Peyronie's Disease

What is Peyronie’s disease?

Peyronie’s (pay-roe-NEEZ) disease is a condition in which scar tissue (plaque) in your penis causes it to bend, curve or lose length or girth (circumference). You may be able to feel the scar tissue through your skin, or you may have pain in a specific part of your penis as the scar tissue forms. When you have an erection, your penis may bend up, down or to the side, depending on the location of your scar. Some people who have Peyronie’s disease don’t have a curve, but might have an indentation that gives their penis an “hourglass” appearance.

Most men and people assigned male at birth (AMAB) don’t have perfectly straight erections. If your penis has a little curve — even if you’ve had the curve your whole life — it doesn’t mean you have Peyronie’s disease.

What are the stages of Peyronie’s disease?

Peyronie’s disease has two stages: acute and chronic.

• Acute Peyronie’s disease. The acute stage lasts between six and 12 months. During this period, a scar forms under the skin of your penis, causing it to curve or change its shape another way. It may be painful when your penis is erect or soft (flaccid).
• Chronic Peyronie’s disease. The scar is no longer growing during the chronic stage. The curvature won’t get any worse. Pain usually goes away during the chronic phase, but it can sometimes continue, especially when you have an erection. Erectile dysfunction (ED) may develop during this phase.

How common is Peyronie’s disease?

Medical experts estimate that about 6% to 10% of people between the ages of 40 and 70 with penises have Peyronie’s disease. It can affect anyone with a penis, but it’s less common at other ages.

Peyronie’s disease may be even more widespread because many people may feel too embarrassed to talk about it with a healthcare provider. It’s a good idea to talk to a healthcare provider any time you have concerns about your sexual health.

What are the symptoms of Peyronie’s disease?

The primary symptom of Peyronie’s disease is a curve or bend in your penis. You may also be able to feel scar tissue under the skin.

Other symptoms of Peyronie’s disease include:

• A loss of length in your penis.
• Loss of girth in your shaft, which may look like an indent or have an hourglass shape.
• Lumps in your penis.
• Painful erections.
• Softer erections.
• Difficulty having sex for you or your partner.
• Pain while having sex (dyspareunia).

Peyronie’s disease symptoms may develop quickly or over a long period of time. Pain tends to decrease over time, but the bend in your penis can cause complications. If you have a bend in your penis greater than 30 degrees (which looks like when the hands of an analog clock read 1:00), it can make sex painful or impossible.

Does Peyronie’s disease hurt?

Yes, Peyronie’s disease can be painful. Pain most commonly occurs during the acute stage. But it may continue in the chronic stage. The severity varies from person to person.

What does Peyronie’s disease look like?

In most cases, the scar forms on the top of your penis, causing it to curve upward when you have an erection. Your penis will bend downward if the scar is on the bottom and sideways if the scar is on the side.

In some cases, the scar develops on both the top and bottom of the penis shaft. This “dents” your penis and makes it shorter. In other cases, the scar goes all the way around your penis. This makes your penis narrow, like the neck of a bottle or the center of an hourglass. About 1 in 3 people who have Peyronie’s disease have calcium in the scar tissue. This can make your penis feel like a bone.

What causes Peyronie’s disease?

The cause of Peyronie’s disease isn’t always clear.

Some researchers believe scarring occurs after an injury to your erect penis — usually abnormal bending during sexual intercourse. However, up to 80% of people with Peyronie’s disease don’t remember a specific event that preceded changes to their penises. These changes may happen as a result of small, unrecognized injuries that occur during regular sexual intercourse. People who have Peyronie’s disease may have a higher risk of developing too much scar tissue in response to these small injuries.

Not all people who injure their penises get Peyronie’s disease, so there may be genetic or environmental factors that play into it.

Is Peyronie’s disease contagious?

No, Peyronie’s disease isn’t a sexually transmitted infection (STI) and it isn’t contagious.

Who does Peyronie’s disease affect?

Anyone with a penis can get Peyronie’s disease. However, the following risk factors may increase your chances of getting it:

• Age. You’re more likely to get Peyronie’s disease as you get older. It occurs in about 10% to 15% of people between 40 and 70 years of age.
• Genetics. You may be more likely to get Peyronie’s disease if you have a biological family member who has it, such as your father or brother.
• Connective tissue disorders. Connective tissue disorders that have a greater risk of Peyronie’s disease include Dupuytren contracture, plantar fasciitis and scleroderma.
• Erectile dysfunction (ED). People with diabetes-related ED are four to five times more likely to get Peyronie’s disease.
• Prostate cancer. Surgical treatments for prostate cancer increase your risk of Peyronie’s disease.
• Autoimmune diseases. If you have an autoimmune disease like lupus, you’re more likely to get Peyronie’s disease.

What are the complications of Peyronie’s disease?

Changes to your penis can affect your mental and emotional health. These may include:

• Depression.
• Anxiety.
• Unfairly focusing a lot on your physical appearance (body dysmorphic disorder).
• Feelings of shame.
• Low self-esteem.
• Fear of rejection or intimacy.

Does Peyronie’s disease cause erectile dysfunction?

Yes, Peyronie’s disease can cause erectile dysfunction. The penile plaque or scar tissue can interfere with how your penis stores an adequate amount of blood during erection. This results in an inability to get or maintain an erection that’s hard enough to have intercourse.

Does Peyronie’s disease make your penis smaller?

Yes, severe Peyronie’s disease can shorten your penis.

How much length do you lose with Peyronie’s disease?

The amount of length that you lose depends on how severe your penile curve is. Severe Peyronie’s disease can decrease the length of your penis from 0.5 cm (about 50 sheets of paper stacked on top of each other) to 1.5 cm (about 150 sheets of paper).

Will Peyronie’s disease keep me from having sex?

It depends on the severity of your Peyronie’s disease. In some cases, you can have sex but it may be difficult or painful for you or your partner. The greater the curve in your penis, pain or degree of erectile dysfunction, the more difficult it is to have intercourse.

How is Peyronie’s disease diagnosed?

A healthcare provider can diagnose Peyronie’s disease. They’ll review your medical history and ask questions about your symptoms, which may include:

• When did you first notice the curve in your penis?
• Have you lost length?
• How much length have you lost?
• In which direction does your penis bend?
• Approximately how many degrees is your bend?
• Is having sex difficult or painful?
• Is having sex painful for your partner?
• How hard or strong are your erections?
• Do you have erectile dysfunction?
• Does anyone in your biological family have Peyronie’s disease, Dupuytren contracture or another connective tissue disorder?
• Do you have any other conditions, including diabetes or an autoimmune disorder?
• What medications are you taking?

The provider will also conduct a physical examination. During the physical exam, they’ll feel the scarring in your penis. They may need to examine your penis when you have an erection. If necessary, they may give you an injection (vasoactive drug) that temporarily makes your penis erect.

What tests will be done to diagnose Peyronie’s disease?

A healthcare provider may recommend a penile duplex Doppler ultrasound examination to help diagnose Peyronie’s disease. An ultrasound is a type of imaging test that helps:

• Reveal where the scarring is in your penis.
• Check for calcium buildup.
• Show how blood flows in your penis.

Ultrasound also allows providers to determine the best treatment for you.

How do they fix Peyronie’s disease?

There’s no single treatment for Peyronie’s disease that’s appropriate for every individual. In fact, you may not need treatment if Peyronie’s disease only causes a small curve in your penis that doesn’t hurt and doesn’t make it difficult to have intercourse.

Peyronie’s disease treatment options include:

Traction therapy

These therapies utilize an external device, such as a vacuum erection device or traction device (RestoreX®), to gently stretch your penis and sometimes even bend it in the opposite direction of the curve. It encourages the scar tissue to break down and can:

• Improve curvature.
• Restore lost length.
• Increase erection hardness.

Most people need to use the traction therapy device for several months to see improvement.

There are generally no long-term side effects of properly using a traction therapy device.

Medications

A healthcare provider may recommend medications you take by mouth (oral medications) or inject into your penis. Providers usually recommend medications if you have acute Peyronie’s disease or if you’re not sure if you want surgery. However, they rarely result in a straight penis.

Injection medications may include:

• Collagenase injections (Xiaflex®). A provider may prescribe collagenase injections if the curve in your penis is greater than 30 degrees to help break down scar tissue. Most people get two shots per week for eight weeks.
• Interferon injections. Interferon is a protein that helps reduce swelling and scarring. It releases an enzyme that may help to dissolve the scar tissue that builds up.
• Verapamil injections (Isoptin®). Providers often prescribe verapamil to treat high blood pressure. However, studies show that it may help reduce pain and curvature in your penis.

Oral medications may include:

• Tadalafil (Cialis®). Taking tadalafil every day helps improve blood flow to your penis. It may help to improve erectile rigidity and stability. It may also possibly prevent the scarring from getting worse.
• Pentoxifylline (Pentopak®). Pentoxifylline also helps improve blood flow to your penis.
• L-arginine. L-arginine is an amino acid that can improve blood flow.
• Colchicine (Colcrys®). Providers commonly prescribe colchicine to prevent and treat inflammation by reducing the amount of uric acid in your body. It can also help reduce swelling in your penis.
• Potassium aminobenzoate (Potaba®). Potaba is a form of vitamin B that may help reduce the size of your scar, but not the curve.

It’s important to know that there aren’t any reliable studies that show that oral medications can effectively decrease penile curvature or Peyronie’s disease-related plaques. However, they may reduce your symptoms.

Surgery

Healthcare providers only recommend surgery if you have severe Peyronie’s disease that makes it difficult or impossible to have sex. You should only have surgery if you’re in the stable or chronic phase of Peyronie’s disease, in which the scarring and curvature no longer progress and you haven’t had any pain for between six and 12 months.

Peyronie’s disease surgery options include:

• Shortening the unaffected side of your penis. Your surgeon will either use tiny internal “tuck” stitches or cut out small pieces of tissue on the outside of the curve and sew the remaining tissue shut. This shortens the outside of the curve to match the inside of the curve, which straightens your penis. This may be a reasonable surgical option if you can achieve strong erections and haven’t lost much length. However, the risks of length loss, decreased penile sensitivity and decreased erectile function may be significant.
• Making the side of your penis on the inside of the curve longer. A provider will recommend this type of surgery if you have a severe curve or if the shaft is narrow or very short. Your surgeon will cut the scar tissue and may remove some of it. They’ll cover the remaining space with some type of material. This may be a reasonable surgical approach if you can achieve strong erections but you have severe curvature, you’ve lost a lot of length or your shaft narrows and affects your ability to have sex. However, the risks of decreased penile sensitivity and decreased erectile function may be significant.
• Penile implant. A penile implant is the best surgical approach if Peyronie’s disease causes significant penile curvature and erectile dysfunction that doesn’t respond to oral medications, making intercourse difficult or uncomfortable for you or your partner. During this procedure, a surgeon implants a totally concealed inflatable device into your penis that allows you to achieve a straight, rigid erection without medications that lasts as long as you’d like. When you no longer wish to have an erection, you can simply deflate the implant.

How soon after treatment will I feel better?

It depends on the severity of your condition and what type of treatment you receive. A healthcare provider will give you an estimate on when you can expect to feel better after treatment.

Does Peyronie’s disease go away?

Some mild cases of Peyronie’s disease go away without treatment. But it’s rare for severe penile curvature or plaques to go away on their own without treatment.

What happens if Peyronie’s disease is left untreated?

Your body is unique, and how it responds to Peyronie’s disease may be different from others. In mild cases, your symptoms may improve without treatment. In more severe cases, your symptoms may stay the same or gradually get worse.

Can Peyronie’s disease be prevented?

As you get older, your erections may be softer, or it may be more difficult to maintain firmness. Softer erections are more prone to bending unexpectedly during sex, leading to injury. You and your partner can reduce your chance of this type of injury during sex through the following:

• Erectile dysfunction medications. A healthcare provider may prescribe oral medications, including sildenafil (Viagra®), vardenafil (Levitra®) or tadalafil (Cialis), if erectile dysfunction makes sex difficult or impossible. It’s a good idea to use ED medications as soon as your erections become softer.
• Using lubricants. Lubricants (lubes) reduce friction during sex, which can help reduce your risk of injury.
• Guiding your penis during insertion. If you change positions or your penis slips out during sex, you or your partner should use your hand to carefully guide your penis during insertion.
• Being careful if your partner is on top. You increase your chances of bending your penis in sexual positions where your partner is on top.
• Maintaining a straight and steady thrusting motion. Avoid any movements that might bend or twist your penis.

You may still get Peyronie’s disease even if you’re not sexually active. There’s no way to prevent Peyronie’s disease if genetics or autoimmune diseases are the cause.

What can I expect if I have Peyronie’s disease?

If you have Peyronie’s disease, it’s important to remember that your symptoms may not be permanent, even without treatment. It also won’t physically affect any other parts of your body, including your ability to have a biological child (fertility). Treatments can help reduce or eliminate your symptoms.

It’s also important to remember that even with treatment, it may take weeks or even months before you see results. However, the earlier you start treatment, the better your of chances of improvement. Waiting to start treatment or for the pain to go away can be frustrating, especially if you’re not able to have sex.

How do I take care of myself if I have Peyronie’s disease?

The following tips can help you take care of yourself if you have Peyronie’s disease:

• Be honest with your partner. Peyronie’s disease can affect your relationship with your partner. It’s a good idea to be open and honest about your condition and your feelings.
• Talk to a sex therapist. A certified sex therapist can help you process the mental and emotional aspects of Peyronie’s disease. Encourage your partner to see a sex therapist with you, especially if Peyronie’s disease makes having sex difficult or impossible.
• Talk to a psychiatrist. Peyronie’s disease can cause stress, anxiety, depression and issues with your body image. A psychiatrist can help treat any conditions that affect your general mental and emotional health.

When should I see a healthcare provider?

See a healthcare provider as soon as possible if you notice a curve in your penis — especially if it gets worse over time — or have any concerns about your sexual health.

When should I go to the ER?

Go to the nearest emergency room if you have Peyronie’s disease symptoms as well as:

• An inability to pee.
• External bleeding.
• Trauma that causes severe pain in your penis.

What questions should I ask my healthcare provider?

• How do you know that I have Peyronie’s disease?
• What should I do if the curve gets worse?
• Will my Peyronie’s disease go away or do I need treatment?
• What treatments do you recommend?
• Do you think I should have surgery?
• What kind of surgery do you recommend?
• How often should I return for checkups?
• Should I see a urologist?
• Can you recommend a counselor or support groups for people who have Peyronie’s disease?
• Can you recommend a sex therapist?

Does Viagra fix Peyronie’s disease?

No, Viagra can’t treat Peyronie’s disease. However, erectile dysfunction medications may help reduce your risk of injury, which can help prevent Peyronie’s disease.

What is the difference between Peyronie’s disease and penile curvature?

Peyronie’s disease is a type of penile curvature. Some people have penile curvature at birth (congenital penile curvature or chordee). There’s typically no association between congenital penile curvature and penile plaque, scarring or injury, and the condition doesn’t change over time. You may not notice it until after puberty, when you start having more regular erections.

Can Peyronie’s disease cause cancer?

No, Peyronie’s disease isn’t cancerous and it won’t turn into cancer.

Can Peyronie’s disease cause infertility?

No, Peyronie’s disease won’t affect your ability to have a biological child.

Can Peyronie’s disease cause urinary problems?

No, Peyronie’s disease doesn’t affect your ability to pee. Talk to your healthcare provider if you have Peyronie’s disease and have problems peeing.

Can Peyronie’s disease cause blood in your pee?

No, blood in your pee (hematuria) isn’t a symptom of Peyronie’s disease.

Can Peyronie’s disease kill you?

No, Peyronie’s disease isn’t deadly. It affects the size and shape of your penis, but it doesn’t affect the rest of your body.

A note from Cleveland Clinic

Any symptoms that affect your penis can be alarming and embarrassing, especially if they involve changes to its size and shape. You may think your symptoms will go away on your own or if you ice the area. However, these symptoms are your body’s way of telling you that something is wrong. It’s important to talk to a healthcare provider. They can diagnose Peyronie’s disease and get you the proper treatment.