General Information on Disorder
Peyronie’s Disease is a disorder affecting 1-4% men of all ages. Chronic inflammation of the connective tissue disorder (fibrosing process) causes the growth of fibrous plaques in the penile soft tissue. The process specifically affects a fibrous envelope that surrounds the penile corpora cavernosa (called the tunica albuginea). This leads to an abnormal curvature of the penis, making it bend to the right/left or upward.
Most men with such problem are still able to have sex, but for some of them it’s painful or difficult.
Fortunately, the problem often fades on its own, but when it doesn’t, a man needs treatment. The prescription may involve injection of medications into the penis. If the penile curvature deteriorates over time and causes strong pain surgery may be approved.
It should be noted that a certain degree of the penile curvature is not necessarily a pathology. Benign congenital curvature is quite normal in many men, on condition that the penis is soft. If you doubt whether your condition is related to a disorder, see an urologist specializing in Peyronie’s Disease.
Manifestations and Symptoms of Peyronie’s Disease
The symptoms may appear overnight or develop slowly.
The disease causes pain during erection due to hampered flexibility as a consequence of scar tissues formation and chronic inflammation. The elasticity in the affected area is reduced. Sometimes the disorder doesn’t involve penile curvature, causing indentations or divots instead. Scar tissue formation may lead to shortening or shrinkage of the penis.
It’s typical of scar tissues (plaque) to form on the penile upper side, but the bottom side may be affected as well. About one third of men have concurrent tissue fibrosis in the hands or feet.
A certain percentage of men complain about pain and discomfort during sexual intercourses. Formation of hard scar tissue may cause soft erections. Sexual penetration may also become difficult to the curvature.
The pain is often likely to ease over time, while the penile bend can remain a problem. In case of milder forms of the disease bending may be not permanent, pain may be absent and the symptoms may go away without medical interference.
Causes and Risk Factors
Though the underlying causes of the disorder are not definitely determined, it’s considered that the problem may be:
- genetically induced
- a result of injury or traumatic event that many men are not even aware of; the trauma may occur during sex or in other circumstances (bending or hitting) that cause bleeding inside the penis
- a result of using anti-hypertensive medications (calcium channel blockers), but there’s no proof of such connection
Some men are more likely to experience Peyronie’s Disease due to the risk factors. The disorder is not directly related to the age, though older men are more likely to suffer from it. It can be explained by the fact that possible traumas and injuries heal more slowly in older men due to tissue changes and dampened regeneration. It should be mentioned, however, that about 8-10% of patients are younger than 40 years of age.
Dupuytren’s contracture, a disorder of connective tissues, also puts men at risk. It involves the hand’s thickening inward pulling of fingers.
A certain percentage of patients had a history of ED. Peyronie’s Disease in its turn may cause development of an erectile dysfunction as well.
Diagnosis and Necessity of Treatment
When visiting a doctor in case of suspecting Peyronie’s Disease, tell about all injuries/traumas that preceded the problem (if you had ones). The doctor will ask you questions and examine the tissues to find out if they’re hardened or aching.
An injection of a special medicine is usually used to make the penis erect, because it’s necessary for the examination. Perhaps your penis will also need to be exposed to ultrasound or an X-ray. Sometimes a biopsy is necessary when it’s difficult to confirm the diagnosis: a bit of tissue is taken from the affected area for laboratory testing.
Since the symptoms of Peyronie’s Disease in its mild form don’t affect sexual life and often disappear over time, the doctors often suggest that a patient waits for a year or two, and then, if the condition remains – prescribe the treatment.
There may be situations, however, when immediate medical attention is required. If you have severe pain (either during erection or not) or priapism (persistent erection for more than 30 minutes), you should visit a doctor as soon as possible.
Treatment Methods and Their Effectiveness
The prescription may involve injection of medications into the penis. If the penile curvature deteriorates over time and causes strong pain, surgery may be approved.
- Drugs for oral administration
First, you will probably be prescribed some pills, such as potassium para-aminobenzoate or pentoxifylline.
Potassium para-aminobenzoate (branded name Potaba) is aimed at reducing the plaque and stabilizing the condition by gradually softening the tissues, which means it’s able to prevent the disease’s progression. One should not, however, expect a reduction of penile curvature or a reduction of pain. In general, the medication is considered relatively safe. On the other side, its price is quite high and it’s badly tolerated by some patients (causing gastrointestinal upset). Taking medication with enough liquid or a snack/meal may help to prevent upset stomach. Nausea, lack of appetite, fever and rash are less common adverse effects. Potaba tabs are usually supposed to be taken four times a day. Overdose may cause low blood sugar. The drug may negatively interact with other drugs, such as antibiotics, and with alcohol.
Pentoxifylline is a drug intended for use in patients with mild-to-moderate disease, including as a part of a complimentary treatment along with Xiaflex, injection therapy or traction therapy of the penis. The drug is relatively safe. The studies showed that it can help to lower progression of the disease, reduce the volume of plaque and improve the curvature, in comparison with placebo. Its effectiveness is not 100% proved.
- Injections of medicines
Xiaflex (clostridium hystolyticum) is a drug approved by the FDA for treating the Peyronie’s Disease. Men with more-than-30-degrees penile curvature are given injections into the scar tissue of the penis in order to stop abnormal collagen buildup.
Another drug that may be prescribed to break down the fibrosing process is interferon. Also oral administration of verapamil may be recommended for treating high blood pressure.
To deliver medicine through the skin a technique of Iontophoresis may be used, which involves the use of a weak electrical current.
- Penile traction/stretching
After receiving treatment with Xiaflex, patients can contribute to their speedy recovery by doing gentle exercises:
- stretch the penis three times a day (when not erect); each stretching should last for half a minute
- in case of having a spontaneous erection that is not related to sex, straighten the penis for half a minute, once a day
Besides self-administered manual stretching, one can use vacuum devices (pumps). It’s recommended to do traction for several weeks (1.5 month).
- Leading a Healthier Lifestyle
To reduce the risk of erectile dysfunction, patients with Peyronie’s disease can quit smoking, reduce consumption of alcohol and introduce physical activity into their lives.
- Natural Remedies
The effectiveness of Peyronie’s disease treatment with natural remedies is not well-studied yet.
The researches consider the use of acetyl-l-carnitine for treating early chronic and acute Peyronie’s disease. Coenzyme Q10 supplements are believed by some specialists to improve erectile function and reduce early curvature of the penis.
The benefit of E and B vitamins is yet to be proved. In combination with colchicine, Vitamin E is thought to be delaying the condition’s progression.
When all remedies and methods of treatment have been exhausted, the doctor and the patient may decide to resort to surgery to make the penis straighter. It may include the following solutions:
- implants into the penis (used in men with both ED and Peyronie’s disease)
- lengthening of the side affected by the scar tissue (the method increases the risk of impotence)
- shortening the side that is not affected (used in case of less severe curvature); as a result of removing excess tissues from the longer side, the penis becomes shorter – a result the patients are often unhappy with
Usually doctors delay surgery because of the possibility of complications that are difficult to correct.
- Other Options
Sometimes radiation therapy is used to relieve pain related to Peyronie’s disease, but it’s rarely done because of its ineffectiveness in curvature treatment. The doctors don’t put much effort into pain management, because painful sensations often fade on their own as the injury heals, which may take from 0.5 to 1.5 years.
There’re some other treatment methods that are investigated, such as shock wave therapy intended to break up plaque.
Conclusions Concerning Treatment
To this moment, no cure was found for Peyronie’s Disease and no treatment methods have shown to be universal or equally effective in all patients. There’s no 100% guarantee that this or that option will be helpful for a particular patient. As a rule, doctors tend to prefer minimally invasive treatment for the disorder and many consider traction therapy an effective and promising method.