Peyronie's Disease

Peyronie’s disease symptoms are directly related to the shape and appearance of the penis.

The most common symptoms of Peyronie's disease are:

• Bend or curve to the penis, either upward, downward, or to the side

• Difficulty getting and maintaining an erection

• Penis appears smaller or shorter than it was before

• Scar tissue along the side that curves inward

• Pain

• Other changes, like narrowing or pitting along the side of the penis

Because Peyronie’s disease results from scar tissue pulling the penile tissue into a curve, the most common cause of the condition is injury to the penile tissue. This could be the result of sports injuries or traumas, but it also can be caused by vigorous sexual activity. The injuries, often micro injuries that are not noticed, heal but then more scarring occurs following more injuries.

Other possible causes include:

• High blood glucose (sugar) 

• Family history of Peyronie’s disease

• Some medications, such as beta blockers, interferon and phenytoin

A number of factors increase the risk of developing Peyronie's disease. Not all people with risk factors will get Peyronie's disease. Risk factors include:

• Family history of Peyronie’s disease

• Age: Men in their 50s and 60s are at higher risk for developing the condition

• Having a connective tissue disorder, such as Dupyutren’s contracture

• Smoking

Because Peyronie’s disease is often caused by trauma to the penis, preventing the condition relies heavily on preventing injury. You may be able to prevent or lower your risk of Peyronie's disease by:

• Using adequate lubrication for sexual activity, to lessen irritation to the penis

• Avoiding sexual movements that bend or twist the penis

• Protecting your groin from injury during athletic events

• Speaking with your doctor about medications if you are having difficulty getting or maintaining an erection

• Having sex from the top, rather than underneath, so the penis stays as straight as possible

If you have noticed any signs of Peyronie’s disease, speak with your doctor to see what other steps you might take to prevent the condition from worsening.

Tests for Peyronie’s disease are not usually necessary, although a doctor may ask for some tests, like a biopsy, to rule out other possible problems. Usually a physical exam of the penis, along with a history of the symptoms, is sufficient for diagnosis.

Your doctor or licensed healthcare practitioner will ask you several questions related to your symptoms including:

• How long ago did you notice the symptoms?

• Do you remember any particular injuries to the penis?

• Are you experiencing any other symptoms, such as difficulty urinating?

• Are you taking any medications, including over-the-counter products?

• Do you have any other medical problems?

Your doctor may want to see a photo of an erection, indicating the severity and location of the curve. In some cases, a doctor may inject a medication directly into the penis to cause an erection, or send a patient for an ultrasound to see if there are any areas that are blocking the blood flow to the penis.

The doctors who treat Peyronie’s disease are urologists, specialists who treat urinary and sexual medical issues.

Occasionally, Peyronie’s disease will go away on its own, so immediate treatment is not usually recommended. Treatment is also not needed if the condition does not cause any problems, such as pain or difficulty having sex. If the condition is disturbing, continues or worsens, treatment depends on whether the condition is acute (it just happened) or chronic (long-term), as well as the severity of the symptoms.

Doctors avoid invasive or surgical procedures if possible. Surgery is usually not recommended for acute Peyronie’s disease. Nonsurgical treatments could include:

• Oral medications and supplements, such as vitamin E, potassium aminobenzoate, tamoxifen, colchicine, and carnitine

• Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen (Advil) or naproxen (Aleve) to relieve pain

• Injections of medications directly to the scarred area on the penis to help control swelling and scarring

• Penile traction therapy, using mechanical traction or vacuum devices, help stretch the penis and reduce the curve

• Shockwave therapy directed towards the scarred tissue may reduce pain.

In cases of chronic Peyronie’s disease, treatment could include:

• Observation or “watchful waiting” to see if the condition worsens

• Injections

• Traction therapy, which uses a mechanical device to strengthen and straighten the penis

• Surgery. This can include suturing (plicating) the side of the penis without scar tissue, helping to straighten the shaft. Another surgical option is incision or excision with grafting, in which a surgeon removes the scar tissue and grafts on healthy tissue from elsewhere on the body or from a donor.

• Penile implants, semi-rigid material surgeons place inside the penis that can be controlled either manually or through a pump implanted in the scrotum.

Surgery is generally only recommended if less invasive treatments have not worked, or if the curvature is so severe that it causes pain and makes sex impossible. Doctors will also wait until the curvature has been stable for at least three months before performing any procedures. If the surgery is done before the disease stabilizes, the curve could return.

Men also may find it helpful to speak with a counselor or therapist to manage the emotional stress of Peyronie’s disease and the challenges it can present in intimate relationships.

Peyronie’s disease has no harmful impact on a man’s physical health, but it can affect him in other ways. Peyronie’s disease could lead to:

• Impotence or inability to have sexual relations

• Anxiety or depression

• Inability to naturally father a child

• Pain

Although rare, Peyronie’s disease surgery can cause other complications, such as:

• Infection 

• Numbness

• Some curvature remaining

• Continued erectile dysfunction

There could also be complications related to other treatments, such as side effects from medications. Talk to your doctor about your risk for complications and ways to mitigate this risk as you seek successful treatment.