Peyronie's disease and abnormally bent penis - causes, symptoms and treatment options

What is Peyronie's disease?

Peyronie's disease is a connective tissue disorder of the penis that leads to bending and disfiguration of the penis and to hard thickened inelastic areas in the penis.

Peyronie's disease consists of fibrous tissue, called plaques, developing within the penile shaft. The plaques are hard, thickened and stiff areas with exagerated growth of connective tissue, actully a kind of internal scarring.

The Peyronie's ailment is also called cavernositis, and also sometimes plastic induration. There is probably a chronic inflammation process that leads to this scarring.

Scarring is fibre rich conective tissue that can grow on places in the human body. Usually this happen to repair damage. Chronic inflammation in areas in the body often lead to damages that causes exagerated growth of scar tissue.

The thickened area has less blood flow than normal penile tissue, and do not fill with blood and swell as the normal spongy areas in the inside of the penis. Therefore the penis swells more at the opposite side, and gets a curvature towards the side containing the plaques when erected.

If the plaques are situated at both sides, more complex deformations will develop. The abnormal bending, twisting or swelling within the penis, often also lead to painful erections.

Scar tissue formed to repair damage or caused by inflammation tend to be replaced by normal functioning tissue after some time. This can happen also by Peyronie's disease. Therefore the condition can sometimes improve or heal by itself.

The diseases is named after the French surgeon, François de la Peyronie, that first described the disease in 1743.


The symptoms and consequences of Peyronie's disease

The main characteristics of cavernositis are:

• One or more small hard lumps underneath the skin, or a continous hard, stiff and thickened area.

• Abnormal bent or crooked penis when erect. 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 fasion. The penile bending are most often up, but may be down, to the left side, to right, sloping or down.

• The benings are usually to the same side of the hard thickened area when the penis is erected.

• The hard areas in the erected penis may look like bumps, making the penis irregular.

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

• The plastic induration may progress and cause erctile dysfunction or impotence.

• Pain during erections caused by the pressure from the hard areas in the penis, or from the streched 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.

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

• Plastic induration of the penis is not cancer or an infection, and cannot cause cancer or infections, however a lomp or deformation in your genitals that developes, must be examined.

The disease sometimes makes it difficult or impossible to perform intercourse or other sexual activities, or the joy of sexual activities is dimmished or gone. This may lead to emotional distress and problems in the relationship with the partner.


How common is Peyronie's disease?

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. The disease is most often seen in caucasian males. Ca 1 % of all men have this disease to some degree.

Men having Peyronie's disease also often have connective tissue disease in their hands and feet, for example a condition called  Dupuytren's contracture, which is a cord-like thickening across the palm causing fingers to pull inward.

The cause and development of Peyronie`s disease

The exact causes of the indurations are not fully known.

It's currently thought that some men may have a inherited genetic disposition to the condition.

It's not a sign of an underlying serious condition and it's not a sexually transmitted infection. However, infections may cause damage that stimulates formation of plaque, also after the infection has gone away.

There may be an auto-immune reaction towards the erctile tissue contributing to the disease.

Repeted injuries to the penis may cause the disease or contribute to its cause. A habit of forcefull sexual activity may cause such repetitive injuries.

The initial causes create an inflammation and this inflammation induce growth of fibrous connective tissue that form the plaques.

The erectile bodies corpora cavernosa laying at the side of each other at the upper part of the penis have a sheet of connective tissue. Between the bodies, these sheets form a common tissue layer.

The connection between this common sheet and the indiviuals heets of both erectile bodies is especially voulnerable to mechanical forces, and at these points ruptures easily take place that proceed into the erectile tissues of the bodies.

Such ruptures seem to induce proliferation of fibrous tissue tha grow into the erctile tissue and form the plaques.


Traditional and althernative treatments of peyronie's disease

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.  Here is a survay of treatment methods used tody.

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

Intralesional injections: Sometimes the doctor injects substances that can break down connective tissue fibres into the thickened areas, such as the enzyme collagenase or calcium channel blockers. This softens the area and may allow normal tissue to replace the scarring. One gives several injections in a three month's time. Injections of anti-inflammatory drugs, like steroids has been attempted, but has showed to cause more damage than help.

Vitamin E: Vitamin E is sometimes effective in easening the pain and as treatment for the penile deformity by Peyronie's disease.

Potassioum aminobezoate (potaba):

This is a form of a vitamine in the B-complex. Also this substance may help by Peyronie's disease.

Verapamil: 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.

Shock wave therapy: 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 plication one removes tissue opposite to the curve to straighten the penis.

- By Placque excision, the placque is removed and replaced by a graft from the skin of the pubic area.

- Plaque incision with saphenous vein graft. This procedure involves cutting lines in the plaque that allow straightening, and then  putting a graft consisting of a part of a vein within these lines.

-In certain cases of Peyronie's disease,  surgical insertion of a penile prosthesis (implant) is recommended. This will straighten the penis and make it more stable.

Radiation therapy: This treatment modality has been tried, but the results are unpredictable and sometimes the opposite of the intended one.

Traction devices: On the market, you can buy mechanical devices to use on the penis some time dayly that gently pull upon the penile tissue to streighen out the penis, and thus remending the penis from the curvature caused by Peyronie's disease. Many men report positive results from such devices. Another use of traction devices is to enlarge, and especially enlongate the penis. The method has shown to give good results according to scientific research, and such devices are also prescribed by doctors for the purpose.

Penis pumps: Like traction devices some men also have tried penis pumps to correct the curvature or irregularities by Peyronie's disease, and have reported positive results. Also penis pumps are elswhere used to enlarge the penis. Penis pumps must however be used cautiously to avoid hurting the penile tissue. But also this method ha shown to give good effects and are sometimes recommended by doctors.


Prevention: of peyronie's disease:

A factor in the cause of Peyronie's disease is an injury to the penis. Preventing penile injury will prevent some cases of this disease, for example by protecting the penis when doing hard contact sport or avoiding violent sexual activities.



Other causes of curved penis

The penis of most men are a little naturally curved from the birth., sometimes to the left and sometimes to the right. This congenital curvature can sometimes be greater than one likes it to be. Such a curvature that have been there all the time is not Peyronie's disease.

Another cause of penis shape problems is a too tight circumcision, so that the remaining skin is not big enough for the penis to attain a straight erect state.

Sometimes also a man gets an injury to the penis that destroys some of the erectile tissue. This can also cause irregular or curved penis.