FDA OKs Drug for Curved Erections
A curvature to the penis isn’t always cause for concern. If it’s minor and the penis has always had a bit of a curve, that might just be its normal erect shape. But for men who suffer from Peyronie’s disease, the onset of a curvature happens later in life, it’s pronounced, and might be a reason to see your doctor.
Fortunately, new advances in medicine give doctors another avenue for treating Peyronie’s disease with effective and less painful methods than before. The FDA’s recent approval of the drug Xiaflex, by Auxilium Pharmaceuticals, gives hope to men who either didn’t respond to the traditional medications or who don’t want to undergo surgery.
Peyronie’s Disease is More than a Curve
A healthy penis becomes erect, firm, and generally straight during sexual stimulation, but not always perfectly straight. Blood fills two semi-cylindrical, spongy chambers running the length of the penis, causing it to lengthen and thicken. When Peyronie’s disease affects the penis, the erection has anywhere from a slight to pronounced curve.
With Peyronie’s, the tissue’s normal ability to stretch during an erection is impaired in one or more areas, so the penis doesn’t expand evenly. The problem doesn’t lie in blood flow, but in the tissue’s ability to accommodate it.
Scarring is the usual culprit behind Peyronie’s, and there are different causes. Where healthy tissue can stretch, scarred tissue is less supple. And it’s usually beneath the layer of skin that you can see. The Mayo Clinic explains that scarring can sometimes be identified as “flat lumps or a band of hard tissue” beneath the skin.
This scarring can cause the penis to curve in any direction, and sometimes it’s severe enough to make sexual stimulation and intercourse painful. In some men, the curve is so pronounced that sex is nearly impossible. It can also lead to problems achieving or maintaining an erection.
Causes and Traditional Treatments for Peyronie’s
Injury is usually responsible for scarring, but the injury doesn’t have to be obvious. Some injuries are difficult to forget, such as sports-related one. But injury can also happen during sex.
Scar tissue can form as an injury heals. With Peyronie’s Disease, ruptured small blood vessels inside the penis may heal with blood and other cells trapped at the site of the injury, says Mayo Clinic. This creates the thickened scar tissue, which isn’t as flexible as it was before the injury. Not all injuries result in scar tissue. It’s an injury that doesn’t heal properly that produces thickened tissue. Some men may be genetically predisposed to scarring.
In some men, no evidence of injury is found. The Mayo Clinic says in these cases, it can gradually evolve and worsen over time, and may be related to an immune disorder. Men with a connective tissue disorder are more susceptible, and there is a higher risk of inheriting it for men with relatives who have Peyronie’s.
Testing may involve a physical examination, ultrasound, and X-rays. Traditionally, treatment has been either oral or injected medications, or surgery, with surgery being much more effective than medication.
Medications have included Verapamil, which is a high blood pressure medicine, and Interferon, which can help break down scar tissue. Surgery is a scary consideration, but has been warranted for men with an extreme curvature that caused pain and prevented or impaired sex.
The Mayo Clinic describes two surgical procedures; one shortens the healthy side of the penis to match the side with scar tissue, and the other lengthens the scarred side by altering the scar tissue with grafts. Penile implants may be another option for some men, and all surgery comes with the risk of impaired ability to achieve and maintain an erection.
Other treatments that aren’t yet proven include radiation to break up the scarred tissue, and a rather diabolical-sounding device that puts the penis in traction, stretching it to help regain flexibility.
The Effects May, or May Not, be Minor
For some men with Peyronie’s disease, the curve is more of an appearance concern than anything else. A slight curve may not alter arousal, erections, or sexual activity at all. Other men are less fortunate.
More severe cases can result in erections with a 90-degree curve, or even greater. Sometimes there is no curve, but an indentation around the penis shaft that causes an hourglass appearance. Sometimes there is both.
The more scar tissue is present, the less flexible the scarred portion of the penis, and the greater the difference between the scarred and unscarred areas. In men with a severe curvature, arousal and erections might cause equally severe pain. Orgasm might also be painful, and sexual intercourse might be impossible.
The A.D.A.M. Medical Encyclopedia at the U.S. National Library of Medicine paints a not-so-rosy picture of Peyronie’s disease and the medications traditionally used to treat it. However, it does note that the condition is quite rare.
A.D.A.M. explains that traditional treatments often have little or no effect on reversing the curve, and they can create more scarring, which worsens the condition that it’s supposed to help. As for surgery, the encyclopedia cautions that it can result in the loss of ability to achieve an erection. That’s not very helpful.
But in all of this gloom and doom, there is finally some good news.
Xiaflex Offers Hope for Real Improvement
With a lack of successful Peyronie’s Disease treatments available, any new hope is noteworthy. But Xiaflex might be more than hope, it could offer clear and substantial results.
Auxilium Pharmaceuticals developed Xiaflex (collagenase clostridium histolyticum) for the treatment Dupuytren’s contracture. People with this disorder develop one or more cords of scar tissue under the skin of the palm of the hand. These cords pull fingers into a permanent curve toward the palm, and surgery often fails to correct the condition completely.
There is a Dupuytren’s contracture connection, as people who suffer from this condition may have a higher risk of Peyronie’s disease.
On Dec 6, 2013, the U.S. Food and Drug Administration issued a press release stating that Xiaflex had received FDA approval for the treatment of Peyronie’s disease. What makes this such an exciting announcement is that it’s the first medicine ever to receive FDA approval for this purpose.
Xiaflex is made from a protein, and is an injected drug. Instead of a daily pill taken as a routine therapy for years, patients undergo a cycle of four or fewer treatments. After that, no more treatments may ever be necessary.
Treatments require strict doctor supervision, as there are risks of penile fracture and other injury to the penis, according to the FDA. At each treatment, the patient receives two injections of Xiaflex, administered directly into the penis (numbing agents are administered first), and then the doctor performs what’s known as a “modeling” procedure.
Modeling means the doctor or another health care professional carefully manipulates the scarred areas of the penis, which helps break down the scar tissue.
In clinical studies, 832 men with Peyronie’s disease were observed for 52 weeks. Some received Xiaflex, and others received a placebo. The men who received Xiaflex experienced a significant reduction in penile curvature, which also reduced other effects of the disease.
More moderate risks from Xiaflex treatment include penile hematoma, swelling, and pain.
For men living with Peyronie’s disease, it seems that help has arrived. The drug won’t be suitable for everyone, but now doctors have a real choice for treating, and possibly even correcting, the disorder. FDA approval means a lot — Xiaflex has undergone extensive study, and the results are promising.
Finally, there has been a real, proven, and safe advance in the treatment of Peyronie’s disease.
Columbia University Medical Center reports that when Peyronie’s is in very early stages, before a curvature has developed, some men respond to the erection health drugs, Levitra, Cialis, and Viagra.
Ask your doctor whether an erection health drug is right for you. It could reduce your risk of developing more complicated problems.
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