The penis consists of three tubes: the hole urethra that carries urine and semen, and two tender, spongy tubes known as the corpora cavernosa that fill with blood to stiffen the penis in an erection. All three are encased in a tricky, fibrous sheath known as the tunica albuginea that, when plaque kinds, makes the sheath much less versatile. Relying on the situation of the plaque (in 70 p.c of circumstances, it kinds on the highest aspect of the penis), it could actually trigger the penis to bend up, down or to the aspect when it stiffens. Typically plaque kinds across the penis, making a slender band just like the neck of a bottle.

Heredity and sure connective tissue problems like Dupuytren’s contractures improve the danger of creating Peyronie’s. Elevated blood sugar, smoking and pelvic trauma additionally improve the danger. The illness can develop steadily or come on out of the blue. It happens in two phases: acute and power. The acute part, which frequently causes painful erections, lasts for six to 18 months, throughout which plaque kinds and deformity of the erect penis worsens. Within the power part, the ache ends, the plaque stops rising and the deformity stabilizes.

Mr. Cummings’s physician instructed him it was good that he got here for remedy early, earlier than the plaque turned calcified and more durable to deal with. As he described it, the various injections of verapamil put holes within the plaque, “altering it from Cheddar to Swiss” and making the penis extra versatile. He additionally spent hours a day stretching his penis with a traction system known as Andropenis, an F.D.A.-approved penile extender.

This and related units can assist lengthen a penis shortened by Peyronie’s and foster straighter reworking because the plaque is changed with wholesome collagen.

“Xiaflex isn’t a miracle drug,” Dr. Mills mentioned. “The trial that led to F.D.A. approval noticed a 35 p.c enchancment in curvature, though we’re seeing a few 50 p.c lower. I inform sufferers ‘You’re by no means going to get again the penis you had, however you may get a practical penis,’ which is what most males need.” Solely not often does the issue appropriate itself with out remedy.

Extreme circumstances that don’t reply adequately to injections could also be handled surgically, an possibility normally reserved for males with disabling deformities that make sexual exercise troublesome. Surgical procedure isn’t performed till the plaque and curvature have stabilized. Choices embody shortening the aspect of the penis reverse the curve or extending the curved aspect by filling in with a graft, a more difficult method.

Some males with Peyronie’s illness who even have erectile dysfunction could also be fitted with an inflatable pump or malleable silicone rods that straighten the penis and make it stiff sufficient for penetration.

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