Monthly Archives: June 2010

Difficulty Finding the Peyronie’s Plaque

Posted on by Dr.Herazy

Peyronie’s disease plaque

Let’s clear up the confusion about the Peyronie’s plaque, the fibrous scar-like tissue that is the most common characteristic of Peyronie’s disease.  Many people when reading “scar” automatically think they should see it on the skin surface; for this reason I prefer the term Peyronie’s plaque.

Peyronie’s plaque is usually a flat or slightly elevated mass of fibrous tissue just under the skin, in a thin but tough membrane of the penis known as the tunica albuginea.  Sometimes it is cord-like or nodular, but usually it lies flat making it difficult to locate.

Peyronie’s plaque is not in any way related to plaque material that line artery walls. It is benign, meaning it is not cancerous and it is not a tumor.  Peyronie’s disease and this fibrous material is not in any way contagious, and is not in any way the result of any transmittable disease or microorganism – thus there is no way for a sexual partner to “catch’ the Peyronie’s plaque.

The mystery of Peyronie’s disease

For a male health problem that affects up to nine percent of the adult population, it is amazing that practically no man ever hears about PD until the day he is given the diagnosis.  It is this shock – a “mystery” condition that comes out of the blue, for which there is no known cause and no known cure that can wreck a man’s life.  While caught off guard, totally confused and shocked upon first learning about Peyronie’s disease, a man is often does not ask all the standard questions and does not remember the information as he receives his diagnosis.

With so many details pouring into his ears, and so many questions rolling around in this brain, it is easy to understand why a man can leave his doctors office and not remember much about the mystery condition.  Even the doctor’s explanation about a Peyronie’s plaque can become confused, making it sound like it is related to the blood vessels.

Location of Peyronie’s plaque suggested by penile curvature

You can usually count on finding your internal plaque on the concave part of a curved penis.  If a plaque is located on the topside of the penile shaft (the most common location), the penis will bend upward.  A plaque on the underside causes a downward penile curvature.  A plaque on the left lateral side of the penis causes a curvature to the left, and a Peyronie’s plaque on the right lateral side of the penis causes a curvature to the right.

Many times a distortion develops on both top and side, or top and bottom, resulting in twists, hourglass deformities or indentation, even shortening of the penis.

Peyronies plaque is elusive

Each week I receive emails asking, “Since my doctor examined me and could not find any Peyronie’s plaque material, and I cannot see a scar, do you think I really have Peyronie’s disease?”

There is never an EXTERNAL scar or plaque in Peyronie’s disease that can be seen.  The Peyronie’s plaque is always an internal mass of fibrous tissue that is sometimes called a scar, but is not a scar in the usual sense.  Peyronie’s plaques or ‘scars” are only sometimes obvious, while at other times they cannot be found if a person’s life depended on it.  Ultimately, if you have Peyronie’s disease you must assume it is there and you should try as many different tactics as you can to find your scar(s) because having a clear and accurate information will help your Peyronie’s disease treatment effort.

To find the internal Peyronie’s plaque, sometimes it is helpful to think about it being much larger than you have previously imagined; mentally expand the size of the scar you are looking for.  If you were looking for a “pea” before and couldn’t find it, start looking for a “postage stamp” or a “thumb nail” size structure.  This change of the mental image increases your odds to detect it.

When the plaque cannot be located, but there is still pain and distortion of any kind, a diagnosis of PD can still be made.  This is so because the fibrous plaque can be so:

1. Small – it cannot be found

2. Soft – it blends into the other tissue and cannot be detected

3. Deep – it cannot be reached easily

4. Large and flat – that the edges are not determined, almost like something that is so close to you that you do not see it because you are looking far away

When plaque is never found it is because of a combination of two or more of these factors – deep and small, or soft, large and flat, or deep, soft and doctor error, and so on.

It is common to have difficulty locating the plaque for the first time.  Sometimes it is best to forget about finding a “scar.” Instead just try to find something – anything – within the mass of erectile tissue that feels unlike the other tissue.  Finding something unlike the rest of the penis tissue will help define the problem tissue that can be difficult to locate. It might be you have an unreasonable expectation of what a “scar” or Peyronie’s plaque should feel like, making it easy to miss what is rather obvious to someone else with experience in this regard.

After an unusual tissue is found, mark its location on the penis with a marker pen or something that will stay on the skin for a few days.  Return to that location each day to re-evaluate it.  You want to determine if it becomes easier to make sense of it, so you can monitor it during your Peyronie’s treatment.

Curved Penis and Peyronie’s Disease

Posted on by Dr.Herazy

Can a curved penis be normal?

One of the common questions I am asked is if a lifelong curved penis could be Peyronie’s disease.  The fast answer is that not all penile curvature or bends are abnormal, or even a problem.  If you have had a bent penis all your life it is probably not PD.

To help readers make sense of the situation, a longer answer is that a curved penis might indicate Peyronie’s disease under these two basic situations:

  1. Curved penis that occurs with other signs and symptoms:
    A.  Pain – the pain of Peyronie’s disease can be variable
    i.     Constant
    ii.    Only when erect
    iii.   Only when non-erect
    iv.   Occasional
    B.   Nodule or chord of fibrous tissue (Peyronie’s plaque) present somewhere under the surface of the shaft, usually located on the concave side of the curved penis C.   Penile curvature, bend or distortion not present earlier
    D.  Loss of sexual function
  2. Sudden appearance of penile distortion or bend that was not present earlier in life

Causes of a normally curved penis

Everyone has some degree of difference or asymmetry between one side of the body and the other.  I can just about be 100% certain that if you looked into a mirror you would notice not one, but many, differences in the appearance of your face:

  1. One eye shaped differently than the other.
  2. Wrinkles around the mouth or eyes that are different on one side of the face than the other.
  3. Nose and nostrils not even on the face.
  4. Mouth crooked.
  5. Center of chin not lined up with the tip of the nose or the space between the eyes.
  6. Ears shaped differently.
  7. Cheek bones not curved the same.

While all of this relates to the face, but can also be said of the hands, feet, legs, abdomen – or penis.  All parts of our body demonstrate slight irregularities and imperfections that make us human.  These are the small and unimportant things that make us unique individuals.

Inside the penis are three long tubular chambers that contain erectile tissue – one corpora spongiosa and two corpora cavernosa.  If there is any difference in the length, width or straightness of these three chambers it will result in an erection that is curved or imbalanced in some way.

When a small boy first notices his erections he accepts them for what they are.  Later he begins to question and wonder if he is as good as other people, and does not like being different from other people who he assumes are all perfect.  Don’t allow a curved penis to become more than what it is.

It would be a good idea to have your curved penis evaluated by a doctor who has experience in this area if you also have recently started to have pain, a nodule or mass of fibrous tissue, and/or reduced sexual ability.

Your curved penis may or may not be Peyronie’s disease, therefor this diagnosis is always best left to the experts.

Visit the Peyronie’s Disease Institute website for information about the Peyronie’s disease natural treatments.

Peyronie’s Disease and Masturbation

Posted on by Dr.Herazy

Masturbation prominently factors into Peyronie’s disease.   A man will either cause his own Peyronie’s problem when he abusively or violently masturbates , or later as he attempts to cope with the growing sexual frustration and limitation created by  the curved penis of his Peyronie’s disease.

Masturbation is the self-stimulation of the female or male genitals to arouse sexual pleasure, usually to the point of orgasm or sexual climax.  It is commonly performed by touching, stroking, or in some way pleasurably stimulating the penis or clitoris until orgasm occurs.

Peyronie’s disease intersects with masturbation in particular for several reasons:

  1. Older boys and men of all ages can injure themselves during rough masturbation rituals with the potential to lead to Peyronie’s disease, especially if genetically predisposed to develop PD.
  2. Men who are unable or too embarrassed to expose their deformity to their sexual partner often resort to masturbation to release sexual tension, and perhaps in a negative mindset will be abusive to themselves.
  3. Men who are unable to engage in sexual intercourse because of severe penile distortions can receive masturbation from them partner as a way to share sexual pleasure, serving as a substitute for traditional intercourse.
  4. Women who are denied sexual intercourse because of a partner’s severe penile distortion or erectile dysfunction related to Peyronie’s disease can be masturbated as a way to share sexual pleasure, as a substitute for traditional intercourse.
  5. Women who are denied sexual intercourse because of her partner’s emotional and physical withdrawal, thus isolated from the man with Peyronie’s disease, can use masturbation to release sexual tension while he is working out his own problems.

General masturbation comments

At one time or another or all life long, just about everyone masturbates – male and female.  It is an extremely common behavior, even among people with access to sexual intercourse and other erotic outlets with a partner. While in one national study 95% of males and 89% of females reported they have masturbated, those who reported they had never masturbated admitted they would be reluctant to admit it if they did – thus these numbers are probably low.

For young children masturbation is a normal part of youthful exploration, often becoming the first sexual act. Most people continue to masturbate in adulthood, and many do so throughout their lives.  The most common explanation given why people limit or avoid masturbation is the shame and guilt that arises from religious and societal pressure.

Once regarded as a perversion and sign of a mental problem, masturbation is now seen as a normal, healthy sexual activity that is pleasant, fulfilling, acceptable, and safe. Masturbation is only considered a problem under certain circumstances:

  1. Directly or indirectly inhibits sexual activity with a partner.
  2. Causes significant distress if done compulsively and uncontrollably, against the greater desire of the individual to stop.
  3. Interferes with daily activities of life.
  4. Compulsively done in public or at socially inappropriate times.

No longer considered as being harmful, masturbation is thought to improve sexual health and interpersonal relationships, if after learning what is personally pleasurable this knowledge is shared with a partner.  Especially in the situation of Peyronie’s disease many partners use mutual masturbation to develop and refine techniques for a more satisfying sexual relationship, when more traditional sexual outlets are not an option.

Masturbation can contribute to sexual dysfunction in Peyronie’s disease

Men who habitually masturbate in ways that are not common with a sex partner – employing mechanical measures that produce an unusually intense stimulus, stroking with great pressure or unnatural friction, resulting in soft tissue damage of the penis – can become so accustomed and dependent on that particular level or type of stimulus that partner-sex becomes insufficient for sexual arousal and leads to retarded ejaculation.  When a man experiences this sexual dysfunction he finds it difficult or even impossible to climax during more conventional partnered sex.

Michael A. Perelman, PhD, clinical associate professor of psychiatry, reproductive medicine, and urology at Weill Cornell Medical College in New York City and the president of the Society for Sex Therapy and Research states, “Any man experiencing any sexual dysfunction should ask himself if he’s masturbating in ways that produce sensations that differ from those he gets from his partner’s hand, mouth, or vagina.  If so, then he should consider what he could say to her to make the stimulation more similar — and how he could change the way he masturbates to make it feel more similar to what his partner does.”

Safe masturbation in Peyronie’s disease

Generally, the best and safest masturbation you can enjoy by yourself or with a partner is that which is most like vaginal stimulation.  This can be as simple as using the hand in a fist to surround the erection while applying upward and downward stroking, oral stimulus, or sex toys that feel like a vagina.   This kind of masturbation is therapeutic once the Peyronie’s curvature has been corrected and more traditional sexual encounters can be enjoyed once again.

Lastly, because penile injury is thought to be a prime cause of Peyronie’s disease, it is mandatory that all masturbation be gentle and well lubricated to avoid worsening of an already bad situation. For more information, click on “Peyronie’s Disease and Sex.”

Common Peyronie Treatment Problem

Posted on by Dr.Herazy

Peyronie treatment when husband does not help

A few weeks ago I received an email from a woman who wrote about the trouble she was having with her husband who did not want to cooperate with his Peyronie's treatment:

“My husband of 22 years developed a severely curved penis when his Peyronie problem started after taking blood pressure medicine.  The doctor who prescribed the drug that started this whole mess didn’t seem too upset.  He said we would just have to learn to live with it.

“My husband is a proud man, and he is taking this condition very badly.  He has withdrawn from me and refuses to discuss his condition.   He gets angry and shouts if I bring it up.  We have not had sex in over a year.  He keeps telling me it would be alright with him if I left him.

“What can I do to help him deal with this?”

I wrote back to her:

“Sorry to learn that your husband has withdrawn from his problem and from you.  It is important for you as a wife to remember that your husband’s reaction is very common.  Some men become emotionally devastated by the loss of their sexual ability and sexual identity that they just withdraw from the person they think they are hurting.  There are usually elements of shame and embarrassment that arise from the physical appearance of a severe penile curvature.  It can be very stressful and confusing for a woman in this situation who desperately wants to help.  It can hurt a lot.

“This subject is broad and deep.  In fact, because it is so common and important in Peyronie treatment I devoted a considerable portion of the 2nd book I wrote to this area of the relationship of any couple dealing with Peyronie's disease.  I suggest you go to the PDI website and order the book, “Peyronie’s Disease and Sex” to learn what you can do to help your husband, because there is actually a lot you can do.  To view information about this book, click “Peyronie’s Disease and Sex”    What you will find is that his inability to face his PD problem, his lack of communication with you, and his withdrawal from sexual contact are all related to fear and shame.  I believe this book will help you to understand what is going on inside him, and what you can do now to bridge the gap between you.

“Please let me know if you have any specific questions I can assist you with.”

Well, I never did hear back from that woman.  The story is very common in which a grown man behaves like a scared little boy when his physical appearance and masculinity are threatened.  It is unfortunate that some marriages get stronger under this stress, while others fall apart under this dark cloud.   There is help and a solid plan of action that many men find comforting and effective to treat their Peyronie problem.

The key seems to be for a woman to convince her spouse to get started with Peyronie’s treatment.  Once a man finds direction and takes control of his situation his attitude and behavior often change for the better.  Don’t allow your man to feel like a Peyronie victim.

Peyronie’s Symptoms

Posted on by Dr.Herazy

Do I have Peyronie’s disease?

When someone asks about Peyronie’s disease symptoms they usually want to know if they have Peyronie’s disease.   This is a diagnosis that is not always easy to make, since the actual signs and symptoms of Peyronie’s disease can be tricky at times.

In order to answer this question it is first important to remember that a symptom is something a person feels or experiences inside, meaning it is subjective. A symptom is what someone experiences as a result or during an illness, injury or disease.  Symptoms can include chills, Peyronie’s pain, shaking, shivering, nausea, or dizziness.  Symptoms are reported by the patient to help a doctor diagnose a problem.

In the case of Peyronie’s symptoms the only subjective finding would be the penile pain that can be variable; pain can be felt constantly, only when erect, only when non-erect or only when flaccid.  In addition this pain can be extremely mild, very severe, or something between. Because the Peyronie’s pain is not always present – and is sometimes totally absent – it is not always a reliable way to make a diagnosis of PD.

You might say a sign is the opposite of a symptom.  A sign is an outward or obvious physical indicator or manifestation of illness, injury or disease.  In this way it is said that a sign is objective, since it is always something that another person can detect, measure in some way or see that helps to make a diagnosis.  Some common signs are rapid pulse, elevated body temperature, low blood pressure, bleeding, a rash or open wound, bruising, to name but a few.

In the case of Peyronie’s disease, there are only a few signs or outward findings that are used to make a diagnosis.  These signs can be just as variable as the Peyronie’s pain, such as the elusive Peyronie’s plaque or scar, a curved penis or some other distortion, and impotence or  reduced sexual ability.  Because each of these Peyronie’s signs are also not always present – and can be sometimes totally absent – it is not always a simple or easy thing to make this diagnosis.

Very often only a few Peyronie’s symptoms and signs are available to make a diagnosis, with perhaps the most common being some type of curved penis or distortion.

Click here for more information about Peyronie’s disease.