Male patient at urologist's office

What Is Peyronie’s Disease?

Peyronie’s disease is a significant curvature or bend of the penis caused by the development of fibrous scar tissue inside the penis. This benign (noncancerous) scar tissue is called a plaque.

The top and bottom of the penis are the most commonly affected areas. As the plaque builds over time, the result is a painful erection that can make having intercourse difficult or prevent it altogether. Stress and anxiety are also side effects of Peyronie’s disease due to the erectile dysfunction and pain.

Though Peyronie’s disease can sometimes resolve on its own, in most cases it remains stable or worsens over time. In some cases, treatment is warranted if the penis curvature severe enough to prevent intercourse. Men with Peyronie’s disease should be referred to a urologist for diagnosis and treatment.

Signs and symptoms may develop over time or appear suddenly. Some of the most common signs and symptoms include the following:

  • Erectile dysfunction – problems getting or maintaining an erection
  • Pain in the penis with or without an erection
  • Significant curvature of the penis
  • Penis bump or hard lump on one or more sites on the penis
  • Shortening of the penis
  • Narrowing of the penis or an hourglass shape
  • Scar tissue formation

Complications that arise from Peyronie’s may include:

  • Erectile dysfunction
  • Inability to perform sexual intercourse
  • Anxiety
  • Relationship stress with a sexual partner
  • Impaired reproductive ability due to difficulty or inability to perform intercourse

Peyronie’s disease cause is unknown; however, many factors are thought to be involved. The prevalent theory is that Peyronie’s results from repeated injury to the penis. Examples include repeated sex injuries, athletic activity or trauma from an accident, though minor injury to the penis does not always mean that Peyronie’s will develop.

The onset of this disease is gradual in some men and not related to any injury. Peyronie’s disease is rare in younger men. Research is ongoing into the causes of this disease. There are some known risk factors, including:

  • Heredity – increased risk if father or brother has Peyronie’s
  • Age – incidence increases with age, especially over age 55
  • Connective tissue disorders or autoimmune disease
  • Smoking
  • Prostate surgery (some types)

A physical exam can identify the scar tissue associated with Peyronie’s. During the physical exam, the doctor will palpate (feel) the penis when it is flaccid (not erect) to locate the scar tissue and determine the amount. The length of the penis may also be measured, which helps tracking the course of the disease in case the penis shortens over time.

Ultrasound or other tests may be ordered to examine the penis when it is erect. These tests usually require an injection in the penis to cause an erection. Ultrasound is the most common test as it produces images of soft tissues, the presence of scar tissue, other abnormalities and blood flow to the penis. An X-ray may also be used for additional imaging studies.

In many cases, the watchful waiting approach is taken as Peyronie’s resolves sometimes resolves on its own. This approach is used if the curvature is not severe and not progressing, erections and sex are still possible with mild or no pain, and good overall erectile function is present. If symptoms become worse or are severe, medication and surgery may be recommended.

Nonsurgical treatments

There are some medications that have been shown to help with the Peyronie’s disease treatment. Oral medications and supplements include:

  • Acetyl-L-carnitine
  • Colchicine
  • Potassium para-aminobenzoate (Potaba)
  • Tamoxifen
  • Vitamin E

Medications may also be injected directly into the plaque(s). These include:

  • Collagenase clostridium histolyticum (Xiaflex)
    • Only medicine specifically approved for Peyronie’s disease treatment
    • Works best in conjunction with modeling – bending the penis in the opposite direction of the curvature
  • Interferon alpha 2b
  • Steroids
  • Verapamil (this may also be prescribed as a topical medication)

Surgical Treatment

If the curvature is very severe and prevents intercourse, surgery may be recommended. Peyronie’s disease must be present for at least one year and in a stable (non-progressing) condition for at least six months before surgery. There are a few surgical options, including the following:

  • Plication – suturing or pinching in the unaffected side of the penis. Plication straightens the penis, but is usually reserved for less severe curvatures, may result in shortening of the penis and occasionally results in erectile dysfunction.
  • Grafting – cutting or removing the plaque, then attaching a patch of skin, vein or animal material. Grafting can straighten the penis and restore some lost length, but numbness and erectile dysfunction may be complications.
  • Penile implant – device inserted to cause an erection and straighten the penis. Penile implants may be combined with another surgery if erectile dysfunction is also present. Once an implant is inserted, it must be used in order to attain an erection.

Our providers are professional, experienced, discrete and dedicated to patient safety, privacy and the best quality care. If you have any of these symptoms or are concerned you may have Peyronie’s disease, you are not alone. Please contact us today for a private consultation about how best to work with your individual needs.

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