My husband will not see a doctor about his curved penis (we think it is Peyronie’s disease), what should I do?

Avoiding medical care for Peyronie’s disease is common  

Refusal to see a doctor about a bent penis is an unwise but common reaction among men who find themselves dealing with the long-term negative prospects of Peyronie’s disease. The male tendency to be slow about seeking medical attention in general is compounded by the shock and utter disbelief of learning that there is actually a urological medical condition called Peyronie’s disease that undermines the ability to function as a sexual human being.

In Peyronie’s disease the development of fibrous plaque tissue below the surface of the shaft results in a curved penis or some other deformity that reduces or eliminates the ability to engage in sexual intercourse.  Making matters worse it frequently reduces the length and girth of the shaft, as well as weakens the quality of erection.

Take advantage of the fact the body cures Peyronies disease half the time

When a woman looks for helpful information about Peyronie’s disease she can turn to the Peyronie’s Disease Institute woman-to-woman program for a telephone discussion during which our nurse will answer any questions about PD treatment, sexual dysfunction problems or anything that is of interest to a woman when her husband will not help himself.

The proposal that a man can move his status from someone who was not able to eliminate his own Peyronie’s disease to become a member of the 50% group who rid themselves of this affliction is a simple and easy one to understand.  It is based on the observation that about half of the men naturally and spontaneously heal or correct their Peyronie’s disease within the first 12-18 months after onset.

When a man finds that he has not self-corrected or eliminated his Peyronies plaque he still has the option to promote his own recovery.  This can be attempted by an aggressive plan to actively support or increase his natural healing ability using several different natural therapies identified by medical research to assist the removal of the offending fibrous plaque material. To find out more about this process go to “Start Peyronie’s treatment.”

Alternative Medicine offers natural treatment options to Peyronie’s surgery and drugs

Since 2002 the Peyronie’s Disease Institute has developed the concepts, as well as nutritional and external techniques, that proposes any man can follow a program of self-administered Alternative Medicine care in an effort to increase his ability to heal and repair the Peyronie’s plaque.  By focusing multiple therapies to enhance healing potential many men find they can increase their immune response against the soft tissue changes that cause all the outward signs and symptoms that are so deeply disturbing and disruptive to normal male function.

This is good news for any man who realizes that there is indeed a cure for Peyronies disease; half of the time the body will naturally rid – or cure – itself of the internal scar or plaque material that causes all the problems of altered sexual structure and reduced sexual ability without any outside help or intervention. In other words many men just get rid of their own PD without any help.  Using well placed and logical assistance that is guided by research done in this area for the last 40 years, the Peyronie’s Disease Institute finds that it is often worthwhile for a man to simply support his immune system to reduce the foreign fibrous material of Peyronie’s disease in order to support his tendency to eliminate his PD fibrous plaque as happens half of the time.

A woman can help her man in many ways   

Probably as the two of you were going through information on the Internet your husband got stuck on the idea that there is nothing that can be done for PD except Peyronie’s surgery, which the Internet information also reports will be followed by recurrence of the same problem in a few years and the possibility of side effects that are sometimes worse than before the surgery (loss of all sensation, constant pain, impotence).  With the negative atmosphere and bleak prospects for medical care associated with Peyronie’s disease many men feel a natural hesitancy to get started moving in that direction.

A great paradox commonly develops for a couple when they struggle to understand what is happening to them when they are first learn about Peyronie’s disease.  The contradiction is that after getting the diagnosis and learning about the disease that neither of them knew existed, the man is typically motivated by embarrassment and fear of the future to be quiet and introspective while the woman instinctively wants to discuss the problem and explore her feelings with others.   As time goes on and Peyronies exerts its negative influence on their lives, each will be driven deeper into their opposite direction, and each will not understand why their partner is behaving that way.  This makes for increasing tension between the couple while they should be coming closer together to deal with their mutual problem.

The special relationship between a woman and a man is always tested greatly when Peyronies enters the scene.  While not absolutely true, it has been my observation that most couples will find that the many trials and tribulations of Peyronie’s disease and women will cause whatever is good and strong in their relationship to increase and become better, and whatever is troubled and weak in their relationship to deteriorate further.  Peyronie’s disease does not actually create new conflict within a relationship, but only increases and intensifies whatever strength or weakness was present before it arrived on the scene; it acts as a great reference point that amplifies whatever was going on between the couple before its arrival.  It does not have to be that way, but it happens because people are not prepared for what lies ahead.  They are caught so unprepared for the drama that becomes their lives together that the truth of their relationship is not only exposed but it is exaggerated by the emotions that emerge.

During countless talks with PD couples since 2002 it has been observed many times that either a couple is a naturally good problem-solving team, or it is not.   When it is not, and the man and woman do not work together well, it is very difficult for them to develop and practice whatever new personal skills of good communication, tolerance, compassion, forgiveness or whatever assistance might be needed to help their situation.  It takes extra effort and great patience to acquire the skills and ability needed to come together as a team, while at the same time dealing with the harsh realities of Peyronie’s disease.  Just as it might be difficult to learn to swim while being swept away in a flood, it is just as difficult to develop those skills that lead to becoming a solid team if at the same time they are being tossed about while dealing with PD.  Having presented that observation, it should bring comfort to know it is still possible to minimize and perhaps even overcome the negative and destructive forces that develop as a result of Peyronies disease if exceptional effort and honesty are applied.

You can begin to help your husband with his Peyronie’s disease by encouraging him with information that it might be possible to help himself correct his own PD problem as those 50% of men whose internal plaque are naturally eliminated.  Offer this information to him, showing him that there are more options available to him than Peyronie’s surgery.

Curved Penis and Peyronie’s Disease

Peyronies bent penis is focus of problem

While the primary interest of Peyronie’s disease treatment is the internal scar tissue or fibrous  plaque material that causes the distortion or curved penis to develop, it is not the primary interest of the man who has PD.  For him, the most important aspect of Peyronie’s disease is the curved penis that plagues him.  For this reason Peyronies is also known as the “bent nail disease.”

For those interested in viewing graphic pictures, click curved penis of Peyronie’s disease.

Peyronie’s disease causes a curved penis when the fibrous tissue of the Peyronie scar or plaque pulls unevenly or causes incomplete filling within the erect penis.  This can vary in degree or severity from man to man.  For this reason the curved penis does not indicate the severity of the Peyronies problem or success of Peyronies disease treatment.  The true success of Peyronies treatment is based on the change that occurs in the Peyronies plaque or scar.  Once the fibrous scar changes, eventual improvement in the curved penis can be expected in time.

The internal tissue of the healthy penis is flexible and expandable.  This normal tissue is able to allow for a normal erection to develop when blood is trapped inside the organ.

In Peyronie’s disease some of the tissue is not healthy or flexible and elastic.  Specifically, the deep tissue known as the tunica albuginea is not elastic because it replaced by dense and inelastic fibrous tissue that is called a scar or plaque.   As an erection develops the elastic tissue of the tunica albuginea must stretch and expand evenly on both sides, left and fright, and top and bottom, of the penis.  If this cannot happen because an area of the penis is no longer flexible and expandable, then a curved penis results.

Peyronie’s disease usually begins with a small nodule or bump that is found on the top or sides of the penis, just immediately below the surface.  A few weeks to several months to a year later, a small fibrous nodule can expand into a larger irregular scar of variable size, shape, density and surface quality.  These scars can be as long as the penis.  Some appear like a collar to go around the shaft.   Some are one large mass, while others appear to be like small isolated islands of fibrous tissue in many areas.   Scars can be so soft or small, with edges so tapered and vague that no scar can be found.  In a case of Peyronie’s disease when no scar or plaque can be found, it is still assumed to exist when a curved penis develops during erection. .

Normally curved penis

Most men have a straight erection, but some are born with a penis that curves or bends (usually upward).   Just as fingers on the hand or a nose can display a natural bend, or arms can be of different length on the same person, the penis can be bent without the presence of Peyronies.  Typically, the normally curved penis follows a more gradual and arched design, more like a banana.  In Peyronie’s disease the curved penis is more localized and abrupt, like an angulated bend.

When the two primary chambers (corpora cavernosa) of the penis are a different diameter or length, the penis will bend when erect.   The penis will appear straight when flaccid, and on erection it will bend.

This slight penile distortion will not be associated with pain, there will be no trauma in the history, and it will not appear suddenly as does the curved penis of Peyronie’s disease.

Curved penis affects sexual intercourse

It is estimated that 75-90% of Peyronie’s disease couples will sooner or later experience a sexual intercourse problem, in regard to either pain or difficult penetration – or both.   The curved penis of is the primary reason sexual penetration is compromised, and it is also the reason for the pain that can be experienced by either – or both – partner. This is especially so in those cases in which the distortion is so severe it is described as “cork screw” or “cane handle.”

Incomplete filling of the penis with blood during erection can also happen in Peyronies.  This results in an area of the penis, either small or large, that is soft and unable to sustain the rigors of intercourse.  A soft area within an otherwise firm erection presents a weakness and vulnerability of the normally turgid erection.  A weak area of erection can suddenly collapse or buckle during intercourse, causing additional injury to the penile tissue.  This can cause pain, inflammation and additional fibrous infiltration.

It is a rare Peyronies couple that does not deal with some level of sexual difficulty related to penile distortion and reduced firmness of the erection.  The many physical, emotional and social issues of Peyronie’s disease are complex.  For this reason the reader is referred to “Peyronie’s Disease and Sex” for more information about this complicated area of life with a curved penis.

Treatment of the curved penis

It is important to remember that any penile distortion that develops in Peyronie’s disease is not the primary problem of this condition.   A curved penis that appears one night is difficult to ignore, but is only a symptom of the real problem of Peyronie’s disease – the scar. Without the Peyronies scar there would be no curved penis.

This is the reason I advise men who are undergoing Peyronies treatment to focus on the size, shape, density and surface qualities of the scar or plaque to determine if their Alternative Medicine treatment is being effective.  The curvature can improve or worsen as the scar is reduced.

A small scar can cause a large bend, just as a large scar can cause no bend at all if it is balanced and symmetrical.   For this reason a curved penis can worsen as the scar is being reduced or eliminated.   Estimating progress or success of a PD therapy plan is difficult .  A man can have many more scars than he is aware of, and they can be larger than can be detected since they are often difficult to locate and often overlap.

If only one scar is present the curvature problems are direct and easy to understand, although  this is unusual.   However, if multiple scars are present the internal pulling and twisting they cause can be very complicated.   Several scars can interact on many  planes of internal penile tissue.   Any reduction in one or more scar will alter the internal tension and pulling of the tissues, resulting in an altered curvature.  There is no guarantee the curvature will change for the better initially – sometimes it can look worse as the scars become smaller.  This is why I advise to focus all attention to the size, shape, density and surface qualities of the scar while treatment of the Peyronies problem continues.  Realize the curved penis is just a reflection of what is going on with the scar9s) below the surface.

Do not be discouraged by the curved penis of Peyronie’s disease.  Instead, stay focused on your plan for effective Peyronies treatment.  Learn more about Peyronie’s disease treatment.

Peyronie’s Plaque

Peyronie's disease plaque or scar

There is much confusion and lack of information concerning Peyronie’s disease, especially the elusive Peyronie's plaque or scar .

It is truly amazing that for a male health problem that according to some surveys affects up to nine percent of the adult population, practically no man ever hears about this problem until the day he is given the diagnosis of Peyronie's disease.  It is no wonder that no one has ever heard of a Peyronies plaque until he has one.  It is this shock – that a “mystery” condition that comes out of the blue, a condition for which there is no known cause and no known Peyronie's cure can suddenly wreck a man’s life – that contributes to the lack of information about Peyronies.  While feeling totally confused and shocked upon first hearing about the Peyronie’s plaque or scar that accompanies it, prevents a man from asking all the standard questions and retaining the information he is told when he receives this diagnosis.

With such bad news pouring into his ears, and so many questions rolling around in this brain, it is no wonder that a man can leave his doctors office and not remember much of what he is told  about Peyronies.

In addition to this shock of learning he has Peyronies, most medical doctors do not like to manage cases of Peyronie’s disease, and therefore do a bad job of it, further adding to the common situation in which a man will not understand the basics of this problem – like the Peyronies plaque.

We all know Peyronies disease is called the “doctor’s nightmare” because of the problems associated with dealing with men who have this problem.  With no known cause or cure, the doctor comes off looking like a dummy for not having more clear information or help for his newly diagnosed Peyronies patient.  Adding to the negative atmosphere for the doctor in dealing with a Peyronies patient, the doctor also knows there will be hard feelings that will arise later when the PD patient develops additional penile curvature, reduced sexual performance, and frequent marital problems.  All of this happens while the doctor can only stand by as his Peyronies patient deteriorates over time. The doctor is often held responsible for these problems since he did not offer any help to his patient.  None of this is fair, but this is how it happens.   For these reasons many doctors try to get a man out of the office as quickly as possible, and often without sufficient time to ask questions or adequate explanations to prepare a man for the future.

In this atmosphere of minimum time and minimum information, the shocked Peyronies patient does not understand or recall basic facts about Peyronie’s disease.  For example, the fundamental problem of PD pivots around the presence of one or more masses of fibrous material located within the covering of the substance of the penile shaft, called a Peyronies plaque or scar. Many times a man who has had PD for many years will no absolutely nothing about his  Peyronie's plaque.

Peyronies Plaque is elusive

Another common situation exists in which the doctor cannot find a Peyronie's plaque, and neither can the man who owns it.  Each week I receive several emails asking me, “Since my doctor examined me and could not find anything, and I cannot see a scar, do you think I really have Peyronie’s disease?”

The fat is, there is never an EXTERNAL scar or plaque in Peyronie’s disease; it is always an internal mass that conveniently is known as a scar, but is not a scar in the usual sense.  PD “scars” or plaques are quite variable.  Some men have an obvious scar and others cannot find one if their life depended on it.   Ultimately, it is there and you should try as many different tactics as you can to find your scar(s) because having a good knowledge of your scar situation will help your treatment effort.  Hint:  Try to think in terms of your scar being much larger than you have previously imagined, so mentally expand the size of the scar that you are looking for.  Meaning, if you were looking for a “pea” before, start looking for a “postage stamp” or a “thumb nail” size structure.  This information should change your methods and what you can detect when trying to locate your Peyronies plaque.

A Peyronie’s plaque or scar can be quiet variable; some men have an obvious plaque and others cannot find one if their life depended on it.   Often, when a scar is not found, but there is still pain and bending or any kind of recent penile distortion, a diagnosis of PD is still made.  This is so, because it is the Peyronies plaque or scar that is causing the pain or bending is either:

1. So small – it cannot be found

2. So very soft – it blends into the other tissue and cannot be detected

3. So deep – it cannot be reached easily, especially during erection

4. So large and flat – that the edges are not determined, almost like something that is so close to you that you do not see it because you are looking far away

5.  The doctor’s lack of ability, experience or concern when he does the examination – that he simply misses what is actually there if he was better at this kind of thing – yes, I know, it is difficult to imagine but it is true.

Usually, when a scar is NEVER found it is because of a combination of two or more of these factors – deep and small, or soft, large and flat, or deep, soft and doctor error, and so on.

I often suggest that men try this:  forget about finding a “scar.”  Just try to find something – anything – within the mass of erectile tissue that does not feel like the other tissue pf the shaft.  Find something that is unlike the rest of the tissue.  When you find it, mark its location with a marker pen of something that will stay on the tissue for a day or two.  Go back each day to that area and re-think what you are feeling.  You are trying to determine if it becomes easier to make sense of it.  It could be that you have an unreasonable expectation of what a “scar” should feel like, and you are missing what is really rather obvious.  Really, how could you know what a Peyronie's plaque feels like if you have never had to do this before?  It is a common problem.

Let me know your experiences and problems in locating your Peyronie’s plaque. Take this chance to tell others your experiences and problems with this elusive tissue.

Cause of Peyronie’s disease

How Peyronie’s disease starts

As anyone who has the problem knows, the cause of Peyronie's disease is not well understood.  However, any research topics that shed light on this basic question are of great interest to men who have Peyronie’s disease.

Perhaps a good question to start with is, what causes the erect penis to bend in a case of Peyronie’s disease?  The answer lies in the function of the corpora cavernosa functions in the mechanism to produce an erection. There are actually two corpora cavernosa, laying side by side like two cigar shaped, paired balloon-like chambers that must be filled with blood to create an erection. Their connective tissue wall, the tunica albuginea, offers resistance and rigidity when it is stretched to its maximum.  The tunica is elastic to a point, but unlike the thin and flexible wall of a balloon, the tunica albuginea is interlaced with strong connective tissue fibers. These strong fibers do not allow for much expansion, and eventually determine the shape of the erect penis because of their structural rigidity.

Thus, in a very real and fundamental way, Peyronies disease is a disorder of the tunica albuginea. By producing dense and rigid areas of the tunica, called Peyronie's plaque or scars, Peyronie’s disease interferes with the full expansion of the tunica. Plaques are either regions of reversible inflammation in early phases of Peyronies, or permanent scars later if the inflammation is severe and continues too long.  Much like a piece of tape placed on the wall of a balloon, the plaque or scar causes uneven filling and expansion of the tunica, and this causes bending  of the column of the corpora cavernosa.

A basic question is, what causes these plaques to begin?  Microscopic and chemical studies show that plaques represent an early stage of the wound healing process when the tunica is injured. Whatever starts Peyronie’s disease, the problem seems to the inappropriately increase of the normally healthful and proper process of wound repair.  Actually, wound healing may not be the appropriate term in all situations.

Most likely cause of Peyronie's disease

One cause of Peyronies disease is obvious and direct trauma to the erect penis. This trauma can range from sudden and unexpected angulation during sex, to am actual rupture of the corpora cavernosa.  However, the fact is, many men with Peyronies do not recall any such traumatic occurrences.

Over time, all sexually active men will experience some degree of wear and tear on vulnerable areas of the soft tissue erection mechanism. Both the structural arrangement of the corpora and the inherent elasticity of its connective tissues counteract the strong mechanical stresses created by strong sexual activity.  But when men reach their mid-fifties, fundamental connective tissue elasticity throughout the body, and the penis, is on the decline.   And so, it just so happens that the average for appearance of Peyronies disease is fifty-four.

Peyronies plaques most often appear along the top surface of the penis. It is this region where the two corpora meet side by side, along the upper edge of the “inflatable I-beam” created during an erection that is most vulnerable to stress induced delamination.  Another word for a layer is a lamina; when layers are disrupted or separated, it is called delamination.

Autopsy studies in the mid-1990s on men have shown the earliest microscopic changes thought to be early Peyronies disease changes are actually a common finding.   It seems that while many men develop these changes, they will evolve into Peyronies plaques only for a small percentage of cases.

So what causes the process of normal wear and tear to develop abnormally into the destructive process of wound healing that is called Peyronie’s disease?  There are no clear answers to this question.   However, Peyronies disease is more common in diabetics, as well as men who have gout.  These are two conditions that can have an adverse affect on normal connective tissue healing. It is also more common in the presence of Dupuytren’s contractures. These scars of the fascial covering of the finger tendons in the palm of the hand are thought to be inherited, and may reflect an abnormal tendency toward scar formation in other areas.

Thus, we see that much is still to be learned about Peyronie’s disease, but as these microscopic tissue clues are unraveled, the mystery of this problem will be advanced, as well as Peyronie’s disease treatment.

Peyronie's disease treatment with Xiaflex

Peyronie's treatment with experimental drug, Xiaflex

Peyronie’s disease is best known for the plaque, scar or hard lump that causes a curved penis to develop. Peyronies begins as a localized inflammation, usually as a result of injury of some type. It is currently believed that Peyronie’s disease is caused by vascular trauma or injury to the deeper penis anatomy. Peyronie’s disease is most common in men over 50 years, and the incidence increases with age. This inflammation often progresses to a hardened plaque or scar that reduces flexibility of the tissue of the penis, and results in a bend or distortion during erection due to incomplete filling or restriction of the tissue. Often, this causes constant pain or pain during erection, and for some men these can prevent sexual intercourse due t physical incompatibility or erectile dysfunction.

Aside from the physical changes, depression and reduced self-esteem are commonly experienced by men with Peyronie’s disease.

Peyronie’s disease is most often treated by urologists, even though there are no approved drug therapies for Peyronie’s disease. Peyronie's surgery may be an option for some patients although complications such as worsening of the PD distortion can develop, as well as loss of penile length can occur. Xiaflex, a type of collagen reducing enzyme, or collagenase, has been experimentally injected into the Peyronie’s disease scar or plaque as an in-office procedure. The purpose of injecting Xiaflex into the Peyronie's disease scar is to soften the scar tissue and improve or reduce the curvature of the penis. Further, this is hoped to improve sexual function and eliminate the distressing negative psychosocial aspects of Peyronie’s disease.

Peyronies Xiaflex trial results

Sponsored and monitored by BioSpecifics Technologies Corp., licensor of Xiaflex, the 12 month phase II open-label trials of Xiaflex showed limited but promising results. These research tests were conducted to evaluate the ability of Xiaflex to successfully treat Peyronie's disease, as well as its compatibility and side effect potential. In this process clinical success was defined as a baseline change of penile angulation of at least 25 percent.

Each of the study participants received three injections of Xiaflex, administered on a separate day, and given over seven to ten day period. Twelve weeks later, each man received a second series of three injections. Research subjects were evaluated at three, six, and nine months after the Xiaflex injection series.

The average baseline angulation was 52.8 degrees. In this study clinical success was achieved at three and six months with 58 percent and 53 percent of patients, respectively. This would suggest that early success might not last very long or that the improvement to the Peyronie’s disease distortion was temporary.

In this study there were adverse reactions with Xiaflex that were not described in the general media. The most common adverse reaction was only reported as a problem at the local administration site that was mild or moderate in severity, non-serious, and resolved in time without medical attention. No comment was made about worsening of the Peyronie’s disease after the nine month time frame as a direct result of repeated injury to the delicate tunica albuginea tissue from the multiple needle injections of the needle used to deliver the Xiaflex.

It is the opinion of PDI that for some men these repeated injections could make their Peyronie's disease condition worse over time. It might be prudent for the average man to wait until more clinical treatment results are collected and interpreted before considering this treatment approach.

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