Peyronie’s disease is the eponymous term given to angulation of penile erections with scar tissue (often palpable plaques) involving the lining of the erectile bodies; there may be associated penile shortening. While a typical cause is female above trauma, in my experience the second most likely explanation is uncertainly – perhaps rolling over on an erection while sleeping. Although 3% of all men may have a curved erection, if they can function perfectly well and their partners have no pain during coitus, then medical intervention is at the discretion of the patient. However, in some men, Peyronie’s disease causes a significant bend or pain along with a strong emotional overlay.
Our office has had extensive experience treating patients with Peyronie’s. Before and after photographic examples are shown on our website http://penisdoctor.com/
Risk factors include:
• Connective tissue disorders; Men who have a connective tissue disorder appear to have an increased risk of developing Peyronie’s disease. For example, a number of men who have Peyronie’s disease also have condition known as Dupuytren’s contracture a cord-like thickening across the palm that causes the fingers to pull inward.
• Age. The prevalence of Peyronie’s disease increases with age and
• Certain health factors such as smoking and some types of prostate surgery.
As a rule, no surgery should be performed until there a been a pain free period with no further evolution of curvature for a good 6 months, as sometimes after the bruise effect subsides, the curve reverts back to normal.
The American Urological Association has put out extensive advisory for evaluation and management (updated 2015). Vitamin E has been de-listed as being effective. In all honesty, most medications may be partially beneficial, but the degree of improvement may not be entirely satisfactory. A good example is costly Xiaflex (Clostridium histolyticum). Surprisingly penile traction without medication or surgery may be restorative.
Surgery involves more commonly plication (of the longer side) which admittedly results in shortening of about 1/8th” +/-, or insertion of a graft to replace scarified tissue with a new and longer internal sheath (graft). In that the latter operation is fraught with some risks such as erectile impairment, a hinged erection, etc. if the patient is experiencing erectile impairment; consideration should be given to a penile prosthesis so both concerns can be addressed simultaneously.
When there is insufficient rigidity, your urologist may recommend a color coded penile Doppler ultrasound to verify that the vascularity of your penis is intact. Good arterial inflow and good venous occlusion to be sure enhanced blood flow is contained within the erectile bodies, versus going out as fast as it is coming in.
2 weeks following surgery, erections are encouraged, but we advise no penetrating sex for 6 to 8 weeks, as the penis still regaining tensile strength.
Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America
International Society for Sexual Medicine