Since one patient's inquiry may provide information to another, Doctor Gelbard is opening an anonymous public forum as an online exchange for the questions of patients, physicians, and family. Hopefully this will become a place to share your concerns and experiences. Submission to this Forum implies your consent for the material and commentary to appear on the site or in subsequent educational publications. The doctor's commentary is intended to be educational information for the public, not individual medical advice. The unique background of each person must be considered when making medical decisions, which requires a specific history and examination. Topics submitted from all sources will be posted anonymously unless specifically requested to the contrary.

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04/16/2014 - 17:21
What should my next step be?

I was diagnosed with PD one and a half years ago. Back then the hospital suggested Nesbit tretment, but I was not much affected so I declined and they did not suggest any oral or other treatments. However after reading on the net I took E vitamins for a while, and then it got worse. 90 degrees upward bend and the plaque moved from lower end to the glans and left a string all the way. Now I am sceduled for incision of the string and grafting at our main national hospital. Recently I read that incision is a suboptimal method that not deals with the plaque itself and that I should seek excision and removal of all the plaque. Which way to go?

Originally, graft procedures were performed after total excision of the plaque - recall that the plaque is just a scarred portion of the erectile chamber wall, so this meant removal of part of the wall.  These procedures had an unacceptable rate of post operative impotence.  Over time the technique has been modified to leave the wall in, and graft (multiple) relaxing incisions of the deforming scar.  It gives better results so I would say no, total excision of the plaque is not the way to go.  MG
BY THE WAY... We are in the process of upgrading and in the process the forum has been temporarily overwhelmed by spam.  This is the reason for the lack of recent postings & responses.  MG

04/16/2014 - 17:26
Xiaflex, length and girth

Hi there, I was wondering whether treatment with xiaflex has been shown to have any effect on length and or girth? I'm assuming that as the plaque softens, the penis will be able to extend further as it used to before the onset of the condition? Also, I've seen you mention that PD shouldn't affect blood flow, but my gland is now far less erect than previously, what could be causing this and what could help relieve this? Thanks

We have seen patients with hourglass or areas of girth loss improve with Xiaflex.  Although length restoration or gain in clinical trials was not statistically significant compared to controls, there have clearly been some Xiaflex patients where some part of lost length was restored.  Lack of glans filling can be due to distal constriction of the shaft with loss of distal girth. MG

04/16/2014 - 17:30
very weird shape of my penis

Im 33, and im circumcised.. my penis is about 8 inches long when erect, but when erect its shaped like a l pointing downwards, or a hook is more like it, its been this way for as long as i can remember.. let me plz emphasis it goes out about 3 inches then str8 down,, and for its length does me no good when having sex, its a constant battle to keep it in the vagina no matter what position i try.. if i do anything other then keeping it in all the way and short thrusts while in it just pops out... i really would like to know how much of a problem this is and what i can do to fix it.. ty very much for your time..

This is congenital curvature or so-called Chordee, not PD.  It can be fixed quite effectively using nesbit plications by an experienced reconstructive surgeon. MG

04/16/2014 - 17:37
regaining length

I've had Peyronie's Disease for over 2 years. I took Pentox daily for the first six months along with L-Arginine and Vitamin E. The pain diminished after the first few months but the curvature and hour glass effect worsened. It seems like there was a hinge on the top mid way down the penis shaft. I was not sexually active at the time I got Peyronie's and have avoided intimate relationships out of insecurity and embarrassment. I didn't experience ED but did have occasional erections that did not seem full. I went to another Urologist that told me to discontinue the Pentox. After about one year the curvature seemed to lessen to about 30 degrees, the hourglass effect went away and my erections seemed firmer. Then I noticed that I had lost about 1.25 inches in length. Although, I still have enough length for intercourse, my self confidence and image has prevented me from pursuing intimacy. My question is whether Xiaflex would help restore the lost length? I bought a vacuum device and a traction device but neither were easy to use on a daily basis and I feared doing more damage.

In combination with stretching exercises ( or vacuum device / traction device ) Xiaflex has better potential for  partial length restoration than any other treatments.  Surgery of any type usually causes shortening. MG

04/16/2014 - 17:41
PD after small penile fracture

Hello, I'm a single 35 year old man. Nine months ago during sex with the female on top, she made a wrong movement and i felt a short but heavy pain. The penis remained hard and didn't turn blue or swollen. The next week I felt only burning pain during urinating. After 2 weeks I felt a small lump on the right side of my penis and pain during ejaculation. I went to the hospital and they saw a hematoma and i was diagnosed with a small penile fracture (of the right corpus cavernosum). The treatment was conservative, no surgery. During the weeks after it got worse, deformity, loss of elasticity. I started with pentoxyfilline, still taking it. Presently I'm receiving extracorporal shockwave therapy. Recently my penis while erect bents to the left, starting from the base. I think this is peyronie's. I'm finding it difficult to deal with. I can't seem to accept what happened. I recently started taken vit E as well. Is there anything else I can do? Do you think this will heal? Thanks! Man from Belgium

Unfortunately shockwave therapy does not have very good results.  If you have had the deformity for 9 months now I would suggest a course of Xiaflex if imaging studies do not show the presence of calcification.  MG

04/16/2014 - 17:48
Length of treatment

Dr. G, from start to finish how long is the Xiaflex treatment for PD and how many visits/how many injections? And is Medicare covering this. Thanks -

We have learned from our west coast Medicare administrator, Noridian, that yes Xiaflex is covered by Medicare. It is given in a treatment cycle format:  one injection on the first day (say, Monday),  one injection 3 days later (Thursday) then a third visit the day after the second injection (Friday) for stretching exercises.  In the clinical trial, these treatment cycles could be repeated up to 3 times (at roughly 6 week intervals) for a total of 8 injections.  In patients without severe bends, sometimes 2 treatment cycles were successful in getting the bend under 15 degrees (considered normal curvature).  Many patients went through 3 treatment cycles and most patients with severe bends went through 4.  MG

03/20/2014 - 13:31
Post Surgery

I am just over 3 weeks post op from a Peyronies graft. I was operated on in Huntsville Alabama. The Doctor told me it was the single largest graft he has ever removed. I have 2 questions. 1.I have no feeling to the head of my penis. How long does this usually last? 2. I have a spot just under my foreskin that feels like it is raw but it looks ok. It is very sensitive. I have been alternating with bandages with triple antibiotic ointment and letting it air out when possible. Is there something else I can do? I am about 4 hours away from my Doctor and my next appointment is in 3 weeks. Thank you in advance!

Usually the sensation will start to return within 4 -6 weeks. If there is no open wound you can use triple antibiotic on the irritated area without a bandage.  MG

03/20/2014 - 13:38
Testisterone and peyronies

I am a 45 yr old guy who used to be pleased with his erections and sexual functioning. Over the past year I have been having investigations for iron overload, and one of the symptoms was low libido, quite a change from previously. My testosterone is on the low side - 250ng/l- and I can't think that I have had more than 4 erections in 12 month, with no waking erections to speak of. Have not really had the drive or sexual interest and also wanted to get the iron overload sorted out too. Having wanted to get a decent erection again I tried levitra and to my horror I have found that have an hour glass constriction below my glans, that my normally quite engorged glans is narrower than my shaft and there is an upward curve of my shaft just below my glans, also a bit painful. Also to my dismay my shaft length is a good 2 cm shorter. This has been devastating as it seems to have come on so quickly, though in truth probably been a while just that with no erections I had not noticed? Any idea if low T has an effect on PD generation, whether non use of penis, ie not getting regular penile erections has an effect on PD. I wonder if we had tried intercourse or masturbation with a semi rigid erection that might have caused damage. There again it can onl have been one or two times given my energy and low sex drive. Any idea if TRT would prove of benefit here as we are not at a point where TRT is being discussed. I am loath to mention this new finding in case I am denied PDE5i medication. Many thanks CF

It does not appear that low testosterone causes PD, but there is evidence that men with PD have an increased incidence of of low testosterone compared to the general male population.  We don't really know what the exact connection is.  It may be worthwhile to try a period of testosterone replacement to see if it helps with libido and erections.  I do not feel it would help the hourglass or bending.  MG

03/20/2014 - 13:41
Is this likely Peyronies?

Hi, after sex a couple of weeks ago, I noticed that my penis has developed a noticeable upwards bend towards the top when erect, that is still there. No trauma occurred. It almost looks like it's 'broken' slightly. This has led me to discover Peyronies online. I can't find any plaques on my penis near the bend, but I do remember about 6 months ago, feeling one or two hard lumps on the underside of my penis. I suffer from no pain when erect or otherwise. There is no bend when I'm not erect. I have also noticed lately that my penis feels much less spongey when flaccid, and I'm not finding it as easy as I used to maintain an erection (something I'd put down to age). I'm also a type 1 diabetic. As a precaution, I have began taking your advised supplements - L-arginine 2 x 1000mg, Vitamin E (400iu) and Acetyl L-Carnitine (2 x 500mg). Does this sound as though it could be Peyronies? I'm confused by the lack of pain, and no plaques anywhere near the point of the bend (the lumps I felt were on the underside, although the penis bends upwards). Many thanks in advance.

This does sound like it could be PD, and I think the supplements you have started are reasonable.  In some cases plaque can be very difficult to feel unless the penis is stretched out.  MG

03/06/2014 - 22:11
Where can i find xiaflex in Canada

Is Xiaflex approved in Canada? Which doctor could I look for help?

Dr Gerald Brock in London Ontario has done a lot of excellent research in the Peyronies field, though I do not know if xiaflex is available there at present.  MG

03/06/2014 - 22:02
xiaflex injection in the UK

Hello Mr. Gelbard. Is there any doctor who could offer xiaflex treatment in the UK?

Dr David Ralph is well known in London for his work in Peyronies disease, though I don't know if Xiaflex is available in Europe or the UK yet.  MG

03/06/2014 - 22:22

I was diagnosed with P D three years ago a was put on pentoxyfilline but it didn't seem to help so my Dr. took me off of it and said there wasn't much else he could do. So I started taking the vitamins that you recommended on this website. I can't seem to find the hard lumps anymore and the bends I had seem to be getting better. So I have two questions, is it possible the vitamins cured it or could it just be going away on its own? The other is I still have the hourglass affect and the length did not come back, will this go away or is there something that I could take our use to help?

In many cases the scarring process seems to come to a halt after a year or so.  The curious thing is that as the scarring reduces length, it reduces the extensibility of the penis which itself reduces the tendency to bend.  In other words, the less the shaft extends out, the less a given plaque will cause it to curve.  so when this happens you are left with less curvature, but some length loss and no improvement in girth changes or hourglass.  We will have to wait and look at results to see if the new medical option for PD will affect this.  MG

03/06/2014 - 22:23
Austin Urologist

Do you have a doctor in or near Austin who was involved in the Xiaflex triials?

I would suggest dr. Mohit Khera at the Baylor School of Medicine in Houston.  MG

03/01/2014 - 22:07
Downward curvature

Are you, or have you, treated patients with Xiaflex who have significant downward curvature? If so, what have been the results? Thanks for maintaining this forum.

When we first began treating patients with collagenase back in the 80's, we did treat some with downward bending. Recent clinical trials with Xiaflex included only patients with upward or lateral bending, so we do not have any data on the treatment of downward bending.  MG

03/01/2014 - 22:11

I am 16 yrs old and have recently noticed the development of a hard, rope like vein under my skin at the bottom of my shaft. To go along with this I also have a slightly curved penis to the left although when I adjust it it will stay centered. I am very concerned that this is peyronies although it is uncommon to get it this young. Is it peyronies and what should I do?

No, this does not sound like Peyronies.  A hard vein under the skin will usually resolve with time.  MG

03/01/2014 - 22:18
Painful erections and soreness after sex

Hello Doctor, I am a 44 yr old married white male. About two years ago I noticed a couple of lumps about 3/4s the way down the shaft of my penis, near the head. One is the size of a small pea and the other about the size of BB. They are horizontally parallel to each other with little space between. I didn't recall any particular injury or other incident that could have caused them. I then went to the Urologist and he diagnosed me with Peyronies. He suggested I take aspirin for some series of weeks in the hopes it would reduce the swelling. I did so but noticed no reduction in the swelling. The good news is that my erections have not changed in shape and I haven't noticed any other obvious visible symptoms. That said, lately I have found the plaque in my penis sometimes becoming sore after sex/masturbation. They are not painful unless touched, but they still are tender even when sex is not particularly vigorous. My erections too, will be mildly painful and will awaken me from sleep. I find that if I do not engage in sexual activity, that soreness will subside. And on occasion, my wife and I will have sex and I will have no pain after sex. My question is, should I revisit the doctor since this new pain has started manifesting itself? Should I be concerned that the soreness could be a symptom of a worsening condition? Thank you for taking the time to provide this forum and to answer questions.

The early phase of Peyronies disease not infrequently causes pain - the good news is, this will resolve over 4 - 6 months in most cases. If the pain is increasing it may help to return to your doctor and try some of the medications that have been used such as colchicine and / or pentoxyfilline.  MG

03/01/2014 - 22:19
Seeking nesbitt treatment

Hello Dr, would you be able to recommend a surgeon experienced in Nesbitt plication surgeries in or near Hamilton, Ontario, Canada?

Gerald Brock MD in London Ontario.  MG

03/01/2014 - 22:23
Peyronie disease Xiaflex treatment

Hi doctor, I´m 62 and 10 years PD, suppose the plaque is already calcified and Xiaflex won´t help. Ultrasound will be need or will be useless. Can I have your opinion? Thanks.

If you have a heavily calcified plaque and good erections, you might consider either nesbit procedure or if the bending is severe and there is associated indentation, excision of the calcification & grafting.  MG

03/01/2014 - 22:26

Dear Dr. Gelbard My husband has had PD for over a year. He is severely depressed normally but this is causing his depression to get worse. It started as a lump a little larger than a bb (little smaller than a pea). Over the last year it has caused severe curvature and shortening of the penis. His Urologist prescribed (Colcrys and Vitamin E). We live in Atlanta, GA. Do you know of any specialist that deals with PD in our area that can help.

It is common for PD to cause depression.  Please look at the peyronies advocates website which has a geographical physician locator. MG

03/01/2014 - 22:27
Dent in erect penis

I am 59 years of age. I recently notice a dent in the middle of my penis on the left side only when erect. I think this was from some very prolonged masterbation session. The dent kind of resembles a small finger grip. The erection is straight and not noticeable when limp, but doesn't look good when erect. There is no pain, hard spots or other problems. What can I do to get it back to normal.

Vacuum erection devices are a form of physical therapy that may assist in expanding the contracted segment out to more normal diameter. MG

03/01/2014 - 22:28

Have you heard of anybody treating Peyronie's with acupuncture? What is your opinion on this?

Yes I have heard about it, but I've never seen any real results.  MG

03/01/2014 - 22:31
Does massaging the lump help?

I'm 62 yrs old and my PD was "officially" diagnosed in Oct 2013, but the symptoms had come on quite quickly a few months before that time. My urologist really didn't seem too concerned or supportive, and told me to take daily Vitamin E. That doesn't really seem to have been doing anything, and actually the deformity really worsened about a month later, but seems to be stabilized at about 45 degrees now. My internist mentioned vitamin D also and that he understood that Viagra also helps, but to seek a specialist in PD. Initially, I just felt a twitchy small nodule about half way down the shaft. What I've noticed now is that right after I've ejaculated and am cleaning up, my penis seems to be much more straight and the lump feels longer and less knotty when I squeeze it,, if that makes any sense? I feel like I want to mash it and stretch it out inside with some localized massage of the lump, but fear it might be more damaging, rather that helpful?? I also want to bend it in the opposite, downward direction, which seems to make it straight for the moment, but fear I could be damaging it more?? I've also noticed that my penis length has been compromised and even when flacid, seems kinda stubby with that mild, upward curvature, rather than hanging free like it used to. It's weird that the circumference seems quite a bit fatter (for lack of better word) before the "band" area of the plaque, but in the post ejaculation period, it seems to be more uniform the whole shortened length. This is very depressing to me, as I'm quite sexually active but sense my gf is kinda uncomfortable and less interested due to my limitations, causing a significant change in our intimacy. I don't really have pain, but just the physical act has to be much more careful and less the hammer jammer action of even a year ago (sorry if that's too colorful). I actually live very close to your office, so would probably be seeking your assistance. At what point do I consider seeing someone about the ultrasound and possibly the injections?

usually compression of the nodule will not help.  If you are in my area by all means come in and I will take a look.  MG

03/01/2014 - 22:34

Dear Dr Gelbard. First of all I can't not thank you enough for all your information you have given on this frustrating disease. I am a wife of a peyronie sufferer. Our journey started with a accident at work. My husband fell approx 4-5 feet, landed on his back and continued down 3-4 metal steps straddling one of them which made a red mark on his inner thigh and penis. Approx 2-3 months later (not for sure which month) he mentioned a knot on the side of his penis. He did not tel me right away already thinking he had cancer. So we went to family doctor and he asked if he had any trauma to penis. Of course his first thought was nobody had hit him directly in that area. He told him he thought it was peyronies and sent him to uroligist. It took a month or so to get appt. The first one said feels like peyronies put him on vit e and see you in 3 months. Went back to see him he referred us to another uroligist in group. Again 3 months later. The second uroligist placed him on pentoxifyll 400mg tid. Not much improvement. His last visit he told us that he needed a implant but our insurance does not cover it. During this waiting penis has shortened in length, hour glass when errected. Large plaque encircling at base of penis and approx 3/4 up shaft. Penis will become somewhat firm but with shrinkage it is almost become impossible for penitration. It has been a total devistation to say the least. I have read all I could find. We have been married 30 years. So no sex mishaps. The more I read the more I am convinced it was the penile trauma from his fall. The first two physicians asked if trauma but the third said it can not be caused from trauma. We are 16 months out from start of symptoms no pain at present time. Would love to see you but work won't allow. Any physicians in the st Louis area you recommend.Was also iinterested if you have seen any cases of peyronies due from work trauma . I have loved this man for 30 years and want another 30. Please help. And think you again. This site has been the most informative.

Direct trauma to the penis can cause peyronies disease. You might try getting a second opinon from another specialist on the physician locator (see links).  MG

03/01/2014 - 22:41
Would I be a candidate for Xiaflex?

Hello Doctor, I am a 56 y.o. healthy male that is desperate for a solution to my Peyronies. It was during an episode of sex approximately 1 year ago where my penis was painfully bent back at the coronal third of my penis near my circumcision scar. No bruising but a noticeable indentation at that point of the bending. Scared, frustrated and too embarrassed to talk to my doctor left me quiet but hopeful that this was something that would resolve on its own. 6 months later, it had remained on erection, a triangular area that is pretty well defined but to my untrained hands, I do not feel a plaque or cord causing the curvature, but rather this indentation area which does not stretch with the rest of the penis. A urologist that I consulted with basically gave me the "hit it with everything approach" VitE, Cholchicine, VED, Viagra, etc. no instruction or protocol. I showed him pictures but he really didn't offer anything more than the idea that Xiaflex was a drug that would be soon approved for use. I really don't think he wanted me to follow up with him. Another telephone urology consult recommended to use a penile stretching device without even seeing me. I didn't have much hope that this would work especially since it was recommended without so much as a look at the nature of my curvature and the time commitment to reward was difficult to justify. Is there any hope that Xiaflex could be the answer to my problem? Is the fact that I cannot feel a plaque eliminate me as a candidate? Is the techniques and dosages of Xiaflex use still being worked out by doctors such as yourself? Should I wait on this or should I just give up hope on Xiaflex for me? My general doctor says that I shouldn't deal with such an unproven drug and that there are just too many risks. Sex is difficult now and my attitude is at an all time low. Thank you for your response.

If this plaque is not calcified, Xiaflex could help you. I have been working in clinical trials with this drug for many years and I would not characterize it as either unproven or dangerous.  In fact, it is more proven than any drug that has been used in this disorder.  The treatment protocol is well worked out, and we have been treating patients here in Burbank since it was approved by the FDA in December.  MG

02/15/2014 - 17:01
Is this Peyronie's? What can this be?

Hello Dr., I am 26 years old and have been having both flaccid and erect penile pain for about two months. Five months ago I developed a ring around my penis, right below my head. It's somewhat "hard" when touched, but get's even more engorged when I put friction and too much pressure on it. When erect, the ring is the size of a medium sized rubber band. I later developed prolonged nocturnal erections that made me had to get up and walk around at night in order for them to go down. I am still getting those, but to a lesser degree now. Once a week vs a couple times every night. The latest thing that I noticed is that the pain seems to be coming from the ring, but also from this circled "lump" that's below that ring. The lump becomes harder when erect, but can just be slightly felt when flaccid. You can't actually see it, but can be felt underneath the dorsal vein. I would say that it's 1/2 the diameter of a pea. You notice it because the dorsal vein is soft throughout its path, save for when it gets to that hardened piece. I feel like the pain diminishes when I don't touch the lump/ring, so I have abstained for two weeks now. Lastly, I also have other symptoms like what has been known online as "hard flaccid" (tight and hardened penis when flaccid) and ED, which I have had for a year now. I have no curvature. Does this sound like Peyronie's? What can this be?

The pain and presence of a nodule suggests PD, though this condition may come and go without ever producing curvature.  You might consider seeing a urologist to start one of the oral medications that are used in this setting such as pentoxyfilline.  MG

02/15/2014 - 17:10
seeking xiaflex treatment

Dear Dr. Gelbard: You are the pioneer of collagenase / Xiaflex and I believe you are treating PD patients with Xiaflex shots. I wonder if you are accepting new patients? My PD was diagnosed in June,2013, I have a plaque size of 2MM X 2MM, plus a long dense cord on dorsal from base to glans. My curvature is about 45 degrees. I have experienced shrinking (by approximately 1" ) and lose of girth. The long dense cord on dorsal makes feel there is some sort of metal wire in it and it's threatening to me. I am 58, married to the same loving wife for 32 years. I miss the days when we could enjoy intimacy without issues. I hope it can be restored. Currently, I have HMO which will not cover for my treatment at all. I don't know when the insurance industry will start paying for it. If you think I can be a good candidate for for Xiaflex therapy, I am willing to pay for it albeit it is very expensive. I live in Wisconsin. I will have to stay in California while I receive the treatments. I am so tired of PD and am willing to pay the price to get some improvement. Right now my local urologist does nothing for me except "wait and watch" and he mentioned surgery if I get worse. I do not wish to have surgery. I will appreciate if you could give some info if I pursue the xiaflex therapy performed by you.

Yes I am accepting and treating new patients with PD.  I have had more experience with xiaflex injections than anyone else, and I would be glad to help you.  I would recommend you have your doctor get an ultrasound, low kilovoltage xray, or xeroradiograph (mammogram technique) to see if you have a significant amount of plaque calcification as heavy plaque calcification is the only thing (other than the use of blood thinners than cannot be temporarily stopped) that would eliminate you as a candidate for this new FDA approved therapy.  MG

02/15/2014 - 17:19
Where to find PD injections in Alberta?

I am located in southern Alberta, Canada and also have the official diagnosis of PD. Do you know of any urologists in Alberta, or Canada where I could be referred to for the injections?

I suggest you visit Dr. Gerald Brock who is in London Ontario.  MG

02/15/2014 - 17:21
Medication Finesteride Effects

My PD treatment based on comments in your forum has been oral and extenders. Recently read instructions on one extender that said Finesteride use for prostrate slows or inhibits results from extenders. Is there any evidence of this and can I continue to take the drug along with my extender use? Thanks so much for your forum that encourages all of us.

I know of no data suggesting finasteride would interefere with extender use.  MG

02/15/2014 - 17:22
Successful Nesbit Procedure

Am nearly 61 and in my mid-50's developed a severe enough case of Peyronies as to curtail sex with my wife. Had the Nesbit procedure performed on me by Dr. Angermeier at the Cleveland Clinic and a couple months later was a good as new. A little shorter, but the trade-off well worth it! Years later I never think about it, and feel fortunate the solution worked for me. Only reason I am writing this post is to let your readers know surgery can work, and work well. I remember being scared about the surgery, but the thought of never having sex again made the risk acceptable, and I'd do it again in a heartbeat.

Thanks for the submission.  I agree this is an excellent option in certain circumstances, when done by an experienced surgeon.  MG

02/07/2014 - 10:53
Can the size of the plaque make excision and graft surgery impossible or unfeasible?

I am 29 years old and have hourglassing from 2 ring of plaque 7cm length, 3mm wide and 4mm thick in top . I think I passed the active phase my first pain was almost 1 years ago which is disappeared now. A doctor in Turkey where I live said excision and grafting operation is inoperable because of the plaque size. Does that sound right to you, and do you know where I could get a second opinion in Turkey?"

I would suggest you see Dr. Ates Kadioglu at the University of Istanbul.  MG

02/07/2014 - 10:41
Please help detection of PD

Hello dear Doctor, please help me detecting peyronie. I am 30 years old male. I don't have any erection problems and no curvature, no pain on erecton. 5-10 years ago i have noticed some pain on climax/ejaculation. I don't know how to describe this pain, is it pain ot just very high sensitivity, but when i ejaculating, pain high enouth to immediately break climax and ejaculation. This only happens when my penis glans touching(or squishing a little), for example, when ejaculating to vagina there is a pain, but if i masturbating and don't touch glans, there are no pain(or almost no pain) and i have good ejaculation. So it does not related with ejaculation by itself, and how i may see, pain relates with increasing penis glans size during ejaculation(it also depends on power of excitation, more high excitation=more big penis glans(because more powerful erection) and more high pain; lower excitation=lower pain). This pain also happens sometimes in time of intercourse(depends on excitation power and dryness of vagina), but pain weak enouth to break action. I made: check for 12 STDs, none found; prostate discharge test-no inflammation; sperm test for leycocites-no inflammation; ultrasonografy without any injections and in non-erected state-no problems found. I visited 5 doctors, 3 of them didn't find any problems, 1 have palpated glans and said that there are plaques and this can cause problem, another doctor said that he feels plaques on entire long of penis. I tried: gialuronidase injections(about 10) - no changes; Verapamil ionthoforesis(made at home by me, but as stated in medical books) about 30 times@5 minutes each, no changes. How do you think, is it peyronie or not? Unfortunately i don't have other doctors to visit. Sorry for my english. Thank you.

Your condition does not really sound like PD to me. MG

02/07/2014 - 10:36
The holdup in treatment for Peyronies

Hi Dr. Gelbard: Very happy to hear that Xiaflex has been approved for the treatment of Peyronies. It has been almost 2 months since its approval and nothing. What are the delays? Insurance or product supply?

It is my understanding that Auxilium is launching the product initially to Urologists who have specifically been trained in its use.  I think that training effort is getting underway.  I know that as one with extensive experience with this agent, both in clinical trials and before, I am receiving shipments and treating patients with Xiaflex now.  MG

02/07/2014 - 10:38
curve penis, no pain when masturbate, sexual intercourse difficulties

Hi doctor, I had my penis curve downwards and I had notice it seen 5 years back, I didn't seek any treatment because of the lag of knowledge on this subject, Its unlikely to be cause by injuries as i cant recall any of them. I got no issue on erection, no pain on masturbation on my own but i face intercourse difficulties and its hard for me to reach ejaculation when my partner try masturbating for me but I got no problem doing it myself

Downward bending due to PD can be a difficult problem.  If the curvature is severe, you should seek out urologist with expertise in reconstructive surgery to perform a Nesbit plication, assuming your erections are hard and well maintained.  MG

02/07/2014 - 10:33
Venous leakage and bruising.

I was diagnosed with Peyronie's disease 12 months ago after experiencing pain inside my glans and noticing it was tilted to the left. My urologist and I also noticed some bruising around the tip, mostly below the opening of the urethra. The curve/tilt has disappeared and I now have an hourglass deformity forming below the head and extending about 1/2 an inch down, maybe more. Until recently, the deformity was only appearing on the sides, but as it is progressing to the top, pain has increased and there is more blood/bruising appearing around the edges of the glans and the tip. I regularly have erections while sleeping that are strong and seem to cause bruising and pain the next day. I am finding very little info about this bruising or venous leakage, so I am concerned that it is making my condition worse or might be another problem in addition to Peyronie's. I have heard that this blood under the skin could be causing the plaque to spread? I also have a fear that my erections themselves are causing more damage because of the tightness, I feel like the blood pressure is going tear up the inflamed areas even more. My urologist's only suggestion was to take aspirin, but I am also taking 400mg Vitamin E orally and 400mg topically daily. The topical Vitamin was just started this week and seems to make my flaccid penis softer and reduces the discomfort caused by underwear, jeans, etc... Thank you for this site and all your help!

Unless the penis has been injured during vigorous sex,  we never see bruising or skin discoloration from PD alone. For this reason, unless you are on big doses of a blood thinner, I would suggest you seek an additional opinion on your condition because it does not sound like PD to me.  MG 

02/07/2014 - 10:29
Painful Erections

I'm 33, and for the past two months, it has been painful for me to have an erection. The pain is mostly near the base,going into my body. It came on quickly and was a lot worse at first,and has gotten slightly better. I feel some soreness and pressure when soft sometimes too. I've tried not touching it for days, no intercourse for weeks at a time, and still the pain persists. I went to the doctor, and he didn't think it was PD, and said it was probably a strained muscle, and would go away within 6-8 weeks. It has not gone away, and I'm getting concerned. It's very painful for me to have intercourse, to the point were I can't maintain an erection because of the pain. I have no curvature, and have come back negative on STD tests. I can't feel any lumps or bumps either. I'm not sure what else to do. I'm considering finding a urologist and getting checked out. I'm nervous!

I think evaluation by a urologist would be a good idea.  MG

02/07/2014 - 10:29
drugs advertized on the internet

Doctor Gelbard, I recently became aware while masturbating that my penis is now curved. This seemed to come from nowhere. It points up I quess about 30 degrees. I see all these drugs on the internet and I don't know if they are legitimate or not. I would love to try something orally as surgery and injections to the penis scare me. Have you heard about treatments with a combination of Serracor NK, Serra Rx80, and VitaminD-5000I.U.? Another is Neprinol which you commented on earlier. I saw a third one but wondered how can all these things work. I am 68 years old and am devastated to have to deal with this now. My urologist seemed to put me off and I am not sure where to procede. Any suggestions ? Thanks.

There is no peer-reviewed scientific evidence that any of those compounds help.  MG

02/07/2014 - 10:27
Xiaflex option

I have a question regarding treatment with Xiaflex, Three weeks ago I went to the urologist because my penis was bent for 45 degrees. This started 4 months ago with in the beginning 30 degrees. The urologist did an examination and told me I have Peyronie's disease. I read on this forum that treatment with Xiaflex is a good option. So I want to find out were I can go for this treatment. Iam living in the Netherlands and on the sites here nobody knows of treatment with Xiaflex. Can anybody tell me were I can go to in Europe to get a treatment with Xiaflex.

I am not sure.  I have a patient from Norway who is travelling to see me here in Los Angeles to be treated with Xiaflex.  MG

02/07/2014 - 10:25
Health Insurance: PPO vs HMO

Having just started new employment, I am having to choose a health plan. Of the two I have to choose from, one is a Preferred Provider Organization (PPO; a for-profit) and a Health Maintenance Organization (HMO; a non-profit). My urologist and the Peyronie's expert in my state are included in both plans. My question is, which is most likely to cover Xiaflex? Must make a commitment by end of day on Wednesday, January 15th. Any guidance is appreciated.

At this point it is hard to say if there would be any difference.  MG

02/07/2014 - 10:21

i am 70 and it appears i am developing peyronies .Cialis literature has a statement that those with Peyronies should not use Cialis .What evidence is there that Cialis causes side effects and , do you know what the side effects are and how frequently there is actually a problem when using Cialis ? How about using viagra instead on an as needed basis ? George Laguna Beach

Cialis Viagra and Levitra have warnings against use by PD patients.  This is based only on the manufacturer's compliance with FDA rules that not having specifically tested their drugs in a group of PD patients, they are unable to recommend them. It appears that at least theoretically, the effect of these (phosphodiesterase inhibitors) can benefit patients with PD.  MG

02/07/2014 - 10:16
Insurance Coverage for Xiaflex

I haven't been able to find any conclusive answers as to whether the major insurance carriers (e.g. Blue Cross) will cover Xiaflex injections for PD when protocols are established and the drug becomes available to physicians. Has anyone heard anything?

we are just starting to submit requests for authorization and it appears most insurers are covering it.  MG

02/07/2014 - 10:15
maturbation over the years.

can masturbation cause this condition ? about two weeks ago I notice that I had an indentation on the left side of the penis when erect , when feeling around that area I notice that there seems to be a hard area on the left side around the base of the penis when flaccid.

Only if it is traumatic, involving a lot of bending, cracking etc.  MG

02/07/2014 - 10:13
Peyronies and Glans Insensitivity

I was diagnosed with Peyronies about 1.5 years ago. Mine manifests itself in two ways: Plaque at the base (actually some into the pubic bone region) which causes a decided bend to the right. Secondly, and most significant to me, is an "hour glassing" about 1.5-2.0 inches below the tip of the glans. In addition to all the other symptoms which I have experienced, I have noticed a decrease in sensitivity in the glans and frenulum region. My uneducated "diagnosis" regarding the insensitivity is that the plaque causing the hour glassing is impacting the nerves leading to the glans area. My girlfriend suggested that it might be a blood flow issue (although during the ultrasound I got the doctor said that blood to the penis is very good). Just wondering if either of these are possibilities…or is it just age (I'm 52)? I rather doubt there is anything that can be done about it…but I would like to know the cause. Thanks.

PD does not generally affect nerve function. Probably a component of what you always felt in the past as "normal" was the extension and stretching of this area, which is now reduced. MG

02/02/2014 - 22:44
FDA approved Xiaflex

When will doctors be able to start treating patients with xiaflex? I've waited so long for this...why must waiting continue?

Xiaflex is available, though there are a few hurdles left to getting insurance approval and finding the right doctor. The initial launch of this drug is through urologists that have been specifically trained in its use. MG 

02/02/2014 - 22:41
Penile Traction Therapy

Hi, I developed PD around Oct. 2011. After more than 2 years and oral therapy only (bend has been stable for over 1 year), I'm thinking of approaching the Penile Traction Therapy: is it too late for that? Also, where I can find the very latest news/information about most effective oral therapy? Thanks.

it is not too late for traction therapy, which may help to restore length.  Unfortunately there is no good peer-reviewed controlled scientific data on oral therapy. MG

02/02/2014 - 22:40
PD since march

Hello. I am only 27 years old and have been diagnosed in November with PD. Though I have varying degrees of pain since March the worst part startet in June with constant hardness in the flaccid state and needle like pain emanating from the base of the penis. I do not recall any specific injury or Trauma. Since August I noticed a gradual decrease in length during erections (before: 17.5 cm to roughly 16 cm now), but no curvature. I was diagnosed with a Plaque on the underside, below the glans of 4 mm in Diameter as well as a small nodule on the topside, 1.3 mm in Diameter. Since October I have been taking 2.5 mg Cialis daily with interuptions, a month now I'm taking Potaba which I had to quit last week. Under Potaba the constant pain and hard flaccid disappeared, but I had severe dizziness, concentration Problems, jaundice, sleepiness and lost over 20 Pounds weight in 4 weeks (despite eating 4 large meals a day). The pain came back quickly after quitting the drug. The Plaque on the underside to me feels more pronounced and I m very scared the condition worsens without Treatment. I have also Pentoxifylline, but I have not had the Courage to try it after my experience with Potaba. Here in Germany the doctor only prescribed Pentox on my request and does not Support the idea. So I'm on my own if there are side effects. Should I take the Pentox or wait it out? Another question: On a lot of Websites I read PD "might" lead to loss of size and length. But ever Person on the Internet with this condition has desribed severe size loss (at the order of inches). So I conclude this is a dead certainty. The penis Looks tiny most of the time while flaccid. I noticed in October after taking Cialis for the first time that the erections came out almost full size again (at 17 cm). But by now I have even under Cialis some apparent real loss of size. Given that I am a very sensitive and introverted Person, I know that I can not bear any more consequences of this disease that I read about and therefore am only left with suicide as the ultimate Option. Im really concerned about this. Is there anything that can prevent size-loss? Would Pentox have any effect on this aspect in case the Plaque-size decreases? Is daily Cialis helping prevent this? Thanks.

Pentox is usually better tolerated than potaba, and is probably as effective.  I believe the daily cialis may help you as well. It is usual to have some decrease in length from PD, although it may not be severe.  Be warned that PD has powerful psychologic effects - nearly 50% of men with this diagnosis had clinically significant depression. Counseling may be a good idea. MG

02/02/2014 - 22:36
Prone Masturbation and Peyronies

I previously engaged in heavy prone masturbation for a period of about four years. I am now 18 and have switched to conventional masturbation, however, I am somewhat certain that I have Peyronies because my erection has a downward curve of more than 30 degrees. Did my prone masturbation cause this? My erection also curves to the left and there feels like a taut band of fibers along the left side. Is this Peyronies? Or a congenital disorder?

Masturbation didn't do this - you have mild congenital curvature, correctin of which is fairly straightforward by an experienced reconstructive surgeon.  MG

02/02/2014 - 22:33
A few questions regarding surgery etc

Dear Dr. Gelbard, I was diagnosed in June this year. Right now I have 38 degrees upward curvature. Pain has gone away 3 months after the onset. My questions are: 1.After having had 5 verapamil shots with no improvements, my urologist told me that next treatment is to perform Nesbit procedure a year from now. I told him I can't accept it because my penis is small to begin with and it has shrunken due to PD. It is now less than 2 inches flaccid - I have lost more than a inch. I don't want to shorten it further. Will the grafting surgery shorten the penis less? 2. Is it a possibility to have penis surgically lengthened combined with the grafting surgery? 3. If PD gets worse and shortening continues, have you seen a patient's penis totally retracted into the body and eventually disappeared from the surface of the body? Can this issue be surgically corrected? 4. I have a palpable plaque about 8mm in dorsal /base and a cord like structure on dorsal. Do you think traction device may help with lengthen and straighten the penis? 5. My curvature has been 40 degrees since October. It has been almost 3 months and the bend has not become worse. I know it is very difficult for a doctor to predict, but from your experience, do you think my curvature is stable or it will get worse? 6.I can still manage to have intercourse with my wife. However, each time after sex, I feel discomfort in the penis, a feeling that is hard to explain. Will celibacy have less adverse effect on PD? I really appreciate your help. Thank you very much!

Grafting surgery also shortens the penis, though less than a Nesbit. Surgical lengthening of the penis doesn't work well and creates a lot of problems - not recommended.  PD will not cause the penis to completely retract.  A traction device may help to restore length but it usually doesn't change the curvature a great deal. The pain you are feeling will resolve, usually around 12 months after onset.  Celibacy is not generally a good policy for PD patients - it is good to maintain some level of sexual intimacy. MG

02/02/2014 - 22:27
Xiafex treatment

Hi, I have PD for about five years already and considering Xiaflex treatment. I live in Ukraine and not sure when it will be available here. Can you recommend me a reliable and experinced urologist in US or Israel and how much would it cost?

The peyronies disease advocates web site listed in the links section has a physician locator that should help you.  At present in the U.S, each vial of xiaflex costs about $3,000 USD - pricing may be different overseas.  MG

02/02/2014 - 22:24
while sex was in the mix my partner missed me, bent his penis, and now it is bulging and a black and blue color.

What do I do?

He should be examined by a urologist - this sounds like a penile fracture or a small tear of the tunica albuginea.  MG

02/02/2014 - 22:22
Pain and deformation

Hi. I'm a 30 year old Caucasian male. I noticed about a year ago I had some sudden penile discomfort, upon inspection I noticed a indention about midway up my shaft, almost as if someone tied some string around it. Below the indention, I have a fleshy, meatier fold that is sometimes very painful when I have an erection. I also notice that sometimes, it may be difficult for my penis to become fully erect and stays lodged in the fatty fold, similar to a turtle not wanting to stick his head out of his shell. On at least one occasion, I had to extend it manually. It has become a great cause of concern for me and to say I'm depressed and worried would be an understatement. I've had nightmares of my penis having to be amputated because of a lack of blood flow caused by the indention. I'm very confused by the sudden appearance of what ever I may have and would appreciate any feedback you could give. Thanks.

Sometimes PD causes indentation rather than bending.  This will not cause any damage to penile blood flow, and in many cases responds to the treatments used for bending: medications, Xiaflex, surgery. MG

02/02/2014 - 22:16
penile pain/possible pd ??

HI dr. Gelbart, I am one of your past/current patients - on my last visit you told me that you don't think that I have pd due to the fact that my penis was stretchable and no palpable lumps ,yet I have this pain that comes and goes , inside my glans , specially if I apply pressure on my pelvic area or if I use a ring that engorges me to much(this is happening after using a pump in the summer of 2012 ,because of some mild erectile issues ) .Do you think I should schedule another appointment for more investigations like ultrasound , etc.(you told me to contact you if I'm developing any more problems)? THANKS!

Yes If you are still having pain we should re assess your situation carefully - with the intent of offering relief of your symptoms.  MG

02/02/2014 - 22:13
Peyronies and ED

Hi. My husband has had Peyronies for several years. He is now experiencing ED that isn't resolved with Viagara or Cialis. He has also started thyroid and BP meds. Is there any hope?

Yes there are many options to restore lost function.  If your husband has not responded to oral medications for ED, a vacuum device may help.  If curvature is a big problem,  placement of an inflatable penile prosthesis with correction of the bending has a good track record for restoring the ability to have intercourse.  MG

02/02/2014 - 22:09
Xiaflex- How long to wait until treatment?

I have Peyronies disease and first noticed the curve about 6 months ago. I will be in the USA in June about one year after I first notice noticed the curving.It is getting worse. In an earlier post to another's question you wrote, "but if you have to wait it will not compromise response to therapy." So does mean that Xiaflex does not have to be started in the first year? Thanks for this forum and all your help.

Clinical trials with Xiaflex were conducted in men with Peyronies disease for at least a year - waiting should not reduce the response to this medication.  MG

12/15/2013 - 14:23
xiaflex options

Do insurance carriers regard Peyronies disease as a cosmetic condition?

No. To date, most insurers cover consultation, treatment, medications, and surgery for Peyronies disease, because it is a disabling functional condition causing not only sexual difficulties but severe secondary psychologic effects such as depression, anxiety, loss of body image and loss of intimacy. I cannot imagine that insurers would reverse this long-standing precedent simply because of the high cost of the historic, first ever FDA approved treatment (Xiaflex). I would be interested to know how the readers of this forum would respond if insurers issued this hypothetical statement:
feel free to write in and express your own opinion as PD patients. MG

12/15/2013 - 14:09
Xiaflex options

I have a question regarding the Xiaflex treatment option. I was reading that the bend must be a minimum of 30 degrees with a palpable plaque. How strict are these requirements? My plaque is narrow, palpable, and runs about an inch down the dorsal just below the glans. However, my angle is difficult to measure because it only bends slightly at the glans. I am mostly interested in Xiaflex to relieve to pressure that the plaque is putting on some nerves and maybe allow better blood flow to the area. I realize that these conditions were not measured in the trial, but I want to know if I will even be given the option to try this therapy. If I don’t qualify then do you know of any further research for people with my condition?

Actually the presence of a narrow cord pulling the tip of the penis upward is a good indication for Xiaflex; it may be more effective in this situation than when there is a wide, flat, irregular plaque.  The 30 degree bend is not an absolute criteria, though some insurers may require this.  The only real question is if the pulling and distortion caused by this long narrow plaque are disturbing enough to warrant taking on the expense (pretty big) and risks (which are actually pretty small) of Xiaflex, its use would be warranted.  It's the old question of where the risk - benefit balance lies. MG

12/15/2013 - 14:03
Penis curves to the left

I've been noticing that my penis has been curving to left when I have erections, also during mastiurbation after ejaculation it tends to fall back on to my lower stomach (only when I'm laying down masturbating) I've had sex twice and it slips out during inter course when the girl is on top, but it stays in when I'm on top. I'm 21and I'm not sure if this is definately peyroines disease but what else could it be? And what can I do to correct this problem?

This sounds like congenital curvature, not PD.  If it is causing problems with intercours it is easily repaired by a qualified surgeon by a plication procedure.  As you may have read in this forum, doing the plication by simply sewing knots into the convex side of the bend can have its complications.  My own personal opinion is that the original technique of nesbit (excise and close small ellipses of tunica on the convex side) or the modification of Yachia are my preference.  MG

02/05/2014 - 12:03
questions regarding Xiaflex

Dear Dr. Gelbard: Having read articles on Xiaflex treatment for PD, Some stated that the drug breaks down the plaque and the trained physician would bend the penis to reduce the curvature. Does Xiaflex dissolve the plaque or just soften it? If it is not dissolved, does the plaque still stay on Tunica Albuginea after treatment? I was diagnosed in June this year. My urologist started verapamil in September. The pain when erected was reduced, but the curvature has not improved. (My curvature was 10 degrees in July. It worsened from August to October. Now it is about 35 degrees upward). The urologist stopped verapamil after the 5th shot. Initially, the plaque was a nodule on dorsal near the base. It is now a cord-like structure extending to the glans. It's hard to say whether it's the progression of PD or the verepamil shots caused it (According to Dr. L. Levine's article, 6-8% patients get worse because verapamil shots) Do you think my condition is now stabilized? Do you think Xiaflex will help my condition? Last but not the least, I probably won't be able to receive Xiaflex treatment until insurance company agrees to pay for it. It may take a year or so. Do you think it would be too late by then? Thank you.

First of all, plaque is just a thickened part of the tunica albuginea, they are not separate from it.  Xiaflex works by reducing the amount of scar collagen in these areas so it is softer and exerts less pull against the normal extension of erection. The stretching by the doctor or so-called modelling is simply using force to elongate the enzymatically altered (softened, with reduced amount of reistant fibrous scar tissue) area of the tunica so the erection extends more symmetrically. The progression of a flat plaque to a longer cord-like structure running the length of the penis is a commonly observed evolution in PD patients; I do not think it represents worsening from verapamil. Be reassured that the latest data with Xiaflex, the phase III study, required that subjects had PD for 1 year or more prior to treatment.  I hope it will not take the insurers 1 year to get on board with this historically first FDA approved treatment, but if you have to wait it will not compromise your response to therapy.  MG

12/15/2013 - 13:49
Severe pain from PD plication

I had plication on a Monday and removed the Coban & Xeroform dressings on Thursday as instructed. My pain went from a 3/10 to 8/10 from Thursday all through Tuesday (today). It occasionally goes down, but the overall trend is that it is increasing. I cannot walk around for more than 2-5 minutes at a time or the pain will skyrocket. Sleeping is very difficult due to the pain. Norco isn't helping much, and it causes sleep problems for me. My penis has no visible sign of infection, and does not feel unusually warm. I have no fever. In the past, I have broken my nose, jaw, and spine (compression fracture) on separate occasions - and never had pain anywhere CLOSE to this. My nose and jaw were also fixed surgically (with multiple screws in my jaw) - and the recovery from those things took a few days, with 2-3 days of vicodin keeping pain to a 4/10. Those incidents felt like papercuts compared to this. And, if I even get a hint of a nighttime erection - it's excruciating. I can't believe the pain of these sutures & how many sutures there are for a basic 50 degree upward curve. They form two L shaped mirrored figures on the bottom of my penis, 2 cm from the urethra. One corner of the L is nearly on the side of my shaft, which very odd to me. I didn't expect any knots on the side, but I went to one of the most published, respected PD docs around. So, I assume there is a reason for this? Not all of the knots hurt - but there is one extremely painful one. Is it possible that some people are just not meant to have plication surgery due to some kind of hypersentitvity - either in the pain center or in the inflammatory response? I had PD for 4 years, so I am not in the active phase, though my curve did increase between years 1-3. I had a full year of swelling from my broken nose repair (necessitating kenalog), though the jaw was fine. My primary care doc gave me gabapentin in addition to norco, and it's helping slightly. I may end up trying lyrica...but none of that solves the true problem - the inflammation and pain signals. Have you allowed patients to take a medrol dosepack after surgery? Also, the pain goes down if I put new coban bandage on semi-tight, but is that safe to keep doing? Would compression slow healing? Are there any kind of local patches or creams that are safe? Would EMLA be safe with the circumcision scar still healing? I am asking you all of this because my doctor was apparently told my his secretaries that I am "calling 3 times a day" - so when he finally got on the phone to talk to me, he just seemed annoyed. I had called a few times (a bit too drugged in the first days, admittedly) to remember any of it. Mostly, I tried to ask them how to clean the area, if it was bad that the wound bled for 10 hours after removing the dressing, and why I had a fuzzy grey patch on my skin. But, he just seemed irritated - so I didn't get clear answers to these questions. And, he said pain just depends on the person. I think I have an overly aggressive inflammatory response and need to be on medrol to stop the pain & not have PD triggered all over again. I think there has to be a reason this has been the most painful experience of my life. In the worst case, have people had plication stitches removed? The idea of having sex ever again is just unfathomable to me right now. Sorry this was so long... I just wanted to get all of this out. Thank you so much for reading all of this.

I think it would be reasonable to take a medrol dosepak, and I think re-wrapping gently with a dressing that is not too compressive would be OK as well.  If you did this, I don't think you would need to use emla (topical anesthetic) cream.  If after complete healing has taken place (3 - 6 months) there is still one stitch that is painful, it could be removed. MG

12/15/2013 - 13:44

Hi I am 23 years old and have been dealing with what I think is peyronies for about 3 years now. I first notices a bend to the right and slightly upward. soon it started wasting and eventually now it curves left. I had an ultrasound about a month ago and there were a couple of tiny plaques but nothing to amount to the amount of wasting that has occurred. I have experienced the wasting throughout my entire penis and it seems as though after 3 years it hasn't sustained and slowly gets worse. this sounds different than what I usually here of peyronies patients. Could this be something else?

In the absence of big easily palpable bumps or plaques, I don't think it is likely anything else.  MG

12/15/2013 - 13:42

Hey doctor I am 19 years old I have banana shape curve downward penis but its curved a lot when its erect I don't have any pain but I am worried about it.

Don't worry about this, it is a congenital issue, not a disease or anything wrong.  If it becomes a problem with sexual activity, it is easily corrected by a qualified surgeon.  MG

12/08/2013 - 09:48
Xiaflex side effects

"The Xiaflex injections do come with some side effects, including possible fracture or rupture of the scar tissue which can lead to erectile dysfunction." Dr. Gelbard, how likely is this to happen, percentage wise?

In the phase III clinical trial experience involving about 850 subjects there were 3 patients that required repairs of tears in the tunical albuginea or so called "corporal ruptures". These were successful and to my knowlege did not result in erectile dysfunction.  MG

12/08/2013 - 09:45
bending after Op

12/07/2013 - 16:19 PD I have had PD for about 6 months. 3 weeks ago I had nesbitts. I was adviced not to have a 'meaningful erecyion for 5 weeks, however, I have significnt erections at night and it appears as the weeks have gone on, my penis is begining to bend again. in this normal, will it recitfy or do I have yet a futher problem?? it is worrying to say he least The forum feed back was "sometimes with healing after a nesbit the suture lines stretch out a bit and a small amount of curvature can return. This is not usually a problem. MG For information: Since the forum message the bending got worse. eventually, back to th 90 degree bend. My follow up determined that the sutures has broken and fortunately completly (if not it could have caused a lateral bend). I now have to undergo further surgery. it has been recommended that on this occasion that small diamond shape cuts should be made and material removed, this will allow for the bend to be better managed and to hide the knots of the 'industrial' grade sutures

Thanks for the followup.  Complete recurrence of the curvature underlines a risk of a plication procedure that relies entirely on the integrity of the sutures & knots, i.e. a procedure where the small ellipses of tissue are not resected.  MG

12/07/2013 - 11:48
FDA Approves Xiaflex for Peyronies Treatment!

Thank you for your participation in the clinical trials Dr. Gelbard, today's FDA decision is great news! CBS News: The Food and Drug Administration (FDA) has approved Xiaflex as the first non-surgical treatment for Peyronie’s disease (PD), a condition that causes penis curvature that can make sexual intercourse impossible. "In my practice, treating PD has been a challenge as, until now, we have had few options to offer our patients,"Dr. Martin K. Gelbard, clinical trial investigator and clinical faculty member of the department of urology at the UCLA School of Medicine, said in a press release. "I believe the FDA approval of Xiaflex is a significant achievement and offers a new option for urologists: the first approved in-office treatment to be administered non–surgically that is proven safe and effective for this physically and psychologically devastating disorder." Patients with Peyronie’s disease have a connective tissue disorder which causes fibrous collagen-based plaques or hard scar tissue to grow in the soft tissue of the penis. This reduces the elasticity on one side of the penis, which can cause the penis to bend. Xiaflex, which is manufactured by Auxilium Pharmaceuticals, is the first non-surgical treatment for men with PD that have a curvature of 30 degrees or more and tangible scar tissue plaque in their penis. Dr. Ryan Berglund, a urologist with the Cleveland Clinic, explained that about 5 to 10 percent of the male population have some curvature with their penis. According to Auxilium Pharmaceuticals, about 65,000 to 120,000 patients are diagnosed with PD each year, but 5,000 to 6,500 actually get their PD treated. “If the penis is curved 90 degrees, they may not actually be able to have intercourse,” Berglund told CBS News. “The greater the curvature, the more likely there will be problems.” Previously, the only way to treat Peyronie’s disease was through surgery. The invasive procedure came with risks including potential shortening and erectile dysfunction. Xiaflex is administered through two injections given by a medical professional into the area where the hardened collagen collected on the penis. Then, the area is massaged to break down the scar tissue. Patients could receive up to four treatment cycles. "I wouldn't say it is a game-changer, but it represents a step before surgery," said Berglund. The Xiaflex injections do come with some side effects, including possible fracture or rupture of the scar tissue which can lead to erectile dysfunction. It can also cause penile swelling, bruising or pain. “Men’s Health Network is very pleased to see FDA move promptly to approve Xiaflex to treat the important, rare condition of Peyronie’s Disease,” Dr. Salvatore J. Giorgianni, Jr., a member of the board of advisors of the non-profit Men’s Health Network, said in a press release. “Peyronie’s is a rare, disfiguring condition that has devastating effects on male self-image and relationships. Peyronie’s often leads to additional medical and sociologic conditions. Availability of this medication provides patients with a safe and effective option compared to currently available treatments, which have significant limitations.”

Thank you, we are all excited about this news. It will offer a lot of men with PD a rational new treatment option.  MG

12/07/2013 - 11:49
Fibromedica product

Hello Doctor and thank you heartily for this site. I have a question on a product called Neprinol AFD, is it a useful product? Thanks

Neprinol has been used for some time, but there is no good peer-reviewed scientific data on its effects or safety. MG

12/07/2013 - 11:53
Peyronies with no plaque?

Hi. About 6 months ago, I noticed a very sudden change in my erection. The base of my erection was constricted ("bottleneck"), and the rest looked ballooned out. There is a lot of pressure near the tip, and I have lost 2 inches in length. I can still get erections and have sex. There is no pain but a feeling of tightness or pressure. I went to a urologist, and he swears I have no plaque. He sent me for an ultrasound which also showed no plaque. He says I'm fine, but I'm worried about the sudden change in my erection. Can something else cause an indentation like this? This problem is really affecting my sex life. Thanks for the help.

Internal scarring in the septum between the erectile bodies can cause narrowed segments, and it can be difficult to detect a bulky scar deposit ("plaque"). This does sound like PD to me, and I would reccommend you seek an opinion from a peyronies expert in your area.  MG

12/07/2013 - 11:55
Supplements and PD.

I am 61 years old. I have PD which I noticed and confirmed about 11-12 months ago. For past 3-4 years I have been taking 'Ultimate H.A' formula which "contains" the highest quality HYALURONIC ACID -- manufactured by Purity Products ( for support of my Joints and Mobility, etc, etc. Its major component is BioCell Collagen (1000mg). Do you see any correlation to PD here? Thank you very much. AR

There have been reports of PD occurring in patients on joint health supplements with hyaluronic acid or glucosamine.  Probably a good idea to discontinue it.  MG

12/07/2013 - 11:57
Pyronie's disease

I have had PD for over 2 years now and was treated with Intron A injections. 3 series of 6 injections. the curvature is a little better but now the base of the penis is narrowed and more pliable. intercourse is difficult anyway and now is worse. not only does it look horrible but the function is reduced. Any ideas. Thanks

Now that Xiaflex is approved it would be an option, if you have a plaque associated with the narrowed area that is not calcified.  The clinical trial data only really looked at curvature correction, but experience has shown it may help with segmental narrowing.  MG

12/07/2013 - 12:00
Flare up after 12 years

In 2001 I experienced a classic episode of PD, with the detection of a couple small nodules on the sides of my penis, soon followed by a painful bend just behind the glans. After a couple months, the bend released but ever since, I've been left with some distal flaccidity in the glans - annoying, but manageable. To my horror, some 12 years later (about two weeks ago), I've now detected a couple small soft nodules way back near the base of the penis, center-line, almost feeling like they're between the two corpora, though slightly left of center. There was no triggering incident, no injury, and there is no pain and no bending or indentation present (yet!) But I immediately went to a GP and got a prescription for Pentoxyfilline and began taking Ubiquinol, as I've kept up with PD issues and these seem to be good early treatments (back in 2001, I wish these had been available). In my heart of hearts I hope this is some kind of blood clot or vein issue, but my head tells me it's likely PD rearing its horrible head for a second time in my life, and perhaps with the final blow - as if it results in flaccidity beyond the lesions, given their placement near the base, I'm really screwed. My question is in two-parts: Is there anything else you'd recommend I do at this point (besides wait nervously for pain or bending!)?; and is an unexplainable reoccurrence in a different location after more than a decade as rare as I get the impression it is? Thanks for your work with this board.

If there is a palpable plaque in the tunic of the corpora (not a hard vein in the skin), there may be a role for xiaflex even though all clinical trial data was based on lesions present and stable for 1 year. The other option would be to continue on the meds you started and get an intralesional course of verapamil or interferon.  MG

12/07/2013 - 12:03
peyronie suicide

suicide is the best option

Yikes!  you need to talk to someone about this.  your comment illustrates what so many of us have seen in our patients - severe psychological secondary effects with depression, anxiety, loss of body image, loss of intimacy, and a feeling of hopelessness.  MG

12/07/2013 - 12:06
Post-Op questions - congenital penile curvature

Dear Doctor, About 4 and half months ago I underwent a modified Nesbit procedure to correct a congenital penile curvature of about 45 degrees up (dorsal curvature from the middle of the shaft). The surgeon used long-absorbable sutures (he said approx. 9 months until full absorption, so I can only assume he used PDS type sutures). A part of the shaft's skin seems to be stuck to the beneath layer (I don't have a foreskin –which was removed in childhood), in particular the skin is stock in the incision circumference – as if the skin is "sewn" to the underneath layer, and thus far this has not been improving. In addition, I don't feel the orgasm (but I do feel the glans normally and I can achieve an orgasm), and I have loss of sensation starting from the incision up until the glans (not including the glans) in the ventral (bottom) side of the penis. My surgeon told me that temporary loss of sensation is common. My questions are as follows: A) Is it normal that the skin is stuck (especially in the incision line)? B) Will it improve or am I due to undergo another surgery to "release" it? C) How much time normally does it take the skin to loosen up? D) How much time normally is "temporary" loss of sensation? E) Will I feel the orgasm again with the (hopefully) return of the sensation? Thank you very much for the help.

Uusally adherence of the skin to the surgical site will release itself, though this can take 6 months.  Sensory recovery can take significantly longer, up to 10 months or more.  MG

12/07/2013 - 12:08
Does it sound like Peyronies?

I'm only 19 years old, and I started to notice a curve about 10 months ago. I honestly don't remember what my erection looked like before (I know, weird), but I'd imagine I wouldn't have all of a sudden noticed a curve if it was always there. It curves about 30-35 degress from about 1/3 up the shaft. There seems to be a bit of an indent on the right side, and the base is a little narrower than the rest of the saft. I'm a virgin and have never injured it to my knowledge, the only thing I know that could put trauma on was was getting an erection while wearing jeans, which really pushed it to the left (it defintiely always naturally leaned a bit in that direction). I don't think it has really gotten worse, although the curve seems to vary in degree a bit from time to time. And currently I'm waiting to see a urologist, but the wait to see one was months.

This may not be PD, but a slight change in pre existing mild congenital curvature.  I think seeing a urologist is a good idea.  MG

12/07/2013 - 16:19

I have had PD for about 6 months. 3 weeks ago I had nesbitts. I was adviced not to have a 'meaningful erecyion for 5 weeks, however, I have significnt erections at night and it appears as the weeks have gone on, my penis is begining to bend again. in this normal, will it recitfy or do I have yet a futher problem?? it is worrying to say he least

sometimes with healing after a nesbit the suture lines stretch out a bit and a small amount of curvature can return.  This is not usually a problem.  MG

12/07/2013 - 16:21
Is this peyronie's?

When aged 13 I was shaking my erect penis up and down vehemently (out of curiosity, I think) and suddenly I felt a sharp pain which did not last that long. Afterwards, for about 20 years, my penis bends downwards when erect. I can feel no palpable plaque. I remember there was a pain at that area of the penis when erect during some period after that incident. Currently I have no erectile problems and no pain either in whatsoever condition. Could this be peyronie's? I have visited a clinician (this is Seoul, Korea) and he didn't seem to be familiar with my condition. Could you please recommend some professionals in this area?

That is probably not PD, but congenital curvature.  I don't know anyone in Korea but I would reccommend Dr. Chris McMahon in Australia.  MG

12/07/2013 - 16:25

Hi. My husband has had a curved (to the left) penis since I met him 10 years ago. While erect there are no visible lumps and it does not prevent intercourse. How do I know if this is Peyronies? What concerns me is that he has a lower than normal libido (in my opinion). He was 25 when we got married and we had intercourse on average around once or twice a week. And lately I've also noticed a slight softness to his erections. This is quite a sensitive issue as I'm sure it is for most men. He refuses to see a doctor. I managed to get him to go for a blood test about 4 years ago which showed his testosterone levels were normal. Are these conditions connected? How do I convince him its serious enough to see a doctor about? Please help!

The curvature is probably not a problem as it doesn't sound to interfere functionally, and I don't think it is PD.  The libido loss is an issue however, and you probably should have the testosterone checked more than once. There are a variety of excellent medications now to help erections, and I think you need to communicate to him that this serious to you as you don't want to see any physical issues compromising you relationship, and have him see a urologist.  MG

12/08/2013 - 09:51
full length plaque differences?

Is there any difference: cause, treatment, hope for eventual resolution when the plaque runs the full length, as opposed to lumps and bumps. Mine came from out of nowhere last January full length, with the nasty bend in the middle.

Narrow plaques that run the length of the shaft are actually quite common and in fact these are less likely to be calcified and seem to be good candidates for Xiaflex.  MG

02/05/2014 - 12:02
Lump on underside of penis

Hello. I'm 23 years old and about 8 months ago (though it could've been there longer than that) I noticed what seems to be a lump on the underside of my penis. It's located ventrally, more to the left side of the shaft, just below the glans (about 1 to 1.5 centimeters below it when flaccid). It feels slightly harder then the surrounding area when flaccid. The harder area seems to be circular shaped and less than 5mm in diameter. When erect it feels like a slightly elevated hard nodule (though I can't tell whether it's harder than the surrounding tissue) and it's about 2 or 3 mm in diameter. I'm not sure about that but I think I might be able to see the outline of the nodule when I stretch the skin while erect. I dont't feel any kind of pain in the area. My penis curves slightly down and to the left but it has always been this way, I didn't notice any change in shape or size recently but I'm really worried about it. Could this be a nodule from peyronie's disease? Also when erect the shaft of my penis doesn't seem completely smooth. I can feel and see some ring like structures encircling the shaft at certain places. But they seem to be actually part of it, like if the shaft were formed by various rings put together. Is that normal? The nodule which I described seems to be part of these structures, but rather than a ring it seems more like an "isle". I was hoping it to be just a peculiarity of the penile structure since it hasn't been causing any problems but I'm worried it might be an early stage of peyronie's. What could that be, does that sound like peyronies or is there another possibility? Thank you very much.

This does not sound like Peyronies disease to me, though if you are worried about it, examination by a urologist might be a good idea.  MG

12/08/2013 - 09:53
Peyronies & Prostate Cancer

Is there a relationship between Peyronies and Prostate Cancer? I have been recently diagnosed with both and within six months of each other.

No I don't think there is.  MG

12/08/2013 - 09:57
Probably PD - recommended medical help ?

Doctor, I am a married 57-year-old based in the UK. I think I may have PD (see below); my age and geography alone place me in the right bracket. My GP would confirm I am generally in good health: I don't smoke, don't drink excessively, blood-sugar & cholesterol levels are under control. I don't eat too much rubbish but I admit to being overweight through lack of exercise (185 pounds, should shed 25 of those). I have essential hypertension (diagnosed about 5 years ago ?). I started out on an ACE inhibitor (Lisinopril) but went through a couple of episodes of chronic cough which were assumed to be ACE-induced, so I was switched to a combination of ARB (Losartan, 100mg) & CCB (Amlodipine 10mg) after 12 months. In fact, I now think the cough is a seasonal result of post-viral hypersensitive airway, but I haven't reverted to ACE inhibitors. To counteract stage fright, I also take a very occasional dose of Propranolol, which my GP was happy to prescribe. So I'm interested in whether any of the above drug regime may also make me more susceptible to PD and if there is any point going back to Lisinopril. I don't tend to take any other drugs other than swallow an occasional Omega-3 capsule. About 18 months ago, quite suddenly, I became aware of a left curvature of perhaps 35 or 40 degrees, but no upward/downward bending. I wouldn't claim any 'pain' as such, but the curvature can feel slightly 'uncomfortable' in the mornings. Sexual activity isn't really affected although I am self-conscious and a bit frustrated with appearances. I've never been aware of any physical trauma, there doesn't appear to be any hour-glassing. I'm not even convinced I can feel any plaque under the skin although, interestingly, during this same period, a couple of small pea-sized lumps have appeared then shrunk again in the skin of my scrotum, but my GP checked them out and diagnosed them as sebaceous and harmless. However, I'm just wondering if the same changes in my body that cause these cysts are related ? I haven't had a professional opinion, but I guess this sounds like standard PD ? I have no desire to undergo surgery, but wonder what you would recommend medically to see if I can diminish the degree of curvature ? Great web site - thank you.

There appears to be a relationship between peyronies and the use of beta blockers (propranolol) so I would suggest you talk to your doctor about discontinuing it.  The best data to date on medications that can reduce curvature is with Xiaflex.  MG

12/08/2013 - 09:58
Newly Diagnosed

Have had trouble with ED for some time even with meds erections don't last long enough. Recently Penis has begun to bend down and to the right. Diagnosed with Peyronies. Are these two related? Urologist has me on Colcrys for the time being.

Yes, a modest number of men with PD will experience some degree of ED. MG

12/08/2013 - 10:04
Mild peyronie's?

I have a BB size gristle/ lump on the upper left-side of the penile shaft, about 1cm below the head. It can be felt when flaccid with a little probing but is more palpable when erect. Occassionally, depending on the strength of erection it also slightly visible. I notice a curve and collapse to the left below the lump when semi-erect but my full strength erections are generally straight. It's been there for one year. More recently, my erections have become less frequent with little to no 'morning wood', although there is no problem when engaging in sex with my partner. However, I'm experiencing some heaviness, dull ache on left of my penis and scrotum from time to time. The vein which runs on the top left of penile shaft is also quite prominent when flaccid. My penis head does tend to hang a little more leftwards than usual and the foreskin looks more saggy and wrinkled. I'm suspecting a mild form of Peyronie's I should also point out that over the last 18 months I have been treated on /off for prostatitis with mild recurring hematospermia. DRE, urine and blood tests all negative for infection. I'm undergoing a cytoscopy and MRI in the next 6 weeks as urologist would a further evaluation. I previously gave no thought to raising the issue of the lump as the urologists were satisfied with things after palpable inspection (I have one or two cysts in my scrotum that have previously diagnosed as benign). I will raise accordingly though at the MRI. What questions should I be asking of the urologists and I would also appreciated your thoughts. Many thanks and best to you.

I would ask the urologist to re examine the area where you can feel the bump. BTW, there is a very minute risk that cystoscopy could aggravate PD if it is present. This risk is extremely small and much less than the risk of missing an important problem if you have blood in the urine (not blood in the semen) so you should clarify this with your doctor. MG

12/15/2013 - 13:18

Is this true that Levofloxacin can cause Peyronie's or can increase if some one had it already ??

The concern with this drug is a known risk of tendon weakening or rupture.  Some doctors have suggested that if it also weakened the tunica albuginea of the erectile bodies it could predispose to injuries and possibly PD.  This is a reasonable conjecture but at present there is no data to support this.  MG

12/15/2013 - 13:20
fda approval

Just checking to make sure the new medicine was approved and to see if you can prescribe it for me yet. I am a patient of yours and have been looking foreward EAGERLY to the release of the new med. thanks Dr. G.

As you probably know by now it was approved on December 6th 2013.  Right now in my office we are working on the logistics of drug shipment and insurance coverage so we can proceed to scheduling treatment.  MG

12/15/2013 - 13:26

hello doctor - you have helped me in the past answering my questions, thank you! i have peyronies for about one year now - i am taking 6 tablets of pentoxifylline a day and not only seems to get my penis smaller and smaller but also there is hardly an erection anymore...frustrating and depressing are too mild of words! this morning i felt for the first time a bone-like hardness near the shaft inside my penis, about an inch wide - i am mortified! not only am i afraid it keeps growing and might be the reason for a smaller penis and soft erections, but what can be dome about it, if anything? (the plaque part is somewhere else, near the head of the penis) what does xiaflex do? - does it help with the calcification too? i so would appreciate your answer! 

Xiaflex can only dissolve or soften collagen, so it appears to be ineffective in the presence of large calcium deposits.  Small spots of calcium that don't interefere with injection however will not preclude treatment.  Either an xray or ultrasound can help to determine if the hard spot is calcium.  MG

12/15/2013 - 13:34
Any significantly bad side effects or outcomes during Xiaflex clinical trials?

Were there any significantly bad side effects or outcomes for some patients in the Xiaflex clinical trials? If so any idea how common they were? Thanks for your help.

All the adverse events with xiaflex were confined to the penis.  These included bruising, swelling, and discomfort all of which were common but resolved without treatment. Blood blisters and blood collection (hematoma)  were very uncommon and resolved without treatment. In about 1,000 cases (phase IIb and III studies) there were 4 tears of the tunica albuginea (so-called corporal rupture), 2 of which appeared to due to resuming sexual activity sooner than 2 weeks after injections. They were all repaired successfully. There were no allergic reactions in the Peyronies studies, though this is a theoretical possibility.  MG

12/15/2013 - 13:35
Vascular stimulation and/or Low Intensity Shock Waves effect on Peyronies or future use of Xiaflex

Are low intensity shock waves (using a Renova devise) and/or injections designed to increase neovasculation in the penis something you'd recommend? Are they likely to improve Peyronies? Likely to help a patient's future Xiaflex treatments be successful? Thanks for hosting this Forum !

we will need controlled studies on this before any reccommendations can be made.  MG

12/15/2013 - 13:39
Peyronies treatment

I was prescribed Pentoxyfilline and L-Arginine to treat my Peyronies. The medication made me light headed and nauseated. I stopped taking the medication. Is there something else worth taking? Was the injection treatment approved by the FDA, September 6th?

Pentoxyfilline and l-argenine are widely used for PD, though there is no controlled studies confirming their effectiveness so I would suggest you stop taking them.  Depending on the type of bending you have and the presence or absence of calcification, Xiaflex (which is now approved) may well be your best first line treatment.  MG

12/07/2013 - 11:44
Size loss

Is there a calculation or average size loss for certain degrees of peyronies? I had a 5 inch, now I have a 90 degree curve and I think it is about 3 inches on the curved side. Will I lose more when I have nesbits surgery?

a good way to see what you will end up with after a nesbit plication surgery is to stretch out the flaccid penis and measure the length long the top - it should be fairly close to this.  MG

09/07/2013 - 14:45
Looking for Urologist

My husband has had PD for over a year now and we are interested in the trying Xiaflex but I think that his doctor may not be up to date on Xiaflex and using this new drug as treatment. Is there anyone that you might could recommend in the Jackson, MS area for him to go to?

I would suggest you contact Auxilium Pharmaceutical Inc, the manufacturer of Xiaflex and the sponsor of its recent clinical investigations.  They should be able to refer you to a urologist in your area who participated in the clinical trials and is experienced in its use.  The clinical trials took place in 54 different sites in the United States and 10 sites in Australia. MG

09/07/2013 - 14:40
Trial and error or implant surgery right a way?

Trial and error or implant surgery right a way? I'm a 63 year old man living in Oslo, the capital of Norway. I have suffered from Peyronie for about two years. By means of a conveyor (semi-circle), I estimated the curve to between 60 and 75 degrees. (By looking at YouTube, I learned how to measure the curve). The bend is upward. There is no bend to the left or right. My erection is just sufficient to have intercourse by means of Cialis or Viagra. Perhaps my questions is a bit weird, but my urologist is a man of few words and very unwilling. I have not had a girl friend since I got Peyronie. Therefore I face two choices, I think: 1) Find a girl friend who is willing to experiment and help me figure out if it is possible to have sexual intercourse with my some 60 degree curvature. What is the chance of a successful outcome? Do you know of books on how to have sexual intercourse with a curved penis? 2) Surgery the sooner the better if the chance of success seems very little. If the surgery of type incition/excition fails, can the situation in a way be saved by implant surgery? Growing older and operation of type incition/excition may cause reduced erection, do you think that implant surgery may be the best solution for me? Do you know anything of UGRS International in Frankfurt. Their internet pages seem very promising. In Norway very few operations on Peyronies is performed.

These are good questions.  A general rule is that intercourse become physically difficult with bending that exceeds 50 degrees or so - especially if you have indentation and a segement that tends to collapse or cause a hinge effect. We know that PD has some significant psychological effects on your self image, confidence, etc. so that entering into new sexual relationships with this issue can be difficult. If your erection requires the use of medications for hardness, that raises another question about the best form of treatment.  My approach would be to due an ultrasound study called a penile duplex doppler exam, which allows us to see if you have good arterial inflow and no abnormal outflow so-called venous leakage.  If the erectile physiology is intact and functioning well, the choice would be to wait for Xiaflex (Xiapex in Europe) if it becomes available in Norway, or consider either Nesbit or plaque incision and fascial graft to straighten the penis. If erectile function is less than perfect, straightening of the penis in conjunction with inflatable implant placement would be a good option. I am not familiar with the clinic in Frankfurt. MG

09/07/2013 - 14:25

I am 53 years old, About two years ago, i had a circumcision, when it healed i noticed that when i am erect, it is only half the size. I remember doing some research on the web, and i found some information about "Dwafted penis or something simular to that title,after agressive circumsition". I am trying to find that information again but i can not find it. I am returning to the surgon who performed the circumsition for some other fixing to the foreskin. The article i found, said that the dwafted erection or something called simular to that , can be fixed with some simple surgury. Can anybody help me with this information.

I think returning to your surgeon for re evaluation is the proper thing to do. MG

09/07/2013 - 14:23
harder erections

If blood flow is increased due to Xiaflex's breakdown of the plaque, wouldn't that mean erections will be harder too due to the increased blood flow? That seems to be another side effect of Peyronie's that few talk about - softer erections. By the way, just read that FDA is postponing Xiaflex until December. Thanks, Dr. G.

At this point we don't know what effect Xiafex has on blood flow, as this was not measured during clinical testing. You are correct, many patients with PD experience some loss of erectile rigidity or hardness.  The FDA decision date on this drug, initially slated for September 6th of this year, was extended 3 months to December 6th in order to resolve issues with package labeling.  The FDA did not request any further clinical data or clinical trial testing.  MG

09/07/2013 - 14:19
Checkup whit erection

I am very new to this. Have discovered it bout a year ago and never really been diagnosed, except for my main doctor who only commented on my verbal report. My initial question/dilemma is how and who can really diagnose it, and do I have to/should I show it to a practitioner when erect. I think, at least for me, the only way to really see it or understand my difficulty (I have not been able to stay inside after penetration (which is also difficult), unless they can see it when erect. Thanks for the guidance

The best way to demonstrate the deformity to your doctor is to take cellphone picture at home while erect.  MG

09/07/2013 - 14:16
New PD

Iam 32 years old. One year ago, I was diagnosed with a PD. I mentioned Xiaflex or Collagenase clostridium histolyticum to my urologist but he told me that: The treatments you are referring to require a certain plaque size and significant curvature of the penis. When we measured your plaque I calculated the diameter at 3.7mm, which is currently too small for any topical treatment. I am not sure what to do. The curve is still small but annoying , downward, and not sure if it is getting worse. I am currently having vitamin E 300 i.u daily. My urologist advised me to have potaba, 3g QSD. What do you think is best for me, need your advice, thank you.

You could give the Pobaba regimen a trial, though results with this agent are mixed. Clinical trials with Xiaflex did not include patients with downward bends, so we are lacking experience for this particular application.  MG

09/07/2013 - 14:11

Hi I hurt my penis 2-3 month ago when I had sex white my wife after that I have felt pain in my penis and about 1 month ago it started to bend to the right. It gets more and more benth for everyday that goes by is this Peyronies? And in that case what can I do to stop it from getting more bent. Should I try not to have sex so it gets a chance to heal? Is ther any ting else I can do to stop it from getting worse? Should I take some medicine or vitamins? Does a penis lengthening divice work? I read on Internet that this kind of things could straitening a penis white Peyronies. I am 34 years old.

There is no need to avoid sexual activity.  In some instances stretching devices can help, if they are used for several hours daily and don't cause any discomfort.  MG

09/07/2013 - 14:09
PD amount of loss severe

I am 23 and used to have a 5 inch penis (4.5" girth). I suddenly developed PD over the past few years and have now got an over 90 degree curve to the left (not upward or downward). My penis is still 5" along the right, but seems severely shortened on the left. My doctors have said the Nesbitt surgery could reduce my size by quite a bit, possibly leaving me with a micropenis, as they said at least 2" will be lost. How much is usually lost? can you calculate something? I would just be happy to have a straight small penis,rather than an average bent one, and I have someone who loves me very much. But it is quite a concern. They have offered implants and cutting of the cord to lengthen, but I don't want this as I don't want to lose any chance of erection. Just looking for an opinion, cheers.

A good index of how much length you will have after a Nesbit is to stretch the penis straight out from your body while flaccid.  MG

09/07/2013 - 14:05
Low Energy

I have been on Colcrys .6 mg, 1 twice a day and Pentoxifylline ER 400mg, 1 twice a day, for the last two weeks. I have noticed that my energy level feels like it has dropped about 30% simultaneous with the starting of these two medications. I don't know that this is what is causing it, so, before I do an experiment of stopping the medication to see if my energy returns, I was wondering if anyone else has had this issue.

Assuming you are having no intestinal problems in relationship to these meds, I think it is unlikely they are responsible.  MG

09/07/2013 - 14:02
Mondor's or Peyronies?

About 4 months ago I had pain in my penis so severe during intercourse that I could not finish. After examining it, I noticed a large extremely painful lump right on the dorsal vein of my penis and the vein itself was very thick and hard. I went to the ER and the doctor there said he believed it to be thrombosis. He referred me to a urologist but I didn't go because I am uninsured. So after letting it rest and taking NSAIDS, Vitamin E, hot compresses, etc., the pain disappeared in about 2-3 weeks and the lump was gone completely in about 6 weeks. Fitting right into everything I've read about the duration of Mondor's. The thing that is worrying me is that during this time my penis had a slight upward curve that it never had before. I figured this was just due to the blood clot. But now (about 4 months since the first onset of pain) the curve is still there. I have no other pain erect or flaccid that I know of and no scar tissue that I can feel, just this slight curve. I am wondering if I was somehow wrongly diagnosed and have peyronies or if this is just an after effect of dorsal vein thrombosis. Any help would be greatly appreciated. Thank you very much for your time.

I think if you cannot feel any hardness, lump, or plaque in the flaccid penis, this probably is not PD but rather some lingering inflammatory residual from Mondors superficial vein thrombosis. MG

09/07/2013 - 13:59
Loss of size and girth?

Hi, I've had peyronies for 18 months or so. Although my curvature is not too bad, the length and girth of my erections have reduced considerably. I am guessing that this is due to poorer blood flow because of the plaques etc. Would Viagra help improve this??

Peyronies can impact erectile function, so yes you may find Viagra or one of the other phospodiesterase inhibitors will help.  MG

09/07/2013 - 13:58
Peyronie's with no pain and no loss of erection?

About 3 weeks ago I noticed a dent about half and inch from the right base of my erection. I feel no nodules or bumps, though I do notice that that spot stays harder a little longer as my erection subsides. There is absolutely no pain and I am still able to have sex without complications. I cannot recall any injury or damage done, but I have masturbated when I wasn't fully erect a few times recently which I heard can damage it. I have an appointment with a urologist named Weinstein in Santa Barbara, but I have no idea if he is knowledgeable when it comes to PD. I'm not really excited about traction or vacuum devices, but I don't want it to get worse. Should I abstain from sex? Should I rest it or use it more? Is my lack of pain or ED a good sign? Thanks for maintaining this site.

The lack of pain and ED are positive factors. I would see no reason to use a traction device to treat an indent, and based on your fully functional status I would be inclined to monitor your situation while taking some of the oral meds / supplements rather than adopting a more agressive approach.  MG

09/06/2013 - 20:39
Hourglassing and Xiaflex

I'm experiencing severe hourglassing about 1/3 of the way up from the body. This forms an almost finger deep indentation on one side, and a slightly smaller trough on the other. Overall, it's creates a slight bend toward that side, but the biggest problem is strong erections are painful, and weak erections flex too much. I can feel a nickel size plaque on the top of the shaft, which seems to cause this constriction (looks like an invisible rubber band around it). How well might Xiaflex treat this issue? Has there been any treatment or study of this symptom of PD? What side effects or risks are there with Xiaflex? If collagenase dissolves scar tissue, what replaces it? (I'm a bit nervous thinking about dissolving bits of the old manhood...)

Some of the clinical trial cases have shown Xiaflex may help with indentation.  Clearly, it can lessen bending by softening the restricting scar and allowing more expansion in that area. In some cases it eliminates enough of the bulky scar to allow the remaining tissue to stretch better.  In other cases patients report a "snap crackle pop" sensation as they do the stretching exercises that follow injection, suggesting it is actually breaking or dividing small parts of the plaque. Collagenase sticks closely to the site of injection and will not spread around and cause excessive dissolution of connective tissues so some of the effects depend on how and where it is injected.  This technique is being standardized based on clinical trial work. There have been a few cases of tears or rupture of the wall of the corpus cavernosa after collagenase injection, though some of these may be attributable to resuming intercourse too early, when the wall is still weakened by the drug. In the case of beneficial "pops" where the plaque breaks apart and the bending improves dramatically, the defect created by this event heals with the assistance of the adjacent overlying layers of fascia. MG

09/06/2013 - 20:26

I went to a Uroligist this week for a lump in my penis. I also have pain with erection. He told me I have Peyronies and there is no effective treatment.I have been having ths problem for about 2 months...I want to try something, I feel like this Doctor just collected his fees and shuffled me off to Buffalo!!!!!!

This can happen when you see a busy urologist who has little interest in treating this problem.  Check the links at the end of this site which can reccommend an experienced physician with an interest in treating PD.  MG

09/06/2013 - 20:23
Hard moveable lump not on penile shaft.

I have had an ultrasound on my genitals today due to a hard movable lump. The lump is not on my shaft it is underneath, between my testes. The dr told me it was calcifacation and nothing to worry about. My question is.. Is the plaque for PD always on the shaft or can it appear elsewhere?

This is not PD - the palpable lump or plaque always involves some part of the shaft of the penis.  MG

09/06/2013 - 20:21

I was diagnosed with PD 3-4 years ago. The result of PD for me has been a 45% overall shrinkage in size, both girth and length. I have only a very slight bend when erect, I just don't have much...about 3 inches. I do not have any pain. My penis has also shrunk in size when flacid leaving a extra skin that almost makes me seem uncircumsized though that procedure was done to me as a newborn. MY GP has now diagnosed me with balanitis even though I shower twice a day and have excellent hygene. My penis has become a worthless, ugly, rashed tool that will not allow me urinate without dripping on my testicles. Is there any hope for me to fix this?

I think there is.  There is currently an interest in combining enzymatic softening of collagen with stretching or the use of vacuum to produce tissue expansion, which may lead to some practical clinical strategies for your condition.  MG

09/06/2013 - 20:17
why do the men get this disease?

I am with my partner for over 8 years. He is the best for me. And suddenly it happened that he got this disease. It makes our relation discomfortable, cause he has pain after every time we make love. How could we solve this problem? He is getting stressed and I dont want him to be stressed

Your sentiments are understandable, as this is a very frustrating condition. Probably best for you to both go together and visit a urologist who has an interest and experience with this problem. MG

09/06/2013 - 20:15
Early Intervention?

I have recently been diagnosed with peyronies. First symptoms appeared about 2 months ago and curvuture stops penetration. The urologist basically recommended I just wait and see over 6-18months and said no clinical studies to prove any effective treatments. Amongst your excellent info some options require early intervention and I don't wish to 'miss the boat'. What do you recommend as worthwhile trying out at this stage. Some hope is better than none :)

Conventional medical therapies for PD are not backed up by airtight evidence but they do help occaisionally and are better if started early.  These include oral pentoxyfilline, colchicine, citrulline or carnetine, and intralesional verapamil.  There is pretty convincing evidence for the effectiveness and safety of collagenase (Xiaflex), but it is not FDA approved yet.  The initial September 6th date for the FDA's decision was extended 3 months to sort out some labeling issues with the manufacturer.  MG

09/06/2013 - 20:09
Peyronies and venous leakage?

Hello Dr. I am 90% sure that I have peyronies disease but I just wanted to hear your opinion. I think I may also have venous leakage due to it, any thoughts would be greatly appreciated. I am 24, from England. In November 2011 whilst having sex with my (now ex) girlfriend, we were both very drunk and I wasn't 100% erect. I was seated and she was on top. In this position, I slipped out of her and she came down on top of my penis. There was slight pain for me initially but then we continued until we were finished. I haven't had sex again since this occurred and I believe this incident caused my condition. Immediately afterwards (the following day onwards), for a period of around 3-4 months, I had continuous pain on the top side of my penis just below the glans. This pain would disappear upon erection but was present constantly when flaccid. It was a dull ache just below the glans, the top left of my penis with very slight bruising under the skin. I adopted a 'wait and see' approach which I now regret very much, I still haven't gone for any treatment though because I am very embarrassed and in no pain anymore thankfully. My penis has developed a noticeable upward bend to the left, its shorter overall, when I am attaining an erection my penis feels blocked and uncomfortable, and there is noticeable plaque just below the glans. I can feel it below the skin with my fingers and its extensive enough that it is pinchable to an extent. I also have a slight delay from when I begin to urinate and when urine comes out, with a sense of incomplete voiding at the end sometimes. When flaccid my penis looks normal really, if a bit red around the glans, but when I retract the foreskin the bend becomes noticeable slightly. Lines in the foreskin have developed where the scar tissue and bend begins. Since I am in no pain anymore (thank God) I feel I can live with the aesthetics of my condition, I don't care what anyone would think of me, my main problem though is the blood supply to my glans and thus erectile dysfunction: When I get an erection, the bottom 3/4 are normal, but my glans is soft compared to how it used to be. I lose erections very quickly. My morning erections are not as hard or as long lasting as before. Laying down I have to keep my legs closed or it is guaranteed to go down in less than a minute. I have to clench my PC muscles constantly just to keep blood in my glans. Erections are impossible to maintain whilst seated now, I can gain erections whilst standing, they seem to be best when I'm standing. I am in good physical shape, I exercise and do not not take any medications whatsoever, I'm thinking the top side scar tissue is causing the veins to be unable to restrict the blood flow out of my glans? Thanks in advance for any help, and for setting this site up and helping people. God bless you.

That is a fairly common scenario for the kind of trauma that can cause PD: partner on top who "misses" and bends the penis. It is also known that PD can produce venous leakage of varying degrees which causes some of the trouble with rigidity you describe. The good news is when this happens in your 20's it is very much more likely to eventually improve or resolve that it would with a similar injury to an older man.  I would try l-argenine at about 2,000 mg daily for 4 - 6 months as it may help.  Pentoxyfilline is another option though you'd need to consult with an MD to start on that. MG

09/06/2013 - 20:01
traction or ved

Doctor I have been using VED for my peyronies for 3 months but I see no results. Would it do any harm or good to try traction? or can I try them both? I have a 45 degree downward and about 30 degree to the left bend.

There is no harm in using both as long as you cause no discomfort and monitor the results on your own natural erection.  MG

09/06/2013 - 19:58
Vaccum pump exacerbating bend?

I've had Peyronies for two years. My urologist put me on Pentoxifylline three months ago (400 MG three times a day). He also suggested I use a vacuum pump for ten minutes a day, which I've been doing this for about two months. A few weeks after starting the pump, I began to feel that the bend of the penis had become more pronounced when at rest. It's just a few degrees worse, and there's no pain (that subsided a few months ago), and the upward curve while erect is about the same as before commencing treatments. Even so, I wonder if using the pump may be causing the worsening angle while at rest, and whether I should stop using it. I saw that, in a response to another poster, you stated that this is an unlikely occurrence but I thought I'd ask nevertheless. One further point: When I use the pump (using the smallest of the two rings provided), quite a lot of the scrotum is sucked into the tube. I can't seem to avert this from happening. Might this be a problem? The salesman who I purchased the pump from at the urology center said that this often happens and is nothing to worry about, though I haven't asked him about the worsening bend yet. (It seems odd to ask this salesman about potentially consequential medical matters, but I won't be seeing my urologist again until November). Thanks for your help, this is a great resource.

In some cases, depressing the barrel of the VED more firmly into the tissue around the base of the penis may prevent scrotal skin being pulled in. I have seen the occasional instance where either the use of a traction device or a VED aggravated the Peyronies and seemed to have caused the bending to worsen - if the bend really seems worse to you (as measured during a natural erection), perhaps you should take a break from using the VED for 4 - 6 wks. MG

09/06/2013 - 19:53
Peyronie's medication causing swollen night-time erection during sleep?

Dear Doctor, I was diagnosed with mild Peyronie's and I've been taking Pentoxifylline and L-Citrulline for about 3 months. Numerous times during sleep I've been awoken by my erection, which felt very tight (not necessarily painful, but a lot of tightness). I recently got out of bed to view its appearance and saw that it was more swollen than what I'm used to during the day when I give myself an erection. Should I be concerned? My fear is that a much higher blood flow is being caused by either the Pentoxifylline or the L-Citrulline, and that this could lead to injury of blood vessels or other complications. The erection dissipates quickly if I get out of bed. I'm not sure how long they persist while I'm asleep if I don't get woken up. I've never observed my night-time erections before, so I can't say if this is new and unusual for me. Is it normal for night-time erections to be significantly more engorged that day-time erections? Should I stop the medications for now? Please advise. And thank you in advance.

Pentoxyfilline facilitates blood flow and it is possible this is responsible for increased fluid tension during erection. I don't think there is any danger associated with this - but I would not exceed the usual dose of 400 mg up to the maximum of 4 times per day. If you are at this level you may want to back off a bit.  MG

08/07/2013 - 11:20
My bent penis

Three weeks ago I had a bladder neck operation , and could not wee so they left my catheter in for about 9 days . When it was removed it seemed fine , but later that week found that when I was getting an erection It was very bent also really hurt am I worrying over nothing and leave a little longer before getting touch with my gp

I would discuss with your GP but we would not expect Peyronies disease to come on this quickly after catheterization.  MG

08/07/2013 - 11:21
Peyronies Disease and Ejacution

I was diagnosed with PD about a year ago. Along with PD i have BPH. Im taking cialis and flomax for BPH. Recently I have been having ejaculatory issues during masturbation even though I can achieve an erection. My question is are these ejaculation problems common among men with PD? Your help and advice is much appreciated.

Peyronies will not affect ejaculation but the meds you are taking for BPH will.  MG

08/07/2013 - 11:24

I've had a pain in the end of my penis for a while now, probably 6 months or so, the last couple of months the head of my penis is now bending back at 45' and painful when erect, I'm 37 and have been very sexually active with my wife for many years, I can't feel any hard lumps at all, and I've got to say it's really beginning to get to me now. Thanks.

This certainly sounds like PD to me.  Intercourse can become difficult when bending gets to 45 degrees.  I would see a urologist in about 1 month, as the date the FDA has given for their decision on a new and promising medication for bending (xiaflex) is September 6th.  MG 

08/07/2013 - 18:01

Any word on when Ziaflex will get it's FDA approval?

September 6th has been listed as the date when FDA will give their decision on Xiaflex.  MG

08/07/2013 - 18:03
I Don't Know What's Wrong With Me

I’m 61, overweight, and a heavy smoker. I suffer from depression severe enough to have reached the “I’m not suicidal, but I don’t want to be here anymore” stage. My wife stopped having sex with me a couple years ago as her overall interest in sex diminished to nothing. Since that time my flaccid penis has shortened to about half the length it was. I haven’t had a full erection in probably three years or more. I assumed the shortened length was from, quite frankly, lack of sexual activity. Tonight, I woke up with an erection, a rare occurrence for me. And then fear set in. Though the erection was full, the skin at the base was pulled dramatically from the right. The shape was an almost perfect “C” to the left. I was terrified. I felt a ‘spongy’ spot near the base, that seemed to indent on the left side. Obviously, the erection didn’t last long after that shock. I’m scared, which should also be obvious because here I am posting this after scouring the internet for any answer as to what’s happening to me. Help? Please?

This does sound like PD, which can cause length loss as well as curvature.  You should be checked by your local urologist. The good news is, knowing what the problem is will lead to potential solutions. MG

08/07/2013 - 18:06

Hi I was diagonsed with Pd about 18 months ago, I am now 66 UK resident, I wrote to you several months ago saying that I was to put on a course of ultrasound treatment. However my urolgist eventually decide that the nesbitt operation was the best option, and this was performed 12 weeks ago, in the UK. I was given all the warnings prior and also told that circumsion may be necessary. After recovery, I was surprised in the amount of shortening that had resulted, and though the shape of my penis was more consistent there has been very little if any im provement in curvature. Happily my erections are still strong, but i do get soreness where the incision was made and a pulling sensation, and i wonder if the size, curvature and soreness would have been better if circumsion which was not done, would have improved this. Whereas I fully understand that you will say I should refer back to my urologist, I spend most of my time in the far east and Australia so this is not easy. I would appreciate your views on the following: Will the curvature improve without further treatment,or will Xiaflex when available help,would viagra or similar improve the curvature and or length,and do you think circumsion would have improved the situation? I can still feel the internal stitches, though not painful or worrying should these have dissolved by now? Thankyou in anticipation, I discovered your site just after being told i had PD and the confidence it gave me knowing that i was not on my own was beyond value... thankyou.

If you still have curvature after nesbit procedure, it is possible Xiaflex may be of help to you in the future. I doubt that circumcision would have changed your result, and usually the dissolving sutures become less noticeable after about 3 months.  MG

08/07/2013 - 18:08
Topical Treatments

I recently read that some are using vit. E in a topical treatment. Would that help along with taking it orally? Also I read suction devices can further cause bruising and further damage to PD. Any precautions as it appears to be more accepted use now? Thank you for your hard work and information to those of us who need some encouragement.

Vitamin E is widely used but seems to do little more than stabilize the condition. I think it is safe to try vacuum devices for stretching / straightening, but they should be applied for no more than 4 - 5 minutes daily and not long enough to cause bruising.  MG

08/07/2013 - 18:10
Pump failure

Hi Dr, I had a the full pump operation about 2 years ago and the surgery was quite intense (over 6 hour long). Following the op my emotions were mixed. The pump work very well in as much as making me rigid but the length I archived was far less than before the op (only being able to pump it about three times at most before the pump itself goes completely hard and will not pump further) and my wife and I still find it very difficult to have normal sex. Last week I was rushed to a&e with suspected appendicitis but following blood tests, X-rays and a CT scan they Lund nothing wrong. He surgeon did however state that the pain was exactly where the pump reservoir was located. I was wondering if you have ever heard of this before? I am going back to see my surgeon In the near future but would like your opinion so I know if I'm being fobbed off. Thanks, Rob.

It is possible the reservoir is involved in some process causing abdominal pain though this is very unusual.  MG

08/07/2013 - 18:11
Ugrancy of starting injections in acute phase.

I have had this condition for approximately 5 to six months. I am just now scheduling with a urologist. After talking with his office staff, his main treatment protocol is injections of verapamil every three weeks. From my research on the internet this has limited success. I wanted to inform myself about this procedure and it's efficacy before I do anything. I am currently taking carnitine, enzymes and CoQ10 that have at least given some people benefit. My question is: Is it critical to start Verapamil injections ASAP is would it be better to wait for something better? Do you think any of the things I am taking orally will help? Thanks for you help. Doug

I would wait to see if Xiaflex is approved by the FDA next month.  Clinical trial data suggests it is more effective than verapamil.  MG

08/07/2013 - 18:13
ED may have something to do with peyronie's disease

So i'm 20, about to be 21.I suffer from ED. I dont have medical insurance but they did a testosterone check and they said everything is good. I cant get fully erect its always in a flaccid state, i can get hard if i'm masterbatting but i cant get an orgasim from that no feeling at all. My penis started to curve a bit too i dont know whats wrong with me, any suggestions ?

It sounds like you should see a urologist that specializes in sexual dysfunction.  MG

08/07/2013 - 18:17

About 1.5 years ago I noticed a hard lump near the base of my penis. I went to my doctors and was given a Urology scan that confirmed I had Peyronies. I was put on a course of Pentoxyflyn 3x a day. I have since seen a specialist who also put me on a course of Cialis. After a year or so the small lump changed in to a general thickening of the center of the penis shaft with very slight curvature upwards but due to the Peyronies being centrally located not much curvature is noticeable. Unfortunately recently I have noticed three new hard lumps, similar to the initial ones I found. They are located on the base of the shaft at the front, back and also on the right hand side of my penis shaft. I have a follow up appointment with the specialist at University Collage Hospital, London at the end of July 2013 and was wondering whether to suggest Xiaflex to him? I don't know much about this drug, is it the most advanced medication to treat Peyronies to date? Finally, are injections likely to help me at this stage? Kind regards

In clinical trials Xiaflex has been helpful in improving curvature and if this is an issue for you, it may be worth considering.  MG

08/07/2013 - 18:17

How can I find out who the 5 top Dr,s in the US for treatment of pyronie,s

check the doctor referral link in the links section of this website.  MG

08/07/2013 - 18:18
Using Infrared heat lamp

I was just wondering what is the max watts a person should use for their peyronies, and what distance to keep away from the bulb... because i know and heard the risks of cell death and necrosis, i ask because i read online study that shows 150W with a distance of 20cm around 8 inches... reduced plaque size, i have a heat lamp and planning to get 150W bulb, but my instructions say to keep 18+inches away from the body... Should it be safe to use the same distance and bulb of 150w because i was told that's a safe temperature they did in the study.

I would be very careful to avoid burning yourself, especially since there is no data proving that local heating will help PD.  MG

08/07/2013 - 18:20
Curvature / Doctor's visit / Peyronie's

I'm 34 years old. About 6-12 months ago, I began to notice that my penis seemed to bend leftward in a way that I had not observed before. It's most noticeable when it's in-between flaccid and hard (and looks like maybe a 30 or so degrees kink in the penis). When I'm fully erect it's not very noticeable and I am more straight (with an upward curve). When it's fully flaccid it also curves to the left (sometimes significantly and with a twists). It is very aggravating because it seems to always want to go to the left and curl up, and it feels kinked and less comfortable when it's like that. I find myself always wanting to adjust myself and move it to the right side, and try to wear underwear that keep in positioned that way. I have been experiencing some pain and soreness mainly when flaccid or partially erect, which feels mostly concentrated around the inner side of the curved area (and is greater when I let it bend that way). There was an event that occurred after the problem initially began, where a girl tried to sit on me to ride me, and my penis was only maybe 80% hard and didn't quite align right, and ended up bending to the left while hard like that. It seems like that is a weaker side. It hurt when that happened, and I lost my erection, but regained it and finished. I have noticed there is a lump under the skin where the bend occurs. If I move the skin up or down, the lump does not move (it is under). The lump is on the outside of the curve. It seems to be sort of elongated and wider horizontally, and may have two branches on each side (hard to tell it's shape or what it is). On that right side there are also other rough spots that don't move, which I don't observe so much on the left side. There is also a similar thing toward the base on the right side, almost like a partial ring. I have been concerned that I have Peyronie's. Since the time that this all began, I think it has actually gotten a little bit better, and was feeling good about that. Recently though, I went to a urologist to see what they'd say. They did in exam in which they squeezed the shaft of my penis between their fingers, and felt all around. They squeezed pretty hard (harder than I ever have). It didn't hurt bad, but wasn't comfortable. He said usually if it's Peyronie's he can feel very hard tissue, and he didn't observe that in me, except in the one area where my concern is he did detect something, but said it wasn't much, and he had to go really deep to feel it (and he squeezed extra hard there and for a longer time). He said he wouldn't even treat for that, and marked me as normal. Since he squeezing me hard during the exam I have felt greater soreness (mainly when flaccid), and the curvature seems to be worse (still seems OK when fully erect, but the lump is slightly detectable then too). I think he aggravated the problem by squeezing so hard to examine me. Do you think that is likely? The lump area almost seems like it's bigger. It's really stressing me out that things had been seeming a lot better, and now because of that exam I feel like I'm worse than ever. What do you feel my symptoms are likely to be? Thank you very much!

This does sound suspicious for a mild form of PD.  MG

08/07/2013 - 18:23
Peyronie's disease

I am 65 years old and have had Peyronie's disease for about 1-1/2 years. The urologist told me that there was nothing he could do, short of surgery that he did not recommend. He said there were numerous naturopathic remedies, but they do not work. Because he left me with no alternatives I have been seeing a Naturopathic doctor. I have had no positive results after using PABA, Vitamin E, Centella lotion and Epsom salt baths. I also tried a series of cold laser therapy that did not work. The ND is now recommending oral pentoxifylline, however an ND cannot prescribe medications in the state where I reside. And, even though I have documentation of a double-blind study showing positive results using pentoxifylline for Peyronie's with low adverse effects, the MD's and DO's I have talked to do not want to prescribe it. Do you have any experience with pentoxifylline? Thanks.

Yes, many of my patients have used pentoxyfilline at 400 mg 2 to 3 times daily.  There have been cases where it helped, though I don't have a control group for comparison. MG

08/07/2013 - 18:25
Use of sex toys with Peyronie's?

Hi, Dr. Gelbard -- Thanks for your highly informative site. I work with the sex shop Good Vibrations, and we recently had a male with Peyronie's shop with us and ask whether it was safe to use men's pleasure devices like pumps and rings. Our staff member didn't know what to tell him. I've done no specialist study on this condition and so am not positive whether constriction play (as with a cock ring), in particular, would be harmful. I've scanned your Forum page enough to see mentions of pump use in a therapeutic context; I also saw your warning against metal rings, with which I strongly agree. Is it safe to say that a man with Peyronie's (excluding a complication like diabetes) could use a stretchy or a snap or velcro softer-material cock ring without damage? If you wouldn't mind sending me your reply, I'd be grateful -- could get this info out faster to staff members who assist customers (and please do feel free to post on your forum too if you think it would be helpful for your readers -- I imagine some guys and their partners might be interested). . Thanks so much!! --CQ

Yes, the use of a soft or stretchy penile constriction ring should not be dangerous if not used for an excessive amount of time or in a way that causes pain.  MG

08/07/2013 - 18:27
Decade of problems

My husband has had Peyronies disease for over a decade. The urologist that he saw in the beginning fo this disease was not very promising. He admonished my husband for having "rough" sex and told him that there was nothing to be done medically and further that surgery usually had poor results. That was it for my husbands mind there was no hope and it was pointless to see another doctor. Needless to say we are not intament. Sex is painful for both my husband and for myself.

The two of you should see a urologist that specializes in the treatment of PD - there are things that can be done to restore function.  MG

08/07/2013 - 18:28
Safest Procedures for PD

I noticed the lump on the top three months ago followed by a shortening but wider appearance. Just last month I also noticed a slight up curve at the head. Which is the safest procedure for lengthening and straightening PD? Would a pump be better and safer then an extender? It appears from the instructions one is used for about 10 minutes daily as opposed to the extender that requires 6 hours of use. I am currently taking per your recommendations on this forum, vitamin E 4oo units and 2000 mg L-arginine daily. My doctor would like me to try the six course injections but I have heard mixed reviews. Why not wait for the new drug that sounds like it works if I am going to take any injections? Thank you for your response and forum that is very helpful

I think waiting for the new drug makes a lot of sense - it appears to work better than verapamil.  Either a traction device or Vacuum pump may help to straighten out the bend - it may be easier to use pump for 5 minutes a day rather that a stretching device for 2 - 3 hrs daily.  MG

06/12/2013 - 17:34
xiaflex approval and pd treatment regiment

dear dr.gelbard - again, thank you SO very much for your kindness and sharing your expertise! i read online, that they approved xiaflex in april for the dupuytren syndrome (which i have besides pd) - if i see a urologist, will he now use xiaflex for my pd as well - and what does it exactly entail? (how often does it have to be administered and is it expensive?) can he also help with my hand or do i have to see another specialist for this (and pay)? i trust your ethics, since i sometimes wonder, how much money less ethical doctors make off peyronies? (the ultrasound imaging almost bankrupted me - and waht did it help?) so looking forward to reply!

At some point in the future your urologist should be able to use Xiaflex to treat your PD.  It is quite expensive, which means you should probably wait until it is approved by the FDA for PD (expected in Sept 2013), because to use it off label now you would have to pay for it.  It is currently approved by the FDA for use in dupuytrens, so theoretically this would be covered by insurance - but you would have to see a hand specialist (orthopedic or plastic surgeon) for treatment.  MG

06/12/2013 - 17:25
PD, something else or a combination?

First I would like to say that I appreciate your running of this forum and have found it highly informative. I have been suffering with a condition for close to two years now involving my penis. It has become hard and retracted the majority of time in the flaccid state, aggravated especially by exercise, anxiety and even urination. When lying down it can often return almost to 100% normal (in its flaccid state). I have visited multiple urologists, one who did not believe there was any issue, one who could very much feel something wrong but had no idea what it was and finally a third who described it as possibly fibrosis from a priapism combined with possible PD. The third urologist sent me for an Ultrasound (this revealed no issue with bloodflow) and an MRI (this revealed no visible plaque). The urolgist recommended I begin VED therapy and I am now waiting for a follow up appointment to see a VED vendor. I have ED issues occasionally where only half the penis seems to become erect leading to a downward banana shaped curve. However if I apply constant stimulation and am less anxious, I am able to acheive a full erection. When fully erect I have a gradual curve to the left of between 25 and 35 degrees but have had this since birth. I also seem to have a number of solid veins within the penis (they are however movable under the skin) and these have only appeared since the onset of this condition. As far as I can see, my erect penis has remained unchanged as long as it is fully erect although it has become bumpy in texture (seemingly due to the veins). To my knowledge I have never suffered a priapism an I am confused by this diagnosis which does not seem backed up by the scans I have had performed. I am debating paying to see Dr David Ralph (I live in the UK) privately and perhaps shed more light on this issue. I thought I would first write a question on here to see if you recognised any of the symptoms described. My own research online has turned up a condition seemingly related to a pelvic floor condition involving chronic retraction of the ischiocavernosus muscle and other sufferers seem to describe my condition exactly and have resolved it using internal trigger point therapy, but I am weary of self diagnosis. Also is there any word on whether Xiaflex will become available within the UK either on the NHS or through private means. Thank you.

This sounds like a problem internally, possibly some kind of a change in the consistency of the spongy erectile tissue within the corpora cavernosa. It does not sound to me like peyronies and if you have no plaques or palpable lesions in the walls of the the corpora, there would be no point in using Xiaflex.  MG

06/12/2013 - 17:20

How bad does the curve need to be to get surgery?

Surgery is generally reserved for patients who have had PD for a year or more, have not responded to medications, and have enough bending that makes intercourse difficult or impossible.  Just how many degrees this is depends on the individual.  MG

06/12/2013 - 17:17
Not sure if I have Peyronies

Hello I am 16 and have recently discovered two lumps on the right of my penis. One is located just below the head and is firm, very small and skin colored. The other I struggle to tell if it is a lump, but is located further to the bottom where multiple veins meet, and it sticks out a little. Yet this is what makes the penis look angled. At first I thought they were lymphocele's, as my penis only bends 2 or 3 degrees to the left yet I think I may just be in the early stages. Is it possible I have it, even when the the small bend is towards the left whereas the lumps are on the right? Pictures I have seen show the plaque being on the side the penis bends so I am really unsure. I am not sure if this is important but I masturbate daily, and as far as I am aware of have suffered no injury to my penis. I noticed this only a week ago and am also unsure if I have only just noticed or it has always been there. A reply soon would be incredibly helpful, thanks!

A lump that protrudes outward as you describe does not sound like PD to me.  MG

06/12/2013 - 17:15
Still in pain after Peyronie's surgery one year later...

Hello, I had surgery for Peyronies disease in April of 2012. I have an allergy to iodine but the incompetent post-op nurse put iodine all over my penis to insert a catheter. This caused massive quarter-sized blisters all over the head of my penis that spread into the sutures. I still have pain and the scar is very bumpy. The worst part is that I have electrical shooting pains through my penis on a regular bases. I can't even take a shower without having to cover my penis because a stream of water hitting that area makes me double over in pain. I have to shave my pubic hairs because if a hair pokes that area I get that excruciating shooting pain. Erections are extremely painful so sex is not an option. The surgical doctor said I have nerve damage from the allergic reaction. The hospital is arguing this point saying that nerve damage could not possibly be caused by an allergic reaction. The largest blister was at the top of my penis. After this finally bursted, I had a huge scab that kept breaking open every time I got the morning wood which woke me every morning abruptly. After the scab fell off, there was a visible hole in my penis filled with pus where the sutures were that took a long time to close up. The surgical doctor said that if it was nerve damage from the surgery that there would be no feeling rather than sharp electrical shooting pains. Have you ever heard of anybody experiencing this after this long period of time? I am trying to establish if this pain was caused from surgery of the severe allergic reaction that I had. Any thoughts?

That is hard to say, because both can affect nerve function. MG

06/12/2013 - 17:13
no ridgidity in penis

i am 25 years old,i have been taking Viagra for the past 4 months about 3 times a week 100m tablets, I have taken Viagra before over the years but not that consistently, about 13 weeks ago I went to take a piss and my flaccid was completely curled round I had to bend it straight, I didn't panick much because I didn't know about peyronies and was getting erections fine and was using Viagra because I had gone down a few times with my girlfriend due to stress an anxiety. it all went really bad after I was masturbating my penis has always curved to the left slightly I was measuring my penis repeatedly I kept bending it straight I was masturabating bout half an hour, I went to take a piss again it was severly bent to the left I was semi erect at the time, I masturbated again an I noticed a tight numb sensation when I ejaculated I thought it was strange so I masturabated again an the same thing happened. in the morning I went to masturbate an I realised I couldn't get hard at all my penis seemed to have gone to rubber when I masturbate it expands but doesn't get hard, it has been like this for 5 weeks, my flaccid has been changing loads going incredibly thin an small sometimes, I havn't had a erection in 5 weeks unless I masturbate and even then it is soft like rubber, do u know what is happening do I have peyronies? I have noticed hardened areas, the whole shaft seems hard sometimes then at other times its really soft it has gone a yellow coulor aswell, will the ridgidity come back? will I lose length and girth? do you think the Viagra caused it? even after a Viagra I can't get any ridgidity

Based on the curvature that I assume you didn't have before, I'd say this sounds like PD.  I would recommend you see a urologist who may elect to do a penile duplex dopper ultrasound to check whether penile blood flow is normal.  MG

06/12/2013 - 17:11
penile fracture causing PD

6 years ago I fractured my penis 0,5 cm below the head on the left. I didn't go to the doctor, but the swelling went away, it seemed to be healed. Looking back, it wasn't properly healed. The pain after sex remained. Sometimes after intensive usage, the mucosa peels off. I can feel a little gap on the place of the fracture beetwen the two part, and it can be bent more easily. It's like the tunica albuginea wouldn't be continuous, and corpora cavernosa would hold it together. But there is no swelling, so it's not totally fractured. My erection is a little bit weaker in the end part. About 1,5 years ago, a lump started to grow on the right side of my penis, and it caused loss of penile diameter. What should/can be done with the fracture, sholuld it be repared surgically? I know it's an extreme case of stupidity, but I really need your help, I'm very frightened about developing more scar tissues. Thank you very much for your answer.

The lump present in this area is probably scar tissue.  Sometimes after trauma it can become calcified, which can be detected on x ray or ultrasound.  If this is the case and calcium deposits are present, a graft procedure by someone experienced in this type of meticulous work may correct the situation.  I the absence of calcium, you may benefit from collagenase (Xiaflex) injection if this gets FDA approval sometime in September. MG

06/12/2013 - 17:06

Does Peyronie's disease damage corpora cavernosa?

PD damages the wall of the corpora cavernosa, which is called the tunica albuginea. The internal spongy muscular tissue that expands during erection is usually not affected.  MG

06/12/2013 - 16:26
Changes almost daily after 3.5 years of PD

I have had PD for 3.5 years now. I was as recently diagnosed with high cholesterol and have made major changes to my diet and an doing as much exercise as I can. Although I have a set of pain management drugs the pain levels have increased and I keep feeling as if the blood is trying to break through the third band of visible scaring that I can see around the top half of my penis. The blood has already broken through two other bands of scar tissue in an extremely painful fashion. I've also noticed the large puffy white dorsal area of my penis seems to be going or at least flattening. Sometimes I think I can feel tiny rushes of blood or tingly nerves deep into the lower region of the penis. The dorsal bend which has been 45 degrees for about 3.5 years is changing almost every day and varies, seemingly at random, from about 10 degrees (massive improvement) to about 65 degrees (a lot worse). The bend is now even more apparent in the flaccid penis than before. I'm tending to view this all as good news in that things are chaining. I'm wondering if the changes are more rapid in the lower portion of my penis and this is making the bend worse but that hopefully in time the upper area with the visible scar tissue will open up to allow blood through. When I exercise I'm sure I feel the blood really pushing into and trying to get through this scar. it can get quite painful. Do you think high cholesterol has had an effect on my ability to naturally heal and that by reducing it the blood flood is improving?

High cholesterol alone won't do it, but if you have other signs of vascular disease the recovery of potency may be affected.  MG

06/12/2013 - 16:24
Swollen ring behind penis head--no correct erections since

Little over a week ago (8 days), the woman I was with reached into my pants and pulled out my erect penis. I wearing jeans, so there wasn't much room. She'd grabbed the bottom and bent it against the jeans until it was at 12 o'clock. There was no sudden pain, no snapping that I would hear. But when I checked an hour later I there was a swollen ring behind the head. The head also felt limp, numb. I haven't had a correct erection since. A day later I was able to bring myself to climax, but it was only a few watery drops, and I couldn't even feel it. I tried sex a couple days later, lost erection a couple times and couldn't climax. By the end of the week the small erections stopped. Urination is still fine. On Sat I went to the ER. ER doc spoke with a urologist and said it probably wasn't a fracture and would resolve itself. It hasn't yet. I just came back from my urologist app. and he told me he'd never seen anything like this before. There's no real swelling anywhere, maybe just a couple veins. Said it could be PD--but why would this happen suddenly? Now wants me to get an ultrasound to check blood flow. I've never once had an issue with getting or maintaining erections, and now it's been over a week with this problem. I'm really out of answers. Anyone heard of this before?

This does not sound like Peyronies.  A penile duplex doppler ultrasound may help to clarify the situation.  MG

06/12/2013 - 16:22
ESWT Treatment in treating Peyronie's Disease

Hi Doctor I am a sixty-four year old white male living in the United Kingdom, six foot tall, twelve and a half stone in weight and I consider myself to be in good health. I am not on any medication, I exercise regularly, sleep well, eat healthily and had a good sex-life with my partner. Since mid-December 2012 my penis has been sore and tender to the touch and I have been in considerable discomfort when wearing underpants or boxer shorts. In January 2013 I noticed that my penis had a distinct curve to it when erect and that the erection was accompanied with quite a lot of pain. I went to my doctor's in mid-February and was referred to a consultant urologist who I saw at the end of March 2013 and I was diagnosed with Peyronie's Disease. I had already done some research online as to the possible causes of the curve and pain that I had experienced so the diagnosis came as no great shock but it still caused me and my partner considerable upset. The consultant urologist explained to me the various stages of the disease, advised me to take high dose vitamin E 400iu tablets every day, stop taking glucoseamine tablets and said that he would refer me for a course of ESWT (Extracorporeal shock wave therapy). The discomfort when my penis is flaccid has now gone but it is still painful when erect but not as much as it was, there is a hard lump in the shaft of my penis about three and a half centimetres long, also the curve in my penis is now very pronounced at around ninety degrees and I have a narrowing of the shaft, I suppose it's what is referred to as an hour glass shape. I received notification from the consultant urologist today (24/05/2013) to attend his day surgery center on 10th June 2013 for Lithotripsy which is a treatment usually carried out on patients with renal stones. My question: Is this procedure (Lithotripsy) the same thing as an ESWT, how effective is it in treating Peyronie's Disease, is it too early to do this procedure as it is only been six/seven months since the disease first started and how safe is the ESWT procedure? Many thanks for all the information Peyronie's.Org has published, it has helped me enormously to come to terms with the disease.

Yes this is the same as lithotripsy.  It is safe at your point in the disease process, but unfortunately the results of ESWT for PD are mixed.  If you urologist does an x-ray and there is no calcification, you might want to ask when collagenase may be available in the UK.  MG

06/12/2013 - 16:18
Morning Erections

I recently had surgery to correct Peyronies, along with a circumcision. I used to have eretions in the A.M. prior to surgery. I have not had a morning erection since the surgery 5 weeks ago, and am still having difficulty reaching climax, like after an hour of oral stimulation, and masturbating-no orgasm, then I lose the erection. Will this eventually resolve after a longer post-op recovery period?

That is likely but recovery after peyronies surgery can extend out over several months.  MG

06/12/2013 - 16:17
Reaching orgasm after circumcision and temporalis fascia graft to treat Peyronies

I am a 69, and recently had a circumcision and temporalis fascia graft to correct Peyronies. Prior to surgery, I could only get a partial erection and even with oral sex, it took a long time to have an orgasm. Several weeks following surgery, I am able to get a full erection, but have been unable to reach climax. I was told later that the foreskin that was removed had nerves that increased the sensation facilitating orgasm. Is this a common post-op complication? Will the sensation return, plus the abilty to reach orgasm? Both I and my partner are extremely frustrated. The surgery corrected one problem, but created another. My penis also seems shorter since the surgery. Does Viagra help with better erections and/or orgasms?

Full recovery of sensation can take up to 6 or 8 months, not so much for the foreskin that was removed, but for the nerves that were lifted off the plaque for the grafting procedure.  This surgery can shorten the penis slightly, but as the grafts mature and soften much of the length can be recovered.  This can take 10 - 12 months.  Viagra may help with your condition.  MG

06/12/2013 - 16:14
Peyronies / Mondor's - delayed diagnosis?

Dear Dr Gelbard, thank you very much for your efforts and all the information on this site – it is extremely helpful. I would hugely appreciate your advice. My problem started in December 2012, when I began to experience sharp pain when my penis was erect, the pain emanating from the centre (inside) of the glans. I also noticed the presence of a small but quite hard ‘lump’ roughly at the centre of the penile shaft but very close to the glans. At that stage I had no curvature or indentation; the lump was (and remains) not on the surface of the skin but apparently at the centre of the shaft. My doctor (here in UK) referred me to a local urologist who (in February) was unsure whether this was Peyronies or Mondor’s Disease; on balance (in the absence of curvature) he felt it was Mondor’s and advised taking aspirin (or ibuprofen), which of course I have done. Changes have been slow, but by now (May 2013) they are definite. I have significantly less pain; the sharp pain occurs (now only intermittently) when I have full (excited) erection; the pain is in the same place. Also, the ‘lump’ is now more like a hardish ‘cord’ (still at the centre of the shaft) running for about one inch up to the beginning of the glans, but this is only strongly noticeable when the penis is erect or semi-erect. When the penis is flaccid, there is mild tenderness in the ‘cord area’ if gently sqeezed, but the cord seems of much less volume than when the penis is erect. There is now also an indentation to the upper side of the penis, again just before the glans, and thus apparently (the beginning of?) a curvature upward. At present the indentation/curvature is mild but definite. Erections are recently becoming less strong and slightly problematic. I am 55 years old. I am waiting for a second appointment with the urologist, but it is not for eight weeks (National Health Service). I would be very grateful for any advice re the following. Does my description suggest Peyronies rather than Mondor’s? If so, what can I do about it while waiting for the appointment? Vitamin E , Colchicine and Collagenase are indicated on your site as potentially helpful - are you able to recommend effective but safe dosages (assuming I can convince my doctor to prescribe the latter two)? I am concerned that delay in diagnosis may have lessened my chances of limiting the onset/increase of scar tissue and/or curvature. Lastly, would you advise obtaining a sooner appointment with a private urologist, and if so, can you recommend any particular clinics or individual urologists in the UK? Thank you very much for everything - as I say, the whole site is very much appreciated.

This sounds more like Peyronies than Mondor's syndrome. Some of the ususal oral remedies used at this point include l-argenine 1000 mg twice a day, pentoxyfilline at 400 mg 2 - 3 times a day, and colchicine 0.6 mg twice a day. I think you would be safe to wait for your scheduled appointment, as changes in this condition are pretty slow.  MG

06/12/2013 - 16:09
Bending recent and rapid onset.

Hi Dr. I am a 25 y/o male. About six months ago started having minor pain, (dorsal side) just below the tip of my penis. never bad enough to not have sex, maybe 4/10 at it's absolute worst. Pain was intermittent and went away after about a month. I forgot about the whole thing and chalked it up to maybe being too rough. 2 days ago I noticed a slight but distinct curvature in the tip during an erection, which has repeated the past few erections. I am going to the doctor this week: A. If it is Peyronies, am I doing any damage by continuing my normal sex life at this stage? Should I be avoiding erections? B. As I am under-insured would it be possible to get a referral to a urologist immediately by calling their office, or do I need to see a GP first? Any help is appreciated!

There is no harm to continuing your usual sex life, and no need to see a GP first - find a good urologist in your community and go see him/her.  MG

05/14/2013 - 11:29
Peyronies & E.D. medications

After discussing my personal situation with my family physician about E.D., he prescribed Staxyn. In reviewing the medication and similar ones (Viagra & Cialis), there is a general concern about these E.D. medications and Peyronies. I do have a slight curvature which may have been caused by catheterization about three years ago but I'm not sure. Since that time, I've noticed about a 20°-30° curvature during times when I'm erect. What are the general concerns about using any E.D. medicine on a patient with Peyronies Syndrome? While they all say it, none give any specifics as to what to be aware of, what to watch for or be concerned about. Thank you for the wonderful service you provide...

This whole class of medicine (phospodiesterase inhibitors, Viagra, Cialis, Staxy, Levitra) was never specifically studied in a group of men with PD, so the manufacturers have to make this type of a disclaimer.  Most authorities are of the opinion that they are not harmful to men with PD, and there are some urologist who recommend them specifically for this purpose as they my tend to counteract scarring. They are widely used by men with PD who have erectile problems an should be considered safe in this setting.  MG

05/14/2013 - 11:24
Cord like structure on penile shaft. Is this a plaque from peyronie's disease?

Hello, I'm 23 years old and about a week ago I noticed something on my penis. There are two cord like structures located on the shaft on the right side near the center of the penis when it's flaccid. They look like large veins and run around the penis, the visible portion starts on the underside and go almost halfway to the top of the penis, forming almost half a circle around it (like if I were to wrap a piece of string around the shaft, but not encircling it completely, or like half a ring put at the right side of the shaft). So if they are indeed veins, they are not like most veins on my penis which run parallel to it, along its length. They are close to half a centimeter in diameter(maybe about 4mm) and there's about half an inch between them. They feel somewhat like a vein, but I think they feel a little harder than a vein should be. Also I can't move them but I can see them behind the skin(when I move the foreskin, it seems they stay in place, not moving with it, like if they were attached to the structure that forms the penis). They are better felt and seen when the penis is flaccid. Also they tend to bulge more when i'm standing up and the penis is flaccid. Also when the penis is flaccid and only in the flaccid state, I can see a small indentation in the space between them. They are not painful or tender to the touch. But I think I might have felt a very, very mild pain or discomfort lately when i'm erect, but this pain usually lasts like a second or so and might just be my imagination. When my penis is erect I can still see them if I compress the skin a little, though it's more difficult to feel them. When erect they also look more like veins. Also my penis has always curved slightly downwards and to the left. So, my concern here is, could these structures be some kind of plaque from peyronie's disease or are these only veins or maybe something else? I' ve heard the penis should curve to the same side which the plaque is located but that's not the case with me since mine curves to the opposite side, but I've only recently noticed these structures so if they are indeed scar tissue, the curve could still be under development, couldn't it? Also are there veins which run around the penis rather than along its length? And is a nodule from peyronie's disease always hard or could it be more soft like a vein or just slightly harder than it? Thank you

This doesn't sound like PD to me, just prominent veins.  MG

05/14/2013 - 11:22
59 Year Old with PD for 20 Years

I am 59, have had PD for 20 years and married. 30-40% curve to the left, some small scarring at the base of the shaft, and some shortening of the erect penis. I think I got it during sex with minor bleeding that led to scar formation. I saw a Urologist for it when it started but he steered me away from surgery and said it might self-correct if I just do nothing. Since then for the most part I've been able to achieve and maintain an erection and have as normal a sex life as I could expect but in the last year the issue has become maintaining an erection. Cialis doesn't work. I'm on Diovan HCT for blood pressure but my research shows that drug does NOT have the ED side effect, so I'm still on that. Should I go back to a Urologist and get a scan and see what the scar/calcification situation is? Any thoughts on the erection issue? Who do you recommend in the Columbus, Ohio area? As a side story, I was on finesteride last year for about 9 months (1 mg/day) as a preventive (prostate cancer runs in my family) but I took myself off it when I read it can cause ED problems. That was coincidentally around the time I started having the ED problem -- not sure if it's connected to the finesteride or not. I can probably live with the curvature/shortening, but I really need to address the erection issue as I thought Cialis would take care of it but no luck.

I think having a penile duplex doppler ultrasound to look at blood flow might help to clarify the ED issue.  You can check the physician locator link in this site for a qualified Dr in your area.  MG

05/14/2013 - 11:21
Newly Diagnosed

Hello Doctor, I am a 30 year old man that has been diagnosed with PD by Urologist today. The diagnosis consisted of him just listening to my description and feeling the bumps I have and I am wondering if this is definitely PD. Two weeks ago after having rough sex I started to notice an mild irritation during erections. A few days later I found two lumps under the skin on the top of the shaft near the base of my penis. the lumps are tender when pressed on but are not visible nor do they hinder an erection or cause any type of curvature of the penis. The doctor says they were probably there for a while but I think that would be something I would notice unless I maybe just felt around because of the pain. Does this sound like PD in the early stages? Am I headed toward a worsening condition where this is just the first stages of the problem? Lately Ive been having sex but have just been taking it easy in fear of worsening any condition and I have no clue if I should be abstaining from rough sex forever....I have been taking glucosamine for a few months and I read in your posts that it can be related to it so I should probably stop that. Thanks for any info you can provide I greatly appreciate it Richie

It is a little unusual for the bumps in PD to appear that quickly.  You may have a temporary condition called mondor's syndrome which is little clots in some of the penile veins.  It usually goes away on its own.  If the bumps are mobile with the skin  - when you move the skin around the bumps move with it rather than the skin moving over bumps deeper down which don't move - it is probably not PD.  MG

05/14/2013 - 11:17
Tainted Steroid Injections

Last Oct.(2012) I was given two steroid injections in my lower back for pain. Those Steroids were later found to have been made by NECC and were suspect of being tainted. I went through several tests to confirm that I didn't have fungal meningitus, and thankfully I didn't get the tainted doses. However, shortly afterward, I developed a bend in my penis and have become impotent and can no longer achieve an erection. Is it possible that the two incidences are related? Would taking Vitimine E possibly help in my situation? I read in other letters about a new drug that is on the horizon that looks promising as well. Do you have any idea when or if it may become available and do you think it would work for me? Thank you in advace for any information you can share.

I seems unlikely that these injections are related to your PD.  The new drug you are referring to is Xiaflex.  I believe we should have word from the FDA regarding approval or not by early September.  MG

05/14/2013 - 11:15
Effectiveness of current treatment options

I was recently diagnosed with PD but the condition likely began 9-12 months ago. I experienced a recent worsening of the condition which my urologist says is likely due to another inflammatory event. The same urologist is recruiting for a double blind study on a new topical compound that he thinks is likely to produce positive results. I can choose to participate in the study but there is a 50% chance I will be in the placebo group. The study doesn't start for another month and a half and runs 3 months. Before and during this time I won't be able to use any form of treatment so there is a possibility that by participating in the trial, I may miss the opportunity to treat the symptoms while still in the inflammatory stage. I know there is limited clinical research on Pentox and L-arginine but in your experience, what is the approximate proportion of patients that have seen significant improvement on each of these treatment options? I will have had PD for 13-18 months by the end of the study. If I opt for the study and end up in the placebo group or if the treatment is ineffective, what are the chances it will be too late for pentox or verapamil to be effective? I have only minor curvature and some ED at this point. Are oral treatments effective enough to warrant beginning treatment immediately or should I delay treatment and take a chance on my urologist's clinical trial?

You are doing a good job of weighing complex issues.  The experience that most of us urologists have is that oral therapy, even early on in the inflammatory phase, are usually not that effective. I don't know the potential effects of the clinical trial drug since you did not mention it. If there is good potential to the trial it might be worth participating, because missing a chance at oral therapy is not a major problem.  Also, if you fail to respond by the time you no longer are in the acute phase, it is possible you might have Xiaflex as an option.  This is a drug with promising results that is in FDA review now.  If it gets approval, it is known to be effective in the later or chronic phase of PD.  MG

05/14/2013 - 11:09

I had a curvature of 60 degrees and had an operation 5 months ago. After the operation I still had a 10 degree curve that my doctor said was a satisfactory result but my penis was at least 2" shorter. I was advised to purchase a traction device and have looked online to see what is available. I'm sure some are probably better than others in terms of lengthening and comfort. My question is which brand is more popular or recommended by the majority of doctors that would most likely give the best result.

I can't really give you a fair survey of all the available devices, but the patients I have seen who have used the andropenis device have found it acceptible.  MG

05/14/2013 - 11:07

Is it simply money??? After millions of years of evolution under the moon, mankind decided to go to it. After transplanting faces, hands, hearts; after stem cell therapy for organs; after regrowth of tissue around scaffolding; after observing a Salamander's ability to regrow extremities; after going to the moon, mankind can't repair a penis??? Mankind can't relieve the sufferers of this atrocious malady. I wonder if it deeply affects patients and their wives on a psychiatric level. My question is: WHY IS FAILURE ACCEPTABLE. Is it simply money?

All good questions. I think with the new research being done with collagenase, progress is being made. MG

04/20/2013 - 17:24

Should iontophoresis be performed with the penis erect or flaccid?

There isn't really any research to back this up, but drug penetration into the tissue is probably more effective when it is soft.  MG

04/20/2013 - 17:28
calcification and new medicine

hello doctor - thank you for taking the time to answer our letters - pd is a cruel disease, i am 56, single and most likely to remain that way - it is so humiliating and embarrassing and renders one useless in sex. my penis lost length and girth and the ability to erect - viagra does not help at all - the vacuum device is painful, but somewhat helpful, regarding girth right after use. i have pd for about 8 months now and i just felt a serious hard area, almost like a bone forming, about an inch long, which scares me enormously.. i am taking 6 pentoxifylline a day, according to my doctor, the ONLY thing that is beneficial... my main question is, is the new medicine, which is about to be approved, we hope, truly helpful? - what would it exactly do for us pd patients, especially regarding calcification? thank you for your kind response in advance!

The new medicine, Xiaflex has been much more effective at improving curvature and symptoms than placebo in extensive clinical trials, so it really does seem promising.  If an x ray shows speckles of calcification, it can be used, though if there are large calcifications it probably won't be effective.  Be assured, having a plaque that feels very hard does not mean it is calcified.  MG

04/20/2013 - 17:28
White-house-petition about PD

Hi, i am suffering of some form of PD and today i have explored, that there is a white-house-petition ongoing until 9. of may about PD and trying to focus the government on spending more money in researching a cure. My plea is, that all readers sign up for yourselves and tell your friends or others about it. Recognize Peyronie's Disease; A Quality of life condition "NOT" a lifestyle choice. | We the People: Your Voice in Our Government With kind regards

thank you - I actually signed this petition last week.  MG

04/20/2013 - 17:32

The pain from erection has subsided now, after about 7 months, but am left with a major indent and maybe 20 degree bend to the right, making sex uncomfortable. Another web search advertises Neprinol to break down the scar tissue that causes both. Can you recommend it? Is it likely that calcification has occurred by now, and will Xiaflex be of any use to me now?

There is no peer - reviewed research on Neprinol, so there is no real science to recommend it, but it seems to be safe and may be worth a try. Calcification is not common, and the chance of it occurring does not always increase with the passage of time.  MG

04/20/2013 - 17:36
4 months after PD surgery

Hi Doc. I am 47 years old and developed PD around 6 years ago as a result of an injury during sex. I lived with the 60 degree curve and a downward spiral until last year when I opted for surgery. At first I tried the vitamin E and copper with DMSO (topically) and E orally along with gentle stretching excercises, but after several months of no results, I went to a urologist. (I believe I waited too long for the natural remedies to work) At any rate, the doctor informed me I was to get the Nesbitt procedure. I researched it online as best as I could, and the surgery was preformed. Initially, the penis was strait with maybe a 5-10 degree lean toward the left. (before the surgery it was a bad curve to the left) then after several weeks, I noticed it leaning more to the left. Erections were never a problem before, and the first several weeks after the surgery, I was always getting them. But since then, I have noticed numbness on my right side of shaft, a rather large bump on the right side near the base, and the head is so sensitive, it hurts when it rubs clothing that I wear. I tried sex with my wife several times and was only able to ejaculate once, but the pain is bad around the base of the shaft and I have refrained from having any more sex since. I have also lost interest, and nothing seems to get me aroused. I noticed when I came home after the surgery, the incision was on the testicles not the typical de-gloving incision. I asked the surgeon about it, and he said it was a much less invasive surgery than the nesbitt. I told him about the rather hard bump and he examined it also about the numbness and he waved it off as nothing to worry about and advised me to keep taking vitamin E along with C. I'm not sure if I should go back to the natural treatments, or hope that in time the problem will resolve. Any advise. Thanking you in advance.

sometimes the firmness and bulk of the plication (tissue gathered up to correct the curve) can be very noticeable for several months after surgery.  Likewise, the nerves traumatized on the right side of your penis to creat the tuck that pulls it over to the right and corrects the left bend may take 12 months to fully recover.  MG

04/20/2013 - 17:46
Loss of sustained erection

I have PD and am a couple of years into it. My issue is that now that I have a lump, I don't get full flow and erection. Therefore, only during the heightened point, do I get fully erect. Before and after, I get quite soft. Is there something that can help this? Thanks

You will probably notice a big improvement if you use one of the phosphodiesterase inhibtitor drugs (Viagra, Cialis, or Levitra).  MG

04/20/2013 - 17:57

I was extremely ill in June of 2012 and hospitalized. I have had to have stretching of the urethra about 3 years prior to this. They tried to cath me and they Nurse pinched the top of the penis just up from the base and could not get the catheter in. I was hospitalized three more times and in July of 2012 had a colon re-sectioning. I had no problems before this illness. After coming home for the re-cover period I had an erection with sever pain and bending of the penis and hard lumps where the penis was handled during hospitalization. The prescribed medicine did not help and sexual intercourse is not possible due to pain. Can PD come on this quickly? Should surgery be the best option?

Peyronies disease can occaisionally come on after catheterization or urethral instrumentation.  Whether surgery is a good options depends on how severe the bend is, how much your problem interferes with intercourse, and how well the erections function.  If erections function well, you might want to wait until the new medicine (Xiaflex) is FDA approved.  One thing that will reassure you is that pain will ultimately go away on its own.  MG

04/20/2013 - 17:59
Excession and Graft

Hi, I am 55 years old and had the excession and graft surgery back in November 2011 for PD. I experienced a loss in length of approx. to 2 inches and now have an even more deformed penus with excessive skin that hangs down on the bottom side in all states. I am no longer able to have an erection without aide. I was prescribed Cialis, even though I have a heart condition and am on two different types of Nitrates. I was told I had to use it or loose, so I quit taking my Nitrates and would take Cialis, wait a few days and take my Nitrates again. Sex is now possible, but my erections are pointed to the extreme left, the same direction as the original bend. When erect my penus can be moved from my left to a straight position, but cannot be moved to the right. I also have a 1/4 inch hard knot on the surgical side that gives me an itch I cannot scratch and after a day of just moving around it becomes sore at night so I sleep with a pillow between my legs. I was told the knot is a stitch that has not dissolved. That knot also causes a raw feeling during and after sex and can become quite sore. Before I had the surgery, I did go through a series of shots every week for 6 weeks, and the location I was given the shots is not the same place as the graft. It's been over 5 months and I am not too sure about my current Doctor. Should I just give it more time?

After 6 months you may want to get a second opinion from a urologist that has a special interest in this field.  MG

04/20/2013 - 18:01
Recently diagnosed

I am 38 years old and was recently diagnosed with Peyronie's. I would consider my case on the minor side (I hope) but would just like some clarification. I noticed this condition about 3 months ago and have an indentation and have lost some rigidity as well. My erections usually curve upward and slightly to one side. My urologist only prescribed vitamin E (1200 iu's daily). 1.) Is this too much Vitamin E and what I else should I be taking? 2.) Can I expect to gain full rigidity? 3.) What should be my next step? My urologist said to come back in 6 months but told me I should be "better" by then and didn't offer much of anything else than Vitamin E. As a married man, who's had one life partner and is utterly confused and a bit frightened by this condition, I want to say thank you for having this forum and answering these questions.

It has been shown that high doses of vit E can cause problems, so it's probably best to limit this supplement to 400 units (1 pill) daily.  There are other meds which have been helpful in some cases, such as pentoxyfilline and colchicine - you may want to ask you doctor about this.  MG

04/20/2013 - 18:05
Surgical Treatment

I have been diagnosed with PD for about 13 months. I still have some pain at times but it has mostly subsided. I am still able to have intercourse but my wife complains that it is painful to her at times. I saw a specialist who my urologist recomended today and he said he could remove the plaque by going into the side of the penis. He said he does this surgery every week and it is successful. It is not the same as the patch and it is also not the common surgery that causes shortening. This specialist is well known and he said that this new technique is working the best for people like me. He said that the plaque in my case is under the part of the penis that would require the patch and that he can remove it from the side without needing a patch. Will this procedure give me back the length I lost? Will it fix the indentation at the base? Thank you for giving me your opinion.

I'm really not sure what procedure is being recommended - I understand he is proposing to remove the plaque, but not do a graft or patch.  By the way, most Peyronies surgeries (not just the nesbit or plication) shorten the penis somewhat.  MG

04/20/2013 - 18:09
Possible PD after RP

I am a 52 year old male 2 months post-op from labroscopic RP. Prior to surgery always had very strong erections without pain. As part of the penile rehabilition I was given a vacuum pump by a nurse at my surgeon's office at my first PSA draw. She said watch the DVD and practice with it when I thought my body was ready for it. I "practiced" with it a few times and was encouraged by the erections I was getting, very similar to pre-surgery. Upon my 8 week post-op visit my surgeon said to start using the vacuum pump for intercourse at least once a week. The next time I used it the shape of my penis inside the tube looked remarkably different than I had ever seen. The base of the shaft looked somewhat engorged, with the middle of the shaft somewhat limp, and the head somewhat engorged and slightly curving like a "C" shape to the left. Is that the "hourglass" shape I've heard described? I am on a daily 5mg dose of Cialis but have not had any "erections" except for those I described when I first started using the pump. I posted my concern on a prostate cancer forum and received a reply that this may be PD. What do you think?

It is known that PD is considerably more common in men who have undergone radical prostatectomy, and that sounds like what is going on here.  At this point I would continue using the cialis + vacuum device for rehabilitation of the erections. MG

03/18/2013 - 08:32
Mechanical devices

I have PD, recently diagnosed. My urologist offered no treatment except future surgery if the bend becomes too severe. Currently, I have a slight bend downward with an indentation on the left underside of the shaft. I have read on numerous forums that ved's and traction devices are beneficial in correcting the bend and restoring lost length. Do you see any benefit in using these devices? If so, do you prefer one over the other? Thank you for maintaining this forum.

Research suggests these devices may help, though the data is preliminary and not well confirmed.  For isolated angulation a traction device will serve, while for combined angulation and girth loss the vacuum device may be more appropriate.  MG

03/18/2013 - 08:33
start again

Hi Dr I wonder how common it's that pd start a second time once it has gone into stable phase. Thank you.

The reactivation of Peyronies Disease once it has truly stabilized is rare, in the absence of repeat injury.  MG

03/18/2013 - 08:39
Painful/unpleasant orgasm and Peyronies

Sir, I am a 63 year old white male. At 52 I developed hyperthyroidism which was treated with RAI and since them I have stabilized with 175mcg Levoxyl daily. During recovery, I developed peripheral neuropathy, symmetrical in both feet. Since about 2005 I have mediated the pain with Fentanyl patches, 100mcg/hr, and oxycodone, 3-325, 2 tabs daily. In the past two years testosterone has dropped markedly and is being regained with Testim application to the skin, 10mg daily. I have not had intercourse for 3 years and over the last 18 months I have developed Peyronies-like curvature half-way along the penis of approx 30 degrees. Girth is reduced along the length of the penis and a formerly smooth, solid erection is now lumpy and irregular. I cannot feel anything new or abnormal in the penis, flaccid or erect. There has been no pain before or during erections. I can easily gain and maintain erections for 10-40 minutes. The immediate problem is that orgasm and ejaculation are painful and very uncomfortable and accompanied by very deep, rapid breathing, uncontrollable yawning (! lack of oxygen?) and near-fainting. While intercourse is not possible due to other reasons on my wife's part, my condition is interfering with other enjoyable sex play and affection. My questions are: Can Peyronies-causing plaque always be felt with the fingers in the flaccid or erect penis? Is Peyronies known to be associated with hyperthyroidism or other auto-immune hormonal problems? Is Peyronies known to be associated with continued opioid use? With reduced testosterone levels? Are the painful ejaculation, yawning and fainting even related to the Peyronies-like symptoms? I don't think I need the curvature of the penis corrected, but must address the orgasm and ejaculation problems. Thanks for your patience and advice.

Peyronies plaques are not always easy to appreciate in the flaccid penis.  The is no known association of PD with hyperthyroidism, other autoimmuned disorders, opiod use, or low testosterone. I do not recognize the combination of yawning and fainting as anything I have seen reported in the past, though painful ejaculation is clearly a part of early PD.  Fortunately that will resolve on its own.  MG

03/18/2013 - 08:40

Hi Doc, I'm 43 and been diagnosed with Peyronie about 6 weeks ago. The urologist that saw me prescribed a treatment with Nolvadex and vitamin E 400iu for two months after which I'm to undergo an Ultrasound scan again. I've seen however on this forum and on other forums online that as an alternative treatment some are recommending streching devices and vacuum pumps. My question(s): are these accepted by the medical community as effective means of treating Peyronie? Many thanks...

Yes these methods are accepted - see the response above.  MG

03/18/2013 - 08:43
Do I bother with treatment

Hi, I'm 47, and live in Australia. I have been diagnosed with an extreme case of Peyronies, curvature, hourglassing, calcification (some 18mm)and ED due to the condition. The only urologist for hundreds of miles has said it is a major operation with the risk of complications. Anyway - I'm a single dad with my kids 24/7 and as such have no social life let alone any sex life. The doc said I could have the op, with a very long recovery period in case I ever did meet someone with whom I wanted to start a sexual relationship.... or look at having an operation if I found myself in a relationship. Is it worth the hassle? I have been offered no other form of treatment.

If you have severe curvature and calcification, surgery may be the only way to restore function.  I realize in your situation travel may not be an option, but if you elect surgery have it done by someone with a lot of experience.  In Australia I would recommend Dr. Chris McMahon.  MG

03/18/2013 - 08:58

I noticed a small bb sized bump under the skin just below the head of my penis on the left side. It has been there for approx 1 month. During erection I have no pain but noticed the head of my penis seems to be bending slightly to the left. Again, no pain but was curious if this could be the start of pd or something else? I am a 31 year old healthy man otherwise.

This is more likely to be Mondor's syndrome, which is a localized blood clot in one of the superficial veins.  This usually resolves spontaneously.  MG

03/18/2013 - 09:06

Hi Dr. I was diagnosed with PD a year ago and I had one lump under the top of my penis and indentation. The doctor did not tell me much about it. This past summer I felt pain a couple of times with erection but the pain went away after a few weeks. I have one indentation were the lumpe is and last summer I also hade one indentation on top of the penis, the one on the top is now gone and I discovered a small lump were that indentation was. I decided to talked to my doctor again last week. I told him the story and he could still not tell me much. But he said that the scar could be PD or a "normal" scar healing slow. The first lump was about 5mm a year ago and is now flatter and about 10mm, the second one is about 3mm and has been the same since I discovered it. I discovered the first lump about 4 month after receiving a hard elbow to my penis (Training). I have minimal bend just were the 10mm lump is, the injury happened 18 month ago. I think both lumps has been the same size for at least 3 month and I have not had any problem with erections during this time. I take acetyl l carnitine since september 2012 and I just started to take l arginine, hopefully the indentation will get smaller. I´m 46 years old and train a lot of sport. The only health thing I have exept this is a small scar of Duprenes in my right hand, the scare is minimal and has not changed for worse in 8 years. It´s better now than 8 years ago. What is your opinion of this? PD or not? If PD, is it now stable or can it still get worse? What should I do? Best regards

The size of the lump, the prompt resolution of pain, and the lack of bending all suggest this will probably not be a functional problem, but the fact that you have Dupuytrens in your hand means this is a minor case of PD as those two disorders are closely related.  MG

03/18/2013 - 09:09
Calcification of Plaque

How long from the onset of Peyronies symptoms until calcification of plaque occurs? I first noticed symptoms and felt the plaque formation about 4 years ago, and am now 58 year old. Plaque does not feel hard but may be a bit more stiff than it was originally. Just hoping and praying that I will be a good candidate for Xiaflex once it's approved. thanks Dan

In some patients calcification can be present after a relatively short duration of the disorder, and in others this can take 10 - 12 months. If the plaque is smooth and narrow after 4 years it is unlikely to be calcified, though it would take either a low kilovoltage Xray or ultrasound to know for sure.  MG

03/18/2013 - 09:11
Traction device

They say they are guaranteed to add length and girth is there any truth to this? I lost both to P.D.

Traction devices are legitimate (see above) but the guarantees are not.  MG 

03/18/2013 - 09:12
hour glass

about 10 months ago i was diagnosed with pd and was given verapamil injections for 6 weeks the curvature went away yet now i have hour glass will vitamin e help and is cialis a good idea , as well as a vacuum pump. I still get erection just shorter. What will testosterone do?

Unfortunately testosterone is not known to contribute to the treatment of PD - at this time.  Future studies may clarify this.  MG

03/18/2013 - 09:15
Does this sound like Peyronie's?

Hello, and thank you very much for your help. When my penis is flaccid, the left side feels firmer than the right. I can't really tell if I feel a lump or's just firmer. There is also a spot on the left where I notice a very slight (almost hard to see) "dent" when flaccid. When erect, the base of my penis is narrower than the shaft, and around this same spot on the left, the width changes a bit more dramatically from base to shaft. About four years ago, I noticed I had some painful erections(and I eventually was unable to get an erection for some time), but I had other medical problems going on then so I didn't make much of it. Fast forward to the present--I am able to get and maintain an erection, I don't have any pain during erections, and my penis isn't curved/bent. All I notice is the firmness on the left side, which I am worried is plaque. One last thing--when I started masturbating (around age 15), I did so from the prone position, usually rubbing my penis against the floor or bed. I stopped doing this once I learned it was wrong, but I've always worried that the time spent doing that caused some damage. I have two questions: 1) I know it's harder without a physical examination, but does this sound like PD? and 2) If I have even a mild case of PD, is it something that's likely to get worse over the rest of my life? I'm 22 now and still a virgin--I don't want to be worried that something I do whenever I start having sex will aggravate a condition I don't even know I have. Thanks again for your help and very informative website.

I don't think you have PD, so future problems seem unlikely.  MG

03/18/2013 - 09:23
Waiting Game?

Mid-50s, developed PD approximately 6 months ago after sex-related injury. Cord-like structure formed on left side of penis, extending from base of penis to bend approximately half the length of the penis from the base. Some constriction of girth at this point, along with minor reduction in length. Intercourse somewhat painful with increased sensitivity/premature ejaculation a problem. Other problems include embarrassment regarding appearance and fear of further damage during intercourse (me) and increasing frustration regarding frequency of intercourse (my partner). Surgical treatments described on this web site and others do NOT seem promising. Is there a downside to simply waiting for XIAFLEX to be approved? Or, should I be doing something now to prevent further damage/scarring? Is there a published study describing the XIAFLEX trials, including how effective they the drug has been toward reversing the condition?

There is no significant downside to waiting, though most authorities would recommend getting on a nutrtional supplement regimen of vit E  400 units daily and l-argenine 1,000 mg twice a day to keep things stable.  The phase IIb results of Xiaflex were published in the June 2012 issue of the Journal of urology.  The phase III paper reflects the largest most comprehensive placebo - controlled clinical trial ever conducted in PD, about 800 subjects in USA and Australia. It confirmed the positive results seen in the phase IIb study, with statistically significant correction of bend (mean angular improvement 34%) and subjective bother scores. It is currently available on line, and is due to be published in the Journal of Urology in July 2013.  MG

03/18/2013 - 09:26
PD & VIAGRA is it ok to take if erections are not painful

is it ok to use viagra if my erections are not painful

Yes.  Viagra (and the other drugs in this class) have not been shown to be dangerous to use in PD. It's just that their FDA -compliant literature must contain a warning since these drugs were never tested specifically in patients with PD.  MG


02/17/2013 - 13:22
Changing Conditions!

Developed PD two years ago, awaiting the Xiaflex. There are no solid lumps present more of a strand of something harder along the side of the penis. At the start the penis was shaped as a wedding cake, larger base, then half way up becoming smaller around the entire circumference, leaving it straight, but as I said, looking like a wedding cake. Lately the front side has regained much of it's shape, becoming fuller and has created a slight curve over the entire penis, not an angle and no pain at all. The length seems to have suffered. Is the common in PD or it something else occuring? Xiaflex is currently used to treat other conditions? Why the lengthy approval process, are there downsides? In tests are shape and length impacted? Urologist in the area took part in the test some time ago. Is there something on the market that may treat the condition successfully or just wait for approval?

Diameter changes such as you descibe are commonly seen in PD, in addition to loss of length.  Xiaflex is currently approved by the FDA for the treatment of Dupuyten's contractures.  The FDA approval process always takes its time, and xiaflex was submitted for approval in November of 2012. There are no other medications on the market that have shown the same results as Xiaflex.  MG

02/17/2013 - 13:26
Auto-Immune diseases

I developed Psoriatic Arthritis shortly after receiving a Hepatitis vacination. My Peyronies, soon after that. Could this be related to an auto-immune response, and if so is it possible that my Embrel injections might help? Thank you very much for your website.

I think that is a possiblity, though I know of no published data that answers your question.  Perhaps you would be willing to report what if any progress you see with your PD after starting Embrel.  MG

02/17/2013 - 13:29
pain gone.

I couple months ago I had painful erections. And did notice a small sunken spot on the middle of my penis shaft.I started vitamin E 400iu every day and also vitamin C. I haven't noticed any curve as of today and went to see a urologist yesterday. He said peyronies and didn't aid me in any way other then saying he would have said to take the vitamin e. He said that nothing really works and that 50% of men clear within a year. I can say the pain has gone with erection. My question is if the pain is gone does this mean the peyronies is in the stable stage or can I look forward to a bending of the penis.Also have been looking at a traction device to help.

A fair number of men with bending due to PD have never gone through a painful phase.  It usually takes 12 - 18 months for the disorder to settle into a more stable stage. MG

02/17/2013 - 13:32
penis lump

I discovered a lump in the muscle of my penis. it looks like a raised half ring on the right side, (and not going fully around the penis shaft). The raised area does not seem to follow a vein, and does not follow the penis lengthwise. Rather, as i said previously the raised area follows halfway or less around the shaft. When i move the skin up and down, the lump remains in place and does not move. When the penis is fully deflated, it is hardley noticible except for slight discompfort or occaisonal and very minimal pain. When the penis is erect, it is not noticable and no pain. no curvature of penis. When the penis is deflating from erection it is most visable, and the bump is very prominant. Also I have felt a vibrating sensation in the penis, which occurs on and off during the day, some days more often than others. It also feels like the penis muscle is sometimes rigid when in deflation. If I massage lightly the rigidity goes away, although it may return soon after. Will this get worse with sex and or masturbation? Will the vibrating and mild pain go away? will it progress into something worse?

This sounds more like a blood clot in superficial circumflex veins (Mondor's syndrome, which will resolve on its own) than PD.  MG

02/17/2013 - 13:35
Relatively new case / Is my situation likely stable

Hello Appx 5 months ago I was slightly injured during sex. I was numb afterwards but no bleeding nor bruising. Injury was not visible. MRI was negative. Dr. Advised to wait and recommended Acetyl L Arginine 1000mg 2X day, Cq10 100 mg 3X per Day and Vitamin B and 200 mg Vit E 3x per day in addition to OMega 3. 1.5 months after injury I saw slight indent on left side yet still straight and NO pain with full erection. Three weeks later the indent was almost gone and slight bend to side was present with full erection, still no pain. A few weeks further (scar visible under skin) and maybe just slightly more bent (barely more though) and still no pain. Forward another month and the scar is visible under skin when erect and is about the shape of a small capsule (like a small herb supplement) but completely flat and cannot be felt (been that way for weeks and has changed little). Still No pain whatsoever and bend has not gotten worse in last several weeks or a month or so. I have had some problems with erection but this seems partially self inflicted from complete disgust with this mentally. IS IT POSSIBLE my problem has begun to stabilize and the bend may not get much worse? Would it have gotten worse by now? Have you heard if warm compresses help or hot baths or should i leave well enough alone. My bend is there but its by no means drastic at this point. Inotice it because it was perfectly straight before, I would estimate it at 15 degrees or so but the scarring is there under skin Thanks

Considering it has been 5 months since the injury and your situation is currently as described, I think it well may have reached a stable point.  Not all penile injuries result in PD.  MG

02/17/2013 - 13:39
Peyronie's and metoprolol

About a year ago, at age 63, I noticed the rather abrupt onset of an upward curve of the erect penis--no obvious change in the appearance of the flaccid organ. This has worsened until the curve is now around 80 degrees, and the erection is at least an inch or two shorter than before. No trauma has occurred as far as I know. I do ride a road bicycle with a narrow saddle a moderate amount. I read that beta blockers are thought to be an etiological factor, and I have taken metoprolol for the past two years for my CAD and hypertension. It seems the connection with Peyronie's is unclear. What's the story? And is there hope for improvement if one stops taking metoprolol? Thanks.

There have never been any careful studies of the issue, but the association between beta blocker use and PD has been noted by many in our field. I don't think we really understand the mechanism of this effect, though it would make sense to replace the metoprolol with something else if your cardiologist approves.  MG

02/17/2013 - 13:44

Have had PD for approximate 3 years. I am 64 years old. Recently I have been experiencing KORO which is most annoying not to mention dealing with PD as well. My question is ..are the two related? Does having sex lead to the Koro due to my bend? Have an upward 35-40 percent curve. Have read some sites that say the Koro is psychological . Is there a treatment or anything out there to help with Koro?

It is my understanding that to diagnose Koro (obsession that penis is shrinking), one must first undergo a physical examination to rule out physical causes of penile shrinkage - such as Peyronies disease.  If you have peyronies, the shrinkage is probably real, not in your head.  MG

02/17/2013 - 13:48
Penile curvature of 40-45 degrees upwards

Dear Doctor, I am a 21 years old man, healthy, no pains during erection or ejaculation. I have 40-45 degrees upwards congenital penile curvature (starts at the middle of the penis). I haven't had sexual intercourse yet due to this embarrassing situation. My penis's girth is about 4.7 inch, the length while curved up, measured straight from the basis of the penis from above is about 6 inches. Length while stretching the penis to a straight pose is about 6.5 inches. My questions are: a)Since I haven't had sexual intercourse yet, will this curvature, taking into account the girth, length and the upward curved, be painful for the woman? Will I have penetration difficulties? Will I be limited in some positions? -- This is extremely important to me, and I would appreciate your answer according to other people's reports with the same characteristics of my problem. I have read about the Nesbit procedure, and in with regard to it I have some questions: a. Is it really considered a relatively easy and safe procedure? b. What would be the expected shortening, if I choose to undergo it according to my characteristics and your experience? c. The expected shortening is from what? I.e. since the penis is curved up, there are different measuring results depending on how one measures it. Because if in Nesbit, the long side is shortened to match the short side, then will the post-operation measurement will be as if I am stretching the penis today to make it straight while erect? Thank you for your kind help.

With a 45 degree upward bend, some partners may be uncomfortable and some positions will be restricted. Length loss with a nesbit procedure for this amount of bend would be around 1/2 inch - the postoperative condition would be similar to what you would see now by stretching the flaccid penis.  The nesbit is usually uncomplicated in experienced hands, though occasionally it can produce areas of indent, or less that perfect angular correction.  MG

02/05/2013 - 14:05
Early stages

Hi From.the UK i have just been diagnosed with pd by a urologist who recommended potaba however my gp was reluctant to prescribe it because its not known to be very effective and it means taking around 16 tablets per day. I am getting pain with erection and have been for a few months but i am just noticing a slight curve. Would you recommend to use potaba or something else such as vitamin e which i have seen mentioned here? Also is there anything to do to help the pain and how long will it last? Can getting regular erections help to lessen the pain and effects of pd? Lot of questions here i know which have probably been answered but this page is so long! Thanks

some day I would like to break the page into searchable sections for ease of use.  Basically, Potaba is not an unreasonable option if your stomach can take it. Most of the remedies for PD are not all that helpful with the pain, so using ibuprofen before sex is a consideration.  fortunately the pain will eventually resolve on its own.  Mg

02/05/2013 - 14:07
peyronies & prostate cancer

In May 2008 I was diagnosed with peyronies, (photo evidence) Right after that diagnosis my PSA started to increase. It is now at 6.52 I had a prostate biopsy done 12 sections i section came back endocarcinoma measuring o.2 mm in length and 1 cm to the linked end. My question was peyronies linked to my prostate cancer?

there is no known connection between PD and prostate cancer - though patients who have undergone surgery for prostate cancer have a slightly higher incidence of PD.  MG

02/05/2013 - 14:09

I went to a urologist and he was puzzled over my case. I've had penis pain for almost 7 months. My penis always hurts and burns down the left side, and I am curving more to the left when flaccid, but when fully erect there's no curve. The penis burns along the whole left side whether erect or flaccid. It seems like a clear cord runs down the left side, along with a big blue vein. Is it possible to injure this white cord or blue vein, so that it hurts for 7 months, or is this the acute pain phase of Peyronie's? Help would be greatly appreciated.

This does not sound like PD to me. If you've had any kind of skin breakout in the area I would suspect shingles or herpes.  MG

02/05/2013 - 14:12
Classical symptoms but lump seems oddly located?

Thanks for the excellent forum everyone. I've just been diagnosed with Peyronies, which came out of nowhere about 4 weeks ago. I'm 32. No overt trauma though my wife can be very small at times and some positions can pinch a bit. Penis is painless unless erect, where pain is located at the lump and sharp bend in middle of my penis. Rather than a slow curve I seem to be more kinked and pointing up suddenly, though the angle is maybe only 15% or so at present. I have a large firm lump about the size of two peas stacked on top of each other, shaped like one of those long pills you take sometimes. But rather than being on the top of my tunica albuginea it runs straight from the top vertically down through the tunica albuginea's septum, ending almost near the tissues surrounding the urethra (straight down through the center of my shaft perpendicular to the erect penis). Ultrasounds were difficult due to the location of the lump, and while traces of calcification and fibrosis seemed to be evident, they were not in abundance for such a large lump (though cancer was ruled out). I felt I was diagnosed on symptoms rather than imagery of a typical plaque. My question is about the size and location of my lump, is this typical or common? to be a dense lump going through the septum rather than on the outer surface somewhere? About 12 months ago I had some benign cysts found on the surface of my testicles but they were no cause for alarm, quite common they said. Thanks for your input, I can live with Peyronies but at 32 and with no onset and an oddly positioned lump I'd like to keep my options open! :)

What you have is plaque involving the intercorporal septum, which is not terribly unusual. If the bend is very well localized into a small area this implies there is less tunica fibrosis which bodes well for eventual healing.  MG

02/05/2013 - 14:13
quad mix cause

I have been using a quad mix injection for ED for about a year now. I recently noticed what appears to be Peyronies Disease. My erection bend severely upward near the head. Based on a small amount of research that suggests scar tissue or internal bleeding may be a cause, is it likely that the injections on the side of the penis may have caused this and if so, is it possible that it will get better over time?

We do know that men who use intracavernous injections are at increased risk to develop PD.  It may be a good idea to hold off on injections for a while.  MG

02/05/2013 - 14:14
Stretching device or manual massage.stretching for PD

My boyfriend has Peyronies. Do stretching/traction devices help? Can manual manipulation/massage/stretching help correct the curve and gradually reduce the pain/

Preliminary research suggest stretching devices can help.  They need to be used on a regular basis for several months.  MG

02/05/2013 - 14:17
Wait for Xiaflex or start Verapamil now?

I am a 26 year old male recently diagnosed with Peyronies. At my first visit, the Dr. recommended we start a trial of Verapamil injections on 1/25/2013. What would be more benefical- begining treatment with Verapamil now or wait the possible 6 months-1 year for Xiaflex? My problem is less about curvature and more hourglass deformity and pain near the base of my penis.

A course of verapamil now will not interfere with the use of Xiaflex in the future, should it get FDA approval. As there is little downside to verapamil, it may be a consideration.  MG

02/05/2013 - 14:18
Implant Surgery

Will implant surgery restore the 2.5 inches I have lost with PD or will the implant simply help girth and the curve? My curve is slight, but my length and girth loss is great. Also, is sensation and organsam the same with the implant? In reading the forum, I know you have said the successful PD treatment (including Xiaflex) rarely restore length. Thanks so much for your time. It is greatly appreciated.

unfortuntely implant surgery will probably not restore lost length.  Sensation and orgasm should not be significantly altered after implant surgery.  MG

01/14/2013 - 11:10

I've been diagnosed with "it". Will penis traction stretching work to help the curve? How about Vacuum devices used several times a day for several weeks?

While these haven't been tested extensively, there is evidence that use of a stretching device for 2 hrs per day for 4 - 6 months , or the regular use of a vacuum pump may improve curvature due to PD.  MG

01/14/2013 - 11:14
Surprise, totally and unexplanable!

64 years-old; 5'9", 150 lbs. Healthy hair, no gray to date. Strong build, never broken bones, except for arthritis related hip issues, addressed below. Weight variation negligible since being "grown", at approx. 18 years-old. Never an erection problem, very active sex life, with no issues of any kind, since becoming active in early teens. Participated in all major athletics. In April of 2012, I was shocked to see a sudden 55-60% bend to the left in my penis. There was no indication of any issue a month to six-weeks prior, and there has been no trama, whatsoever, during my life. I am healthy, although I have had 4 total-hip surgeries, (2 each side), beginning with the left in 1996, right.-1999, left 2010, and right 2012. Due to a lifting injury, I have had 3 lower vertebra fused, 2009. I have had gout since graduate school, (1971), which necessitated the removal of the left side of my right great toe, and subsequent reduction in length of approx. 1/2 ", (2007). No further flare-up since the surgery, except after total-hip, 2010, I had a larger build-up of tofi which when "lanced" drained and did not re-appear I returned to work within a week of total hip(s), with the only noticeable effect of absolutey no pain after 30 days. This is extremely embarrassing, and depressing. The bend is now perhaps 65-70%, but has not increased, nor decreased, noticeably since May 2012. I discussed the "condition" with my primary care physician in May, at which time he referred me to a well-respected urologist here in Memphis. His advice, come back in six-months. I have an appointment in 3 weeks, but cannot imagine what he could add. There seems to be little if any advice, hope of treatment, explanation of how it happened, not why. The only generice contributing factor of which I am aware is my blood type is A+. I have great insurance, and even if I didn't I could and would pay for any treatment that had a reasonable chance of correction. Have you any advice? If it matters, I am 3 hours away from Vanderbilt, where there seems to be a source of deep resources on may medical problems.

We may never really know how or why you developed PD, this is often hard to explain.  Xiaflex is a new drug, potentially effective in your situation provided the plaque is not calcified.  At this time it is being reviewed by the FDA, and would not be expected to get approval until this summer. It might be a good idea to get an exam and opinion from one of the urologists at Vanderbilt.  MG

01/14/2013 - 11:20

I've had a burning pain in the left side of my penis for 6 months. I can't seem to find the exact spot of the pain. I went to a urologist, and he said the penis looked and felt 100% normal. He said the only reason I'd have a burning pain in the side of my penis for 6 months is Peyronie's. Then he told me to take two 400 UI of vitamin E a day. Is it possible this isn't Peyronie's? I have recently gained 20 pounds and I sit for about 10 hours a day. I wonder if those are factors to consider...

It is possible that Herpes could cause a persistant burning pain, but it would not be expected to last that long, and would probably be associated with some type of skin breakout.  MG

01/14/2013 - 11:22
Traction therapy

Is traction generally considered safe as a peyronies therapy. What would you recommend. Afraid to do anything that might cause another flare up, or worsen condition, but also would like to attempt some form of therapy.

Yes it is generally considered safe if not used to the point of causing discomfort.  MG

01/14/2013 - 11:24
My husbands penis suddenly is bending majorly with a hinge effect when we try to straighten it.

My husbands penis has always had a normal upright erection. Suddenly the past 2 times of erection. His penis is literally bent. Bending so drastically that when you try to move it. it as a hinge like effect. It bounces right back into the bent position. Like a complete L shape. Almost trying to make a U shape. What is happening. He is 46 yrs old.

This certainly sounds like Peyronies.  I would suggest he see a urologist with experience in this area. The Physician locator in the links section of this site may be helpful.  MG

01/14/2013 - 11:25
PD developed 1 year ago, have I left it too late for treatment?

I noticed a distortion in my penis about 14 months ago, although I didn't recognize it as PD so ignored it. The PD progressed fairly quickly, the plaque size stabilized and is no longer painful but has left a bend of approx 70-80 degrees when erect. I'm 52 & don't really have a sex life so wasn't too bothered (although going to the toilet at 7am has been occasionally a challenge, but I am now having second thoughts as it is making me feel a little 'past it'. Is it worth going to see my doctor still?

Yes, it is not too late to look into treatment options after your doctor has confirmed the diagnosis.  MG

01/14/2013 - 11:26
Peyronie's Disease Key points:

1. Peyronie's disease is characterized by a plaque, or hard lump, that forms within the penis. 2. In severe cases, the hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection. 3. The plaque itself is benign, or noncancerous. It is not a tumor. Peyronie's disease is not contagious and is not known to be caused by any transmittable disease. 4. Treatments for Peyronie's disease include oral medicines, injections, and surgery. 5. Medical experts suggest waiting 1 year or longer before attempting to correct Peyronie's disease surgically.

I agree.  MG

01/14/2013 - 11:29

I am a 65 years of age and live in the UK,I still have a very active sex life, well did have until I was diagonised with Pyronnes about a year ago, at which time my urologist told me that as I was in no real pain to defer any treatment for a further year to see how it progressed, as it has appeared to have worsened he is now arranging for me to have ULTRASOUND treatment which he has said will be over a 3 month period. On looking at the post on your forum, I cannot recall this treatment being mentioned, and whereas I am grateful that my treatment will be funded by our NHS service, would appreciate your comments on Ultrasound treatment. JH...UK

Ultrasound treatment has been used in the past for PD, and it is certainly safe. Most centers no longer offer it however, as it was not very effective. MG

01/14/2013 - 11:40
Penis ring

Hi, I have had a case of peyronies pain without deformity. It cleared up. I recently used a rubber cock ring that was a little too tight even in a flaccid state. I only wore it in a flaccid state, and took it off after a few seconds because of the discomfort, like pinching. There was no bruising. What is the likelihood that it could reactivate any peyronies if I only wore the rubber ring flaccidly and for a few seconds? Do mild pressure injuries reactivate peyronies? Thanks.

I don't think this would re activate your PD. MG

01/14/2013 - 11:43
Iam worried

Hi I am 17 years . I have been excessive musterbating 2 times a day until one day I noticed a narrowing at the shaft of the penis . Now when semi erect it has hourglass shape but gets to normal when fully erect . Iam worried if anything is wrong . Pls answer asa possible

A normal erection with hourglass configuration when semi erect does not suggest anything to worry about. MG

01/14/2013 - 11:47
Measuring Curve & Tolerance

Hello, I had a few questions about measuring penile curvature and the tolerance of curvature in the vagina. My first question is how one is supposed to measure the curve - I've been measuring by placing the protractor as far back into the base of my penis of possible without pushing into my pelvic area, centering it, and measuring to the center of the head. Is this the correct way to measure? If not, how? My second question is how much of a tolerance for curves can a vagina handle. When I measure my curve, it comes out to be somewhere between 30 and 40 degrees to the left, and it does not curve up or down. What is the tolerance for penile curves in the vagina, and will I experience any problems with penetration? (I'm a 16 year old virgin). I'm not certain that I have Peyronies disease, due to the lack of any plaque or bumps that I've ever felt, and because I've had my curve since early puberty. Could TMS (Traumatic Masturbatory Syndrome, I was a bed humper) have caused my curve? I've had no problems achieving or maintaining an erection however, the curve is what concerns me. Thanks for your time, A worried teen

It sounds like you simply have congenital curvature, which occurs when one corpus cavernosa (the right in your case) develops slightly larger than the other causing curvature away from the larger side. You can just take a cellphone picture and measure it with a protractor. Generally, curvature less than 45 degrees will not cause vaginal pain. MG

01/14/2013 - 11:48
glans penis & Peyronie's

Have been diagnosed with PD due by urologist. Not ba so far but now the head of the penis seems tp psometimes swell and be very tendr. Is that also part of PD? Any treatment? suggestions? Thanks!

Swelling and pain in the glans is not usually part of PD.  MG

12/31/2012 - 13:02
Colcrys and Statins

Thank you Dr. for replying to my question regarding colcrys and calcification. However, I am now now concerned as I am taking generic Lipitor which is a statin in addition to the colcrys. I informed my Doctor of this at the time he prescribed the colcrys. Is there a problem with interactions between these two drugs? I feel fine other than having peyronies. The plaque does not appear to have hardened over the past several years, and I hope that it will be treatable once xiaflex becomes available. Thanks, Dan

Rarely colchrys can interact with lipitor and produce rhabdomyolysis, a damaging inflammatory condition of muscles. This causes severe muscle aches and really makes you feel sick, so if you have been on the two drugs for a while and are feeling fine it probably isn't a concern. MG

12/31/2012 - 13:09
Verapamil Treatment Questions

Further to your last reply to my original question regarding Verapamil injections, I think that 65-70% success isn't bad at all. What might an individual realize in terms of percentage of correction? What is the frequency of theses injections, if it is more than one? Is this painful? What is the cost? Is this something that you can provide to me in your office? Thank you MG, I really appreciate your time

Verapamil injections are given once every two weeks, usually for a total of 6 injections.  After the 12 week injection course has finished, we re evaluate patients 8 weeks later as the effects take a while to be seen.  If there is clear improvement at this juncture, we may reccommend a second course of injections. They are given after a small dose of lidocaine (local anesthetic) and are not painful. Typically patients who respond will loose 20 to 40% of the bend. The cash price for doing this in our office is $185 per injection, though most insurance companies cover the treatment.  If you need to reach our office please use the contact link in the site.  MG  

12/31/2012 - 11:40
Treatment Questions

I'm 64 yrs of age. Have between 30-45 degree bend up. Had this for 2 to 2-1/2 years. Will Vitamin E and I Argenine help or is it too late? Also, would you please comment on Verapamil (sp) injections. I tried a Verapamil topical and could not deal with the itching it was causing. Thank you so very much.

After 2 1/2 years, neither Vitamin E nor l-argenine are likely to change the bend. Verapamil injections definitely have a better track record than topical application, though 30 - 35% of patients will not experience much improvement.  MG

12/31/2012 - 11:52
After Prostate Surgery

Hello, I'm a 72 year old married male and I had Prostate surgery 3 years ago at the age of 69. After the surgery everything was fine in terms of erection and intercourse. I said to myself, I can live with this with this situation. My erection was good and intercourse was also good. After about a year and a half after the surgery I developed peyronies disease. My penis bends down rather severely and intercourse is almost impossible. My wife and I try to fine a semi workable position which most of the time doesn't work. It's a very frustrating thing for both my wife and I. I don't have any pain. After the surgery my doctor recommended using the Pump which I did use for about a year. I don't use it any more. I have had 6 Verapamil injections from my urologist which have not worked. He suggested implants which I will not do. At this point I'm not doing anything. Would you have any suggestions that I might try? Thanks.

Peyronies disease is more common after radical prostatectomy.  If your erections are working well, your downward bend prevents intercourse, and medications have not helped, you may wish to consider a Nesbit plication. The risks would be shortening of the penis, and a chance of sensory reduction due to placement of dorsal plications. Xiaflex, which is currently in FDA review, might be an option in the future, though clinical trials with this agent excluded downward bending for safety reasons, and it could well be mid to late 2013 before this is available.  MG 

12/31/2012 - 11:55

56 year old with PD for about 7 months. Is there anything I can take besides vitamin E that would help relieve the bend? Also, how can I join a study for experimental meds?

The other oral supplement that may be of help is l-argenine, 2000 mg daily.  I don't believe there are any open clinical trials with Xiaflex at this point.  Dr. M. Khera at Baylor medical center in Houston has been conducting clinical trials with other agents - you might check on  MG

12/31/2012 - 12:00

I'm 30 and have been reading about peyronies. I have a very slight downward curve, been there for years. Will masturbation harm this or make it worse? Would the frequency of masturbation (I.e. Twice a day make a difference) kind of has me worried.

Masturbation will not cause a problem, provided it doesn't hurt or traumatize the under side (shorter side of the curve) of the penis.  MG

12/31/2012 - 12:02
colcrys to stabilize pd while waiting for xiaflex approval

I have had pd for ~4 years and am 58. My Dr prescribed colcrys about 5 months ago which I continue taking. Does this make sense? Is it safe to keep taking this until I can get the xiaflex collagenase treatment? What is calcification and will it block xiaflex efficacy? Thanks Dan

that makes sense if you have no intestinal problems with the drug or are currently on statins for high cholesterol. Calcification refers to small areas of bone formation within a plaque.  If they are large enough, they may limit the use of Xiaflex as this agent will dissolve scar but not bone.  MG

12/31/2012 - 12:05
Pain In Penis!!

I am 24 years old unmarried guy and never had sex in my life and masterbate 10-12 times a year roughly!!I had a nighfall and was awaked with a painful erection(second erection after nightfall) and I thought this pain will go within some hours but its been 50 days now I feel pain during full Erection and some times when penis is not erected. To check, i masterbated and the enjoyable feeling was good but rubbing of penis was weak and felt some pain and i ejaculated without pain and with good feeling!!after ejaculation,first 8-10 hours, I had severe pain in my penis and slowly pain got reduced.I constantly feel pain/ache(not that severe pain that came right after masterbation) and pain during full erection!!I dont feel pain while urinating!!I went to a urologist and my urine test etc was clear and he didnt understand my problem and rather suggested me to get married!!but i am very worried!!What is the problem and immediate solution!!Reply soon plz!!

pain in the erect penis without bending raises the possiblity of early PD, so starting on Vitamin E 400 units daily may be of help to stabilize the situation - until you get a second urological opinion.  MG

12/26/2012 - 10:26
Rupture of erectile tissue at base of corpus spongiosum7 1/2 years ago due to inappropriate manual compression a few seconds after orgasm.

I am now 64 years old. About 7 1/2 years ago, soon after climaxing from oral sex, my penis was held between the base and the testicles and squeezed progressively harder for several seconds, whereupon I felt a sharp pain below the base in the front chamber or corpus spongiosum and immediate congestion of the area. I tried hot showers, DMSO, massage, etc. over the next number of months; after eight months I went to a urologist I'd seen a few times for prostate exam and blood tests but he was dismissing it before even examining me and you could only detect the problem if I was erect or semi-erect, so he could find nothing. Soon after I went to a second urologist who, after a more thorough exam, diagnosed that I had had a rupture of erectile tissue at the base of the corpus spongiosum and said ultrasound wouldn't be any help, there is no treatment, it takes about a year to soften up, be happy. After seeing him several times over the next year and asking him about the prognosis, because it wasn't much better, he didn't respond, so I stopped seeing him. A couple years later I saw third urologist who had me lie down for the exam but didn't find anything – when I told him about the previous diagnosis he said maybe I had a slight tear, just don't do that again – very dismissive and infuriating. What this injury has done is to cause a swollen and overly sensitive area below the base of the penis in the corpus spongiosum and a weaker deflated area above it on the bottom half of the corpus spongiosum, so that it feels like my penis is divided into two parts and the energy, blood and feeling doesn't flow continuously across the blockage at the base. Erections take longer and are harder to maintain and it feels like someone else's penis when I'm masturbating. For several years I would have to pull my testicles out when I sat down because there wasn't enough room and I felt I felt pressure in my groin when I walked around. Although I can maintain an erection during intercourse, the orgasm is slowed down and when I masturbate instead of shooting out a foot or so it most often dribbles out. There was a period of a couple years after it happened when it hurt when I had an orgasm during sex but that passed. I may have caused additional damage in my attempts to manipulate, massage, and even out the feeling. I previously had no issues with erections or PD. I had already taken a lot of supplements for many years before this such as vitamin E, coenzyme Q 10, ginkgo biloba, B vitamins, and minerals, etc. but not arginine or acetyl L carnitine because they overstimulate me. I recently tried serrapeptase for a couple months but it didn't help, may have made it worse. I occasionally use infrared light or DMSO. Any suggestions you have would be appreciated. Thank you.

It sounds as if an examination of the erect penis (done after a vasoactive intracavernous injection) might be helpful in identifying the long term effects of your injury.  MG

12/26/2012 - 10:34
after PD surgery, twice

62 years old, pd for at least 3 years, decided to do something about it. before surgery , had lost some girth and length, but still at least 5 inches, good feeling,used the pump,worked good,increased size, but did not take the curve out, masturbate, no problem. no pain ,30-45 degree bend , right below head of the penis.backwards to the body. had the local urologists perform, the stitch surgery, uncircumcised, after surgery was a question mark, more bleeding than normal, a lot more swelling than normal, all the surgeon had to say was, he had to do something different, and stop short of saying any thing else. very few words were spoken, no remarks on the surgery, had to wear a bag home. six weeks later, i have to sit down to pee, too much skin in front of the penis. the head would not go through the skin. i thought that holding my length back.hardness no problem. second surgery,circumcised and another stitch. four weeks later ,healing well, but all of a sudden , i noticed, hardness, good feeling, but something had gone wrong with my length,it feels like something was holding it back and it still does, i may have two inches. I lost over three inches, i can't do any thing,too small for anything. doctor says that's what you had before, which is not true. i was told before surgery no loss of length. then he says , well i could take the stitches back out , to see what that would do. then he says , try the pump for 4 weeks and come back to see me . i tried the pump, penis doesn't move. everything fine except the length. feeling, hardness is good etc. he look like he was guessing on taking the stitches out. what do i do ?? second opinion ?? i am located in little rock arkansas, this driving me crazy! resconstructive surgeon ? please help

I think getting a second opinion from a reconstructive surgeon with particular experience in Peyronies work would be a good idea.  There is a physician finder link in this site that should help to locate someone in your area. I know there is good group at Baylor Medical Center in Houston.  MG

12/26/2012 - 10:40
need treatment!

I am a 21 year old male. I was diagnosed with peyronies and I have a curvature of about 45 degrees to the left. I have had the curvature for about 5 years without it getting better or worse. I recently went to a urologist for the first time for treatment. he has me taking 1000 mg of vit-E a day and massaging the scar tissue daily to see if it will resolve itself. I've done this for a month with no improvement. also, the curvature causes my girlfriend pain during intercourse and it also makes me feel very tender on the right side (due to the increased pressure and friction). this is starting to damage my relationship with this girl, but the urologist seems to want to be very conservative with treatment. what advice can you give me? what would the best treatment options be for me?

If your condition has been stable for 5 years, it is unlikely to get better with vitamin E. Based on your age I wonder if this condtion, first noticed at age 17, was truly Peyronies or if it was worsening of a congenital bend (curvature that had been present since puberty). If that was the case, a Nesbit Plication by someone skilled in this field would be the answer.  If not, and if you have a hard lump or plaque in the curved area, you may want to wait and see if Xiaflex is approved by the FDA, as this biologic agent appears to hold promise.  MG

12/26/2012 - 10:44

Healthy fit 60 year old vegan in a thirty five year relationship with my wife. Condition began a little over a year ago. About a 30 degree upward bend. Lost one inch in length. At first I had some minor pain during erection at the bent area, but none in the past year. Got one small drop of blood at first, none since. Base of my penis has deformed or flattened some during erection. The odd part is where the bend is, my penis when erect has a "hinge" effect that allows the penis to flex slightly when erect. Can feel some firm areas above base when flaccid but no pain. Sex continues to be excellent, no organism or erection problems. Does this all sound like Peyronies? All seems stable and would give up sex before considering surgery. Any reversal possibilities? Supplements? What a great service you provide with this website, thank you.

A hinge effect due to narrowing is not uncommon in PD. If you are careful not to bend the penis and it doesn't interfere with intercourse, it can be safely left untreated. You may want to consider supplements such as vitamin E 400 units daily, l-argenine 2,000 mg daily or acetyl carnetine. If your sexual function remains good, there is probably nothing further that you need to do.  MG

12/26/2012 - 10:48
anorgasmia after penile sugery

I was operated on for serious Peyronies, 90 degree curvature to the left. This required a bypass of the left blood vessel. To do this there it required a incision around the glans to pull back skin to do the bypass as I understand it. This resulted in loss of sensation to the glans area. I was told this would correct its self after a few months. It has been several years now with no return of sensation in the glans. I cannot feel anything inside my wife's vagina during intercourse. I used to be able to wiggle the glans by finger manipulation, with no stroking of the penis and have an orgasm. Today the only way to orgasm is to watch porn, which is fake and totally boring, but sometimes I find an act that is a little exciting, but then it takes up to an hour to orgasm and the penis must be stroked at an extremely fast rate along with total concentration and imagination on the fantasy. I don't believe there is a remedy?

If there has been little return of sensation after 2 years, you will probably need to identify other erotically sensitive zones on your body, or consder the use of a vibrator.  MG

12/26/2012 - 10:50

Four years after diagnosis( with apx. 30 deg. bend ) and trying different treatments with no improvement I believe length and diameter are worse. Is this in my minds eye or is it possible.

This is not just in your perception - unfortunately physical length and girth loss can occur with PD.  MG

12/26/2012 - 10:52
Just Self Diagnosed with PD- How Urgent is it to start treatment

I am 53 years old and in good condition. I have developed all of a sudden a pronounced bend (maybe 30 degrees?) at the top third of the shaft, and my penis is noticeably shorter when erect. No pain. The bend recently appeared, but for six months or so before that i was experiencing softer erections, and difficulty in staying erect. Then the ED symptoms seemed to go away, but were then followed by the development of the bend. I would like to reverse this before the scar tissue gets to old. The first urologist appointment I could get is inFebruary. Is that too long to wait? Do I need to get on therapy now?

Waiting a month or so is probably not a problem.  Not everyone responds to medications for PD, but when they are effective it is usually in the earlier phases of the disorder.  MG

12/26/2012 - 10:53
52 year old diagnosed with early Peyronie's

My urologist diagnosed me with early Peyronie's. He has recommended that I take Vitamin E and daily doses of Cialis (5 mg). He said the Cialis will give me erections in the night that will keep the blood flowing to the penis, delivering oxygen, helping with the healing and reducing plaque buildup. Is what he says about the Cialis correct?

There is no good controlled clinical trial evidence that cialis helps peyronies disease, but there is rationale to use it and many urologists are doing so.  MG

12/26/2012 - 10:56
Is this Peyronies Disease?

I am 65 and developed about a 40-45 degree curvature to the left about 15 years ago. I was told it was peyronies, but my urologist tells me every time I visit and have exam that he has never been able to identify a "spot" or "nodule" to locate the area precisely. In the last year or so, I was told I have Dupetrins(sp) Contracture as well. I have an issue on my right ring finger. If this isn't Peyronies, is there something I could be doing to improve about my erectile condition?

If you have Dupuytrens contracture in your hand, this bending is almost certainly PD.  Somtimes a "spot" or plaque cannot be felt, only a linear scar or cord that can be identified by stretching the penis.  MG

12/26/2012 - 10:59
Traction devise

I've had PD for about two years, my case seems to be a bit different I have found three lumbs and have three curves, up, left and right. I'm taking Pentoxifylli L-Arginine amd E with no results. I've been thinking about trying a traction devise but have heard sometimes it can make the PD worse is this true? I've lost over and inch in length and afraid to lose any more. Will it give me the length back I once had? If they are helpful what traction would you recomend? I've read something about a new medication that may be approved will they treat all curves or do they have to be a certain degree of a curve to treat? The reason I ask is my curves are hard to judge because they work against each other. Thank you for this forum its very helpful!!!!!

Early reports indicate that using a traction device more than 2 hours per day can help to straighten the penis, though many patients cannot accomplish this.  The new medication currently in FDA review, Xiaflex, may be worth waiting for as our studies have shown it is effective in reducing bending.  MG

12/26/2012 - 11:02
Small dent

Hi, About 6 months ago i have notice a small dent on the right side of my penis about 2 centimeter down from the ring's head. It is not causing pain when having erection or sexual activities but i am wondering if i should consult right away or simply wait and see if my condition worsen, i am in total darkness regarding the evolution of this condition and somehow nervous of what might be in store for me when looking at pictures of more serious conditon on the internet but at the same time feel a little embarass to consult if my situation is not that serious at the moment.

Some authorities feel vitamin E may stabilize this process, so taking 400 units daily may be a consideration.  If on this regimen you notice no further progression, it would probably be safe just to observe it for the time being.MG

12/26/2012 - 11:06
Night time erections

I am 43 years old and have had peyronies for about 2 1/2 years. Started with one scar on left with little painand a small bend. Then about 8 months later after sex one day with my wife I started to have pain and noticed new scar on top and right side. I have been on pentox and vitamin E. since then. The right scar with the left has made me shorter but straight. My wife and I have oral sex and are safe. I have 2 questions. First is I have erections most of the night. Almost everytime I wake up I have an erection. They go away if I wake up completly or go to the bathroom. This has been happening since this started. Can erections that last at night like this cause damage? Second question is over this 2 1/2 years it seams that my peyronies will not stablize. Could this be because of the night time erections? Thank you!

Night time erections are normal, and are not likely to contribute to damage. A small percentage of men with PD may continue to experience changes in their disorder beyond the 18 month point where most patients stabilize.  MG

12/26/2012 - 11:09
Loss of sensation and Xiaflex collagenese

I’m 42 and developed peyronies in early 2006 as a result of minor trauma due to rough sex and recreational Viagra. My bend is very mild, maybe 5 degrees left at the glans, but I have a bigger problem. I have lost sensation at the area right under the glans where the plaque has developed. During an erection it used to be very sensitive, throbbing sensation, but now it is very dull. I don’t believe the nerves are dead because I can still feel pain, of course, if I push hard enough on it. Do you think Xiaflex Collagenese will help my situation? Even a little restored sensation would be better than nothing. Let me clarify that the glans themselves are still very sensitive. It’s the area just below the surface on the topside where the plaque resides that feels dull. Hopefully that is an accurate description.

We don't have any data on this from our recent clinical trials, but I can tell you I had one patient in my collagenase clinical trial at UCLA many years ago who had sensory loss that improved with this treatment.  MG

12/26/2012 - 11:11
Possible Correlation?

Hi. I'm 31 years old. About two years ago I started experiencing health issues that I'm wondering could have caused PD. The health issues began when I had pneumonia. Shortly after I started having intestinal issues. The intestinal issues lasted for about a year and a half during which time a regular bowel movement was rare. During this time I began having discomfort in my penis and rectum (which was discharging). As of now my intestinal problems have gone away but I still have discomfort in my rectum and pain in my penis has increased along with the curvature. It has become very obvious this is PD. The curvature has become very pronounced and I can feel the plaque. Having sex has become very difficult and even when flacid my penis can be quite painful. Is it usual for patients with PD to have other symptoms?

No that is unusual.  I often tell patients that PD is not really a "disease", because other than dupuytrens contractures of the hand, it is unrelated to other internal or medical issues.  MG

12/26/2012 - 11:13
Not sure if congenital or pyronies

Hi I am 17. Have always had some degree of left congenital curvature, but noticed about 1-2 months ago that it became more severe (at least doubled)I would not associate this with any injury unless it happened without me realizing it. The right side curves smoothly however there is a distinctive point on the left side where the bend occurs. It is hard to estimate the degree because a curve does not line up with a protractor but I would estimate between 30-40 degrees. I can not feel any plaque when flaccid,and the curve is visible while flaccid but this could be the congenital curvature. While erect, I can feel an irregularity (inward fold, narrow ~3mm) in a on the left side bend point but this could be related to the bend itself, not a cause of the bend as it is narrow and not present while flaccid. Could this recent gain in curvature be peyronie's or can this happen with congenital curvature as well. Should I see my doctor?

This can happen with congenital curvature, as the concave side is vulnerable to increased tissue stress during sexual activity.  It would probably be a good idea to see a urologist.  MG

12/02/2012 - 18:52
Two months into diagnosed PD

I have been diagnosed with PD on 29/09/2012. First noted a lump 3/4 way down. Have since onted a curve. My doc said it's 43 degrees. No rela pain in erection but since have had some mild pain when flaccid. I am on Trental (since 10/10/2012 now on 4 tablets) - L-arginine 3g (last 5 days) L-Acetly Carnitine 1g - low dose Vit E - CoQ10 300mg. My doc suggested verapramil injections and traction. Will start early next year as I have a planned overseas trip. I have applied some soft manual stretching - but this has caused mild itchy type pain on my penus. Not sure if traction will help as I am not sure what stage I am in. Doctors who I have seen have mentioned: Urologist 1 believed 6 months old condition - said to come back in 4 months --- Urologist 2 said 6-8 months condition - said to come back in 6 months and suggested VED - Doc 3 noted two nodes - and said it was a mild case -Trental might help and recommend L-Acetly Carnitine and come back in February. Doc 3 suggested Trental 4 per day - L Arginine - Traction and Verapramil Injections. He meassured the angle and gave 43 degrees. I had tohught it was more like 30 degrees but I might have measured wrong - or it might have worsen. I have bought the traction device should arrive this week. But not sure after getting the mild pain manually with gentle stretching. Not sure either how to measure properly the traction device. The guide takes about the length of the stretched penus and add 1 cm. But is the stretched penus the length of an erect penus or what? I have has sex with care - which was still pleasurable - so I don't know if the mild pain I am now getting is because of this or because of the gentle manual stretching. This is certainly a frustrating condition - I only wish there was an EFFECTIVE treatment. The fact of not knowing how it will progress - is probably the hardest. Your comments will be valued. Thankyou

The different recommendations you have received underline how responses to the various therapies (including traction) can differ.  The released top-line data for Xiaflex are quite encouraging, and it was submitted to the FDA for approval just under one month ago. My opinion is that in many cases this new drug will prove to be more effective than some of the remedies you have mentioned, but all the options you have been given are reasonable and I would follow those for the time being.  If traction hurts you need to back off the tension.  MG

12/02/2012 - 19:53
Small rice size lump on corpus cavernosum

I have recently found a small hard bump on the tip of the corpus cavernosum near the head of the penis on the lower side as it joins up to the corpus spongiosum. It is stationary and about the size of a grain of rice. Had a pinching injury 2-3 weeks ago with clothing getting bunched up in a sitting position. No pain until sex and now have a mildly irritated feeling (just minor soreness) Could this be related to PD or something else?

PD usually takes much longer than 2-3 weeks to develop, so I would say this is some kind of transient response to trauma - it will probably resolve on its own.  MG

12/02/2012 - 19:56
Revised question with more pertinent information

About a week ago I was having sex in the "cowgirl" position when my penis slipped out and my partner didn't realize it. She came down on my penis which caused some pain and we stopped. Over the next few days we had sex a couple more times without much pain, although we had to go slowly because I was slightly tender. A few days later I looked into the mirror and my penis that was already slightly curved previously looked more curved, also there seems to be more of a "bend" shape than a curved shape with the point of the angle being near the base of my penis. I went to a urologist and talked to him about what happened, because I was concerned about developing Peyronie's disease. He didn't seem to know much about what Peyronie's was and was only really concerned about whether I suffered a fracture. Over the last few days, since i went to the doctor, my pain has worsened and I feel a hardness on the left side of my flaccid penis. The parts that feel hard are also tender to the touch. Is it possible that the trauma has lead to the beginning stages of Peyronie's in only a week or is this all a response to trauma? Should I be taking L-argitine and Vitamin E, in case Peyronie's is developing? I am only 16 but I was already getting treatment for erectile dysfunction which my urologist is not sure of the cause of, for which i was taking 15mg Cialis as needed.

The short time span since this began suggests it is probably not PD. It probably wouldn't hurt to take the vitamin E and l-argenine for a couple of months anyway.  MG

12/02/2012 - 20:02
HELP!!! injured husband's penis during intercourse

Two days ago, my husband and I were having intercourse in the morning with me on top. I was using a lot of friction and force when he accidentally slipped out and I came down hard against his penis with my inner thigh. His erection started to go down so I began to initiate oral sex to "get things going again" but he said that it hurt. We inspected everything and there was no swelling, no redness or bruising, no bending, no popping noise. The only issue was tenderness in a pin point area on the right side of his shaft about 1/2" below his glans. I palpated the area and it seems to be a very small area where tenderness exists only when directly pressed upon. He said he thought he'd be fine by the evening and wasn't worried. The next morning,24 hours later, I woke him up to gentle oral sex (no manual stimulation) just to see how things were going down there. He said his penis was still tender to oral stimulation but that oral sex felt great. He easily achieved a full erection and was able to ejaculate. Again, no swelling, no bruising, no bend or curve, and no urinary issues. Then, later that night (about 30 hours after injury) he complained that he might have a "bladder infection" because it kind of hurt when he started urinating. I expressed that this was not normal and that I was concerned. He said that he felt "achy" everywhere including his butt and his scrotal area. Nothing major, just achy, and he had no idea why his scrotal area was now tender. The next morning, around the 48 hour mark, he woke up and said that he felt totally fine. I wasn't convinced because I felt he was just trying to avoid the doctor visit that he knew I'd make if he wasn't miraculously better. He insisted that he was totally fine now so I asked him let me inspect the area again. I did so, and again, there was no swelling in the scrotum or penis, no discoloration, no nodules, bends, etc... Everything looks normal. I then decided to test things out and initiated oral sex. He was immediately able to get a full erection and experienced a lot of pleasure from the act. He did not ejaculate, however, which is atypical. He said it was because he was distracted by the fact that he had to leave for a meeting within 15 minutes and felt pressed for time (again, him not ejaculating is strange). I was trying to be gentle at first and asked him several times if he had any discomfort at all and he emphatically said "no" that it felt great and that he didn't want me to stop. So, I started to use my hand over his shaft to give him the stimuli/friction he needed. I also gently kneaded his scrotal area and he had not problems with that at all. Again, he was loving every minute of if and indicated no discomfort at all- in fact he was really into the whole thing. Immediately afterwards, he said that his penis felt tender and sore and that I needed to be careful about my teeth rubbing against him and causing this irritation. I have been married to this man for over 2 decades and can assure you that my teeth were not an issue as I know what I'm doing. The bottom line is that his penis is much more sensitive to oral sex or touch since our "incident" two days ago- it feels good to him during the act, but then is sensitive and slightly painful after the activity. Is this likely to be a penile fracture, or possible a slight penile fracture, the onset of Pyronie's, or something else? We're getting ready to go a vacation next week (for an entire month)and I need to know if we should avoid sex or if its okay. I called his urologist and explained the situation but he just blew it off and said "oh, it's not a fracture it sounds like Pyronies and there's nothing you can do except maybe take CoQ10 and have him come see me sometime. Have a good vacation." This is unacceptable to me as I need to know what signs to look out for, when to seek medical attention, and when we can safely resume sexual activity. Also,he takes Cialis (he has taken this for a few years due to slight ED which occurred after taking Propecia to prevent hair thinning) so will this mask the symptoms/problems if there are any? Is it okay for him to still take Cialis if we want to have sex of any sort? I am hoping that the burning during urination that he said only happened briefly and the tender small region on his penis is only indicative of mild trauma that will resolve on its own and without complication. I am a realist, however, and need to know what we're likely facing so we can get with a good urologist if deemed necessary. If it is Pyronie's what should we expect and what is the normal trajectory for PD if caused by mild trauma from intercourse. Will his penis likely start curving or bending? Will the tenderness likely subside or escalate? I really need your direction on this. We have not tried to have intercourse again and I don't know if/when we should try to do so. Also, is it a bad idea for me to give him oral sex each day even if it is gentle (without use of manual stimulation)? This is my gauge to see how he's doing because he's not always straight forward about these things so I'd like to be able to test the waters. With that said, I don't want to cause him further irritation if the area needs time to heal. Thanks for taking the time to share your expertise.

The observations you have made are probably based on the trauma your husband experienced.  I think you need to "give it a rest" and stop checking out his sexual response for a week or two.  This does not sound like PD to me.  MG

12/02/2012 - 20:05
Prognosis and Treatment

A week or so ago you helpfully answered a general question about L aginine and Acetyl L carnitine. I would now like to ask a more specific question regarding my situation. I am a sexually active 70 yr old. At the beginning of this year I began noticing an indentation on the side of my penis near the base. I did some web searches and came across your helpful site. One of the fourms mentioned ACL and it seemed worth trying, which I did and have been taking 1000mg twice daily for about the last 6-7 months. I also went to my doctor and confirmed that I had PD - small lumps can be felt when not erect. The condition seems to have stablized. I can maintain an erection and engage in intercourse. I am otherwise healthy and physically active. Quesitons: if the changes are stablized at this point (after about 10 -11 months, can I assume it will not deteriorate further? also, I started taking L agrinine after receiving your response to my question - 1000mg twice daily. This is in addition to the ALC. Do these treatments make sense as far as you can tell? Any recommendations appreciated. I would obviously like to avoid surgery and would welcome any other suggestions.

It is likely that after 11 months or so that your situation has stabilized and will not progress further.  Since you are functioning well, surgery would be out of the question.  Continuing on the nutritional supplements would be a safe bet.  MG 

12/02/2012 - 20:09
Male - 27 - Worried about PD

Over the last few months I have been experiencing telltale PD symptoms (chronic penile pains/aches, slight curvature) and I had a question about potential shortening. As far as shrinkage is concerned, is it reversible if the Peyronie's Disease itself is reversed? Is shortening permanent in all cases? I have heard that the elasticity never returns even if you get rid of the bend/plaque/disease. Also, is it a good idea to abstain from masturbation at this time to help with healing? It seems to get worse with the act but I also don't want to repress myself either. Luckily these symptoms are still in the early stages since they've only started around summer time and I'm seeking more advice/help on the issue so I can deal with it as soon as possible.

There is no need to avoid masturbation.  Unfortunately, most of the length loss that occurs with PD cannot be fully recovered.  MG

12/02/2012 - 20:13
My Peronies saga

Dear Dr., I'm a 60 year old man in peak physical condition. I exercise daily, eat well most of the time and except for a bit of overwhelm and burn out I'm usually a pretty happy guy. I contracted Peyronies disease about 5 years ago. I believe the onset occurred after I banged myself pretty good during intercourse and then again during a masturbation session where I felt and heard a definite popping sound near the base of my shaft. Shortly thereafter I noticed a significant change in the shape of my Penis. It morphed in to bottle neck appearance with a slight bulge at the base, indentations on each side about 1/4 of the way up, lost length 1-1/4 in. and lost girth near the head approx. 1"in. I also noticed a significant decline in sensation and it was much more difficult to attain/maintain an erection and have an ejaculation. Needless to say I was very scared and quite depressed. That was one cold winter. I was embarrassed and finally got up the courage to see a doctor about 3 months later. He basically told me that there was nothing I could do except surgically remove the scars. By that time I was able to masturbate to the point of ejaculation! But usually my penis would loose it's firmness a couple of times prior to that occurring. I found a website called the Peyronies Disease Institute and created a supplemental program based on the recommendations therein that apparently has stabilized the disease. Over time I've amended my supplemental program several times over the years. My penis still changes shape and sometimes appears somewhat normal and at other times it shrinks up and / or leans to the right. Recently I had some dull aching but never really had to much real pain. Prior to the onset of Peyronies I had never really experienced ED and I was pretty popular with women and have always had lovely and sexy partners. Currently I can have intercourse but usually my penis goes from erect to semi-erect several times before I climax. I also need some manual assistance to initiate an erection. When I masturbate and I'm highly aroused (while viewing porn videos) I seem to be able to maintain a longer lasting and harder erection. However the porn is no substitute for a loving companion. I have tried some of the popular natural supplements to augment my erection capacity but they have not helped. I'm not in a relationship at the moment and quite frankly my confidence level is pretty low. I'm intending to finally submit to seeking additional assistance either with a urologist or a sex therapist or both. I'm not interested in surgery at all!! However reading over some of the PD victims stories and personal histories leaves me pretty confused on what I can or should do. I haven't tried Viagra or Cialis because I didn't want to create a dependency. I guess I was more focused on trying to deal with the issue holistically, privately with the hope of over coming the disorder with pure intent and courage. So much for that train of thought. I'm not sure what to do next. I understand that the clinical trials and FDA approval for the plague attacking drug XIAFLEX will be completed in 2013. Perhaps that will be the answer many of us are seeking. In the mean time any suggestions or recommendations that feel real to you in relation to my personal PD sage would be appreciated. Thank you in advance for your good work and any insights you submit to me. 

Xiaflex is expected to help with deformity, but is not intended to treat the ED that can accompany PD.  I would suggest you go ahead and try Viagra, Cialis, or Levitra. MG

12/02/2012 - 20:16
Penis "ring"- 24 years old

Hello, 24 years old here, after masturbating harder than normal a few weeks ago, my penis felt a bit swollen after a while so I stopped. Not a sharp pain, just some discomfort and irritation though as a result of the tight grip. Kind of like after an intense sex session. BUT later that day I noticed that I had a thin, soft-ish, puffed up ring (and another half one) encircling around the middle of my penis, it is more prominent on the sides. It can be seen best when "Deflating"... going flaccid. Also, strangely, the ring completely disappears for at least an hour when I ice my penis... It is a very thin structure, soft and rubbery, and totally painless. It looks almost exactly like a vein, but it doesn't move with the skin... which is why i'm worried. Again, I have no pain or curvature, but am worried... is this is some early stage peyronies? Is any tissue in the body of the penis automatically peyronies? Also, why does it disappear when I ice it? Is it some sort of lymph structure or vein perhaps?

This sounds like Mondor's syndrome, a harmless condition where the veins under the skin get temporarily hard and prominent in response to trauma.  It will go away; it is not PD.  MG

12/02/2012 - 20:17
small lump in shaft of penis

exactly two weeks ago i noticeed a small lump directly in the center of the shaft of my penis a little less than half way through it has an uncomfortable feeling sometimes a little painful no problems with getting erection no curve a little uncomfortable during sex seems to be a little smaller and not as hard as when i first noticed it ive seen a regular md he said no worries i wasnt satisfied with that seen a urologist said it might be peyroines and said see u in a year take advil for the pain definitely wasnt happy with that ive been riddled with anxiety have an appt on friday with a specialist my brother was diagnosed with pd but does not have coverage for treatment

PD can run in families.  MG

12/02/2012 - 20:18
peyronies and diabetes

i am a 31 yr old male. i recently have had reaccuring problems with my penis such as leesions after intentercourse. i also have pearl inserted in my penis. about a year ago right before i ejaculated my penis blew up like a hourglass. also i have had my penis peal like a snake do to my blood sugar level is this peyronies disease

From your description that is hard to say.  Probably best for you to see a urologist.  MG

12/02/2012 - 20:20
Pencil Eraser Sized Lump

Hi, I am 24 years old... I'm not exactly sure when I found it but I roughly believe it to be a year ago... I discovered this pencil eraser sized lump on the shaft of my penis, its not on the skin but under the skin, I can feel it whenever I have an erection and its almost impossible to find when flaccid... it hasnt gone away... I don't think its cancer or some serious crap like that... I just want an opinion without wasting a ton of money at a doctor's office with him looking at my junk... there has never been swelling or pain and I don't believe it has changed in size at all.. Thanks

Keep tabs on it, if it isn't changing and you are functioning normally you can probably safely ignore it.  MG

12/02/2012 - 20:23
What should I try

I was diagnosed with PD about a month ago. I have had the condition for roughly 7 months after a bad bend during sex and it seems to be getting worse. I do take glucosamine for knee issues and I have seen the possibility of it irritating PD mentioned in this blog. My doctor prescribed vit E, but my wife and I don’t see how that could cure my condition. What treatment do you recommend? Should I stop using glucosamine? Should I get a second opinion from another doctor? Thank you sir.

I would stop using the glucosamine, as in some cases it may aggravate or be related to PD.  Vitamin E will not "cure" PD, but it may help to stabilize it.  If you are not getting the answers you need, a second opinion is never a bad idea.  Check the doctor finder link in that section of this website for someone in your are with a lot of PD experience.  MG

12/02/2012 - 20:25
Male 52 years old

About 8 months ago, I was trying to get my penis erect and was masturbating fast and hard. I ejaculated while my penis was still very soft. I had a sharp pain in my penis (seemed near the head) during ejaculation. I didn't think much about it until about 3 weeks afterward when I started feeling like I had a urinary tract infection - sore burning at tip and along shaft. Antibiotics were prescribed and didn't seem to help much Anyway, over the past several months, I have had problems with pain on the side of my shaft about midway down after intercourse. The pain would last for a few days and then subside. Then 2 months ago, it was painful for about two weeks after intercourse. I saw a urologist who mentioned PD but didn't feel any real noticable plaque and recommended taking Vitamin E, which I have been doing since. My last 2 erections (today and two days ago) were very strange. My penis had much more girth from the base to midway up the shaft. The top half of my penis was much smaller in diameter. Also, the larger base felt a little painful. What is this?

The distal tapering or loss of girth out near the far end of the penis does sound to me like PD.  MG

12/02/2012 - 20:26
relief for a painful erections due to testosterone shot.

my doctor started me on testosterone shot due to low testosterone. now i always have an erection and it is painful. someone please give me suggestions for relief.

Talk to your doctor about checking testosterone levels in your blood, and possibly changing your dose.  MG

12/02/2012 - 20:28
Shaft sore

i have a sore on the middle of my shaft, and it happened i believe after sleeping with my wife. Initially i i did not think that it is something major but it is not dying away.At first it was on the left side at the middle of the shaft, about an inch long and half inch wide, but now it has shifted in a layout of starting from below the head on the left to the middle right. It is not painful unless i press the sore. It has been a week since i have experienced this, and it worries me.

If this has only been present for a week, you may want to try ibuprofen daily for 7 -10 days.  MG

12/02/2012 - 20:30
Hourglass shape in semi-erection

I'm 23 years. 6 days ago while having sex with my gf (she was on top) the penis somehow slipped out and missed the hole. It quite hurt there, but the pain subsided and we continued the intercourse to the end. During the rest of the day I had no discomfort, but in the evening I noticed the infamous hourglass shape. This would go away while in full erection, and it seems to me it's not noticeable while flaccid. Anyway it's new, and made me think a minor trauma occurred (i also started to feel a mild ache to the left testicle, more intense while I seat). Seems to me i'm having less erections than usual and those are harder to mantain (this maybe psychological, but then again I can't be sure). Altough I notice no lumps at the moment, I fear there could be problems in the future if some sort of trauma occured (today doctor dismissed me after a quick look, he noticed nothing unusual). Testicle seems less aching every day, but the hourglass in semi-erection is still present six days later. I have actually no pain in the shaft, no pain while peeing or ejaculating. Questions are: will the hourglass go away over time? am i at risk of having PD in the future for these kind of injuries? thanks.

Although this kind of injury can lead to PD, it sounds to me that given the time duration in yours the condition will probably reverse itself in relatively short order.  MG

12/02/2012 - 20:32
ED and Erection.

Dr. Gelbard, I am 40 years old. Over the course of the last last 10-14 months I have had a few issues, I had bouts with occasional ED early on which was diagnosed mainly as stress. A variety of tests showed that everything appeared normal, even testosterone test levels were normal. However, one thing that has been becoming more frequent over this time is that I no longer feel my orgasms. When the penis is erect, I notice the left side of the urethra appears to be “opening up”, and that the semen seems to just ooze out. It is difficult to tell if there was ejaculation other then the penis goes flaccid and my sex drive at that time drops. Even not having sex or masturbating for extended period of time did not make a difference. Occasionally because of the “opening up”, the stream when I urinate is some times split. There is no pain, and there is no blood in my urine or semen. I am not sure what to do at this point as this is a somewhat embarrassing issue to discuss with my PCP, and I believe these issues have contributed greatly to the issues in my relationship as it has made me want to shy away from sex as it no longer feels satisfying as it once did. Please advice to some course of action. Thank you.

Fortunately PD is not an issue here.  You should see a urologist.  MG

12/02/2012 - 20:35
Moving forward

Hi Dr, I´m 46 yers old and I was diagnosed by a urologist with peyronies disease ten month ago. I wrote to you about this four month ago. I still have a small lump on my penis right side half way up. I still have no bend but I still have small indentations close to the lump. The only change I can feel is that the lump is a bit harder now compared to four month ago. The indentation are about the same or little less than before. Do you think It will stay like this without getting worse? I read that erectile dysfunction may develop in the stable phase. Do I have to worrie about this? I'm still stressed about this and often check for new lumps or signs of Peyronies progressing to worse. The only treatment I had taken is acetyl l carnitine for tree month (read a lot of good things about it) should I continue taking l carnitine? Thank you for providing me with information that my doctor didn't give.

If you don't have ED now, you are unlikely to develop that problem.  It usually takes PD 12 - 18 months to stabilize completely, so continuing the supplement would be a good idea.  MG

12/02/2012 - 20:37

I'm 24 and uncircumcised. When erect there is a small 2-4 mm nodule on my shaft about a half cm below the glands under the skin. It is ONLY present when erect and is not near the vein. I do not experience any pain with the nodule unless I have prolonged intercourse in which case it seems to ache for 30 min afterwards. Would like to know what this may be and if I should see a urologist?

It's possible it could be a mild form of PD, but that is just a guess.  Probably a good idea to see a urologist and be examined.  MG

12/02/2012 - 20:39
Massage with oil

Thank you Dr. Gelbard for your time and effort in this excellent web page. I am new to peyronie disease, found about five months ago. Am 49 years old and going through a depression since last year. Married although had lost sexual atraction to my wife for several years. Due to the different medicine I am already taking I am looking for a natural treatment to PD. Have you heard of massages with oil, particularly Argan oil, rich in vitamine E? Thanks so much. JAM

I know of no reports on results with this oil, but I doubt it would be harmful.  MG

12/02/2012 - 20:41
Bump in vein on top of penis at the base.

I have firm mass in the large vein on top of my penis at the base. It's been there about a year and seems to be getting just slightly larger. No pain really though it sometimes feels a little irritated. It used to disappear when flaccid but now I can locate it all the time. I think it started after a particular vigorous sex session with my wife when it slide out of her but she kind of slammed down on it funny with her body, and it hurt a little at the time. I made an appointment with a urologist in my area, but it's not for two months. I'd like to know a little more beforeI go in. Thanks.

If the mass is truly in the vein, it would not be expected to be PD.  MG

11/18/2012 - 21:01
Male - 20 - Possible PD issue?

8 months ago my former girlfriend was on top of me and accidentally sat on my erect penis as I lied on the bed. It felt really painful but the penis didn't lose erection. Later on, it felt like a blood rush or breakage of a blood vessel... but this was a few moments later as we were cuddling. I went to the Urologist after the next few days being in a good amount of pain (4-5 sharp/dull pain at the base of the penis). A few months later it started to stop hurting but now it started up again. I think its because my current girlfriend and I got a little too rough and she hit it a little too hard which initiated pain the base of the penis again. I'm worried because in the region where it hurts, the base of the penis, there is a bunch of indentations that you can feel by pressing on my erect penis. I feel that this area is much narrower (4" compared to my 4.4" at the midshaft in girth). This I've hard most of my life. I don't know the reason exactly as to why I have it but I think its an hourglass figure but I am not quite sure. Also, since i can remember, my penis can only "rise when erect" as I am standing at full 100% hardness and me tightening my kegal muscles too push blood in. I'm worried about impotency... erectile dysfunction... I feel like I shouldn't be dealing with this at my age. As of now all i feel is sharp pains that periodically happen throughout the day. Is this PD? Should i be worried? What can i do to stop it from progressing further?

At this point, with the presence of pain and indent without firm nodules or bending, it is a little hard to tell.  It is possible this is just the inflammatory reaction to injury and re-injury.  You might want to consider taking low dose vitamin E (400 units only) and l-argenine for 3 to 4 months and see if it subsides.  MG

11/18/2012 - 21:02
Is this normal?

I'm 30 and just started using a PE Extender. Trying to straighten my dick. 2 week in an I have noticed that it is getting straight! Anyways I have noticed that the skin between my balls and anis is sore and has two stretch marks . They feel like scars should I be worried?

No.  MG

11/18/2012 - 21:05
scar / pain

3 months ago I had penile surgery to remove a benign fibrous lump right below my glans (I am circumcised). The incision healed ok however I now have a new mass which is scar tissue about the size of a raisin, which is slightly hard and stuck to the skin. If I attempt sex it causes abrasion and inflammation due to tearing where it is surrounded by healthy softer tissue. Do you think it will return if I have a revision surgery ? If the scar tissue softened the problem would be resolved. Would an injection or topical cream help ? Or an oral medication like pentox or supplement be beneficial ? I would prefer to avoid surgery again unless there is no alternative. Also I am in within driving distance, so please let me know if you offer any of these services. Many Thanks.

This may just be a keloid (excessive scar) in the skin, and these respond to local corticosteroid  injections in some cases. I have had experience with this problem, so if you are in the area I would be glad to help you.  MG 

11/18/2012 - 21:16
Treatment option

11/01/2012 - 13:47 bent during sleep In the above forum you mention I arginine as a possible Rx. when I try to search the web for information all I can find is L argenine. Are these the same? what is the relative merit of either compared to Acetyl L caritine? thanks for your help.

L-arginine is an amino acid that is a precursor to nitric oxide, a neurotransmitter involved in erection.  It also takes part in modulating the wound healing response, hence its use in PD. Acetyl carnetine is an antioxidant, like vit E.  MG

11/18/2012 - 21:19
continue medical therapy or consider surgery

I have been diagnosed with PD now for 4 years. I have a 70 degree deformity upward. i have been receiving interferon injections 2 rounds with little to no result and at the recommendation of my urologist starting a third. i am aware that xiaflex may soon be out but i fear that the plaque i have is too large to have a significant effect. Is it time to conisder surgery? I do not want the nesbitt procedure so that leaves graft versus implant and i am leaning towards implant because with the PD i lose the erection rather quickly, dos this make sense?

Yes it does.  It certainly appears you have given non-surgical methods a reasonable trial, and you have a severe bend. Given the proper indications, implant surgery can be a very effective way to overcome many of the problems caused by PD.  MG

11/18/2012 - 21:21
Dis ordar of penice

My penis is going left and at the bace the left side the nerve is sweling and my urine also go left when i pres that nerve i feal a bit pain and my age is 15 my abdomen is fat i no iced that when i sarted master bulating it is swolen

Not sure what this is but you should ask to see a urologist for an examination.  MG

11/18/2012 - 21:22
Stuck Inside The Skin.

I Notice That When I Get An Erection That It Seems Like If My Penis Doesn't All Come Out. It Looks Like If Some Is Still Stuck Within The Skin And It Hurts A Bit When It's Hard. I Tried Easing It Out But It Hurts. I Feel It Hard Underneath So It's Still Got Room To Go But I Think The Skin Is Too Tight And Won't Let It All Come Out.

This sounds like Phimosis, a restrictive problem of the foreskin that can be cured with circumcision.  MG

11/18/2012 - 21:24
Peyronies and Implants

I have had ED for some time and in the last year and a half have been using injections. Never really that effective and causing seven hour erections. In the last three month's I have now developed an upward curve of around 30%. Is this considered extreme and how much does it generally affect intercourse. I am considering an implant and was under the assumption it would help with straightening, is it your experience that it would? Thanks for your time and input

A 30 degree bend is not extreme, but if the erection is hot hard, it can make it difficult to have sex.  Implant surgery will generate a hard erection, and can also help to straighten out a bend.  MG

11/18/2012 - 21:26
Peyronie Disease

Dear Sir, Unmarried 30 yrs age. My penis when flaccid is twisted towards right and the blood vessels on the penis is not straight. when try for erection penis erects to some extent then bends towards right and then the erection is gone. sometime it feels that the penis also bends downwards from base. this all started after i had rough masturbation; i frisked my penis against bed while masturbating two to three times. its nearly 10 months now. No nodes are present, but there is itching and sometime slight pain sensation on the right shaft below the skin. But somehow when full erect the bend is not noticeable. Currently i am taking Vitamin E 400 mg + Pentoxifylline 1200 mg. it has made me crazy and depressed. life has become tasteless to me.Does it sound like peyronie disease or some other sort of problem.

If a bend is not noticeable during full erection, I doubt this is PD.  MG

11/18/2012 - 21:29

Hey Doc Im 16 years old and when my penis is erect it bends downwards and slightly to the left, i have done a bunch of research and found that they're may be possible scar tissue built up which is causing the bend so i started taking Vitamin E daily and doing jellying techniques to try and correct the bend but im not sure if its working and if i will stunt my growth by this what should i do could this be pyronies? Thanks

No I don't think this is PD - the downward bend is probably congenital curvature.  If it is a problem, it can be corrected with the nesbit procedure.  MG

11/18/2012 - 21:32
peyronies recurrance

I emailed you about the possible relationship between glucosamine and PD, but just remembered that the PD recurred a few weeks before I restarted the glucosamine. However I have begun to feel discomfort in my penis when flaccid in the last week, since beginning the glucosamine again- so not sure if the two are related. Also, I had a phone consultation with my Kaiser Urologist about a month ago, soon after the PD returned, and his advice was let it run its course for 6 mos. or so without treatment. Does that seem right? It seems worse this time than last, more painful, a marked bend to the right, and very hardened tissue at the site of the dent. What would you recommend, especially regarding L argenine, vitamin E, or any of the other drugs I have seen mentioned here: sildenafil, tadafil, etc.

If it seems worse to you now, you might want to discuss taking some medication with your Urologist - a common combination would be colchicine + Pentoxyfilline + l-arginine + vit E.  MG

11/18/2012 - 21:35
frequency of erections, and recurrance related to glucosamine

I had an occurrence of what I now know to be PD a couple of years ago, which just went away after several months. Recently it has flared up, and is worse than before: a significant indent near the base on the right side, and +/- 15 degree bend to the right. Reading thru your forum, I realize I just started a new regimen of glucosamine at 2000mg/day for back pain, and that I used to take it a few years ago but stopped - I don't recall when. There may well be a relationship between these events, and I will stop the glucosamine and report back. Second, as I recall from last time, it seemed that the more erections I had the less painful they were, and eventually the pain subsided completely. I am 64, and I just get fewer erections now unless I seek out ways to stimulate them. Do erections in themselves stretch the scare tissue? I am relieved and grateful to have found this site. Thanks for operating it.

If the erections are firm they may stretch the scar tissue slightly.  Some urologists are recommending stretching devices or vacuum pumps to assist in this process. MG

11/18/2012 - 21:39
Lower abdomen and penis

A couple of years ago I thought I had a hernia. I had symptoms of my right testicle ascending into my scrotum. It also felt like my testicles were being squeezed. Anyway I went to a doctor a couple days later and he said I didn't have a hernia. However since this happened my penis now points to the right both when I'm erect and flaccid. Out use to point straight forward. It also looks like my right testicle is sitting a little behind my left testicle from a birds eye view. The doctor said I just pulled a muscle. However why do my genitals act in such a way since then. I also get a suttle pain in my lower abdomen on the right side, and I get a sensation of having to go number two. Is it possible for a two year long hernia?? And why the difference in appearance of my genitals? Other than that everything seems to be working right, and I have no pain during any usual body functions like laughing or coughing.

Hard to say what this is.  Might be a good idea to have a specialist (general surgeon) check you for a hernia.  MG

11/18/2012 - 21:40
Slight curve.

Hi, I'm twenty one years old and I've noticed a bend in my penis when erect and even when flacid. It occured quite suddenly and I think it could be the result of maybe gripping it too hard during masturbation. It's a relatively small bend and I was thinking I could have possibly bent the spongy chambers inside of the penis. If I refrain from sex and masturbation for a while is it likely to heal on it's own?

Yes I think that is quite likely.  MG

11/18/2012 - 21:44
Bulge OPPOSITE side of curvature

I've had a noticeable cordlike bulge that runs (under the skin, not a lesion, not lumpy or bumpy) on the RIGHT of my penis in line with the dark brown line of my circumcision. When fully erect, it is still there to the touch but does not protrude, when pseudo erect or flaccid it is tender to the touch to the point where normal activity (e.g. walking) irritates it. The minor curvature I have to the LEFT is very pronounced (midway to the end of my penis bends to the left 35+degrees) when obtaining an erection but slight (<10degrees from the base not halfway down) when fully erect. The bulge has been there for 10 years and in the last two has become much more pronounced. In the last year I have developed a slight dent on the left, almost to the exact opposite of the bulge slightly lower on the 'shaft'. The dent seems consistent with PD but the bulge doesn't. No obvious plaque, no trauma of any kind in my history. Does this sound like PD, scarring from circumcision?, combination of issues? Grateful for your input. Thanks

To me this sounds more like a combination of the issues you mentioned than PD.  MG

11/18/2012 - 21:46
Dent in side of penis

Hello, Thank you for your website - it's useful to be able to read other issues and ask for information. 57 year old male, reasonably fit (but probably should exercise more), lifelong non-smoker, low to moderate alcohol intake (1 large G&T and 1/2 bottle of wine and one beer per week, mostly at the weekend) not massively overweight (probably c. 15 lbs over my fighting weight - I'm 6' 4" and 200 lbs), no drugs apart from 40mg Simvastatin daily for cholesterol (level was 4.4 when last checked; HDL/LDL ratio 3.7) BP 120/75 when last checked last year. Eat reasonably healthily - no butter, not much saturated fats, little sugar, no added salt on food or in cooking, olive and rape seed oils in cooking and on salads, etc. Take 1000mg Vit C, a proprietary multivitamin tablet, 1000mg omega 3 fish oil and 400 mg Vit E daily with breakfast. Yesterday I noticed a pronounced "dent" in the left side of my penis when erect (well, it looked pronounced to me), about 1/3 the way from the root to the head. No pain, no noticeable curvature (I've always naturally curved slightly left anyway), no loss of firmness. I woke with an erection this morning and I could feel the dent in the side - again, no pain and firmness felt normal. When flaccid I can't feel any plaques, nodules or anything out of the ordinary. I'd say that the dent has appeared in the last week as it wasn't there the last time I looked at my erection. Obviously the first question is - does this sound like early PD? If yes, should I go to the doctor now or see if it resolves? If you don't think it is PD, any idea what it might be?

The appearance of a dent like this can be early PD, so it might be a good idea to consult a urologist.  MG

11/18/2012 - 21:51
lump in muscle of penis that comes and goes.

have a question.may girlfriend and i discovered a lump suddenly in the muscle of my penis after went away and continue`s to do so,she call`s the damn thing a love bump though i`m scared to death!!!it hasn`t gotten any larger and goes away after sex.totally disappears. but the longer we have sex the longer it`s seem`s to pain and no discomfort and it comes out slowly.if it`s a short session like 20 min`s or so,it`s practically non exsistant,just,small,like pin needle head.anything over 35 min,it is pronounced,like tear a tiny coner of a piece of paper and wadd it up,there you go.but no pain.i`ve been smashed a few times as i`m a former amature boxer an low blow are part of the business.i do have a few on either side few boxing but this is just under the tip on the underside.even when i have sex the other bump`s have became pronounced.seem to come and go and get bigger and smaller.this one just scared the hell out of me. any idea what it is?? r.m.

This doesn't sound like PD so much as a small clot in a vein (also called Mondor's syndrome) which can get more swollen with more activity. With the passage of time it will usually subside on its own.  MG

11/11/2012 - 15:26
Male age 72 symptoms first noticed two months ago.

Woke with an erection. First the erection is only about 1/2 to 3/4. Definite Curvature to the left. Probably 30 degrees. Examined penis shaft and could see an area of slight discoloration on the bottom and left along the shaft of the organ. Also the erection almost feels as though it is broken at the base. No pain, probably because of lack of full erection. Not having sex so no big deal in the scheme of things. But I am still a man and not having the ablilty to stand up and salute is a real downer. Might Viagra help?

If there are no palpable firm areas or nodules and no pain, it is quite possible that with a more full and rigid erection  the bending will be less.  Viagra would definitely help to sort this out.  MG 

11/11/2012 - 15:29
serious question about penis.

Hi......I am in my late 40's and in the last year or so my penis went from pretty striaght (when erected) to kind of a bend, not painful but it does have a bend, and having intercourse is not a problem, no pain at all, penetrates fine, I also have noticed that from the base to the middle of my penis there are maybe 4 or 5 rows of lines going around my penis....I know this is quite detailed, but I need some help and direction for this

I would not attach any significance to the lines, but the fact that you have developed a bend could mean you have PD - even without pain or problems with intercourse.  It might be a good idea to be evaluated by a urologist. MG

11/11/2012 - 15:37
Lump in penis

About 2-3 months ago I noticed a thickened lump near the base of my penis (pea sized). It seems to be oriented more on the bottom side. My penis has always had a downward curve (sort of like a arch). It is not very pronounced but is noticeable in profile. Even when erect, it is not difficult to bend my penis downward. I have no memory of any trauma and I do not have any pain (nor have I ever had pain). I'm writing because it appears that the bend in my penis now appears to be more pronounced and it seems to be more in the area where I have the lump. I'd estimate that my bend overall is in the 40-45 degree range. I don't notice any shortening but I haven't really measured to tell. Intercourse is not really a problem and there is no pain. I'm taking Vitamin E and waiting it out but I don't want it to get any worse. I'm 48 yrs old. I also take beta blockers occasionally for public speaking anxiety have used them for many years (sometimes a few times a week, sometimes not for weeks: 10 mg usually). I've heard this can be related to PD. Should I stop taking beta blockers altogether? Does this sound like PD and should I see my urologist to be evaluated? The only other thing I notice is that I don't really ejaculate like I used to. At best I get a small dribble of semen and sometimes I need to "milk" it out. Maybe this is just a function of getting older but I wonder if it's related? I also take propecia. Thanks for this great resource.

Having a slight amount of pre existing (congenital) bend is not usually a problem, but it does expose the concave side of the curve (in your case, the underside) to increased mechanical stress during sex.  This increases the chance of PD ocurring there, which would be accompanied by a firm bump and increased bending.  There is some evidence that beta blockers can also contribute to PD, so I would definitely discontinue using them. Propecia can reduce the volume of ejaculate.  MG

11/11/2012 - 15:31
Feels as if there is a knot inside my penis

I am 17 and about 2 weeks ago i felt a small little knot under the skin in my penis. I do not know what this but it might be serious so i was wonder what it might be and what i can do about it.

At your age it is probably nothing but if it doesn't go away in a month or so, you should have someone check it.  MG

11/11/2012 - 15:43
Young with Peyronies

I am 19 and about 8 months ago I first started noticing a curve to the left in my erect penis. This wasn't anything new except that I thought it was slightly more prominent than what I've always had. After palpating my penis, I found a very small, hard nodule down near the base on the left. I was starting to get pain during erections and as the months went on the curve started to increase to about 30-40degrees but no more, however with a palpable indent (small but it can be felt). The nodule has grown larger and I think has spread slightly further. I have had no traumatic injury to my penis that I know of, nor have I been rough during masturbation. I have not been in a sexual relationship. After fairly extensive research I am aware that I have Peyronies disease however my question is how much worse will it get over time? Will it ever plateau and not get worse or will it continue until there is a severe bend (e.g 90 degrees)? Also, how much curve can a woman's vagina take before there is pain?

Peyronies disease is more likely to improve in response to treament, or just to the passage of time in your age group - I would not expect this to progress significantly.  It is rare to hear of any partner's complaint when the bend is less than 45 degrees.  MG 

11/11/2012 - 15:46
Seeking Enlightenment

Two years ago I was diagnosed by my GP with PD. Confirmed by a recommended urologist who proceeded to precribe a drug that wasn't manafactured anymore and told me that the FDA was on the verge of approving a drug that was highly succesful in clinical trials (name escapes me). The next urologist I attempted to see wanted 6 pictures and $200 before they would even make an appointment. The cash advance was because only surgery or injections were the only cure available, didn't make the appointment. My condition is more "Empire State Building" bigger on the base, smaller about half way up, than bent. No pain associated with or without erection. I just don't feel like making another appointment to have someone tell me what I already know. Is there anything on the FDA front or anything worth while happening out there?

Yes there is a promising drug (called Xiaflex) for Peyronies disease that was submitted to the FDA on November 7, 2012.  It is possible it could be approved for use within about 6 months.  MG

11/11/2012 - 15:51
Very soft penis multiple pop sounds heard over the years during intercourse.

Hello, I'm 36 years old. First time I had hurt my penis was with aggressive intercourse penis came out and missed I heard a loud pop sound and penis went soft immediately. I couldn't get a erection for 3 weeks or so eventually it was hard enough to have intercourse again. Never was able to get a hard erection again maybe 80% at best. As time went on pretty much same thing occurred again. This time it popped and went soft immediately, and same thing took weeks to get and erection and now I found that any other position then her being on top of me would cause my penis to go soft. So we just used that position for some time. I would notice now that at the base of my penis at or just below scrotum I could feel my penis shift to one side when I would insert my now 80% hard penis if I'm lucky into my wife almost like it broke at that point. Time went on we made that work for a long while and then one night my penis wasn't very hard and seemed to go soft inside her and it came out and sure enough it pop'd again. Felt more pain then normal this time. After awhile I was able to have intercourse with wife on top and now I seem to go soft over time like it drains on me and need to stay at maximum arousal to keep penis hard. I'm really worried now even when masturbating I can't keep him hard unless maximum arousal. If I get a hard on and stand up it goes soft in 10 seconds. Now when I read forums etc it seems that when you damage your penis you need immediate medical attention. I was too scared to seek medical advice and was ok hiding problem as long as it was still semi functioning. What do you think is the problems I'm now facing and is it too late to do anything or what are my options Dr. Thanks in advance!

It sounds like you may have developed venous leakage secondary to the scarring caused by the traumatic episodes you recounted.  Usually this responds quite well to phospodiesterase inhibitors (Cialis, Viagra, Levitra), so I would reccommend you see a urologist experienced in male sexual dysfunction who can do a penile duplex doppler utrasound and prescribe any indicated medications.  MG

11/11/2012 - 15:54
is viagra helpful as part of the treatment? (blood-flow), etc

dear dr.gelbard - i have peyronies for 4 months now (i am 55) for the last 2 months, i am taking vitamin e, argenine l and pentoxifylline i also do the stretching daily - i have a few questions please: when is the final (or worst) shape of my "new" penis reached? is it helpful to take viagra, as part of the treatment? ( for more blood flow) for how long, do i have to take all the medications and for how long do i have to do the stretching? in the last two months, it has not gotten much worse, but definitely not better. (terrible erections, much smaller penis and harder to ejaculate, when masturbating) i almost lost my entire sex drive thank you SO very much for your kind replies, it is much easier talking to you, then my intimidating and super-busy urologist.

It usually takes a while for Peyronies to stabilize - up to 18 months in some cases.  Most physicians like their patients to take the medications and use stretching for about 12 months.  Erection medications can definitely help, with most urologists using low dose (5mg) cialis that is taken on a daily basis.  MG

11/11/2012 - 15:55
Iam worried

Hi Ian 17 years. My penis has hourglass shape when semi erected but get normal when fully erected. This has happened 2 weeks ago and still . Is there anything wrong , should I worry. Pls rrply

No to both of your questions.  MG

11/11/2012 - 16:12
Is this a penis fracture or PD ?

A few years ago I was having sex with my girlfriend..she was on top and leaned back and I heard aa audible popping sound...there was no pain or problem continuining having sex at the time...but I have noticed a dull pain on left side from time to time but no pain while I have an erection...or during or after sex..there are no noticable nodules but there is a definite curvature to the left that has developed..I have always had a curvature up towards the navel...but since this incedent I have noticed a definite curve to the left..more so when flaccid then when erect...I wanted to know if this could be either PD or a fracture ??? I would really appreciate your opinion.

Since the episode did not cause you to loose the erection or have to stop having sex at the time, and was not followed by a lot of swelling and bruising, I don't think you had a fracture. If the direction of curvature has changed but is more severe when flaccid and the foregoing happened a few years ago, it is probable that you developed a mild case of PD that is probably stable at this point.  MG

11/01/2012 - 13:42
Pain in penis

Hi I'm 46 yrs old and about 3 myths ago woke up with the most painful erection any way it seems now to have two lumps in the shaft of my penis I've been the docs and am awaiting a hos appointment but the question is I'm waking up 2 or 3 times a night with really bad pain in my erect penis clothing to do with sex but when I get a hard on the pain in unbearable any help would be appreciated no bends at all from my penis just two lumps and a hell of a lot of pain

The combination of bumps and pain sounds a lot like Peyronies, even if there is no bending.  Fortunately the inflammatory phase that goes along with this type of pain is usually self limited.  In the meantime, I would suggest taking 2 alleve (probably with some food) prior to bedtime.  MG

11/01/2012 - 13:44

I'm 18 and noticed that my penis was slightly less thick on the right side than the left. I googled some stuff and tried some methods similar to jelqing on one side. I was obviously a bit too rough with it because i noticed two little (less than a tic tac) nodules in the core of it about two weeks ago. They're not rock hard. I never noticeably hurt myself and my erections are as they were before the injury, with no pain. The nodules did cause my semi-erect penis to curve though. I've seen a doctor and a urologist and they dont think i have peyronies. One of their suggestions was that it could be hardened blood and that this will be re-absorbed. I just want some hope that this could actually be the cause of the nodules. Is it possible that they are only hardened blood and that they will go away with time?

Yes that is quite possible.  The compression during "Jelqing" may traumatize blood vessels and cause small clots - which would be expected to resolve over a month or two.  MG

11/01/2012 - 13:47
bent during sleep

about 7 months ago i was very aroused and decided on not having intercourse but to rather go to sleep on a futon. During the night my penis was erect during my entire sleep. as i was moving constantly trying to adjust. Once i finally got to a position that was comfortable i feel into deep sleep. i could feel my penis on a space at the edge of a support bar on the futon. i woke up the next morning and where i had been laying on my erect penis was very painful flaccid and more intense during erections. my penis was always very rigid during intercourse before the injury. i did not go see a doctor and the pain subsided in 4 -5 days. Now i feel as if my penis hasn't been as rigid since the incident where the pain occurred and my penis dosnt reach its s maximum potential. also there is a very noticable bend on the spot at which the beam was contacting. i am scared that i cause harm to myself that is there anything i can do to increase blood flow to my possibly damaged veins?

Low dose aspirin may help, and l-argenine (which is used for Peyronies disease) may be of benefit.  MG

11/01/2012 - 13:48

I am a Married man lately, I notice that my penis is not active enough during sex, it seem somehow reluctant, what mighty be the problem. thanks

Many possibilities here - you should see a urologist with an interest in treating ED.  MG

11/01/2012 - 13:50

Dear Dr. Today i visited urologist for treatment of ED. he performed penile doppler by injecting papavarine in the right shaft of penis. the flow was 26cm/sec. after some time(45-50 min) there was swelling/bulge and pain at the spot of injection. can this lead to PD in future. regards

No, a single injection followed by local bruising / swelling (hematoma) should not lead to PD.  There is commonly a bit of local reaction for a while after one of these injections.  MG

11/01/2012 - 13:53

Good Morning; Can pentoxifylline useful in the treatment of Peyronie Disease. Can Sidenafil/Tadalafil can be used for erection if a person is having PD.

Pentoxyfilline is commonly used in the treatment of Peyronies.  There is no good placebo-controlled data on its effectiveness.  Sildenafil or Tadalafil can both safely be used by patients with PD.  MG

11/01/2012 - 13:58

Hi, I've had Peyronie's disease for several years now, and although there is moderate curvature, my main concern is thick plaque buildup on the left side of my penis that is very noticable when both erect and non-erect. I recently purchased Serracor-NK in hopes of at least reducing this thickness of the plaque and I was wondering if you had any other tips on ways to reduce the plaque. Also, Serracor-NK is not FDA regualted so if you have any knowledge of it being unsafe, I would really like to now. They recommend at least three pills a day. Thanks.

This is a proprietary mix of a variety of enzymes. As it is considered a nutritional supplement, it is not FDA regulated.  The manufacturer does not publish any data on its results or side effects - probably because this work has never been done to the standards of a peer-reviewed journal.  All I can say is I do not know it to be unsafe. MG

10/21/2012 - 21:16
progression or not?

Hi, I’ve got a curvature to the left with nodule on the same side in about the top 1/3 of the shaft. I seen an urologist about this nodule about 7-8 years ago and he said not to bother with it and an operation was not necessary. Since that time the degree of bend has slightly worsened though the nodule is the same size. And I actually measured the curvature it and I think its around 7 degrees. There is pain with an erection and it lasts sometime afterwards but it’s only mild. What do you think, should I seek further treatment or is it OK as is.

In the most recent clinical trial of Xiaflex for Peyronies disease, the protocol called for stopping further injections when the bend fell below 15 degrees. This was based on the consensus among investigators that up to 10 - 15 degrees of curvature with an erection is normal. So on that precedent, I would leave it alone if if is working OK.  MG

10/21/2012 - 21:25
Thanks and self diagnosis, history

I am 55 years old. I am glad to have found More information here than in a number of longer books I've looked through that seems to confirm my own suspicions that I probably have Peyronies, both congenital and probably exacerbated by injury during coitus. I always remember a slight bend to the left and perpendicular to upright posture. It has always been inflexible and extremely rigid, painfully so, but have gotten used to that. I am of the opinion that my penis is too long for the comfort of a number of my past partners who have complained that it hits them in their ovaries. Also in regard to its downward rigidity, my penis uncomfortably presses downward in their vagina, which doesn't feel good to them during face-to-face coitus. I think that perhaps during circumcision, too much tissue may have been removed on the left side (from my perspective, as I would look downward). It is resistant to upward and downward movement or flexibility when hard, but flexibility in upward direction has improved. Downward from perpendicular position has remained about the same. During intense coitus with a few heavy-set girlfriends (more than 30 years ago), while they were each straddling my waist, me on my back, I noticed with great pain a few times, my penis literally bending in half or in thirds under pressure of a missed stroke or partially inside their vaginas. In the latter instances, my rigid penis would have been forced into an “S” shape. On the concave side of the curve, looking down at my penis, which is more bent than the parenthesis here > ) , as I would be looking down on it, when it is from tumescent to turgid, there is an extremely taught cord-like structure that runs along the slight left side of the top base of the penis, to the slightly lower left topside behind the head of the penis. The cord is equal in thickness and hardness the entire length. Suspensory ligament injury/displacement? I am very embarrassed about this curvature, which has slowly but steadily gotten worse over the years. The injuries I discussed above happened a little over thirty years ago. Very intense pain occurs during ejaculation. This seems to be getting worse. The pressure inside my penis seems to be excessive to me. I wouldn't mind if it was a tad shorter and a tad softer on a regular basis during sexual activity. I think the pains regarding my penis have not reduced, or rather I have become desensitized over time. I don't remember what ejaculation feels like with out the sharp, intense pain. How much pain is there supposed to be during ejaculation? Perhaps some of this pain, which is in the muscular and skin areas of my penis, maybe in end of urethra, too, has little to do with Peyronies. Some type of neuralgia? Thanks c

That type of coital trauma you described with partner-on-top is fairly common, and can lead to PD. It sounds like you had some congenital downward curve to begin with, which makes sense.  It is easier to miss a stroke or bend the penis during sex if it is curved, and in addition downward congenital curvature can be caused by overgrowth of the corpora cavernosa in relation to the urethra - the net result (besides curvature) being a longer penis. Ejaculation is supposed to feel intense, but not painful.  If Xiaflex gets approved by the FDA, injection of this collagen-dissolving enzyme into the cord you describe may improve things considerably.  MG

10/21/2012 - 21:27

Now; I am experiencing rather unusual condition. when my penis is erect it seems that one side of the chamber is bulged (more inflated) and the other side is straight. after some time of erection the penis starts to bend to one side and then the erection is gone. the glans penis also looks small than used to be. When in flaccid stage; the penis is soft and no palpable node is identified. Sometimes in the flaccid stage the penis retracts towards the the pubic hair and feels hard. This started after i had rather rough masturbation. Does this indicate peyronie disease.

Not neccessarily - it may be responding to the temporary inflammation following trauma, which does not always lead to PD.  MG

10/21/2012 - 21:30

In a previous post you commented that I might have a slowly resolving trauma. Semi erect I have dented in on left side and a tiny bit on right when penis is filling up.. it never goes up straight like it used to but with some stimulation it gets perfectly straight and this are fills out normal.. maybe if you look very closely its a tad narrower. Never had nodules.. checked by 3 urologists they said I dont have a problem.. sometimes I still feel tenderness and a dull ache there after sexual activity just in that area.. can this still be resolving I dont understand, it has been the same for 24 months now! I thought with peyronies its increasinly curved the harder you get and I have the opposite.. really its hard when flaccid and thats the easiest time to see the slight band. No shortening or bend just narrower when flaccid. Its driving me crazy and please give me your opinion DR. Thank you

You are correct, with PD the harder the erection, the more noticeable the curve. After 24 months you may have developed some limited scarring in the erectile tissue that makes the penis slightly firm when flaccid, but I don't think you have PD.  MG

10/21/2012 - 21:33
erections and anxiety

I was wondering can depression and performance anxiety decrease the strength and rigidity of an erection?.

Yes.  Depression can have a negative effect on libido and sexual perfomance, and one of the primary effects of anxiety is that it can cause release of catecholamines which constrict blood vessels - not good for erections.  MG

10/21/2012 - 21:35
Progression of the disease query

Hey, i'm 23 and have Peyronie's disease. I believe I got it when I was having sex with my partner at the time. From memory I never noticed anything though. I do remember first noticing it though. I went to bed at my house and woke up and had a pain in my erection with the node noticeable in the morning. I just thought I injured it and it'd go away and at no point associated it with sex. I honestly thought it was because I slept with my jocks on a it was injured during the night. I never thought it was a a disease. I had no problems with my erections apart from the pain, which subsided after about a month I think. Everything was fine for a while... Anyway that was quite a long time ago, about 4-6 months if not longer. Just recently I noticed my erections weren't as hard as they had used to be. I literally just started dating a new girl that week so I thought it was psychological as we spent a while having sex to no avail as I could never maintain an erection but could by myself. I asked the doctor for Viagra so I could remove my brain from the equation and not have to think about the stress of having sex with this new girl for the first time and it was perfect. My penis was completely normal and back to what it used to be, rigidity and all. But still without the viagra it just doesn't feel 100% but I can't help but wonder when even by myself the stress of getting an erection is killing it. But even morning erections don't feel the same so I can only assume it's not. I was curious as to is this permanent? Will it get worse? Is there anything I can do to slow it down if so? I'm visiting a urologist in December but the wait is killing me.

Inflammation in the wall of the erection chambers (corpora cavernosa) may reduce the closure of veins that normally trap blood and contribute to hard erections.  Inflammation may last for months after an injury, but it is not permanent.  In the absence of palpable nodules, pain with erection, and curvature, there well may be no PD present.  MG

10/16/2012 - 22:00

Hi, I'm 17 years old and my penis has an extreme bend upward, there is no pain, but because my penis is so stiff there is no way to bend it straight outward. It has been this way forever and I worry that I won't be able to perform intercourse because of it, as well as the possible embarrassment. There are no lumps and on occasion some erections are straighter then others, is it possible to straighten my penis without seeing a doctor? Also, if I attempt to curve my penis manually could this be harmful to my health? I have been considering making a contraption to hold my penis straight out during my sleep because I sometimes wonder if the origin of my bend came from the fact that for the longest time I slept on my stomach causing my penis to go upward and run against my lower stomach.

Don't build the contraption, it might end up hurting you.  Normally an up-pointing erection that cannot be forced down when really hard will not interfere with intercourse.  Sometimes, the suspensory ligament that connects the top of the penis to the pubic bone may tether the penis and make intercourse uncomfortable, but this is unusual. MG

10/16/2012 - 22:08
does this sound like peyronies?

Okay so my 49 year old husband just found this name last night that seems to describe a lot of symptoms he's been having. The number one concern he has is what he describes as a big thick "knot" of some sort inside the very base of his penis that is very painful - especially after sex, but even when not having sex. This has been there for the last several months. (He drinks a lot of Pepsi and at first thought maybe it was from that, like women get knots in their breasts from caffeine. He hasn't had a Pepsi for almost 2 weeks and said he noticed that he can now push his urine out harder than he has been able to in awhile so maybe that could still be a contributing factor.) Both he and I have commented over the last month or two that his penis seems to be smaller both in length and girth, but it was fairly large to begin with so we thought maybe it was our imagination. He doesn't have erectile dysfunction, but he says it takes more to get hard than it used to. Just thought it was age before but now wondering if it's related. I haven't noticed a curvature but he says that he is noticing that it is "trying to" start curving (again this is all only a few months old) we're not into doctors practicing on something that they don't have a cure for, but would prefer to get started on a natural remedy if this indeed sounds like what he may have. I don't see as much about the painful internal "knot" listed on the peyronies sites so thought I would ask more about that. thank you!

That painful internal knot does sound a lot like early Peyronies. The pain will eventually go away, but in most cases the knot will coalesce into an area of scarring that can cause shortening, indenting, and or curvature of the penis. At this time taking L-argenine and low dose vitamin E may stabilize the process.  Check this site for updates on the new medicationn (Xiaflex) that will soon be submitted to the FDA - it may not offer "cure" but if it becomes the first medication approved by the FDA for the treatment of PD it would be worth considering.  MG

10/16/2012 - 22:15
peyronies and class IV treatment with klaser

Doc...34 6'1 185lb male taking pexeva 20mg q.d. and adderall 20mg b.i.d (2nd dose as needed). I have noticed a decline in erections, probably due to stress and adderall. 3-4 months ago I noticed some bend in the shaft of my penis about 1inch below the glans. I definitely have engaged in rough masturbation with a strong firm grip. I noticed that depending on my grip or frequency of masturbation, the bend would become more pronounced. I estimate the bend to be 25% to 30%. I have noticed and indentation on the left side of the shaft and glans appears smaller during erections. I can feel what I would describe as scar tissue in the area of the bend. My questions are: 1. It is 1.5 months until appt with urologist. Should I be doing something in the meantime. 2. Have there been any real medical studies of the use of traction 3. I have access to a klaser and have utilized it to treat various injuries. my wife (physician) feels it cant hurt and could possibly assist in healing. 4. is there hope for reversal, or is stopping progression the best result to be expected. Already self-consious about penis size (around 6 inches) and might lose my mind if it gets shorter. any thoughts would be tremendously helpful.

There are a few studies on the use of traction devices in PD, but their scope and conclusions are limited.  If the device can be worn for 2 hours per day or more, it may improve curvature and prevent shortening.  Many urologists are employing stretching devices in the early treatment of PD. I am not familiar with data on the use of K laser for PD.  MG

10/11/2012 - 13:38

Can you eloborate on its use? Topical? I have just been diagnosed. I have about 45 degrees of bend to the left. I am looking to do the right things for twelve months before assessing any further treatment than an anti inflamatory and maybe vitamin E

Vitamin E in doses higher than 400 IU may have deleterious effect on heart / blood pressure.  Topical vit E should be OK.  Both of these remedies will at most help to stabilize the situation, not reverse curvature.  MG

10/11/2012 - 13:40

Hi Dr, I am 31 years old,circumcised, pretty healthy guy.I have pain on head part of my penis(about 1cm below the hole),around top of glans,for 1 year. About 10 months ago,when I had sex with my girlfriend(she was on top),my penis came off and hurt a bit.Next night after that, I could do sex,but it was uncomfortable and I couldn't be on top since then. I thought it may go a way but it didn't. I went to a doctor who refereed me to blood test work outs which every thing(STD,HIV,,...), seemed fine.She refereed me to an urologist who said to me after examination, he has no answer to me .He examined my penis flaccid and didn't discover any abnormalities . He also did Cystoscopy to check my bladder and said looks normal and cited having Peyronie disease chance is not or may be.He cited, I should seeing a sex consultant .My problem is I feel discomfort when I have sex especially when my girlfriend is on top(extremely pain).I feel dry and rigid(too hard)on my penis,when I have sex(I used lubrication.It didn't help). I don't seem to have erection issue,but my sex drive has been increased.I think, I had the feeling of my penis being too hard,and stiff before the sex trauma incident which I cited earlier.When my penis is hard, If I pressed against it from head, it hurts. My penis doesn't have an angle.My girlfriend and I both agree that my penis got a bit shorter and skinner.I take multivitamin daily,smoked cigarettes occasionally,weed 3 or4 times monthly.When I smoked weed ,head part of it is more sensitive.I use minoxidle5% for my hair about 7 months. And I have lost about 5 kilos during a year.Please let me know if my discomfort is PD?. and Thank you kindly.You are my last resort.

If you did develop a mild form of PD, the fact that you have no bending after 10 months is a very favorable sign.  the discomfort will resolve eventually - in the usual case of PD pain takes 6 - 18 months to clear up.  MG

10/11/2012 - 13:44

I am 48 years old and am working with my urologist using three ideas for treatment of my PD. every two weeks I go in for direct injections, many of them right into the scar tissue. He has me taking CoQ10 as a supplement and using a manual vacuum pump 2x daily off ten minutes and especially after the injections. I believe he is using the Verpamil. I have an upright curvature near the head of the Penni's and I have noticed shortening a bit but right now there is not any pain and I am able to still have intercourse and no pain after orgasm. Tomorrow is my 6th injection in a series of 12. How does this sound to you and will I get the normal length of my penis back which was about 6 1/2 inches. Thank you for monitoring this site. My urologist also told me that the recent explosion in this arena he feels has to do with the craze of glucosamine/condroiton supplements that hit the market to help us aging guys with joint pain. I have not seen this mentioned in any of the sites I have been reading so I thought it may be helpful to get it out there. Makes sense to me and I was taking that before I noticed the change in my penis. I remember falling on my cross bar in earlier years and really hurting my penis. That is the only thing I can recall. Cheers!

The treatments you are receiving are very much in line with the state of the art at present, so I think you should continue under your Dr's care.  Keep an eye out for Xiaflex, which if approved will add a very effective new option.  I have seen a number of men who developed PD after glucosamine / chondroitin supplements, so I would tend to agree with your doctor. MG

10/11/2012 - 13:46
Early symptoms of peyronies

I had a double hernia operation (laproscopic - I think that is the term) and had to also have a naval hernia (convential) as the finale... Things seemed fairly ok - except for the catheter that I was not informed was needed- and no sex followed for the next month... When the penile bruising went away, Mr Wiggly was again ready. Seemed ok. Within the next month, things felt different - like I had someone else's penis (I know - wierd). Shortly thereafter I noticed a slight curvature to my penis. Back towards my navel. NOTE: after the hernia surgery I think my penis stuck out further and seemed longer - but different. Definitely seeme longer. Now the curvature is more severe - approaching 30 to 40 degrees.. No pain. Still seems larger - or at least no size reduction - but sensation is different and the curvature is continuing to increase. I have ordered a ton of L Arginine and Vitamin E as it seems safe. I sense/feel a 'rigid' flat surface inside the flacid penis. I have made a call to my GP (I am 58 and rather good health). Prefer no surgery & think I am in early symptoms. Suggestions??? Would like suggestions as souther Indiana is limited for health attention...

PD occais develops after pelvic surgery and/or catheters. I think the supplements you are starting are OK but see the above on high dose vit E - to be avoided.  Look at the doctor locator under links on this site in the peyronies association site, regarding specialists in your area.  MG

10/11/2012 - 13:47


No, I have not heard of this association.  MG

10/11/2012 - 13:48
Trying new TX for Peyronies

I'm 53, was diagnosed with Peyronies a couple of years ago. The plaque postage stamp sized growth in my penis over this time has moved from distal toward my body, making the curviture more difficult for sex, and I have also lost some of the "strength" of the erection. I was put on 800 mg of Vitamin E when first diagnosed (don't know if this is helping), but yesterday my doctor put me on a month trial of Pentoxifyll, 400 mg x's 3 per day. Anyone out there trying this? I will keep you updated if there is any changes, good or bad.

The pentoxyfilline is OK, but I would reccommend keeping the vit E dose at 400.  MG

10/11/2012 - 13:50
hurt my penis

ok so i am 18 years old and i was having agressive sex and i missed then hole and bent my dick. I it hurt and i lost my erection. then i was fine and kept having sex again. when i got home i iced my balls for 20 mineuts, and now i have noticed that my balls are extreemly big and it hurts to touch or to shake...please help i am freaking out

You probably had a minor fracture, with blood accumulating in the scrotum. At your age this will probably heal ok but you should avoid sex for a couple of weeks and if the swelling doesn't come down by then see a urologist.  MG

10/11/2012 - 13:51
Pyeronie Disease

Thanks for starting such an forum. i had previously sent a query. my penis remains near the pubic hair and the shaft feels hard (same on both side). Cannot get erection as earlier used to get. when fully erect there is no sign of angulation or curve; but when going limp the penis always bends towards right and that side feels hard. i don't know i am able to explain my condition properly or not. i am very depressed at not getting erection. kindly advise on the curve of penis towards right. this started only after i masturbated while pressing my penis towards bed in sleeping position.

this doesn't really sound like PD, but you should see a urologist about your erectile problem.  MG

10/07/2012 - 20:14

I am 43 years old and literally just noticed about one month ago that my previously very straight 6/7ish penis had a horrible upward curve. it also feels less erect and look smaller. the other disturbing issue is the base of the penis almost (when erect feels disjointed from the above parts, it is like i can actualy wiggle it around) it it looks really odd and i do not recognise this as my penis. i have not had sex for a while (really have not been feeling horny at all, this was a total surprise, any advice?) thanks andrew

It certainly sounds like PD, which in many cases seems to appear without any preceeding trauma or other identifiable causes.  At this point it would be a good idea to start on a nutritional supplement such as l-argenine and consult a knowlegeable urologist. Most authorities agree that if medication therapy is going to be effective in PD, the earlier it  is started the better.  MG

10/06/2012 - 11:41
measuringment angle

When measuring lying down my erection seems shorter than when standing up. Why is this?

I don't know if you are talking about angle or length, but if you are interested in tracking progress or response to treatment just make sure you use the same approach each time.  MG

10/06/2012 - 10:26
acute phase

Can the acute phase continually reoccur over the years?.

I have seen the occaisional rare case where PD appears in a different site, years after the original site has developed then stabilized, with its own new acute phase in a new location but this is very unusual.  MG

10/05/2012 - 16:11
Effectiveness of Inexpensive Vacuum Therapy to Correct Curvature

I have read several cases about vacuum therapy helping to correct curvature and it makes sense from a physical point of view - The suction stretches the tissue like an elastic and straightens it out simply due to the force of vacuum - I get that,but I'd like to know some opinions on the lasting effects of more basic vacuum pump models. I have read a change between 2-25 degree difference. Now part of my question is regarding the exact pump, some of these on medical websites are awfully expensive and being an older man I cannot afford such luxuries just to correct a curved penis. I came across this supply store as I was researching related issues online and talked to the customer service rep, they said it should work but they are not medical professionals so they referred me back to my doctor. I understand they cannot give medical advice for legality reasons, most supply stores act the same way now-a-days. Tell me any professionals out there, what is your opinion on a manual vacuum device? Am I wasting money or will it work? Thanks in advance. Jean T

Physical stretching is being increasingly used in the management of PD - either via vacuum device or traction device.  There is some evidence that if these are used regularly they can reduce angulation. If the investment is not too great for you, it would probably be worth a try.  Evidence suggests a traction or stretching device needs to be used about 2 hours per day to be effective.  Vacuum pumps on the other hand can only be used for about 5 -10 minutesa at a time. MG

10/05/2012 - 16:06
Downward curve

Hello, I'm 30, I have MAYBE a 10 degree downward curve when erect. Is this normal? Common? Should I be concerned. My erections are painful.

Ten degrees of curvature is generally regarded as normal.  If however this causes pain during sex, a corrective procedure (nesbit plication) may be a consideration.  MG

10/05/2012 - 16:04
cialis use - aggravation?

I am a 57 year old who recently (6 months ago) asked for and received an Rx of Cialis (20mg)to assist in sustaining an erection during intercourse. The side effects of the 20mg were evident (headache, stuffiness, vision disturbances) so I initially discontinued. I then used a pill splitter to lessen the dose to 10mg and and side effects diminished. However, around this time I developed the first symptoms of possible Peyronies Disease (slight indentation on left side, with slight pain associated at the bend site). My question is, "any association between cialis and PD?" The website references PD as one of the conditions to be considered prior to taking cialis but beyond that there isn't any mention. In fact, that is what brought me to your website today. Thank you in advance for your advise. I will start on vitamin E and L-arganine today

I know of no association between the use of any of the phospodiesterase inhibitors (viagra, cialis, or levitra) and PD.  The product literature includes a caution regarding PD, the reason being that a study involving a specific group of PD patients was not included in the material submitted to the FDA for their approval. MG

10/03/2012 - 13:49
Prostritis and PD

Hello Dr. Thanks for the reply to the post(09/19/2012 - 17:39 ). I have few more queries - Presently i am taking homeopathic medicine and feeling somewhat fine; my concerns are - 1. I do not get erection if i want to masturbate. 2. After a certain time of erection my penis bends towards right (at that time my penis is semi-erect). 3. in standing position my flaccid penis always remains near the pubic hair and remains hard; while lying it goes soft with no sign of hardness or plaque. 4. When semi erect feel like my penis is experiencing pull towards right. Is it possible that PD manifests itself without occurrence of plaque.

Yes, in some cases scarring due to PD can only be felt as a tight cord that can be felt only when the flaccid penis is stretched. MG

10/02/2012 - 21:36
No erection

Several years ago, my husband had emergency surgery because he became ruptured and now he cannot get an erection at all. Is there any help for him?

Yes, if he had a rupture of the corpora he may respond to medications such as viagra, levitra, or cialis.  If not, implant surgery is capable of completely restoring function. MG

10/02/2012 - 21:31
Peyronies follow up

I posted about a year ago concerning the diagnosis of Peyronies I have been given. The symptoms fit perfectly. 40 – 45 degree upward bend when fully erect. I'm now 32 months into this condition and I'm constantly in pain. In fact the pain has got worse and I'm getting referred pain elsewhere. I have full dose of pain control medications. When it really wants to hurt no drug will prevent the pain. The dents on my penis (hour glassing) have pretty much cleared up and are not apparent when erect. My erections have got stronger and my penis bigger since having PD. No palpable plaque has been found in spite of five examinations. Two GP's not sure if it is PD, one Uro said definitely not, two (one of whom didn't examine me) said it is PD. Pain consultant says nerve damage present and thinks the nerves that control circulation may be effected. Here's the tricky bit that I don't get, I've had two times when I've got 90 percent better over night. I've woken with a completely straight full erection bigger than before this condition started but with a small dorsal dent. There has been lots of pain when erect and straight. After five days penis slowly returned to being bend when erect. This has happened twice. I have also been sure I've felt blockages tearing and clearing with a rush of blood in my penis. I can see visible bumps on the surface. My right testicle is often nearly black in colour presumably due to blood sitting there. Testicles often tender. Any idea why I should get better briefly then get worse again? Is there anything I can do to try to hold on to or encourage a lasting recovery. I'm unable to have sex as it puts pressure on the bend which huts me. Ejaculating leaves me in pain for 24 – 36 hours afterwards.

After 32 weeks I would consider graft surgery for disabling bend,  but with your recurring "90%" recovery episodes, that would be a bad idea. I am not sure why the severity of the bend changes to such a degree, other than perhaps there is variation in the fullness of erections. MG

10/02/2012 - 21:33
Peyronie's questionnaire

To all fellow sufferers. As there is little understanding of the cause/s of Peyronie's Disease I have been considering creating a questionnaire to be filled in by sufferers who wish to take part. The purpose of the questionnaire would be to see if there is a common link amongst sufferers which could point to a cause. Whilst certain types of medication may cause Peyronie's (Beta blockers), we have to remember that the disease has been around for a long time, before such medicines were available. This suggests that any link between Peyronie's causing medications and the disease itself must be a trigger for another process. We need to understand the process, so it is vital that we identify triggers. The questionnaire I propose to write would consist of a set of questions relating to such things as diet, smoking and drinking habits, exercise, sleep, medications etc. It would also include questions relating to the participant's PD, duration, type and degree of deformity, amount of pain etc and whether or not the sufferer was aware of an injury prior to the onset of PD. If enough people participate in this we might find clues as to the cause of the disease. This would be extremely useful as it would offer a starting point in the search for ways to halt or even cure the disease. I would be happy for an administrator of to take this up on my behalf as there will be a need for confidentiality and perhaps anonimity. Perhaps the site could produce an online form? I look forward to hearing people's views on this. Kindest regards MH

I like your idea but unfortunately there is no administrator of, only me! As it is I have some difficulty keeping up with forum posts due to all the crazy machine spam that comes in.  MG

10/02/2012 - 21:24
New to Peyronies? Or just another Episode?

Hello. I live in Australia and yesterday I was diagnosed with Peyronie's disease. I originally noted minor discomfort that did not interfere with sexual activity. A few days later I noticed a small lump in the inside of my penis, that felt like a small descent when I had an erection. The GP that initially examined me, said he would feel the lump and that the descent was caused by a tear in the corpora cavernosa. This sounded to me like partial penile fracture. But he suggested I could still have sex, but to take it easy. Anxious as I am, I ended up in an Emergency Department, hoping I would get to see an Urologist on the day. Lucky for me I saw a Consultant Urologist, who gave me the diagnosis. He suggested I visit in three months. Did not start me on anything. Said there is no clear evidence. At this stage, I don't really care about scientific evidence. He also said I could continue to have sex. The registrar actually said that some professionals are in favour of continuing to have erection as a means to improve blood circulation. Since I read on the net about this medical condition, I have bought Vitamin E 1000UI and have been using this twice a day. I have read through: Never having really payed much attention to the natural bend of my penis, I have now noticed a bend 3/4 down my penis well marked, but not profound (I think). This is higher then the lump that I felt around two weeks ago. So I am not sure if I have had previous episodes. I have never had any problems with sex. But in this last ten years being with my partner, there have been occasions when she has come down wrong and there has been some pain, though nothing big. Because I am a person that needs to do everything possible if and when I encounter a problem, I am looking at what I can do. I have not really felt strong pain when having an erection, but I am now sensitive, with some pain, when flaccid. I have no problems with erection, or ejaculation. I don’t have any problems passing urine. I can’t remember seeing bruising. I never noticed anything until I felt the strong erection and later the lump three/four weeks ago. Now… How do I keep my penis as healthy as possible? What can I do to prevent scaring? (Hence prevent bending) Of all the oral medication, what should I try? (Do I need a prescription for these options?) I am not really looking for "evidence based". I feel I don’t have time for this. If I am in the active phase, then now is the time to tackle any possible treatment (s) that might help prevent any further deterioration. Your advice is critically sought.

As we don't have any great evidence for effectiveness among oral medications, the best guideline is safety.  L-argenine has a good track record in this regard, and may interfere with scar proliferation.   Many urologist are employing stretching or traction devices to retard scarring and contracture. Other urologists reccommend an prescription medication called pentoxyfilline.  MG

10/02/2012 - 21:16
loss of penile length

When someone has Peyronie's Disease, how much length can they lose?. One of the urologists that I went to said you only could lose up to a couple of centimeters in length. However I have read in blogs that men can lose an inch or more.

Yes, length loss in some cases of PD can exceed an inch.  MG

10/02/2012 - 21:15
keeping an erection

When I was a kid I was racked real hard play fighting due to being backed against the wall and kneed it was not cool and I turned green and sweaty and had to drag myself to the bathroom and my penis temporarily turned black and blue but I never told my parents about it. Long story short Im pretty sure thats why its so hard for me to keep an erection and i have semi hard erections at that unless less ive been abstaining from sex for a couple of weeks and still have to use a ring, or take pills that you get at sex shops to achieve an erection in which stiff nights really work. I had read in a magazine article years ago on the mechanics of an erection and that what i have can be fixed through surgery but the mechanism that locks the penis off after it fills with blood is not locking down or shutting the flow off so Im constantly having to do a pelvic lunge to fill the penis and use a ring to keep it up. About six months ago I finally got circumcised which was a great improvement but still didnt fix it but is helping alot due to my penis was so sensitive before so it was hard to achieve an erection and then it was so sensitive that i would ejaculate too quickly so I never got the good sex life like many of my peers did and remained a virgin for a long time but now that im older and have insurance i can try to address but is there any hope to improve keeping an erection and is there a physical way to massage or manipulate the mechanisms that keep an erection? I do recommend to anyone out there to get circumcised I was alway self conscience due to everybody else being circumcised so no hitting the showers for me in gym class but im glad its done now and my wife is too. Gravity is my friend on keeping my erection as well but it would be nice if there was a fix.

It sounds like the trauma you experienced was a tear of the corpus cavernosum.  While this doesn't neccessarily pertain to Peyronies disease, I am running your post because the result of this injury sounds like venous leakage - a condition that is not uncommon among men with PD. It can make it very difficult to maintain an erection. MG

09/29/2012 - 19:58
Loss of sensation

I had the Nesbit Procedure for a 30 degree curvature inwards about five months ago. I can obtain an erection, though not at the previous rigidity. While there is some discomfort during sex, I have no sensation whatsoever. I am very worried that he damaged a nerve or that this is permanent. Is this normal or does it take some time to regain feeling in the penis? Also, my penis now has a bend about 10 or 15 degrees to the right, but the doctor who performed the surgery says it was just a slight over correction. I went to a reputable hospital for the procedure but I would like to know if over corrections are common or did the doctor fail me. I feel horrible that I went through this terrible procedure just to have a curve in a different direction.

After 5 months, there will probably not be much more change in the correction you have.  If it is bending opposite to the original direction, there may be some degree of over correction. Sensory loss can take cosiderably longer to recover, so there is definitely hope your sensation may improve. MG

09/29/2012 - 19:54
Could This Be a mild form of Peyronie's?

In my last post you told me that my inflammation comes from the mechanical stress put on my penis. This firmness has not gone away for three months. Is there any way to reduce this inflammation?. I was also wondering that because peyronie's starts with an area of unusual firmness that this could be the disease in the acute phase.

It is possible that this is early PD.  Although conventional medications and anti inflammatories don't usually change PD much, the best response is early on so it might be a good idea to see a urologist and be fully evaluated.  MG

09/29/2012 - 19:52

Im 18 never had problems getting hard. However within the last week it takes awhile for me to get comptletly hard. The other problem is bottom of my penis gets hard but at the middle it like pinches and it takes me a little bit to get fully hard to do anything. I also feel like its not as big. What is going on? Should i get it checked out?

If this is a change from your previous condition, it might be a good idea to get checked by a urologist.  MG

09/29/2012 - 19:51

My penis when flaccid feels firm and sometimes after I masterbate I get the sensation of a dull ache occasionally. I have examined my penis and i feel no such lump or nodule. I have gotten this inflammation for over a year. This has also caused some loss of erectile length. I want to know why and I also want to know if I should abstain from masterbation.

I'm not sure you need to do that.  At any rate, this does not sound like PD to me. MG

09/29/2012 - 19:49
Penis curvature

I'm a 71 year old man who has and still is sexually active...My problem is my penis has always been straight no curvature at all left or right up or down, about 6 weeks ago I was with a lady friend and got an erection but I was really amzed to see my penis was now curved at about a 45% angle as if it had been snapped in half and was stuck at that position, it was also a lot smaller than it usually is....Is this something to do with my age or a medical thing? I mean it looks ridiculous just like a fat hook Please can you tell me whats happened and if there is a remedy...

Yes it is a medical thing, but it does not go along with any other internal disorders or health risks.  That is why Peyronies Disease is not really a "disease".  Regarding medicine to help it straighten out, the most promising remedy appears to be Xiaflex.  This is an enzyme that partly dissolves the distorting scar tissue, and it is being submitted for FDA approval some time this fall.  MG

09/29/2012 - 19:46
Post Nesbit

I'm 23 yrs old and recently had my nesbit operation a 1 week ago for congenitile penile curvature - around 60 degrees during erections. While my erections seem to be come and go, i've noticed less sensitivity on the top half of my penis and my penis forehead is non extistent, even during an erection and looks crushed. Foreskin has firmly covered the top. Is this normal? and will by penis forehead come back in time? Kindly note that i have almost no pain and that i am not circumcized. Also can u suggest activities that will speed up the healing process?

If you had a nesbit procedure for downward bending, the nerves on top of the penis had to be mobilized to create the  tucks along the top.  This can create some sensory loss, which usually resolves after a few months.  I don't know of any way to speed up the healing process.  MG

09/24/2012 - 21:42
Single Trimix shot - Peyronies?

I am 36 years old and have a 30 degree bend to the left, which a urologist thought was a congenital curve. It feels weaker than the right side and have been taking Cialis for about 7 years with great results at 5 mg. I went to check out other ED options and the clinic I went to injected my right side (Stronger side) with a single trmix shot. They assured me it would not cause a scar, but I got a bruise for a couple days and have been freaking out because my right side seems weaker than before and does not stay firm even with Cialis now. It's been 6 days since the injection and the bruise went away in 3 days but my erections won't stand up on their own because both sides seem weak now. The right side also hangs differently now as it has straightened out my left curve somewhat when semi erect. Will this cause the dreaded hourglass peyronies condition and possibly complete ED since my erection won't stand up on it's own with Cialis anymore? I have been using a lot of Vitamin E oil. I have been worried sick about this. Thanks for any feedback.

A small hematoma (blood accumulation) in the wall of the right corpus cavernosa would temporarily restrict its expansion, which could cause diameter reduction and corresponding loss of rigidity on this side for a couple of weeks.  I think any permanent damage from a single trimix injection is extremely unlikely.  MG 

09/24/2012 - 14:56
lymphocele or PD?

Hello. I'm a 22 year old male and I've been having issues with a lump on my penis. About a year and a half ago, after I was nicked by someone's tooth during oral sex, I developed a small lump about a centimetre and a half under my glans, top side and slightly to the left that swells with my erection and subsides when I am flaccid. The lump itself is the issue, as I had an episode in the bath where I became erect and then naturally lost the erection, only to find after getting out that the lump was connected to a thick vein like structure travelling around and to the tip of my penis. While massaging this structure I felt a pop and the vein disappeared but the lump remained. I assumed that the lump was a lymphocele because of this. However, now i'm not so sure. When I feel the lump, it feels like there is a hard immobile lump that the vein comes from. The only way I can explain is is to show it like this ===() where = is the soft vein and () is the lump. It's changed very little over the year and a half, perhaps growing slightly, and while I experience some pain on the skin around that area it moves with my foreskin and isn't fixed. Most literature that i've read suggests that lymphoceles vanish with a few weeks. Do I have scarring involved or potential to develop PD, or should I not be worried?

This may be the residual of minor local trauma to a superficial vein.  I don't think it exposes you to any risk of PD.  MG

09/23/2012 - 18:00
Penis Has a Slight Hourglass Shape

HI Dr, I am 19 and have been sexually active for about a year and a half. My issue today is that my penis when flaccid, tends to show an hourglass shape , pretty much looking normal and healthy from the base to a little above the middle of the shaft, from the middle to the head, the penis is less wide (clearly) than the shaft. Pretty much i think it would hang lower if it wasnt all scrunched up. sometimes though it hangs normal, when im in the shower or whatever. some days its worse than others and ill have to pull the skin around the base downwards and use pressure as if to pee, for the rest of the penis to widen up again. When erect, there is a slight difference in width from bottom to top but i do notice that where it is scrunched up flaccid, it tends to not be as hard there when i am erect. Now, i have witnessed my penis functioning normally and blood flowed all the way through and my penis was around 7 1/2, but usually its around 6 1/2 or 7. im wondering what has caused this, if i should go to the doctor, and if there are any cures? I'm guessing it may be either from sleeping on my chest or when masturbating i may have squeezed to hard for too many times on the middle of the shaft and now its forming that way? hopefully not the case..but please help!

I don't think you have peyronies disease (fortunately) nor do I think there is anything wrong with your penis based on  what you have written.  MG

09/23/2012 - 18:08
is Pentoxifylline sufficient as a medicine in the beginning stages?

thank you so very much for taking the time to answer our questions, doctor! here is a follow-up question : i did see an urologist and i was right with my self- diagnosis of PD - he prescribed Pentoxifylline for my PD, i am not sure, whether this urologist is as experienced as you are - and since it is mentioned, that in the beginning phase of the disease there can be a lot of positive things done towards "healing"... (i am in the 2nd month of noticing the disease) and everywhere is mentioned, that Pentoxifylline is a very conservative approach - with other words, is my urologist playing it too safe? and therefore the results might be minimal too? thank you so very much again, for your kind reply in advance! i am 55 and somewhat devastated, since i am single...

pentoxyfilline is commonly used in the early stages of PD, so this seems like a reasonable approach.  You may wish to add an over the counter supplement called l-argenine, which is taken as a 1,000 mg capsule twice daily.  MG

09/19/2012 - 15:19
Penis is gradually shortening

Hello, I am quite young as I am only 18 and I believe this issue started when I was 12. My problem began with curvature on the underside of my penis and penile shortening. For several years it was difficult to gain an erection and I only could achieve one through masterbation. The problem around 2 years ago seemed to resolve as I was gaining strong erections. This lasted about a year until my penis became firm and gradually shortening by a couple centimeters. It seemed like it was going through an inflammation process. I can only theorize this problem arose from sleeping face down. This resulted in my penis bending down. This process lasted about 3 months until the firmness went away. This problem has come back every 5-6 months since then. I notice each time this problem occurs it shortens a 1 or 2 centimeters. My full erection 2 years ago was about 5 3/4. It is now about 5.5 or sometimes smaller depending on the day at full erection length. Last year I went to 2 different urologists who said I seemed to have no lumps or scar tissue, yet I know from evaluating my penis that I seem to have a mild case of peyronie's disease. Currently I seem to undergoing an inflammation process that hasn't really resolved much. It seems masterbation makes the firm area worse. I have no idea if the shortening can be reversed or if I should go see a urologist again. Peyronie's is not a well understood disease and from what I have read there is no effective treatment. I would appreciate it if you could give me some of your advice.

The downward bending noted at adolescence is not Peyronies, but congenital curvature.  In some young patients I have seen this associated with mild venous leakage, a condtion that can make maintaining a rigid erection for a prolonged time difficult. In addition, the downward bend makes the concave underside subject to more mechanical stress than the rest of the penis during sexual activity - which can result in episodes of inflammation. A nesbit procedure to straighten the congenital curvature may address some of these problems.  MG

09/19/2012 - 15:23
Purple Balls, purple shaft, pronounced bend, hard tissue around base

Please help! I am a 26 yr old, perfect health, no allergies, always had a 6 inch penis which bent a bit to the left. After some rough drunk sex, i assume my GF came down hard on my erect penis, missed the hole, and caused it to bend hard to the left. Symptoms: Blue/purple balls, shorter penis, more pronounced bend to the left, with an accumulation of hard tissue at the base. No pain while peeing, or when experiencing pleasure. Swelling has started to come down, but the bend is still very pronounced. Please help !

sounds like you had a mild penile fracture, which might require a surgical repair - if you had a lot of swelling and now severe bending.  You should see a urologist experienced in reconstructive surgery.  MG

09/18/2012 - 09:41
Don't know what it is

I am 29. Everything started about 3 months ago, during prolonged and aggressive sex, I bent my penis, it was a little bit painful and I lost erection, than within couple of minutes everything was fine again and continued to have sex. In about 24 hour I discovered small bruising on penis shaft, did not think about it much as it disappeared within 2 days. In about 3 weeks started noticing that my flaccid penis hangs to the left... within month or so I think it started curving a lot to the left when semi erect, when it's erect it is straight or maybe curved 5 degrees to the left, not sure. Also I noticed hard vain like pencil on my penile shaft that moves left and right and I have feeling as it is too short and it pulls my penis to the left side when flaccid. Not sure but after reading about dents, there might be small dent on the left side, don't know if it was there before. I don have pain during erection or when flaccid. I could not find any lumps also. Have not visited doctor yet, not sure what to do. Please help as it drives me crazy

It is not clear that this is PD - may be just slowly resolving trauma.  I would suggest supplements like l-argenine and vitamin E, then a checkup with a urologist if it does not resolve in a couple of months.  MG

09/18/2012 - 09:44
possible peyronies???

Hi Dr, a few months ago my partner began to complain of pain in his penis during intercourse, very soon after he noticed what he called a bend in his penis. Since this time I have noticed what I can only describe as a hard ring around the shaft of his penis. He has become less and less reluctant to have sex in the past few months and says it is getting more painful and really doesnt like me to mention it when all I want to do is help and understand. We have a really good relationship otherwise and I want to reassure him. He is only 47, in very good health and is quite fit but wont see a doctor about it. Could you tell me what the long term outcome may be with this condition.

If this is a mild case of PD, there will usually be some persistant bend or constriction over time.  For that reason, and since mild PD responds best to medical (non-surgical) treatment early on, it would be a good idea for him to see a urologist.  MG

09/19/2012 - 15:26
does viagra help?

i am 55 and i first thought, i have ED due to my age - but now i can see, that i have almost all the symptoms of PD, except a hard lump - i am single now and just met someone - worst timing possible! - how can i perform sexually with a shortened and softer and slightly curved penis, and the additional pain during the erection? (i do have a few hard bumps on the palm of my left hand for a few years now) would viagra restore the hardness and length? thank you for your answer in advance...

Viagra will probably restore the hardness and help you with sex, though it may not bring back the length. MG

09/19/2012 - 15:28
Peyronies, Dupuytren and Plantar Fibromatosis

First, thank you for this forum, it has been very interesting, but also has unfortunately confirmed in my mind that in addition to Peyronies Disease my husband also has Dupuytren Contracture as well as Plantar Fibromatosis. He has been seeing a urologist who basically has advised him there is not much that can be done for his Peyronies other than surgery. He is also seeing a podiatrist for his foot problem, but now with the problems with his hands I hate to have to see another doctor. By chance are you aware of a doctor in the Chicago area that may be able to handle all three conditions?

Although these problems are related, unfortunately one doctor will not be able to handle all of them.  For the Peyronies I would reccommend Dr. Laurence Levine who is with Rush medical college in Chicago.  MG

09/19/2012 - 17:35
Bloody Ejaculate/PD

Hi, I wrote you another e-mail yesterday regarding the progression of my Peyronie's, but I realized I have another question. Around the same time I developed PD (about 7 months ago) I began having bloody ejaculates. I have had a thorough work-up for the blood (MRI, cystoscopy, ultrasound, PSA, etc.) Nothing was found except that my prostate bleeds easily. My urologist believes that I have varicose veins around my prostate. I have had the bloody ejaculates unabated for the last seven months. I have been told that there is no connection to the Peyronie's but it all seems so odd. Do you think there's a connection? Can these bloody ejaculates worsen my PD? As of now, I have been told that my treatment options for the blood are either Proscar or a surgical cauterization, both of which run the risk of importence. My instinct is to just live with the blood for now. What are your thoughts?

I believe your doctor is correct; I know of no connection between bloody ejaculate and PD.  MG

09/19/2012 - 17:36
Peyronies calcification

I'm a 49 year old. Diagnosed w / peyronies. Had ultrasound and confirmed. Probrably 8 months, noticeably into my condition. My curve is more sideways to the right . Able to have erection, and orgasm. My Urologist said to wait, no treatment, till it runs it's course. I have appt w/ the Dr you recommended in Sloan, Dr Mulhal, in early Nov. 2015 . Since I have caclificatiin do you think that new drug you spoke about that may be FDA certified in 2013 would help me ( Xiaflax ). I feel that I / we should be doing or trying something in the developmental stage???

Xiaflex may be helpful if calcification is limited or spotty.  With extensive calcification, this drug probably will not offer a lot of improvement.  MG

09/19/2012 - 17:38

Hi, I have had Peyronie's for a little over six months. I present with mild curvature (13 degrees), a dent midway through the shaft and flattening on the top side of the penis. I am luckily sexually functional. During this time I have been treated with six rounds of Verapamil injections. I am also in my fifth month of using the Fast Size traction device. I initially had one small, pea size scar. During the course of injections, about 2 and a half months ago, a new scar appeared on the left side of my penis. I also now have a twinge sensation near the new scar when I pull on the penis, even gently. As of now, my deformity seems largely unchanged despite the new scar. My question is as follows. I still feel tremendous fear and anxiety. When can I relax? Given the treatment I have received and the fact that the deformity appears basically unchanged in six months, what are my odds? Am I out of the woods? Also, what do you make of the "twinge" sensation? Thank you.

These twinges are pretty common and I wouldn't make too much of them.  If your condition is stable at 6 months there is a good chance you will see no further progression.  MG

09/19/2012 - 17:39
Prostritis and PD

Dear Dr. I am 31 year old; unmarried. One night in February(2012) i masturbated with my penis supported against bed. on the following morning i noticed the the following condition - 1. Pain on the tip of the penis. 2. Glans Penis seemed dried/wrinkled. 3. Penis was stiff even when flaccid. 4. The veins had become prominent (on the top) and the blood vessels were prominently visible after sliding the skin. 5.Sometimes pain at the base of penis. I was diagnosed with prostritis by Urologist and took the medication for the same. the pain subsided but i am facing the following problem - 1. I am unable to get erection if i want to masturbate again. 2. My penis remains stiff even in flaccid stage. 3. Penis is slightly twisted towards right. 3. Recently 4-5 times i observed that my penis bends right side when semi erect. though i am unable to find any difference between both side of my penis. Kindly advice. Do i have PD; if so how can i identify the plaque; will it resolve with time.

PD will cause increased bending with increased erection - if you see angulation with semi erection that straightens out when it gets hard, this is probably not PD.  MG

09/19/2012 - 17:41
Peyronies due to masturbation ?

Hi, I am 24 year old male. I've been masturbating once a day since i was 17. Now my penis is bent 45 degrees downward during erection. Is it due to masturbation ? Should I stop ?

this is probably congenital curvature.  no need to stop masturbating.  MG

09/19/2012 - 17:43
Does a long waiting time to see an urologist reduce the chances of a successful treatment?

I am 65 years old. Six months ago I had what looked like a fungal infection on the glans which was finally diagnosed as lichen planus (skin condition elsewhere on my body and inside my mouth confirmed this) which was successfully treated by corticosteroids in less than six weeks. A few weeks later I noticed that my penis had an abnormal bend in it and I suspected it to be PD. I have been experiencing an aching pain for about a year whenever I had an erection. I had not had sexual intercourse since the first onset of the symptoms appearing in case it might have been an infection. After discovering the bend I visited my General practitioner who has made a referral to an urologist. I have attempted intercourse once since but I found it was extremely difficult to achieve penetration due to the misalignment and I suspect to the difficulty of achieving a sustained erection. I have never had ED and I suspect this problem to be psychological as I am embarrassed. I have not yet been diagnosed by a medical professional but my condition seems consistent with PD. Because the bend seemed to appear so suddenly I was anxious that the distortion might continue, so I monitored its condition. Over the last three months I have found no change in the bend which is downwards. My penis curves 10 degrees to the right from halfway along the shaft at a radius of about3inches (viewed from above), and bends downwards about ¾ of the way along the shaft at 40 degrees sharply at an internal radius of 1 ½ inches (as viewed from its right side). (I think) my wife is unaware of my condition despite our difficult sex and I am too embarrassed to talk about it as I feel inadequate until I see a specialist. I cannot contemplate having sex because of the. I am concerned that I have waited about four months for an appointment to see the urologist and I would appreciate your opinion whether a long wait might worsen the problem and chances of successful treatment. Could my condition be associated with Lichen Planus and the use of the steroid ointment, or do you think this might be just coincidence?

The association with lichen planus is probably coincidental.  Usually, the earlier medical (non surgical) treatments are started, the better the result. MG

09/19/2012 - 17:46
Peyronies options?

I had a nerve sparing prostectomy 12 months ago, and ED is still a significant problem. The "therapy" has been injections into the penis 3x week. The result of these injections appears to be peyronies. Half way up, there is an hour glass indent on the left side. Also my penis points up, between 55-65 degrees from midshaft. Should I seek additional help about the peyronies, or wait to see if it things self heal? Is peyronies hurting my recovery with ED? Or conversly, will trying to fix the peyronies hurt my recovery with the ED problem? It was extremely painful to have an erection months ago, but now is less painful. Thanks, CW

PD is more common after radical prostatectomy, and after the use of injections.  It may be better to adopt a vacuum device to help with erections at this point, rather than injections.  You might want to talk to your urologist about the curvature you have developed.  MG

09/19/2012 - 17:47
ACE Inhibitors?

I am a 47 year old male. I started taking an ACE Inhibitor blood pressure medication 6 months ago and have since developed PD and Dupuytren's in my right hand. I feel strongly that there was some relationship there between the start of my medication and the onset of these two conditions. Do you know of any such relationship?

The only drug-based relationship to PD that I know of would be with beta blockers - could the medication you're taking possibly be a combination of the two?  MG

09/10/2012 - 18:07
plaque calcification

I am 60 and have had peyronie's for 5 years. I have a 45 degree upward curve which has been stable the last two years. My doctor prescribed cialis 20mg to improve my erections which are not as firm as before. He told me I would probably benefit greatly from xiaflex, should it get approval later this year. At my next appointment I'm going to have the full workup, ultrasound etc. If the tests show calcification, do you feel xiaflex would still be a viable treatment option?

In the clinical trials, patients with extensive or contiguous plates of calcification were excluded, but not patients with punctate or small calcifications.  I think the same thinking will hold true in clinical practice.  MG

09/10/2012 - 18:09
a small to medium bump on the underside of penis

Hello, I'm writting for my huband who has tried research but hasn't gotten anywhere. So Ithought id try for him. He's scared of doctors. I'm the first who's really noticed it very clearly. When he is soft its on the underside of his penis and to me it just looks like a raised bump and skin has kindof bult around it. He was born with it. Its embaressing for him to say but it gives himextreem pleasure durring sex. He discribes it as though what it would feel like as a clitorus to me. Its more sensitive than the head of his penis. He loves it and so do i, we are just curious as to what it could be? And also there is a thin line that goes straight up from that to under the tip of his head. Its all sensitive like crazy. I thought at first it was how he was circomsized? But the bu an inchss under the head confuses me. Never any pain, discomfort or change in color. Just extreem pleast ure. Do you thave any suggestions as to what it may be. He's stuborn and embaressed to go in for it. Thank you for any answers we haven't found any he gave up monthsz ago, not me! Lol

This bump does not sound like Peyronies.  If it has been present lifelong, is not changing in size, and it works for the two of you, leave it be.  MG

09/10/2012 - 09:21
Diabetic with possible Peyronies and loss of libido

My boyfriend of 6 years has experienced gradual loss of erections, sensation and libido. He has diabetes type 2 and is 59. He used to be able to get semi-hard erections without much help, though has been taking viagra for about 3 years. The effect of the viagra is lessening, even though he is on the maximum dose. I noticed his penis started to bend downwards a little and there is now noticeable plaque along one side and a more severe bend to the side, which has worsened in recent months and an erection is now almost impossible. He has also lost length and experiences a lot of pain if we try and have sex. He is struggling with not being able to have sex and we very rarely do anything now, which I am finding very difficult. He won't go and see a doctor as he thinks there is nothing which can be done and the diabetes has basically caused it which is not going to get any better. I also wonder whether he has low testosterone levels which is also causing the lack of libido and sensation. When we first met, we had really great sex. I enjoy times of intimacy with him which do not lead to intercourse, but they are getting less too as he does not want to think about how he used to be good at sex and now he isn't (or so he thinks) Is there anything I can suggest?

This is obviously a very difficult situation but you do need to influence him to see a urologist experienced in the treatment of PD.  He also should have a testosterone level checked. As you know, Diabetes itself can have deleterious effects on male sexual function, and when combined with downward - bending PD (which usually causes more difficulty than the usual upward bend), the effects can be particularly difficult. Intercouse is not everything but intimacy is.  The big problem in this scenario is the gradual erosion of intimacy, which will compromise the relationship and incur psychological costs. It would be a good idea to address and deal with the treatable physical issues before this happens. MG

09/10/2012 - 09:43
Penis has a dent on the left side of the base

Recently I noticed my penis has a dent at the base on the left side. I'm a 57 yer old who recently had back surgery and had a catheter. Could the catheter have caused damage to a blood vessel? I've also noticed my volume of ejaculate has decreased and sometimes I there is the feeling of orgasm but very little or no ejaculate is present. I'm on pain meds but have been on these for the last 3 years due to multiple back surgeries. My left testicle is also somewhat tender at times and slightly drawn up. My testicles use to hang somewhat evenly now my right one hangs much lower than the left. Seeing a urologist next week but wondering what some of these causes may be in your opinion. Thanks

The dent at the base on the left side could be early PD, which can sometimes come on after a period of catheter use. The other symptoms are probably not related.  MG

09/10/2012 - 09:46

Doctor, 56 a couple years ago I started to get a pinching about a third of the way up the shaft. Now pinching is servere and texture feels hard around the pinch. Shortning and unable to get fully erect. Peyronies?

Yes that sounds to me to be the case.  In some cases of PD, there is more pinching in of diameter and less bending.  Both forms cause loss of length and may contribute to the erectile issues.  MG

09/10/2012 - 09:48
pain at base 6 weeks after trauma

Great forum, thanks. 38 yr old in general good health. About 6 weeks ago i experienced trauma during sex. The pain was moderate, but no bruising or swelling. About 2 weeks ago i started getting a mild pain/discomfort on the base and bottom side of penis during masturbation. Also the erection has not been as full. I haven't noticed any lumps or curvature, other than a very slight curvature which i've always had. Nevertheless i've never experienced a pain like this before and it's continued for the past few weeks. Does this sound like mild peyronies related to healing which will subside? Or something that will continue to worsen?

No it does not sound like PD, which takes a lot longer than 6 wks to develop. There is probably some residual inflammation which will take a while to clear up.  MG

09/10/2012 - 18:10
Long Term Peyronies

Doctor Gelbard - I just sent a message a few minutes ago and wanted to add - I have taken Trental/Pentoxifylline, Natural Vit E, L-Arginine, Cialis - all with no improvement in pain or progression. thank you

thank you see below.  MG

09/10/2012 - 18:12
Long Term Peyronies

Hello Doctor, I was diagnosed with Peyronies several years ago, it started with a small lump and pain while flaccid, and has evolved to several areas of plaque - lumps, bands, small chunks - and pain. I was stable for a period of about 6-7 months once, while I still had pain, the deformity did not progress during this time. Have you ever known of a case that progressed for this long - 4.5 years? Is there anything that can be done? At this point I would seriously consider having my entire penis removed to take the pain away. thank you

low dose radiation is no longer used to treat PD, but in those very rare cases with perisisting pain it may be worth considering.  MG

09/10/2012 - 18:13
Lumps and masturbation

Hi Dr, I was diagnosed with PD about six month ago and I wonder if it' s bad for the desease to mastubate every day, can the lumps/indentations get worse? I'm afraid that I will make the disease progress to worse. I also wonder about the lump that I have. Some times I can feel the lump very well and some times I can almost not feel the lump, It's like it shrinks sometimes why is that? I have no bend but indentations were the lump is. When can I relax and stop worrie about this getting wors, bend or bigger indentations. Thank you!

Masturbation will not be harmful, and it is normal for the bumps to change their configuration.  MG

09/10/2012 - 18:14
Treatment for Peyronies

I'm a 57 year old male. I had a normal sex life until I was recently diagnosed with PD. I have an issue with curvature, but no problems with errections. Everything feels quite normal,except for the curved penis. No pain at all. My doctor prescribed vitamin E along with cialis and he recommended an Andropenis, which I find uncomfortable. I did some research and came across another recommedation that treats PD and the associated curvature. It is Serranex-Ft and Nattolizyme combined with Vitamin D. This supposedly treats the PD and curvature. Is this a viable option? Thank you SA

This is an enzyme preparation that to my knowlege has never been evaluated critically or scientifically for its effectiveness in treating PD.  MG

09/10/2012 - 18:17
Instant curvature

Hello, I am 47 years old. Does PD happen instantly? My penis head started curving to the left about a week ago. My penis has always favored the left since a youth but , literally the head area wants to go to the left. My wife commented last night when did this happen? There is no pain and I dont feel any bumps or scaring? I dont recall any injury. Any comments would be appreciated.

In some cases PD seems to come on "over night".  That is probably not the case as the process may be developing and escape notice for a long time. At any rate, we do hear this history from a number of patients, that it just "suddenly appeared".   MG

08/30/2012 - 18:03
PD with no lump

I noticed pain down right side of shaft about six months ago and now have a curvature at the end of my penis upwards and to the left. All the signs are of PD but I cannot detect a lumpat all. Is this possible or is a lump a prerequisite of the condition?

This definitely sounds like Peyronies to me.  A lump or plaque is not always present - sometime it can be a band of scar that can only be felt on stretch.  MG

08/30/2012 - 18:07

Hi Doc, I was diagnosed about 15 months ago. Dr. M. from Memorial Sloan said I had very mild case less than 10 degree curve, have indent top left side, when erect left side is smaller erections are not as firm, when flaccid lays completely on left side and is smaller, shrinks when play sports. Has affected my confidence being single man and active but have found when erect it is almost 100percent but I have to be really erect. My big concern is when flaccid or before erect left side is unstable and not firm because of indent, it doesn't hang like it used to at all when flaccid. I did traction for many months which helped with curve. I now consulted with urologist in Alabama and am using VED 20 mins/day plus ultrasound 2x 10 mins/day and Verapamil cream 2x day plus VitE, L-arginine. Main question is left side instability feels like this side has been shaved away a bit, indentation where break or fracture took place is obvious small improvement. No lumps, possibly a chord I can feel! Any suggestions. Thank You Much! Jerry

Dr. M at Memorial is one of the best. The Vacuum therapy may help, though I have little confidence in the benefits of topical verapamil.  MG

08/30/2012 - 18:08
Downward Erection

Although not officially diagnosed with PD, I have most symptoms: over age 55, curvature, shortening of penis, semi-rigid, noticeable lump, and over the years there have been incidences of trauma to the penis. My question concerns my erections, although not nearly as rigid as they once were, they are always downward. I can no longer get it perpendicular to my body as it once was. Is this also a symptom of PD?

Yes, if PD occurs on the underside of the penis, it will cause downward bending. MG

08/30/2012 - 18:09
Heated back massager

Has anyone tryed a heated back massager for PD the heat for healing and the vibrating to increase blood flow to the area?

I'll put this out to the readership - I know of no studies examining this method.  MG

08/30/2012 - 18:11
Hard lumps without curve or bend

I have been contemplating coming to see you. I noticed about six months ago a hard lump inside the shaft of my penis. It is most noticeable when flaccid. There are no noticeable external signs except that erections are slightly painful and length has been slightly effected (shortened). There is now another one of these masses a little further down the shaft away from the head and needless to say all of this is quite disconcerting. Is this PD even without bends or curves or is this something else?

The combination of palpable bumps, discomfort with erection, and shortening sounds suspicious for PD to me.  MG

08/30/2012 - 18:17
disappointed with outcome

I developed Peyronie's symptoms suddenly in September, 2011. After several unsuccessful verapamil injection treatments, I underwent an excision/grafting procedure in April, 2012. I was told i required a "large" graft of approx. 8 cm. After a couple of weeks, i began taking daily Cialis. Not long thereafter, my penis became swollen, particularly around the sutured area near the glans. I stopped taking the Cialis. For several days, I squeezed substantial amounts of blood out of the penis through suture openings that had not yet healed. Eventually things seemed to normalize. I was cleared to have intercourse approximately in late May, 2012, about 5 or 6 weeks after the surgery. My first erections were straight, although length and girth were clearly lost. Nonetheless, I was extremely pleased to be straight. I had sex twice in late May, 2012, though was not able to ejaculate. A few days later, I contracted a high fever of 104. I was given fluids, and tested negative for any viruses at the ER. My fever broke and I was released from the ER. A few days later, my fever returned, and this time was accompanied by swelling in my penis (I had resumed the daily Cialis for a while). I was able to discharge some fluid from the same area. However, at first, the fluid was yellow this time. Later it became rust colored, and then blood red. I contacted the surgeon and was quickly admitted to the hospital where i was administered some powerful antibiotics and kept overnight. I was released the next day and got progressively better thereafter. The swelling was gone as well. However, ever since, my penis has had a substantial upward curve when erect. There is a noticeable narrowing on the shaft where the curve begins. I do not believe there is any plaque. My surgeon believes that the graft he gave me has tightened. The length and girth of my penis have diminished distressingly. Now the curve is back as well. I am extremely disappointed. I have not been able to have intercourse, both because of the size and shape, as well as my distress when i see or feel it. Can a non-plaque caused curve be corrected? Was the graft placed improperly? My surgeon is recommending a prothesis, which I simply am not ready for. I feel i am too young. I am at the point where i want to propose to my girlfriend, but this is a serious concern. We want children and i want her to be happy and fulfilled. Needless to say, my life changed dramatically and without warning that day about one year ago. I want to be normal again. I've lost some confidence in my surgeon, who is a very reputable urologist in a major city. I don't know what to do, but will do anything to avoid a prothesis.

My question is regarding the nature of the graft - it sounds like it became infected, which is unusual in a graft taken from your own body.  If this was not an autologous graft (tissue from your own body), it may be possible to revise the curvature while removing the foreign graft material and subsituting autologous tissue.  MG

08/30/2012 - 18:22
I need help!

I think my boyfriend suffers from this condition, I have been researching for some time now(I'm a biologist) and I'm convince the cause of his bent upwards penis and the fact that he can only get one erection a day is Peyronie's disease. I love him to death and this has never been an issue for me, but Im afraid in the long run it will translate into impotence. We have a great communication but I don't know how to approach the subject without making him feel belittled. Can you guys give me some pointers? Thanks in advance.

That is a difficult question. Your communication skills seem great, perhaps you should cc the email that you sent me, with the comment that concern for a loved one is never belittleing.  BTW if he is functional now this condition is not likely to lead to impotence.  MG

08/24/2012 - 21:39
Insurance for Xiaflex treatment?

I am interested in determining what insurance might be most likely to cover the Xiaflex treatments should it become available in near future.

This of course will have to wait for FDA approval.  My opinion is if approval is granted and Xiaflex becomes standard first line therapy for Peyronies Disease, insurance carriers will be obliged to cover it.  MG

08/24/2012 - 21:41

Dr. I was diagnosed with peyronies in Sept. 2008 Since that diagnosis I was taking Vit. E 400mg twice daily. Since the diagnosis my PSA have been rising from 3 before diagnsis to 6.47 now. Is this a coinsidence or something related to peyronies?

Peyronies Disease has no interaction with or effect on PSA.  You should have the rise in PSA checked out without too much delay. MG

08/24/2012 - 21:46
Wife of Peyronies sufferer- correcting surgery

My husband developed Peyronies a few years ago and had the Nesbit procedure after 16 months. We were aware that the procedure reduces length but we were not prepared for how much (two and half inches). This has a dramatic effect on our sex life. Having known my husband’s penis for 20 years I don’t believe that they put the sheath of his penis back correctly and there seems to be quite a lot of penile tissue retracted into the body. I believe that they cut too much foreskin away and re attached higher up reducing the usable length. Can this be rectified?

When a Nesbit procedure is done for severe bending, the resulting shortening can present problems.  You may wish to consult with an experienced reconstructive surgeon, though this issue can be difficult to resolve.  MG

08/24/2012 - 21:48
Lack of use

I'm currently 30 years old going through an absolutely devastating divorce. I've not had an erection or any sexual contact etc for the past 2-3 months, lack erections due to stress no doubt. Is there a risk of penile shortening etc from lack of use here?

No, fortunately you don't have to worry about that.  MG

08/24/2012 - 21:54

Hi, I am unsure if I hve peyroines or not, and unsure if my curvature has always been natural. I have about 20-30 degrees curvature on erection and a tight sheet-spot on left side of penis base. The right side of the base feels weak in comparison so I wonder if this is just more developed tissue on the left base. The curve goes to the left and isn't so much of a curve as it just points that way. The left base tightness does not hurt and feels basically like a stronger muscle, almost rock hard. While flaccid this area feels tougher in comparison to the right side and is basically the tissue that connects penis to pubic boen or something. When i flex my PC muscles it pulls on my penis from this area. Is this a plaque?

I don't think so, from your description.  Some men have thicker fibrous tissue around the suspensory ligament, which connects the base of the penis to the pubic bone.  This can have the effect of pointing the penis off to one direction or other with a really hard erection and is not usually a problem.  MG

08/24/2012 - 21:55
Just want to say thank you

Dear Dr Martin Gelbard I just want to express my gratitude to you for the time you dedicated to answer our questions. Please keep up the good work. In my case, the condition I had turned out -as you have suspected- to be a thrombised vein. I am almost completely recovered now. Thanks a lot again... Sincerely yours ... MMW

Thank you - I appreciate your taking time to give us some followup. MG

08/24/2012 - 21:56
20 year old

Hi, 3 weeks ago I bent my penis when I was dancing at the club. It hurt pretty bad - no bleeding, erections are ok, and no pain while urinating. However there was some bruising, and there still is some discoloration today. 2 or 3 days later I noticed a bit of a curvature. My penis already curved a little bit to the left but now it does more so. Anyways, the injury is on the right side of my penis. The area is still a bit discolored and looks a little inflamed with broken blood vessels, there is a very slight indentation where the injury was - not noticeable while errect, and I have some pain that goes on and off. I went to the urologist a week and a half ago and he said that I dont have pd and that I should rest it until today so it can heal. I have no plague and I thought it was sort of weird that the injury is on the right side but curve is to the left. Should I get a second opinion about pd or just give it time?

Just give it a rest, it doesn't sound like PD to me either.  MG

08/24/2012 - 22:00
Peyronies & Other conditions

Hi, looking though your forum comments it seems that I have this problem. I am living in what some call the third world so treatment or even an authoritative diagnoses is not all that easy. However a few answers to questions may assist. It is mentioned that those suffering from Dupuytren’s contracture may be prone to Peyronies?? It is mentioned that there can be a loss of length (penile)as a result of the condition??Is this permanent?? I seem to have contracted two other conditions in the same period as I realized the Peyronies. 1, a large lump on the ball of my left foot, different from the lump associated to Dupuytren’s. 2, pain in the first three fingers of each hand. All sounds like just a coincidence however it would be good to understand that to be the case and not somehow linked. Like all of you other correspondents I feel that I am healthy. Details Male 65 years old Totally active in all areas, Running, biking, Sex (young 37 year old wife) Take no medication other than beer. Have had both hands operated on for Dupuytren’s contracture, so far no recurrence. Not vastly over weight, 1m 95cm tall 107 KG no beer gut.

What you are describing is all part of one picture.  Dupuytrens and Peyronies are closely related, as well as plantar fibromatosis (bumps on the soles of the feet).  Yes Peyronies often causes shortening of the penis and in some cases this can be permanent - particularly in a man who also has dupuytrens contracture and a plantar fibroma.  MG

08/17/2012 - 15:26
Diagnosed with PD

I am a 57 year old male with no medical issues. About a year ago, I begin to notice that my penis was beginning to curve upwards. It continued and I finally saw a Urologist a few weeks ago. As I suspected, I was diagnosed with PD. He suscribed a combination of L-Arginine, Vitamin E and Cialis. This along with purchasing an Andropenis. I am concerned about the Cialis and it's side effects. Plus the fact that I don't have any problems with a sustained errection, nor do I have any pain at all as a result of the PD. In other words, everything has continued to feel quite normal during sex except for the fact that I don't have enough to work with as a reslult of the curvature. I do not suffer from ED, which is what I thought that Cialis treated. At this point I am very confused! I continued to research options. One option was a combination of Serranex-Ft and Nattolizyme, along with Vitamin D10. Do you have any thoughts on this combination? Do you agree with the original recommendation that I stated above? Thanks for your input. AS

The use of low dose cialis is a common reccomendation, as this class of drug seems to have some anti - fibrotic (anti - scarring) effects.  However there is really no good peer-reviewed double blind study data confirming it helps, so if you don't have ED, it's sort of an expensive "maybe". The use of an extender device such as andropenis and the supplements / enzymes is a reasonable course of action at present.  The topline phase III data on Xiaflex (collagenase) that was released earlier this year shows great promise in my opinion, and I believe it will be submitted for FDA approval by the end of this year.  If that drug becomes available, it may prove to be a very compelling option for many men.  I will post updates on that in the future.  MG

08/17/2012 - 14:54
Self-treatment of PD if caused by vasculitis.

Hello Dr, I'm a 31yr old male, in good health. 2 or 3 months ago i had the impression that my penis was becoming 'stiffer' when in flaccid state. Also, the superficial veins in the foreskin, the dorsal vein and the branches on the side became swollen and more visible. The foreskin and the glans penis are irritated and show redness. I have problems getting erections, and experience a slight burning pain after erections (sometimes lasting 1 or 2 days). There is no bending of the penis upon erection, but it does not become fully erected as before. Also the tip of the penis does not get as stiff as before. Yesterday, my urologist presumed Peyronie's disease (in an early stage), after palpation. Is it possible to get Peyronie's from vasculitis? (If vasculitis is the cause) His plan is to culture a semen and a urine sample, and i can come back in 2 weeks for the results and an echo of the prostate and the scrotum. I don't like to wait for 2 weeks without doing anything. My question is: can i start some kind of therapy on my own? Like: Antibiotics? (against a possible bacterial infection) (4yrs ago i was treated for an infected prostate). If yes, which kind of antibiotics? Corticosteroid creme? (to break the inflammation chain and build-up of connective tissue) Hirudoid creme? Against intravascular clotting. Cooling? Thanks! Regards from Holland PS: keep up the good work on this site! It is really helpful.

I'm not sure this is PD.  If the superficial veins themselves are prominent and firm, it may be something called Mondor's Syndrome.  This is thrombophlebitis of these veins, which is a benign and self-limited condition that often responds to aspirin 325mg 3 to 4 times per day over about 10 days.  If you have a history of prostatitis I believe a course of antibiotics might be helpful as prostatits often causes pain referred to the glans and can temporarily inhibit erections. Pathologists have noted that there is a vasculitis component to early PD, which is limited to the areas involved by palpable plaque.  Systemic vasculitis is a rare and serious illness that to my knowlege has no relationship to PD.  MG

08/17/2012 - 14:57
micro penis

Hi Dr I have a problem I think I have a micro penis I Have not had sex for seven yr because Iam ashamed of the size when soft it about 2half inches I've had women walk out on me so I gave up is there anything I can do I've heard of these stretching devises dont know what to do and Iam losing weight was 300 pounds thank you

Normally I don't respond to inquiries about condtions unrelated to PD.  In your case I would suggest you consult with a urologist experienced in reconstructive surgery.  You may wish to try a traction or stretching device.  MG

08/17/2012 - 15:00
Lump on penis shaft

Hi dr I have had like a small white lump on the shaft of my penis for about six months it wasn't affecting me and didn't notice it that much but a few days ago it started to feel quite painful so I had look at it and it had turned into a realy big lump and realy red but it sort of popped and a bit of white stuff like what you get from a whit head came out and then blood so I stopped and thort it might go down now but it felt like ther was a realy hard bit of something in the skin under this spot but then tonight I got back from work and it was painful so had a look and there was white stuff coming out so squeezed and when it was out it was hard don't no how to describe realy like a grain of rice but more round and a bit bigger would you have any advice

This is an infected sebaceous cyst.  You should see a urologist to get it cleared up.  MG

08/17/2012 - 15:06
Early Peyrinie's disease

Hi I am 36 year old healthy man. I think I just developed a PD. the story is as follow less than a week ago, after having sex with my wife, I immediately felt minimal pain in the penis (which happens to me sometimes if I have a lot of sex). Few hours later, my penis became mildly swollen and tender. My pubic area was also very tend to touch. This was associated with one day fever. About 24 hours, I started myself on Amoxi-calv ( i am an MD) sine my wife turned out to have mild cervical infection. So I thought this was cellulitis of the skin of the penis. The swelling and tenderness both on the pubic area and the penis decrease but, On the 3rd or 4th day, I noticed a hard band-like structure around the tip of the penis (c-shaped). This band is still mildly tender. The tip of my penis is slightly itchy and some of the skin still sloughs away. My penis is not bent when erect although the erection is not as hard af before. I did not have sex with my wife since then waiting for her infection to improve and my itchiness and tenderness to improve too. My questions are as follow 1- is this a Peyronie's disease? 2- if it is, can I do anything about in this very early stage? 3- what is the prognosis in my situation? Thanks a lot

Please see my response to the question about vasculitis.  The  c - shaped structure is probably a superficial vein, and this sounds to me like Mondor's Syndrome as well.  Peyronies doesn't usually start off this way.  If it comes on after traumatic sex, it takes months to develop unless there is a frank rupture of the tunica albuginea with bruising and dramatic "eggplant" swelling etc.  I would consider a course of aspririn, to hasten the recovery of the thrombosed superficial vein.  MG

08/17/2012 - 15:09
Post Nesbit

I had the Nesbit procedure done 10 weeks ago. I have pain while having sex. Is this normal? If so how long should this last?

Normally patients can resume sex about 5 - 6 weeks after a Nesbit procedure. If it was done for severe curvature (>50 or 60 degrees), it may take longer to feel comfortable.  MG

08/17/2012 - 15:14
Treatment for curvature and Weak Penis.

I am 54 Male, Have 6" long curved Penis which is curved towards upward. Penis is very weak if we see ring thickness and look of the penis is not in proper shape.I can not go for sexual intercourse with my wife. I feel helpless and desperate in this situation. Please see erection is there but not so satisfactory and up to need of action. Erection does not sustain till the ejaculation.When it is penetrated with difficulty it becomes loose and not do its Job. S C, India.

You should see a urologist who could start you out on injection therapy (with papaverine / phentolamine, which is not expensive) or perhaps you would be a candidate for implant surgery. Dr. Krishnamurti in Hyderabad has experience in treating your problem.  MG

08/17/2012 - 15:16

Hello, Thank you for your previous response to my post about a week ago (23 year old who bent penis while having sex). I've gone to two urologists now who both agree that I will heal and be fine. They also prescribed me Naproxen for two weeks. My concern is about the indentation that I mentioned in my last post though. It is on the right side of my corpus spongiosum. It is most noticeable when I have an erection and that portion of the spongiosum seems to not "inflate" with the rest of my penis. This causes it to appear to be slightly sunken in. I mentioned it to the second urologist that I saw and they said that it was more than likely due to the healing process. Does the tissue just require more time to heal? If so, should I try to avoid having erections? Thank you again for your help.

Proper healing may take months.  There is no need to avoid erections, in fact the use of a vacuum device may help to expand and correct the indented area.  MG

08/17/2012 - 15:17
Hard spot inside penis when squeezed between thump and pointer finger

Dear Doc, I recently noticed a hard spot maybe 1 cm in the very centre of my penis shaft, what feels like right above my urethra (have to squeeze pretty and deep to feel it) when I was urinating. This has led me here and I am curious if I could have PD without having any symptoms (pain/viable lumps) while erect. I have masturbated more than usual for the past couple weeks but just noticed about 4 days ago. My penis feels semi sore while it is in the stage of getting hard but once it is hard there is no pain. Does this sound like PD or anything else I should consider looking at. Thanks

This little lump and the soreness you feel could be early PD.  Consider having an examination by a urologist.  MG

08/07/2012 - 13:02
my penise round shap

hiiiii dr. i m viki from India my question is my penis round shape. for top side. i m very confuse. i m engaged newly what i do? what i do for my penis? shall do beeter sex?

I presume you mean it is round on the top because it is curving downward.  This is the most common form of congenital curvature, which can be corrected with a nesbit procedure if it is causing a problem with sex. MG

08/04/2012 - 19:47

Hello, I am 23 and about 5 weeks ago I bent my penis some while having sex. The dull, achy pain lasted for about 4 days and then went away, even when I had an erection. The pain came back a week or so later after I had sex again. The sex was not vigorous nor did I bend my penis, but the dull, achy pain came back for a few days again. I noticed a slight indention that was quite small on my penis. Just to be safe, I went to a urologist a week ago who listened to what happened and then examined my penis, checking for plaque. I also told him about the slight indentation, and he checked that as well. He said that he found no plaque and that I don't have peyronies. I have no curvature at all, but every now and then I get a slight sensation in the side of my penis that feels like inflammation. I can still get regular, rigid erections that have no curve. My question is whether or not I can have non-vigorous sex with my girlfriend, and also if there is a good possibility that with the absence of curvature and plaque that this will just take some time to heal. How much time should I give it to heal?..sorry for all the questions. Thank you for your help!

I would agree with you Urologist - you don't have PD. A sore spot from bending the penis (and a little indent from the associated inflammation)  may take several weeks to resolve.  In the meantime, gentle sex should be OK .  MG

08/04/2012 - 19:48
Stretching device

Hi Dr. Is there a medical website or a reliable place I could buy a stretching device from? I want to make sure I'm not wasting my money on something thats not going to work.

The two reasonable devices I know of are called Fastsize and Andropenis - I think they are both available on line.  MG

08/04/2012 - 19:49
Peyronies Disease

07/31/2012 - 13:46 Thank you Dr for your answer and this exelent web site. So if I understand you right: I don't have to worrie about this getting any worse but probably the lump or/and the change of shape across the penis will stay as it is? Thanks again!

correct.  MG

07/31/2012 - 13:46
Peyronies Disease

Hi Dr, I´m 46 yers old and I was diagnosed by a urologist with peyronies disease six month ago. He did´t tell me much about the diagnose exept that It´s not dangerus. I have a small lump on my penis right side half way upp. It´s 4-5 millimeters, I have no bend but i have a small change of shape across the penis at that area. Lately I feel a mild pain sometimes but no problem with erection and often the pain goes away with full erection. The only change I can feel is that the lump is a bit wider and flat now compared to six month ago. At the beguining I could feel the edges very well. My question is: Do you think this will get any worse, I worries me because I also have a mild form of dupuytren's contracture in one of my hands (just lumps, no bending fingers). Thanks!

The discomfort will almost certainly go away on its own eventually. The fact that you've had this for 6 months without progression to severe curvature is a good sign, though you should know that the presence of Dupuytren's contractures makes this situation more likely to persist in some form. MG

07/31/2012 - 13:43
Streching device

Hi, I was diagnosed with PD and am taking Pentoxifylli and not seeing much of a change. I heard about a streching device, do these work? If they do could the device be covered by insurance?

Please see the response below.  In some cases these may produce enough extension to lessen the bend. I don't think most insurance carriers cover stretching devices, but that is something to check with your particular policy. MG

07/31/2012 - 13:41
Penis Traction

To avoid a surgery procedure for fixing Peyronies. May a Penis Traction be a substitution for minor cases?

Current experience suggests that traction devices may offer mild improvement in curvature if used regularly for several hours daily. Surgery is generally reserved for more severe cases which will not respond as well to stretching.  MG

07/24/2012 - 13:07
Peyronies Disease

Hi Dr, I am a 55 year old who has been diagnosed by a urologist with peyronies disease. His clinical examination showed that there is a palpable dorsal plaque in the penile shaft and he reckons I have a dorsal angulation of about 25 degrees on erection from a digital image I showed him on camera. I had began noticing the curvature and experiencing pain on erection for the past 7-8 months. Prior to that I had also had at times had some E.D problems over the previous 12 months but this was put down down to stress through a family bereavement. He did some routine blood tests, testoterone, liver and kidney function tests which all came back normal and has informed me that the peyronies disease needs a period of observation for the condition to stabilise before the he considers intervention. He reckoned a period of 18 months would give the penis enough time to reach stabilty at which point he would then consider surgery to rectify the problem. He did offer to prescribe something to assist with any E.D. problems I was still having but I declined as I told him this was no longer a major issue. What I would like to know after reading everything about peyronies is whether I am doing the right thing in taking his advice and waiting so long before I receive treatment. As the days go by I can see that the curvature in my penis is worsening and intercourse is becoming more difficult with my wife. I am afraid that by the time I do go back to see the urologist the curvature in my penis may be too great to correct. Your advice would be much appreciated.

Your Doctor is correct in waiting 12 - 18 months before intervening surgically, as the disease often takes that long to stabilize and the optimal surgical results are in patients with stable disease. Unfortunately the non surgical options (oral medications, plaque injections of verapamil, stretching devices) are not always that helpful. The recently released topline phase III results with Xiaflex, an enzyme that dissolves scar, are promising enough that you may want to wait for this (Possible FDA approval early in 2013) prior to electing surgery.  If not, and your condition is progressing, it would be reasonable to opt for surgery at the 12 month point.  MG 

07/22/2012 - 13:02
Peronies Disease

A little over a year ago I began to notice a slight change in the size and intensity of my erections during sex with my wife. My penis seemed to be getting slightly shorter when erect and for a few months I had trouble getting and maintaining an erection. I was finally diagnoised with chronic lyme disease about 5 years ago after several years of chronic exhaustion, joint pain, as well numerous other symtoms. I had 3 doctor confirmed tick bites about 1994 and was treated with a 10 day course of antibiotics at that time that apparantly didnt do the job. In the same year as that diagnoises, I also had a LAD blockage that was corrected with a stent and a few months later, I had my gall bladder removed. In my early twenties, was diagnoised with erratic blood sugar that would come and go, sometimes there were years between the symtoms, but the doctors who diagnoised it told me that I would be a diabetic later in life. In 2002, this was confirmed, I was diagnoised with type 2 diabetes that I still controll with medication and diet. In 1986, I had my chest crushed to the sternum along with numerous other injuries when I was hit broad side by a drunk driver who had ran a red light. I will be 57 years old later this year and despite health problems, my wife and I have continued a reasonably good sex life until the problems that started last year. Earlier this year I quit taking Effexor-XR that I had been taking for the last 8 or 9 years and my ED symtoms began to ease. However, I noticed my erections that all my life had a slight bend upward now bend downwards 45 to 50 degrees even though they seem to be just as hard as before. After a while I began to experience pain on the bottom side of my penis during and sometimes after sex and it seems to be increasing. I have also found that I experiece the same pain if I try to force my penis straight during an erection. After recently combing the internet for answers I found some information about PD. After reading up on PD, I checked my penis while in it's usually state and I feel a small mass that feels thicker and denser just past midlength. Now I am convinced that I have Peyronies Disease. I plan to make an appointment with my doctor and discuss it with him, but I am worried that he might not know much about it. My questions are: Does this sound like PD? If so, what are my options?

This does sound like PD to me, and downward bending due to this disorder can be a problem when it exceeds 30 or 40 degrees. Your doctor may want to start you on some of the usual medications such as the supplements mentioned in this forum, colchicine, pentoxyfilline, and intralesional verapamil. If the bend does not respond and the duration of the PD if > 1 year, you may want to consider a dorsal plication procedure - though this will shorten the penis a little bit. MG

07/22/2012 - 12:56
Lump on penis

I am 26 and I noticed a lump on the right side of my penis that goes from the top to bottom of the penis. There is no pain and sometimes it more visible than others, usually after an erection. I am very sexually active with the same person. This has been visible for around 5 months and it seems to be less noticeable at times. Does this sound like PD? the urologist said he thinks it is the early stages and prescribed vitamin e and transdermal verapamil 15% gel. I also started to take Aceyl L-Carnitine. Does this sound like PD? should I try other meds?

This may be PD. I think the meds you mentioned are reasonable, though the experience of my patients using topical verapamil has not shown it to be very effective.  MG

07/22/2012 - 12:51

Hi Dr, I am 14, and I have been wondering what I can do about my curvature problem. it bends to the left, but when you straighten it out, the left side of the penis is straight, but on the right, below the head, the right side seems to not be as straight as the left and merges left. It's confusing because the penis curves left when there is more skin on the left. Can you help figure this one out?

This type of congenital curvature is due to a mild disparity in size between the right and left corpus cavernosum, and does not usually cause any problems. If in the future it becomes difficult to deal with, it can easily be corrected by an experienced surgeon using the nesbit technique.  MG

07/22/2012 - 12:47
PD with ED

Hello Dr. I am suffering from PD with mild to moderate ED. My uro suggest Viagra 50mg during sex so that I can have firm erection. I also find in othe forum as they suggest low dose Calis/viagra daily basis to maintain penile health. My question now: 1. Will viagra 50mg use of 2 or 3 time in weak make me dependent on it? 2. Will low dose daily use of such medicine loose it's efficiency in long time?

Daily low dose treatment usually employs Cialis at 2.5 or 5 mg daily, as it has a long duration of action.  The long term effectiveness of this in helping erections is good.  Using 50 mg of Viagra a few times per week should not make you dependent - in some cases as the acute effects of the PD resolve, you may find you don't need to use it any longer. MG

07/22/2012 - 12:43
Feel I May Have Peyronies

Doctor, Thank for taking the time to open up this forum for individuals who may have peyronies desease. I am a 29 year old male in otherwise excellent health, I am not on any medications and I don't have any known medical issues. About 5 months ago I first began to notice some slight pain when I had an erection in my upper right hand side of my penis. I didn't think much of it. I don't recall any trama to my penis and hadn't had sexual intercourse for 4 months pior to notices the pain. The pain came and went and really wasn't to concerned about it till about a week ago I woke up with an erection and noticed I had a slight right side bend in my penis near the top. I immediately check my penis for abnormalities. I discovered a lump inside my penis about 2/3 of the up on the right hand side. It's about the size of a small pea. It is not completely calcified and but is fairly dense. I immediately fell into internet search mode and discovered Peyronies Disease. Needless to say I am concerned about my chances of developing a significant Penis distortion. I have not made an appointment to see my primary phyisican because I am out the country on work till mid September. I plan on making an appointment when I return. Meanwhile I am considering suppliments as a intern step to seeing a urologist. I am considering Vitman E and Neprenol. Honestly, I because of my youth and health I'm hoping the lump will subside over time. The bend in my penis at this point would not cause significant sexual disability but I am very concern it will develop even further into a major issue. I have no trouble with maintaining and sufficient erection and have not notices changes beyound the lump and bend towards the end of my penis to the right. I now have a dull ach in ny penis but no significant pain during and erection. I have been researching spontanious recovery from this abnormality. My feeling is generally men have this occurance, it gets a little better stablizes and they move on. Honestly, I know there is no way to predict the outcome of any disease with certainity but what are feeling on my situtation. I live in upstart New York. Is there doctor you know how has experience with this desease outside the NYC area. If I had to and my insurance carrier accepts it I would travel to NYC to see a specialist. Thanks.

This does sound like a mild case of PD. You are correct in feeling comfortable that at your age it will resolve - that is often the case.  Supplements are not a bad idea - the usual combination is vitamin E  400 units daily and L-Argenine 2,000 mg daily.  Albany Med Center may be able to direct you to someone upstate; if not I would reccommend Dr. John Mulhall in NYC at Memorial Sloan Kettering.  MG

07/22/2012 - 12:37
Vein enlarged on penis

About a 10 days ago I went to the ER for an enlarged vein on my penis, also my penis hole seems to be darker. The doctor in the ER told me I had urethatitus and did an STD test which came back negative they gave me antibotics & sent me on my way. I did some research and what came up was thrombosed vein. Im concered that something is wrong. About 2 weeks ago my wife and i was having sex consistanly for about 2 weeks and thats when all this happened, ive had slight burning when i ejaculated. What should i do?

A thrombosed (clotted) vein under the penile skin, or Mondor's Syndrome, can be mistaken for Peyronies because it causes a palpable bump in the penis.  It will resolve on its own - aspirin may help speed up the process.  MG

07/16/2012 - 16:24
Oral medicine

Hi Doctor, I have PD with a plaque on tunica causing a tapped shape for last 2 years. I want to have arginie, but I can only find here in my country as intregated with lysine and ornithine. Is that Ok of I take this?

Yes, I know of no problems with that combination.  MG

07/13/2012 - 13:10

Hi Dr, I noticed the other day in the shower a lump directly below the head, slightly smaller than a marble and another directly under it the size of a pea. Almost directly in the center. My penis is strait when erect however if feels like on the left side towards the head is almost dented in slightly and possibly slightly bent down when erecet. After feeling the lumps enough some irritation is felt but for the most part there is no pain. I can remember one night of sex about two weeks ago where my fiance and I were having rigorous sex and from going out to back in I jabbed into her skin painfully but no pop or what not. I am concerned although both lumps appear to have shrunken slightly. Many thanks for any insight. I am a 31 year old male.

These lumps or inflammed areas are probably the result of the trauma you describe, and in most cases they will eventually resolve without leading to further scarring or PD.  It would probably be wise to "give it a rest" for a couple of weeks.  MG

07/13/2012 - 13:07
Small dent underneath head of penis

Hello doctor thank you for the forum I am 21 years old not really sexually active but I do masturbate a lot a couple of days ago I noticed a small dent right underneath the head is this a sign of peryiones disease not seeing any curvature yet nor pain during erection I'm starting to get worried...

This does not sound like PD, which is extremely rare in your age group.  MG

07/13/2012 - 13:06
Ventral issues

Dr. Gelbard I'm 29, I have a ventral curvature of about 10 to 15 degrees. Is this unusual? It seems like most all penises curve up, now I'm paranoid that I'm biologically malformed. I have 2 children, and I'm married, but I wish my penis curved the right direction. Will this condition worsen as I age?

This is not terribly unusual.  Downward curvature does not commonly produce any functional problems unless it exceeds the 30 to 40 degree range. It will probably not worsen as you age, though congenital curvature in any direction exposes the concave side to increased stress during sexual activity - it is important to avoid traumatizing the penis as this can occaisionally lead to Peyronies disease.  If the bend is a bother to you, a Nesbit procedure to correct your degree of curvature is not a complicated affair - in experienced hands.  MG

07/10/2012 - 13:57
PD and Isotretinoin

First, the most sincere thanks are in order, to Dr. Martin Gelbard. I have had PD for over 6 years now, it is at an advanced stage. I may be put on a course of Isotretinoin for my acne. Will it make my PD worse? If there is no established link, based on the already known mechanisms of operation of Isotretinoin, is it likely that there would be any worsening? To sum up, taking only acne and PD into consideration - will the Isotretinoin be worth the risk? Many, many, thanks.

I have seen no problems in my patients using isotretinoin in the presence of PD, and my search of the literature does not show any direct contraindications or warnings specific to the PD patient.  To my knowlege, there has been no prospective scientific study regarding the effects of this drug on PD, but based on its mechanism of action (supresssing sebaceous gland secretion) I would consider it reasonable if the acne itself is severe enough to warrant treatment.  MG  

06/30/2012 - 14:19
On the road to Peyronies...

Hi, First of all, I can't thank you enough for starting this forum and helping people out. I am 26 and for almost a year now due to extremely busy work life have not had the time for a personal life that lead to occassional bouts of masturbation. The only problem is that the duration of such activity became longer and longer, as well as the wear and tear on the skin. One day, during a particularly rough session, as I looked at my penis, there was a reddish lump beneath the head, a bit to the side. The lump was soft and painless yet scared the living daylights out of me. I managed to keep the first erection up for around 3 hours, and ejaculated twice after that as well, the third time lead to the lump. I immediately went online and read around and concluded that this must be thrombosis or scelerosing lymphangitis and gave everything a rest for 4 to 5 weeks even though the lump was considerably reduced on the 4th or 5th day. Then just to see if things worked properly, I masturbated to see if the plumbing worked again. Everything was fine. Then, a few days later, trying to push the limits, I managed to get another lump, around the same place. I am now certain that the abuse I have been putting on my penis has probably lead to Peyronies. Because the skin where the lumps were now looks more damaged (wrinkled) and of a lighter color. If this is the onset of Peyronie's, can early action save me? I wish to avoid going to a urologist till it becomes absolutely necessary. If, on the other hand this is penile thrombosis and/or Mondor's disease, can they also lead to Peyronie's? Any help would be greatly appreciated. Thank you in advance.

Peyronies will not cause any changes in the overlying skin, nor does it usually present in this fashion.  I think you probably have Mondor's syndrome (thrombosis or clotting in superficial veins) which is usually self-limited, and will not lead to Peyronies disease. Some authorities prescribe a week or two of low dose aspirin for this. MG

06/27/2012 - 17:37
5 + Years Peyronies

This is a great site, thank you!! Had a great sex life, pulled out during a thrust in and heard a pop, bothered me a bit for a few months but nothing serious. Then I noticed my erection felt odd and I lost sensitivity. From highly sensitive to barely sensitive. My wife started to feel pain from my penis bending up and me taking so long to ejaculate. The extra time and friction caused her discomfort and for the first time, I would roll over and give up. My Urologist diagnosed Peyronies and said the calcification seems to be limited to the base of the penis, which makes the penis point up against my stomach, but it can be pushed down, but will take a hard turn right at that point. Pushing down and to the left seems to make it go back to the upright position. The erection feels too hard at the head and not hard enough at the base. The sensation at the head is a bit of stiffness where it doesn’t belong. I tied the verapimil cream for a while, it helped (or so I thought) a little, but plateaued real fast. I am 62 years old, over weight, take paroxitine 40 mg a day, Bayer 81 mg per day, metropol ( 130/80 BP ). I can have an erection and ejaculate, but it takes a long time to get to ejaculation. Any suggestions would be much appreciated. Thanks very much

It is not clear how long you have had the severe bend.  If Xiaflex (collagenase) is approved by the FDA sometime in 2013 this may help your cuvature considerably, if it is not calcified on x-ray or ultrasound.  If it is heavily calcified, surgery may be a consideration - you need to make sure the surgeon has plenty of experience with PD.  You may know that paroxetine is used to delay orgasm in men with premature ejaculation - I assume you are taking it for depression.  It is probably contributing to your problem in coming to a climax.  MG

06/27/2012 - 17:46
Treatment options: COLLAGENAS and Pntoxifylline

I have had PD for about two years and am 62. I am otherwise in excellent health and condition. After I doubled my dosage of vitamen E I thought I saw slight improvement but no longer. IF anything I think I am worsening and in just the last 6 months have had trouble with intercourse. Entry is difficult and once accomplised, I have so little to work with it is difficult to thrust. I find this very depressing. Is it worth it to talk to my uroligist (actually I have only seem him once) to explore either/both taking COLLAGENAS or Pntoxifylline? The data for either of these drug is at best luke warm. Frankly I am a bit desperate. Thanks in advance

It would definitely be worth discussing this with your urologist.  Pentoxyfilline is commonly used in PD, though there is no good controlled data on its effectiveness.  Collagenase (Xiaflex) has shown quite a bit of promise in phase II and Phase III studies, so it may be an attractive alternative within a year - if it gets FDA approval.  MG

06/19/2012 - 14:53
How much Of A Curve Is Too Much?

Hi, I was wondering how much of a curve is too much. Mine curves to the left, about 35 degrees. At what point is a curve too big, assuming it were to curve to the left? Also, does Peyronies cause pain during sex, as I'm a virgin, and I'm wondering if it will cause me or my partner pain. Thanks for your time, John Doe

That degree of curvature will probably not cause pain for your or your partner. MG

06/17/2012 - 22:18
Pntoxifylline for PD

I'm curious why therer is no mention in the forum or TREATMENT section about this drug. I was just prescribed it by my urologist but only found sopmething opn the web from 2006 where it states the drug "may have efficacy in the treatment of PD". Until I asked my urologist about my problem I didn't even know there was a name for it and the reason I'm questioning the drug therapy is that I don't like the associated side effects such a dizzyness, headache & some anxiety. In any case, after two days of Pentoxifylline I rather live with the erectile bend than suffer with the waking side effects of this drug.

The treatment section needs updating in this regard, as pentoxyfilline is prescribed by many physicians for the treatment of PD. Unfortunately there is no peer reviewed placebo controlled clinical trial data confirming its effectiveness. MG

06/17/2012 - 22:12
Ventral curvature

Hi, Dr. Gelbard, great site. I'm 31, I have a ventral curvature of possibly 10 degrees, I'm not 100% positive but think it might have resulted from an old injury, however I'm concerned, the length of my penis as is already bothers me, and concerned if the condition progresses surgery might be the only option, in that possible eventuality, can a ventral plaque be grafted so as to reduce loss of length? These issues are highly frustrating, a man walked on the moon in 1969, it boggles my mind these issues are so difficult to treat.

It is possible to incise & graft a ventral plaque that is causing downward bending.  Extensive ventral grafting can lessen erectile rigidity, however. In the ongoing research with collagenase for PD, patients with ventral bending have been excluded from clinical trials. If it gains FDA approval in the future, the indications may be widened to include patients with ventral bending. MG 

06/17/2012 - 22:05

Is there any risk of vasectomy resulting in Peyronie's disease or makes an existing condition worse as would be the case? I'm quite paranoid about having this done.

There is no data to suggest vasectomy could cause PD or make an existing case worse.  MG

06/17/2012 - 15:03
Prednison treatment

Hello. I have peyroni plaque about 2 cm dorsal for 4 months. I wonder if the disease is an inflammatoric or autoimmun reaction why not try a oral prednisolon treatment to dimish the inflammation and pains? Ex prednisolon 25 mg fore one or two weeks, dimishing to 12,5 for one or two weeks more? What is your knowledge, or experience about this kind of treatment? Greetings from a Danish doctor..

Your reasoning is excellent - others have made this observation and incorporated corticosteroids (oral medrol dose pack, intralesional decadron or trimancinolone) into treatment regimens over the years.  Unfortunately the results have been disappointing.  I prescribe  a limited course of corticosteroids for my own patients only in those rare cases where pain is unremitting and disabling. MG

06/17/2012 - 15:08

This may seem an odd thing to ask, but I'm 31, and occasionally I get erections while wearing shorts or blue jeans if I'm thinking of sexual things. I normally have a slight downward curvature, but if I have an erection where my penis penis is pointing upwards while confined within my pants will this cause peyronie's disease? I don't think I ever become fully erect when this happens simply because it has no where to go.

No I don't think you need to worry that this will cause PD.  However, congenital curvature  may make you slightly more likely to develop Peyronies as it exposes the concave side of the bend to increased mechanical forces during intercourse. This would really only be an issue in response to repeated rough sex.  MG

06/15/2012 - 20:18
What Makes It Peyronies?

Hi! I had a few questions about Peyronies. Peyronies is often described as a a curvature of the penis. How is this angle of curvature measured? When I measured my curve, I measured from the center of the base of my penis to the center of the tip, is this the correct method of measurement, assuming the penis curves to the left? Also, how large does a curve have to be in order for penetration to be impossible (when I measured mine, I get results between 30-40 degrees to the left)? Thanks for your time, John Doe

Some degree of curvature is normal - having a bit of a bend does not mean you have Peyronie's. Generally the overall angle is measured from the part of the shaft joining the body to the direction of the shaft at the far end of the penis. Usually an angle of > 50 degrees up  or >35 degrees down starts to interfere physically with intercourse.  MG

06/15/2012 - 20:28
double trouble

I have PD for sure, i diagnosed it via web sites, and have been to the clinic where im now awaiting ultrasound, to confirm this. I noticed i had this lump half way down my penis when i was going to the loo, which scared the hell out of me, as i thought cancer, then when i got an erection i noticed slight shortening, an hour glass shape with a bend up wards and painful to maintain and erection.. it looks like a boomerang and it has knocked my self confidence for six. i didnt do anything for months to see what would happen, also after reading various sites i decided its PD, months later i then had sex with this matter and it seems i damaged it further during sex due to it popping out and basically it hurt and i felt/heard a popping sound and now i feel 2 lumps practically on top of each other within my penis. At this point was when i went to the clinic and saw a doctor who confirmed it is possibly PD and hence im now awaiting ultrasound, im worried this is the end for my sexual life im only 31, im worried and stressed as a result i don't even know how or what i can do .... nothings changed over time even from the first lump it hadn't changed,my love life has become none resistant as getting an erection proves painful and i feel its not worth the risk of even more damage... what will i do if this is how it will be for the rest of my life ? there must be a cure .... or does every option come with a possible negative consequence? sorry in advance for negativeness but i feel pretty useless as a man and for my future as a man.

At age 31, there is no chance this will end your sex life.  But it will take a while to recover.  Usually the inflammatory or painful part takes 6 months or more to settle down. Though the lumps ("plaques") may go down, some degree of curvature may persist. If the work with collagenase continues to make progress, the drug xiaflex may become available next year  -  in clinical trials the results appear reasonable. Even in a worse case scenario, if you have severe curvature or dense calcification, the results of surgery are quite good in your age group.  But the chances you will ever need surgery are slim.  MG

06/15/2012 - 20:29
My erection is un drasticaly uneven, soft with small diameter at base hard & regular top

I have been depressed over an unwanted divorce, I live in a new town and have been masturbating a lot more than normal. I have always had normal erections and noticed no injury. One day going to masturbate i noticed an uneven erection and a bit softer than normal.when aroused, The base stays soft and pretty bendable with a small diameter as the rest grows like normal, kind of like filling a water balloon but normal diameter at top. I can still climax but it hurts a bit with tingly sensations that can go to my toes. It is only an issue during erection, It is scary. I don't have the money for any major doctor trips and don't have insurance. Does that sound familiar?

Fortunately, this does not sound like PD.  MG

06/15/2012 - 20:35
One year post diagnosis

I was diagnosed with Peyronies a little over a year ago. In that time the hard patch (calcium? Fibroids?) under the skin has gone from near the tip of my penis to close to my abdomen. Because of this the curve went from close to the tip to now the whole penis is trying to curve making intercourse difficult. The erection is not as strong as it used to be, and sometimes the penis wants to fold backward - in half- curing sex...this hurts! What are my options for treatment? Thanks. Tim

With severe bending that causes the penis to double back, and duration of PD> 1 year, you may wish to consider plaque incision and grafting - by someone who does this on a regular basis. Plication surgery, or "nesbit" would cause unacceptable shortening with this type of severe bend. If you can deal with the current situation for another year and you don't have plaque calcification, it is possible that xiaflex might be an option if it gets FDA approval. MG

06/07/2012 - 21:34

I recently had exploratory abdominal surgery and an appendectomy due to a necrotic piece of tissue between appendix and intestine. The next day when trying to urinate I had to strain immensely and could not go at all the first couple of times trying. The nurse offered to catherize me but I decided I would continue to try on my own. Eventually, I was able to get started and it was fine. That same day I noticed that my penis felt strange in my own hand. It just didn't feel like mine. Upon further inspection I was noticeing that it was like it was broken. At the top of the shaft it was able to bend like a joint would and more towards the base, it felt like this also. The back side was swollen just below the head. As the days went on, I noticed it starting to bend upwards when erect and the head not swelling as much as usual. There was/is a discomfort near the tip when erect. I went to an uroligist and he diagnosed PD. There is a lump of plaque now growing slowly near the head. I have not had any trauma other than the surgery. Could this have triggered the PD ? This is strange that it happened the very next day. The only other thing different in my daily routine is that I have been taking Lamisil for about 3 months for toenail fungus. I have had gout and was on colchicine and allupurinal for a few years and have stopped the colchicne about 1 year ago. I continue to take allupurinol. Can you find any coorelation between any of this? Do you know anything about Neprinol? Would it be benificial ?

Peyronies Disease can be associated with some surgical procedures, such as radical prostatectomy or urinary tract endoscopic operations.  These all directly involve penile anatomy in one way or another.  I am unaware of any cases coming on after an appendectomy - the association among the events you described is really a mystery to me. Neprinol has its adherents, though there is no peer-reviewed controlled clinical trial data on this supplement. MG

06/02/2012 - 22:09
Glucosamine/Chondroitin as cause

Dr. Gelbard, I am 51 years old. After using Glucosamine/chondroitin at recommended doses for about 3 weeks, I noticed I was getting painful erections. After reading about a possible connection to PD, I stopped using the supplement immediately. I noticed that I now have a "hard nodule" on the shaft of my penis near the start of the glans. There is no curvature yet. It has been about a month since I stopped the supplement but the pain and nodule are still there. Do you think this will clear up? I have doctor appointment scheduled but it is not for a few weeks and I am concerned. I never had any erection pain before taking the supplement. Thank you.

It is likely that this will clear up.  Since there has been so little time elapsed since it started, I would reccommend some type of anti inflammatory regimen such as oral colchicine 0.6 mg two or three times a day for several months if you Doctor agrees.  I have heard of others who developed similar problems after taking glucosamine / chondroitin supplements, though to my knowlege there has been no well controlled scientific study of this observation.  MG

06/02/2012 - 22:03
Enzyme treatments + nesbit

I am 54 and have had PD for about 5 years now. I was going through the treaments of Colchecine, and verapamill- external application and shots. It didn't help much. I have about 70 - 80 degrees upward curve.I never suffered from pain (my wife does) and the curve is not worsening. I lost about 1/3 of legnth. I have 2 questions: What do you think about enzyme treatments and what is the percentage of ED suffered with the nesbit procedure. just found your website and want to thank you for it.

Regarding the enzyme treatments (Xiaflex or collagenase clostridium histolyticum, which is being developed by Auxilium Pharmceuticals Inc) I would refer you to our article that just appeared in the June issue of the Journal of Urology.  You can probably get the abstract through the Pub Med website (national library of medicine). Based on that data I would say it is promising. In a man with good erections, the likelihood of developing ED from a Nesbit procedure is quite low - probably 5% or less.  MG

05/31/2012 - 17:26
Med's and procedures

I have had peyronies for almost 2 years I discovered it about 2 weeks after my son committed suicide. I masturbate very rarely and have not been with a woman in over 12 years. I had ED problems a few years prior to the peyronies. I started using Verapamil cream and Potaba pills. for 1 month now with no results! Really Doc. does any of this stuff really work? Injections included which is the next step Verapamil as well. I havent in your forum heard anyone say that anything has worked! Is surgery or implants really the only way to go? I havent heard any one even say that that was all that successful either. Would you by chance tell us here what you think is the best way to fix this problem. The ones with the highest success rates ? Their is a girl I'm now intrested in and she is probably wondering why I haven't made a move ya know? Due to my peyronies Their is no way intercourse is going to happen in my condition!

The treatment decisions are complicated, as they depend on how well the erection works in addition to what type of curvature / deformity there is.  For the most part, the conventional oral or topical medical therapies such as potaba or verapamil cream are not very effective.  Injectable verapamil will help some patients but not all.  The research recently published in the June issue of the Journal of Urology suggest there is promise to the new drug Xiaflex, though it has yet to be submitted and approved by the FDA.  In those patients with longstanding problems where medications haven't worked, plication surgery is effective for minor bends, grafting for more significant deformity (in those with good hard erections) and implant surgery can be very restorative in those patients with PD and very  poor or soft erections.  MG

05/31/2012 - 17:29
Peyronies and Varicocele

Sir, Thank you very much for your immediate reply. Whats the exact cost of Nesbit Plication procedure? Is it for life time or temporary process? Does the procedure lead to any problems or difficulties during sex? Sir, I have recently come to know about varicocele.... I have my testis a little bit hanging when penis is erect. However,when penis is not erect,the testis are normal i.e. not hanging or streched downwards..... Am I suffering from varicocele?How to ensure this? If yes then what are remedies? Are Peyronies and Varicocele both genetic? Thank you.

Nesbit surgical fees are in the $1800 to $2,000 range, with facility fees (to hospital or surgery center) of about $3,000. Varicocele feels like "a bag of worms" due to varicose veins in the scrotum, and usually occurs on the left side. MG

05/30/2012 - 17:37
Peyronie's Disease

Hello I m 24 yrs old and have some questions. Firstly,thanks to u Dr Gelbard tht this forum has cleared lot of doubts. I have bend to the left side from the base of shaft of penis wch is more than 45 degrees; and increasing. Also the black outline to the outer side of shaft of penis is askewed and not straight. I have no pain in my penis. It also seems to me that... I dont have any plaque. Is it Peyronie's disease? If not then what is it? Is it serious? Still I am very concerned about this bend to the left side.Because I am sure it has been increasing for years. Earlier 7-8 yrs ago it was not severe left. But I findit increasing...... Wht should be done to stop this curvature? Sir what should I do?The bend is going to increase for sure.Should I use devices to get the curve right? Should I use supplements?

If you have congenital curvature, the concave side is exposed to greater mechanical tensile stress, which can lead to scarring on that side.  This is turn can increase the bend, and may be the reason some men born with moderate curvature will find it gets worse over the years.  If this is indeed happening, you may want to consider undergoing a nesbit plication procedure which will even out the stresses, straighten the penis, and probably help to prevent future progression. I don't think supplements will do much, as you probably don't have PD.  MG

05/29/2012 - 14:41
Is this Peyronies and will this curve be too much?

Hi! I have a 30 degree curve to the left in my penis. There are no hard spots and it doesn't have an hour glass shape. I don't have any pain with erections either. I noticed it when I was about 10, and am 18 now. The curve only shows up when I get hard. Is this Peyronies and will a 30 degree curve be to much for penetration, as I'm a virgin and haven't found out for myself? Also, can the way I masturbated for years (I was in my bed leaning the left, the same way as my curve) cause my curve? Thanks, John Doe

No, this is not Peyronies and a 30 deg lateral curve will not interfere in anyway with intercourse.  You have congenital corporal dysproportion, which is a fancy way of saying you were born with the right corpus being slightly larger than the left.  With erection, this causes a slight curve to the left.  This is not the result of masturbation technique.  MG

05/29/2012 - 14:45
37, chronic recurring prostatitis and now this?

I'm 37 years old and about 6 years ago I was diagnosed with prostatitis by my urologist (I found him simply due to the pain in testicles and general genital area). It has come and gone... It comes back with a vengeance when I'm under stress, and pain varies from general bladder/prostate area to back, testicles and sometimes penis. Nonetheless, OTC anti-inflammatories and a couple of weeks without caffeine tend to resolve it. I've never been prescribed antibiotics for it, despite reading that this is common. Anyway, recently I felt like maybe I had a urethral infection or UTI of some sort. The opening of the urethra and glans of the penis were swollen one day, and following that it seemed to get slowly better, with slightly blotchy or red glans. I wasn't too worried until I had an erection one morning and noticed it was leaning to the left and the head/glans seemed slightly twisted (turned), along with slight pain in the one side up near where the glans meets the shaft (pain from shaft, not glans). It freaked me out. Erections are strong and I have had sex with my wife several times, and sometimes it seems the angle to the left reduces, but the twist of the penis head doesn't change, it's there when I'm erect and even slightly when not. I went to my urologist. He looked at me for about 10 seconds and said I had PD, and to take a low dose of ibuprofen for 3 months and come back. I had not much pain at that time, but after the exam pain went through the roof.... it ranges from a dull ache to a shooting pain, and now I have what is maybe prostatitis symptoms, including pain near the anus, and up in my "pelvic floor" muscles, testicles, a slightly hard flaccid penis at times (comes and goes), along with a feeling of either pressure, pain (shooting or dull), or "itchy" feeling, much like when I have a partial erection, resolved by bringing myself to full erection, but inconvenient throughout the work day or while driving. I have very little pain when fully erect, and my wife and I have had sex, and in fact it seems to relieve pain. My wife and I have had sex even more often since having this (6 weeks?), because it seems to relieve pain, although it may hurt more afterward if we are not as careful about the one tender area.... If I get a really full erection (with partner, strongest mental stimulation), I see very little angle to the penis, but the head-twist is there. Although the urologist says he could feel something on there, it's in the area just below the head, where my foreskin bunches up and even when I pull it back, I can really barely feel any sort of bump or anything there.... I do feel the soreness or pain if I am too rough right in that tiny spot. Is this really PD? I have an appt with a specialist at a research hospital clinic in Houston (where I live), because I want a second opinion and I want to know why my prostatitis has come back with a horrific vengeance. I haven't had a flare-up this bad in years.... Other items of note: Severe work stress (changing jobs, and major turmoil at work, plus concern over penis problems??).... Also, the idea of a shortened or problematic penis terrifies me. As it is, my penis is only about 4.5 inches fully erect, so the idea of it shortening, as a relatively young man (37), and affecting my sex life with my wife makes me very anxious (I'm already susceptible to anxiety and have taken meds for that, but I'm out...).. I also had adhesions of my foreskin to glans that were only resolved by surgery 8 years ago (I was a virgin until I was married 6 years ago), and I wonder if I already had this scarring and an infection has inflamed it, causing the slight angle to the left? I know anxiety and stress flare up prostatitis, but does this sound like a typical case of PD? A serious one? Will it get worse or better, stay the same? Will the pain subside, and if I can resolve the prostate flare-up, will that help? I know that's a lot to throw out there, and I do have a second opinion coming, but a third opinion from an expert is very welcomed.

I'm not even sure this is PD, but I know that with painful early PD, erections and intercourse make the pain a whole lot worse and this doesn't sound like your case to me.  Furthermore, PD will not cause pain in the anus, pelvic floor, etc. - that sounds more like prostatitis.  MG

05/25/2012 - 13:59

I have been on Bystolic for about 4 to 5 years, after suffering a heart attack. I am now 59 and have recently been dignosed with PD by a nurologist. My question is, if my PD was in part caused by taking a beta blocker, would changing the medication now possibilty help correct the problem, or is the damage already done? The PD started about 4 months ago. In other words, would you suggest talking to my heart doctor about changing the medication or is it to late to help? Thanks so much for this form...

We don't have any definitive evidence that beta blockers cause PD, but they do seem to aggravate it.  As the PD process can go on developing for well over a year, it would be a good idea to get off the Bystolic even if you have had the PD symptoms for only 4 months.  That is, of course, if your cardiologist thinks there is a safe and effective alternative drug.  MG

05/23/2012 - 17:49
very slight bend

Hello. I first noticed a small "dimple" or small dent just beneath the tip of my penis. I thought nothing of it. About 7 months ago, I think I might have sustained a injury to my penis during sex. It didn't hurt or pop or anything, just felt bad for a fleeting moment. Today, I have maybe a 5-10 degree bend (it really is almost straight), one half of my penis fills up all the way, the right side does not. The head of my penis doesn't seem to fill up as much. It used to hurt during intercourse with my girlfriend, but not anymore. There is never any pain anymore. I can feel a small lump at the base of my penis. I am taking Vitamin E, L-Cartinine, and L-Arginine. I don't really know what to ask, Dr, just looking for general advice. I dont even know if I have peyronie's - in fact when I went to see my primary care physician 6 months ago, he told me not to worry about it (that if i had damaged my corpus cavernosum i would have known due to the pain)

There is a wide range of those scarring responses we call "Peyronies disease".  From the dimpling, assymetric inflation, transient pain and slight bend, I would suspect you have a very mild case which has stabilized and will probably never get any worse. I think it would be good to stay on the supplement you are taking for about a year.  MG

05/22/2012 - 21:22
Angulation at the base

Hi! I have an angulation at the base, about 60 degrees upwards, that is only present when the erection is really hard, since a little more than a year. The thing is that my urologist seems to think this angulation is the same thing as 60 degree bending of the penis, but I find that strange because the penis itself does not have much of a bend -- it is only that the angulation at the base is upwards, which to me seems different and less troublesome. I've had an ultrasound and they think I have some diffuse type of peyronies or somethings similiar. I have some other symptoms, like a little band of raised penile tissue on the left side, increased sensitivity, hard flaccid, less flexibility when erect (too rigid/worried it might break if I have intercourse)and sometimes prolonged erections and hourglassing when becoming erect. The first symptoms appeared about 16 months ago and it hasn't changed much since last summer. The size is the same as before. Do I really have a peyronies plaque at the base or is this more likely to be some diffuse scarring of the entire tunica? And, do you think intercourse is possible/unwise when it's like this. It's really rigid and inflexible so I'm a bit worried I might fracture it if I try. Thanks for a great web page!

I suspect with the way a rigid erection is pinned upward at 60 degrees and feels so fixed in that position that you are worried it may be injured with sex, that you do have a peyronies plaque at the base of the penis where the suspensory ligament attaches it to the pubic bone. Remember that the plaque is nothing more than scarring in the tunica albuginea (the wall of the corpus cavernosum), and this may have come on as the result of some past trauma.  If it has been stable for 16 months I doubt it will progress.  Fortunately, as long as you avoid levering down on the erection, there would be little functional impairment to expect from having the (straight) erect penis be at a 60 degree angle to the body axis.  MG

05/21/2012 - 16:01
weird injury

Hello Dr, I want to begin by saying that reading through this forum has helped tremendously. However I a still not convinced whether I have peyronies or not. Let me start from the beginning, October of 2010 I used propecia for about a month. I don't recall any traumatic injuries except I slipped out one time during intercourse which has happened a handful of times with some slight burning feeling but no ache. I was on top so it wasn't that hard.BTW this was way earlier, long time before. Anyway within 10 days of dropping the drug I started getting incomplete erections which dents in right below the head and slightly lean to theright. This only happens when semi erect incriminating achieve a full erection it is perfectly straight but I do feel occasionally soreness at the site where I get the renting. I never have pain fully erect nor do I have any plaques or knots. 2 urologists one being a specialist examined and said he couldn't feel anything at all. Now I know something has happened and its not in my head because it takes a little massaging and manipulation to get the dented area to fill out which it does. But this cause ls me not to I've any solid rigid erections just by thought it has to be "adjusted". The doc said I probably have a little scar tissue in there but it had been nearly 17 months and I still feel some stinging in there occasionally but ONLY when flaccid. I got this at 29 I have been taking pentoxifylline 3x a day but urologists don't seem convinced I have peyronies because there's no sort of hardening just something obstructing bloodflow right under the head. When I wear warm pants it fills out easier as well. What your take on this I can mostly tell where the weird hourglassing is when I'm flaccid.

This sounds more like some type of local reaction to trauma (which has not progressed) than the scarring we usually call "Peyronies Disease" - which is to say your chances of this resolving are better.  MG

05/21/2012 - 16:03
Condom use

Hi I'm 30 years old, mild PD from injury in years past, married 2 kids, and recently my wife had issues associated with her IUD, and so we've had to resort to condom use for the time being. I have difficulty with them, putting them on is painful from just the sheer tightness and during a recent sexual encounter it was difficult for me to even roll it on, so obvious I need to try another size, however is there much risk of injury to the tunica from using the ones I already have. Even though putting them on at times can be painful (too tight) and difficult, I'm mindful not to cause much if any bending of the shaft.

You might want to try switching to another brand. I am unaware of any significant problems occurring in Peyronie's patients due to tight or constricting condoms.  MG

05/19/2012 - 17:29
injury leading to Peyronies?

Hi, Doctor Gelbard. I am 33. I apologize for the long (and graphic) story, but I want to be thorough. 2 weeks ago, I was masturbating. I had already ejaculated twice this particular day and for whatever reason, I tried to go for a 3rd. I was only able to achieve a semi-erection, so in a stupid attempt to achieve a more solid erection, I gripped my penis with my thumb and index finger and performed what I have now learned to be a motion called "jelquing". It is a technique in which some men use to try to enlarge their penis. After a few strokes, I did not achieve any more of an erection, and I found what I did to be rather uncomfortable, so I gave up and went to sleep. Over the next few days, I noticed that I was unable to achieve erections and that I had an ache at the base of my penis. I also noticed that my penis was stiff even when flaccid (this was attributed to anxiety by my doctor). I decided to see a urologist. He examined me and recommended that I "rest" for about a week. I did so and within a few days I noticed that I was getting erections again, but they were very weak. I noticed that sitting up made my erection harder, but it would quickly soften again if I lied back down. Then a couple days ago, I was having testicular pain so I went back to my doctor. He said that I had "blue balls" and recommended that I very gently masturbate to "clean the pipes". The next morning I used my slight morning erection to my advantage, and was able to bring myself to climax by simply massaging my testicles. The next morning I also experienced a "wet dream". I awoke with a mild erection and ejaculated almost immediately without any stimulation... Here's where my Peyronie's question comes in: Since all of this, my erect penis has taken on a seemingly slightly different shape. It hasn't been anything major, until last night. I was urinating and upon completion felt my penis begin the erection process. However, when I looked at it, there was a rather severe (but gradual, not sharp) curve to the left. I quickly did a mental "de-arousal" and left the bathroom. This happened again later in the night. My urologist said that my penis seemed normal, but this was before this curve appeared... This "curving" incident is 2 weeks to the day from the "jelquing" masturbation incident. I intend to follow up with my urologist again, but do you think it's possible that I have caused some kind of injury that is resulting in development of Peyronie's? Thank you.

No I don't think you have developed PD over the last 2 weeks.  I believe you may have temporarily traumatized the cavernous erectile tissue within the penis by the pressurizing manuever you described, and this can result in temporary firmness of the flaccid penis and changes in shape. MG

05/18/2012 - 08:52
Do's and Dont's

I am 52 years old and about a month a go I started experiencing a little pain during intercourse and then noticed a hard spot along the top of my shaft near the base. I have been way from my wife for about a 10 day period and when I returned home yesterday and we had sex I noticed that I had a bend near the base of my penis to the left. I have also noticed that sometimes I am not as hard as I use to be but I thought this was just due to age. Anyway, my question is weather or not I should continue to have intercourse right now. I have an appointment with my Dr. soon to diagnose and begin treatment but by my explanation by phone he is pretty sure that I have Payronies. Are there any other does and Dont's that I should be aware of. Also could you recommend the best clinics to go to and the best treatment at this early stage. Thank You.

If you do have PD, there is no need to avoid sex, as long as you avoid activities that are painful or put a great deal of mechanical stress on the erection. In fact one of the challenges for men dealing with PD is to remain sexually active to some degree, rather than retreating from it and suffering loss of intimacy in your relationship etc. There are no restrictions on diet or medications, with the exception of beta blockers (usually for blood pressure) that may aggravate peyronies, or large doses of glucosamine / chondroitin supplements (for arthritis and joint health) as there are anecdotal reports of problems with these products.  Try using the finder in our links section to identify physicians with special interest / training in treating PD, listed geographicallly.  MG 

05/13/2012 - 15:00
Peyronie's age 18

I am 18 and pretty sure I have peyronie's disease. I began to feel pain after having masturbated 3-4 months ago. I have always had a slight curve to the left, however now when I get an erection it curves even more to the left and I have a couple hard cord-like lesions(which i assume is the plaque) going two different directions from the base of my penis to close to the top. When I am lying down the curve with an erection is hardly noticeable, however when I stand up my penis seems to hang much more to the left. I also notice what appears to be a vein when flaccid, and in the coming days after masturbating I'll sometimes have pain on the right side at the base of my penis when flaccid. Does this sound like Peyronie's disease to you? If so is the curavture likely to greatly worsen over the coming months? I have not consulted a physician.

If you really had the scarring and plaque that characterize Peyronie's, I think the curvature with erection would be pretty similar lying down or standing up. Also, PD does not seem to be associated with dilated or inflammed veins. This sounds to me more like some kind of delayed response to trauma, which at your age is likely to resolve with a temporary reduction in the intensity of sexual activity.  Note that pre-existing or congenital curvature to a given side will make that (concave) side more vulnerable to trauma. MG

05/10/2012 - 18:03
Protein Supplements and a worsening of the condition

Dr. Gelbard, I am 29, and I *may* possibly have mild Peyronie's from an injury several years ago. For fitness I lift weights and to maintain/build muscle mass I take 2 -3 scoops of Whey protein powder. Should I worry about this protein supplementation causing the condition again, making the condition worse, etc???

There is no reason to worry about the effects of protein supplement on PD - as far as I know there are none.  The only association of PD with supplement use that I have heard of is glucosamine / chondroitin (used for arthitis). I should emphasize strongly that this relationship is unproven at present, though I have a had a few patients where this seemed to be an issue.  MG

05/10/2012 - 13:41
Do I have Peyronies?

I Noticed about a year ago that my penis was distincly shorter and with a much sharper upward bend. Much like the Wikipedia photo. It has an hourglass shape and is about a 1/3 shorter. My Doctor and I had discussed my borderline highblood pressure but when he suggested that the cause of my shortned penis might be a blood pressure issue I immediately folled his suggestion and went on Bystolic. While my blood pressure is now perfect this did not improve my Penis. Researched, discovered Peyronies and asked him about it. He recomended a urologist. I went to him but I may have poisend the well in that I basically announced my diagnosis. He examined me briefly and commented "I don't even feel a lump". So my question is: If there is no lump do I have peyronies?

I believe the answer to you question is yes.  In many cases Peyronies can cause linear scarring which produces deformity but not any palpable "lumps" bumps or plaques. In light of the new onset of upward bending, hourglass, and length loss I would say you do have Peyronies. Based on this I would talk to your primary doctor about switching you to a different high blood pressure drug.  Bystolic is a very good drug for blood pressure, but it is a beta blocker and this class of drug may be associated with aggravating Peyronies disease.  MG

05/02/2012 - 17:47
Timolol and PD?

About 6 months ago my opthamologist doubled my dosage of timolol eye drops to control glaucoma, and probably about 4 months ago I noticed about a 15-degree curve to the left, with a depressed area in the tunica about 1cm causing the curve. The timolol info sheet lists PD as a potential side effect - is this rare and might it be reversable with the discontinuation of timolol?

timolol is a beta blocker, and these drugs have been associated with PD.  I would recommend your have your eye doctor give you a different medication, if that is possible. This is likely to be reversible if the time span is short. MG

05/03/2012 - 14:25
Beta Blockers and Peyronie's Disease

I am 57 years old and about 3-4 years ago I was having Erectile Dysfunction. I was taking Lopressor for hypertension which is a Beta Blocker. It was very difficult for me to get an erection and when I did it would go limp when I went to penetrate my wife. Sometime my penis would not get hard. My erections were soft and I could not penetrate my wife's vagina because my penis was not hard enough. My wife stimulated my penis by rubbing it with oil, masturbating me, etc. but nothing worked. After getting my Blood pressure under control without medications I started to get better erections sometimes. But when I did my penis had a slight curve to the left side and it had a upward curve along the shaft toward the head of the penis. My penis was straight with no curvature prior to this. I went to a Urologist and he diagnosed me with Peyronie's Disease.I never had pain but he felt 2 small lumps in my penis. He prescribed 100 mg of Viagra to take prior to sex so I could have more firmer erections. My erections now are very hard within 30-45 minutes after taking Viagra. I now enjoy a very fulfilling sex life. My wife always has an orgasm and I am able to ejaculate in her vagina. I have intercourse once every week with no pain or discomfort. Is it possible that I got Peyronie's Disese from the Blood Pressure medication? I read that Beta Blockers list Peyronie's Disease as a side effect.

Please see the forum entry adjacent - there does seem to be a relationship between beta blocker use and peyronies disease. It is good to hear that you remain fully functional, which is often the case in PD.  MG

05/03/2012 - 14:22
Beta blockers and Peyronies

Background: I'm a 28 year old male and about 4 weeks ago, I noticed my penis had a noticeable indentation about a 1/2 inch above the base. It looked as if an elastic band had been wrapped around the shaft in a slightly diagonal direction. The indetation on the right side was much more pronounced and only slight on the left side. Seems to be consistent with what this site calls the diameter reducing hourglass shape. I was completely horrified and made an appointment with my doctor who referred me to a urologist. After examination, I was told I had Peyronie's plaques (actually a few) throughout the penis) and that they had probably been there for a while, but only just gotten bad enough to cause noticeable distortion. Questions: 1. I have been on Toprol (beta blocker) 25mg for about 4 years. Peyronnie's is listed as a possible side effect, but my urolgist doesn't think it's related. What do you think? 2. I strength train 5x a week and take a Glutamine supplement for muscle recovery (5 grams of L-Glutamine immediately after workouts in 12 oz of water). Do you think this could have contributed to my development of PD? 2. My urologist prescribed a vitamin E treatment (200 IU x3 daily) for 4 months leading up to my follow up with him. I noticed 400 IU seems to be the suggested amount, am I taking too much? I've heard of additional health risks associated with higher than upper limit vitamin E doses. 4. I have difficulty maintaining an erection during intercourse, but not during masturbation. I think this is all mental and due to PD-related anxiety. Is there anything I can do to mitigate this other than trying to ignore it? I'm married so my wife is understanding but it is nontheless embarassing, plus I shouldn't be having this sort of issue at 28.

Although there is no convincing proof, many reports suggest there is a relationship between beta blockers and peyronies disease.  It is not know whether it contributes to causing this problem, or making a mild (sub clinical case) that would otherwise escape detection show up.  400 IU is the standard dose for Vitamin E - taking more than this is not recommended.  Even if your current erectile problems are due to anxiety, it would help you if you used one of the phosphodiesterase inhibitors (viagra, cialis or levitra) for a while.  MG

05/03/2012 - 14:27

Can taking propecia cause peyronies?

There is no evidence to suggest this.  MG

05/03/2012 - 14:54
Curved Penis

I am 18 years old and have a curved penis. It has always been this way but it has recently become a lot worse. I first had sex with my girlfriend when we were 15, and despite the curve, everything worked fine. We were away from each other for about a year when we were 17, so were not able to have sex. I am not sure if it developed during that time. Now we are together again, and when we do have sex I have to be extremely careful so as to not hurt her. I think the curve is a lot worse then it used to be. When I was younger, I was always really rough with the way I masturbated, so I am not sure if this could have caused it or not. I do not think I ever had an lumps or scars that they say are signs of Peryonie's disease being developed. Any help would be greatly appreciated. Thanks.

You do not have Peyronies Disease, but congenital curvature of the penis.  This is a benign condition which is a slight variation of normal anatomy - the two erection chambers are of slightly different size, which causes bending.  It the bend is severe enough to cause problems with sex, it should be corrected surgically by one experienced in this type of reconstructive work.  MG

05/03/2012 - 15:10
PD Onset

I have recently had trauma three four months ago. I have a hard plaque on the left side and curvature. Also, the vein on top seems to be hardened. My urologist has prescribed vitamin e and L-Carnitine. I have read that Acetyl L-Carnitine should be used. Is there a difference? The head of the penis seems to have restricted blood flow. I have also read that Cialis or Viagra can further damage the tissues. What is your opinion? I have also read about using DHEA and arginine to allow blood flow to the area. I am so confused about what is correct and what is not. Vitamin E, L-Carnitin, DHEA, Arginine. Can you shed any light? Does anyone else have any truthful experience of turning this around?

Acetyl-l-carnetine, l-argenine, and vitamin E are all safe nutritional supplements used in the management of PD. Unfortunately there is little in the way of evidence-based guidelines for supplements or oral medication in Peyronies.  Most authorities feel there is no significant risk using cialis or viagra, if the erection itself is soft. There is no well-established role for the use of DHEA in PD. MG

05/03/2012 - 15:23
Question on PD

42 yr. about six months ago was told i have PD, this after 3 wait and see follow ups. No bend but "tic tac" size lump in lower third of penis. Can get erection but at site has indent and pretty much can bend at section when erect. Can not maintain erection during sex, i think mostly because its on my mind. Does diagnosis sound correct? Is the vitamin e that i read about the same as over the counter or is it prescribed? Any thoughts? Should i get a second opinion? Thanks for your help

This does sound like PD to me. The vitamin E that is used is the standard over-the-counter version.  You should talk to your doctor about getting some pills (viagra, levitra, cialis) to help with the erection temporarily, and possibly some medications for the Peyronies itself, beyond vitamin E. The possibilities would be colchicine pills, pentoxtfilline pills, and/or verapamil or interferon injections.  MG