Dr. Mulhall answers: This is an excellent and frequently asked question. There is no indication that ILV causes more trauma and the evidence for this is that many men have stabilization or improvement of the Peyronie’s disease when they have used ILV. Likewise, there is no evidence to suggest that older men who do ILV do more poorly than younger men. Exactly how ILV changes the biology of the plaque is unclear and much research needs to be done to explore this. Of note the kind of trauma that results in Peyronie’s disease is most probably excessive torqueing of the penis and not penetrating trauma as occurs with the sue of a needle penetrating the plaque.