The cause of Peyronies disease is still unknown

Premature ejaculation is the most prevalent male sexual dysfunction. It is defined in The Merck Manual, a highly regarded reference guide for physicians, as the constant failure to maintain intromission of sufficient duration to satisfy a responsive partner. It is also defined as ejaculation occurring before the individual wishes.

Ejaculation is usually preceded by orgasm or climax. Ejaculatory control is an acquired behavior that is minimal in adolescence and increases with experience.

According to Merck, normal biologic response is to ejaculate within two minutes of vaginal penetration. Since this is not usually enough time for the female partner to reach orgasm, most men must learn how to retard ejaculation.

In the adolescent, premature ejaculation may be aggravated by pathogenic factors that interfere with learning control, most frequently sexual ignorance. Intrapsychic factors may include feelings of sinfulnesss about sex, fear of discovery and impregnating the female partner, fear of getting a sexually transmitted disease, anxiety over performing to the partners expectations and depression.

Some of these concerns continue into adulthood. Interpersonal factors such as marital problems, unresponsiveness of mate and power struggles may be causative. Obscure physical causes are usually not present; although either prostatis or organic diseases affecting the nerve pathways (often due to surgery or trauma) or the effects of pharmacologic agents may be involved.

After all these years, the cause of Peyronies disease is still unknown though some cases are clearly associated with penile trauma. Many researchers believe the plaque of Peyronies disease develops following trauma that causes localized bleeding inside the penis An internal cavity that runs the length of the penis is divided into two chambers, the corpora cavernosa, by a vertical connecting tissue called the septum.

If the penis is abnormally bumped or bent, the area where the septum attached to tissues lining th chamber walls may stretch beyond its limits and rupture small vessels in the lining. With aging, dimished elasticity near the point of attachment may increase the risk of injury. The damaged area might heal slowly due to repeated trauma and minimal blood flow. In cases that heal within a year, the plaque does not advance beyond an initial inflammatory phase. In cases that persist for years, the plaque forms tough fibrous tissue and may even calcify or form calcium deposits.

While trauma may explain acute cases of Peyronies disease, it does not explain why most cases develope slowly and with no apparent traumatic event. It also does not explan why some cases disappear quickly and why similar conditions such as Dupuytrens contracture do not seem to result from severe trauma.

Because there is no known cause of the condition, there is not form of treatment that is universally successful. Treatment ranges from no treatment, medical treatment (medication), radiation treatment, ultrasound treatment, to surgery. All treatments can be successful, but the overall rate of success is about 50%.

Experts usually recommend surgery only in long-term cases in which the disease is stabilized and the deformity prevents intercourse. The key is to discuss with your doctor what he feels is the best treatment option for you and why. Current options include:

Watchful waiting None of the non-surgical treatments available today has been more effective than the bodys natural ability to heal itself. Because spontaneous remissions are known to occur in 15 - 20% of cases, medical experts suggest 1 to 2 years of siple observation and simplegrave;watchful waiting.

Vitamin E and potassium para-aminobenzoate (POTABA) Some researches of small-scale studies have reported some improvement with oral administration of Vitamin E;l but no controlled studies have established the effectiveness of this theraphy. Similar inconclusive success has been attributed to oral application of potassium para-aminobenzoate, a substance belonging to the family of B-complex molecules.

Injections Researches have injected chemical agents such as collagenase, dimethyl sulfoxide, steroids, and calcium channel blockers directly into the plaques; but none have produced convincing results. Steroids, such as cortison, have produced unwanted side effects such as atrophy or death of healthy tissues. The most promising directly injected agent is collagenase, an enzyme that attacks collagen which is the major component of Peyronies plaques.

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