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Erectile Dysfunction Radio Podcast
Dr. Devang Sharma joins us on the Erectile Dysfunction Radio Podcast to discuss Peyronie’s disease and erectile dysfunction. Dr. Sharma is a urologist in Germantown, Maryland with Chesapeake Urology Associates.
This podcast is dedicated to educating and empowering men to address erectile dysfunction, improve confidence, and enhance the satisfaction in their relationships. This podcast is hosted by certified sex therapist, Mark Goldberg, LCMFT, CST.
Transcript of Episode 10 – Peyronie’s Disease and Erectile Dysfunction with Dr. Devang Sharman
Mark Goldberg: Today we are joined by Dr. Devang Sharma. Dr. Sharma is a urologist practicing in Germantown, Maryland. In addition to general urology, he has specialized training in male infertility, sexual dysfunction and reconstructive surgery. His practice is focused on men with urinary complaints related to the bladder, prostate or urethra, erectile dysfunction, Peyronie’s disease, low testosterone, fertility concerns and prostate cancer survivorship.
Dr. Sharma completed a fellowship in sexual medicine, has published numerous articles and is an active member of numerous organizations and societies committed to men’s health. As part of our mission here, we want to bring high-quality and easy to understand information about erectile dysfunction and some of the conditions that can contribute to it.
Accurate information is not only important for treatment, it also helps with anxiety, motivation and how a man thinks about his situation. Dr. Sharma, we want to understand more about Peyronie’s disease and its connection to erectile dysfunction. So let’s start with what Peyronie’s disease is. Can you give us some background and some information about it?
Dr. Sharma: Sure. Peyronie’s disease is a condition of scar tissue that can develop in the penis, really after routine sexual activity or after something more traumatic like a bending or a popping that can be experienced during intercourse. There are normally small amounts of trauma that happen to the penis with any type of routine activity.
The penis heals perfectly fine in a large majority of men, but when that healing involves an abnormal deposit of scar tissue, that can be experienced by men as an area of firmness or a plaque, and that can lead to issues with the architecture or the shape of the penis, curvature, narrowing or shortening of the penis.
That can make sexual activity more difficult, that can interfere with erectile quality, and that can have a significant impact on the distress and interactions that a man experiences.
Mark Goldberg: Okay. And how common is Peyronie’s disease? And who is at maybe higher risk for it?
Dr. Sharma: That’s a great question, and I don’t know that we know those answers. The prevalence rate is probably higher than we think it is, and there have been some studies that have given numbers anywhere in the 1 – 10% range, which is pretty high. But honestly, it may be higher than that because men with Peyronie’s disease don’t often reach out and seek medical attention.
There is a lot of work that’s been done to try to find out the underlying cause.
We know that Peyronie’s disease runs in families, that may not be obvious because a lot of guys don’t talk to their dads or their uncles about curved penises. But we know that it can be more common in men who are diabetics and/or smokers and men who have lower testosterone levels.
Now, I don’t want people to misunderstand and get the impression that smoking is going to cause your penis to become curved, so these are not necessarily risk factors as much as their associations. We know that Peyronie’s disease is more common in men with those conditions, and that might have something to do with the fact that you’re more likely to have abnormal scar tissue if you have some of those conditions.
Mark Goldberg: So how is Peyronie’s detected and diagnosed?
Dr. Sharma: That’s a good question. It’s really not too complicated. It is usually detected by the patient. If a man is experiencing pain with erections, curvature that slowly progresses over the course of months, maybe shortening in the length of the penis when it’s erect or narrowing, that can be anywhere in the shaft of the penis, the patient usually seeks attention for that.
In a good history and physical examination by someone like myself or another urologist with experience with Peyronie’s disease, it could be diagnosed on a history and exam alone. There’s no special blood tests. There’s no special x-rays or testing that needs to be done to get a diagnosis.
Mark Goldberg: So men will know for the most part if they have Peyronie’s disease. Is that correct?
Dr. Sharma: They may. They are going to be the first person to realize that something is wrong. Nobody knows a man’s penis better than himself. So there’s usually some abnormality that’s noticed by the patient, and they come to see a urologist and typically walk away with a diagnosis.
Mark Goldberg: So Dr. Sharma, can you explain more specifically how Peyronie’s disease impacts erections?
Dr. Sharma: Sure. They’re very interrelated, and it depends on how bad the curvature is and how bad the plaque is. But when a man has a curved penis, the blood flow to the penis and the blood flow that stays in the penis can be altered. So let’s talk a little bit about normal erections first, because that’ll be helpful.
In a normal erection, the penis fills with blood and that allows it to get longer, thicker and firmer. And that blood has to stay trapped in the penis for a certain amount of time to maintain that rigidity for as long as the demand wants for satisfying sexual activity.
Now, in Peyronie’s disease, there is an area of the penis, usually in the shaft, that has an abnormal lump of scar tissue, and that scar tissue is not stretchy like the normal parts of the penis. So when the penis fills with blood, most of it is getting longer and thicker and harder, except for that area where there’s abnormal scar issue, and it’s basically a hinge point.
If that area is not stretching, but the rest is, the penis is going to curve in that direction. When that happens, that can actually interfere with the normal trapping of blood that’s supposed to happen during an erection. So often what I hear in men with Peyronie’s disease is, “Doc, I can get an erection, but it’s not quite as firm as it used to be, and it doesn’t seem to last quite as long.”
Mark Goldberg: I can appreciate the differentiation between being able to gain and maintain an erection and the level of firmness. You’re saying some of that might be attributable to scar tissue or Peyronie’s disease in the event that a man has that. Is that correct?
Dr. Sharma: That’s correct.
Mark Goldberg: Now, some of our listeners are probably going to be interested to know if they’re experiencing or they have a curvature or a bend in the penis and they are not experiencing pain and are having erection problems. Is that perhaps an early indicator of Peyronie’s disease? Or would that just be the natural curvature to the penis and other problems may be at play?
Dr. Sharma: Every man’s experience with Peyronie’s disease is different. Not all men experience pain. Some men just notice curvature. There are phases of Peyronie’s disease. If you take people in general, there may be a period of weeks to months early on in the onset of the condition, where the erections are more painful and the curvature is becoming progressive, worse and worse over time.
Then at some point after the first several months, things just stop changing. The pain usually resolves on its own and the curvature is what it is. And at that point, maybe 5% – 10% will have some natural improvement, but really the majority of men are stuck in that condition. I believe your question was, what is the timeline or how does a man know if it’s an early sign or a late sign?
Mark Goldberg: Right. If there’s curvature and no noticeable pain, and like you’re pointing out, pain can fade over time, which means that it may have been there at some point. But if a man has the curvature and is struggling with an erection, is there a particular reason to go visit a urologist to see his doctor about to potentially rule out Peyronie’s disease?
Dr. Sharma: Absolutely, any time there is an abnormal or a new curvature of the penis, it could be Peyronie’s disease. So it’s certainly worth seeing a urologist for a good examination. And if it’s unclear, one of the things that we can do is called a penile duplex. It’s a special type of ultrasound that’s done in the office, and it is an opportunity for us to study the blood flow to the penis to make sure that there’s normal blood flow into the penis and that the blood flow is remaining in the penis after an erection.
That does involve a small injection of a medication that goes directly into the penis, but that allows for the patient to have an erection and for the urologist and the patient to really be on the same page, because then we can look at it together and say, “Hey, this is the way that it curves, and these are your treatment options, based off of what we’re dealing with.”
Mark Goldberg: And speaking of treatment options, I would imagine some of our listeners are going to want to know if Peyronie’s disease is treatable, and if so, what that treatment process looks like?
Dr. Sharma: It’s absolutely treatable, but one of the first things that we talk about during our visits for Peyronie’s disease is, it is a progressive condition and it’s not reversible. It’s irreversible and it can get worse, but that doesn’t mean that we can’t treat it.
The treatment is really focused on restoring function in the bedroom. So whether that means creating erections that can be affected by Peyronie’s disease, whether that means treating curvature or length loss, those things can all be addressed, depending on what the patient’s goals are.
Not every man with Peyronie’s disease has the same goals of treatment. So we make sure that we’re on the same page and that we individualize a treatment regimen for that patient.
Mark Goldberg: If I’m understanding you correctly, one of the focal points of treatment, if not the primary focal point, is to restore sexual function.
Dr. Sharma: Absolutely. So a man may decide that they are comfortable knowing that they don’t have cancer, that this is not a condition if left untreated is going to lead to some worsening of their health condition. They just want to know that they’re okay, and if they’re able to have satisfying sexual encounters, then we don’t need to do anything about it.
But if it’s interfering with their ability to achieve or maintain erections, with their ability to have intercourse without pain for themselves or pain for their partners, and whether or not they’re able to accept the new shape or configuration of their penis, they may or may not need treatment.
Now, if they’re distressed by any of those things, then that’s when we start talking about penile rehabilitation using traction devices, so these are little devices that can help stretch and mold the penis into a more usable configuration or closer to what it was before the onset of the condition. There are medications that can be injected into the scar tissue, to help soften it and allow the patient to use exercises or kind of like rehab, but for the penis.
And then there’s corrective surgery, and oftentimes, that is the quickest path to achieving a straighter erection that’s more functional in the bedroom.
Mark Goldberg: So from a physical perspective, once treatment has been implemented, the measure of successful treatment would be erectile function? Correct?
Dr. Sharma: It’s really a patient satisfaction, because sometimes the erections are fine, and the issue is really the penis is curved. If you have a 90-degree bend in the penis and instead of pointing straight it’s pointing hard left, it’s hard to have intercourse with that, and that’s very treatable.
Mark Goldberg: I love that phrase, patient satisfaction. It’s such an important measure to so much of the work that I do and really and just so much of addressing erectile dysfunction and the challenges that come with gaining and maintaining satisfactory erections.
Now to that point, some of the patients that I’ve worked with who have Peyronie’s disease seem to also have an elevated level of emotional distress.
Dr. Sharma: Absolutely.
Mark Goldberg: And what do you attribute that to? Is there something particular about Peyronie’s disease that evokes that type of stress?
Dr. Sharma: Well, I think it’s just the relationship between a man’s mind and his penis. I think we all have a certain degree of confidence or identity or self-worth that’s related to our ability to perform in the bedroom. And when a man has even the thought that something about their penis is not right, it can affect all of those things.
It can affect confidence. It can affect self-image. It can affect feelings of self-worth. There are men who have significant degrees of relationship distress or depression with Peyronie’s disease. And it’s not like the scar tissue is causing this, it really has to do with the understanding of what’s going on and how that could impact a man’s feelings of themselves and their ability to perform.
Mark Goldberg: Absolutely, and so much of the work that I do is around those exact topics of the impact that it has on the way a man feels about himself, his relationship. Now, in your experience, do you find that the distress that a man experiences can compound the erection problems?
Dr. Sharma: Oh, absolutely. When we see men with erectile problems, it’s not always a penis problem. Stress plays a huge role in normal erectile function. When people have maybe heard the commercials for medications: “If you have an erection lasting longer than four hours, please seek medical attention.”
So that medical attention is us. We see men who have abnormally prolonged erections that need to be reversed. We literally inject adrenaline or a version of that into the penis to make that erection go away.
So when a man is trying to have sexual activity and they have an erection, the moment he stops thinking about his partner or some sexual fantasy and he starts thinking about his penis, whether or not it’s hard enough, whether or not it’s straight enough, whether or not he’s going to be able to perform or maintain to tap a satisfying encounter, that stress completely changes the chemicals in the body.
There’s a rush of hormones that can happen that can make the erection softer or even disappear completely. So the stress and distress associated with both erectile dysfunction and Peyronie’s disease, it’s like a vicious cycle. It can make the erections worse.
Mark Goldberg: As we’ve established on this podcast, so many times what a man thinks, what he feels in those moments, what he’s focused on can make a tremendous difference in the quality of the erection, whether he gets erect or not, if he can maintain it.
So to that end, are there specific thoughts, fears or concerns that men with Peyronie’s and erectile dysfunction express to you when you’re treating them?
Dr. Sharma: I think there are two main things. The first thing everybody wants to know is that this is not cancer. This is not something that is going to be life-threatening. And the other thing that they want to know is, are they going to be able to be involved in satisfying sexual experiences?
That might be solo, that might be with a stable partner, that might be with partners that they have yet to meet and discover. And those are all equally important for us, and it’s really about finding out what is bothering the patient about their condition and how we can get that better.
Mark Goldberg: Now, Dr. Sharma, have you encountered patients who have gone through the physical treatment, have been assessed, have had significant reduction in scar tissue or a significant improvement, so that physically they should be able to gain and maintain an erection, but continue to struggle in that department?
Dr. Sharma: Sure. Erectile function, Peyronie’s disease are interrelated, but they’re really two separate things sometimes. So just because we’ve addressed a curvature issue with Peyronie’s disease, doesn’t mean that the erections are adequate or perfect. We typically address both simultaneously, and it may mean that pills are necessary to get satisfying erections or other treatments.
If there is a significant problem with both erections and curvature, then oftentimes the treatment is a penile implant, which can really address both simultaneously. And that’s all part of the evaluation upfront, when we’re meeting the patient and evaluating them for what their treatment options are.
Mark Goldberg: Dr. Sharma, one question that I want to ask you that I think some of our listeners are going to be interested to know and something that definitely comes up in a clinical setting, and I myself will be interested to know your thoughts about this, around whether masturbation can play a role in facilitating, causing or furthering Peyronie’s disease and potentially leading to erection problems?
Dr. Sharma: Again, we don’t know enough about what the actual causes of Peyronie’s disease are, but we do know that it can happen with really routine sexual activity. I would throw masturbation right into the mix with that. So there’s no specific association with masturbation in Peyronie’s disease.
This is not anything that any man has done wrong. Okay, this is to a certain degree an inherent genetic disposition to creating abnormal scar tissue, combined with something maybe as minor as routine sexual activity or something more traumatic, maybe a procedure that was done, endoscopic procedure for treatment of the prostate or treatment of kidney stones or something like that, maybe a treatment for prostate cancer or maybe a traumatic event during intercourse, popping or bending, penile fracture. It can be a number of things.
Mark Goldberg: And I appreciate that. Can I ask you just to repeat that one last line about it not being the patient’s fault, because I’ve worked with a number of men who struggle to not look back on the past, not try to attribute blame to themselves. And I find that it oftentimes precludes being able to properly manage and ultimately find that satisfactory solution. So I’m just going to ask you to re-emphasize that for our listeners.
Dr. Sharma: Nobody did anything wrong. Some men develop abnormal scar tissue from really minor and routine sexual activity. So it’s not super common, but it happens, and when it happens, it’s very treatable.
Mark Goldberg: Thank you for that Dr. Sharma. So as a wrap-up, if I were going to ask you to give a sentence or two, to men who may be experiencing some of the symptoms of Peyronie’s disease or they may have that diagnosis, are there any words of encouragement that you could put out there in terms of being able to work towards achieving a satisfactory sex life while managing this condition?
Dr. Sharma: I would really just emphasize how important it is to partner with healthcare professionals, who have training and experience in Peyronie’s disease.
Not all urologists treat Peyronie’s disease, and not all therapists have as detailed of an understanding as you do about the psychological effects of Peyronie’s disease on men. So really what I would tell listeners for this podcast is, go work with your doctors. Go work with your therapist. This is something that is worth your time and can be improved on.
Mark Goldberg: Thank you for joining us and enlightening us, and we look forward to having you join us on the podcast in the future.
Dr. Sharma: Thanks, Mark. Take care, and stay safe.
Learn more about Dr. Sharma and his clinical work with patients.
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