Peyronie’s Disease and Cancer Surgery

How Peyronie’s disease can start after cancer treatment

This blog entry will be different from the usual discussion of Peyronie’s disease. In this blog posting I will offer my comments about an email I discovered on another website that covers the subject of prostate cancer and Peyronie’s disease; it is predominantly a medically leaning website in which the moderator and visitors discuss their personal experiences with prostate cancer treatment.

Because there is a statistical relationship between men who undergo radical prostate surgery and Peyronie’s disease, I am interested in discussing this topic from a different perspective. There is a bit to say about these cases of secondary PD that occur after cancer surgery, often ignored in comparison to the more pressing problem of prostate cancer.

The man who wrote the following email wanted to tell others his experience while visiting an ED specialist after his radical prostate surgery. After this kind of surgery it is common for erectile dysfunction (ED) to develop due to the large amount of nerve damage that occurs. The writer mentions he developed Peyronie’s disease after his prostate operation, and makes several comments about PD that are typical of those I receive daily. This is why I bring this email and my comments to the Peyronie’s Disease Institute blog. Many people believe what this man expresses because of what they are told and read from other sources. I present my thinking to you to challenge your thoughts and beliefs. If you disagree, I would like to hear from you.

The email I am using was posted on this other website without comment because no one thought there was anything wrong or unusual about this man’s Peyronie’s disease treatment comments. It is important for my audience of PD men to read this email because of the popular ideas and attitudes that the writer reveals.

The email from the man (RR) who had the radical prostate surgery is written in black, and my comments inserted within his email are in red.

From RR:

A recent posting stimulated me to go to my ED specialist, a trip which I have been putting off. My history: RP
This means “radical prostatectomy,” or surgical prostate gland removal along with surrounding tissues – usually related to cancer. 9/20/99 at age 65, one nerve spared, PSA still undetectable, and some detectable Peyronie's, or at least a bending of the penis at about a 20% angle to the left (looking down on it) about one inch from the base.

I started early pursuing ED options and had tried Viagra, a VED and injections by seven weeks post RP. For those who have read the PDI website and blog you will immediately notice that this man within seven weeks after his cancer surgery did three things that are associated with causing Peyronie’s disease: 1. He used Viagra – this can excessively stretch and injure the tunica albuginea; the same is true of Cialis and Levitra. 2. He used a VED – this is the vacuum pump device that can overstretch and injure the internal tissue of the shaft. 3. He received injections into the shaft of the penis, probably to create an artificial and temporary enlargement, apparently because his doctor thought this is beneficial to his recovery. I never really had success with the VED, partly because I got enough initial take from the Viagra for a stuffable erection, This is an interesting point he makes here. After using Viagra he says it is necessary to “stuff” his penis into the vaginal opening for intercourse to take place. Forcing or stuffing a weak enlargement into the vaginal opening is a common way to start Peyronie’s disease or worsen your problem if you already have it. If a man is so soft that insertion is difficult, he runs the risk of abruptly bending his weak erection during insertion or possibly causing the shaft to bend, buckle or collapse during the thrusting of intercourse. This can easily injure the delicate tunica albuginea enough to start or worsen Peyronies. You never want to engage in sexual relations with less than a fully hard erection because a soft erection is an unstable situation that often leads to injury and PD. His doctor should have warned this man about his need to “stuff” his penis, but apparently did not. This fellow is writing as though this is just the way things are supposed to be when you use Viagra; you just have to push and “stuff” yourself in, like it is no big deal. This is a foolish and dangerous thing for a man who already Peyronie’s disease, but no one has warned him about this danger. but primarily because I had early success with injections. Notice he uses the plural form, “injections.” You will see in his next sentence he is referring to injections of the drugs Trimix and Papaverine Chloride into the shaft to create a temporary artificial enlargement. I have repeatedly warned about any kind of injection into the penile shaft that is known to start or worsen Peyronie’s disease because the needle damages the tunica albuginea. I have scores of conversations in which men who tell me their PD started after just one injection. It is certainly possible that this fellow’s PD started because of repeated injury caused by inserting a needle into the tunica albuginea and leaving irritating chemicals there. Trimix gave me too much discomfort for intercourse, so I was soon switched to Papaverine Chloride which is one of the three ingredients in Trimix. A 30 cc dose of this gives me a reliable erection for about an hour, and the pain-free reliability of this made me forsake the other options, even though I still take 100 mg. of Viagra two to three times a week to encourage nocturnal erections.

I now get nocturnal erections both with and without Viagra, and can get rather full erections without Viagra, but it takes a fair amount of stimulation, so that my wife and I have just continued with the Papaverine when we desire intercourse, Papaverine is an injection drug that is used each time this couple desires sexual union. So, rather than take Viagra because it is too much work because it requires “a fair amount of stimulation,” he chooses to inject himself each time with Papaverine. He does not say how often he does this, but this could be many injections monthly. Yet no one has presented the idea to this fellow that his shaft is not a pin cushion that could eventually develop Peyronie’s disease after this kind of repeated injury. This is how people get into trouble being far too casual about the use of drugs and intrusive therapies. rather than risk the undependability or hassle of the other options. Because he wants to avoid the risk of undependability and hassle of other options, he repeatedly stabs a needle into his tunica albuginea and now wonders why he has Peyronie’s disease. This kind of casual and repeated use of drugs in general is a common way for many people to create many problems for themselves – yet no where in this discussion does this fellow's doctor try to stop this kind of behavior.

The Peyronie's hadn't seemed to be getting worse, and didn't interfere with the enjoyment of sex, so until today I had been putting off the trip to my ED specialist because it involved a long trip. My specialist is Dr. Steven Auerbach who is listed as an ED specialist in the appendix to Eid's book and who also contributed the chapter on erectile dysfunction in A

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Auerbach's reply was that there did not seem to be enough scarring to take any action now. If it gets worse he will give me either Verapamil cream or Verapamil shots if the problem is more localized. He has about 15 men on Verapamil, and although there is not yet any real documented success he is pursuing this treatment. Please read that last sentence again. Both the doctor and this patient are not at all bothered that there are no reports of success using Verapamilthey will use it anyway. Neither the doctor nor the patient do not mind there are real dangers (increased or decreased blood pressure, lung and breathing complications, liver and kidney damage) posed by the use of topical Verapamil, because they think it might help his PD. Further, he does not mention that Verapamil is a calcium channel blocker that has been implicated as the cause of Peyronie’s disease in some men. He also continues to recommend taking Viagra frequently, if for no other reason than to stimulate blood flow. This is a favorite topic of mine – the idea that Viagra should be used “to stimulate blood flow.” First, no one can question the need for good blood flow and adequate circulation for health and healing. But, when should a person really consider taking action to increase blood flow? Answer: when there is actual evidence of reduced or inadequate blood flow to an area. This evidence would be slight coolness or a slight blue colored tint to the skin. We all know that if your skin is cold and blue, you need to increase circulation. If your penis is not cold or blue, but it is as warm as the rest of you and is the usual color, this is strong evidence that your circulation is fine. Second, the idea of increased circulation of blood should bring to mind either a faster blood flow into an area or more blood than is normally found in an area of the body. Let’s say that you are running for a while. You would expect more blood to be flowing into the lungs and legs, at least, and probably all the rest of you. This would be an example of increased blood flow. Do you know what an example of decreased blood flow is? (Remember, before you answer, that this means “a faster blood flow into an area or more blood than is normally found in an area of the body.”) Well, a good example of decreased blood flow in the body is what happens during an erection. What? Think about it. During an erection blood is trapped in the spaces of the corpora cavernosae and corpora spongiosum of the shaft. The primary veins of the shaft close, stopping drainage of blood that goes in and out, thus backing up or trapping blood to increase pressure against the walls of the tunica albuginea. This is what creates the characteristic hardness and enlargement of an erection. The shaft does get longer and thicker because more blood enters the shaft, but for the average man this might be only 2-3 tablespoons more blood than is normally present while flaccid. However, this slightly greater amount of blood is still trapped inside the shaft and does not flow freely like when you exercise. There is a very small amount of exchange or circulation of blood during this time; otherwise it would be dangerous to have an erection for more than a few minutes. But, overall, the actual movement and flow of blood is less at this time, compared to the non-erect state. You can prove this to yourself by close examination of your erection. Your entire organ is darker and more purple colored – when the normally red head or glans becomes tinted blue because of reduced circulation, it appears to be purple by mixing of the two colors. Also, the veins of the shaft become obvious (like varicose veins) in the same way they will if you wrap one hand around the other wrist and squeeze to stop the blood flow. So, if all this is true – and it is – then how does taking Viagra increase blood flow? Answer: it does not increase circulation in the penis. An erection can only happen if blood is trapped like air becomes trapped inside a balloon to make it more rigid. Go tell that to your MD the next time he wants to write a prescription for you to “increase circulation” down there. He/She is not thinking, but only repeating some nonsense he/she read somewhere.

His web site is not all that encouraging about the use of Verapamil, but he now seems encouraged. I do not understand this comment at all.

I questioned him on the use of the VED for exercise, The VED (vacuum erection device) is not exercise. It does not increase blood circulation; again, it merely traps more blood in the shaft by creating a negative force. This is why the penis turns very dark and purplish while it is in the VED, and the penis comes out cold – because blood is trapped there, not moving. This is also why in order to stay enlarged after removing himself from the VED, it is necessary to put a tight rubber ring around the base to keep the blood trapped inside. but he did not recommend it, but also did not recommend against it. He recommended taking Vitamin E and counseled against taking Vitamin C, especially in the mega dosages that some take. MDs do not study nutrition in medical school, did you know that? The vast majority of MDs think you do not need to take additional nutrients beyond what you get in your diet. I could go on and on about what MDs as a group do not know about nutrition, but this blog post is too long already. I have never heard of anyone who has taken vitamin E by itself – in the way that MDs recommend – and gotten any help with their Peyronie’s disease.

He also thought that my Peyronie's, or whatever we want to call it, may be entirely independent of the injections I am taking. It is common for a doctor to not admit to the possibility that a patient’s Peyronie’s disease was caused by the Papaverine injections he prescribed. That could result in a law suit. He believes most of the Peyronie, scarring or fibrosis comes from lack of use. In all my years of researching PD, I have never heard of this before; that PD is caused by lack of use. There is no way to support this idea that PD results from lack of sexual use – it just not make sense at all. He is strongly against sitting idly by for any period of time after an RP, believing that exercise and blood flow is very important for recovery. Of course good blood flow is important for recovery. But taking a bucket of Viagra is not going to make that happen. However, applying heat packs (rosy red skin and a larger shaft afterward) would be a good way to increase circulation. Wearing boxer shorts rather than tighty-whitey briefs would be a good way to help circulation. Also, a massage of that area to actually increase blood flow to the lower pelvis would be great. However, this man’s doctor apparently did not mention any of that. Your average MD would rather quickly write a drug prescription than take two minutes to talk about hot packs, underwear and massage. My bending is on the left side of the penis, which means that the scarring would be on that side, so being right handed I probably would be giving myself more injections on the other side. He probably gave himself more injections on the left side of the shaft. Just thought I would throw this information into the hopper of information to which we all have access. I believe what this post actually did was to create more confusion and bad information about what to do after RP surgery and what not to do if you have Peyronie’s disease. This is simply more drug promotion and little new thought about true health care.


Please forward your thoughts and comments about my opinions. I would be happy to hear from you, especially if you are interested in Peyronie’s disease natural treatment.