We Have Questions: Peyronie's Disease

No two penises are the same. They vary in length, girth, shape and color—some even curve a little to the left, right, up or down. If that curve goes past 30 degrees, however, it becomes a condition known as Peyronie's disease.

A slight penis curvature is common, said James A. Kashanian, M.D., a urology professor and director of male sexual health at Weill Cornell Medical College in New York City. A curve between 5 degrees and 30 degrees is normal and occurs in as many as 1 in 5 men, one Australian study suggests.

Peyronie's disease, which occurs when fibrous scar tissue develops in the penis and causes it to curve, is found in an estimated 6 percent to 8 percent of men, Kashanian said. Peyronie's disease is not life-threatening, but can cause pain, erection issues and other detrimental effects on a man's quality of life.

In this interview, Kashanian answers questions about Peyronie's disease and explains when penis curvature becomes a cause for concern.

Editor's note: This interview has been edited for length and clarity.

What causes a penis to curve?

Kashian: Penile curvature falls into two categories: One is congenital, or something that you're born with, and the other one is acquired.

Congenital penile curvature occurs when the tissues surrounding the erectile cylinders of the penis—called the tunica albuginea—-don't develop equally. When this occurs, some tissues become more fibrous and less elastic. When the penis gets erect, part of the penis may stretch and curve in the direction of the more elastic tissues. Congenital curvature to varying degrees is common.

Then, there's the acquired type of penis curve, which oftentimes comes from some sort of penile trauma or injury. This can cause a buildup of plaque or scar tissue under the skin of the penis, a condition called Peyronie's disease.

What are the symptoms of Peryonie's disease?

With Peryonie's disease, plaque or scar tissue can cause curvature in addition to volume loss and the narrowing or shortening of the penis. In some cases, it can also cause erectile dysfunction and pain.

Peyronie's disease has two phases: the acute or active phase and the chronic phase. During the acute phase, things are changing. A mild curvature on day one may become more pronounced in weeks or even months. The chronic phase occurs when curvature has stabilized for six to 12 months.

How is Peryonie's disease treated?

Treatment options largely depend on symptoms, the degree of curvature and whether erectile dysfunction occurs. There's an FDA-approved medication called collagenase clostridium histolyticum, or Xiaflex, which is injected directly into the penis to target plaque or scar fibers and break them down.

Then, there are surgical options, which revolve around the degree of curvature and erectile function. Urologists may perform Peryonie's disease plication surgery, where they put stitches opposite the curve and straighten out the penis. In other instances, urologists may remove the scar and put a graft in its place to straighten out the penis.

Men with the most severe degree of Peyronie's disease and erectile dysfunction may have a penile implant recommended to them.

How much penis curvature is too much? When should you seek treatment for Peryonie's disease?

If you notice a difference in the shape of the penis, it's never too soon to visit your doctor. The sooner you do, the sooner a qualified professional can help with treatment options and intervention.