Peyronie’s disease is characterized by a fibrous scar tissue that forms beneath the surface of the penis that can alter its appearance and function. If left untreated, this scar tissue, which can be mild or acute, can make it problematic for otherwise healthy men to have normal erections by creating a painful curvature of the penis which can make having sex difficult or impossible. Although the symptoms can sometimes relieve themselves, often a male who is given this diagnosis should speak with their doctor to determine what options may be available to him to have it treated.
Although penises, like fingerprints, are all different and can even have a natural curve to them, men who experience pain when erect or during sex should speak to their doctor about the possibility that these problems stem from Peyronie’s disease.
Stages of Peyronie’s disease?
Peyronie’s disease has two stages: acute and chronic.
Acute phase: This stage lasts between six and 12 months. During this period the scar forms under the skin of your penis, causing a curvature or other change in its shape. You may feel pain when your penis is erect or when it is soft.
Chronic phase: The scar has stopped growing in this phase, so the curvature in the penis doesn’t get worse. The pain will usually be gone by this time, but sometimes it can continue, especially with erections. Also, erectile dysfunction (ED) or problems getting or keeping the penis hard may develop.
The following factors may increase a man’s chance of developing Peyronie’s disease:
- Vigorous sexual or nonsexual activities that cause microscopic injury to the penis
- Certain connective tissue and autoimmune disorders
- A family history of Peyronie’s disease
- Aging (between 40 and 70 years of age)
Causes of Peyronie’s disease
In most cases, the cause of Peyronie’s disease is unknown. Some of the known causes and risk factors include:
- Injury to the penis, such as bending the erect penis severely enough to rupture the membrane that covers the blood vessels
- Family history (which suggests there may be a genetic factor)
- Inherited collagen abnormality in the genes that regulate the growth of fibrous connective tissue proteins (collagen)
- Infection of the penis
- An autoimmune response, which causes the plaques to form
- Certain drugs, including blood pressure medications (beta blockers), interferon and anti-seizure drugs
Peyronie’s disease symptoms
The following are the most common symptoms of Peyronie disease:
Changes in the way an erection looks:
- Plaque on the top of the shaft causes the penis to bend upward when erect. This is the most common condition.
- Plaque on the side causes the penis to bend to the side of the plaque.
- Plaque on the underside causes the penis to bend downward during erection.
- Plaque on both the top and bottom, or that wraps around the penis, can cause deformity, indentation, and shortening of the penis.
- Painful erections
- Trouble with sexual penetration
Pain, bending, and emotional distress can greatly affect the man’s sex life.
The symptoms of Peyronie disease may look like other conditions or health problems. Always talk with a healthcare provider for a diagnosis.
Complications of Peyronie’s disease may include
- The inability to have sexual intercourse due to penile curvature
- Erectile dysfunction
- Emotional distress, depression NIH external link, or anxiety about sexual abilities or the appearance of the penis
- Stress in a relationship with a sexual partner
- Problems fathering a child because intercourse is difficult
Diagnosis and test
A physical exam is often sufficient to identify the presence of scar tissue in the penis and diagnose Peyronie’s disease. Rarely, other conditions cause similar symptoms and need to be ruled out.
Tests to diagnose Peyronie’s disease and understand exactly what’s causing your symptoms might include the following:
Physical exam: Your doctor will feel (palpate) your penis when it’s not erect, to identify the location and amount of scar tissue. He or she might also measure the length of your penis. If the condition continues to worsen, this initial measurement helps determine whether the penis has shortened.
Your doctor might also ask you to bring in photos of your erect penis taken at home. This can determine the degree of curvature, location of scar tissue or other details that might help identify the best treatment approach.
Other tests: Your doctor might order an ultrasound or other tests to examine your penis when it’s erect. Before testing, you’ll likely receive an injection directly into the penis that causes it to become erect.
Ultrasound is the most commonly used test for penis abnormalities. Ultrasound tests use sound waves to produce images of soft tissues. These tests can show the presence of scar tissue, blood flow to the penis and any other abnormalities.
Treatment and medications
Generally, your doctor will recommend the most conservative and least invasive approaches first. Treatment options include:
Carson explains that no oral medicines have yet been approved for use in Peyronie’s disease, but some men are given pentoxifylline, a drug that’s typically prescribed to improve blood flow in people with other circulation issues.
Other oral treatments that might be recommended are vitamin E, an antioxidant which may help reduce plaque size and curvature, per the UCF, and potassium para-aminobenzoate (Potaba) which may reduce plaque size but doesn’t affect curvature.
During the acute phase of Peyronie’s, medicine can be directly injected into the scar tissue (or plaques). Penile nerve blocks numb the penis before the shots.
- Collagenase (Xiaflex) is the first drug to be approved by the U.S. Food and Drug Administration (FDA) for the treatment of Peyronie’s in men who have a Peyronie’s plaque and whose penis curves at least 30 degrees.
- Verampamil is used in treating in high blood pressure; the NIDDK notes that it may reduce curving and pain in the penis when injected into scar tissue.
- Interferon-alpha 2b is a protein that seems to break down scar tissue.
There are several surgical procedures that can be used in the treatment of Peyronie’s disease. The type of surgery recommended will depend on your symptoms and the location of the penile plaque(s).
- Plication surgery is performed on the opposite side of the penis from the affected side. It involves making a tuck in the lining of the penis (using stitches) to try to even out the curve. Possible risks of this surgery include penile shortening and erectile dysfunction.
- Incision/excision of the plaque and grafting. This involves cutting the plaque, and sometimes also removing the scar tissue and grafting healthy tissue to the affected area. Erectile dysfunction is the major risk associated with this type of surgery. Numbness of the penis can also occur.
- Penile implants may be considered in men with Peyronie’s disease and erectile dysfunction. It involves the insertion of prosthesis to help straighten the penis and make it firm enough to have sex.
Because the condition can improve on its own, doctors recommend waiting at least one year before considering surgical treatments. Also, surgery is usually only an option once the curvature is stable (no longer increasing).
Prevention of Peyronie’s disease
Men may not realize that they can damage their penis during sexual intercourse; making it difficult or even impossible to have sex. To avoid this type of injury there are a number of things a man and his partner can do.
As men age, their erections may be less rigid or there may be difficulty in maintaining firmness. Less rigid erections can be injured because regular thrusting during sexual intercourse bends the penis. The following suggestions can help:
- Doctors will usually prescribe oral medications (Viagra, Levitra, Cialis) when a man has erectile dysfunction and sexual intercourse is either difficult or impossible. The first step in avoiding penile injuries is to begin to use one of these medications as erections become less rigid.
- The woman should make sure that the vagina is lubricated. If it is not, the woman should use an over-the-counter vaginal lubricant.
- If the penis slips out of the vagina during sexual intercourse, the man or his partner should use their hand to guide it back in.
- Sexual intercourse with the partner on top should be avoided or used with caution because this position may increase the chances of the penis bending.
- Regardless of the position, the man’s thrusting movements during sexual intercourse should be straight in and out. He should avoid movements that might bend or twist the penis.
- Sexual intercourse should be avoided when the man is tired or has had too much alcohol to drink as erections may be less reliable on these occasions.