Peyronie's Plaque

Peyronie’s disease plaque or scar

There is much confusion and lack of information concerning Peyronie’s disease, especially the elusive Peyronie’s plaque or scar .

It is truly amazing that for a male health problem that according to some surveys affects up to nine percent of the adult population, practically no man ever hears about this problem until the day he is given the diagnosis of Peyronie’s disease.  It is no wonder that no one has ever heard of a Peyronies plaque until he has one.  It is this shock – that a “mystery” condition that comes out of the blue, a condition for which there is no known cause and no known Peyronie’s cure can suddenly wreck a man’s life – that contributes to the lack of information about Peyronies.  While feeling totally confused and shocked upon first hearing about the Peyronie’s plaque or scar that accompanies it, prevents a man from asking all the standard questions and retaining the information he is told when he receives this diagnosis.

With such bad news pouring into his ears, and so many questions rolling around in this brain, it is no wonder that a man can leave his doctors office and not remember much of what he is told  about Peyronies.

In addition to this shock of learning he has Peyronies, most medical doctors do not like to manage cases of Peyronie’s disease, and therefore do a bad job of it, further adding to the common situation in which a man will not understand the basics of this problem – like the Peyronies plaque.

We all know Peyronies disease is called the “doctor’s nightmare” because of the problems associated with dealing with men who have this problem.  With no known cause or cure, the doctor comes off looking like a dummy for not having more clear information or help for his newly diagnosed Peyronies patient.  Adding to the negative atmosphere for the doctor in dealing with a Peyronies patient, the doctor also knows there will be hard feelings that will arise later when the PD patient develops additional penile curvature, reduced sexual performance, and frequent marital problems.  All of this happens while the doctor can only stand by as his Peyronies patient deteriorates over time. The doctor is often held responsible for these problems since he did not offer any help to his patient.  None of this is fair, but this is how it happens.   For these reasons many doctors try to get a man out of the office as quickly as possible, and often without sufficient time to ask questions or adequate explanations to prepare a man for the future.

In this atmosphere of minimum time and minimum information, the shocked Peyronies patient does not understand or recall basic facts about Peyronie’s disease.  For example, the fundamental problem of PD pivots around the presence of one or more masses of fibrous material located within the covering of the substance of the penile shaft, called a Peyronies plaque or scar. Many times a man who has had PD for many years will no absolutely nothing about his  Peyronie’s plaque.

Peyronies Plaque is elusive

Another common situation exists in which the doctor cannot find a Peyronie’s plaque, and neither can the man who owns it.  Each week I receive several emails asking me, “Since my doctor examined me and could not find anything, and I cannot see a scar, do you think I really have Peyronie’s disease?”

The fat is, there is never an EXTERNAL scar or plaque in Peyronie’s disease; it is always an internal mass that conveniently is known as a scar, but is not a scar in the usual sense.  PD “scars” or plaques are quite variable.  Some men have an obvious scar and others cannot find one if their life depended on it.   Ultimately, it is there and you should try as many different tactics as you can to find your scar(s) because having a good knowledge of your scar situation will help your treatment effort.  Hint:  Try to think in terms of your scar being much larger than you have previously imagined, so mentally expand the size of the scar that you are looking for.  Meaning, if you were looking for a “pea” before, start looking for a “postage stamp” or a “thumb nail” size structure.  This information should change your methods and what you can detect when trying to locate your Peyronies plaque.

A Peyronie’s plaque or scar can be quiet variable; some men have an obvious plaque and others cannot find one if their life depended on it.   Often, when a scar is not found, but there is still pain and bending or any kind of recent penile distortion, a diagnosis of PD is still made.  This is so, because it is the Peyronies plaque or scar that is causing the pain or bending is either:

1. So small – it cannot be found

2. So very soft – it blends into the other tissue and cannot be detected

3. So deep – it cannot be reached easily, especially during erection

4. So large and flat – that the edges are not determined, almost like something that is so close to you that you do not see it because you are looking far away

5.  The doctor’s lack of ability, experience or concern when he does the examination – that he simply misses what is actually there if he was better at this kind of thing – yes, I know, it is difficult to imagine but it is true.

Usually, when a scar is NEVER found it is because of a combination of two or more of these factors – deep and small, or soft, large and flat, or deep, soft and doctor error, and so on.

I often suggest that men try this:  forget about finding a “scar.”  Just try to find something – anything – within the mass of erectile tissue that does not feel like the other tissue pf the shaft.  Find something that is unlike the rest of the tissue.  When you find it, mark its location with a marker pen of something that will stay on the tissue for a day or two.  Go back each day to that area and re-think what you are feeling.  You are trying to determine if it becomes easier to make sense of it.  It could be that you have an unreasonable expectation of what a “scar” should feel like, and you are missing what is really rather obvious.  Really, how could you know what a Peyronie’s plaque feels like if you have never had to do this before?  It is a common problem.

Let me know your experiences and problems in locating your Peyronie’s plaque. Take this chance to tell others your experiences and problems with this elusive tissue.

Peyronie's Disease Treatment Success Stories – Big and Small

Men do not like to discuss their Peyronie’s disease condition

Each day I run into many examples of reluctance to talk about their Peyronies disease. A woman will tell me her husband has shut her out completely about his PD, and just clams up and walks away when she asks him about his Peyronies. I often write notes on the PDI order forms that go out to men when they receive their shipment of Peyronie’s treatment supplies; I ask, “Please write me a note and tell me how it is going for you.” I rarely get a reply, even when I learn later things are going great. Men send me an email, asking a question about their Peyronies treatment or something about their penis problem. In that email many of these men will often admit that it has taken them a few months to get the nerve to write to me.

It seems that there is something in most men that they just do not like to address the problem of Peyronie’s disease – almost like by not discussing it, it does not exist. Whatever the reason, I hope that men will some how feel more comfortable using this blog to discuss their small and large successes using the Peyronies treatment ideas found on the PDI website. I trust that men will share the good news of reducing and eliminating pain in the penis or curvature, eliminating or reducing Peyronies plaque or scar material, regaining lost length, and improving or restoring sexual function.

Please take a moment to tell others about the areas where you have had success and the things that have improved since you have begun using the Alternative Medicine treatment concepts to increase your ability to heal your Peyronie’s disease.

Cause of Peyronie's disease

How Peyronie’s disease starts

As anyone who has the problem knows, the cause of Peyronie’s disease is not well understood.  However, any research topics that shed light on this basic question are of great interest to men who have Peyronie’s disease.

Perhaps a good question to start with is, what causes the erect penis to bend in a case of Peyronie’s disease?  The answer lies in the function of the corpora cavernosa functions in the mechanism to produce an erection. There are actually two corpora cavernosa, laying side by side like two cigar shaped, paired balloon-like chambers that must be filled with blood to create an erection. Their connective tissue wall, the tunica albuginea, offers resistance and rigidity when it is stretched to its maximum.  The tunica is elastic to a point, but unlike the thin and flexible wall of a balloon, the tunica albuginea is interlaced with strong connective tissue fibers. These strong fibers do not allow for much expansion, and eventually determine the shape of the erect penis because of their structural rigidity.

Thus, in a very real and fundamental way, Peyronies disease is a disorder of the tunica albuginea. By producing dense and rigid areas of the tunica, called Peyronie’s plaque or scars, Peyronie’s disease interferes with the full expansion of the tunica. Plaques are either regions of reversible inflammation in early phases of Peyronies, or permanent scars later if the inflammation is severe and continues too long.  Much like a piece of tape placed on the wall of a balloon, the plaque or scar causes uneven filling and expansion of the tunica, and this causes bending  of the column of the corpora cavernosa.

A basic question is, what causes these plaques to begin?  Microscopic and chemical studies show that plaques represent an early stage of the wound healing process when the tunica is injured. Whatever starts Peyronie’s disease, the problem seems to the inappropriately increase of the normally healthful and proper process of wound repair.  Actually, wound healing may not be the appropriate term in all situations.

Most likely cause of Peyronie’s disease

One cause of Peyronies disease is obvious and direct trauma to the erect penis. This trauma can range from sudden and unexpected angulation during sex, to am actual rupture of the corpora cavernosa.  However, the fact is, many men with Peyronies do not recall any such traumatic occurrences.

Over time, all sexually active men will experience some degree of wear and tear on vulnerable areas of the soft tissue erection mechanism. Both the structural arrangement of the corpora and the inherent elasticity of its connective tissues counteract the strong mechanical stresses created by strong sexual activity.  But when men reach their mid-fifties, fundamental connective tissue elasticity throughout the body, and the penis, is on the decline.   And so, it just so happens that the average for appearance of Peyronies disease is fifty-four.

Peyronies plaques most often appear along the top surface of the penis. It is this region where the two corpora meet side by side, along the upper edge of the “inflatable I-beam” created during an erection that is most vulnerable to stress induced delamination.  Another word for a layer is a lamina; when layers are disrupted or separated, it is called delamination.

Autopsy studies in the mid-1990s on men have shown the earliest microscopic changes thought to be early Peyronies disease changes are actually a common finding.   It seems that while many men develop these changes, they will evolve into Peyronies plaques only for a small percentage of cases.

So what causes the process of normal wear and tear to develop abnormally into the destructive process of wound healing that is called Peyronie’s disease?  There are no clear answers to this question.   However, Peyronies disease is more common in diabetics, as well as men who have gout.  These are two conditions that can have an adverse affect on normal connective tissue healing. It is also more common in the presence of Dupuytren’s contractures. These scars of the fascial covering of the finger tendons in the palm of the hand are thought to be inherited, and may reflect an abnormal tendency toward scar formation in other areas.

Thus, we see that much is still to be learned about Peyronie’s disease, but as these microscopic tissue clues are unraveled, the mystery of this problem will be advanced, as well as Peyronie’s disease treatment.

Peyronie's disease treatment with Xiaflex

Peyronie’s treatment with experimental drug, Xiaflex

Peyronie’s disease is best known for the plaque, scar or hard lump that causes a curved penis to develop.   Peyronies begins as a localized inflammation, usually as a result of injury of some type. It is currently believed that Peyronie’s disease is caused by vascular trauma or injury to the deeper penis anatomy. Peyronie’s disease is most common in men over 50 years, and the incidence increases with age. This inflammation often progresses to a hardened plaque or scar that reduces flexibility of the tissue of the penis, and results in a bend or distortion during erection due to incomplete filling or restriction of the tissue.  Often, this causes constant pain or pain during erection, and for some men these can prevent sexual intercourse due t physical incompatibility or erectile dysfunction.

Aside from the physical changes, depression and reduced self-esteem are commonly experienced by men with Peyronie’s disease.

Peyronie’s disease is most often treated by urologists, even though there are no approved drug therapies for Peyronie’s disease.  Peyronie’s surgery may be an option for some patients although complications such as worsening of the PD distortion can develop, as well as loss of penile length can occur.   Xiaflex, a type of collagen reducing enzyme, or collagenase, has been experimentally injected into the Peyronie’s disease scar or plaque as an in-office procedure. The purpose of injecting Xiaflex into the PD scar is to soften the scar tissue and improve or reduce the curvature of the penis. Further, this is hoped to improve sexual function and eliminate the distressing negative psychosocial aspects of Peyronie’s disease.

Peyronies Xiaflex trial results

Sponsored and monitored by BioSpecifics Technologies Corp., licensor of Xiaflex, the 12 month phase II open-label trials of Xiaflex showed limited but promising results.  These research tests were conducted to evaluate the ability of Xiaflex to successfully treat Peyronie’s disease, as well as its compatibility and side effect potential.  In this process clinical success was defined as a baseline change of penile angulation of at least 25 percent.

Each of the study participants received three injections of Xiaflex, administered on a separate day, and given over seven to ten day period.  Twelve weeks later, each man received a second series of three injections.  Research subjects were evaluated at three, six, and nine months after the Xiaflex injection series.

The average baseline angulation was 52.8 degrees.  In this study clinical success was achieved at three and six months with 58 percent and 53 percent of patients, respectively.  This would suggest that early success might not last very long or that the improvement to the Peyronie’s disease distortion was temporary.

In this study there were adverse reactions with Xiaflex that were not described in the general media.  The most common adverse reaction was only reported as a problem at the local administration site that was mild or moderate in severity, non-serious, and resolved in time without medical attention.  No comment was made about worsening of the Peyronie’s disease after the nine month time frame as a direct result of repeated injury to the delicate tunica albuginea tissue from the multiple needle injections of the needle used to deliver the Xiaflex.

It is the opinion of PDI that for some men these repeated injections could make their Peyronie’s disease condition worse over time.   It might be prudent for the average man to wait until more clinical treatment results are collected and interpreted before considering this treatment approach.