One of the other very common sexual dysfunctions
for men is a disease that is named after the
man who first described it. It's called Peyronie's
disease. It's an extraordinarily common problem
where scarring of the two cylinders in the
penis that fill with blood with erection tether
the penis so it it it misdirects and it can
be up, down, sideways. But the curvature can
make intercourse almost impossible and oftentimes
it makes it quite painful. And again men are
reluctant to talk to anyone about it and are
reluctant to seek medical attention. Happily,
there are treatments that we have that can
be very helpful to these men, particularly
if the curvature of their penis is such that
it makes intercourse almost impossible. The
cause of the scarring in the cylinders that
fill with blood in the penis remains a mystery
to us. It is interesting that a a common condition
seen by hand surgeons called Dupuytren's contracture
or in some cases, it's referred to as trigger
finger, is a is a similar process and men
who suffer from Dupuytren's contracture seem
to disproportionately have the problem. So
in some senses most of us think it's more
a connective tissue disorder. And one of the
things we always try and reassure the patients
is is that it isn't something that they've
done. Oftentimes men blame themselves, saying
some bizarre sexual practice must have led
to this problem. And that's almost never the
case. When we see men with Peyronie's disease
the first question that I always ask them
is, is it possible for you to have sex? And
then if the answer is yes, do you have pain
when you're having sex? And if the answer
to the first question is yes and the answer
to the second question is no, in general we
take a very benign approach to trying to treat
them. The treatments are generally instituted
for people who either have such severe pain
or such severe curvature that they simply
can't have intercourse. And in that situation
we begin oftentimes with medication. The second
treatment that we now use is an injection
of a medication directly into the scarred
area. And this was a technique that was used
first in people with trigger finger or Dupuytren's
contracture and what it does is it tries to
release that fibrous scar and soften it up
so that the tissue regains its ability to
stretch. The last treatment that we hold in
reserve is surgery and in that situation you
actually go in and you excise the area that
is scarred and depending on how much of that
tissue you have to remove in some cases a
graft has to be put in place. And that oftentimes
restores a good deal of straightening to the
penis to make sexual intercourse possible.
