Is it possible I was injured during catheterization and this caused my Peyronie's disease?

Hello, I developed curvature a few months after back surgery. Prior to the back surgery I had no urological problems. The night of my back surgery, I could not void and had to be catheterized. The nurse made several attempts with a disposable “cath” then opted for a foley. It took a couple of tries to get in but she was finally successful.

My question is if it is possible I was injured during my back surgery by improper positioning or is it more likely that the multiple attempts to “cath” me was the culprit or neither of these and Peyronie's disease was inevitable.

Greetings,

Of course, as the saying goes, “anything is possible.”   You might have been made to lie face down in a strange position with your body weight resting squarely on your bent penis for a long time, resulting in tissue damage that developed into Peyronies.  Could be, I suppose – but I rather doubt it.

It is also possible that you are genetically predisposed, and it was simply your time to develop Peyronie's disease without any obvious provocation at all.   Perhaps you are taking a statin drug, a beta blocker or Propecia, and your current problem with a curved penis is just a drug reaction.

Given the story that you relate about the nurse struggling to insert the catheter up your urethra, based on the information you have related, in my opinion it is far more likely and reasonable that during your repeated catheterization attempts is when your actual injury took place that lead to your Peyronie's problem.  For more information see Possible Peyronie's disease cause – Catheter and cystoscope trauma.  In my work with the Peyronie's Disease Institute I speak and write to many men with some frequency who report the same kind of story with the same end result. 

I suppose you could think back to the time when all of this was going on to remember if there were clues when the nurse was having a difficult time for clues to help you decide how it happened: if the nurse seemed to be rushing, if the nurse said something about pushing hard or jamming the tube up your urethra, or if it is now apparent somehow that direct force was being used.  Anything like that would give support to the idea your urethra, corpora cavernosa and tunica albuginea were injured while all of these repeated attempts were being made.

Regardless of how it happened, the real pressing question is what are you going to do about the fact that you have Peyronies now?  Many men have used the ideas and suggestions found on this PDI website to increase their natural ability to recover from Peyronie's disease.  To learn more about how you might be able to  eventually increase your ability to heal this problem, please go to recovery over Peyronie's disease.

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If I can help you in any way, please let me know.  TRH

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I continued jelqing for months even though my penile curvature was getting worse and now I might have Peyronie's disease

Dr. Herazy,   Firstly, I would like to thank you and this community for even being here to help those who suffer with penile curvature.  Finding information online regarding Peyronie's disease has been very tricky and even an anxious affair due to the condition's unnecessarily embarrassing nature. Anyway, a little background: I am a 23-year-old male who has had a healthy sex life for the last seven years. While dating my previous girlfriend, we had some bouts with sexual difficulty, mostly on her end due to numerous urinary tract infections and her mental condition; she has been on anti-anxiety and antidepressants for some years now. This made her very self-conscious during sex and, admittedly, other factors like privacy created tension. I have never experienced this before and thought something was wrong with me, and for some stupid reason, I wondered if my penis was somehow inadequate. So, I looked into enhancement options and discovered the murky world of jelqing and stretching.

I followed the exercise regiment very closely, with my workouts beginning in February of 2012 and ending at the end of October of 2012. I made sure to warm up every time with a hot wrap and never pushed myself too far, or so I thought. I discovered that my penis grew in length and girth, going from about 5.5 inches erect to 6.5 inches; flaccid, my penis has always been about one inch, no joke. Now, it is usually two but often three inches in length when totally flaccid. My ex at the time noticed it and was shocked I managed to change the size and shape of my penis. I was taking L-Arginine, L-Lysine, and Zinc on my workout days, including Pygeum Africanum, Lecithin, Flaxseed Oil, Fish Oil, Super B Complex, and a solid Multivitamin. But during the last week of October, after we had broken up, I think I went too hard and stretched too far, feeling an uneasy sensation in my penis. It's important to note that I had noticed the progression of a curve for months preceding this but with no pain. It is also important to note that I have always had a slight curve to the left, as several photos taken years ago prove.

Anyway, after this weird feeling from stretching, I finished my workout and decided to take some days off. But the pain got worse and I noticed a small bruise/discoloration and what appeared to be a reddish stretch mark running about two inches on my penis. So, I scheduled an appointment to see a urologist. I saw him and he said I essentially “sprained” something or caused a microtear near the glans of my penis. He told me to abstain from sexual activity for six to eight weeks. He didn't feel any plaque and said that he couldn't diagnosis Peyronie's because there wasn't significant curvature or plaque. While I didn't exactly abstain as much as I should have, I did mostly stop masturbating for weeks on end.

The pain is now completely gone but the discoloration and stretch mark (maybe inflamed vein) are still there, though they seem to have faded a bit. I am now living in Chicago and have scheduled an appointment with Dr. Levine for March 1st. I need some kind of closure on this; I need to know if I have to start treatment or maybe I just have a congenital curvature. The curve hasn't increased since my injury and, as stated above, I noticed the enhanced penile curvature while flaccid months before my injury. While erect, there's not much of a difference between the way my penis looks now and a few years ago when I was sixteen. The only difference is the discoloration/bruise, stretch mark/inflamed vein, and a bigger, more curved flaccid penis.

I am currently taking a Multivitamin, L-Arginine, CoQ-10, Acetyl L-Carnitine, and Vitamin E. I also was using Bio-Oil and Cocoa Butter, but have cut back significantly; I liked how smooth it made my unit feel. I have continued sexual activity with no pain and no loss of erectile function. Based on what you all know and what I have told you, can you point me in the right direction? Can you give me advice? My current girlfriend and ex have been very supportive through all of this, including my brother, best friend, and mother. I just want some kind of pointers and opinions; it can be quite suffocating with everyone telling you “you're going to be fine” or “you're overreacting.” This is a serious condition and I am not sure where to turn. Dr. Levine has me scheduled for an ultrasound the morning of our appointment so he can check it out before meeting with me. I seriously hope there is no scar tissue or, if there is, it is something I can deal with. I have grown fond of my curved flaccid penis and don't mind it; life is too short to dwell and panic about these things as long as I can have a functional sex life. Please. And thanks in advance for reading my story and any opinions. It means a lot!

Greetings,

Thank you for your detailed report and  insightful commentary concerning your experience with jelqing and penis stretching.

In many posts I have written about the dangers of forced penis stretching: for example please see I think I have Peyronie’s disease from jelqing. What should I do?  Too many men take a cavalier attitude about remodeling their penis to Adonis proportions.  The websites that sell the books and tapes attempt to support the idea that all problems of low self-esteem and difficulty with female relationships will simply disappear with a sausage-like member tucked in below the belt.  Life is perfect for men who have an unusually large penis.  They do not discuss the many problems and tragedies that occur with these strategies of forced stretching.  The jelqing websites try to create the idea that the penis can be squeezed and molded like a slab of clay can be tugged and strangled into an exaggerated size to please a lady or gratify a weak ego.  When penis tissue is taken forcefully and repeatedly beyond a certain point of limitation it will suddenly fail.

At this point you can only be certain that you have a bruise or micro-tear of the external tissue of the shaft.  You might be one of the luckiest guys in the world to only have a superficial injury, and not a deeper problem in the shaft at the level of the tunica albuginea; if it turns out that you have injured the tunica you are perhaps a step closer to having a case of Peyronie's disease.  Even so, with injury to the tunica and an early case of Peyronies to deal with, about half of these cases repair or reverse on their own without outside intervention – spontaneous recovery is the medical term for self healing. This is mentioned so that you can appreciate the gravity of what you have done and the position you are in at the moment.  

When you wrote that you “…  never pushed myself too far, or so I thought,”  you made a critical point about jelqing that gets to the heart of the craziness about this brutal practice. Did you ever watch a movie in which the bomb squad is called for help to defuse or take apart a complicated explosive device?  The tension and drama of those scenes where the bomb wires are being cut is based on the person never knowing if he is cutting the correct wire or in the correct sequence until it is too late.  The trick of taking apart the bomb is that you can be doing it correctly when everything is going well, until the moment you make a mistake and the bomb and you blow up.  Jelqing is not much different.  You can think you are doing it correctly and safely, until you make a mistake and injure your penis to cause a problem like Peyronie's disease.  Who knows how far to go until after you have gone too far?  Who knows how hard to squeeze and stretch, until after you have squeezed and stretched too much?  Everything can go well until after everything does badly, when the whole jelqing idea blows up in your face.

Based upon what you have written, I suspect that you have injured yourself enough to have caused Peyronie's disease.  I am lead to this conclusion by your statement, “… I had noticed the progression of a curve for months preceding this but with no pain. “  By this you say that for months your penis was becoming curved and yet you continued to jelq for months.   Since I have not examined you I can only speculate, although you will learn in time if I am correct or not.  I further suspect that you do not have at this time a curved penis when erect only because your condition is still too early and you are in the stage where the plaque has not yet formed the telltale Peyronie's scar that is far more capable of causing penile curvature.  Further based upon what you have written, “While I didn't exactly abstain as much as I should have, I did mostly stop masturbating for weeks on end, ” even when the doctor told you to abstain from sexual activity you did not.  Not only did you not stop having intercourse, you only reduced masturbating. You need to read a bit about the subject of hedonism.   

If you do not develop Peyronie's disease as a result of your immaturity and lack of self-respect, and I hope you do not, it will be a miracle.  Please try to use this experience as a way to learn something not only to learn about the dangers of jelqing and Peyronie's disease, but more so to learn about yourself and what aspects of your personality are in need of growth and maturity.

If it does turn out that you have an incipient case of Peyronie's disease, please consider that there is much you can do to assist your body to heal and repair the problem.  If half of the men who develop Peyronie's disease eventually heal it on their own without assistance and their penile curvature goes away on its own, there is the possibility you can assist your recovery over Peyronie's disease  by using information found on the PDI website.

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Good luck to you, sir.

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After my penis implant failed, will I ever be able to get an erection again and keep it?

I developed Peyronie's disease about 10 years ago.  I guess there wasn't much treatment then because my doctor put me on vitamin E for a couple months ,but it didn't help.  I had almost a 90 degree bend to the left and had torn tissue on the left side.  He did surgery to correct it and he did a penis implant.  As a result  I lost about 50 to 60 percent of size.  Now after about a year and a half to two years my implant no longer works, but I am still able to get a erection but have a problem keeping it for very long!!  Now at best I can only get maybe half an erection, but can't keep it very long!!  Is there any hope for me now and can anything be done to improve size now after all theses years.  Will I be able to ever get a hard on again and keep it?

Greetings,

Any doctor who performs a penis implant surgery is supposed to completely and in great detail explain what he is going to do and tell you exactly what is going to happen as  result of surgery:  what you can expect in the near and distant future, your risks and rewards, as well well as your  odds for partial and complete success, the pros and cons of that kind of surgery, and if the changes are permanent or reversible, and what it might take to reverse the surgery – all before actually doing the implant surgery.  This is called informed consent; it means the surgeon must inform you of you everything you need to know in order to be able to make an intelligent decision about whether you want the surgery or not.  I hope this was done for you. 

I suggest that you contact that doctor who did your penile implant and tell him the problems you are having.  Ask him those same questions you have asked me, and do not let him push you out of the office until you have a clear answer you can understand.  Bring someone with you who you trust for this discussion.  Tell the doctor that you want that person in the room to help you process the information he will give to you.  Do not go into the room without that person with you because you need to have someone there to catch ideas and information you might miss.  You have a right to this person being there so do not let anyone tell you that it cannot be done. 

No matter what kind of answers or promises you get from this first surgeon who did the actual operation, then please, please, get a second opinion from another surgeon  before you actually let anyone cut on you again. 

You might want to read, Should my husband have a penile implant?

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If you need further help, please let me know. TRH

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Waiting for further information

Hi Dr. Herazy, After talking to you on 6/3/11, I started treatment on April 15, 2011 with the medium treatment plan, I read your handbook and have done the external treatments with heat included 3 times a day ( I have followed the plan and all your methods faithfully including the diet plan and no cold drinks etc.(boy is that tough especially when it is triple digits are here in Casa Grande AZ and will be for the next 3 months. I have dotted all the i's and crossed all the t's but with little signs of progress, I'm trying not to get depressed since I only started on April 15th of 2011, Spend most of the day doing the program including Nel Gung and Kegel exercise. I do not do the message part

since I was not included in the medium package. Not sure if that part would be beneficial at this time. What would you suggest I do next to kick it up a notch. I already ordered another month of the medium package but maybe I should add Acety-l-carnitine or perhaps Neprinol to help expedite the process. I finally got the ability to have sex after changing diets two plus weeks later. I have no pain but everything is still status quo from the start as for the symptons go. Curviture is still there and hasn't lessened any. I have only one scar and had it about 10 months prior to starting the PDI program. FYI I also have dupuytrens tissue mass build up in my right hand and I am treating that with DusaSal.

Greetings,

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There are several things that confuse me about your email, especially the dates.  Would you please contact me by a direct email to me at herazy@comcast.net so I can understand what it is that you are saying.  I want to help you as much as possible, but I first need to get these dates clear in my mind. After that I will be able to study your usage pattern to get an idea of how you are using your plan.  Contact me soon, please.   TRH  

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Where can I find a multi-tube VED to treat Peryronies disease?

I have been diagnosed with Peyronies disease. It came on very quickly.

I work as a consultant. I am 62 years old. Until recently I enjoyed a very energetic sex life. I began to notice around May of last year pain when I acquired an erection.  My penis remained straight despite the pain. I was able to ejaculate and erection was not a problem.

I was on a job. My wife visited me mid October last year.  Then she went home. I had two more weeks until the job ended. I decided to wait until I returned to California and give my penis a chance to heal.  During first sex after two week layoff my penis was bent to the left. I was stunned.  I can feel the hard areas along the left side of my penis. My urologist suggested vacuum therapy.

I bought a device with a large tube that still permits my penis to bend.  I am an engineer.  To me this is just teaching my penis to continue bending. Now I learn there is multi-tube device and suggested therapy.

Where is this mythical multi-tube device ?

Thanks,

John K.

Greetings John K,

I do not endorse the idea if using a vacuum erection device (VED).   You can read this information in Peyronie's disease treatment with vacuum pump (VED).  

Over the years I have encountered too many men who had negative experiences after using the VED, either causing injury that resulted in Peyronie's disease or they noted that the device simply made the penis larger than usual for a few minutes but did not help the actual problem of PD.  The fundamental issue of Peyronie's disease is not the penile curvature weak or erections of Peyronie's disease that get your attention.  The real problem of PD that causes all the other nasty problems that you are experiencing is due to the existence of the Peyronie's scar inside the shaft of the penis.  Using a VED will not get rid of the Peyronie's scar; it will only stretch the tissue temporarily.

As an engineer I am sure you are familiar with the concept of trying to apply traction to a material that has rigid and less rigid areas; the traction force will be absorbed by the less rigid areas and will not allow the more rigid area to be stretched by the traction force.  This is the fallacy of the VED concept to treat Peyronie's disease, as well as the mechanical penis stretcher or extender devices.   This idea was discussed in some depth in a post I wrote called My Peyronie’s disease started after I tried to straighten my curved penis with a penis stretcher, should I use another one?  I would appreciate a comment or two from you concerning the engineering and physics principles that are discussed in this post. 

As far as where you can get a double-walled VED device, I can only suggest that you speak to a urologist who advocates the VED idea. The problem with the double-walled VED is that while it does not allow for the lateral bending of the distorted PD penis (which is good), it also does not allow for the expansion or stretching of the tissue (which is not good on one hand since this is supposed to be how this device is purported to help PD, but is good because it is less likely to injure the penis while it is being used). 

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Overall, it is my opinion the VED is not an effective therapy for Peyronie's disease. Note, that it is not only my idea that the VED is not a great Peyronie's therapy; many urologists are against their use for the same reasons I cite.   Having said that, you will note that makers of the VED and those MDs who advocate the penis pump product for PD will point to a few positive published research reports for the VED.  My answer to those positive VED research reports is the same concerning the thousands of positive research reports for hundreds of new drugs that come out annually.  These hundreds of new drugs, because of the positive research behind them, receive FDA approval each year .  And each year hundreds of them are taken off the market in a year or two after they are proven worthless or injure hundreds of people in the short time they are used.  TRH

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What plan do you recommend for someone with a 10 year-old case of Peyronie's disease?

Hello Doctor,

I've had a mild curvature to the side, enough for me to be pretty self-conscious but not enough to interfere with intercourse, for about ten years. Extremely rarely does it cause mild pain.

I'm 30, in good health, I haven't used ED drugs, and I haven't tried PD treatment before.  What plan do you recommend for someone like me who has had Peyronies for almost 10 years?

Also:  Do the plans include instructions for maintenance therapy once the scar has faded?

Thank you.

Ron

Greetings Ron,

The problem with a Peyronie's disease situation like yours is one of instability and vulnerability to re-injury. I see it happen often: A man with a nuisance kind of problem he can live with will suddenly have an accident during sexual activity and make his PD worse. With even a minor curve the penis is more likely to suddenly bend while thrusting than a straight shaft.  A  curved penis , even when mild, is an accident waiting to happen; the problem is that you have no way to know when that accident might happen and how bad it can be.   In my opinion the reason for you to do something about your PD is based more on prevention of this kind of problem, rather than being self-conscious.

Please go to  Suggestions to help you decide how to start Peyronie's treatment. You will see a lot of help there for yourself and it will put things into perspective for you as you decide how you wish to proceed. Based on the protocol outlined in the chart I think the age of your condition supersedes the fact your problem presents with only a mild curve at this time.For this reason it would seem appropriate that you begin using a large level treatment plan for Peyronie's disease.

Complete instructions are included for the use of all therapies that are ordered. Some men follow a maintenance program and some do not; usually the maintenance program consists simply of a low dose of systemic enzymes.

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Please let me know if I can help you in any way.  TRH

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Sex is better after PDI treatment, but still needs help to locate the Peyronie's scar

Dr. Herazy,

I began using your small treatment plan about 4 weeks ago with what I feel have been very good results. My upward curvature was most extreme at the end of the penis, but still not very extreme based on what I've read on your site. When I first noticed the problem, the pain was terrible during intercourse but has gotten much less over the course of treatment. I want to thank you for your website as it gave me hope without a sense of over confidence about getting healed. I read both booklets and with some adjustments sex is back to being very, very good although there is still some dull pain.

My question is about locating the scar. While I can definitely tell where painful areas are when erect, it's difficult for me to locate exactly where the scar is when applying PMD. Do you have any suggestions on what it should feel like or will there be any noticeable areas on the skin?  The only thing I can tell is that a good portion of the penis from head to about 3/4 of the way to the base is somewhat harder in the center (like along the urethra.)

Thank you again for your work, and any advice is appreciated.

Greetings,

Most men with Peyronie's disease need help to locate the Peyronies scar.

The painful areas you feel when erect might not exactly correlate to the location of the actual Peyronie's fibrous scar tissue.   You do not want to be treating painful areas; you want to be treating where the scars are located and this will in turn reduce your pain and assist in your overall recovery.

It is a rarity to be able to see an elevated area of the skin that is caused by the internal Peyronie's scar tissue; for the most part, it is a waste of time trying to actually see the Peyronie's scar from the exterior.  The best way to locate the scar material is when flaccid, meaning not erect.

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Do not be discouraged if the scar you have is large since it does not seem that the size has much to do with difficulty or time required to eliminate it.  Larger scars can take just as long as smaller scars to treat.

Try this:  forget about finding a “scar.”  Just try to find something – anything – within the mass of erectile tissue that feels unlike the other tissue.  Find something that is unlike the rest of your penis.  When you find it, mark its location with a marker pen or something that will stay on the tissue for a day or two.  Go back each day to that area and re-think what you are feeling.  You are trying to see if it becomes easier to make sense of it.  It could be that you have an unreasonable expectation of what a “scar” should feel like, and you are missing what is really rather obvious only because your expectation is wrong.  Really, how could you know what a PD scar feels like if you have never had to do this before?  Trouble locating the scar is a common problem.

PDI has much success with the methods we present to you.  Just because your doctor could not locate your scar does not mean it is not there.  And it definitely does not mean that you cannot find it just because he can’t.   As so many men with PD finally come to understand, you must take control of your situation and begin to get well on your own.  A large part of being in control of your treatment is to have a vivid image of the scar physical qualities in your mind.

If you need additional help to locate the offending Peyronie's scar, please contact me directly.  TRH

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What program would you suggest I try for my four year-old Peyronie's disease?

I have had Peyronie's Disease for probably 4 years or so (not initially diagnosed) and the initial bend and associated pain is no longer apparent. I have several plaques on the shaft and these cause somewhat of an hourglass effect and an associated constriction.

I no doubt have suffered from depression during this period partly due to feelings of guilt and helplessness. I have taken l-carnatine and more recently Neprinol. I have found that if nothing else doses of vitamin E have also been good for my skin health.

More recently I have been diagnosed with Ehlers-Danlos syndrome. I am in quite good health and have not experienced any loss of sexual function. In taking the Neprinol – this is probably of no association – I now wake with an erection.

I recognize that I should have acted earlier but as it took several attempts to find a doctor that could actually offer help I had already somewhat resigned myself to my fate. As described there has been substantial improvement from the original condition and I am looking to continue my recovery. What program would you suggest that I try? I look forward to receiving your advice.

Greetings,

As I suggest to all men who contact me with the same basic question about what program to get started with, I think you should visit the page  Suggestions to help you decide how to start Peyronie's treatment.  This is a good starting point for anyone who wishes to increase his ability to naturally heal and eliminate the offending Peyronie's scar tissue.  The basic idea is to support and encourage the strongest healing response possible by using the largest and most aggressive plan you can use for at least 2-3 months.

It is encouraging to think that you saw some degree of improvement by just using acetyl-L-carnitine and Neprinol.  This is not a good plan design, so if you decide to use what we offer as a viable treatment plan I would guess your results would be considerably better than what you did on your own. 

Fifty percent of men who initially develop Peyronies will cure or eliminate it without any outside help.  You saw what your body could do when you helped it a little in a lop-sided way.  The PDI therapy idea is simply to encourage that natural healing ability by supplying at the same time and in an elevated dosage all possible nutritional elements to help that healing process along.  

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If I can help you in any way, please let me know. TRH

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Does Bill Clinton have Peyronie’s disease or a curved penis?

Not every curved penis is Peyronie's disease

To offer a definitive and accurate answer to the question “Does Bill Clinton have a curved penis or Peyronie’s disease?” would require the presence of several pieces of clinical information determined by direct medical examination:

1. History of pain while erect, or less commonly pain while flaccid, or both
2. A mass or nodule of foreign scar tissue located below the surface of the penis shaft, detected by manual palpation or ultrasound examination
3. Structural deviation of the shaft of the penis during erection, (bending or curvature, hourglass, bottleneck, rotation or torque, or indentation deformity)
4. Erectile dysfunction, either total or partial, caused by the internal Peyronie’s scar material interfering with the pneumatic mechanism that creates a normal erection

Since none of the above information has been presented in any factual way, the curious public has only to rely on hearsay and innuendo.  Taking the sketchy information and various unconfirmed newspaper reports as credible, the only safe conclusion at this time is that former President Clinton does not have Peyronie’s disease.

A diagnosis of Peyronie’s disease can be complicated.  Peyronie’s disease is not determined solely on the presence of a curved penis, any more than the absence of penile curvature indicates a man does not have Peyronie’s disease.  Simply because a penis is curved does not support the conclusion that the cause is Peyronie’s disease, especially when the presence of the curvature is solely based on the observation of a layperson.

However, whether Mr. Clinton has Peyronie’s disease, or even a curved penis, cannot be confirmed in any meaningful way at this time due to the legal maneuvering and sealing of many court documents in which this question has been apparently asked and answered under oath.  As such, the presence or absence of a curve in Mr. Clinton’s penis is apparently known, but is not currently available for the public record.

Whether or not Bill Clinton, the 42nd U.S. president, does or does not have a bent penis, and is consequently assumed to have Peyronie’s disease, became an important political question during two different sex scandals in which President Clinton was famously involved.

The first, in 1994, centered on the sexual harassment suit that Paula Jones filed against President Clinton for conduct that was said to have occurred in 1991 at the Excelsior Hotel in Little Rock Arkansas. Her lawsuit was eventually dismissed on the grounds that she failed to prove damages as a result of her encounter with Clinton.  When Jones appealed the dismissal Clinton agreed to a $850,000 out-of-court settlement.

The second, in 1998, became known as the Lewinsky scandal.  This high profile sex scandal centered on the extra-marital affair between President Clinton and a 22-year-old White House intern, Monica Lewinsky. Eventually the scandal resulted in the impeachment of President Clinton by the U.S. House of Representatives and a subsequent acquittal on all impeachment charges of perjury and obstruction of justice by the U.S. Senate after a stormy 21-day trial.

Both of these women hoped to prove that Mr. Clinton was sexually active in their presence by offering that they saw a “distinguishing characteristic” of his private anatomy, suggested by others to be some degree of penile curvature.

However, the public record regarding Mr. Clinton’s alleged bent penis has been purged from their testimony.  Because the Jones and Lewinsky cases involved a sitting U. S. president, all testimony and affidavits that would quickly answer this question about Peyronie’s disease were sealed by court order and remain so. Detailed review of Monica Lewinsky’s August 6th and August 20th grand jury testimony, released on September 21, 1998 reveals no questions asked or answered about his penis.  Detailed review of Paula Jones’ testimony during her deposition to the U. S. Senate on February 17, 1998 also reveals no questions asked or answered Mr. Clinton’s penis.

As a result of the court enforced silence on this subject the public does not know what these two women said about what they saw. The Washington Times has reported that several sources with close ties to the Paula Jones case indicated that in her sworn affidavit she alleges Mr. Clinton’s displayed a distinctly angled bend of his erect penis.

Even if it was widely known that both women said Mr. Clinton has a bent penis, this isolated information does not definitely prove that the former president has Peyronie’s disease; it would only mean that his penis is curved.

However, the New York Times newspaper has reported that on October 3, 1998 a detailed genital examination was conducted on Mr. Clinton by the chief of urology from the National Naval Medical Center, Capt. Kevin O'Connell whose interest was to specifically rule out Peyronie's disease.   The New York Times has reported that Dr. O’Connell, as a result of this examination would testify if given the opportunity, that Mr. Clinton does not suffer from Peyronie’s disease.  But this information is also under a court seal, so the best that can be done currently is to speculate.

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Some normal penises are curved while other normal penises are straight; just part of the normal variation that exists between men that makes us all unique.  When those court documents are finally opened and made public, few of us will be around to care about the private parts of President Clinton.

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Do you know of any link between Peyronie's disease and PSA (Prostate-Specific Antigen)?

My question is, do you know of any link between Peyronie's disease and PSA?

Since I acquired Peyronies, my PSA has increased over a couple of years.

Dave

Greetings Dave,

In my opinion there is a possible link between an elevated PSA test and Peyronie's disease, actually two links, but only in an indirect way and probably not as you might expect.  I will discuss that association a bit later after a few preliminary remarks so all readers can be more familiar with the PSA test.

Every man needs to know that PSA (prostate-specific antigen) is a protein made by normal prostate gland tissue in the adult male.  A recent ejaculation, any inflammation of the prostate whether caused by  acute injury, benign (non-cancerous) enlargement (BPH or benign prostatic hyperplasia) associated with aging, or prostate cancer can elevate the PSA level found in the blood.

In the mid-80s the PSA test was approved by the FDA only to monitor the progression of prostate cancer that was previously diagnosed.  In the mid-90s the PSA test was approved by the Food and Drug Administration (FDA) to be used in conjunction with a direct digital rectal examination (DRE) to annually test men who did not have active prostate symptoms as a screening procedure for prostate cancer. 

However, due to recently becoming aware of the limitations of the PSA test and the potential harm that can arise with its use, it the FDA acknowledges the PSA test is not a dependable prostate cancer screening procedure; it yields a false-positive result in about 75% of positive tests (only one correct test result out of four positive tests) . This means that three men who do not have prostate cancer will receive an incorrect test result for every four positive tests.  Prostate biopsy operations are performed on a routine basis when a PSA test is positive, so this means that three out of four prostate biopsies are unnecessary and expose those men to unnecessary risks and side effects.

On the other side of the coin, a false-negative PSA test can also come back with a low or normal readying even thought active prostate cancer is present.  This does not happen nearly as often as a false-positive PSA test, but it does occur, giving a man and his doctor, as well as his family, a false sense of security that cancer is not present when in fact he might have prostate cancer that requires immediate treatment.

As a cancer screening test the PSA, when it is actually correct,  can help detect the presence of small cancers that do not cause symptoms.  However, simply locating a small prostate cancer does not result in a man living longer.   Several types of prostate cancer detected by PSA testing grow so slowly they are unlikely to be a cause of death.  Further, detecting cancer early might not help a man survive a fast-growing or aggressive tumor that often spreads to other tissues and parts of the body long before it is detected.   For this reason the FDA now takes a different position about the PSA detecting prostate tumors:  early detection of slow growing and non-malignant prostate tumors that do not threaten a man’s life can result in “overtreatment” of low-threat problems, and this routine screening use of the PSA test has been called “overdiagnosis.”

Active and aggressive treatment of a low threat and slow growing prostate cancer is called overtreatment because the side effects and complications that arise from this kind of cancer treatment are often far worse and more life threatening than the cancer itself.   Beginning with  suppression or weakening of the immune system that makes a man more susceptible to infection anywhere in the body and other diseases, urinary incontinence (inability to control urine flow), bowel and urinary dysfunction and erectile dysfunction are a common side effect of cancer treatment.

More commonly now only those men who report actual prostate symptoms will be given a PSA test along with a digital prostate examination to determine the cause of their symptoms. The exception to this more limited use of the PSA test is for those men who are who are at greater risk of malignant prostate cancer (black men or those men whose father or brother had prostate cancer).  For this group it is recommended that they begin to screen for prostate cancer in their mid-40s.

For these men in a high risk group, PSA testing spread out over a period of several years rather than several months gives the most accurate and revealing diagnostic information. One individual elevated PSA test may be a reason for only mild concern, because often the next PSA test will be normal.  But a series of slowly raising PSA tests over a period of a few years is another matter and warrants further prostate testing. 

PSA testing is also controversial for men 75 years old and above.  This age group is far more likely to have a slow growing cancer.  This type of cancer posses very little immediate health risk compared to the other cancers, heart, lung and kidney diseases, diabetes, degenerative neurological and vascular disease (that often occur as multiple health problems) in the elderly.  For this reason PSA screening is not recommended for elderly men with multiple health problems or a single major medical problem, or when life expectancy is less than 10 years.

So now, Dave, with all that on the table, allow me to offer my thoughts about a possible connection between Peyronie's disease and the PSA test. 

When a man has a PSA test and the results come back positive, the doctor treating doctor will do additional tests that will probably include a prostate biopsy.  After the prostate biopsy the man might be catheterized (a thin catheter tube inserted up his urethra – the urinary passage in the penis) to help him void urine. I have written in the past about the issue of abusive catheterization leading to PD in  Possible Peyronie's cause: Catheter and cystoscope trauma. In this sense, men who have had a PSA test can develop Peyronie's disease indirectly as part of the process of having their prostate gland treated.

As a second possible link of PSA tests and Peyronie's disease, please consider the man who goes to his medical doctor for symptoms of prostate enlargement (urinary frequency, urinary dribbling, difficulty starting or stopping the flow urine or pelvic and penis pain).  As these things often progress, this man could be given a PSA test to assess the condition of the prostate and subsequently be prescribed the drug Proscar (finasteride) to reduce prostate enlargement (benign prostate hyperplasia – BPH).   There are a growing number of lawsuits now pending which claim that Proscar can cause Peyronie's disease; for additional information please see Will the drug finasteride (Proscar) (Propecia) affect my Peyronie's disease in any way?

I would be interested to learn more about your situation, Dave.  In particular, if you have ever taken Proscar in relation to prostate enlargement; and if have, if your Proscar was taken before you knew you had PD.  Now that you have Peyronie's disease I believe there is no direct connection between your prostate gland or Peyronie's disease and the raising pattern of your PSA readings.     

For additional information please see Prostate screening and Peyronie's disease.   TRH

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Do any of your Peyronies therapies have harmful side effects?

Hi Dr Herazy,

Please advise whether any of the Peyronie's Disease medications are known to have any harmful side effects. Also, I'm located in South Africa – is there a local agent I can contact or do I need to purchase the medication online? Thanks.

Kind regards,

Paul

Greetings Paul,

Diarrhea is the only adverse reaction that happens from time to time with some men when they begin taking higher doses of systemic enzymes.  With every order of systemic enzymes that we send out we include detailed instructions explaining what to do if a temporary diarrhea “reaction” occurs.

In all the years that PDI treatment has been used I have not encountered any adverse reaction when the plans are used appropriately and as instructed. Since the PDI treatment concept uses vitamins, minerals, food-based enzymes and herbs the possible range and frequency of side effects are not what is commonly associated with drugs.  As far as your body reaction to the increased nutritional intake that is part of this kind of PD treatment, you are simply eating better.

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I am not aware of anyone doing this kind of work other than PDI located in the U.S.   We send to South Africa almost weekly without any problem.  TRH  

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Upward 40 degree curved penis with Peyronie's disease, 22 year-old thinks sex is over and mentions suicide

I am 22 years old, i was messing around with a girl (not having sex) but, she got turned on and thrusted down on me and her pelvic bone hit on the end of my erect penis and it hurt momentarily and i thought nothing of it and went on with business. When we finally had sex the next week and i felt smaller but just shrugged it off to a bad day. Then it still seemed to stay smaller and it began to hurt.

After 2 months of it hurting when i got an erection and noticing a bend in the middle i scheduled an appointment with a Urologist and wasn't too worried because i figured no matter the cost it would be fixable and i have an upcoming deployment so i would have the money to pay for any reconstructive surgery (which i looked up and found out there is nothing to fix it!).

I went to the urologist appointment and he said real quick it was Peyronie's disease and explained what i injured, to take vitamin E and just it will heal but i'll lose length and girth and will be more liable to injure it further in the future then he abruptly left the room and that was it.

The past week since my visit i have been scouring the internet and becoming very depressed and have been contemplating suicide ( seen another 22 year old post similar which made me feel as i should ask for help also) i have a 40 degree upward bend, the top of my dick when flaccid has a hard feeling to it, sort of a elongated lump. I feel about 3/4 to an inch smaller and much thinner. Also weaker erection but, that has started since the diagnosis which i believe is more mental that actual physical condition. But just a quick prelude, when having sex with girls for the first time i've always been shy and would struggle to hold an erection the first time or two until i was comfortable. Had a good sexual relationship with the girl before and was almost always ready to go no problem, and then that ended and after finally having confidence in my sexual self, i hurt myself and feel i'm ruined forever.

Greetings young man,

No, you are not ruined forever.  You are only ruined if you allow yourself to be ruined.  But, you are too good for that; you have already proven that you are too good to allow Peyronie's disease to ruin you because you have already started to take steps to take care of yourself and to learn about this ugly problem.  You have already showed me in your email that you will be one of those who survives Peyronie's disease one way or the other.

However, it sure as hell is true you are deeply scarred; you are also confused about this mystery condition that came out of the blue to hit you when you weren't looking; you are also shocked at how little the medical profession has to offer you; and you are also upset at the cold and indifferent way the urologist treated you.  When you put all these powerful negative emotions together it can rattle your thinking and put you mentally and emotionally off-balance for just a little bit.  Because of this you have allowed yourself to think about suicide for maybe the first time in your life.   How do I know you are feeling this way?  I experienced something similar when I developed PD in 2002.  In fact the majority of the thousands of men I have communicated with about PD have felt just like you, and have thought many of those same black thoughts.  When you have a lousy medical experience with Peyronie's disease like you did – just like almost all men do – you can understandably have an almost identical emotional reaction – just like almost all men do. The difference is that only a few men are honest enough to talk about it.

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What you must do now is get busy to help yourself because you already know there is very little help for you from the medical side.  Most MDs are rather indifferent to the plight of the men they diagnose with Peyronie's disease.  In your reading and investigation of the PDI website I am sure you have come across the information by now that is repeated many times about 50% of men who develop PD getting over it  (spontaneous remission of Peyronie's disease) without any outside help at all. The message of the Peyronie's Disease Institute is that you always have the option of improving your odds of recovery by supporting your natural ability to heal PD like those lucky guys who do it naturally.   In fact, you could be one of those men and you just do not know it at this time.  There is much you can do to support the natural tendency of the body to always do the most it can to heal and recover to the best of  its ability.

You admit that you are a shy person.  Many times shyness comes from insecurity and lack of confidence that are rooted in past childhood issues.   There is nothing like being naked in front of someone for the first time to test your self-confidence and personal comfort.  Now that PD is an issue these insecurities and self-doubts are challenged even more.   This is a vitally important and complex subject that is central to the negative emotions that so many men feel when they first deal with Peyronie's disease.   I want to say many things to help you with this subject but my time and space is limited.  I strongly encourage you to get one of the books I wrote that I think will help you greatly, “Peyronie's Disease and Sex.”  There are so many helpful topics covered in this book that I am confident will help you think your way through your self-doubts.  Hopefully reading it will guide you to the other end of the problem at which time you will feel differently about having Peyronies disease.  If it does happen that you continue to have thoughts of suicide it is important that you talk to someone you trust for help and advice.

At the end of your email you said”…I hurt myself…”  Actually, that is only partially true.  The truth is that you put yourself in a dangerous situation and you allowed someone else to hurt your penis.  This happened because you did not know any better because you and 99% of the men in the world do not know about Peyronie's disease until they developed it.  If men do not know about PD, you can imagine that women are even more ignorant of it.  Therefore, it is likely that in your life you will never meet a woman who understands how dangerous it is for a man to be jammed and smashed down by her when he is erect.  You know; she never will.  Therefore, it is not up to you to deliver any lecture about PD and sex safety.  But, it is up to you to be smart; do not ever again allow a young lady to get that close to you when you are erect when she could duplicate that kind of injury. You must select a different range of safer sexual positions in which you are more in control of sexual activity, or at least learn to hold on to her waist so that you can limit how far back she can move to avoid a similar injury.

Please contact me again if you need help of any kind and I will do all that I can for you.  TRH 

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Will the drug finasteride (Proscar) (Propicia) affect my Peyornie's disease in any way?

Dr. Herazy,

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My urologist prescribed finasteride (PROSCAR) to shrink my enlarged prostate and lower my PSA level.  Will this affect my Peyronies in any way?

Thanks,

Lou

Greetings Lou,

Finasteride (prescribed under different names depending how it is being used) is used to treat enlarged prostate and prostate cancer,  (under the name Proscar), and it is used to treat hair loss and male pattern baldness (under the name Propecia).  Initially when finasteride was first given approval by the FDA (Food and Drug Administration) the known side effects of  fatigue, dizziness, weakness, breathing difficulty and reduced blood pressure were thought to be acceptable because they were mild.  Since approval by the FDA and greater usage in the general population more disturbing side effects have been associated with finasteride use.

In mid 2012 the FDA announced that finasteride use can increase the risk of a very serious form of prostate cancer, even though it is sometimes used to treat symptoms of a mild form of prostate cancer.

My first thought when reading your email was, “I wonder if Lou told his urologist that he has Peyronie's disease?”  But being your urologist, I assume you have gone to this doctor in the past simply because you have Peyronie's disease, right?  If so, it appears to me that you probably have gone to this urologist for your PD and now your enlarged prostate, and the doctor prescribed the finasteride for you anyway.

You see, there are currently several lawsuits being litigated against against Merk & Co., the maker of finasteride, about the many apparent side effects of this drug, including complaints related to the urogenital system:  Peyronie's disease, reduced semen volume, reduction of the size of the penis, genital numbness and lowered sex drive.  Unlike many drug side effects that stop once a drug is discontinued, the side effects of finasteride that affect the male reproductive system appear to be permanent and do not go away after the drug no longer is taken.  In addition, there are other categories of lawsuits being processed due to the mounting evidence that it also causes depression, anxiety, “brain fog”, memory problems, comprehension issues, reduced exercise tolerance, weight gain, and muscle and joint aches.

The FDA (Food and Drug Administration) has ordered Merck & Co. to revise its labeling of Propecia in recognition of the growing body of complaints that the side effects of this drug appear to cause permanent sexual dysfunction long after it is no longer being taken.  Most disturbing it seems is that the FDA acknowledges that new side effects and complaints against finasteride are being reported over time, creating a new medical condition now called the Post-Finasteride Syndrome.

Please see, Another case of Propecia and Peyronie’s disease.

Your urologist was not negligent or wrong in prescribing Proscar for your prostate enlargement because the FDA has not officially stated that finasteride causes Peyronie's disease or aggravates established cases of PD.  All of these claims are being studied and evaluated to determine if the association between the drug and the side effect are real or merely coincidence.  While the FDA might take perhaps a few years to reach an official conclusion, and your urologist can still prescribe this medication, you must decide if you wish to take it.

Just a few weeks ago I worked with a man in his late-40s who took Propecia (finasteride) for his thinning hair problem.   He was on it for perhaps a few months when he developed many unusual problems of skin eruptions, anxiety, forgetfulness and weight gain.  A few months later he developed severe erectile dysfunction (ED) and a curved penis.  His doctor denied any connection or association between his patient taking finasteride and these health problems that started after taking the drug.   In the face of all the information and evidence that is developing about this drug, I told him that his MD was not being honest because he was trying to protect himself from a possible law suit.  You must assume that an MD who prescribes a drug knows about its growing history of drug side effects.  The MD must make a decision:  Do I prescribe this drug knowing that it is getting a lot of bad reports of side effects and the drug maker is drowning in law suits, or do I continue to use it because the FDA has not pulled it from the market?  It seems to me that MDs play with fire, but it is their patients who get burned while the MD is protected by a good lawyer!

The problem this 40 year old fellow was having as he worked to reduce his Peyronie's scar, was that his response was very irregular and very slow.  Some days the scar was softer and smaller, and other days it would return to its previous density and size; some days the curved penis was straighter and other days it was not.  He was getting very discouraged.  I later learned that he was also taking a beta-blocker drug for high blood pressure, long known to cause PD.  Apparently this double-whammy of two drugs that cause Peyronie's disease was the basis of his slow and unusual response to his aggressive PDI treatment plan.   

Perhaps you should consider that some of the other drugs you are currently taking for different health issues might also contribute negatively against your Peyronie's disease.  For information along this line, please see Could these drugs be the cause of my Peyronie’s disease?  

I cannot answer your question if Proscar will affect your Peyronie's disease in any way.  My guess is that if it is possible for  finasteride to cause Peyronies disease, it would be possible to make an existing case of PD a bit worse and it might also be possible for it to make recovery all the more difficult as I work to reverse the problem with a PDI plan. 

To my way of thinking, being a very conservative person in these areas related to health and well being, I would talk to my urologist.  I would  learn if there are options to explore;  if there is an enlarged prostate drug that does not carry the possible side effect of causing all these different urinary symptoms that could be used as a substitute for Proscar.  If I had an enlarged prostate and I had Peyronie's disease, I would not take Proscar.  I strongly advise that you should do what you and your urologist decide to do.  TRH

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My Peyronie's disease started after I tried to straighten my curved penis with a penis stretcher, should I use another one?

Winter 2010 I used a penis extender for around 1.5 months (4-6 hours each day or less), where I probably made an injury on the left side (too hard penis with too hard stretch), just below the glans.

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I realize now that I probably have had congenital curved penis all my life.

When my penis is rock hard, it curves 30-40 degrees to the left. I think it was less before Winter 2010 when I started using the penis extender.

I wonder if it could have been possible that I didn't injure the penis, but bigger curve at the glans is due to longer extension on the right side compared to the left side (because of scar tissue on the left side) ?

Seriously, I didn't think so much about the curve before, so the curve might only have been congenital before this likely injury. I went to an urologist in May and he indicated that I maybe have had a little injury on the tunica albuginea (which makes the overall curve bigger).

In December I started to use an extender again, with the use of  XXXXXX, said to work specifically for PD. I stopped after 34 total effective days (9 h each day) as I have read some studies where they have used Verapamil injections before usage of an extender. In one study the curvature went from 30 to 0 and lengthened with 1.5 cm :)   I stopped using the extender 10 days ago.

Is this something you recommend? To remove the plaque first and then start using the extender after the plaque has been removed? Because it is speculated that some of the reasons the lengthening is shorter with PD, is because of the plaque. I have just started to use DMSO and SSKI (both topical), and will start to use Serrapeptase and Nattokinase as well. I see on this site that you also recommend Neprinol and some copper + +.

I have another question, so I may have to call you for more clearance; when the plaque diminished, will it leave an empty area in the flesh, maybe making the curvature worse and the penis shortened?

Peyronies disease is not just having plaque, but also having one side shorter than the other. It is then vital to use an extender so the shortest side can catch up the longest side, right?

I`m 31, which package do you recommend to me?

Greetings,

First of all, I removed the name of the penis stretcher product from your email because I think all of them are dangerous, as you have already shown us by reporting you injured yourself with one.  I wish to not promote these contraptions in any way.  The name of your particular device is not important because none of them are different from the others in any important or meaningful way.   All cars are fundamentally the same because all have a motor, seats, windows, wheels and a steering wheel; in that sense they are all identical in their basic design.  The same can be said of penis stretchers.  They all have a clamping device that holds the penis at or near the head, a base that is held against the pubic region, a pair of extendable threaded rods that lengthen the device while it is worn on the penis, a book of instructions that tells you what to do if you develop blisters and skin erosion while using the extender, and surgical wool and antibiotic ointment to keep you from hurting yourself further.

You are a rare man.  I have communicated with very few men who are able to wear a penis extender device for more than a short while; some could not wear one for even 10 minutes.  I have worked with many men who told me they could only put it on only one time and threw it away because of pain and apparent injury.   Many of those men who persisted in spite of the pain and superficial tissue erosion caused by these stretchers soon developed Peyronie's disease.  Some men put a penis stretcher on only one time for 30-60 minutes and then never again because they next day they have signs of early penis injury, and later demonstrate full blown Peyronie's disease.

It seems the prolonged pressure from the head clamp  causes local tissue anoxia (oxygen starvation) deep within the penis tissue; this is probably what happened to you.  When there is a lack of blood circulation in the penis caused by smashing it down with the clamp of the penis extender, blood circulation is cut off and a lack of oxygen occurs where the head is compressed.  This is very much like what happens when a tourniquet is worn too tight or for too long – the lack of oxygen caused by poor blood flow will kill tissue.  Any good boy scout or soldier learns that even if your arm or leg is severely cut you must periodically release the tourniquet – even if hemorrhaging starts again – so that fresh blood can deliver oxygen into the injured limb.  If this is not done the entire limb can become damaged and gangrene can develop.   But you report in one area of your email that you wore yours for 4-6 hours daily for six weeks, and you state later you wore another penis stretcher for nine hours daily for 34 days.  That is incredible.  If you were a boy scout you would have flunked the first aid class for leaving the “tourniquet” on for far too long.  No wonder you developed PD.

You state your congenital penis curvature is now worse than it was before you started using your first penis stretcher; your bent penis now curves 30-40 degrees to the left, more than before using the stretcher.  You think that the solution to the problem caused by the first penis stretcher is to use a second penis stretcher.  I do not agree with your thinking, and I will explain why later.

Please think about this statement I am about to make because it is very important in helping you to understand why you have injured your penis, and why I feel you are going about treatment in a totally wrong way:  If you have Peyronie disease, your problem is not that your penis is bent, dented or otherwise distorted; your problem is that you have dense scar tissue within the tunica albuginea layer of  the penis that as a secondary factor is causing your penis to be curved, dented or otherwise distorted.

Think of it this way.   If you cut yourself shaving, what is the actual problem?  Is your problem the blood running down your chin?  Or is the  problem the hole in your skin that as a secondary factor is allowing blood to leak out of the blood vessels and run down your chin? Certainly the blood gets your attention, but it is not the problem.  If you did not have the hole in your skin the blood would not be running down your chin.  If I was to offer you a way to wipe your face clean, it would not address the real problem which is the hole in your skin.   If I was to offer you something that would help you heal the hole in your skin rapidly you would not have to worry about the blood running down your chin.  Certainly when your penis is bent it gets your attention, but it is not the problem.

I emphasize this point because I believe you are seeing Peyronie's disease as being a curved penis, when it is not.  Peyronie's disease is a soft tissue condition of the penis in which a fibrous plaque of scar tissue develops excessively for some reason (congenital predisposition, nutritional deficiency, trauma, chemical or hormonal imbalance, drug side-effect, or a combination of some or all these) in the tunica albuginea, which in turn prevents the even and symmetrical expansion of the erection and a few other nasty symptoms.

You ask, “Is this something you recommend? To remove the plaque first and then start using the extender after the plaque has been removed?”   The answer is simple:  No.  If you did something to remove the plaque first, you would not need to use an extender because you would not have Peyronie's disease.  With no plaque in the tunica albuginea you would not have a curved penis and there would be no point in using the penis extender unless you are one of those men who believes stretching on the penis will make it bigger – and that is an entirely different topic.

You also ask, “…when the plaque diminished, will it leave an empty area in the flesh, maybe making the curvature worse and the penis shortened?”   The short answer is again, no.   As a longer explanation:  When a pregnant woman delivers a baby, does her abdomen stay stretched out?  When a weight lifter stops exercising, does he develop empty areas and voids where the larger muscle tissue used to be?  When you over-eat and your stomach and abdomen expand and bulge out, does it stay that way permanently?  No, to all of that.  All our body tissues are elastic (even bone to a very minimal degree), allowing the removal of unneeded or foreign tissue cells that are eliminated and healed over in the best way the body can accomplish under the circumstance.   The body always attempts to return to the most efficient and normal state it can whenever and however possible.  In the case of Peyronie's disease the body will attempt to reabsorb the strands of fibrous tissue and heals the tunica albuginea to the best of its ability.  In about half of the men who develop Peyronie's disease this attempt at self-repair and self-healing is successful.  In the approximate other half, the condition is not healed and becomes more or less permanent.

This tendency of the body to always attempt to return to normal (homeostatis), or self-heal, is the basis of the PDI concept for eliminating the Peyronies disease scar. By presenting to the tissue a wide variety of helpful and supporting vitamins, minerals, enzymes, and naturopathic modalities like moist heat applications, DMSO, gentle manual penis stretching (which is vastly different from your mechanical penis stretching concept), ultrasound and acupuncture therapy, we attempt to support, promote, stimulate and accelerate that ability of the body to eliminate the Peyronie's scar that works in 50% of men and fails in the other 50%.  What PDI attempts to do is really not so far fetched or bizarre.  We only attempt to assist and  promote a natural process that is successful in 50% of men when they eliminate their PD scar without any help from anyone.  We are not trying to make pigs fly.  The PDI concept of helping PD correction is one of working with the man who has PD so he can do a better job of what he failed to do in the first place.

Another question you pose is,  “PD is not just having plaque, but also having one side shorter than the other. Ii is then vital to use an extender so the shortest side can catch up the longest side, right?”   You ask that question as though having plaque and having a shortened side of the penis are two separate and distinct problems.  I get the impression you believe that the shortened concave side of penis curvature happens independent of the plaque, when that is not the case.   It is the presence of the dense fibrous scar that shortens the side of the penis in which it is located, and not the other way around.

To solve the problem of Peyronie's disease the body must eliminate the mass of dense fibrous scar in the tunica albuginea.  You cannot eliminate that tissue by stretching or pulling on it.  How do I know that?   Simple laws of physics governing our universe explains why stretching a penis with a PD scar will not influence that mass of inelastic tissue. 

We all have heard the expression many times, “A chain will break at its weakest link.”  We all intuitively understand what that means.   When a stretching or traction force is applied to a series in which there are stronger or stiffer areas as well as weaker or more flexible areas, the weaker or flexible parts or areas will give way, break down, fail or somehow give  up before the stronger parts or stronger areas.   In war: when the enemy attacks, the weaker part of a battle line will give in before the stronger part of a battle line.  Toilet paper and postage stamps: when the paper is pulled the area of paper that has been weakened by the small perforation holes will tear before the non-perforated paper has a chance to tear.  Tires on a car:  the softer the tire, the more it will absorb the vibration energy of a rough ride, and the harder the tire the more it will pass the energy of a rough road to your body.  There are countless examples of the idea that a weaker, thinner or more flexible area will absorb energy before a stronger, thicker or more rigid part is able to do so.  This is why a chain will break at its weakest link.  What does this have to do with Peyronie’s disease?

The PD scar is thicker and stronger than normal skin and corpora cavernosa tissue of a penis. When a traction force is applied to the penis, the normal elastic corpora cavernosa and skin tissue will absorb the energy of the traction force as it stretches out before the inelastic scar tissue has a chance to stretch – the scar will not get a chance to get stretched because the healthy penis tissue will absorb the energy as it stretches first.  Don’t believe me?  Do this experiment.  Find  three rubber bands– two that are thin and stretchy and one that is thicker and heavier than the two thin rubber bands.  Loop these three rubber bands together in a series, placing the two thin stretchy rubber bands at the ends and the thick heavy one in the middle.  Now hold this series of rubber bands at the two ends and pull on it so you are stretching the whole thing out to make them all longer.  Notice that all movement and stretch  is coming from the two thin stretchy rubber bands that are at the ends, and no movement or stretch is taking place in the thick rubber band in the middle.  Only when you stretch so far that the two thin rubber bands are near their breaking point and are ready to snap, will the thick rubber band in the middle begin to move a little.  If you continue to pull, one of the thin bands will break before the thick band has stretched only a small amount.  This will happen every time.  Thus, when you pull on a flaccid penis that has Peyronie’s disease you cannot stretch the thick fibrous scar tissue because the normal elastic skin and deeper corpora cavernosa tissue will absorb the traction force to do all the stretching just like the thick and thin rubber bands looped together.  

In Peyronie's disease any apparent inequality of length is caused by unequal expansion of the corpora cavernosa due to the presence of the dense fibrous scar material within the tunica albuginea. The dense and inelastic scar prevents full expansion of the erect penis, and perhaps only a minor amount of actual contraction of the tunica albuginea.  When I work with men who have been successful in reducing or eliminating the their PD scar material their curved penis returns partially or completely back to normal depending on how much scar elimination occurs.  I am told for some the scar elimination is complete and for others only partial; when I treated my own Peyronie's disease in 2002 it was complete elimination of the PD scar.  No mechanical penis stretching is done and no mechanical penis stretching is needed.  In 2006 a research project was undertaken during which we devised and perfected a gentle manual penis stretching method that works completely unlike and contrary to the concepts presented in the mechanical penis stretchers.  Additionally, I find that lost penis length and girth that occurs is a result of fibrous infiltration of the tunica albuginea and this often improves to the degree the body is successful in its attempt to remove this foreign fibrous tissue, owing to the natural tendency of the body to heal itself when given the opportunity.

Your last question about what Peyronie's treatment plan I recommend for you is the most difficult and also easiest one to answer.   Since I am not your treating doctor I can only advise you as I advise all other men who come looking for help in starting self-treatment.  I suggest you use the largest and most aggressive plan of treatment that you can sustain for at least 3-4months while you follow the PDI concepts of Peyronie's treatment that supports and encourages your body to eliminate this terrible scar material.  If you decide to do so, you might use the gentle manual penis stretching technique as part of that effort.

I appreciate your hard work, earnest effort and sincere desire to rid yourself of your Peyronie's disease.   You are like many men I deal with daily.  I commend you for not accepting your problem and encourage you do all you can to heal your problem.  If I can help you in any way, please let me know.  TRH

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Can you help me with a penis that has been shortened by scarring from x-ray radiation?

I have had peyronies since 1977 when  I had a testicle removed and very soon after I contracted peyronies.  The oncologist treating me for the cancer also zapped the peyronies.  My problem is the x-ray treatment scar has shortened my penis form 6″ to 3.5″ also left me with the inability to maintain an erection so when I use the cock ring for intercourse it only leaves about 2.5″ and that ain't much fun. I have just found your web and am wondering if you can help.

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Greetings Mate,

You have a few things going on here at the same time and that will impact the outcome you finally earn. 

While the PDI gentle manual penis stretching technique was developed specifically for the effects of Peyronie's disease, it has been used by many men who wished to change their congenital penis curvature and a few men so far who have had scarring of the penis surface from x-ray radiation treatment.  Based on the reports I have received back from some of these men the  response was most often good enough that they were pleased with the outcomes and they thought it was worthwhile, even in those cases in which total recovery did not happen.

You have dealt with your problem for a very long time, so I assume you will be patient with this process and allow ample time for your tissue to respond to the best of its ability – if at all.  I mention this because I have no idea how bad your scarring is, where it is located, how deep it is, and most importantly, I have no idea how well and how faithfully you will use the stretching technique to assist changes to happen.  I can only hope you will follow the detailed technique instructions exactly as they are presented and that you will not try to use only penis stretching as the only way to try to regain lost penis size.  This is usually the best way to fail to get help.

To work well it is necessary to help your scarred tissue also from the inside by also using systemic enzymes, DMSO, vitamin E and Scar-X.  When these are combined with the stimulus of gentle manual penis stretching it might be possible to regain perhaps a part of what you have lost, perhaps a lot.  I have no way of knowing.   I cannot predict or promise anything to you because there are so many variables and unknowns.  The important thing is that you try to do this in the best and most aggressive way possible for at least 3-4 months.

If you decide to follow for a few months a therapeutic trial to see if changes can be made in your situation, please advise me by email when your order is placed.  I will supply specific information for you.  This is not what our therapy protocol is normally used for, so I will have to guide you through a few special steps.   TRH

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Questions about taking Neprinol in a Peyronie's treatment plan

Hello Dr Herazy,

I have a question regarding the intake of Neprinol and the absorption of proteolytic enzymes. I understand that they need to be taken away from meals. My understanding is that on an empty stomach they act/are absorbed in one way, and with food they act in another way. On your site somewhere you say they they should be taken 90 minutes before or 90 minutes after eating. 90 minutes before eating sounds extreme. Surely they are out of the stomach and on the way to the intestines in a lot less time than that. And by the same reasoning, taking them 90 minutes after eating … wouldn't there still be food in my stomach at that time? 90 minutes before suggests REALLY away from food; but 90 minutes after suggests that mixing it with food then is OK. Can you clarify this a little further. I just want to be sure what I take can be as efficacious as possible. My practice has been to take it 15 to 30 minutes before eating. (At which time I also take other herbs (for other non-PD concerns) that also need to be taken on an empty stomach.  Thanks.

Walter

Greetings Walter,

What you are asking about is called “gut transit time,” or the amount of time it takes for food to pas through the digestive tract, as well as absorption rates for different molecules that pass through the stomach wall. As you can imagine, this is a variable factor from one person to the next. The 90 minute stipulation is a good average for most men following a Peyronie's treatment plan,  but it might far shorter or far longer than it should be for some people; yet, it is a good average.

If you feel that you need to increase or decrease these times for taking Neprinol based on your personal digestion physiology, by all means please do so. Having said that, I would caution you that you should err on the side of assuming there is food in your stomach longer than what you think. Please give yourself a bit more additional time when taking the enzymes before a meal, and give yourself a bit more additional time before you eat after taking the enzymes. The world will not come to an end if you take your enzymes to close to the time you are going to eat, or you eat too soon after taking enzymes, but your therapy will be diminished and Peyronie’s treatment is too important to make this kind of error.

You write that you take your systemic enzymes 15-30 minutes before a meal. That might be perfect for you, but it might not be enough time for the next person. Further, that might not be enough time for your stomach to get the enzymes into your blood stream and into the fibrous tissues. How would you know?

You write that taking Neprinol 90 minutes before a meal sounds extreme to you, but I must wonder what you base that on. All I propose is that you give your gut ample time to get all the systemic enzymes through the gut wall, into the blood stream, and disbursed to start working on the excess foreign protein that is in the Peyronie’s scar. Maybe this can take place in 17 minutes, or 59 minutes, or 90 minutes, no one knows for sure because these particular digestive enzymes have never been studied for absorption times or delivery times. So why not make sure you allow enough time to allow it to happen so you get the best results from each and every dose you take?

If all you are doing is using that “full stomach” sensation to judge if food is still in your stomach you might be incorrect. Many people have food still being digested for hours after a meal – they might be exceptions, but it does happen. Further, gut transit time – the time food stays in the stomach – changes in the same person from one meal to the next depending what kinds of fats, carbohydrates and proteins are in each meal, and changes based on your emotional state, how well or poorly you chewed your food, how physically active or rested you might be at that time, how warm/cold you are, and other factors.

Lastly, let me guess that your question is not based on the usual situation in which you can control your food and enzymes schedule perfectly. I will guess you are asking this question really based on those days when your schedule for eating, working, and taking a handful of different therapy items is totally out of your control. We all have too many of those days when we forget to take Neprinol 90 minutes before we eat, or we absolutely will not be able to take the Neprinol 90 minutes after we eat. What do we do then? When we cannot allow ample time to take systemic enzymes on a good schedule because of forgetting or something we cannot control, what should we do? Do the best you can. Then promise yourself that the next dose will be taken at a better time to allow for better absorption and delivery. That is all you can do.

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Give your gut ample time to empty food, and to absorb Neprinol, so as to maximize the ability of Neprinol and other proteolytic enzymes to the target Peyronie’s disease fibrous scar material.

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