Peyronie’s Disease FAQ. Xiaflex treatment

What are the Symptoms?

The three ways if you know you have Peyronie’s disease in the hallmark are:

  • an abnormal plaque or scar tissue,
  • pain with an erection,
  • or deformity or curvature.

Those are the three hallmarks of Peyronie’s disease.

What is a Plaque?

 A plaque is scar tissue; it’s not like the plaque you have in your heart, it’s typically like a scar calcified piece of tissue, which results in an abnormal curvature of the penis when it’s erect.

Can Peyronie’s Disease cause problems with erections?

Peyronie’s disease can actually cause problems with erections. We believe that as men get greater curvature (greater than 60 degrees), it becomes more prohibitive for intercourse, typically when the curvature so severe, men are not able to penetrate. In many times the partners experience pain during intercourse. Also as a penis curves, it makes it more difficult to get blood flow past the distal part of the penis.

Is penile fracture Peyronie’s disease?

Penile fracture occurs during intercourse, where there’s actually a rupture of something called the tunica albuginea. Penile fracture is not Peyronie’s disease, and penile fracture can result in Peyronie’s disease.

What conditions are associated with Peyronie’s disease?

There are many conditions that are associated with Peyronie’s disease. The most common is Dupuytren’s contracture, which is an abnormal scarring of the hand. Studies have shown that up to 20% of men with Peyronie’s disease will have a Dupuytren’s contracture. Others are tympano sclerosis, which is scarring of the ear; we also know that diabetes, beta-blocker use, even now low testosterone usage has been implicated in Peyronie’s disease.

Can Peyronie’s disease turn into cancer?

There are no data to support that the scar can increase the risk for cancer.

Can Peyronie’s disease cause psychological problems?

Peyronie’s disease can cause significant psychological problems. Studies have shown up to 48% of men who have Peyronie’s disease suffer from some degree of depression. It also can cause a significant impact on the partner as well.

Xiaflex for Peyronie’s disease

Xiaflex is an enzyme derived from a bacteria called Clostridium histolyticum. And it’s a very specific enzyme derived from bacterial species that dissolves collagen, which is the major component of scar tissue, which is to say Peyronie’s plaque. These other medications are taken orally, they go through your digestive system, and there’s no peer review data that shows, they do anything really powerfully against Peyronie’s like certainly nothing even close to Xiaflex accomplishes.

You have to realize that Xiaflexis injected directly into the scar tissue plaques and dissolved it. It sounds really dangerous; the fact is a drug itself is a purified form of that enzyme, so it does not involve the bacteria, it doesn’t spread or causes kind of problems. It does appear to be effective and safe.

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Studies on Xiaflex

There is a paper that has already been published electronically. There was a clinical trial “Xiaflex versus placebo.” This study Involves 800 men approximately, both in the United States and Australia. And it shows that in terms of correcting curvature and in terms of improving subjective responses on a questionnaire about symptoms, Xiaflex outperformed placebo with statistical significance. So it is effective.


The safety profile in this study was quite acceptable because of black and blue, some bruising, there were some tears of the corpora cavernosa or so-called ruptures; about three cases of that were repaired surgically in this group of 800 patients. A couple of cases of hematoma, where blood accumulated and needed to either be aspirated, one case had to be drained surgically. But for the most part, there were very few complications or problems that didn’t resolve on their own within 14 days. But the important thing is, despite the fact that 90% of patients developed antibodies against this, there was no hypersensitivity allergic reactions, anything of that sort in this group.


In the most current paper, the one that’s published online, it causes on the average something like 34% decrease in penile bending compared to the patients, who got a placebo, where they experienced about an 18% decrease in penile bending. And you have to realize that the placebo group in this clinical trial was actively being treated by stretching or modeling. So it was what we call it “active placebo,” it wasn’t like they got nothing at all, they were getting stretching as well, which probably helped a little bit. But the patients, who got Xiaflex, were getting Xiaflex followed by modeling or stretching of the penis, and they improved considerably more than the patients, who received placebo.


Does Clitoris Size Matter?

This week on it is time for a little bit of cliteracy. This week’s question is coming from someone, who would like to remain anonymous and has a clitoral conundrum. So to summarize anonymous’ issue, she says that she recently became sexually active with a female partner and before that, she masturbated and knew that it took her a little while to reach an orgasm, but now that she’s having partnered sex it is zero, zilch, nada in the ozone. It is not a lack of attraction, libido, feeling like something is wrong or broken in her for being sexually active at this point. She says, ‘I apparently have a very small clitoris, which according to the above articles might be why it is so hard for me to orgasm. Even though I am very sex positive and don’t feel guilt or shame about being sexually active, and I know that I am not “broken” and there isn’t anything “wrong” with me, I still feel upset, frustrated, anxious and stressed about it.’

First of all, anonymous, I want to assure you, that you are by no means alone. Studies and surveys that study the frequency of women orgasming purely through vaginal penetration range between 30 and 40%. Statistically lesbian partners do tend to enjoy more orgasms. A 2014 study in the ‘Journal of Sexual Medicine’ found that 25% of lesbians don’t have an orgasm every time they have sex.

Number 2, Anonymous, your clitoris isn’t too small. Those 8,000 nerve endings in the glans, which is the visible part of your clitoris,  they can still fit in really, really, teeny, tiny space. And at this point, Anonymous is saying, “Uh, but what about that study, which was widely disseminated across the Internet, which found a relationship between small clitorises and anorgasmia, an inability to have an orgasm.?’. That study was based on but 30 women, mostly white, self-reporting about their orgasm frequency. The study author for that small clitoris study said: “you know, we don’t know entirely what this correlation or relationship between two variables means, we just know that it is there and that maybe it is a possibility.”

Finally, number 3, which is important for everybody reading this article, whether you have a vagina or not. When it comes to what our vulvas and more specifically our clitoris look like, normally is non-existent. In 2005 the very first study looking at a large study sample in an attempt to establish what normal might mean in terms of vulval and clitoral dimensions concluded that: “Women vary widely in genital dimensions.” That’s as close as these researchers could come to establishing normal. Also, the sizes of our clitorises are constantly in flux. When you’re aroused it doubles in size, by the time we’re in our sixties it has grown seven times the size, it was during puberty. There is a whole clitoral complex we cannot see with the naked eye, that consists from anywhere from 3.5 to 5 inches of erectile tissue.

I think when it comes to these negative emotions and anxieties that anonymous has been experiencing, some of it likely stems from the miseducation, that many of us received regarding our anatomy, not really knowing, whether what we have is sufficient, or sexy, or normal.

One final study found that I want to drop, which is very relevant to anonymous’ issue, our genital self-esteem is very influential on our sexual satisfaction. If we go into any kind of sexual activity just assuming that something is wrong with us and something is going to be wrong, probably not going to go well. Now, dear readers, I want to know if you have ever grappled with any size anxieties like this, whether we’re talking about vaginas or penises, let me know in the comments below.

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How to Reverse Erectile Dysfunction Naturally

Today we want to talk about erectile dysfunction and ways to stop it.

There are a number of causes of ED, but a major cause is “does not have a good blood supply to the penis.” Because that’s how an erection works. Blood flows into the penis, it gets hard; when you’re done blood flows out. So anything that you can do to increase blood supply helps with erections. And there are foods that you can use to help with this, that help the cardiovascular system. There are also some male enhancement supplements that are guaranteed to work, and I’ll mention one at the end of this article.

Nitrates in leafy greens and beets

 So the first is nitrates, nitrates from green vegetable, celery, spinach can increase circulation because nitrates change into nitric oxide, which helps dilate your blood vessels, which contribute to improving blood flow.

Flavonoids in dark chocolate

Another is flavonoids. Flavonoids can be found in dark chocolate among other places. And a recent study found that flavonoids in dark chocolate improve circulation, again improving circulation not only helps cardiovascular health but blood flow for an erection.

L-Arginine in pistachios

L-Arginine is an incredibly important amino acid as it is a precursor to nitric oxide. It is found in a number of places; pistachios are an excellent source. They did a study that shows that the pistachio nuts that eaten every day help with ED. I have to see that to really feel comfortable with that approach, but if you’re going to have a snack, pistachios are great as opposed to cookies.

Zinc in oysters and other shellfish

Zinc in oysters is very good because high levels of Zinc help produce testosterone, which though it’s not directly related to blood flow for erections, it’s really good to help with libido and desire.

Antioxidants in watermelon

Watermelon has an amino acid called L-citrulline in it. And L-citrulline works with an L-Arginine to produce nitric oxide in your body. There are some studies to show that watermelon has a Viagra-like effect, which would help to produce an erection.

Lycopene in tomatoes and pink grapefruit

It is another excellent nutrient for circulation and therefore good for blood flow and cardiovascular health.

Food is great, though the concentrations of the nutrients you need is not high, so it’s ideal for prevention and it’s perfect for maintenance. I question how great it is for reversal of issues? So, nitric oxide is what we want to have produced in the body to be able to facilitate erections, to facilitate lowering your blood pressure.

Now let’s talk about causes of erectile dysfunction and what you can do about reversing it now, today, not sometime in the future.

There are three main areas that cause ED.

  1. One is some type of physical problems such as surgery for prostate cancer, such as multiple sclerosis, Parkinson’s disease, any kind of nerve-damaging diseases, autoimmune diseases also can cause ED.
  2. There are also non-physical causes such as really high levels of stress, performance anxiety, not getting enough sleep.
  3. But by far the largest percentage of ED causes fall into the category of diabetes, heart disease, and hypertension. And if you have those, you have ED problems because they affect the lining of your arteries, of your blood vessels, which stops the production of nitric oxide, which is an integral part of having an erection.

Now estimate say that ED impacts 30 million men in the US and 100 million men worldwide. The US has a 8% of the world’s population and  30% of ED sufferers. Why is that? In part, it’s reporting men have greater access to doctors here than in undeveloped areas of the world.  Men here are more interested in fixing the problem; it’s not quite as stigmatized here as it is other places. So there’s a reporting problem or reporting issue that over report in the US.

But the other thing is that lifestyle issues are a major factor for ED and lifestyle issues are a major factor for men suffering from the three diseases we were talking about: diabetes, high blood pressure, general cardiovascular issues. So those go hand in hand.

Now if there’s any good news in this is that type II diabetes, heart disease, hypertension are all lifestyle-related and therefore correctable through proper nutrition, exercise, cutting down or eliminating smoking, getting adequate sleep. It’s all lifestyle, and you can make a significant change in that.

But the lifestyle is one part of it, the other part of it is repairing the damage to the lining of your blood vessels, and that’s going to take a little bit of intervention as aside from lifestyle changes. And one of the best interventions that I’m familiar with is something called nitric oxide therapy. As I said before, the lining of your blood vessels has been damaged, so they cannot produce nitric oxide for proper blood flow. Nitric oxide therapy does two things: one – it gets nitric oxide into the system, and two – nitric oxide in your system helps repair the lining of your blood vessels.