Peyronie’s Disease

Peyronie’s disease is a condition that causes the penis to curve or bend abnormally during erections due to scar tissue formation beneath the skin. This can lead to pain, difficulty with sexual activity, and emotional distress for many men.

Table of contents

• What is Peyronie’s disease?
• Who is affected by this condition?
• Stages of Peyronie’s disease
• Signs and symptoms
• What causes Peyronie’s disease?
• How doctors diagnose Peyronie’s disease
• Treatment options
• Emotional and relationship impact

What is Peyronie’s disease?

Peyronie’s disease is a disorder in which fibrous scar tissue, called plaque (a hardened area of tissue), forms in the deeper tissues under the skin of the penis. This plaque forms in a structure called the tunica albuginea, which is a sheath of elastic fibers that surrounds the erectile tissue in the penis.^[1][2]

When this scar tissue builds up, it prevents the penis from expanding normally during an erection. This causes the penis to curve, bend, or change shape. The condition can also make the penis shorter while erect.^[1]

It’s important to understand that many penises naturally have some curvature, and not every curved erection means someone has Peyronie’s disease. A slight curve of about 10 to 20 degrees is usually not a cause for concern.^[2][17] However, in Peyronie’s disease, the bend can be much more severe, sometimes reaching 90 degrees or more, which can make sexual intercourse painful or even impossible.^[17]

Peyronie’s disease is not caused by cancer and is not contagious.^[1] The condition was first fully described in 1743 by François Gigot de la Peyronie, a French surgeon who was the personal physician of King Louis XV.^[6]

• Penis
• Tunica albuginea
• Corpora cavernosa

Who is affected by this condition?

Medical experts estimate that about 6% to 10% of people between the ages of 40 and 70 with penises have Peyronie’s disease.^[2] The condition mainly affects men over 40, but younger men can also develop it.^[5]

The actual number of people with Peyronie’s disease may be even higher than these estimates suggest. Many men feel too embarrassed to talk about the condition with a healthcare provider, which means cases often go unreported.^[2] However, it’s important to seek medical help if you notice changes in your penis, as early treatment can be more effective.^[1]

Stages of Peyronie’s disease

Peyronie’s disease develops in two distinct stages: the acute phase and the chronic phase.^[2]

The acute phase, also called the active phase, lasts between 6 and 18 months. During this time, the scar tissue is actively forming under the skin of the penis. As the scar tissue develops, changes in the curve or length of the penis become worse. Many men experience pain during erections in this phase, and sometimes pain occurs even when the penis is soft. The pain and the area over the scar tissue may feel tender to touch.^[1][8][17]

The chronic phase, also called the stable or passive phase, begins when the scar tissue has stopped growing. During this stage, the curvature of the penis will not get any worse. Pain usually goes away during the chronic phase, though it can sometimes continue, especially during erections. Problems with getting or keeping an erection, known as erectile dysfunction, may develop during this phase.^[2][8][17]

Signs and symptoms

The most common symptom of Peyronie’s disease is a curve or bend in the penis when it’s erect. You may also be able to feel the scar tissue under the skin as flat lumps or a band of hard tissue along the shaft of the penis.^[1][2]

Other symptoms include:^[2][4][5]

• Hard lumps along the shaft of the penis where scar tissue has formed
• A loss of length in the penis
• Loss of girth (thickness) in the shaft, which may look like an indent or give the penis an “hourglass” shape
• Painful erections
• Softer, weaker erections
• Difficulty having sex for you or your partner
• Pain during sex
• Problems getting or keeping an erection
• Changes in the shape of the penis – it may curve upward if the scar is on the top, downward if the scar is on the bottom, or sideways if the scar is on the side

Symptoms may develop suddenly or appear gradually over time.^[1] The severity of symptoms varies from person to person. If you have a bend in your penis greater than 30 degrees, it can make sex painful or impossible.^[2]

What causes Peyronie’s disease?

The exact cause of Peyronie’s disease is not always known, but most experts believe it’s related to injury or trauma to the penis.^[5][6] The most common theory is that repeated trauma or injury to the penis during sex can trigger the condition. Research has found that men who engage in more vigorous or frequent intercourse appear more likely to develop Peyronie’s disease.^[17]

It’s important to understand that if you develop Peyronie’s disease, it doesn’t mean you did something wrong. The condition affects how tissue in the penis heals after it has been wounded, and the injury is often silent and may occur more than once.^[4][22]

The inflammation from trauma is thought to cause scar tissue to form in the tunica albuginea. Over time, this scar tissue builds up and prevents the penis from expanding normally, causing it to curve.^[17]

Several factors can increase your risk of developing Peyronie’s disease:^[5]

• Diabetes
• High blood pressure
• High cholesterol
• Coronary heart disease
• Thickened blood vessels in the heart
• Taking certain medicines, such as beta blockers or some antidepressants
• Smoking
• Family history of Peyronie’s disease

Some men with Peyronie’s disease also have thicker, less flexible skin in other parts of their body. For example, some men with the condition also have Dupuytren’s contracture, a condition that affects the hands.^[5]

There’s also a connection between Peyronie’s disease and erectile dysfunction. Some experts believe that weaker erections can contribute to the development of Peyronie’s disease because when men have sex with an erection that is not strong enough, the penis is more likely to bend and get injured.^[22]

How doctors diagnose Peyronie’s disease

Healthcare professionals can often diagnose Peyronie’s disease by doing a physical exam. During the exam, your doctor will feel your penis when it’s not erect to figure out the location and amount of scar tissue. They may also measure the length of your penis. If the condition becomes worse, this measurement helps determine whether the penis has gotten shorter.^[8]

Your doctor might ask you to bring in photos of your erect penis taken at home. This can help determine the degree of curving, the location of scar tissue, or other details that might guide treatment.^[8]

In some cases, your doctor might order an ultrasound (a test that uses sound waves to create images) or other tests to check your penis when it’s erect. Before testing, you’ll likely receive a shot directly into the penis that helps it become erect. These tests can show the presence of scar tissue, blood flow to the penis, and any other irregular signs.^[8]

Treatment options

Peyronie’s disease rarely goes away on its own. In most people with the condition, it will remain as is or may get slightly worse early on.^[1] However, if you have a slight curve that isn’t getting worse and you have good erectile function, treatment may not be needed.^[12]

Early treatment during the acute phase may help keep the condition from getting worse or even improve symptoms. Treatment options depend on which phase of the disease you’re in and how severe your symptoms are.^[1][8]

Medications

Medication is one of the best ways to treat mild to moderate Peyronie’s disease.^[16] Several types of medications may help:

Oral medications (pills) include:^[12]

• Pain relievers like ibuprofen or naproxen
• Pentoxifylline to improve blood flow to the penis
• A combination of vitamin E and colchicine or carnitine to reduce scarring

Injectable medications are given as shots into the scar tissue and may include:^[12][13]

• Collagenase (also known by the brand name Xiaflex) – the only FDA-approved injectable medication for Peyronie’s disease in patients with curvature between 30 and 90 degrees
• Verapamil to help fight scar tissue growth
• Interferon to reduce scarring
• Corticosteroids to reduce inflammation and pain

Treatment with collagenase involves four treatment cycles. Each cycle consists of two injections separated by 3 to 7 days, followed by daily penile exercises. About 70% of men will have improvement in patient bother and/or improvement in curvature after four treatment cycles. However, the treatment comes with risks, including bruising, swelling, and in rare cases (about 1 in 250), a penile fracture that may require surgical repair.^[13][14]

Treatment with verapamil is considered “off label” (not FDA approved for this use). It involves a series of six injections given every two weeks. About 50% of patients will have some improvement in penile curvature, usually modest improvement of 10 to 15 degrees. Side effects are uncommon and include mild swelling and bruising.^[13]

Stretches and traction therapy

Penile traction therapy uses a device to gently stretch the penis in the opposite direction of the curvature. These gentle stretches can help to reduce the curvature and improve penile function and may restore length. However, it may take several months of consistent use to see noticeable results.^[16][17]

Other treatments

Some treatments use sound waves or other procedures to break down the hard area on the penis, though evidence for these approaches varies.^[5]

Surgery

Surgery is usually only considered for men who have severe pain, a severely curved penis, or sexual dysfunction related to Peyronie’s disease. Surgery is typically recommended only after the disease has reached the chronic phase and the curvature has been stable for at least 3 to 6 months.^[12][20]

Surgical options include:^[13][20]

• Penile plication – putting stitches on the opposite side of the penis that is curved to straighten it. This procedure can correct approximately 65 degrees of curvature. Almost all patients will experience some shortening of the penis, usually about 3/4 of an inch. Sexual activity is not allowed for about 6 weeks after surgery.
• Incision of the plaque with graft – cutting into the scar tissue and placing a graft to help straighten the penis. This is usually recommended for patients with over 70 degrees of curvature. Sexual activity can be resumed approximately 6 to 8 weeks after surgery.
• Penile prosthesis – placing an implant in the penis to help keep an erection during intercourse. This is recommended for patients with both erectile dysfunction and penile curvature that cannot be resolved with other treatments.

While surgery can be effective, it comes with risks, including incomplete correction, changes in sensation to the penis, and risk of erectile dysfunction.^[13] It’s important to discuss the risks and benefits with your doctor to help you make the best decision for your health.

Lifestyle changes

For many men, lifestyle changes can help manage Peyronie’s disease. Maintaining a healthy weight, exercising regularly, and avoiding smoking and alcohol can all help improve blood flow and reduce inflammation in your body.^[16]

Emotional and relationship impact

For many people, Peyronie’s disease causes significant stress, anxiety, depression, and low self-esteem. The changes to the penis caused by the condition can have an impact on how you feel about yourself and on your relationship with your partner.^[1][4]

If you have Peyronie’s disease, you may feel anxiety during intimacy or choose to avoid intimacy completely. You may also feel self-conscious about discussing your symptoms. This can lead to frustration and misunderstandings that disrupt your life and your partner’s life and leave you feeling isolated.^[4]

It’s important to know that you don’t have to deal with these challenges alone. Working with a therapist or counselor can help address concerns about self-esteem and sexual function and improve your overall well-being.^[16] Counseling can also help couples maintain an active sexual life despite the challenges of the condition.^[12]

Most men with Peyronie’s disease are able to remain sexually active with appropriate treatment and support.^[12] Don’t feel embarrassed about getting help – Peyronie’s disease is a common problem that healthcare providers are used to dealing with.^[5]