Peyronie’s Disease
What is Peyronie’s Disease?
Peyronie’s disease is an acquired penile curvature due to scar tissue in the penile shaft.
This can cause penile pain and discomfort, can reduce or diminish the quality of erections, may complicate sexual intercourse, and can cause significant psychological burden for affected men and their sexual partners.
Peyronie’s is different from congenital penile curvature, as the latter is present since the time of birth, where Peyronie’s is acquired later in life. Some men will have penile pain associated with the onset of symptoms.
Curvatures can range in severity from a slight bend to significant curves greater than 90 degrees. Peyronie’s disease can make sexual intercourse painful, difficult, or impossible. In extreme cases, scar tissue may cause shrinkage or shortening of the penis.
Symptoms of Peyronie’s Disease
The main symptom of Peyronie’s disease is the formation of flat scar tissue underneath the skin of the penis. The scars, called plaques, can feel like lumps to the touch. The scarring limits blood flow and leads to a constellation of potential symptoms including penile curvature, penile shortening, pain, and erectile dysfunction.
Peyronie’s disease can be very distressing to both the man and their partner. In fact, among men with Peyronie’s completing depression questionnaires, nearly 50% meet the threshold for clinically meaningful depression, and just over 50% reported relationship stress because of their Peyronie’s disease.
Peyronie’s disease can be found in up to 9% of men, most often occurring among men in their 50’s to 60’s but may occur in men of all ages.
Peyronie’s Disease can cause:
- Lesions (plaques) under the skin of the penis shaft.
- Curvature of the penis when erect.
- Pain during erection.
- Inability to achieve satisfactory erection.
- Inability to successfully penetrate during sexual intercourse.
- Indentation of the penis shaft (called “waisting”) giving it an hourglass shape.
- Shortening of the penis.
A curved penis can be normal, but if you observe an increase in the amount of curvature, or if a bent penis interferes with sexual activity or causes pain, it is advisable to seek medical attention.
Progression of Peyronie’s Disease
Peyronie’s disease is variable among men. Based upon studies in the literature, we know that among men who seek treatment, complete resolution of penile pain occurs in nearly 90% of patients.
With respect to penile curvature, only 12% of men will report improvement over 1 year if left untreated, while 21-40% will report no change in symptoms and 48-76% will report worsening curvature.
In nearly all cases, treatment may reduce penile curvature and pain, and improve men’s sexual function.
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What Causes Peyronie’s Disease?
The underlying cause for Peyronie’s is not known and is under investigation in doctor’s labs around the world. The proximate cause of the penile curvature is the Peryronie’s plaque scar tissue.
Normally, when the penis changes from a soft/ flaccid state, to an erect state, a series of neurochemical reactions occur that result in more blood entering the penis than leaves. For this to occur, the smooth muscle in the penis must relax and expand, as does the tunica albuginea (lining of these erectile chambers).
However, the lining that has a Peyronie’s plaque cannot stretch and expand like the remaining normal penis; thus, as the erection expands in length, the non-expanding plaque causes that section to be shorter than the opposite side resulting in a curve. Similarly, as the penis expands in girth with an erection, the plaque fails to expand and stretch and may result in an indentation, narrowing or tapering.
Research has suggested these agents as possible causes of plaque or scar formation in the penile shaft:
- Vitamin E deficiency.
- Beta-blocking drugs.
- Elevation in serotonin levels.
- Genetic causes.
- Trauma to the penis.
Making the Diagnosis
In most cases, based upon history and physical examination the doctor will be able to make the diagnosis. When the penis is flaccid, one may be able to palpate the ‘plaque’ or site of fibrosis on the penis; however, curvature to one’s penis and deformities can only accurately be assessed when the penis is erect.
In most cases our doctor will perform a penile curvature assessment where we will induce an erection with medication and perform a very detailed assessment of the abnormalities.
Peyronie’s Disease Treatments
Peyronie’s disease treatments include shockwave therapy, penile injections, oral medications, topical therapies, penile traction devices, lifestyle modifications, and surgical procedures.
The sooner treatment is begun, the more options available and the better results you are likely to get. The aim of most treatments is to stop the disease progressing further, maintain or improve sexual function, relieve any penile pain and to straighten the bend as much as possible.
The doctor will evaluate your case and determine the best course of action. First line treatments can include:
Shockwave Therapy
Trimix
Injection Therapy
Sex Therapy
Supplemental Peyronie’s Disease Treatments
Oral Medications
Coenzyme Q10
PDE-5 Inhibitors
Vitamin E
Penile vacuum therapy
Surgical Therapies
For men that are not candidates for other forms of therapy and are both psychologically and functionally bothered by their Peyronie’s Disease, surgery may be an option. This may include different techniques depending upon the nature of the curve, deformity, and baseline erectile function. The doctor will discuss these if they are appropriate but generally include:
- Penile plication – shortening the ‘long side of the penis’ opposite the curve.
- Penile plaque excision and grafting – the scar tissue is cut and stretched, and a graft is sewn in place.
- Penile implant device that replaces the erectile tissue and helps to straighten the penis (typically reserved for men with significant curvature and erectile dysfunction).
Lifestyle Modifications
- Quitting smoking.
- Exercising regularly.
- Reducing the consumption of alcohol.
- Eliminating the use of recreational drugs.
A man may also want to undergo counselling to help with stress, anxiety, or depression. Understand that these lifestyle changes may not affect Peyronie’s disease. Changes of this kind are intended to improve the ability to have sexual intercourse without worrying about ED symptoms.
