Peyronie's Disease...What Men Should Know
Peyronie's disease, a condition of uncertain cause, is characterized by a
plaque, or hard lump, that forms on the penis. The plaque develops on the upper
or lower side of the penis in layers containing erectile tissue. It begins as a
localized inflammation and can develop into a hardened scar.
Cases of Peyronie's disease range from mild to severe. Symptoms may develop
slowly or appear overnight. In severe cases, the hardened plaque reduces
flexibility, causing pain and forcing the penis to bend or arc during erection.
In many cases, the pain decreases over time, but the bend in the penis may
remain a problem, making sexual intercourse difficult. The sexual problems that
result can disrupt a couple's physical and emotional relationship and lead to
lowered self-esteem in the man. In a small percentage of patients with the
milder form of the disease, inflammation may resolve without causing significant
pain or permanent bending.
The plaque itself is benign, or noncancerous. A plaque on the top of the
shaft (most common) causes the penis to bend upward; a plaque on the underside
causes it to bend downward. In some cases, the plaque develops on both top and
bottom, leading to indentation and shortening of the penis. At times, pain,
bending, and emotional distress prohibit sexual intercourse.
One study found Peyronie's disease occurring in 1 percent of men. Although
the disease occurs mostly in middle-aged men, younger and older men can acquire
it. About 30 percent of people with Peyronie's disease develop fibrosis
(hardened cells) in other elastic tissues of the body, such as on the hand or
foot. A common example is a condition known as Dupuytren's contracture of the
hand. In some cases, men who are related by blood tend to develop Peyronie's
disease, which suggests that familial factors might make a man vulnerable to the
disease.
Men with Peyronie's disease usually seek medical attention because of painful
erections and difficulty with intercourse. Since the cause of the disease and
its development are not well understood, doctors treat the disease empirically;
that is, they prescribe and continue methods that seem to help. The goal of
therapy is to keep the Peyronie's patient sexually active. Providing education
about the disease and its course often is all that is required. No strong
evidence shows that any treatment other than surgery is effective. Experts
usually recommend surgery only in long-term cases in which the disease is
stabilized and the deformity prevents intercourse.
A French surgeon, François de la Peyronie, first described Peyronie's
disease in 1743. The problem was noted in print as early as 1687. Early writers
classified it as a form of impotence, now called erectile dysfunction (ED).
Peyronie's disease can be associated with ED; however, experts now recognize ED
as only one factor associated with the disease--a factor that is not always
present.
Course Of The Disease
Many researchers believe the plaque of Peyronie's disease develops following
trauma (hitting or bending) that causes localized bleeding inside the penis. Two
chambers known as the corpora cavernosa run the length of the penis. The
inner-surface membrane of the chambers is a sheath of elastic fibers. A
connecting tissue, called a septum, runs along the center of each chamber and
attaches at the top and bottom.
If the penis is abnormally bumped or bent, an area where the septum attaches
to the elastic fibers may stretch beyond a limit, injuring the lining of the
erectile chamber and, for example, rupturing small blood vessels. As a result of
aging, diminished elasticity near the point of attachment of the septum might
increase the chances of injury.
The damaged area might heal slowly or abnormally for two reasons: repeated
trauma and a minimal amount of blood flow in the sheath-like fibers. In cases
that heal within about a year, the plaque does not advance beyond an initial
inflammatory phase. In cases that persist for years, the plaque undergoes
fibrosis, or formation of tough fibrous tissue, and even calcification, or
formation of calcium deposits.
While trauma might explain acute cases of Peyronie's disease, it does not
explain why most cases develop slowly and with no apparent traumatic event. It
also does not explain why some cases disappear quickly, and why similar
conditions such as Dupuytren's contracture do not seem to result from severe
trauma.
Some researchers theorize that Peyronie's disease may be an autoimmune
disorder.
A number of drugs list Peyronie's disease as a possible side effect. Most of
these drugs belong to a class of blood pressure and heart medications called
beta blockers. One beta blocker is an eye drop preparation used to treat
glaucoma. Other drugs that may cause Peyronie's disease are interferon, used to
treat multiple sclerosis, and phenytoin, an anti-seizure medicine. The chances
of developing Peyronie's disease from any of these medicines are very low.
Patients should check with their doctor before discontinuing any prescribed
drug.
Treatment
Because the course of Peyronie's disease is different in each patient and
because some patients experience improvement without treatment, medical experts
suggest waiting 1 to 2 years or longer before attempting to correct it
surgically. During that wait, patients often are willing to undergo treatments
whose effectiveness has not been proven.
Some researchers have given men with Peyronie's disease vitamin E orally in
small-scale studies and have reported improvements. Yet, no controlled studies
have established the effectiveness of vitamin E therapy. Similar inconclusive
success has been attributed to oral application of para-aminobenzoate, a
substance belonging to the family of B-complex molecules.
Researchers have injected chemical agents such as verapamil, collagenase,
steroids, and calcium channel blockers directly into the plaques. These
interventions are still considered unproven because studies have included low
numbers of patients and have lacked adequate control groups. Steroids, such as
cortisone, have produced unwanted side effects, such as the atrophy or death of
healthy tissues. Another intervention involves iontophoresis, the use of a
painless current of electricity to deliver verapamil or some other agent under
the skin to the plaque.
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