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Welcome to Dr. Landon Trost - Directly answering member questions in the "Medical Professionals" section below the Treatment boards. https://www.peyroniesforum.net/index.php/topic,16512.0.html

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Author Topic: People with hard flaccid:  (Read 2464 times)

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smashin

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People with hard flaccid:
« on: August 08, 2020, 08:07:28 AM »

Does the hard flaccid and cramped chambers cause any sort of lumpiness or so the veins feel at all under more pressure or easier to palpitate when in a hard flaccid state?

Sometime when I have hard flaccid I can feel what feels like palpable veins or lymphatic Versailles in the penis? Can this be a result of hard flaccid. Or is it always more likely lumpy fibrotic tissue or plaques

Also I very often have what feels like a cramp in the perineum, which comes almost always after masterbation or sometimes erections. Is there a chance this is the result of perineal scarring, as I know some people with hard flaccid get this. I however seem to get it often, sometimes without erection.

Thanks in advance

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Logarn

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Re: People with hard flaccid:
« Reply #1 on: August 08, 2020, 05:27:45 PM »

I believe it is normal to have raised ridges or a ribbed feeling in the penis if that is what you mean.  Hard flaccid likely just makes this much more noticeable.  I've had hard flaccid for over 10 years and it has felt lumpy
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Dipstick

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Re: People with hard flaccid:
« Reply #2 on: August 10, 2020, 12:44:12 AM »

This is an extremely interesting post...

I too have this what you’re describing. In the flaccid state I run my fingers along the top part with the tunica between my fingers and I can feel two things. A thickened tunica, and hard fibrous like veins or chords, it feels a bit lumpy and fibrous.

I have been flipping back and forth between hard flaccid and peyronies.
My ultrasound shows no plaques but instead a thickened fibrous tunica.

I have done some intense study on the penis anatomy since finding this out.

I have some answers.

You’ll have to take a moment and understand some basic anatomy which I’ll explain to you and it will start to make sense.

Firstly, any tension on collagen fibers or muscles will cause it to thicken and lay down new collagen.

Now, the dick has a few layers of facia. The dortos facia is just below the skin, then below that you get the bucks facia which rests and meshes just above the tunica.

Along the top, between the bucks facia and tunica, you have these veins and nerves as well as your dorsal arteries rubbing along parallel. This is called the neurovascular bundle.

So......

There are two important pelvic floor muscles that basically wrap around the root of your dick.

Right at the back there the penis splits into the crus of the penis, these are the two legs of the penis

There are two cavernosal muscles that wrap around these two crus, those two muscles extend and join into the facia of the dick, much like a tendon. So when those muscles permanently contract there will be tension along the facia all the way through the penis. This will cause the facia to thicken and become fibrous and literally cause a hard flaccid dick. The muscles at the crus merge into the top layer of facia that runs on the top of your cc chambers.

When you take a way the tension, in time, the thickened tunica will start to soften. I believe this, due to the nature of how facia works and remodels.

The spongiosum part, has a layer of facia that runs between the cc chambers and spongiosum all the way back and merges with the bolbospongiosum muscle, which is the second muscle that covers tthe bulb of your penis.

That muscle when contracted will do the same thing to the facia on the spongiosum side of the dick.

So you could possibly have a tickened tunic on top, dorsal, and below, ventral thickening, which is what I have.

It obviously effects the veins as well.

I think this is how it works, my pelvic muscles sometimes spasm , sometimes in the middle of the night my anus will be so damn sore from a spasm I have no idea how to relieve it.

So my pelvic floor is definitely involved.

I read up on the study on cadavers where they dissected the penis and noted the dorsal and ventral thickening on sexually active people versus thinner tunica on non sexually active historys.

Makes sense, since maybe the sexual active have tighter pelvic floor muscles.
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Anton36

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Re: People with hard flaccid:
« Reply #3 on: August 10, 2020, 05:25:48 AM »

Can you explain to me what is hard flaccid ?
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Paolo

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Re: People with hard flaccid:
« Reply #4 on: August 10, 2020, 06:15:52 AM »

Hard flaccid is when your erection doesn't completely subside and you end up with your penis stuck out 90 degrees (straight) and about a 1/3 to 2/3rd its erection size.

I don't know what causes it but I think the sympathetic nervous system (excitation) and the parasympathetic nervous system (relaxation) gets stuck, or malfunctions somehow  ??? :-\
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HeyThereYou

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Re: People with hard flaccid:
« Reply #5 on: August 10, 2020, 10:39:16 AM »

Hard flaccid is when your erection doesn't completely subside and you end up with your penis stuck out 90 degrees (straight) and about a 1/3 to 2/3rd its erection size.

I don't know what causes it but I think the sympathetic nervous system (excitation) and the parasympathetic nervous system (relaxation) gets stuck, or malfunctions somehow  ??? :-\

Hey again Paul, very intersting you say this. Like mentioned in our PM's, I do get hard flacid where the penis is just solid but it's small and not sticking out like a proper erection BUT like you said it kind sticks out slightly, and it kind of pulls to the left, Is it common for people with hard flacid/pelvic floor dysfunction to have their penis pulled to the left/right? I'm sure i've heard a few people mention this in the PE Gym forum

smashin

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Re: People with hard flaccid:
« Reply #7 on: August 11, 2020, 08:11:27 PM »

Great information Dipstick. Yes I think we’re in the same boat. I had pelvic floor issues before my peyronies type symptoms began. And I believe you can eventually relax this fascia too, as sometimes it actually hangs well. I think there is a psychological component to the pelvic floor flexing too.

Unfortunately I have a mild peyronies band either side below the glans, caused from tears, which has caused the end of the cavernosa to harden just below the glans, due to the compressive nature of the bands, though I feel this is not related to the hard flaccid. Sometimes this looks better than others and all in all it my penis is straight, it’s more a narrowing that is the problem.

Have you lost sensation in the glans?
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Logarn

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Re: People with hard flaccid:
« Reply #8 on: August 11, 2020, 09:05:39 PM »

smashin, are you officially diagnosed with peyronies?  A lot of you problems sound hard flaccid/pelvic floor related.
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smashin

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Re: People with hard flaccid:
« Reply #9 on: August 12, 2020, 05:11:19 AM »

I have lost girth along the shaft and have a hard spot at the end of the cavernosa, pretty sure Pelvic floor dysfunction alone can’t cause this. I have also lost sensitivity in the glans and have semi erect bending.

Seen two urologists, first did he could feel some gardening at tip of cavernosa, second said it was in my head, despite my dick looking completely different to normal.

The whole penis feels tight like Dipstick describes. Can pelvic floor issues cause half inch loss of girth down shaft in certain areas and what feels like thickened tunica and flaccid aches, I’m not sure it can.

Do you know if pelvic floor dysfunction can cause any of these symptoms?
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Logarn

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Re: People with hard flaccid:
« Reply #10 on: August 12, 2020, 12:23:20 PM »

Pelvic floor dysfunction can cause the penis to be so tight that it is thinner when erect because the muscles are contracted.  It can also cause tons of pain in the penis. Sometimes my pain has been an ache in the penis and sometimes it has been numbness or skin sensitivity that burns.  If by thickened tunica you mean ribbed or ridges then yes, that has been described by many.  I also had severe hourglassing when flaccid or semi erect. I had an ultrasound years ago by a world renowned peyronies specialist and he told me I had no plaque and that it was a muscle issue. So that's why I was wondering if you were actually diagnosed because youre problems sound like "hard flaccid"

Part of the reason I think I am so worried about my injury that you've commented on is because I have learned too much about these issues when going through the diagnosis process years ago for the hard flaccid so it is easy for my mind to become obsessive about this stuff
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smashin

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Re: People with hard flaccid:
« Reply #11 on: August 12, 2020, 12:59:16 PM »

Thankyou for the helpful response Logarn.

I have definitely had muscles injuries and pelvic floor dysfunction for a while and it could well be the problem. I believe I also have a small bit of hardening at end of cavernosa too, however; and hard flaccid has made it unable to sort itself out.

I can relax my pelvis and things ease up and things seem much better, but as soon as I chance position it can change in an instant, really tough to rebalance the pelvic muscles.
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Logarn

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Re: People with hard flaccid:
« Reply #12 on: August 12, 2020, 01:19:31 PM »

If you get changes that  improve or worsen based on position or mood then that it is very telling of a muscular problem.  For example, my hourglass would occur when I was cold, when I was stressed, after a bowel movement and go away when relaxed or warm.  My erections would be tight and hard to maintain when standing but fuller and stronger when sitting down or lying down.  I am not exactly sure about the hardening you are talking about but all kinds of things can feel hard/weird when you are "hard flaccid"/CPPS.  I was sure I had some plaques years ago because it felt like tiny pebbles of BB's in a couple spots on my shaft but it wasn't peyronie's.  That being said, hard flaccid can be overcome but it is not easy. Mine has come back many times due to bad habits and stress.

Also, it is easy to start worrying about your penis all the time.  As you can see by my other posts I am in a bad place emotionally and am checking my dick all the time and it has made my pelvic floor worse. It really is a vicious cycle.  Having been through the whole process diagnosis process of peyronies/penis disorder before being diagnosed with pelvic floor issues has put the idea in my mind that it can occur and it is easy to fall back into the trap and now I worry about minor injuries having catastrophic consquences.  Hopefully you dont fall into that trap.  Can you go to a peyronies specialist? I paid out of pocket because I wanted an ultrasound
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HeyThereYou

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Re: People with hard flaccid:
« Reply #13 on: August 12, 2020, 03:01:30 PM »

Wow Dipstick sounds like we have a very similar thing and i'm on the fence with what it is.

I've recently had an ultrasound scan which shows a small thickened zone (Can't remember where it was described to be) but aparently only 8mm and urologist said it's very very mild and wouldn't be causing erectile dysfunction or anything.. Theres nothing that is felt.. Although in the last few months i did develop these ribs on the side of the penis, which urologist said is definitely not a form of Plaque and it seems a lot of guys have these.

If you see from my history, I've been masturbating from a very young age mostly everyday and always with a very tight clench/kegel to ejaculate as quick as i could! Never had any issues with my penis up until i was about 14 and i thought i was heartbroken (lol) and was masturbating a lot and one day the fourth one of the day i had this massive shooting pain in the penis (No snapping noise/no bruising etc) but since then i noticed bottle necking/Penile pain/Difficulty maintaining erection all that stuff which has been stabalised over the last 7 years until recently in the last few months it all kind of got worse again after i was enduring on a lot of edging to try and combat my premature ejaculation...

- I get hard flacid a lot.
- I too have most of my curvature/deformity/thinning when in a hard flacid state or when semi erect and then things don't look that bad when fully erect.
- I can't get a a full erection lying down, it fills up more when standing up or sitting down (I know this is the opposite to the norm)
- I get bad premature ejaculation (I have involuntary back kegels/clenching contantly during masturbating)
- Constipation?
- While i'm peeing my penis looks more normal.

So maybe i have some issues from the thickening that was discovered but also a lot to do with pelvic floor.

What is your method to combat hard flacid?

My routine to be done 2-3 times a day is:

- Hindi squat with back against wall while anal breathing for like 5-10 mins.
- happy baby pose and hold for a few mins.
- Reverse kegels when ever i can (I struggle big time with these, i feel like i'm doing nothing)
- Rolling tennis ball on perenium when can.

smashin

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Re: People with hard flaccid:
« Reply #14 on: August 12, 2020, 05:17:40 PM »

Logarn - yes I definitely have a case of hard flaccid there’s no denying that, but sometimes I feel the hour glass or narrowing would have no place to do so with out some scarring underneath. I have had mild injuries which have caused inflamation for a few days, but nothing super serious. I just feel sometimes that having an inflamed penis in a hard flaccid state could be enough to see the tunica thicken a little as the penis is not in a natural hanging state while the inflamation is dealt with. I have been thinking about going to get private scans too, however I was looking more towards an MRI.

Hey there you 12335 - I think I have a similar thing with you and dipstick, with some sort of thickening along the dorsal nerves arteries and possibly some on the underside too. I am however not certain as I have not had tests. Did you leave doctor say anything about the thickening being reversed/treatable/or deconstructed If in a mild form? Oh and btw, edging is the worst thing you can do for premature ejaculation. It is typically a result of a tight pelvic floor which edging majorly contributes to and is often described as a precursor.
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Logarn

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Re: People with hard flaccid:
« Reply #15 on: August 12, 2020, 05:29:19 PM »

Smashin,

I had such bad hourglassing which was very freightening to see.  Like the middle of the shaft looked like it was almost half the width of the base and tip when I would get out of cold water.  Sometimes it was more like a soda bottle with the tip not inflating.  After some urologists seemingly blew me off I went to a world renowned peyronies specialist and got the ultrasound. He found nothing abnormal and told me it was related to pelvic tension and I needed to work on relaxing the muscles. The muscles are are tensing and contracting in certain circumstances. You should get an ultrasound at a real specialist if you can.  Nothing you described is abnormal for hard flaccid.  It can lead to a lot of really severe looking symptoms although they are not actually serious or severe.  I started going to Physical therapy where they did internal massage for pelvic floor tension and it did really help the issue for a while.  I have been through a lot regarding the hard flaccid diagnosis and recovery process so feel free to ask any questions about it
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Dipstick

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Re: People with hard flaccid:
« Reply #16 on: August 13, 2020, 11:34:04 AM »

Great information Dipstick. Yes I think we’re in the same boat. I had pelvic floor issues before my peyronies type symptoms began. And I believe you can eventually relax this fascia too, as sometimes it actually hangs well. I think there is a psychological component to the pelvic floor flexing too.

Unfortunately I have a mild peyronies band either side below the glans, caused from tears, which has caused the end of the cavernosa to harden just below the glans, due to the compressive nature of the bands, though I feel this is not related to the hard flaccid. Sometimes this looks better than others and all in all it my penis is straight, it’s more a narrowing that is the problem.

Have you lost sensation in the glans?

I've lost sensation overall, which is possible with hard flaccid as the dorsal nerves are running through the muscles that would compress them as well.
In my case it's years of chronic tension, I also have a slight curve to the right and what appears to be a slight bit of hour glassing. Any sort of chronic tension I think will warp the penis in a way that's not uniform.

It's interesting what I've read in the literature, some of the anatomy is incorrect and you'll find some pictures where the bulbo muscle envelops both the crus and the bulb of the penis, this is incorrect. It's actually specific to the spongiosum, and the muscle runs right through into the facia. The same as the cavernous muscles, they only evnelop the crus, which become the cc chambers and the facia is layered ontop exactly where the dorsal thickening would be.

It's continuous, if you read the studies on the cadavers you'll find they actually label it as dorsal and ventral thickening, continuous with the pelvic muscles. It stands to reason there is an intimate relationship between the facia and muscle tension.

In order to thin the fascia, or soften it, you'll need prolonged periods of relaxed pelvic floor muscles, while having good blood flow as well.

If I feel my tunica, I can feel what feels like hardened ribs, I can rub it between my fingers and I'm certain they are the circumflex veins or arteries that run around the penis starting from that dorsal thickening.

I think those hardened bumps and lines are the vessels hardened in the fascia due to the strain and tension on them from the constant retardation of blood flow, it's constantly pressurized in those veins with a chronic pelvic floor tension. Hence their hardening.

I think the bending, the scarring can also come from it because any more friction and strain on already hardened fascia might make more nodules or thickening.

I mean, we don't seem to ask ourselves, why the hell is it just dorsally and ventral where all those structures are running through. Well, if you feel with your fingers that thickened tunica I bet runs all the way into your perineum, where the source of the problem is.

The tunica facia that wraps around the penis doesn't seem to be thickened right?  Because the muscles are only continuous with the dorsal and ventral fascia of the penis. That's why we dont feel this thickening just along the side, instead it's softer and thinner there, if we did feel thickening there then it's probably more of an injury I'm guessing.

Also, retarding the blood flow is like priapism, a mild chronic form of it. You might then notice discoloring of your penis.  This kind, does not enlarge the dick like a normal priapsm would, I'm guessing it would shrink the hell out of it.

Can you loose size? Sure can, I was over 8 inches by over 6 inches in girth. I'm now 7x5 and not nearly as hard.

Want my old dick back and want it back yesterday, will get it back!
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smashin

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Re: People with hard flaccid:
« Reply #17 on: August 13, 2020, 04:24:45 PM »

Ye I can feel the tension and how it arises from the muscles deep in the perineum and on the dorsal side where it connects to the pubis. It’s as if the nerves are just firing none stop and causing tension in the muscles and fascia. It’s like the nerves fire very easily from a psychological standpoint. Like the mind and muscles have become stuck in this loop.

I think not only do we need to learn to relax the muscles, which I can do; but we also need to calm this quick fire psychological nerve response. There’s definitely a psychological thing to this. Like as soon as my mind starts thinking about it, those nerves instantly fire and cause the muscles to immediately tense up. Relaxing muscles needs to coincide with retraining the mind when these impulses arise and calming the reaction so the cycle becomes less viscous over time.

How have you planned on combatting this? I think cialis and pentox give the body a chance whilst it is resolved. I think both a mental recovery is just as essential as the physical, as the tension doesn’t seem to give way whilst we obsess about possibly the most stressful thing we could imagine is going on. Need to learn to accept the situation maybe whilst we recover the muscles and not give in to the mental rumination.

You seem clued up. Have you had any success’s or reasons to be positive? My optimism seems to come and go in accordance to additional stressors.
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Logarn

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Re: People with hard flaccid:
« Reply #18 on: August 13, 2020, 05:54:43 PM »

The psychological aspect is extremely important.  Take me for instance, I have bad anxiety and have had terrible panic attacks recently and my pelvic floor has gotten so much worse during this time.  The skin on my penis felt like it was was burning for the past month or so and it has been fine these past couple days after I've calmed down.  I think it is nearly impossible to work on the tension if your mind is in a bad place. Calming anxiety, stretching, and trigger point massages will make a big difference.  Also, there will likely be good and bad days even if you recover from hard flaccid since so many variables affect it.  For me the key to my positivity regarding hard flaccid was having more good days than bad days and knowing that I can do work to get it back to a good day again.
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smashin

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Re: People with hard flaccid:
« Reply #19 on: August 15, 2020, 07:56:44 AM »

Thought it might be worth bringing up Dipstick; I also had inguinal hernia mesh surgery (larascopic)

I felt the tightness in the abdomen before I had this though, so I really don’t know if this is the cause or not. The area of the hernia and my abdomen was really hard and tough for months and months. It has gone down now, but I can still feel tough tissue in the inguinal area, and if I prod around there is a nerve which I can rub which causes a very sharp sensation. I don’t know if the hernia mesh caused this, or simply caused the area to heal in the way my muscles were set at the time. Either way I do have a thickening feeling to the tunica along the dorsal side, and hardened nerves arteries in that area.

I honestly don’t know how much of a cause the mesh is, but I was in agony after it was performed and bled internally for a while and actually passed out twice the day after.


Heythereyou2233456; don’t suppose you had hernia surgery also?
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HeyThereYou

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Re: People with hard flaccid:
« Reply #20 on: August 15, 2020, 08:05:58 AM »

Nope i've never had hernia surgery

Dipstick

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Re: People with hard flaccid:
« Reply #21 on: August 19, 2020, 11:26:06 PM »

Thought it might be worth bringing up Dipstick; I also had inguinal hernia mesh surgery (larascopic)

I felt the tightness in the abdomen before I had this though, so I really don’t know if this is the cause or not. The area of the hernia and my abdomen was really hard and tough for months and months. It has gone down now, but I can still feel tough tissue in the inguinal area, and if I prod around there is a nerve which I can rub which causes a very sharp sensation. I don’t know if the hernia mesh caused this, or simply caused the area to heal in the way my muscles were set at the time. Either way I do have a thickening feeling to the tunica along the dorsal side, and hardened nerves arteries in that area.

I honestly don’t know how much of a cause the mesh is, but I was in agony after it was performed and bled internally for a while and actually passed out twice the day after.


Heythereyou2233456; don’t suppose you had hernia surgery also?


Yes, interestingly... I have had a hernia mesh done on the left side. My problems seem to coincide with it. I actually went down a very long path of the mesh as a cause to the point I was booked in to have it removed.

But I decided to do some proper research on anatomy and see how it would be possible.

Firstly the mesh itself is designed to cause fibrosis that’s why it feels hard there. The body scars over it and turns it into a tough fibrous patch that holds prevents the hernia reoccurring.

I was convinced the mesh caused it. I recall even after having the mesh installed (15 years ago) that my erection 2 days after the surgery was very different, incredibly hard as well. I also had blood in the urine which was strange.

It was an open mesh repair for me, also one of my nerves had been trapped in the mesh and scar tissue. My genitofemoral nerve to be exact.

So it’s very interesting to hear from you, however, I did an excel spread sheet and went through every aspect of the mesh and how it could be a cause.

Nerve involvement: no, inflammatory response: no, lymphatic: no, arteries or blood vessel involvement: no!

I don’t think the mesh can cause it, if we think it can be a cause we have to find a link as to how it could cause it.

I had an mri done on it, I had a neurolysis as well done on the mesh.

Anyway, I’m of the opinion that the mesh isn’t it. Perhaps the only way it could be a cause is if it somehow caused tight pelvic floor issues.

I’ve had like 5 ultrasounds of my penis, 3 dopplers, and an mri of my penis. Honestly, I’ve been obsessed at trying to get to the bottom of it.

I’m on cialis at times, pentox and verapamil cream. I have a rice sock that I use while strentching after I have applied the verapamil. I try to keep my muscles relaxed as much as possible.

Yes there is positive hope, because if you read about facia (which is obviously a big part of the tunica), read about it and you will see that facia actually begins to thin out and break down when there is no longer strain or tension over long periods of time. This made me wonder if traction will cause it to thicken, I think it could! If you do it too hard, I think gentle traction with heat is good, the verapamil and pentox will stop further thickening... so combining that with traction seems to be a good plan.

I got a second Doppler scan a year later and it showed that the tunica thickening is a tiny bit less. I think my protocol is working. I actually did this follow up scan yesterday so waiting for the results. Although I measured the tunica myself using the diagnostic tools in the image software between the this scan and the previous and the tunica measures a bit thinner.

Up to 0.5mm thinner than before at some places.

My tunica has thickened areas Up to 2.2 - 2.4mm on the dorsal part.
And 2 - 2.5mm on the ventral. It gets thicker toward the base, makes sense since it’s closer to the pelvic floor. I’d imagine it to be quite thick in the premium area.


How long have you had your hernia mesh in? And how long have you had this hard flaccid for?
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smashin

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Re: People with hard flaccid:
« Reply #22 on: August 20, 2020, 06:44:06 AM »

Thanks for the input dipstick.

To be honest I had started to conclude the same. I don’t think the hernia mesh is the cause of all this. I’m sure it’s pelvic floor related. The last few days my penis was starting to hang and feel normal, then last night my pelvic floor slowly started to tense up while a good few hours before I slept.

I was up for about 6/7 hours trying to simply relax my pelvic floor, but couldn’t seem to manage it. I ended up masterbating so I could simply fall asleep. I know this is the worst thing to do when you are having tight pelvic floor symptoms as it always seems to lead to the failure of detumescence. And you always end up having a tight numb and rubbery penis which just doesn’t feel right at all.

This state always seems to lead to depression as it just looks and feels like it is doing damage.

My thoughts: pelvic and abdominal tension definitely leads to the failure of detumesence after erection, which seems to cause almost instant sensory changes and also leads to an almost instant psychological plummeting. I think it’s essential to realign the fascia and muscles in order to beat this, as I know I have sent them all out of whack with bad habits in the past, which has lead to sensory changes. but it seems it is very easy to take two steps  back if you make bad decisions like masterbating whilst having a bout of severe tension. This is probably the reason it is such a hard problem to beat, you have to be diligent And have a lot of will power.


My current question to you and any other forum: Is the penis’ in ability to fully detumesce after an erection essentially doing the same damage as priapism? and could this be a cause of my and some others’ problems? Does the penis need to be erect to cause priapism like issues? Or is tightness from surrounding muscles and into the penis enough to cause problems with blood escaping. Or in this state, does the blood still manage to circulate, but just not quite as well.

 When my penis fails to detumesce normally and retracts into a tightened state, whilst being almost flaccid size, is this causing significant damage, or will the blood still circulate/regulate to some extend as there is not a complete inability for the penis blood to escape (I.e where the penis remains highly erect like in cases of priapism ).

Anyone have any thoughts on this, apologies for rambling.

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