The Straight Facts About Reconstructive Surgery for Peyronie's Disease

Even if you feel like you're in the best of health, a painful sensation in your penis is cause for alarm. Penile pain is highly uncomfortable, difficult to ignore and usually implies something has gone seriously wrong. Given that the penis is used for both "business" and pleasure, pain should absolutely be addressed immediately.

When the pain occurs is as important as where, however, and can be a huge indicator of the exact problem. Pain while urinating could indicate a sexually transmitted infection (STI), a urinary tract infection (UTI), a kidney stone or even cancer or prostate disease. If you experience pain at other times, you might have sustained an injury, or suffered a strain after too much sexual activity.

If the pain comes during an erection, well, it might be Peyronie's disease.

What is Peyronie's disease?

Peyronie's disease is a condition in which plaques—segments of flat scar tissue—form under the skin of the penis, causing painful curvature in erections, difficulty maintaining an erection, and deformities to the penis, such as narrowing, shortening and an "hourglass shape."

"The majority of people do not have a clear, identifiable cause for their Peyronie's disease," said Paul Chung, M.D., a reconstructive urologist serving Philadelphia and Cherry Hill, New Jersey. "While Peyronie's disease has been shown to have a familial component, and also separately related to soft tissue diseases such as Dupuytren's contracture, the majority of people likely develop Peyronie's disease from trauma to the penis."

Chung established most men are less likely to develop Peyronie's disease from severe events, such as penile fracture, than from micro-traumas occurring from penetration with a weak erection, in what he described as a "buckling injury."

Treatment for Peyronie's disease

Men can choose from quite a few Peyronie's treatment options, including oral medications, injection therapy, traction devices and surgical therapy.

Each of these has its own requirement of duration, pros, cons and degree of success. And, naturally, the choice also comes down to personal preference.

For some people, the idea of surgery can be terrifying.

"Deciding on a course of treatment can be overwhelming," acknowledged urologist S. Adam Ramin, M.D., founder and medical director of Urology Cancer Specialists in Los Angeles. "Wanting to make the right choice specific to a very personal situation, to cause the least harm and achieve the greatest benefit, can be quite the daunting task. It has been my experience, in medicine and life in general, that people tend to shy away from things they aren't familiar with."

Understanding the process of surgery before going in is crucial to ensuring it's the right decision.

How Peyronie's surgery works

Surgery for Peyronie's disease can be performed in different ways, but generally, patients undergo penile plication and plaque incision/excision grafting.

"People with Peyronie's disease develop shortening of one side of the penis, which causes curvature," Chung said. "Penile plication is a quick outpatient procedure where stitches are placed on the opposite side of the curvature to cause equal shortening of the penis and straightening of the penis. This allows for near-complete correction of the curvature with one 30- to 45-minute surgery."

Overall, penile plication surgery is a minor procedure with a minimal recovery period, and pain and discomfort that are well tolerated. The biggest downside with this procedure, however, is men can lose some length in their penis—not enough to make penetration impossible, but a noticeable amount.

"It's about restoring function," Chung said. "This procedure does nothing for the plaque."

In more severe cases or when a man wants maximum restoration, surgeons additionally conduct plaque incision/excision grafting, a more involved approach in which they manipulate the shell of the penis to remove plaque and physically reconstruct it. Men are less likely to see a significant reduction in length—this is often called a "lengthening" procedure—but it might still happen due to contracture of the graft.

'People will benefit [from] seeing a specialist who can actually offer all treatment options.'

The grafting process can lead to erectile dysfunction (ED), so it is often combined with the addition of a penile implant.

Due to the obvious personal and sensitive nature of the surgery, both Chung and Ramin caution patients to have thorough conversations with their doctors before undergoing the surgical process.

"The research tells us that with increased skill, training and experience comes a decrease in the risk of surgical complications," Ramin said. "In order to obtain the greatest possibility of curative treatment while also optimizing a patient's quality of life, it is crucial that any type of surgery be performed only by highly skilled surgeons at centers that support highly technical programs."

"Selecting the best treatment option relies on having an in-depth discussion about the patient's goals, desired treatment timeline, presence of existing erectile dysfunction, and preferences of approach," Chung added. "People will benefit [from] seeing a specialist who can actually offer all treatment options."

Naturally, the best-case scenario for anyone is to not develop Peyronie's disease in the first place. Help yourself avoid damage to your penis during sex by using lubrication, thrusting in an in-and-out motion, making sure you're rigidly erect, and being careful when you're on the bottom, because penile fractures commonly happen when a partner on top lands incorrectly.