Collagen days

News for penises. And fingers. And, possibly to come, buttocks.

The larger topic is the line between what counts as normal and what counts as abnormal, diseased, or morbid. Today, the discussion starts with some television commercials for the drug Xiaflex® (from Endo Pharmaceuticals), marketed as a treatment for Peyronie’s Disease.

The news for penises. From the 2018 campaign for Xiaflex:


The ad ‘Peyronie’s Disease: Not Alone’ shows men (sometimes with their female partners) being anxious about the state of their curved penises. From the site, the medical text in the commercial:

Endo Pharmaceuticals wants men to know that it is possible to injure yourself during intercourse, and you’re not alone if you suffer from a curved erection. If you suspect you may have Peyronie’s Disease, Endo encourages you to talk to your urologist and go to its website for more information.

Before I go on, I need to point out that curved erections are common (in a significant minority of men) and most are unproblematic; there is, in fact, a Page on this blog on postings about the angle or curvature of (erect) penises, a topic that is of interest to those who fancy penises because some of them have preferences about these physical variations.

Now, the 2019 ad campaign for Xiaflex ‘All Shapes and Sizes’, which takes an antic turn in its approach to Peyronie’s, approaching the topic via curved fruits, vegetables, and artefacts (bottles, in particular):

(#2) The cucumber

(#3) The ketchup bottle (there’s also a beer bottle)

From the site, the medical text in this ad:

XIAFLEX is a prescribed medication that is intended to treat those who suffer from Peyronie’s Disease when taken regularly as ordered.

It’s all about the collagen. From NOAD:

noun collagen: the main structural protein found in skin and other connective tissues, widely used in purified form for cosmetic surgical treatments.

Xiaflex is Endo’s trade name for collagenase clostridium histolyticum, or CCH, which Endo is already marketing as a treatment for Peyronie’s disease and for Depuytren’s contracture (see below), and is now being readied for marketing as a treatment for cellulite in women (see further below).

Then, from Wikipedia on Peyronie’s, with some crucial materal bold-faced:

Peyronie’s disease is a connective tissue [that is, collagen] disorder involving the growth of fibrous plaques in the soft tissue of the penis. Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa, causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening. A variety of treatments have been used, but few have been especially effective.

It is estimated to affect about 10% of men. The condition becomes more common with age

A certain degree of curvature of the penis is considered normal, as many men are born with this benign condition, commonly referred to as congenital curvature.

… The underlying cause of Peyronie’s disease is not well understood. The most common cause is a buildup of plaque inside the penis. It could be by trauma or injury to the penis usually through sexual intercourse or physical activity, although many patients are often unaware of any traumatic event or injury.

normal. The fact is that Peyronie’s (aka PD) can’t be distinguished from congenital curvature just by looking; the degrees of curvature are essentially the same (despite the use of abnormal curvature in the Wikipedia entry). What’s crucial is pain and dysfunction, and in general, symptoms of disease.

Both PD and congenital curvature are abnormal in the sense of being off the statistical norm, or average; they are minority states. But the relevant sense of normal here is opposed not to minority, but to morbid ‘unhealthy, diseased’. From NOAD:

adj. morbid: 1 characterized by or appealing to an abnormal and unhealthy interest in disturbing and unpleasant subjects, especially death and disease: he had long held a morbid fascination with the horrors of contemporary warfare. 2 Medicine of the nature of or indicative of disease: the treatment of morbid obesity. ORIGIN mid 17th century (in the medical sense): from Latin morbidus, from morbus ‘disease’.

(The distinction is familiar from other contexts. The sexual orientation of homosexuality, for instance, is certainly a minority state, but that doesn’t make it a sickness or disease — though many have made exactly that conceptual leap in an attempt to condemn homosexuality and homosexuals.)

The marketing strategy. The Xiaflex commercials seem designed to blur the distinction between PD and congenitial curvature, to sow anxiety in men with curved erections that they are suffering from a disease, so as to send them for treatment by a physician (and, possibly, a Xiaflex prescription). No doubt the Endo company maintains that they are merely performing a public service, alerting men to the possibility that a curved erection might indicate a condition needing treatment.

(The efficacy of Xiaflex in treating PD is something of a murky area. According to the Mayo Clinic site, treatments for PD include: oral medications (Pentoxifylline to reduce the amount of scar tissue, CCH / Xiaflex to break down collagen, Verapamil (a blood pressure medication) to disrupt the production of collagen, Interferon to disrupt the production of fibrous tissue); drugs injected directly into the penis; surgeries of several types, up to and including penile implants; and administration of electric currents, shock waves, or radiation. The efficacy of the non-surgical treatments seems to be unclear, though Xiaflex looks to be the best of a dubious field.)

Depuytren’s contracture. Xiaflex is also marketed as a treatment for DC. On the condition, from Wikipedia:

(#3) (From the Clifford Craig Foundation site)

Dupuytren’s contracture is a condition in which one or more fingers become permanently bent in a flexed position. It usually begins as small hard nodules just under the skin of the palm. It then worsens over time until the fingers can no longer be straightened. While typically not painful some aching or itching may be present. The ring finger followed by the little and middle fingers are most commonly affected. It can interfere with preparing food, writing, and other activities.

The cause is unknown. … The underlying mechanism involves the formation of abnormal connective tissue [collagen] within the palmar fascia.

And the condition is distinct from tenosynovitis. From my 5/16/18 posting “Trigger finger”

(#4) AMZ’s trigger finger

My ring finger occasionally gets stuck in a bent position. No pain, no swelling or anything, just stuck … I can push it back with my other hand, and it makes a little pop! as it resumes its normal working position. It’s called trigger finger, fancy name tenosynovitis.

This time, neither trigger finger nor DC is normal (though DC appears to be a lot less common than tenosynovitis). From the Orthopaedic Center of Southern Illinois’s website:

Trigger finger and Dupuytren’s contracture are both problems that affect the fingers and so one issue is often confused for the other.

On the palmar side of each finger, there is a tendon that helps each finger bend toward the palm. Each of these tendons is surrounded by a sheath which is lined with synovium. Synovium produces a fluid that allows the tendon to glide easily as you bend and straighten your finger.

In the case of trigger finger, one of these tendons becomes inflamed and the tendon or the sheath surrounding it can swell and thicken to the point that the tendon can no longer glide smoothly. Because of this, when you try to straighten the finger, the tendon catches and can “trigger” into a bent position as it tries to squeeze back through the sheath. Diagnosis is typically made by physical examination by the physician. You may be asked to make a fist and then straighten your fingers. In the case of trigger finger, the affected finger may stay curled or may suddenly pop out straight. You may have to straighten the bent finger with your other hand. The palm of the hand contains a fibrous layer of tissue called the palmar fascia. The palmar fascia acts as a protective barrier between the skin and the tendons that help to bend the fingers toward the palm.

In the case of Dupuytren’s contracture, the palmar fascia thickens and draws in which causes the affected finger to bend toward the palm. Small hard knots can form just under the skin at the base of the finger. The ring and little fingers are most commonly affected. Diagnosis of Dupuytren’s contracture is made by physical examination by the physician. Knots at the base of the affected fingers and scarlike bands across the palm are obvious signs, as is the inability to lay the hand down flat on a surface. Unlike a finger which is bent due to trigger finger, a finger bent by Dupuytren’s contracture is unable to straighten, even with help from the other hand.

More collagen: for cellulite. Word is that Xiaflex is soon to be marketed as a treatment for a condition that is entirely normal (both in the statistical sense and in the medical sense), but is widely viewed as unsightly. From Wikipedia:

(#5) The dimpling of cellulite

Cellulite is the herniation of subcutaneous fat within fibrous connective tissue that manifests topographically as skin dimpling and nodularity, often on the pelvic region (specifically the buttocks), lower limbs, and abdomen. Cellulite occurs in most postpubescent females. A review gives a prevalence of 85 to 98% of women, indicating that it is physiologic rather than pathologic. It can result from a complex combination of factors ranging from hormones to heredity.

Cellulite is very different from the skin infection cellulitis. On the latter, see my 9/8/10 posting “NICE ‘n’ RICE”. The names share cellule ‘small cell’ etymologically, but the conditions are different (and the names come from different registers of use). From NOAD:

noun cellulite: persistent subcutaneous fat causing dimpling of the skin, especially on women’s hips and thighs. Not in technical use. ORIGIN 1960s: from French, from cellule ‘small cell’ [OED3 (Dec. 2008): The fat deposits were so called because they were at one time supposed to be caused by inflammation of cellular connective tissue. [early cites are from the fashion industry in popular publications]]

noun cellulitisMedicine inflammation of subcutaneous connective tissue. [ORIGIN from OED3 (Dec. 2008): Either (i) formed within English, by derivation [with –itis]; modelled on a French lexical item. Or (ii) a borrowing from [medical] Latin. [1st cite 1849; most cites are from the medical literature]]

Final notes on collagen, from Wikipedia, which will take us back to the glue factory and then to the artist’s studio:

Collagen is the main structural protein in the extracellular space in the various connective tissues in the body. As the main component of connective tissue, it is the most abundant protein in mammals, making 25% to 35% of the whole-body protein content. Collagen consists of amino acids wound together to form triple-helices of elongated fibrils. It is mostly found in fibrous tissues such as tendons, ligaments, and skin.

Depending upon the degree of mineralization, collagen tissues may be rigid (bone), compliant (tendon), or have a gradient from rigid to compliant (cartilage). It is also abundant in corneas, blood vessels, the gut, intervertebral discs, and the dentin in teeth. … Collagen constitutes one to two percent of muscle tissue …

The name collagen comes from the Greek κόλλα (kólla), meaning “glue”, and suffix -γέν, –gen, denoting “producing”. This refers to the compound’s early use in the process of boiling the skin and tendons of horses and other animals to obtain glue.

Yes, collagen and collages, together in etymology; English collage is a borrowing from the French collage ‘gluing’.

So, to knit everything together, this minimally simple collage of mine, with a stud fantasizing about curvature:

(#6) The Spanish banana, plátano fantástico

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