Peyronie’s Disease: Symptoms, Causes, Diagnosis And Treatment

Peyronie’s disease is penis problem caused by scar tissue, called plaque, that forms inside the penis. It can result in a bent, rather than straight, erect penis.

Penises vary in shape and size, and having a curved erection isn’t necessarily a cause for concern.

But Peyronie’s disease causes a significant bend or pain in some men.

This can prevent you from having sex or might make it difficult to get or maintain an erection (erectile dysfunction).

For many men, Peyronie’s disease also causes stress and anxiety.

Peyronie’s disease sometimes goes away on its own. But in most cases, it will remain stable or worsen.

Treatment might be needed if the curvature is severe enough that it prevents successful sexual intercourse.

How Does the Penis Normally Work?

The main roles of the penis are to carry urine out of the body and sperm into the woman’s vagina.

There are 3 tubes inside the penis. One is called the urethra. It’s hollow and carries urine from the bladder through the penis to the outside.

The other 2 tubes are called the corpora cavernosa. These are soft, spongy tubes that fill with blood to make the penis stiff during an erection.

The 3 tubes are wrapped together by a very tough fibrous sheath called the tunica albuginea.

During sex, the stiffness of the penis makes it hard enough to push into the woman’s vagina.

Then the urethra acts as a channel to carry semen into the vagina.

Male reproductive system
Male reproductive system

Symptoms of Peyronie’s Disease

Peyronie’s disease signs and symptoms might appear suddenly or develop gradually.

The most common signs and symptoms include:

  • Scar tissue. The scar tissue (plaques) associated with Peyronie’s disease can be felt under the skin of the penis as flat lumps or a band of hard tissue.
  • A significant bend to the penis. Your penis might be curved upward, downward or bent to one side. In some cases, the erect penis might have narrowing, indentations or an hourglass appearance, with a tight, narrow band around the shaft.
  • Erection problems. Peyronie’s disease might cause problems getting or maintaining an erection (erectile dysfunction).
  • Shortening of the penis. Your penis might become shorter as a result of Peyronie’s disease.
  • Pain. You might have penile pain, with or without an erection.

The curvature associated with Peyronie’s disease might gradually worsen. At some point, however, it typically stabilizes.

Pain during erections usually improves within one to two years, but the scar tissue and curvature often remain.

In some cases, both the curvature and pain associated with Peyronie’s disease improve without treatment.

Causes Peyronie’s Disease

Peyronie’s disease plaques mostly (70% of the time) form on the top (or dorsal side) of the penis.

The plaques make the tunica albuginea less flexible and may cause the penis to bend upwards when it stiffens.

When plaques form on the bottom or side of the penis, the bend will be downward or sideways.

Some men have more than- plaque, which may cause complex curves.

Sometimes plaques form that go all the way around the penis.

These plaques most often don’t cause curving but may cause the shaft of the penis to narrow like the neck of a bottle (sometimes called “bottle-necking” or “waisting”).

In bad cases, the plaque may collect calcium and become very hard, almost like a bone.

Men may also notice that their penis has shrunk or gotten shorter.

Other signs that you may have Peyronie’s disease are:

  • bent/curved penis
  • lumps in the penis
  • painful erections
  • soft erections
  • having trouble with sex because of a bent/curved penis

Peyronie’s disease can make your quality of life worse. Over 75 out of 100 men with Peyronie’s disease are stressed and depressed because of it.

Unfortunately, many men with Peyronie’s disease are embarrassed and choose to suffer in silence rather than get help.

Risk factors

Minor injury to the penis doesn’t always lead to Peyronie’s disease.

However, various factors can contribute to poor wound healing and scar tissue buildup that might play a role in Peyronie’s disease. These include:

  • Heredity. If your father or brother has Peyronie’s disease, you have an increased risk of the condition.
  • Connective tissue disorders. Men who have a connective tissue disorder appear to have an increased risk of developing Peyronie’s disease. For example, a number of men who have Peyronie’s disease also have a cord-like thickening across the palm that causes the fingers to pull inward (Dupuytren’s contracture).
  • Age. The prevalence of Peyronie’s disease increases with age, especially in men over 55.

Other factors — including certain health conditions, smoking and some types of prostate surgery — might be linked to Peyronie’s disease.

Complications

Complications of Peyronie’s disease might include:

  • Inability to have sexual intercourse
  • Difficulty achieving or maintaining an erection (erectile dysfunction)
  • Anxiety or stress about sexual abilities or the appearance of your penis
  • Stress on your relationship with your sexual partner
  • Difficulty fathering a child, because intercourse is difficult or impossible.

    Tests and Diagnosis

    If you think you have Peyronie’s disease, the first step is to visit your primary doctor.

    A physical exam helps your doctor determine if you have the condition. This exam may involve taking an initial measurement of your penis.

    By measuring the penis, your doctor can identify the location and amount of scar tissue.

    This also helps determine whether your penis has shortened.

    Your doctor may also suggest an ultrasound or X-rays to reveal the presence of scar tissue, and she may refer you to a urologist.

    Treatment for Peyronie’s Disease

    There is no cure for Peyronie’s disease, but it is treatable and may go away on its own.

    Though it may be tempting to request medicine right away, many doctors prefer the “watchful waiting” approach if your symptoms aren’t severe.

    Medication

    Your doctor may recommend medications — often drugs injected into the penis — or even surgery if you’re experiencing more pain or penis curvature over time.

    Only one medication, clostridium hystolyticum (Xiaflex), is approved by the Food and Drug Administration (FDA) to treat the condition.

    It’s approved for use in men whose penis curves more than 30 degrees during erection.

    The treatment involves a series of penile injections that break down the buildup of collagen.

    Two other types of medicines that may be prescribed are:

    • oral verapamil (usually used to treat high blood pressure)
    • interferon injections (helps break down fibrous tissue)

    Nonsurgical Options

    Iontophoresis, a technique that uses a weak electrical current to deliver medication through the skin, is another treatment option for Peyronie’s disease.

    Nondrug treatments are being investigated, such as:

    • shock wave therapy to break up scar tissue
    • penile traction therapy to stretch the penis
    • vacuum devices

    Patients being treated with Xiaflex may benefit from gentle penile exercises. For six weeks after treatment, you should do two activities:

    • Stretch the penis when not erect, three times daily for 30 seconds per stretch.
    • Straighten the penis when experiencing a spontaneous erection unrelated to sexual activity for 30 seconds, once daily.

    Lifestyle Changes

    Lifestyle changes may reduce the risk of ED related to Peyronie’s disease. These include:

    • quitting smoking
    • reducing alcohol consumption
    • stopping use of illegal drugs
    • exercising regularly

    Surgery

    Surgery is the last course of action in the case of severe penis deformity.

    According to the NKUDC, you should wait at least a year before turning to surgery for Peyronie’s disease. Surgical solutions include:

    • shortening the unaffected side
    • lengthening the scar tissue side
    • penile implants

    Lengthening runs a greater risk of erectile dysfunction. Shortening the unaffected side is used when curvature is less severe.

    One type of shortening is a procedure called the Nesbit plication.

    In this procedure, doctors remove or cinch excess tissue on the longer side. This creates a straighter, shorter penis.

    Natural Remedies

    Most natural remedies for Peyronie’s disease are not well-studied, and based on anecdotal evidence.

    A couple remedies have been studied and show promise.

    A 2001 study published in BJU International concluded that acetyl-l-carnitine “is significantly more effective and safe than tamoxifen in treating acute and early chronic Peyronie’s disease.” No follow-up study has been published.

    Results of a 2010 study published in International Journal of Impotence ResearchTrusted Source found that coenzyme Q10 supplements improves erectile function.

    They also reduced penile curvature in patients with early chronic Peyronie’s disease. More study is needed.

    According to an article published in Reviews in UrologyTrusted Source, vitamin E has been extensively studied for treating Peyronie’s disease.

    Recent studies show no improvement in patients treated with vitamin E compared to placebo.

 

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