Peyronies Disease

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Peyronie’s disease, is a condition of uncertain cause, it is characterised by a plaque, or hard lump, that forms within the penis.  The plaque develops on the upper of lower sides of the penis in layers surrounding erectile tissue.  It begins as a localised inflammation and can developed into a hardened scar.

Penises vary in shape and size, and having a curved erection isn't necessarily a cause for concern. But Peyronie's disease causes a significant bend or pain in some men. Cases of Peyronie’s disease range from mild to severe.  Symptoms may develop slowly or appear over-night. The typical signifying characteristics include, pain, a bend in the erection and problems gaining an erection (Erectile Disorder).

Adapted from: Porterbrook Clinic and Sheffield Hospital Andrology Service Information on Peyronie’s disease.

The causes of Peyronie’s disease are not clear but it is thought to happen after repeated bending or bumping of an erect penis.  The tearing in the lining of the erectile tissue leads to an inflammatory plaque that does not heal in a normal way.  Small blood vessels can burst and interfere with blood flow.  Usually, this kind of injury only swells, or becomes inflamed (red and/or hot), and will heal within a year.  However, in some men recovery takes longer and scaring can happen.

Whilst Peyronie’s disease occurs mostly in middle-aged men, younger and older men can acquire it.

In approximately 30% of people with Peyronie’s disease will also present with fibrosis (hardened cells in other elastic tissues of the body, such as on a person’s hand or foot, also known as ‘Dupuytren’s contracture of the hand’. In some cases, men who are related by blood tend to develop Peyronie’s disease.  This suggests family factors might make a man vulnerable to the disease.

Adapted from: Porterbrook Clinic and Sheffield Hospital Andrology Service Information on Peyronie’s disease.Andrology Australia Factsheet.

Peyronie's disease signs and symptoms might appear suddenly or develop gradually. The most common signs and symptoms include:

• Scar tissue.

- The scar tissue associated with Peyronie's disease is called ‘plaque’. It is a different from plaque that can build up in blood vessels. It can be felt under the skin of the penis as flat lumps, or a band of hard tissue.

• A significant bend to the penis.

- Your penis might curve upward or downward or bend to one side.

• Erection problems.

- Peyronie's disease might cause problems getting or maintaining an erection (erectile dysfunction). Often men report erectile dysfunction before the beginning of Peyronie's disease symptoms.

• Shortening of the penis.

- Your penis might become shorter as a result of Peyronie's disease.

• Pain.

- You might have penile pain, with or without an erection.

• Other penile deformity.

- In some men with Peyronie's disease, the erect penis might have narrowing, indentations or even an hourglass-like appearance, with a tight, narrow band around the shaft.

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The curvature and penile shortening associated with Peyronie's disease might gradually worsen. At some point, however, the condition typically stabilizes after three to 12 months or so.

Pain during erections usually improves within one to two years, but the scar tissue, penile shortening and curvature often remain. In some men, both the curvature and pain associated with Peyronie's disease can improve without treatment.

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When to see a doctor

See your doctor as soon as possible after you notice signs or symptoms of Peyronie's disease. Early treatment gives you the best chance to improve the condition — or prevent it from getting worse. If you've had the condition for some time, you may wish to see a doctor if the pain, curvature, length or other deformities bother you or your partner.

Aside from the physical pain and changes caused by Peyronie's disease, the symptoms and other related potential difficulties can cause psychological problems. It could be trying to adapt your condition in your relationship and sex life, or maybe it is interfering with your sex life. For the man living with Peyronie's it is important to work as a team with your partner to overcome the effects of Peyronie's disease. If you are single, then it is important that you hold a healthy self-esteem to be able to address any difficulties that may arise with any casual partners. Dave Wells can support you through, locating appropriate referral to medical staff who specialise in Peyronie's Disease, whilst supporting your psychological journey, and any difficulties that arise from having the condition.

Adapted from : Porterbrook Clinic and Sheffield Hospital Andrology Service Information on Peyronie’s disease.

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Medical

Peyronie’s disease is individual in each case and because some patients experience improvement without treatment, medical professionals suggest waiting 1 to 2 years or longer before attempting to correct it surgically.  During this waiting period varied treatments are available, such as medications, and devises aimed at improving the curvature of the penis, although their effectiveness is less then conclusive.

Peyronie's disease rarely goes away on its own. In most men with Peyronie's disease, the condition will remain as is, or worsen. Early treatment soon after developing the condition may keep it from getting worse or even improve symptoms. Even if you've had the condition for some time, treatment may help improve bothersome symptoms, such as pain, curvature, and penile shortening.

During his study placement in the Urology Department at Hallemshire Hospital in Sheffield, England, Dave Wells gained first-hand experience and knowledge, working with men who had the Peyronie's Disease (curvature of the penis). Hallemshire Hospital was one of the leading health facilities that supported men in England who lived with Peyronie's disease, and due to surgery for the condition being very invasive, alternative methods were encouraged. These alternative methods included a combination of the use of penile pumps sever times per day, and erectile dysfunction medication. For most men with Peyronie's, Viagra and similar medications were much less effective, and Caverject penile injections the only option. The thought of injecting into a man’s penis horrifies most men, however the injection is small and painless. Men were trained in its usage, and most adapted to it and found the process easy.

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Surgical

Peyronie’s Disease has been treated with some success by surgery.  The two most common surgical methods are the removal or expansion of the plaque followed by placement of a patch of skin or other artificial material, and removal or pinching of tissue from the side of the penis opposite the plaque, which cancels out the bending effect.  The first method none as the ‘Lue procedure’ can involve partial erectile dysfunction problems (not getting hard).

The second method is known as the ‘Nesbit procedure’, which can cause a shortening of the penis. Most methods of surgery produce positive results however, complications can occur.

Your doctor might suggest surgery if the deformity of your penis is severe, sufficiently bothersome or prevents you from having sex. Surgery usually isn't recommended until you've had the condition for nine to 12 months and the curvature of your penis stops increasing and stabilizes for at least three to six months.

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Common surgical methods include:

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- Suturing (plicating) the unaffected side.

A variety of procedures can be used to suture (plicate) the longer side of the penis — the side without scar tissue. This results in a straightening of the penis, although this is often limited to less severe curvatures.

Several plication techniques may be used, generally resulting in similar success rates depending on surgeon experience and preference.

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Plication of the penis

During plication of the penis, an artificial erection is created from either injection of a saltwater solution or selected medications. The outer skin of the penis is pulled back. The penis is straightened, and the excess tissue on what had been the outer side of the curve is cinched together by placing a series of stitches or "tucks." The final penile length will depend on the length of the shorter side — the side with the scarring from Peyronie's disease.

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- Incision or excision and grafting.

With this type of surgery, the surgeon makes one or more cuts in the scar tissue, allowing the sheath to stretch out and the penis to straighten. The surgeon might remove some of the scar tissue.

A piece of tissue (graft) is often sewn into place to cover the holes in the tunica albuginea. The graft might be tissue from your own body, human or animal tissue, or a synthetic material.

This procedure is generally used in men with more-severe curvature or deformity, such as indentations. This procedure is associated with greater risks of worsening erectile function when compared with the plication procedures.

- Penile implants.

Surgically placed penile implants are inserted into the spongy tissue that fills with blood during an erection. The implants might be semi rigid — manually bent down most of the time and bent upward for sexual intercourse.

Another type of implant is inflated with a pump implanted in the scrotum. Penile implants might be considered if you have both Peyronie's disease and erectile dysfunction.

When the implants are put in place, the surgeon might perform additional procedures to improve the curvature if needed.

The type of surgery used will depend on your condition. Your doctor will consider the location of scar tissue, the severity of your symptoms and other factors. If you're uncircumcised, your doctor might recommend a circumcision during surgery.

Depending on the type of surgery you have, you might be able to go home from the hospital the same day or you might need to stay overnight. Your surgeon will advise you on how long you should wait before going back to work —generally, a few days. After surgery for Peyronie's disease, you'll need to wait four to eight weeks before sexual activity.

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Other treatments

A technique known as iontophoresis uses an electric current to administer a combination of verapamil and a steroid noninvasively through the skin. Available research has shown conflicting results on penile curvature and erectile function.

Several nondrug treatments for Peyronie's disease are being investigated, but evidence is limited on how well they work and possible side effects. These include using intense sound waves to break up scar tissue (shock wave therapy), stem cells, platelet-rich plasma and radiation therapy.

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Adapted from: www.mayoclinic.org/diseases-conditions/peyronies-disease/diagnosis-treatment/drc

Often for many men, we only reach out for help with health problems that are attributed to our genital regions, when we can no longer address the problem ourselves.  Even when this time comes, we address the medical side of the problem and attempt to solve the problem through treatment, but we overlook the emotional impact.

It is important not to overlook the emotional side of Peyronie’s, as the disease does not only affect the body.  Men with Peyronie’s disease go through wide range of emotions, they can feel angry, sad, ashamed, embarrassed, isolated, and afraid. They can feel loss of manhood, lack of control, and be uncertain about what to do, or not to do.

Peyronie’s can lead to poor self-esteem and lead to loss of sexual confidence. Some men isolate themselves, get withdrawn, and even become depressed.

Adapted from: Porterbrook Clinic and Sheffield Hospital Andrology Service Information on Peyronie’s disease.

Andrology Australia Factsheet.

‍http://www.mypeyronies.com

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‍How can Dave Wells help?

‍Addressing the psychological aspect of Peyronie’s is therefore as important as addressing the physical part. Dave Wells is empathetic, non-discriminatory, and non-judgmental, he has a wealth of knowledge about conditions that affect the penis from his experience, training at Hallemshire Hospital, as well as volunteering with the Prostate Cancer Foundation Australia (PCFA) to provide a support group for men who live with Prostate cancer. Men who have a prostatectomy experience difficulty with achieving an erection as well as other penile conditions.

Dave Wells can support a person diagnosed with Peyronie's by assisting with referral options to health professionals, navigation through the treatment options, addressing relationship concerns, and finding peace in themselves.

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The sexual problems that result from Peyronie's Disease, can disrupt a couple’s physical and emotional relationship. For men regardless of their relationship status, any sexual expectation to perform sexually, when they have a condition which effects the penis, has a high potential for developing problems around self-esteem, self-confidence and anxiety which can further escalate problems with sexual performance.

Adapted from: Porterbrook Clinic and Sheffield Hospital Andrology Service Information on Peyronie’s disease.

Andrology Australia Factsheet.

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Most urologists would agree that having consistent, healthy erections is key to maintaining peak sexual performance. However, due to the painful nature of erections for many Peyronie’s disease suffers, they may find sex unenjoyable or impossible.

Dave Wells believes in a unified approach to supporting a person with their health needs as the best way to support the participant. As a result, Dave Wells would encourage communication was held with other health professionals involved in the maintenance of Peyronie’s disease, such as Urologists, doctors, etc, to ensure the best standard of support would be provided.

When working with men and their partners who were affected by Peyronie's disease in Sheffield, England, I discovered that the use of alternative equipment, such as penile pumps (hospital grade), combined with erectile dysfunction medical treatments were very effective in improving the symptoms for the men that we treated. An essential part of the treatment journey for the clients was the excellent relationships that they had with the clinic staff built on trust and respect, in a friendly and safe environment where they were treated as a person, and not a number.

Dave Wells can provide emotional and psychological support, alongside holding a medical understanding of Peyronie's disease. An important area of support also involves navigating the changes, pressures, and stresses that Peyronie's disease can place on a romantic relationship, or for men who enjoy casual partnerships. Having a person that you can talk to on a regular basis can be an essential part of your recovery.