Posts Tagged ‘tunica albuginea’

Curved Penis and Peyronie’s Disease

Monday, February 8th, 2010

Peyronies bent penis is focus of problem

While the primary interest of Peyronie’s disease treatment is the internal scar tissue or fibrous  plaque material that causes the distortion or curved penis to develop, it is not the primary interest of the man who has PD.  For him, the most important aspect of Peyronie’s disease is the curved penis that plagues him.  For this reason Peyronies is also known as the “bent nail disease.”

Peyronie’s disease causes a curved penis when the fibrous tissue of the Peyronie scar or plaque pulls unevenly or causes incomplete filling within the erect penis.  This can vary in degree or severity from man to man.  For this reason the curved penis does not indicate the severity of the Peyronies problem or success of Peyronies disease treatment.  The true success of Peyronies treatment is based on the change that occurs in the Peyronies plaque or scar.  Once the fibrous scar changes, eventual improvement in the curved penis can be expected in time.

The internal tissue of the healthy penis is flexible and expandable.  This normal tissue is able to allow for a normal erection to develop when blood is trapped inside the organ.

In Peyronie’s disease some of the tissue is not healthy or flexible and elastic.  Specifically, the deep tissue known as the tunica albuginea is not elastic because it replaced by dense and inelastic fibrous tissue that is called a scar or plaque.   As an erection develops the elastic tissue of the tunica albuginea must stretch and expand evenly on both sides, left and fright, and top and bottom, of the penis.  If this cannot happen because an area of the penis is no longer flexible and expandable, then a curved penis results.

Peyronie’s disease usually begins with a small nodule or bump that is found on the top or sides of the penis, just immediately below the surface.  A few weeks to several months to a year later, a small fibrous nodule can expand into a larger irregular scar of variable size, shape, density and surface quality.  These scars can be as long as the penis.  Some appear like a collar to go around the shaft.   Some are one large mass, while others appear to be like small isolated islands of fibrous tissue in many areas.   Scars can be so soft or small, with edges so tapered and vague that no scar can be found.  In a case of Peyronie’s disease when no scar or plaque can be found, it is still assumed to exist when a curved penis develops during erection. .

Normally curved penis

Most men have a straight erection, but some are born with a penis that curves or bends (usually upward).   Just as fingers on the hand or a nose can display a natural bend, or arms can be of different length on the same person, the penis can be bent without the presence of Peyronies.  Typically, the normally curved penis follows a more gradual and arched design, more like a banana.  In Peyronie’s disease the curved penis is more localized and abrupt, like an angulated bend.

When the two primary chambers (corpora cavernosa) of the penis are a different diameter or length, the penis will bend when erect.   The penis will appear straight when flaccid, and on erection it will bend.

This slight penile distortion will not be associated with pain, there will be no trauma in the history, and it will not appear suddenly as does the curved penis of Peyronie’s disease.

Curved penis affects sexual intercourse

It is estimated that 75-90% of Peyronie’s disease couples will sooner or later experience a sexual intercourse problem, in regard to either pain or difficult penetration – or both.   The curved penis of is the primary reason sexual penetration is compromised, and it is also the reason for the pain that can be experienced by either – or both – partner. This is especially so in those cases in which the distortion is so severe it is described as “cork screw” or “cane handle.”

Incomplete filling of the penis with blood during erection can also happen in Peyronies.  This results in an area of the penis, either small or large, that is soft and unable to sustain the rigors of intercourse.  A soft area within an otherwise firm erection presents a weakness and vulnerability of the normally turgid erection.  A weak area of erection can suddenly collapse or buckle during intercourse, causing additional injury to the penile tissue.  This can cause pain, inflammation and additional fibrous infiltration.

It is a rare Peyronies couple that does not deal with some level of sexual difficulty related to penile distortion and reduced firmness of the erection.  The many physical, emotional and social issues of Peyronie’s disease are complex.  For this reason the reader is referred to “Peyronie’s Disease and Sex” for more information about this complicated area of life with a curved penis.

Treatment of the curved penis

It is important to remember that any penile distortion that develops in Peyronie’s disease is not the primary problem of this condition.   A curved penis that appears one night is difficult to ignore, but is only a symptom of the real problem of Peyronie’s disease – the scar. Without the Peyronies scar there would be no curved penis.

This is the reason I advise men who are undergoing Peyronies treatment to focus on the size, shape, density and surface qualities of the scar or plaque to determine if their Alternative Medicine treatment is being effective.  The curvature can improve or worsen as the scar is reduced.

A small scar can cause a large bend, just as a large scar can cause no bend at all if it is balanced and symmetrical.   For this reason a curved penis can worsen as the scar is being reduced or eliminated.   Estimating progress or success of a PD therapy plan is difficult .  A man can have many more scars than he is aware of, and they can be larger than can be detected since they are often difficult to locate and often overlap.

If only one scar is present the curvature problems are direct and easy to understand, although  this is unusual.   However, if multiple scars are present the internal pulling and twisting they cause can be very complicated.   Several scars can interact on many  planes of internal penile tissue.   Any reduction in one or more scar will alter the internal tension and pulling of the tissues, resulting in an altered curvature.  There is no guarantee the curvature will change for the better initially – sometimes it can look worse as the scars become smaller.  This is why I advise to focus all attention to the size, shape, density and surface qualities of the scar while treatment of the Peyronies problem continues.  Realize the curved penis is just a reflection of what is going on with the scar9s) below the surface.

Do not be discouraged by the curved penis of Peyronie’s disease.  Instead, stay focused on your plan for effective Peyronies treatment.  Learn more about Peyronie’s disease treatment.

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Peyronie’s disease and baby boomers

Saturday, December 26th, 2009

Peyronie’s disease:  male health problem no one knows about

If you are a member of the baby boomer generation and have never heard of Peyronie’s (pay-row-neez) disease, you are not alone.  However, if you are a male baby boomer or married to one, you are in the prime age group to experience a problem you know nothing about.  This is so because Peyronies disease primarily affects men between 50 to 65 years of age, although an age range of 18 to 80 years has been reported, with an average age at onset of 53.

Few people know about the problem until they need Peyronie’s disease treatment.   This is why it is important for all baby boomers to know about, and how to avoid, it because this health problem can easily ruin your life.

Peyronie’s disease remains one of the most perplexing and difficult urologic diseases to treat; it has been called “the doctor’s nightmare”.  Most everything about this condition (cause, progression, symptoms, age distribution, response to treatment) is variable and unique to the man who has it.  The great variability of Peyronie’s disease that makes it difficult to study and to understand, also makes it almost impossible to treat like other medical conditions.

It is a complex problem that is much more common than most people realize. Estimates suggest that up to eight out of 100 men over the age of 40 have Peyronie’s disease – that is a lot of people worldwide – and still only a small percent of people have ever heard of it.

People are reluctant to discuss this problem because it involves the male organ.  For this reason it is difficult to develop accurate information and statistics, especially since men are so shy on one hand, yet also inclined to exaggerate.

Definition of Peyronie’s disease

Peyronie’s disease can best be understood as an exaggerated wound healing in response to an injury in which an excessive amount of Peyronie’s scar tissue develops within the man’s shaft.

Peyronie’s disease (also known by over 12 different names, among which is “iduratio penis plastica”) is very special disorder of the connective tissue in which fibrous “scars” or “plaques” develop usually after direct injury.   This Peyronie’s plaque occurs in a special tissue of the shaft known as the tunica albuginea, a fibrous chamber or envelope that surrounds the two penile cylindrical shaped masses of spongy tissue known as the corpora cavernosa.  The corpora cavernosa enlarge during sexual excitement, and the tunica albuginea covering, are designed to expand and elongate.  If there is fibrous scar or plaque material in the tunica albuginea, the expansion and elongation cannot develop properly resulting in bending, weakness, shortening and incomplete filling of the organ.  Sometimes this distortion is mild (just a few degrees) and does not affect the ability to perform, while at other times the distortion can be extreme (more than 90 degrees) resulting in greatly adverse consequences.

A certain degree of normal penile curvature can and does occur in some men.   This is a benign and natural condition many men are born with, commonly referred to as congenital curvature; this is not Peyronie’s disease.

Peyronie’s disease signs and symptoms

Four common findings of Peyronie’s disease:

  1. Pain – caused by inflammation and stretching of internal tissues in response to injury and distortion; can be present constantly or only during erection
  2. Nodule or mass formation – variable size lumps or elongated cords can develop in one or multiple areas; sometimes these are difficult or impossible to locate depending on the density, depth and size of the scar formation
  3. Curvature or distortion – caused by presence of one or more nodules or masses of scar tissue in the tunica albuginea, preventing normal expansion during erection; can be minor to gross in appearance
  4. Reduced sexual ability – due to physical distortion that prevents penetration or due to reduced firmness that also prevents penetration (erectile dysfunction).

The onset of Peyronie’s disease symptoms can be sudden or slow, but often appears within a month or two after direct injury.  The pain of Peyronie’s disease is extremely variable; from hardly noticeable to the kind of pain that prevents sleep.  Peyronie’s pain is worse in the beginning, usually gradually improving over time – improvement in a few weeks while others continue for years. For these reasons Peyronie’s pain is not a reliable way to judge the severity or calculate the time for eventual recovery.

Even though Peyronie’s disease is a male health problem, women are also affected by it.  They are indirectly and adversely affected by the erectile dysfunction, organ curvature and distortion that make intercourse often impossible, as well as loss of organ size that often occurs over time.  Additionally, and perhaps even to a greater degree than men, woman bear the brunt of the mood swings, anger, brooding and ill-temper that accompany their partner’s Peyronies problem.

Treatment of Peyronie’s disease

There is no standard or accepted medical treatment for Peyronie’s disease since no drug is proven to eliminate the scar within the shaft.  The only accepted and available medical treatment is surgery.  However, given enough time after Peyronie’s surgery the condition will only re-appear in a worsened presentation.  This surgical outcome is made bleaker by knowing that even the first Peyronie’s surgery can result in total loss of sensation (anesthesia), increased pain and increased curvature and greater scar formation than before surgery, and in some cases amputation.

The Peyronie’s Disease Institute has specialized for the last eight years in the use of Alternative Medicine therapies and techniques that are found to be successful in perhaps 60-80% of cases. None of the therapies are known to result in adverse reactions or side effects.  For more information about the Alternative Medicine approach, visit Peyronie’s disease treatment.

Prevention of Peyronie’s disease

With so many variable aspects of this problem to consider, it is important to know that in addition to everything else, there is no universal agreement about the cause of Peyronies. Some say that injury alone cannot start the problem as we have described above, but that other genetic and metabolic factors must also be present.  The Peyronie’s Disease Institute takes the position that this is true.  However, if a man never sustains direct injury to the area he is far less likely to develop Peyronies.

With age not working in the favor of any baby boomer couple, it is important to evaluate all situations in which direct injury can affect this area – especially sexual activity.  This requires  that special caution is exercised if a baby boomer gentleman finds he no longer has the usual firmness he previously possessed (erectile dysfunction).  Attempting intercourse with a partially flaccid organ can result in sudden buckling or abrupt bending during insertion or the sex act itself.  Another way to prevent injury is to modify the techniques used during sexual relations.  The single most common injury that starts Peyronie’s disease occurs when the female partner is on top, and she loses hold of him while she thrusts down, jamming and painfully bending him against her upper thigh.  To avoid this kind of injury it is important to not use any female-superior position, but to use other techniques in which physical contact is controlled, firm and not likely to disengage during activity.

Even if baby boomers have never heard of this terrible condition that robs a couple of one of the greatest pleasures of life, it happens every day.  Now that you know about Peyronie’s disease you can do a lot to protect the best years of your life.

Dr. Theodore Herazy has practiced Alternative Medicine for over 40 years, and has directed the Peyronie’s Disease Institute for the last eight years.  He has written two books about this problem, “Peyronie’s Disease Handbook” and “Peyronie’s Disease and Sex.”   He can be reached at http://www.peyronies-disease-help.com

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Peyronie’s plaque or scar

Monday, December 21st, 2009

The central issue of Peyronie’s disease is the infamous Peyronie’s plaque, also called a scar. Peyronie’s disease typically occurs in men between 40 and 65 years of age, although a range of 16 to 80 years is documented; some experts say it can occur at any age. From personal communication with a particular man, I was told that his own Peyronie’s disease was started after a dog bite to the groin – at the age of 10. Nonetheless, it is most important to recognize that all clinical signs and symptoms of Peyronie’s disease originate from the effects of the plaque upon the internal tissue layers (tunica albuginea) of the penis.

A developing Peyronie’s plaque appears in response to either micro-trauma to the small blood vessels from a single injury of great force, or multiple injuries of a small force. While there is strong evidence that genetic factors and drug factors also influence the start of PD, it is trauma that is usually considered to be the most likely cause of the Peyronies scar, or plaque.

A Peyronie’s plaque on the cellular level initially consists of fibrin threads deposited in a massive network throughout an area of injury within the tunica albuginea of the penis. Peyronie’s plaques, or scars, later combine the dense threads of fibrin connective tissue with reduced and fragmented elastic connective tissue fibers, as well as excessive amounts of type III collagen material, which happens to be specially inclined to excessive scar development. In about one-third of chronic cases of Peyronie’s disease, calcification of the plaque can occur over time. For more technical information about the Peyronies plaque, please go to http://peyronies-disease-help. com/ peyroniespathology.html

The curvature of the Peyronies penis is due to the fact that scar tissue does not stretch as easily or as fully as healthy normal tissue. The normal tunica albuginea is composed of elastin fibers and collagen, although the site of scar tissue from Peyronie’s disease is composed mostly of collagen. This difference in composition of these two tissues is what causes a bent penis to develop during erection.

Eventually as one or more Peyronie’s plaques develop into a mass of hardened tissue in the delicate tunica albuginea, it results in variable pain and penile distortion that most often takes the form of a bend or curve; sexual function is often reduced as a result of direct or indirect affects of Peyronie’s disease, also. The penile curvature of Peyronie’s disease is caused by the dense inelastic scar, or plaque, material that shortens the involved side of the tunica albuginea layer that covers the corpora cavernosa of the penis. In approximately one third of patients, the scarring involves either the top or bottom portion of the penis shaft, occasionally both. The lateral sides of the penis can also be affected by Peyronie’s plaque development, if that area experiences injury.

In some men the Peyronies plaque is easily found on manual examination, in others it is found with difficulty, and in some men no Peyronies plaque is ever located. It can be frustrating to have a wicked penis distortion, and still not be able to locate the Peyronie’s plaque.

To locate the plaque or scar material a light and inquisitive touch is most effective. Do not be heavy-handed, or press down into the deeper layers to find the Peyronie’s plaque material, because it is found just below the surface of the skin. And, oh yes, you will never directly see the plaque or scar, since it is not on the surface of the skin, but below. Make peace with the Peyronie’s plaque and do not hate it, just determine how to assist your body to remove it.


To learn about using Alternative Medicine to increase your ability to heal and repair the Peyronie’s plaque, a good place to start is the PDI website at http://peyronies-disease-help.com/ treatmentintroduction.html

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Peyronie’s pain

Friday, November 13th, 2009

Peyronie’s disease pain is different with each man

Peyronie’s disease symptoms – even Peyronie’s pain – can be extremely variable. In fact, one of the things that makes Peyronie’s pain so undependable as a factor on which to create a diagnosis of Peyronie’s disease is that the penile pain is a different presentation from one man to another. Because of the wide variety of Peyronie’s disease pain symptoms, Peyronies treatment can be equally variable when using Alternative medicine.

Peyronie’s pain symptoms

The onset of Peyronie’s pain symptoms can be sudden or slow, but most often will appear in less than a month after direct injury. Often the pain related to Peyronie’s disease is worse at the beginning of the problem, and then gradually improves over time – perhaps in a few weeks or months. Other men have a delayed onset of Peyronie’s disease pain. For all these reasons it is not a reliable way to judge the severity of the condition or to use to calculate the time necessary for eventual recovery.

For many men the pain associated with the actual injury that causes the problem to begin can be greater than the daily Peyronie’s pain that is associated with living with the condition. For others, the pain associated with the actual injury is mild and brief compared to the daily Peyronie’s pain they experience. Again, all of this is related to the variable nature of all Peyronie’s disease symptoms.

Peyronie’s disease pain patterns

Peyronie’s pain most often occurs with an erection during the first six to 18 months after onset. However, pain associated with Peyronie’s disease may present itself in many ways:

  • Only during an erection
  • Only when not erect (flaccid)
  • Only during an orgasm
  • Only when the penis is touched

Peyronie’s pain originates in Buck’s fascia

The scar tissue, also known as a plaque, associated with Peyronie’s disease and the variable pain it can cause can often – but always – be felt below the surface of the skin of the penis as small elevated or flat beads, lumps, bands of slightly to greatly dense and hard tissue. These soft tissue masses are located in a layer of soft tissue in the tunica albuginea. However, the scar in the tunica albuginea does not cause the actual Peyronie’s pain. The pain originates from the many pain fibers found just below the tunica albuginea in another layer of soft tissue called Buck’s fascia.

Apparently, when a man experiences intense or frequent Peyronie’s pain, it is because the scar is large enough or deep enough to press down deeper from the tunica albuginea into Buck’s fascia. And when pain is not as great a complaint, it is because Buck’s fascia is not being irritated by the scar or plaque material.

For a more comprehensive discussion of Peyronie’s disease pain, local penile anatomy and Peyronie’s disease treatment you can start searching the PDI website at http://peyronies-disease-help.com/peyroniesabout.html

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Peyronie’s disease plaque fibrin patterns

Friday, September 11th, 2009

Peyronie’s disease is an abnormal collection of fibrous pathological tissue in the deep tissue layers within the substance of the tunica albuginea and the Peyronies plaque; it is also characterized by excessive deposition of collagen within that same plaque material. Even thought the cause of Peyronie’s disease remains unknown, direct injury or repeated small trauma is most often thought to be the two most likely inciting events eventually resulting in Peyronie’s disease.

Materials and Methods


To understand the onset and cause of the Peyronie’s disease plaque or scar tissue that is always present in every case of PD, it is necessary to follow a simple approach that examines for the presence of collagen, elastic fiber, and fibrin content within the PD plaque material and evaluate its distribution.

Peyronies plaque or scar tissue specimens were taken from 33 Peyronie’s disease patient volunteers, and control penile tissue samples and nodular tissue samples were taken from eight patients with Dupuytren’s contracture (a related and similar problem of the hand). These samples were analyzed to determine collagen staining characteristics, and patterns of elastic tissue distribution. In addition, plaque tissue from another 19 Peyronie’s disease patients, control tissue and nodular tissue from Dupuytren’s disease were also analyzed for fibrin in these same samples.


Results

Abnormally stained collagen was found in 32 of 33 plaque specimens (97%), disrupted elastic fibers in 31 of 33 plaque specimens (94%), and abnormal fibrin deposits were also found in plaque tissue from 18 of 19 patients (95%). None of these abnormalities were located in normal or scared tunica from control patients.


Conclusions

These findings of fibrin deposits in Peyronie’s plaque tissue is consistent with the concept that repetitive injury and disruption of the small blood vessels and capillaries of the area results in fibrin deposition in the tissue space and has served to provide insights into the pathophysiology of Peyronie’s disease.

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Peyronie’s disease treatment philosophy – general comments

Monday, November 3rd, 2008

The Peyronie’s Disease Institute treatment philosophy for dealing with Peyronie’s disease is not accepted within the medical community.  You should know the opinions and philosophy of PDI are not current mainstream medical thinking, although PDI has assisted perhaps a dozen or more MDs with their Peyronies problem in the last few years.

The Peyronie’s Disease Institute philosophy for Peyronie’s treatment is different from standard medical thinking in two fundamental ways.

                1.  PDI recommends using mainstream Alternative Medicine therapy products (vitamin E, copper copper, DMSO, enzymes, etc.), and procedures (a special manual stretching technique we have developed,  http://peyronies-disease-help.com/penis-stretching.html exercise, massage and acupuncture).  These are recommended even though  they have not fulfilled the testing standards usually required of medication.

                2.  PDI has found after seven years of review and research that taking multiple therapies, all at the same time, in sufficient quantities as described on its website that it often stimulates or supports some degree of improved ability to heal and repair the famous Peyronie’s plaque or scar.  The scientific term for this phenomenon is “synergy”. 

The specific therapy products used by PDI are well known and generally accepted as important, and often essential, for health and well being, such as vitamin E, MSM, acetyl-L-carnitine, etc.  However, what is unique is that PDI advocates these therapy products are used in combination and in significant number for maximum potential effect and benefit.  This synergistic concept of therapy used by PDI to treat PD takes advantage of the affect of synergy – a concept that is very well known in medical practice. Synergy is the ability of two or more substances to work together to produce a total effect greater than what each individual therapy could produce by itself. To learn more about synergy, go to http://peyronies-disease-help.com/penis-stretching.html

This Peyronie’s disease treatment concept is based on simple observations about this problem:

·         Why do some men completely recover from Peyronie’s disease without treatment?  You know, this happens in about half of the case.   

·         Why do some men get worse and need surgery, no matter what treatment they try?

·         If the Peyronie’s plaque is similar to scars like I have on other parts of my body, why does it seem to change so much – not only the size, shape, and density of the scar, but also the location?

·         If it’s actually the same problem among all the men who have it, why does Peyronies vary so much from one man to the next?

·         What’s the difference between the two groups of men whose Peyronie’s disease goes away on its own, and the other in which it only gets worse no matter what they do for it?  

·         What is the fundamental difference between these two groups of different responses?

·         How can I join the group that repairs and eliminates the Peyronie’s plaque and reverses the bent penis of PD?

Certainly , no one has complete or easy answers to this questions – yet.  However, I think it makes perfect sense that the man whose Peyronie’s disease simply goes away on its own has a better healing capacity, than another man whose PD never improves.  It cannot be a mater of luck; nature is just not that way.   It is my opinion that you can increase your healing capacity and become healthier in some yet undetermined way so you are able to heal your Peyronie’s scar and reverse your Peyronie’s bend  to the best of your ability.

The fact that some men are able to recover better than others, must mean there is variable − not static − capacity to healing and repair among men.  Common sense and generally accepted knowledge about health, nutrition, and the healing process offers you and I the foundation for a treatment concept and philosophy that should improve your chances to recover from Peyronie’s disease better than if you did nothing to enhance your ability to heal.  It is really as simple and direct as that.  The Peyronie’s plaque found within and on the tunica albuginea can be seen as an expression or extension of the overall health and healing potential of the body in which it occurs.  Similar to an ulcer, a Peyronie’s plaque or scar can be thought of as the result of abnormal body chemistry and physiology.  As such, treatment of Peyronie’s disease should attempt to improve that distressed or abnormal chemistry and physiology of the penile tissue in which the plaque is found.

All therapy products, nutrients, techniques and ideas presented by PDI are all directly or indirectly intended to improve the chemistry and physiology of the body in general and plaque elimination in the tunica specifically. The end result of this effort should be a healthier person with healthier tissue that can heal better. That is the reason all Peyronie’s therapy items are selected on the basis of their potential to improve or normalize the chemistry and physiology of the tunica of the penis and the foreign plaque material.  

This Peyronie’s treatment philosophy is not offered as those it is a Peyronie’s cure, not at all.  It is merely presented as a way to treat the man who has Peyronie’s disease, becausue  we all know this happens in 50% of the cases – so it can be done, and it is being done.  PDI is merely offering a way to increase your potential to join th ranks of the men whose Peyronie’s plaque is healed naturally.  The only difference is that you are doing specific things in a deliberate and methodical manner to heal yourself better than you did the first time around. 

Peyronie’s Disease Institute adopts the judgment of Mayo Clinic concerning Peyronie’s disease  when it stated. ”early stage disease [of Peyronie’s disease] is reputed to respond better than well-established plaques, an early trial of inexpensive, safe and well-tolerated oral therapy is often initially recommended. … With advances in the molecular biology of inflammation and wound healing, the management and understanding of this frustrating disease will no doubt improve.”   

With this statement in mind, I strongly recommend that any man, in any stage of Peyronie’s disease – no matter how chronic or advanced – should at least investigate the use of synergy created by the combination of several simultaneous non-invasive treatment measures selected on the basis of the best understanding of your problem and the information that is available to you.  Peyronie’s disease treatment is variable from one man to the next. Because the Alternative Medicine therapies used in Peyronie’s disease treatment are intended not to treat the disease but to support and strengthen the man who has the problem, so he can heal and repair it to the best of his ability.  Since we are all different, each man must approach his own search for a Peyronies cure on an individual basis.

When you look at the different therapy products on PDI website, realize that they are intended to increase your ability to heal and repair PD, just as it naturally and spontaneously happens in 50% of the men who develop this condition.   Keeping this in mind should change the way you look not only at Peyronie’s disease, but also the way that you consider your relationship to the problem and how you hope to eventually overcome it.

 

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