Dear Dr Herazy,
I recently had a cystocopy and developed approximately 2 weeks later hardness in the perineal area of corpus carvernosum. The shaft is still unaffected. However because of the hardness that probably reminds of of a reverse bottleneck I have had trouble getting the penis down after an erection. This is particularly problematic during the night where I wake up from the erections and then have to get out of bed to get it down.
My urologist said that I could have developed developed peyronies disease in the perineal area but I have searched the Internet and have not seen any similar cases. The area covered is around 2 inches. Have you heard about something similar including the decreased "back-flow" following the erections?
I am also worried I could develop a priapism from this condition that would make things a lot worse. Can you make an advice as how to move on?
Thank you very much in advance.
First of all, I think a few people who read your email would have some questions of his own about some of the terms you used. So, here is a bit of information about these terms to help understand your email a little better:
1. Cystoscopy – a medical procedure in which a long tube or probe is inserted up into the urinary passage (urethra) of the penis for the purpose of looking into the urinary bladder or the urinary passage, itself. It sometimes happens that when this is done that the urethra and tissue of the shaft of the penis can become injured, resulting in Peyronie's disease.
2. Perineal area – the region of the very lower part of the pelvis in men that is found between the back part of the scrotum and the anus, and in women between the back end of the vulva or outer lips and the anus.
3. Corpus cavernosum – or corpora cavernosae – one of the two long cylinder shaped masses of tissue that make up the bulk of the penile shaft. Each corpora cavernosa is covered by a thin tough layer of fibrous tissue called the tunica albuginea that when injured becomes scarred and leads to Peyronie's disease.
4. Back-flow – release of blood that was trapped in the two corpora cavernosa during an erection that creates the hydraulic pressure within the penis to make it expand and hard.
5. Priapism – this is a persistent, and often painful, erection that is considered a medical emergency when it lasts longer than four hours and develops without sexual stimulation. Priapism occurs when blood in the penis becomes trapped and not able to drain as it normally does.
OK, now that we have that out of the way, allow me to address a few points you made:
1. The penis is attached to the front part of the pubic bone in the area directly behind the pubic hair. If you are an average size male, there is probably 4-5 inches between the point where the penis ends and where the perineal area begins. These two structures are not connected or related. There is no perineal area of the corpora cavernosa. Any hardness, mass formation, swelling or abnormality of the perineal area is not related to the penis and is not related to Peyronie's disease. If you truly have a hard mass or lump between the base of your scrotum and the anus I suggest you get it checked out immediately.
2. I know what a bottleneck deformity is in relation to Peyronie's disease, but I have no idea what you mean by a reverse bottleneck. Please explain.
3. The reason you could not find any reference to Peyronie's disease in the perineal area is that it does not happen that way and it is not possible.
4. Your decreased back flow causing persistence of an erection could be related to the mass in your peineal area; for that reason you should see a doctor immediately.
5. Pripism can occur as a result from many different situations, but not Peyronie's disease:
- Sickle cell anemia
- Medications, like Thorzine and Desyrel
- Illicit drugs (marijuana and cocaine)
- Trauma delivered to the lower pelvis or spine, or something in that same area causing reduced blood flow
- Black widow spider bites
- Carbon monoxide poisoning
6. I assume that your doctor did not give you much of the information you have shared here because it is mistaken. To move forward I suggest you stop trying to figure these things out for yourself and immediately get yourself examined by a competent urologist. TRH
Penile conditions, other than the curved penis of Peyronie’s disease
There are additional problems of the penis that can develop while a man treats his Peyronie’s disease. There are not many additional problems, but all can complicate your life more than you need at this time.
Priapism is a persistent, often painful erection that is not associated with sexual activity and is not relieved by orgasm, lasting from a few hours to a few days. In priapism blood enters the penis but does not leave, thus the erection is maintained. The more common causes of priapism:
- Penile injections, as verapamil, collagenase, steroids or interferon-alpha-2b
- Drugs, such as anesthetics, antidepressants and blood pressure medications
- Alcohol or drug abuse, especially cocaine
- Spinal cord disease
- Injury to the genitals
- Blood diseases, including leukemia and sickle cell anemia
Rapid treatment for priapism is important, even without Peyronie’s disease present, because a prolonged erection can result in tissue destruction by reducing blood flow and lead to scar formation. Treatment involves removing trapped blood with a needle placed in the corpora cavernosae, as well as treating any underlying medical condition or substance abuse problem that might be present.
Balanitis is an inflammation of the foreskin, or skin covering the head of the penis. Symptoms are redness, swelling, itching, rash, pain and a foul-smelling discharge in the area of the foreskin. Balanoposthitis is a similar condition in which the glans (penis head) and foreskin are inflamed and present similar symptoms. Both problems can occur in men or boys who are uncircumcised (foreskin has not been surgically removed). If an uncircumcised male does not wash under the foreskin regularly, then sweat, debris, urine, dead skin cells and bacteria will collect under the foreskin and cause irritation. Other common causes include:
- Infection – local or systemic infection with candida albicans, the yeast responsible for thrush, can result in an intensely itchy and scaly rash. Several sexually transmitted diseases (STD), gonorrhea, herpes and syphilis can also produce balanitis in addition to their unique infections that affect other parts of the body.
- Dermatitis/allergy – Dermatitis is any inflammation of the skin often caused by contact with an allergen or irritating substance. Sensitivity to even a small amount of certain chemicals in soaps, detergents, perfumes and spermicidal preparations can cause balanitis.
- Diabetes – When a diabetic has glucose (sugar) in the urine, this can be trapped under the foreskin and acts a rich breeding medium for many bacteria.
Treatment of balanitis depends on determining the underlying cause, improved hygiene and perhaps circumcision if the balanitis cannot be controlled in any other way.
Phimosis and paraphimosis
Phimosis is a medical problem in which the foreskin (prepuce)of the penis is so tight, preventing it from being pulled back or retracted from the head of the penis. Paraphimosis is a medical emergency in which the foreskin is stuck, after being rolled back or retracted, and cannot be slid back to its usual position over the head of the penis.
Phimosis is most often observed in children, and may be present even at birth. When it occurs in an adult male it is usually caused by an infection of the reproductive tract, or scar tissue that formed as a result of injury or chronic inflammation of the prepuce. Phimosis can also be caused by balanitis when it causes the foreskin to the scarred or tight around the head of the penis. Immediate medical care is required if phimosis makes urination difficult or impossible.
Paraphimosis is a medical emergency because serious complications can arise if it is not treated. Paraphimosis may occur after sexual activity, a nocturnal or typical daily erection, or after trauma to the head of the penis, leading to pain and swelling, and impair blood flow. When extreme, this reduced blood flow can result in death of the penile tissue (gangrene), making amputation of the penis necessary.
Treatment of phimosis may only require gentle manual stretching of the foreskin repeated daily over a period of time. Circumcision is often used to treat phimosis. When the phimosis has gone on a long time the prepuce sometimes adheres to the glans. When this happens, a surgical procedure called preputioplasty is used to separate the foreskin from the glans.
Treatment of paraphimosis focuses on rapidly reducing the swelling of the glans and foreskin, using ice and pressure applied to the head of the penis. If these simple measures are unsuccessful, an injection of medication can be used to drain the inflammation and blood from the penis, or small cuts in the foreskin are made by a surgeon to release the prepuce from behind the glans.
Penile cancer is a rare form of the disease. While the exact cause of penile cancer remains unknown, certain risk factors for cancer are known, including:
- Phimosis – Tight foreskin that is constricted and difficult to retract, discussed above.
- Uncircumcised penis – Men who are not circumcised are at higher risk for cancer of the penis.
- Smegma – Natural oily secretions from the skin of the prepuce can accumulate if not cleaned daily. If allowed to collect under the foreskin, this results in thick, cheesy white, bad-smelling substance, known as smegma. Smegma by itself is irritation to the prepuce and lead to inflammation and a host of other problems.
- Human papillomavirus (HPV) infection – More than 70 types of human papillomaviruses can cause warts (papillomas). Only a few of these HPVs infect the reproductive organs and the anal area, being passed as a STD from one person to another.
- Smoking –Cigarette smoking brings many cancer-causing chemicals into the blood stream that affect more than the lungs.
- Psoriasis treatment – The medication and ultraviolet light used to treat can cause penile cancer.
- Age – Penile cancer occurs most commonly in men after age 50.
Common symptoms of penile cancer are sores or unusual growths on any area of the penis, abnormal discharge from the penis, and bleeding. Surgery or radiation is commonly used to remove the cancer from the penis.
Since 2002 PDI has advocated Alternative Medicine Peyronie’s treatment options to avoid any of these complications that compromise penis health.