As a rule, patients with Peyronie’s disease (fibroplastic penile induration) have several complaints characteristic of this condition.
There are 3 most important groups of complaints in fibroplastic penile induration, which should be addressed by the treatment:
- presence of one or several plaques in the tunica albuginea of the cavernous bodies of the penis;
- curvature (deformation) of the penis during erection;
- pain in the area of the plaque during erection and/or during sexual intercourse.
In the initial stage of the disorder, patients usually complain of pain in the penis during erection and/or during sex. Later stages are characterized by the presence of penile curvature during erection, difficulty and even impossibility of sexual intercourse, as well as the detection of fibrous plaques during penile palpation. The effectiveness of conservative treatment of fibroplastic penile induration largely depends on the stage of the illness.
The presence of palpable hard formation under the skin of the penis – plaques – is one of the most frequent complaints in patients with Peyronie’s disease. The number of plaques may vary. Sometimes there are patients with non-palpable plaques.
The dimensions of plaques usually range from a few millimeters to several centimeters with an average of 1 to 2 centimeters. Plaques may not disturb the patient or cause minimal discomfort, for which reason men often do not seek medical advice or are not aware of the existence of plaques at all, and therefore do not receive any treatment.
The Peyronie’s disease may be diagnosed by a urologist during physical examination of the genitals as part of preventive examinations or in connection with the treatment of a completely different disorder. As a rule, men with fibroplastic penile induration reveal plaques under the skin of the penis when they notice the curvature of the penis and, trying to find the cause of these changes, conduct an independent examination of their penis by palpation. Another reason for self-examination and plaque detection is often pain in the penis during erection or coitus.
Penis deformation during erection is the main and most important criterion that reduces the quality of life of the patient and forces him to consult a doctor. The degree of penis deformation during erection is also a key factor in determining the methods of treatment of Peyronie’s disease. There is no strict correlation between the number and/or size of the plaque and the degree of penile curvature: it is the nature and degree of curvature of the penis that decisively influence the choice of treatment tactics. Erectile deformation can be both simple (with the formation of an angle of varying severity) and complex (with the formation of “loops” or the symptom of “sand glass”).
Pain or discomfort in the area of the plaque is present in about 35 – 45% of patients in the acute inflammatory stage of the disorder. Pain passes over time in about 90% of men, usually within the first 6 to 12 months after the onset of the illness or as a result of treatment.
Penile curvature and pain syndrome lead, in turn, to other symptoms: deterioration of sexual life, erectile dysfunction, depression. For example, among patients with fibroplastic penile induration who have completed mental health questionnaires, one in two have mild or moderate depression. The quality of life of patients with Peyronie’s disease deteriorates significantly: depression may develop, self-esteem and/or work activity may decrease, and a man may lose a sense of leadership in family relationships. Unfortunately, psychological manifestations in fibroplastic penile induration are often underestimated by urologists and therefore are not taken into account during treatment.
Sexual partner of a man with Peyronie’s disease may also develop anxiety: changed geometry of the penis can be disturbing, and in case of a pronounced curvature, it may bring discomfort and even pain during sex. In addition, a patient with fibroplastic penile induration in the later stages may experience a lack of adequate blood filling above the affected area of the tunica albuginea due to the local failure of the veno-exclusive mechanism (decreased blood flow through the arteries and increased outflow through the veins). Veno-exclusive dysfunction, present in Peyronie’s disease, is associated with an impairment of the ability of the tunica albuginea to expand and receive increased blood flow as a result of its scarring and plaque formation.
The deterioration of erectile function in Peyronie’s disease is associated with many reasons, including changes in the shape of the penis, which make sexual intercourse impossible. The resulting hypermobility of the penis (associated with cavernous fibrosis or vascular abnormality), psychological anxiety or erection disorders caused by veno-occlusive dysfunction, further reduce the quality of life of the patient and his sexual partner.
It should be noted that the clinical presentation of fibroplastic penile induration: may vary: a patient may have only one symptom (pain, or erectile diformation, or palpable plaque), a combination of several symptoms, or one complaint may follow another over time. Variability of symptoms should be considered when choosing treatment methods.
As a result of the fact that the disorder often occurs with minimal symptoms, which at the beginning do not bother the patient a lot, men with fibroplastic penile induration, unfortunately, very often seek medical advice after a few months (or even years) from the onset of the first symptoms of the sickness, which makes the prognosis of conservative treatment less favorable.