Penile implant age 24
I struggle with terrible ed. Im almost certain it’s because I’ve had priapism alot of nights for like months straight everyday mini episodes stuttering. It then led the Cialis to barely work anymore. After this I started mixing high dose Viagra and Cialis daily together as prescribed and it got a bit better but then boom it’s still not strong again. I’ve been on TRT for a more than a year and a few months. The TRT does nothing for my sex drive or erections I just look more mature and have better size than before. I was prescribed injections but I hate them so much it really burns inside because of the medication. I’m thinking of going back to injections but I’m almost certain I have scar tissue in the corporal bodies from all the past episodes. I’ve been through so much about this that I’m basically numb to it. Next treatment will be pills mixed with injections or maybe just the injections. I did a Doppler test and it was stated arterial insufficiency for the diagnoses without a cause of course. How can I get a doctor that actually cares? Any young guys with a penile implant? Anyone else been through this ?

I struggle with terrible ed. Im almost certain it’s because I’ve had priapism alot of nights for like months straight everyday mini episodes stuttering. It then led the Cialis to barely work anymore. After this I started mixing high dose Viagra and Cialis daily together as prescribed and it got a bit better but then boom it’s still not strong again. I’ve been on TRT for a more than a year and a few months. The TRT does nothing for my sex drive or erections I just look more mature and have better size than before. I was prescribed injections but I hate them so much it really burns inside because of the medication. I’m thinking of going back to injections but I’m almost certain I have scar tissue in the corporal bodies from all the past episodes. I’ve been through so much about this that I’m basically numb to it. Next treatment will be pills mixed with injections or maybe just the injections. I did a Doppler test and it was stated arterial insufficiency for the diagnoses without a cause of course. How can I get a doctor that actually cares? Any young guys with a penile implant? Anyone else been through this ?

29M. Height - 164cm, Weight - 162lb, South Asian in the United States.
Hello,
Recently, I got a whole bunch of tests due to some symptoms I've been having. I've been diagnosed with Secondary Hypogonadism (Have a pituitary Cyst I'm looking into), possible hypothyroidism (TSH is high, normal T3, T4. TPOAb mildly elevated (38 where the reference is 34). Of course, I have low testosterone, but I did a penile Doppler recently and it says I have mild to moderate arterial insufficiency and mild venous leak. Also have a varicocele on my left testicle, if relevant.
My main symptoms - ED, fatigue, Tired legs (Major issues with this), memory issues that are getting worse and worse since 2 years, cognitive issues, panic attacks, depression and extreme anxiety, non-restorative sleep, on and off headaches and burning eyes.
For ED, had this issue at the age of 20, went to a urologist and used Tadalafil for a while and it got a little better. Lost weight after that, but the tired legs made it difficult to sustain.
Questions:
What kind of doctor should I see to address a wide majority of these issues? Could they be connected in any way, especially the ED and tired legs, to any of the endocrine issues? If the tired legs issue is the root cause for ED, will handling that somehow help fix ED?
Another question about a penile Doppler ultrasound - Does low libido / low testosterone affect the findings of the test? Meaning, can mild to moderate arterial insufficiency or venous leak be due to low testosterone?
Will appreciate your help! Thanks.

I just came back from the urologist having a penile doppler ultrasound, the dose was 45 units of 30/4/40. While not fully rigid, she told me was no venous leak and arterial flow was ok but not enough to sustain an erection and takes longer to get one. There was no plaque. Before today, I was just doing Trimix, after the scan, she suggested to add 5mg Cialis to the mix but I know this is a progressing disease, should I try her recommendation or just go forward with the IPP. It's probably a short window before I need to get an implant. The thing I don't like about the injections are the dull ache/pain after and the spontaneity, kind of breaks the moment.
What are your opinions?

I have some family history of CAD and found out I was a 9p21 homozygote and apoe 3/4. I do regular lab work because I've been on TRT for a few years because my levels were low (300ng/dl) in my mid-late 20s. The cause seemed to be idiopathic secondary. Looked at thyroid/prolactin/cortisol/etc. I feel better than I did with low T.
I've read more about heart health lately and am terrified to be honest. My grandpa had a quadruple bypass at 60 and is alive along with all of my other grandparents today in their 80s. His side had some early deaths though and my aunt with high lp(a) had a heart attack in her 50s and is alive. Mom tested for low lp(a) luckily.
I scheduled a vascular screening that my local hospital does in a few months. They do a few things. I'm not sure if the carotid ultrasound is duplex or CIMT, but am hoping for the latter. I've read the Beat The Heart Attack Gene book and have gotten some of the tests from that as well as Peter.
Blood pressure typically runs 120-125 over 70-75 when I relax for 10 min so that seems like something to lower maybe.
I'm really freaking out over this LP PLA2 result though. My other labs seem solid so I was shocked that it came back high. I have seen that maybe it doesn't have a lot of clinical significance and establishment, but I'm not sure. Does it mean I already have plaque in the arteries?
Should I try to meet with a cardiologist and get on a statin? My LP PLA2 was just pulled so it wasn't on my labs that my primary looked at. He thought everything looked great.
My labs are below:
Total Cholesterol - 169 mg/dL (<200)
Triglycerides - 39 mg/dL (<150)
HDL - 57mg/dL (> 40)
LDL - 101mg/dL
Apob - 77mg/dL (<90)
Lp(a) - <10nmol/L (<75)
LP PLA2 - 156nmol/min/mL (<=123) HIGH
Fibrinogen - 203mg/dL (175-425)
HS CRP - <0.2mg/dL (<1.0)
Homocysteine - 7.9umol/L (<11.4) This had been higher normal as I'm C677T heterozygote. B/Folate supplementation seems to help.
TSH - 2.97mIU/L (.4 - 4.5) I've pulled fT3 and fT4 in the past and they were close to top of the range. TSH always runs a bit higher, no hypo symptoms
Glucose - 89mg/dL (65-99)
SHGB - 10.7nmol/L (10-50)
Total Test - 876ng/dL (250-1100)
Free Test - 253pg/mL (46-224) HIGH
E2 Ultrasensitive - 60pg/mL (< 29) HIGH - I feel better not taking an AI and have read that E2 is cardioprotective
DHEAS - 286mcg/dL (93-415)
Albumin - 5.1g/dL (3.6-5.1)
Protein - 7.5g/dL (6.1-8.1)
Globulin - 2.4 (1.9-3.7)
Bilirubin - 2.3mg/dL (.2-1.2) I believe I have Gilbert's Syndrome. This always runs high especially with longer fasts
Alkaline Phosphatase - 50u/L (36-130)
AST - 19 (10-40)
ALT - 16 (19-46)
GGT - 11 (3-90)
BUN - 15 (7-25)
Creatinine - 1.24 (.6-1.26)
Calcium - 10.1 (8.6-10.3)
Cystatin C - .8mg/dL (.52-1.31) eGFR with this is 117
Sodium - 140 (135-146)
Potassium - 4.5 (3.5-5.3)
Chloride - 103 (98-110)
Carbon Dioxide - 31 (20-32)
Platelet Count - 184 (140-400)
Red Blood Count - 5.52 (4.2-5.8)
Hemoglobin - 16.6 (13.2-17.1)
Hematocrit - 49.8 (38.5-50)
Rest of reds and whites and PSA are in range

The link between Post-SSRI Sexual Dysfunction, Hard Flaccid Syndrome, Post Finasteride Syndrome, Pelvic Floor Dysfunction, Chronic Pelvic Pain Syndrome and advice on how to start your healing journey based on 8 years of research and personal experiences : pssdhealing (reddit.com)
Here are all my thoughts and advice based on my personal experiences, other people’s insight and helpful experiences, and research I have done on and off about pelvic floor issues from the past eight years or so. I am not claiming that any of this is revolutionary, but I hope it can help some of you out there to give you a head start on healing and advance our understanding of these conditions. As I am a 27 year old male with previous major problems with pelvic floor issues and hard flaccid, some of my advice may be biased towards my condition. However, I believe everyone can benefit from a lot of this because I really do think that all of these conditions that I mentioned are linked in at least some way, especially by pelvic floor dysfunction and sex hormone desensitization. I try not to come to these forums because it increases anxiety and negative emotions which leads to worse pelvic floor symptoms, so my apologies if I do not respond to your questions. For hard flaccid and pelvic floor affected people, follow my advice and I am confident you can heal and reach a place where your symptoms barely affect your life, if at all, which is where I am at now. The mentality of trying to find a 100% “magic cure” solution just leads to anxiety and catastrophic thinking if you have a set back which will only worsen your symptoms. You can and will heal. I know this is a lot of information, but try to implement just one or two things at a time. Focus on the present, and take it one day at a time. Don’t get overwhelmed. All of this is my opinion and not professional medical advice. Talk with your doctor before starting anything.
Post Finasteride Syndrome (PFS), Post-SSRI Sexual Dysfunction (PSSD), Hard Flaccid Syndrome (HFS), Pelvic Floor Dysfunction, and Chronic Pelvic Pain Syndrome all can have some similar symptoms. I believe that they are all either caused or can be exacerbated by androgen and estrogen receptor insensitivity and are triggered by medication, genital injury, and pelvic floor inflammation and dysfunction. The pelvic floor is rich in androgen receptors and estrogen receptors. However, without proper androgen receptor activation and sensitivity, the pelvic floor muscles don’t have enough DHT which line the tissues of the pelvic floor, genitalia, and lower urinary tract. DHT is vital for healthy sexual functioning in both sexes - it provides an anabolic effect to tissues to provide strength, stability, healing, and relaxation to tissues. As a result of androgen receptor insensitivity and lack of DHT, the pelvic floor can become chronically weakened, tight, and inflamed which reduces blood flow to the region leading to even more androgen receptor insensitivity and thus less DHT. These symptoms can cause psychological stress to the individual which tightens the pelvic floor further leading to more symptoms and less blood flow. One study found that androgen sensitivity has raised the possibility that androgens can be used to rebuild the weakened and/or damaged muscles comprising the pelvic floor - source. Some people may also have normal hormone levels in the blood when tested, but these hormones cannot reach or be effective in the pelvic floor tissues or brain due to sex hormone insensitivity and the lack of the blood flow in the region caused by pelvic floor tightness and dysfunction. It is also likely that there is a problem with desensitized estrogen receptors causing a similar mechanism of dysfunction because they are also found in the pelvic floor, genitals, and brain and are important for pelvic floor health, sexual functioning, cognition, and emotions in both sexes. The most important element to remember to help start the healing process for these disorders is to boost blood flow through supplements, stretches, and exercises which will increase both androgen and estrogen receptor sensitivity over time.
Many males with PFS, PSSD, and Pelvic Floor dysfunction are affected by the hard flaccid condition.
Post Finasteride Syndrome (PFS) caused by Finasteride, a 5-alpha-reductase inhibitor (5-ARI), plummets DHT levels in the body to try to help hair loss causing sexual dysfunction and pelvic floor issues. Androgen receptors that surround the pelvic floor, genitals, and brain become desensitized due to the Finasteride leading to less DHT binding to these receptors causing dysfunction and a tight, weak pelvic floor. The tight, dysfunctional pelvic floor now restricts blood flow which impacts healing and the delivery of testosterone to this area that further exacerbates androgen insensitivity leading to less DHT in these tissues. Since androgen receptors are found in the brain and androgens have neuroprotective effects, this could be one reason why some PFS and PSSD sufferers are also impacted cognitively. An herbal supplement called Saw Palmetto has also been reported to cause a disorder similar to PFS because it is also a 5-ARI that blocks the conversion of testosterone into DHT. Another disorder called Post Accutane Syndrome (PAS) is also similar to PFS and it reduces DHT as well through being a 5-ARI: “Isotretinoin, used to treat severe acne, has been shown to induce hormonal changes, especially to reduce 5 alpha-reductase in the production of the tissue-derived dihydrotestosterone (DHT) metabolite 3 alpha-Adiol G.”. PFS, PAS, and PSSD are thought to cause not only androgen receptor desensitization, but likely estrogen receptor desensitization as well.
For Post-SSRI Sexual Dysfunction (PSSD), SSRIs are also known to decrease androgens and down regulate androgen receptors. This study shows that SSRIs can have an anti-estrogenic effect as well and can even reduce the expression of estrogen receptors (ER), including in the hypothalamus.. As sex hormones get desensitized in the pelvic floor, genital region, and brain, it causes localized DHT and estrogen levels in these tissues to decrease causing emotional blunting, sexual dysfunction, pelvic floor issues, hard flaccid syndrome, and more. The pelvic floor dysfunction can then prevent the sex hormone receptors from being reactivated and sensitized due to restricting oxygen and sex hormone rich blood flow to the tissues. SSRIs can cause androgen receptor insensitivity and estrogen receptor insensitivity by severely inhibiting the serotonin transporter (SERT) leading to increased serotonin levels which desensitizes those receptors throughout the body. One key to help heal from PSSD is increasing androgen production, androgen receptor sensitivity, and blood flow to boost BDNF, SERT, and DHT levels to hopefully allow any estrogen receptor desensitization recover on its own over time after everything else is normalized. Once androgen levels in local tissues (pelvic floor, brain, genitals) are normalized again through androgen receptor activation and sensitivity, it will encourage the conversion of androgens into estrogens in these tissues via aromatase. It is also worth to mention that some community members are trying to restore estrogen receptor sensitivity via boosting estrogen in various ways including by taking hops extract which is a potent phytoestrogen. This is also interesting: Estradiol represents another important natural ligand for androgen receptors that may play an essential role for the androgen receptor function and the development of the male reproductive system.
As mentioned earlier, people with PSSD and other disorders might have normal looking hormone blood tests (testosterone, DHT, estrogen, etc), but the issue is that these hormones are not functioning in the brain, pelvic floor, and genitals properly due to androgen and estrogen receptor insensitivity. An important thing to also recognize is that the medical community still has no official explanation how exactly SSRIs cause all of these debilitating side effects, but they are still being readily prescribed without informed consent about the risks of PSSD. It is unfortunate that it is people like us on the internet leading the charge to investigate and inform. We all need to continue to do our part to spread awareness of these iatrogenic disorders to warn people about the risks of taking these medications because their medical providers aren’t likely going to. Thank you to the PSSD Network for helping to give a voice to the unheard.
Post-SSRI Sexual Dysfunction (PSSD): Biological Plausibility, Symptoms, Diagnosis, and Presumed Risk Factors
Androgen receptor (AR) inactivation in mice led to reduction in hypothalamic neural nitric oxide synthase (nNOS), indicating the regulatory sexual function of this neurotransmitter. Furthermore, activation of the pre and post-synaptic 5HT1A receptors was found to be correlated with inhibitory effect on erectile function. All of these factors are speculated to be involved in this symptom and might be related to epigenetic alteration of androgen receptor (AR) and estrogen receptor (ER) densities due to influence of SSRIs on the epigenome.
In male PSSD sufferers, the penile shaft can be rigid during erection, yet the glans of the penis remains flaccid.This symptom may arise from hypo-activation of the dopaminergic and oxytocinergic pathways. The glans of the penis, in particular, receives its blood supply from the deep dorsal artery. Perhaps this points to a selective arterial malfunction relative to pelvic floor dysfunction which usually accompanies PSSD.
Here is another interesting study that gives support to the importance of increasing blood flow to help heal:
If SSRIs produce sexual side effects by impairing vasocongestion to the genital region, it would be expected that pharmacologic agents that increase blood flow to the genital region would improve sexual functioning. Indeed, several anecdotal reports and studies have found that sildenafil (a drug designed to treat erectile failure by increasing blood flow into the penile tissue) was successful in reversing SSRI-induced sexual dysfunction in both men and women [8,9,87,88,109]. Sildenafil acts to increase blood flow into the genital tissue by facilitating c-GMP activity that is initiated by nitric oxide [19] and preliminary evidence suggests that the SSRIs may cause sexual difficulties by inhibiting nitric oxide synthase [39,118].
Here is a paper from a community member that hypothesizes that the main issue is lasting estrogen receptor insensitivity just to give another interesting perspective on Post-SSRI Sexual Dysfunction, Post-Finasteride Syndrome, and Post-Retinoid Sexual Dysfunction
As the body is starved of DHT, ARs upregulate in response. At the same time, ER activation is significantly increased as a result of the increased production of Estradiol during treatment (due to higher Testosterone availability by reduced 5a reduction to DHT) - eventually leading to ER downregulation.
Hard Flaccid Syndrome (HFS) - There are many men suffering from HFS and pelvic floor issues due to PSSD, PFS, heavy weight lifting, excess kegeling, or in the case I’m presenting here, physical damage to the genitals from excessive, vigorous sexual activity (my case) or penis enlargement exercises. When the genitals get damaged, an inflammatory process starts and the pelvic floor contracts to protect itself. Since the pelvic floor is now in a chronic, contracted state, it limits oxygen and sex hormone rich blood flow to the genitals and pelvic floor which leads to sex hormone insensitivity and negatively impacts healing, muscle relaxation, and DHT production in these tissues. Finasteride, Accutane, and SSRIs also desensitize sex hormone receptors in the genitals and pelvic floor tissues leading to hard flaccid and pelvic floor dysfunction. Since the pelvic floor tightness restricts blood flow, it is difficult for hard flaccid sufferers to reactivate and sensitize their pelvic floor muscle androgen receptors again to regain relaxation and strength in their pelvic floor muscles, including the ischiocavernosus (IC), bulbocavernosus (BC), and pubococcygeus (PC) which are in a contracted state; the IC muscle in particular is thought to be the most implicated in the cause of hard flaccid. We first need to promote relaxation in the pelvic floor by boosting blood flow through supplements and stretches because tight muscles are weak muscles. Once the pelvic floor is in a chronic state of tension, it is hard to heal from pelvic floor issues because you likely already had bad habits such as poor posture, unhealthy sexual practices, stiff muscles, sedentary lifestyle, unchecked anxiety, and other negative lifestyle factors. Along with supplements, exercises, and stretches, correcting these bad habits is necessary to heal to have an even healthier pelvic floor than you ever had before because it likely was already tight and dysfunctional to begin with before developing obvious issues, but it was more subtle and you had no awareness of your pelvic floor muscles until now. You have the potential to now become a much healthier person overall than you ever would have been without being affected by pelvic floor dysfunction and hard flaccid.
32% of women will develop a pelvic floor disorder in their lifetime which is double that of men. While childbirth and pregnancy plays a role in this discrepancy, women also have far less testosterone and DHT levels than men which I believe plays a major factor. Since women have less testosterone, their androgen receptors that line the pelvic floor don’t make enough DHT to adequately support these tissues compared to men. This makes them more prone to pelvic floor dysfunction that causes them a disparate amount of pain, tightness, and inflammation. Androgen receptors and their ability to convert testosterone into DHT play such a vital role in pelvic floor health and sexual functioning. This is mentioned in a research study: Prevailing scientific literature has indicated the presence of androgen receptors in the levator ani muscle and pelvic fascia. The existence of androgen receptors in the vaginal wall can play an essential role in the development of pelvic floor disorders in women.Thus, androgen-related disorders may interfere with the function of pelvic floor muscles. [Many people mistakenly believe that androgens are only important for male sexual health:](https://www.bumc.bu.edu/sexualmedicine/patientinformation-physicians/androgen-insuffiency-in-women/#:~:text=Androgen%20insufficiency%20syndrome%2C%20characterized%20by,of%20sexual%20dysfunction%20in%20women.] Androgens have a three-fold action on female sexual function. They (1) increase libido by providing the fuel for a woman’s psychosexual stimulation, (2) increase sensitivity and blood flow to the external genitalia, and (3) increase the intensity of sexual gratification.
What I see in all these conditions is that sex hormone receptors become desensitized in the pelvic floor and genital tissues either from a drug, pelvic tightness, or inflammation from injury leading to less hormones being produced causing sexual and pelvic floor dysfunction. The pelvic floor now goes into a chronic tightened state as a response, leading to less oxygen and testosterone rich blood flow to the genital and pelvic region which leads to more androgen insensitivity and subsequently less DHT. This all explains why many people who have these conditions are helped by supplements that improve androgen receptor sensitivity and blood flow, and why pelvic floor therapy and exercises are so helpful to many of them. Estrogen receptor insensitivity in the pelvic floor also appears to have a similar mechanical negative effect by leading to less estrogen levels in the pelvic floor and genital tissues. It is also possible that some people with PSSD/PFS may have subtle or no pelvic floor symptoms, but the medication still desensitizes sex hormone sensitivity in their genitals and pelvic floor tissues that is leading to sexual dysfunction.
Another study linking androgens and the pelvic floor: Levator ani and other muscles of the pelvic floor and lower urinary tract are sensitive to the anabolic effects of testosterone. Androgen receptors are also expressed in the pelvic floor and lower urinary tract of both animals and humans. Anabolic effects of androgens may play an important role in the female pelvic-floor and lower-urinary-tract disorders. Furthermore, the interactions between androgen and nitric oxide synthase and arginase have been demonstrated, suggesting that androgens may also participate in modulating the physiological functions of the lower urinary tract through nitric oxide. The action of androgens in the lower urinary tract and pelvic floor is complex and may depend on their anabolic effects, hormonal modulation, receptor expression, interaction with nitric oxide synthase, or a combination of these effects.
My solution to help heal and improve the well-being of people with these issues is to try to improve sex hormone receptor sensitivity and pelvic floor function through supplements, stretches, exercises, and boosting blood flow which will hopefully restore normal levels of estrogens and androgens in pelvic, genital, and brain tissues. The body has a tremendous capability of self-healing, but we need to support it through active recovery methods.
We will first start with supplements (this is not professional medical advice - talk with your doctor before taking):
L-citrulline - This is the precursor to l-arginine, and it will improve blood flow and levels of nitric oxide to help get oxygen and testosterone rich blood to the pelvic floor and genital tissues to increase androgen sensitivity. Nitric oxide can also induce smooth muscle relaxation which is important for relaxing the pelvic floor. Herein we report on a young man affected by PSSD who regained sexual functioning after 3-month treatment with EDOVIS, a dietary supplement containing L-citrulline and other commonly used aphrodisiacs.. I recommend taking at least 6000 mg daily by taking 2000mg three times throughout the day. The max dose is 10,000mg. Even potentially better, people report great results using Cialis to improve blood flow and healing rather than L-citrulline and some doctors will even prescribe it to women if you show them the evidence - talk with your doctor. “Tadalafil (Cialis) reversal of sexual dysfunction caused by serotonin enhancing medications in women”. L-Citrulline and Cialis are not recommended to be taken together.
L-Carnitine - This will improve the number of androgen receptors and their sensitivity to testosterone to increase levels of DHT in the pelvic floor, genital tissues, and brain. I recommend taking 2000mg daily. Acetyl-L-Carnitine can pass through the blood-brain barrier, while Propionyl-L-carnitine has a high degree of interaction with testosterone. Propionyl may be better for sexual and pelvic floor dysfunction, while Acetyl might help people suffering from the mental effects of PSSD. This study used each at 2000mg daily to improve erectile dysfunction along with Viagra.. I would work up to 2000mg each of Acetyl and Propionyl L-Carnitine along with Cialis instead of Viagra as it lasts in the body for much longer (36 hours) for increased blood flow healing purposes. You can also use L-Citrulline instead of Cialis as mentioned earlier. Discuss with your doctor before taking them.
Vitamin D - This vitamin, which acts more like a hormone, works directly with the endocrine system. It has its own receptors throughout the body and they are often in close proximity to androgen receptors. Deficiency in vitamin D is associated with a stunting of testosterone's effects on androgen receptors and a decline in testosterone levels. Vitamin D will encourage androgen receptor resensitization. One study found that higher vitamin D levels are associated with a decreased risk of pelvic floor disorders in women, and The levator ani and coccygeus muscles are skeletal muscles that are critical components of the pelvic floor and may be affected by vitamin D nutritional status. I recommend 4000IU of vitamin D daily or whatever gets your levels to 60 - 80 ng/ml.
If you have inflammatory issues or pain due to pelvic floor dysfunction, I recommend a fish oil supplement daily. I take fish oil, and I find that it helps limit pelvic inflammation. I also take Magnesium Glycinate to relax the smooth muscle that lines the pelvic floor and genital tissue. I recommend it for people with clear pelvic floor dysfunction, but others should be careful as research says magnesium is a 5-alpha-reductase inhibitor. Take quercetin and bromelain as needed if you experience pelvic inflammatory flare ups and pain, but just be careful as quercetin can also inhibit the production of DHT from testosterone as well. Some say fish oil blocks DHT too, but experiencing chronic pelvic floor pain and inflammation will do more harm to you than minimal DHT blocking. I recommend staying away from all DHT inhibiting foods and supplements for people with PSSD, PFS, and PAS unless you are experiencing pelvic pain and inflammation.
As always, discuss these supplements with your doctor to see if they are okay for you. Lower your supplement intake based on side effects. These aren’t a magic cure, but a tool to help you on your journey to recovery. Don’t do anything without doctor supervision, but this thread gives more evidence for the “cure” for PSSD/PFS being resensitizing androgen receptors and estrogen receptors along with enhancing blood flow as it details how some men recovered through taking high doses of androgens, post cycle therapy, and Cialis. This at least gives hope that a hormonal cure can be created one day by medical professionals. I would of course recommend trying to heal yourself naturally for a long time before doing any hormone treatments under the supervision of a doctor.
I also recommend doing some form of yoga or pelvic floor stretches daily to improve blood flow for pelvic floor relaxation and sex hormone receptor sensitivity. You also need to request to see a pelvic floor therapist for an evaluation and treatment. Learn how to do reverse kegels. Doing reverse kegels will be difficult at first because your pelvic floor is tight and you have little to no awareness of these muscles, so just focus on lengthening and relaxing the pelvic floor through stretches for now. Do not do regular kegels for pelvic floor issues. Learn how to diaphragmatically breathe in 360 degrees to create expansion in your rib cage and abdomen to encourage pelvic floor relaxation. Do not breathe through your chest, and “belly breathing” isn’t the right term because the ribs need to expand as well. You can learn how to diaphragmatically breathe through an exercise such as 4-7-8 breathing. Here is a great video on diaphragmatic breathing and another video. I cannot overstate it enough: retraining yourself to properly breathe diaphragmatically is the single most important thing that you can do to heal from pelvic floor issues. Be a student of breathing: study and take notes on how to breathe better.
Stretches/Yoga poses I recommend:
Hold the Malasana/hindi/yoga squat pose for at least 5-10 minutes at least twice a day, but doing it morning, mid-day, and at night would be the best. Some get great results holding it for 15-20 minutes.This is one of the most important things for your pelvic floor because it will help lengthen and release it. Doing them barefoot is also very beneficial to strengthen your ankles and feet which are connected to your pelvic floor. Again, remember to breathe deeply down into your belly and pelvic floor for all these stretches.
Begin your stretching routine with an Exercise ball ab stretch and Upward-facing dog/cobra pose. This will help stretch your lower abs and psoas muscles so that you can get more breath deeper down into your pelvic floor for the rest of your stretches. Some people say that these types of stretches aren’t great for people who have Anterior Pelvic Tilt, which we should fix, but I still do them as it is important to stretch the lower abs that are hard to get to. You can experiment with doing them sporadically instead of every time you stretch.
This is my current personal complete stretch routine I do in order 3+ days a week:
Myofascial release on my glutes with an orb massage ball but you can use any small hard ball (don’t do this if glutes are currently sore) > Calf stretch against a wall or a yoga block which is what I use > exercise ball ab stretch > upward facing dog > (optional) Do a handful of cat cows > Supine hamstring stretch with yoga strap or an IdealStretch tool which is what I use > Kneeling hip flexor stretch > flat on back supine single knee to chest stretch > then bring knee to opposite shoulder stretch > supine figure four > I do this stretch next right after figure four > Reclined bound angle pose > (optional) butterfly stretch > (optional) A little bit of downward facing dog to stretch the calves > (optional) Lizard Pose) > (optional) Half split stretch/Half monkey pose with yoga blocks > Half-pigeon pose > Child’s pose > Wall quad hip flexor stretch > Wall figure four stretch > Wall straddle pose > Wall happy baby pose > Flat on back while pulling knees apart > kneeling with one leg, other leg out to side for adductors > (optional) Frog pose with feet together > regular Frog pose with feet separated in line with the knees > Yoga squat/malasana > Corpse pose
All these stretches are the ones I found most useful in a routine. See what works for you and develop your own routine. Consistency is the most important. This long stretching routine may not be possible for you to complete regularly so make adjustments, but doing this routine at least 3 days a week is ideal. Stretches such as the yoga squat, supine hamstring stretch, hip flexor stretches, and wall stretches are vital and should be done most days to help relax the pelvic floor. For how long you should hold each stretch, just go by how you and your body feels. Really let go, breathe, and sink into every stretch. On rest days, doing some deep breathing in child’s pose, reclined bound angle pose, flat on back while pulling knees apart, and the happy baby wall pose is really great while trying to do gentle reverse kegels.
You can also work on more individualized stretches for posture to correct anterior pelvic tilt, muscle imbalances, and to release other tight muscles, such as the upper body. Listen to your body if you need to give yourself a rest day from stretching. Adding in a 30-60 minute walk/swim on rest days is incredibly beneficial as well. Eventually, you can also try to learn isometric PNF stretching to incorporate it into some of the stretches such as the kneeling hip flexor stretch and hamstring stretch.
After working to relax and lengthen your pelvic floor through yoga and stretches, I would begin gentle body strengthening exercises that are pelvic floor safe. The pelvic floor is a master compensator. So, if the glutes, adductors, deep hip rotators, transversus abdominis, and other supportive muscles are weak, then the pelvic floor is in the prime position to pick up the slack which leads to a lot of strain on the pelvic floor which results in tightness and dysfunction. You need to strengthen the surrounding muscles to relieve tightness in the pelvic floor. This is where working with a pelvic floor therapist would be helpful to point out safe individualized exercises for you. Yoga will help strengthen your muscles in a safe way too.
The glutes and transversus abdominis in particular are very important to strengthen. Glute bridge, single glute bridge, side lying leg raises, lateral band walks can help build up glute strength. Deadbugs, Bird Dog, 8- point planks, or planks with pelvic floor-friendly modifications, can help to strengthen the transversus abdominis (TVA). Abdominal work may be triggering to your pelvic floor symptoms, especially the 8 point plank, so you can instead look into hypopressive exercises to work the TVA without overworking the pelvic floor. These exercises will help you bring more awareness to your breathing, diaphragm, TVA, and pelvic floor which are all important for recovery. Here is how to find and become aware of the TVA. Do side planks for your oblique ab muscles.
For hip/abductors do the side lying hip abduction exercise, fire hydrants, and the shinbox lunge. For the adductors, do Copenhagen adductor exercise, cossack squats, and an exercise where you squeeze a soft ball between the knees just don’t do any crunch movements with pelvic floor issues. For hamstrings, Nordic hamstring curl/glute ham raises, and single leg bridge. For the back, do supine pelvic tilt. One person even reported that dorsiflexion exercises and stretches were one important element to solve his pelvic floor issues; this is most likely because the ankle bone, like everything else including even our jaw, is connected to the pelvic floor.
Like with anything, do all these exercises in moderation and stop if you sense your pelvic floor is not responding well to them - do them one at a time to see which ones your pelvic floor can handle for now. Here is an exercise routine from another poster that has helped many people. Just be careful of the ab exercises such as the ab wheel and 5 minute planks with your pelvic floor issues - don’t over do it or avoid it if they cause too many symptoms.
Myofascial release and foam rolling to release trigger points also helps a lot of people to relax their pelvic floor muscles and improve blood flow. The glutes are the most important area to target for pelvic floor issues when foam rolling in my experience if you only had limited time. Using a soft ball to lay on and breathe deeply can help release trigger points in the abdominal muscles and psoas which can help you breathe better and relax the pelvic floor. I haven’t done it, but you can also try out a massage gun for myofascial release; just be careful and don’t use it in sensitive pelvic areas. Some men and women also report success using a therawand to release internal trigger points that are causing them pelvic floor dysfunction symptoms.
Walking and swimming for 30-60 minutes are some of the best exercises to lengthen, relax, stretch, and release your pelvic floor, boost blood flow, and help to retain and build strength in muscles that give support to the pelvic floor. Walk or swim for 5+ days a week for the best results. The breaststroke and freestyle are very helpful for pelvic floor sufferers. Along with swimming, people also use an elliptical at a low resistance to help provide a cardio workout that is safer for your pelvic floor.
Fix your posture. Pelvic floor issues and hard flaccid syndrome are closely associated with Anterior Pelvic Tilt and other postural issues. Get evaluated by a physical therapist so that they can give you exercises and stretches to fix it. You could also look into the Postural Restoration institute and see one of their providers and try to implement some of their exercises. In the meantime, here is one video playlist on how to fix APT. Another video to fix APT says to stretch the hip flexors, lower back, while focusing on strengthening the abs, glutes, and hamstrings. Make sure that you sit and walk with good posture - watch this to learn how to walk correctly - activate your glutes during each step and push off with your back foot!. I also recommend getting a standing desk to try to avoid sitting for long periods of time.
Weight training can be effective for boosting active androgen receptors in the body to increase testosterone and DHT levels. However, you need to make sure that it isn’t making your pelvic floor symptoms worse which defeats the purpose. If you are going to lift weights with pelvic floor issues, don’t lift heavy, do any intensive ab workouts, or any other exercises that can put extra strain on your pelvic floor. Do lifts where you can sit down instead of standing up. Start with yoga, stretching, and gentle body exercises to relax your pelvic floor and strengthen surrounding muscles before incorporating consistent weight training. I highly recommend, however, just sticking with yoga and pelvic floor safe body weight exercises to build strength instead. Those with PSSD without pelvic floor dysfunction may benefit a lot from lifting weights, high-intensity interval training, and doing bodyweight exercises such as squats regularly to boost androgen receptors and DHT. Remember to see a pelvic floor therapist to get evaluated first before starting any weight lifting because many people have pelvic floor issues without even realizing it.
Work on your mental health. Anxiety can worsen pelvic floor issues. Just as dogs tuck and tense their tails when stressed, we tense our pelvic floors which are directly connected to our tailbone where we used to have tails ourselves in our evolutionary history. As we are impacted by sexual dysfunction and pelvic floor dysfunction symptoms, we become anxious along with other negative emotions which leads to more pelvic floor tension symptoms due to the fight or flight mode response causing even more anxiety leading to more symptoms. It is a vicious cycle that needs to break by not becoming anxious and negative when we experience pelvic floor symptoms or hard flaccid and instead let go, accept, and realize that it is a normal process when trying to heal because sometimes our muscles that are used to that tightness don't want to let go of the tension we hold in our pelvic floors. Daily yoga, meditation, stretching, and walking will help with anxiety. I would also see a mental health therapist because all of these issues are deeply traumatic and we cannot go through this alone. We often hold tension in the form of emotions and trauma in our bodies, especially our pelvic floor and genital areas. By openly talking about these issues with a therapist, it will help us process and release our emotions and trauma that we are holding inside our bodies to improve our anxiety, relax our pelvic floor, and to let go of all of our tension. Many people who healed their hard flaccid and pelvic floor issues said that solving their anxiety and negative thoughts by talking to a mental health counselor was vital in recovery. The mind-body connection is so powerful, and it directly impacts our pelvic floor. Those who are stuck in the cycle of experiencing pelvic floor symptoms leading to anxiety and negative thoughts will also benefit from Cognitive Behavioral Therapy you can do by yourself like in this video or preferably with a trained therapist. Here is an informative mini lecture on how stress impacts the pelvic floor.
I would also definitely go on a healthy anti-inflammatory diet. Avoid caffeine, alcohol, marijuana, and other substances. Avoid foods and liquids that can trigger pelvic floor inflammation such as highly acidic fruits and veggies, carbonated beverages, very spicy foods, and artificial sugars. To maintain a healthy gut to reduce inflammation in your body I recommend trying a low-histamine probiotic supplement along with eating healthy. You should also work on preventing or fixing constipation; eat a lot of soluble fiber to not get constipated - take a supplement such as metamucil if you have to. Check the Bristol stool shape chart to identify if you are constipated because even mild constipation can contribute to pelvic floor tension. This is because the constipation leads to a lot of pressure being put on your rectum and pelvic floor leading to the muscles becoming weak and dysfunctional. I am willing to bet many of you are constipated and don’t know it because it isn’t just whether you go regularly, it is also how your stool is shaped. People with pelvic floor disorders are at a high risk of constipation which makes their tension and dysfunction worse which then worsens the constipation, another cycle to fix. I recommend getting a Squatty Potty to reduce strain on the pelvic floor during elimination.
To help heal hard flaccid and pelvic floor issues, never watch pornography again (this is vital). Go on NoFap for 90+ days to help heal your brain and body from any unhealthy pornography and sexual habits you have partaken in. Pornography leads to involuntary kegels, a tight pelvic floor, desensitizes you, and messes up the dopamine and arousal circuitry in your brain. Don’t climax too often. Learn how to reverse kegel by yourself and during sexual activities. Never edge or regular kegel - it leads to pelvic floor tightness and dysfunction - just relax your arousal through a reverse kegel. Keep your pelvic floor relaxed during sexual activities.
Stay strong and never give up. You will heal. Thank you for reading.

Hi everyone health info:
27F, 115 lbs Median Arcuate Ligament Syndrome(diagnosed by angiogram in January 2024) Bilateral Iliac Vein Compression(no may thurner anatomy) Slipping Rib Syndrome(surgically repaired in Feb 2024) Endometriosis
Medications: Zyrtec, recently tapered off gabapentin, Mirena IUD
Symptoms: Left leg pain from calf to groin Hurts worse with activity Has begun to keep me up at night due to pain
I was diagnosed with bilateral iliac vein compression earlier this year when I did a workup for mals. I didnt want to stent yet and my vascular surgeons office told me to follow up as needed. 10 days ago I started having pain in the left calf up through the groin. I don't have any redness, warmth or swelling as of now, but hasnt gotten better with stretching, rest, etc. I called my surgeons office to get their opinion since from what I understand you can be more susceptible to dvts with iliac vein compression. I go in for my ultrasound and they kept talking about my arteries and my angiogram, but said there's nothing wrong with my leg. After the ultrasound, I see the note from the doctor and he again mentions my arteries writing "the duplex scan shows essentially normal arterial supply to the left leg" and talked about my MALS but not my iliac vein compression. If they were looking for dvt would they order an ultrasound of the veins not the arteries, or does the ultrasound cover both? I just want to be sure that my negative result actually means it ruled out a dvt, or if they thought I wanted a scan because of the angiogram and so they ordered the duplex for arteries. Thanks!

Dubai stands as a beacon in the realm of real estate investments, drawing in discerning investors with its robust economy and flourishing property sector. Within its dynamic landscape lie abundant prospects for investors seeking to broaden their portfolios. Among these opportunities, off-plan properties have emerged as a focal point of interest in recent times. Let us delve into the enclaves hosting the most promising off-plan properties in Dubai.

Unveiling The Potential Of Real Estate: Premier Off-Plan Property Enclaves In Dubai To Keep An Eye On

Dubai has etched its name as a premier destination for real estate investments, magnetizing investors globally. Upon scrutinizing the merits and demerits of real estate acquisition in Dubai, one finds a plethora of advantages stemming from its strategic position in the MENA region, elevated lifestyle standards, compelling value propositions, and hospitable business climate.

Understanding Off-Plan Properties in Dubai

Off-plan properties in Dubai encompass projects at various stages of development, ranging from those in construction to those in the nascent planning phase. Opting for off-plan properties holds distinct advantages over acquiring ready properties, including favorable pricing and potential returns.
Moreover, off-plan properties typically offer greater flexibility in payment arrangements, enabling investors to disburse funds over extended periods. Prominent developers in the region consistently unveil their latest off-plan properties, enticing investors and affluent clientele to the emirate.

Prime ‘accessible’ Off-Plan Investment Enclaves In Dubai

Jumeirah Village Circle (Jvc)

Jumeirah Village Circle burgeons as a burgeoning community, presenting an array of accessible off-plan properties in Dubai. Catering to families and young professionals alike, this locale boasts an array of amenities such as verdant parks, educational institutions, retail outlets, and dining establishments. Prospective investors can select from a diverse range of residences, including apartments, townhouses, and villas.

Al Furjan

Al Furjan emerges as a swiftly evolving hotspot for off-plan endeavors, showcasing a diverse selection of residences. These encompass apartments, townhouses, and villas complemented by flexible payment options. Al Furjan’s appeal lies not only in its residential offerings but also in its superior communal amenities and seamless connectivity to Dubai’s arterial thoroughfares and public transit systems.

Arjan

Arjan’s off-plan properties present lucrative investment prospects within one of Dubai’s most rapidly developing residential precincts. Nestled within the expansive Dubailand area, Arjan captivates with its array of tourist attractions, including the renowned Dubai Miracle Garden and Dubai Butterfly Garden. Investors can peruse a curated selection of top off-plan projects in Arjan, boasting affordable accommodations compared to other Dubai locales.

Damac Hills 2

DAMAC Hills 2 (D2) emerges as an idyllic locale for families, distinguished by its superlative amenities and commitment to sustainable community living. As the neighborhood continues to evolve, amenities such as parks, recreational facilities, and retail outlets are set to proliferate. D2 stands as a premier destination for acquiring affordable villas in Dubai, with numerous off-plan and ready developments offering residences at compelling price points.

Dubai South

Dubai South unfolds as a burgeoning community featuring an amalgamation of ready and off-plan projects. Notable among these are The Pulse Residences, South Bay, and The Pulse Beachfront Villas, developed by Dubai South Developers. South Bay, an off-plan endeavor within the Dubai South precinct, enjoys a coveted location near Al Maktoum International Airport and Expo City Dubai. The development promises a diverse array of residences, including villas, townhouses, and contemporary living amenities.

Enclaves Housing The Finest Off-Plan Projects In Dubai — Boutique Residences

Dubai Hills Estate

Dubai Hills Estate sprawls as a multifaceted development offering an assortment of residential properties set amidst verdant expanses and panoramic vistas. This premier development boasts a championship golf course, retail and dining establishments, and seamless access to Dubai’s major thoroughfares. The allure of Dubai Hills Estate lies in its central yet secluded ambiance, appealing to investors and potential tenants seeking unrivaled recreational amenities and family-centric offerings.

Dubai Creek Harbour

Dubai Creek Harbour emerges as a captivating off-plan investment enclave, boasting picturesque waterfront panoramas and a medley of world-class amenities. Destined to become the cornerstone of Dubai’s waterfront communities, this development encompasses over 30,000 residential units alongside a myriad of commercial and retail spaces. Investors are presented with an array of options, ranging from luxury waterfront apartments to expansive duplexes and opulent penthouses.

Tilal Al Ghaf

Tilal Al Ghaf stands as a distinctive residential community developed by Majid Al Futtaim, centered around a captivating lagoon. Encompassing luxury villas and mansions, Tilal Al Ghaf is revered among the locales hosting the finest off-plan properties in Dubai. The master community spans over 300 hectares, featuring cycling tracks, jogging paths, and promenades, catering to outdoor enthusiasts. Moreover, the expansive lagoon, spanning 70,000 square meters, with its 400-meter beach and 1.5-kilometer shoreline, augments Tilal Al Ghaf’s allure.

Mohammed Bin Rashid City (Mbr City)

Mohammed Bin Rashid City (MBR City) emerges as a meticulously planned neighborhood situated near Sheikh Zayed Road (E11) and Al Khail Road (E44). This vibrant precinct boasts an array of amenities, including parks, private beaches, lagoons, educational institutions, supermarkets, dining establishments, and landscaped gardens, positioning it as one of Dubai’s preeminent mixed-use developments. Noteworthy among MBR City’s myriad advantages is its diverse array of off-plan projects, presenting investors with a plethora of investment opportunities.

Closing Remarks

Dubai’s real estate landscape presents a compelling avenue for investment, promising lucrative returns amid a burgeoning economy and thriving property market. By strategically investing in the locales hosting the finest off-plan properties in Dubai, investors can capitalize on the city’s exponential growth trajectory. However, prudent evaluation of the rationale behind off-plan property acquisition in Dubai is imperative before finalizing investment decisions. Moreover, partnering with InchBrick Realty can provide invaluable guidance and insights, ensuring investors make well-informed decisions in navigating Dubai’s dynamic real estate landscape.

Hi guys. 23 year old male, 5’8” 160lbs. Been dealing with erectile dysfunction for 4 years now (started at 19 years old).
I have gone to countless doctors throughout this years. I have gone to 3 urologists, I got scammed 5400 for shockwave therapy, and like 10 different visits between 3 clinics including a mens clinic.
Every doctor that has evaded me has said that I’m good physically. All lipid and hormonal panels have come out fine. Most recently I did an Doppler ultrasound to see if there was an issue with my penile arteries. Urologists showed me the ultrasound while he was doing it and he said my levels could not be more perfect. He showed both arteries pumping. And the ultrasound the waves were perfect. He said there’s no issue physically and that it’s all mental.
He told me to try a low dose of antidepressants, I told him I’m scared because antidepressants give you ED but he said it’s not true and he prescribed them all the time. This was the 3rd visit with this urologist.
It’s the second time I hear the antidepressant opinion, first time was a GP who told me to take fluoxetine. The urologist didn’t prescribe me any but in a podcast he mentioned he usually prescribed sertaline (I think that’s how you spell it).
I am too scared of antidepressants. There is a subreddit dedicated to permanent sexual dysfunction from antidepressants called pssd. But I just don’t know what else to do. I feel like I’m running in circles. These last 4 years have brought the most pain I’ve ever experienced, I haven’t woken up a day without wanting to kill myself due to this disease. This ED has taken my life away. I want to enjoy life but it’s impossible.
Things that I have tried are: clomid 50mg, taldalafil 5mg daily and 20mg as needed, sildenafil 50mg and 100mg, zinc 50mg, vitamin E, Viramin D, L-Cirruline 1200 mg, triple omega, ashwaganda, iron, magnesium, vitamin b12. Nothing has worked.
To clarify, my issue isn’t just performance anxiety. I cannot get hard alone, I cannot get hard to porn or imagination. My penis is completely dead.
I’ve heard buspar and Wellbutrin are good options but wanted to hear more.

I’m sorry to post here but I’m not sure where else to ask - I had an unrelated MRI see a lesion with some septations on my left ovary along with some fluid so they told me to get an ultrasound.
The ultrasound saw a different size on that side (maybe it burst?) and some hypoechoic lesions on the other side. I have a bunch of abdominal symptoms but I also have diagnosed Crohn’s disease, so just always assume it’s due to that. I just moved here and don’t have a primary care doctor yet - is this worth following up with a gyno?
Unrelated MRI (couple of weeks ago):
The left ovary appears enlarged by follicles and a 33 mm cystic-appearing lesion with a couple of septations measuring up to 2 mm in thickness. There was a small amount of fluid noted in the cul-de-sac.
Ultrasound (this week):
The right ovary measures 3.0 x 2.2 x 2.6 cm. Few hypoechoic ovarian lesions, largest measures 1.7 x 1.7 x 2.2 cm, likely simple cysts. Normal arterial waveforms are identified in the ovary on Duplex Doppler analysis. Small free fluid in the right adnexa.
The left ovary measures 2.8 x 1.9 x 2.8 cm. Few ovarian cysts, minimally complex, measure up to 9 mm, could represent a hemorrhagic cyst. Normal arterial waveforms are identified in the ovary on Duplex Doppler analysis.

Findings: Moderately and diffuse echogenic liver is present measuring up to 15.5 cm. The
liver is obscured due to technique and bowel gas. Otherwise, The liver and gallbladder
appears grossly unremarkable without other well-defined lesions in the visualized portion.
Spleen: The spleen is grossly unremarkable in size and morphology in its visualized portion.
Common bile duct: The common bile duct in visualized portion is normal in caliber.
Pancreas: The pancreas is obscured by bowel gas.
Kidneys:
The kidneys are otherwise grossly unremarkable in size and morphology . No other
hydronephrosis or obstructive calculi are identified. Doppler images show flow within the
arterial and venous system intrarenally.
VASCULAR DUPLEX COLOR FLOW DOPPLER IMAGING
Abdominal Aorta: The visualized portion of the abdominal aorta from proximal to distal portion
is unremarkable without evidence of aneurysm or significant luminal stenosis. The peak
systolic velocities of the visualized arterial system do not appear to exceed 120 cm/s.
Visualized portion of IVC, portal and hepatic veins are patent and unremarkable.
IMPRESSION: Suboptimal exam as above.
Diffuse echogenic liver as above likely fatty infiltration versus other hepatocellular diseases.
Correlate clinically and follow-up

Please consult this FAQ before posting a duplicate question.
Authors: Everyone
This is being written by a lot of people. This is a collective, community effort. If problems with some of the answers, please offer a constructive alternative or suggestion and/or re-write the paragraph
Do I have hard flaccid?
Hard Flaccid Syndrome (HFS) presents itself with a set of overlapping symptoms which may include physical and textural alterations in genital appearance, sexual dysfunction and dysesthesia. At this point in time, hard flaccid syndrome is almost entirely self-diagnosed.
Some of the hallmark symptoms of Hard Flaccid Syndrome are:

1. A shrunken, shrivelled penis in the flaccid state: The penis may appear shrunken, shrivelled and retracted in the flaccid state. Upon palpation, the flaccid penis will often appear to be hardened and rubbery. Other commonly reported visual and textural changes include altered appearance of veins on the penis body (engorged veins, spider veins), constantly retracted testicles, a penis tilt or curve in flaccid and erect states, dimples at the base of the penis, as well as wrinkly, discolored, leathery and dry skin.

2. Hourglassing: Many sufferers report the appearance of a penis that is pinched in the middle of the shaft. The penis shape will resemble the shape a hourglass. The pinched area will sometimes seem hardened and discolored. Hourglassing is noticeable in both flaccid and erect states.

1. Worsening of symptoms before, during and after bowel movements and urination.
   
2. Sexual dysfunction: Hard flaccid may lead to difficulties with achieving or maintaining an erection. Spontaneous and nocturnal/morning erections are sometimes entirely absent. Erections are alternatively described as "hollow feeling", "disconnected", "uneven- filling" and "posture-dependent". Libido is sometimes negatively affected.
   
3. Pelvic floor dysfunction: Symptoms of hard flaccid will ofter occur alongside PFD symptoms including but not limited to urinary issues (urinary hesitancy, weak stream, post-void dribble, urethral burning), sphincter dysfunction (dysynergia, involuntary kegelling), muscle fasciculations, spasms, pain or tenderness (levaror ani syndrome, CPPS).
   
4. Sensory changes: These include paresthesias, dysesthesias and numbness. Commonly reported symptoms include but are not limited to numbness (= reduced sensation or lack of sensation), lack of erogenous sensation, cold and hot sensations, pulling/crawling/pins-and-needles/tingling sensations in and around genitals.
   

What causes hard flaccid?
The current established causes are still unknown. However, there have been many theories and hypotheses. There is no established singular cause and many individual conditions have been hypothesised to independently give rise to hard flaccid symptomatology. Such conditions include: trauma to the genitals, pelvic myoneuropathy and pelvic floor dysfunction (PFD), chronic prostatitis/ chronic pelvic pain syndrome (CPPS), pudental neuralgia and pudental nerve entrapment (PNE) syndromes, hip issues (hip impingement and hip dysplasia), spine issues (bulging disks, annular tears, perineural cysts), PSSD, various neuropathies (small fiber neuropathy), HPA axis dysfunction.
Goldstein et al. (2023) proposed five regions that contribute to hard flaccid. Please see Appendix A for more information on this. genitals.
I have hard flaccid. Now what?
Consider following one of the treatment algorithms: Algorithm 1 Algorithm 2
Is hard flaccid a result of pelvic floor dysfunction (PFD) or chronic pelvic pain syndrome (CPPS)?
For many cases, hard flaccid syndrome is concomitant with PFD and CPPS symptomatology.
Is hard flaccid a result of pudendal neuralgia?
For many cases, it could be a contributor or a cause. Until more research is conducted on HFS, we won’t have an exact answer to this question.
What is the difference between hard flaccid and long flaccid?

• Hard flaccid is characterized by a penis in a consistently semi-rigid flaccid state. Symptoms can include pain, burning, numbness, cold glans, and loss of size in Niedenfuehr et al. (In-peer review) and Abdessater et al. (2020) review,
• Long flaccid is characterized by the penis being excessively soft and long while in a flaccid state.

Is hard flaccid and peyronie's disease the same condition?
While they have some overlapping symptoms, hard flaccid and peyronie’s condition are completely different and should not be considered as such. Peyronie’s is caused by the build-up of scar tissue (fibrosis) in the shaft of the penis. However, in the overwhelming majority of cases involving hard flaccid there is no fibrosis. The disease is characterized by the development of fibrous scar tissue or plaques in the penis. These plaques can cause the penis to bend or curve during erections, leading to pain, discomfort, and in some cases, erectile dysfunction. The exact cause of Peyronie's disease is not well understood, but it is believed to involve a combination of genetic, trauma-related, and inflammatory factors. While the condition often develops gradually and can affect men of any age, it has been reported as being more prevalent in middle-aged men.
Symptoms of Peyronie's disease may include:

1. Penile curvature: The penis may develop a noticeable curve or bend during erections.
2. Pain: Some men may experience pain or discomfort during erections, especially if there is tension on the affected area.
3. Erectile dysfunction: Peyronie's disease can lead to difficulties achieving or maintaining an erection.

How is Peyronie's diagnosed:

1. Physical examination: The urologist will palpate for plague inside the penis body in flaccid and erect state.
2. Ultrasound: The urologist will look for plaques using ultrasound in flaccid and erect state.

In some cases, Peyronie's disease may resolve on its own without treatment. However, if symptoms are persistent or severe, medical intervention may be necessary. Treatment options may include:

1. Medications: Certain medications, such as collagenase clostridium histolyticum (Xiaflex), may be injected directly into the plaque to help break it down.
2. Penile traction devices: These devices are designed to apply gentle and consistent stretching to the penis, with the goal of reducing curvature over time.
3. Surgery: In more severe cases, surgical procedures may be considered to correct the curvature and remove the plaque. However, surgery is typically reserved for cases where other treatments have not been successful or when the symptoms are particularly severe.

Reference:Reference: Sandean DP, Lotfollahzadeh S. Peyronie Disease. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560628/
Do I have nerve damage/irreversible nerve damage?
There is no way to diagnose nerve damage from symptoms alone. A set of specialised tests (EMNG, MRN etc) are needed to assess the function of nerves.
Is surgery recommended for hard flaccid?
If the symptoms are chronic and debilitating, surgery is often recommended to such patients with a reduced quality of life.
The current surgeries that have been attempted by patients include:

• Renauld Bollens’ pudendal nerve release surgery: This surgery is not for HF or anyone with a mild case. It’s for severe pudendal cases only (e.g., individuals with less than 5% feeling/sensations in their penis). Someone with intense HF and mild to moderate ED should not get surgery. The results of Bollens’ surgery appear to be mixed. While some patients have reported improvement in their hard flaccid symptoms, most of the time the improvement was only marginal and waned over the months and years following the operation. Moreover, a significant number of patients on Reddit who underwent Bollens’ surgery have either reported no improvement or even a significant worsening of their symptoms, sometimes to the point of ending up with severe chronic pain. Several of the few patients also have had multiple comorbid conditions, took SSRIs, or had overlapping contributors/symptoms that have not been diagnosed yet, which have may have affected the overall results of this surgery. Patients report no transparency from the doctor and no diagnostic testing.
• Endoscopic discectomy surgery by San Diego Sexual Medicine with Dr. Choll Kim: While the existing results have been reportedly positive, the current patients have continued to need cognitive therapy and pelvic floor PT after the surgery. An anesthetic block is needed for diagnostic testing. More research is needed to conclude the efficacy of such a procedure on hard flaccid symptoms in comparison to persistent genital arousal disorder. We have attached some literature to read more about the procedure itself.

References:
Maggi, M., Pirola, G. M., Absil, F., De Plaen, E., Mosca, A., Salciccia, S., Sciarra, A., & Bollens, R. (2020). Erectile function recovery after laparoscopic decompression of pudendal artery and nerve: a documented case report. Central European journal of urology, 73(4), 569–571. https://doi.org/10.5173/ceju.2020.0088.R1
https://auanews.net/issues/articles/2023/may-2023/hard-flaccid-syndrome-proposed-to-be-secondary-to-pathological-activation-of-a-pelvic/pudendal-hypogastric-reflex
/doctor_appointment_generic_questions/
I am having surgery, how should I prepare for surgery?
https://www.reddit.com/HardFlaccidStudy/comments/14o6gq4/generic_surgery_preparation_list/
Will sexual intercourse make my hard flaccid worse?
As a general rule, sexual activity should be avoided during the initial period following the injury that resulted in hard flaccid symptoms. Following the end of the acute period of injury it should be fine to engage in sexual intercourse (if possible). Moreover, anecdotal evidence suggests that sexual intercourse is preferable to masturbation as it is less likely to cause a flare up of symptoms. However, avoid all sexual activity when you’re experiencing pain in the penis.
What should I ask my doctor in an appointment?
https://www.reddit.com/HardFlaccidStudy/comments/14ng32e
I went to a doctor and they told me that my hard flaccid symptoms are all in my head. Is it true?
The mental aspect is not a CAUSE of hard flaccid and is it NOT in your head. Depression and a negative mood may exacerbate them for some people, but not cause. If the symptoms of hard flaccid persist for an extended period of time it is unlikely that they are a result of mental health issues.
Is there a link between diet and hard flaccid symptoms?
At present, there is no research suggesting any direct correlation between diet and hard flaccid symptoms. While maintaining a proper diet can be beneficial as part of a holistic treatment approach for any sexual dysfunction condition and maintaining good health to prevent comorbidities, it is VERY unlikely that a proper diet alone is enough to recover from hard flaccid. However, there have been reports of alcohol consumption resulting in flare ups of the hard flaccid symptoms. Additionally, there is anecdotal evidence suggesting that excessive consumption of caffeine can also result in a flare up of hard flaccid symptoms.
Can a penile implant help resolve hard flaccid symptoms?
There is limited research on penile implant surgery. Regarding a penile implant as a treatment for hard flaccid also has no research. Therefore, it is difficult to ascertain whether the surgery will yield any improvements to the hard flaccid symptoms. However, it may be a valid treatment for individuals with hard flaccid who mainly suffer from erectile dysfunction. It must be noted that a decision to undergo a penile implant surgery should not be taken lightly and should be a measure of last after exhausting all other treatment options (e.g. exercise, medication, etc.) as it is irreversible and precludes the patient who undergoes it from ever being able to achieve an erection without a penile implant. Moreover, penile implants have to be replaced every 10-15 years and there is no guarantee that they will be able to alleviate symptoms not related to erectile dysfunction like pain or genital numbness.
What is the Dynamic Contraction Technique (DCT) and is it helpful in treating hard flaccid?
Dynamic Contraction Technique (DCT) is a primarily paid online-based exercise program that advertises itself as offering an exercise regimen that can help recover from hard flaccid. However, the feedback regarding the effectiveness of the program has been rather mixed (if not relatively negative) and a significant number of participants of the program did not experience any notable improvement in their hard flaccid symptoms.
Is there a link between stress and hard flaccid symptoms?
Anecdotal evidence suggests that periods of intense stress can contribute to the worsening of the hard flaccid symptoms. However, the exact extent to which stress can be linked to hard flaccid is unclear. Moreover, management of stress, depression, and anxiety alone is usually not sufficient for recovery from hard flaccid in most cases.
Are kegels recommended for treating hard flaccid?
Kegels are always debated in every sexual dysfunction forum and it's a your mileage may vary” treatment for hard flaccid symptoms. With all sexual dysfunction conditions, many suggest that kegels are particularly bad for the pelvic floor. The general consensus, particularly among those who believe that hard flaccid is caused by overly tense (hypertonic) pelvic floor, is that kegels can result in the worsening of the hard flaccid symptoms due to making the already tense muscles even more tense. On the other hand, there has been a notable increase in the amount of anecdotal evidence that kegels, when done in moderation, can be beneficial as part of a holistic treatment of hard flaccid, particularly for those who believe that their hard flaccid symptoms is a result of weak pelvic floor muscles. However, it is strongly advised not to do kegels exercises without consulting with a pelvic floor physical therapist as they can evaluate whether your pelvic floor muscles are tight (hypertonic) or weak (hypotonic). Do them at your own risk.
Does hard flaccid have any affect on fertility?
There is no research suggesting a correlation between hard flaccid symptoms and fertility. Therefore, it is unlikely that hard flaccid can result in infertility. The only effect that hard flaccid can result in infertility is an indirect one as the common symptoms of hard flaccid include erectile dysfunction and genital numbness, which can make conception through sexual intercourse challenging. However, it should not affect alternative conception methods such as in-vitro fertilization
Any helpful videos?

• San Diego Sexual Medicine: https://www.youtube.com/watch?v=6Y1u4xUlHUA
• UroChannel: https://www.youtube.com/watch?v=PA4FvmK5M2s&t=1s
• Annular Tear and Spine: https://www.youtube.com/watch?v=J0DbgX3nHus&t=654s
• BtCalvit Lecture: https://www.youtube.com/watch?v=b6unN4_-wAw&t=177s
• HF video by Hink: https://www.youtube.com/watch?v=CBWlrpLhTEo
• Dr. Eric - A Guide to Hard Flaccid Syndrome: Causes, Symptoms, and Treatment Options Urologist explainshttps://www.youtube.com/watch?v=IYX1oQ836ac
• Game Changing HF - AUA Dr. Goldstein's paper commentary https://www.youtube.com/watch?v=q45NOhq4n98&t=5s
• Diagnosing Hip Issues: https://www.youtube.com/watch?v=NQ0uvTDoPvM&t=1281s

Has anyone been cured from Hard Flaccid?
Given the nature of the internet and online self-report format of these forums, we cannot confirm the validity of people claiming to be cured. We define "cure" as people who have basically returned to baseline prior to receiving hard flaccid symptoms. The only confirmed case-report includes Btcalvit’s case by Nico et al. (2022). There is no scientifically agreed upon treatment method for hard flaccid yet. However, there have been several reports of people experiencing a major improvement and even complete resolution of hard flaccid symptoms from a variety of treatment methods.
Nico, E., Rubin, R., & Trosch, L. (2022). Successful Treatment of Hard Flaccid Syndrome: A case report. The Journal of Sexual Medicine, 19(4), S103.
Reddit Reports of People Self-Reporting to Be Cured or Almost Cured - Read at your own risk

• https://www.reddit.com/NoFap/comments/a64zbu/how_i_cured_my_hard_flaccid_after_8_years_100/
• https://www.reddit.com/NoFap/comments/75o1vx/how_i_cured_from_hard_flaccid/
• https://www.reddit.com/NoFap/comments/9stoqp/how_i_cured_hard_flaccid_full_guide/?utm_source=share&utm_medium=mweb
• https://www.reddit.com/AngionMethod/comments/14nsgwj/update_hard_flaccid_getting_cured_by_fixing_my/
• https://www.reddit.com/Hard_Flaccid/comments/jmswoe/a_doctor_with_hard_flaccid/?rdt=38128
• https://www.reddit.com/hardflaccidresearch/comments/10sy98q/hard_flaccid_finally_gone/
• https://www.reddit.com/hardflaccidresearch/comments/14nsov2/update_hard_flaccid_getting_cured_by_fixing_my/
• https://www.reddit.com/hardflaccidresearch/comments/15ed5zm/update/?share_id=SjzqY4UG2Ay99O2T6GXhs&utm_content=1&utm_medium=android_app&utm_name=androidcss&utm_source=share&utm_term=1
• https://www.reddit.com/Hard_Flaccid/comments/xfa83q/my_story_and_my_cure/
• https://www.reddit.com/hardflaccidresearch/comments/177ghjv/how_i_healed/
• https://www.reddit.com/hardflaccidresearch/comments/16s73sw/you_can_get_better_whats_worked_for_me_10_months/
• https://www.reddit.com/gettingbiggecomments/16u0wcs/car_accident_i_developed_hard_flaccid_before_even/
• https://www.reddit.com/hardflaccidresearch/comments/1264dvn/99_cured_from_terazosin_and_cialis/?sort=new
• https://www.reddit.com/hardflaccidresearch/comments/14jx605/finally_im_cured/
• https://www.reddit.com/hardflaccidresearch/comments/y3l00e/message_from_someone_who_cured_his_hf/

Where is Ben’s routine?
https://www.reddit.com/Hard_Flaccid/comments/s18opt/experimental_hf_routine/
Where are the discords?

• https://discord.gg/6eFdYFnV - Hard Flaccid Study Discord Server
• https://discord.gg/uhyvWvDK - CPPS & HF Rehab/Support Group Discord Server

What are the existing hard flaccid websites?

• www.hardflaccidsyndrome.com
• www.hardflaccid.com
• https://www.instagram.com/hard_flaccid_austausch/

Confusion 😭
1st ultrasound - told I have epididymitis 2nd ultrasound - told I have a small varicocele and epididymal cyst. 3rd ultrasound - told I have no varicocele just epididymitis and epididymal cyst
Should I request another ultrasound from the urologists?

It all started when I was 24(I’m 29 now). One day it felt like getting an erection was nearly impossible. I’ve been to two different urologists and told two GP’s. 3/4 didn’t do much of anything other than a testosterone test which was at a normal level both times and it was tested in the morning.
Recently a couple months ago the last urologist I went to did a Doppler scan on my penis and told me I had calcification in my penile arteries. He’s one of the doctors that basically only focuses on penile implants, so he wasn’t very help. I guess I’ll go see a urologist, but idk if I need to see another type of doctor or what. Idk how one would go about reversing calcification of the arteries in the penis but idk what to even do at this point.
Any doctor I’ve gone to has never really given me the proper help I need. At best they’ll do an examination and give me viagra or cialis and shrug their shoulders. Then I just get some generic performance anxiety rant and they call it a day. I’m just so unbelievably frustrated cause it feels like a part of my isn’t the same as it use to be and idk how to get it back.

Like many of you, I hate that this takes so damn long, and I've also wondered why some people can restore much faster than others. Recently, while researching these issues, I chanced upon some information which led me to what seems to be a new discovery that may help speed up the glacial pace of restoring progress.
Short version:
There is a group of substances, known as vasodilators, which act upon the vascular smooth muscle cells in the Dartos Fascia (the bottom layer of the penile shaft skin and mucosa) in a way that appears to speed up the process of growing a foreskin.
Method of action:
Vasodilators are commonly used to control blood pressure. They act in various ways to relax the walls of arteries, increasing the diameter of the artery and letting more blood flow, thereby lowering blood pressure.
Now here's the connection: the tissue in the artery walls that vasodilators act on is the same vascular smooth muscle cells (VSMC) that are in the Dartos Fascia. Vasodilators appear to act the same on both tissues. It's this relaxation of the VSMC that provides the benefit for foreskin restoration.
How this was discovered:
A guy wandered into our little oasis with the most over-the-top restoration story possible. Amazingly enough, his story checked out, as much as it could be. That got me looking into how Cialis could have affected his progress, and then I had the 'Aha!' moment when I made the vasodilator-VSMC-Dartos Fascia connection. In short order I found several other restorers with similar experiences, then realized my own much-better-than-average restoring results were likely aided by the prescription vasodilator I take for blood pressure. I've collected 10+ case histories of restorers with similar journeys. The pattern is clear enough that I feel confident it's time to put this out to our community.
Here are some of our members who have given me information and have graciously consented to being identified"
u/Disastrous_Cost3980 has experienced far better than average foreskin growth while using several vasodilator supplements.
u/uneeknesss is a relatively new restorer who has also achieved well-above-average results while using a prescription vasodilator, losartan and a nitrous oxide supplement.
u/AllAboutTime2 restored from a painfully tight CI-0 to CI-2 in 20 months without even knowing foreskin restoration was possible. He was treating another condition with a traction rig and a prescription vasodilator.
u/Prepucious10 has achieved far better than average results in his first 6 months while using several vasodilator supplements.
What are these vasodilators?
Many substances readily available as supplements are known to be vasodilators, including:
Omega-3 fatty acids, L-Arginine, L-Citrulline, Creatine, Taurine, Horny Goat Weed, Pomegranate and Pipirine are among the ones that restorers have mentioned to me. Here is a paper with a lot more. These supplements are known to be safe when taken in moderate amounts, however you must do your own research and determine which is right for you and how much to take.
There are also prescription vasodilators, including: daily Cialis, ACE II inhibitors like Lisinopril, ARBs like Losartan and CCBs like Amlodipine. While they seem to be more potent than supplements, they are prescription drugs for a reason, and must only be used with a doctor's prescription.
How can vasodilators help us restore faster?
The foreskin has 3 layers: epidermis, dermis and Dartos Fascia. In the common medical procedure of tissue expansion, doctors can double the area of skin - epidermis and dermis only - in 3 to 4 months, while it takes us up to 36 months to do the same. There are several reasons for the speed difference, including the presence of the VSMC in the Dartos Fascia, which has always seemed like the most difficult of the 3 tissues to grow.
The VSMC of the Dartos Fascia will always resist being stretched - it's job is to keep the shaft skin and mucosa snug to the interior erectile structure of the penis - so helping it relax may do 2 things: 1) allow more tension to be felt by the dermis and 2) increase the rate of growth of the VSMC itself.
There is plenty of scientific evidence proving how vasodilators affect VSMC, and I will be happy to provide details if asked. I'll also put up a post with more on the scientific information.
How to use this information:
If you're interested in vasodilators, you must do your own research. There's plenty available. Google 'Is L-Arginine a vasodilator?', then 'Is L-Arginine safe?', and go from there. WebMD has been a reliable source of information for me. The supplements I listed above are widely regarded as safe, and are readily available from reputable sources, like drug stores and Amazon.
I think the easiest and best way to start using vasodilators is with Omega-3 fatty acids. Aside from how they can help your restoration progress, they are arguably the best dietary supplement you can take. So you get multiple benefits.
L-Arginine and L-Citrulline are common amino acids (they are related, and you probably don't have to take them both), and WebMD has info on safe dosages for these and other supplements.
We obviously know little about effective dosages of any of these supplements, so it's up to us to experiment (starting slowly) and share knowledge. One of the restorers I talked to used 3 to 5 grams of L-Arginine daily with excellent results.
Part of the reason I'm putting out this information is so that we can collect data on how well vasodilators assist restoration progress. If you do decide to experiment with one or more of these substances, please keep data on your tugging progress. If you've been using a vasodilator during your restoration journey (without knowing it would help, of course), please let me know how you have progressed.
For those using prescription meds for blood pressure, BPH or ED:
Some BP meds are vasodilators, others, like diuretics, aren't. If you're restoring and taking a non-vasodilator for BP, you may have the option to switch to a medication that is - but only at a doctor's direction, of course.
Viagra and Cialis are potent vasodilators, but when taken occasionally, are probably of little to no use for restoration. Daily-use Cialis, however, has been used by 4 different restorers who have had outstandingly fast results, including the accidental restorer linked above.
Again, these are prescription medications for good reasons. Do not mess around with them. Talk to your doctor, and only use them with a legitimate prescription.
One last note - vasoconstrictors:
Just as there are vasodilators, there are vasoconstrictors - substances that cause blood vessels to narrow. just as they have the opposite effect on blood pressure, vasoconstrictors likely have a negative effect on restoration progress. I don't have any data - yet - to back this up, but the logic is sound.
Nicotine is a vasoconstrictor, so if you smoke, you should quit, and if foreskin restoration is your motive, that's fine. Pseudoephedrine, the active ingredient in Sudafed and other OTC meds, is also a vasoconstrictive, especially in extended-release form.
Brand new discovery: many OTC allergy meds contain both fexofenadine, an antihistamine, and pseudoephedrine, a decongestant. Allegra-D has both, Allegra has no pseudoephedrine. Restorers who are taking Allegra-D but who can get adequate relief from Allegra may find their restoration progress improved.
Finally:
If I was a scientist, I'd be setting up some trials and studies to figure this out, but I'm not. Thanks to the lack of interest in foreskin restoration from the medical and scientific communities, we have to rely on ad-hoc, crowd-sourced research to make advancements.
Don't use these substances if you haven't satisfied yourself that they are safe - don't rely on my word, do your own research. And if you do use them, please let us know how well they work, and at what dosage. That's how we can determine whether vasodilators are as useful as I believe they are.
Oh, one more thing: if you don't know for sure that your blood pressure is in the normal range for your age, PLEASE get it checked, even if you're young. It might not only save your life, but if you do have high blood pressure (or if it's marginal), you may need a prescription drug to help control it... and if so, make sure (if possible) that it's a vasodilator, so you can help your restoration progress as well.
Thanks for reading and Keep on Tugging!
Cheers.