Many men are reluctant to seek help for medical issues that they feel are embarrassing — even if those issues are causing them physical pain. That’s often the case with a condition called Peyronie’s disease.
As a urologist, I see many cases of this condition. But I know that there are men with Peyronie’s disease who are embarrassed to talk about it, and therefore don’t want to bring it up to their provider. I think it’s important for all men — and their partners — to understand this condition and to know that it can be treated. Men just need to speak up and get the help they need.
What is Peyronie’s disease and who is at risk for it?
Peyronie’s disease is triggered by scar tissue, called plaque, that forms on the covering of the erectile bodies and under the skin of the penis. Over time this plaque builds up and pulls on surrounding tissues, causing the penis to curve or bend, usually during an erection but sometimes even without one. A curved penis can make sexual intercourse painful, difficult, or even impossible. Peyronie’s disease can also change the shape of a penis, making it shorter or narrower, for instance.
The plaque associated with Peyronie’s disease isn’t the same plaque that can clog your arteries. This plaque is typically caused by either an injury to the penis or an autoimmune disease. The plaque is benign, meaning it’s not a tumor and it’s not cancerous.
Between 10% and 13% of sexually active men have Peyronie’s disease, making it a relatively common condition. You may have a higher risk of developing it if you:
- Have erectile dysfunction (ED). I often see Peyronie’s disease in combination with ED, and it can make ED worse.
- Have a connective tissue disorder, such as plantar fasciitis, which is an inflammation of the thick tissue on the bottom of the foot, or scleroderma, which is the abnormal growth of thick, hard patches of connective tissue.
- Have an autoimmune disorder, such as lupus.
- Engage in vigorous sexual or nonsexual activities that can cause microinjuries to the penis. These injuries can cause bleeding and swelling inside the penis. When an injury heals, scar tissue can form, triggering plaque.
- Have a family history of Peyronie’s disease.
- Have had surgery for prostate cancer.
You’re also more likely to have Peyronie’s disease as you age. With age, tissue in the penis can change, making it more vulnerable to injury and less likely to heal well.
Two phases of the condition
Peyronie’s disease has two phases: active and stable.
It’s during the active phase that plaque forms. This phase, which lasts 12 to 18 months, is marked by pain and a worsening of symptoms. After those initial months, the disease becomes stable, meaning symptoms exist but remain unchanged.
You can get treatment during either stage of Peyronie’s disease. However, the earlier you seek treatment, the better.
How is Peyronie’s disease diagnosed and treated?
The first step is a consultation with a urologist, like me. At this first appointment, I’d take a thorough medical history and then perform a physical exam. Typically, I can feel plaque whether the penis is erect or not. But if I need to examine the penis during an erection, I inject a medication that will cause an erection.
Researchers haven’t yet identified how to prevent Peyronie’s disease. However, medication or surgery can help reduce pain, straighten the penis, and make intercourse possible. The therapy that’s right for you depends on your specific symptoms and health.
Nonsurgical treatments include:
- Injections. In the stable phase of Peyronie’s disease, medications can be injected directly into the plaque. I can do injections right in the office. Collagenase, which is approved by the Food and Drug Administration (FDA) for treating Peyronie’s disease, is an enzyme that helps break down the substances that make up plaque in the penis. This can reduce the curve and improve erectile function.
- Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin or ibuprofen, can help with the pain associated with Peyronie’s disease. Pentoxifylline is an oral medication that may reduce inflammation, pain and curve.
- Non-drug medical therapies. Mechanical traction and vacuum devices work at stretching or bending the penis to reduce curving.
I recommend surgery for men who are unable to have intercourse, or whose symptoms haven’t improved. Surgery is usually only an option in the second stage of the disease, when symptoms have stabilized. Surgical options include:
- Grafting. In this procedure, I remove the plaque and replace it with new tissue. Grafting can straighten the penis and restore some length lost due to Peyronie’s disease. However, some men experience numbness and erectile dysfunction after this surgery.
- Plication. This procedure “cinches” tissue on the side of the penis opposite the plaque. Plication can help straighten the penis and is less likely to cause the numbness and erectile dysfunction that can come with grafting. However, plication can’t restore any length or girth that may have been lost, and it can cause the penis to become shorter.
- Device implantation. This is often an option for men who have both Peyronie’s disease and erectile dysfunction. The procedure implants a device in the penis that can cause an erection and perhaps straighten the penis during the erection as well. If the implant isn’t enough to straighten the penis, I can combine this procedure with grafting or plication.
Don’t wait to get help
If you think you have Peyronie’s disease, I strongly urge you to schedule an appointment with a urologist. I find that men are initially reluctant to tell any doctor about the signs of the condition. However, symptoms don’t usually improve spontaneously. By the time they see me, men typically wish they’d sought treatment earlier.
At Temple, our urologists are specialists in treating penile injuries and disorders. We have a dedicated team that offers both medical and surgical treatments, and we have a wealth of experience treating Peyronie’s disease.
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