Friday, 28 August 2009

Natural ways to treat Erectile Dysfunction

Low testosterone levels appear to be linked to the severity of the curve in peyronie's disease (See: Testosterone deficiency). Of course correlation does not imply causation, but even if this link comes to nothing, many men with peyronie's disease do suffer from ED. Should you wish to attempt to address this issue with a natural approach I have a suggestion for boosting testosterone levels, based on the below study.

- A combination of five herbal extracts (Panax quinquelotius (Ginseng), Eurycoma longifolia (Tongkat Ali), Epimedium grandiflorum (Horny goat weed), Centella asiatica (Gotu Kola) and flower pollen extracts) was demonstrated to be comparable to the effects of sildenafil citrate. The study is recent and was carried out on rats, but there are various reports of Tongkat Ali and Horny Goat Weed combatting ED in humans, so this combination may well be worth trying. I've seen a few studies relating to Tongkat Ali raising testosterone levels. Check out the study below - http://www.ncbi.nlm.nih.gov/pubmed/19494825

Of course not all ED problems relate to low testosterone levels, far from it. Therefore there are various other approaches worth trying if your T-Levels are fine:

- L-arginine (see L-Arginine) alone has the ability to combat ED, but for many men it is insufficient. In combination with pycnogenol though, it is much more effective. The synergy between l-arginine and Pycnogenol appears to significantly increase the effects of l-arginine on either atime related or dose relates basis, depending on how you read this. - http://www.ncbi.nlm.nih.gov/pubmed/12851125

- A new study on diabetic men suffering from erectile dysfunction (due to vascular damage and the role of metabolic factors) suggests that propionyl-L-carnitine, L-Arginine and nicotinic acid (Ezerex) help to combat erectile dysfunction. They appear to be somewhat more effective when used with an inhibitor of 5-phosphodiesterase such as Levitra. On the IIEF5 scoring system (http://ts-si.org/files/IIEF-5ScoringSystem.pdf) the most effective version of the treatment showed an increment of 5 points, which in my view means that it's a good option for many men suffering from ED - http://www.ncbi.nlm.nih.gov/pubmed/19624286

Thursday, 27 August 2009

Dr David Ralph

Dr David Ralph is perhaps the best known peyronie's specialist in the UK and is part a practice called Andrology on Harley Street, London. He has written extensively on peyronie's disease and respected urologist Dr Lawrence Levine holds him in high regard. He is the biggest implanter of penile prostheses in the UK and also carries out less drastic peyronie's surgery.

A copy of his CV is here: http://www.andrology.co.uk/cv/David-Ralph-CV.pdf

As there appears to be a certain lack of community in the UK regarding peyronie's disease and reporting experiences, I feel that this is a good opportunity to contribute. If you're a current or previous patient of Dr David Ralph please do contact me with your experiences. Please include as much detail as possible such as:

What kind of treatment you received or are receiving (oral treatments, surgery etc)?

What was your route to treatment (private or NHS)?

If you had surgery what procedure did you receive and was it a success?

Was your overall experience good or bad? Why?

Please also include a contact email if possible.


Your contributions will make the process of seeking help less daunting for other men. Much of the worry about seeing a urologist relates to the unknown, and reading experiences of others will at least ensure that you have a more rounded patient centric view of what to expect.

If you have experiences with another urologist, feel free to get that info to me too. I'll be posting writeups of other doctors, and may compile a list or directory of experiences if I get enough interest.

Saturday, 22 August 2009

Surgery

In cases where curvature is significant (usually indiciated by the ability to comfortably have sexual intercourse), some men choose to undergo a surgical procedure. Surgery should not be considered where the condition is not entirely stable, as further changes to curvature post surgery will negate undergoing surgery to begin with. As a general rule, you should be painfree for six months and not undergoing further physical changes before you consider this option. Waiitng 9-12 months would not be unwise.

There are several different approaches to sugery and the condition of your penis typically dictates the procedure you will undergo. Plication is typically carried out on men with a less prounced curve, and the grafting surgeries are more suited to men with curves over 40 degrees.

Plication - This is typically seen as a less invasive and more straightforward surgical option than others, and involves shortening the convex side of the curvature (so essentially not touching the scarred side at all). It involves placing stitches opposite of the PD scar resulting in the penis being straightened, or thereabouts. This type of treatment cannot treat bottleneck or hourglass deformaties, it is used to treat simple curvature. As with many procedures, improvements are made to the procedure over time. This is true of plication, and Dr Lue's 16 dot technique, is a slightly updated version of the procedure.

Incision and Grafting and Excision and Grafting - With "Incision and Grafting", shallow incisions are made in the scar tissue. This is done to open up the plaque somewhat. A graft (autologous or synthetic) is used to effectively patch up these incisions. In "Excision and Grafting" the scar tissue is actually removed and replaced, again with a graft. With grafting satisfaction is typically high, but for a minority of men erectile dysfunction can become an issue, as well as loss of sensitivity. There are various oral treatments for ED though, and for many men these are effective.

Penile Implant Surgery - For cases where erectile dysfunction is not helped by testosterone injections, viagra and other ED treatment options, penile implant surgery may be the only available route.

Depending on the surgery in question, loss of length may occur during the procedure. Therefore some men attempt to minimise this by using a traction or vacuum device for several months in order to stretch the scar tissue and reduce curvature somewhat before undergoing surgery. In much the same way, men often use vacuum therapy after surgery in order to exercise the penis and reduce any scar tissue and ED issues that may develop post surgery.

Vacuum Therapy Protocol

For those wishing to use the VED to reduce curvature, it would be sensible to use a tried and tested system. The Peyronies Protocol (aka Multi-Cylinder Vacuum Protocol) is a multiple vacuum cylinder approach designed by Chris Spivey, of Urology Centers of Alabama, to treat peyronie's disease. You can see the reasoning behind its use here: VED Therapy.


I want to state that it's important not to have unrealistic expectations. This type of therapy will not work for all men, and some of those it does work for will have to stick at it for many months in order to see results. Do not over pump, else you will do more harm than good. Pressure does not need to be excessive, and there is no benefit from doing so.


The multi cylinder VED approach is used to stretch the peyronies scar is different ways. The small cylinder is more adept at stretching length, the large at girth, and so on. The protocol itself is 26 weeks long, but should you reach the end, there is no harm returning to week one and going through the whole process again.

Spivey on the site peyroniesprotocol.com recommends that each daily session should consist of ten cycles of these four steps:

a) Create negative pressure around the penis
b) Fill the space inside the cylinder and hold a "straight" erection for 5-10 seconds
c) Release the negative pressure in the cylinder
d) Repeat the cycle ten times to complete one daily session

If pain occurs you should of course stop the session and rest. Done correctly and without excessive pressure this is a good approach. Vacuum Therapy and Traction Therapy are the two mechanical methods of treating peyronie's disease. While they're unlikely to cure the condition as such, they can reduce curvature and improve sexual functioning. Aims which should be the primary concern of all peyronie's patients.

Wednesday, 12 August 2009

Links


Induratio - An established peyronie's disease site for our German friends. The site has English and French translation options too.


Dupuytren's Disease Site - Duputren's disease is a condition related to peyronie's disease. If you suffer from it, this is the go-to site.


Cure Peyronie's - A site where the author details the latest peyronie's disease developments.

Pentoxifylline

Over recent years Pentoxifylline (aka Pentox, Trental) has emerged as a treatment for peyronie's disease. Where some other treatments have come and gone, pentoxifylline does at least appear to be helpful to some men, and has been useful in various other conditions where fibrosis is an component. There have not been many peyronie's specific pentoxifylline studies carried out as yet (aside from this case study), but results in animal studies caused a decrease in PD plaque and collagen/fibloflast ratio, so there is logic to choosing this as a treatment option.

Trental is usually taken in three daily 400mg doses, each seperated by 8 hours. The treatment is typically combined with l-arginine and sometimes viagra. This approach is used by the likes of Dr Levine and Dr Lue, both of whom are respected in urologists. Dr Lue noted that "We have noted regression of calcified chronic plaques in over 50 men treated with 6 months of pentoxifylline". Pentoxifylline downregulates collagen expression, reduces proinflammatory and increases antiinflammatory response so I'm of the believe that for those with peyronie's, the earlier you start taking it the better. Pentoxifylline is oftens used alongside  L-Arginine and Viagra as part of the PAV cocktail.

Further information including a .pdf file of the recent pentoxifylline study here.

Saturday, 8 August 2009

Viagra

Many peyronie's disease sufferers have problems attaining a firm erection (or an erection of any description). Some find sex uncomfortable due to the extent of the curvature, or pain present, but for others ED (erectile dysfuntion) is the key component in hindering typical sexual functioning. In these individuals viagra (Sildenafil) can often be a useful treatment option.

Viagra is a PDE5 (phosphodiesterase type 5) inhibitor. The drug works by preventing the action of this particular chemical within the body. In laymans terms, the effect of inhibiting PDE5 stops another chemical messenger (Cyclic GMP) from being broken down. As Cyclic GMP is known to widen blood vessels within the penis, the use of viagra allows more blood to enter the penis, resulting in a powerful erection.

Aside from aiding sexual funtion, it is posible that regular erections may impede some of the processes that result in scar tissue formation (which is synonymous with peyronie's). A couple of top urologists combine Viagra with other treatments which should theoretically help treat peyronie's disease. One such regimen is known as the PAV Cocktail. It consists of Pentoxifylline, Arginine + Viagra and is perhaps the best first line treatment available for those new to peyronie's disease. It is occasionally used alongside traction therapy or VED use in order to attack the problem from several angles.

Also read: Viagra vs Levitra and Cialis

Contribute

I intend to add content to this site until it represents something of real value to the peyronie's disease community. This condition is one which is neglected to some extent by medical professions, and due to the embarrassment and distress of sufferers, advocacy groups are few and far between.

My intention here is to touch on various existing treatment options, and have a forward looking approach to potential developments and breakthroughs. What would also be useful is to have some actual sufferers feedback, in terms of what worked and what didn't work for you personally. This really would add to the relevance of the site and be of great help to other sufferers.

Information that would be of use would be your experiences being treated under a specific doctor, the treatment regime you undertook, how successful it was, useful contact numbers and advocacy efforts in the UK and abroad. Anything really. Your input is appreciated and any ideas are welcome.

Also, if you own a site relating to medical issues, and/or are writing an online article, it would be great if you give this site a mention, as I want to reach and make contact with as many peyronie's sufferers as possible. Feel free to post a comment below, or contact us.

Thursday, 6 August 2009

Vacuum Erection Device

For some men use of a vacuum erection device (VED) can be helpful in the treatment of peyronie's disease, though as with other treatment options it can take quite some time for results to show. The thinking behind this strategy is that use of a VED improves the blood flow to the penis, while also stretching out the scar tissue / penile plaque that is present. This is not only useful for those trying to avoid surgery (by lessening curvature somewhat) but also those hoping to reduce curvature to ensure that less length is lost if they do go for a surgical option at a later date. Aside from traction it is the only other mechanical treatment used to treat peyronie's disease.

VED use has not been extensively studied, but it is certainly a method of treatment that was helped some men regain lost length caused by peyronie's disease. Anything that stretches and exercises the penis is good for peyronie's sufferers, because it can help to increase and/or recover the elasticity of the penis cause by scar tissue. Many men with peyronie's struggle to maintain an erection, and as such this may contribution to the worsening of their condition. Regular penile exercise via erections through various means (oral, natural, devices) is a must in my opinion. It is actually thought that regular use of the VED may help some men avoid Erectile Dysfunction.

As with most methods it will not work for all, but some men swear by it. Once again it is a long haul treatment, so unless you are willing to stick with it every day for several months, VED therapy is probably not be the right treatment option for you. Treatment of peyronie's is a marathon and not a sprint. Improvements take time and VED therapy is no different to any other approach in that regard.

There are a number of quality vacuum erection devices for sale, so please do not go down the route of purchasing a cheap "penis pump". The VED required needs to be of a high quality, effectively medical grade. The Soma Correct is a good option, and Boston Pump also provide quality pumps and cylinders. A more detailed post relating to how to best use these devices is here --> Vacuum Therapy Protocol.

Traction devices are another option for reducing curvature and returning lost length. Click through for device info and news of successful traction device studies.