Corpora cavernosa and the tunica albugnea in relation to Peyronie’s disease

This is an anatomy question based on the two illustrations from your website.The first illustration of the inside view of the penis is one of the best I've seen. I particularly like the picture in the left corpus cavernosum showing a lattice like structure.

The second illustration has three parts (a,b, and c. Part c shows a penis curving upwards. When looking at the left corpus cavernosum in Part c, there is what appears to be a series of almost parallel squiggly lines. I've seen these lines in numerous anatomy illustrations, but have never (ever)seen anyone actually label what these lines are.

As the tunica albuginea is supposed to be smooth, I find these lines confusing. Do these lines represent the lattice like structure underneath the tunic. Or do they represent veins? Just what are these squiggly lines trying to represent?

Thanks
Rob

 

Greetings Rob,

Great question; thanks for asking.  I always enjoyed the study of anatomy when I was a student; a fascinating and exacting subject that is the basis of understanding disease and our effort to return to health.

For those who do not know the picture Rob is  referring to, go to "Peyronies Penis Anatomy," to see the layer of tissue known as the tunica albuginea and the corpora cavernosa.

The wavy or wiggly lines that Rob is referring to are simply what the artist drew to represent the walls that make up the caverns or chambers or cavities of the spongy tissue of the corpora cavernosa.  You are just seeing the cut ends of those chambers represents shown in Box B that are shown as wavy lines in Box C because those same structures are shown from a different perspective.  These wavy lines are similar to a blueprint of a house where the architect draws a series of straight lines to represent the various walls that make up rooms, hallways, closets and outside periphery of the structure.  TRH

What can I do to reduce the PD plaque?

i am 48 years old, and have had peyronie’s for approximately 5-6 years from unknown origin (but most likely from a crush injury). my condition has progressed to the point where i have a very significant plague that runs almost the entire length of my penis; the plague quite literally feels like bone, and is located more near the top of my penis (between the outer skin and urethra). my penis is not curved, but rather has shortened (fairly substantially) and has lost significant girth; while my erections are reasonably hard (though not as hard as previous to the condition), the overall size of my penis has reduced quite significantly. in addition, i seem to have lost nearly, if not all feeling in my penis, so much so that when i do have sex w/ my wife, i feel virtually nothing, where it takes me a very long time to reach orgasm, if at all. sadly, i most often fail to reach such; only very rarely am i able to achieve orgasm now. in fact, it is somewhat difficult for me to even know precisely how full/ hard my erection is unless i actually palpate such. i have recently returned to the united states (from living in china), and will now be able to resume taking a fairly substantial series of supplements recommended by you and provided from your company. what can i do to reduce the plaque, and to hopefully regain feeling in my penis? can i ever regain feeling? your assistance is greatly appreciated … eric

Greetings Eric,

Thank you for your detailed description and questions.

I am a bit confused by your description of the location of your Peyronie’s scar or plaque (part of your description sounds like your plaque is on the bottom/under side of the shaft and another part sounds like your Peyronie’s plaque is on the top/upper surface).

In my reply I will assume it is on the upper/top surface of the shaft as you are looking down at your erection, since this is by far the most common presentation of plaque that runs the length of the shaft. This plaque location is most often responsible for lost length and girth, such as you describe, and for generalized erectile dysfunction. Many men with PD experience localized reduction of erectile ability, resulting in soft spots, or nicks or dents or dings in various areas of the shaft. Yours sounds like the entire shaft is soft, often the result of plaque development within the septum of the penis (the point where the tunica albuginea that is around one corpora cavernosa touches or combines with the tunica albuginea of the other corpora cavernosa).

Your loss of feeling is not common; most men with Peyronie’s disease with have little trouble with loss of sensation. While lost penile sensation could be due to other factors unrelated to PD, I will assume it is related to the central location of your plaque compromising your nerve supply. If this is true, and I have no way of knowing for a fact that it is since I have not examined you, I assume that your penile sensation should return once your plaque is reduced. Besides reduced reduction of sexual sensation, do you also notice general loss of sensation to light touch or pain (as when you pinch the skin of penis)?

You ask what you can do to reduce the plaque. I saw in today’s list of orders that you purchased a large assortment of internal therapies (Acetyl-L-carnitine, MSM, Neprinol, Omega T, Quercetin-Bromelain, Factor 400/400 and Maxi-Gamma). However, you did not order any internal therapies (PMD DMSO, Unique-E oil, Super CP Serum, or Genesen Acutouch pointers). Both internal and external therapies are necessary for effective treatment. It is also necessary that you follow the dietary modifications outlined in “Peyronie’s Disease Handbook” to keep your blood pH toward the alkaline side. The stretching video contains detailed information how to address plaque formation found within the septum, such as you have. All of these therapies must be applied at the same time to achieve best results.

You will probably have to modify your plan to achieve favorable changes to the size, shape, density and surface features of your plaque. Do not be slow in making those changes to your plan when you see that after 10-14 days of treatment the plaque is not responding. For this reason it is absolutely critical that you clearly can identify the size, shape, density and surface features of your plaque. I know I might sound like a broken record when I continue to repeat this, but if you do not know these four aspects of your plaque description, you are only guessing at your treatment. Please, do not guess. Know what is going on down there below your belt and you will have an excellent way to direct and guide your therapy toward the greatest degree of success of which you are capable.

Please stay in close contact with me as you begin your self-directed therapies. Let me know of any problem or questions that arise, and I will be happy to offer you information and ideas for your consideration. TRH

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Erections and Peyronie’s Disease

Erections can be difficult to develop on demand while in a sexual situation.  Paradoxically, erections can be difficult to stop or inhibit at certain times, especially during sleep.  All of this is important to Peyronie’s disease treatment since erections during sleep can have an adverse affect on progress of care.

A nocturnal, or nighttime, erection occurs because it is important for the basic health of the deep tissue, known as the corpora cavernosa, of the penis.  These deep tissues of the shaft fill with blood and trap it within the corpora cavernosa to create the erect state. If this term, corpora cavernosa, sounds familiar it is because the tunica albuginea is a thin and tough layer of tissue that covers the corpora cavernosa and the tunica albuginea is where the Peyronie’s scar is located. A nocturnal erection can be thought of as type of stretching exercise that takes place during the night when there is little other activity going on, to make sure the penile tissue is stretched and used in this unique way to keep the tissue healthy.

The problem during a nocturnal erection when Peyronie’s disease is present is that restriction and binding of the already-bent erection can be sustained against the penis for a long period of time.  Also, it is important to keep in mind that this added pressure poses a risk of additional injury top the man who already has PD.  For this reason it is important to be careful with an erection when the penis has no comfortable or safe direction to extend itself.   Since it is not possible to stop an erection while asleep, it is smart to not wear tight or limiting underwear or pants while sleeping if you have Peyronie’s disease. It might be even smarter to wear nothing at all while you sleep since this avoids a great potential for binding and restriction.

For the most part, a normally occurring erection th

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at can simply “stand on its own” with no pressure against it, is not going to bind or incorrectly stretch out the penile tissue in a way that is detrimental to the penis.  Problems occur during a drug-induced (Viagra, Cialis, Levitra) or artificial erection, during which an abnormally great amount of blood is drawn into the penis by more soft tissue relaxation than normal.   For this reason it is understood that a naturally occurring erection is safer than an artificially created erection.

Drug induced erections can start Peyronie’s disease

Over the years I have communicated with many men whose PD started after a drug induced erection that stressed the penile tissues by greatly increased internal pressure.  This process would not be much different than taking a car tire that is meant to go no higher than 40-50 pounds per square inch during normal use, and over-inflating it to 100-150 pounds per square inch.  Because it is not built to take that kind of pressure, you could expect some problems to develop in using a tire that way.  Not much different with the penis.

Sexual activity is NOT to be avoided if you have Peyronies, but rough, aggressive, hard sex can be dangerous and really injure the already damaged tissue further. Developing and using a natural erection is not to be avoided either in Peyronie’s disease.  However, it is important to keep your wits about you and do not go wild during sex.  The emphasis should be on an easy, smooth and gentle sexual encounter.  Any sexual activity or posture that causes pain should be avoided.

Many important related topics about taking care of yourself, avoiding injury, doing nothing to set your progress back while you are attempting to heal your problem, are covered in my book, “Peyronie’s Disease and Sex.”  You will enjoy learning more about what you can and should do to take care of this nasty problem.

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Peyronie’s Disease and Baby Boomers

Peyronie’s disease: male health problem no one knows about

If you are a member of the baby boomer generation and have never heard of Peyronie’s (pay-row-neez) disease, you are not alone. However, if you are a male baby boomer or married to one, you are in the prime age group to experience a problem you know nothing about. This is so because Peyronies disease primarily affects men between 50 to 65 years of age, although an age range of 18 to 80 years has been reported, with an average age at onset of 53. Few people know about the problem until they need Peyronie’s disease treatment. This is why it is important for all baby boomers to know about, and how to avoid, it because this health problem can easily ruin your life. Peyronie’s disease remains one of the most perplexing and difficult urological diseases to treat; it has been called “the doctor’s nightmare”. Most everything about this condition (cause, progression, symptoms, age distribution, response to treatment) is variable and unique to the man who has it. The great variability of Peyronie’s disease that makes it difficult to study and to understand, also makes it almost impossible to treat like other medical conditions. It is a complex problem that is much more common than most people realize. Estimates suggest that up to eight out of 100 men over the age of 40 have Peyronie’s disease – that is a lot of people worldwide – and still only a small percent of people have ever heard of it. People are reluctant to discuss this problem because it involves the male organ. For this reason it is difficult to develop accurate information and statistics, especially since men are so shy on one hand, yet also inclined to exaggerate.

Definition of Peyronie’s disease

Peyronie’s disease can best be understood as an exaggerated wound healing in response to an injury in which an excessive amount of Peyronie’s scar tissue develops within the man’s shaft. Peyronie’s disease (also known by over 12 different names, among which is “iduratio penis plastica”) is very special disorder of the connective tissue in which fibrous “scars” or “plaques” develop usually after direct injury. This Peyronie’s plaque occurs in a special tissue of the shaft known as the tunica albuginea, a fibrous chamber or envelope that surrounds the two penile cylindrical shaped masses of spongy tissue known as the corpora cavernosa. The corpora cavernosa enlarge during sexual excitement, and the tunica albuginea covering, are designed to expand and elongate. If there is fibrous scar or plaque material in the tunica albuginea, the expansion and elongation cannot develop properly resulting in bending, weakness, shortening and incomplete filling of the organ. Sometimes this distortion is mild (just a few degrees) and does not affect the ability to perform, while at other times the distortion can be extreme (more than 90 degrees) resulting in greatly adverse consequences. A certain degree of normal penile curvature can and does occur in some men. This is a benign and natural condition many men are born with, commonly referred to as congenital curvature; this is not Peyronie’s disease.

Peyronie’s disease signs and symptoms

Four common findings of Peyronie’s disease:

  1. Pain – caused by inflammation and stretching of internal tissues in response to injury and distortion; can be present constantly or only during erection
  2. Nodule or mass formation – variable size lumps or elongated cords can develop in one or multiple areas; sometimes these are difficult or impossible to locate depending on the density, depth and size of the scar formation
  3. Curvature or distortion – caused by presence of one or more nodules or masses of scar tissue in the tunica albuginea, preventing normal expansion during erection; can be minor to gross in appearance
  4. Reduced sexual ability – due to physical distortion that prevents penetration or due to reduced firmness that also prevents penetration (erectile dysfunction).

The onset of Peyronie's disease symptoms can be sudden or slow, but often appears within a month or two after direct injury. The pain of Peyronie’s disease is extremely variable; from hardly noticeable to the kind of pain that prevents sleep. Peyronie’s pain is worse in the beginning, usually gradually improving over time – improvement in a few weeks while others continue for years. For these reasons Peyronie’s pain is not a reliable way to judge the severity or calculate the time for eventual recovery. Even though Peyronie’s disease is a male health problem, women are also affected by it. They are indirectly and adversely affected by the erectile dysfunction, organ curvature and distortion that make intercourse often impossible, as well as loss of organ size that often occurs over time. Additionally, and perhaps even to a greater degree than men, woman bear the brunt of the mood swings, anger, brooding and ill-temper that accompany their partner’s Peyronies problem.

Treatment of Peyronie’s disease

There is no standard or accepted medical Peyronie’s cure since no drug is proven to eliminate the scar within the shaft. The only accepted and available medical treatment is Peyronie's disease surgery. However, given enough time after Peyronie’s surgery the condition will only re-appear in a worsened presentation. This surgical outcome is made bleaker by knowing that even the first Peyronie’s surgery can result in total loss of sensation (anesthesia), increased pain and increased curvature and greater scar formation than before surgery, and in some cases amputation. The Peyronie’s Disease Institute has specialized for the last eight years in the use of Alternative Medicine therapies and techniques that are found to be successful in perhaps 60-80% of cases. None of the therapies are known to result in adverse reactions or side effects. For more information about the Alternative Medicine approach, visit Peyronie’s disease treatment.

Prevention of Peyronie’s disease

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With so many variable aspects of this problem to consider, it is important to know that in addition to everything else, there is no universal agreement about the cause of Peyronies. Some say that injury alone cannot start the problem as we have described above, but that other genetic and metabolic factors must also be present. The Peyronie’s Disease Institute takes the position that this is true. However, if a man never sustains direct injury to the area he is far less likely to develop Peyronies. With age not working in the favor of any baby boomer couple, it is important to evaluate all situations in which direct injury can affect this area – especially sexual activity. This requires that special caution is exercised if a baby boomer gentleman finds he no longer has the usual firmness he previously possessed (erectile dysfunction). Attempting intercourse with a partially flaccid organ can result in sudden buckling or abrupt bending during insertion or the sex act itself. Another way to prevent injury is to modify the techniques used during sexual relations. The single most common injury that starts Peyronie’s disease occurs when the female partner is on top, and she loses hold of him while she thrusts down, jamming and painfully bending him against her upper thigh. To avoid this kind of injury it is important to not use any female-superior position, but to use other techniques in which physical contact is controlled, firm and not likely to disengage during activity. Even if baby boomers have never heard of this terrible condition that robs a couple of one of the greatest pleasures of life, it happens every day. Now that you know about Peyronie’s disease you can do a lot to protect the best years of your life. Dr. Theodore Herazy has practiced Alternative Medicine for over 40 years, and has directed the Peyronie’s Disease Institute for the last eight years. He has written two books about this problem, “Peyronie’s Disease Handbook” and “Peyronie’s Disease and Sex.”

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