What Are the Symptoms and Causes of Peyronie's Disease?

Peyronie's disease is a multifaceted condition that affects the penis. It involves the man's erect member taking on a new curvature or another shape it didn't previously have. But what causes Peyronie's disease and what are its symptoms?

The condition isn't life-threatening, nor is it particularly dangerous. Peyronie's can, however, cause physical, mental and emotional complications for men and their partners. Here, we'll dig into what Peyronie's is and what it isn't, look at some of the potential reasons the condition occurs and tell you how to recognize the ways it might appear.

What is Peyronie's disease?

By a certain age, guys realize penises come in all shapes and sizes. Some are longer than others. Some are thinner. Some are thicker. Some have a mushroom-shaped head, some more of a helmet. And some are more curved than others. It's just the roll of the genetic dice.

Despite the sometimes-debilitating insecurity with which some men regard the appearance of their penis, it takes quite a remarkable specimen to fall outside the range of what's considered normal.

Peyronie's may have a genetic component—Caucasian men are most frequently affected—but it's an acquired condition that people aren't born with.

Most men affected by Peyronie's usually only encounter the condition once they're 40 or older. According to some estimates cited by the National Institutes of Health (NIH), Peyronie's may affect up to 1 in 10 men, though it often goes unreported.

The curvature associated with Peyronie's is due to a build-up of scar tissue on a structure inside the penis called the tunica albuginea. The tunica is a thin but tough membrane that runs the length of the shaft of the penis on the inside. It surrounds and supports the corpus cavernosa—the chambers that fill with blood when a man gets an erection—and helps to trap the blood there.

Sometimes, this sheath can be damaged, either through one traumatic event or by simple wear and tear over the years. This damage causes scar tissue—aka plaque—to build up as the tunica heals, making the erect penis curve in the direction of the original trauma.

The curvature can be quite profound or a slight bend.

Urologists don't typically recommend invasive interventions such as surgery unless the curve interferes with intercourse. About 30 degrees of curvature is the general guideline.

Many men live perfectly normal lives with some version of this condition.

What causes Peyronie's disease?

The cause of Peyronie's disease is the scar tissue that develops on the damaged part of the tunica albuginea. Scar tissue develops due to trauma and pulls the penis into a new shape.

There is no shortage of men who report a single traumatic event in which they heard and felt a "crack" in their penis during vigorous sexual activity. Often, the anecdotal reports include stories of the man's partner being on top and his penis slipping out.

The partner's weight coming down on the end of the penis then causes it to "crack," usually indicating a tear in the tunica. Sometimes, though, it may include damage to the corpus cavernosa, too.

That was the standard model of what was thought to cause Peyronie's for many years. Plenty of men know the exact moment they "broke their penis," thus beginning the process of scar tissue build-up that would become Peyronie's.

However, urologists today are leaning more toward a model that includes the possibility that micro-trauma occurring over many years may be as much or more of a cause than a single unlucky injury.

This hypothesis fits with the fact that mostly older men develop the condition—men who've been using their penises for decades longer than their younger counterparts and wearing down those interior structures.

The micro-trauma theory also fits with the idea that older men are more likely to have erection difficulties. A penis that isn't quite as hard as it could be is more likely to bend in unfortunate ways, possibly leading to micro-tears in the tunica that scar over and cause more permanent bending.

"There's a lot of debate about that: which came first, the Peyronie's or the ED [erectile dysfunction]?" said Neel Parekh, M.D., a men's fertility and sexual health specialist with Cleveland Clinic. "We don't know for sure. But if a guy's having issues with his erections, then maybe their erections aren't as rigid, so there's a little more bend to the penis. Bending all the time could cause the scar tissue to form."

What are the symptoms of Peyronie's disease?

The main symptom of Peyronie's is a newly developed curve or other change in the shape of your erect penis. When the penis is soft, the curvature is usually not detectable to the naked eye. A urologist may be able to locate the bundles of scar tissue in the tunica albuginea with a manual exam of a flaccid penis.

Other common symptoms include the following:

• A loss of apparent length in the penis
• Loss of girth in the shaft, which may appear to have an hourglass shape or an indentation
• Pain when your penis is erect
• Lumps in the penis
• Erections that aren't as hard as they were before
• Pain during sex
• Difficulty with sex for you or your partner

"Peyronie's is basically a deformity of the penis that can cause curvature or changes in the shape of the penis," said Amy Pearlman, M.D., a men's health specialist and co-founder of Prime Institute in Fort Lauderdale, Florida. "In its simplest form, it's a scar. In many people, it may not cause any bothersome symptoms, and some guys will come in just for reassurance.

"But it can cause pain, or cause the partner pain, and if you know that you're causing your partner pain while you're penetrating, that can also affect how enjoyable sex is."

This symptom—that Peyronie's can sometimes cause the man's erections and penetrative sex to be painful—can lead to other complications, such as ED. Experiencing pain while having sex could directly contribute to ED. Even a mental association between a painful penis and sex could exacerbate ED over the long term. The pain can last 12 to 18 months as the condition develops—called the acute phase.

"Some guys won't have any pain, and some guys will have a lot of pain," Pearlman said. "And every time they get an erection, it's not just pain because there's a pull in that area. It's actually really tender. The plaque is inflammation, and inflammation is what causes pain. It can take months for that pain to go away."

Conclusions

Peyronie's disease, or a newly formed curvature to the penis later in life, is a more common condition than you might think. It's not the same as a naturally curved penis that many men are born with.

While Peyronie's can be somewhat painful during its early phase, the pain usually subsides once the condition stabilizes—known as the chronic phase.

For people whose pain continues, or for whom the curvature is too great to tolerate, there are very effective treatments for Peyronie's. We will cover those in a future story.