Peyronie's (pay-roe-NEEZ) disease is the development of fibrous scar tissue inside the penis that causes curved, painful erections.
Men's penises vary in shape and size. Having a curved erection is common and isn't necessarily a cause for concern. However, in some men, Peyronie's disease causes a significant bend or pain.
This can prevent a man 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.
In a small percentage of men, Peyronie's disease 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.
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 stabilizes in the majority of men.
In most men, pain during erections improves within one to two years, but the scar tissue and curvature often remain. For a few men, both the curvature and pain associated with Peyronie's disease improve without treatment.
When to see a doctor
See your doctor if pain or curvature of your penis prevents you from having sex or causes you anxiety.
The cause of Peyronie's disease isn't completely understood, but a number of factors appear to be involved.
It's thought Peyronie's disease generally results from repeated injury to the penis. For example, the penis might be damaged during sex, athletic activity or as the result of an accident. However, most often, men do not recall specific trauma to the penis.
During the healing process, scar tissue forms in a disorganized manner, which might then lead to a nodule that you can feel or development of curvature.
Each side of the penis contains a sponge-like tube (corpus cavernosum) that contains many tiny blood vessels. Each of the corpus cavernosa are encased in a sheath of elastic tissue called the tunica albuginea (TOO-nih-kuh al-BYOO-JIN-e-uh), which stretches during an erection.
When you become sexually aroused, blood flow to these chambers increases. As the chambers fill with blood, the penis expands, straightens and stiffens into an erection.
In Peyronie's disease, when the penis becomes erect, the region with the scar tissue doesn't stretch, and the penis bends or becomes disfigured and possibly painful.
In some men, Peyronie's disease comes on gradually and doesn't seem to be related to an injury. Researchers are investigating whether Peyronie's disease might be linked to an inherited trait or certain health conditions.
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 condition known as Dupuytren's contracture — a cord-like thickening across the palm that causes the fingers to pull inward.
- Age. The prevalence of Peyronie's disease increases with age. Age-related changes in tissues might cause them to be more easily injured and less likely to heal well.
Other factors — including certain health conditions, smoking and some types of prostate surgery — might be linked to Peyronie's disease.
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
- Stresses on the relationship with your sexual partner
- Difficulty fathering a child, because intercourse is difficult or impossible
If you have Peyronie's disease symptoms, you're likely to begin by seeing your family doctor or general practitioner. You might be referred to a specialist in male sexual disorders (urologist).
Preparing for your appointment will help you make the best use of your time.
What you can do
Make a list ahead of time that you can share with your doctor. Your list should include:
- Symptoms you're experiencing, including any that might seem unrelated to Peyronie's disease
- Key personal information, including any major stresses or recent life changes
- Medications that you're taking, including any vitamins or supplements
- History of injury to the penis
- Family history of Peyronie's disease, if any
- Questions to ask your doctor
List questions for your doctor from most important to least important in case time runs out. You might want to ask some of the following questions:
- What tests will I need to have?
- What treatment do you recommend?
- Can you tell if symptoms are likely to worsen or improve?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend?
In addition to the questions you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them might reserve time to go over any points you want to discuss further. Your doctor might ask:
- When did you first notice a curve in your penis or scar tissue under the skin of your penis?
- Has the curvature of your penis worsened over time?
- Do you have pain during erections, and if so, has it gotten worse or improved over time?
- Do you recall having an injury to your penis?
- Do your symptoms limit your ability to have sex?
Your doctor might also ask you to complete a survey, such as the International Index of Erectile Function, to help identify how the condition affects your ability to have sex.
A physical exam is often sufficient to identify the presence of scar tissue in the penis and diagnose Peyronie's disease. Rarely, other conditions cause similar symptoms and need to be ruled out.
Tests to diagnose Peyronie's disease and understand exactly what's causing your symptoms might include the following:
Physical exam. Your doctor will feel (palpate) your penis when it's not erect, to identify the location and amount of scar tissue. He or she might also measure the length of your penis. If the condition continues to worsen, this initial measurement helps determine whether the penis has shortened.
Your doctor might also ask you to bring in photos of your erect penis taken at home. This can determine the degree of curvature, location of scar tissue or other details that might help identify the best treatment approach.
Other tests. Your doctor might order an ultrasound or other tests to examine your penis when it's erect. Before taking images of your penis, you'll likely receive an injection directly into the penis that causes it to become erect.
Ultrasound is the most commonly used test for penis abnormalities. Ultrasound tests use sound waves to produce images of soft tissues. These tests can show the presence of scar tissue, blood flow to the penis and any other abnormalities.
Your doctor might recommend a wait-and-see (watchful waiting) approach if:
- The curvature of your penis isn't severe and is no longer worsening
- You can still have sex without pain
- Pain during erections is mild
- You have good erectile function
If your symptoms are severe or are worsening over time, your doctor might recommend medication or surgery.
The goals of treatment with medication include reducing plaque formation and pain, as well as minimizing curvature of the penis.
There is one medication approved by the Food and Drug Administration for the treatment of Peyronie's disease. It's called collagenase Clostridium histolyticum (Xiaflex). This medicine is approved for use in men with a palpable lump from plaque in the penis that causes a curvature of at least 30 degrees during erection.
The treatment works by breaking down the buildup of collagen that causes penile curvature. It involves a series of in-office injections, directly into the penile lump, as well as penile modeling — brief exercises to gently stretch and straighten the penis.
In clinical trials, this collagenase therapy significantly reduced curvature and bothersome symptoms associated with Peyronie's disease in many participants. Discuss potential side effects of this medication with your doctor, as some of them can be serious.
Examples of off-label use of medications for Peyronie's disease include an oral medication called pentoxifylline (Trental), verapamil (injections or topical gel) and interferon (injections).
Most experts recommend against surgery during the early inflammatory phase of Peyronie's disease. Your doctor might suggest surgery if the deformity of your penis is severe, especially bothersome, or prevents you from having sex. Surgery usually isn't recommended until the curvature of your penis stops increasing.
Surgical methods include:
- Suturing (plicating) the unaffected side. A variety of procedures, such as Nesbit plication, can be used to suture (plicate) the longer side of the penis (the side without scar tissue). This can straighten the penis, but it might result in actual or perceived penile shortening. In some cases, plication procedures cause erectile dysfunction.
- Incision or excision and grafting. Generally used in cases of more severe curvature, this procedure is linked to greater risks of worsening erectile function compared with plication procedures. The surgeon makes one or more cuts in the scar tissue, sometimes removing some of that tissue, allowing the sheath to stretch out and the penis to straighten. The surgeon may sew in a piece of tissue (graft) to cover the holes in the tunica albuginea, a membrane within the penis that helps maintain an erection.
- Penile implants. Surgically inserted penile implants replace the spongy tissue that fills with blood during an erection. The implants might be semirigid — manually bent down most of the time and bent upward for sexual intercourse. Another type of implant is inflated with a pump implanted in the scrotum. Penile implants might be considered if you have both Peyronie's disease and erectile dysfunction.
The type of surgery will depend on your condition. Your doctor will consider the location of scar tissue, the severity of your symptoms and other factors.
A technique known as iontophoresis uses a weak electrical current to deliver a combination of verapamil and dexamethasone noninvasively through the skin. Research shows conflicting results.
Several nondrug treatments for Peyronie's are being investigated, but evidence is limited on how well they work and possible side effects. These include using intense sound waves to break up scar tissue (shock wave therapy), devices to stretch the penis (penile traction therapy) and vacuum devices.
Peyronie's disease can be a source of significant anxiety and create stress between you and your sexual partner. The following suggestions might help you cope with Peyronie's disease:
- Explain to your partner what Peyronie's disease is and how it affects your ability to have sex.
- Let your partner know how you feel about the appearance of your penis and your ability to have sex.
- Talk to your partner about how the two of you can maintain sexual and physical intimacy.
- Talk to a mental health provider who specializes in family relations and sexual matters.
Oct. 18, 2014
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