A Doctor with Hard Flaccid - Updates and Advice

[Big Al]

This thread keeps getting better! :thumb:

 

[Romero MD]

This thread keeps getting better! :thumb:

Thank you Big Al

 

[Romero MD]

Hi Dr. Romero. I have read most, if not all, of your posts in this thread. Thank you for taking so much time and effort in helping everyone solve HF. If you have the time, I would be grateful if you could help me.

Hi Zeroo! You're welcome. It's my pleasure
I'm glad you showed up. I was really in need of a post to add some information and details, which other members have asked me. I hope you don't mind if I use your post…

I myself have Hard Flaccid - it has been about 8 years now. I tried physiotherapists and doctors to no avail. I have read many books and consulted different sources for information which have helped me significantly. I am at a point, however, where I am unable to progress any further. Aside from the hard flaccid state and no libido, I used to have a feeling of inflammation in the penile area and a serious discomfort while sitting down (I had to lie down whenever doing something that required a rested position, like reading or using the laptop). These two symptoms went away completely when I performed skin rolling on my fascia all over my legs (I highly recommend this if external trigger point therapy hasn't worked). The only symptoms that remain are: a hard flaccid penis and almost non-existent libido. I haven't been able to fix these.

Okay. Pelvic pain is a very common symptom in Hard Flaccid. Due to the compression of the pudendal nerve, caused by the contracture of the pelvic muscles. I think that in addition to Hard Flaccid, you also had/have the famous Chronic Pelvic Pain Syndrome, whose causes are basically the same - Pelvic Floor Dysfunction and Stress. If you were able to partially resolve these two symptoms, it means that the treatments you did partially worked. This is already a great start.

Thanks for the advice on Skin Rolling. It is still a Trigger Point style massage. It is only more intense and applies greater pressure and stimulation to muscle tissues. I'm glad it worked.

I stretch my legs everyday and do posture exercises (e.g. wall angels) which help relieve some of the pelvic floor tightness but it only to a certain extent and temporary.

Good. Okay, so let's move on to the academic section, for everyone:
1 - ALL muscle stretches in the legs do NOT DIRECTLY stretch the Ischiocavernosus Muscle. Because the IC muscle is inside both hip bones. All pelvic floor muscles have both their muscle insertions within both hip bones. Therefore, it is impossible to stretch them DIRECTLY when training leg flexibility. It would be necessary to detach the two hip bones for the pelvic floor muscles to undergo direct stretching. What doesn't happen, the hip bones are fixed on each other.

2 - All other muscles - Hamstrings, Psoas, Piriformis, Quadriceps, Adductors, Abs - have their muscle insertions outside the hip bones. Therefore, the IC muscle does not undergo DIRECT stretching with any of these exercises. Not even with the butterfly stretch or with the Hindi Squats (Wait, wait! Don't freak out... I'll explain xD) The IC muscle is only stretched directly through Reverse Kegels (that's why I recommend you to do it ALL day) and through manual penile stretches (what I absolutely do NOT recommend you to do, until you are fully healed of Hard Flaccid. It is counterproductive. The penile smooth muscle is not soft. They can worsen the injury)

"Romero, are you kidding us?! So what's the use of muscle stretches?... Why did you tell HFrecovering to go splitting on the riverside?... "
Okay, three reasons:
1 - Leg stretches INDIRECTLY stretch the IC muscles. First, through the skin. Because the skin is continuous along the legs and the pelvis. Second, Hindi Squats (which are very important!!!) increase the pressure that the pelvic organs create on the pelvic floor muscles (they create a larger balloon on the pelvic floor). That is why it is great to do Reverse Kegels while in the Hindi Squat position. There is a synergistic effect between both, promoting greater stretching. It is one of the best exercises you can do.

2 - Because the more muscles, around the pelvic cavity, have flexibility and are relaxed daily, the more easily the IC muscle will also be relaxed. Due to neuronal motor stimulation. The muscle tension created by the brain will progressively decrease in all surrounding muscles (including the IC). If we force the brain to gain flexibility in these muscles, it will also minimally relax the IC muscles.
Second, fascias. When we stretch the Psoas muscles, the adductors, the hamstrings, etc... we are stretching the connective tissue (fibrous tissue) that runs through the whole body and all those muscles, and that are all interconnected (including with the pelvic floor). It is as if we are stretching the inner skins.

3 - Because it improves posture. And Hard Flaccid is very much associated with the tension of the Anterior Pelvic Tilt. And the more flexibility and mobility we have (through muscle stretching) the less APT we will have.

Zeroo, you still have tension on your pelvic floor. You absolutely need Reverse Kegels. You have to do Reverse Kegels ALL day. Along with Trigger Point/Skin Rolling massages and Hindi Squats (the best secondary stretch, because the pelvic organs dilate the pelvic floor).

Conclusion: Reverse Kegels is the most important exercise for all patients with Hard Flaccid. All of them. It is the direct stretching of the muscles that are contracted and creating the problem. This consequently stretches the penile smooth muscle (Hard Flaccid). All other stretches are accessory exercises, but they also help a lot.

I don't think I have a lot of stress but I would say I am more sensitive to it when it comes around, so definitely something I can work on in that area. I am happy with everything I have in my life except for HF.

Okay good.

Pornography use is definitely a weak spot for me which I try to limit as much as possible; I watch it roughly 1-2 times a week.

You already know what you have to do, right? :biggrin1:

From what I understood in your posts, aside from stretching, you recommend Hindi squats, reverse kegels and working on relaxing (not just mentally, but being in a warm environment). I haven't worked on the latter three and will begin doing them everyday. Is there anything else I am missing?

Read again the first post of this thread. I update the whole summary there.

 

[Zeroo]

I will work on all of the things you suggested everyday and return when I have something to ask or add on my condition. Until then, I just want to say thank you for helping us. Words can't fully express my gratitude.

 

[Big Al]

Thank you Big Al

You're most welcome!

 

[Pegasus]

How very interesting . Post 123 explains why many stretches have been less effective then one would normally expect

I note most physio in the area regard HF as a subset of the more generalised term cpps .
One should note also that having hf does not preclude having other pelvic floor issues . That is if we accept that HF is a spasm of the ic muscle (and I have thought that for some time ) then that does not mean there are no issues in other parts of the pelvic floor .

 

[DickerSchwanz]

Thinking about it I see how the IC might be a big part of it.
The IC seems very fickle and thin compared to other larger PF muscles like the BC muscle.

It innervates into the CC. I isolated and trained the IC muscle a lot.
Engaging it strongly while being flaccid hardens up the CC and pulls on it. It keeps it in a inflexible state.
I can imagine doing that all day would result in something akin to HF.
(read only this page so pardon if already mentioned)

3 - Because it improves posture. And Hard Flaccid is very much associated with the tension of the Anterior Pelvic Tilt.

HA! Which gives credence to the idea that HF is a rather new "epidemic" that is (partly)due to rise of pornhub and co.
I'm on mens forums since 20+ years and this topic is increasingly happening since ~2010.

When I wanked as a teen I had centerfolds and mag pics placed in different positions. Kneeling, squatting, standing, one leg a "stair" up or simply laying on the back..
Basically different stretches to the PF while wanking.
Later renting VHS or DVD and watching relaxed leaned back on a couch.

Nowadays young guys sit hunched over all the time in the same position wanking to a fixed screen. Same Hip and Pelvis position over and over! (=Anterior Pelvic Tilt?)
That then coupled with the increasingly paced porn which adds anxiety which gives tension(in the IC..).
Then abusing the meatus vigorously pulls against the tension creating Trauma.

Now accusing every HF sufferer of being a notorious wanker is politically incorrect, and it might not be the prime issue, but to me it seems not far fetched that modern masturbation habits are a big part of it.

 

[HFrecovering]

Thinking about it I see how the IC might be a big part of it.
The IC seems very fickle and thin compared to other larger PF muscles like the BC muscle.

It innervates into the CC. I isolated and trained the IC muscle a lot.
Engaging it strongly while being flaccid hardens up the CC and pulls on it. It keeps it in a inflexible state.
I can imagine doing that all day would result in something akin to HF.
(read only this page so pardon if already mentioned)



HA! Which gives credence to the idea that HF is a rather new "epidemic" that is (partly)due to rise of pornhub and co.
I'm on mens forums since 20+ years and this topic is increasingly happening since ~2010.

When I wanked as a teen I had centerfolds and mag pics placed in different positions. Kneeling, squatting, standing, one leg a "stair" up or simply laying on the back..
Basically different stretches to the PF while wanking.
Later renting VHS or DVD and watching relaxed leaned back on a couch.

Nowadays young guys sit hunched over all the time in the same position wanking to a fixed screen. Same Hip and Pelvis position over and over! (=Anterior Pelvic Tilt?)
That then coupled with the increasingly paced porn which adds anxiety which gives tension(in the IC..).
Then abusing the meatus vigorously pulls against the tension creating Trauma.

Now accusing every HF sufferer of being a notorious wanker is politically incorrect, and it might not be the prime issue, but to me it seems not far fetched that modern masturbation habits are a big part of it.

My gut tells me there is 100% a connection to porn and conditioning the pelvic floor by continuously contracting that contributes to HF.

However many many people have gone on nofap and done the physical therapy with it and got fuck all results.

I personally did over 10 months of nofap back in 2018 and I've done 10 years of almost non stop physichal therapy, it did absolutley nothing for my HF.

I don't think hard flaccid is a new phenomenon, there are medical texts going back 1000 years in China and Japan describing it and the way they describe it is textbook HF word for word.

I also think there have probably been many people over the century's who just don't know what the fuck it is or what to do about it so they just resign themselves to it.

 

[Zaid1997]

So have any of the chinese or japanese doctors found out how to deal with it?

 

[HFrecovering]

So have any of the chinese or japanese doctors found out how to deal with it?

Nothing of value, mostly spiritual sh*t about blocked energy's and chi

 

[DickerSchwanz]

One of the things with the PF is that once the muscles are tense they tend to be chronically and need to actively loosened.
Compared to lets say the biceps the PF muscles are rather unconscious. It`s like getting aware of small neck muscles which can be tense all day everyday forever.

I did never have HF but a very tense PF without noticing the full extent. No awareness, just the signs of it.(like pain or bad erections)
I also though I knew RK`s but in reality only expanded a small set of muscles. Until I looked into it and opened up my whole PF outwards, all muscles stretched.
Was never aware of the IC muscle but now I can stretch and contract it willfully..
Now knowing the difference between unaware PF and aware PF is quiet stark.

Chi and energy is just fancy words for focusing conscious awareness and nerves which are literally electrically charged(very low voltage obv.).
A big part of getting the PF fully controlled is the mind body connection. It`s like training to wiggle your ears isolated from other muscles. You first imagine in your mind what you will do and then you try to get there.
So can one get conscious awareness out of the head into the PF? Of course! Try it with your hands or feet..
Most just walk with an idea of their feet but never are right in their feet from within lol


https://imgur.com/a/5LFLhbP
Once I focused on expanding these areas via RK, and not solely on the ones crossed, my PF was successively getting "untangled".

 

[DickerSchwanz]

Ok pardon me and let me add this:

In turquoise the IC Muscle.

https://imgur.com/a/wT5xhEJ
Red arrows is the way and direction I engage the IC to tense my dick in a way I imagine HF is similar to. (here only the left IC "arrowed")
It pulls on the CC`s/Tunica. I guess that could be what happens chronically to the IC with HF sufferers..
Doing that movement while erect increases the erection trapping blood in the CC`s, which would be contra-productive if theres no blood in the penis.

Here is what I do to stretch the IC:

https://imgur.com/a/6byzHGq
The black circles are imaginary "balloons" that I blow up and expand in all directions outwards but especially towards the legs and buttocks.
The black arrows show the direction I expand the IC outwards. That`s a Reverse Kegel basically.

Now you can also see where IC`s are anchored towards the inside of the body/PF(the red arrows point to it too).
If that area is tense or tilted in the wrong way(I guess what the Doc explained anterior pelvic tilt) it will pull the IC back or tighten it influencing the Penis.
So the ability to move the IC might be hampered by such a condition.

Can HF sufferers move the "flaccid" penis easily to the sides?(like doing helicopter stretches..) Or is that a problem?
Up Down?

 

[Romero MD]

Thinking about it I see how the IC might be a big part of it.
The IC seems very fickle and thin compared to other larger PF muscles like the BC muscle.

It innervates into the CC. I isolated and trained the IC muscle a lot.
Engaging it strongly while being flaccid hardens up the CC and pulls on it. It keeps it in a inflexible state.
I can imagine doing that all day would result in something akin to HF.
(read only this page so pardon if already mentioned)

Hi DickerSchwanz

Yes, I had mentioned it a few times during the posts:
Hard Flaccid is a contracture of the IC muscle.

As you said, the IC muscle innervates into the structure of the Corpora Cavernosa. Therefore:
IC contracture (post-injury or not) ---> contracture of the Penile Smooth Muscle within the CC ---> Hard Flaccid
And this can be understood very well through the schematic images, from your last post. Thank you!

But, as Pegasus said, there may also be injuries (or contractures) in other pelvic floor muscles.
I think I also had a minor injury in the BC muscle, given my initial symptoms.

Can HF sufferers move the "flaccid" penis easily to the sides?(like doing helicopter stretches..) Or is that a problem?
Up Down?

In a flaccid state, I think it's easy for everyone, in all directions. Because the muscles are not too stretched, nor with enough tension to arouse pain. However, in the first few weeks after I started having erections again, I was unable to bring my erect penis towards my right groin. It hurt. It was a stretch too intense for the left IC muscle (where I had the injury). However, in a flaccid state, I rest the penis on the right groin to promote flexibility gains in the left IC muscle.

Thank you very very much for these 3 posts, DickerSchwanz!
I really enjoyed reading them. They are very informative, interesting and didactic.
And I agree with everything you said.

P.S.: I have been reviewing anatomy through the book that has the images that you have posted :biggrin1:
It was one of my greatest companions throughout medical school.

 

[Romero MD]

My gut tells me there is 100% a connection to porn and conditioning the pelvic floor by continuously contracting that contributes to HF.

:amen:

However many many people have gone on nofap and done the physical therapy with it and got fuck all results.
I personally did over 10 months of nofap back in 2018 and I've done 10 years of almost non stop physichal therapy, it did absolutley nothing for my HF.

HFrecovering, what a stab in my heart, man...

There are at least 7 posts dedicated to you on this thread. One is the longest post and the one that took me the most work to write.
Both I, and especially you, already know the reason why physical therapy and no porn/nofap do not give you the results you desire.

I'll even answer you with your own words, from another thread... :eyebrows: A beautiful piece of advice you gave to another member. Even my jaw dropped:

If you release the tension with the wand but don't work on your mental state then the tension is just going to come back again.

In my opinion I don't even think you need the wand. If you just lived your life and stopped thinking about it then it would get better on its own.

(Yes, I had this one kept, waiting for the day to use it... :biggrin1

Come on, tell us what we all want to hear: How is therapy going?

 

[HFrecovering]

:amen:



HFrecovering, what a stab in my heart, man...

There are at least 7 posts dedicated to you on this thread. One is the longest post and the one that took me the most work to write.
Both I, and especially you, already know the reason why physical therapy and no porn/nofap do not give you the results you desire.

I'll even answer you with your own words, from another thread... :eyebrows: A beautiful piece of advice you gave to another member. Even my jaw dropped:



(Yes, I had this one kept, waiting for the day to use it... :biggrin1

Come on, tell us what we all want to hear: How is therapy going?

Impossible to get any therapy atm, especially with covid.

Im just trying to practice acceptance and sticking to somatics.

 

[troublecouple2aa]

Impossible to get any therapy atm, especially with covid.

Im just trying to practice acceptance and sticking to somatics.

another thing that covid came to ruin

 

[DickerSchwanz]

Read most of your posts in this thread now and implications go beyond HF!
The most important is to never forget about full Pelvic Floor reverse Kegels, to open up the whole area. Can`t be overstated.
Made me put more focus on it again and noticed a lot of moments of tense PF! Without creating more stress it wouldn`t be wrong to advice all day reverse Kegels.. I enjoy them a lot during walking for example..

P.S.: I have been reviewing anatomy through the book that has the images that you have posted :biggrin1:
It was one of my greatest companions throughout medical school.

It only started for me to click once I started checking out diagrams from different angles! Literally enabled the Mind Body connection to form to the muscles vs. kegeling in the dark..

practice acceptance and sticking to somatics.

Which is great, somatics if done in context, as in acting out, releasing and then shifting to a neutral or positiv expression is powerful. More so than any talk only therapy.(but great in combination)

 

[HFrecovering]

Read most of your posts in this thread now and implications go beyond HF!
The most important is to never forget about full Pelvic Floor reverse Kegels, to open up the whole area. Can`t be overstated.
Made me put more focus on it again and noticed a lot of moments of tense PF! Without creating more stress it wouldn`t be wrong to advice all day reverse Kegels.. I enjoy them a lot during walking for example..



It only started for me to click once I started checking out diagrams from different angles! Literally enabled the Mind Body connection to form to the muscles vs. kegeling in the dark..


Which is great, somatics if done in context, as in acting out, releasing and then shifting to a neutral or positiv expression is powerful. More so than any talk only therapy.(but great in combination)

I believe you are talking about somatic experiencing?

I was referring to somatic pandiculation which is very simmilar, you basically contract and very slowly release different muscle groups in a peaceful meditative state while paying attention to sensations felt during the releasing of the muscles.

It has done fucking wonders for neutralising my sympathetic nervous system, far more so than anything I've ever done before.

 

[Romero MD]

I was referring to somatic pandiculation which is very simmilar, you basically contract and very slowly release different muscle groups in a peaceful meditative state while paying attention to sensations felt during the releasing of the muscles.

It has done fucking wonders for neutralising my sympathetic nervous system, far more so than anything I've ever done before.

Sounds great

 

[Oluphil20]

Good day Remero MD. Thanks for all you do here. You're surely helping us..hf sufferers. Apart from all common Hf symptoms.. I have two major symptoms that is really bothering me. I have this obvious twist/turning of my entire shaft from the base to the right that almost disappear when erect. It more obvious when I'm flaccid and tend to bend to the right side from the base when it's semi erect. What can I do to correct this?
The second symptom is a sagging balls... Sagging than my former balls before Hf.
Please help me.
Thanks in anticipation.