Too Weird to Make Up

In one clinic afternoon, I saw two patients with Peyronie's disease. For those who don't know, Peyronie's disease involves a plaque of fibrous tissue which forms in the tunica albuginea, a thick band of tissue which wraps around the erectile tissue within the penis. The tunica albuginea is what provides an erect penis its stiffness and shape, and incidentally is what "breaks" in a penile fracture. When a plaque forms, it causes a change in curvature to the penis, often causing the tip of the penis to angle sharply away from the base. It's associated with varying degrees of painful erections, difficulty with intercourse, and erectile dysfunction.

To make the correct diagnosis, one must palpate the penis for any fibrous plaques. Then, schedule the patient to return to clinic for the next available penile doppler ultrasound, which will evaluate any arterial flow disturbance. While waiting for his appointment, have the patient take photographs of his erect penis and bring them to the next clinic visit. (Don't take those to the drug store!)

Finally, after one has determined the correct diagnosis, surgery may entail a penoplasty, plication of the plaque, and/or a penile implant to prevent curvature. ED may of course be treated with any of the medications advertised on television.

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I mean, sometimes, even though the problem is serious, and the patient is frustrated by their sexual difficulties and pain, it's really hard not to giggle a little bit.