Peyronie's Disease

Many men seek a doctor because their members have shrunk, bent and because they notice a small "lump" inside. Some are even frightened by the suspicion of a dreaded form of cancer. Others have difficulty having sexual relations, for the difficulty in having erections.

Peyronie's Disease or induratio penis plastica is a disorder that afflicts mostly men aged 50 or older, being quite common in diabetic individuals. It is a generative disease that affects penis resilience. If such resilience is more affected in one of the sides, when the penis has an erection, it will lean towards this less stretching side. If the impairment affects this penis diffusely when erected, it will not extend much, thus becoming smaller. It is common for members to lose up to 5cm in length as a result of the disease, which is chronic and progressive.

Caption: In Peyronie's disease, the normally resilient tissue of the tunic albuginea is replaced by a fibrous plaque. The curvature may reach 90 degrees either upwards, downwards or sideways, and it may or may not be associated to pain during erection.

The loss of resilience and subsequent hardening of the penile structure often leads to an increasing reduction of the erection ability. As this diseases progresses, nearly 20% of men develop impotence.

Although this disorder was first described in 1743 by the French doctor François Gigot de La Peyronie, an established treatment does not yet exist for this pathology. For a good percentage of cases, pharmacological treatment may be recommended, as well as application of energy sources on the fibrosis (radiotherapy, ultrasound, lithotripter and laser) or surgery to shorten the long side of the penis with or without graft. Penile prosthesis is suitable for cases where there is impairment of the erectile function.

The existence of several treatment options points to the absence of a really efficient alternative. The surgical treatment is justified in more advanced cases entailing impairment of the sexual function. In early or intermediate cases, it is recommended to try a clinical treatment.

One of the revolutionary treatments, with encouraging results, is physiotherapy with dynamometric appliances. We make a point of emphasizing this kind of treatment for Peyronie's disease, as many men who could benefit from this sort of technology have no access to this information. This therapy was surely one of the greatest contributions to Peyronie's Disease treatment, especially in those cases in which the main complaint is curvature or reduction of penis size.

In case a man has such penis curvature from birth, it may have been caused by a puckering problem on one of the penis' membrane (tunic albuginea and/or coverings outside the tunic). This is the so-called congenital curved penis or congenital penile curvature, the treatment of which is similar to Peyronie's disease.

There is no known cause for the plaque (scar) formation. Some studies show that the problem arises from a self-immune disease, while others believe it is hereditary. But it is generically believed that these patients would be more prone to the formation of scars.

Penis trauma during sexual intercourse also has a strong connection with the development of the disease, however, only 30 to 40% remember this fact when asked. This trauma would lead to a would, which in turn would lead to an inflammation and consequently formation of a scar on the tunic, which would prevent it from stretching during erection, causing it to lean sideways. It is estimated that 3% of men will develop the disease in life.

Source: Dr. Bayard Ollé Fischer Santos , Dr. Eduardo Berna Bertero , American Academy of Family Physicians.