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Peyronie's Disease

Peyronie's Disease | Jo Divine

Peyronie’s Disease is a condition where patches of scar tissues or fibrous plaques develop along the shaft of the penis, resulting in bending or deformity of the penis, painful erections and difficulties in having sexual intercourse. It is named after the French surgeon Francois Gigot who discovered it in 1743. The condition is usually only obvious when the penis is erect.

Causes

The cause of Peyronie’s Disease is unknown but it has been suggested that it may be due to hitting or bending the penis which damages blood vessels causing them to rupture, leading to bleeding and swelling inside the penis. This swelling can reduce the blood flow through the layers of the penis, causing clots to form and trap immune cells. As the injury heals the immune cells release chemicals which can lead to the formation of too much scar tissue which then builds up and forms a plaque. The plaque reduces the elasticity and flexibility of the penile tissue during erection, making the penis curved. The plaque can lead to calcification within the penile tissues, making the penis inflexible.

It may be as a result of genetic development or low levels of testosterone. Babies can be born with a congenital condition which does not become apparent until they sexually mature.

Who is affected by Peyronie’s Disease?

It is difficult to estimate how many men are affected by the disease as many are too embarrassed to seek medical advice. It is thought to affect between 3-9 men out of every 100 men, mainly over 50, although a small number of teenagers do have the condition. The congenital form of the disease is rare. The chance of developing Peyronie’s Disease increases with age.

Who is more likely to develop Peyronie’s Disease?

  • Any man who engages in vigorous sexual or non sexual activities which cause microscopic injury to the penis.
  • Certain connective tissue and autoimmune conditions whereby the immune system attacks the cells in the penis, causing inflammation, leading to scarring.
  • A family history of Peyronie’s Disease, so it is important to discuss your problem with your father, uncle, brothers or grandfather to see if you are at risk.
  • The ageing process.

What are the signs and symptoms of Peyronie’s Disease?

There are several signs and symptoms of the disease including:

  • Hard lumps on one or more sides of the penis
  • Pain during sexual intercourse or during an erection
  • A curve in the penis with or without an erection but more noticeable when erect
  • Narrowing or shortening of the penis
  • Symptoms of erectile dysfunction such as inability to get or maintain an erection.

Symptoms of Peyronie’s Disease can range from mild to severe. Some symptoms may develop slowly or appear quickly. In many cases, the pain slowly decreases even though the curve in the penis remains. In less severe cases, the curve disappears too.

Complications of Peyronie’s Disease

  • Inability to have sexual intercourse due to pain or discomfort
  • Erectile Dysfunction (ED)
  • Stress and anxiety about sexual abilities or the way the penis looks, often leading to ED
  • Relationship problems leading to stress
  • Unable to father a child due to inability to have full penetrative sexual intercourse

What can your GP do?

If you think you may have Peyronie’s Disease, ask your GP to refer you to a urologist – a doctor specialised in urological problems.

A urologist will initially take your history by asking questions about:

  • Your ability to have an erection
  • Any sexual intercourse problems such as pain or discomfort
  • How long you have had the symptoms
  • Any family history
  • Any medications which could be causing the problem
  • Any other symptoms
  • Other medical conditions.

The urologist will conduct a physical examination of the genital area to ascertain if there are any plaque deposits in the penis. These can often be felt under the skin. An x-ray or ultrasound scan may be performed to find out if there is any structural defect causing the problem.

Treatment of Peyronie’s Disease

Non surgical treatments include medication to reduce inflammation, pain plaque size and curvature. These can be administered orally, by injection or as a topical formulation applied directly to the skin over the plaque. Treatments to break up the scar tissue may be used, including:

  • High-intensity ultrasound focused directly onto the plaque
  • Radiation therapy in the form of high energy x-rays aimed at the plaque
  • Shock wave therapy using low intensity electrical stimulation to break up the plaque.

Mechanical treatments include:

  • Penis traction worn up to 4 hours daily to stretch the penis
  • Vacuum penis pumps to stretch the curve. A device such as Bathmate Hydromax incorporates the use of water rather than air which is said to be gentler on the delicate tissues of the penis. The warmth of the water, either in the bath or shower promotes the softening and relaxation of the penile tissues making it more comfortable to use.

Surgical interventions may be recommended when symptoms have not improved, erections, sexual intercourse or both are painful or the curve of the penis is so great it does not allow the man to have sexual intercourse. They include:

  • Grafting: removing the plaque and grafting the area with new skin. It may lead to a shortening of the penis and some loss of sensation after surgery which goes away with time.
  • Plication: A piece of the tunica albuginea on the opposite side of the plaque is removed to make the penis straighter. This procedure is less likely to cause numbness or ED but may cause a shortening of the penis.
  • Device implantation: This is often used when a man has both Peyronie’s Disease and ED. Once implanted the man has to use a device to trigger the implant in order to have an erection.

A new study (2016) at the University of Turin has shown that a surgical treatment can be effective for treating Peyronie’s disease. The study, published in the Journal of the British Association of Urological Surgeons (BJU) found that 28 patients experienced an average penile lengthening of 3.2 cm after undergoing the surgery which involved a “sliding technique” and penile prothesis implant.

This surgical technique is currently under study to see if it benefits other male sexual health conditions and already showing promising results said Dr Marco Falcone, co-author of the study.

Many men have a fulfilling sex life with Peyronie’s Disease but if you are experiencing any of the symptoms mentioned above or have any concerns that you may have Peyronie’s Disease, seek medical advice. Your GP will be able to refer you to a urologist who will help you to resolve the problem, often with minimal medical intervention.