All about Peyronie's disease (From A to Z)

Learn & understand the basics…

What causes Peyronie's disease?

Most experts are of the consensus that Peyronie's disease usually develops following a trauma or injury that causes bleeding inside the penis.  However, while this trauma may explain acute cases of Peyronie's disease, it does not explain why most cases develop slowly and progressively (chronic cases), or what causes the disease after no apparent traumatic event or accident.

What happens in Peyronie's disease?

Peyronie's disease is characterized by a plaque, or hard lump, that forms on the erection tissue of the penis. Fortunately, this plaque is benign (or non-cancerous) and often begins as an inflammation that may develop into a fibrous tissue. In most of the cases, when the disease heals within a year or so, the plaque does not progress beyond an initial inflammatory phase. However, when the disease lasts for years, the plaque often becomes a tough, fibrous tissue, and calcium deposits may form.

What are the signs & symptoms of Peyronie's disease?

While each individual may experience symptoms of Peyronie's disease differently, the most common symptoms of Peyronie's disease may include:

• Plaque: Which (if present on the top of the shaft) causes the penis to bend upward. Similarly, this plaque (if present on the underside of the penis) causes the penis to bend downward. 
• Shortening of penis: In cases where the plaque develops on both top and bottom, indentation and shortening of the penis may occur
• Pain, bending, and emotional distress can prohibit sexual intercourse
• Painful erections may occur. 

It should also be noted that the symptoms of Peyronie's disease may resemble other conditions or medical problems. Therefore, it is recommended to always consult your physician for a diagnosis.

How is Peyronie's disease diagnosed?

A diagnosis of Peyronie's disease is usually made with the help of a complete medical history and physical examination. For example, men visiting the doctor often seek medical attention for erections and difficulty with intercourse. This diagnosis is further confirmed by:

1-    Ultrasound examination of the penis: A diagnostic technique which uses high frequency sound waves to create an image of the internal organs.

2-    Color Doppler examination: A type of ultrasound that uses sound waves to measure the flow of blood through a blood vessel; waveforms of the blood flow are shown on the ultrasound screen (to evaluate erectile function, anatomy, and blood flow). 

How is Peyronie's disease treated?

In general, the goal of treatment is to keep the patient with Peyronie's disease sexually active. Providing education about the disease and its course is often included in the treatment plan. In some cases, treatment is not necessary, as Peyronie's disease often occurs in a mild form that heals without treatment in 6 to 15 months. Treatment may include:

Surgery: Surgery is often the last resort and is associated with high risk of complications, costs and side effects.

Vitamin E: Some clinical trials have reported improvements with oral vitamin E prescribed by a physician.

Drugs: In some cases, injections of various chemical agents into the plaques have been utilized in a small number of patients. However this mode of treatment does bear a strong potential for unwanted side effects.

Radiation therapy: With this treatment approach, radiation is aimed at the plaque to reduce pain, but does not affect the plaque itself; unwanted side effects or worsening of the disease may occur.

Use of extenders: For those who believe in the potency and effectiveness of alternative or natural treatment options, traction-based penis extenders (such as those of SizeGenetics) offer an attractive, safe and economical option with multiple benefits.

An expert review of alternative treatments of Peyronie's disease

Is natural the better?

As the surgical treatment of Peyronie’s disease is risky, expensive and is often considered as the last resort, more and more treatment modalities are being introduced.  Some of these include include vitamin E in tablet or cream form, potassium aminobenzoate (a chemical that belongs to the Vitamin B group and is used to break down hard, fibrous skin), and quite recently, the use of external penis stretchers.

Vitamin E: Antioxidants such as vitamin E prevent fibrosis. Early studies on the use of vitamin E in Peyronie’s disease reported a decrease in penile curvature in 78% of patients and a decrease in plaque size in 91%. Though the recent evidence does not support a strong role for vitamin E, the low toxicity and cheaper cost of the supplement encourages its use either alone or in combination with other treatment options in Peyronie’s disease.

Potassium para-aminobenzoate (POTABA): POTABA has long been suggested both by medical / alternative treatment experts as an effective therapy for the plaque, curvature, and pain produced by chronic Peyronie's disease. In a study done on 32 adult men who were treated for at least 3 months with POTABA on daily basis, symptom resolution was significantly seen. For example, improvement in penile discomfort / pain was seen in 8 of 18 patients, and decreased plaque size was found in 18 of 32 patients. Similarly, a significant improvement in penis angle (curvature) was seen in 18 patients while 8 patients reported complete correction of the curvature. However, even PTABA is not free of side effects and its efficacy still needs to be established in a vast majority of patients.

Traction-based extenders: Out of all these alternative options, penis stretchers (or extenders) have emerged as the most promising treatment option because of their high successful rate, long-lasting impact and safety. The most unique fact about the successful use of penis extenders in the treatment of Peyronie’s disease is that, unlike other natural / alternative methods of supplements, their use has been documented, established and recommended by several clinical trials and studies. In one of such study which was presented in the 2nd European Congress of Andrology (September 2002), the efficacy of mechanical penile stretching (PS) to reduce penile deformity during erection was tested. The study was done in Italy on ten patients affected by Peyronie's disease, apparently unchanged at least for the latest 3 months and with penile curvature during erection (PEC). Measurements were performed before and after daily home penile stretching application (at least four hours / day) for 3 to 6 months. As a result, penile curvature during erection was significantly and successfully decreased after 3 months. Also, the treatment was well tolerated (no severe complication and no patient drop outs occurred). The results suggested a promising use of penile stretchers in selected Peyronie's patients affected by penile curvature without erectile dysfunction.

While surgery is still an option, it is often associated with a high risk of complications, more costs and other problems.

Can medications cause Peyronie’s disease?

The dangers of drugs

One of the least common or rare risk factors associated with the development of Peyronie’s disease is long-term administration of certain drugs. These drugs can belong to a variety of different classes and are used to treat different disorders. However, the chance of developing Peyronie's disease from any of these medicines is very low and there is no absolute evidence that Peyronie's disease is directly related to taking these drugs. There role, however, is still considered important.

Which drugs may have a role in Peyronie’s disease?

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.

Major drugs that can cause Peyronie’s disease as a side effect

• Beta blockers
• Cerebyx
• Dilantin
• Dilantin Kapseals
• Glaucoma eye drop beta blocker
• Interferon
• Mesantoin
• Peganone
• Phenytek
• Phenytoin

How can drugs lead to Peyronie’s disease?

There have been various theories that attempt to explain how the prolong use of certain drugs or medications can lead to abnormal curvature of penis and Peyronie’s disease. Scientists believe one of such possibilities is that a particular medication or substance may be the real cause of the disease. Certain medications, chemicals, toxins or substances may possibly be underlying causes of Peyronie's disease. Side effects of medications or exposure to toxins, chemicals, or other substances may cause a symptom or condition. Hence, they become possible underlying causes of Peyronie's disease but are often misdiagnosed or overlooked as a cause.

Finally, it must be remembered that Peyronie’s disease (PD) does not develop overnight and is not an acute disease. Instead, it is a long-term, chronic disorder that develops progressively, over the period of time and can result from a number of causes such as injury / trauma, genetic history of PD, autoimmune factors and, very rarely, as a side effect of certain drugs as listed above.  If this is the case, proper consultation of a urologist or your physical is essential to know what drug is actually causing the problem.