Peyronie’s disease is where the penis when erect, curves abnormally. It is a rare form of erectile dysfunction, a situation where a man finds it hard to get and maintain an erection. Although a curved penis does not necessarily mean there’s an issue, men with Peyronie’s disease may have a hard time having sex because of the pain and discomfort. That, along with penis appearance, may lead to anxiety and discomfort.
Understanding Peyronie’s disease
Penises differ in shapes and sizes. As stated earlier, a curved erection isn’t a cause for concern. However, when there is a significant bend or pain, then one could be suffering from Peyronie’s disease. Men with this condition can still have sex. But for some, the act can be painful and can even result in erectile dysfunction. According to NIH, 1% to 23% of men aged between 40 and 70 are affected. Another study revealed that the prevalence of diagnosed Peyronie’s Disease in the US had been approximated to 0.5% in adult males.
Causes
It is not clear what causes Peyronie’s disease. Many doctors and researchers believe that the scar tissue (plaque) that forms inside the penis can happen after trauma (bending or hitting), leading to internal bleeding. Sadly, a man may not even notice trauma or injury. Although the condition may be linked to injury, the National Kidney and Urological Disease Clearinghouse reveals that it can happen without a traumatic event. Some cases are linked to genetics – where a relative suffers from the same condition.
Risk factors
Age and genetics appear to contribute to Peyronie’s disease. As men get older, the changes in the tissue make them prone to injuries, but slower to healing. Men with Dupuytren’s contracture, a connective tissue disorder, are also more susceptible to developing Peyronie’s disease. Dupuytren’s contracture is a hand deformity that affects the tissue that lies below the skin of the palm, creating a cord that pulls a finger or more into a curved position.
Complications
Complications include:
- The inability to have sex
- A hard time achieving and maintaining an erection
- Stress and anxiety about the appearance of the penis or sexual abilities
- Strained relationships, especially when a partner is not understanding
Pain during erection
Many patients report feeling pain during arousal and intercourse, especially during the early, active stages of the disease. The pain often reduces with time as scarring along the penis stabilizes. Again, many men report feeling little to no pain over a year as the curvature stabilizes.
Difficulties with erection and intercourse
Peyronie’s disease is known to cause trouble in achieving an erection. Some men who manage to get an erection find it hard to sustain it. According to doctors, erectile dysfunction may be due to pain or the deformities of the penis. Issues with intercourse may arise when the penis curves in a manner that makes penetration painful or challenging to achieve, both for the patient and their partner. Sex issues can also occur due to stress and changes in self-image.
Shortening of the penis
Many men with Peyronie’s disease often worry about how the condition will affect the size of their penis. This only makes sense considering the disease causes the penis to bend. The way the scar tissue on one side of the penis makes it hard for the affected area to stretch resulting in a curve is the same way a scar tissue on the other side or other parts of the penis may cause the penis to become shorter. The penis will become even shorter when there’s extensive scarring.
Stress and depression
Anxiety, stress, and depression are common in men who are experiencing the shortening of the penis as well as changes in sexual function. These issues can make some men feel as if there is a problem with their masculinity. It is even worse for men whose function and size of their penis is a significant part of their identity. Note that, in some cases, the sex side effects of the condition may be more inclined to stress as opposed to the disease itself.
Symptoms
The signs and symptoms of this condition can develop over time or appear suddenly. And while the signs vary from one man to another, the most common ones include:
Scar tissue: plaques linked to the disease can be felt as a band of hard tissue or flat lumps under the skin of the penis
Erection issues: Peyronie’s disease causes anxiety and stress, which consequently causes one to fail to maintain an erection
Significant penis bend: The penis may curve upward, downwards or sideways.
In some cases, it might have indentations, narrowing or an hourglass look, with a narrow, tight and banding around the shaft
Pain: One might suffer from pain irrespective of whether they have an erection or not
Shortening of the penis: The penis might shorten in size
The bend linked to Peyronie’s disease might slowly worsen but will eventually stop. Pain during erection often gets better within a year or two, but curvature and scar tissue remain. Some people report the pain having improved even without medical intervention.
Tests and diagnosis
Men who suspect the condition should seek medical help. Although the situation can get better on its own, it’s always a good idea to get an expert opinion. Doctors will perform a series of tests to identify the amount and location of scar tissue. The test will also help determine if the penis has shortened. Other tests may include X-rays or ultrasound to find a plaque, and he/she may also refer the patient to a urologist.
Treatment
If the symptoms aren’t severe, the doctor may suggest a “watchful waiting” approach. However, if one is experiencing more penis curvature or pain over time, then the doctor may recommend medication. Clostridium hystolyticum is the only FDA approved drug for the treatment of Peyronie’s disease. The drug is also only used on men whose penis bend exceeds 30 degrees when erect. Interferon injections and oral verapamil may be prescribed. Doctors may also perform surgical or non-surgical procedures to help address the condition. But patients are advised to make lifestyle changes like reducing alcohol intake, quitting smoking, exercising regularly, and stopping the use of illegal drugs.
Pills
Most doctors often prescribe Pentoxifylline as the first-line medication to help patients cope with the condition. You will need to take medicine for some months before knowing whether it is effective or not. Some doctors will prescribe para-aminobenzoate or vitamin E supplements even though there’s little evidence supporting their effectiveness. If your condition is accompanied by erectile dysfunction, then ED medications can help.
Injections
You may get some injection into the penis to disintegrate the scar tissue. In which case, your doctor will use different kinds of drugs, including histolyticum, verapamil, and so on. These have been shown to have great results in reducing the pain and curve in many men. You will need about four rounds of double shots each session together with a non-surgical procedure to address the issue.
Surgery
Penile implants
Also known as penile prosthesis, a penile implant is a prosthetic device that enables men with erectile dysfunction (ED) – a condition that makes it hard for one to have or maintain an erection – to achieve an erection suitable for sex. The procedure can be used as a last resort when one fails to respond to other treatments, and the patient’s curvature is so severe that it prevents sex. This is because, unlike other ED and Peyronie’s disease treatments, implants need surgery. The corpora cavernosum, a spongy tissue that fills with blood during an erection, is removed, and in its place, two cylinders that inflate or deflate in an erection are fitted. And since the implants are permanent, the process is irreversible.
Although penile implants have high satisfaction rates, getting one is a big decision. That’s why it is essential to take some time to understand what the process involves, along with its risks, complications, and follow-up care.
Why it’s done
As stated earlier, penile prosthetics are considered the last resort when addressing erectile dysfunction. Doctors recommend other non-surgical remedies such as lifestyle changes, self-injections, oral medications, and vacuum erection devices first. The only problem is that these treatments aren’t appropriate or effective for every man. For instance, you might not be an ideal candidate for pills or self-injections if you are on medications that have nitrates as a component.
Your doctor may also discourage you against having a penile implant procedure if you have an infection like urinary tract infection or pulmonary infection, ED that’s situational or diabetes that is not well-controlled. Surgery can also be utilized in the treatment of severe cases of Peyronie’s disease, a condition that leads to plaques forming insider the penis, causing bent, painful erections.
Plicating the side without scar tissue
This is a penile straightening treatment for Peyronie’s disease. Surgeons apply non-absorbable suture to minimize the chances of recurrent curvature. Different procedures can be utilized to plicate (suture) the unaffected side of the penis (or the longer part). This causes the penis to straighten, though it’s usually restricted to less serious bends and might lead to a real or perceived shortening of the penis.
Excision, incision and grafting
The surgery involves the surgeon making one or more cuts to the problem tissue, enabling the sheath to stretch out and thus straightening the penis. During this procedure, the surgeon may extract some scar tissue. They will then sew a graft to cover the tunica albuginea’s holes. Often, graft may be tissue from your body or someone else’s body. In some cases, it may be obtained from an animal or synthetic material. Incision grafting is utilized in situations where one has more severe deformity or curvature.
Living with Peyronie’s disease
Peyronie’s disease affects each individual differently. For some men, the condition can be frustrating and end up affecting their confidence levels during sex. To others, Peyronie’s disease may result in depression or relationship issues. It is not uncommon for some men to suffer from all these effects. It is therefore essential for patients, as well as their spouses, to learn as much as they can about the condition.
An excellent mental health provider may offer a safe place for you to look into how you are responding to your condition and how it is impacting your life. Accepting the new shape of your penis is the first step towards feeling better and enhancing your sexual function. With that in mind, if your condition is interfering with your sexual life, it might be best to talk to a sex therapist. He or she is in a better place to help you and your partner deal with the problem. They will work with you to find ways to make your intimate life less stressful and more pleasurable.
