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Peyronie's disease

Peyronie's disease

Peyronie’s disease is characterized by a plaque, or hard lump, that forms within the penis. The plaque, a flat plate of scar tissue, develops on the top or bottom side of the penis inside a thick membrane called the tunica albuginea, which envelopes the erectile tissues. The plaque begins as a localized inflammation and develops into a hardened scar. This plaque has no relationship to the plaque that can develop in arteries.

 

Cases of Peyronie’s disease range from mild to severe. Symptoms may develop slowly or appear overnight. In severe cases, the hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection. In many cases, the pain decreases over time, but the bend in the penis may remain a problem, making sexual intercourse difficult.

 

The sexual problems that result can disrupt a couple’s physical and emotional relationship and can lower a man’s self-esteem. In a small percentage of men with the milder form of the disease, inflammation may resolve without causing significant pain or permanent bending.

 

The plaque itself is benign, or noncancerous. It is not a tumor. Peyronie’s disease is not contagious and is not known to be caused by any transmittable disease.

 

A plaque on the topside of the shaft, which is most common, causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. At times, pain, bending, and emotional distress prohibit sexual intercourse.

 

Estimates of the prevalence of Peyronie’s disease range from less than 1 percent to 23 percent. A recent study in Germany found Peyronie’s disease in 3.2 percent of men between 30 and 80 years of age. Although the disease occurs mostly in middle age, younger and older men can develop it. About 30 percent of men with Peyronie’s disease develop hardened tissue on other parts of the body, such as the hand or foot.

 

A common example is a condition known as Dupuytren’s contracture of the hand. In some cases, Peyronie’s disease runs in families, which suggests that genetic factors might make a man vulnerable to the disease.

 

A French surgeon, François de la Peyronie, first described Peyronie’s disease in 1743. The problem was noted in print as early as 1687. Early writers classified it as a form of impotence, now called erectile dysfunction (ED). Peyronie’s disease can be associated with ED-the inability to achieve or sustain an erection firm enough for intercourse.

 

However, experts now recognize ED as only one factor associated with the disease-a factor that is not always present.

Symptoms

Symptoms of Peyronie's disease may develop slowly or suddenly.

 

Common symptoms include:

 

  • A lump or thickening along the shaft of the penis that is most noticeable when the penis is soft (flaccid).
  • A bent or curved appearance of the penis that is most noticeable when the penis is erect.
  • A painful erection. Some men do not have pain with an erection but have tenderness when the lump along the side of the penis is touched.
  • An inability to maintain an erection.
  • An inability to achieve penetration during intercourse.

Causes

The cause of Peyronie's disease isn't well understood, but it's generally considered the result of a wound that doesn't heal properly. The wound is most likely minor trauma to the penis during sexual activity. For example, the erect penis might be bent during sexual intercourse. A wound could also be the result of an accident or sports injury.

 

The role of wound healing

 

The penis contains two sponge-like, tube-shaped chambers (corpus cavernosa) with many tiny blood vessels. When a male becomes sexually aroused, nerve impulses increase blood flow to these chambers. An erection occurs when these chambers fill with blood, causing the penis to expand, straighten and stiffen.

 

The corpus cavernosa are encased in a sheath of elastic tissue called the tunica albuginea, which stretches during an erection. Injury to the penis can damage this elastic tissue. This damage can cause inflammation and damaged tissue. If an injury heals properly, there are generally no long-term problems.

 

In Peyronie's disease, problems in the normal wound-healing process result in permanent scar tissue. The section of the sheath with scar tissue is no longer flexible. Therefore, when the penis becomes erect, the region with the scar tissue doesn't stretch, and the penis bends or becomes disfigured.

Treatment

Peyronie's disease is usually diagnosed using a medical history and physical examination. Your doctor will ask you questions about when you first noticed your symptoms and whether the symptoms were gradual or sudden. This will help determine which stage of Peyronie's disease you are experiencing.

 

Because symptoms of Peyronie's disease are usually most noticeable when the penis is erect, your doctor may ask you to take a photograph of your penis while it is erect.

 

Other tests that may be ordered include:

 

• An X-ray, to produce a picture of the structures within the penis.

• Doppler flow studies, which use sound waves to monitor blood flow patterns. It is important for your doctor to determine whether blood flow to the end of your penis is interrupted or decreased during erection.

Treatment usually is not necessary unless Peyronie's disease causes pain or interferes with sexual function. Peyronie's disease goes away without treatment in some cases.

• Most men are able to remain sexually active. Counseling can help couples maintain an active sexual life.

• Although there is no standard treatment for Peyronie's disease, medicines (such as verapamil, potassium aminobenzoate, colchicine, or injected steroids) andvitamin E may help treat pain and improve sexual function. But the use of medicines has shown only limited success, and none are well studied for the treatment of Peyronie's disease.

• Surgery is considered for men who have severe pain, a severely curved penis, or sexual dysfunction related to Peyronie's disease. Surgical options include removing the scar tissue or shortening the unaffected side of the penis (plication). In some cases, use of a penile prosthesis may be used to help maintain an erection during intercourse.

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