pain and a foul-smelling discharge in the area of the foreskin.   Balanoposthitis is a similar condition in which the glans (penis head) and foreskin are inflamed and present similar symptoms.   Both problems can occur in men or boys who are uncircumcised (foreskin has not been surgically removed).  If an uncircumcised male does not wash under the foreskin regularly, then sweat, debris, urine, dead skin cells and bacteria will collect under the foreskin and cause irritation.    Other common causes include:

  • Infection – local or systemic infection with candida albicans, the yeast responsible for thrush, can result in an intensely itchy and scaly rash.  Several sexually transmitted diseases (STD), gonorrhea, herpes and syphilis can also produce balanitis in addition to their unique infections that affect other parts of the body.
  • Dermatitis/allergy Dermatitis is any inflammation of the skin often caused by contact with an allergen or irritating substance. Sensitivity to even a small amount of certain chemicals in  soaps, detergents, perfumes and spermicidal preparations can cause balanitis.
  • Diabetes – When a diabetic has glucose (sugar) in the urine, this can be trapped under the foreskin and acts a rich breeding medium for many bacteria.

Treatment of balanitis depends on determining the underlying cause, improved hygiene and perhaps  circumcision if the balanitis cannot be controlled in any other way.

Phimosis and paraphimosis

Phimosis is a medical problem in which the foreskin (prepuce)of the penis is so tight, preventing it from being pulled back or retracted from the head of the penis.  Paraphimosis is a medical emergency in which the foreskin is stuck, after being rolled back or retracted, and cannot be slid back to its usual position over the head of the penis.

Phimosis is most often observed in children, and may be present even at birth.  When it occurs in an adult male it is usually caused by an infection of the reproductive tract, or scar tissue that formed as a result of injury or chronic inflammation of the prepuce.   Phimosis can also be caused by balanitis when it causes the foreskin to the scarred or tight around the head of the penis.  Immediate medical care is required if phimosis makes urination difficult or impossible.

Paraphimosis is a medical emergency because serious complications can arise if it is not treated. Paraphimosis may occur after sexual activity, a nocturnal or typical daily erection, or after trauma to the head of the penis, leading to pain and swelling, and impair blood flow. When extreme, this reduced blood flow can result in death of the penile tissue (gangrene), making amputation of the penis necessary.

Treatment of phimosis may only require gentle manual stretching of the foreskin repeated daily over a period of time.  Circumcision is often used to treat phimosis.  When the phimosis has gone on a long time the prepuce sometimes adheres to the glans.  When this happens, a surgical procedure called preputioplasty is used to separate the foreskin from the glans.

Treatment of paraphimosis focuses on rapidly reducing the swelling of the glans and foreskin, using ice and pressure applied to the head of the penis. If these simple measures are unsuccessful, an injection of medication can be used to drain the inflammation and blood from the penis, or small cuts in the foreskin are made by a surgeon to release the prepuce from behind the glans.

Penile cancer

Penile cancer is a rare form of the disease.  While the exact cause of penile cancer remains unknown, certain risk factors for cancer are known, including:

  • Phimosis – Tight foreskin that is constricted and difficult to retract, discussed above.
  • Uncircumcised penis – Men who are not circumcised are at higher risk for cancer of the penis.
  • Smegma – Natural oily secretions from the skin of the prepuce can accumulate if not cleaned daily.   If allowed to collect under the foreskin, this results in thick, cheesy white, bad-smelling substance, known as smegma.   Smegma by itself is irritation to the prepuce and lead to inflammation and a host of other problems.
  • Human papillomavirus (HPV) infection – More than 70 types of  human papillomaviruses can cause warts (papillomas).   Only a few of these HPVs infect the reproductive organs and the anal area, being passed as a STD from one person to another.
  • Smoking –Cigarette smoking brings many cancer-causing chemicals into the blood stream  that affect more than the lungs.
  • Psoriasis treatment – The medication and ultraviolet light used to treat can cause penile cancer.
  • Age – Penile cancer occurs most commonly in men after age 50.

Common symptoms of penile cancer are sores or unusual growths on any area of the penis, abnormal discharge from the penis, and bleeding.  Surgery or radiation is commonly used to remove the cancer from the penis.

Since 2002 PDI has advocated Alternative Medicine Peyronie’s treatment options to avoid any of these complications that compromise penis health.

Pentoxifylline and Peyronie’s Disease Treatment

Pentox for Peyronie’s treatment is an off-label use

Every now and then I get an email asking for my opinion about using Pentox (Pentoxifylline) for Peyronie’s disease treatment.  Over time I have developed a few ideas about this controversial drug that is gaining some popularity as an off-label Peyronie’s treatment.

Those MDs who prescribe Pentox are still trying to figure out the best way to use it, not only for PD but for many other conditions.  While the primary use for Pentoxifylline is based on its ability to increase peripheral blood circulation, hence it is used to treat senile dementia and intermittent claudication, Pentox is gaining acceptance with the medical community for Peyronie’s treatment.

Some MDs who have learned the hard way that PDE5 drugs (Viagra, Cialis, Levitra) are not at all a safe or effective Peyronie’s treatment have instead begun to prescribe Pentox to increase blood flow in Peyronies.   But to have that make any sense at all you have to believe that PD is caused by reduced blood flow in the first place, or that merely increasing the blood flow will somehow help PD.  I can totally agree with that thinking if you have evidence that your penis suffers from reduced blood flow (it is cold and blue).  But if your penis is not cold and blue and bent, then you probably will not benefit from Pentox in the way that most people think.

It is my opinion that when Pentox is said to help men with PD it is because as the blood flow is increased to the periphery, it also brings in an increased flow of nutrients to assist the healing process.  Further, when Pentox helps a case of PD it is because of the totally secondary benefit of increasing the body’s ability to heal and repair the PD plaque when there are more nutrients in an area of the body.   It is a small point, perhaps, but a vitally important point to understand that it all comes down to the body healing the PD scar – not the Pentox having some curative ability by itself.   If Pentoxifylline can increase general circulation more safely than Viagra, Cialis, and Levitra, then great I am all for that.  But you have to consider that if you do not have a circulatory problem in the first place, then why take any of these drugs at all?

If the benefit of Pentox is to bring more nutrients into the tissues, to assist healing and repair of the PD plaque or scar, that is wonderful.  If it is beneficial to bring more nutrients into the tissue, would it not be a more logical and effective Peyronie’s treatment to intentionally and intelligently supply a wide variety of nutrients at a higher than average dosage to the body to assist the healing process?  After all, that is what PDI has been doing since 2002 and it works in a great percentage of cases when it is done correctly.

Since extremely few men actually have any evidence of a circulatory problem in the pelvis, taking Pentox or even Viagra, Cialis, and Levitra, will not make a difference because that is not the problem that is going on with PD.   If the problem is that you did not heal your tunica albuginea injury because of poor nutrient availability then I suggest it would do you a lot of good to increase the nutrients directly, not indirectly by playing with the circulatory system when there is no circulatory problem.

You notice that I do not say, “Do not take Pentox,” I only say it is new so use caution.  I also say that when Pentoxifylline helps it probably does so only because it helps the body work better by increasing available nutrients, not because it specifically increases blood flow.  If you want to help your pelvic blood flow:

1.    Wear boxer shorts

2.    Uncross your legs when you sit

3.    Do some Kegel exercises

4.    Put a moist hot pack on your privates when you watch TV

Most MDs are taking the attitude that while they do not know if Pentox helps PD, or why it helps when it appears to help PD, at least they currently have no evidence that it makes PD worse – so what the hell, take it and let’s see what it does for you.  This is how many medical patients get hurt in the long run with such a cavalier attitude about drugs.

I say better to take an Alternative Medicine approach to your problem to help your body heal and repair the Peyronie’s pathology naturally.