Peyronie’s disease is a connective penile tissue disorder characterized by bent erections, pain in the erected penis, and palpable penile plaque.
Peyronie’s disease is quite common, affecting as many as one in 11 men, despite the lack of public awareness.
The penis is composed of the same connective tissue as every other joint in the body. The anatomy of the penis is composed of three cylinders: the paired erectile bodies and the urethra. The erectile bodies (corpora cavernosa) are made up of sinusoidal tissue that fills up with blood during an erection and an outer covering (tunica albuginea) composed of tough fibroelastic tissue. The outer covering determines the size and shape of the erection.
The principal finding in men with Peyronie’s disease is the deposition of scar tissue in the tunica albuginea. All of the clinical symptoms are derived from this event. The curvature of the penis is due to the fact that scar tissue does not stretch as well as normal tissue. The normal tunica albuginea is composed of elastin fibers and collagen. The site of scar tissue from Peyronie’s disease is composed mostly of collagen that can harden to the thickness of bone.
Although most men with Peyronie’s disease report that their penis is bent upwards, a variety of other abnormalities are frequently observed, including bends in other directions, complex bends, divots in the side of the penis, and hourglass deformities.
The palpable plaque is the actual scar tissue that has been deposited on the outer covering of the erectile bodies. This is present in the vast majority — but not all — patients with Peyronie’s disease. The plaque may become calcified, like bone, with severe disease. Finally, the pain experienced with erections is thought to be due to active inflammation in the plaque and usually disappears on its own with time (usually by 12 months).
Peyronie’s Disease and ED
Erectile function may be adversely affected by Peyronie’s disease. It is unclear whether erectile dysfunction causes Peyronie’s disease or vice versa. It is probably a little bit of both. While most patients with Peyronie’s disease report normal penile rigidity during erections, some have trouble maintaining erections due to leaky veins in the penis (a process called veno-occlusive disease of the penis).
The disease process of Peyronie’s disease does not normally affect the sinusoidal tissue within the erectile bodies, but it can affect the veins exiting the erectile bodies and preventing their proper closure. The main sexual complaint despite the physical deformity is the bend itself, preventing vaginal intromission or causing pain to the partner.
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