What is Peyronie’s Disease?
Peyronie’s disease causes flat scar tissue (plaques) to form underneath the skin in the penis. This can result in the penis being bent when it becomes erect.
This condition is thought to affect just over three percent of males in the US, although it is likely underreported. It can cause considerable physical and psychological stress for sufferers. (1)
Recognised by physicians and anatomists since the early 13th century, it was named after Francois Gigot de La Peyronie. This surgeon, who attended King Louis XIV, described this condition in 1743. (2, 3)
The penis has two main functions: to carry urine from the body, and to ejaculate sperm during sex.
There are three tubes inside the penis. One is the urethra which carries urine and semen from the body. The other two are the corpora cavernosa. These two tubes are spongy and soft and enable a penis to become erect when they fill with blood.
All three tubes are contained in a sheath of fibrous tissue called the tunica albuginea.
When plaques form they are generally found in the elastic membrane of the tunica albuginea. As a result when an erection occurs the penis bends or curves. (4)
The cause of this disease is unsure; there are however contributing factors. One of these is minor injury to the penis, likely caused as a result of vigorous sex or accidental injury.
Injury might cause scar tissue to form in the cells of the the tunica albuginea which then forms plaque. This however does not happen in all cases of penile trauma. There are generally other contributing factors.
Genetics, certain health conditions such as diabetes, and smoking can lead a greater chance of the development of Peyronie’s disease. (5)
This condition could also be as a result of an autoimmune response by the body. The immune system usually protects the body by destroying harmful bacteria, viruses or other invaders. Men who suffer from autoimmune conditions might find that the immune system attacks cells in the penis leading to inflammation and scarring. (6)
Peyronie’s disease becomes more common with age, thought to affect about six percent of males between the ages of 40 and 70. (7)
The symptoms of Peyronie’s disease include:
As a result of the formation of plaque the penis will curve or bend when erect.
Plaque can form in different places in the penis. It is most commonly found on the top, which causes an upward curvature. When plaque forms on the side or underneath the penis, the curvature will likely be sideways or downwards.
There are occasions when plaque can form and be situated all around the penis. In this case the shaft of the penis can narrow looking similar to a hourglass. It is also possible for the length to be shortened when plaques are located on both sides of the penis.
The plaque might sometimes become very hard, feeling like a bone.
Curvature can be noticeable whether or not the penis is erect. (8)
Solid lumps might be felt under the skin on the sides, top or underneath the penis. (9)
This condition causes pain in an erect penis. It also interferes with sexual function, making penetration during intercourse more difficult and painful. (10)
Failure to achieve an erection happens in between 20 to 50 percent of men with Peyronie’s disease.
The plaque which has formed can impede the penis’ ability to fill with the blood needed to become erect. Men might also feel anxious about their sexual ability due to curvature and fail to reach, or maintain, an erection. (11)
There are several complications associated with this disease. Erectile dysfunction and a possible inability to have intercourse can have psychological effects. Stress, anxiety, depression and lack of self esteem are often felt in men with Peyronie’s disease.
This condition can lead to problems in sexual relations with a partner, and might lead to fertility issues if intercourse is difficult. (12)
There are two stages associated with Peyronie’s disease.
This is classed as the acute phase and lasts for between six and eighteen months. This happens while plaque is growing in the penis.
It is characterised by the development of curvature in the penis. This is accompanied by the onset of pain when the penis is erect.
Classed as the chronic stage, the plaque has now stopped growing and the extent of the curvature is complete. The appearance of the bend will not progress any further.
Any pain present during the acute stage of the disease might no longer be felt. (13)
The aim of treatment for this condition is to reduce any associated pain and to restore the ability to have sexual intercourse.
The condition can sometimes resolve itself without medical intervention. Also, treatment might not be necessary if the plaque formed is minimal, curvature is small, sexual function is satisfactory and there is no pain.
When treatment is required there are both non surgical and surgical options.
Non Surgical Treatments
These treatments include medical therapies and medications.
There are oral medications, topical creams and injections available. They aim to reduce the extent of the curvature, reduce the size of the plaque and relieve inflammation.
Oral medications such as vitamin E, tamoxifen, colchicine, acetyl-L-carnitine or pentoxifylline might be prescribed.
Injections of verapamil, interferon, steroids or collagenase could be administered by a urologist.
Verapamil can also be applied topically to the penis.
There are therapies which are used to decrease the size of plaque, dissolve scar tissue and reduce curvature.
High intensity ultrasound uses sound waves directed at the plaque to reduce it.
Radiation therapy employs the use of high energy rays, again aimed directly to plaque.
Shockwave therapies are low intensity electric currents which are focused on the reduction of plaque.
Iontophoresis is again a low level electric current but this delivers medication through skin located over the plaque. This painless procedure can decrease the size of the plaque and straighten the curvature.
There are also therapies involving devices which use vacuum or traction to stretch and bend the penis to minimize curvature.
When the condition has been present for a long time, interferes with sexual function or is painful, surgical intervention might be recommended. This could also be the case if symptoms are not getting any better.
Surgery is aimed at reducing plaque and straightening the penis.
The general recommendation will be to wait about a year after the onset of symptoms before surgery is considered. Individual cases can vary and there can be side effects such as a shorter penis.
The types of surgery available include:
During this procedure the plaque is surgically removed and replaced with a vein, patch of skin or other organic material. This surgery can straighten the penis and help restore any length which might have been lost.
Side effects noticed by some patients following surgery are erectile dysfunction, or a feeling of numbness in the penis.
This surgery pinches or removes a piece of the tunica albuginea on the side of the penis opposite the plaque. The result can be a straighter penis.
This procedure does not restore girth or length to the penis but tends to cause less erectile dysfunction and numbness.
Penile prosthetic devices can be placed inside the penis to straighten the curvature and assist an erection. These implants could be an inflatable pump or silicone rods which can be molded.
These devices can be implanted alongside other surgical options if they are not able to straighten the penis sufficiently on their own. (14, 15)
What is Peyronie’s disease? Peyronie’s disease causes flat scar tissue (plaques) to form underneath the skin in the penis. This can result in the penis bending when it becomes erect.
What are the signs of Peyronie’s disease? This condition causes a curvature of the penis.
How do you develop Peyronie’s disease? The exact cause of this condition is unknown, however, genetics, age, autoimmune conditions and lifestyle factors play a part. It can also be the result of injury to the penis.
How are you diagnosed for Peyronie’s disease? Physical and visual examination will usually indicate if this disease is present. Imaging tests might be required to confirm diagnosis.
What is the best treatment for Peyronie’s disease? Treatments include medications and/or surgery. Dependent on the severity of the condition a doctor will decide the best course of action.
What are the complications of Peyronie’s disease? This condition can lead to erectile dysfunction. It might also cause psychological issues such as depression and low self esteem. Sexual function can be impaired which can affect relationships.
Is Peyronie’s disease considered a disability? This disease is not considered a disability, however there are occasions when social security benefits might be paid. (16)
Is there a cure for Peyronie’s disease? There are treatments available to relieve and correct the symptoms caused by this condition.
Is Peyronie’s disease life threatening? While this condition can affect quality of life, it is not considered life threatening.
Peyronie’s disease causes the penis to curve or bend making it painful when erect and interfering with sexual function.
While the exact cause of this condition is unknown, there are treatments available to rectify the resulting symptoms.
The good news is these can straighten the curvature of the penis and restore sexual function.