Peyronie’s is also known as Induratio Penis Plastica.
It’s caused by an inflammatory condition of the tunica albuginea, which is the fibrous membrane around the corporate cavernosa of the penile body. You can see this illustrated in the diagrams below.
The Tunica Albuginea is represented above as the “Deep Fascia”.
The Nature of The Problem
Basically the condition involves the growth of a series of plaques which form as a result of injury in the soft tissue of the penis.
The tunica albuginea may then become infiltrated by fibrous tissue and possibly calcified deposits. In either case, the inflexibility and rigidity of the abnormal tissue prevents the penis from expanding on one side during erection.
This causes a curved erection, and possibly other symptoms such as erectile dysfunction, indentation, shortening of the overall length of the penis, and possibly a loss of girth.
There is also another variation of the condition in which the damage causes the penis to take on an hourglass shape, due to the nature of the constriction inside the body of the penis. In fact, although the general view of Peyronie’s is that it produces a curved penis, it’s entirely possible for the scar tissue to produce either divots or indentations as well as curvature.
Now, it’s important to recognise that many men are born with a naturally curved penis, and this should not regarded as an abnormality like Peyronie’s. The reality is that individual anatomy varies, both in respect of the exact shape of the man’s penis and the woman’s vagina.
Often a couple need to accommodate each other’s specific anatomy by finding the sexual positions which suit them. Moreover, it’s fair to say that a slight curve on erection can enhance the comfort of both partners.Indeed, many women report that intercourse with a man who has a completely straight erection can be uncomfortable.
Peyronie’s disease is different to this normal range of variation: it produces a curve which is sometimes so acute that it may actually prevent sexual intercourse from taking place.
Knowing what causes the problem may well help the search for a cure: and that matters, because up to now, comparatively few treatments have been successful.
To start with, unlikely as it seems, apparently certain beta-blockers list Peyronie’s disease as a possible side effect. More on this later!
More importantly, we know that trauma or injury to the penis is often a cause of Peyronie’s disease, which may develop some time after the original injury. Unfortunately, many men with Peyronie’s disease are unaware of any injury that may have led to its development.
We shall examine this issue in more detail later, but it is possible that a major cause of the condition is minor injuries which pass unnoticed during sex, yet result in bleeding and tears in the lining of the penis, subsequently inducing fibrous tissue growth.
Perhaps a number of factors may be involved. It’s been known for some time that rupturing of small blood vessels inside the penis, which may occur during sex, athletic activity, or as the result of an accident, is often linked to the development of Peyronie’s.
In these cases, it’s possible that blood cells and other tissue debris is trapped inside the injury, thereby triggering an inflammatory response and the buildup of scar tissue.
On the other hand, not every man who has an injury to his penis is going to develop Peyronie’s disease.
And it may be that here is a genetic influence at work, because we also know that a significant number of men with Peyronie’s disease – in fact about one third of them – also develop fibrosis in other tissues, particularly in the hands and feet, most notably in the form of Dupuytren’s contracture.
And there is a higher incidence of Peyronie’s disease in genetically related individuals than would be expected by chance alone, which also suggests a genetic component.
So: we can say that Peyronie’s disease is caused by some kind of problem in the normal wound healing process in the tunica albuginea, which results in the formation of permanent scar tissue.
This scar tissue is inflexible, so that when the penis becomes erect, any area that contains the scar tissue will neither stretch nor bend, resulting in a curved erection, and often pain and discomfort.
However, to complicate matters further, in some men Peyronie’s disease develops gradually, and doesn’t appear to be linked to any kind of injury. This suggests that one of the factors at work may be an immune system disorder.
Well, diagnosis is not difficult, because sometimes the curvature of the penis is very noticeable indeed.
However, other very definite indicators of Peyronie’s include the formation of scar tissue plaques which can be felt under the skin of the penis as either flat lumps or a band of significantly inflexible and hard tissue.
In addition, the presenting symptoms will usually include some kind of erectile difficulty, either problems getting in maintaining an erection, or significant curvature on erection.
Regrettably, shortening of the penis is also common, as is pain during erection, pain during orgasm, or pain when the penis is touched. Generally symptoms are progressive, but only up to a certain point when the curvature stops getting any worse.
Indeed, even the pain generally improves within one or two years of the onset of the condition, but the curvature tends to remain as a permanent feature of the man’s erection.
Whether or not medical treatment is advisable depends on the exact nature of the condition, and the degree of difficulty encountered in having sexual intercourse.
Now, as we all know, the inability to have sexual intercourse will have an impact on a couple’s relationship, though the nature of the impact depends on how significant and important sexual intimacy is to the couple concerned. But even so, it’s not hard to imagine that this condition is going to cause stress and anxiety for both the man and his partner.
Should it really be necessary to go the whole hog, as it were, and have some tests to identify exactly what is at play, both ultrasound tests and x-rays may be used to identify the presence of scar tissue, or check on blood flow to the penis.
This can be a tricky issue, because unfortunately few of the treatments available seem to have much impact on Peyronie’s.
Indeed, there is a case for arguing that if the curvature is stable, and intercourse is both acceptable and relatively pain-free, treatment may not even be necessary.
While a number of medications have actually been used to try and combat Peyronie’s, none of them appear to be as effective as surgery.
The medications which have been used include Verapamil, Interferon, vitamin E and collagenase, among others.
Again, we will examine these in more detail later.
Surgery has been developed over a long period of time, and can be a reliable solution in certain cases. There are several approaches: in the first case, the surgeon will shorten the longest side of the penis, that is to say the side without any scar tissue. Clearly shortening the side that has no scar tissue so that it is the same length as the scarred side of the penis when it is erect, is going to shorten the overall length.
This would be an operation as indicated in men who have adequate penile length and perhaps not as much of a curvature as others. The procedure is known as the Nesbit plication; regrettably it can cause erectile dysfunction.
An alternative approach is to lengthen the side of the penis which has developed scar tissue.
When the surgeon employs this type of surgery, he will make cuts in scar tissue, or possibly break any calcified deposits, thereby allowing the elastic tissue of the tunica albuginea to stretch out, and the penis to become more straight when erect. Scar tissue may be removed, and either a graft of tissue or a membrane made of synthetic material may be implanted.
It’s a process that tends to be used when the man has a shorter penis, more severe curvature, or a complicated problem. Regrettably it runs a higher risk of erectile dysfunction.
Other Treatment Approaches
Other treatments have been developed over the years, but again their effectiveness is variable. These include radiation therapy, ultrasound therapy to break the scar tissue, and penile traction therapy, which means basically using a device to stretch the penis.