Peyronie's disease

Peyronie's disease symptoms

Initial symptoms of Peyronie's disease include:

• Painful erections.

• Feeling a hard lump (called a plaque) in the shaft of the penis. This can be on the top, the bottom, or sometimes in the middle of the shaft of the penis.

• Curving, bending, or shortening of the penis, that occurs over several months.

Peyronie's usually starts with a painful 'inflammatory' phase. This usually lasts for about a year. After this, the pain typically stops. Peyronie's then develops into a 'chronic' phase, where the bending or curvature of the penis remains the same, with no new changes developing.

Usually, the penis looks normal when soft (flaccid), and the curving or bending is only visible when erect.

Some men with Peyronie's disease have:

• Difficulty having sex, due to pain or the shape of the penis.

• Erectile dysfunction (ED). Sometimes, Peyronie's disease interferes with the blood flow to the penis, which is required for an erection. Other times, ED can develop due to emotional or mental distress as a result of having the condition.

• Mental health problems. Studies suggest that up to half of all men with Peyronie's disease suffer from depression.

Peyronie's disease images

Peronie's disease: penis bent upwards

By Peyronie (Own work), via Wikimedia Commons

Peyronie's disease - penis bent sideways

By Kentkalell (Own work), CC BY-SA 4.0, via Wikimedia Commons

What causes Peyronie's disease?

Peyronie's disease is thought to be caused by a problem with wound healing.

Small injuries to the penis can happen during sex or masturbation, particularly if the penis is squeezed or bent. Normally, these heal without causing problems. In Peyronie's disease, a lump of scar tissue, called a fibrous plaque, forms at the area of damage. Initially, the plaque is inflamed (causing pain). As the plaque develops, the normal stretchy tissue of the penis is replaced by stiff scar tissue.

If the plaque is on the top of the penis, it causes the penis to bend upwards. Similarly, if it's on one side, the penis will curve to that side, or curve downwards if it's on the bottom. Sometimes, the plaque develops in the centre of the penis, causing shortening.

We don't really know why some men develop plaques, and others don't.

Peyronie's disease is seen more frequently in people who:

• Have diabetes.

• Have high blood pressure.

• Have high cholesterol.

• Have Dupuytren's contracture (a thickened band across the palm).

• Smoke.

• Drink excessive amounts of alcohol.

• Have a family history of Peyronie's disease.

How common is Peyronie's disease?

Peyronie's disease is common. Between 1 in 100 to 1 in 200 men have a diagnosis of Peyronie's disease, but it's thought that many men don't see a doctor about it, and go undiagnosed. Estimates suggest that 1 in 10 men may have Peyronie's.

Peyronie's disease can affect men of any age, but middle-aged men are at greater risk.

Is Peyronie's disease permanent?

Peyronie's disease is usually permanent. Treatment can improve symptoms, but, currently, we don't have a treatment that returns the penis to how it was before developing Peyronie's disease.

In almost all men, the pain felt during the inflammatory phase of Peyronie's disappears with time as they enter the chronic phase.

After entering the chronic phase, approximately:

• 4 out of 10 men don't experience any further changes in the penis, and the shape and appearance remain stable.

• 5 out of 10 men get further plaque development, causing worsening curvature of the penis.

• 1 out of 10 men notice an improvement in the curvature of the penis. Sometimes, a second plaque develops on the opposite side to the original one, causing the curvature to reduce.

How is Peyronie's disease diagnosed?

The typical symptoms of painful erections and a curved or bent penis are usually enough for the doctor to make the diagnosis. The doctor will usually want to measure the bend or distortion of the penis whilst it is erect. This can be assessed by either of two methods:

• Photographs you have taken at home.

• More accurately, by use of a vacuum pump or injection into the shaft, in the surgery, to stimulate an erection.

Your doctor may ask you to complete a short questionnaire to assess how much the condition is impacting on your life.

In most cases it is not necessary to do any other tests but, occasionally, you may be asked to undergo a type of scan called a duplex ultrasound which shows up the blood circulation of the penis.

Peyronie's disease treatment

Many men with Peyronie's disease don't need any treatment. Treatment for Peyronie's is based on how bad the symptoms are.

You may not want treatment if:

• You have a mild version of the disease which does not cause much pain, or;

• You are not sexually active, or;

• You have few or no difficulties with sexual intercourse.

As you can imagine there a lot of treatments offered online for a bent penis and Peyronie's disease but most of them don't work! Speak with your doctor before spending money on something online.

Devices

• A traction device (penile traction therapy): this is worn for about two hours a day and gradually straightens out the curved penis.

• A vacuum device: this is similar to the traction device and is worn at home. It gradually straightens out the penis.

• Shock wave therapy: this uses sound waves produced by a large machine. It is done in hospital or in a clinic.

Tablets

Many different tablets have been tried for Peyronie's disease. Unfortunately, there is little or no evidence for most of them.

There are two tablets that may have some effect:

• Non-steroidal anti-inflammatory drugs (NSAIDs) can help treat pain during the inflammatory phase of Peyronie's.

• Erectile dysfunction treatments (eg, sildenafil/Viagra®, tadalafil/Cialis®) can help to achieve erections.

Other tablet medicines do not seem to help.

Medicines injected into the scar tissue

Various different medications have been used as injections directly into the penis.

An example is verapamil, which can dampen down the scar tissue and can help it flatten out.

• Interferon alfa-2b has been shown to work well when injected into the curved bit of the penis.

• Collagenase of Clostridium histolyticum (Xiaflex®) is an enzyme which dissolves scar tissue. It can reduce the curvature of the penis. Unfortunately, Xiaflex® is no longer sold in the UK and Europe, having been withdrawn by the manufacturer on commercial grounds.

Surgical treatments for Peyronie's disease

There are several surgical procedures for Peyronie's disease.

Surgery is usually only offered to men who have bending of the penis that prevents them from having sex.

Surgery usually requires an anaesthetic. Like any operation, it has risks, and requires some recovery time.

A urologist (surgeon) can advise on whether surgery is an option, and, if so, which surgical approach they recommend.

Examples of surgery for Peyronie's disease include:

• Plication. This involves removing or 'bunching' a piece of tissue on the opposite side of the penis to the plaque. This causes shortening of the penis, but has a lower risk of erectile dysfunction and penile numbness than grafting.

• Grafting. This involves cutting into, or removing, the plaque, and replacing it with a patch of tissue taken from elsewhere in the body (a graft). This can restore some of the shortening, but has a higher risk of causing penile numbness and erectile dysfunction.

• Implantation of a prosthesis. If the plaque is causing erectile dysfunction, and tablets haven't worked, this might be offered. It involves inserting a device into the penis that causes an erection. It is a major operation.

What is the outlook for Peyronie's disease?

Sometimes, Peyronie's disease does go away on its own, although in most cases it doesn't. Many men with Peyronie's disease have mild symptoms, and don't need any specific treatment. For more distressing symptoms, there are various treatments that can help.

If you have a curved or bent penis, and it's bothering you, speak to a doctor.