Peyronie’s Disease

Peyronie’s disease at a glance

Peyronie’s disease is a condition where scar tissue forms inside the penis that can cause bending or narrowing of the penis during an erection.
Peyronie’s disease can cause pain and erectile dysfunction, which can result in the man avoiding sexual situations and can cause significant emotional stress.
In mild cases, the symptoms of Peyronie’s disease sometimes dissipate on their own, but severe cases may require treatment.

What is Peyronie’s disease?

Peyronie’s (pay-roe-NEEZ) disease is a condition that causes the penis to curve when erect because of scar tissue that forms inside the penis. This scar tissue is also called plaque. The plaque can form in any part of the penis.

Peyronie’s disease can cause pain and significant bending of the penis. Although it is normal for some men’s penises to bend slightly during erection, Peyronie’s disease often causes a more significant bend. It also causes significant mental and emotional stress for men who suffer from the condition.

Peyronie’s disease can cause complications including:

Erectile dysfunction (problems with maintaining or achieving an erection)
Inability to have sexual intercourse
Anxiety or stress regarding the appearance of the penis or sexual ability
Stresses on the man’s relationship with his sexual partner
Difficulty fathering a child, because intercourse is difficult or impossible.

Up to 10 percent of men experience this condition. The exact prevalence is unknown, however, because men do not always report it. Peyronie’s disease is most common in middle-aged men, although older and younger men also can experience it. In some cases, it can cause serious problems if it is not corrected.

Causes of Peyronie’s disease

Doctors do not know the exact cause of Peyronie’s disease, although it is possible that several factors could be involved.

Most often, doctors believe Peyronie’s disease occurs after an injury to the penis. This injury often occurs during vigorous sexual activity. Most patients, however, don’t remember any specific injury.

Some men notice a gradual onset of Peyronie’s disease. In these cases, the condition may not be related to any particular injury. Researchers theorize that there might be some inherited tendency toward Peyronie’s disease, or that it might be connected to certain health conditions.

Another possible cause of Peyronie’s disease is that with age, the tissues in the penis can be injured more easily and don’t heal as well, causing scar tissue to build up.

It is also possible that smoking and having some types of surgery for prostate cancer or benign prostatic hyperplasia (BPH) could carry a higher risk of Peyronie’s disease. Some medications list Peyronie’s disease as a possible side effect, but researchers haven’t linked the condition definitively to any medications.

Symptoms of Peyronie’s disease

During a normal erection, cavities or sponge-like spaces in the penis fill with blood. These areas normally stretch to allow the penis to become erect. With Peyronie’s disease, the scar tissue in these areas does not stretch. As a result, the penis must bend to accommodate the non-stretching tissue. This bending can be significant and quite painful.

Peyronie’s disease signs and symptoms might appear suddenly or develop gradually. The most common indicators include:

A bent or curved penis. Peyronie’s disease causes the penis to curve either upward, to one side or downward when erect. Sometimes a tight band of scar tissue forms around part of the penis.
Scar tissue. This forms under the skin of the penis and can feel like lumps or hard bands.
Erectile dysfunction.
Penis becomes shorter.
This can be present when the penis is flaccid or when it is erect.
Dupuytren’s contracture. This condition is the development of fibrosis in the palm of the hand. About 30 percent of men who have Peyronie’s disease also have Dupuytren’s contracture or other fibrosis in other areas of the body.

Over time after Peyronie’s disease is detected, the associated penis curvature might gradually worsen. At some point, however, it stabilizes for most men.

Diagnosis of Peyronie’s disease

Most men with Peyronie’s disease find that the pain they experience during erections gets better in one or two years. Still, the scar tissue and the curvature usually remain.

For 10 percent of men with Peyronie’s disease, the symptoms go away without treatment. But for most men, symptoms stay the same or get worse. Treatment is usually necessary if the curvature is so severe that it makes sexual intercourse impossible.

Before deciding on a course of treatment, physicians may do the following examinations:

Physical exam. The doctor will feel the penis to check for scar tissue and identify its location. The doctor also might take measurements as a baseline to tell later if the disease has shortened the penis. To evaluate the condition of the penis when it is erect, physicians may request that the patient bring photos taken at home of the erect penis.
If the physician needs more information about the extent and effects of scar tissue, he or she might order imaging tests, such as ultrasound, to study the erect penis and evaluate scar tissue, blood flow and other visual information. In some cases, a medication is injected into the penis to make an erection prior to the ultrasound.
If the condition has come on suddenly, or if the doctor can’t verify Peyronie’s disease through a physical exam, he or she might perform a biopsy. This procedure takes a sample of tissue for laboratory examination. The purpose is to rule out other conditions that could be causing the symptoms.

Treatment of Peyronie’s disease

Watchful waiting

Many doctors first recommend watchful waiting (a wait-and-see approach). This is because, in some men, Peyronie’s disease gets better without treatment. Waiting is an especially likely course of action for men who:

Have good erectile function.
Have mild or no pain during erections.
Can have sexual intercourse without pain.
Have minimal curvature of the penis.
Have a consistent degree of curvature (i.e. curvature is not increasing)

Physicians may recommend additional treatment to men whose situation is more severe or whose Peyronie’s disease appears to be getting worse.

Medication

Medication can reduce the scar tissue, minimize pain and potentially minimize penis curvature, as well.

Xiaflex (collagenase Clostridium histolyticum), the first medication specifically for treating Peyronie’s disease, breaks down the collagen buildup that causes the scar tissue. It is injected into the penis, and men may receive up to four treatments of two injections each. Xiaflex is only for men with lumps present or who have an erection curvature of more than 30 degrees.

Some physicians may recommend other drug treatments as well. For instance, verapamil is another medication that has been injected into the plaque to assist with correcting curvature.

Surgery

Most physicians do not recommend surgery until Peyronie’s disease has stopped changing the curvature of the penis. Ultimately, surgery may be recommended for men who experience severe curvature that is especially bothersome or interferes with sexual activity.

Surgical methods include:

Suturing the unaffected side. This procedure, also called plication, places sutures on the longer side of the penis—the side that does not have scar tissue. In this manner, the two sides of the penis are “evened up” and the curvature is straightened.
Removing the scar tissue. This procedure is called incision or excision. The surgeon makes cuts in the scar tissue and sometimes removes some of it, in order to allow the penis to straighten. The surgeon may need to graft (re-attach) another piece of tissue. This surgery does not always allow successful erection afterward.
Penile implants. Men who have Peyronie’s disease and erectile dysfunction might be candidates for permanent penile implants that allow a man to achieve erection. Some implants are inflated by using a pump implanted in the scrotum. Other implants are bendable to permit sexual intercourse.

Because surgery may cause additional problems with sexual function, other treatments are preferable when possible.

Other treatments

For the majority of men who experience pain from Peyronie’s disease, the condition improves with time as the injury heals. Some men may need pain relief support, however. Some people experience relief from calcium channel blockers that a doctor injects into the scar tissue of the penis.