Peyronie’s disease
Peyronieâs disease is an abnormal curvature of the penis caused by fibrous or scar tissue in the tough coating that makes up the covering of the erectile tissue in the penis. This covering or tunic is called the tunica albuginea. The condition is fairly common but largely undiagnosed as most men assume they have to live with it, as they are too ashamed to seek medical help.{{more}} Besides, some men with accommodating partners assume that they are normal, as the women âworkâ with the deformity.
We do not know what actually causes peyronieâs disease, but we know that chronic irritation of the tunica albuginea has a role to play. In other words, repeated trauma to the penis, usually through sexual intercourse, causes chronic irritation of the tunica albuginea (CITA). This heals with scar tissue. The scar tissue is usually localized to one area, so it is called a plaque. Scar tissue is not soft or elastic and does not expand, so when an erection occurs most of the penis expands except for the area of scar tissue. In other words, the rest of the penis expands around the scar tissue and so the penis bends around this plaque. This bending around the scar tissue is what peyronieâs disease is.
Peyronieâs disease has also been associated with older men (over 40) and the use of antihypertensive medications like beta-blockers and calcium channel blockers. One third of men who suffer from a curvature of the penis also have excessive scar tissue in other areas, like the sole of the feet or the palm of the hands. This points to a genetic component.
The problem with peyronieâs disease is the inability to have satisfying intercourse due to the curvature of the penis. The penis is too bent to enter and if it enters it is too painful for the giver and/or the recipient. Men who suffer from peyronie, due to their poor performance, tend to avoid intercourse and some may suffer with physical or psychological impotence. The psychological impotence is self-explanatory, but the physical is due to the impediment to the flow of blood caused by the scar tissue.
Treating peyronieâs is rather challenging, because of the multitude of unproven and over-the-counter treatments available. Most do not work, but I will mention the few that actually work, even if to a small degree.
Medications
Several medications have been used. They have a role either in preventing further scar formation (e.g. vitamin E and colchicine or a combination of both) or helping to soften the already formed scar tissue (e.g. Trental, Viagra and Potaba). Most of these medications give slight straightening to some of the men using them, but so do just using the bent penis and the natural history of the disease. That is about 1 in 10 men will get better on their own, 6 in 10 will remain curved after 6 months of progressive bending and the other 3 in 10 will continue curving beyond 6 months.
Newer medications are designed to âbreak upâ the scar tissue. Unfortunately, these have to be injected into the scar tissue and apparently they work better than the oral medications (tablets) mentioned above. One of the medications is a steroid (dexamethasone), an antihypertensive (verapamil) and collegenase or scar tissue lyser, marketed for other uses, but used off-label for this condition.
Surgery
Surgery on such a precious organ, as you would expect, is delicate. It is almost 100% effective, but invariably leads to a small amount of shortening. Most men, except for those with the most severe amount of curvature, find this unacceptable. Therefore, surgery is going out of vogue, except for the most severe forms of curves that are also associated with impotence. In this case, a prosthesis or implant is placed in the penis to straighten it and create a semi-permanent false erection in the meantime.
Physical therapy and devices
These devices are called âpenis extendersâ. They are designed to stretch the scar tissue and straighten the curvature. They are presently experimental, but showing some promising results. They are growing in popularity largely because men are trying to avoid surgery and the medical (medication) alternative gives poor results generally. These will most likely be the treatment of the future, if the preliminary results are promising.
For comments or question contact:
Dr. Rohan Deshong
Tel: (784) 456-2785
email: deshong@vincysurf.com
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