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Peyronie’s disease: a common yet obscure disease of men

Peyronie’s disease (pronounced: pay-row-knees) is a disease that affects the male penis. It is considered a connective tissue disorder that affects an estimated 10-12 percent of men. Scar tissue, also known as fibrous plaques, develops along one side of the shaft of the penis. Commonly the penis is bent rather than straight when erect. However, when present, this scar tissue can cause the penis to take on a curved shape. Sometimes the curve is extreme.



In addition to curvature, the condition can also cause general pain, erectile dysfunction, pain with intercourse, and a decrease in penile size. The disease can range from extremely mild to markedly severe.

Peyronie’s disease can occur at any time, but it most commonly appears in middle-aged men and is more common in older men. When present, the severity of Peyronie’s disease becomes more pronounced over time.

Signs and symptoms

A mild curvature of the penis is considered normal and termed “benign
congenital curvature.” When the condition is present, cord-like scar
tissue can cause both penile curvature and depression or dents in the
penile shaft, although a curved penis is the most commonly reported
manifestation of the disease.

Many men with significant disease report discomfort and pain with
intercourse. Men with mild disease may not experience uncomfortable sex.
About 10-20 percent of men with Peyronie’s disease will also develop
connective tissue conditions that affect the hands and feet.

Cause

The exact cause of Peyronie’s disease is not clearly understood. Many
doctors believe Peyronie’s disease may be a combination of both genes
and trauma. Theories suggest it is the result of some traumatic event or
repeated minor trauma to the penis from sexual encounters or physical
activity. Oddly, most men with Peyronie’s disease don’t report any
history or memory of injury to the penis.

It does seem to occur more commonly among family members, so there
may indeed be a genetic basis to the disease. Some medications may list
Peyronie’s as a side effect, but there is no medical proof that drugs
cause Peyronie’s disease.

Diagnosis

A urologist can diagnose the condition. In most cases, a hard fibrous
plaque or cord can be felt along one side of the penile shaft. The
urologist may also order an ultrasound imaging study to confirm the
diagnosis.

Sometimes the determination can only be made when the penis is
erect. In those cases, a medicine can be given at the doctor’s office to
cause an erection and enable the diagnosis. In rare cases, a biopsy of
affected tissue may be required to solidify the diagnosis.

Prognosis

It is estimated that about 10 percent of cases will improve on their
own, without any treatment. About 50 percent of cases will worsen over
time, and the rest of the cases will appear and remain unchanged.

Treatment

Treatment of Peyronie’s disease is both challenging and
controversial, and is usually reserved for symptomatic cases. Because a
small percentage of cases resolve spontaneously, patients with mild
Peyronie’s disease may elect to observe the condition without
intervention.

Many doctors, in mild to moderate cases, will recommend just
observation for one or two years before engaging in treatment. If
Peyronie’s disease does not affect sexual performance or produce pain
with intercourse, treatment may not be required, at all.

If Peyronie’s disease is causing pain, oral medications such as
vitamin E supplementation have reportedly been effective in some, but
certainly not a majority, of cases. It appears that earlier studies
reporting the effectiveness of vitamin E have not been able to be
replicated recently. Reports of B vitamins and closely related
medications indicate that these might also be beneficial.

Prescription medications

There is a medication that is now FDA-approved to treat Peyronie’s
disease. It is an enzyme named collagenase clostridium histiolyticum
that is injected into the penis and works by breaking down the scar
tissue or fibrous cords that cause Peyronie’s disease.

Some medications that function as non-steroidal anti-inflammatory
medications (like pentoxifylline, verapamil and others) have also been
used with success. These anti-inflammatory medications appear to be not
as effective in treating longstanding disease.

Physical therapy

There are penile devices that can straighten and stretch the penis to
improve the condition. The results are mixed, but because it is safe
and cost-effective, this treatment may be worth trying. Unfortunately,
experts are not in agreement about how much, how often, and for what
time period penile stretching is optimal for disease treatment. At this
point, this option appears to be more trial and error than any unique or
specific plan.

Surgery

Surgery is indicated when Peyronie’s disease prevents sexual
intercourse. The plaque itself can be surgically excised, or the area
opposite the affected area can be removed. This surgical procedure,
called the “Nesbitt” procedure, was developed by and named for a famous
urologic surgeon.

The Nesbitt procedure is used as a last-hope treatment for extreme
cases when nothing else works. The Nesbitt surgery is a complicated
procedure that requires both extreme experience and skill and causes a
shortening of the penis. In cases where erectile dysfunction is present,
a prosthesis may be surgically implanted.

Many surgeries can be helpful. However, the risk of causing a side
effect that can’t be corrected causes surgeons to recommend surgical
correction infrequently.

Counseling

Peyronie’s disease can be psychologically devastating. Affected
persons can have low self-esteem. Often patients develop symptoms of
depression and avoid social or sexual partners. In these cases,
appropriate counseling from experienced therapists can make a
significant difference.

Peyronie’s disease is a common, but little-discussed disease. It can
have severe mental and physical effects in those suffering from it and
affected by it, and can completely ruin the sexual component of a
relationship.

The good news is that Peyronie’s disease is being discussed more and
there is an FDA-approved treatment for the condition. If you or a loved
one may be suffering from symptomatic Peyronie’s disease, help may be as
close as your doctor’s office.

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