I continued jelqing for months even though my penile curvature was getting worse and now I might have Peyronie's disease

Posted on February 24, 2013July 21, 2015 by Dr.Herazy

Dr. Herazy, Firstly, I would like to thank you and this community for even being here to help those who suffer with penile curvature. Finding information online regarding Peyronie's disease has been very tricky and even an anxious affair due to the condition's unnecessarily embarrassing nature. Anyway, a little background: I am a 23-year-old male who has had a healthy sex life for the last seven years. While dating my previous girlfriend, we had some bouts with sexual difficulty, mostly on her end due to numerous urinary tract infections and her mental condition; she has been on anti-anxiety and antidepressants for some years now. This made her very self-conscious during sex and, admittedly, other factors like privacy created tension. I have never experienced this before and thought something was wrong with me, and for some stupid reason, I wondered if my penis was somehow inadequate. So, I looked into enhancement options and discovered the murky world of jelqing and stretching.

I followed the exercise regiment very closely, with my workouts beginning in February of 2012 and ending at the end of October of 2012. I made sure to warm up every time with a hot wrap and never pushed myself too far, or so I thought. I discovered that my penis grew in length and girth, going from about 5.5 inches erect to 6.5 inches; flaccid, my penis has always been about one inch, no joke. Now, it is usually two but often three inches in length when totally flaccid. My ex at the time noticed it and was shocked I managed to change the size and shape of my penis. I was taking L-Arginine, L-Lysine, and Zinc on my workout days, including Pygeum Africanum, Lecithin, Flaxseed Oil, Fish Oil, Super B Complex, and a solid Multivitamin. But during the last week of October, after we had broken up, I think I went too hard and stretched too far, feeling an uneasy sensation in my penis. It's important to note that I had noticed the progression of a curve for months preceding this but with no pain. It is also important to note that I have always had a slight curve to the left, as several photos taken years ago prove.

Anyway, after this weird feeling from stretching, I finished my workout and decided to take some days off. But the pain got worse and I noticed a small bruise/discoloration and what appeared to be a reddish stretch mark running about two inches on my penis. So, I scheduled an appointment to see a urologist. I saw him and he said I essentially “sprained” something or caused a microtear near the glans of my penis. He told me to abstain from sexual activity for six to eight weeks. He didn't feel any plaque and said that he couldn't diagnosis Peyronie's because there wasn't significant curvature or plaque. While I didn't exactly abstain as much as I should have, I did mostly stop masturbating for weeks on end.

The pain is now completely gone but the discoloration and stretch mark (maybe inflamed vein) are still there, though they seem to have faded a bit. I am now living in Chicago and have scheduled an appointment with Dr. Levine for March 1st. I need some kind of closure on this; I need to know if I have to start treatment or maybe I just have a congenital curvature. The curve hasn't increased since my injury and, as stated above, I noticed the enhanced penile curvature while flaccid months before my injury. While erect, there's not much of a difference between the way my penis looks now and a few years ago when I was sixteen. The only difference is the discoloration/bruise, stretch mark/inflamed vein, and a bigger, more curved flaccid penis.

I am currently taking a Multivitamin, L-Arginine, CoQ-10, Acetyl L-Carnitine, and Vitamin E. I also was using Bio-Oil and Cocoa Butter, but have cut back significantly; I liked how smooth it made my unit feel. I have continued sexual activity with no pain and no loss of erectile function. Based on what you all know and what I have told you, can you point me in the right direction? Can you give me advice? My current girlfriend and ex have been very supportive through all of this, including my brother, best friend, and mother. I just want some kind of pointers and opinions; it can be quite suffocating with everyone telling you “you're going to be fine” or “you're overreacting.” This is a serious condition and I am not sure where to turn. Dr. Levine has me scheduled for an ultrasound the morning of our appointment so he can check it out before meeting with me. I seriously hope there is no scar tissue or, if there is, it is something I can deal with. I have grown fond of my curved flaccid penis and don't mind it; life is too short to dwell and panic about these things as long as I can have a functional sex life. Please. And thanks in advance for reading my story and any opinions. It means a lot!

Greetings,

Thank you for your detailed report and insightful commentary concerning your experience with jelqing and penis stretching.

In many posts I have written about the dangers of forced penis stretching: for example please see I think I have Peyronie’s disease from jelqing. What should I do? Too many men take a cavalier attitude about remodeling their penis to Adonis proportions. The websites that sell the books and tapes attempt to support the idea that all problems of low self-esteem and difficulty with female relationships will simply disappear with a sausage-like member tucked in below the belt. Life is perfect for men who have an unusually large penis. They do not discuss the many problems and tragedies that occur with these strategies of forced stretching. The jelqing websites try to create the idea that the penis can be squeezed and molded like a slab of clay can be tugged and strangled into an exaggerated size to please a lady or gratify a weak ego. When penis tissue is taken forcefully and repeatedly beyond a certain point of limitation it will suddenly fail.

At this point you can only be certain that you have a bruise or micro-tear of the external tissue of the shaft. You might be one of the luckiest guys in the world to only have a superficial injury, and not a deeper problem in the shaft at the level of the tunica albuginea; if it turns out that you have injured the tunica you are perhaps a step closer to having a case of Peyronie's disease. Even so, with injury to the tunica and an early case of Peyronies to deal with, about half of these cases repair or reverse on their own without outside intervention – spontaneous recovery is the medical term for self healing. This is mentioned so that you can appreciate the gravity of what you have done and the position you are in at the moment.

When you wrote that you “… never pushed myself too far, or so I thought,” you made a critical point about jelqing that gets to the heart of the craziness about this brutal practice. Did you ever watch a movie in which the bomb squad is called for help to defuse or take apart a complicated explosive device? The tension and drama of those scenes where the bomb wires are being cut is based on the person never knowing if he is cutting the correct wire or in the correct sequence until it is too late. The trick of taking apart the bomb is that you can be doing it correctly when everything is going well, until the moment you make a mistake and the bomb and you blow up. Jelqing is not much different. You can think you are doing it correctly and safely, until you make a mistake and injure your penis to cause a problem like Peyronie's disease. Who knows how far to go until after you have gone too far? Who knows how hard to squeeze and stretch, until after you have squeezed and stretched too much? Everything can go well until after everything does badly, when the whole jelqing idea blows up in your face.

Based upon what you have written, I suspect that you have injured yourself enough to have caused Peyronie's disease. I am lead to this conclusion by your statement, “… I had noticed the progression of a curve for months preceding this but with no pain. “ By this you say that for months your penis was becoming curved and yet you continued to jelq for months. Since I have not examined you I can only speculate, although you will learn in time if I am correct or not. I further suspect that you do not have at this time a curved penis when erect only because your condition is still too early and you are in the stage where the plaque has not yet formed the telltale Peyronie's scar that is far more capable of causing penile curvature. Further based upon what you have written, “While I didn't exactly abstain as much as I should have, I did mostly stop masturbating for weeks on end, ” even when the doctor told you to abstain from sexual activity you did not. Not only did you not stop having intercourse, you only reduced masturbating. You need to read a bit about the subject of hedonism.

If you do not develop Peyronie's disease as a result of your immaturity and lack of self-respect, and I hope you do not, it will be a miracle. Please try to use this experience as a way to learn something not only to learn about the dangers of jelqing and Peyronie's disease, but more so to learn about yourself and what aspects of your personality are in need of growth and maturity.

If it does turn out that you have an incipient case of Peyronie's disease, please consider that there is much you can do to assist your body to heal and repair the problem. If half of the men who develop Peyronie's disease eventually heal it on their own without assistance and their penile curvature goes away on its own, there is the possibility you can assist your recovery over Peyronie's disease by using information found on the PDI website.

Good luck to you, sir.

Is it possibile for Viagra, or any other medication, to cause Peyronie disease?

Posted on November 4, 2012March 18, 2013 by Dr.Herazy

Is anyone doing research on the possibility of Viagra causing Peyronie disease or any other type of medication causing this disease? Mine seems to have started after I took Viagra . Thank you, Floyd Mathis

Greetings Floyd,

Sorry to hear of your problem with Peyronie's disease.

Yes, there is growing evidence that Viagra, Cialis and Levitra (all the PDE5 inhibitor drugs) can cause Peyronie's disease in some men. I have reported this and written about this observation for many years now. You can read more about this topic in these posts from the PDI website: Viagra Peyronie's disease connection and Viagra, Cialis and Levitra Use with Peyronie’s Disease and Peyronie’s Disease Plaque, Viagra, C ialis, Levitra, and Blood Supply . There are more articles that are available but I think you will get the idea from these.

The basic way the injury happens that leads to the start of Peyronie's disease is from "over inflation" that damages the internal tissue of the penis called the tunica albuginea.

I was talking to a man the other day from Australia whose PD started from just a single use of one of these PDE5 drugs. He told me that he developed an erection that was so hard and large that he was scared what might happen to him. He said he thought he might explode. Obviously that was the last and only time he took any drug like that. About two months later he had three internal Peyronie's plaques and a curved penis of 45 degrees. Because he did not have any sexual activity for months before that event or after it he is positive it was the drug that injured him.

He went to his medical doctor who told him that this sometimes happens to men. You will notice that there is a caution on inside drug product information that warns that men with PD should not use these PDE5 drugs.

What strikes me as especially careless and inappropriate is that there are medical doctors who actually prescribe Viagra, Cialis and Levitra to men who already have Peyronie's disease to help them have an erection when they show signs of erectile dysfunction.

Yes, there are other drugs that are said to be associated with or to cause Peyronie's disease. The common list includes beta blockers used for heart problems and all of the statin drugs used to lower cholesterol.

I suggest that you review some of the Alternative Medicine treatment ideas on the PDI website to learn how you can use Peyronie's natural treatment to help yourself correct this problem. Please let me know if there is anything I can do to help you. TRH

Will this surgery work to correct my Peyronie’s disease?

Posted on September 29, 2012March 18, 2013 by Dr.Herazy

I have peyronies a year and a half now with a 45 degree bend when erect.i have consulted my doctor.i have seen a surgeon and I am not satisfied with his straightening method.he just wants to put a slit in it and sew it back.i don't believe this would would work.i need a second opinion.i am on medical card and live in county roscommon in the west region of Ireland. i need a surgeon who is prepared to carry out the full and proper treatment I would be very thankful for your assistance doctor and advice.i am only 39 and this is ruining my relationships and I am depressed. please help me.

Greetings,

Are you sure you heard and understood everything that was told to you about this penis surgery?

I cannot directly comment about what your surgeon explained about the Peyronie's surgery he or she proposed because I was not there to hear the explanation you were given, and you were. However, as I understand penis surgery to correct a penile curvature caused by PD, the typical procedure is much more complex than simply putting a slit in the shaft and closing it up.

If you are positive you were given this exact explanation, I suggest you contact another urology surgeon who will take your case more seriously for a second opinion. Using the information that follows I propose that this next time around you be prepared to ask many questions and demand answers. You should fully understand what is being proposed to you so you can make an intelligent and informed decision. I also suggest that you spend some time on the Peyronie's Disease Institute website to learn about the possibility of using non-drug and non-surgical treatment to increase your ability to eliminate the Peyronie's plaque naturally.

I am sensitive to what you are asking and I understand your concern about penis surgery. However, I have no way to know what is the full and proper surgical treatment for your particular problem, and frankly neither do you. Something as vitally important and final as surgery requires a great deal of trust in the skill and competence of the surgeon in an area that a layperson does not have enough knowledge or skill to judge what needs to be done. Having said that, I think you might be correct to want to talk to another surgeon if only because it is not correct or proper that you were allowed to leave that office without a better understanding of the proposed surgery. In my opinion, a half-hearted explanation is no explanation, and does not bode well for the kind of surgery that a doctor like that would provide.

There is always the possibility you misunderstood what was explained to you, but it is still the responsibility of the doctor to make sure you do fully understand so you can give informed consent to a surgical procedure. There is also the possibility the doctor did not want to give you all the (somewhat gruesome) details of the surgery, since it might scare off someone with a squeamish stomach. Another possibility is that the doctor simply did not want to take the time from a busy office schedule to explain what would happen in the proposed surgery. It has been my observation that many times a surgeon will greatly limit or modify the truth about some aspect of a proposed surgery (risks, chances for recurrence, changes for failure, degree or frequency of complications or side effects) so that the patient is more inclined to accept the idea of the surgery, and agree to have the surgery done. It is somewhat of a "selling job" that is done. It is not appropriate, it is not correct, and it is not legal, but it is done. Perhaps something like this happened in your case. Whatever was the reason that you thought the doctor was going to "put a slit in it and sew it back," it is the fault of the doctor for that notion and possible misunderstanding to remain.

More than likely, and I could be completely wrong since I was not there, the doctor proposed to do a Nesbit procedure for your curved penis.

For the most men the Nesbit procedure is the most common, easiest and most direct way that a surgeon can address the penile curvature of Peyronie’s disease. However, it causes shortening of the erect penis by 2.5 to 6 cm (one to two and a half inches), and this is the greatest drawback of it. The operation is performed under a general anesthetic and takes 40 to 60 minutes. Men usually go home the day after surgery, or even the same day.

Basically, in the Nesbit operation the main idea is to make an elliptical incision to remove some of the shaft tissue and tunica albuginea from the long side of the bent penis (on the side opposite the inner curve of the bend), in an effort to straighten the curvature. This tissue removal is responsible for the overall effect of penis shortening when the long side is reduced. The rule of thumb is that for every 25-30 degree of curvature that is present, a loss of approximately 1 to 1.5cm penis (about half to one inch) length at erection will occur.

An incision is made all the way around the shaft, a few millimeters behind the edge of the head (glans) of the penis. The cut skin of the penis is rolled back down (like rolling or peeling your socks down off your leg), exposing the two corpora cavernosae so the one corpora cavernosa that is opposite the bend and the Peyronie's plaque can be shortened. This is done by either removing tissue of the corpora with removal using an elliptical incision or simply by drawing it tighter with internal stitches. After this is done the foreskin usually has to be shortened also so that it matches the new shorter length of the penis. As in any operation, infection of the incision lines can be a problem and the foreskin, if left behind, sometimes becomes swollen after surgery; for this reason many surgeons will also perform a complete circumcision to prevent this complication. Otherwise direct surgical complications are not common, but occasional to infrequent side effects after surgery of erectile dysfunction, permanent numbness and penile pain can occur.

Hopefully, this explanation of the Nesbit procedure is helpful. Keep in mind that this is the simplest Peyronie's surgery. You can see Peyronie's surgery is a lot more complex than what you thought. TRH

Does this sound like Peyronie's disease to you?

Posted on June 27, 2012July 21, 2015 by Dr.Herazy

Hi Dr. Herazy,

I’m glad to have found your site. I recently was diagnosed with Peyronie’s disease after having gone through numerous urologists who were stumped as to what the issue was. My initial symptoms were pain and swelling of the glans specifically the coronal ridge. This ridge now appears more pronounced than before and although I no longer feel soreness I have the sensation of the glans feeling separate from the shaft. Soon after I noticed a dent on the underside of the shaft right below my glans which is only noticeable when erect. This area also feels somewhat numb to touch. My glans also do not get as hard as before I had this dent. My urologist mentioned a “distal neurovascular bundle” which is obstructing and preventing blood staying in the head.

Have you come across such a dent accompanied by soft glans and what is the likelihood of this being permanent damage?

Suffice to say this has caused tremendous stress however I am optimistic that the body given the right conditions and support can heal almost anything.

I appreciate any comments or advice you may have regarding this matter,

Chris

Greetings Chris,

From the limited information I would say you have at best a Peyronie's-like condition. Peyronie's disease is not associated with a neurovascular bundle, but a formation of collagen and other cellular components within the tunica albuginea tissue layer of the shaft. Numbness, glans swelling, glans softness and ridge formation are not part of the Peyronie's picture. While an indentation does sometimes occur with Peyronies I think this is perhaps more of a coincidence of a similar phenomenon and does not offer sufficient support for the diagnosis you say you were given. Perhaps you misunderstood?

Keep in mind I did not examine you, and the others did see your problem, so my opinion is of limited value. But still this diagnosis does not add up to me. Further, you say that several urologists were at a loss to determine the nature of your problem. Perhaps this is just what you were told so that they were off the hook to give you a diagnosis.

From my experience it is common that when several specialists get involved in a problem like yours, it is common for them all to be more concerned about not offending each other or being guilty of contradicting anyone that the patient is often forgotten. I say see another specialist and do not tell him anything about the other doctors so that this next opinion is more honest. TRH

Is it beneficial to achieve erection and masturbate in the early stages of Peyronies disease?

Posted on May 12, 2012March 18, 2013 by Dr.Herazy

Dr. Herazy,

I spoke with you on the phone this evening, Friday May 11th. I sincerely thank you for taking the time to talk with me. Much appreciated. I will be ordering your book as my first step.

If I operate under the assumption that my situation is in fact Peyronie's disease, it would be safe to assume since my symptoms of curvature and pain started about a month ago that I am in the initial stages of the syndrome. I have two questions for you:

1. Is it beneficial to achieve erection and masturbate in this stage? My thought is that this may have some benefit in protecting from scarring, similar to prescribed rehab after a knee surgery. In that example the patient manipulates the joint frequently to break up formed and forming scar tissue. Would this be useful?

2. Do you recommend or discourage the use of Viagra and the other similar drugs in this period? Could they help or hurt healing?

Thanks again for your time. I will keep you posted!

R. Brown

Greetings R.

As you recall, I mentioned that there are often many irregularities and inconsistencies in the way Peyronies disease will present itself; it is rare to find someone with a classic text book presentation. Since your particular symptoms and history does not strongly suggest that you have PD, and only a few a small part that does, I suggest you consult with a second urologist to confirm one way or the other your actual diagnosis.

That masturbation might be beneficial for Peyronies' disease because exercise of joint after surgery is a standard therapy, is a flawed comparison. What you are proposing would not be much different than watching movies after eye surgery, smelling flowers after nose surgery or listening to music after ear surgery. In Peyronie's disease the lesion or problematic tissue is relatively passive or non-functional relative to sexual activity. Even though it is obviously the primary structure that is involved in sexual activity and it certainly gets involved, in my opinion there is limited and minimal direct therapeutic benefit to masturbation for Peyronie's disease. Having said that I think there is considerable secondary or indirect benefit. Masturbation is helpful not only from an emotional basis, but also due to the increased blood circulation that occurs during any type of sexual activity. I doubt that frequent or occasional masturbation would make a great difference to your eventual recovery, one way or the other, but if it feels good and it benefits you even a small amount then that is probably reason enough to do it.

While exercise to rehabilitate a damaged joint and weak muscles are obviously appropriate and necessary therapy for a bony articulation that is meant to move and muscles that are meant to contract, none of this applies to the corpora cavernosa, corpora spongiosum or tunica albuginea of the penile shaft.

If I have not stated the point clearly enough, allow me another round at it. While there might be small and indirect benefit to masturbation if you have any stage of Peyronie's disease, I am sure the direct therapeutic benefit is only minimal. I get the sense from your question that you had the idea you could "masturbate your way out of PD." To the extent this is what you had hoped, the answer is no.

All sexual activity, especially masturbation, for a man with Peyronie's disease should be gentle, easy and non-traumatic in every way possible. A critical part of being as gentle and easy on yourself is to use an above average amount of personal lubrication to avoid abuse to the involved tissue. Easy does it. If it hurts, even a little, stop doing and never repeat whatever does not feel pleasant to you. One of the worse things you can do for yourself would be to reduce or alter your usual and customary sexual activity simply because you have Peyronie's disease. Many men do this, and it sets up an attitude of defeat and hopelessness that is not beneficial for eventual recover. Go at it, sir, but be careful.

I can tell you a long list of sad stories related to me by teenage boys who developed Peyronies after injuring themselves while using rough and exotic masturbation practices; more 14 and 15 year old virgin boys than you would imagine, who will never have intercourse in their lives if they follow the standard medical advice of "do nothing until I say it is time for Peyronie's surgery."

I have written extensively about the frequent situations in which the use of the PDE5 inhibitor drugs (Viagra, Cialis, Levitra) can precipitate injury to the delicate tunica albuginea of the shaft and lead to Peyronie's disease. You can search the archives for these articles, but a few are "Peyronie's disease plaque, Viagra, Cialis, Levitra and blood supply" and "Viagra, Cialis, and Levitra use with Peyronie's disease," and" Viagra Peyronie's disease connection."

Please let me know if I can help you in any other way. TRH

I have Peyronie’s disease and cannot develop an erection, what can I do?

Posted on April 16, 2012March 18, 2013 by Dr.Herazy

Hi Dr, I have been to a GP and was told i have Peyronies. My penis curves to the left but I cannot have a erection and feeling in my penis is just about null. What do i do to get an erection so at least intercourse is possible ?

Regards…D

Greetings D,

There are many reasons a man might not be able to develop an erection. Penis erection is a complicated process and many things can affect it. To keep this discussion from being a three hour email, I will limit my response only to the single issue of Peyronie's disease as it relates to ED (erectile dysfunction) or the inability to develop an erection.

During the cold winter months I like to warm up the bathroom before taking a shower. To warm the room I will turn on a small portable electric heater in the bathroom 30 minutes before showering to bring the temperature up to a toasty temperature. Sometimes I forget to completely close the door to the bathroom, and this prevents the heat from being trapped in the room. If I leave the door open just a little, only a little heat collects in the room; if I leave the door wide open, no heat collects in the room. Most of the time when I make this mistake my wife will close the door for me (after reminding me I made that mistake again), and I will give her a big hug. But when she does not notice the heater running with the door open I will have take a shower in a room that is cooler than I like.

That little heater does a great job of heating the room if the door is closed. Closing the door is part of the process of trapping the heat that is created. In a way, the door is more important to the room warming up than is the heater because the heater could run all day long with the door open and it never would warm the room.

A similar mechanism happens in the penis to develop an erection. Blood is continually being pumped to all parts of the body, sometimes more and sometimes less depending on activity and needs of the body, but all parts of the body have a continual supply of fresh blood. The penis has a much different kind of blood vessel arrangement than other parts of the body because it can almost immediately trap the blood that is being pumped into it. When this happens it is like the bathroom with the door closed, or like a balloon that has been tied off.

When Peyronie's disease happens, a mass of fibrous tissue called a plaque or scar develops within the layer of the penis known as the tunica albuginea. This scar is not supposed to be there; it is not a normal thing, and the fact that it is there within the tunica albuginea very often makes it difficult or impossible for the veins of the penis to trap blood. You might say that the veins have valves within them, and the fibrous plaque prevents those valves from closing. When the valves do not close, the blood is not trapped and no internal pressure is built up that is associated with an erection. This inability to close the valves of the veins might affect just a small part, or a large part, or all of the penis, causing a small, large or the entire penis to be soft or not erect.

The solution for this problem is not to pump your body full of drugs to make an artificial and temporary erection, because this does nothing for what is really wrong with you (plaque in the tunica albuginea) and it might cause other health problems as a side effect. The solution is to eliminate, if possible and as much as possible, the plaque that prevents the valves from closing that causes the penis to be soft or flaccid (not erect).

To learn how to help your body eliminate the Peyronie's plaque or scar please review the information at "Start Peyronies treatment." TRH

Would a Peyronie’s scar on the surface have the same affect as if it were underneath?

Posted on March 21, 2012March 18, 2013 by Dr.Herazy

I have curvature to the left side and don't feel any bump or Peyronies plaque. I know this means the Peyronies scar can be too small or too large and flat and I've also read that it won't be on the surface of the skin. However, I do see a few little things that appear to be surface scars where my curve starts. Why wouldn't a scar on the surface of the skin have the same effect as if it were underneath? Don't all scars share the same characteristic of not being flexible?

Greetings,

No, a Peyronie's scar on the surface would not have the same affect as if it were underneath.

Yes, all scar formation within the body shares the fact that a greater amount of collagen and fibrin fibers is present that is not as elastic and pliable as normal skin.

Even so, the location of the scar or plaque material does make a difference. It is the hydraulic tension or over-filling with blood within the two corpora cavernosae of the shaft that creates the hardness and expansion of an erection. Each corpora cavernosum is covered by the tunica albuginea (which is normally also elastic) but will not expand as it should when the Peyronie's plaque is present within the tunica. The external skin layer does not participate in that response of creating the erection, even though it does to a degree also expand; even when erect the external layer of skin of the shaft is not especially tight or overly stretched. Only if these were extremely large in comparison to the overall size of the shaft would an external scar cause a distortion of an erection.

I cannot comment on what you refer to as the few little things that appear to be scars on the surface of the shaft. A scar on the surface of the shaft skin not have the same effect as if it were underneath because no blood is trapped in the skin; there is no anatomical mechanism for it to happen. It is the trapping of blood that creates the hydraulic effect, and this takes place only in the corpora cavernosae and nowhere else.

It might be helpful to you to review some basic penile anatomy on the PDI website at "Peyronie's anatomy of the penis and related areas" and "Tunica albuginea and Peyronie's disease."

If you are unable to find the Peyronie's plaque that is causing your distortion, I suggest that you arrange for a telephone discussion and I will work with you to help you locate it. It is essential to good treatment results that you know about the size, location, density and surface features of the scar that is causing your bent penis. TRH

Corpora cavernosa and the tunica albugnea in relation to Peyronie’s disease

Posted on November 23, 2011March 18, 2013 by Dr.Herazy

This is an anatomy question based on the two illustrations from your website.The first illustration of the inside view of the penis is one of the best I've seen. I particularly like the picture in the left corpus cavernosum showing a lattice like structure.

The second illustration has three parts (a,b, and c. Part c shows a penis curving upwards. When looking at the left corpus cavernosum in Part c, there is what appears to be a series of almost parallel squiggly lines. I've seen these lines in numerous anatomy illustrations, but have never (ever)seen anyone actually label what these lines are.

As the tunica albuginea is supposed to be smooth, I find these lines confusing. Do these lines represent the lattice like structure underneath the tunic. Or do they represent veins? Just what are these squiggly lines trying to represent?

Thanks
Rob

Greetings Rob,

Great question; thanks for asking. I always enjoyed the study of anatomy when I was a student; a fascinating and exacting subject that is the basis of understanding disease and our effort to return to health.

For those who do not know the picture Rob is referring to, go to "Peyronies Penis Anatomy," to see the layer of tissue known as the tunica albuginea and the corpora cavernosa.

The wavy or wiggly lines that Rob is referring to are simply what the artist drew to represent the walls that make up the caverns or chambers or cavities of the spongy tissue of the corpora cavernosa. You are just seeing the cut ends of those chambers represents shown in Box B that are shown as wavy lines in Box C because those same structures are shown from a different perspective. These wavy lines are similar to a blueprint of a house where the architect draws a series of straight lines to represent the various walls that make up rooms, hallways, closets and outside periphery of the structure. TRH

Is it really possible that Peyronie’s disease completely disappears?

Posted on August 19, 2011March 18, 2013 by Dr.Herazy

Hello,

Is it really possible that Peyronie's disease actually completely disappears?

One often-quoted study says that 13% of cases improve spontaneously after one year. This, however, includes very small curvature or plaque reduction. However, I have not heard of one single reliable and medically documented story of complete remission. It seems that even if some treatments appear to be effective in reducing or even dissolving the plaque, the tunica can never regain its original elasticity.

Can you give us your thoughts about this please.

Best regards,

Leo

Greetings Leo,

Thank you for the excellent question.

How often, and to what degree, Peyronie's disease spontaneously recovers is such an interesting and important PD topic that I wrote, "Spontaneous Remission and Natural Cure of Peyronie's Disease." You might consider reading this also for additional ideas.

Anyone who has looked for help with Peyronie's disease knows why it has been called the bastard-child of medical practice. No one should be surprised it has never been the subject of investigation to determine the frequency or degree of spontaneous recovery or natural healing. I could not find any information about what criteria is used to determine a complete response to treatment or a spontaneous remission of Peyronie's disease. For example, when all outward signs of cancer disappear after treatment, this is called a "complete remission" or a "complete response." These terms do not necessarily suggest the cancer has been cured. It only means the cancer cannot be detected in a way that it was previously used to identify it. If after treatment the cancer is still present but in a reduced capacity to incapacitate the patient or of a reduced size, it is called a "partial remission." In regard to Peyronie's disease these concepts might also apply, but this has not been worked out clinically for PD. For this reason, the words we use (remission, recovery, response, cure, improvement, complete, partial) are subject to controversy because they have not been defined in relation to Peyronie's disease.

Thus, there is room for interpretation when you ask if Peyronie's disease ever "completely disappears." A consensus would have to determine if a practical (functional) or anatomical (structural) definition of recovery was to be used for Peyronie's disease. Previously I have written, "the average man would not care at all that he had Peyronie's disease if it did not cause a penile distortion that denies him from having sexual intercourse. If the Peyronie's lump did not interrupt sex activity, the problem would be essentially ignored."

While i understand the thought and motive behind asking about a study of spontaneous remission of Peyronie's disease, I believe it is unlikely for the pharmaceutical or medical industries to actually spend money to research if this problem goes away on its own. Their focus is far more likely to be directed toward drug creation or surgical advancements. In preparation for writing this reply I Googled "spontaneous remission cancer" and "spontaneous recovery flu" and could not find any medical studies for those searches. That this information is not available should not be interpreted that these things do not happen, but only that no one yet has taken the time, effort and money – or has a vested interest – to study these topics.

For a majority of men, from a practical or functional standpoint, restoring sexual function would define "complete recovery" if this occurred as a result of direct treatment, or "spontaneous remission" if this occurred without treatment, regardless if the Peyronie's plaque persisted or the tunica albuginea was less elastic. To underscore this prevailing and practical attitude that men take about their Peyronie's condition, I have communicated with many men who have told be that they like having Peyronie's disease because their particular direction and degree of penile curvature increased the sexual pleasure of their partner and thus they saw themselves as better lovers. Their interest in correcting their Peyronie's disease was equally practical and sexually motivated: they were concerned that if the curvature worsened, they would not be able to engage in intercourse. Conversely, from a clinical or anatomical standpoint, restoring previous physical normalcy (external appearance of the shaft, elimination of the internal fibrous plaque, complete elasticity of the tunica albuginea), would define "complete recovery" if this occurred as a result of direct treatment, or "spontaneous remission" if this occurred without treatment. Without these terms being defined it is difficult to communicate accurately.

Yes, I am aware of that study reporting 13% of cases improve spontaneously; others reports suggest up to 50% of Peyronie's disease cases simply go away without treatment. This variation in numbers is probably due to a different set of criteria for determining what degree of improvement constitutes a real improvement or recovery; this is discussed in the 3rd paragraph. Given the nature of the problem It is easy to understand why there is still controversy and revision (usually upward) of the reported rate of occurrence of PD in the general population, to say nothing of the rate of spontaneous remission for the problem.

When I developed Peyronie's disease I struggled frantically looking for a way out of the Peyronie's nightmare. After reading reports of 20-50% spontaneous recovery from PD my thoughts turned in a more positive and productive direction. The pivotal insight that occurred to me was: "If 50% of men heal their own PD, then the body has a cure – even if the MDs do not. All I have to do is increase my immune response to this PD scar in whatever way makes sense to me, and I believe I might be able to heal my problem like those lucky men who spontaneously correct their own problem. Now I am in control." Before that I held the common negative and hopeless victim mentality displayed on many of the Peyronie's forums. This little bit of information so encouraged me and uplifted my thinking, that I eventually developed the treatment protocol that enabled my body to heal my PD problem. This same protocol (now improved in several significant ways) has since been used many hundreds of times by men who learned about it on this PDI website.

From my experience in working with men since 2002 I have used the informal, uncommitted, and long-distance format of the internet, emails and telephone calls. Since I am not conducting formal research, I have no way to control, monitor or verify how anyone is conducting his PD therapy plan. Men do what they want to do. I can only offer suggestions and hope my message gets through. Not only does everyone seem to create a slightly different therapy plan, but each man goes about using his plan in a different way. The non-uniform and irregular application of the ideas you see on the PDI website makes it difficult to evaluate effectiveness or degree of improvement achieved. Not only that, men are notoriously bad communicators about this aspect of their private life. Once Peyronie's disease is eliminated from a man's life he quickly disengages from the problem and happily returns to his previous life, rarely contacting anyone about his success. They gladly try to forget about the condition that so humiliated them and nearly ruined their lives. Men are reluctant to discuss or report on the stigma of diminished size, erectile dysfunction and disfigurement associated with Peyronie's disease. For these reasons the number of men who experience spontaneous improvement of their PD will always be much more speculative than even the number of men who have PD, which is wracked by speculation for the same reasons.

You are correct, there are no formal medical studies of complete Peyronie's remission. But what of those published medical statistics reporting 13-50% of cases that get well without treatment or outside intervention. Is that not more than the medical acknowledgment or the single story of complete remission you asked for? Further, what of the hundreds of urologists and family doctors each day around the world who advise their newly diagnosed Peyronie's patients to "come back in six months to see it it goes away"? Aren't each of these MDs implicitly saying that from their experience they see a sufficient percent of PD cases clear up on their own, thus justifying the standard wait-and-see strategy they all use? "Wait-and-see-back-in-6-months" is part of the standard medical protocol and must exist for some reason; do you think that spontaneous remissions happen often enough to build a treatment protocol around it? I do.

I offer a simple speculation about the condition of the tunica albuginea after favorable Alternative Medicine treatment, because I do not know. The body eliminates to the best of its ability what it does not need. I have a scar on my knee from a childhood injury. Over the years it has slowly faded and now is barely visible. I assume that if there is no useful purpose for the PD scar within the tunica albuginea, the body will pick up the collagen fibers over time. This might not be a fast process like the body removing the cells of inflammation, but it should at least in theory happen if only because the body is designed to eliminate foreign matter. Along that line of thought, I am a retired chiropractor with a highly refined sense of touch developed over 42 years of practice. When I report that I cannot find any evidence of my previous gang of PD scars, you can believe that they are either gone or so dramatically diminished in size. Of course, this is ultimately speculation because surgery would be required to verify the actual state of my tunica.

Lastly, it is difficult to know how to label my particular improvement of Peyronie's disease or the experiences of those men with whom I have worked. They no longer come to the PDI site for treatment information because they are apparently satisfied with their previous Peyronie's problem after following their version of PDI therapy protocol. I do not know if I can say my body eliminated or cured my Peyronie's disease, or not. I do not know if I can say I had a "complete remission" or a "partial remission" because those terms have not been defined clinically.

All I know for a fact is that back in 2002 when I was at my worst, I could easily describe 4-5 different plaque primarily on the left and dorsal aspect of the shaft. My primary distortion was a combination 35 degree curve to the left, a ten degree curve upward, with a counterclockwise rotation. I say primary distortion because twice while I had this combination curve and twist, it was replaced for a few weeks by a severe bottle-neck deformity that made me sick to look at. After following an aggressive and faithful PD therapy plan that I devised over many months, all of that went away. I was able to monitor the slow and gradual reduction of the size, shape, density and surface features of each of those 4-5 plaque. As I observed them slowly fragment and disappear, my distortions disappeared and my lost length and girth returned. Today I cannot find any PD plaque and my shaft is straight. I have worked with many men who have reported various stories along that same basic outline. Of course, some men respond better to Alternative Medicine therapy than others; not all respond well, and some do not get any improvement at all. When I learn of men who are not making improvement I can usually trace it back to a small and non-aggressive application of the PDI therapy concepts that is revealed by meager and irregular purchase of therapies. Conversely, those men who report better results ask more questions, follow a more faithful and aggressive plan of action, and overall seem to be more focused and serious about their eventual recovery.

Back to your original question, "Is it really possible that Peyronie's disease actually completely disappears?" By that question I take it that you mean, "Is it possible that the tunica albuginea returns to a completely normal state after what you call a self-repair, self-healing or spontaneous remission?" To that question l answer that I do not know. I must assume that in order for my curvature pattern to improve, for my scars to be undetectable, for my lost length and girth to have been returned, that some favorable and demonstrable tissue change must have occurred within substance of my tunica. This in turn should have caused the tunica to become more elastic than when it supported the nasty Peyronie's plaque. Speculation, for sure, but logical.

For me, and I believe for the men who come to the PDI website looking for some straight information about what they can do to help themselves get well, I wish to say we do not care if the tunica albuginea completely returns to normal or not. I am satisfied when a man tells me he cannot find his PD scar any longer; that he can have intercourse for the first time in many years; or that his penis is now straight. At this time I am more interested in learning how to more effectively help the men who have Peyronie's disease so they can more quickly and efficiently eliminate their problem, than I am in splitting hairs while defining the words cure, healing, recovery and remission.

Again, thanks for the great question that gave me the stimulus to put a few thoughts on the internet that were not there previously.

Good luck to you and I trust that you are successful in dealing with whatever prompted your interest in this subject. If you have interest in learning about Alternative Medicine Peyronie's disease treatment, please let me know. TRH

Is it possible for the Peyronie’s scar to be that small?

Posted on August 16, 2011March 18, 2013 by Dr.Herazy

Hello,

Please allow me to explain what's going on with me and advise on if I should proceed with treatment.

I've been having painful erections for 6 months now. It was an immediate progression and the pain has not subsided at all. It begins as i'm getting erect and the pain is quite substantial for the first few minutes after which it subsides quite a bit. There is additional pain when I squeeze/flex it…like you would if you tried to stop peeing midstream. This leads me to believe that it's something with the blood stream. The range of motion is extremely limited and is very painful whenever it's moved too much. I'm now at the point where i'm not getting as hard as I used too and part of it is a mental block because I know it's going to hurt. I haven't been able to achieve a full hard erection on my own for a couple months now.

I've gone to my general practitioner and a urologist and left without a resolution. I've searched tirelessly for an answer and peyronie's is the only thing that even remotely fits my symptoms. I've been checked for STD's, did a urine and blood sample, and everything checked out. My hesitancy with the diagnosis is I have no deformity with my penis and I'm unsure of any plaque buildup. There is a very small hardness in the center of my penis when flaccid that is a little painful when I press it. I would relate it to the size of the tip of a ballpoint pen. But it's not rock hard because it still feels somewhat squeezeable. Is it possible for the Peyronie's scar to be that small?

Could I be in the beginning stages and still feel this much pain? Is it safe for me to treat myself as if I have it to see if works? I keep reading about where this could lead and it's quite scary. My experience with traditional doctors has been very frustrating and expensive. The urologist didn't even consider peyronie's until i mentioned it but both doctors checked for it and neither felt any buildup. He said to take some vitamin E and that should fix it. I've been taking an extensive amount for 2 months now and nothing has changed.

'm 32 years old and in great health with an active sex life. I'm extremely concerned with these issues and i feel completely lost in finding a solution…please help.

Greetings,

Your story creates a picture of some poor care.

First some basics about a few statements or observations made about Peyronie's disease in general and your situation in particular. I will just respond back to what you have mentioned:

Peyronie's symptoms can be rather variable from one man to the next. You are having more pain, and more consistent pain, than most men experience with PD, but that does not mean it is not PD. Some men have no pain with their PD condition.
Not having the advantage of having examined you, I can only speculate about the source of your pain. My educated guess is that it is not coming from a blood vessel but from the PD scar pressing on the tunica albuginea and another layer of penile tissue called Buck's fascia which is rick in pain fibers. If you had constant pain, or if your pain coincided with your heart beat I would then consider it could be related to a blood vessel. Both of these tissues I mentioned could be irritated and stimulated enough to generate pain when being squeezed.
You say you left two medical offices without resolution, meaning they did not come up with the diagnosis of PD. What did they speculate could be your problem. Did they just leave you hanging with no ideas, no follow up? So it is you who has come to this possible conclusion of Peyronie's disease on your own after doing some reading on the internet. The fact that you mention your blood work was negative makes a case for not having a serious or life threatening problem going on, my speculation is that this supports PD as a possible diagnosis. Personally, I have to suggest that you go to a third doctor to see if you can find a doctor who will take your problem more seriously than the first two.
Peyronie's disease does not always cause a deformity, especially as early i the problem as you could be at six months duration. Do not expect all cases of PD to demonstrate deformity, or to have it so soon; some do, and some do not.
The small area of hardness you feel when flaccid that is the size of a ballpoint pen tip, could be your PD scar. Did you show the MDs this area? What was their response? Many times a rushed medical examination will miss a small lesion like this. You should have shown it to both of them, and demanded more time and attention to your problem.
Not all PD scars are rock hard. Some are so soft as to be almost undetectable. This is why so many are missed on examination.
Yes, you could have this much pain in the early stages of your problem. It is amazing to me that you could have seen two doctors about your PD and not have been given this basic information.
Considering you were told you have Peyronie's and they only extended vitamin E as a treatment option, it is up to you to determine how you wish to proceed. It is also up to you to determine the safety and appropriateness of undergoing a therapeutic trial of care for Peyronie's disease using Alternative Medicine I cannot make that judgment; you have to take that responsibility for yourself. I have had many men take this approach and were glad that they did.
The PDI website is full of information for you to read and learn. I suggest that you go the PDI website to learn how to start Peyronie's treatment if that is what you decide to do.

Good luck to you and let me know if I can answer any questions as you look into this further. TRH