American Medical Association Family Medical Guide - American Medical Association [561]
A diagnosis of phimosis is based on the symptoms and a physical examination. The condition is usually detected during puberty, when erections cause pain in the penis. If you have phimosis, your doctor will probably recommend circumcision (surgical removal of the foreskin).
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Paraphimosis
Paraphimosis is the inability to pull a retracted foreskin back over the head of the penis. This condition often results from phimosis. The symptoms include pain and swelling, especially in the head of the penis. Paraphimosis can also cause loss of blood flow to the head of the penis, which is a medical emergency that requires immediate medical treatment. If you cannot pull your foreskin back over the head of your penis, call your doctor right away or go directly to the nearest hospital emergency department. Paraphimosis is usually treated with circumcision (surgical removal of the foreskin).
Peyronie’s Disease
In Peyronie’s disease, the penis bends or curves during an erection. In this noncancerous, progressive condition, a scar called a plaque develops in the erectile tissue inside the penis after an infection or injury, or for no obvious reason. The scar usually forms in the upper or lower part of the penis, but can form in both. If the plaque does not clear up within a few months, it can develop into permanent scar tissue or calcium deposits that do not allow the spongy tissue of the penis to expand, causing it to bend during an erection.
Symptoms
In Peyronie’s disease, the penis bends at an angle during an erection, making intercourse painful and sometimes impossible. The curvature may develop slowly or rapidly and can be mild or severe. The condition is usually painful, but the pain sometimes decreases over time. In some men, Peyronie’s disease causes erection problems (see page 486).
Diagnosis
A doctor can diagnose Peyronie’s disease by the symptoms and by a physical examination. The doctor may inject medication into the penis to induce an erection so he or she can evaluate the curvature. Ultrasound (see page 111) of the penis is sometimes performed to locate the plaque that is causing the problem.
Treatment
The treatment of Peyronie’s disease depends on how severe the curvature is and on how long the person has had it. Some treatments can reduce the pain but cannot correct the bend in the penis. Because surgery can cause complications and make the condition worse, doctors usually try other measures first. For example, most doctors recommend treatment with vitamin E supplements to help prevent the plaque from growing. Other treatments include injecting corticosteroids, calcium channel blockers, or other medications into the scar tissue to keep the scar from growing; using an electric current to deliver a drug to the scar tissue to keep the scar from growing; or directing high-energy radiation (using ultrasound guidance) to the affected site to break up the scar.
In most cases, surgery to correct Peyronie’s disease is successful. In one procedure, the surgeon removes the plaque and grafts a patch of skin or other material onto the treated area. In another procedure, tissue on the unaffected side of the penis is removed, which straightens the curve but makes the penis shorter when it is erect. In some cases, inserting an implant into the penis can straighten it. Although these procedures can cure Peyronie’s disease, they can also cause further scarring that could make the condition worse or cause erection problems (see page 486).
Priapism
Priapism is a painful, persistent erection that occurs without sexual stimulation. This rare condition can occur when an underlying condition leads to blood vessel or nerve abnormalities that cause blood to become trapped