WHAT IS PEYRONIE’S DISEASE?
Peyronie’s disease is a noncancerous condition resulting from fibrous scar tissue that develops on the penis and causes curved, painful erections. Penises vary in shape and size, and having a curved erection isn’t necessarily a cause for concern. But Peyronie’s disease causes a significant bend or pain in some men. This can prevent you from having sex or might make it difficult to get or maintain an erection (erectile dysfunction). For many men, Peyronie’s disease also causes stress and anxiety.
Peyronie’s disease signs and symptoms might appear suddenly or develop gradually. The most common signs and symptoms include:
- Scar tissue– The scar tissue associated with Peyronie’s disease — called plaque but different from plaque that can build up in blood vessels — can be felt under the skin of the penis as flat lumps or a band of hard tissue.
- A significant bend to the penis – Your penis might curve upward or downward or bend to one side.
- Erection problems – Peyronie’s disease might cause problems getting or maintaining an erection (erectile dysfunction). But, often men report erectile dysfunction before the beginning of Peyronie’s disease symptoms.
- Shortening of the penis – Your penis might become shorter as a result of Peyronie’s disease.
- Pain – You might have penile pain, with or without an erection.
- Other penile deformities – In some men with Peyronie’s disease, the erect penis might have narrowing, indentations, or even an hourglass-like appearance, with a tight, narrow band around the shaft.
You may be able to feel the scar tissue (plaque) through the skin or you may have pain in a specific part of your penis as the scar tissue forms. During an erection, your penis can bend up, down, or to the side depending on the location of the scar. Some men with this condition don’t have a curve but might have an area of indentation or “hourglass” appearance. Most men don’t have perfectly straight erections. Just because there is a little curve in your penis, that doesn’t mean you have Peyronie’s disease. In most cases, the scar forms on the top of the penis, causing it to curve upwards when it becomes erect. Your penis will bend downward if the scar is on the bottom, and sideways if the scar is on the side. In some cases, the scar develops on both the top and bottom of the shaft, which can cause the penis to become “dented” or shorter. Sometimes the scar will go all the way around the penis, making it narrow like the neck of a bottle or the center of an hourglass. About one in three men with this condition may have calcium in the scar tissue that can make it feel like bone.
Peyronie’s disease has two stages: acute and chronic.
- Acute phase: This stage lasts between six and 12 months. During this period the scar forms under the skin of your penis, causing a curvature or other change in its shape. You may feel pain when your penis is erect or when it is soft.
- Chronic phase: The scar has stopped growing in this phase, so the curvature in the penis doesn’t get worse. The pain will usually be gone by this time, but sometimes it can continue, especially with erections. Also, erectile dysfunction (ED) or problems getting or keeping the penis hard may develop.
What Causes Peyronie’s Disease?
The cause of Peyronie’s disease isn’t completely understood, but many factors appear to be involved. It’s thought Peyronie’s disease generally results from repeated injury to the penis. For example, the penis might be damaged during sex, athletic activity, or as the result of an accident. However, most often, no specific trauma to the penis is recalled.
During the healing process after an injury to the penis, scar tissue forms in a disorganized manner. This can lead to a nodule you can feel or the development of curvature. Each side of the penis contains a sponge-like tube (corpus cavernosum) that contains many tiny blood vessels. Each of the corpora cavernosa is encased in a sheath of elastic tissue called the tunica albuginea, which stretches during an erection. When you become sexually aroused, blood flow to these chambers increases. As the chambers fill with blood, the penis expands, straightens, and stiffens into an erection. In Peyronie’s disease, when the penis becomes erect, the region with the scar tissue doesn’t stretch, and the penis bends or becomes disfigured and possibly painful.
Men who have an autoimmune disease may develop Peyronie’s disease if the immune system attacks cells in the penis. This can lead to inflammation in the penis. Scar tissue may form and develop into plaque.
Minor injury to the penis doesn’t always lead to Peyronie’s disease. However, various factors can contribute to poor wound healing and scar tissue buildup that might play a role in Peyronie’s disease. These include:
- Heredity – If a family member has Peyronie’s disease, you have an increased risk of the condition.
- Connective tissue disorders – Men who have certain connective tissue disorders appear to have an increased risk of developing Peyronie’s disease. For example, some men who have Peyronie’s disease also have a cordlike thickening across the palm that causes the fingers to pull inward (Dupuytren’s contracture).
- Age – Peyronie’s disease can occur in men of any age, but the prevalence of the condition increases with age, especially for men in their 50s and 60s. Curvature in younger men is less often due to Peyronie’s disease and is more commonly called congenital penile curvature. A small amount of curvature in younger men is normal and not concerning.
- Other factors — including certain health conditions, smoking, and some types of prostate surgery — might be linked to Peyronie’s disease.
The exact cause of Peyronie’s disease is not known. However, whatever can cause plaque or scar formation in the penile shaft is a likely causal candidate. Researchers have suggested several possible agents such as vitamin E deficiency, beta-blocking medications, elevations in serotonin, and genetic causes.
Is Peyronie’s Disease Painful?
Yes, Peyronie’s disease can be painful. This is most common in the acute (early) phase of the disease. However, pain may continue with erections even in the chronic phase. The severity of it varies depending on the person. Peyronie’s disease is where plaques (segments of flat scar tissue) form under the skin of the penis. These plaques can cause the penis to bend or become indented during erections. The plaques can often be felt through the skin and can be painful. In most men who have penile pain due to Peyronie’s disease, the discomfort usually will fade on its own as the penile inflammation subsides. This process may take as long as 6 to 18 months.
What are the Best Treatments for Peyronie’s Disease?
MEDELINE ZECH RUIZ in the book I MARRIED A DICK DOCTOR, says:
“General Urologists are usually the best place to start for any problems you may be having down there. They evaluate, diagnose, and treat all the most common urological issues. General urologists will refer you to a sub-specialist when indicated for specific situations.”
Treatment recommendations for Peyronie’s disease depend on how long it’s been since you began having symptoms.
For the acute phase of the disease, treatments range from:
- Recommended – When used early in the disease process, penile traction therapy prevents length loss and minimizes the extent of curvature that occurs.
- Optional – Medical and injection therapies are optional in this phase, with some more effective than others.
- Not recommended – Surgery isn’t recommended until the disease stabilizes, to avoid the need for repeat surgery.
For the chronic phase of the disease, several potential treatments are available. They may be done alone or in combination:
- Watchful waiting
- Injection treatments
- Traction therapy
Several oral medications have been tried to treat Peyronie’s disease, but they are not effective consistently and are not as effective as surgery. In some men, drugs injected directly into the penis might reduce curvature and pain associated with Peyronie’s disease. Some of the medications used include Collagenase, Verapamil, Interferon, and others.
Penile traction therapy
Penile traction therapy involves stretching the penis with a self-applied mechanical device for a while to improve penile length, curvature, and deformity. Depending on the specific device, traction therapy may need to be worn for as little as 30 minutes to as much as three to eight hours a day to achieve benefits. The effectiveness of the treatment may also depend on the specific device used. Traction therapy is recommended in the early phase of Peyronie’s disease. It’s the only treatment shown to improve penile length. Traction therapy may also be used in the chronic phase of the disease, combined with other treatments or after surgery for a better outcome.
Your doctor might suggest surgery if the deformity of your penis is severe, sufficiently bothersome, or prevents you from having sex. Surgery usually isn’t recommended until you’ve had the condition for nine to 12 months and the curvature of your penis stops increasing and stabilizes for at least three to six months.
Common surgical methods include:
- Suturing (plicating) the unaffected side- A variety of procedures can be used to suture (plicate) the longer side of the penis — the side without scar tissue. This results in a straightening of the penis, although this is often limited to less severe curvatures.
- Incision or excision and grafting- With this type of surgery, the surgeon makes one or more cuts in the scar tissue, allowing the sheath to stretch out and the penis to straighten. The surgeon might remove some of the scar tissue. A piece of tissue (graft) is often sewn into place to cover the holes in the tunica albuginea. This procedure is generally used in men with more-severe curvature or deformity, such as indentations. This procedure is associated with greater risks of worsening erectile function when compared with the plication procedures.
- Penile implants. Surgically placed penile implants are inserted into the spongy tissue that fills with blood during an erection. The implants might be semirigid — manually bent down most of the time and bent upward for sexual intercourse. Another type of implant is inflated with a pump implanted in the scrotum. Penile implants might be considered if you have both Peyronie’s disease and erectile dysfunction. When the implants are put in place, the surgeon might perform additional procedures to improve the curvature if needed.
The type of surgery used will depend on your condition. After surgery for Peyronie’s disease, you’ll need to wait four to eight weeks before sexual activity.
A technique known as iontophoresis uses an electric current to administer a combination of verapamil and a steroid noninvasively through the skin. Available research has shown conflicting results on penile curvature and erectile function.
Several non-drug treatments for Peyronie’s disease are being investigated, but the evidence is limited on how well they work and possible side effects. These include using intense sound waves to break up scar tissue (shock wave therapy), stem cells, platelet-rich plasma, and radiation therapy.
In the book I MARRIED A DICK DOCTOR, MEDELINE ZECH RUIZ discusses various treatments and medical options available to men. Read the book for simple and understanding discussion on complicated issues that both men and women face.
Peyronie’s disease is a cause of concern for men; however, treatment is possible. Hopefully, this article helped you to know about Peyronie’s disease and its treatment.