- Why It’s Called Peyronie’s Disease?
- Does Peyronie’s Disease Affects All Men?
- Coexist with Erectile Dysfunction
- Symptoms Of Peyronie’s Disease
- Causes Of Peyronie’s Disease
- Factors That Makes People Susceptible
- Other Risk Factors
- Medical Procedures May Trigger Plaque Formation
- Medications That May Contribute To Peyronie’s Disease
- General Risk Factors
- Other Risk Factors
- Various Possible Treatments
- Medical Treatments
- Some Thoughts
- Primary Goal For Peyronie’s Disease Treatment
There have been a lot of mentions about Peyronie’s disease previously within this website. However, there has been no article on this website detailing the condition, until now.
This article will attempt to explain what is a Peyronies disease. The information from which this article is based on the recent review of the medical literature.
On the other hand, I would like to make a disclaimer regarding the information on this article.
The information on Peyronie’s disease discussed in this article is purely for educational and not a substitute for professional advice from a Urologist.
Products recommended or mentioned within this article do not directly imply it is a 100% solution of the condition, though they are backed medically with proof at the product’s official website.
Peyronie’s disease is a condition that results in scar tissue that can cause the penis to remain either curved, deformed or shortened during erection. Early on it can cause pain during erection. Peyronie’s disease can also cause erectile dysfunction, a situation where a man is unable to obtain or maintain an erection.
Why It’s Called Peyronie’s Disease?
Peyronie’s disease is named after Francois de la Peyronie who was a brilliant surgeon in France in the 18th century.
He was sought after to treat many of the royal family members including Peter the Great. In fact, he became Louis XV court doctor.
As to whether or not there is any relation between his royal patients and de la Peyronie’s namesake disease, is up for speculation.
What is known is that de la Peyronie published a detailed description of disease for the first time in 1743.
Although the disease had been in the medical literature for hundreds of years before that.
Peyronie’s disease was thought to be relatively common, although statistics are not firm in the literature.
Unfortunately, it tends to be kept under wraps sexual problems, and erectile dysfunction is sensitive matters for most men and their partners.
With more men talking about their actions in the past few years, however, thanks to drugs like Viagra, it is now understood the Peyronie’s disease is more common than initially thought.
Does Peyronie’s Disease Affects All Men?
Several studies indicate that anywhere between 0.4 and 8% of men may have parents disease.
That is up to 8 men in every hundred. Most of these men are middle-aged between 45 and 60 years, but patients with this condition can be of any age.
Peyronie’s also affects men have northern European descent more commonly than other ethnic groups.
In order to understand Peyronie’s disease better, you need to first have some knowledge of the anatomy of the penis.
The penis contains 3 chambers, the 2 on top are called the corpora cavernosa or erectile bodies, which run along the length of the penis and attached to the pelvic bones.
The third chamber is beneath the two corpora cavernosa and contains the urine channel called the Urethra.
The corpora cavernosa contains spongy tissue made up of smooth muscle, fibrous tissue, veins, and arteries. Space is called Sinusoids within this tissue can fill up with blood during erection and expand the corporate dramatically.
The expansion of the corpora compresses the veins in the penis preventing leakage of blood. All of this tissue is surrounded by a very strong fibers coating call the Tunica Albuginea.
A Close Look At The Tunica Albuginea
This is a more detailed look at the Tunica Albuginea, the thick fibrous coating around the penis that helps hold blood in and limit the expansion of the penis during erection.
The Tunica Albuginea is in layers as shown in the image.
In Peyronie’s disease, one or more plaques of thickened scar tissue develop in the tunica, which limits its ability to expand on that side.
The result when the opposite side expands normally during erection and the affected side cannot is a curve toward the side with the plaque.
This figure shows how a plaque on the upper side of the penis causes it to curve upward as that side cannot expand properly during erection.
Coexist with Erectile Dysfunction
There are several reasons why men with Peyronie’s disease may also experience erectile dysfunction or ED.
Firstly ED is common amongst the general population, so any man can suffer from it regardless of whether or not he has Peyronie’s.
Peyronie’s sufferers, however, may also have ED because of psychological or physically effects.
The abnormal appearance of the penis and pain with erections may cause embarrassment or fear, which might limit his arousal.
The plaque may also physically block blood flow into the penis or interrupt the normal mechanisms to keep blood inside. Men with Peyronie’s often noticed their erection is less rigid beyond the area scarring.
Along with ED, in some men, the curvature caused by Peyronie’s can be severe enough to interfere with penetration during intercourse, or cause discomfort to his partner.
Fortunately, most men with Peyronie’s disease are able to function adequately.
Symptoms Of Peyronie’s Disease
- Pain on the penis during erection
- Penis is bent or deformed, sometimes bent to a right angle
- Shortened penis during erection
- Hardened lumps called plaques anywhere in the penis shaft
- May not able to achieve erections in severe cases
These symptoms may develop over a long period of time or may shock you buy happening quite quickly. Some males are born with a penis that was bent or curved. This is not Peyronie’s disease. By definition, Peyronie’s disease is an acquired disease meaning something that you develop later in life and not a disease you were born with.
You may wonder if the slump or hardened area in the shaft of your penis may mean that you have an infectious disease. The answer is NO if you’re diagnosed with Peyronie’s disease. If you are still able to have sexual relations, you should feel free to do so in the same way you did before you appear on his diagnosis.
In seeing a lump or change in the shape of your penis, you may also worry you have cancer. If you are diagnosed by a physician with Peyronie’s disease, there is no need for this worry at all. There’s no evidence that cells of Peyronies associated plaque are malignant or cancerous.
Causes Of Peyronie’s Disease
It appears to be a stepwise process. The first stage likely involves direct physical injury to the penis rarely from a single incident where the Tunica gets torn, or fracture during sex, and more commonly for minor repetitive trauma over time usually during sexual activity.
This trauma can cause bleeding in the shaft of the penis and the body responds to this injury with an inflammatory reaction through the release of special molecules called free radicals. This inflammatory reaction leads to scar tissue formation.
Normally this scar would be minor and will soften with time. In certain susceptible individuals, however, abnormal and excessive scar tissue formation occurs leading to the formation of plaques in the shaft of the penis
Factors That Makes People Susceptible
- Inherited factors
- Auto immune factors
- Abnormal connective tissue Certain medications
Other Risk Factors
Peyronie’s disease may run in some families. It won’t affect all males, but if you have one or more family members with Peyronie’s, you have a higher chance of developing it. In addition if your family members close to you have Dupuytren’s contractures you may be at risk of developing Peyronie’s disease.
Dupuytren’s contractures are an abnormal thickening of the tendons at the Palms, which can cause the fingers to curl inwards. Some studies have indicated that up to 20 percent of men with Dupuytren’s contractures have Peyronie’s disease.
Some Peyronie’s disease patients may also have an autoimmune disorder. These are conditions where the body’s immune cells attack the body’s own cells. Examples of autoimmune diseases include multiple sclerosis and lupus.
The reason for this link is unclear, but the same process that makes the body’s immune cells attack the body’s own cells in autoimmunity may contribute to the excessive scarring and plaque formation on the penis in Peyronie’s disease.
The Plaque Formation
A step in the process of plaque formation likely involves excessive connective tissue production in the Tunica Albuginea of the penis. Connective tissue is the tough material that scar tissue tendons and cartilage are made up, and consist of substances such as collagen and fibrin.
In a normal healing response to injury, the body lays down collagen and fibrin in the injured region of the Tunica Albuginea of the penis. This is what forms the scar tissue. If the body over does this response, then you get the hard plaque formation you see in Peyronie’s disease.
The targets of these antioxidants are special molecules in the body called free radicals.
Free radicals are generated all the time in the body as a by-product of normal metabolism and immune function. When your body is unable to get rid of free radicals they can destroy cells in your body.
In Peyronie’s disease, free radicals are thought to be produced during the repeated inflammatory response to injury to the penis, and the main target cells have the Tunic Albuginea.
Well, technically not Peyronie’s disease, it should be pointed out one of the most common causes penile curvature is the injection of medications into the penis for the treatment of erectile dysfunction.
These drugs work extremely well in stimulating an erection. Unfortunately, it can have the side effects of causing excess scar tissue formation and plaques just like Peyronie’s disease.
Older medications such as the drug Papaverine used alone were much more likely to cause this than modern drug combinations.
Medical Procedures May Trigger Plaque Formation
Certain medical procedures may result in injury to the penis, and plaque formation including;
- Prostate surgery
Medications That May Contribute To Peyronie’s Disease
Some prescribed medications may contribute to Peyronie’s disease in rare cases. The most common of these drugs are class called beta blockers.
Beta blockers are typically used to treat high blood pressure and heart ailments. It is not known how these drugs cause Peyronie’s, but this disease is listed as a rare side effect.
- Beta Blockers including Propranolol, Metoprolol, Atenolol, Acebutolol, etc.
- Dimethylsergide, which is a migraine medication also known as Sansert
General Risk Factors
It is also now appreciated general risk factors that can affect your heart and blood vessels can also be associated with Peyronie’s disease including;
- High blood pressure
- Alcohol intake
These factors may predispose the penis to injury by causing loss of rigidity and increase the potential for bending an injury.
Other Risk Factors
AGE – Besides penile trauma, there may be risk factors that increase your chance of getting Peyronie’s disease. Age probably plays a factor since elastic tissues such as those found in your penis do not heal as well as you get older.
GENETIC – As mentioned earlier, there may be a genetic factor and family history plays a role. There seems to be a higher number of men northern European descent that have Peyronie’s leading to this ethnic link.
Diagnosis of Peyronie’s disease by your doctor is usually straightforward and usually only includes a careful medical interview for history and a physical examination. Mostly, the doctor will ask the questions;
- When you first notice your symptoms?
- What activities that you may have been performing that aggravated the symptoms?
- Whether you have hardened tissues anywhere else?
- Whether you have family members with Peyronie’s disease?
- What medical procedures you may have experienced recently?
- What drugs you may be taking?
You’ll also be asked to estimate the degree of curvature or deformity of the penis and any changes to sensation in the penis or the ability to have an erection.
Here, the doctor also needs to know if the curvature is causing any functional problems with your ability to have intercourse such as discomfort to you or your partner or the need to use only certain positions for intercourse.
Moreover, the doctor also wants to know if the condition is changed over time for better or for worse and if you’re having any pain or discomfort with erections.
Working with Your Doctor
Your doctor will then perform a physical examination which focuses on the genital region but also includes a general examination. If you do have Peyronie’s disease, the hardened plaque can usually be felt by your doctor when examining the penis.
It is helpful to bring in a photo of your erect penis from different angles to show your doctor the degree of curvature or deformity.
If there’s any question of the diagnosis and if your doctor needs to get a better impression that the severity of the situation, he/she may induce an erection by injecting a small amount of medication directly into the shaft of the penis.
Rarely, or as part of a research protocol, a doctor may order an ultrasound to further assessment of the Peyronie’s disease.
Ultrasound as a non-invasive process that uses sound waves that high frequency to generate pictures that the body’s tissues and organs. An external probe is passed over the penis to generate a clear image of the plaque area.
If you have been diagnosed with Peyronie’s disease, you have already been experiencing the negative effects but can look forward to positive changes. The negative effects you may have experienced include;
- Pain upon erection or difficulty achieving an erection
- Difficulty in performing a sexual intercourse
- Relationship problems
- Negative self-image
- Emotional stress
It is good to know the Peyronie’s disease can be managed, and your doctor can help.
Various Possible Treatments
There are certain ways in which Peyronie’s disease can be managed. The goals of treatments are two-folds such as reduce the pain feel during erection and reinstate sexual activity to a satisfactory level.
Treatment should only be sought if there is a significant functional impairment or on the penis with 30-degree angle curvature.
In order to provide proper treatment, it is essential to know the natural history or evolution of the condition. In most men, Peyronie’s disease comes on quickly, and it is associated with painful erections.
Early Active Phase
This is wherein the active inflammatory reaction is taking place. Scar tissue develops and changes at this time.
During this period of active inflammation, it is probably the best time to consider non-surgical or non-invasive medical therapies that might alter the inflammatory process.
While waiting, it is also recommended especially when sexually active to modify the method of sexual activity in order to cause less stress on the penis to prevent further scarring.
Stabilization – The Second Stage
In this stage, the pain will resolve within 1 year in 94% of men as the condition stabilizes. During this process, the scar tissue in the penis could diminish or disappear in 13% of men, stabilizes in 47%, or worsens in another 40%.
Chronic Phase – The Third Stage
At this stage, usually 1 to 2 years of the process the final result is usually known and the condition enters a long-term or chronic phase. It is at this point that surgery will be considered on men for the disease is causing significant functional problems.
As demonstrated in the 3 phases of which Peyronies disease evolved, it is vital to consider treatment at its early stage. Using non-invasive means at this early stage, many men improve or stabilize and do not need surgical treatment.
A popular non-invasive method is through the use of traction devices. Most top penis extenders available online these days, and most of them are classified as Medical Type 1 devices.
However, there is a traction extender device with specialized package dedicated to correcting penile curvature and Peyronie’s disease treatment called X4 Labs.
Although X4 Labs looks like an ordinary penis extender system just like the others available in the market, it has several packages dedicated to men with Peyronie’s disease and includes some components not found in penis extender packages designed for size enhancements.
Urologist Explains How Traction Device Helps Correct Penile Curvature
Here’s a urologist guest in The Doctors show demonstrating how a penile traction device can help correct penis curvature due to Peyronie’s disease especially if the curvature is not painful.
In the demo, he used a traction penis extender FastSize, but unfortunately, that brand is not available anymore.
Along with employing an external traction device, dietary supplementation could also play a vital role in minimizing or even eliminating the build-up of plaque tissues.
And, in certain cases a prescription medication is necessary, which a doctor prescribed it to the patient.
Pills To Be Taken Orally
There are no currently proven effective pills that can be taken orally to reverse the changes of Peyronie’s disease. Below are the list of pills for reversing the condition, however, their benefits are not proven and not all doctors used them.
- Vitamin E (400 IU per day), which commonly used during the initial phase to shorten the duration of pain and as an anti-oxidant. In theory, the anti-oxidant property of Vitamin should counteract the release of free radicals that are involved in this condition.
It has been recommended to take 400 International Units per day during the early painful phase of the disease in the hopes it might shorten the duration of the pain and lessen the progression of plaque formation.
- Para-Aminobenzoate or PABA
- Tamoxifen, an anti-cancer drug
- Colchicine, an anti-gout medication
Usually, Vitamin E is combined with Colchicine. This combination or Vitamin E alone is the most commonly use medical therapy on PD.
FDA-Approved Drug For Peyronies Disease Collagenase (Xiaflex®)
At the time the video below was created, FDA was in the approval process for Collagenase(Xiaflex®). Finally, on December 2013, FDA announced its approval for Xiaflex® as the first FDA-Approved drug for Peyronies Disease treatment. You can ask your doctor/urologist about it.
- Healthy and holistic approach. There is no scientific evidence for holistic remedies in treating Peyronie’s disease. However, many approaches have been tried and recommended.
- Improving nutrition by eating a balanced diet rich in fruits, vegetables, legumes, and whole grains.
- Avoiding processed foods, refined carbohydrates, caffeine, and quitting smoking may help the immune system functioning well.
- Taking herbal remedies that anecdotally but not scientifically been shown to help with PD such as Bromelain(digestive enzyme) and Gotu Kola are believed to target excess connective tissue similar to that found in Peyronie’s plaque.
Consult a doctor prior to trying any non-conventional remedies.
Injection of medication directly into the scar tissue plaque.
Medication can also be directly into the Peyronie’s plaque, and many have been tried already. Currently, the most widely used for this is a drug called Verapamil, which is a class called calcium channel blockers.
This drug may work to break down the plaque, soften, and lessen its impact on erections. These injections should be given under the care of a urologist and must be given regularly in order to have an effect.
Steroids and collagenase have also been injected into Peyronie’s plaque, but there is no evidence to support they have significant benefits.
Other Unproven Treatments
Several interesting therapies have been tried to break down plaque of Peyronie’s disease including;
- Electromotive Drug Administration (EMDA) where therapeutic drugs are driven into tissues using an electric current.
- Extra-corporeal Shock Wave Therapy (ESWT) where shock wave is used to break down the plaque similar to how kidney stones are treated.
This is what ESWT equipment looks like and how it is used on the patient.
Unfortunately, all of these treatments are cumbersome, expensive, and unproven. Therefore, at this time none of them are recommended treatments and they remain experimental only, or for cases of persistent pain, or nothing is else being working.
Straightening procedures include those that shorten the side opposite the plaque and those that attempt to preserve length by cutting or removing the plaque and placing a graft into it.
Peyronie’s disease can be a difficult diagnosis to face for many men. The good news, there are many management techniques and treatments available to if diagnosed. The APDA(Association Of Peyronie’s Disease Advocates) offers an interactive comparison on various treatments available.
Furthermore, there is a great deal of interest in research into Peyronie’s disease. Through studies in animals and cell cultures, scientists will learn how Peyronie’s develops at the level of molecules in the immune system, and the cells in the Tunica Albuginea.
These will lead to better treatments through the development of an effective drug. Additionally, through animal studies, scientists will be able to refine surgical techniques and are continually aiming for improved results. Alternative treatments are also being explored and may play a significant role in the future.
Primary Goal For Peyronie’s Disease Treatment
The primary goal of treating Peyronie’s disease is to optimize sexual functioning with the least invasive therapies possible. The early or active phase of the condition involves an active inflammatory process.
During this phase, treatment such as using a traction device like The Peyronie’s Device along with taking Vitamin E can be very helpful.
In most cases, the pain will resolve completely, and the curvature or deformity will eventually stabilize. In some men, it diminishes or away, worsens on others, and it simply remains the same on many men.
Surgery is the treatment of choice if and when the curvature, deformity or erectile dysfunction associated with Peyronie’s disease limits a person’s ability to function adequately.