Peyronie's Disease: An Overview of Peyronie's Disease
Guest: Dr. Ross Rames – Urology Services, MUSC
Host: Dr. Linda Austin – Psychiatry, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m talking, today, with Dr. Ross Rames, Associate Professor of Urology at MUSC. Dr. Rames, a very common malady for men is Peyronie’s disease. What is that disorder?
Dr. Ross Rames: Peyronie’s disease is curvature of the penis, caused by scarring in that occurs in the erectile bodies of the penis.
Dr. Linda Austin: How would a man know he has that?
Dr. Ross Rames: Well, when a man gets an erection, typically the penis is relatively straight. In men that have Peyronie’s disease, they may see a pronounced curvature that wasn’t there before. They may also have some pain or tenderness associated with the area of scarring. And the other word for that scarring is plaque. This is something, again, that develops, sometimes, very rapidly; sometimes over the course of several weeks.
Dr. Linda Austin: Several weeks? That is really rapid. That must be pretty disturbing when that happens.
Dr. Ross Rames: Yes. It can be very frightening. And, of course, men are worried about their penis. They worry if something happens to it. And this is clearly something that’s not normal, so they may be very distressed by it. In addition, it may be painful.
Dr. Linda Austin: I’ve treated men in psychotherapy who’ve had Peyronie’s disease and I’ve been struck by how disturbed they were by it. How do you counsel men with this problem?
Dr. Ross Rames: Well, number one, we explain to them what causes it, which is scar tissue that forms in the erectile bodies. Many men are worried that they may have cancer, because they can feel a bump down in the penis. And, of course, that’s the number one concern on their mind, that they may have cancer and may actually lose their penis. So, many of them are relieved when they find out that it’s not caused by cancer. Additionally, we tell our patients that it’s very common, that there are a lot of men out there that are experiencing the same issue that they are. Many men are also worried about sexual dysfunction. In some cases, it can be so severe that they’re not able to be sexually active anymore. And we’ll counsel them that if this is a situation that arises, we can help them with that.
Dr. Linda Austin: How do you help them with that?
Dr. Ross Rames: There are a number of different things that we do. For most patients, their Peyronie’s disease is not so severe that they’ll need surgery. Many of them, over time, as the disease subsides, will find that they have a little residual curvature of the penis, but they’re still able to be sexually active, without any medications or surgical treatment.
It’s common to have erectile dysfunction with Peyronie’s disease. And, for these men, we may prescribe medications, called PD-5 inhibitors; things like Viagra, Levitra, Cialis. Those are the brand names. And this will often help them have an improved erection and allow them to be sexually active again. Additionally, there may be patients that do need surgery, ultimately.
Dr. Linda Austin: As a psychiatrist, when I’ve talked with men about this problem, from the psychiatric point of view, the most difficult thing to get across is that, for their female partners, other forms of sexual activity, besides vaginal intercourse, can be very acceptable and satisfying. You must also have those conversations with your male patients.
Dr. Ross Rames: Yes. We do talk to them about alternate techniques in intercourse. There are a number of different things they can do in terms of positioning that may allow them to have comfortable intercourse even with Peyronie’s disease. So, the partner is definitely a part of therapy when we’re talking about sexual dysfunction.
Dr. Linda Austin: I’ve had the impression, though, that, for men, to satisfy their female partners with vaginal intercourse is way more important for the man than it actually is for the woman. And that has been a very difficult idea, for the men I’ve treated, to wrap their minds around.
Dr. Ross Rames: Yes. I certainly would agree with you there. There’s a big difference between men and women in terms of how they think and function sexually, and it creates problems sometimes in relationships.
Dr. Linda Austin: What are some of the medical, or medication-based, treatments for Peyronie’s?
Dr. Ross Rames: If you look through the literature, you’ll see a number of different things that have been done for Peyronie’s disease; things like vitamin E, nonsteroidals, Potaba. All of these medications have been shown to have some efficacy in some studies, and then later on were found, perhaps, to be not all that effective. My idea there is that they provide the patient with something to do, to treat the symptoms, until the Peyronie’s disease, perhaps, improves on its own.
Dr. Linda Austin: How about surgical treatments?
Dr. Ross Rames: Surgical treatments are reserved for patients who have very severe Peyronie’s disease, which my cause sexual dysfunction, or perhaps they have a deformity that’s so severe that it impacts their life. They may be patients that also have very severe pain with erections, or perhaps a very severe erectile dysfunction.
There are a couple of different techniques that we use to help people, surgically, with Peyronie’s disease. In some patients, we will go in and release some of the scar tissue, and actually graft a substitute tissue into the penis to add additional length, and straighten out the penile shaft. In other patients, we may go in, to the other side of the penile shaft, and put in some straightening sutures.
Quite commonly, in patients that have severe Peyronie’s with erectile dysfunction, we may implant an inflatable penile prosthesis. And then, during the procedure, we’ll actually straighten the penis under anesthesia. You’ll hear the scar tissue areas, or plaques, snap and crack, and break. Then, the penile prosthesis acts as a cast to keep the penis straight during the healing phase. And it’s actually one of the more successful ways of correcting severe Peyronie’s disease with erectile dysfunction.
Dr. Linda Austin: Dr. Rames, thank you so much for talking with us today.
Dr. Ross Rames: Alright, thank you.
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