BENT BUT NOT ALWAYS BROKEN: PEYRONIE’S DISEASE
The other significant complication of Self Injection Therapy (SIT) is Peyronie’s disease. This disease causes an unnatural curve in the penis at erection and can be very distressing. It can also progress to permanent impotence.
Before injection therapy was available, Peyronie’s would occur in one man in every 100. The men were usually over 40 and the origin of their unfortunate condition was unknown. Since Peyronie’s was first described 230 years ago, it has been attributed to everything from excessive masturbation to auto immune disease. It could spontaneously appear for no obvious reason, although it was relatively rare in young men. With the availability of injections, the picture is changing, and Peyronie’s across all ages is becoming a common feature of urology practice.
Many men naturally have a minor curve that is no impediment to intercourse. This should not be confused with Peyronie’s, which is caused by a gradual build-up of a plaque of scar tissue inside the tough elastic sheaf of the penis.
The plaque is inelastic and does not expand with the sheaf during erection. The erect shaft is forced to curve around it.
There are three ways injection therapy may lead to Peyronie’s. The injected chemicals may act as an irritant and cause scarring, they may be injected incorrectly in the wrong area, or they may cause an erection that is much harder than normal. Penile tissue in a man of 40 or 50 is not as elastic as it used to be. While artificially hardened, it is vulnerable to cracking if accidentally bent or bumped during intercourse. After a crack develops, scarring and Peyronie’s follow.
About a third of those who develop it as a result of injection therapy have it so badly that it stops them having sex. Their penis becomes too painful, too bent for penetration or just too limp.
The other two-thirds often feel a lump, perhaps go through anxiety about it being cancer and experience some pain during intercourse. The disease usually burns out in 12 months, leaving them with a painless scar. Often men are bitterly disappointed with injection treatment because they end up with a scarred, bent penis.
Doctors are experimenting with different drugs to try to arrest Peyronie’s in its early stages. If it is advanced and the bend is severe, there are two possible operations to straighten it. One is a nip and tuck procedure, which is 100 per cent successful but results in a shortening of the penis. Depending on the position of the bend, the shortening may be considerable.
The second operation involves removing the plaque and replacing it with a graft taken from a vein or a deep layer of skin from elsewhere in the body. This works about 70 per cent of the time, but if it fails, it can lead to further scarring and impotence.
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