The Facts About Peyronie's Disease

Penises vary in shape and size, and while a slight bend isn't necessarily a cause for concern, a serious curve could be a serious problem. Peyronie's disease, also known as penile fibrosis, is a condition in which scar tissue builds up inside the penis and creates curvature in erections. Peyronie's disease can cause erectile dysfunction (ED) and painful intercourse, as well as anxiety and stress.

About 1 in 100 men in the United States have been diagnosed with Peyronie's, but based on reviews of reported symptoms, some researchers postulate that as many as 1 in 10 men could be living with it undiagnosed. Although Peyronie's disease can affect men at any age, it is most common in men older than 40.

The symptoms of Peyronie's can be managed, but the disease rarely goes away on its own. If you think you may have Peyronie's disease, talk to your doctor so you can start treatment immediately.

Causes of Peyronie's

Peyronie's disease is caused by plaque, or scar tissue, which causes the penis to bend when erect. Why the scar tissue builds up in the first place is often unknown but can sometimes be the result of physical trauma to the penis, either from a sports injury or vigorous sex. If the penis heals from that trauma incorrectly, the scar tissue can create a nodule that leads to curvature.

Evidence indicates a possible genetic influence, so it's worth checking your family history to see if any relatives have experienced Peyronie's. It is often seen in men with connective tissue disorders, such as Dupuytren's contracture, which is the inability of a finger to straighten due to abnormal scar tissue.

While Peyronie's disease is more commonly diagnosed as men age, it should not be considered a normal effect of aging.

Symptoms of Peyronie's

In most cases, symptoms of Peyronie's disease won't become apparent until the penis is erect and may appear suddenly or gradually over time. Men should look for the following:

• A hard lump (plaque)—more than one is rare—in the shaft of the penis
• A curve in the penis when erect, most commonly curving upward
• A change in the shape of the penis, which may appear narrower or shorter
• Pain during an erection
• Pain during sex or, in severe cases, a complete inability to perform due to curvature and pain
• Erectile dysfunction, which can occur when Peyronie's disease is unchecked

The curvature and shortening of the penis can gradually worsen over time, but the disease usually stabilizes after a few months.

Peyronie's disease has two distinct phases: acute and chronic.

Acute

This phase lasts from six to 18 months while the plaque is still forming and growing. Over this period, the penis begins to curve, and you may begin to experience pain with or without an erection.

Chronic

Normally beginning 12 to 18 months after the initial symptoms of Peyronie's disease, this phase sees the plaque and the curvature begin to plateau. Pain during an erection can lessen or even disappear, but problems with erectile dysfunction can occur.

Complications of Peyronie's

For some men, Peyronie's disease can lead to complications, including painful intercourse (or the inability to have intercourse), erectile dysfunction, reduced penis length, and stress and anxiety over sexual performance and penis appearance. In addition, it can be difficult to father a child because of painful or impossible intercourse.

Diagnosis and treatment of Peyronie's

A physician can often diagnose Peyronie's disease with a physical examination since the hard plaque can be felt when the penis is erect or flaccid. In some cases, the doctor may administer an injection that causes an erection so they can observe the curvature of the penis. If you'd like to avoid this procedure, consider bringing a picture of your erect penis.

Not every case of Peyronie's disease requires treatment. If the plaque is not causing pain, ED or difficulty during intercourse, treatment may be unnecessary. However, if you are experiencing problems and your doctor thinks treatment will help, then you have options.

Penile injections

Penile injections have been found to have great success and may be your doctor's go-to option. Verapamil, collagenase and interferon are the three types of injection medications usually offered to treat Peyronie's disease, but collagenase (Xiaflex) is the only one approved by the Food and Drug Administration and will most likely be the one your doctor recommends. Injections are not recommended for patients in the acute phase of the disease. Only when the plaque is stable and painless are injections considered. Side effects for injection could include a hematoma at the injection site and a possible penile fracture, which requires emergency surgery. Oral medication is not recommended by urologists to treat Peyronie's disease.

Surgery

In severe cases, if symptoms do not improve and Peyronie's disease is beginning to have a negative impact on your life, surgery may be recommended. One of three types of surgery is usually offered:

• Cutting away the plaque and attaching a patch of skin to straighten the penis.
• Removing an area of the penis opposite the plaque to correct the curvature. This procedure may result in a slight shortening of the penis.
• Inserting an inflatable penile prosthesis to straighten the penis (suggested only for sufferers of Peyronie's disease and erectile dysfunction).

Peyronie's disease can sometimes resolve on its own, so doctors usually recommend waiting at least 12 months before considering surgery. Since the treatment varies from person to person and is very specific to the individual, it is best to speak to a doctor if you are concerned about curvature in your penis.

Living with Peyronie's

One of the more frustrating consequences of living with Peyronie's disease is how long it takes to successfully diagnose and treat the condition. As soon as you notice any Peyronie's symptoms, schedule an appointment with your doctor to get started on treatment right away. The earlier you start treatment, the better. Communicate with your partner about what Peyronie's is and how it affects your sex life. If your mental health is suffering, reach out to a mental health professional to discuss ways to manage your anxiety.