Can You Adapt to the Peyronie's Curve?
Some penises are going to curve a little. Given how many of them there are in the world, it's inevitable for some to bend to the left or the right. However, some curved penises are more of a problem than others.
Men who develop a penile curve attributable to Peyronie's disease see it occur because of an injury of some kind, sexual or otherwise. Others may notice a change in phallic shape without any obvious cause.
"So they'll be having relations—penetrative sex with their partner—and the penis may slip out of the vagina or the anus and hit a bone and you feel it pop or you have an injury," said Stan Honig, M.D., a urologist and the director of men's health at Yale School of Medicine in New Haven, Connecticut. "That's how it happens in some cases. [In] bad cases, people got hit with a baseball, a surfboard, the dog jumped on them...So a lot of different things can cause it, but most of the time, you don't remember a specific type of thing."
The Peyronie's learning curve
One of the first details to understand about Peyronie's is the curve is not the only "shape shift" associated with the condition. Honig said the variety in potential Peyronie's cases is partly why it's difficult to prescribe behavior and/or lifestyle practices in broad strokes.
"It can bend the penis, shorten the penis, it can indent the penis, it can kind of narrow the penis," he said. "And over the course of about a year, 10 percent will get better and then stabilize, 40 percent will get worse and stabilize, and 50 percent will kind of stay the way it is."
Some patients who see Honig are not bothered by the condition and can function sexually. In those cases, he leaves them alone because he really can't make them any better. On the other end of the spectrum, there are men who come in and are incredibly bothered and anxiety-ridden about it. For some, the curvature is bad enough that they can't penetrate their partner; those are the ones who need treatment.
"So we kind of cater our treatment to how much it bothers them and how functional they are," Honig said.
No oral medication has any effect on Peyronie's, but minimally invasive treatments exist. You can inject a minute amount of medicine with a tiny needle into the penis, which has shown success at improving curvature. Some men, though, are going to need surgery.
The minimally invasive procedure is going to require some user involvement once the injections have been professionally handled. Xiaflex is the only medical therapy for Peyronie's approved by the Food and Drug Administration. Verapamil is used "off-label" by many doctors and facilities, in order words, not for its approved use.
"The protocol involves injecting the medicine essentially twice a week for four separate sessions that are separated by about six to seven weeks," Honig said. "It's an enzyme that breaks up the scar, and then afterward the patient has a mechanical bend to the penis, where they kind of break up the scar more. So it's a combination of the enzyme that loosens up the scar and the mechanic breaks it up, as well."
Honig said the patient-employed physical modeling/stretching that accompanies the injections as part of this treatment could be viewed as a sort of physical therapy. Men pursuing this method of treatment should know the potential success rates, too. About 70 percent of people have improvement in their curvature, but it's going to be moderate. Someone with a 60-degree curvature might get to 40 degrees. A guy with a 40-degree curve might go to 20 degrees. That's not a complete fix, obviously, but Honig said it may make the difference between being functional and not.
As for sexual activities and behaviors, Honig said patients shouldn't limit themselves. If something is uncomfortable, they need treatment.
"Those that are shy should understand that there's good treatment available," he said. "And those that are shy that are very bothered or can't function, they should come and see a doctor sooner rather than later."
A rounded pain threshold
Most patients who have pain from Peyronie's eventually feel the pain fade or go away. It's typical for the pain to last up to a month during the condition's inflammatory phase, but there are exceptions to the rule on both ends, according to Hossein Sadeghi-Nejad, M.D., a professor of surgery and urology at Rutgers New Jersey Medical School, as well as the chief of urology at the New Jersey Veterans Affairs Hospitals.
"It may take that one month, but basically when that inflammatory phase ends, the pain goes away," he said. "But the caveat is that not everybody has pain, even in the inflammatory phase."
For the patients who do have pain, however, it might be surprising to find out just how severe the pain can feel. Sadeghi-Nejad, who does a lot of general urology, said he has seen cancer patients who are not as bothered by their pathology as men with this penile condition.
"It kind of goes to the very core of who they think they are and it's very, very traumatic for them," he said.
The actions people should take to adapt to Peyronie's are different for everybody, but Sedaghi-Nejad suggested some parameters in terms of considering severe or mild cases.
"It's a question of degrees, right? So if you think of the degree of curvature, the degree of deformity, there are many men out there that we never find out that they have a natural congenital bend or that they have Peyronie's, because their bend may be mild. Maybe it's only 10 or 15 degrees," he said. "If somebody has a bad curvature—again, bad is a relative term—but in general, if they have more than a 30-degree curvature, that is for sure a curvature or deformity that we recommend doing something about."
That's the group more prone to reinjury, because the curve is severe enough that if they have sexual activity, their risk of injury is higher. Repeated or chronic injury to the penis is something most men definitely want to avoid. Clearly, though, a bit of scar tissue or penile curvature isn't enough to stop some men from doing what (or whom) they love.
"Now, having said that, there are some guys who say, 'You know what, I have this curve, I'm through the inflammatory phase, I don't have any pain. It doesn't bother my wife, it doesn't bother my partner. I'm fine with it,'" Sadeghi-Nejad said.
Different strokes
Regardless of how bothered a man is by his particular case of Peyronie's, Honig cautioned against taking any impulsive action to address the issue. Urologists have developed options for men living with Peyronie's, so turning to shady corners of the internet for advice or self-concocted cures is not recommended when tried-and-true medical methodologies are available.
"I think the biggest thing is not to do kind of weird, crazy things that don't work, but to really seek the help of a medical professional, because a lot of people think that there aren't good treatments out there," he said.
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