What Can I Do About My
Bent Penis -- Peyronie's Disease
And other possible dysfunction questions. How about YOUR question here? Read below or choose another question.
I have a problem that is a bit
embarrassing to ask about -- it is, technically, called
Do you know of any natural remedies
to this situation?
I have had such
questions several times and have decided to publish
this as one of my FAQs.
have a standard explanation of Peyronie's disease --
where scar tissue builds up on the penis and prevents
it from be straight when you have an erection.
MSM has been
reported to eliminate scar tissue, but the reports
certainly did not mention scar tissue on the penis --
and I don't know if your scar tissue is "internal" or
not, or whether the scar tissue which MSM has been
reported to help was "internal."
A US Patent has been
issued showing that Alpha Lipoic Acid reduces scar tissue -- it would be
easy and safe to try as an external application. MSM would be much
cheaper to try. If it doesn't work, try alpha Lipoic Acid.
Is your scar tissue
which apparent to the eye?
In any event, it would
be very easy and safe to try.
The cheapest way to go
would be to buy bulk MSM and mix it with water, spray
it on several times per day. This would be a bit
inconvenient, but I think this removal of scar tissue
depends on the amount of time that MSM is in contact
with the scar tissue. So several times per day would
You can dissolve about
25% of the weight of the water with MSM. Sterile water
would probably be best, but any water you bathe with
would also be fine.
If you can figure a way
to soak the penis in MSM water that would be fastest.
A bath tub would be fine, but you would need lots of
MSM to get the solution level high enough to do any
good. This will not harm you in any way.
More effective would be
our MSM cream, called CalmCream. It absorbs quickly and would not leave
a greasy or "wet" skin surface. The MSM would be held
in place better and longer this way. Our CalmCream
also has some fine oils and vitamins, in addition to
Ayurvedic herbs -- and I think would work better than
the plain MSM.
You should probably not
expect to see results until some months have gone by --
with three to six daily applications.
It will not be
In some cases like yours
the only problem is the bent penis? In some others
there is also a loss of hardness?
I doubt if the MSM would
remedy the loss of hardness, but if the "bent" is from
scar tissue, the MSM, or cream are well worth the try.
Let me know what else
you think about this. If you try this remedy I
certainly want to hear of your results.
PEYRONIE'S DISEASE: CURVATURE OF THE PENIS
Peyronie's disease is a
severe curvature of the erect penis. It's named
after an Italian physician to King Louis XIV of
France. This physician was the first to note the
disorder back in the 1700s. While it is somewhat
common, it is not often mentioned.
A minor bend in the erect penis is perfectly
normal, as few penises are straight as an arrow. In
some cases of Peyronie's, however, the penis can
form a "J" or a corkscrew, making intercourse
What causes a curved penis?
The cause of Peyronie's
disease is unknown. Some physicians theorize the
cause of the curvature may be from trauma to the
penis, perhaps if the penis is bent backward during
rough sex. The injury causes an inflammation in the
tunica, and subsequently leads to scarring.
There are other theories,
and some reports suggest that men who take
beta-blocking medications for high blood pressure
How is the penis constructed?
The penis is composed of
three cylindrical cavities. The two on top are
called the corpus cavernosa, and the one on bottom
the corpus spongiosum, which contains the urethra
(the tube that urine flows through).
The two top corporal cavities expand to trap and
hold the blood that produces an erection in the
male. The bottom body, corpus spongiosum, functions
mainly for the passage of urine. Each of these
corporal bodies is surrounded by a very elastic
covering called the tunica albuginea.
On top of the two corporal cavernosa are the
superficial nerves and blood vessels of the penis.
Why does the penis curve?
In Peyronie's disease, the
normal elastic tissue of the tunica is replaced by
scar tissue. Normally with erection the elastic
tissue of the penis expands and elongates
symmetrically resulting in a straight erection.
Because the plaque, or scar tissue, is not elastic,
but rather hard, it will not stretch with erection.
The disease starts as a small bump or constriction
on the shaft of the penis below the skin, which
expands to form a flat deposit that's sometimes as
large as the diameter of a silver dollar. This
"plaque" invades and replaces the elastic covering
of the penis with inflexible material. When a man
with Peyronie's has an erection, the plaque does
not expand, so the penis curves to one side.
How does a curved penis affect sexual intercourse?
A third of men with
Peyronie's have pain with their erections. A few
men with Peyronie's become impotent. In some cases,
the head of the penis does not fill with blood.
Because inflammation is initially associated with
the scar tissue, there can be some discomfort with
erection and distension. Many patients complain not
only about the curvature of the erection but the
loss of length and girth. These are all results of
the inelastic tissue and lack of distention that
Most patients with Peyronie's disease can continue
to function sexually with the curvature in the
penis. Rarely, some patients with greater
distortion are unable to have satisfactory sexual
Does a curved penis cause impotence?
Recent studies indicate
that some men with Peyronie's disease lose the
ability to trap the blood in the penis. It can,
however, be difficult to distinguish the man who
has a leakage problem from one who is quite anxious
about his penis and loses his erection secondary to
anxiety and stress.
Most of the time the plaque is on the top surface
of the penis causing an upward bend. However,
plaques can occur at any point on the penis. In
some patients the penis beyond the plaque will not
become as rigid.
How common is a curved penis?
Peyronie's disease is an
extremely common ailment. At the Male Health
Center, physicians see about five patients a week
with this problem.
Most patients are middle-aged, though the youngest
patients we have seen are in their twenties, and
there are a number of still sexually active men in
their eighties with the disease.
Some men first notice the sudden onset of a curved
erection even though the previous erection was
straight. In other men, the curvature may be slight
at first, but then it keeps getting worse.
Eventually, the curve stops, and gets no worse. In
most cases, the active process of Peyronie's
disease lasts less than a year. At the time the
process stops, the scar tissue may remain or in
some cases disappear.
How can you straighten a curved penis?
Rather than focus on
cosmetic goals related to the aesthetic ideal of an
arrow-straight penis, the real goal of treating a
curved penis is to keep or restore sexual function.
Physicians are aware that a man can have a great
deal of apprehension and anxiety associated with a
curved penis. There is absolutely no connection
between Peyronie's disease and cancer, for example.
There is no specific therapy for Peyronie's
disease. We presently prescribe 400 units of
vitamin E to be taken with meals. It is theorized
that vitamin E promotes healing and prevents
scarring. Additionally, we prescribe Advil for its
antiinflammatory effects, to be taken with meals.
For men having significant pain with erections, a
drug called Colchicine may be used. Before
beginning this treatment, patients should have
their white blood cell count checked to ensure that
there is no change with this medication.
At the Male Health Center we are currently
conducting a study from the University of Chicago
that uses injections into the scar tissue.
No other non-surgical treatment for Peyronie's
exists. And steer clear of any physician
recommending bizarre treatments, including steroid
injections into the plaques (which don't help).
Radiation and ultrasound are of no benefit. Oral
potaba, which is often prescribed in huge
quantities, is of no benefit.
When the disease process stops, there is usually
some residual distortion of the penis but the vast
majority of patients are able to function
adequately sexually. However, if there is enough
distortion of the penis to preclude sexual
intercourse, surgery is possible.
Can surgery straighten a curved penis?
include tightening or tucking the penis opposite
the curvature to produce straightening. This
usually results in some small loss of length.
The Nesbitt Tuck is a 10 to 20 minute outpatient
procedure that puts a stitch at the underside of
the maximum point of the curve. It requires about a
week off work and discomfort with erections for
four to six weeks. Another surgical treatment
consists of incision to the plaque or scar tissue
and patching with a vein. Since this is usually on
the top surface of the penis, the nerves and blood
vessels previously described must be elevated.
A specialized surgeon may be able to cut away the
plaque and graft new tissue, treat the side
opposite the plaque, or install a penile implant.
The first two approaches may cause impotence, since
they may damage the tissue within the penis. The penile implant is the last resort.
Some new treatments involve the use of lasers to
remove the plaque, which may pose less risk of
tissue damage. But this technique is still
experimental and not widely available.
What does the Male Health Center recommend?
Generally speaking, we at
the Male Health Center recommend that the man be
patient enough to see if the problem will correct
itself, because one-third of cases get better
within 18 months after the onset of the problem.
During this period, we recommend 400 international
units of vitamin E three times a day. While the
application of vitamin E at this time is not
substantiated in scientific journals, the vitamin E
won't hurt you and may, in fact, help prevent heart
If a mild curve does not get better within 18
months, further treatment may not be recommended,
as long as the bend itself isn't severe enough to
prevent intercourse, and the problem doesn't pose
the risk of impotence.
In the case of an extreme curve, painful
intercourse, or if there is the potential for
impotence, surgical correction of the curve may be
Generally speaking, if the bend is not severe, and
it doesn't prevent sex, we at the Male Heatlh
Center recommend trying to live with it.
Considering that few partners will see your penis
on display, a curved penis that doesn't affect your
sex life is something you and your partner can
learn to appreciate as just another unique aspect
Peyronie's Disease: Current Management
- JAMES FITKIN, M.D., and GEORGE T. HO, M.D.
- Mount Carmel Health System
- Columbus, Ohio
Peyronie's disease is
an acquired inflammatory condition of the penis
associated with penile curvature and, in some cases,
pain. It primarily affects men between 45 and 60
years of age, although an age range of 18 to 80 years
has been reported. If left untreated, Peyronie's
disease may cause fibrotic, nonexpansile thickening
of relatively discrete areas of the corpora tunica,
typically resulting in focal bend, pain or other
functional or structural abnormalities of the erect
penis. Many cases resolve without treatment. Medical
therapies, including antioxidants (such as vitamin E
and potassium aminobenzoate) and corticosteroids
injected directly into the plaque, lack adequate
scientific support. Surgery remains a mainstay when
conservative measures fail. (Am Fam Physician
disease was first described in 1704. It is named for
Francois de la Peyronie, who, in 1743, described a
patient who had "rosary beads of scar tissue to cause
an upward curvature of the penis during erection." The
penile curvature of Peyronie's disease is caused by an
inelastic scar, or plaque, that shortens the involved
aspect of the tunica albuginea of the corpora cavernosa
during erection.1,2 In approximately one third of patients, the scarring
involves the dorsal and ventral aspects of the shaft.
Such offsetting plaques may cause the penis to be
straight but shortened or to have a lateral bend (Figure 1). The circumference of the shaft may also
be reduced, resulting in an erect penis that is flail
at the site of the constriction, firm proximal to the
constriction and soft distally.3
The first symptom of Peyronie's disease may be focal
pain with erection, new curvature with erection or
inability to penetrate as a result of curvature or
distal flaccidity.3,4 Some patients who do not have pain with erection have
tenderness on palpation of the indurated plaque.
FIGURE 1. Penile curvature associated with Peyronie's
disease. (A) anatomy of a normal erection. (B) Peyronie's disease. Penile cross-section
showing plaque between the corpora. (C) Penile curvature. Fibrous plaque prevents uniform
lengthening as erection occurs. As the rest of the
corpus cavernosum and corpus spongiosum lengthen,
the penis bends toward the involved area.
A number of authors believe that Peyronie's disease
results, in part, from trauma.5-7 More than 75 percent of patients with Peyronie's
disease are between 45 and 65 years of age, when
elasticity of the collagen of the penis has diminished.5 Many patients recall an episode of penile trauma, such
as an invasive procedure, blunt trauma or injury during
intercourse, at the site of subsequent plaque
formation. Up to 47 percent of patients with Peyronie's
disease also had another condition associated with loss
of elasticity, such as Dupuytren's contracture or
Ledderhose's disease (fibrosis of the palmar and
plantar fascias, respectively).8-11 Some authors5,12 suggest that either a single episode or recurrent
episodes of flexion of the tunica albuginea may result
in tears that bleed and form a clot, with subsequent
fibrin deposition. Biopsy may demonstrate fibrin
deposition and perivascular inflammation underlying the
tunica albuginea and, occasionally, within and beneath
Buck's fascia overlying the plaque.5
Patients typically present with focal pain that
occurs with erection, bent erection, presence of a hard
mass and/or inability to have intercourse secondary to
flail penis distal to the lesion.3 One half to two thirds of patients with Peyronie's
disease describe pain as a symptom. Pain is associated
with the inflammation generated by the active phase of
the healing process, and it typically disappears as the
inflammation resolves. It is believed to be the result
of inflammation of the adjacent Buck's fascia, since
the tunica albuginea itself has no nerve fibers.5
During the first year or so after formation of the
plaque, while the scar in the tunica is undergoing the
process of remodeling, penile distortion may increase,
remain static or, as is most often the case in younger
men, resolve and disappear spontaneously.3-5 In most patients the curvature remains static as the
scar matures although, in some patients, it becomes
worse as fibrosis ensues and the scar contracts. In 25
percent of these patients the scarring process
progresses to calcification, and in 25 percent of those
it progresses to bone formation.3,5
|Patients with Peyronie's
disease may present with a painful, bent penis
on erection, a palpable, hard penile mass and a
flaccid penis distal to the lesion.
After the scar has matured, the configuration of the
tunica albuginea is unlikely to be changed by
nonsurgical treatments.4 However, many patients with advanced disease who have
not sought surgical correction have been able to
continue mutually satisfactory sexual intercourse with
a partner. Approximately one third of patients with
end-stage disease have a disabling curvature that
requires surgical correction.
Pain that occurs in conjunction with Peyronie's
disease may also progress with the onset of new
injuries to the corpora cavernosa occurring as a direct
result of the patient's attempts to correct or
compensate for the original defect during sexual
intercourse.5 One of
the more common reasons for seeking treatment involves
discomfort of the patient's partner during intercourse,
which is associated with penile curvature.
Indurated plaques may be palpated on physical
examination of the penis. Such palpation may elicit
pain if the disease is still in the inflammatory stage.
Corroboration of Peyronie's disease may be obtained by
having the patient photograph the erect penis,
demonstrating curvature, an hourglass shape or flail
Radiographs of the penis may show calcification in
20 to 25 percent of patients with end-stage disease,
and 25 percent of these patients have frank bone.3,5 Doppler flow studies and results of dynamic infusion
cavernosometry and cavernosography are normal both
proximal and distal to the plaque, demonstrating that
disparity in the erection is not associated with lack
of blood flow at or beyond the lesion.3-5
Despite numerous treatment options, there is no
generally accepted, standard nonsurgical treatment for
Peyronie's disease. Moreover, the success of treatment
may be difficult to assess because 20 to 50 percent of
patients with Peyronie's disease experience spontaneous
potential for improvement probably warrants delay of
surgical correction for at least six to 12 months after
diagnosis unless the plaque is calcified or the patient
is completely incapable of sexual activity.4
Oral agents, particularly those with antioxidant
properties, have been tried with limited success. Such
agents include vitamin E,10 potassium aminobenzoate (Potaba),13 and colchicine. Experimental intralesional treatments
include corticosteroids, parathyroid hormone,11 collagenase and verapamil (Calan).8,14,15 Various modes of energy transfer, including ultrasound,
radiation, laser therapy, short-wave diathermy and
lithotripsy, have also been used.10,16,17 However, all current published reports of these
treatments have been compromised by limited-sample
patient populations, lack of control populations,
poorly characterized outcome parameters, inadequate
follow-up periods and inconclusive results. It has been
difficult, therefore, to determine which, if any, of
the nonsurgical treatments may be effective. Caution
should be used when recommending any of these
Vitamin E and Verapamil
One possible medical regimen is 100 mg of vitamin E
taken three times a day for a minimum of four months.
Theoretically, this antioxidant will prevent further
development of plaque, although studies have suggested
that it is no more effective than placebo.
|The most commonly used
surgical procedure for Peyronie's disease is
excision of the plaque and a patch graft using
the patient's skin.
Injectable verapamil also has received some
attention recently, although studies have either shown
no statistical improvement over placebo or have been
critically compromised by very small study size.14,15
Potassium aminobenzoate is considered a member of the
vitamin B complex and is believed to promote
antifibrotic activity through its mediation of
increased oxygen uptake at the tissue level. Potassium
aminobenzoate is rapidly excreted in the urine, so
dosages are given at approximately three-hour
The standard regimen of potassium aminobenzoate is
12 g daily, divided into six doses of four 500-mg
tablets. The total of number of tablets per day is 24
(720 tablets per month). Since a minimum of six to 12
months of treatment is recommended, patients must take
a huge number of pills during the course of treatment
to achieve any benefit. In a study of 21 patients with
Peyronie's disease who were treated with potassium
aminobenzoate,13 morphologic deformity resolved completely in 18 percent
of the study subjects and decreased in an additional 82
percent. The plaque resolved completely in 11 percent
and decreased in size in an additional 67 percent, and
pain resolved in every patient.13 A retrospective review18 noted that no well-controlled prospective, double-blind
study containing adequate study subjects has been
conducted to establish the efficacy of potassium
aminobenzoate in the treatment of Peyronie's disease.
Since the rate of spontaneous resolution is high, the
results with potassium aminobenzoate may be no better
than the results with placebo.
The corticosteroid preparation used in the treatment of
Peyronie's disease varies, but two common regimens are
dexamethasone (Decadron), in a dosage of 0.2 to 0.4 mg
per plaque injected weekly for 10 weeks,8 and triamcinolone hexacetonide (Aristospan
Intralesional), in a dosage of 2 mg administered once
every six weeks for a total of six injections. Courses
of treatment have been repeated in some instances. A
small syringe and a fine needle are used to inject the
medication into the plaque and the tissues immediately
adjacent to it. Local anesthetic agents are not used
routinely because of the risk of injection into the
Using the dexamethasone regimen in 31 patients, one
study13 reported an
81 percent benefit to a moderate or greater degree,
with 42 percent of patients achieving what they
described as marked improvement. In a study4 of 42 patients treated with triamcinolone, 33 percent
of patients had complete recovery or marked improvement
in symptoms and signs during the course of treatment.
Steroid injections are probably most effective
during the initial formation of Peyronie's plaque, and
success is limited with mature plaques. Patients are
advised to abstain from sex during treatment to
minimize further potential trauma to the penis.
A number of surgical techniques are used for treatment
of Peyronie's disease. The technique should be
individually chosen for each patient. The optimal
surgical approach considers penile rigidity, degree of
curvature, shaft narrowing and erectile response.19 One commonly used surgical technique, the Nesbit
procedure, involves excision of the plaque accompanied
by "patch grafting" of the defect left by the excision.
Graft material generally is taken from scrotal tunica
vaginalis or nonhair-bearing skin from the forearm.
Artificial graft material such as Gortex has also been
used but with mixed results. These materials are
generally less elastic and do not permit adequate
stretch of the corpora during erections. Other
techniques include penile prosthesis and plication of
the tunica albuginea.
Excision of the plaque has been associated with
complaints of diminished rigidity of erection and
impotence following surgery. These problems have been
attributed to damage of the erectile nerves during
penile surgery. Thus, it is sometimes more practical to
treat severe cases of Peyronie's disease with placement
of an artificial penile prosthesis following incision
and release of the plaque.
JAMES FITKIN, M.D.,
currently has a private practice in Grove City, Ohio. A
graduate of the Ohio State University College of
Medicine in Columbus, Dr. Fitkin completed a residency
in family practice at Mount Carmel Health System, also
GEORGE T. HO, M.D.,
is director of research in the surgery residency
program and attending staff in the Department of
Surgery, Division of Urology, in the Mount Carmel
Health System. A graduate of Northwestern University
Medical School, Chicago, Dr. Ho completed a residency
in urology at Harvard Medical School, Boston, Mass.
correspondence to George T. Ho, M.D., Mount Carmel
Health System, 793 W. State Street, Columbus, Ohio,
43222. Reprints are not available from the authors.
- Ehrlich HP. Scar contracture:
cellular and connective tissue aspects in Peyronie's
disease. J Urol 1997;157:316-9.
- Brock G, Hsu GL, Nunes L, von
Heyden B, Lue TF. The anatomy of the tunica albuginea
in the normal penis and Peyronie's disease. J Urol
- Devine CJ Jr. Introduction to the
International Conference on Peyronie's disease. J
Urol 1997;157: 272-5.
- Williams G, Green NA. The
non-surgical treatment of Peyronie's disease. Br J
- Devine CJ Jr, Somers KD, Jordan
SG, Schlossberg SM. Proposal: trauma as the cause of
the Peyronie's lesion. J Urol 1997;157:285-90.
- Van de Water L. Mechanisms by
which fibrin and fibronectin appear in healing
wounds: implications for Peyronie's disease. J Urol
- Jarow JP, Lowe FC. Penile trauma:
an etiologic factor in Peyronie's disease and
erectile dysfunction. J Urol 1997;158:1388-90.
- Desanctis PN, Furey CA Jr.
Steroid injection therapy for Peyronie's disease: a
10-year summary and review of 38 cases. J Urol
- Somers KD, Dawson DM. Fibrin
deposition in Peyronie's disease plaque. J Urol
- Rodriques CI, Njo KH, Karim AB.
Results of radiotherapy and vitamin E in the
treatment of Peyronie's disease. Int J Radiat Oncol
Biol Phys 1995;31:571-6.
- Morales A, Bruce AW. The
treatment of Peyronie's disease with parathyroid
hormone. J Urol 1975;114:901-2.
- Davis CJ Jr. The microscopic
pathology of Peyronie's disease. J Urol
- Zarafonetis CJ, Horran TM.
Treatment of Peyronie's disease with potassium
para-aminobenzoate (POTABA). J Urol 1959;81:770-3.
- Levine LA. Treatment of
Peyronie's disease with intralesional verapamil
injection. J Urol 1997;158: 1395-9.
- Rehman J, Benet A, Melman A. Use
of intralesional verapamil to dissolve Peyronie's
disease plaque: a long-term single-blind study.
- Wahl SM. Inflammation and growth
factors. J Urol 1997;157:303-5.
- Heslop RW, Oakland DJ, Maddox BT.
Ultrasonic therapy in Peyronie's disease. Br J Urol
- Carson CC. Potassium
para-aminobenzoate for the treatment of Peyronie's
disease: is it effective? Tech Urol 1997;3:135-9.
- Levine LA, Lenting EL. A surgical
algorithm for the treatment of Peyronie's disease. J
Urol 1997;158: 2149-52.
Alternative names Return to top
Definition Return to top
Retrograde ejaculation refers to the entry of semen
into the bladder instead of going out through the urethra during ejaculation.
Causes and risks Return to top
Retrograde ejaculation may be caused by prior prostate or urethral surgery, diabetes,
some medications, including some drugs used to treat hypertension and some mood altering drugs.
The condition is relatively uncommon and may occur either partially or
completely. The presence of semen into the bladder is harmless. It mixes into
the urine and leaves the body with normal urination. Men with diabetes and those
who have had genitourinary tract surgery are at increased risk of developing the
Prevention Return to top
Maintaining good blood sugar control in diabetic men
may be helpful in preventing the development of this condition. Avoiding the use
drugs that cause retrograde ejaculation will prevent the condition developing as
a result of their use.
Symptoms Return to top
- Little or no semen discharged from the urethra in conjunction with the
male sexual climax (during ejaculation)
- Possible infertility
- Cloudy urine after sexual climax
Signs and tests Return to top
A urinalysis performed on a urine specimen that is obtained shortly after ejaculation will
reveal a large amount of sperm in the urine.
Treatment Return to top
If retrograde ejaculation is caused by drugs, removal
of the specific drug may resolve the condition. Retrograde ejaculation caused by diabetes or following genitourinary tract surgery may be responsive to the use of
epinephrine-like drugs (such as pseudoephedrine or imipramine).
Prognosis Return to top
If retrograde ejaculation is caused by medications, discontinuation of the
medication often restores normal ejaculation. If retrograde ejaculation is
caused by surgery or diabetes, it is often not correctable.
Complications Return to top
The condition may cause infertility.
Call your health
care provider if Return to top
Call for an appointment with your health care provider
if you are having difficulty conceiving a child or you are concerned about
Update Date: 8/10/2001
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