Can Peyronie's disease cause a "back-flow" that maintains an erection?

Dear Dr Herazy,

I recently had a cystocopy and developed approximately 2 weeks later hardness in the perineal area of corpus carvernosum. The shaft is still unaffected. However because of the hardness that probably reminds of of a reverse bottleneck I have had trouble getting the penis down after an erection. This is particularly problematic during the night where I wake up from the erections and then have to get out of bed to get it down.

My urologist said that I could have developed developed peyronies disease in the perineal area but I have searched the Internet and have not seen any similar cases. The area covered is around 2 inches. Have you heard about something similar including the decreased "back-flow" following the erections?

I am also worried I could develop a priapism from this condition that would make things a lot worse. Can you make an advice as how to move on?

Thank you very much in advance.

Kind regards

C

 

Greetings C,

First of all, I think a few people who read your email would have some questions of his own about some of the terms you used.  So, here is a bit of information about these terms to help understand your email a little better:

1. Cystoscopy – a medical procedure in which a long tube or probe is inserted up into the urinary passage (urethra) of the penis for the purpose of looking into the urinary bladder or the urinary passage, itself.   It sometimes happens that when this is done that the urethra and tissue of the shaft of the penis can become injured, resulting in Peyronie's disease.

2. Perineal area – the region of the very lower part of the pelvis in men that is found between the back part of the scrotum and the anus, and in women between the back end of the vulva or outer lips and the anus.

3. Corpus cavernosum – or corpora cavernosae – one of the two long cylinder shaped masses of tissue that make up the bulk of the penile shaft.  Each corpora cavernosa is covered by a thin tough layer of fibrous tissue called the tunica albuginea that when injured becomes scarred and leads to Peyronie's disease.

4. Back-flow – release of blood that was trapped in the two corpora cavernosa during an erection that creates the hydraulic pressure within the penis to make it expand and hard.

5. Priapism – this is a persistent, and often painful, erection that is considered a medical emergency when it lasts longer than four hours and develops without sexual stimulation.  Priapism occurs when blood in the penis becomes trapped and not able to drain as it normally does. 

OK, now that we have that out of the way, allow me to address a few points you made:

1.  The penis is attached to the front part of the pubic bone in the area directly behind the pubic hair.  If you are an average size male, there is probably 4-5 inches between the point where the penis ends and where the perineal area begins.  These two structures are not connected or related. There is no perineal area of the corpora cavernosa.  Any hardness, mass formation, swelling or abnormality of the perineal area is not related to the penis and is not related to Peyronie's disease. If you truly have a hard mass or lump between the base of your scrotum and the anus I suggest you get it checked out immediately.

2. I know what a bottleneck deformity is in relation to Peyronie's disease, but I have no idea what you mean by a reverse bottleneck.  Please explain.

3. The reason you could not find any reference to Peyronie's disease in the perineal area is that it does not happen that way and it is not possible. 

4.  Your decreased back flow causing persistence of an erection could be related to the mass in your peineal area; for that reason you should see a doctor immediately.

5.  Pripism can occur as a result from many different situations, but not Peyronie's disease:

  • Sickle cell anemia
  • Medications, like Thorzine and Desyrel
  • Illicit drugs (marijuana and cocaine)
  • Trauma delivered to the lower pelvis or spine, or something in that same area causing reduced blood flow 
  • Black widow spider bites
  • Carbon monoxide poisoning

6.   I assume that your doctor did not give you much of the information you have shared here because it is mistaken.  To move forward I suggest you stop trying to figure these things out for yourself and immediately get yourself examined by a competent urologist.  TRH

Would you like me to send you pictures of Peyronie's disease?

Dr. Herazy,

I am not concerned with sex right now and I have no pain, except I have depression from my Peyronie's disease.

It seems I have only two problems. 1) a failure in the integrity of the wall of my penis on the left side. This is at a specific point rather than so much at a curve, even though that is there also when it is more erect. My penis doubles over to the left because of the failure in the shaft wall when not erect. 2) When erect my penis wants to hug the trunk of my body towards the left side.

Would you like me to send you pictures?

 

Greetings,

it is very common for men with Peyronie's disease to feel depressed for a variety of reasons.   For many men this depression arises from the (false) idea there is little you can do to help yourself with your Peyronie's disease and that your life will never be the same.  I suggest you begin spending more time reading and studying the PDI website to overcome this feeling of helplessness that seems to come from the idea that no drug has been found to help PD.  You need to know that the body reverses and corrects PD in a fair number of cases, and for this reason your energy should be focused on increasing and supporting your natural ability to overcome your PD.   Once you understand there is a lot you can do to increase your odds for self-repair and learn more about Peyronie's disease you will feel less scared and depressed.   Once you begin to actually do something to improve your physical condition you will feel empowered and in control of you situation.

There is a great technique I use to help men with their depression, called EFT.   Please go to the PDI website to the page about using EFT for distressing emotional states.  I have worked with many PD men using this technique and the results are often rapid and gratifying. Contact me directly for an EFT session when you are ready to feel better. 

What you describe as a failure of the integrity of the wall of the wall of the penis on your left side is not at all uncommon for men with PD.  This is commonly called a ding, dent,, hinge or pivot.  It can be caused in one of two ways, or a combination of both.  The first is by the abnormal internal tissue tension or pulling from within the shaft by the fibrous PD scar located in the tunica albuginea.  The second is by leaky veins within the shaft that do not close completely because the presence of the PD scar.  You can think of the PD scar acting almost like someone putting his foot in the doorway and preventing door from closing.  In PD the scar prevents the veins from closing, thus no pressure is built up within the shaft.  Without trapping of blood in the shaft the needed hydraulic pressure never develops to create a completely strong erection.  This can happen in just one small area of the shaft that creates the small dent in the side of the penis.   

Your left leaning erection is probably related to both the scar and weak erection on the left side of the shaft. 

There is not any need to send pictures at this time, since PD treatment is not based on the distortion or curve of the shaft.  Treatment is guided by the size, shape, density and surface features of the PD scars that create the distortion.   You must develop an exact knowledge of these characteristics in order to help your PD.   Once you reduce your scars, you will improve the distortion pattern that  bothers you so much.  This physical improvement will greatly help your sense of depression. 

So, i suggest you get busy.  Please get started with a reasonable Peyronies treatment plan that you can find on the PDI website.   If you need help with this, please let me know.  TRH 

Erections and Peyronie’s Disease

Erections can be difficult to develop on demand while in a sexual situation.  Paradoxically, erections can be difficult to stop or inhibit at certain times, especially during sleep.  All of this is important to Peyronie’s disease treatment since erections during sleep can have an adverse affect on progress of care.

A nocturnal, or nighttime, erection occurs because it is important for the basic health of the deep tissue, known as the corpora cavernosa, of the penis.  These deep tissues of the shaft fill with blood and trap it within the corpora cavernosa to create the erect state. If this term, corpora cavernosa, sounds familiar it is because the tunica albuginea is a thin and tough layer of tissue that covers the corpora cavernosa and the tunica albuginea is where the Peyronie’s scar is located.A nocturnal erection can be thought of as type of stretching exercise that takes place during the night when there is little other activity going on, to make sure the penile tissue is stretched and used in this unique way to keep the tissue healthy.

The problem during a nocturnal erection when Peyronie’s disease is present is that restriction and binding of the already-bent erection can be sustained against the penis for a long period of time.  Also, it is important to keep in mind that this added pressure poses a risk of additional injury top the man who already has PD.  For this reason it is important to be careful with an erection when the penis has no comfortable or safe direction to extend itself.   Since it is not possible to stop an erection while asleep, it is smart to not wear tight or limiting underwear or pants while sleeping if you have Peyronie’s disease. It might be even smarter to wear nothing at all while you sleep since this avoids a great potential for binding and restriction.

For the most part, a normally occurring erection that can simply “stand on its own” with no pressure against it, is not going to bind or incorrectly stretch out the penile tissue in a way that is detrimental to the penis.  Problems occur during a drug-induced (Viagra, Cialis, Levitra) or artificial erection, during which an abnormally great amount of blood is drawn into the penis by more soft tissue relaxation than normal.   For this reason it is understood that a naturally occurring erection is safer than an artificially created erection.

Drug induced erections can start Peyronie’s disease

Over the years I have communicated with many men whose PD started after a drug induced erection that stressed the penile tissues by greatly increased internal pressure.  This process would not be much different than taking a car tire that is meant to go no higher than 40-50 pounds per square inch during normal use, and over-inflating it to 100-150 pounds per square inch.  Because it is not built to take that kind of pressure, you could expect some problems to develop in using a tire that way.  Not much different with the penis.

Sexual activity is NOT to be avoided if you have Peyronies, but rough, aggressive, hard sex can be dangerous and really injure the already damaged tissue further. Developing and using a natural erection is not to be avoided either in Peyronie’s disease.  However, it is important to keep your wits about you and do not go wild during sex.  The emphasis should be on an easy, smooth and gentle sexual encounter.  Any sexual activity or posture that causes pain should be avoided.

Many important related topics about taking care of yourself, avoiding injury, doing nothing to set your progress back while you are attempting to heal your problem, are covered in my book, “Peyronie’s Disease Handbook.”   Check out the website about this book at  http://www.peyronies-disease-help.com/PD-owners-manual.html I think you would enjoy learning more about what you can and should do to take care of this nasty problem.

Viagra, Cialis and Levitra Use with Peyronie’s Disease

Peyronie’s treatment using erection producing drugs

The erectile dysfunction and soft erections associated with Peyronie’s disease are sometimes treated with Viagra, an erection causing drug made by the Pfizer Pharmaceutical Company.  The information about Viagra duplicated in this blog post is written by Pfizer about Viagra, in relation to Peyronie’s disease.   The basic information presented by Pfizer is essentially true for other erection producing drugs, like Cialis and Levitra.

Here is the Viagra drug information from Pfizer, found their website.  I have removed a considerable amount of technical Viagra information that does not apply to Peyronie’s disease to make it easier to find what you need to know. Notice the section below that I have put in bold and underlined.

PRECAUTIONS

General

The evaluation of erectile dysfunction should include a determination of potential underlying causes and the identification of appropriate treatment following a complete medical assessment.

Before prescribing VIAGRA, it is important to note the following:

The safety of VIAGRA is unknown in patients with bleeding disorders and patients with active peptic ulceration.

VIAGRA should be used with caution in patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis or Peyronie’s disease), or in patients who have conditions which may predispose them to priapism (such as sickle cell anemia, multiple myeloma, or leukemia).

The safety and efficacy of combinations of VIAGRA with other treatments for erectile

dysfunction have not been studied. Therefore, the use of such combinations is not recommended.

In humans, VIAGRA has no effect on bleeding time when taken alone or with aspirin. In vitro studies with human platelets indicate that sildenafil potentiates the antiaggregatory effect of sodium nitroprusside (a nitric oxide donor). The combination of heparin and VIAGRA had an additive effect on bleeding time in the anesthetized rabbit, but this interaction has not been studied in humans.

Use of any drug to assist erections in Peyronie’s disease

It is my opinion that any man who is undergoing Peyronie’s disease treatment is taking a huge risk to use any of these erection producing drugs because it has been my observation and experience in talking to hundreds of men about their Peyronies problem, that these drugs can injure the penis and actually start Peyronie’s disease, make it worse, or possibly delay or interfere with your effort to try to heal your Peyronie’s plaque.   This happens because of the damage done by the surprisingly strong and uncontrollable erections these drugs can create.

With the use of these drugs it is possible that the forced erections they cause can place great internal stress within the penis that can injure the delicate tunica albuginea.  The erections created by these drugs can be indeed super-erections, greater than what a man normally experiences.

I have had a number of men tell me they are convinced their Peyronie’s disease started after using Viagra, Cialis, etc.   I am confident that at a later time we will start to hear reports about more side-effects of these medications.  This should not be so difficult to believe when you can read for yourself that the drug manufacturer is already warning men in particular with Peyronie’s disease to be cautious about its use.

Peyronie’s disease aggravated easily

Super-charging an erection is not the way the body was designed to be used.

What if you could take a drug that would enable you to lift a ton of weight above your head and keep it there for an hour?  Nice trick, very impressive, but your body is not built to take that kind of pressure to the muscles, ligaments, joints, bones and blood vessels.  A trick like that would cause great damage to internal organs, your spine, blood vessels, all major joints, etc.  Simply put, “It just ain’t natural.”  Same with these erection drugs like Levitra and Viagra.  The increased pressure created by these medications can be very damaging to the delicate tunica albuginea, and can result in or worsen a case of PD.

What would happen to your car tires if you happened to over-inflate them with 100 pounds of air pressure, even though they were built to take just 40 pounds of pressure?  You would be running the risk of damage to the internal structure of tire, wouldn’t you?  Of course.  The same thing can happen if the penis is over-inflated and then given a “rough ride.”  This is where the problems start, and this is what I want to bring to your attention.

Viagra, Cialis and Levitra are not a Peyronie’s treatment

It is very likely that the MDs who prescribe these medications to men with Peyronie’s disease will not agree with this thinking.  MDs tend to favor a chemical “fix” to most problems, so you would tend to expect a natural and automatic prejudice from an MD to use drugs to solve most problems.

If you have taken Cialis or any other erection producing drug because it was prescribed for you, and you mention this information to your MD, what do you suppose he or she will say?  Well, the first thing you must consider is that this information indicates that your doctor prescribed something for you that was not safe or appropriate.  The natural reaction would be for your doctor to immediately defend her decision.  That makes sense.  It is not my intention to make trouble for your doctor, she was only doing what she thought was best for you.  It is my intention for you to independently think about these things and see if they make sense to you, the owner of the penis that could become injured.  Do more research on your own, then talk to your doctor.  This way you are armed with both sides of the story.

It is my further intention to prevent you from injuring yourself further with these erection producing drugs.

A penis that is predisposed to Peyronies in the first place cannot tolerate the kind of stress that these erections drugs create.  It is just like someone with asthma cannot tolerate dust, odors or smoke that does not bother other people.  If you already have Peyronies you should do everything you can to avoid any kind of stress to this tissue, including avoidance of erection producing drugs.

I talk to a lot of men who are given a prescription for Viagra, etc. to help their sexual difficulty, and they instinctively know that this treatment does not make sense to them.  Yet, they are tempted to use the drug because of the promise of improved sexual performance; besides, they are also tempted because they feel, “Heck, my doctor would not do anything to hurt me, maybe it is OK to do.”  I would agree, your doctor would not want to hurt you intentionally.  Yet, we all know that tens of thousands of people are hurt each year by drugs that are given with good intentions and bad consequences.

In addition, I have talked to many men who have reported to me that they used these erections drugs many times, maybe for several months, with absolutely no problem.  The erections were “normal” and controllable, and everything was fine, and the sex was great.  Then, one night, one time, they took that same drug in the same way, and they got an erection that was unbelievably hard and huge, and they thought they were going to explode.  It scared the devil out of both partners.  A few days or weeks later – a curved penis and Peyronie’s disease developed.

If you attempt to think independently and logically about what might happen to your Peyronie’s disease when these drugs are used, you should have no trouble understanding how this could work against you.  If your doctor can convince you that they are perfectly safe, then you should do what your doctor says to do. Just remember, who that penis is attached to if a tragedy happens.  Your doctor will shrug his shoulders; you will have a worse case of PD.

My opinion is that the use of Viagra and similar erection drugs could easily be worsening the very problem you are attempting to heal.   The use of these drugs represents a calculated risk that you are taking, and you should be aware of it.

Please write a comment or question about this article if you want to know more about Peyronie’s disease treatment with Viagra, Levitra or Cialis.

How an Erection is Affected by Peyronie's Disease

Peyronie’s Disease Stops Normal Erection Mechanics

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An erection is the stiffening or hardening with enlargement of the penis that periodically occurs upon a sexual and non-sexual stimulus. The primary purpose of an erection is sexual intercourse.  The curved penis of Peyronie’s disease occurs when this process is interrupted or impaired by the presence of the Peyronie’s plaque material.

There is a direct, safe and effective technique for manual stretching of the curved penis of Peyronie’s disease that has been researched and developed by PDI.  For details, click on stretching curved penis.

View graphic pictures, click on pictures of Peyronie’s disease and Peyronie’s pictures

If your Peyronie’s penis is causing sexual distress, you might be interested in the in-depth and detailed discussion and loads of helpful information found in Dr. Herazy’s   second book, “Peyronie’s Disease and Sex.”

The complex erection mechanism can start in either the brain (a thought), the penis (a touch), or the bladder (when filled). Upon stimulation a beautifully intricate and balanced reaction of nerve messages occurs between the brain and the reproductive organs. The first thing to happen to the penis is a message is received from the brain. This message causes nitric oxide to be released from the tissue of the penis. Nitric oxide in turn causes the same cells of the penis to produce cyclic guaosine monophosphate (cGMP). This chemical, cGMP, has the ability to cause rapid relaxation of both the arteries of the penis and the smooth muscles that line the network of small interconnected spaces of the corpora cavernosa and corpus spongiosum. This relaxation response has an expansive and enlarging effect on the penis, because it causes more blood to flow into the penis and it is “loosened up” to receive and hold the extra blood that is being shunted to it .

Going up

Blood quickly enters the network of erectile tissue spaces as this relaxation continues along the length of the penis. A small amount of blood enters the corpus spongiosum, but the majority of it engorges the corpora cavernosa which expand to hold 90% of the blood involved in an erection.

As more and more blood enters the relaxed spaces of the penis, the expanding spongy tissue presses against the firm tubular connective tissue sleeves known as the tunica albuginea and Buck’s fascia. This increased pressure in turn pushes against veins that normally let blood out of the cavernous and spongy spaces of the penis, compressing and closing their valves. Now with the veins closed off a greater and greater amount of blood is trapped in the penis. When the three penile chambers are filled with blood the penis is at its maximum length, diameter and rigidity, and is said to be erect.

The glans or head of the penis, the mushroom-like end of the corpus spongiosum that sits like a cap on the end of the penis, remains more soft and pliable during erection because its tunica albuginea is much thinner than elsewhere in the penis. This thinness of the tunica at the head of the penis does not allow it to develop the rigidity that other parts of the penis achieve. Of course this is a good design feature, since the relative softness of the glans protects the cervix of the uterus during intercourse.

Going down

After ejaculation, or upon loss of mental or physical stimulus, the brain stops sending signals to the penis to release nitrous oxide. With loss of the nerve signal and subsequent chemical release, the flow of blood is reduced, the pressure drops, the vein valves are no longer held closed and so open up to release blood, and the erection ceases. The penis returns to its normal pre-erectile size and flaccidity.

A simple balloon can give you a better idea of how an erection works: Before you blow up the balloon, the balloon wall material is very soft and flexible. Put a little air into the balloon and it begins to change shape by filling, making the balloon larger. As more and more air gets trapped inside the closed space of the balloon, it continues to become more rigid and large, until a limit is reached. After this certain limit point the previously flexible balloon material gets surprisingly tight and rigid. To keep it rigid you tie off the opening, and to reduce the rigidity you untie the opening.

Click on “Peyronie’s Disease and a History Lesson” to completely change the way you think about Peyronie’s treatment.

Peyronie’s disease and leaky valves

PD causes a problem with the erection mechanism because the vein valves “leak” and cannot build up sufficient pressure to create a full erection, due to interference from the scar or plaque tissue in the tunica albuginea. Its as thought the scar tissue blocks the closer of the vein valves, just as a kink in a car door keeps the door from closing completely, or not at all. As improvement occurs in the size, shape and density of the PD scar as a result of successful therapy, one of the first observable changes will be in the quality of erection response.

And this is why we contend, as you will read in other parts of this website, Peyronie’s disease is all about the scar.

For an interesting PD therapy discussion, click on Heads You Win, Tails You Don’t Lose with Peyronie’s Treatment.

Curved Penis and Peyronie’s Disease

Peyronies bent penis is focus of problem

While the primary interest of Peyronie’s disease treatment is the internal scar tissue or fibrous  plaque material that causes the distortion or curved penis to develop, it is not the primary interest of the man who has PD.  For him, the most important aspect of Peyronie’s disease is the curved penis that plagues him.  For this reason Peyronies is also known as the “bent nail disease.”

For those interested in viewing graphic pictures, click curved penis of Peyronie’s disease.

Peyronie’s disease causes a curved penis when the fibrous tissue of the Peyronie scar or plaque pulls unevenly or causes incomplete filling within the erect penis.  This can vary in degree or severity from man to man.  For this reason the curved penis does not indicate the severity of the Peyronies problem or success of Peyronies disease treatment.  The true success of Peyronies treatment is based on the change that occurs in the Peyronies plaque or scar.  Once the fibrous scar changes, eventual improvement in the curved penis can be expected in time.

The internal tissue of the healthy penis is flexible and expandable.  This normal tissue is able to allow for a normal erection to develop when blood is trapped inside the organ.

In Peyronie’s disease some of the tissue is not healthy or flexible and elastic.  Specifically, the deep tissue known as the tunica albuginea is not elastic because it replaced by dense and inelastic fibrous tissue that is called a scar or plaque.   As an erection develops the elastic tissue of the tunica albuginea must stretch and expand evenly on both sides, left and fright, and top and bottom, of the penis.  If this cannot happen because an area of the penis is no longer flexible and expandable, then a curved penis results.

Peyronie’s disease usually begins with a small nodule or bump that is found on the top or sides of the penis, just immediately below the surface.  A few weeks to several months to a year later, a small fibrous nodule can expand into a larger irregular scar of variable size, shape, density and surface quality.  These scars can be as long as the penis.  Some appear like a collar to go around the shaft.   Some are one large mass, while others appear to be like small isolated islands of fibrous tissue in many areas.   Scars can be so soft or small, with edges so tapered and vague that no scar can be found.  In a case of Peyronie’s disease when no scar or plaque can be found, it is still assumed to exist when a curved penis develops during erection. .

Normally curved penis

Most men have a straight erection, but some are born with a penis that curves or bends (usually upward).   Just as fingers on the hand or a nose can display a natural bend, or arms can be of different length on the same person, the penis can be bent without the presence of Peyronies.  Typically, the normally curved penis follows a more gradual and arched design, more like a banana.  In Peyronie’s disease the curved penis is more localized and abrupt, like an angulated bend.

When the two primary chambers (corpora cavernosa) of the penis are a different diameter or length, the penis will bend when erect.   The penis will appear straight when flaccid, and on erection it will bend.

This slight penile distortion will not be associated with pain, there will be no trauma in the history, and it will not appear suddenly as does the curved penis of Peyronie’s disease.

Curved penis affects sexual intercourse

It is estimated that 75-90% of Peyronie’s disease couples will sooner or later experience a sexual intercourse problem, in regard to either pain or difficult penetration – or both.   The curved penis of is the primary reason sexual penetration is compromised, and it is also the reason for the pain that can be experienced by either – or both – partner. This is especially so in those cases in which the distortion is so severe it is described as “cork screw” or “cane handle.”

Incomplete filling of the penis with blood during erection can also happen in Peyronies.  This results in an area of the penis, either small or large, that is soft and unable to sustain the rigors of intercourse.  A soft area within an otherwise firm erection presents a weakness and vulnerability of the normally turgid erection.  A weak area of erection can suddenly collapse or buckle during intercourse, causing additional injury to the penile tissue.  This can cause pain, inflammation and additional fibrous infiltration.

It is a rare Peyronies couple that does not deal with some level of sexual difficulty related to penile distortion and reduced firmness of the erection.  The many physical, emotional and social issues of Peyronie’s disease are complex.  For this reason the reader is referred to “Peyronie’s Disease and Sex” for more information about this complicated area of life with a curved penis.

Treatment of the curved penis

It is important to remember that any penile distortion that develops in Peyronie’s disease is not the primary problem of this condition.   A curved penis that appears one night is difficult to ignore, but is only a symptom of the real problem of Peyronie’s disease – the scar. Without the Peyronies scar there would be no curved penis.

This is the reason I advise men who are undergoing Peyronies treatment to focus on the size, shape, density and surface qualities of the scar or plaque to determine if their Alternative Medicine treatment is being effective.  The curvature can improve or worsen as the scar is reduced.

A small scar can cause a large bend, just as a large scar can cause no bend at all if it is balanced and symmetrical.   For this reason a curved penis can worsen as the scar is being reduced or eliminated.   Estimating progress or success of a PD therapy plan is difficult .  A man can have many more scars than he is aware of, and they can be larger than can be detected since they are often difficult to locate and often overlap.

If only one scar is present the curvature problems are direct and easy to understand, although  this is unusual.   However, if multiple scars are present the internal pulling and twisting they cause can be very complicated.   Several scars can interact on many  planes of internal penile tissue.   Any reduction in one or more scar will alter the internal tension and pulling of the tissues, resulting in an altered curvature.  There is no guarantee the curvature will change for the better initially – sometimes it can look worse as the scars become smaller.  This is why 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 what is going on with the scar9s) below the surface.

Do not be discouraged by the curved penis of Peyronie’s disease.  Instead, stay focused on your plan for effective Peyronies treatment.  Learn more about Peyronie’s disease treatment.

Peyronie’s Disease and the Erection

Peyronie’s treatment and how to care for erections

An important consideration of Peyronie’s disease treatment concerns how the ability to develop a normal erection will be influenced.

While erections can be difficult to develop on demand during a sexual situation, paradoxically, an erection can be difficult to stop, especially when it develops while asleep.  Nocturnal (nighttime) erections occur for a reason, and they are important for the overall health of the spongy tissue of the corpora cavernosa and corpora spongiosum (deep tissues of the penis that fill and trap blood to create the erect state).

It is as though the body takes the opportunity to develop an erection during the night when there is little other activity going on, to assure that the penile tissue is stretched and used in this particular way for its own benefit.  The problem with a nocturnal erection in Peyronie’s disease is that confinement and binding of the erection can be sustained against the penis for a long period of time at the risk of additional injury.  Be especially careful about getting an erection during a time when the penis has no comfortable place to go – do what you can to avoid an erection while wearing tight underwear or pants.

For this reason it is important to not wear tight clothing to bed in order to avoid this problem.

For the most part, a normally occurring erection that can simply “stand on its own” with no pressure against it, is not going to bind or stretch out the penile tissue to any great excess that is going to be detrimental to the penis. Where you can get into trouble is in creating a drug-induced (Viagra, Cialis, Levitra) or artificial erection, during which an abnormally great amount of blood is drawn into the penis by more soft tissue relaxation than normal.  So in this way we see that a naturally occurring erection is safer than an artificially created erection.

Over the years I have communicated with many men whose Peyronies disease started after a drug induced erection that stressed the penile tissues by greatly increased internal pressure.  This process would not be much different than taking a car tire that is meant to go no higher than 40-50 PSI during normal use, and over-inflating it to 100-150 PSI during use.  Because it is not built to take that kind of pressure, you could expect some problems to develop in using a tire that way.  Not much different with the penis.

Sexual activity is NOT to be avoided if you have Peyronie’s disease, but rough, aggressive, hard sex could really hurt you.  Developing and using a natural erection is not to be avoided either in PD.  Just keep your wits about you and do not go wild during sex.  The emphasis should be on an easy, smooth and gentle sexual encounter.  Anything that causes pain should be avoided.

Many important related topics about taking care of yourself, avoiding injury, doing nothing to set your progress back while you are attempting to heal your problem, are covered in my recent book, “Peyronie’s Disease Handbook.”   I think you would enjoy learning more about what you can and should do to take care of this nasty problem.

Peyronie’s Disease Impotence

Peyronie’s Impotence facts

There are several reasons why Peyronie’s disease impotence (erectile dysfunction) develops in about 75 percent of the men who have this condition. Peyronie’s disease impotence can be mild or total, it can be occasional or constant, but it is extremely common for men with Peyronie’s disease to experience sexual intercourse performance problems or alteration of erection strength.

Impotence is defined as the continual inability to sustain an erection long enough or strong enough for sexual intercourse or the inability to achieve ejaculation, or both. Peyronie’s disease impotence is the erectile dysfunction that develops due to abnormal changes in the penis that are part of Peyronie’s disease.

Most people assume that Peyronie’s impotence develops due to lack of blood flow to the organ. This might be true in especially in those cases in which the man has an underlying problem with the cardiovascular system (high blood pressure, elevated cholesterol, vascular disease, diabetes, etc.) In other men , another occasional cause of Peyronie’s disease impotence is emotional. Because of the reduced self esteem, shame, embarrassment and anger related to penile distortion and reduced length and girth of the organ, a man can develop strong emotional reactions expressed as Peyronie’s impotence. However, for most men the primary cause of Peyronie’s disease impotence is simply due to what is known as “venous leakage.”

Peyronie’s impotence fundamentals

In a great number of cases of Peyronie’s disease impotence the fundamental problem is that the blood is no longer being trapped by the veins of the penis to dam it up to create the greater fluid pressure of an erection. The problem is that the veins of a man with Peyronie’s disease do not close to trap blood well. This imperfect or absent closing is caused in great part by the presence of the Peyronie’s scar. The scar acts like something that is blocking a door from closing. That is where therapy should be directed in Peyronie’s disease impotence – toward removal of the scar so the veins can close to allow a normal erection to develop.

One of the easiest and most effective ways to directly treat Peyronie’s impotence is with an Erektor. An Erektor is an external penile support device that offers just enough gentle support to the penis – even without an erection – to hold it for easy penetration to allow intercourse to continue as long as the couple desires. The Erektor allows men to perform full quality intercourse without erectile medications or supplements. Unlike ED medications, the Erektor is safe because it has no drug side effects.

The Peyronie’s Disease Institute is proud to be the only company to serve as an authorized distributor of the Erektor. For those couples who must deal with the frustration of Peyronie’s disease impotence, the Erektor is often the only thing that helps.

Please go to our sister website known as Natural ED Solutions to learn more about the Erektor and get some real help for your Peyronie’s impotence.

Cause of Peyronie's disease

How Peyronie’s disease starts

As anyone who has the problem knows, the cause of Peyronie’s disease is not well understood.  However, any research topics that shed light on this basic question are of great interest to men who have Peyronie’s disease.

Perhaps a good question to start with is, what causes the erect penis to bend in a case of Peyronie’s disease?  The answer lies in the function of the corpora cavernosa functions in the mechanism to produce an erection. There are actually two corpora cavernosa, laying side by side like two cigar shaped, paired balloon-like chambers that must be filled with blood to create an erection. Their connective tissue wall, the tunica albuginea, offers resistance and rigidity when it is stretched to its maximum.  The tunica is elastic to a point, but unlike the thin and flexible wall of a balloon, the tunica albuginea is interlaced with strong connective tissue fibers. These strong fibers do not allow for much expansion, and eventually determine the shape of the erect penis because of their structural rigidity.

Thus, in a very real and fundamental way, Peyronies disease is a disorder of the tunica albuginea. By producing dense and rigid areas of the tunica, called Peyronie’s plaque or scars, Peyronie’s disease interferes with the full expansion of the tunica. Plaques are either regions of reversible inflammation in early phases of Peyronies, or permanent scars later if the inflammation is severe and continues too long.  Much like a piece of tape placed on the wall of a balloon, the plaque or scar causes uneven filling and expansion of the tunica, and this causes bending  of the column of the corpora cavernosa.

A basic question is, what causes these plaques to begin?  Microscopic and chemical studies show that plaques represent an early stage of the wound healing process when the tunica is injured. Whatever starts Peyronie’s disease, the problem seems to the inappropriately increase of the normally healthful and proper process of wound repair.  Actually, wound healing may not be the appropriate term in all situations.

Most likely cause of Peyronie’s disease

One cause of Peyronies disease is obvious and direct trauma to the erect penis. This trauma can range from sudden and unexpected angulation during sex, to am actual rupture of the corpora cavernosa.  However, the fact is, many men with Peyronies do not recall any such traumatic occurrences.

Over time, all sexually active men will experience some degree of wear and tear on vulnerable areas of the soft tissue erection mechanism. Both the structural arrangement of the corpora and the inherent elasticity of its connective tissues counteract the strong mechanical stresses created by strong sexual activity.  But when men reach their mid-fifties, fundamental connective tissue elasticity throughout the body, and the penis, is on the decline.   And so, it just so happens that the average for appearance of Peyronies disease is fifty-four.

Peyronies plaques most often appear along the top surface of the penis. It is this region where the two corpora meet side by side, along the upper edge of the “inflatable I-beam” created during an erection that is most vulnerable to stress induced delamination.  Another word for a layer is a lamina; when layers are disrupted or separated, it is called delamination.

Autopsy studies in the mid-1990s on men have shown the earliest microscopic changes thought to be early Peyronies disease changes are actually a common finding.   It seems that while many men develop these changes, they will evolve into Peyronies plaques only for a small percentage of cases.

So what causes the process of normal wear and tear to develop abnormally into the destructive process of wound healing that is called Peyronie’s disease?  There are no clear answers to this question.   However, Peyronies disease is more common in diabetics, as well as men who have gout.  These are two conditions that can have an adverse affect on normal connective tissue healing. It is also more common in the presence of Dupuytren’s contractures. These scars of the fascial covering of the finger tendons in the palm of the hand are thought to be inherited, and may reflect an abnormal tendency toward scar formation in other areas.

Thus, we see that much is still to be learned about Peyronie’s disease, but as these microscopic tissue clues are unraveled, the mystery of this problem will be advanced, as well as Peyronie’s disease treatment.

Peyronie’s Disease Plaque, Viagra, Cialis, Levitra, and Blood Supply

Different way to look at Peyronie’s disease and blood supply

Peyronie’s disease is all about the Peyronies plaque, because the Peyronie’s plaque causes all the problems we normally associate with this condition.  To back this idea up, and to show you are doing something that is potentially dangerous to your Peyronie’s disease by using erection enhancing drugs, let’s review some interesting research that took place about 15 years ago.

First, some background.  According to two Peyronies disease researchers, Drs. J. A. Lopez and J. P. Jarrow, from the Department of Urology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina, most of the erectile dysfunction that is associated with Peyronies disease is probably not due to reduced blood supply coming into the penis.  Hence, taking Viagra, Cialis, Levitra, or any erection producing drugs, is often not effective and when it is it could be dangerous when someone with PD takes any erection producing drug.

Let’s get through the technical material first and then I will put it all together as it relates to using these drugs because you have Peyronies.

In the study done by Lopez and Jarrow, they did a penile vascular (blood flow) evaluation; they tested the penis arteries (to determine blood flow coming into the penis), and they tested the penis veins (to determine the blood flow leaving the penis).

They tested 95 consecutive men who came to them for evaluation or treatment of Peyronie’s disease; of these 95 men, 19 were potent (able to become erect) and 76 were impotent (not able to become erect).  They also did the very same kind of penile vascular (blood flow) evaluation on 100 consecutive impotent men who did not have Peyronie’s disease so they could compare the condition of their blood vessels as it relates to erections and erectile dysfunction.

Potent men with Peyronie’s disease

After testing the 19 potent men who had Peyronie’s disease, they found only one (5%) of the 19 potent patients had abnormal arterial blood flow coming into the penis, and none (95%) had evidence of abnormal venous blood supply leaving the penis.

Impotent men with Peyronie’s disease

After testing the 76 impotent men who had Peyronie’s disease, they found that 27 men (36%) had abnormal arterial blood flow coming into the penis, and 44 men (59%) had evidence of abnormal venous blood supply leaving the penis.

Potent and Impotent men who did not have Peyronie’s disease

There was no significant difference in historical risk factors for impotence between the impotent men with or without Peyronie’s disease and the control population of impotent patients.

After testing the 100 men who did not have Peyronie’s disease they found they had about the same percent of abnormal arterial blood flow coming into the penis.  However, they found these same men had significantly less (16%) abnormal venous blood supply leaving the penis.

So the big difference was that the impotent men (59%) with Peyronie’s disease had a whole lot more abnormal venous blood supply leaving the penis, than the impotent men (16%) who did not have Peyronie’s disease.

This means that although men with Peyronie’s disease may suffer some impotence due to artery blood flow problems, the research proves that the primary and overwhelming cause of impotence in men with Peyronie’s disease is abnormal venous blood supply leaving the penis.

So you ask, “What could be wrong with my venous blood flow leaving my penis?”  Answer:  your Peyronie’s plaque.

Peyronie’s plaque causes impotency

It is the Peyronie’s plaque that causes the veins of the penis to not close properly. Click here to understand a bit about Peyronie’s disease and erection.

There are special valves within the veins of the penis that close off at special times, to trap the blood inside the penis – to create an erection.  If the veins do not trap the blood, no erection.  The presence of the plaque or scar material is the problem that causes the valves of the veins to not trap blood, hence a poor or absent erection.  Yes, there are surely many emotional reasons a man with Peyronies will develop impotency, but this vein problem is by far the primary physical reason for this erection problem that we all are interested in.

Imagine that you want to close a door to trap warm or cold air inside a room.  You try to close the door, but you cannot because there is something causing the door to not close all the way – perhaps the door is warped, or maybe there is something lying across the doorway like a doorstop and the door will not seal the room shut.  If the door cannot be closed fully, it will be difficult or impossible to close the door, and you cannot trap the air in that room. It is the same in Peyronie’s disease. If the valves of the veins cannot be closed fully, it will be difficult or impossible to close them, and you cannot trap the blood to create the erection.

The presence of one or more Peyronie’s disease plaques or scars can and will cause physical interference with the normal closing of the valves inside the penis veins and one or more areas of the penis stay soft, preventing intercourse.  It is as simple as that.

So your medical doctor, hearing that you are having a problem with impotence along with your Peyronie’s disease says to you, “Do not fear.  I have my magic prescription pad here.  I will happily write a prescription for  Viagra, Cialis, or Levitra and you will get an erection that will amaze and delight the woman you love, and amaze all your family, friends and neighbors.  Please pay the nurse at the front desk as you leave.”

Elsewhere I will write more about the potential dangers of erection producing drugs like Viagra, Cialis, and Levitra in relation specifically to Peyronies.  For this discussion it is sufficient to state that Viagra, Cialis, and Levitra only bring more blood into the penis.  The do not and cannot help you to trap it there to create an erection.  This is why they may or may not work for you, and in fact, could potentially make your Peyronie’s disease worse.

For more information about the safe and effective treatment of Peyronie’s disease with Alternative Medicine, go to the Peyronie’s Disease Institute website.