Today we continue our discussion about Peyronie’s Disease as a subtopic of sexual dysfunction. The exact cause of Peyronie’s disease is not well understood. There are a few potential causes that most of the urological world believes may play a role in the condition.

The first of these potential causes is trauma. If the penis bends in an awkward position or undergoes direct trauma the tunica albuginia which is the covering of the corpora cavernosum gets torn. This leads to the production of collagen during the process of wound healing. This excess of collagen reduces the normal elasticity of the penis and can cause painful erections, penile curvature and deformity. Mostly this is thought to happen on a microscopic level. Indirectly, it has been theorized that this repeated micro-trauma to the tissue of the penis may trigger an immune response to try and heal the injury but the body is improperly acting by the production of excess fibrous tissue. An overt tear of the corpora is called a penile fracture. This is usually seen during intercourse where the penis is forcefully bent at an odd angle, literally breaking the corpora, causing immediate and severe pain as well as immediate detumescence. A penile fracture is a urologic surgical emergency and is beyond the scope of this discussion.

There are certain medications which have been implicated in Peyronies disease because they have been reported to cause fibrotic tissue disorders. Beta blockers which are common medications for hypertension or cardiac arrhythmia may be a potential cause of the problem. Phenytoin, which is an anti-seizure medication, as well as supplements such as glucosamine and chondroiton have also been implicated. Finally large doses of Vitamin C may also promote the production of excess collage.

There is also the line of thinking that there is a genetic predisposition to Peyronies disease. It appears to be related to other fibrotic type disorders such as Dupuytren’s disease which is a buildup of fibrotic tissue in the palm of the hand which causes pain and palmar contractures. Similarly plantar fibrosis in which the buildup of plaque is in the foot is thought also to possibly be related.

Finally, there are other conditions which may have an association with Peyronies disease such as diabetes, gout and heart disease. As you can see, we have a ton of theories on why Peyronie’s disease happens. Unfortunately, we have no real definitive answers to the etiology of Peyronies disease. When you see this in medicine, it should tell you something. That something is that we just don’t have enough information. Also, it is likely that the etiology of the problem is multi-factorial.

Next time we will discuss available treatments for Peyronie’s disease. They range from watchful waiting, to medications and finally to surgical repair. Each has its benefits and drawbacks, and like everything else in medicine one size does not fit all.

Nice win by the Ravens this week. This was a game that we needed to win and do so convincingly. It was as they say, just what the doctor ordered. Although they gave up more yards than typical, the defensive backfield represented well. They will need to continue their hard work as they go to New England and face one of the best quarterbacks in the game. I think this is a winnable game. I see the Patriots as a carbon copy of the Broncos. Neither team has an effective running game and the Patriots just traded away their home run receiver. In addition, their defense is just not what it used to be. I am looking for the Ravens to steal a hard fought win in a difficult venue in which to play. If they do so, it is home to Baltimore to play the hapless Buffalo Bills and go into the bye potentially with a league leading 6-1 record. Let’s hope it happens. It will make all the fans in Ravenland very happy. Have a great week.