If your penis is painful, bent, or has lumps, it may be Peyronie's disease!

Author: Bai Wenjun, Chief Physician, Peking University People's Hospital

Vice Chairman of the Sex Medicine Committee of the Chinese Society of Sexology

Reviewer: Zhang Yi, Chief Physician, Peking University International Hospital

Peyronie's disease is a relatively rare male disease, which is divided into acute phase, chronic progressive phase and stable phase.

Figure 1 Original copyright image, no permission to reprint

1. What are the symptoms of Peyronie's disease?

The acute phase is mainly characterized by pain, and it also hurts under normal circumstances, and the pain is more obvious during erection.

Later, when the disease enters the chronic progressive stage, nodules can be felt on the penis. Most of them are single and usually grow between the tunica albuginea and the corpus cavernosum tissue.

The white membrane is equivalent to the banana peel, and the spongy tissue is equivalent to the flesh. Most nodules grow on the banana peel or between the banana peel and the flesh.

The pain usually subsides a bit at this stage, but it is still quite noticeable during an erection.

Figure 2 Original copyright image, no permission to reprint

When it reaches the stable stage, the pain is not so obvious, the nodule is more fixed and larger, and the main manifestation is that the erection angle is not good, forming a bend, which affects sexual life.

Generally speaking, Peyronie's disease has three main symptoms: the first is pain, the second is hardness, and the third is penile curvature.

2. What causes Peyronie's disease?

The cause of primary Peyronie's disease is not very clear. It is now believed that one of the causes is the older age, which is more common in elderly people over 50 or 60 years old, without clear injuries or causes. In addition, it is currently found that it is more common in patients with diabetes. The specific pathogenesis is not clear, and it may be related to abnormal metabolism and abnormal local tissue repair.

Secondary Peyronie's disease usually has a clear history of injury, such as a poor angle during sexual intercourse, which causes the rupture of the cavernous tunica albuginea. If the tunica albuginea is completely ruptured, the pain is severe and the swelling is severe, and emergency surgery is required; if the rupture is shallow, a small incision, the pain is relatively light, and there is no obvious bleeding, the local injury will be repaired after two or three weeks. If the repair is not good, the collagen fibers will replace the elastic fibers, and the poor elasticity will cause curvature and form scar nodules.

The appearance of a nodule in Peyronie's disease will affect erection and thus sexual life, but it will not affect the quality of semen or urination.

If the penis is painful, a lump can be felt, and the erection angle is not good, you should go to the hospital for examination in time. In addition to physical examination, the doctor will also do auxiliary examinations. Through B-ultrasound, focus on the condition of the penis cavernous body and white membrane, how big the lump is, how the echo is, and whether there is calcification. Generally, in the early stage, it is an acute inflammatory change, with a slightly lower echo. In the chronic progressive stage, the echo is slightly stronger. In the later stage, there will be changes in strong echo after calcification.

The diagnosis can basically be confirmed through symptoms, physical examination by a doctor, and auxiliary B-ultrasound examination.

In a very small number of cases of Peyronie's disease, the penis may gradually become smaller and eventually disappear, but in most cases it will gradually become larger.

3. How to treat Peyronie's disease?

In the acute stage of Peyronie's disease, the pain is quite obvious and can be treated with glucocorticoids, such as prednisone, either orally or by local injection. Local injection is more effective and the pain will be relieved quickly after an injection. After the pain is relieved, the nodule will also disappear a little.

In most cases, other drugs are needed to treat nodules, such as tamoxifen, which has anti-inflammatory effects. Combined with vitamin E, these two drugs are relatively safe and have a better therapeutic effect on pain and nodules.

I just said that glucocorticoids can be injected locally. Other drugs such as verapamil or hyaluronidase can also be injected locally to eliminate nodules, but these methods are rarely used.

In addition to local injection, local minimally invasive treatment is also a common method. When the pain is relieved and the nodules are relatively fixed, shock wave therapy can be used, called low-energy extracorporeal shock wave therapy. Generally, one treatment lasts 15-20 minutes, and the whole course of treatment is 3-5 times. It can relieve pain, reduce nodules, and finally disappear. The treatment can be repeated.

When the penis is bent during erection, a negative pressure erection-assisting device can be used to stretch the corpus cavernosum of the penis, reduce the bending angle, and alleviate the development of induration. Long-term treatment is required, and the treatment should be continued for several months or a year.

When it reaches the stable stage, the curvature is very serious and affects sexual life. If it is really impossible, surgery can be performed to cut off the hardened plaque. After cutting, it can be filled with autologous tissue or a patch made of artificial materials to correct the curvature.

If the plaque is not removed, a folding operation can be performed on the opposite side of the nodule to correct the curvature. The advantage of the folding operation is that no patch is required. The disadvantage is that after the operation, the erect length of the penis will be shortened, such as by 1 cm, 1.5 cm, or 2 cm. If the length is already insufficient, this operation may not be suitable.

If you still cannot maintain an erection after curvature correction and are unable to complete sexual intercourse, you can undergo penile prosthesis surgery, also known as penile implant surgery.

These are probably the methods currently used to treat Peyronie's disease.