Will reduction of masturbation help Peyronie’s disease?

Hello Dr. Herazy,

I am 32 and very recently developed Peyronie's disease.  I noticed the pain in early November. The pain then resolved itself by late December, around the same time two plaques appeared and a curvature of 5-10 degrees. At the time I developed it, I was under more stress than I can remember experiencing. I'm seeing a urologist next week. So that is my status but I was wondering if I currently masturbate daily do you think that reducing my masturbation by 50-75% would help. Also, in situations such as mine (young, early development, changed lifestyle (much stress now – except for the Peyronies concern)) and with the proper treatment plan the chances of recovery are high? Very very much appreciated….  J

Greetings J,

I have to smile.  Here you think that masturbation might be aggravating your Peyronie's disease, yet your solution is not to stop masturbating but only to reduce it by 50-75%.   I hope women appreciate this kind of thinking we men have when it comes to sex.

Masturbation, per se, did not cause and cannot aggravate your Peyronie's disease.   But it could have been the injury and repeated tissue strain that you sustained during masturbation that could have caused or aggravated your Peyronie's disease.   Do you get the point?   Gentle and easy masturbation that does not injure the tunica albuginea of the penis will not cause Peyronie's disease.   But the aggressive and sometimes violent masturbation practices and techniques that some men use can injure this deep tissue, causing or aggravating Peyronies disease.  It all depends on how you do it. 

The cause of Peyronie's disease is complex and not fully understood.   In my opinion your best chance for recovery is found in doing all those things that enable the body to heal as it does in 50% of men who develop PD.  This is what you will find explained in great detail on the PDI website. 

The earlier treatment starts and the more correctly, faithfully and aggressively the treatment is employed, will tend to favor tissue response and eventual recovery.  TRH

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.

Causes of Peyronie’s Disease

Many possible Peyronie’s causes, few proven ideas

While the cause of Peyronie's disease is not well understood, it is generally thought to be the result of an excessive response to wound healing, or exaggerated internal scar formation at the site of injury.  The traumatic cause of Peyronie’s disease is said to be repeated minor trauma to the penis that occurs during sexual activity; from my experience it is often from significant or major injury during sexual activity in which the penis is suddenly bent during sexual intercourse or during aggressive foreplay of various types.   This type of injury can also occur during a work related or sports accident.

Factors that influence causes of Peyronie's Disease

  • Inherited weakness – a genetic predisposition is thought to exist because Peyronie's disease is seen to be more common in men with family members who also have  PD, or Dupuytren’s contracture, or Ledderhose disease, or systemic lupus erythematosus, (SLE, a connective tissue disorder).   This is supported by a commonly found inherited abnormality of the human leukocyte antigen B27 (HLA-B27).
  • Injury – Peyronie's disease can sometimes start after trauma to the penis in which localized bleeding occurs.   Sufficient injury may happen during  an accident related to sexual intercourse, a medical procedure such as catheterization in which a tube or catheter is passed through the urethra of the penis, or unusual events like falling forward on the ice or even prolonged bicycle riding.
  • Vitamin E deficiency – some evidence this makes Peyronie's disease easier to occur after injury.
  • Drug side-effects – Peyronie’s disease is a rare side effect of blood pressure medications that belong to a group called beta blockers (Inderal).
  • Diabetes – Prolonged diabetes can predispose to damage to the internal lining of blood vessels, including the penis, making either trauma, vitamin E deficiency or genetic factors easier to trigger an occurrence of Peyronie's disease.
  • Infection – When inflammation occurs secondary to an infection it sometimes can spread to the blood vessel walls (vasculitis) causing a reduced blood flow because the response is very similar to a direct trauma to the penis.

Peyronie’s disease and wound healing
Two things you need to know about Peyronie’s penis anatomy is that the penis is made of three long tube-shaped cylinders of tissue – two larger ones called the corpus cavernosae, and one smaller one called the corpus spongiosum; both are filled with a blood-filled type of tissue that resembles a sponge. And the other is that these three tissue structures are wrapped by a layer of tough but delicate tissue called the tunica albuginea.   During sexual arousal or when erection occurs nerve impulses from the higher centers are sent down to chambers signal that they should fill with blood, resulting in the penis being able to expand, straighten and stiffen, causing trouble with sexual activity.

The two corpus cavernosae are surrounded by a sheath of thin elastic tissue called the tunica albuginea, which very slightly stretches during an erection.  During penile injury the tunica can become damaged, causing inflammation.

When Peyronie's disease develops – especially easily in men who are genetically predisposed, but in other men as well when the injury is more significant – normal wound-healing process does not occur because the internal scar tissue becomes excessive.  When this happens the area of the tunica albuginea with the internal scar is no longer flexible and expandable, and the ability to develop an erection in Peyronie’s disease is reduced totally or partially.   When erect, the Peyronie’s penis is distorted and often painful.

For more information, cause of Peyronie’s disease.

Possible Peyronie’s Cause: Catheter and Cystoscope Trauma

Unrelated cancer surgery possible cause of Peyronie’s disease

Debate and confusion persist about a Peyronie’s cause, no matter how much time passes.

We who deal with Peyronies on a daily basis know that not much research effort is given to this problem we share.  Medical research into the cause of Peyronie’s disease is often directed toward a genetic quirk or biochemical flaw within the cellular structure – that can be treated with drugs.  In spite of a hundred years of failure looking for a pharmacologically treatable Peyronie’s disease cause, one obvious area has not received much interest: trauma.

No one denies that trauma is at least a common secondary cause of Peyronie’s disease, if not the primary cause.  Yet, there is nothing in the medical literature that addresses the great amount of totally preventable trauma delivered while under medical care.  It is my opinion that doctors can be a Peyronie’s cause during the sometimes brutal and hidden trauma of male catheterization and cystoscopic examination that occurs before, during or after many types of surgery, like bladder or penis surgery.

Since 2002 when I started the Peyronie’s Disease Institute I have communicated with a host of surgical nurses.  They advise me that during surgery, while a man is under general anesthesia and is catheterized or given a urethral scope examination for any reason the process is often rushed and aggressive since the patient is not awake or aware.

To understand the potential problem, consider that the male urinary opening at the tip of the penis is a slit that averages 0.15 to 0.20 inches (4-5 mm) in length, compared to a 9 mm catheter or cystoscope that is put into that slit.  .

The potential for abuse that can lead to Peyronie’s disease exists because the size of the cystoscope used for men ranges from between the thickness of a pencil up to approximately 9mm.  In addition, many cystoscopes have extra tubes to guide other instruments for surgical procedures to treat urinary problems.  That is a lot of material that goes up that little passage way.  Sometimes twists and narrowed areas of the male urethra are encountered that prevent passage, when the catheter or cystoscope will be forced deeper by a surgeon who encounters difficulty.  This, I have been told, is a common problem that is not much talked about.

Nurses get into big trouble, and jeopardize job security, for revealing what they see and hear in the operating room.

It is my speculation that unnecessary injury related to forceful and rushed catheterization or cystoscope insertion is the reason many men develop PD that they cannot otherwise explain.  This opinion is based on the number of men I speak to who tell me they cannot account for their PD based on penile trauma.  Of these men who recall no direct penile trauma, when I ask about any kind of surgery that took place within a year or so before developing PD, at least 95% tell me they were either catheterized or received a cystoscopic examination for one reason or another.

For this reason I speculate these men were traumatized during their catheterization or cystoscopic procedure sufficiently to injure their tunica albuginea enough to cause Peyronie’s disease.

One example within Peyronie’s disease research to support this theory of an association between surgical catheterization and cystoscopic examination and PD, comes from the Urology Service of the Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, in June of 2010 published an article in Urology Times titled, “Peyronie’s Disease Following Radical Prostatectomy:  Incidence and Predictors.”

This search for a cause of Peyronie's disease must consider that for men in their 50s, both prostate cancer and Peyronie's disease are fairly common.  The purpose of this project was to determine if there was an actual link between those men who had a radical prostatectomy (RP) operation for prostate cancer and Peyronie’s disease.

They reviewed their sexual medicine database from 2002 to 2008.  They isolated men who received a RP as the only form of treatment for a well-defined and localized prostate cancer, looking for those who developed Peyronies within three years after their RP surgery and compared this group to those men who did not develop Peyronies.  They studied 1,011 such men, of whom 15.9% PD – a number higher than the general population.   They found that the average time for a man to develop PD after his RP was 14 months, give or take a month.   The average curvature was determined to be 31 degrees, +/- 17 degrees.   They further found that younger men (average of 59 years) who had a RP operation were more likely to develop PD afterward, than older men (average of 60 years), and that white race men (18%) were more likely to develop PD than non-white rave men (7%).    Also, they discovered that erectile function after RP surgery did not predict the later development of PD.

Because men who experienced sexual dysfunction after RP were found to develop Peyronie’s disease more frequently than the general population, the study suggested that this group should be routinely evaluated for PD.

This study, written by R. Tal, M. Heck and others, speculates that the Peyronie’s cause for these men might be somehow related to their prostate cancer.

Because it is common for the medical community to primarily delve deeply and intently into the biochemical and hereditary factors for a cause of Peyronie's disease,  without consideration of more simple and obvious reasons, they do not much evaluate for trauma.   Surgical trauma is a possible Peyronie’s disease cause for those with a history of prior radical prostatectomy (because of the cystoscopic and catheterization procedures they receive), but apparently is not investigated since this would cause a medicolegal problem for the medical community and little reason to use medication.

Masturbation as Cause of Peyronie’s Disease

Here is a common kind of question asking me if I think this young man's Peyronie’s disease started with masturbation.  In this discussion we explore the cause of Peyronie's disease, and my response advising him how to manage his problem.

hi dr. herazy

thank you for your quick replies to my questions!!

i know that i cannot ask anyone else this question, because it is so embarrassing for me…and you are the only one i know who I can trust…but i need to know because it is just driving me crazy and i do not know who else to ask before i hurt myself even more.

as i told you, i got my pd almost two years ago when i was 17, and i have kept this problem from my parents all this time…the reason i have not told them is because i do not know how they would react if i told them that i think i got peyronies by masturbating too hard…do you think this is possible?  ever since i was about 11 or 12 i would masturbate sometimes a few times a week…sometimes a few times a day…and I developed what i now see are some pretty strange and brutal rituals to reach ejaculation….one day i got so carried away with rubbing and twisting really hard that i got so sore for over a week that i thought i broke something inside…i got black and blue and then about a month later i noticed a lump of tissue on the top and side; after that the curve started that has only gotten worse for two years.

please tell me if you think i did this to myself, so i will know and maybe i will be able to stop masturbating after all this time…waiting for your answer.


thanks for your past advice.

Regards
cxxxxxx

—–Original Message—–
From: herazy@sbcglobal.net
To: CXXXXX@netscape.net
Sent: Fri, 12 Oct 2008 4:54 AM
Subject: RE: Question

Greetings, CXXXXXX,

It seems like every few weeks I get a phone call or an email from someone who tells me his Peyronie’s disease started from a injury that started from over-aggressive masturbation.  I mention this to you so you know you are not alone.  It seems many men – both young and old – sometimes get so carried away with their masturbation that they injure the delicate tunica albuginea membrane inside the shaft of the penis. When this happens it is possible for one or more masses of fibrous material (called plaque) to develop in response to the injury as a way of healing it – it has been said that PD is nothing more than an excessive or exuberant healing response of the tunica to injury.  This plaque prevents a normal erection from developing and leads to the severe 90 degree bend you now have.

I have no way of knowing for sure if that was the case with you.  However, based on what you have told me how you have rubbed and rammed your penis against your mattress or into a pillow for years, I think there is a good chance that this is how your problem started.  Actually, my concern is more about how to take care of your problem than in trying to help you blame yourself.  It is in the past.  The only thing that is important right now is what you are going to do to help yourself today.

So what are you to do now?  We have already discussed how I suggest you go about using Alternative Medicine to promote repair of your PD. You need to carefully and faithfully work that Medium Plan and add in the information from the gentle manual stretching video just as soon as you receive it.

In addition to all that, you need to stop being so rough in your masturbation – notice I am not saying stop masturbating – I am telling you to refine and improve your technique so that it is more like intercourse.  I know that you have never had sex with a girl because of your PD, so you need to imagine what it is like and use your hand to mimic what you think that feels like.   Do not use inanimate objects for the time being – use only your hand so that you can control the softness of the stimulation and to heighten the pleasure that you are looking for.  You must use a lot – loads – of lubrication when you masturbate so that you do not injure yourself further.  Never masturbate “dry” again.  There is no sense in you doing all this work to help your body to heal your Peyronie’s plaque if you beat yourself up every night while masturbating, OK?

You have to get ahead of your problem and being soft and gentle is the way to do it.  I am sorry, but you will probably find that in the beginning maybe for a few days or a few weeks you will not be able to come to orgasm with your new way of masturbating.  You will have to change what you do, young fella, even if it is difficult and not as familiar to you at the start.  Over time your nerve system will adapt to this new pleasant sensation and you will probably enjoy it more in the long run.

Let me know if you have any more questions.

Regards,

Theodore R. Herazy, DC, LAc

Beta Blockers and Peyronie’s Disease

One cause of  Peyronie's disease

A number of drugs list Peyronie's disease as a possible side effect.

Most of these drugs belong to a class of blood pressure and heart medications called beta blockers. One beta blocker is an eye drop preparation used to treat glaucoma. Other drugs that may cause Peyronie's disease are interferon, used to treat multiple sclerosis, and phenytoin, an anti-seizure medicine.

The chances of developing Peyronie's disease from any of these medicines are very low, however it does occur so this possibility should be kept in mind if there is a family history of PD.   Many times a man will consider taking a heart medication when some safer form might be available, never realizing that a beta blocker can lead him straight to Peyronies surgery and penile curvature.

Patients should check with their doctor before discontinuing any prescribed drug while undergoing any Alternative Medicine form of  Peyronie's disease treatment.