What’s Neater Than Your Peter (a series on male sexual dysfunction): A Bend in the Road: Peyronie’s Disease

Fiona McMahon PT, DPT Pronouns: She, Her, Hers Hello everyone! This is our second addition to our What’s Neater Than Your Peter series. In this series, we will be taking deep dives into penile and testicular health. Our first edition covered the ins and outs of premature ejaculation. Check out what we already have written on penile and testicular health by referencing the articles listed at the end of this blog. Peyronie’s disease is an often distressing condition resulting in a curvature of the penis, pain and sometimes erectile dysfunction and loss of penile length. Unsurprisingly, a disease like Peyronie’s can come with huge psychological burdens. Up to 48% of patients with this condition suffer depression. Peyronie’s disease (PD) can have a huge impact on your life, but the more you understand it, the more you can do to treat it. In this blog, we will be discussing the potential causes of PD, treatments including emerging treatment to aid in reducing pain and improving the function and aesthetics of your penis. What Causes Peyronie’s? Peyronies, classified by Francois Gigot de la Peyronie, the personal physician of King Louis the XV, is thought to occur due to microtrauma to the delicate blood vessels and tissues of the penis during intercourse. This microtrauma is thought to cause inflammation, irritate nerves, and can eventually cause plaques to form in the tissues of the penis. These plaques can result in curvature of the penis, erectile pain, and dysfunction. It usually occurs in older folks; however 10% of its sufferers are under age 40. Microtrauma during intercourse is not necessarily considered the sole cause of PD. PD has been seen in men who have never had sex and can be more prevalent in people with certain conditions. PD is often seen in men who have changes in the gene that expresses transforming growth factor- b1. It is also seen in men with diabetes, men with Dupuytren’s contracture, and plantar fibromatosis. PD is now more often regarded as a disorder of healing. Peyronies can be divided into both an acute and chronic phase. The acute phase occurs within 6 months of the onset of symptoms. After 6 months the condition is considered to be stable; however in an article by Chung in 2015; 50% of people with PD will experience progression of the disease if left untreated. What Treatments are Available for PD? There are a small minority of patients who spontaneously get better after having PD. For the majority of people, further treatment is required to resolve this disease. The techniques that have been extensively studied for the treatment of PD are oral medication, injection into the penis, traction devices, extracorporeal shock wave therapy, and surgery. Many of these techniques are considered pretty invasive and many men opt to try oral medications first. The currently available data fail to show good long-term effects; however, the field is rapidly developing new drugs. Some common medications prescribed for PD include vitamin E, Potaba, Colchicine, Carnitine, and more. Their respective mechanisms of actions are varied and include working to reduce inflammation, downregulate tumor growth factor B 1, and to reduce the size of plaques within the penis. Injections of collagenase, to break up plaques in the penis have been shown to improve penile deformity somewhat, as well as the calcium channel blocker, verapamil. Obviously, many people find the idea of injecting medication into their penis overwhelming, but so far, current studies are showing that injection may work better than the medication. Extracorporeal shockwave therapy is another non-surgical option for men seeking help for PD. In severe and stable cases, patients may opt for surgery to correct PD especially after failing less invasive modalities. Can What you do at Beyond Basics Physical Therapy Help PD? Currently, there is no research available that directly examines the role physical therapy has in treating PD. It just has not been done yet. That said pelvic floor physical therapy (PFPT) has been shown to treat the comorbid conditions associated with PD effectively, i.e. the painful spasm of the pelvic floor as well as the downstream effects of bladder, bowel, ejaculatory issues and pelvic and genital pain conditions. Our therapists are trained to recognize decreased mobility due to scar tissue and adhesions, as well as tight and restricted muscles that may also contribute to an asymmetrical look of the penis. Furthermore, although it has not been looked at directly, myofascial release and scar tissue mobilizations have been shown to reduce adhesions in other tissues, thus treating these restrictions within the penis and surrounding areas may be effective for reducing pain and deformity in the penis. If you think physical therapy can help or have any questions, call us today. More Male Pelvic Pain Resources What is Neater than your Peter? A Guide to Penile Health and Function Part 1: Premature Ejaculation All About Testicles LGBTQ+ Topics: Special Considerations for People with Prostate Cancer in the LGBTQ+ Community Prostatitis What it is and What to do About it Dell’Atti L, Galosi A. Sonographic pattern of peyronie’s disease in patients with absence of palpable plaques. Int Braz J Urol. 2018; 44: 362-9 Chung E. Peyronie’s disease and low intensity shock wave therapy: Clinical outcomes and patient satisfaction rate in an open-label single arm prospective study in Australian Men. Korean J Urolo 2015; 56775-80 Kayes O, Khadr R. Recent advances in managing Peyronies disease F1000 Research 2016. 5 Yafi F, Pinsky R, Sangum P, et al. Treatment advances in the treatment of peyronie’s disease. Andrology. 2015 Jul;3(4):650-60