What is Peyronie’s Disease?
Peyronie’s Diseases (PD) is an abnormal curvature of the penis caused by a hard fibrous tissue (called a plaque) that forms in the shaft of the penis.
How common is Peyronie’s Disease?
PD has been reported in about 3% to 9% of men worldwide. It is most common in men between the ages of 40 and 70 but can happen at any age.
What are the symptoms of Peyronie’s Disease?
The symptoms of PD are divided in to an Acute Phase (sometimes called the Hot Phase) and the Chronic Phase (also known as the Cold Phase)
Acute Phase
This phases usually lasts for 18 to 24 months. During this phase there is pain in the penis especially during erection. The severity of the pain varies greatly. In some patients, the pain is so mild that they do not see a need to seek medical attention.
Chronic Phase
During this phase the pain subsides. A hard fibrous lump called a plaque becomes palpable in the penis shaft. The penis starts to curve. Most times the curvature is only visible when the penis is erected. However in some severe cases, the penis is obviously bent even when flaccid. In about 40% of patients the curvature stabilizes but in another 40% the curvature can continue to worsen for years. In the most severe cases the penis can be bent 90 degrees which makes sexual penetration impossible. The most common direction for the curvature is dorsally (upwards). But curvature can occur in any direction.
Pain can persist especially when the penis is erect. Also, PD can lead to Erectile Dysfunction. This can be due to the pain upon erection but also could be due to the plaque reducing blood flow to the penis.
What causes Peyronie’s Disease?
Till now nobody knows for sure what causes PD. It has been found to occur more frequently in people who have Diabetes and High Blood Pressure. It is also seen more in people with a genetic condition that causes scar formation in the hand (Dupuytren Contractures). People who smoke also have a higher risk of developing PD.
The prevailing theory is PD is triggered off by a minor injury to the penis (often during sex and goes unnoticed) and the plaque develops in people who are susceptible. But this is yet to be proven.
Will Peyronie’s Disease go away on its own?
The pain from PD during the Hot Phase almost always resolves with time. Even without treatment.
However, the curvature is unlikely to resolve on its own. In scientific studies, Curvature from PD resolves without treatment in about 10% of men. In 40% it continues to get worse. In 50% it remains stable.
How is Peyronie’s Disease diagnosed?
PD is most often diagnosed clinically. Doctors will feel for the plaque in the penis shaft.
You can help the diagnosis by taking clear pictures of your penis from the top and from the side while it is erect. This will let the Doctor visualize the angle, direction and severity of the curvature.
If necessary, the Doctor can give you a penis injection to stimulate an erection in the clinic.
Sometimes, the Doctor will ask for an ultrasound of the penis to help with the diagnosis.
Do I need to be treated for Peyronie’s Disease?
If the curvature is mild and not affecting your lifestyle there is really no need to treat the PD.
However if the curvature is severe and affecting your sex life or causing erectile dysfunction, you should consider seeing a Doctor and getting it treated.
PD can also cause discomfort to your partner during sex. This may also be a reason to get treatment.
What are the Treatments for Peyronie’s Disease?
Medicines
Various oral medicines and supplements have been prescribed to treat Peyronie’s Disease. They all have varying reports of success. Some can cause severe gastro-intestinal side effects. So in conventional medicine, oral medication is not routinely prescribed to treat PD.
Medicines that have been tried include:
- Vitamin E
- Tamoxifen
- Colchicine
- PABA
Tadalafil 5mg daily
One notable oral medication that shows more promise in the treatment for PD is daily low dose Tadalafil.
In a small scale study presented at the 18th Sexual Medicine Society of North America Annual Scientific Meeting, a group of patients took Tadalafil 5mg for 12 weeks (without any other treatment for PD). 70% of these patients became pain free. On average the penis curvature improved by 6.2 degrees. And plaque size reduced by 0.2cm2.
Li-ESWT (Low Intensity Electro Shock Wave Therapy)
Li-ESWT is an established treatment for Erectile Dysfunction. Li-ESWT also has been used alone and in combination with other treatments for PD.
One small study using Li-ESWT for PD reported a 47% improvement in angulation and 60% improvement in pain. Another bigger study involving more than 100 patients reported a “significant effect on decreasing penile curvature” but did not put a number to it. Another study with more than 300 patients reported a mean decrease in plaque size from 1.78cm2 to 1.53 cm2 but did not report on penis curvature. Interestingly this same study reported an average increase in penis length from 13.0cm to 14.0cm. This is most likely from the resolution of the plaque rather than an actual increase in length per se.
Li-ESWT has also been studied as a co-treatment with Tadalafil 5mg but the focus was more on fixing Erectile Dysfunction as opposed to penile curvature.
Li-ESWT has also been studied as a co-treatment with PRP injections with favorable results.
Penis Injections
Various different medicines have been trialed to treat PD via injection. All have reported improvements in penile curvature. There is some debate as to whether it is the active ingredient that is causing the improvement of the actual mechanical effect on the injection volume to break up the plaque. Medicines that have been tried include:
- PGE1
- Triamcinolone
- Veerapamil
- Nicardipine
PRP injections
Platelet Rich Plasma (PRP) injections involve taking the patient’s own blood, centrifuging it and then injecting the plasma portion back into where it is needed. Simply put, it works by concentrating the body’s own healing factors to the affected area. It has been used very successfully to treat various orthopedic conditions like injured muscles, ligaments and tendons.
PRP injection has been studied for the treatment of PD. In a 2014 study, patients with PD were given 4 injections of PRP over 2 months. After 9 months, 77% of the study participants reported a 30% improvement in curvature. In a continuation of this study published in 2017, penile curvature was reported to improve by 6.54 to 10.51 degrees.
All penis injections come with a risk of pain during injection and bruising after injection.
Surgery
Surgery for PD is only done when the plaque is stable. And the patient has tried other medical treatments and failed. Also only if the PD is causing significant erectile dysfunction and problems with sexual penetration.
What should I do now?
If you have a curvature of your penis that is affecting you or your partner, you should see a Doctor.
If you wish to see us drop us an email at doc@drtanmedicalcenter.coms.sg
Or visit our website to make an appointment
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