Peyronie’s Penis

What causes curved penis?

Before I discuss what can be called a “Peyronie’s penis,” it would be good to mention the normal penile curvature of many men.  Many men look for answers to “Why is my penis curved?” and eventually come to think they have Peyronie’s disease, when that is not the case.  They think that just because they have curvature of the penis, that it must be a Peyronie’s penis, when it is not.

Normal penile curvature

A small degree of curvature of the penis is common among men and can be considered normal, as many men are born with this benign condition, commonly referred to as congenital curvature. Probably the single best and easiest way to determine is a curved penis normal, is to answer the question “Have you had this curved penis problem all of your life?  When you were a small boy, was your erection bent?”  If the answer is “yes,” then it is most likely your current problem is not a Peyronie’s penis.

It is most common for the curvature of Peyronie’s disease to cause a bend or distortion that is angular or abrupt, like a sudden bend in the road, while a congenital curvature is usually gradual and milder in degree, like a banana.  Some cases of Peyronie’s disease will cause a gradual, mild, banana-like curvature, however.  Because no case of Peyronie’s disease can be diagnosed on the basis of the appearance of the curved penis, a doctor must evaluate the condition for other signs and symptoms.

When a man has Peyronie’s disease the condition is characterized by an internal scar or plaque, or hard lump that forms within the substance of the penis. Congenital penile curvature will not exhibit this internal scar material.  If the cause of the penile curvature is Peyronies, it will often appear rather suddenly, be accompanied by pain, be accompanied by some degree of lost penile length or girth, and cause a certain degree of erectile problem that has not been experienced before.   Not all of these factors must be present for a diagnosis of Peyronie’s disease; the presence of the internal scar or lump is most valuable to make the decision.

Peyronie’s disease can cause pain, penile distortion and reduced sexual ability due to the presence of flat or cord-like internal lesions (scar tissue known as “plaques”) located on the top, bottom or sides of the penis within a thin but tough membrane known as the tunica albuginea.  Although it is a popular notion that Peyronie’s Disease always involves curvature of the penis, the scar tissue sometimes causes other distortions like a bottle neck deformity, an hour-glass deformity, or divots or indentations or nicks, rather than the classic curvature.

How to fix penile curvature

Once it has been determined that a man has only a normal congenital curvature of the penis, it is still possible to help him using a few parts of the standard Peyronie’s disease treatment approach.  He can use topical DMSO, Callisto topical vitamin E oil, Super CP Serum, and the gentle manual penis stretching technique developed by the Peyronie’s Disease Institute to make positive improvement safely and effectively once he knows he does not have a Peyronie’s penis.

Peyronie’s Disease Surgery

Surgical Peyronie’s treatment has many limitations

The Peyronie’s Disease Institute is not against Peyronie’s disease surgery.

The Peyronie’s Disease Institute is against the abuse of surgical treatment of Peyronie’s disease. Considerable surgical risk exists for any man with PD who has an operation to attempt correction of penile distortion.  Adverse outcomes and worsening of the original problem are associated with even a small incision (or injection) made to a penis that already has demonstrated the tendency to create excess Peyronie’s scar formation.

The overuse and abuse of Peyronie’s surgery should be suspected when the treating doctor does not follow reasonable and conservative guidelines to consider a patient a surgical candidate.   A good surgeon will know that a man with Peyronie’s disease should fulfill these basic points before suggesting surgery:

  1. Severity, the most important indicator. The deformity must be severe enough to seriously interfere or stop sexual intercourse.
  2. Adequate time for healing and spontaneous recovery must be given. Usually thought to be from 12-18 months from the time of onset of PD.
  3. Non-responsive to a fair trial of medical therapy. In practice, many doctors attempt only one form of medical treatment.  When that fails the patient is told surgery is the only other option.  It appears that doctors know the poor results achieved by medication to make a difference with Peyronie’s disease that they are quick to want to skip this step and proceed to the operating room.   When vitamin E is offered as a therapy option, it is done so reluctantly and with little hope for success.  Further, no instruction is offered for the correct use of vitamin E, or information about the eight different members of the vitamin E family.  Since no real help is offered to assure that the patient will use vitamin E correctly, it is no wonder that so many men fail.   There is a large body of information available that can assure a man is more successful with vitamin E therapy for his Peyronie’s disease.  Using the correct type of vitamin E, and using it correctly in conjunction with other forms of therapy that work synergistically with it, would only increase the chance of success.
  4. Stable and unchanging scar.   This can mean changing for the better or worse. Since so few doctors, and the men with PD, even locate the PD scar, it is doubtful that this criteria is seriously considered.

For information about the Leriche surgery technique for Peyronie's disease.

Risks of Peyronie’s surgery

Surgery is not a Peyronie’s cure. Because of the unique anatomy and physiology of the penis, the risks of surgery to this area are a little different than other tissues.

  1. Additional scar formation and possible worsening of PD.  Because any man attempting a surgical correction of PD who already has massive scarring, must expect more scarring to develop as a result of that surgery. It is a known fact – seldom discussed with a PD patient before surgery – that surgery for PD will result in more PD, sooner or later.
  2. Loss of penis size. Extensive scar tissue that is severe and persistent enough to cause a deformity serious enough to justify Peyronies surgery, represents a large mass of internal scar tissue. Surgery will remove a large and irreplaceable loss of connective tissue and loss of elasticity of the tissue that is not removed. If it is not bad enough that surgical correction and return of sexual function cannot be guaranteed because of the possibility of complications, every surgical candidate must understand that there will always be a loss of length and diameter of the penis.   Many men tell me that this secondary consequential loss of penis size is hardly discussed before surgery. Most men learn about the loss of penis size after it is too late.
  3. Incomplete straightening, no change, or worsening of the original PD deformity.  Loss of elasticity, additional scarring, and damage to the veins of the penis that can occur as a result of surgery, can also reduce or prevent correction of the original PD problem.
  4. Loss of sensation.  Due to anatomical location of important sensory nerves of the penis, PD surgery can slightly, or greatly, or totally, reduce skin sensation and  pleasure associated with sexual activity.  Temporary reduction of sensation is very common, and permanent sensory loss is less common.
  5. Loss of erection strength.  Surgery cannot help but alter both the inflow and/or outflow of blood to the penis.   By disturbing the pneumatic mechanism that creates an erection it is not uncommon for men to report either loss of erectile rigidity (hardness) or inability to maintain an erection (impotence) – and sometimes both.

If a surgeon has been attempting to get you to undergo PD correction surgery, and you were told the surgical outcomes are “good,” I strongly suggest you get a very clear and detailed explanation for what the surgeon means by “good.”  You might think “good” means that you will be perfect again, that your PD will be gone, that you will feel like a teenager.  The surgeon might be thinking that “good” means only a one or two inch loss of length, only a 50% chance of loss of penile rigidity, only a 50% loss of skin sensation, and restoring your curve from 90 degrees to only 30 or 40 degrees.   It is not an easy thing to determine how to straighten a curved penis.

If your surgeon tells you these things are not true, and that surgical results are “excellent” you might want to ask him what he means by excellent.  If he says you are worrying too much about such a safe and simple operation, ask the surgeon to put that in writing.  Ask the surgeon to guarantee that the surgery will not result in impotence, loss of skin sensation, that you will have a completely straight penis, and that your Peyronie's penis will never return.  You will not get that guarantee because no one can say what will happen to you as a result of PD surgery.

This blog post is not anti-surgery.  This blog post is all about getting a clear and honest idea about reasonable expectations after Peyronie's surgery.  It is my experience that most men are led to believe that their surgery results will be far better than the surgeon and reality can deliver.

Keep in mind that what is good for the surgeon might not be good for the man with Peyronie’s disease.

Peyronie’s Treatment Sensations

Strange reaction to Peyronies therapy

Every now and then I get a question about the variety of unusual sensations and reactions that men notice during Peyronie’s treatment, or immediately after, a particular therapy used in Peyronies treatment.  These are the Peyronie’s disease therapies most often associated with this kind of response:

  1. Genesen Acutouch Pointers
  2. Manual stretching method found on the CD
  3. DMSO PMD formula
  4. Super CP Serum copper peptide ointment

Most often the sensation is described as a "tingling” or “aching” or “electrical” sensation in or near the area of treatment.  It can be felt during or within the hour any of these therapies are applied.  The intensity can be variable from time to time it is felt; sometimes very mild and hardly noticeable, and at other times enough to wake a person from a sound sleep. Sometimes the response occurs each time the treatment is done, and for other men the reaction occurs every now and then at irregular times.

If you experience this kind of reaction in the area of your Peyronie’s scar, do not become alarmed. It is common and usually signals some good response to your Peyronie’s treatment as changes are occurring in the condition of the scar.

This is not something that has been studied much in the scientific literature since those researchers prescribing drugs or standard medical procedures for PD do not get the kind of reactions and responses that occur while following the Peyronie’s Disease Institute therapy principles.  They do not report this kind of reaction because they do not make the kind of rapid changes that are seen in men using the PDI protocols.

Therefore, there is no research that has been done to explain this phenomenon.  It is my theory that these reactions are due to the rapid changes that take place in the tissue in and around the scar material.  During or after a particular Peyronie’s treatment a change may occur in the tension and length of the otherwise contracted scar material of the penis.  These alterations of tension and position of the tissue layers could easily explain the unusual sensations that occur. I find from my own treatment experience, and that of other men who have had improvement in their Peyronie’s disease, that these "moving" or “tingling” or “aching” sensations appear when the scar is undergoing some level of change (improvement).  Many men come to count on the appearance of these changes to herald improvement of their scars from time to time.

It is most probably NOT just one therapy or just the one product causing this usual sensation.   It is closer to the truth to say that these sensations are the sum total of all the synergistic efforts that are included in your therapy plan. The problem (a good problem) with using so many of these therapies together is that you will never be able to accurately say which one did the most or least for you.   A synergistic Alternative Medicine therapy plan is a group effort, with all therapies making some contribution to whatever happens to you.

Please email your questions about Peyronie’s disease treatment to this blog.

Curved Penis and Peyronie’s Disease

Peyronies bent penis is focus of problem

While the primary interest of Peyronie’s disease treatment is the internal scar tissue or fibrous  plaque material that causes the distortion or curved penis to develop, it is not the primary interest of the man who has PD.  For him, the most important aspect of Peyronie’s disease is the curved penis that plagues him.  For this reason Peyronies is also known as the “bent nail disease.”

For those interested in viewing graphic pictures, click curved penis of Peyronie’s disease.

Peyronie’s disease causes a curved penis when the fibrous tissue of the Peyronie scar or plaque pulls unevenly or causes incomplete filling within the erect penis.  This can vary in degree or severity from man to man.  For this reason the curved penis does not indicate the severity of the Peyronies problem or success of Peyronies disease treatment.  The true success of Peyronies treatment is based on the change that occurs in the Peyronies plaque or scar.  Once the fibrous scar changes, eventual improvement in the curved penis can be expected in time.

The internal tissue of the healthy penis is flexible and expandable.  This normal tissue is able to allow for a normal erection to develop when blood is trapped inside the organ.

In Peyronie’s disease some of the tissue is not healthy or flexible and elastic.  Specifically, the deep tissue known as the tunica albuginea is not elastic because it replaced by dense and inelastic fibrous tissue that is called a scar or plaque.   As an erection develops the elastic tissue of the tunica albuginea must stretch and expand evenly on both sides, left and fright, and top and bottom, of the penis.  If this cannot happen because an area of the penis is no longer flexible and expandable, then a curved penis results.

Peyronie’s disease usually begins with a small nodule or bump that is found on the top or sides of the penis, just immediately below the surface.  A few weeks to several months to a year later, a small fibrous nodule can expand into a larger irregular scar of variable size, shape, density and surface quality.  These scars can be as long as the penis.  Some appear like a collar to go around the shaft.   Some are one large mass, while others appear to be like small isolated islands of fibrous tissue in many areas.   Scars can be so soft or small, with edges so tapered and vague that no scar can be found.  In a case of Peyronie’s disease when no scar or plaque can be found, it is still assumed to exist when a curved penis develops during erection. .

Normally curved penis

Most men have a straight erection, but some are born with a penis that curves or bends (usually upward).   Just as fingers on the hand or a nose can display a natural bend, or arms can be of different length on the same person, the penis can be bent without the presence of Peyronies.  Typically, the normally curved penis follows a more gradual and arched design, more like a banana.  In Peyronie’s disease the curved penis is more localized and abrupt, like an angulated bend.

When the two primary chambers (corpora cavernosa) of the penis are a different diameter or length, the penis will bend when erect.   The penis will appear straight when flaccid, and on erection it will bend.

This slight penile distortion will not be associated with pain, there will be no trauma in the history, and it will not appear suddenly as does the curved penis of Peyronie’s disease.

Curved penis affects sexual intercourse

It is estimated that 75-90% of Peyronie’s disease couples will sooner or later experience a sexual intercourse problem, in regard to either pain or difficult penetration – or both.   The curved penis of is the primary reason sexual penetration is compromised, and it is also the reason for the pain that can be experienced by either – or both – partner. This is especially so in those cases in which the distortion is so severe it is described as “cork screw” or “cane handle.”

Incomplete filling of the penis with blood during erection can also happen in Peyronies.  This results in an area of the penis, either small or large, that is soft and unable to sustain the rigors of intercourse.  A soft area within an otherwise firm erection presents a weakness and vulnerability of the normally turgid erection.  A weak area of erection can suddenly collapse or buckle during intercourse, causing additional injury to the penile tissue.  This can cause pain, inflammation and additional fibrous infiltration.

It is a rare Peyronies couple that does not deal with some level of sexual difficulty related to penile distortion and reduced firmness of the erection.  The many physical, emotional and social issues of Peyronie’s disease are complex.  For this reason the reader is referred to “Peyronie’s Disease and Sex” for more information about this complicated area of life with a curved penis.

Treatment of the curved penis

It is important to remember that any penile distortion that develops in Peyronie’s disease is not the primary problem of this condition.   A curved penis that appears one night is difficult to ignore, but is only a symptom of the real problem of Peyronie’s disease – the scar. Without the Peyronies scar there would be no curved penis.

This is the reason I advise men who are undergoing Peyronies treatment to focus on the size, shape, density and surface qualities of the scar or plaque to determine if their Alternative Medicine treatment is being effective.  The curvature can improve or worsen as the scar is reduced.

A small scar can cause a large bend, just as a large scar can cause no bend at all if it is balanced and symmetrical.   For this reason a curved penis can worsen as the scar is being reduced or eliminated.   Estimating progress or success of a PD therapy plan is difficult .  A man can have many more scars than he is aware of, and they can be larger than can be detected since they are often difficult to locate and often overlap.

If only one scar is present the curvature problems are direct and easy to understand, although  this is unusual.   However, if multiple scars are present the internal pulling and twisting they cause can be very complicated.   Several scars can interact on many  planes of internal penile tissue.   Any reduction in one or more scar will alter the internal tension and pulling of the tissues, resulting in an altered curvature.  There is no guarantee the curvature will change for the better initially – sometimes it can look worse as the scars become smaller.  This is why I advise to focus all attention to the size, shape, density and surface qualities of the scar while treatment of the Peyronies problem continues.  Realize the curved penis is just a reflection of what is going on with the scar9s) below the surface.

Do not be discouraged by the curved penis of Peyronie’s disease.  Instead, stay focused on your plan for effective Peyronies treatment.  Learn more about Peyronie’s disease treatment.

Peyronies and Viagra

Peyronies and Viagra are connected

Questions about Peyronie’s disease and Viagra are common.   Viagra, one of the PDE5 inhibitor drugs, is wildly popular and widely used not only among men who have erectile dysfunction (ED, impotence), but healthy men who merely use it to have longer lasting and more repetitive sexual intercourse.

While I hate to spoil the fun, over the years I have had a disturbing number of men tell me that they now have Peyronies  and Viagra was the cause of it.  They report the erection that occurred after using Viagra was a super-erection and caused greater than normal internal pressure and pain.  Shortly after having such an episode they report having Peyronie’s disease; they reason that Viagra use is the only possible cause, because no trauma occurred.

It makes sense that any of the PDE5 inhibitor drugs (Viagra, Cialis and Levitra) increase pressure that is sometimes greater than normal with the tunica albuginea. In addition, these drugs create such hard and long-lasting erections because they induce an artificial condition within the penis.

If it were possible to take a drug that would allow you to lift a truck above your head and keep it there for an hour, should you do it?  That would be an interesting, and very impressive to the ladies, but is that reason enough to subject your body to the potential risk that would be involved?   The fact is that the body is not built to be used that way.  Lifting a great amount of weight causes internal pressure on tissue and organs that were not meant to bear that kind of weight.  Great injury would occur to internal organs, your spine, knees, hips, shoulders, blood vessels, and so on.  The same relationship exists between Peyronies and Viagra, and the rest of these products.

All of this is so unfortunate because there are far safer methods for Peyronie’s disease treatment.

Even though it sounds like a teenagers dream come true, the penis is not designed or intended to sustain such great internal pressures that are created by these drugs, nor is the penis built to be used in hour after hour of intercourse.  Just because you can, doesn’t mean you should.  That kind of activity can be abusive to the delicate tunica albuginea and could be the connection between Peyronies and Viagra or any other PDE5 inhibitor drug.

Several months ago a man told me he injured his penis while using Viagra.  He took some Viagra for the first time to the delight of his wife, and him.  After rousing intercourse, both fell asleep except his penis stayed erect.  He enjoyed the enormous erection and at first he thought it was great.  While asleep with this huge erection he rolled over and jammed his penis into the mattress.  In great pain, he heard and felt the tissue of the penis “pop.”  Two months later he was diagnosed with Peyronie’s disease.

Weekly I am told or I read that MDs write orders for their patients with Peyronies and Viagra is the most commonly prescribed drug.   The MD will explain that the Viagra will increase the blood flow to the penis and this is beneficial to Peyronie’s disease.  I think this is nonsense.

While there is an increased amount of blood within the penis during an erection that causes the greater size of the organ, it is perhaps only 2-3 tablespoons more blood than is normally present.  But here is the most important point that explains why this idea is so silly:  The extra blood, and even the normal amount of blood that is inside the penis during an erection, is TRAPPED there.  It is not freely flowing, or moving in and out as you would like to happen, to actually increase circulation.  During an erection, there is less true circulation of blood – that is why the penis gets darker, because there is less oxygen present – and so there is no therapeutic purpose in creating super erections with Viagra because that is not the way to get better circulation.

A man would know he actually is suffering from poor circulation in his penis, just as he would know he has poor circulation in any other part of his body – like his feet or hands.  When the feet or hands have poor circulation they become cold, painful and pale.  If your penis is not cold, painful and pale, then reduced circulation is probably not your problem.  And enduring prolonged erections from a PDE5 inhibitor will not help your Peyronie’s disease, and could make it worse.

If you want to increase circulation to the penis, you can do it as you would to your feet or hands.  You would apply heat to the area as with a hot water bottle, or cover it with a blanket.  You can even rub it!  It is as simple as that.

The increased occurrence of Peyronies and the increased use of Viagra is not a coincidence.  There is a reason more and more men are getting Peyronie’s disease at the same time that more and more men are using Viagra and the other PDE5 inhibitors.  Now you know about Peyronies and Viagra.