Urology/Penis injury - healing and drugs
QUESTION: Dear mr Leslie,
3 months ago I had an injury during intercourse with my girlfriend. - as she recalled, my penis hit somewhere inside her. By the moment we finished I was in excruciating pain, which was diffused all over my penis and lasted for ten days.
In spite of this, my penis didn't bruised or swelled, it just stayed in an extremely small and painful flaccid state, and for this reason we decided to be patient and not go the doctor.
However as the days passed, we noticed a deterioration of my erections, mainly my inability to get a full erection when standing and the strange phenomenon of my penis staying for quite a time in a semi-erect state after an erection.
In addition to this, we noticed the creation of two semi-circumferential bumps on the left side of tunica albuginea.
When we did finally go to the doctor, he dοwnplayed the injury, stating that the only severe injury would be a penile fracture and that mine was not.
By that time my anxiety was extreme. During night time I started having a couple of too tight erections which were awaking me and leaving me with pain (like a dull burning) for hours after.
Counter-intuitively I kept testing my erections and they continued to deteriorate to the point that I couldn't manually produce one. My penis didn't inflate symmetrically and lost its normal cylinder-like shape. Moreover, in its semi-flaccid state it started to curve to the left.
By the end of May, we returned to the doctor, which was once more reassuring, telling us that all this was in our head, since it couldn't be justified by the injury.
He ordered a MRI which turned out normally and a DUS with the following results:
0,07ml trimix // erection grade 3
1. PSV left (37,9) / EDV left (0,72)
PSV right (39,16) / EDV right (1,14)
2. PSV l (39,8) / EDV l (3,34)
PSV r (42,16) / EDV r (1,78)
3. PSV l (40,8) / EDV l (3,94)
PSV r (42,16) / EDV r (2,78)
Doctor said everything was ok. However the erection I was able to have was barely sufficient for intercourse and resembled the weak erections I had all that time.
Since then I have -finally - almost abstained from any erection and the few erections I did have were improved.
1. The only injury that can affect erectile function is a full blown fracture - as my doctor said - or it is possible for an atypical injury as mine to lead to such consequences?
2. Me and my girlfriend are 100% sure that the penis shape (both flaccid and erect) has changed as well as the way it inflates with blood. Which could be the reasons for this, since there has not been a fracture?
3. In the last weeks I have noticed some subtle progress. Can we hope for a return to the pre-injury state?
4. FINALLY AND MOST CRUCIAL, I would like to be proactive with this situation.
Reading through internet, I have found many references to a combined therapy that helps to overcome penile injuries, that is a daily dosage of cialis combined with pentoxifylline, in order to decrease inflammation and increase tissue healing.
I would really like to hear your opinion about this therapy. Should I try it?
Currently I am on mirtazapine (remeron), quetiapine (seroquel) and venlafaxine (efexor) as a way to overcome the extreme anxiety I face due to this situations.
Can pentoxifylline interact with the above drugs?
Dear Mr Leslie,
thank for your time and patience
and your kind and informed reply.
It is not true that only a penile fracture grade injury can affect erection quality; lesser injuries can do so also. Recovery is more problematic.
While there may be lots of internet references to cialis/pentoxyphylline therapy, there is almost nothing in the official peer-reviewed medical literature supporting it. However, to me, this combination is reasonable and may be worth a try.
To my knowledge, there is no obvious interaction, but your pharmacist can check to make sure. Good luck.
---------- FOLLOW-UP ----------
QUESTION: Dear mr Leslie,
thank you so much for your prompt reply!
Just a couple of more questions, that I will be grateful if you could answer.
1. The fact that in the first three months after the injury my erection quality reached a nadir and now it is improving can be interpreted as a positive sign?
2. Judging by your experience, could I hope that erections may normalize with enough time given?
From what I have read, penile injuries may take a long time to settle. According to your opinion what would be a reasonable time-frame?
3. Do you find my doppler results reassuring? From what I 've read and what my doctor said, everything is in the normal range. However, could the decreasing RI and elevating EDV point out to an injury-obtained veno-occlusive dysfunction?
4. Finally, along with the cialis / pentox treatment, would you advise me to practice abstinence for the next months?
Thank you very much for your time
and your enlightening answers.
To answer your questions:
1) The fact that things are improving is a good sign. However, this does not necessarily guarantee full recovery.
2) In my experience, some do eventually return to normal functioning, but many will see "adequate" function that may not be as good as they had previously. A reasonable time frame would be 1 year after the injury.
3) Doppler results only indicate blood and vascular flow. They do not evaluate tissue function or possibly soft tissue injury or scarring. Specific interpretation of the Doppler is the responsibility of your urologist.
4) As long as things are slowly improving, overindulging in sexual activity is not recommended for the time being.