Symptom: Your penis has developed a striking resemblance to that Boomerang you brought back from your backpacking holiday in the Australian Outback. Unlike the boomerang though, you’re newly bent penis doesn’t fill you with happy memories, isn’t as big…and probably wouldn’t look that good stuffed and mounted on your living room wall.
Cause: A penile bend that gradually develops over a few weeks or months is caused by a condition called Peyronie’s Disease. You don’t need to worry though, Peyronie’s disease isn’t some strangely exotic STD, or even really a disease per se, but simply refers to a penile specific condition that results in a loss of elasticity at a point along the length of the penile shaft – hence leading to a kinked erection.
This loss of elasticity is caused by the build up a tough, fibrous ‘plaque’ of scar tissue on a small section of the ‘tunica albuginea’ (the thin elastic sheath of tissue that encloses the erectile chambers like a balloon). In fact, if you think of how a balloon would end up misshapen if you blew it up after sticking a bit of Sellotape on one side, you get a pretty good analogy for the effect the build-up of Peyronie’s scar tissue has on the penis.
This plaque of scar tissue can form anywhere around the circumference of the penis – causing a penile curve in any direction. It’s also not uncommon for the penis to narrow like an hourglass at the point of the deformity – all of which can also lead to quite painful erections.
The Root of the Problem…
Peyronie’s Disease:
A plaque of inelastic scar tissue causes the
penis to bend at the point of formation.
Source: Harvard Health Publications
The underlying reason for the development of Peyronie’s disease remains hotly debated. Urologists attribute many cases to minor penile injury to the tunica albuginea (possibly sustained unawares during sex or by rolling over on a nocturnal erection for example) which lead to the development of the bend causing scar tissue during healing. However, a small percentage of incidences of Peyronie’s develop with other minor connective tissue disorders. Sufferers of Dupuytren’s contracture for example, a condition that inhibits finger dexterity due to a loss of elasticity in the connective tissue of the palms of the hands seem more susceptible to Peyronie’s – with about 30 percent of sufferers developing the conditions in tandem.
Incidences of Peyronie’s also increase with age – with a disproportionate number of men developing the condition in their 50’s and 60’s. Experts suggest that this increased age related risk factor is simply due to the increased susceptibility to minor injury that forms an inevitable part of the aging process.
It’s important to realise however that not all cases of penile curvature are attributable to Peyronie’s disease. It’s quite normal to have some degree of penile curvature present from birth – with experts suggesting that a deviation of anything up to 30 degrees from straight being quite normal. In fact, urologists say that it’s more uncommon to have a penis that’s as straight as Nelson’s column as opposed to one that resembles the Leaning Tower of Pisa.
The distinguishing feature of Peyronie’s is that the resulting curvature develops in adulthood; and is caused by a plaque of scar tissue developing on the lining of the erectile bodies – scar tissue that can in fact often be felt quite prominently as a flat hard lump under the penile skin.
Treatments for Peyronie’s Disease:
Unfortunately, there isn’t a ‘one size fits all’ treatment for Peyronie’s disease. The condition progresses at different rates between individuals, the symptoms can vary from mild to severe and the underlying cause can be difficult if not impossible to establish – all of which have a strong bearing on the effectiveness of any particular treatment.
In fact, if the bend isn’t severe enough to make sex difficult and / or erections cause little or no pain, most doctors would recommend against anything but the least invasive types of treatment. Although only around 20 percent of cases rectify themselves naturally, surgery is saved as a last resort because of the significant potential for further complications.
Conservative Treatments…
As a first line treatment option, Vitamin E supplementation is often recommended because of its scar reducing properties. This, along with anti-inflammatory medications are often enough to at least reduce the severity of the curvature and manage pain.
More severe cases sometimes respond positively to injections of medications directly into the Peyronie’s plaque tissue – which are designed to break down collagen (the key protein found in scar tissue). This isn’t a quick fix though – multiple injections are required over several months – and there’s no certainty of success.
Shockwave therapy (the same technology that’s used to break down kidney stones) has also shown some promise as a non-invasive way of breaking down Peyronie’s scar tissue – but the treatment is still experimental and not widely available.
Surgical Treatments…
Extreme downward penile curvature
caused by Peyronie’s disease.
Source: Center for Reconstructive Urology
A couple of different surgical procedures can be employed if all else fails, but neither is without its drawbacks.
Penile Plication…
The first, called penile plication, involves gathering together the internal penile tissues on the opposite side to the plaque build-up like a curtain on a rail – a procedure that shortens the healthy side of the penile shaft to the same length as the diseased side. Whilst this obviously helps to straighten the penis, the downside is that about 90 percent of patients undergoing the procedure can expect to lose about an inch in length.
Penile plication evolved out of an older, more invasive operation called the Nesbit procedure, which involved cutting a wedge of erectile tissue out of the healthy side of the penis, as opposed to simply tethering the tissues together with permanent sutures. Due to its more invasive nature, the Nesbit procedure carries a greater risk of post-operative complications such as loss of penile sensitivity and reduced erectile function.
Because penile plication and the Nesbit procedure involve shortening the healthy side of the penis to the same length as the affected side, they tend to be reserved for less severe cases.
Plaque Incision and Grafting…
A more complex alternative to penile plication that’s more suited to those suffering from extremely prominent curvature, involves attempting to restore normal elasticity to the diseased side of the shaft – either through the partial or total removal of the scar tissue and its replacement with either a skin or vein graft.
Whilst this may help to preserve penile length whilst reducing the severity of the curvature, a review published in the urological journal BJU International in 2005 warns that the procedure leaves over 20 percent of patients suffering from long-term erectile dysfunction.
Because all of the above procedures involve either the surgical shortening or lengthening of part of the penile shaft, they’re only undertaken when the condition has fully stabilised and there’s been neither an improvement nor deterioration in the severity of penile curvature for at least 12 months.
Penile Traction…A Promising Alternative to Surgery…
Interestingly, a study conducted at the Department of Urology, Rush University Medical Center in Chicago suggests a new non-surgical alternative for those who’ve failed to respond positively to previous medical therapy. The study, reported in the Journal of Sexual Medicine in 2008, showed that the use of penile traction over a 6 month period not only helped to reduce angles of penile curvature by between 10 – 45 degrees but also restored lost penile length. The ten Peyronie’s sufferers involved in the trial achieved an average 33 percent reduction in curvature from 51 to 35 degrees, and achieved an average ‘stretched flaccid penile length’ increase (a measurement that roughly equates to erect length) of between 0.5 and 2 cm. A clearly quite impressive result considering the test subject’s apparent unresponsiveness to conventional forms of treatment.
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