What is Peyronie's disease?
Peyronie’s is a disease where scar tissue in your penis causes it to bend, curve or lose length or girth. You may be able to feel the scar tissue (plaque) through the skin or you may have pain in a specific part of your penis as the scar tissue forms. During an erection, your penis can bend up, down, or to the side depending on the location of the scar. Some men with this condition don’t have a curve, but might have an area of indentation or “hourglass” appearance.
Most men don’t have perfectly straight erections. Just because there is a little curve in your penis, that doesn’t mean you have Peyronie’s disease. Men who have had a curvature their whole lives do not have Peyronie’s disease.
In most cases, the scar forms on the top of the penis, causing it to curve upwards when it becomes erect. 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 shaft, which can cause the penis to become “dented” or shorter. Sometimes the scar will go all the way around the penis, making it narrow like the neck of a bottle or the center of an hourglass. About one in three men with this condition may have calcium in the scar tissue that can make it feel like bone.
How does the penis work?
Your penis has two roles: to carry urine and to carry sperm. There are three tubes inside it: the urethra, which carries urine from the bladder and through the penis, and two tubes called the corpora cavernosa that fill with blood to make the penis erect. All three are wrapped together by a tough fibrous sheath known as the tunica albuginea. When you’re having intercourse, the blood flowing to your penis makes it straight, stiff and hard, and able to penetrate. Semen then exits through the urethra after orgasm. This process is called ejaculation.
Peyronie’s disease affects the shape and size of the penis, but not urination or ejaculation.
What are the stages of Peyronie’s disease?
Peyronie’s disease has two stages: acute and chronic.
- Acute phase: This stage lasts between six and 12 months. During this period the scar forms under the skin of your penis, causing a curvature or other change in its shape. You may feel pain when your penis is erect or when it is soft.
- Chronic phase: The scar has stopped growing in this phase, so the curvature in the penis doesn’t get worse. The pain will usually be gone by this time, but sometimes it can continue, especially with erections. Also, erectile dysfunction (ED) or problems getting or keeping the penis hard may develop.
What’s the difference between Peyronie’s disease and penile curvature?
Peyronie’s disease is one type of penile curvature that happens to adults. Some men can be born with penile curvature and this is called congenital curvature or chordee. It is not caused by scar tissue, and the condition does not change over time. It might not be noticeable until after puberty when a man begins having more regular erections.
Who is likely to get Peyronie’s disease? What are the risk factors?
Several risk factors might increase your chances of getting Peyronie’s disease:
- Age. Peyronie’s disease is more likely to happen as you get older. It occurs in about 10-15% of middle-aged men.
- Genetics. If you have a close relative (brother or father, for example) with the disease, you’re at a higher risk.
- Connective tissue disorders. Those with a connective tissue disorder are at a greater risk. Examples of those disorders include Dupuytren's disease, plantar fasciitis and scleroderma.
- Erectile dysfunction. Men who have diabetes-associated erectile dysfunction (ED) (impotence/difficulty getting and keeping an erection) are four to five times more likely to develop Peyronie’s disease. Sometimes erectile dysfunction can be caused by having Peyronie’s.
- Prostate cancer. Men who have had surgery for prostate cancer are at an increased risk.
- Autoimmune disorders. If you have an autoimmune disorder like lupus, you’re more likely to get Peyronie’s disease.
How common is Peyronie’s disease?
Experts estimate that about 6% to 10% of men between ages 40 and 70 have Peyronie’s disease. It’s been observed in other ages, but it’s less common. There’s a theory that the actual number may be higher since some men choose not to talk about the disease with their healthcare provider, and others may not be bothered enough to seek medical care. If you have concerns about your sexual health, be sure to report your symptoms to a healthcare provider.
Does Peyronie’s disease hurt?
Yes, Peyronie’s disease can be painful. This is most common in the acute (early) phase of the disease. However, pain may continue with erections even in the chronic phase. The severity of it varies depending on the person.
Does Peyronie’s disease make the penis smaller?
Yes. Peyronie’s disease can shorten your penis. Treatments for Peyronie’s disease can attempt to restore length.
Does Peyronie’s disease cause erectile dysfunction (ED)?
Peyronie’s disease can cause erectile dysfunction by interfering with the normal blood trapping valves that are important for getting or maintaining an erection.
Is Peyronie’s disease contagious?
No. Peyronie’s is not contagious or caused by any other disease.
Will Peyronie’s disease keep me from having sex?
You can have sex, but it might be painful or difficult for you or your partner. The greater the curve, the more difficult it is to have sex.
Symptoms and Causes
What causes Peyronie’s disease?
The cause of Peyronie’s disease is not always clear. Some researchers believe the scar occurs after the erect penis has been injured or abnormally bent, typically during sexual intercourse. However, 80% of men don’t remember a specific event that led to the changes in their penis. These changes probably happen due to small unrecognized injuries that happen during regular sexual relations. Men with Peyronie’s disease may be at risk of having too much scar tissue form in response to these small injuries compared to men who don’t develop this condition.
If you have a close family member with the disease, then you are more likely to get it. Not all men who have injuries end up with Peyronie’s disease, so it is likely that there are genetic or environmental reasons. You’re also more likely if you have certain connective tissue disorders including Dupuytren’s contractures or tympanosclerosis.
There are also health issues that have been linked to Peyronie’s disease. It is unclear if they cause Peyronie’s disease, or if they happen alongside it:
- High blood sugar.
- Pelvic trauma.
- Problems with wound healing.
- Using tobacco products.
- Autoimmune diseases such as lupus, Sjögren’s syndrome and Behçet’s disease.
What are the symptoms of Peyronie’s disease? What are the signs?
The primary symptom of Peyronie’s disease is curvature in the penis. You may feel scar tissue (a plaque) under the skin of the penis. You may be able to tell that the plaque is forming because of the following signs:
- Your penis is shorter.
- Your penis is bent/curved.
- There is loss of girth, an indentation or hourglassing of your shaft.
- There are lumps in your penis.
- Erections are painful.
- Erections are soft.
- Sex is difficult because of the bend.
Symptoms of Peyronie’s disease may develop slowly or can seem to appear overnight. The pain of Peyronie’s disease is usually mild and often does not require treatment, but medications like ibuprofen can be used if needed. In most cases, the pain decreases over time, but the bend in the penis related to the scar can remain a problem. If the bend is bad enough, such as greater than 30 degrees, the curve can interfere with sex.
A man with Peyronie’s disease may also notice that this condition affects their mental health. Changes in the penis can cause body image issues, anxiety or even depression. It can cause strain in a relationship and in other aspects of life.
Your sexual health is as important as any other aspect of your health. Talk to your healthcare provider about your concerns. Bringing your partner to the visit can help ensure both partners’ concerns are addressed.
Do certain foods worsen or improve Peyronie’s disease?
No. At this time there is no evidence to suggest that what you eat or drink affects Peyronie’s disease.
How long does Peyronie’s disease last?
Peyronie’s disease is usually a permanent condition. True Peyronie’s disease rarely goes away on its own, but can occasionally change even years after diagnosis in response to further injuries. The changes in the penis can always be improved using a variety of treatments.
Can Peyronie’s disease cause cancer?
No. Peyronie’s disease is not cancerous and does not turn into cancer.
Can Peyronie’s disease cause infertility?
No. Peyronie’s disease is caused by plaque forming under the skin of your penis. It bends the penis, but does not affect fertility. It also does not cause any problems with urination or ejaculation.
Can Peyronie’s disease cause blood in urine?
No. Blood in your urine is not a symptom of Peyronie’s disease.
Can Peyronie’s disease kill you?
No. Peyronie’s disease changes the shape and size of the penis, but it is not deadly and does not affect the rest of your body.
Can Peyronie’s disease cause urinary problems?
No. Urinary issues are not a symptom of Peyronie’s disease. If you have urinary problems, be sure to report your symptoms to your healthcare provider.
Is Peyronie’s disease genetic?
Experts think it is likely that there is a genetic component to some cases of Peyronie’s disease. You may get the disease if a close family member has it.
Diagnosis and Tests
How is Peyronie’s disease diagnosed?
Your healthcare provider will ask you about anything that may have happened before the symptoms appeared, such as an injury. They will feel the hardened tissue caused by the disease, although sometimes it is necessary to do the examination when your penis is erect. If needed, an injection will be used to temporarily make your penis erect for the exam.
Your healthcare provider may recommend an ultrasound. The ultrasound will reveal where the plaque is, check for calcium buildup and show how the blood flows in your penis. This test can allow your healthcare provider to determine which treatment options you might be a candidate for.
What questions might my healthcare provider ask to diagnose Peyronie’s disease?
- How long have you noticed the curve in your penis?
- Have you lost length and, if so, how much?
- Is having sex difficult?
- In which direction does your penis bend and roughly how many degrees?
- Are you in pain currently or during sex?
- Does your partner have pain during sex?
- How strong are your erections? Do you have erectile dysfunction (ED)?
- Does anyone in your family have Peyronie’s disease or Dupuytren’s contracture?
- What medications are you taking?
- Do you have any other medical problems or conditions such as diabetes or an autoimmune disorder?
Management and Treatment
How is Peyronie’s disease treated?
If you have very little penis curvature with no pain and no problems with sex, you may not need to be treated at all. Some cases of Peyronie’s disease go away without treatment. Talk to your healthcare provider about what options are right for you.
Is there a cure for Peyronie’s disease?
There is no cure for Peyronie’s disease, but there are always ways that the changes in the penis can be improved. Many different treatments exist including stretch therapy (traction), medications and even surgeries.
What can I do for my Peyronie’s disease without medication or surgery?
Traction (or stretch) therapy uses a device to stretch the penis and sometimes even bend the penis in the opposite direction of the curvature. This encourages the scar tissue to be recycled into more normal tissue and can improve curvature, restore length lost due to Peyronie’s disease, and even improve the hardness of erections.
The device needs to be worn daily for several months to show improvement. Many men wear the device while sleeping. There have been no long-term side effects from this treatment. Men may need to buy the device independently, but often receive reimbursement from their insurance companies. The only FDA-approved traction device is the Restorex® device.
Vacuum erection devices are used by many healthcare providers to treat Peyronie’s disease. However, traction therapy has shown better improvements in curvature because it causes more stretch on the scar tissue.
What medications help with Peyronie’s disease?
There are medications taken by mouth and medications injected into the penis. The oral medications show little effectiveness compared to the injections. Injections that go right into the scar tissue are able to break down the scar and improve the curvature in the penis. Medications can be used in the acute phase, or in men who aren’t sure if they want surgery. Medications rarely result in a straight penis.
There is no oral medication guaranteed to help with Peyronie’s disease 100% of the time. Oral medications that may help include:
- Pain Medications. Ibuprofen and similar medications may help with the pain and reduce inflammation.
- Tadalafil (Cialis®). Daily tadalafil improves blood flow in the penis and may prevent the scarring from worsening.
- Pentoxifylline. Pentoxifylline also improves blood flow but may cause upset stomach.
- L-arginine. L-arginine is an amino acid that can improve blood flow.
- Colchicine. Colchicine is an anti-swelling agent.
- Potassium amino-benzoate (Potaba). This vitamin B-complex may help reduce plaque size, but not necessarily the curve of the penis.
- Collagenase injections (Xiaflex®). This is prescribed for men with penises that curvature more than 30 degrees but less than 90 degrees. It breaks down scar tissue to improve curvature. This is the most effective injection available and is given in a series of two shots per week for eight weeks.
- Interferon injections. Interferon is a protein that helps control swelling and scarring. In theory, it slows down the rate of scar tissue buildup by making an enzyme.
- Verapamil injections. This drug can be taken by mouth to treat high blood pressure, but has been shown when injected into Peyronie’s plaque to help with penile pain and curvature.
Is there a specialist I should see to help with Peyronie’s disease?
Urologists specialize in sexual and urinary problems in men. Peyronie’s disease specialists generally include urologists who received extra training or have expertise in genital reconstruction, sexual medicine or andrology.
Can I have surgery for Peyronie’s disease?
Mild curvature of the penis caused by Peyronie’s disease usually does not need treatment. Men in the chronic phase who desire the most rapid results or those who desire a straight penis may be better served with surgery to correct the problem. Surgery is only performed on men whose Peyronie’s disease makes it hard to have sex. Healthcare providers may have you wait until the scar and curvature have stopped worsening and there has been no pain for around six to 12 months. Surgery should only be performed in the chronic phase.
There are three surgical options to possibly fix your Peyronie’s disease. These surgeries:
- Make the side of the penis opposite the plaque shorter. This surgery is done either by using small internal “tuck” stitches or by cutting out small pieces of tissues on the outside of the curve and then sewing the remaining tissue closed. This shortens the outside of the curve to match the inside of the curve and make the penis straight. This is a good approach for men with good erections who have not lost much length from their Peyronie’s disease.
- Make the side of the penis on the inside of the curve longer. If the curve is very bad, or the shaft has become narrow or very shortened, this might be the right type of surgery. In it, the surgeon cuts the scar tissue (plaque) and may remove some of it. The space left behind is then covered with a patch (graft). There are several types of grafts, but the most common ones are processed human or animal tissue. Sometimes grafts can be obtained from another part of your own body. This is a good approach for men with excellent erections and severe curvature who have lost a lot of length or who have narrowing of the shaft that interferes with function.
- Insert a prosthetic device inside the penis. This is the best approach for men with very poor erections who still want to have sex. In this surgery, the penis is straightened over an inflatable device called a penile prosthesis (or penile implant). The implant allows a man to control his erection by squeezing a pump hidden inside the scrotum between the testicles. The pump is squeezed until the penis is hard and then can be deflated when sexual activity is done. This procedure is also commonly performed in men with erectile dysfunction who do not have Peyronie’s disease.
Before surgery, your healthcare provider will need to do an ultrasound on your penis. This will check the blood flow to the penis and see if there is erectile dysfunction (ED). A medicine is injected during the ultrasound to create a temporary erection to see which surgery you might be a candidate for.
Are there side effects or complications of surgery?
All surgeries have some side effects which are generally rare. The “tuck” or shortening surgery can make the penis shorter, cause temporary sensation changes or sometimes lead to a knot or lump that can be felt under the skin. The scar removal (lengthening) procedure has a longer recovery period. The risks are the same, except that there is a higher risk of worsened erections that may require pills or a penile implant. That is why this surgery is only offered to men with excellent erections. Penile prosthesis surgery also has risks including implant infection (2% or less), device malfunction (15% risk at 10 years after surgery), loss of length and others.
What other procedures help with Peyronie’s disease?
Some healthcare professionals recommend shockwave therapy. This is where focused, low-intensity electroshock waves are directed at the plaque. The goal is to reduce your pain which can also be accomplished by over-the-counter medications.
Researchers have not found any proof that shockwave can help improve penile curvature. This treatment may be expensive and is rarely covered by insurance.
How can I prevent Peyronie’s disease?
As men age, their erections may be less rigid (firm), or there may be difficulty in maintaining firmness. Less rigid erections can be injured because regular thrusting during sexual intercourse may cause the penis to bend and lead to pain. To avoid this type of injury, there are a number of things you and your partner can do:
- Your healthcare provider may prescribe oral medications (Viagra®, Levitra®, Cialis®) if you have erectile dysfunction and sexual intercourse is either difficult or impossible. The first step in avoiding penile injuries is to begin to use one of these agents as soon as erections begin to become less rigid.
- You should make sure to use adequate lubrication during sexual activity. If there is not enough natural lubrication then use an over-the-counter lubricant.
- If the penis slips out during sexual intercourse, the man or his partner should use their hand to guide it back in.
- Sexual intercourse with the partner on top should be performed with caution because this position may increase the chances of the penis bending.
- Regardless of the position, the man’s thrusting movements during sexual intercourse should generally be straight in and out. He should avoid movements that might bend or twist the penis.
Many men still get Peyronie’s disease even without sexual activity. If your Peyronie’s disease is caused by genetics or a condition such as an autoimmune disorder, there was no way you could’ve prevented it.
Outlook / Prognosis
What can I expect if I’ve been diagnosed with Peyronie’s disease?
If you have Peyronie’s disease, you may have a curved/bent penis, pain with an erection or possibly difficulty having sex. It’s important to remember that these symptoms may not be permanent and that Peyronie’s disease doesn’t harm the rest of the body. It’s not cancerous. It doesn’t affect fertility. There are treatments.
Whether you’ve just been diagnosed with Peyronie’s disease or have had it for a long time, understand that you will have to be patient. Waiting for the treatments to help manage your symptoms can be frustrating. The pain makes the disease even more frustrating, as does your inability to have sex if you have a severe case. Talk to your healthcare provider about your symptoms and concerns.
Can Peyronie’s disease be cured?
The symptoms of Peyronie’s disease can be improved using the various available treatments. Unfortunately, no treatment can claim to cure Peyronie’s disease 100% of the time.
How do I take care of myself?
More than 75% of men with Peyronie’s report that they’re stressed and depressed because of the disease. There are treatments for depression. A certified sex therapist is uniquely qualified to help you deal with these issues. You can also see a psychiatrist for medications and a general therapist for counseling (therapy).
Peyronie’s disease can affect your relationship with your partner. Be open. Be honest. Discuss your concerns with your partner and, if needed, see a therapist together. Bring your partner to the visit with you whenever possible to make sure the healthcare provider discusses any concerns either of you might have regarding this condition.
How can Peyronie’s disease affect my relationship?
Peyronie’s disease is truly a couple’s disease because it can affect both partners. Curvature in the penis can cause pain to both the man with Peyronie’s and his partner. It’s important to include your partner in the discussion with your healthcare provider so that they can understand how the condition is affecting both partners.
What are the other ways Peyronie’s disease might affect me?
In addition to causing physical changes in the penis, Peyronie’s disease can also affect your mental health. Changes in the appearance of the penis can lead to body image concerns, anxiety and even depression. This can affect many areas of your life including your relationship, work and others.
When should I see my healthcare provider about Peyronie’s disease?
Notify your healthcare provider if you notice a curve in your penis – especially one that gets worse over time. Look for the signs that you may have plaque building up under the skin of your penis:
- Your penis is shorter.
- Your penis is bent/curved.
- There are lumps in your penis.
- Erections are painful.
- Erections are soft.
- Sex is difficult because of the bend.
- There is a loss of girth, an indentation, or an hourglass appearance of the penis.
Return to your healthcare provider immediately if you have these symptoms in addition to the ones listed above:
- Trouble urinating.
- External bleeding.
- Penile pain that doesn’t go away.
What questions should I ask my healthcare provider about Peyronie’s disease?
- What should I do if the bend gets worse?
- Do you expect that this will go away or require treatment?
- How often should I return for a checkup?
- What treatments do you recommend?
- Do you think I should have surgery?
- What kind of surgery do you recommend?
- How can I talk to my partner about this disease?
- Can you recommend a counselor or support group?
- Can you recommend a sex therapist?
A note from Cleveland Clinic
Your sexual health is important and affects your quality of life. Penis health, especially when it comes to shape and size, can be a difficult, awkward conversation to have with a partner or healthcare provider. But, if you want to improve your Peyronie’s disease, those conversations need to happen. This condition is common and affects upwards of 10% of men, so you are not alone. Don’t hesitate to tell your urologist or other healthcare providers exactly what your symptoms are. Be specific. Talk about your concerns and fears. Listen to your healthcare provider. Find the best next step you can take to manage your Peyronie’s disease.
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