HERE’S THE FIRST thing to know about Peyronie’s disease: It’s not actually a disease. It’s the result of an injury brought on by either normal sexual activity, which can create micro-injuries to the penis, or something more extreme, like a sports injury. This causes scar tissue (also called plaque) to form in the penis, which creates a bend when it becomes erect. As a result, people with Peyronie’s disease may have difficulty with intercourse, or sex may become painful for you or your partner.
It’s no wonder, then, that people who this happens to are eager to find a treatment. And that brings us to the second thing to know about Peyronie’s disease: Different people will benefit from different treatments. Here are three main options to consider, followed by a quiz to figure out which one to discuss with your doctor.
How Doctors Decide on Treatment
THERE’S NO ONE way to treat Peyronie’s disease, since it can affect men very differently. In fact, some men may not treat the disease at all. “If you have a small upward curve and it doesn’t impact sexual activity, we may not do any treatment,” says Frederick Taylor, MD, a men’s health specialist and urologist with Central Ohio Urology Group. “But if the curvature is significant enough that you can’t have intercourse or it’s painful for your partner, we would treat it.”
Multiple factors are taken into account when deciding treatment type. If you’re still in the active phase, which is the first six to 12 months after injury, your doctor will likely recommend a wait-and-see approach. “The disease is still evolving, so we don’t want to fix how a penis looks only to find it looks worse or different down the road,” Dr. Taylor says.
If you’ve moved to the chronic stage, which is after the scar tissue has stabilized, it’s time to make some treatment decisions. Your doctor will consider factors like the severity of the curvature, whether it’s impacting your sex life, and if it’s accompanied by erectile dysfunction (ED). Another major consideration is personal preference. “I always tell people, we have a treatment for everyone—it’s just a matter of how far we want to go to fix the problem,” says Stanton Honig, MD, professor of urology at Yale School of Medicine.
Here’s a closer look at your treatment options:
Medications
If you go the pharmaceutical route, you’ll do a series of collagenase injections directly into the scar tissue. “This breaks down collagen, which is the building block of the scar tissue,” Dr. Taylor says. “It softens the scar, which is what’s causing the curvature, and you can see around 20 percent improvement or so.” You can do the injections alone or combine them with traction therapy, where a device slips over your penis to help stretch it out in the correct direction.
Collagenase is best for people with more mild curvatures of 30 to 90 degrees. You’ll need to go to the doctor multiple times for the injections, and you’ll also need to be patient, as it could take around four months to work.
Surgery
You have two surgical options to help straighten out your penis: plication and grafting. With plication, your doctor puts stitches on the penis opposite of where the plaque is. This, in effect, bends the penis back to make it straighter. It works best when there’s less than 60 degrees of curvature, but there’s one big drawback: “It will typically shorten the penis a little bit, and no one wants to sign up for a shorter penis,” Dr. Honig says.
If you have more than 60 degrees of curvature, grafting might be a better option. During this surgery, your doctor removes the scar tissue and replaces it with graft tissue, which can come from somewhere else on your body, a donor, or a lab. Unlike plication, this option doesn’t cause any shortening.
Both surgeries tend to have high success rates, with the majority of men reporting their penis is “adequately straight” afterwards. Keep in mind that there may be a recovery time of 4 to 8 weeks without sex. And that’s not all: “Surgery may also sometimes affect sensations of the penis, but it almost always comes back with time,” Dr. Honig says.
Penile implants
An implant is a more involved option that’s best for those who also have erectile dysfunction (ED). “Peyronie’s disease doesn’t cause erectile dysfunction, but the best way to treat a man with both is a penile prosthesis, because that will solve both problems,” Dr. Taylor says. The procedure involves surgically implanting a device inside the penis to restore erectile function while also helping straighten the penis.
If you don’t have ED but your curvature is greater than 100 to 120 degrees, this may still be something to consider, as other surgeries could potentially cause ED, Dr. Taylor says. The procedure itself is an outpatient one that’s relatively quick, but the recovery can take up to six weeks.
Finding the Right Path
CHOOSING A TREATMENT can feel overwhelming, but you don’t have to navigate it alone. Your urologist can help you weigh the pros and cons of each option and find the best path forward. “Treatment should be a shared decision,” Dr. Taylor says. “We’ll present you with all the options and then ask what you’re comfortable doing.”
Quiz: Which Treatment Is Worth Discussing With Your Doctor
Read the full article here
