Friday, 4 November 2011

Peyronie's disease

As it's a repeat weekend on spiritplants radio I thought I would do a piece on a medical condition of particular interest to men who are over 50 and have high blood pressure as this is the group most often affected by Peyronie's disease.

So what is Peyronie's disease? I had never heard of it until I developed it. It's small areas of scar tissue that form between the two outer layers of skin on the penis, this scar tissue restricts the blood flow on that side of the penis and causes it to become bent when erect. Not so much deformed as specially shaped to provide extra stimulation – well that's how I try to sell it anyway LOL

Mine is about 2 thirds of the way up from the base and the side closest to my body and has an angle of about 80 degrees. In some men it can develop to an angle of 120 degrees! Yes when the consultant told me that my eyes watered as well. The consultant went on to say “we don't know what causes it and there is no treatment other than resorting to surgery in very extreme cases”. The surgery is not always successful and can lead to loss of sensation due to nerve damage, it also reduces the size as don't lengthen the short side but shorten the long side of course.

I had been diagnosed with high blood pressure for 3 or 4 years before it developed but as a man I ignored it – had I known of Peyronie's I would have been down to the doc's treatment lickerty split.

Most of the sites dealing with Peyronie's seem set up to sell “treatments”, http://bbc.com has a page on the subject but I hav'nt been able to see it as Leeds City Council who run the network I use for internet access has it BLOCKED – I am in discussion with them about it.

But you can try http://www.peyronies.org/index.htm and you can find pictures at http://www.peyroniesmd.com/pictures-of-peyronies-disease.htm. But I worn you to be careful not to go to a site with pictures of the surgical procedure I did and I can still picture them in my mind's eye.


Here is some information I downloaded for my self, I will also include some on the related condition Penile Fracture. On the later subject even if you have no interest please skip to the bottom and read “A Case History - Broken Penis by Pfhor” it's worth reading just to see how he managed to keep his sense of humour.


Peyronie's disease

Usually, penile trauma arrives quietly -- via small tears in just a few layers of the stretchy tunica albuginea. These don't qualify as fractures and often don't even hurt. But experts believe the unnoticed damage can build up and lead to unmistakable problems: the curved penis of Peyronie's, which affects about 1 in 10 middle-aged men. (Exact numbers are tough to know; estimates range from 1% to 24%.)

The body relies on blood flow to repair damaged tissue without leaving a scar, yet very little blood circulates in a penis -- except when it's erect, of course. As a consequence, extensive scars can build up in the organ's elastic layers over time.

Imagine inflating a hot-dog-shaped balloon while pinching one side. As the balloon expands, it bends toward the pinched side. Likewise, a penis with Peyronie's disease looks normal when flaccid but curved when erect. And the greater the scarring, the greater the curve.

Most men who encounter the disease do so in their early 50s. One possible reason is that penile tissue can weaken with passing years. Elastic layers in a middle-aged penis are more likely to give out during vigorous intercourse than in a youthful one.

Also, erections soften with age, which makes even unathletic sex more accident-prone. Just as it's easier to bend and twist a half-blown balloon than a fully inflated one, less-than-rigid penises buckle more easily during intercourse.

The topside, mid-shaft of the penis usually bears the brunt of this buckling pressure, so scars often form there -- giving most affected penises a skyward curve. In severe cases, the penis resembles a hook, curling back to touch the abdomen.

A bend causes dual problems: erection difficulties and logistical issues with intercourse. "Some people will have a rigid penis, but it's so curved that there's nothing they can do," Lue says.

Erectile dysfunction medications such as Viagra might protect some men -- and harm others. In men with mild erection problems, the drugs can bring a medium-soft erection up to full strength, "so there's less chance of injury during normal sexual activity," Montague says.

But for men with severe erectile dysfunction, the drugs might make matters worse, by providing an erection that's just about firm enough for penetration but still soft enough to buckle easily during intercourse.

Cardiovascular problems -- particularly diabetes, high blood pressure and high cholesterol -- boost the risk of Peyronie's as much as six times, according to a 2006 study. Smoking and drinking alcohol each increase chances five-fold. These tend to soften erections and change the structure of the stretchy penile tissue.

Healing from prostate surgery can cause problems, and genetics is probably involved too.

Treatment for Peyronie's disease is still tricky. Dr. Francois de la Peyronie -- who wrote about the condition in 1743 -- suggested that men apply mineral water and mercury to their organs. Electricity, arsenic, cow's milk and a deep heating of the rectal muscles have also been recommended in past times.

Medicines used today directly target the scars on the elastic sheath of the penis. But most have not been tested in large, convincing clinical trials. Two drugs -- interferon and verapamil, both of which help stop new scar tissue from forming -- have shown promise in smaller trials.

Currently underway by Auxilium Pharmaceuticals is a large clinical trial for collagenase, an enzyme that might break down scar tissue in the penis. Also planned is a smaller study by Allergan to investigate the use of botulinum toxin -- Botox -- which might relax penis muscles and reduce scarring.

About 10% of the time, untreated penises with Peyronie's disease will straighten on their own. If not, doctors may recommend surgery after a year or so. Options for reducing the curve include implanting a prosthesis (which adds firmness but requires set-up before sex); permanently pinching a bit of elastic tissue opposite the scar (which also shortens the penis); or replacing scar tissue with a tissue graft (which can sometimes cause other problems, such as numbness or complete loss of erections).

The best approach to Peyronie's disease involves preventing penile trauma in the first place, urologists say.

A bit of biomechanical common sense helps: Stay well-lubricated during sex to reduce friction. Be aware of pubic bones and other hazards, especially during entry and reentry. Keep thrusting motions along the length of the shaft. And avoid maneuvers that bend, twist or buckle the penis.

In short, be careful. It's not a toy.


Peyronie's

Peyronie's disease is a benign (noncancerous) condition of the penis that tends to affect middle age males. The incidence is 4.3 per 100,000 men aged 20 to 29 years and increases to 66 per 100,000 men aged 50 to 59 years. Peyronie's Disease (also known as "Induratio penis plastica") and more recently (CITA) Chronic Inflammation of Tunica Albuginea, is a connective tissue disorder involving the growth of fibrous plaque in the soft tissue of the penis affecting 1-4% of men. Specifically the fibrosing process occurs in the tunica albuginea, a fibrous envelope surrounding the penile corpora cavernosa causing an abnormal curvature of the penis (Medical Definition). Approximately two thirds of affected men are between the ages of 40 and 60 years.

The exact cause of Peyronie's disease is not known. The disease is characterized by the formation of plaques in the tunica albuginea of the penis. These plaques may be felt on penile examination and at times can feel as hard as bone. The plaques are like scar tissue and affect the function of the tunica in that area. Because the plaque is not elastic and stretchy like the rest of the tunica, it pulls the penis to the side of the plaque during an erection and may also cause "wasting" (an indentation in the penis) at the site of the plaque. There may also be pain associated with an erection. Lastly, because the plaque does not behave like normal tunica, it may also cause erectile troubles. The plaque may occur anywhere along the penile shaft but is more commonly identified on the top (dorsal) surface of the penis. More than one plaque may be palpable. The hallmarks of Peyronie's disease are a palpable plaque (a hard spot along the shaft of the penis that one can feel when examining the penis), penile curvature, and a painful erection.

After the scar has matured, the configuration of the tunica albuginea is unlikely to be changed by nonsurgical treatments.4 However, many patients with advanced disease who have not sought surgical correction have been able to continue mutually satisfactory sexual intercourse with a partner. Approximately one third of patients with end-stage disease have a disabling curvature that requires surgical correction.

Pain that occurs in conjunction with Peyronie's disease may also progress with the onset of new injuries to the corpora cavernosa occurring as a direct result of the patient's attempts to correct or compensate for the original defect during sexual intercourse.5 One of the more common reasons for seeking treatment involves discomfort of the patient's partner during intercourse, which is associated with penile curvature.



Peyronies Diagnosis

The disease typically has a slow onset, and most men cannot identify a precipitating factor. Several theories exist as to the cause of Peyronie's disease; the most commonly accepted theory is that minor trauma during intercourse leads to minor tears in the tunica or rupture of small blood vessels. Bleeding and abnormal healing occurs after this injury and produces the plaque. In some men, there is a family history of Peyronie's disease, and 16% to 20% of men with Peyronie's have a disease called Dupuytren's contractures. Dupuytren's contractures is an inherited condition that causes contractures in the hands that pull the affected fingers inward. An increased incidence of arterial disease (30%) and diabetes with its associated small arterial disease (2.7% - 12%) has also been noted in men with Peyronie's disease.

The natural history of Peyronie's disease is variable. The disease is thought to have two phases: the acute phase, which usually lasts up to 18 months and is associated with pain, penile curvature, and plaque formation, and a more chronic phase, in which there is minimal or no pain, a palpable plaque, and residual penile curvature. Over time, the disease may progress in about 42% of men, improve in 13%, and remain the same in about 45%. In many cases, the disease produces few symptoms, the curvature does not prevent sexual performance, and there is no pain or associated erectile dysfunction. In such cases, reassurance that there is nothing bad going on is often all that is necessary.



Evaluating your Peyronie's disease?

As with any initial presentation, the evaluation of Peyronie's disease starts with a history of symptoms: duration and presence of pain; current erectile status and erectile status before the onset of the Peyronie's disease; whether symptoms are stable, progressing, or regressing; and degree of penile curvature and its effect on sexual function. The physician will ask about a history of prior penile trauma or manipulation.

1. Erectile dysfunction is found in about 19% of men with Peyronie's disease. The erectile dysfunction in Peyronies disease may be the result of: performance anxiety;

2. the penile deformity preventing intercourse; a flail penis, whereby extensive Peyronies disease causes scarring in a segment of the penis that therefore does not become rigid, while the remainder is able to become rigid

3. an impaired erection, which may be related to concomitant arterial disease (36%) or veno-occlusive disease (59%)



Preventing penile fractures and Peyronie's disease

Penile fractures, in which penis tissue ruptures, occur more often than you might think. Other injuries from wear and tear are even more common and can lead to Peyronie's disease, which leaves the penis with a bend, sometimes so great the penis is unusable.

From a purely biomechanical point of view, the design of the human penis has its pros and cons. Thanks to clever hydraulics and some very stretchy material, the organ is capable of eyebrow-raising changes in size and shape.

But indestructible it is not.

"It's too bad men aren't issued an owner's manual for their penis. They don't realize it's possible to injure it during sex," says Dr. Drogo Montague, director of the center for genitourinary reconstruction at the Cleveland Clinic in Ohio.

Fans of ABC's "Grey's Anatomy" got a peek at this possibility when the character of Dr. Mark Sloan "fractured" his penis during sex in a recent episode. Within hours, "penile fracture" and "broken penis" topped Google's most popular search terms.

Fractures -- in which penis tissue ruptures like a burst tire -- occur more often than one might think. "We usually see a fractured penis every month at our hospitals," says Dr. Tom Lue, professor of urology at UC San Francisco. Even more common, though, are mild, painless injuries to the penis during sex. Such wear and tear can lead to an increasingly prevalent condition known as Peyronie's disease, which leaves the penis with a dramatic bend.

Both conditions are as old as sex itself and documented as far back as the 10th century. But during the last decade a new factor has emerged that may be linked to more complaints of penile trauma: erectile dysfunction medications such as Viagra, Cialis and Levitra.

Experts say these drugs help protect some men from injuries during sex -- but put others at greater risk.


Fractures

When a man becomes aroused, rapidly pumping blood gets trapped in his penis. Two spongy tubes that run through the shaft swell and strain against the surrounding stretchy sheath -- known as the tunica albuginea, or "white tunic."

As the penis thickens and lengthens, its elastic tunic expands and thins. But if the tunic stretches beyond a certain point -- as the shaft suddenly flexes too far, for instance -- the layers can rip, releasing a small surge of blood. "There will be a sudden blowout," Montague says. "It's usually at the base of the penis, and it's very dramatic."

Doctors call this a fracture (despite the lack of bones in the penis). It is usually accompanied by a popping sound, then swelling and discoloration of the penis to a deep purple hue. Usually, the erection fades and pain sets in (though some couples reportedly try to continue with sex). Men may later find it impossible to urinate.

Young men are most at risk, in part because of the firmness of their erections and athleticism of their activities. Certain sexual positions are more perilous than others. "When a woman is on top, that's a dangerous situation," Lue says. If she bends too far forward or backward, she can create excessive torque on the penis.

Also risky is rear-entry vaginal intercourse because, again, the penis is more likely to bend too far at its base. According to a report published in December in the British Journal of Urology International, this sexual position accounted for half of the penile fractures treated at Brookdale University Hospital in New York between 2003 and 2007.

Careless insertion of the penis can spark a mishap in any position. Men, or their partners, should manually guide the shaft during entry to avoid colliding with a partner's nearby pubic bone, Montague says.

Occasionally, Viagra or related medications are associated with penile fractures. A 2002 case study from India, for instance, described a three-week period in which six men arrived at an emergency room with fractured penises -- all resulting from recreational use of sildenafil, the drug sold as Viagra, to achieve, the authors wrote, "prolonged sexual enjoyment, out of curiosity."

Medical reports have also discussed cases resulting from men attempting to fold an erect penis into tight underwear, or rolling onto their stomachs while asleep with nocturnal erections. And then there are odd habits.

In some Middle East regions, men engage in a practice known as taqaandan ("to click" in Kurdish), explains Dr. Javaad Zargooshi, urology professor at Kermanshah University of Medical Sciences in Iran. It's a painless process, similar to knuckle-cracking, in which the top half of an erect penis is bent forcefully while the rest of the shaft is held stationary.

Usually this produces only a loss of erection and a satisfying popping noise, says Zargooshi, who published a report on the phenomenon in December in the Journal of Sexual Medicine. Other times, it will fracture the penis. Taqaandan is a public health concern in western Iran, where penile fractures are unusually common. "The practice of taqaandan is increasing, and we don't know why," Zargooshi says.

Doctors can easily repair fractures with emergency surgery, with fewer complications than the previously standard treatment of ice packs and sex-free bed rest. A 2004 study found that more than 90% of men with surgically repaired fractures resumed their sex lives without problems.




A Case History
Broken Penis
by Pfhor
Mon Aug 11 2008 at 16:04:59

This is not my proudest moment

Around about two nights ago, me and my lady decided there were many, many things that needed celebrating. Abe's new job, her cousins visiting her, and my continued holding of the title "Guitar Hero God" (Ok, so not that many but when you're young and beautiful do you really need such profundity?).

There were many drinks involved, which is, in a roundabout way, where this tale of woe starts. We made our way back home, parting ways with the rest of our party and taking the metro, where we were mostly alone and taking true advantage of this. We left the subway and stumbled through the streets to our apartment where we started where we left off and eventually fell into that blissful torpor of drunken sleep.

The next day is where the problem started. Sex, Watson, and lots of it. Not entirely unheard of, right? Two young people, a sunday morning, not a care in the world, horrific hangovers, and far too many hormones than can feasibly be good for you. To make a potentially long story short: Sex can be bad for your health and I will endeavour to explain how, so that those reading may be warned, or at the very least get off on the schadenfreude of it all.

Theoretically, if the woman is on top and she is, um, slightly aggressive then there is generally a lot of movement, and almost certainly a lot of momentum. This is ordinarily fine, as the penis is usually somewhere safe where it can be protected from the harsh reality of what is actually happening and just strap itself in for the ride. You ocassionally get curious penises, however, that decide it's in their best interest to pop their head out to see what's going on. These are the ones you must watch out for, and if you have one be sure to chastise it before such a malady befalls you. Needless to say I didn't take such precautions and paid the ultimate price. My penis popped out to say "Hello!" where it was greeted quite harshly by my lovers pelvis who wasn'tá quite as friendly as it would initially seem. I've been told that there's a popping sound that is supposedly heard, but I can't recollect if this is true as the moment was very much upon us. What I do remember is a very sudden pain the likes of which I have never experienced and flaccidity on a scale that I had never encountered before.

She was blissfully ignorant of my predicament and must have decided that in my suddenly stunned state I was ready to go again. She took matters into her own hand and attempted to reawaken the beast. It failed and very nearly brought tears to my eyes. I made the suggestion that maybe she should take a shower and freshen herself up a little, as I needed to check on something. She hesitantly accepted and I did what any red-blooded male would probably do when faced with a problem: Consult the internet!

My first google search of "pain in penis" revealed a lot of results, most of which while fascinating in their own right wasn't really what I was looking for. I finally stumbled across the culprit, I believed, and my stomach turned (type "Broken Penis" into the image search of your choice for pictures that will make you cringe).

Wikipedia will gladly tell you that:

"A penile fracture is an injury caused by the rupture of the tunica albuginea, which envelopes the corpus cavernosum penis. It is an uncommon injury, most often caused by a blunt trauma to an erect penis."

Which is a very good if slightly sterile summary of the injury. A penile fracture is actually a very painful injury that causes fibrous tissue to hemorrhage internally thanks to the breaking of a very thin wall designed to prevent such occurances.

Neither explanation was really much comfort to me as I took the most awkward taxi ride in my life, with a very unnaturally concerned taxi driver who kept making a point to ask if I was Ok ("He's fine. His water broke 5 minutes ago"). Thankfully ER was very much empty and I was able to be seen to quite quickly. I was almost certainly an oddity, to the point where they were slightly incredulous of my tale and needed many "second opinions" (which I've found is probably code for "Come and look at this guy who's hung like Clifford the Big Red Dog"). I finally got to see a Urologist who took the time to explain to me what had actually happened in great detail. A lot of this flew over my head but my girlfriend, who is a med student, took the time to explain it in terms that would probably be easier to understand:

"So imagine you have a sausage with two casings, and you bend it just enough that the internal casing breaks but the outer one stays intact. This releases a lot of grease that doesn't have much options as to where it can go."

Did I happen to mention she found this very amusing?

I was also told that I was very wise, lucky and fortunate to come when I did as a large amount of cases can go unreported and this can lead to an incredibly high complication rate. I would have to undergo surgery as soon as possible. They took my medical history and all relevant information and after going through the technicalities they put me under and did the surgery.

I awoke several hours later with an incredible amount of throbbing pain in my groin. My girlfriend was there to lovingly tell me that it was Ok, they didn't remove anything. The doctor reappeared sometime later and told me that the operation was a success. They removed the clotting, repaired the damage that was done and after briefing me on the proper precautions I should be fit to leave whenever I feel up to the task.

The first was no sexual activity for at least a month, and it was at a physicians discretion when I would be allowed to resume. This means regular checkups that the healing process is going smoothly and that there's no post-surgery complications. I could already see the problem here. I'm reasonably certain I could refrain from such activity. I'm also reasonably certain that foul temptress of mine would be doing everything with her rather limited options to make this a true test of endurance. The briefest hint of a smirk gave away her intentions.

Second was an issue of hygiene. When washing (an act that in and of itself will be a long time coming. I look like the mummy from the waist down), I should be incredibly careful when washing my genitals, as not only will it be very sore but there is also risk of further injury.

I could agree that yes, this wasn't what I wanted, and took note.

The third was regards to that wonderful pastime, urination. I was given one of those things which I can only really describe as a piss bottle (when I spent quite some time in hospital as a child these were made of some sort of cardboard. I got the much more chic, infinitely more sexy plastic model.) Things are still very much messed up down there. There's swelling in pretty much every part of my being and this will obviously make urination difficult. I can use this to urinate in then empty it into the toilet to make things far easier for myself as I'm liable to have very little flow control, or at least less than normal

The last was regarding pain management. I was given quite heavy duty painkillers and told to take them on a regular basis. The swelling will go down eventually but the discomfort would almost certainly last longer.

Yes, it probably would.

So I discharged with much soreness (that is, left the hospital), and made a slightly less frantic but no less uncomfortable taxi journey back home. Every jostle resulted in pain, every sharp turn the promise of agony.

Arriving back at the apartment I could finally see the inherant disadvantages of living on the second floor with absolutely no elevator. Making what I feel is a herculean effort to climb the stairs I finally managed it and attempted to get to sleep. This was an utter failure. Absolutely every single position resulted in at least 2 areas being incredibly painful and even with a pillow propping my legs open it was not to be. So this has left me, for the past several hours, complaining, writing this, and thinking of plausible ways to explain my absence from work.

I'm open to suggestions.


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