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 or Scar

Peyronie's plaque or scar central issue

The central issue of Peyronie’s disease is the infamous Peyronie’s plaque, also called a scar. Peyronie’s disease typically occurs in men between 40 and 65 years of age, although a range of 16 to 80 years is documented; some experts say it can occur at any age. From personal communication with a particular man, I was told that his own Peyronie’s disease was started after a dog bite to the groin – at the age of 10. Nonetheless, it is most important to recognize that all clinical signs and symptoms of Peyronie’s disease originate from the effects of the plaque upon the internal tissue layers (tunica albuginea) of the penis.

A developing Peyronie’s plaque appears in response to either micro-trauma to the small blood vessels from a single injury of great force, or multiple injuries of a small force. While there is strong evidence that genetic factors and drug factors also influence the start of PD, it is trauma that is usually considered to be the most likely cause of the Peyronies plaque or scar.

A Peyronie’s plaque on the cellular level initially consists of fibrin threads deposited in a massive network throughout an area of injury within the tunica albuginea of the penis. Peyronie’s plaques, or scars, later combine the dense threads of fibrin connective tissue with reduced and fragmented elastic connective tissue fibers, as well as excessive amounts of type III collagen material, which happens to be specially inclined to excessive scar development. In about one-third of chronic cases of Peyronie’s disease, calcification of the plaque can occur over time. For more technical information about the Peyronies disease plaque.

The curvature of the Peyronies penis is due to the fact that scar tissue does not stretch as easily or as fully as healthy normal tissue. The normal tunica albuginea is composed of elastin fibers and collagen, although the site of scar tissue from Peyronie's disease is composed mostly of collagen. This difference in composition of these two tissues is what causes a bent penis to develop during erection.

Eventually as one or more Peyronie’s plaques develop into a mass of hardened tissue in the delicate tunica albuginea, it results in variable pain and penile distortion that most often takes the form of a bend or curve; sexual function is often reduced as a result of direct or indirect affects of Peyronie’s disease, also. The penile curvature of Peyronie's disease is caused by the dense inelastic scar, or plaque, material that shortens the involved side of the tunica albuginea layer that covers the corpora cavernosa of the penis. In approximately one third of patients, the scarring involves either the top or bottom portion of the penis shaft, occasionally both. The lateral sides of the penis can also be affected by Peyronie’s plaque development, if that area experiences injury.

Peyronie's plaque not easy to find sometimes

In some men the Peyronies plaque is easily found on manual examination, in others it is found with difficulty, and in some men no Peyronies plaque is ever located. It can be frustrating to have a wicked penis distortion, and still not be able to locate the Peyronie’s plaque.

 

To locate the plaque or scar material a light and inquisitive touch is most effective. Do not be heavy-handed, or press down into the deeper layers to find the Peyronie’s plaque material, because it is found just below the surface of the skin. And, oh yes, you will never directly see the plaque or scar, since it is not on the surface of the skin, but below. Make peace with the Peyronie’s plaque and do not hate it, just determine how to assist your body to remove it.


To learn about using Alternative Medicine to increase your ability to heal and repair the Peyronie’s plaque, a good place to start is the PDI website, Peyronie's disease treatment introduction.

Peyronie's Plaque and Fibrin

Peyronie's disease plaque and fibrin

The tissue changes that occur in Peyronie’s disease are unique in regard to the Peyronie's plaque that develops.

In a November 2005 abstract account, Kenneth D. Somers and Dawn M. Dawson, of the Department of Microbiology and Immunology, Eastern Virginia Medical School, Norfolk, Virginia, and Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, reported on their findings concerning the tissue changes that occur in Peyronie’s disease.

To begin this explanation, they remind us that Peyronie's disease is actually a pathological fibrosis, or a situation in which there is excess fibrin tissue located in a small area to the degree that it becomes a problem for the body. In the case of Peyronie’s disease, this fibrosis also is associated with an excessive deposit of collagen in the same area of the fibrin plaque or scar.

Although the cause of Peyronie's disease remains unknown, they tell us, injury or trauma has long been thought to be the inciting event. To determine if this is true, they looked at the cellular structure of the Peyronie’s plaque or scar to get an insight into the cause of this condition.

Materials and methods they used

Small samples of plaque tissue was taken from 33 patients with Peyronie's disease, and control tissue and nodular tissue was taken from the penis of eight patients with Dupuytren's contracture; both groups of tissue were analyzed for collagen staining, as well as fibrin and elastic fiber structure and distribution.

Their results

As a result of this study they found abnormally stained collagen in 97% of the samples, disrupted elastic fibers in 94% and excess fibrin deposition in 95% of the samples. These same findings were not found in the normal scared tunica albuginea of control patients who did not have Peyronie’s disease. The presence of abnormal fibrin accumulation in Peyronies plaque tissue was detected in a special chemical analysis, while this abnormal fibrin was not found in skin tissue samples from the same patients.

Their conclusions

Their conclusions from this study is that the fibrin deposits in Peyronies plaque tissue is consistent with the theory that repeated minor injury or single major injury to the tunica albuginea results in fibrin being deposited in the tissue spaces at the site of trauma to start this condition.

PDI therapy concept

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Peyronie’s Disease Institute has taken the position that it is this excess fibrin deposit within the excess collagen formation that can be safely and easily removed by the use of a battery of systemic enzymes that are specific for foreign fibrin protein in the body. By using natural Peyronie's disease treatment methods to increase the healing response of the immune system against Peyronie’s disease plaque, it is possible to reverse the abnormal tissue found in the tunica albuginea and therefore eliminate the cause of pain and penile curvature associated with Peyronie’s disease.

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Peyronie’s Plaque and Fibrin

Peyronie’s disease plaque and fibrin

The tissue changes that occur in Peyronie’s disease are unique in regard to the Peyronie’s plaque that develops.

In a November 2005 abstract account, Kenneth D. Somers and Dawn M. Dawson, of the Department of Microbiology and Immunology, Eastern Virginia Medical School, Norfolk, Virginia, and Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, reported on their findings concerning the tissue changes that occur in Peyronie’s disease.

To begin this explanation, they remind us that Peyronie’s disease is actually a pathological fibrosis, or a situation in which there is excess fibrin tissue located in a small area to the degree that it becomes a problem for the body. In the case of Peyronie’s disease, this fibrosis also is associated with an excessive deposit of collagen in the same area of the fibrin plaque or scar.

Although the cause of Peyronie’s disease remains unknown, they tell us, injury or trauma has long been thought to be the inciting event. To determine if this is true, they looked at the cellular structure of the Peyronie’s plaque or scar to get an insight into the cause of this condition.

Materials and methods they used

Small samples of plaque tissue was taken from 33 patients with Peyronie’s disease, and control tissue and nodular tissue was taken from the penis of eight patients with Dupuytren’s contracture; both groups of tissue were analyzed for collagen staining, as well as fibrin and elastic fiber structure and distribution.

Their results

As a result of this study they found abnormally stained collagen in 97% of the samples, disrupted elastic fibers in 94% and excess fibrin deposition in 95% of the samples. These same findings were not found in the normal scared tunica albuginea of control patients who did not have Peyronie’s disease. The presence of abnormal fibrin accumulation in Peyronies plaque tissue was detected in a special chemical analysis, while this abnormal fibrin was not found in skin tissue samples from the same patients.

Their conclusions

Their conclusions from this study is that the fibrin deposits in Peyronies plaque tissue is consistent with the theory that repeated minor injury or single major injury to the tunica albuginea results in fibrin being deposited in the tissue spaces at the site of trauma to start this condition.

PDI therapy concept

Peyronie’s Disease Institute has taken the position that it is this excess fibrin deposit within the excess collagen formation that can be safely and easily removed by the use of a battery of systemic enzymes that are specific for foreign fibrin protein in the body. By using natural Peyronie’s disease treatment methods to increase the healing response of the immune system against Peyronie’s disease plaque, it is possible to reverse the abnormal tissue found in the tunica albuginea and therefore eliminate the cause of pain and penile curvature associated with Peyronie’s disease.

Peyronie’s Syndrome is more than a curved penis

Peyronie's disease defies classification

Technically, Peyronie’s syndrome is not the correct way to refer to Peyronie’s disease.  Actually, calling it Peyronie’s disease is not correct, either, but more on that later.

First, the term Peyronies syndrome.   A syndrome refers to a group of several essential and clearly recognizable clinical signs, symptoms and characteristics of a health problem that often occur in association or together.  In the situation in which a syndrome occurs, the presence of one feature, sign or symptom would alert a doctor to the possibility a particular syndrome was present, so he/she would automatically look for other features, signs and symptoms that normally occur with it.  If those additional findings are detected, then  a diagnosis of that syndrome could be made.

Peyronie’s syndrome is not a valid term because the characteristic Peyronies symptoms are actually too few, and they do not usually form a tightly bound set of features that suggest this particular health problem. The few symptoms and signs associated with PD are actually vague by usual medical standards. Since there are typically only three such standard features or clues associated with Peyronie’s disease  (penis pain, distorted or curved penis, and the common Peyronie’s plaque or scar), this set of presenting characteristics is not large enough or strongly suggestive of the condition, hence syndrome is not a good term to use.

Peyronie’s syndrome is not a disease, either

Then we come to the term Peyronie’s disease, which is not all that accurate either.  A disease refers to any condition that causes extreme pain, significant organ or system dysfunction, social problems, and even death, and is usually acquired through direct or indirect transmission or communication from one person to another.  Of course, there are many definitions and ways of looking at what constitutes a disease, but that is generally acceptable in most cases.

Since Peyronie’s disease seldom causes extreme pain, and sometimes no pain at all, it does not fulfill that requirement.   Since the genitourinary system of which the penis is only a part continues to function, and the penis continues to carry urine and oftentimes is still capable to function sexually, it does not fulfill the requirement of loss of function.  While having a bent penis plays havoc with the man who has it, and the woman or women he is sexually active, it does not affect society as a whole, the way actual diseases like the flu or measles, syphilis, tuberculosis or alcoholism do.  Peyronie’s disease is not fatal, except to some couple’s sex life, so it also does not fulfill that part of the requirement.  And lastly, this problem is not communicated or transmitted from one person to the next; you cannot catch Peyronies.

When referring to Peyronie’s disease it is more accurate and fair to use other terms like “condition,” or the more descriptive terms that follow in this list.  These are more clinically accurate names that have been collected and were taken from the PDI website:

  1. Indurato penis plastica
  2. Chronic cavernositis
  3. Fibrous sclerosis of the penis
  4. Fibrous cavernositis
  5. Fibrous plaques of the penis
  6. Penile fibrosis
  7. Penile fibromatosis
  8. Penile induration

This list of descriptive terms was taken from the PDI website where the basics of Peyronie’s disease are discussed at length.  If you wish to learn more about this condition, called Peyronie’s disease, please review this additional information.  But whatever you do, do not call it Peyronie’s syndrome, OK?

Peyronie’s Syndrome

Peyronie’s disease defies classification

Technically, Peyronie’s syndrome is not the correct way to refer to Peyronie’s disease.  Actually, calling it Peyronie’s disease is not correct, either, but more on that later.

First, the term Peyronies syndrome.   A syndrome refers to a group of several essential and clearly recognizable clinical signs, symptoms and characteristics of a health problem that often occur in association or together.  In the situation in which a syndrome occurs, the presence of one feature, sign or symptom would alert a doctor to the possibility a particular syndrome was present, so he/she would automatically look for other features, signs and symptoms that normally occur with it.  If those additional findings are detected, then  a diagnosis of that syndrome could be made.

Peyronie’s syndrome is not a valid term because the characteristic Peyronies symptoms are actually too few, and they do not usually form a tightly bound set of features that suggest this particular health problem. The few symptoms and signs associated with PD are actually vague by usual medical standards. Since there are typically only three such standard features or clues associated with Peyronie’s disease  (penis pain, distorted or curved penis, and the common Peyronie’s plaque or scar), this set of presenting characteristics is not large enough or strongly suggestive of the condition, hence syndrome is not a good term to use.

Peyronie’s syndrome is not a disease, either

Then we come to the term Peyronie’s disease, which is not all that accurate either.  A disease refers to any condition that causes extreme pain, significant organ or system dysfunction, social problems, and even death, and is usually acquired through direct or indirect transmission or communication from one person to another.  Of course, there are many definitions and ways of looking at what constitutes a disease, but that is generally acceptable in most cases.

Since Peyronie’s disease seldom causes extreme pain, and sometimes no pain at all, it does not fulfill that requirement.   Since the genitourinary system of which the penis is only a part continues to function, and the penis continues to carry urine and oftentimes is still capable to function sexually, it does not fulfill the requirement of loss of function.  While having a bent penis plays havoc with the man who has it, and the woman or women he is sexually active, it does not affect society as a whole, the way actual diseases like the flu or measles, syphilis, tuberculosis or alcoholism do.  Peyronie’s disease is not fatal, except to some couple’s sex life, so it also does not fulfill that part of the requirement.  And lastly, this problem is not communicated or transmitted from one person to the next; you cannot catch Peyronies.

When referring to Peyronie’s disease it is more accurate and fair to use other terms like “condition,” or the more descriptive terms that follow in this list.  These are more clinically accurate names that have been collected and were taken from the PDI website:

  1. Indurato penis plastica
  2. Chronic cavernositis
  3. Fibrous sclerosis of the penis
  4. Fibrous cavernositis
  5. Fibrous plaques of the penis
  6. Penile fibrosis
  7. Penile fibromatosis
  8. Penile induration

This list of descriptive terms was taken from the PDI website where the basics of Peyronie’s disease are discussed at length.  If you wish to learn more about this condition, called Peyronie’s disease, please review this additional information.  But whatever you do, do not call it Peyronie’s syndrome, OK?

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.

Peyronie’s desease

Peyronie's disease misspelled commonly – Peyronie's desease

Peyronies disease is commonly misspelled as Peyronie's desease. There is so much basic information that people lack concerning this problem that even the name is confusing to some. Other than Peyronies desease, the most common way I find people referring to this problem is to shorten the name and avoid the apostrophe and just call it peyronies, without even capitalizing the first letter, and peyronie, by dropping the final letter altogether.

Just as a basic review, it is important to know that Peyronie's disease is most well known for the Peyronie's plaque or deposit of fibrous tissue (also called a scar) that develops within the deeper layers of tissue of the penis.  This fibrous material often, but not always, will cause a Peyronie's curved penis and pain in the penis.

This Peyronie’s plaque or scar material itself is benign, meaning it is always non-cancerous. It is a common fear among men when first learning they have Peyronies desease to wonder if it could develop later to become something more serious.  This is not the case.  You can rest assured that Peyronie’s disease will not develop or progress into a worse or life-threatening condition – Peyronie’s disease is bad enough.  It does not need any help to make a person’s life miserable all on its own.

Peyronie's disease typically occurs in men around their mid-50s, however,  even teenagers can develop it.  The cause of Peyronie's disease and its natural progression or development are not well understood because the course of the disease is so variable.  In my experience while researching Peyronie’s desease and in discussion with hundred’s of men every years concerning all aspects of this problem, it is rare to find two cases that share a remotely similar history or course; each case is unique in small and large ways.  This great variability is what makes this condition so difficult to diagnose, treat, and live with.  While many researchers believe the Peyronie’s plaque often develops in response to some type of trauma, either minor or significant, that results in localized bleeding within the internal tissue of the penis.

Sexual problems associated with Peyronie’s desease can also be variable, since there are such physical and emotional differences among couples, to say nothing of the variability of sociological factors that also can disrupt a couple's physical and a stressful emotional relationship. The goal of Alternative Medicine Peyronie’s treatment is to keep a man and woman who deal with this problem as happy and whole as possible.   Peyronie's disease surely affects all the people whose life it enters, even if you happen to spell it Peyronie’s desease.

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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