Dr Kohler sees many men with this common yet debilitating condition:
What is Peyronie's Disease?
It is a condition marked by penile curvature, indentation, and loss of penile length (with or without pain) upon erection. These deformities of the penis can appear in men of all ages but is most commonly present in men in their 50’s.
The cause of Peyronie’s Disease is not well understood. In most cases, the disease is a result of inflammation and plaque formation after repeated trauma to the penis; most commonly occurring during sexual intercourse.
The deformity of the penis is due to plaque formation that is, in fact, a thick inelastic scar. This thick inelastic scar can create curvature of the penis upwards, downwards or sideways.
Erectile dysfunction is also found to occur in up to 58%-90% of men with Peyronie’s Disease
What is the impact of having Peyronie’s Disease?
The impact of Peyronie’s Disease can be significant. It can cause one or more of the following conditions:
- This condition has been recognized to affect a man’s psychological state including causation of depression and anxiety disorders. Appropriate diagnosis and treatment may require the help of an experienced medical professional.
- Resulting in indentation, narrowing or loss of length
- Can interfere with the ability to engage in sexual activity and penetration
- Peyronie’s Disease is frequently associated with a reduction in rigidity, or hardness of erections
- Correction of the curvature rarely leads to correction of erectile dysfunction
- If erectile dysfunction coexists with Peyronie’s Disease, treatment options exist that will correct both problems
How is Peyronie’s treated?
The goal of therapy is to maintain or regain sexual function by straightening the penis. Treatment should be individualized based on a number of factors including, but not limited to, degree of penile curvature, severity of penile shortening, the presence of penile narrowing, and whether erectile dysfunction is present.
There are a number of interventions available including:
- Oral medications like vitamin E or pentoxifylline
- Mechanical stretching with vacuum devices
There are three techniques to make the penis straight:
- Plication: Shortening the long (unaffected) side
- The formation of scar tissue on one side of the penis shortens that respective side of the penis, resulting in a curvature. i.e., if the scar tissue is on the right side of the penis, the right side will become slightly shortened creating a pull of the penis to the right (Figure 1).
- Shortening the longer side of the penis can help create equal length on both sides (Figure 2). Although some shortening may occur, the amount of shortening is typically no more than 3/4 inches. This procedure is utilized for less severe cases of Peyronie’s Disease.
Scar tissue is cut or partially removed on the shorter (affected) side. After removal of this tissue, the defect is covered with a natural, soft graft material. The graft material has been used in more than 2 million implants without any incidents of infection. It provides a safe, natural support when strength and security are needed.
Resultant penile length is approximately equivalent to the longer side of the penis. This procedure is utilized for men with severe deformity and no erectile dysfunction.
This is an excellent approach when both penile curvature and erectile dysfunction are present. The device implant itself will resolve 30 degrees or less of curvature, and more severe curvature is easily corrected at the time of implant with a process called penile modeling. Many experts believe any man with Peyronie’s disease over age 50 should undergo the penile implant since the other procedures can worsen underlying erectile dysfunction and age is a risk factor for progression of erectile dysfunction.
The link between Peyronie’s and ED
Erectile Dysfunction is the consistent inability to obtain and sustain an erection sufficient for sexual intercourse. ED is frequently connected with Peyronie’s Disease.
How does an erection occur?
An erection is an involuntary reaction in response to sexual stimulation and excitement. A man cannot get an erection simply because he wants one.
What are the risks of surgery?
With any surgery, there are some risks to consider. Please discuss the following with your physician:
- Change in penile sensation (usually returns in 1-2 months after surgery)
- Recurrent curvature (rare if deformity is stable for 6-9 months before surgery)
- Erectile dysfunction (this is less likely to occur in men with strong pre-operative erections)
- Penile shortening (usually 3/4 inches if at all)
- Bleeding and infection are complications associated with most surgical procedures, but are quite rare with these operations
Frequently Asked Questions for Peyronie’s Disease
Q: Will my penis be perfectly straight after treatment?
A: The goal of surgery is not to make the penis perfectly straight, but functional. This is accomplished in 98% of cases (6).
Q: Will I regain the former length of my penis?
A: The loss of elasticity that occurs with the disease can reduce the length of the penis. Your length may vary depending on the selection of your treatment.
Q: My erections have become weaker with Peyronie’s Disease; will they improve after surgery?
A: The surgery to correct the curvature will not address the rigidity, or hardness of the erections. Erectile dysfunction is a condition that can be treated separately.
Q: What can I do to improve my erections and make them last longer?
A: Erectile Dysfunction is experienced by approximately 30 million men (7). There are many treatment options that can improve the quality of your erections, including:
- Oral therapy (Viagra®, Levitra®, Cialis®)
- Penile injections
- Vacuum devices
- Intraurethral suppositories
- Penile Implant
Your urologist will discuss with you which treatment option is most likely to be satisfactory for you.
Q: Will my insurance plan cover a surgical procedure?
A: Medicare and most insurance plans cover the procedure in most cases. Billing specialists in the physician’s office can help confirm your coverage.
You’ve already taken a major step by educating yourself about the treatment options available for Peyronie’s Disease. Remember, Peyronie’s Disease and Erectile Dysfunction are not an inevitable part of aging. These conditions are treatable and virtually everyone can be helped.
- Make an appointment with Dr. Kohler who specializes in Peyronie’s Disease and Erectile Dysfunction
- Come prepared with questions
- Discuss your treatment options
- Ask to speak to a man who treated his Peyronie’s Disease
- Confirm your insurance coverage
- For more information about Peyronie’s disease, visit www.peyroniesassoc.org.
- Nearly every man can be successfully treated. The ideal treatment solution will be based upon your individual condition and an in-depth discussion with a urologist specializing in the treatment of Peyronie’s Disease.
- Surgical treatment options offer proven, long-term solutions.
2. The Management of Peyronie’s Disease: Evidence-based 2010 Guidelines.
Ralph, D., Gonzalez-Cadavid, N., et al. J. Sex Med 2010; vol. 7
3. It’s a Guy Thing. Levin, L. Med Update 2007
6. Peyronie’s Disease: A Guide to Clinical Management. Levine, L., Totowa, NJ: Humana Press, 2007; pp 225.
7. NIH Publication No 09-3923. June 2009.
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