Dear Dr Herazy,
I recently had a cystocopy and developed approximately 2 weeks later hardness in the perineal area of corpus carvernosum. The shaft is still unaffected. However because of the hardness that probably reminds of of a reverse bottleneck I have had trouble getting the penis down after an erection. This is particularly problematic during the night where I wake up from the erections and then have to get out of bed to get it down.
My urologist said that I could have developed developed peyronies disease in the perineal area but I have searched the Internet and have not seen any similar cases. The area covered is around 2 inches. Have you heard about something similar including the decreased "back-flow" following the erections?
I am also worried I could develop a priapism from this condition that would make things a lot worse. Can you make an advice as how to move on?
Thank you very much in advance.
Kind regards
C
Greetings C,
First of all, I think a few people who read your email about an erection if you have Peyronie's disease would have some questions of their own about some of the medical and anatomical terms you used. So, here is a bit of information about these terms to help understand your email a little better:
1. Cystoscopy – a medical procedure in which a long tube or probe is inserted up into the urinary passage (urethra) of the penis for the purpose of looking into the urinary bladder or the urinary passage, itself. It sometimes happens that when this is done that the urethra and tissue of the shaft of the penis can become injured, resulting in Peyronie's disease.
2. Perineal area – the region of the very lower part of the pelvis in men that is found between the back part of the scrotum and the anus, and in women between the back end of the vulva or outer lips and the anus.
3. Corpus cavernosum – or corpora cavernosae – one of the two long cylinder shaped masses of tissue that make up the bulk of the penile shaft. Each corpora cavernosa is covered by a thin tough layer of fibrous tissue called the tunica albuginea that when injured becomes scarred and leads to Peyronie's disease.
4. Back-flow – release of blood that was trapped in the two corpora cavernosa during an erection that creates the hydraulic pressure within the penis to make it expand and hard.
5. Priapism – this is a persistent, and often painful, erection that is considered a medical emergency when it lasts longer than four hours and develops without sexual stimulation. Priapism occurs when blood in the penis becomes trapped and not able to drain as it normally does.
OK, now that we have that out of the way, allow me to address a few points you made:
1. The penis is attached to the front part of the pubic bone in the area directly behind the pubic hair. If you are an average size male, there is probably 4-5 inches between the point where the penis ends and where the perineal area begins. These two structures are not connected or related. There is no perineal area of the corpora cavernosa. Any hardness, mass formation, swelling or abnormality of the perineal area is not related to the penis and is not related to Peyronie's disease. If you truly have a hard mass or lump between the base of your scrotum and the anus I suggest you get it checked out immediately.
2. I know what a bottleneck deformity is in relation to Peyronie's disease, but I have no idea what you mean by a reverse bottleneck. Please explain.
3. The reason you could not find any reference to Peyronie's disease in the perineal area is that it does not happen that way and it is not possible.
4. Your decreased back flow causing persistence of an erection could be related to the mass in your perineal area; for that reason you should see a doctor immediately.
5. Pripism can occur as a result from many different situations, but not Peyronie's disease:
- Sickle cell anemia
- Medications, like Thorzine and Desyrel
- Illicit drugs (marijuana and cocaine)
- Trauma delivered to the lower pelvis or spine, or something in that same area causing reduced blood flow
- Black widow spider bites
- Carbon monoxide poisoning
6. I assume that your doctor did not give you much of the information you have shared here because it is mistaken. To move forward I suggest you stop trying to figure these things out for yourself and immediately get yourself examined by a competent urologist. TRH
Dear Dr Herazy,
Thank you for your quick reply to my Peyronie’s disease question. I regret if I have used the wrong terminology in my posting. What I meant with the perineal area was the area you can feel of the corpus cavernosum just above the testicles before it goes into the body and what I meant with a “reverse bottleneck” was that this area of the corpus cavernosum feels smaller and much harder than the rest of the penis going out from the body. Hope this makes more sense. Do you have experience with the management of Peyronie’s disease in this area or do you think this could be fibrosis due to a trauma from the cytoscopy that is not Peyronie’s disease? As mentioned the hardness covers an area of the corpus cavernosum of approximately 2 inches.
Kind regards,
C
Greetings C,
I still do not know if I really understand your Peyronie’s disease question. I appreciate that you have tried to be very specific in your explanation but now I am not sure you are using the term corpus cavernosum correctly to describe the location of your Peyronie’s disease. Let’s try again with the first term you mentioned.
The perineum in both men and women is generally the same large area; it is a large erogenous zone that generally encompasses a lot of tissue because it covers the surface area between the pubic bone in front, the coccyx (tail bone) in back, and the inner thighs from side to side. As you can see, the penis – all of it – would be pretty much within the area known as the perineum. And the corpus cavernosum are one of two long chambers of erectile tissue that make up the bulk of the penis; the other being the corpus spongiosum that lies below the corpus cavernosum and contains within its slightly less erectile tissue the urethra. The tissue that is the site of the Peyronie’s disease plaque or scar tissue is the tunica albuginea which is one of a few superficial layers of tissue that surrounds the corpora cavernosae like the casing around a sausage.
Any part of the tunica albuginea can be injured and lead to Peyronie’s disease, and getting to your question, management of PD in any area of the tunica albuginea is essentially identical. I have worked with men whose Peyronie’s disease has affected every part and area of the tunica albuginea that covers the corpora cavernosae. TRH