About Peyronie`s Disease - symptoms, causes, prevention and treatment

What is Peyronie's disease?

Peyronie's disease gives hard, thickened and stiff areas inside the penile shaft. These formations may give the penis a bulky shape both in a flaccid and erected state. The most visible symptom appears however in an erect penis. The penis will be bent, usually at the opposite direction of the side where the formations reside, or the penis gets twisted in various ways.

The formations, also called fibrous plaques, consist of connective tissue containing rigid fibres situated inside or around the erectile bodies - corpora cavernosa and corpus spongiosum. The connective tissue is of the same kind that is formed when a scar is healing, so called scar tissue.

The erectile bodies are normally filled with blood during erection.The thickened areas have less blood flow than the normal erectile tissue of the penis, and have less capasity to fill with blood. Therefore they doe not swell as the rest of the inner penile tissue during erection. Therefore the penis swells more at the opposite side of the indurations during the erection, and give the curvature towards the side where the plaques are. There will however usually be felt a bump at the side of the plaques.

The Peyronie's condition is also called cavernositis, since the disease has the appearance of a cronical inflammation of the erectile bodies, and also sometimes plastic induration of the penis. Formation of excessive fibrous tissue is a common symptom of chronic inflammations.

Any man from the age of 18 and upwards can develope Peyronie's disease. The average age of men suffering from Peyronie`s disease is 50. About 80,000 men in the UK have the condition.


What symptoms are felt and seen by the condition

The main characteristics of cavernositis are:

- A small hard lump underneath the skin, or a continous hard, stiff and thickened area.

- An unerected penis can have bumps, be twisted or bent to the opposite side of the bumps.

- An erected penis, however, will have a distinct bending towards the side where the bumbs are situated. All penises have some curvature, but by this disease, the penile bend increases, and one may get a very curved penis. The penis may be bent as a banana or in an angular fashion. The penile bending are most often up, but may be down, to the left side, to right, sloping or down.

- The bendings in an erected penis are usually to the same side as that of the hard thickened area. With many plaques at different sides of the penis, the bending pattern will be more irregular, or the penis can appear twisted ib arious ways.

- Sometimes the penis bends greatly enough to make sexual intercourse difficult, painfull or impossible.

- Pain during erections caused by the pressure from the hard areas in the penis, feeling like lumps in the penis, and from the stretched skin at the opposite side of the penis.

- One may not notice the bend immediately as it tends to develop over one to three months, and later than the hardness and stiffness of the indurations. It will often only be noticeable when the penis is erect.

- The plastic induration may progress and cause impotence.

- Sometimes the peironi's disease will clear up by itself, but this may take several years.


Normal and non-Peyronie curvature of the penis

Most penises are curved, most often to the left, but sometimes to the right, and also slightly twisted. This can be seen in a flaccid penis that will hang down a little to one of the sides. It can also be seen in an erect penis that will be slightly bent in a bow to one side. If the penile tissue is smooth without any bumps and hard areas all the way, one does not suffer form Peyronies disease, and the penis is perfectly normal.

If the penis is markantly bent or twisted, but there still are not any lumps and hard areas, one does still not suffer from Peyronies disease. The curvature can then be congenital or caused by other disease processes.

On the other hand, if there are hard lumps in the tissue of the penis, one will often suffer from Peyronies disease even if the curvature is slight.


What causes this ailment and how will it develop over time?

The exact cause of cavernositis is unknown. It's not a sign of an underlying serious condition and it's not a sexually transmitted infection. Plastic induration of the penis is not cancer, and cannot cause cancer, however a lomp or deformation in your genitals that is developing, must be examined.

The disease can occur suddenly or develop slowly. Once present, it usually last a long time or for life. It can however slowly dissapear partially or completely.

It's currently thought that some men may have a genetic disposition to react after tissue injury by an exagerated formation of scar tissue, and that this tendency contributes to the condition. If this is the cause, the man should also react by induries also of other parts in the body by exagerated scar formations, for example by injuries in the skin by producing thick bulking scars, so-called cheloid.

Since the hardened areas consist of scar tissue, the cause of the disease may be an exaggerated healing process forming scar tissue after minor injuries to the penis.

It may also be caused by inflammations in the penis with an subsequent exagerated healing process. This inflammation can be of autoimmune origine. The inflammation may also be from an original infection, but Peyronie's disease is in itself not an infection.

Men with other connective tissue diorders have a greater incidense of Peyronie's disease than other men. The disease may therefore be caused by a general tendency for autoimmune inflammations in connective tissues or may even be a manifestation of such a disorder that happens to occur in the penis.

Some drugs can rarely cause the disease, especially beta blockers that are used to treat high blood pressure, heart problems, multiple sclerosis, glaucoma and seizures.


How to prevent Peyronies disease

Many cases of the disease can probably be avoided if boys and men learn to protect their genital area better than is usual to do. There is a tendency in schools, sport and daily life to let males engage in activities in such a way that the genitals are highly exposed to impacts.

A diet that reduce inflammation may also help. The diet should contain food with mono-unsaturated fatty acids and omega-3-unsaturated fatty-acids. Such a diet has much fish, oilve oil, flaxseed oil, canola oil or rapa oil and vegetables. The diet uses less sources of omega-6-fat and therefore avoids great amounts of soy oil, corn oil and sunflower oil. It also avoids chemically altered fat or trans-fat often found in margarines and factory made cookies and snacks.


Generally about treatment of Peyronie's disease

Sometimes the disease resolve by itself within some time and sometimes the condition are just minimal. About 12-13 cases of the disease heal by themselves. 40-50 % of the cases will gradually progress, and the rest will remain stable after some time. Therefore not all men with Payronie's plastic induration require treatment.

If the condition is pronounced, it is also difficult to find a remedy that can cure every sign of the disease, but several methods can take away most penis changes associated with Peyronie's.


Treatment methods used by Peyronie's disease which may be of help

The following are treatment modalities used to help against Payronie's Some are regarded as standard medical treatment, others are under investigation:

In its early stages a tablet called Tamoxifen has been shown to prevent the formation of the fibrous plaque by peyronie's disease. This tablet is also used in the treatment of breast cancer, but the two conditions are not related.

Vitamin E is sometimes effective in easing the pain and as treatment for the penile deformity by Payrony's disease.

Verapamil, often used in the treatment of high blood pressure, has been shown to decrease the size of the plaque and decrease the pain when injected directly into the plaque, and thus also improve the penis shape distortion by peyronie's condition.

Extracorporeal shock wave therapy, or ESWT, a new treatment, is being used in some hospitals for the peyronie's condition. Although the initial results of this new approach to treat Peyronie's disease have been promising, the long-term outcome is still undetermined.

Surgery by Peyronie`s disease: This is sometimes considered if Payroni's disease has lasted for a year or more and it hasn't progressed or regressed for at least three months. By the Nesbitt procedure one removes tissue opposite to the curve to straighten the penis. Another procedure involves putting a graft or part of a vein within the fibrous plaque to lengthen this area. In certain cases of Peyronie`s disease, surgical insertion of a penile prosthesis (implant) is recommended. Surgery has howeber often not satisfactory results and is becomming steadily less popular for this condition.

Herbal products that reduce inflammation, stimulate tissue healing and stimulate blood circulation through tissues may help to stop the progression of Peyronie's disease and get the penis to heal from the lesions.

A daily diet that reduce inflmmatory processes may be of help. Such a diet contains food with mono-unsaturated fatty acids and omega-3-unsaturated fatty-acids. In the daily diet there should be much fish, oilve oil, flaxseed oil, canola oil or rape oil and vegetables. The diet should use little sources of omega-6-oils and therefore avoids great amounts of soy oil, corn oil and sunflower oil. It also avoids chemically altered fat or trans-fat often found in margarines and factory made cookies and snacks.


Penis traction device to cure Peyronie's disease and penis pumps as effective treatment of Peyronies

Many men have experienced a significant reduction of the irregularities and the curvature by using a penis traction device to treat Peyronie's disease some hours each day for some time. The traction may work by two principles. Firstly the force will gently stretch the side of the penis where the tissue is too short and stimulate new cells to fill inn so that the curvature gets streightened up. The traction may also stimulate reactions that build upp new blood vessels with elastic walls in the indured areas.

To be effective the device should be applied at least 2, but not more than 8 hours each day in 6 months.

One pilot study of 10 men with such an approach was performed by Levine LA, Newell M, Taylor FL at the Department of Urology, Rush University Medical Center, Chicago, IL, USA. (source Pubmed). The study gave positive results.

After 6 moths all the men had experienced clear reduction of symptoms, including better penis shape, longer penis and better erections, according to their own view.

Systematic measure before and after the period revealed equally positive results. The bending was reduced by 10 to 45 degrees, with 33% as average improvement. The length of the penis in non-erect, but stretched state increased by 0.5 to 2.0 cm. The girth of the penis when erect increased by 0.5 to 1.0 cm. The erectile potency increased on average by 18.3 to 23.6 measured by International Index of Erectile Function. No side effect could be seen.

Another proven method to treat Peyronie's disease is the use of a penis pump up to half an hour each day in a period. The method is also used to increase the length and girth of the penis. This device is a vacuum pump connected to a cylinder that one places over the penis and with the opening of the cylinder tight against the groin. One makes a partial vacuum in the cylinder which will makes the penis expand so that it is stretched to all sides. There is a danger for tissue injury and bleeding inside the penis if one uses a too high vacuum or uses the pump too long.

The use of penis pumps to correct anatomical misconfiguration caused by Peyronie's disease was investigated in a scientific study, which concluded that the method was effective for this purpose (by the Department of Urology at St Peter's Hospital). This study could also report a lengthening of the penis, even that this was not the objective of the treatment. Use of penis pumps during 6 months to enlarge the penis in men that did not suffer from that disease, but with a penile length less than 10 CM has been investigated by one scientific study, which concluded that the method was not effective according to measures (by Kazem, Hosseini and Alizadeh). In spite of this 30% of the men in the study was satisfied with the results.


Illustration of Peyronie's disease and penile curvature



The picture above shows a typical case of Peyronies disease. Since the curvature is upward, the induration or hard artea unable to engorge during erections are at the upper side jus where the angle is sharpest.




This picture above shows an erect penis with some degree of curvature like that you can find by mild cases of Peyronie's disease but can also have other causes. . If that disease is present, there will be hard areas or lumps in the penis that can be felt both when flaccid or erect. In this case the induration may be at the upper side of the penis and somewhat to the right since the penis is both curved and a little twisted. If there are not indurations in the penile tissue, there can be other reasons for the curvature, or the curvature can even be a normal variation, but that can be examined more closely by feeling on the penis.

The pictures are fetched from Wikipedia org and are therefore free for reuse.


Other causes of penile curvature

All penises are to some extend twisted and curved. A penis use to have thicker tissues at either the left or right side. THis causes the flaccid penis to hang down at one side in the pants. Most penises are also somewhat twisted, causing the slit of the pee-hole to be twisted a little around. According to the side where the penis points, penises are called left-hangers or right-hangers. Sometimes the congenital curvature is just bigger than average.

The irregularities are only caused by Peyronie's disease if there are indurations or hard areas in the penile tissue with decreased ability to swell during erections.

Circumcission can sometimes cause the penile skin to be too tight, and that can cause a curvature of the penis under erection.

If a penis have had an episode of priapism, a condition where an erection lasts for several hours without going back, this can have destroyed some penile tissue and caused a curvature to occur. Problems with the regulation of the blood circulation to a part of the penis can also cause the penis to erect irregularly.