Introduction
Peyronie’s disease causes curved, painful erections due to scar tissue under the skin of the penis. About 4-13% of men worldwide have this condition. It can develop slowly or appear suddenly. While not dangerous, it can make sex difficult or impossible in severe cases. It often causes stress and relationship problems. This guide explains the causes, symptoms, diagnosis, and treatments to help you better understand this condition.
What Is Peyronie’s Disease?
Peyronie’s disease happens when scar tissue (plaque) forms inside the penis after injury. Dr. Caroline Martinez, a urologist at Northwestern University, explains:
“The penis has two chambers called the corpora cavernosa. These fill with blood during an erection. In Peyronie’s disease, scar tissue forms in these chambers. This prevents normal expansion and causes the penis to bend.”
The condition is named after François Gigot de la Peyronie, a French surgeon who first described it in 1743. While known for centuries, our understanding has grown much better in recent decades.
Phases of Peyronie’s Disease
Peyronie’s disease has two main phases:
Acute (Active) Phase: This first phase usually lasts 6-18 months and includes:
- Scar tissue you can feel
- Worsening penile curve
- Pain during erections
- Inflammation
Chronic (Stable) Phase: This phase follows the acute phase and includes:
- Stable scar tissue
- Little or no pain
- No further curving
- Sometimes hardened plaque
Dr. James Howard from Johns Hopkins Medicine says, “Knowing which phase a patient is in helps plan treatment. We usually wait until the disease stabilizes before trying invasive treatments.”
Causes and Risk Factors
We don’t fully understand what causes Peyronie’s disease, but experts have found several likely factors:
Trauma or Injury
Small injuries to the penis are the most common trigger. These can happen during sex, sports, or accidents. Dr. Sarah Chen from Mayo Clinic notes, “Tiny tears in the penile tissue during sex seem to start many cases. But many men don’t remember a specific injury.”
Abnormal Wound Healing
In men with Peyronie’s disease, normal healing gets disrupted. Instead of healing properly, excess scar tissue forms. Research suggests this relates to certain proteins that control inflammation and tissue repair.
Genetic Factors
There seems to be a genetic link. A 2020 study in the Journal of Sexual Medicine found that about 11% of men with Peyronie’s disease have a family member with the same condition.
Other Risk Factors
Several things may increase your risk:
- Age: Men over 50 have higher risk
- Connective tissue disorders: Conditions like Dupuytren’s contracture (a hand condition)
- Certain medications: Some drugs, like beta-blockers
- Smoking: Tobacco use may worsen wound healing
- Diabetes: May increase risk
The American Urological Association notes that while these risk factors exist, Peyronie’s disease can affect men of all ages and backgrounds.
Signs and Symptoms
Symptoms vary widely between men. Common signs include:
Penile Curvature
The most obvious symptom is an abnormal curve during erection. This curve may point:
- Upward (most common)
- Downward
- To either side
- In multiple directions
The curve can range from mild (less than 30 degrees) to severe (more than 60 degrees). Dr. Martin Gelbard from UCLA points out, “The amount of curve doesn’t always match symptom severity. Some men with small curves have big problems, while others with large curves have few issues.”
Pain
Pain during erections is common in the early phase. About 35-45% of men have pain at first. This pain usually goes away as the condition stabilizes. Only about 10% of men still report pain after 18 months.
Scar Tissue You Can Feel
Many men can feel hard lumps or bands under the skin of the penis. These plaques are easiest to notice when the penis is flaccid (not erect).
Erectile Dysfunction
About 30-80% of men with Peyronie’s disease also have erectile dysfunction (ED). The link between these conditions is complex and may involve:
- Physical limits due to the curve
- Performance anxiety
- Blood vessel problems affecting both conditions
Other Physical Changes
Other symptoms may include:
- Shortening of the penis
- Narrowing of the shaft (sometimes called “hourglass deformity”)
- Loss of girth (thickness)
Psychological Impact
The mental burden is significant. A 2019 survey found that 77% of men with Peyronie’s disease reported emotional problems, including:
- Depression
- Anxiety
- Loss of self-esteem
- Relationship stress
Dr. Rachel Wilson, a psychologist at Columbia University Medical Center, says, “The mental impact can be profound. Many men feel embarrassed, which often delays treatment. We need to address these feelings alongside the physical symptoms.”
Diagnosis
Diagnosing Peyronie’s disease typically involves medical history, physical exam, and sometimes imaging tests.
Medical History
Your doctor will ask about:
- When symptoms started
- Pain level
- Changes in penile curve over time
- Sexual function
- Past penis injuries
- Other medical conditions
- Family history
Physical Examination
A thorough exam helps identify:
- Location, size, and number of plaques
- Penis length
- Other genital issues
The American Urological Association recommends examining the penis both flaccid and, when possible, erect to fully assess the condition.
Imaging Studies
Various imaging tests may help doctors see the plaques and curve better:
Penile Ultrasound: This painless test identifies plaques and assesses blood flow. Dr. Thomas Walsh from the University of Washington says, “Ultrasound helps us see plaque that we can’t feel and check if it’s hardened, which affects treatment choices.”
Duplex Doppler Ultrasonography: This special ultrasound evaluates blood flow patterns, which helps identify vascular issues contributing to ED.
Artificial Erection Tests: In some cases, doctors may induce an artificial erection using injected medications. This gives the most accurate view of the deformity.
Treatment Options
Treatment is customized based on disease phase, symptom severity, amount of curve, and patient preferences. Dr. Laurence Levine from Rush University Medical Center says, “There’s no one-size-fits-all approach. The best plan considers the patient’s age, sexual function, curve severity, and personal goals.”
Observation and Conservative Management
For mild cases with minimal pain and curves that don’t interfere with sex, watching and waiting may be appropriate. European guidelines suggest about 13% of cases improve without treatment, especially early in the disease.
Conservative approaches may include:
- Monitoring for changes
- Education about the condition
- Psychological support
Non-Surgical Treatments
Oral Medications
While no oral medication has FDA approval specifically for Peyronie’s disease, several options have been studied:
Pentoxifylline: This improves blood flow and may reduce inflammation. Some studies suggest it may prevent plaque growth.
Potassium Para-Aminobenzoate (Potaba): This B-complex vitamin derivative may help reduce plaque size and pain, though evidence is limited.
PDE5 Inhibitors: Medications like Viagra and Cialis mainly treat erectile dysfunction but may also help manage Peyronie’s-related ED.
Dr. Ira Sharlip from the University of California San Francisco notes, “While oral medications haven’t shown dramatic benefits in trials, they may help in early disease management, especially for pain control.”
Injection Therapies
Collagenase Clostridium Histolyticum (Xiaflex): This is the only FDA-approved medication specifically for Peyronie’s disease. It works by breaking down collagen in penile plaques. A major study showed Xiaflex injections reduced curvature by 34% compared to 18% with placebo.
Verapamil Injections: This calcium channel blocker may reduce plaque size and pain when injected directly into the plaque. While not FDA-approved for this use, it’s commonly used off-label.
Interferon Injections: These proteins have anti-fibrotic properties and may help reduce plaque size and penile curvature.
Other Non-Surgical Approaches
Extracorporeal Shock Wave Therapy (ESWT): This treatment uses sound waves directed at the plaque. It mainly helps with pain, but some studies suggest it may improve plaque absorption and sexual function.
Penile Traction Therapy: These devices apply gentle, progressive tension to the penis. A 2019 review found traction therapy can reduce curvature by 15-20 degrees when used 3-8 hours daily for at least three months.
Vacuum Devices: Similar to traction therapy, vacuum devices may help stretch penile tissue and potentially reduce curvature.
Surgical Treatments
Surgery is typically saved for men with stable disease (no pain or worsening curve for at least 3-6 months) who have curves severe enough to prevent satisfactory sex. The American Urological Association recommends considering surgery when curvature exceeds 30 degrees.
Plication Procedures
These techniques involve placing stitches on the side opposite the plaque to straighten the curve. Dr. Wayne Hellstrom from Tulane University explains, “Plication works well for men with good erections and curves less than 60 degrees without significant narrowing. It’s reliable and safe, though it may cause some shortening.”
Plaque Incision/Excision and Grafting
For more severe curves or cases with significant narrowing, surgeons may cut or remove the plaque and place a graft. Various graft materials may be used, including:
- Patient’s own tissue
- Processed human or animal tissue
- Synthetic materials
This approach may better preserve penis length but has a higher risk of causing erectile problems afterward.
Penile Prosthesis Implantation
For men with both Peyronie’s disease and significant erectile dysfunction, implanting a penile prosthesis may be best. Additional procedures may be done at the same time to address the curve.
A 2020 study found patient satisfaction rates with penile implants for Peyronie’s disease exceed 85%, among the highest of all surgical options.
Living with Peyronie’s Disease
Beyond medical treatments, managing Peyronie’s disease includes addressing its psychological and relationship impacts.
Psychological Considerations
Many men experience psychological distress, including:
- Embarrassment and shame
- Anxiety about sexual performance
- Depression
- Body image concerns
- Relationship strain
Dr. Michael Perelman from Weill Cornell Medical College advises, “Psychological counseling should be considered an essential part of treatment, not just an option. Individual or couples therapy can help address the emotional burden.”
Support Resources
Several organizations provide information and support:
- The Association for Peyronie’s Disease Advocates (APDA)
- Sexual Medicine Society of North America
- American Urological Association patient resources
Many offer online forums, educational materials, and provider directories to help patients find experienced doctors.
Communication with Partners
Open communication with sexual partners is essential. Dr. Laura Berman, relationship therapist and sexual health educator, suggests, “Honest conversations about limitations, concerns, and alternative approaches to intimacy can help couples maintain a satisfying relationship despite challenges.”
Current Research and Future Directions
Research into Peyronie’s disease continues to advance our understanding and develop new treatments.
Genetic Research
Scientists at the National Institutes of Health are investigating genetic markers associated with Peyronie’s disease. Dr. Alexander Pastuszak from Baylor College of Medicine notes, “Finding specific genetic factors could help us understand why some men develop this condition and lead to better treatments.”
Stem Cell Therapy
Early studies using stem cells show promising results. A 2021 pilot study showed that injections of fat-derived stem cells reduced plaque size and improved erectile function in a small group of patients.
Novel Drug Delivery Systems
Researchers are exploring new ways to deliver medications directly to penile plaques, including:
- Hydrogels that release medications slowly
- Nanoparticle-based delivery systems
- Electrochemical delivery methods
These approaches may improve how well existing medications work while reducing side effects.
Frequently Asked Questions (FAQ)
Is Peyronie’s disease rare? No, it affects about 4-13% of men, with cases increasing with age. Many cases likely go unreported due to embarrassment or mild symptoms.
Can Peyronie’s disease go away on its own? In about 13-15% of cases, particularly mild ones, it may stabilize or improve without treatment. However, complete resolution on its own is uncommon, especially once hardened plaques have formed.
Does Peyronie’s disease always require surgery? No, many cases can be managed without surgery. Surgery is typically reserved for men with stable disease who have curves severe enough to prevent satisfactory sex.
Can Peyronie’s disease cause cancer? No, Peyronie’s disease is not cancerous and does not increase the risk of penile cancer. The plaques are benign scar tissue.
At what age does Peyronie’s disease typically develop? While it can occur at any age, it most commonly affects men between 40 and 70, with the average age around 55.
Does Peyronie’s disease affect fertility? It doesn’t directly affect fertility or sperm production. However, if it makes sex difficult or impossible, it may indirectly impact fertility by preventing natural conception.
Can diet or supplements help? While some supplements (like vitamin E, L-carnitine, and coenzyme Q10) have been studied, evidence for their effectiveness is limited. No specific diet has been proven to help, though heart-healthy eating may be beneficial given shared risk factors.
Is Peyronie’s disease contagious? No, it is not contagious and cannot be transmitted through sexual contact or any other means.
Conclusion
Peyronie’s disease is challenging both physically and emotionally, but various treatment options can help. Early diagnosis may prevent disease progression and minimize complications. Research continues to advance, offering hope for better treatments.
Both the physical and psychological aspects need attention for complete care. Men with symptoms should see a healthcare provider specializing in urological and sexual health. Effective treatments exist to address this condition and improve quality of life.