Genetic inheritance or La peyronie disease
- Genetic inheritance or La peyronie disease
- – Causes of the curved penis
- Symptoms of Peyronie’s disease
- Progressive deformation of the penis
- Erectile dysfunction
- How to diagnose an abnormally curved penis
- Treatments for Peyronie’s disease
- Pharmacological treatment
In 1743, the French surgeon Francois De La Peyronie described a dorsal curvature of the penis, attributed to irregular scarring.
Peyronie’s disease is a common problem, with an incidence of about 5%, found mostly in middle-aged men, and often has more psychological than physical impact. It is a scarring of the lining of the two erectile bodies of the penis, known as the corpora cavernosa, whose lining is called tunica albuginea.
Left untreated, this scar tissue, which can be mild or acute, can make a normal erection problematic for otherwise healthy men, creating a painful curvature of the penis that can make sex difficult or impossible. Although symptoms can sometimes be relieved on their own, often a man given this diagnosis should speak to their doctor to determine what options may be available for treatment.
Although penises, like fingerprints, are all different and can even have a natural curve, men who experience pain during erection or during sex should speak to their doctor about the possibility that these problems stem from Peyronie’s disease. – Causes of the curved penis
Although a patient may sometimes recall an injury to the penis that precedes the problem, usually during sexual activity, the most common recurrence occurs spontaneously in men who begin to have less solid but still useful erections.
Small tears in the tunica albuginea are thought to occur during sex which the body heals leaving scars. Sometimes, this scar can be part of a global syndrome, and it can be seen in patients who have hand tendon scars called DePuytren’s contractures. Symptoms of Peyronie’s Disease Pain
A patient with Peyronie’s disease will first notice pain in the penis during erection which is described as pain that can sometimes be considerable. This is the inflammatory response that eventually, usually within a few weeks or months of the onset of pain, produces a scar that can be palpated in the penis at rest. This scar is called Peyronie’s plaque. Most of the plaques are found on the top of the penis. About 20% will eventually scar. Progressive deformation of the penis
The hallmark of Peyronie’s disease is penile deformity. This is most commonly seen as a curvature of the erect penis produced as a result of plaque preventing the expansion of the tunica albuginea in its location. This tunic condition can also cause a shortening of the penis, or an unstable area of the erect penis that causes it to hinge there.
The deformity is dictated by the shape and location of the plaque, and as the plaque develops, the manifestation of the deformity may also change. Peyronie’s disease rarely causes erectile dysfunction on its own, unless it is severe, but it can amplify any degree of erectile dysfunction a man already has. Erectile dysfunction
Often this disease causes difficulty in getting or maintaining an erection. Erectile dysfunction can be the result of pain or it can be caused by the deformity of the penis.
Problems with sexual intercourse can only occur if the penis becomes curved in a way that makes penetration difficult or painful, both for the person with Peyronie’s and for their sexual partner.
Eventual erectile dysfunction can also be the result of changes in self-image and other signs of stress. How to diagnose an abnormally curved penis
Once noticed, many patients seek the advice of a urologist. The vast majority of patients simply need to be reassured about plaque, which could look like a tumor. In almost all cases, the pain resolves on its own over time, and any existing curvature or deformity does not progress to the point that sexual activity is difficult. It is the change in a man’s penis, and the consequent fear of it progressing, that has the greatest negative impact.
Of all cases analyzed, about 20% improve on their own, 40% remain stable, and 40% get worse. But, even among men who get worse, the minority will progress to the point where they will have to seek treatment for Peyronie’s disease to be able to have satisfying sexual activity.Treatments for La Peyronie ‘s disease
The generations following Francois De La Peyronie have proposed a variety of surgical and non-surgical therapies for this disease, although only some of these enjoy the support of high-level evidence.
Today, urologists are widely adopting clostridium hystolyticum collagenase as a non-surgical treatment, and prosthetic implantation for the definitive management, ie the surgical solution.
However, the urological literature following the publication of the American Urologic Association guidelines in 2015 continues to raise fundamental questions about the best application of each of these treatment modalities. At the same time, research continues to clarify our understanding of the disease, and while alternative therapies are constantly revisited, evidence-based practice continues to narrow down to scientifically rigorous options. Pharmacological treatment
And above all the anxiety, and not necessarily the physical deformity, which tends to push men to seek non-surgical treatment. Unfortunately, there is very little data to support the use of oral remedies for Peyronie’s disease, but many men find it unacceptable to simply accept a small curvature of the penis and not seek some form of therapy.
A partial list of such remedies includes colchicine, vitamin E, commercial herbal remedies, coenzyme Q and, more recently, pentoxifylline and L-arginine.
Doctors do not discourage affected individuals from trying these remedies, as long as they are not overly expensive or cause no side effects.
Pentoxifylline, an older antihypertensive called Trental, may help, according to the latest literature.
Vitamin E is the simplest thing to try. But in reality, it will be time and your body that will determine whether the plaque will deteriorate, remodel, stabilize or calcify.
Surgery is only recommended in cases where the disease has been occurring for a long time, and where penile curvature is acute and has not responded to non-invasive treatments.
The most common surgeries include a prosthesis to help support an erection and straighten the penis, the graft to cover the openings in the tunica albuginea once the scar tissue is removed, and the plication in which a surgeon pinches or removes a piece of tunica. albuginea on the opposite side of the plaque to help straighten the penis. These surgeries have risks, including shortening, numbness, or total loss of erectile function.