The Facts About Peyronie's Disease

Peyronie's disease is marked by a bend or curvature in the erect penis. It can cause sex to be painful and even contribute to sexual dysfunction.

Peyronie's disease is a condition in which a man's erect penis develops a new bend or curvature that wasn't there before. While penises naturally have a wide variety of shapes, sizes and curves to them, Peyronie's refers to a new curve that occurs later in life. It's caused by a buildup of scar tissue (also called plaque) in the structures beneath the surface of the penis.

There seems to be a genetic component to Peyronie's, as it runs in families. Other cases may involve a traumatic incident that "breaks" the tough inner sheath of the penis called the tunica albuginea. For instance, a missed thrust during vigorous sexual activity is often blamed, or sometimes a sports injury.

The condition is most common among men between 40 and 70 years old. More urologists are leaning toward a theory that Peyronie's is often not the result of a single incident. Rather, it is due to years of wear and tear—microtrauma—to the substructures of the penis, the subsequent weakening of the tissue and the healing process that creates scar tissue.

Another contributing factor may be that older men can often have erections that aren't as robust, and they may be more easily bent in awkward ways during sex, which can lead to trauma.

The symptoms of Peyronie's generally won't be apparent until the penis is erect. They may include the following:

• A hard lump in the shaft of the penis
• A new curve when the penis is erect, frequently in an upward direction
• A change in the shape of the penis—for instance, an hourglass shape or a "doughnut" bulge encircling the penis
• A change in the length of the penis (the curve may make it appear shorter)
• Pain when erect
• Pain during sex, particularly during penetration
• Erectile dysfunction (ED), either new or worsening

The curvature and apparent shortening of the length of the penis may gradually grow more acute over the initial period in which Peyronie's is developing, but generally, they stabilize after the first few months.

The effects of Peyronie's are most apparent when the penis is erect. A healthcare provider, though, can usually detect the plaque via a manual exam even when the penis is flaccid by feeling for the lump of plaque or scar tissue.

In some cases, especially if they're evaluating the need for more invasive treatment, the provider may feel it necessary to evaluate the degree of curvature of the penis in its erect state. They may suggest an injection in the office to make it erect—likely the most accurate way to properly diagnose the degree of curvature—or that you bring in a picture of your erect penis.

Knowing how severe the curvature is can help your provider recommend the best approach to treatment. If the curve isn't very pronounced, they may tell you treatment isn't necessary.

Your healthcare provider may recommend one of a variety of treatments if the curvature of the penis is more than 30 degrees, if it's causing uncomfortable or painful sex, or if it's causing you distress.

Xiaflex

Xiaflex is the sole FDA-approved medication for the treatment of Peyronie's. It contains an enzyme that breaks down the fibrous scar tissue in hopes of helping to straighten the penis. It's injected directly into the penis. This collagenase injection is labor-intensive for the patient and requires eight to 12 weeks of injections.

Penile traction

This non-invasive form of therapy involves wearing a device for several hours per day that encourages the elongation and straightening of the penis. A 2019 study suggested that wearing the device for at least six hours daily was optimal, adding that it appeared to help some men extend their length by up to 4 centimeters. But that is regaining length that was lost, not new length.

Penile implants

A surgically implanted device can help straighten the penis, as well as help to give the man stronger erections.

Sheath surgery

In some extreme cases, providers may recommend surgery to remove the scar tissue. Another method is plication, which entails putting in stitches to shorten the longer side so it matches the length of the scar tissue side, thus straightening the penis. However, it makes it slightly shorter.

Men's erections naturally become less rigid with age, which may make it more difficult to maintain an erection throughout sex. Because they're more bendable, softer penises are more prone to unexpectedly bending during sex, which can result in the kind of trauma that causes Peyronie's.

Some methods of preventing the condition include the following:

• Use ED meds or devices. Making sure your erection is fully hard can help prevent unexpected bends.
• Use lube. Lubricants can help reduce friction, thus reducing the chance of trauma.
• Guide the penis when inserting it. Don't thrust blindly, especially if it slips out. Carefully guide yourself back in place rather than risk a misplaced thrust.
• Take extra care with the partner on top. Most providers who deal with this sort of thing will tell you the riskiest position for penile trauma is when the receiving partner is on top. Their body weight can slam down on the end of the penis if it slips out mid-action.

Some 6 percent to 10 percent of men may be affected by Peyronie's disease, according to Cleveland Clinic, so it's something millions of people live with every day. In fact, unless the curvature is more than 30 degrees, and as long as the condition doesn't cause too much discomfort, most urologists won't be too quick to recommend invasive treatment.

The results of Peyronie's disease may not even be permanent. The condition sometimes resolves itself.

There is a period called the acute phase, which lasts about six to 12 months. During the acute phase, getting an erection and especially having sex may be uncomfortable or even slightly painful. And the shortening effect can cause men some mental anguish. However, with proper counseling and being open and honest with your partner about your situation, most men with less-severe curves can learn to cope.

One of the most common ways that Peyronie's comes to light in a healthcare provider's office is when a man comes in to talk about ED. The two conditions often co-occur, and not only because they both commonly affect men in the same age group: 40 to 70. That's because one condition may contribute to the other and vice versa; with less-robust erections, the risk of an unexpected bend is greater.

With the discomfort, possible pain and possible embarrassment about the changing shape of his penis, a man's erections might not happen as easily. It's important to talk to a healthcare provider about treatment, yes. It's also important to talk with your partner and consider seeing a sex therapist or psychiatrist to discuss potential mental issues.

Another sexual implication of Peyronie's that's often overlooked is the partner's comfort. The new configuration of the penis, if the bend is great enough, may cause one's partner discomfort during penetration, or even pain.

Again, open lines of communication are key, as is talking with a urologist about your options for treatment.

The prognosis for men with Peyronie's is largely very positive. It's important to remember that the symptoms may not even be permanent. The discomfort and (usually minor) pain you experience at first will usually pass within a year. It doesn't affect anything else, such as your fertility. You can just think of it as your penis having an exciting new look for spring.

Millions of men live with the condition, and as long as the curvature is less than 30 degrees, doesn't cause discomfort or pain once the chronic phase has set in, and doesn't cause undue mental anguish, men often learn to live with it.

Remember that if you do opt for treatment, it's a long road that may take months before you see any changes. And sometimes the changes are less profound than what you might have hoped.

As with all things to do with sexual health, it comes down to a conversation between you, your partner and your healthcare providers as to what the best way forward is.

Does Peyronie's disease go away?

Yes, actually, Peyronie's can go away—sometimes. Some milder cases of the condition have been known to go away on their own, according to Cleveland Clinic, but more severe curvature or scar tissue rarely resolves without intervention.

What does Peyronie's disease look like?

The condition causes the erect penis to curve in a new way. This frequently means that the penis, when erect, will have a new upward curve, but the curve may be to the side or even downward. It's usually not visible to the naked eye when the penis is flaccid.

What happens if Peyronie's is left untreated?

Usually not much. The first six to 12 months are called the acute phase, during which the scar tissue builds, and the curvature settles into its new configuration. It may be slightly uncomfortable during this time to get erect or have sex, but it soon passes. If the curve isn't too severe or bothersome in other ways, it's easy to live with the condition.