Plaque that can cause erectile dysfunction


  • Ask Dr G
  • Sunday, 15 Dec 2013

I am 22 and I suspect that I'm suffering from Peyronie's disease.

Question: It takes me some courage to write to you and ask about my condition.  I am 22 and after searching through the Internet and self-diagnosis, I suspect that I'm suffering from Peyronie's disease.  

During erection, my penis curves downward around the base and I can feel an "indentation" (not sure the right word to use) spot at the underside of my penis which I assume the corpus spongiosum has been damaged.

I have not experienced any sexual intercourse and I do not know how serious this disease will affect my life.  I have been suffering in silence since I was around 14.  However, I do not remember I experience any pain during erection all these years, which is listed as one of the symptoms.  I understand that this disease is uncommon among young men and this worries me.

I would like to know are there any effective treatments for it aside from surgery?  I do not wish to go for surgery if possible.  Should I go to a GP or urologist for proper diagnosis?  What is expected from the diagnosis and treatment?

Hard man.


A: The hard lump in your penis is certainly giving you a real hard time. I certainly hope Dr. G can offer some help.

Indeed, there is a condition called Peyronie’s Disease that has the symptoms that is similar to what you have described, that can affect up to 5% of men. This is a connective tissue disorder that involves the fibrous sheath of the penis. Although a common condition, the etiology of this is largely unknown.

Peyronie’s is a medical condition characterized by the formation of plaque in the shaft of the penis, beneath the skin on the corpus albuginea of the penis. The plaque can be formed both in the dorsal or ventral aspects of the penis and results in the penile curvature towards the opposite site. Miserably, the formation of the plaque and the curvature will also inevitably cause the damage to the penile neuro-vasculature that can result in erectile dysfunction (ED)

In the initial stages of the condition, the sufferer will experience pain or discomfort. This is the period when the treatment such as anti-inflammatory or Vitamin E may make a difference. This acute period typically last for a period of six months. When the condition becomes stabilized, unfortunately the pharmaceutical intervention will also cease to have any effect. 

Characteristically, Peyronie’s will remain unchanged after six months. The minority of subjects will have complete spontaneous resolution of the plaque and curvatures. Sadly, another proportion of the sufferer will even have the worsening of the symptoms that may require surgical intervention.

The surgery for Peyronie’s is brutal! It can either involve the excision of the plaque to replace it with a venous patch or the stitching of the penis to straighten the bend. Either way, the outcome would be far from satisfactory, as this may disfigure or shorten the penis.

You are absolutely right. Peyronie’s is exceedingly rare in youth and adolescence. And I confess I have not come across the condition in young adults like you in my career (Trust me, I have seen my fare share of abnormal external genitalia in my life time). Although exceptionally unusual, it is not completely impossible. You have built up courage to email me, why don’t you also make an appointment to see a urologist. My bet is curvature you are experiencing is physiological rather than pathological!!


Q: First I must say, you have a great sense of humor. Have always enjoyed your consultations and comments on air and online.

Can I have your take on Kegel Exercise.

Terry

A: Thanks for your encouraging words. It is always pleasing having fans who can appreciate my sense of humor. I guess there are not many.

Kegel was an American Gyneacologist who first described the exercise of the voluntary contraction of the pelvic floor muscle repeatedly to strengthen the group of musculature that control both urinary and fecal continence. This is typically described as squeezing of the muscles of the pelvic floor. These exercise are usually done to reduce urinary incontinence is women for stress urinary incontinence. For men, I also advise men to perform such exercise after radical prostatectomy for prostate cancer. 

There are some studies that is published demonstrating the role of pelvic floor in enhancing the erection. One recent report in 2005 also claims significant benefit in men with the problems of Premature Ejaculation (PE), apparently improving the PE in 61% of the subject. In reality, I find no real evidence to support Kegel in the treatment of ED or PE.

I hope that answers your question.


Q: I am in the mid 20's uncircumcised and dissatisfied with my sexual life. I have developed a medical condition called Pearly Penile Papules (PPP) for the research I have done so far.

Is PPP is the main reason of having too much pleasure and also resulting in me having the inability to last longer. 

Will circumcision help in this case? All I want is to be a more fulfilling lover.

I don’t mind to have the prepuce remove and join the 1/3 of the world population for the sake of sexual satisfaction for my partner.

I thank you for your time and hope this mental torture could end soon.

Anonymous


A: I am sorry you suffer from such mental torture. I guess it is the same old devil call “guilt” again!!

Most of us would associate the sense of pleasure with guilt, and that may lead to blame. Many men would blame the occurrence of sexual dysfunction such as premature ejaculation or erectile dysfunction on excessive indulgence of “self pleasure”. Others would blame any penile deformity or infertility on masturbation too. In your case, the slight deviation of norm, such as the PPP is also associated with “self-pleasure”. I hope you can be relieved to learn there is absolute no association of Fodyce nodules with your self-indulgence.

The reality is that PPP the hypertrophied glands in your glans penis. This occurs in many men with prepuce, and can cause distress in some men due to cosmetic disadvantage.

Many treatments such as laser and creams with have the effect of temporary reductions of the nodules. But the outcome may not be overall satisfactory.

If the PPP truly bothers you, go on and get the cut. I am sure you won’t regret it.


The views expressed are entirely the writer's own.

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