Viagra Peyronie’s Disease Connection

Greater Viagra use and increase of Peyronie’s disease


In a 2002 article in the International Journal of Impotence Research about possible causes of Peyronie’s disease, authored by Sikka and Hellstrom of Tulane University, these two medical researchers observed that with the increased use of Viagra, Peyronie’s disease also increased.

In my work with the Peyronie’s Disease Institute, while corresponding with six to 10 men daily who have Peyronie’s disease concerning various aspects of their problem, I have also made this observation – that with greater use of Viagra, Peyronie’s diseases clearly increases.  The difference between Drs. Sikka and Hellstrom’s and my explanation why Peyronie’s disease is becoming more common as the use of Viagra – and other PDE5 drugs like Cialis and Levitra – increases around the world.

Their explanation, quoting Drs. Sikka and Hellstrom’s report:

“Peyronie's disease usually affects 13% of males between the ages of 40 and 70, and the number of patients with such lesions have increased since the advent of oral sildenafil (Viagra, Pfizer) either because more men are becoming manifest and/or not hesitant anymore to come to clinics for such evaluations.”

In other words, these two Tulane researchers say the only reason PD appears to be increasing is that more men are willing to talk about it, now that men are talking more about erectile dysfunction with the greater awareness brought about with the frequent TV and magazine ads about this problem and drug solution of it.

While they offer the simple explanation that because men are becoming less hesitant to talk about their sexual problems, they assume more men are inclined to enter medical clinics asking for help – like asking for a prescription for Viagra, Cialis and Levitra.  That is certainly a possible explanation of perhaps some merit.   But that does not match my experience in talking with men who actually  have Peyronie’s disease.

Peyronie's and Viagra

Men I talk to about starting Peyronie’s treatment still ask about how the mailing package will be labeled and if the return address will mention “Peyronie’s disease,” lest their letter carrier will learn they have PD.   I am asked if the credit card statement will mention that their therapy products are for treatment of PD, lest someone at the credit card company will learn they have PD.   I am asked by men how to explain the problem of Peyronie’s disease to a new girl friend so that she will not be scared away from a relationship with someone who has a disease of the penis.  I talk with men who do not want to talk at work about their PD lest someone overhears the conversation.  I learn from men that the worse thing about PD is not the pain associated with the scar development, but the loss of penile girth and length – something that most men would seem hesitant to tell the world about.

I do not doubt for an instant that men are more relaxed and casual about admitting to a problem with erectile dysfunction, and more willing to ask for a Viagra prescription than they were a few years ago.  This is a more sexually open society – for good or for bad.  Yet, I doubt that men are just as willing to admit that they have Peyronie’s disease in which their penis is shockingly smaller than average or that can be so distorted as to be incapable of entry to engage sexual intercourse.

Erectile dysfunction is one problem related to advancing age that perhaps has some dignity related to it and hope of easy drug solution, but Peyronie’s disease might not be seen in the same way since it is associated with permanent deformity and reduction of the size of the male organ.

My opinion is that Drs. Sikka and Hellstrom are reluctant to discuss the possibility that these PDE5 drugs sporadically, irregularly and without warning cause severe injury to the tunica albuginea by extensive over-inflation of the corpora cavernosa of the penis.  The mechanism of this possible route of injury was discussed on 8-17-09 in the Peyronie’s Disease blog under the title, Peyronie’s Disease Treatment and Viagra, Cialis and Levitra, and again on 8-1-10 under the title Viagra, Cialis and Levitra Use with Peyronie’s Disease.

These doctor’s hesitance to discuss or speculate that the increase of PD parallels the increase use of these drugs due to yet another drug side-effect of yet another group of drugs itself can be speculated upon.   Each man with PD must make up his own mind if this possibility makes sense to him, and if it is further reasonable to avoid the use of these drugs if he wishes to avoid further injury to his penis.     

Fix Penis Curvature

How to straighten curvature of penis

For most, the main focus of Peyronie’s disease treatment is primarily to fix penis curvature or whatever distortion might exist.  However, this is not the best goal to have when you want to get fix your bent or curved penis.

The primary goal of Peyronies treatment should be elimination of the internal scar (Peyronie’s plaque material) that causes a curved penis to develop in the first place – not to fix penis curvature.  Although the most obvious aspect of Peyronie’s disease is the curved penis, it is not the actual problem.  Using penile curvature to determine success of any Peyronie’s disease treatment is unwise and counter-productive since it is not the real problem.

Healthy internal tissue of the penis is able to fill, trap and expand as blood enters it for a normal erection to develop. In Peyronie's disease one or more areas of a layer of tissue known as the tunica albuginea develop a dense and inelastic fibrous scar tissue or Peyronie’s plaque.  During a normal erection the slightly elastic tunica albuginea will stretch and expand evenly in all directions.  But when a man has Peyronies disease expansion is limited because the tunica albuginea contains fibrous tissue, resulting in a curved penis.

Peyronie’s disease usually begins as a small internal nodule or band of fibrous tissue on the top or sides of the penis, within the tunica albuginea.  A few weeks to a year later, this fibrous nodule can develop into a larger irregular plaque of variable size, shape, density and surface quality.  The Peyronie’s plaque can be as long as the penis and sometimes surrounds the penis, creating an hourglass indentation around the shaft. Some are one large mass, while others are small isolated islands of fibrous tissue in many areas. Scars can be so soft and small, with edges so tapered and vague, that no scar can be found.  When no Peyronie’s plaque or scar can be found it is assumed to exist when a curved penis develops during erection.

Peyronie’s disease causes penile curvature because the inflexible fibrous tissue of the Peyronie plaque prevents incomplete filling as an erection develops or by pulling unevenly on those same internal tissues.  The location and degree to which this poor filling and internal tug-of-war takes place is different from man to man, and so the bends and distortions are also different.  At times a small internal scar can cause a great amount of distortion and poor erection quality, just as a large scar can cause very little problem.  In other words, the scar size does not determine the degree of problem that is observed.  Sometimes as a Peyronie’s plaque or scar increases or decreases, the distortion can get either better or worse; many times the degree of penile curvature does not indicate the severity of the Peyronies plaque or the success of Peyronies disease treatment.  For this reason, the true measurement of success of Peyronies treatment should be determined by the reduction of the Peyronies plaque or scar.  Once the fibrous plaque material reduces in size, shape, density or surface quality, only then can improvement of the curved penis or reduced erection strength be expected in time.

Fix penis distortion by treating the Peyronie’s plaque

A curved penis that suddenly appears one day might be difficult to ignore, but it is only a symptom of the real problem of Peyronie’s disease that lies below the surface – the fibrous scar in the tunica albuginea.  Without that Peyronies scar there would be no curved penis; because it is the cause of the distortion it should be the only way that treatment success is determined.

Evaluating progress of a Peyronie's therapy plan can be difficult, if not impossible, if only paying attention to a curved penis.  A small scar – or a scar that is getting smaller – can cause a large penis curvature.  A large scar – or a scar that is getting larger – can cause no bend at all if it is balanced by other scars that are applying a symmetrical force.  Making matters more complicated, a man can have many more scars than he can locate because the often overlap.  Thus, it happens that a curved penis can worsen as the scar is actually being reduced or eliminated.

When only one scar is present the curvature problem is direct and easy to understand, although this is uncommon.  More commonly multiple scars cause internal pulling and twisting that create complicated distortions that can worsen as the scars become smaller.   Several scars can interact on many planes of internal penile tissue.   Any significant reduction in one or more scar will alter the internal tension on the tissues, resulting in an altered curvature.  Because there is no guarantee the curvature will improve initially, 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 Peyronie’s plaque structure below the surface.

Do not be discouraged as you try to fix the penis curvature related to Peyronie’s disease.  Instead, look for changes in the size, shape, density and surface qualities as you continue your Peyronie’s disease treatment.

Peyronie’s Disease Treatment and Insanity

Einstein and Peyronie's treatment

We have all heard Albert Einstein’s definition of insanity:  “Doing the same thing over and over again and expecting different results.”   Well, I think this sometimes applies to the way some men conduct their Peyronie’s disease treatment plans.

I am reminded of Einstein’s famous quote each time I communicate with someone who wants to know why his Peyronies treatment is not getting results even though he is faithfully following it daily, for weeks and months at a time.

Please review the following email exchange between one of your PD Warrior brothers and me. You will see the writer had no idea about the size, shape, density or surface quality of his scars yet he was trying to treat himself with Alternative Medicine.   Because he had no idea of where he was, where he had been, or where he wanted to go, he was easily discouraged and was not successful with his Peyronies treatment.

I will use the familiar method to keep the email question sent to me in black and my responses to him in red within his email so the information becomes more of a conversation between us.

Hello Dr. Herazy,

It has been a while since we talked on the phone when I asked for help getting started treating my Peyronies correctly.   My name is BXXXXX, maybe you remember me.   I am the student at the University of XXXXXXXXX who was in the bike accident and was hospitalized with a fractured pelvis.  Three months later I was diagnosed with PD.  I asked my doctor if he thought there was a connection between the accident and the PD and he said no.  From my experience Peyronie’s disease is a fairly common outcome if you sustained direct injury to the penis shaft when your pelvis was fractured.  Many men develop Peyronies disease  after injuries that occur during sexual activity that are less serious than what you went through, so I am not sure why he would have said this.  Also, your Peyronies could have started either from the injury to the shaft that took place during the bicycle accident, or from the catheterizations that took place during surgery or afterward.  Because of my limited funds I settled on using a PDI medium plan plus PABA.

I thought because I am young and the injury was recent I would get over the PD fast.  That is usually true for most men, but even some younger men take longer to recover because of overall poor health, stressful lifestyle, poor diet, genetic predisposition, or other reasons like drug abuse. But after two months I got discouraged and quit care for a few months.  I was following the medium plan for two months and my curve stayed the same as far as I could tell, so I stopped doing everything.   You made a few mistakes early in your care:  1. You did not contact me for ideas and advice about your treatment when you ran into a problem.  You were in a totally new area of your life and you were trying to do it all by yourself when you have help available.  Big mistake.  2.  I looked up your records and you did not get “Peyronie’s Disease Handbook” that would tell you how to go about treating your problem.  For this reason you used the phrase “my curve stayed the same as far as I could tell.”  This means that you were not using the condition of your curve to tell you if your treatment was successful or not, and this is a big mistake made by people and MDs who have no idea how to approach PD treatment. The condition of the penile curvature is determined by the internal PD scars that affect the tunica albuginea.  If you want the curve to go away you must get rid of the scars.  All of your evaluation and attention should be directed to understanding and documenting the condition of the size, shape, density and surface qualities of each of your scars.  Once your scars are reduced or eliminated you will change in the distortion pattern or bend that you have.  3.  You were guessing about your care because you were guessing about your condition at the time you were treating yourself.

Before you go on a diet to lose weight you must at least measure your waist and weigh yourself so you know your situation at the start of your diet.  If you do not measure your waist and weigh yourself, how will you know if your diet is working?  If you are guessing about your weight, you will either quit a plan that is working because you do not know that it is working, or you will stay on a diet too long that is not working.   If you know your exact waist measurement and weight you will be able to tell immediately when the diet starts to work – or not.

You will then be able to intelligently either stay on a diet that is helping you or change the diet if it is not helping you – all based on your knowledge of the situation.  You must do the same with your PD treatment. Then I reinjured myself during sex   Always be very careful during sexual activity and maintain control of the situation because it is you who will suffer most.  All woman-on-top positions are dangerous because you do not have good control over her and she can bend the penis if she comes up too far and you slip out.   When she comes back down again you will get your shaft bent. and my curve got even worse.  I thought I had no choice but to start PDI treatment again since the idea of Peyronie’s surgery is out of the question for many reasons.     Good thinking.  Surgery is the last thing you want to do if you have PD.  I have many posts on the PDI blog about Peyronie’s disease surgery that goes bad.

I am sorry to say that after ten weeks of faithfully   No, you did not faithfully follow the PDI concepts of treatment. You think you did, but you did not.  You tried to make up your own rules and they did not work for you.  You cut a few steps out of the process and you wasted time and money guessing about your treatment.   As a necessary step at the beginning you must determine the exact size, shape, density and surface quality of each of the scars you can find. Once you know that, then you can begin care.  By applying or using whatever level of treatment you think would help you, you should frequently monitor your scar to see how they are responding to whatever kind of treatment you have chosen to use.  To learn more about this process, please refer to chapter four of the “Peyronie’s Disease Handbook” and many blog pages that refer to this process. treating my problem I believe I have not made any changes with my bend or the pain I have,  Again, it is not the bend or pain that is important – but it is the condition of the scar that is causing the bend and the pain that is important.  All focus and attention should be on the scar that is causing all of the things you notice. although sometimes it is difficult to say.   That is exactly the point I am making.  It is difficult for you to say because you were guessing for four and a half months and you got confused and frustrated along the way. The two nodules on the top of the shaft are smaller some days, but it is difficult to know for sure.  It is good that you can tell that they are changing, that means that your tissue will respond to your treatment if it is already responding to things that you are doing in your daily life.

For the last ten weeks this is what I take:

Nattokinase – 2/dose between meals
Fibrozym – 2/dose between meals
Vitamin E 400/400 – 3/day
Maxi-Gamma E – 1/day
Vitamin C – 1/day
MSM – 3/day
Scar-X – 2/day
PMD DMSO with Unique-E and Super CP serum – 1/day
PABA – 6/day
Massage and Exercise program – 4 or 5/week

There is nothing wrong with the plan you are following.  The problem is that you are not sure your body is not responding to it because you have no baseline for comparison to judge progress.  So, the job in front of you is to know exactly the size, shape, density and surface qualities of your scars, and to then see what you have to do to your plan to make your scars change from that baseline.  It is that simple – and that difficult.  More about that will be covered below.

If you are looking for my suggestions about what you might want to consider changing with your PD program:

1.    Consider increasing your enzyme dosage; maybe even adding Neprinol into your plan.

2.    You really should reduce the Factor 400/400 vitamin E for now

3.    Consider increasing the vitamin C intake

4.    Adding moist heat applications prior to your PMD DMSO treatment is always a good idea

5.    Consider getting the PDI Manual Stretching video – it is an inexpensive way to add a very different level of treatment to your plan

6.    Consider using the Genesen Acutouch pens – they are effective and often increase treatment results within a short time for many men

You do not want to follow all of these changes or additions at once; doing one at a time while monitoring your PD scar for positive changes is how it is done.

Putting these two different times I followed your system of treatment I worked for a total of about 4½ months and do not have anything to show for it.  How do you know you have nothing to show for it?  You could have a nice reduction of the size, shape, density or surface quality of your scars but you would never know it because you have not taken the time to learn how to document these important measurements.

Your system makes sense and I like the logic of it, but I do not know how to make it work for me.   It is really not that complicated or difficult to make the system work once you get a few things explained to you. What changes should I make to my treatment plan to create more definite changes in my problem?    All you have to do is to make some change – any change – to your PD treatment plan and check back in 7-10 days to see if there is any change in the size, shape, density or surface quality of your scars.  If you see a change, then keep doing what you are doing.  If you see no change, then change something else.  It is as simple – and complicated – as that.

Since neither you nor I am smart enough to know ahead of time what your body needs to recover from PD, it is your job to try different things to learn first-hand how your scar will respond to whatever changes you decide to make.

Following the same ineffective plan for four and a half months is insane.  If you are walking north and you really want to be going south, you must stop what you are doing and turn yourself around.  Successful PD treatment is not a matter of popping a handful of pills into your mouth, hoping that something will happen.  You must learn what it takes to make your PD scar respond favorably and continue to do that.  You must be in control of your plan and understand your Peyronie’s plaque or scar behavior better than your MD – and that should be pretty easy.  I can help you if you let me. TRH

Thanks for your time and help.


I hope reviewing this email exchange was helpful.

It really is not a complicated process to figure these things out.  I believe the problem is that most people are accustomed to going to the doctor and following orders; they are not accustomed to being in charge of their treatment.   After men realize that their MD has no viable PD treatment to offer them, then they finally take on the challenge of taking control of their destiny and they start to see results.

Cause of Peyronie’s Disease

Trauma frequently seen as Peyronie’s cause

While the cause or causes of Peyronie’s disease remains open to speculation, some theories are more popular than others.  However it starts, it is important to remember that Peyronie’s disease is a disorder of the tunica albuginea.

Among the several explanations for a possible Peyronie’s disease cause, trauma or direct injury to the penile shaft is almost always mentioned as either a primary cause or at least a significant secondary cause.  More specifically, the cause of Peyronie's disease is universally explained as a wound that does not heal in the normal way, whether related to injury usually associated with sexual activity or a medical procedure. Even when other causes are mentioned it seems that injury will usually be associated in some way.

Role of wound healing in Peyronies disease cause

The penis contains two sponge-like, tube-shaped chambers (corpus cavernosae) with many tiny blood vessels that fill with blood during an erection.  Below the two corpora cavernosae is the corpora spongiosum through which runs the urethra or passage way to release urine from the bladder.  Each of the corpora cavernosa are enclosed in a thin and flexible sheath of elastic tissue called the tunica albuginea, which stretches slightly during an erection. Injury to the penis can cause inflammation and damage to the tunica albuginea.

If an injury heals as it should then usually there are no long-term problems.  But if the healing of the injured tunica does not proceed as it should, it can lead to excess internal scar formation, known as Peyronie’s disease.  The area of the injured tunica albuginea is not as flexible as before injury.  With the area less flexible, when the penis attempts to become erect the region with the scar tissue doesn't stretch, and the penis curves, bends, develops a dent or becomes distorted in some other way (bottle neck or hourglass deformity).

The tunica albuginea has many layers, with very little blood circulation between them.  When an injury to the tunica albuginea occurs, the tissue fluids associated with the inflammatory process can remained trapped between these layers for many months. During this time the cells found in the inflammatory fluid can release chemicals that lead to increased formation of fibrous tissue (fibrosis) that causes reduced elasticity of that area, internal scar tissue and possibly calcification.  The combined effect of these tissue changes is the characteristic penile deformity associated with Peyronie’s disease.

Inherited abnormality as cause of Peyronie’s disease

There is some evidence of a genetic cause or predisposition to PD related to an inherited abnormality of human leukocyte antigen B27 (HLA-B27).  Peyronie's disease is statistically more likely to occur in men whose immediate family members also have PD, or systemic lupus erythematosus (a connective tissue disorder).  PDI research shows that 37 percent of men with Peyronie's disease also experience Dupuytren's contracture, in which hard contracted develops on the palms of one or both hands.

Other conditions as cause of Peyronie’s disease

  • Vitamin E deficiency has been associated with the Peyronie's disease, primarily because early Peyronie’s disease research showed treatment with vitamin E demonstrated success in a significant number of cases.  Since that time less interest has been shown in using vitamin E as a Peyronie’s treatment.
  • Inderal and the PDE5 inhibitor class of drugs (Viagra, Cialis, Levitra) used to chemically stimulate development of an erection have been known to cause Peyronie's disease.
  • Diabetes when severe or prolonged will precipitate damage to the blood vessels in any area of the body, including the penile shaft.  PDI research shows that 21 percent of men with PD also have diabetes.

Regardless of the cause of Peyronie’s disease, it is important to start treatment as soon as possible to increase your ability to heal and repair the underlying injury to the tunica albuginea. Refer to the Peyronie’s Disease Institute website to learn how to start Peyronie’s disease treatment using Alternative Medicine.

Peyronie’s Treatment at the New Year

As this New Year begins it is a good time to stir your commitment to success in your Peyronie’s treatment.

When you consider that your odds for success against Peyronie’s disease are not very good if you do nothing, it is important that you do something to help yourself.  We specialize in doing all that you can to help you to heal this problem of PD.

Good luck to you.  Let me know what I can do to help you along on your path to successful Peyronie’s disease treatment.

“The secret of success is constancy to purpose.”  — Benjamin Disraeli

“Genius is divine perseverance. Genius I cannot claim nor even extra brightness but perseverance all can have.”  —  Woodrow Wilson

Don’t be discouraged.  It’s often the last key in the bunch that opens the lock.    — Ralph Waldo Emerson

“History has demonstrated that the most notable winners usually encountered heartbreaking obstacles before they triumphed. They won because they refused to become discouraged by their defeats.”  —  B.C. Forbes

“The price of success is hard work, dedication to the job at hand, and the determination that whether we win or lose, we have applied the best of ourselves to the task at hand.”   —   Vince Lombardi

Don’t be discouraged.  It’s often the last key in the bunch that opens the lock.   —   Ralph Waldo Emerson

“Desire is the key to motivation, but it’s determination and commitment to an unrelenting pursuit of your goal – a commitment to excellence – that will enable you to attain the success you seek.”  — Mario Andretti

“The difference between the impossible and the possible lies in a man’s determination.”   —  Tommy Lasorda

He conquers who endures.   —   Persius

“Adhere to your purpose and you will soon feel as well as you ever did. On the contrary, if you falter, and give up, you will lose the power of keeping any resolution, and will regret it all your life.”   —   Abraham Lincoln

“The difference between a successful person and others is not a lack of strength, not a lack of knowledge, but rather a lack of determination.”   —  Vince Lombardi

“Always bear in mind that your own resolution to succeed, is more important than any other one thing.”   —   Abraham Lincoln