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Erectile Dysfunction
Peyronie's Disease
Peyronie's
disease is caused by scar tissue, called plaque, which forms
along the length of the penis. This plaque is not visible,
and depending on the severity of the condition, the plaque
can cause the penis to bend making sexual intercourse difficult.
What
Causes Peyronie's Disease?
The cause
of Peyronie's disease is unclear. Many researchers believe
the plaque of Peyronie's disease can develop following trauma
(hitting or bending) that causes localized bleeding inside
the penis. Other cases, which develop over time, may be genetically
linked or inherited (passed on from parents to children through
genes).
In addition,
a number of medications list Peyronie's disease as a possible
side effect. Most are a type of drug called beta-blockers
that are often prescribed for people with heart conditions
or high blood pressure. Other drugs that may cause Peyronie's
disease are interferon, which is used to treat multiple sclerosis,
and Dilantin, an anti-seizure medicine. However, the chance
of developing Peyronie's disease from any of these medicines
is very low and there is no evidence that Peyronie's disease
is related to taking these drugs.
Who
Gets Peyronie's Disease?
One study
found that Peyronie's disease occurs in 1% of men. Although
the disease occurs mostly in middle-aged men, younger and
older men can get it. In some cases, men who are related tend
to develop Peyronie's disease, suggesting the disease can
be inherited.
What
Are the Symptoms of Peyronie's Disease?
Symptoms
may develop slowly or appear overnight. When the penis is
soft, no problem can be seen. But, in severe cases, the hardened
plaque reduces flexibility, causing pain and forcing the penis
to bend or arc during erection. In most cases, the pain decreases
over time, but the bend in the penis can remain a problem.
Occasionally, milder forms of the disease will 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 the top and bottom, leading
to indentation and shortening of the penis. Some men with
Peyronie's disease develop scar tissue elsewhere in the body,
such as on the hand or foot.
How
Is Peyronie's Disease Diagnosed?
First
your doctor will talk to you and ask you about any circumstances,
such as injury, that may have occurred prior to symptoms appearing.
Your doctor can feel the hardened tissue caused by the disease
on examination, although sometimes it is necessary to do the
examination with the penis erect. In some cases where the
doctor's examination does not confirm Peyronie's disease,
or in cases where the condition develops rapidly, your doctor
may perform a biopsy. A biopsy involves removing tissue from
the affected area for examination in a lab.
Can
Peyronie's Disease Be Treated?
Yes. But,
since some people's condition improves without treatment,
doctors often suggest waiting 1 to 2 years or longer before
attempting to correct it. Mild cases of the condition rarely
require treatment. Also, the pain associated with Peyronie's
disease occurs only with an erection and is usually mild.
If treatment
is needed, surgery can be performed. The two most common surgeries
used to treat Peyronie's disease are:
Removal
of the plaque followed by placement of a tissue patch.
Removal or pinching of tissue from the side of the penis opposite
the plaque, which counters the disease's bending effect. This
procedure is known as plication.
Unfortunately, the surgeries do not guarantee normal penis
function. The first method can involve partial loss of erectile
function, especially rigidity. The second method, known as
the Nesbit procedure, causes a shortening of the erect penis.
Most types
of surgery produce positive results. But because complications
can occur, and because many of the complications associated
with Peyronie's disease (for example, shortening of the penis)
cannot be corrected by surgery, most doctors prefer to perform
surgery only on the small number of men with curvature so
severe that it prevents sexual intercourse.
If surgery
is not right for you, there are other options. Some studies
have shown that vitamin E pills improved Peyronie's disease.
Similar studies have been done on para-aminobenzoate, a substance
related to B-complex vitamins, but the results have been inconclusive.
Other
approaches to treating Peyronie's disease that have yet to
be confirmed as effective include the injection of chemical
agents directly into the plaque or radiation therapy. However,
radiation therapy can only relieve pain associated with Peyronie's
disease; it cannot cure it.
Since
the severity of the condition varies from person to person,
talk to your doctor about what treatment strategy is right
for you.
What
Is the Outlook?
Peyronie's
disease is a self-limiting condition. Pain disappears with
time, plaque formation stops and the erection deformity stabilizes.
Most men with Peyronie's disease are able to have sexual intercourse
and for these men surgical treatment is usually not necessary.
Reviewed
by the doctors at the Glickman Urological Institute at The
Cleveland Clinic.
Edited
by Charlotte Grayson, MD, WebMD, May 2004
Portions of this page © The Cleveland Clinic 2000-2004
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