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[Thomas708]

Hi everyone,
Approx. 8 weeks ago I had a „sex injury“ where I probably injured my cavernous body on the right side below my glans.

Since that time I have a strange feeling in my glans, it hurts with some kind of tenderness being there 24/7 which drives me crazy (very bad sleep). Sometimes burning a bit (also sometimes a little bit while urinating). Additionally the glans is very sensitive - even longer walks are not possible anymore due to rubbing on the boxer shorts (even though I'm not circumsized!). And it always feels a bit worse on the right side where I assume I damaged it. Either the pain is getting worse or I am getting more sensitive...
The only thing that seems to get me a bit of relieve is by cooling it.

After the injury it was not getting better after 1 week so I went to see a urologist who said that I will get better soon and that I should drink plenty of water. Unfortunately it didn't get better and I was there several times more. We did all possible checks (multiple urine tests on infection, swabs, cystoscopy, sono, even MRT) and everything looks fine. From the outside everything seems good.
While doing the cystoscopy he didn't even see a scar or anything: so he told me that he cannot imagine that I still have pain there and that I damaged something (I rellay didn't expect that). Finally he has sent me to a pain therapist.

It doesn't matter which drug I try, nothing helps. First Ibu, Metamizole and other NSAID and right now Pregabalin because the pain therapist said it could be a nerve damage.

Today I went to a different urologist (a specialized one) and he did a examination by hand and he felt the same that I feel on the right side and told me that I for sure injured the top of my right cavernous body and that he can feel some scarring there (a small lump which I can also feel) that is causing the pain.

He told me that this could be the first stage of IPP (active phase) or just a long healing phase of the injury with some scarring there. Additionally he told me that the pain could be there for some more time (months!  ).

What do you guys think? Could this already be IPP because of the long healing time?
What else can I do to speed up/improve healing?

Thank you!!
Thomas

[TonySa]

Do you mean could it be Peyronie’s?  If so, it sound like it could. Have you tried diclofenac sodium gel applied to your penis for pain?  Pentox may help as well.

[Thomas708]

Yes, that's what I meant by asking if this could be Peyronie's in the first active phase.
Strange thing it's just a local lump on top of the cavernous body and it's not growing at all, just hurting...

I tried applying some lidocain ointment (called EMLA), it didn't help at all - it seems that I cannot "reach" the pain "from the outside".
Maybe I should ask my urologist for Pentox, thx for the suggestion.

So I guess if the lump stays as it is it's maybe not Peyronie's but just a scarring due to the injury, but the healing time could be similar to the Peyronie's active phase I guess?
The urologist has no more ideas and says that I should just wait and see... 

[Thomas708]

What I forgot to explicitly mention is that it seems that it‘s too small to be visible on the ultrasound. When trying to „feel“ it: it‘s smaller than a pea, probably just a few mm in diameter on top of the right cavernous body.
So still not sure if it‘s Peyronies but the indicator are:
- pain since 2 months after the injury
- small lump that hurts when gently pressing it

I don‘t know if that‘s enough for a Peyronies diagnosis...

[TonySa]

Generic voltaren gel can reach deep inside the penis as it does for muscle pain.  Give it a try.

[Thomas708]

Right now heat doesn’t feel that good, in fact I’m cooling it almost every day.
Maybe Voltaren is not the right thing? But I’ll give it a try.

It’s quite strange that a lot people here are using heat and I’m cooling it every day to reduce the pain, don’t know what that means. 

[bustedchubb]

I couldn't use heat at first.  The first 10 days or so, I used an ice pack.  Then I used heat after that, but I still had to be careful.

[Thomas708]

That’s quite interesting since I had the feeling that e.g. a hot bath was not helping at all.
But maybe it should give it a try again and be a bit more patient about it.
I still don’t understand why the classic inflammation=cooling approach doesn’t fit with the acute phase of Peyronies.
It’s probably about keeping the blood circulating properly to get the healing triggered.

I‘m just a little bit scared when I see that it could take half a year or longer to reach the stable phase, I hope my pain will get better soon.

At least I have an idea what I can try, thx!

[TonySa]

Try ibuprofen and voltaren.

[jan.schaller1958]

Well, I’m not saying I’m an IPP (Peyroines) expert, but Peyroines does not usually start with an acute injury. It just pops up one day totally unexpected. One theory is that it’s caused by repeated micro trauma. That’s, in my opinion, ridiculous. Everyone’s penis experiences repeated micro trauma their whole lives, the trauma heals without scarring and they never get IPP. The true cause of IPP is unknown. I think it’s mostly genetic, but I can’t prove it, and about all you can say is it’s a wound healing disorder. It’s like getting a keloid. Some people develop keloids (benign tumors) from simple incisions made for a facelift. It’s not the natural result of direct trauma. Your dick should heal on its own without any problems.

[Thomas708]

True, it's definitely not typical what's happening here. The strange thing is that it's taking already way too long to heal. That's also what my urologist confirmed. If you have small injuries like that (that are not visible on ultrasound and MRI), it should be a matter of weeks max.
Or it's indeed nerve damage which would be way more complicated, let's see.

[jan.schaller1958]

Right Thomas. Don’t listen to these people who say Peyroines is caused by repeated micro-trauma to the tunica albuginea. Okay, that’s an hypothesis and urologists think that may have something to do with it in about 1/3 of cases. Okay. That’s a maybe. But think about it. Everyone’s penis suffers micro-trauma all the time, their entire lives, and the vast majority of guys never get Peyroines. Everyone has had rougher than usual sex before, got a bit too excited, and never got Peyroines over it.  I know I did, but didn’t get Peyroines. I didn’t get it until I was 56, and I have no idea why, like the vast majority of men.  I just woke up one morning and noticed with the usual “morning wood” as they say, the typical morning erection, that my penis was bending to the right. I thought I had just slept on it wrong. I waited a week and then went to the doctor and got a Peyroines diagnosis and some Pentox (not sure that stuff does anything anyway).

 Why do some people’s penises heal up after micro-trauma and others don’t? Who knows? The experts don’t know. What we do know is that there is some kind of genetic component to it. Not 100% but some. Why do you think most guys in this board are from Europe, the USA, Canada, Australia and New Zealand? It’s not because of the language, that’s for sure. Guys from those parts of the world are hit with Peyroines most (of course anyone can be). I think genetics plays a big part. My dad had Peyroines. Then I got hit with  it at 56. It’s terrible. I went from a very large size down to about 14cm, which was small for me and a 30degree bend. Hopefully Xiaflex and traction will get me closer to what I was (20.5 cm erect ). If I could just get to an average 15 cm erect with no bend I’d be happy. Peyroines is really the shits, I’ll tell you that. But, never give up. There are things you can do.

[TonySa]

Peyronies Disease may be caused by an acute injury or repeated micro trauma.  Regardless, an underlying genetic predisposition is suspected.  It really doesnt matter-just treat it appropriately.

[Thomas708]

Thanks for your comments. I still can’t really figure out what’s happening here, just makes no sense.

I feel the small lump on top of the cavernous body und when squeezing it it hurts. Additionally the whole glans is quite sensitive, the doc says I should wait because he cannot do anything right now.
And I’m feeling some pressure 24/7.

What I did is buying some Voltaren, but before using it: can I really apply it under the foreskin so close to the glans? I don’t want to make it worse...

At least I was able to walk a bit more in the last days, maybe it’s slooooooowly getting better.
Thanks again for the help, the discussion and the positive words.

[jan.schaller1958]

I favor the genetic predisposition cause myself because I think it makes more sense. We definitely see it in certain population groups much more commonly than others, and as to the micro-trauma/immediate or severe trauma argument, we all suffer micro-trauma or occasionally severe penile trauma and 90% of us never get Peyroines. In that sense, the Micro-Trauma argument makes no sense. Otherwise everyone would wind up with Peyroines at some stage. It’s a wound healing disorder like keloids is the best analogy I can think of, of unknown origins, other than a genetic predisposition. But it doesn’t matter the cause. It’s what to do about it that matters.

[TonySa]

Yes, you can spread the voltaren anywhere on the outside of your dick - including the glans - where there is pain.

[Thomas708]

So it seems that Voltaren is not helping at all. Or should I try for a longer period?

I always have the feeling that cooling is much better than Voltaren.

I was walking a bit more in the last days and it seems that the pain is always going down a bit on the right side and the lump is not that sensitive anymore as it has been a few weeks ago (or I'm getting used to it).

[bustedchubb]

Voltaren didn't do anything for me either.  I was prescribed the 3% which is the highest they could prescribe, too.  Overseas, they have 4%, but I doubt that 1% matters that much.

[TonySa]

Thomas you said it didn’t help at all but pain decreased past few days.  Were you still taking it then?

[Thomas708]

No, I was just trying for two days before. Maybe that's way too short. Should I try longer (at least for a week e.g.?).

The lump is a little bit better but I still have a very strange feeling in the glans, somehow very sensitive.
But maybe that's a good sign..

[TonySa]

Yes, I’d give it a week or more.

[Thomas708]

After 4 days of Voltaren I still don‘t have the feeling that it helps that much but I will continue for a week more to see. It’s burning a bit but I can live with that.

Another thing I already mentioned maybe needs more digging into:
The pain that I always feel when walking around can easily be created by slightly putting pressure on the lump when lying on the couch. When cooling it with an ice packs for 15 minutes this pain cannot be „created“ by putting pressure any more.

Do you have any theory what that could mean?
Inflammation, nerves?
I haven’t found many information about Peyronies and cooling since heat is usually recommended.

Thanks!

[Thomas708]

Hey guys,

just to keep the readers of the thread up-to-date:
I went to another urologist with a high-def ultrasound (who is also treating Peyronies and has ESWT equipment).
The ultrasound showed a very small corporal fibrosis at the end of my right cavernous body.
The only symptome I have right now is the ongoing pain that is toggeling between unbearale and uncomfortable.

He says it's not Peyronies (yet  ) and we shoul treat it conservatively.
- Taladafil
- IBUProfen
- Vitamin E

When I check the guide on the forum he's quite close to what is proposed here.
He also says that it might take while and I should come back in 6 weeks - maybe we'll try ESWT if the pain is still there beginning of November.

@all: any thought on fibrosis? I'm not sure about the difference to Peyronie plaque - isn't the plaque also some kind of fibrosis?
Or could I have fibrosis and no bending/hourglass and then it's not Peyronies but just scarring? 

[jan.schaller1958]

Yes, I think Peyroines plaque is a kind of fibrosis, but really, what difference does it make?

The pain should go away on its own. I vaguely recall some pain, but it wasn’t so bad that I needed to take anything for it. And, it did go away on its own (I’m guessing 6 months?)

The stuff you mentioned taking is fine, whether it’s Peyroines or not. Taladafil is just Cialis, a PDE-5- Hemmer (i forgot the English word for this), just a longer acting viagra, ibuprofen is just an over the counter pain reliever, and vitamin E is just the vitamin. The Cialis or viagra are sort of routinely prescribed with Peyroines, whether you need it or not. It might help in the early stages, maybe by helping remodel the plaque slightly? One doc told me it doesn’t do that, so I’m not 100% sure. I know before Xiaflex injections they want you to take it or Viagra at night months before they start injections. Ibuprofen is, in my opinion, just something for headaches. But, it surely won’t hurt anything. And,  I read that vitamin E was proven to have zero benefit in proven cases of Peyroines. If you can’t get Xiaflex, I’ve read that Interferon shows promise. It’s not as good as Xiaflex, but better than nothing. I personally think Pentoxifylline for Peyroines is a waste of time. It’s just a blood thinner. It’s only approved use is to treat muscle pain from peripheral artery disease;  yet, it is commonly prescribed for Peyroines (an „off-label“ use of it).

Whatever yours is may just go away on its own, so keep an eye on it and keep checking in with your urologist.

[Thomas708]

Thanks for the reply.
The strange thing is that the pain is not getting better at all.
When going for longer walks it's just unbearable, doing sports impossible.
Even waking up at night is happening again when getting erections which has already been a bit better last week.

I really don't know what to do since the pain killers do not help at all. Tried Voltaren for more than a week, didn't help. 

I wonder if it's really pain due to the fibrosis or if I damaged some nerves. Is it possible to tell the difference?

Or does it really take that long for the fibrosis to get into a state where it doesn't hurt?
Maybe I should push for ESWT treatment.

Btw: should I try not to touch it all anymore because I'm afraid to interrupt the healing if checking too often?

@Jan: you really think Xiaflex is an option just for the pain? I thought that's more for plaque with visible blending and it has quite some side effects. To do it in a few mm lump right below the glans sounds risky.

[jan.schaller1958]

Thomas708,

No, Xiaflex is for plaque softening after a confirmed case of Peyroines, with traction. It’s not a pain medicine. It’s used to straighten the penis due to the plaque deformity caused by Peyroines. If you had Peyroines the pain would eventually go away anyway. If Voltaren doesn’t help, or over the counter pain meds don’t help, you might ask the doctor for something stronger. But, pain is not usually the most troubling part of Peyroines because it’s not that severe anyway and eventually just goes away.

[Thomas708]

Hmmm, since I‘m treated like it‘s Peyronie‘s and the doctor says that there is no difference between my fibrosis and fibrosis due to Peyronie‘s I guess I already have a small version of it.

In fact he said that the progress will show if it will be more than the small lump. I guess if it grows it will cause some bending (I already see a small bend to the right, but could be natural - never paid attention before).

In the end it doesn‘t matter, both urologists told me that the pain should go away after a few months - they said something about 3-4 months from the start which would be October/November. When I read some other comments here it could take much longer in the beginning, I’m really afraid of that.

I will ask for something stronger for the pain, let‘s see.

But the lump causing the pain is somehow typical I would say, nerve pain should behave differently if I damaged something. At least that’s my guess...

[jan.schaller1958]

Hummm. Well, you got a good clinical work-up with the urologists, which is good. I’m thinking maybe you don’t have Peyroines at all (hopefully not, behause it is terrible or can become terrible), and maybe just a penile injury taking a bit long to heal,  but it should heal on its own and the pain, I would have thought, would  have subsided by now. That is,   if it’s not Peyroines, but the I’m no doctor. So, that gets us back to maybe an early Peyroines plaque possibility, since Peyroines can be painful in the acute phase. And the injury could have triggered it.

The most I’ve learned on this board is how variable Peyroines can be in its presentation. It’s like on a scale of 1-10. Some guys have mild cases, like 1s or 2s, and others are 10s, really bad, but most are somewhere in between. Like I mentioned earlier, I’ve had it for almost 5 years. But, there was no injury. It just appeared one morning. And the diagnosis was really easy for the doctors. The specialist I went to said he couldn’t use Xiaflex, based on the ultrasound,  I guess because I had hour glassing, but recommended a surgery (not a Nesbit- but a plication I think). But, I turned it down, but I now wish I had had it. Stupid me.  I was in the early phase of peyroines then. Now, 5 years out, I’m in the chronic phase. The hour glassing went away and I just have a 30 degree upward bend and now the specialist says he can use Xiaflex with traction. At least I don’t have Erectile Dysfunction, and the specialist said the surgery at my age would put me at a risk of 40% Erectile Dysfunction, so forget that. So, the surgery option is out now. Maybe my memory of it has faded, but I don’t remember any real pain much, but then I didn’t have a trauma either.

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