Doctor's Review: Medicine on the Move

October 28, 2021
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A bend during sex

An erect penis is normally ruler-straight, but it's not uncommon for an erection to have some degree of bend, or twist. If the bend is extreme, causes pain, or makes intercourse impossible, then the condition is called Peyronie's disease, after Francois Gigot de la Peyronie, the French surgeon who first described the disease in 1743.

With Peyronie's, the penis typically curves sharply upward when erect, giving it a hook-like appearance, though curves in other directions are also seen. The immediate cause of the curvature is the development of small, hard, patches on the penis called plaques. These plaques don't expand the same way that the rest of the penis does. When the penis is limp, you don't notice. But when the penis "inflates" during an erection, the stiff plaques force the penis to bend. The plaques themselves are not harmful or contagious in any way. But the penile bending they produce can cause a good deal of consternation, for both a man and his partner. For example, the female partner of one of my patients with Peyronie's complained that her man could no longer stimulate her G-spot because of the way his penis curved.

Because the cause of Peyronie's disease and its development are not well understood, doctors treat it empirically, which just means they keep trying things until something works. The goal of therapy is to restore and maintain the ability to have intercourse - which may mean some degree of curvature remains. Sometimes, the only thing I need to do is educate a man about the condition - most guys have never heard about Peyronie's. But if the situation is causing a problem for the man or his partner, there are a number of treatments to explore.

This isn't a condition that can be "fixed" by a pill or oral medication (studies of a variety of oral treatments, including vitamin E, have been inconclusive). Current treatments involve anti-inflammatory medication to halt the progression, Viagra like medication to increase blood flow to the penis and injecting compounds directly into the plaque to soften it or break it down. One way to deliver a plaque-busting drug is iontophoresis, which uses a painless electrical charge to move the medicine through the skin and into the plaque. If all else fails, there are 3 surgical procedures for Peyronie's disease. Each has pluses and minuses, though they all entail some risk, as does any surgery.

The bottom line: if you or your partner are concerned about a penis that seems to curve more than it should, see a urologist for a formal evaluation!

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