Peyronie's Disease: Curvature of the penis

Peyronie's disease is a severe curvature of the erect penis. It's named after an Italian physician to King Louis XIV of France. This physician was the first to note the disorder back in the 1700s. While it is somewhat common, it is not often mentioned.

A minor bend in the erect penis is perfectly normal, as few penises are straight as an arrow. In some cases of Peyronie's, however, the penis can bend severely left, right, up or down, or even back on itself, making intercourse impossible.

What causes a curved penis?
Although the cause of Peyronie's disease isn’t known for sure, some physicians theorize that the curvature may form as a result of trauma to the penis. A shearing force causes indirect injury and microbleeding. During healing, certain growth factors are upregulated, causing an abnormal amount of scar tissue (or plaque) to form.

Although it was once thought that this might occur during rough sex, that view is less common in recent years.

How is the penis constructed?
The penis is composed of three cylindrical cavities. The two on top are called the corpus cavernosa, and the one on the bottom is the corpus spongiosum, which contains the urethra (the tube that urine flows through).
The two top corporal cavities expand to trap and hold the blood that produces an erection in the male. The bottom body, corpus spongiosum, functions mainly for the passage of urine. Each of these corporal bodies is surrounded by a very elastic covering called the tunica albuginea.

On top of the two corporal cavernosa are the superficial nerves and blood vessels of the penis.

Why does the penis curve?
In Peyronie's disease, the elastic tissue of the tunica is replaced by scar tissue. Normally, with erection the elastic tissue of the penis expands and elongates symmetrically, resulting in a straight erection. Because the plaque is not elastic, but rather hard, it will not stretch with erection.

The disease starts as a small bump or constriction on the shaft of the penis below the skin, which expands to form a flat deposit that's sometimes as large as the diameter of a silver dollar. This plaque invades and replaces the elastic covering of the penis with inflexible material. When a man with Peyronie's has an erection, the plaque does not expand, so the penis curves.

How does a curved penis affect sexual intercourse?
A third of men with Peyronie's have pain with their erections, and a few with the condition become impotent. In some cases, the head of the penis does not fill with blood.

Because inflammation is initially associated with the scar tissue, there can be some discomfort with erection and distension. Many patients complain not only about the curvature of the erection but also about the loss of length and girth. These are all results of the inelastic tissue and lack of distention that results.

Most patients with Peyronie's disease can continue to function sexually with the curvature in the penis. Rarely, some patients with greater distortion are unable to have satisfactory sexual intercourse.

Does a curved penis cause impotence?
Studies indicate that some men with Peyronie's disease lose the ability to trap blood in the penis. It can, however, be difficult to distinguish the man who has a leakage problem from one who is quite anxious about his penis and loses his erection secondary to anxiety and stress.

Most of the time the plaque is on the top surface of the penis causing an upward bend. However, plaques can occur at any point on the penis. In some patients the penis beyond the plaque will not become as rigid.

How common is a curved penis?
Peyronie's disease is an extremely common ailment. I see about five patients a week with this problem. Most are middle-aged, though the youngest patients we have seen are in their twenties, and there are a number of still sexually active men in their eighties with the disease.

Some men first notice the sudden onset of a curved erection even though the previous erection was straight. In other men, the curvature may be slight at first, but then it keeps getting worse. Eventually, the curve stops, and gets no worse.

In most cases, the active process of Peyronie's disease stabilizes within a year or two. At the time the process stops, the scar tissue may remain or in some cases disappear. Reportedly, about a third of men can have a resolution to the problem without treatment, but I have never treated a man whose penis returned to the totally normal state.

How can you straighten a curved penis?
A curved penis can be straightened, but it’s important to have the right goals in mind. Rather than focus on cosmetics related to the aesthetic ideal of an arrow-straight penis, the real goal of treating a curved penis is to keep or restore sexual function.

Physicians are aware that a man can have a great deal of apprehension and anxiety associated with a curved penis. Rest assured, there is absolutely no connection between Peyronie's disease and cancer, for example.
We presently recommend 200 units of vitamin E three times per day to be taken with meals. It is theorized that vitamin E promotes healing and prevents scarring. Additionally, we prescribe Advil or Aleve for their anti-inflammatory effects, to be taken with meals. For men having significant pain with erections, a drug called Colchicine may be used. Before beginning this treatment, patients should have their white blood cell count checked to ensure that there is no change with this medication.

Dr. Larry Levine from Chicago has published a number of articles about a procedure wherein verapamil (a calcium channel blocker) is injected into the scar tissue, which evidently helps break up the scar tissue. The treatment must be done every two weeks and involves numbing the penis at the base, applying pressure for five minutes and then injecting the verapamil at 20 to 30 locations using a very small needle.

Success rates of 70 percent have been reported for verapamil injections, which does not disagree with our experience. If initial treatments don’t work, the dose or concentration can be increased. No systemic absorption of the verapamil occurs. Most insurance companies will cover verapamil injections.

Taking off on this concept, we use topically applied (to the skin) verapamil cream supplied by P. D. L., a San Antonio pharmacy. Over the past six to eight years, we’ve seen improvements of 40 to 60 percent using this technique. Bear in mind, however, that although many pharmacies can compound verapamil cream, it takes a special carrier to get the active ingredient into the scar. I’ve not found other products to be successful.

Verapamil cream is not FDA approved for treating Peyronie’s disease, and few insurance companies will cover it. It’s also not inexpensive, at $250 to $275 per month.

Some urologists are also experimenting with interferon, an anti-viral medication. This is quite expensive, and the jury is still out on its effectiveness.

I know of no other non-surgical treatments for Peyronie's. And steer clear of any physician recommending bizarre treatments, including steroid injections into the plaques (which don't help). Radiation and ultrasound are of no benefit. Oral posada, which is often prescribed in huge quantities, is of no benefit.

When the disease process stops, there is usually some residual distortion of the penis, but the vast majority of patients are able to function adequately sexually. However, if there is enough distortion of the penis to preclude sexual intercourse, surgery is possible.

Can surgery straighten a curved penis?
Surgical alternatives include tightening or tucking the penis opposite the curvature to produce straightening. This usually results in some small loss of length. This is called the Nesbitt Tuck, a 10- to 20-minute outpatient procedure that puts a stitch at the opposite side of the maximum point of the curve. It requires about a week off work and discomfort with erections for four to six weeks.

A decade ago, some physicians experimented with plaque removal, either surgically or using lasers. It has been my experiencing that this has not proved to be a very effective approach to Peyronie’s disease.

As noted previously, some men have difficulty trapping blood in the penis, either because of the Peyronie’s plaque or for other reasons. For a man whose Peyronie’s has made him unable to become erect at all, a penile prosthesis can correct both problems and is not an unreasonable choice.

What does the Male Health Center recommend?
Generally speaking, we recommend that the man be patient and see if the problem will correct itself. About one-third of cases get better within 18 months after the onset of the problem.

During this period, we recommend 200 international units of vitamin E three times a day. While the application of vitamin E at this time is not substantiated in scientific journals, the vitamin E won't hurt you and may, in fact, help prevent heart disease. Also, an over-the-counter anti-inflammatory medication, such as Advil or Aleve, may be helpful.

If a mild curve does not get better within 18 months, verapamil cream or injections may be helpful. But in many cases, further treatment may not be recommended. As long as the bend itself isn't severe enough to prevent intercourse, and the problem doesn't pose the risk of impotence, living with it may be the most reasonable approach.

In the case of an extreme curve, painful intercourse, or if there is the potential for impotence, surgical correction of the curve may be necessary.

Generally speaking, if the bend is not severe, and it doesn't prevent sex, we recommend trying to live with it. After all, this isn’t about a beauty contest for the penis. It’s about a penis that works well enough for mutual enjoyment. Considering that few partners will see your penis on display, a curved penis that doesn't affect your sex life is something you and your partner can learn to appreciate as just another unique aspect of you.


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