Peyronie's Disease

What happens in Peyronie's disease

The penis contains two erectile chambers surrounded by a tough elastic sheath called the tunica albuginea. In Peyronie's disease, repeated micro-injury, often from bending during sex, triggers abnormal healing in this sheath. Instead of normal elastic tissue, a firm fibrous plaque forms. During erection, the plaque does not stretch, so the penis bends toward the plaque, or develops a dent or narrowing.

A mild natural curve present since puberty (congenital curvature) is different and is not Peyronie's disease.

Symptoms

• curvature during erection, most often upward
• a lump, band or hardened area that can be felt
• an indentation or "hourglass" narrowing
• shortening of the penis
• pain with erections, mainly in the early phase
• difficulty with penetration
• erectile dysfunction, present in many men with Peyronie's
• emotional distress, anxiety or depression

Phases

Treatment choices depend on the phase. Surgery is generally done only once the curve has been stable for at least 3 to 6 months.

Causes and risk factors

• minor trauma during sex or other activities
• genetic tendency to fibrosis: associated with Dupuytren contracture of the hand and plantar fibromatosis
• age over 40
• diabetes, smoking and high blood pressure
• erectile dysfunction (which may contribute to bending injuries)
• after prostate cancer treatment

Diagnosis

A urologist will ask about onset, pain, sexual function and the degree of curvature, and examine the penis to feel the plaque. Curvature is best measured during an erection, often induced by an injection in the clinic, or estimated using photos taken at home. A penile Doppler ultrasound assesses the plaque and blood flow, which helps plan treatment.

Treatment

Watchful waiting and pain control

Some men have mild curvature that does not interfere with sex and choose no treatment. A small number improve over time. NSAIDs help pain in the active phase. Oral supplements such as vitamin E, potassium aminobenzoate and pentoxifylline have not shown convincing benefit and are not recommended by the AUA for curvature.

Penile traction therapy

A traction device worn daily for several hours over months can reduce curvature and preserve or regain length. It requires commitment and is often combined with other treatments.

Injections into the plaque

• Collagenase clostridium histolyticum: an enzyme that breaks down collagen in the plaque, with "modeling" exercises; FDA-approved for curvature of 30 to 90 degrees in stable disease. Rare risks include penile fracture.
• Verapamil and interferon alfa-2b: used off label, with more modest results.

Treating erectile dysfunction

PDE5 inhibitors such as tadalafil or sildenafil help erections and may be used alongside other treatments.

Surgery

For stable, significant curvature or deformity that prevents intercourse:

• plication: stitches on the opposite side to straighten the penis; may slightly shorten it
• plaque incision or excision with grafting: for severe curves or narrowing, preserving more length, with some risk of new erectile difficulty
• penile prosthesis: for men with Peyronie's and significant erectile dysfunction, often with additional straightening

Outlook

Peyronie's disease is benign and not cancerous. Pain usually settles within 12 to 18 months. Curvature stays the same in many men, worsens in some and improves in a few. Effective treatments allow most men to have satisfying sexual relationships. Counseling can help with the emotional impact.

Frequently asked questions

What causes Peyronie's disease?

It is thought to be caused by minor, often unnoticed injury to the penis during sex, followed by abnormal scarring in men with a tendency toward fibrosis. Diabetes, smoking, age and Dupuytren contracture increase the risk.

Does Peyronie's disease go away?

Pain usually goes away within 12 to 18 months, but curvature often remains. Some men improve slightly without treatment, while others worsen. Treatments such as traction, injections and surgery can reduce the curve.

What is the best treatment for Peyronie's disease?

It depends on the phase and severity. Traction therapy and collagenase injections are options for many men with stable curves, while surgery is the most reliable way to straighten a severe or complex curve. A urologist can tailor treatment.

Can Peyronie's disease cause erectile dysfunction?

Yes. Many men with Peyronie's disease also have erectile dysfunction, either from blood flow problems related to the plaque, from shared risk factors such as diabetes, or from anxiety. It can be treated alongside the curvature.