Learn about Peyronie's disease, its causes, symptoms, and available treatment options. Get reliable information on Meri Sehat.

Peyronie's Disease

Humza Khizer

Overview

Peyronie&rsquo;s disease is defined as a noncancerous condition characterized by scar formation on the penis, causing painful erections. 
&nbsp;

Peyronie&rsquo;s disease is named after the French surgeon Fran&ccedil;ois Gigot de la Peyronie, who first reported the disease in 1743<a href="#accordion">[1]</a>.

As per recent estimates, Peyronie&rsquo;s disease has a prevalence of up to 9%<a href="#accordion">[3]</a>. The disease most commonly affects middle-aged men. However, according to research, 8 to 10% of Peyronie&#39;s disease patients are younger than 40<a href="#accordion">[2]</a>.

Scar tissue from Peyronie&#39;s disease causes the penis to bend, or lose length or girth. It may occasionally hurt and discourage a man from engaging in sexual activity. This may make it impossible for them to have sex or challenging to obtain or keep an erection (<a href="https://merisehat.pk/disease/erectile-dysfunction">erectile dysfunction</a>). Moreover, it contributes to tension and <a href="https://merisehat.pk/disease/anxiety">anxiety </a>in young men. However, it has no impact on fertility nor constitutes malignancy.&nbsp; 
&nbsp;

Signs and Symptoms

Signs and symptoms of Peyronie&#39;s disease either emerge suddenly overnight or develop slowly. The most typical warning signs and symptoms are: 
&nbsp;

<ul>
	<li>Scar Tissue</li>
</ul>

Plaque formation is the main symptom of Peyronie&rsquo;s disease. It is a type of scar tissue distinct from plaque that can accumulate in blood vessels. The scar tissue can be felt under the skin of the penis as flat lumps of a hard tissue band. It typically forms on the top of the penis but can develop on the side or bottom as well. 
&nbsp;

<ul>
	<li>Bent/Curved Penis</li>
</ul>

Presence of plaque results in the penis bending upward, downward, or sideways. The change in penile curvature is mostly apparent during an erection. 
&nbsp;

<ul>
	<li>Erection Problems</li>
</ul>

Erectile dysfunction is a common occurrence in Peyronie&#39;s disease. However, in some men, erectile dysfunction occurs before the symptoms of Peyronie&#39;s disease begin. Erection problems result from the loss of rigidity due to plaque formation or the penis becoming curved. 
&nbsp;

<ul>
	<li>Shortening Of The Penis</li>
</ul>

The presence of scar tissue may cause the penis to shorten or shrink. 
&nbsp;

<ul>
	<li>Pain</li>
</ul>

Penile pain is a common symptom and occurs more often with erections. 
&nbsp;

<ul>
	<li>Other Penile Deformities</li>
</ul>

The erect penis in certain Peyronie&#39;s disease patients may appear narrowed, indented, or even hourglass-shaped, with a tight, thin ring encircling the shaft. Peyronie&#39;s disease-related penile shortening and curvature may gradually get worse. But after around three to twelve months, the problem usually stabilizes.

Within one to two years, the pain experienced during erections typically subsides, but the penile shortening, scar tissue, and curvature frequently persist. Moreover, the presence of calcium in the plaque can make the penis hard and feel like a bone.

Urination or ejaculation is not affected by Peyronie&rsquo;s disease. 
&nbsp;

Note: Not all men have perfectly straight erections. Many men naturally have a bit of curvature in their penis. Thus, a curved penis doesn&rsquo;t always point to Peyronie&rsquo;s disease. 
&nbsp;

Causes

Although the exact origin of Peyronie&#39;s disease is unknown, several variables seem to be involved: 
&nbsp;

<ul>
	<li>Injury To The Penis - Peyronie&#39;s disease is believed to often originate from repetitive harm to the penis. For instance, the penis might get hurt during sexual intercourse, exercise, or in an accident. As the penis heals from the injury, disorganized scar tissue forms. Thus, leading to a palpable nodule or curved penis. However, often at the time, no specific injury or trauma is present. 
	&nbsp;</li>
	<li>Accumulation Of Blood In Penis - The corpus cavernosum, which is located on each side of the penis, is a sponge-like tube filled with numerous tiny blood vessels. Both the corpus cavernosa are enclosed by the tunica albuginea, an elastic tissue covering that stretches during erection. During sexual arousal, there is increased blood flow to these chambers. The filling of these chambers causes the penis to enlarge, straighten, and become erect. However, in Peyronie&rsquo;s disease, the area with the scar tissue doesn&#39;t expand during an erection. Thus, causing the penis to bend or become deformed and potentially painful. 
	&nbsp;</li>
	<li>Other Causes - In some men, Peyronie&#39;s disease comes on gradually and doesn&#39;t seem to be related to an injury. Thus, researchers predict that the disease may have genetic or environmental causes. Moreover, certain diseases and medications have also been linked to Peyronie&rsquo;s disease. 
	&nbsp;</li>
</ul>

Peyronie&rsquo;s disease occurs in two stages - acute and chronic:

Acute Phase: The acute stage lasts for six to twelve months. It is characterized by a change in shape or curve of the penis due to scar formation. There may also be a pain in the penis when it is erect or soft. 
&nbsp;

Chronic Phase: In this stage, the scar is no longer expanding, preventing further progression of the penis curvature. The pain usually subsides by this point, but it occasionally lingers, especially during erections. Additionally, the person may face erectile dysfunction (ED) or problems with keeping the penis hard. 
&nbsp;

Diagnosis

<h5>Clinical History</h5>

To diagnose one with Peyronie&rsquo;s disease, the doctor will first take a complete history, asking the patient about their symptoms. Questions mostly focus on sexual dysfunction, change in penis length and shape, family history of Peyronie&rsquo;s disease, history of trauma to the penis, and medication history.&nbsp; 
&nbsp;

<h5>Physical Exam</h5>

Next, a physical examination is conducted where the penis is palpated for the presence of scar tissue. The penis&rsquo; length might also be measured to determine any changes if the condition worsens.

Additionally, the doctor might ask for pictures of the erect penis to determine the degree of curvature, the position of scar tissue, and other information that may aid in choosing the best course of action.

Often, at times, the doctor may inject medicine into the penis to make it erect for the exam. 
&nbsp;

<h5>Imaging Studies</h5>

An ultrasound and X-ray can help identify calcium buildup within the plaque. Moreover, anomalies, such as scar tissue, blood flow to the penis, and other issues can also be detected.

Duplex ultrasonography of the penis is conducted if Peyronie&rsquo;s disease is associated with erectile dysfunction. 
&nbsp;

Treatment

Most cases of Peyronie&rsquo;s disease resolve without treatment. Patients with a little curve in the penis, no pain, and no sexual problems are often not administered any treatment. In such cases, doctors may recommend waiting for 1 to 2 years to see if the symptoms are progressing.

There is currently no cure for the disease. However, the following interventions can help improve the changes in the penis: 
&nbsp;

<h5>Medications</h5>

There have been several oral treatments for Peyronie&#39;s disease. However, they have not been generally effective and are not as successful as surgery. The following oral medications may help improve symptoms:

<ul>
	<li>Pain Medications - This helps reduce inflammation and lessen pain.</li>
	<li>Pentoxifylline - This helps improve blood flow in the penis.</li>
	<li>Tadalafil - This prevents scarring from worsening by improving blood flow in the penis.</li>
	<li>Potassium Amino-Benzoate (Potaba) - This is a vitamin B-complex and can help reduce the size of the plaque. However, it might not be effective at improving the curve of the penis. 
	&nbsp;</li>
</ul>

Since oral pills are not very effective, doctors often opt for injectable medicines.

<ul>
	<li>Collagenase (Xiaflex) - This is the only FDA-approved medication for Peyronie&rsquo;s disease. It is recommended for use in adult men with moderate to severe penile curvature and a palpable nodule. The treatment breaks down the scar tissue in the penis. Thus, helping improve the penile curvature. It is more effective when combined with &lsquo;modeling&rsquo;. This is a procedure that involves forcibly bending the penis in the opposite direction of the curvature.</li>
	<li>Verapamil - Although normally used to treat <a href="https://merisehat.pk/disease/hypertension-57">hypertension</a>, it has also been shown effective in disrupting collagen production. Collagen is a significant factor in scar tissue formation within the penis. Thus, verapamil injections can help improve penile pain and curvature</li>
	<li>Interferon - This particular protein seems to interfere with the development of fibrous tissue and aid in its breakdown. One experiment comparing this treatment to a placebo revealed improvement. In addition, interferon has been demonstrated to lessen penile pain in Peyronie&#39;s disease-affected men. 
	&nbsp;</li>
</ul>

<h5>Traction Therapy</h5>

This involves stretching the penis for a small duration of time with the help of a self-applied mechanical device. The traction device may be worn from 30 minutes to 3 to 8 hours per day. This can help improve penile curvature, length, and deformity.

Penile traction therapy is usually advised in the acute stage of Peyronie&rsquo;s disease. However, it can also be used in the chronic phase in combination with other treatments. 
&nbsp;

<h5>Surgery</h5>

Normally, surgery is only advised in patients in whom Peyronie&rsquo;s disease is causing problems with sexual intercourse. Doctors typically don&rsquo;t recommend surgery until the condition has been present for 9-12 months, the scar and curvature have stopped worsening, and there has been no pain.

The three surgical options for Peyronie&rsquo;s disease are:

<ul>
	<li>Suturing (Plicating) The Unaffected Side - The Lengthier, Scar-Free Side Of The Penis Can Be Sutured (Plicated) Using A Variety of techniques. As a result, the outside of the curve shortens and the penis straightens. This procedure is usually used to fix less severe curvatures.</li>
	<li>Incision Or Excision And Grafting - This involves excising the plaque and the space left behind is filled with a graft. The graft material may be synthetic, human, animal, or tissue from their own body. Men with more significant curvature or deformity, such as indentations, typically have this surgery. However, this technique carries higher risks of causing erectile dysfunction than plication procedures.&nbsp;</li>
	<li>Penile Implants - This is often used for men with poor erections, such as those with erectile dysfunction and Peyronie&rsquo;s disease. It involves placing a prosthetic device within the spongy tissues of the penis. These implants may either need to be manually bent upward or require to be inflated with a pump placed in the scrotum for sexual intercourse. 
	&nbsp;</li>
</ul>

<h5>Other Treatments</h5>

Iontophoresis is a method for administering a noninvasive dose of verapamil plus a steroid through the skin using an electric current. Current studies have not shown conclusive results on the method&rsquo;s effect on penile curvature and erectile function.&nbsp;

There are a number of non-drug treatments for Peyronie&#39;s disease being researched, but there is not enough data to know how well they work and whether they have any negative effects. Shock wave therapy, radiation therapy, platelet-rich plasma, stem cells, and powerful sound waves are a few examples. 
&nbsp;

Peyronie&rsquo;s disease may result in complications, such as:&nbsp; 
&nbsp;

<ul>
	<li>Inability&nbsp;to engage&nbsp;in&nbsp;sexual activity&nbsp;</li>
	<li>Difficulty obtaining&nbsp;or sustaining an erection (erectile dysfunction)</li>
	<li>Concerns or anxiety regarding the penis or sexual performance</li>
	<li>Relationship problems due to stress of sexual dysfunction</li>
</ul>

<ul>
	<li>Difficulty having children due to difficulties with sexual intercourse</li>
	<li>Shorter penis</li>
	<li>Pain in the penis 
	&nbsp;</li>
</ul>

Note: If you notice any external bleeding, trouble urinating, or penile pain that doesn&rsquo;t go away, immediately contact a healthcare professional. 
&nbsp;

Peyronie&#39;s disease is not always brought on by minor penile injuries. However, a number of reasons may be responsible for inadequate wound healing and the accumulation of scar tissue, which may be related to Peyronie&#39;s disease. A few of these include: 
&nbsp;

<ul>
	<li>Heredity - You are more likely to develop Peyronie&#39;s disease if a family member does.</li>
	<li>Connective Tissue Disorders - Peyronie&#39;s disease appears to be more likely to affect men with specific connective tissue problems. For instance, some men with Peyronie&#39;s disease also have Dupuytren&#39;s contracture, which is a cord-like thickening all across the palm that leads the fingers to pull inward.</li>
	<li>Age - Although the disease can affect males of any age, it is more common in older men, particularly those in their 50s and 60s. Younger men tend to have congenital penile curvature, which is less frequently caused by Peyronie&#39;s disease. Additionally, in younger men, a small amount of penile curvature is normal and not a cause for concern.</li>
	<li>Erectile Dysfunction - Men with diabetes-associated erectile dysfunction (ED) are more likely to develop Peyronie&rsquo;s disease. The disease might also lead to erectile dysfunction.</li>
	<li><a href="https://merisehat.pk/disease/prostate-cancer">Prostate Cancer</a> - Men who have undergone surgery for prostate cancer are more susceptible.</li>
	<li>Autoimmune Disorders - Peyronie&#39;s disease is more likely to strike those with autoimmune diseases like <a href="https://merisehat.pk/disease/systemic-lupus-erythematosus">lupus</a>. 
	&nbsp;</li>
</ul>

There may be additional causes for Peyronie&#39;s disease, including certain medical disorders, smoking, and specific types of prostate surgery. 
&nbsp;

There is currently no measure that can prevent Peyronie&rsquo;s disease. However, since the trauma is a major cause of Peyronie&rsquo;s disease, the following measures should be taken to avoid any penile injury: 
&nbsp;

<ul>
	<li>Use lubricants during sexual intercourse.</li>
	<li>Avoid sexual positions that can cause the penis to bend. 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Peyronie&#39;s disease is a condition that results in a curve in the penis and could make erections difficult.</li>
	<li>Peyronie&#39;s illness can have an impact on one&#39;s physical, psychological, and emotional well-being.</li>
	<li>Peyronie&#39;s disease can be managed with a variety of drugs, and injections, including surgical procedures. 
	&nbsp;</li>
</ul>

[1] de la Peyronie F. Sur quelques obstacles qui s’ opposent a l’ejaculation naturelle de la semence. Mem Acad R Chir. 1743;1(1743):425–34.

[2] Safarinejad MR. Safety and efficacy of coenzyme Q10 supplementation in early chronic Peyronie’s disease: a double-blind, placebo-controlled randomized study. Int J Impot Res. 2010;22(5):298–309.

[3] Al-Thakafi S, Al-Hathal N. Peyronie's disease: a literature review on epidemiology, genetics, pathophysiology, diagnosis and work-up. Transl Androl Urol. 2016;5(3):280-289. doi:10.21037/tau.2016.04.05

Peyronie's Disease

Medically reviewed by

Humza Khizer

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Peyronie's Disease

Medically reviewed by

Humza Khizer

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