What is Peyronie's disease?
Peyronie’s disease is the presence of scar tissue (plaque) the penis that causes curved, bent, or otherwise deformed erections. This condition frequently interferes with sexual intercourse making it difficult, painful, or impossible.
In addition to physical deformity, men who suffer from Peyronie's disease many times suffer from mental and emotional anxieties about sexual ability or the appearance of their penis.
Because Peyronie's disease makes it sometimes impossible to have normal intercourse, fathering children through traditional means is often made impossible.
Peyronie's disease in rare cases can resolve on it's own. However, in most cases, it remains stable or worsens over time.
What causes Peyronie's disease?
Peyronie's disease is generally the result of an injury or repeated injuries to the penis. As men age, the rigidity of their erections typically are not as strong as when they were younger. Thus, the likelihood of accidental injuries during sex increase. If the penis is put through too much bending or twisting during intercourse, the elastic fibers of the erection chambers inside the penis can begin to tear.
Repeated stress on the penis can cause increased damage which begins to repair spontaneously. Scar tissue (plaque) begins to form at the injury site which causes deformity. Peyronie's disease has been estimated to impact almost 9 percent of men ages 40 to 70.
How is Peyronie's disease diagnosed?
Your doctor will ask you about any injuries prior to symptoms, the ability to obtain and maintain an erection as well as erection rigidity. A physical exam will be done to note the presence of hardened tissue when not erect.
Your doctor may want to perform additional tests to examine your penis when it is erect. To achieve this, an injection can be used to induce an erection.
What are the symptoms of Peyronie's disease?
Symptoms of Peyronie's disease include:
- Scar tissue that feels like a band of hard tissue or flat lumps
- Noticeable bend in the penis
- Shortening of the penis
- Penis pain
Symptoms can develop slowly or appear overnight. Peyronie’s disease often presents in two stages:
- Acute phase: The acute phase lasts six to 18 months as plaque forms in the penis.
- Chronic phase: The Chronic phase signals the end of plaque growth. Pain experienced during the acute phase typically ends. In most men, pain during erections improves within one to two years, but the plaque and curvature often remain.
Complications of Peyronie’s disease may include:
- Inability to have sexual intercourse
- Erectile Dysfunction (ED)
- Anxiety about sexual ability or appearance of the penis
- Relationship stress
- Difficulties fathering a child because intercourse is difficult or impossible
These symptoms can create very serious difficulties in a man's life.
How is Peyronie's disease treated?
In mild forms it does not require any treatment. However, when the degree of curvature interferes significantly with the ability to have sexual intercourse, surgical correction is often recommended to help return the man to normal sexual function.
Pain with erection if present will resolve as healing takes place. However, deformity of the erection or erectile dysfunction may result in difficult or impossible sexual intercourse. Treatment is directed to improve the ability to have sexual intercourse.
- Lifestyle changes to reduce the risk of ED associated with Peyronie’s disease may be recommended, including quitting smoking, reducing alcohol consumption, exercising regularly and avoiding illegal drugs.
- Penile injections to break up plaque include verapamil, interferon, steroids and collagenase (Xiaflex)—the first and only medication specifically approved for Peyronie’s disease.
Medical therapies to break up scar tissue and decrease curvature such as high-intensity ultrasound, radiation therapy, or iontophoresis—a weak electric current that delivers medications through the skin- are no longer considered effective. Low energy shock wave therapy is currently being investigated as a possible treatment for this disorder.
Surgery may be recommended for severe, long-term cases where symptoms do not improve and the bend in the penis or poor erections interfere with sexual intercourse. Surgical options include:
- Grafting removes plaque and replaces it with a patch of skin, a vein or other material to straighten or restore lost length. Numbness and ED are potential complications.
- Plication removes or pinches a piece of the tunica albuginea from the side of the penis opposite the plaque to straighten the penis. While less likely to cause numbness or ED, it cannot restore length or girth to the penis.
- Penile prosthesis implantation is an option for men with both Peyronie’s disease and ED. The implant usually straightens the penis: if it does not, it can be combined with one of the other surgical options.
Most medical experts suggest waiting one year or more from the onset of symptoms before having surgery to make sure the condition is stable. Cleveland Clinic urologists have extensive experience with reconstructive procedures for both congenital erectile curvature and Peyronie’s disease. Correction of congenital erectile curvature is accomplished by surgically exposing the penis, in order to shorten the side of the penis opposite the curvature to match the other side. This results in a straightened erection. This procedure has a high rate of success and can be performed in an outpatient setting.