Peyronie’s Disease

Peyronie’s disease is suspected when the erect penis is curved. It may be painful and there may be a bump present.  Since not all such cases are caused by Peyronie’s disease it is important to seek medical advice.

As is commonly the case with sexual problems, men may not volunteer information to their healthcare provider and may expect that they will initiate the conversation. However, if you experience a curved erection, or think you may have Peyronie’s, it is important to describe the symptoms to your provider so treatment may begin.

Urologists have treatment options for all types of problems affecting the penis, including Peyronie’s disease

About

WHAT IS PEYRONIE’S DISEASE?

Peyronie’s disease is a condition in which a man’s erection curves and may feel painful. It may begin as a bump on the penis. The bump is scar tissue, and it’s known as Peyronie’s plaque. Some men are aware of the Peyronie’s plaque, which can feel like a small bump directly under the skin of the penis. Peyronie’s plaque is benign (noncancerous). It is not a tumor, but only a healthcare professional can make a proper diagnosis. It is not elastic, so during an erection, the penis can’t expand in the area where the plaque is located. As a result, the erection becomes curved.

It might be difficult to talk about a curved erection, but it is important to discuss this symptom with a healthcare provider.

FYI

HOW COMMON IS PEYRONIE’S DISEASE? WHO HAS IT?

The current estimate is that 5% of men have the disease although the reluctance of men to communicate with their doctors would suggest the actual rate may be higher.

The condition exists at all ages but the greatest rate is in men from 40 to 60. At least 65,000 diagnoses are expected annually, with the actual number of cases higher because of under-reporting by men reluctant to communicate with their healthcare provider and seek help for the condition. 

HOW DOES A MAN GET PEYRONIE’S DISEASE?

Although the cause of the disease is not clear in every case, healthcare providers believe that injury to the penis, possibly during sex, may result in abnormal scarring. This scarred tissue is not as elastic and subsequently results in an erection that is curved and possibly painful. It is also possible that genetic factors predispose the individual to such scarring and the subsequent affects.

CAN PEYRONIE’S DISEASE GET WORSE OVER TIME?

In the beginning stages of Peyronie’s, men have curved erections that may also be painful. With time, the pain usually goes away. But it’s most likely that the curve will remain.

There are two phases of Peyronie’s disease:

  • The acute phase, which lasts up to a year, is a time when men can experience painful erections. In addition, the acute phase is characterized by an increase in plaque size, penile curvature, and pain.
  • The chronic phase, which follows the acute phase, is characterized by minimal or no pain and stable penile curvature deformity. While pain usually subsides, other characteristics of the disease remain throughout the chronic phase.

If you have a curved erection or think you might have Peyronie’s, the best thing to do is discuss it with your healthcare provider.

IS PEYRONIE’S DISEASE THE SAME AS ERECTILE DYSFUNCTION?

Erectile dysfunction (ED) may be a symptom of Peyronie’s disease, but it is not the cause of Peyronie’s disease. Not all men with Peyronie’s disease have ED. A man may experience one condition and not the other.

There is an increased occurrence of ED in patients with Peyronie’s disease. Studies of patients with Peyronie’s disease have reported that between 30% and 80% of them may have ED. What remains unclear is whether this is due to psychological or physiological factors. It might be that the curvature deformity and pain of Peyronie’s disease cause distress or performance anxiety that interferes with the ability to have or maintain an erection. Or it could be that the change in fibrotic tissue affects normal blood flow during erection.

Either way, when a man expresses concern about ED it’s important to consider the possibility of Peyronie’s disease.

Symptoms

WHAT DOES PEYRONIE’S DISEASE LOOK LIKE?

Not all curved erections or penile bumps are caused by Peyronie’s disease. It is important for men to discuss their condition with their healthcare provider.

The main feature of Peyronie’s disease is the curved penis caused by a Peyronie’s plaque (lump). The location of the plaque may determine the type of curvature deformity that occurs. The most common type of curvature deformity is “dorsal” – in other words, an upward bend caused by plaques on the dorsal (top) side of the erect penis.

In addition to the Peyronie’s plaque and curved penis, many men initially experience painful erections. Further, the plaque may cause changes to the length or circumference of the penis while erect. Other physical symptoms are penile folding or collapsing during intercourse, and erectile dysfunction.

OTHER THAN PHYSICAL SYMPTOMS, HOW MIGHT A MAN BE AFFECTED BY PEYRONIE’S DISEASE?

Not all curved erections or penile bumps are caused by Peyronie’s disease. It is important for men to discuss their condition with their healthcare provider.

For men with Peyronie’s disease, the impact goes beyond the physical symptoms and may include sexual, psychological and social effects. Because the erection curves and even hurts, intercourse can become difficult and even impossible for some men. Others can become self-conscious about the appearance and limitations of their erections, causing them to avoid sex. For some men, the problem is more than just sexual. Peyronie’s can be embarrassing to talk about – even with a partner. This can lead to relationship difficulties.

Peyronie’s bothers men in different ways. For example, in one study of 92 men with Peyronie’s, 48% had clinical depression.

Peyronie’s disease can significantly impact men in many different and meaningful ways. The effects can be physical, sexual, psychological, or social. Depression, lowered self-esteem, and difficulties with relationships are common.

HOW DOES A HEALTHCARE PROVIDER EVALUATE FOR PEYRONIE’S DISEASE?

A thorough evaluation for Peyronie’s disease is essential so that the healthcare provider can fully understand the man’s condition and make an accurate diagnosis. There is not one universally accepted standardized evaluation for Peyronie’s disease, but during an initial evaluation, the patient might participate in:

  • A physical exam
  • Imaging analysis
  • An interview

Physical exam: A healthcare provider might measure the degree of curvature of an erect penis. The healthcare provider may also look for the number and position of plaques on the penis and the degree of plaque calcification (hardening).

Imaging analysis: Penile ultrasound has gained widespread acceptance as a valuable tool for the diagnosis of Peyronie’s disease in recent years.

Patient interview: During the interview, a healthcare provider may ask questions about the degree of curvature of an erect penis, the onset and duration of symptoms, presenting signs and symptoms, and the presence or absence of pain. Patients should also plan to tell their healthcare provider about personal or family medical history of Dupuytren’s contracture and Lederhose disease as well as risk factors for erectile dysfunction including hypertension, dyslipidemia, tobacco use, and diabetes.

WHAT ROLE CAN PARTNERS PLAY IN RECOGNIZING THE SIGNS AND SYMPTOMS OF PEYRONIE’S DISEASE AND ENCOURAGING MEN TO SPEAK WITH A HEALTHCARE PROVIDER?

It is important to keep in mind that Peyronie’s disease and some of its related symptoms may be very difficult for men to speak about openly. If you recognize any of the signs and symptoms of Peyronie’s disease in your partner offer him support and understanding and encourage him to visit his healthcare provider to see if he may have Peyronie’s disease.

Keep in mind that Peyronie’s disease, in addition to impacting a man physically, may lead to sexual, psychological and social issues. If he is comfortable with the idea of seeing a healthcare provider, offer to go along with him to visit his healthcare provider or offer support by doing research on the condition.

Questions to Ask Your Health Care Provider

HOW SHOULD A MAN INITIATE THE CONVERSATION ABOUT PEYRONIE’S DISEASE WITH HIS HEALTHCARE PROVIDER?

A man with a curved penis may find it hard to start a conversation with his healthcare provider. But seeing a healthcare provider, such as a urologist, is an important step to take. A man should feel free to ask the urologist whatever questions come to mind using whatever words are most comfortable. First, it is important for a man to find out from a healthcare professional whether or not he has Peyronie’s disease.

Ask your healthcare provider:

  • Why do I have a curved penis?
  • What causes a curved penis?
  • What can I do about the pain I have?
  • Will this problem go away on its own?
  • What are my treatment options?
  • Is it normal to feel the way I do about this?
  • How can I make sex more comfortable?

WHAT KINDS OF QUESTIONS WILL A HEALTHCARE PROVIDER ASK?

Since each man’s experience with Peyronie’s disease is unique, your healthcare provider might ask a number of questions to better understand your condition. Some questions might include:

  • When did this problem start?
  • Do you have any bumps on your penis?
  • Do you have a palpable plaque (a bump you can feel on your penis)?
  • Do you have a curved erection?
  • How severe is the curvature (how much does your erection bend)?
  • Are your erections painful?
  • Does this interfere with sex?
  • On a scale of 1 to 10, what kind of impact is this having on your day-to-day well-being?
  • How else does this bother you?

A healthcare provider might ask more than just basic physical questions to better understand how Peyronie’s disease is affecting a man’s life. Some questions he or she might ask are:

  • On a scale of 1 to 10, what kind of impact is this having on your relationship with your partner?
  • Do you find you’re thinking about this when you should be focusing on other matters?
  • What kind of impact is this having on your day-to-day well-being?
  • Do you find it easy to talk to your partner about what’s happening physically?
  • How easy is it to talk to your partner about Peyronie’s disease?
  • How is this affecting your social life?

Treatments

DOES PEYRONIE’S DISEASE LAST FOREVER?

For some men, Peyronie’s disease may go away on its own – this is called “spontaneous resolution.” However, just as it is unclear how many men have Peyronie’s disease; it is unclear how often spontaneous resolution occurs. One study in 2001 suggested that “spontaneous resolution” was a rare occurrence.

In a 1990 study, among 97 patients with Peyronie’s disease, 13% experienced a resolution of their symptoms. They further noted that 40% of respondents perceived that their disease had progressed, and 48% considered that their condition had remained unchanged at follow up.

Surgery

Surgery is the only treatment guaranteed to have a beneficial effect on Peyronie’s disease but it would only be offered to you once the changes caused by the condition had settled down. This normally takes 12-18 months.  You doctor may perform surgery using  one of these available options:

  • Extracorporeal shock wave therapy: This uses vibrations from sound waves to break down the tough fibrous plaques. The sound waves are delivered by a device outside the body. You may be offered sedation during the procedure. The technique is safe but its effects are uncertain.
  • ‘Cold steel’ surgery: This means surgery involving conventional surgical instruments. Several operations are available including:
  • The Nesbitt tuck procedure: this involves removing some tissue from the side of the penis opposite the plaque. This has the effect of straightening but shortening the penis.
  • Plication:  this involves folding the normal tissue on itself rather than removing it completely.
  • Cutting out the plaque : this sometimes is combined with the insertion of a plastic rod (prosthesis) to counteract any shortening.
  • Laser surgery – a carbon dioxide laser is used to thin the plaque.

In some cases, your healthcare provider may choose to treat Peyronie’s disease using one or a combination of the following.

  • Stretching: the technical name for this is external penile traction. It involves wearing a device which stretches the penis. It has shown some effect in improving the length of the penis and lessening deformity.
  • Vacuum devices: these work in a similar way to traction devices by creating a vacuum around the penis, which stretches the shaft.
  • Medicines taken orally: medicines tried in the past for this condition include para-aminobenzoate, colchicine, propoleum, pentoxifylline, vitamin E, tamoxifen and acetyl-L carnitine. Only para-aminobenzoate has the backing of European guidelines and a UK licence to be used for this condition.
  • Medicines injected into the plaques: various medicines have been tried and research studies have reported some improvement in pain, the size of the plaques and the amount of bend of the penis after these injections.
  • Surgery

Last modified: May 30, 2014