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ExoSurge® Peyronie’s Technology Q&A

Common Questions and Answers About ExoSurge® Peyronie’s Technology

What treatments don’t work fixing Peyronie’s Disease?

Traditional Peyronie’s Care Guidelines: Where it’s wrong:

Once ExoSurge is approved by the FDA and available nationwide, we believe that the following standard protocols for treating Peyronie’s will be obsolete.

Failures with a Peyronie’s Disease diagnosis

Physical examination of a patient’s penis will not suffice to provide a proper diagnosis of Peyronie’s disease.

Direct examination, full patient history evaluation about factors currently not examined, detailed blood panels, and a duplex Doppler sonography test will be included.

Presently, Doppler sonography is mostly used to determine if there’s any calcified plaques. In the future, it becomes the roadmap for curative therapy and a key measuring stick for improvement as the size and nature of plaques shrink or dissolve during therapy.

As mentioned previously, Peyronie’s fibrosis is the first cousin of a benign tumor. Would you get a tumorous mass found treated without first measuring its mass to determine if treatments were effective?

Of course not.

Failure to treat during acute phase

At present, Peyronie’s disease is commonly classified into two stages. The term “acute phase” refers to the initial period. It’s often characterized by pain, worsening penile curvature, and the formation of penile plaques, which lasts six to eighteen months.

The second phase is known as the “chronic phase,” and it is distinguished by permanent plaque and penile curvature as well as the likelihood of calcification and erectile dysfunction.

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ExoSurge® Questions and Answers

Is ExoSurge® therapy covered by health insurance?

Yes.

Most commercial insurance companies including Medicare cover about 80% of the cost of ExoSurge® treatments allowing for a therapeutic once every two weeks. As part of our effort to make the technology available to as many men as possible, we don’t presently charge for the medical device or patented technology. We only charge for the administration of the approved drug we use to help destabilize the plaque during therapy

Unfortunately, patients traveling from out of town must pay out of pocket for all but their first therapeutic since it’s not economical to travel to Atlanta for a singular treatment every two weeks.

If a patient is diagnosed with inadequate arterial blood flow coming into the penis (20% of patients usually fall into that category), we employ external counter pulsation (ECP) therapy to remedy that situation and that’s not covered by insurance.

Low testosterone is treated with bioidentical pellet therapy which is also cash-pay although most insurance companies cover the cost of labs and office visits associated with such care.

I have a 45-degree curvature during erection. Can ExoSurge® fix me?

We understand the degree of curvature is what most patients are obsessed over. It triggers penile length reduction and can cause sexual intercourse to become impossible.

Illustration

However, the degree of any penile curvature is just a potential symptom based upon the size and location of the fibrosis within your penis. If the mass is located on the underside of the penis, an erection will point downward. If the fibrosis is on the top of the penis, the erection will curve upward. If it’s positioned along the side of the penis, the penis will point sideways during erection. As the curve triggering fibrotic mass gets larger over time, the curve becomes more severe.

When we treat and break up the plaque, the curve is reduced / removed accordingly. Thirty percent of Peyronie’s cases we treat have little or no curvature but face other debilitating symptoms such as severe erectile dysfunction or a disfigured penis.

Please note that not all men with a curved penis have Peyronie’s disease. Approximately 35% of the patient’s we’ve treated to date had minimal or no curvature when erect, but significant fibrosis in the soft tissue of the penis and / or a thickened tunica.

Most every penis has some degree of slight curve during erection, regardless of a Peyronie’s diagnosis. Additionally, some men were born with a significant “congenital curve” that’s not remotely associated with plaque or fibrosis. If you’ve had significant penile curvature during erections for as long as you can recall since childhood, you most likely have a congenital curve or chordee. If you have a congenital curve, you’ll want to be mindful of be careful steering clear of partner on top

Is ExoSurge® technology available anywhere else besides Atlanta, GA?

Not yet.

Our technology is both patented, proprietary, and still under development. It’s available exclusively in Atlanta, GA at present.

We plan to partner with a pharmaceutical company and begin our journey for FDA-approval starting in 2025. We will be posting updates in this regard as well as announcing the locations for prospective clinical trials in that process.

Following FDA-approval, we expect ExoSurge® to be available globally and hopefully covered by traditional health insurance.

I lost significant length in my penis from Peyronie’s. Will ExoSurge® restore my original length?

Peyronie’s patients often notice a loss of penile length. The reasons behind this reduction are mostly rooted in displacement. Do you recall that lesson from Archimedes?

There’s a finite amount of space in every man’s penis. When an erection is triggered by arousal and blood flows in to pack the sponge-like corpora penis for an erection, the fibrosis limits the amount of blood allowed into the organ. In this case, something has to give, which is often reduced penile length.

When we break up and remove the fibrosis associated with Peyronie’s disease we’ve observed that patients usually recover about half of the loss of their pre-Peyronie’s length. Patients who are diligent with our off-site stretching protocol have better results with length restoration.

Loss of penis size from Peyronie’s disease is why we got into cosmetic penis enlargement, which has become a larger and larger aspect of our practice. We offer a variety of procedures proven to completely restore any lost penile length.

I now have erectile dysfunction since I acquired Peyronie’s disease. Does ExoSurge® also cure ED?

Peyronie’s disease can cause erectile dysfunction because the plaque can block necessary blood flow to achieve and maintain a good erection. Our ExoSurge technology breaks up the penile plaque associated with Peyronie’s Disease and if that’s why your erections are failing, it will repair that.

The testing we performs to evaluate your Peyronie’s case also reveal any issues with ED and their exact root cause. We will discuss any issues we discover with erectile dysfunction at the same time we review your Peyronie’s case.

I just injured my penis during sex. Should I get ExoSurge® now or wait?

At present, standard AUA guidelines77 for the treatment and care of an acute penile injury case recommend a “hands off” approach for at least six months following the dissemination of pain from the penile injury.

ExoSurge technology completely changes that approach. We strongly recommend patients come into our office for care within seven days of penile trauma. ExoSurge® therapeutics reduce the pain from the injury and most importantly, stop the scar tissue and fibrosis from forming that will trigger a subsequent Peyronie’s diagnosis.

 

[77]Nehra, Alaj, et al, Peyronie’s Disease: AUA Guideline, Journal Of Urology, 15, September 1943, 745-753.

I lost thickness in my penile shaft, and I have a couple of “indentions” from Peyronie’s. Will ExoSurge® fix those issues?

Peyronie’s patients with significant plaque often observe some form of disfigurement in their penis. Lost length, narrowing, unexplained indentions are common observations.

The reasons behind this reduction are mostly rooted in displacement. Do you recall that lesson from Archimedes? 

There’s a finite amount of space in every man’s penis. When an erection is triggered by arousal and blood flows in to pack the sponge-like corpora penis for an erection, the fibrosis limits the amount of blood allowed into the organ. In this case, something must give, which is manifested by narrowing, lost length or shaft unevenness depending upon the exact size and location of the plaque triggering a displacement reaction.

When we break up and remove the fibrosis associated with Peyronie’s disease we’ve observed that patients usually recover about half of the loss of their pre-Peyronie’s length. Patients who remain vigilant with our recommended off-site treatments using Restorex® and VED’s have been found to regain more of their lost size than those who skimped on such care.

We have been testing with a modified ExoSurge treatment technique that helps specifically resolve shaft disfigurement, but those new approaches are not yet part of our standard protocol.

Can ExoSurge® technology cure Peyronie’s Disease?

The word “cure” has a very specific meaning for diseases in the healthcare space.

Our mission with ExoSurge technology is to provide for permanent removal of the fibrosis and penile plaques associated with a Peyronie’s diagnosis. However, if you’re one of the unfortunates who are heavily predisposed to acquire Peyronie’s (i.e., patients with select connective tissue disorders) you’ll have to remain extra to not even slightly injure your penis after the plaques are removed as your prone for that to happen. If it does, you’ll face another round of ExoSurge treatments to remove the newly formed fibrosis.

What can I do for my Peyronie’s disease if I can’t afford travel to Atlanta for ExoSurge® therapy?

As we mentioned earlier, we now strongly recommend buying a Restorex penile stretching device if you can’t yet get ExoSurge treatments. At the very least, it will help insure you don’t lose as much additional penile length.

Traction (or stretch) therapy uses a device to stretch the penis and sometimes even bend the penis in the opposite direction of the curvature. This encourages the scar tissue to be recycled into more normal tissue and can improve curvature, restore length lost due to Peyronie’s disease, and even improve the hardness of erections. 

A good quality VED (Vacuum Erection Device) will help maintain good blood flow within the penis. It’s not going to trigger any plaque reduction but as we discussed with stretching, it will help keep things from getting worse.

Verapamil injections are a worthy intralesional treatment that we employ with ExoSurge and our intralesional gas injections cause the drug’s effects to become amplified. If you’re also young and healthy and not facing effects from Peyronie’s accelerators, we believe they’ll help keep fibrotic growth in check.

Exercising and keeping your vascular system healthy is a key ingredient to keep things in check. If you are presently diagnosed with Type II diabetes, you need to stay focused on keeping our A1C below 7. The vascular constricture that occurs when your A1C reaches double digits will almost invariably trigger fibrotic growth in the penis.

Regarding supplements, we recommend a combination of Omega-3 fatty acid (fish oil) and Curcumin to help slow down the process of arteriosclerosis (fat deposition on the blood vessel walls). Neither of these will reverse existing fibrosis, but it will help limit more growth.

ExoSurge is the only therapeutic in the world that measurably treats and removes Peyronie’s disease plaque. Anything else claiming to do so is a sham.

Work to keep your Peyronie’s case in check using the tools we just described. We plan to have our technology in the hands of every Peyronie’s urologist in the world soon.

I had repeated treatments of Xiaflex® with no success. Will ExoSurge® work for me?

We usually have good news and bad news for patients who already had one or more Xiaflex® injections with no success.

The good news?

Yes – we can still use our technology to repair your Peyronie’s Disease indication.

The bad news? 

It usually takes 25%-35% longer to resolve a case that already started with Xiaflex® injections than one that did not.

Why is that?

The active ingredient in Xiaflex® is collagenase, a powerful enzyme that’s akin to an acid, but that is safe for human tissue. The concept behind this solution is that the robust enzyme will essentially dissolve the plaque and heal the condition. Unfortunately, it appears to remove the curvature in less than half the cases. Amongst those where it was perceived to have succeeded, we’re now seeing cases where Xiaflex® was administered 4-5 years ago and the condition returned, albeit with novel “corkscrew” shaped erections. To put it another way, it doesn’t appear to always “dissolve” the plaque, but rather sometimes just soften it enough to where a urologist can manually straighten the curve; only to return later with a new situation.

When plaque has been melted in any manner by collagenase injections, those treated areas become denser than they were before such treatments.

The stronger the density of the plaque, the longer it takes to break it up.

I have a bunch of questions and need to get them answered by the doctor before I consider scheduling a visit to your clinic

We have an ExoSurge®-certified patient support expert available to answer questions regarding what we do and how we do it. However, until we perform our comprehensive diagnostics to evaluate your case, everything we discuss is just conjecture. We’re just starting the process for FDA-clearance for much of our technology. Hopefully, it will be available nationally by 2025.

Traditional Peyronie’s Definitions:

What are some symptoms / indications that you might have with Peyronie’s disease?

The diagnosis of Peyronie’s is the buildup of fibrosis within the soft tissue of the penis and/or thickening of the tunica albuginea. As it advances you can often feel the plaque under the skin with your fingers as nodules or hardened areas. 

Additional signs of a Peyronie’s diagnosis include78

  • Penile curvature during erection that was never there before
  • A reduction in penile length
  • Erectile dysfunction
  • Painful erections
  • Shortening of the penis
  • An “hourglass” shape from the buildup of plaque at the base of the penis
  • Indentions in the shaft of the penis

You may feel scar tissue (a plaque) under the skin of the penis. You may be able to tell that the plaque is forming because of the following signs:

  • Your penis is shorter.
  • Your penis is bent/curved.
  • There is loss of girth, an indentation or “hour glassing” of your shaft.
  • There are lumps in your penis.
  • Erections are painful.

Symptoms of Peyronie’s disease may develop slowly or can seem to appear overnight. The pain of Peyronie’s disease is usually mild and often does not require treatment, but medications like ibuprofen can be used if needed. In most cases, the pain decreases over time, but the bend in the penis related to the scar can remain a problem. If the bend is bad enough, such as greater than 30 degrees, the curve can interfere with sex.

A man with Peyronie’s disease may also notice that this condition affects their mental health79. Changes in the penis can cause body image issues, anxiety or even depression. It can cause strain in a relationship and in other aspects of life.

Your sexual health is as important as any other aspect of your health. Talk to your healthcare provider about your concerns. Bringing your partner to the visit can help ensure both partners’ concerns are addressed.

[78]Mark Jalkut, MD, Nestor Gonzalez-Cadavid, PhD, and Jacob Rajfer, MD Peyronie’s Disease: A Review, Reviews in Urology , 2003 Summer; 5(3): 142–148. [79]Smith JF, Walsh TJ, Conti SL, Turek P, Lue T. Risk factors for emotional and relationship problems in Peyronie’s disease. J Sex Med. 2008;5(9):2179–2184.

Can Peyronie’s disease kill you?

No. Peyronie’s disease changes the shape and size of the penis, but it is not deadly and does not affect the rest of the human body.

Unfortunately, there are documented cases of patient’s committing suicide from depression brought about by a long lasting Peyronie’s diagnosis.

Is Peyronie’s disease genetic?

Yes, and No.

No, the disease is not in itself a hereditary trait.

New ExoSurge® Peyronie’s Insight

Yes, because certain inherited traits and conditions make you predisposed to more easily trigger the significant fibrosis which causes Peyronie’s from only negligible penile trauma that would otherwise not affect men without such markers. Thus, your likelihood to end up with a Peyronie’s diagnosis can be genetic.

These inherited traits include Autoimmune disorders, Connective tissue disorders, Dupuytren’s, Marfan’s syndrome, lupus, Sjögren’s syndrome, and Behcet’s syndrome and a pre-disposition for Type II Diabetes or alcoholism.

Can Peyronie’s disease cause urinary issues?

No. Peyronie’s illness does not manifest as urinary problems. Be sure to inform your healthcare practitioner of any symptoms you experience if you have urinary issues.

Additionally, Peyronie’s disease does not manifest as blood in the urine. Urologists should be consulted as quickly as possible to determine the cause of urine blood, which is usually brought on by other treatable diseases.

Can my partner catch Peyronie’s disease from me?

No. Peyronie’s is not contagious or caused by any form of communicable disease.

How long does Peyronie’s disease last?

For 90% of men, Peyronie’s disease is life-lasting condition that gets progressively worse in the absence of any effective treatment to reduce / remove the penile fibrosis causing symptoms.

New ExoSurge® Peyronie’s Insight

Our findings indicate Peyronie’s is a life-lasting diagnosis in 100% of men who acquire the condition. The handful of men where the symptoms “go away” are only delaying the inevitable and turning and easily treated case into a far more challenging diagnosis down the road.

Is Peyronie’s disease painful?

Both yes and no.

Peyronie’s can be excruciatingly painful80. This is especially common in the acute cases that follow a case caused by a specific penile injury. However, discomfort may persist even in the long-term chronic phase. Its severity may vary according on the individual.

The most common cause of Peyronie’s disease is persistent microtrauma. When this happens, discomfort usually appears only if the specific dimensions and positioning of the tunica’s increased penile fibrosis and plaques put stress on the surrounding tissue during erection.

Some men with Peyronie’s disease experience little to no physical pain, regardless of how serious their case81.

[80]F. L. Taylor and L. A. Levine, “Peyronie’s disease,” Urologic Clinics of North America, vol. 34, no. 4, pp. 517–534, 2007. [81]Nehra, Alaj, et al, Peyronie’s Disease: AUA Guideline, Journal Of Urology, 15, September 1943, 745-753.

What should I do if I just injured my penis during sex?

According to our research, the second most frequent cause of acquired Peyronie’s disease is acute penile injury during vigorous intercourse.

AUA standards of treatment currently recommend that patients wait around a year after such trauma in the hopes that the body would naturally resolve any side effects.

New ExoSurge® Peyronie’s Insight

The current AUA treatment guidelines recommend waiting a year after a penile injury before doing nothing to see if the body heals the problem. ExoSurge therapeutics, when administered within two weeks of a trauma, not only relieves any lingering pain from the injury, but also breaks up and removes fibrosis before it has a chance to spread, grow, become dense, and become more deeply ingrained in the tunica’s soft tissue, making it much more difficult to treat.

According to our findings, a fibrotic response caused by trauma never completely resolves. Instead, a young body can postpone the onset of fibrosis until the Peyronie’s accelerator is introduced into the equation (i.e. reduced vascular flow, decline with testosterone, etc.).

Because the body was unable to manage the fibrosis at the time, it responded to a perceived problem with the penile organ by making more fibrotic tissue. Men who “wake up” one morning with a prominent curve or morphing shape are more likely to have these events.

Does Peyronie’s disease make the penis smaller?

Sometimes.

Due to displacement, Peyronie’s disease can disfigure the penis. Every penis has a limited quantity of available space. If fibrosis and plaque take up more space, something else must give way.

Significant fibrosis in the penis organ is associated with reduced length and shaft indentations82. The severity of each is generally proportional to the size and precise location of the penile plaque.

[82]Bonillo MA, Garaffa G, Ralph DJ. Addressing residual penile deformity in the Peyronie’s Disease patient during penile implant surgery. Current Sexual Health Report. 2007;4:163–166.

New ExoSurge® Peyronie’s Insight

According to our findings, patients who get ExoSurge treatments while also adhering to our stretching and VED regimen restore nearly all of their lost size once the Peyronie’s fibrosis and plaques are fully eradicated.

We have been trying novel modifications in the exact force and focus of the pulsated gas technology treatments within areas of morphing penile shape, which we anticipate will improve these outcomes in the years ahead.

Will my Peyronie’s disease diagnosis cause erectile dysfunction?

Unresolved Peyronie’s instances nearly invariably result in some degree of erectile dysfunction83 because the tumorous mass healthy blood flow required to produce an optimal erect state, in the same way that sludge buildup in a drainage pipe impedes effective water flow.

Peyronie’s ED symptoms are distinguished by an inability to get an erection or the upper portion of the penis not getting entirely hard while the base is completely engorged.

Again, the accumulation of fibrotic bulk and penile plaques causes these consequences.

[83]A. I. El-Sakka, “Prevalence of Peyronie’s disease among patients with erectile dysfunction,” European Urology, vol. 49, no. 3, pp. 564–569, 2006.

Will my Peyronie’s disease diagnosis prevent me from having sex?

It is possible to have intercourse, but it may be uncomfortable or difficult for you or your partner. The more significant the curve, the more difficult sex is.

Can Peyronie’s disease cause infertility?

No, the testicles and urethra are utilized for reproduction and are unaffected by Peyronie’s illness. Urination is not influenced in the same way.

While the actual ejaculation process is unaffected, possible adverse effects include ED, significant penile curvature, and penile numbness, which may make getting to the point of ejaculation more difficult.

How can I prevent Peyronie’s disease?

Because of modest venous leakage, men’s erections typically grow less strong or stiff as they age. Every guy who lives long enough will ultimately develop a venous leak, in which the capillary capillaries that hold the blood in place for a quality erection deteriorate in health, enabling blood to seep out and lose firmness. Less firm erections are more easily harmed during intercourse because they bend more easily during sexual activity thrusts.

To help alleviate this risk, there’s several things you should try and/or keep in mind.

  1. Be aware that your penis can be injured. Men don’t receive an “operating manual” with a penis at birth. Most have no idea how easy it is to injure a penis.
  2. Your healthcare provider can prescribe PDE-5 inhibitors which cause artificial swelling of the capillaries that help retain blood in your corpora and reduce the risk of a bend or injury during sex. Almost all of them (Viagra®, Levitra®, Cialis®) are off-patent and now very affordable. To reduce the likelihood of injury, you should use these medications if your erections become less firm.
  3. If you masturbate often, consider investing in a “Fleshlight” – a silicone inset that simulates a vagina when lubricated. The force of your hand movements during manual masturbation climax can injure your penis. Additionally, this device tends to improve your pleasure with a partner over time as you remain accustomed to ejaculating in a manner consistent with intercourse vs more intensive force from hand stimulation.
  4. Anytime your partner is on top of you during sexual intercourse significantly increases the risk of a penile injury. It’s easy to lose aim during such activity and the weight and force of your partners movements can trigger trauma.
  5. Be mindful of remaining well aligned during penetration and intercourse. Although not as likely as when your partner is in top, it’s still relatively easy to injure the penis during sex when you’re positioned in a manner that’s easier to slip out.
  6. Make sure there’s plenty of lubrication during intercourse. Keep some over the counter lubricant nearby in case natural lubrication is If you were born with a predisposition for Peyronie’s Disease, you must be even more mindful of all these steps. Even the slightest injury can trigger a fibrotic response in your case.

Does my diet affect Peyronie’s disease?

The prevailing thought has been what you eat, or drink has no impact on a Peyronie’s case.

New ExoSurge® Peyronie’s Insight

We’ve discovered diet plays a big role in Peyronie’s Disease.

We found that regularly drinking alcoholic beverages can significantly contribute to the development of Peyronie’s-related penile fibrosis. We found that alcohol can influence fibrotic development in the penis in a manner similar to how it causes cirrhosis of the liver.

This is especially crucial if you decide to seek Peyronie’s care. According to our research, a patient who routinely drinks alcohol won’t enjoy a healthy recovery.

We discovered additional dietary factors in our research which will be detailed in future studies and publications.

Traditional Peyronie’s Care: Testing and Diagnosis of Peyronie’s

How is Peyronie’s Disease most commonly diagnosed? As explained earlier, we believe medically correct definition84 for Peyronie’s Disease (PD) is “a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis and / or thickening of the tunica albuginea85”.

New ExoSurge® Peyronie’s Insight

You’ll notice there was no mention of indications like penile curvature, loss of penis size, nodules, indentions, or erectile dysfunction in this medical definition of Peyronie’s Disease. Those are all just potential side effects of the disorder. The underlying disease that can trigger any or and of those manifestations is the buildup of fibrous plaques in the soft tissue of the penis and/or tunica, which is Peyronie’s Disease.

[84]Swislocki, Arthur, Eisenberg, Michael Peyronie’s Disease as a Marker for Inflammation – Is there hope on the Horizon – m J Med. 2021 Oct;134(10):1218-1223. doi: 10.1016/j.amjmed.2021.06.015.Epub 2021 Jul “Penile Curvature (Peyronie’s Disease)”. National Institute of Diabetes and Digestive and Kidney Diseases. July 2014. Retrieved 25 October 2017. Levine, Laurence A (2010). “Peyronie’s disease and erectile dysfunction: Current understanding and future direction”. Indian Journal of Urology. 22 (3): 246–50. doi:10.4103/0970-1591.27633.

Thus, the traditional approach to diagnosis of “Any board-certified urologist specializing in Peyronie’s will be able to accurately diagnose the existence a Peyronie’s case through an office visit that includes detailed patient history86 and direct examination of the penis” is inaccurate.

New ExoSurge® Peyronie’s Insight

A diagnosis must always be accompanied by a duplex Doppler sonography test. Within these readings, are the building blocks for how to repair the condition.

Additionally, detailed blood panel’s reveal where your body and health are now situated in regard to fighting off Peyronie’s symptoms and helping repair the disorder

As mentioned previously, Peyronie’s fibrosis is the first cousin of a benign tumor. Would you get a tumorous mass found treated without first measuring its mass to determine if treatments were effective?

Of course not.

[86]Kueronya V, Miernik A, Stupar S, Kojovic V, Hatzichristodoulou G, Egydio PH, et al. International multicentre psychometric evaluation of patient-reported outcome data for the treatment of Peyronie’s disease. BJU Int. 2015;115:822–828.

What questions does a urologist specializing in Peyronie’s Disease ask you regarding your Peyronie’s evaluation?

  • Are you currently experiencing any pain in your penis?
  • Do you recall any event where you felt noticeable pain to the penis during sex or any other activity? If so, please describe.
  • Have you had any surgery performed recently?
  • Do you have any health diagnosis you were treated for in the past or for which you’re now under a physician’s care?
  • What medications are you taking?
  • Can you feel any hardened spots or nodules in your penis when erect and/or flaccid?
  • Have you observed any curvature or indurations to the penis to the penis when erect?
  • Curve Related Questions: If Applicable
    • If you have penile curvature, how long has this been the case?
    • Which direction does your penis bend when erect?
    • Which direction does your penis bend and what’s you guess on the degree of erect curvature? (if applicable)
  • Have you lost length and, if so, how much?
  • Has this caused you any problems having sex?
  • Have you experienced any pain during sex from this condition?
  • Has any partner experienced pain from this condition during sex?
  • Have you noticed any symptoms of erectile dysfunction?
  • Does anyone in your family have an autoimmune disorder or Dupuytren’s contracture?
  • Have you ever been diagnosed with an autoimmune disorder or Dupuytren’s contracture?
  • Do you consume alcohol and if so, how often and how much?
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