Man Doing Pushup

#GatekeepersofMen Series
Episode 21

Category: GatekeepersofMen Series

Peyronie’s Disease: Is Surgery Your Only Option?

Peyronie’s Disease: Is Surgery Your Only Option?

Every day I see men who arrive at my clinic with concerns about a “curved penis”, “shorter penis” or “penile deformity”. Even more so, they come in already knowing they have Peyronie’s Disease. Some men diagnosed with Peyronie’s arrive seeking a second opinion after their original urologist told them there is nothing that can be done.

Depending on the specific situation, there are different options that we can offer to help restore function. Most importantly, it does NOT involve surgery!

When Should You Treat Peyronie’s Disease?

Peyronie’s can be broken up into 2 phases: Active and Stable

The active phase is characterized by an actively changing deformity and/or pain. This means that if you feel like the curvature has worsened within the last 3 months, you may still be in the active phase.

Urology experts often try to wait until the curvature has stabilized before they offer any “invasive” procedures to correct it. This is because treating it too early can lead to recurrence. And as you can imagine, we would like to avoid performing more than 1 surgery.

Are There Oral Medications That Can Help with Peyronie’s Disease?

There are several medications that experts have researched for the treatment of Peyronie’s.  Most of these medications theoretically help reduce collagen (or scar tissue) buildup.  However, there have been multiple flaws in these studies, and none have been very promising.

However, there was a recent study published in 2022 that suggested using a daily dose of Tadalafil (also known as Cialis) for Peyronie’s during the active phase. This study suggested that this medication can help prevent the curvature from getting worse. Other than Tadalafil, there are no known oral or topical medications proven to help improve penile curvature.

What Options Do I Have to Improve My Curved Penis?

There are two major groups of treatment: Surgery and Non-Surgery.

How Does Peyronie’s Disease Develop?

The penis has an elastic sheath, called the tunica albuginea, that stretches with an erection.   Peyronie’s is a condition in which collagen, or scar tissue, forms on the tunica albuginea that surrounds the erectile bodies of the penis. This scar tissue does not allow the penis to stretch. It limits the elasticity of the penis. We call that scar tissue a Peyronie’s plaque.  Therefore, the goal of any treatment is to attempt to either break the plaque, stretch the plaque or try to “even things out” by restricting the side that is not causing the curvature.

What is Injectable Therapy for Peyronie’s Disease?

Currently, there is only one medication that is FDA-approved for the treatment of Peyronie’s plaque. This medication is known as Xiaflex or Collagenase Clostridium Hystoliticum. This medication utilizes an enzyme, collagenase, that breaks down collagen. Xiaflex breaks down the Peyronie’s plaque to allow the penis’ elastic sheath to expand. However, this requires “modeling” for it to work and that’s where traction therapy comes in. Your doctor will give you instructions on how to stretch and model your penis at home to maximize your results.  Research has shown that Xiaflex can help improve curvature by 30%. When combined with RestoreX traction therapy, it can sometimes improve curvatures by 50%.  This means that if you have a curvature that is 60 degrees, you may end up with close to a 30-degree curvature.

What is the Xiaflex Treatment Protocol?

Xiaflex is administered by your urologist or provider. The Xiaflex protocol involves a total of 8 injections that are administered in 4 separate cycles. Each cycle consists of 2 injections that are administered 2 to 3 days apart. In our office, we will first numb the area and then give you the injection. The entire process takes less than 5 minutes. After the injection, we will place a small dressing and you will be able to go back home or to work.  If you are interested in Xiaflex therapy, be sure to ask me if this treatment is right for you.

How do I know if I am a Candidate for Xiaflex Injections?

These are the criteria to be a candidate for Xiaflex injections:

  1. Have penile curvature of 30 degrees or more.
  2. Have a palpable plaque.

Does Insurance Cover Xiaflex injections?

Some insurances require the curvature to be in the “stable phase” for the treatment to be approved. Moreover, Xiaflex is not indicated for the treatment of hourglass deformity. The limiting factor for Xiaflex is cost. This is an expensive medication. However, most insurance carriers cover Xiaflex injections. Your provider needs to obtain authorization from your insurance before the treatment. After your consultation and evaluation, we will submit all the information to your insurance. Once we obtain the authorization and receive the injection vials, we will start the therapy.

In Conclusion…

Peyronie’s disease does not always require surgery. Remember that we only treat Peyronie’s if it is bothersome for you and/or your partner.  If you have strong erections and are not bothered, you do not require treatment. However, if you are bothered, there are several treatment options available for you. Fortunately, there are ways to help improve Peyronie’s curvature that do not involve surgery. I am an expert in the management of Peyronie’s disease and will be happy to help you reach your goals. Call us! We can help you!

This article was authored by Dr. Jonathan Clavell. Dr. Clavell is a board-certified urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH. 

Why Gatekeepers of Men? 

How Erectile Dysfunction Affects the COUPLE

Erectile Dysfunction: Physical and Emotional Effect on a man and his partner


Erectile dysfunction is a term no man wishes to ever use.  We do not like talking about it.  Even more,  we wish to never experience it.

However….  When a man experiences erectile dysfunction it affects him both physically and emotionally.


What is the physical impact of erectile dysfunction?

The penis is linked to your heart.   When aroused, Your heart delivers blood to your penis through the arteries. Your penis then has “the responsibility” of keeping that blood trapped inside the penis in order to keep an erection.  If the penis is unable to bring blood in, or keep the blood trapped, the penis will experience erectile dysfunction.


The arteries going to the penis are VERY SMALL, probably smaller than the straw used to stir your morning coffee. When a man has any medical condition that can the decrease blood flow delivery from the heard and the heart is unable to deliver blood to the penis, we call it arterial insufficiency.


Now there is another problem that can happen.  The penis also needs to keep the blood TRAPPED inside the penis. Imagine your penis being a bucket of water that needs to stay full to work.  If the bucket has multiple tiny little holes, the water will not be able to stay inside the bucket.  In the penis, we call that “venous leakage”. Venous leakage can happen in both older men and younger men.  I have even seen men who were born with this problem.


What is the emotional impact of erectile dysfunction?

ED can crush a man’s confidence, self-worth and lead to depression.  A man with erectile dysfunction may pull himself away from his partner and try to avoid intimacy altogether because he may fear failure in bed.  Those who are single often avoid relationships altogether.   Therefore, if you ask me, the emotional impact of ED weighs heavier than the physical impact.  Erectile dysfunction affects relationships, self-esteem, and even work productivity (yes! There is research on this topic!).


Can I overcome ED?

My goal, as a urologist and men’s sexual health expert, is to help men learn about what is going on and how to overcome it.  There are MULTIPLE treatment options and NO MAN should be suffering from ED without finding a solution.  There are pills, injections, vacuum erection devices, psychotherapy, physical therapy and even a penile implant.  We first need to find out what is the cause and then we can find a solution.


The HARD Series

Erectile dysfunction is hard.   The journey to overcome it is even harder. This year I was a part of a documentary series that was created to show EVERYONE what men go through and how we can help men overcome it.  This series will show Men with erectile dysfunction that they are not alone.  It will remind you that there are others who have gone through exactly what you are going through now and that there is a solution.  The Hard Series is meant to show us the truth. It is meant to show us that ED is real, that ED is extremely common.  It shows us that as a society, we need to be more open about these topics.  Erectile dysfunction is very common, and it is about time that we start talking about it.

I invite you to watch this episode in which you will see how erectile dysfunction impacted the relationship of a beautiful couple and how a simple procedure helped a man feel worthy of his relationship again.  Enjoy!

Remember….  My goal is to help bring life to your years.

Remember…. We are #gatekeepersofmen.

This article was authored by Dr. Jonathan Clavell. Dr. Clavell is a board-certified urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH. 

Why Gatekeepers of Men? 

Penile Implant: The Solution for ED?

Is the Penile Implant the “last resort” or “best option” for ED?

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Every day in clinic I meet men who complain that their erection is weaker. I repeat: every single day.  Erectile dysfunction is very common and occurs to approximately 40% of guys above 40 years old.  These men often come in to see me after they‘ve done their research online to know what their options are.  They find many alternatives which include oral medications, injections, urethral gels, vacuum therapy, shockwaves, PRP, stem cells and the penile implant. Unfortunately, some of these are experimental and have not been proven to work. Without knowing the pros and cons of each treatment option, it is hard to know what is the best option for each individual.

“My erection is getting weaker, what can I do?”

I first wish to clarify that ED is NOT an “on and off switch”.  What I mean by this is that many people think that men either have a VERY STRONG ERECTION or NO ERECTION at all.  However, those who suffer from it know that it is a spectrum. Think of it as a scale or grading system.  The erection can be anywhere between 0% (completely flaccid) and 100% (hard as a rock).

Happy couple in nature

That said, every man who notices that he is having problems with either gaining or maintaining an erection should consider going to see his primary care doctor.  They should first make sure that there is no medical condition that could be contributing to his sexual impotence.  If you are diagnosed with Diabetes, heart disease, high blood pressure, thyroid problems, low testosterone, etc : these medical conditions could be the cause of your weak erections.  The second thing they should do is:  visit a specialist!  Visit someone who knows all the treatment options and can help guide you to what is best for you.


What is the best treatment for ED?

This is a difficult question to answer because there are different causes of erectile dysfunction.  For example, men with “hormonal ED” will benefit from Testosterone Replacement Therapy. Men with psychogenic ED benefit from behavioral sexual therapy. However, men with vascular erectile dysfunction, that is problems with blood flow in the penis will not necessarily respond to Testosterone or behavioral therapy.  This is why it is important you go visit a SPECIALIST who can help guide you towards the best treatment specifically for you.

“My doctor told me the penile implant is the last resort”

Another thing we need to clarify is that the penile implant is probably the MOST EFFECTIVE therapy for ED, no matter the degree or severity of erectile dysfunction.   Multiple research studies have shown that men with penile implants are more satisfied with their sexual function than those taking pills, injections or vacuum therapy.  If you wonder, treatment satisfaction rate after the implant is more than 95% for BOTH patients AND partners.  That is more than 30% more than pills, injections and vacuum therapy!

So… why do some consider it the “last resort”?

Most of the time we offer the penile prosthesis for men with severe ED that do not respond to medications or other therapies. The inflatable penile implant is a device that is placed inside the penis. It will occupy the space and disrupt that space within the erectile tissue.  If the implant needs to get removed; then, other therapies (like Sildenafil, Tadalafil or injections) will not work. This is the reason some doctors consider it as the last resort. “….because once you have the implant there is no going back”.  However, I do not think this way and I will explain why…

Does the Penile Implant need to be replaced regularly?

There is a big misconception regarding penile implants.  Many men think that it needs to be replaced regularly, but the fact is that it does not.  In 5 years, 95% of implants still work.  Research studies have gone up to 15 years, and 70% of penile prostheses were still working!  I have seen men 18 to 20 years after their original surgery who still have a functional implant that helps them gain and maintain the erection they want.

Happy couple outside camper van

Is the penile implant the best option for me?

As previously mentioned, the inflatable penile prosthesis has been scientifically proven to be the BEST treatment option for ED and the therapy with the highest satisfaction rate. Even though it is mostly reserved for men who do not respond to medications or other therapies, there are men that get the procedure done for other reasons.  Here are some examples:

  1. Some men do not want to go through EVERY… SINGLE.. THERAPY before they find a solution.
  2. Some men do not want to take medications even though they work.  Oral medications like Sildenafil or Tadalafil are known to have side effects like headaches, back pain, flushing of the face, etc.  To be honest…. Men don’t have to “settle” for a treatment that is causing them side effects.
  3. Other men find injections and vacuum therapies are not good for their lifestyle.  Injections require timing and preparation.   Most of these injectable medications, like Trimix, need to be refrigerated and can cause long-lasting painful erections, scar tissue, among other side effects.  Vacuum therapies need lubrication and a rubber band to “keep the blood trapped” inside the penis which can cause pain and discomfort.  These inconveniences can decrease the spontaneity of the sexual encounter and be a “turn-off” for most couples.
  4. Some men have already failed everything. They still fear the penile implant because someone told them “there is no going back”.  I usually answer them with..   “you’ve already failed everything. What is it you ‘would be going back to, injections or pills that you already know don’t work?’.  Immediately, they understand that it is time to take the next step if they wish to recover their sexual life back.
So… is the penile implant the best option for guys with ED? In most cases, it actually is! Think about it.  The inflatable penile implant is inside your body, completely concealed. It will be there on demand, every.. single.. time you need it.  After you recover from the surgery, it is unlikely you will have pain or discomfort.   It will take you 30 seconds to achieve an erection and it will remain erect until YOU make it go down.

Happy couple on boat

The sexual encounter lasts exactly the amount of time you (and your partner) want it to last. 

In Summary…

Although erectile dysfunction is very common, there are many causes and severities that make treatments to be different for each individual.  Goals are very different for every man and every couple.  My goal as a specialist in Urological Sexual Medicine is to help you reach your goals.  If you think a penile implant is an option for you, come visit us.  You do not have to FAIL everything and all other treatment options to be a “candidate”.   If you have erectile dysfunction, I have great news for you:  You ARE A CANDIDATE for the penile implant. It is not the last resort. In most cases, it is the best resort and solution for ED.   We can help you reach your goals!   Call us!  I would be honored to help you.   Remember we are….  GatekeepersofMen!

This article was authored by Dr. Jonathan Clavell. Dr. Clavell is a board-certified urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH. 

Why Gatekeepers of Men? 

Implante de Pene: La solución para la disfunción eréctil?

El implante de pene: la última opción para la Disfunción Eréctil, o la mejor opción?

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Todos los días veo a hombres que presentan a mi clínica con la preocupación de que su erección está “más débil”. Repito:  TODOS LOS DIAS.  La disfunción eréctil, o impotencia sexual, es bien común y ocurre en 40% de los hombres mayores de 40 años.  Muchos hombres que sufren de impotencia sexual llegan a mi clínica luego de haber investigado en el internet acerca de sus opciones de tratamiento.  Estas opciones incluyen: medicamentos orales, inyecciones, terapia de vacío (Vacuum), terapia de shock, inyecciones de plasma, células madres y el implante de pene.  Desafortunadamente, algunas de estas alternativas aún se consideran experimentales y no son recomendadas por la academia de Urología Americana o la Sociedad de Medicina Sexual.  Por lo tanto, es difícil saber cual es la mejor opción para cada individuo si no conocemos los beneficios y riesgos de cada terapia.

“Mi erección está más débil. ¿Qué puedo hacer?”

Antes que todo, quisiera clarificar una cosa:  La Disfunción Eréctil no es un encendedor que prende y apaga.   Muchas personas (hombres y mujeres) piensan que solo dos cosas ocurren en los hombres en cuanto a sus erecciones:  UNA ERECCIÓN BIEN FUERTE o CERO ERECCIÓN.  Sin embargo, aquellos hombres que sufren de impotencia sexual saben que es un espectro.

Happy couple in nature

Tómelo como si fuera una escala o sistema de notas:  la erección puede ser de 0% (completamente flácida) a un 100% (fuerte como una roca). 


Ahora bien, todo hombre que haya notado que tiene problemas con obtener o mantener una erección debe visitar a su médico primario. Usted debe de asegurarse de que una condición médica esté contribuyendo a su impotencia sexual.  Si usted tiene diabetes, la presión arterial alta, problemas de su tiroide, colesterol, baja testosterona, etc.: estas condiciones pueden ser la causa principal de sus erecciones débiles.  Lo segundo que esos hombres deben de hacer es: ¡visitar a un especialista!  Visite a alguien que conozca a fondo las opciones de tratamiento y que pueda guiarlo y proveer una solución para usted.

¿Cuál es el mejor tratamiento para la disfunción eréctil?

Esta pregunta es difícil de contestar porque hay diferentes causas para la disfunción eréctil.  Por ejemplo, los hombres con “disfunción hormonal” responden a terapia de Testosterona.  Los hombres con “disfunción psicogénica” se benefician de terapias de comportamiento sexual.  Sin embargo, los hombres con disfunción eréctil VASCULAR, eso es problemas con el flujo sanguíneo sanguíneo hacia el pene no necesariamente responderán a la Testosterona o terapias de comportamiento. Por eso es que es bien importante que visite a un ESPECIALISTA que pueda guiarlo a usted hacia el mejor tratamiento específicamente para usted como individuo.

“Mi doctor me dijo que el implante peneano es la última opción.”

Otro argumento que debemos de clarificar es que el tratamiento más eficaz para la disfunción eréctil es el implante de pene. La prótesis hidráulica de pene es el mejor tratamiento para la impotencia sexual sin importar la severidad de la disfunción.  Múltiples estudios investigativos han demostrado que los hombres con implantes de pene están más satisfechos con su función sexual que aquellos hombres que son tratados con pastillas, inyecciones y/o la terapia de bomba de vacío.  Para ser más específico, la taza de satisfacción para los pacientes con implantes peneanos y sus parejas excede un 95%.   Esto es 30% más que las pastillas, inyecciones y la bomba de vacío!

Entonces… ¿por qué algunos lo consideran el último recurso?

La mayoría de las veces nosotros ofrecemos el implante peneano a los hombres que sufren de disfunción eréctil SEVERA. Eso es, aquellos que ya no responden a otras terapias o tratamientos.  La prótesis hidráulica, conocida como “la bombita”, es un dispositivo que se inserta dentro del pene. El implante ocupa y destruye el espacio dentro del téjido eréctil del pene.  Por lo tanto, si el implante se remueve, otras terapias como las pastillas o las inyecciones intracavernosas NO van a funcionar. Por esa razón muchos doctores consideran el implante peneano como la última opción.  Muchos dicen “…una vez te pongan el implante, no hay vuelta atrás.”  Sin embargo, te explicaré porque yo no pienso de esa manera…

¿El implante de pene tiene que re-emplazarse regularmente?

El concepto más equivocado que escucho en cuanto a los implantes peneanos es el siguiente:  Muchos hombres piensan que el implante tiene que cambiarse regularmente, cuando realmente esto no es cierto.  En 5 años, 95% de los implantes aún funcionan.   Los estudios investigativos demuestran que 70% de los implantes funcionan más de 15 años!  Yo he visto hombres 20 años luego de su cirugía que aún tienen su bombita funcionando.

Happy couple outside camper van

¿La mejor opción para mi sería el implante de pene?

Como mencioné anteriormente, los estudios científicos han demostrado que el implante hidráulico de pene es la MEJOR opción de tratamiento para la disfunción eréctil y la terapia con la mayor taza de satisfacción.  Aunque se ofrece mayormente a hombres que han fallado otros tratamientos, hay hombres que se hacen la cirugía por otras razones. Aquí algunos ejemplos:

  1. Algunos hombres no quieren intentar TODAS… LAS.. TERAPIAS antes de encontrar una solución permanente.
  2. Algunos hombres no quieren tomar medicinas aún si éstas funcionan.  Las pastillas como Sildenafil y Tadalafil tienen efectos secundarios como dolores de cabeza, dolores de espalda, palpitaciones en el pecho, enrojecimiento de la cara, etc. Para serte honesto….  Los hombres no tienen que conformarse con un tratamiento que le esté causando efectos secundarios.
  3. Otros hombres encuentran que las inyecciones y la bomba de vacío no son la solución debido a su estilo de vida.  Las inyecciones funcionan en un tiempo específico y toman preparación.  La mayoría de las inyecciones tienen que mantenerse refrigeradas y pueden causar erecciones dolorosas, tejido de cicatriz, entre otros efectos secundarios. La bomba de vacío  necesitan lubricación y un anillo de constricción para “atrapar la sangre” dentro del pene que puede causar dolor e incomodidad.  Estas inconveniencias pueden disminuir la espontaneidad del acto sexual y le “quita las ganas” a muchas parejas.
  4. Algunos hombres ya han intentado y fallado todo.  Aún así temen el implante de pene porque alguien les dijo “no hay vuelta atrás”.  Sin embargo, mi contestación a ellos es la siguiente “ya has fallado todo.  ¿A qué irías de regreso? ¿Inyecciones y pastillas que ya sabes que no funcionan?”.  Inmediatamente ellos entienden que es tiempo de tomar el próximo paso hacia la recuperación de su vida sexual.
Por lo tanto, la contestación a la pregunta “el implante peneano será la mejor opción para mi?” En la mayoría de las ocasiones, sí lo es! Piénsalo.  La prótesis hidráulica de pene está escondida dentro de su cuerpo. Va estar listo para uso en… todo… momento y SIEMPRE que usted lo necesite. Luego que usted se recupere de su cirugía, es poco probable que usted tenga dolor o incomodidad.

Happy couple on boat

Le tomará 30 segundos obtener su erección y se mantendrá firme hasta que USTED lo baje. El encuentro sexual entre usted y su pareja durará exactamente el tiempo que USTED quiera que dure. 

En Resúmen…

Aunque la disfunción eréctil es bien común, hay muchas causas y severidades que hace que los tratamientos sean diferentes para cada individuo. Tanto cada hombre como cada pareja tienen metas distintas.  Mi meta como especialista en Medicina Sexual Urológica es ayudarlo a usted llegar a sus metas.  Si usted cree que el implante de pene es una opción para usted, visítenos! Usted no tiene que fallar todos los otros tratamientos para ser un “buen candidato” para el implante.   Si usted tiene disfunción eréctil, tengo excelentes noticias para usted: Usted ES CANDIDATO para el implante de pene. La bombita no es el último recurso.  En la mayoría de los casos, es el mejor recurso. ¡Nosotros podemos ayudarlo a llegar a su meta! ¡Llámenos! Sería un honor poder ayudarlo.  Recuerde que somos… GatekeepersofMen!

El autor de este artículo fue el Dr. Jonathan Clavell. Dr. Clavell es urólogo diplomático y certificado por la Academia de Urología Americana y es especialista en Salud Sexual Masculina que incluye disfunción eréctil, baja testosterona, Enfermedad de Peyronie’s y problemas de prostata agrandada. 

Why Gatekeepers of Men? 

Congenital Penile Curvature

Congenital Penile Curvature

Are all curves the same?

Curved or bent penis. This is the ONE condition in Men’s Health that generally NO ONE talks about.  Some men even wonder “can that really happen?” and, those who suffer from it think “Am I the only one with this?”.  Many years ago, men with penile curvature suffered in silence and, fortunately, now we even see it in commercials and realize we are not alone.

Penile curvatures are very common.  The penis can bend upward, downward or to the sides.  In most occasions, the curvature is mild and does not cause any problems. However, some men have more complex curves that make them more self-conscious.  Most often, a penile curvature is due to normal differences in penis anatomy, but sometimes scar tissue or another problem causes a bent penis and painful erections.

younger man playing sports

Continue reading “Congenital Penile Curvature”

Why is my penis getting shorter?

Man looking at himself under the covers.

Banana with a messaging tape around it.

Man looking in his boxer briefs.

Why is my penis getting shorter?

A very common concern for men of all ages is:SIZE.   I often see men who come in to my office concerned about the size of their penis.  Sometimes they are originally being seen for a completely unrelated complaint, such as urinary problems secondary to an enlarged prostate (BPH) or interested in a vasectomy.  Then, all of a sudden, the question comes up:  “Hey doc, now that I am here, I wanted to ask you about one more thing. I have noticed that my penis is shrinking…” or ” My penis is getting shorter”… And you can imagine the rest of the conversation.

But first let’s dig into a very popular question:

What is the average penis size?

According to a study published in the Journal of Urology, the average penis size in the flaccid state is 8.8 cm or 3.5 inches.  During the erect state, the average size was found to be 12.9cm (or 5.1 inches).    I would also like to highlight that the flaccid size, in most occasions, does not correlate with the size during the erect state.  Penises tend to “grow” from the flaccid to the erect state.

Even though there are many men who are interested in obtaining a ‘larger or longer penis’, most just want to make sure they do not lose what they already have.    I’ll explain….   The most common surgery that I perform is placement of an inflatable penile prosthesis (also known as a penile implant) and probably the most common question that men have when I talk about the procedure is “But doctor… will I keep my size?  Will the implant make me lose length?”

But….  Why is my penis shrinking?

There are two well-known conditions that can get the penis shorter:  Peyronie’s disease and erectile dysfunction.

What Are Common Reasons Why My Penis is Shortening?

Peyronie’s disease: is a condition in which the body starts forming scar tissue, known as a plaque, in the lining surrounding the corpora cavernosa, known as the tunica albuginea.  Your penis has two chambers (known as the ‘corporas’) that fill up with blood in order to give you an erection.  Those two chambers are surrounded by an ELASTIC layer called the tunica albuginea.  When that elastic tissue has an injury or a condition that develops a plaque (or scar tissue), it won’t be able to stretch out and this can lead to 3 things: pain, curvature and a… shorter penis.  These men not only have distress because they notice that their penis is now bent or curved, but now they notice it’s getting smaller!

Erectile dysfunction: can also cause the penis to lose size.  Have you ever heard the expression: “if you don’t use it, you lose it”? Well, your erections work that way, in a sense.   When our body stops having regular erections, the elastic tissue that stretches the penis from the flaccid state into the erect state can transform in a way that the penis loses its elasticity.   If the penis is not elastic, it won’t stretch when you get an erection, and you will notice you lost length.

Radical prostatectomy (RP):  Penile shortening is a common occurrence after surgical removal of the prostate in patients with prostate cancer. Research studies have reported that this can happen in 15-68% of patients after radical prostatectomy.  You may wonder: but why would that happen?   The real answer to that is: we don’t know yet, but we have theories.  Some urologic scientists proposed one mechanism:  the anatomy changes when the urethra is shortened. When the prostate gets removed, the urethra needs to be reconnected with the bladder and this makes the urethra shorter.   However, one thing that we do know for sure is that after the prostate gets removed, the nerves that help men get erections are injured.  This can lead to poor oxygenation of the smooth muscle inside the penis (cavernous body) which can lead to fibrosis (scar formation), erectile dysfunction,  loss of elasticity and, a shorter penis.

Overweight:  Weight gain can also give you the appearance of a shorter penis.  Unlike women, who gain most of their weight in their thighs, men’s bodies mostly focus their weight gain in the lower abdomen (referred to as ‘panniculus’). Accumulation of fat in this area hinders the penis and limits its visibility, giving you the appearance of a shorter penis.


What Can I Do To Optimize The Length of My Penis?

Traction therapy:   Research shows that some men with Peyronie’s disease respond to traction therapy.  This can be used alone or in combination with surgical and nonsurgical treatments such as Xiaflex intralesional therapy.   There are multiple types of traction devices available that can be used to restore length and correct penile curvature.

Vacuum therapy:  A vacuum erection works by creating negative pressure inside the penis and “suctioning” venous blood into the penile shaft. While inside the vacuum pump, the penis will maintain the erection.  I truly believe (and research has shown) vacuum therapy can help men keep their size and helps with penile rehabilitation.  My recommendation for men who don’t get erections during the night or are planning to get a penile implant in the future is:  GET A VACUUM DEVICE and use it to exercise your penis.   It will keep the tissues elastic and healthy.

Surgery: There are surgical procedures that can give the appearance of a longer penis without actually affecting your true penile size.  These include: ventral phalloplasty, dorsal phalloplasty, panniculectomy, among others.  For men with Peyronie’s disease, there are procedures that can help restore their length, but we will focus on these in another episode.

A penile implant can help you keep your size…

Penile Implant:  Yes.  A penile implant can help you MAINTAIN your length.   The inflatable penile prosthesis  is a medical device that’s placed inside the penis. We offer it to men with ED .  The implant occupies the inside of the penile shaft in its entirety (Want to see how?  Watch a video here). Earlier I described how erectile dysfunction can lead to loss of length.   If there is one thing that will “halt” that process, it would be the penile implant. By occupying the entire space inside of the penile shaft, the penis has nowhere to go.   This is why I encourage men to consider this option when ED continues to progress and oral medications fail. Why? Because… when you have a penile prosthesis, your penis will be in the “long” state at all times.  The penile implant transforms your penis from being a “grower” to a “shower”.

middle aged man relaxing


In conclusion….

Let’s go back to that original question:  Why is your penis “shrinking”?  Your inability to have a strong erection, Peyronie’s disease, history of prostate cancer and weight gain may be factors you need to look into.

And for the second question: will I lose size with the penile implant?  The answer is simple… No. The implant does not cause the penis to be shorter, erectile dysfunction does. When it comes to penile size, it is important to understand that there are many factors that can affect it.   However, I am equipped with the tools to help maximize and restore length and function.  Give us a call!  We will be honored to help you.

Is Your Penis Getting Shorter? Schedule an Penile Implant Consultation Today!

Dr. Jonathan Clavell is a board-certified urologist and men’s health specialist in Houston, Texas. Dr. Clavell is an expert in both inflatable (commonly referred to as the pump) and mechanical implants (Semi-rigid). Performing over 150 implants per year, Dr. Clavell has emerged as one of the leaders in penile prosthesis surgery and implant revision surgery in the state of Texas and the United States. Dr. Clavell can help discover the best penile implant option for you and your lifestyle. For more information about the penile implant procedure, call (713) 652-5011 to schedule a consultation with Dr. Clavell today.

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This article was authored by Dr. Jonathan Clavell. Dr. Clavell is an urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.

Why Gatekeepers of Men? 

A Men’s Health Specialist’s True Purpose

The 3 R’s of Men’s Health

People often ask me what I do as a urologist who specializes in Men’s Sexual Health.   It is simple. I sum it up in 3 words. I refer to them as the 3 R’s of Men’s Health:

1.     Rehabilitate

2.     Reconstruct

3.     Restore

younger man with beard

September is Sexual Health Awareness Month.

Continue reading “A Men’s Health Specialist’s True Purpose”

How a urologist can help men live LONGER…

Helping men live LONGER and BETTER…

A male’s life expectancy 

Every day I see men of all ages who come into our office concerned about their erections.   These range from men in their early 20s to those in their late 80s.  But what they do not know is that in many occasions, their sexual or reproductive concerns can be the effect or aftermath of something far more serious.   In our last post we discussed the relationship between erectile dysfunction and heart disease.  Today, we will dive in deeper and discuss how a we, as a men’s health specialist, can help men live longer.

Middle aged couple riding bikes

June is the official month for Men’s Health!

This week the European Urology Focus journal published a scientific article that immediately caught my attention.  The title was “Male Sexual and Reproductive Health – Does the urologist have a role in addressing inequality in life expectancy?”. [1]  We all know life expectancy for men is less (70.5 years) when compared with women (75.6 years).   This study aimed to evaluate the association between male sexual and reproductive health-related diseases and life expectancy.  In other words, if there is a correlation between these two, then a urologist (the physician who focuses in male sexual and reproductive health) can play a vital role to improve life expectancy for men. So… if you are wondering what research has shown are the leading causes of death in men, here you go:

Main contributors of Death in Men

  1. Cardiovascular disease (CVD)
  2. Cancer
  3. Diabetes
  4. Respiratory disease
  5. Injuries (Trauma)

Studies indicate men have higher premature death rates from CVD because they tend to have higher rates of all major risk factors.  These risk factors include high blood pressure, obesity, diabetes, high cholesterol and smoking.   The number one cause of respiratory disease in men is smoking.  Research has shown that men start to smoke earlier than women and smoke more cigarettes per day than women. [2] Smoking can also lead to CVD, cancer and erectile dysfunction.

Think about it.   All these can be prevented!

If you exercise regularly, eat a healthy diet and control your blood pressure and cholesterol levels, you can prevent or at least delay heart disease and diabetes.

How can we screen for CVD?

A urologist regularly evaluates men with erectile dysfunction and, as discussed in our previous post, erectile dysfunction can be a sign of CVD.  Simple screening tools for CVD include measuring your blood pressure and obtaining blood work. Important labs are a lipid profile to check your cholesterol and triglyceride levels,  and a hemoglobin A1c to screen for diabetes.

Low Testosterone: Helping men live longer

There is a strong connection between testosterone deficiency and diabetes. The American Diabetes Standards of Care recommend to check testosterone levels in every man with diabetes and decreased sexual drive (libido) or erectile dysfunction. Even more, research shows that testosterone can improve overall health and hence, help men live a longer healthier life.  Testosterone, when used appropriately, can offer MAJOR health benefits for men.    Even though there is still a controversy between testosterone replacement therapy and cardiovascular safety, most research studies and experts believe that testosterone treatment is SAFE when managed adequately.

Prostate Cancer and Survivorship

The most common cancer in men (second to skin cancer) is prostate cancer.  Given African-American and Hispanic men are more likely to not only be diagnosed with prostate cancer, but die from it, we strongly encourage prostate cancer screening.  Also, even though there is no conclusive evidence that any single diet will protect men from acquiring prostate cancer, a study published in the World Journal of Urology in 2017 reported that physical activity, controlled body weight and a diet rich in vegetables can reduce the risk of prostate cancer progression.  Therefore, we encourage men diagnosed with prostate cancer to aim to improve their diet and increased their physical activity.

We need to remember that prostate cancer therapies have increased cure rates and overall survival. When detected early, prostate cancer is CURABLE! Surgery and radiation can cure early stages of prostate cancer.   If you survived prostate cancer and now suffer from erectile dysfunction, low testosterone symptoms, urinary incontinence or changes in orgasm, an urologist specialized in sexual health is primed to help you.

In Conclusion…

Many men who come to see me haven’t even seen their primary care doctors in years.  As a urologist and Gatekeeper of Men  I pledge to help screen men to improve not only their sexual and reproductive lives but their OVERALL health. I encourage EVERYONE reading this to visit their primary care doctors and visit your local urologist. We can help and are here to serve you!


This article was authored by Dr. Jonathan Clavell. Dr. Clavell is an urologist who specializes in men’s sexual health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.

Why Gatekeepers of Men? 

1.     Tharakan T, et al. Male Sexual and Reproductive Health – Does the Urologist Have a Role in Addressing Genter Inequality in Life Expectancy? European Urology Focus 2020; 6(4): 791-800.

2.     The WHO regional Office of Europe. The heatlh and well-being of men in the WHO European region: better health through a gender approach. 2018

3.     Peisch SF, et al. Prostate cancer progression and mortality: a review of diet and lifestyle factors. World J Urol 2017;35: 867-74.

Erectile Dysfunction: A Sign of Heart Disease

Erectile Dysfunction: A Sign of Heart Disease

“The penis is the gate way to the heart”

This week I had a patient who was scheduled to undergo a surgery for enlarged prostate.  I was excited to finally be back in the operating room after weeks without being able to perform elective procedures due to the Covid-19 pandemic.  As soon as I step into the surgery center’s building, I received a call from the anesthesiologist who suggested postponing the surgery.  We found that the patient’s blood pressure was very high and not well controlled. Upon questioning, the patient mentioned he decided to stop his blood pressure medications several weeks prior without consulting with his primary care physician.  After listening to the story, one of the nurses then told me:  “My husband does the same.  They notice that medications cause erectile dysfunction and he would rather continue with elevated blood pressure than lose his erections.”  This remark drove me to write today’s article.

Older man doing pushup

June is the official month for Men’s Health!

Therefore, today I wish to focus on a very important topic.   Erectile dysfunction (ED) can be an indication of a man’s risk for heart disease and early death.   Yes, you read that correctly.   Erectile dysfunction is not only a problem that can affect the intimacy between you and your partner but can also be a symptom of something far more serious.

Remember there are 4 types of Erectile Dysfunction

(Do not worry, we will soon discuss and describe each and every one of these in the near future!)

  1. Psychogenic
  2. Neurogenic
  3. Hormonal (low testosterone)
  4. Vascular

However, the most common type is vascular erectile dysfunction.   Vascular ED occurs when there is not enough blood flow getting to the penis (arterial insufficiency) or the penis is unable to “trap” the blood inside (corporo-venous occlusion, also known as ‘venous leak’).  In order to understand how this works we have to remember that the blood vessel that brings blood flow to the penis (penile artery) is extremely small and much smaller than the vessels feeding the heart.  A clogged artery will impede the blood flow necessary to create an erection. Therefore, if a man has heart disease (also known as coronary artery disease), it is very likely that the penile artery will get clogged before the coronary arteries in the heart.

That is why erectile dysfunction can indicate if a man is at risk for heart disease and early death.  The phrase “The penis is the gateway to the heart” stems from this concept.  Men with atherosclerosis, or build-up of plaque in the arteries that cause blockage of blood flow, will have problems with blood flow in the penile artery before the coronary artery.  As we celebrate Men’s Health Month, I feel obliged to let all men know:

Sexual Health Graphic

Erectile dysfunction can be both prevented and treated by practicing a healthy lifestyle. 

If we treat risk factors for heart disease, which include smoking, high blood pressure, high cholesterol, diabetes, obesity, among others, you will not only be able to perform in the bedroom, but also live a longer life.   It is very important that men discuss sexual symptoms with their doctors to help us identify cardiovascular or other risk factors that might be affecting your overall health.

In Conclusion…

So… please, follow your doctor’s orders.  Take those blood pressure medications. Control your cholesterol levels. Try to quit smoking. Do not let the diabetes to get out of control.  We (doctors) are only here to help you.  If you have problems with your erections, we have all the tools to help you.  If you are searching for an urologist, Come visit us!   It will be an honor to help you get back in the game and continue playing the game for a loooooooong time!

This article was authored by Dr. Jonathan Clavell. Dr. Clavell is an urologist who specializes in men’s sexual health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.

Why Gatekeepers of Men? 

Men’s Health during the Coronavirus Pandemic

Men’s Health during the Coronavirus Pandemic

First of all, I want to disclose that I am NOT an infectious disease expert and just like you, I am learning about this new Coronavirus every day. We all know that the human race as a whole is going through a difficult time that will impact our lives, if it hasn’t already. This can be physically, socially and financially. However, when you listen to the experts, there is one great thing about it…  WE HAVE THE POWER TO CONTROL IT.  We can ALL contribute to avoid spreading this disease.

A good friend of mine, and sexual health expert, recently said “Today, Men’s Health has a different meaning”.  He is correct!  We have to focus on what we have in front of us.  This motivated me to write a blog post describing the different things we, as men,  can do at home while we try to #FlattenTheCurve by practicing social distancing.  These practices should be continued even after the pandemic is controlled. The goal of this post is to appease our minds. There is no need to panic, we will get through this.

I was recently diagnosed with prostate cancer and my treatment has been delayed, what should I do?

This is probably one of the most common concerns and a very important one for men.  First of all, remember that prostate cancer is curable. Most prostate cancers are considered “slow-growing”, meaning:  they do not progress as fast as other cancers do.  Some research studies found that certain prostate cancers DO NOT become more aggressive in up to 6 months without treatment. In other words, if you were recently diagnosed with prostate cancer of low or intermediate risk, the probability of it becoming more aggressive while you wait to get treated is low.  However, if you were diagnosed with prostate cancer make sure you contact your urologist to ensure that he or she discusses the severity of your diagnosis and the plan of care.

I have Peyronie’s disease, what can I do at home?      

Traction therapy is one of the least invasive therapies for Peyronie’s Disease and its success has been shown to be dependent on one thing: TIME.  Fortunately for us, the coronavirus has given us more TIME to be at home.   Men who have penile curvature, can go ahead and use their traction devices to help improve their curvature.

Xiaflex is the only FDA approved medication for the treatment of Peyronie’s Disease. These are injections administered in cycles. Each cycle involves 2 injections delivered into the Peyronie’s plaque 2 days apart.  Your doctor will then wait 6 weeks to start the next cycle. What are patients supposed to do in between each cycle? MODELING exercises which can be achieved with or without Traction Therapy.

If the coronavirus interrupted your injections, do not worry.  Peyronie’s disease should not get worse if injections are being delayed.  Take advantage of the time you have at home and exercise the penis through modeling and traction therapy!

I have Low Testosterone, will I need to stop my therapy?

Many men who come to our office with low testosterone are boosting their T levels with Bio-available testosterone pellets.  These pellets are slowly absorbed and usually last in our bodies  3 to 6 months.  If you were getting testosterone pellets and fear to be exposed to the coronavirus or cannot get to your doctor’s office, hope is not lost. You should consider injectable (intramuscular or subcutaneous) testosterone shots while you wait for your next testosterone pellet administration.  These are injections that you or your partner can administer in the commodity of your home once or twice a week.   Moreover, if you are getting weekly injections at a “Men’s T-clinic”,  there is no need for you to do that anymore.  You can give yourself those injections at home! Lastly, for those wondering if pharmacies will run out of testosterone injections, we do not anticipate this happening.

I have ED and my penile implant surgery was cancelled, what should I do?

Recently, the Surgeon General of the United States, World Health Organization and CDC recommended hospitals to cancel all elective surgeries.  Hospitals are trying to preserve beds and ventilators for those who will need it.  We understand penile implant surgery is considered outpatient and will not require a long hospitalization.  For those men who were scheduled for surgery, we have your best interest at heart.  We do not want you to be exposed to the virus and want you to stay healthy.

Rest assured, your surgery will be re-scheduled as soon as we feel it is safe for you to undergo the procedure. 

That being said, if you are wondering what you can do while you wait for your surgery…

Penile Injections

If you haven’t tried Trimix injectable therapy: now is the time to consider using it!  Penile injections work similar to oral medications. They expand the blood vessels that bring blood into your penis to help you gain an erection.  Trimix injections should be first administered by your doctor to ensure what’s the best dose for you. Our goal is for you to have a strong erection for intercourse that will last how long YOU want it while limiting side effects. Call our office and I will be glad to prescribe you the medication.

Vacuum device

If you have already tried and failed injectable therapy and can’t wait for your penile implant, the best thing you could do while you wait is vacuum therapy.   Imagine you are going to run a marathon. The only way you will finish that race successfully is with TRAINING.  Your penis is about to go through a marathon (surgery), and we want your penis to be ready for that “marathon”.  Vacuum therapy can help “train” your penis for surgery and keep its tissues strong and elastic by preventing scar formation, also known as fibrosis. Vacuum therapy will also stretch your penis and allow your surgeon to put in the biggest implant possible.

I was planning on visiting the office, and now I am unsure if I should go.

I have GREAT NEWS for you.  Our office is equipped to provide TeleMedicine visits.  TeleMedicine allows for you to “visit” us and talk to me, your doctor, from the comfort of your home. Call us for more information! 

One last thing, take advantage of the extra time and give your body some love: rest, hydrate, EXERCISE! Also, remember to continue washing your hands, practice social distancing and follow the CDC and World Health Organization recommendations.  This too shall pass and hopefully, soon we will get you back in the game!

This article was authored by Dr. Jonathan Clavell. Dr. Clavell is a urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH. 

Why Gatekeepers of Men? 

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