Bent and curved dick (Peyronie’s Disease)
Here is a description of Peyronie’s disease and a discussion of some treatment options.
Peyronie’s disease was described in 1743 by a French physician named Francois de la Peyroni, who reported that patients with scar tissue in the penis had a significantly bent penis. Until recently, Peyronie’s disease was a poorly understood condition.
Many original descriptions depicted it as secondary to scarring from masturbation or sexually transmitted diseases. It is not a malignant condition of the penis. It affects men primarily between the ages of forty to sixty. The reported incidence is somewhere in the range of 4 percent, but I suspect it is much more common and vastly underreported. Patients often delay seeking medical help out of fear and embarrassment. The hallmark of the disease is a plaque or hard spot along the shaft of the penis.
This occurs in the vast majority of men with Peyronie’s disease. The plaque may range from a few millimeters or may encompass the entire length of the penis. The most common reason for seeking medical help is painful erections and erectile dysfunction.
Causes of Peyronie’s disease
The cause of Peyronie’s disease is not well understood. Currently, a number of theories implicate trauma as the most likely cause. In the cases that I have seen in my practice, this is the most common cause.
Unfortunately, as with most things that relate to human sexuality, we are not taught how to have intercourse.
Consequently, many positions and practices that young men do put a great deal of torque and pressure on the penis, causing microtrauma to its delicate supportive structures.
When there is microdamage, scar tissue develops and restricts the blood flow to the area. It either impedes the blood flow, causing erectile dysfunction, or it causes a bending in the penis at the level of the scar. Occasionally, this bend is so severe that is makes intercourse impossible.
Peyronie’s disease has also been linked to family history. Although this is a difficult linkage, since many men don’t really know if their family had a history of it, enough reports support this as a risk factor. Peyronie’s disease has even been implicated with certain medications such as beta-blockers, the medications used in the treatment of high blood pressure.
Other fibrosing-type diseases such as Dupuytren’s contracture, a disease that causes visible scarring of the palms and soles, have also been linked to Peyronie’s disease.
Peyronie’s disease treatment options
Can Peyronie be cured? Can Peyronie be reversed? These questions are asked again and again, but not everything is so simple, and it\s not that easy to fix bent penis.
The natural history of Peyronie’s disease is variable. The disease has an acute and a chronic phase. The acute phase is variable, but the majority of the scarring and the bending occur during this phase.
The chronic phase may last for long periods of time. Typically, roughly 50 percent of patients with Peyronie’s disease will improve with time, and 50 percent will get worse with time. One study found that almost half the patients never experienced the problems with bending of the penis, and typically, the pain associated with the acute phase of the disease resolved with time.
There have been numerous attempts at both medical and surgical treatments for this disease. Medical management has encompassed everything under the sun, but because there is no clear reason for the disease, there is no clear treatment for it. People have advocated the use of spa waters, mercury, arsenic, radiation treatments, ultrasound treatments, short-wave laser treatments, and shock wave treatments for this condition. None of these have found wide acceptance because none have been proven to be effective.
The only real oral treatment that has been widely available is vitamin E because of its antioxidant properties and Potaba (potassium amino benzoate).
The Food and Drug Administration has classified it as a “possibly effective drug,” although the mechanism of action is not well understood.
Numerous studies have examined the use of other drugs. These include tamoxifen, an anti-estrogen drug used in the treatment of breast cancer. There is no long-term data available on the use of this drug.
Finally, a recent study advocated the use of oral colchicine, an anti-inflammatory drug used in the treatment of acute gout which inhibits the motion of white blood cells and prevents pain in the acute phase of arthritis. This is a complex medication and has been used to treat numerous conditions.
Side effects include diarrhea, and it has been associated with erectile dysfunction as well.
For years people have used intralesional steroids where they have actually injected long-acting steroids into the plaque of the penis to prevent the fibrosis from occurring. Again, there is no long-term data available with regard to this procedure.
Unfortunately, at this time there is no definitive treatment for Peyronie’s disease. In my own clinical practice, I tend to shy away from Potaba as a first-line therapy because of the large doses required and the side effects. People complain of gastrointestinal distress as well as the cost of the medication.
I recommend vitamin E as the first-line medical therapy because it has been shown to have other benefits in the body, and it is not harmful in the recommended doses. There is, however, no control study that demonstrates its benefit.
Surgical Treatment for Peyronie’s disease
The surgical treatment of Peyronie’s disease is similar to the medical treatment–there is no best operation. Before considering a surgical procedure, the disease should be stable for one year. This avoids surgery on the man who may get a spontaneous resolution of the disease.
Surgery should only be performed on men who have difficulty inserting the penis during intercourse because of angulation.
If a patient has somewhat of a bend but is able to enjoy intercourse, I do not recommend surgery.
As long as the penis can remain firm enough for penetration and relatively straight enough for intercourse, I do not recommend therapy other than the use of vitamin E.
Surgeons visualize the degree of bending prior to surgery by taking pictures of both the side and top view. The most important question is, “How firm is the penis past the narrowing or the scar?” This will determine if, in addition to the straightening procedure, something else needs to be done.
Nesbit procedure with Peyronie’s disease
The Nesbit procedure is the gold standard procedure for the treatment of Peyronie’s disease.
This procedure was developed to taper the unaffected corporal body on the side to correct the deformity. In other words, with a substantial bend, we take segments from the corporal body on the opposite side to create a straight penis.
As with all operations, the Nesbit procedure has numerous complications which must be carefully discussed with the prospective patient. They can include postoperative difficulty with erections, over-correcting or bending to the opposite side, scarring, numbness of the glans or the penile shaft, blood collection under the skin of the penis called a hematoma, and wound infection.
It is important to advise patients that this operation will not remove plaque. Tissues are merely shifted around to accommodate for the scarring the plaque has caused.
Peyronie’s surgery: plication technique
Other modified procedures use a plication technique. Instead of cutting wedges into the corporal body, as with the Nesbit procedure, a plication pulls the tissues together by putting multiple loops of sutures farther away from each other. This actually accomplishes what the Nesbit procedure does but on a less traumatic scale. It is a much less invasive technique, and the results are similar.
In addition to using modified procedures for Peyronie’s disease, the plication technique is also useful treating congenital curvature of the penis, a relatively uncommon condition in young men.
It is also possible to excise plaques and use grafts of artificial material such as Gore-Tex or the patient’s skin without its outer lining. Gore-Tex is a product commonly found in waterproof clothing and has been successful in arterial grafts. It was originally developed as a coating for wire, but it has found a multitude of other uses, including grafts.
V.E. was a twenty-nine-year-old man who was urinating with a morning erection. His penis got caught between the seat and the rim of the toilet. Upon standing up, he snapped his penis, and caused a disruption of the right shaft of the corporal body.
Penile prosthesis is another surgical procedure to repair this condition. Prosthesis not only straightens the penis but improves the erection. A careful history and physical examination should first establish that this is in fact a stable disease, and then to maximize medical therapy which includes vitamin E.
Men who are unable to have intercourse because of a significant bend but still have a hard penis can get penile injections at the office to observe firsthand how hard the erection is as well as any other complications.
How to straighten a bent dick: medical help
Additionally, I recommend a rigiscan to compare the base to the tip. If the penis is severely bent but the erection is firm, I recommend only a straightening procedure.
Graft material is not the initial treatment in my practice. If the penis is so severely bent that the tip is soft, surgically straightening the penis will still require an additional method to improve erections, such as a vacuum erection device or penile injections. At this juncture, I recommend a penile implant in men who do not wish to have additional treatments.
B.F. was a thirty-four-year-old man who was having intercourse with his girlfriend in the superior position. His penis became dislodged when his partner moved in an upward fashion. Not realizing that it had slipped out, she came down with all of her weight and snapped his penis in two. This affected both corporal bodies as well as the urethra. This case underscores the need to take care in certain sexual positions so as not to submit the penis to excessive forces.
A penile prosthesis will straighten the curvature without the need for incision of the plaque. Additionally, patients will not need some type of grafting procedure with the prosthesis. Placement of a prosthesis in men with Peyronie’s disease is no more difficult than with most other patients.
But I feel that Peyronie’s patients with a substantial bend that precludes adequate penetration and who are impotent are the only candidates for prosthesis. There is no perfect surgical treatment for this condition, which is why there are so many treatment options.
My recommendations to patients are:
- Be comfortable with the diagnosis to at least face the treatment initially;
- and before considering surgical therapy, be sure that the physician you have chosen is experienced in this type of surgery.