Andrew Siegel MD 3/26/16
Peyronies Disease is an inflammatory condition of the penis that causes penile curvature and an uncomfortable or painful erection. Scarring of a region of the sheath surrounding the erectile chambers of the penis (tunica albuginea) occurs, sabotaging the ability to obtain a straight and rigid erection with the potential for dramatically interfering with one’s sexual and psychological health. The scarring causes the presence of a hard lump(s), penile shortening, narrowing, curvature, a visual indentation of the penis described as an “hourglass” deformity, and painful, less rigid erections.
Penile pain, curvature, and poor expansion of the erectile chambers contribute to difficulty in having a functionally and anatomically correct rigid erection suitable for intercourse. The curvature can range from a very minor, barely perceptible deviation to a deformity that requires “acrobatics” to achieve vaginal penetration to an erection that is so angulated that intercourse is impossible. The angulation can occur in any direction and sometimes involves more than one angle, depending on the number, location and extent of the scar tissue.
Although it can occur at any age, Peyronies most commonly occurs in 50-60 year-olds. The underlying cause is suspected to be chronic penile trauma, associated with bending and buckling following years of sexual intercourse. This type of injury activates an abnormal scarring process with an acute phase characterized by painful erections and an evolving scar, curvature and deformity and a chronic phase marked by resolution of pain and inflammation, stabilization of the curvature and deformity, and, not uncommonly, ED. The chronic phase typically occurs up to 18 months or so after the initial onset of symptoms.
Collagenase (Xiaflex) is an enzyme capable of dissolving scar tissue. It is derived from the clostridium bacteria and has been used for years for Dupuytren’s contracture, a similar situation to Peyronie’s that occurs on the hand, causing scarring of the tissue beneath the skin of the palm and fingers, making it challenging to straighten one’s fingers. Collagenase functions as a “chemical knife” capable of dissolving collagen, the main constituent of scar tissue. It is used for men with Peyronie’s disease and a penile angulation of 30 degrees or greater. The goal of treatment is disrupting the scar tissue and decreasing the curvature of the erect penis.
The injections are performed in an office setting by a urologist with Peyronie’s expertise. One course of treatment may involve as many as four treatment cycles, with each cycle consisting of two injections of collagenase directly into the scar tissue, each spaced 1-3 days apart. A few days after the second injection, the penis is manipulated, massaged and molded in order to “model” it into a straighter version of itself. Thereafter, the patient performs self-stretching of the flaccid penis three times daily for 6 weeks or so. Gentle self-straightening is also performed on a daily basis if spontaneous erections allow one to do so. The endpoint is achieving as straight a penis as possible with an angulation of less than 15 degrees. One treatment cycle may be repeated as many as four times.
Injection of Xiaflex can be highly effective, but is not without side effects including the expected results of an injection into tissue including bruising, swelling and mild-moderate pain. On rare occasions, a rupture of the erectile chamber of the penis (penile fracture) can occur. It is advisable to wait two weeks after the second injection of each treatment cycle before resuming sexual activity, provided the pain and swelling have subsided.
Auxilium/Endo, the pharmacological company that provides Xiaflex, has an excellent patient counseling tool that is available at the following site:
Bottom Line: Peyronie’s Disease, like Dupuytren’s contracture, is the presence of scar tissue in a very “operative” area of the body that can interfere with function and reduce one’s quality of life. Collagenase (Xiaflex) is a scar-dissolving chemical derived from bacteria that can reduce this scar tissue and vastly improve function and quality of life.
Wishing you the best of health,
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Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.
Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Arnold Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.
Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store that is home to quality urology products for men and women. Use code UROLOGY10 at check out for 10% discount.