Peyronie’s disease is characterized by the formation of
hardened tissue (fibrosis) in the penis that causes pain,
curvature, and distortion, usually during erection. The penis
is the male organ for reproduction and urination. It is
composed of two columns of erectile tissue (the corpora
cavernosa); the corpus spongiosum, which contains the tube
that carries urine and semen from the body (urethra); and the
sheath that surrounds the erectile tissue (tunica albuginea).
In Peyronie’s disease, dense, fibrous scar tissue (plaque)
forms in the tunica albuginea.
Incidence and Prevalence
According to a report published in 1995 by the National
Institutes of Health, Peyronie’s disease occurs in about 1% of
men. It is most common between the ages of 45 and 60, but it
also occurs in young and elderly men. Prevalence may be higher
because of reluctance to seek medical attention for the
condition and failure to report in cases with mild symptoms.
Causes and Risk Factors
The cause of Peyronie’s disease is unknown. Cases that develop
suddenly are often caused by trauma to the penis (e.g.,
invasive penile procedure, injury, extremely vigorous sexual
activity). Invasive penile procedures include urethral
catheterization, cystoscopy, and transurethral prostatectomy.
Cases of Peyronie’s that develop over time may be caused by an
inherited abnormality of human leukocyte antigen B27
(HLA-B27), suggesting a genetic link. Also, Peyronie’s occurs
more frequently in men with family members who have the
condition or a connective tissue disorder (e.g., systemic
lupus erythematosus). About 30% of patients with Peyronie’s
disease also develop hardened tissue in other parts of the
body, such as the hand (e.g., Dupuytren’s contracture) or the
foot.
Microscopic examination of hardened tissue in cases of
Peyronie’s disease is consistent with cases of severe
inflammation of blood vessels (vasculitis), suggesting the
condition may have a vascular (i.e., pertaining to blood
vessels) cause. Diabetes, which often leads to blood vessel
disease, is also considered a risk factor.
The use of the antihypertension medication propranolol (Inderal®)
has been found to cause the condition in rare cases.
Peyronie’s disease has also been associated with vitamin E
deficiency.
Signs and Symptoms
Peyronie’s disease may be mild or severe, and may develop
rapidly or over time. Symptoms include the following:
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Hardened
tissue (plaque) in the penis |
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Pain during
erection |
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Curve in the
penis during erection |
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Distortion of
the penis (e.g., indentation, shortening)
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Plaque usually develops on the top of the
shaft, causing the penis to bend upward during erection, but
it may occur on the bottom, causing a downward bend. If plaque
develops on the top and the bottom, indentations and
shortening may occur. In about 13% of cases, plaque does not
cause severe pain or curvature, and the condition resolves on
its own.
In severe cases, pain and curvature result in erectile
dysfunction (impotence). If there are several areas of plaque,
incomplete erection may occur.
Diagnosis
Diagnosis of Peyronie’s disease involves taking a complete
medical history, including any circumstances surrounding the
onset of symptoms, and a physical examination. The hardened
tissue caused by the disorder can be felt upon examination
(palpable). Sometimes, it is necessary to perform the
examination with the penis erect. This is achieved by
injecting a vasoactive substance that affects the blood
vessels in the penis, causing erection. Photographs (digital
or Polaroid) of the deformity may eliminate the need to
produce an erection in the physician's office. Calcified
plaque can be identified using x-ray or ultrasound.
If the physical examination does not support the diagnosis of
Peyronie’s disease, or if the condition develops rapidly, the
physician may perform a biopsy. Biopsy involves removing
plaque cells for microscopic examination and is used to detect
cancer.
Treatment
Treatment options for patients with Peyronie’s disease are
limited. The goal of treatment is to reduce pain and maintain
sexual function. Surgery is the only effective treatment, and
because Peyronie’s may resolve on its own, physicians often
advise waiting 1 or 2 years before choosing this option.
Nonsurgical treatment should be implemented within 6 months of
the onset of symptoms and before the plaque has calcified.
Vitamin E supplementation and para-aminobenzoate tablets (B-
complex substance) may be taken for several months. Chemical
agents such as a calcium channel-blocker (e.g., verapamil), an
enzyme that breaks down connective tissue (collagenase), and
steroids (e.g., cortisone) may be injected into plaque or
delivered by iontophoresis.
Iontophoresis is a painless method of delivering medication to
localized tissue using electrical current. Like electrical
charges repel, therefore a positive charge applied to a
positively charged solution repels the medication into the
tissue. Low-dose radiation (high-energy rays) therapy may
reduce pain, but it does not effectively diminish plaque.
Complications
Tissue atrophy may occur with these treatments, and successful
results are not well documented.
Surgery
Surgical treatment may be used in severe, persistent cases of
Peyronie’s that have not responded to nonsurgical treatment.
Procedures involve the removal (excision) of hardened tissue
and skin graft, the removal or pinching (plication) of tissue
opposite the plaque to reduce curvature (called the Nesbit
procedure), a penile implant, or a combination of these.
The removal of plaque requires a skin graft from another area
of the patient’s body and may result in a partial loss of
erectile function (e.g., less rigidity). The Nesbit procedure
reduces the length of the erect penis.
Penile implant involves implanting a device in the corpora
cavernosa that increases rigidity. This procedure may be
combined with incisions and skin grafts, or plication to
effectively reduce curvature.
During the recovery period, patients are prescribed medication
that prevents them from having an erection and are advised to
avoid sexual activity. Antibiotics are also prescribed to
reduce the risk for infection.
Complications
Complications that may develop as a result of surgery include
the following:
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Adverse
reaction to anesthesia |
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Damage to the
tube that carries urine and semen from the body (urethra)
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Excessive
bleeding |
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Infection
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Neurovascular
damage resulting in a lack of sensation
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Prosthesis
malfunction |
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Scar tissue
resulting in impotence |
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Prognosis
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The prognosis for maintaining sexual
function is good when treatment is started within 6 months of
the onset of symptoms.
Naturopathic Treatment
Peyronie’s disease is a condition in which the fibrous
connective tissue in the penis thickens. The disease is not
fully understood and many cases spontaneously resolve within a
year or two. For those cases requiring medical or surgical
intervention, treatment may be frustrating and ineffective.
Naturopathic treatment may be used in conjunction with
conventional treatments.
Nutrition
Proper nutrition and supplements may be helpful. The
appropriate diet can improve overall health, boost the immune
system, and help the body heal.
Eat, fresh, unrefined, and unprocessed foods. Include fruits,
vegetables, whole grains, soy, beans, seeds, nuts, olive oil,
and cold-water fish (salmon, tuna, sardines, halibut, and
mackerel). Eating organic food helps reduce exposure to
pesticides, herbicides, and hormones.
Avoid sugar, dairy products, refined carbohydrates, fried
foods, junk foods, and caffeine.
Eliminate food sensitivities. Use an elimination and challenge
diet to to determine food sensitivities.
Drink ½ of your body weight in ounces of water daily (e.g., if
you weigh 150 lbs, drink 75 oz of water daily).
Supplements
Bromelain (proteolytic enzymes)- Take 750 mg, 3 times daily,
on a empty stomach. Bromelain is a pineapple enzyme that can
digest proteins (as can all proteolytic enzymes). It helps
prevent the deposition of fibrin, which is believed to cause
the connective tissue to thicken.
Herbal Medicine
Gotu kola (Centella asiatica)-Supports healing and normal
development of connective tissue.
Note: It may be up to 6 weeks of using
bromelain and gotu kola before results are noticed.
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