Andrew Siegel. MD Blog # 88
Peyronie’s Disease is an inflammatory condition of the penis that causes scarring of the sheath surrounding the paired erectile cylinders within the penis. As a result of this scarring, when an erection occurs, there is asymmetrical expansion of these erectile cylinders resulting in a penile curvature/angulation. Peyronie’s causes a deformed and often uncomfortable erection that can dramatically interfere with a male’s sexual health.
Scar formation on the sheath of the erectile cylinders can cause pain with erections; penile curvature during erections; the presence of a penile scar or “plaque” that can be felt as a hard lump under the skin; a visual indentation of the penis described as an hour-glass deformity; and failure of the erectile bodies to properly fill with blood, causing erections of poor rigidity. Penile pain, curvature/angulation, and poor expansion of the erectile cylinders collectively can contribute to difficulty in having a functional and anatomically correct rigid erection suitable for satisfactory intercourse. The curvature can range from a very minor, barely noticeable deviation to a deformity that requires “acrobatics” to achieve vaginal penetration to an erection that is so angulated that intercourse is physically impossible. The angulation can occur in any direction and sometimes involves more than one angle, depending on the number, location and extent of the scarring.
The angulation results from the scarring of the sheath of the erectile cylinders that, upon engorgement with blood, expand in an asymmetrical fashion. This situation is analogous to placing a piece of cellophane tape on a child’s balloon and then inflating it—where the tape (scar) is, the balloon cannot expand properly, resulting in an angulation at the point of the tape placement.
The prevalence of Peyronie’s is roughly 5% of the male population with a mean age of 57 years old. The underlying cause of Peyronie’s is unclear, but is suspected to be penile trauma, perhaps associated with vigorous sexual intercourse. The acute phase is characterized by painful erections and an evolving scar, curvature and deformity. The chronic phase that typically occurs a year or so after initial onset is characterized by absence of pain, stable deformity, and possible erectile dysfunction. Peyronie’s regresses spontaneously in about 15% of men, progresses in 40% of untreated men, and remains stable in 45% of men. Many men—understandably so—become very self-conscious about the appearance of their penis and the limitations it causes, and they avoid sex entirely.
Various treatment options include oral medications, topical agents, injections, shock wave therapy, and surgery. Upon initial diagnosis, most men are started on oral Vitamin E, 400 IU daily, as this has the potential to soften the scar tissue causing the plaque. Unfortunately, however, none of the non-surgical options have proven to be very effective, because the essence of the issue is scar tissue in a very bad location. This scarring sabotages the ability to obtain a straight and rigid erection. Erectile dysfunction can be managed with one of the oral E.D. medications including Viagra, Levitra, or Cialis.
If there is no response to conservative management of erectile dysfunction, a penile implant may be appropriate—this can manage the dual problems of erectile dysfunction and penile angulation. If erections are adequate, but angulation precludes intercourse, options include procedures that attempt to neutralize the angulation effect of the plaque by doing a nip and tuck opposite the plaque in an effort to make expansion more symmetrical. Although this technique is effective in improving the angulation, it does so at the cost of some penile shortening, and I have yet to find a man who is pleased with losing penile length. Other more complex procedures involve incising or removing the scar tissue and using grafting material to replace the tissue defect.
Bottom Line: When scar tissue is only an anatomic consideration but not a functional consideration, it may be cosmetically unappealing, but is actually not such a bad situation. However, when scar tissue occurs on an area of the body that moves, expands or acts as a conduit, it affects form as well as function, which is not a good thing. Thus a scarred elbow can impact mobility of the joint, scarred lungs can disturb breathing dynamics, a scarred bile duct can cause jaundice and scarred erectile cylinders can cause Peyronie’s disease. Unfortunately, it comes down to scar tissue in a bad place.
Andrew Siegel, M.D.
Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com
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