The basics on Peyronie's that every patient needs to know, symptoms, onset, etc. Below is an excerpt from Chapter 1 of the book "Overcoming Peyronie's." You can also download Chapter 1 as a pdf.
This is only the first chapter; the following chapters which you'll find in the full book cover treatment options (a comprehensive list covering both "conventional" and "natural" treatments), a discussion of leading Peyronie's physicians, DMSO, how to set up a recovery program, and more information.
One of the most challenging aspects of overcoming Peyronie’s is how difficult it is to find useful and correct information about it. Most general practitioners don’t know enough about Peyronie’s to give the patient much more than a referral to a urologist. The patient’s first stab at researching Peyronie’s Disease on the Internet yields general medical sites or online encyclopedias that offer limited information, and usually misinformation.
Finding accurate, substantive information about Peyronie’s takes effort. But it is worthwhile. Acquiring even the basic facts about the disease, its causes, its progression and its treatments, gives the patient a sense of control over his situation, and hopefully a sense of purpose as he takes ownership of the task of recovering.
This first chapter provides basic, introductory information about Peyronie’s. It is a framework that the reader can fill in with his own research, experiences and perspectives. (Chapter 4 provides tools to do that research.)
Most male mammals have a penis bone, called a baculum, that makes the penis rigid enough for sexual penetration. But the human penis, for better or worse, is a more complex structure. Instead of using a bone, it becomes erect by using hydraulics (fluids); blood fills the penis, making it expand and stiffen.
lls the penis, making it expand and stiffen.
The corpora cavernosa (singular: corpus cavernosum, Latin for a “body” filled with “cavities” or “holes”) are two semi-hollow cavities in the penis that contain porous spongy tissue. The corpora cavernosa fill with blood, which stiffens and enlarge the penis. The tunica albuginea (Latin for “white tunic”) surrounds the corpora cavernosa and runs between them. The tunica, in turn, is covered by skin. It is the tunica that is damaged in Peyronie’s Disease.
How Peyronie’s Develops: Trauma, Scarring and Plaque
When you cut your finger, the result is a wound, or “trauma” in medical language. The body reacts to the wound by first covering it with a gel-like substance called fibrin, which is a protein made up of fibers. Next, the body produces collagen, another protein fiber, which temporarily fills in area of damaged tissue. The fibrin acts as a kind of primer, or scaffold, for the collagen. Collagen isn’t just for wounds—in fact, collagen holds together much of the body’s solid mass. But the collagen in a wound is slightly different; because the body’s immediate task is to protect the damaged tissue, it deposits the collagen hastily, in unorganized, messy clumps. Eventually, that mass of collagen may be replaced with better collagen whose fibers are aligned, which allows greater elasticity than the tough, inflexible, temporary collagen. When the immune system functions normally, the amount of fibrin and collagen deposited to protect the wound corresponds to the wound’s severity.
Microscopic wounds, called microtrauma, occur regularly in the human body. When you exercise for example, you develop miniscule tears in muscle fiber that, collectively, make your muscles feel sore. Microtrauma also develop regularly in the penis, especially during sexual intercourse. The body’s normal response to microtrauma is to lay down tiny amounts of fibrin and collagen, proportionate to the size of the wound. However, for reasons unknown, the body sometimes overreacts to microtrauma and lays down much more fibrin and collagen than needed. This is what causes Peyronie’s Disease.
Peyronie’s Disease is the body’s overreaction to tears in the tunica albuginea in the penis, in which the immune system deposits protective fibrous tissue and scar tissue in quantities that are totally disproportionate to the original trauma. This tough, fibrous tissue is called plaque. It renders the penile tissue (which is usually elastic, allowing the penis to become erect and flaccid again) tough and inelastic. The plaque eventually becomes a scar, which may remain stiff, and never be replaced by either better, more flexible scar tissue, or normal and elastic healthy tissue.
The plaque can develop anywhere in the tunica—along the top, or “dorsal” area of the shaft, on the underside or “ventral” area, or on the sides. Ventral plaque forms behind the urethra. Plaque can also occur in the part of the tunica that runs between the corpora cavernosa.
The plaque or scar produces bends and deformities when the penis is erect (sometimes also when it is flaccid). Urologists like to tell their patients to imagine sticking a piece of adhesive tape onto an empty balloon and then blowing it up. As it fills with air, the balloon will twist and bend in the direction of the tape, preventing it from stretching. Similarly, the penis bends in the direction of the plaque.
Peyronie’s can be caused by serious trauma to the penis, such as from a car accident or contact sports. It can also result from “false moves” during sex that bend the penis awkwardly and forcefully. But in most cases, so it seems, Peyronie’s develops in absence of any remarkable trauma. It often appears suddenly, without explanation.
Recovering from Peyronie’s means attenuating or softening the plaque and restoring the healthy, elastic tissue so that the penis can expand normally.
Note that many men have some degree of congenital curvature: this is when the penis bends not because of an illness, but because that’s just the way it’s shaped. This is not Peyronie’s. In fact, most penises meander a bit in one direction or another, and it’s uncommon for a penis to be perfectly straight. Most men also have large veins around the shaft, which aren’t related to Peyronie’s either.
From this point, I will stop referring to Peyronie’s as a disease. To me, it really isn’t one, at least not in the way
Hazard! Penile Fracture
A sudden, strong impact or sharp bend forced on the penis can result in a rupture of the tunica albuginea. This is called penile fracture. There is usually an audible snap or popping sound when it occurs.
Penile fracture must be treated immediately. If it happens to you, check into the emergency room right away. You will have an operation; it’s unpleasant but can avoid serious problems later on.
Penile fracture often occurs when the woman is on top and accidentally misses the penis when she comes down. Be careful gentlemen.
most people think of disease. And it’s not helpful to overcoming Peyronie’s to think of it as one. “Disease” makes me think of a virus or bacteria—an invader that’s fighting my body for resources. Peyronie’s is an autoimmune disorder. It’s a mistake, not an attack. That’s why I prefer to think of Peyronie’s as a medical condition. Of course, this is just semantics, and it’s a false distinction if one wants to be really unforgiving about it. But I think the distinction is worth making, and it’s especially important if you decide to try visualization therapy (see page 45).
Underlying Causes of Peyronie’s
We know how Peyronie’s develops—the body overreacts to tears in penile tissue and produces a deforming plaque. But we do not know why it happens. We don’t even know what circumstances, conditions, or habits make a man prone to it.
When you ride a bicycle, do you sometimes feel a numb or tingling sensation in the prostate area? Some doctors suspect that riding a bike for long periods of time can cut off circulation in the tissue that bears your weight on the bike seat. This may contribute to prostate illnesses, and perhaps Peyronie’s as well.
There is evidence, though not much, of a hereditary component. This has been difficult to establish, since men are more reluctant to discuss their Peyronie’s with their fathers and sons than they would be to discuss, say, sickle cell or skin cancer. Poor blood circulation, low oxygen levels and general inflammation are probably contributing factors. There is some suggestion that beta blockers can make a man more susceptible (though some doctors believe the connection is totally unfounded), and some research indicates a link with smoking. Rough sex can definitely provoke it. A few urologists suggest that Peyronie’s frequently develops when a man is asleep and the penis is bent or impacted during nocturnal erections.
But none of these observations explains the underlying cause; every man develops small tears in the tunica, and the immune system usually responds with proportional amount of fibrin and collagen. Why do some men’s bodies overreact by producing large plaques? No one knows.
Our lack of knowledge does not mean that Peyronie’s is untreatable. There are many treatments for Peyronie’s. But our inability to fully understand the illness’s mechanisms and underlying causes does make it more difficult to know which treatments are really effective.
Physical Effects of Peyronie’s
The most noticeable effect of the Peyronie’s plaque is of course the bend or deformity. It varies with the size and toughness of the plaque (though the correlation between plaque size and severity of the bend frequently diminishes, and even inverts, as the condition progresses). The plaque can cause a bend in any direction, left or right, up or down. The plaque can form as a ring around the shaft, causing an hourglass-shaped deformity. It can cause a twisting, spiral shape. Plaque develops along the shaft, never on the head. The bend can be only a few degrees, or as much as 90 degrees or even more, such that the penis bends back on itself. The most common direction of curvature is upward, resulting from a dorsal plaque. Doctors don’t know why this is. But I think that sexually active men can guess from experience that it’s because the dorsal side of the penis receives the most friction during sex, at least when the man is on top.
Pain may or may not be present. Many men report plaques and curvature without pain. There are no nerves in the tunica itself. However, pain definitely can occur, and varies from mild and intermittent to severe and constant. When there is pain, it is usually felt during erections, when the tissue is bent, though mild and even severe pain can occur when the penis is flaccid. Unlike the deformity, pain almost always passes with time.
Prevalence: Is Peyronie’s Rare?
No, Peyronie’s is not rare. Generalist medical web sites often mistakenly call Peyronie’s a rare disease, but this is only an example of the medical community being under-informed about the illness.
No one knows the precise prevalence, but the most current analysis I’ve read suggests that between 3 and 9 out of 100 adult men have it, and I think that most informed urologists would agree with that estimation.
Peyronie’s most commonly develops in men between 45 and 65, and especially those in their early 50s. It does appear in men outside that age group, but less frequently. I developed Peyronie’s in my early 30s. It can develop in adolescents. There have even been infant cases, though these are extremely uncommon.
Peyronie’s seems to be more prevalent among Caucasians, but it occurs in men of all ethnicities. Dr. Laurence Levine, one of the most prominent Peyronie’s experts, writes: “In my practice, I have seen African-American, Hispanic, East Indian, American Indian and Asian men—including Chinese, Japanese and Korean men—with PD.” Several studies on Peyronie’s have been conducted in Korea in the last few years, which indicates that the condition is not uncommon in that country.
Peyronie’s prevalence is difficult to gauge because it is probably under-reported. Many men are embarrassed about it and don’t seek professional treatment. Some men believe that Peyronie’s is a curse or divine punishment (I have personally come across such a case), and therefore believe that cure depends more upon divine will than medical treatment. Peyronie’s is also easy to hide; no one, not even your family doctor, will know you have it unless you want him to. Finally, the persistent advice from the medical community that Peyronie’s is basically untreatable further discourages men from seeking medical attention.
If between 3% and 9% of adult males suffer from Peyronie’s, that’s four to twelve million men in the United States and Canada, nine to twenty-seven million men in Europe, and twenty-six to seventy-seven million men in East Asia. That’s not rare, that’s common, and it’s a major health issue. The little attention given to Peyronie’s, in terms of both public awareness and physicians’ knowledge, is totally out of proportion to its prevalence.
The Phases of Progression
The conventional description of Peyronie’s progression:
Urologists usually think of Peyronie’s as having two distinct phases: an active phase and a stable phase. The active phase comes first, typically lasting from a few months to about eighteen months. During the active phase, the plaque and deformities evolve, becoming either more pronounced or less so.
Next comes the stable phase. The plaques have become permanent scar tissue, and the deformities and curvature won’t change any more. Once in this phase, the Peyronie’s doesn’t get any worse, but it doesn’t get any better either. A urologist will say that you are in the stable phase if you haven’t experienced any change in deformity for about three or four months.
Once in the stable phase, if the curvature is severe, the urologist may propose corrective surgery. Surgery is typically proposed only if the curvature is so acute as to make sexual intercourse difficult or impossible. Urologists think this occurs in about 10% of Peyronie’s cases, though no one knows how accurate this is.
The conventional description says that once the stable phase sets in there is no chance of the deformity getting better (or worse), and that only surgery or other aggressive measure can have an impact.
An alternative description of Peyronie’s progression:
I believe that the conventional description of Peyronie’s progression, though useful, is limited as a dominant framework. I submit an alternate description:
Instead of active and stable phases, I think of Peyronie’s as having a collagen-laying phase and a non-collagen-laying phase. During the collagen-laying-phase, the penis is actively producing excess fibrin and collagen, produced in a hastily constructed, non-aligned manner, which is creating new plaques and contributing to existing ones. During this phase, the deformity is becoming worse. During the non-collagen-laying phase, the penis has stopped producing excess fibrin and collagen, and the deformity is not becoming worse.
The first advantage of the collagen-oriented model of progression is that it gives the doctor and patient a better framework for evaluating and selecting treatments. Some treatments, such as intralesional injection, are particularly risky during the collagen-laying phase. If the penis is in the hyper-reactive collagen-laying mode, then an injection carries a very high risk of producing more plaque—this has been demonstrated in several individual cases. Once the immune system is in the non-collagen-laying phase, when it’s not overreacting to microtrauma with excessive fibrin and collagen, then intralesional injection, though never risk-free, becomes more viable. Other Peyronie’s treatments, such as vitamin C, may actually promote collagen production, so even if they help healing, the patient may want to delay them until he is in the non-collagen-laying phase. The active/stable model does not provide the patient or doctor the framework even to ask that question. It only informs the patient, as a passive observer-victim, of what to expect during each phase. Better to enable the doctor and patient to decide how to attack the problem, rather than to simply tell them what to expect.
Second, the collagen-oriented model encourages more focus on the individual patient, rather than thinking of Peyronie’s as a category whose individuals are more or less alike. It means focusing on the constantly-evolving state of the patient, and selecting treatments dynamically, according to what stage of progress he is in.
Third, the collagen-oriented framework encourages the patient to be proactive and pay attention to his condition, since it is his current and individual physical condition, rather than a generic template, that determines the course of treatment. The patient will be able to get an idea of whether he is in the collagen-laying phase by monitoring his curvature, pain, and unusual rigidity in the flaccid penis.
Fourth, the active/stable model leads to the assumption that once in the “stable” phase, the patient’s condition cannot improve, except by surgery or other aggressive methods. Yet I have read several cases of men whose Peyronie’s improved years after the onset, well after the Peyronie’s had supposedly settled into the stable phase. What’s more, Peyronie’s can recur, even after many years. So the term “stable,” as it is used today, is misleading.
The collagen-oriented model does not reject the notion that Peyronie’s has an active and a stable phase—it does. Certainly, there is a period when the deformity is changing, followed by a period when it is stable. But the distinction is not as sharp or rigid as the active/stable model suggests, and the framework is less useful for treating patients.
Calcification, recovery and recurrence
There is one further phase of progression that can develop, and this is calcification. In some cases, the Peyronie’s plaque develops calcium deposits, during which the collagen is gradually replaced with calcium, and the plaque becomes like bone, which can, if sever, be very painful. Depending on the severity of buildup, the calcified plaque may have to be surgically removed.
Urologists tend to expect about 10% of Peyronie’s patients to recover or significantly improve spontaneously, that is without aggressive treatments like surgery or injections. Recovery is more likely to take place within the first eighteen months or so. Younger men have a higher likelihood of recovery.
There is a misconception that even if there is recovery, Peyronie’s can never be completely overcome. I have read many cases of men experiencing total recovery from Peyronie’s. In my case, after a 45 degree curve, I am almost totally recovered, just one year after the onset.
There is evidence, though not much, of a hereditary component. This has been difficult to establish, since men are more reluctant to discuss their Peyronie’s with their fathers and sons than they would be to discuss, say, sickle cell or skin cancer. Poor blood circulation, low oxygen levels and general inflammation are probably contributing factors. There is some suggestion that beta blockers can make a man more susceptible (though some doctors believe the connection is totally unfounded), and some research indicates a link with smoking. Rough sex can definitely
History of Peyronie’s as a Documented Illness
The earliest known written analysis of Peyronie’s comes from a 1587 work by the Italian anatomist Giulio Cesare Aranzi (1529/30 – 1589). In 1743, the French surgeon François Gigot de la Peyronie (1678 – 1757) wrote a detailed description of three cases of the illness that today bears his name. De la Peyronie was First-Surgeon to French King Louis XV (often mistakenly reported as “Louis XIV” in the Peyronie’s literature—different time, different king).
Almost 300 years later, there is still no single, sure-fire cure for Peyronie’s. There are, however, many treatments with strong evidence of effectiveness and with a sound medical rationale. None is guaranteed to work, but overcoming Peyronie’s is not about guarantees. It is about sober, careful investigation and consideration of treatment options. It is about trial and error, courage, and unassailable perseverance. And it is about believing that exploring and pursuing as many avenues to recovery as possible is a better option than giving in, falling asleep at the wheel, and resigning one’s sexual future to chance.
Those treatments are the subject of the next chapter.
Download Chapter 1 of "Overcoming Peyronie's" in pdf.
Download Chapter 1 of "Overcoming Peyronie's" in pdf.