Peyronie’s Disease is a condition marked by penile curvature, indentation and loss of penile length upon erection. This can be with or without pain.
The penis deformity is caused by plaque formation, which is a thick, inelastic scar. This thick, inelastic scar can cause the penis to curve upwards, downwards, or sideways.
- Diagnosis
- What are Peyronies Disease Symptoms?
- What causes Peyronie’s Disease?
- Stages of Peyronie’s Disease
- What is the impact of having Peyronie’s Disease?
- What Treatment Options Are There For Peyronie’s Disease?
- Peyronie’s Disease Surgery Options
- Peyronie’s Disease Treatment Sydney
- Frequently Asked Questions
Diagnosis
These penile abnormalities can occur in males of any age but are most prevalent in men in their 50s. Up to 90 per cent of men with Peyronie’s Disease also experience erectile dysfunction.
To understand what Peyronie’s disease looks like, the penile curvature should be observed.
The formation of scar tissue on one side of the penis shortens that respective side of the penis, resulting in a curvature, i.e. if the scar tissue is on the right side of the penis, the right side will become slightly shortened, creating a pull of the penis to the right. In this article, we have included Peyronie’s disease pictures for reference.
A physical exam is usually enough to find scar tissue in the penis and diagnose Peyronie’s Disease. However, other conditions can sometimes cause similar symptoms, so it’s important to rule them out.
The following tests may be used to diagnose Peyronie’s Disease and determine exactly what is causing your symptoms:
1. Physical examination
Your physician will palpate your penis when it is not erect to determine the location and quantity of scar tissue (American Urological Organization, 2015). Additionally, they may measure the length of your penis. This initial measurement helps detect whether the penis has shrunk if the problem worsens.
Your doctor may also request that you bring home photographs of your erected penis. This can detect the degree of curvature, the location of scar tissue, and other characteristics that may aid in determining the optimal treatment method.
2. Other tests
Your physician may prescribe an ultrasound or other procedures to evaluate your erect penis. You will likely receive an injection directly into the penis to erect it before testing.
Ultrasound is the most common diagnostic method for penile problems. They provide images of soft tissues using sound waves. Moreover, these examinations can detect scar tissue, blood flow to the penis, and other issues.
What are Peyronies Disease Symptoms?
The signs and symptoms of Peyronie’s Disease may manifest suddenly or develop gradually. These are the most prevalent indications and symptoms or signs of erectile tissue damage:
- A bend or curvature in the penis: Your penis may bend upwards, downwards, or to the side.
- Scar Tissue: The scar tissue linked with Peyronie’s Disease (called plaque) can be felt as flat lumps or a band of hard tissue under the skin of the penis.
- Penis constriction (sometimes referred to as “hourglassing”): In some men with Peyronie’s Disease, the erect penis may exhibit constriction, indentations, or an hourglass-like look with a tight, thin band around the shaft (Martinez et al., 2012).
- Erectile dysfunction or difficulty: Men with Peyronie’s Disease may experience difficulty achieving or sustaining an erection. However, men frequently experience erectile dysfunction prior to the onset of Peyronie’s disease symptoms.
- Painful erections or sex-related suffering: You may experience penile discomfort with or without an erection.
- Shortening of the penis: As a result of Peyronie’s illness, your penis could become shorter.
What causes Peyronie’s Disease?
The cause of Peyronie’s Disease is not well understood. In most cases, the disease results from inflammation and plaque formation after repeated trauma to the penis, most commonly occurring during sexual intercourse. However, this is not always the case.
Although there is still a dark cloud surrounding the cause of Peyronie’s disease, it is crucial to understand its symptoms, stages and available treatments.
Stages of Peyronie’s Disease
Urologists divide Peyronie’s Disease into two stages: the acute stage and the chronic stage (Martinez et al., 2012).
During both stages, a bent or curved penis may interfere with sexual activity. Concurrently, patients may also experience Erectile Dysfunction.
Peyronie’s Disease often develops over the course of six months. During this period, it should be monitored frequently so that the right treatment for its current stage can be administered.
First Stage: The Acute Phase
Plaque begins to form in the penis. It gradually expands in size and develops curvature. In this stage, the plaque will be softer and more malleable. During the first few months of the acute phase, patients may not notice a change in their penis.
Patients will typically suffer pain or discomfort, a bent penis and a localised hardness or lump.
Second Stage: The Chronic Phase
The plaque is fully formed and rigid during the chronic phase, and the discomfort has typically subsided. The blood veins surrounding the affected area are clogged with microscopic plaques, causing the penis to bend during erection. In most cases, the patient will experience partial erectile dysfunction, a reduction of circumference and length, and a softening of the penis tip.
What is the impact of having Peyronie’s Disease?
Individuals with Peyronie’s Disease are at risk for the following conditions:
Penile Deformity
- Resulting in an indentation, narrowing, or loss of length
- Can interfere with the ability to engage in sexual activity and penetration
Penile Dysfunction
- Peyronie’s Disease is associated with a reduction in rigidity, or hardness, of erections.
- Correction of the curvature rarely leads to correction of erectile dysfunction.
- If erectile dysfunction coexists with Peyronie’s Disease, treatment options exist that will correct both problems.
- This condition has been recognised to affect a man’s psyche markedly, including causation of depression and anxiety disorders. Appropriate diagnosis and treatment require the help of an experienced medical professional
What Treatment Options Are There For Peyronie’s Disease?
Peyronie’s disease treatment aims to maintain or regain sexual function by straightening the penis. How long it takes to cure Peyronie’s Disease depends on several factors including, but not limited to, degree of penile curvature, the severity of penile shortening, and the presence of penile narrowing, and whether erectile dysfunction is present.
1. Medications
Several oral treatments have been tested to treat Peyronie’s Disease, but their efficacy has not been consistently demonstrated, and they are not as successful as surgery (Martinez et al., 2012).
Injecting medicines directly into the penis may lessen the curvature and pain associated with Peyronie’s Disease in certain individuals. A local anaesthetic may be administered to prevent pain during injections depending on the treatment.
If you undergo one of these therapies, you will likely need several injections over several months. You may also use injection medications together with oral medications or traction treatments.
2. Oral Drugs
Pentoxifylline (Trental) is often the first medicine that doctors prescribe to help straighten the penis. You have to take the pill for a few months to see if it will work.
Some doctors prescribe vitamin E supplements or a form of potassium called para-aminobenzoate, but there is little evidence that these work (American Urological Organization, 2015).
In men with Peyronie’s Disease who also have some erectile dysfunction, drugs to treat ED may help.
3. Penile Injections
Your doctor may suggest injecting a drug into the penis to break up the scar tissue.
Verapamil is a drug that some doctors use. Studies show that it can help many men feel less pain and lessen the curve.
Collagenase clostridium histolyticum (Xiaflex) is another drug used to treat Peyronie’s that is given by injection.
4. Other Treatments
Iontophoresis is a non-invasive procedure that uses an electric current to give verapamil and steroid through the skin. However, available research regarding penile curvature and erectile function reveals contradictory outcomes (Babu & Kayes, 2020).
Several non-drug therapies for Peyronie’s Disease are also under investigation (García-Gómez et al., 2020; Miner & Seftel, 2013). However, information about their efficacy and potential adverse effects is inadequate. The use of powerful sound waves (shock wave therapy) to break up scar tissue (Hauck & Weidner, 2007), stem cells, platelet-rich plasma, and radiation therapy are examples of these treatments.
Peyronie’s Disease Surgery Options
There are three techniques to make the penis straight (American Urological Organization, 2015):
- Shortening the longer side of the penis to create equal length on both sides. Although shortening may occur, the amount of shortening is typically no more than 1-2 cm. This procedure is utilised for less severe cases of Peyronie’s Disease.
- Scar tissue is cut or partially removed on the shorter side. After removing this tissue, the defect is filled with a graft. The resultant penile length is approximately equivalent to the longer side of the penis. This operation is reserved for men with severe deformity and no erectile dysfunction.
- For men with erectile dysfunction and Peyronie’s Disease, a penile prosthesis may be placed, followed by penile straightening with manual modelling. Want to know more about Penile prostheses and how they work? Click here.
Frequently Asked Question
What are the risks of surgery?
Although rare, like any surgery, there are risks involved. Please discuss these with your urologist to understand any risk application to your circumstances. Risks include:
- Change in penile sensation (usually returns in 1-2 months after surgery)
- Recurrent curvature (rare if the deformity is stable for 6-9 months before surgery)
- Erectile dysfunction (this is less likely to occur in men with strong pre-operative erections)
- Penile shortening (usually 1-2 cm if at all)
- Bleeding and infection are complications associated with most surgical procedures but are quite rare with these operations.
Is Peyronie’s Disease serious?
The severity of Peyronie’s Disease is proportional to the degree to which it impacts the lives of persons who have been diagnosed. Although serious, Peyronie’s Disease is not fatal. However, numerous studies show that the disorder contributes to the development of depression and anxiety in male patients (Randhawa & Shukla, 2019). The societal stigma associated with the condition frequently discourages people from obtaining care for their sexual and mental health (Levine, 2013).
Is Peyronie’s Disease life-threatening?
Peyronie’s Disease is not life-threatening. However, it goes without saying that it can have a negative impact on a patient’s life due to pain or performance issues.
How long does it take to develop?
The onset of Peyronie’s Disease might be rapid or gradual. Some cases are moderate and require simply an observation, while others are severe and might impair a man’s sexual abilities.
How does a man get Peyronies Disease?
Peyronie’s Disease may occur due to penile trauma. Additionally, genetics and age are risk factors for Peyronie’s Disease. A Peyronie’s disease-causing injury may also arise under the following conditions:
- During sex, a person can get hurt from a single event or repeated trauma.
- During a sports event, if something hits a man in the penis and causes an injury.
- Any time a man’s penis is injured
- Injuries to the penile area can lead to the buildup of scar tissue, which can be characterised as “Peyronie’s disease.”
There are also additional risk factors that can make you more likely to get Peyronie’s Disease:
- Genetic predisposition
- Health disorders such as Dupuytren’s contracture and other connective tissue disorders
- Smoking
- Prostate surgery
- Aging can weaken penile tissue and increase the risk of damage
What are the early symptoms of Peyronie’s Disease?
Here are some early signs that you shouldn’t ignore when dealing with Peyronie’s Disease
- The penis curves when erect
- Shortening of the penis
- Narrowing or “hourglass” of the shaft of the penis
- Lumps in the penis
- Painful erections or pain during sex
- Soft erections
Does Peyronie’s Disease Hurt?
Yes. Peyronie’s Disease develops on the penis and results in painful, curved erections. Penises vary in size and shape, so a curved erection is not necessarily alarming. However, some men with Peyronie’s Disease experience a significant bend or pain.
Can Peyronie’s go away?
Peyronie’s Disease rarely goes away on its own, but it can be treated. Your doctor may tell you to wait and see if Peyronie’s Disease resolves itself before giving you any medication.
Some symptoms may stay the same or get worse over time. Curvature, shortening, and pain are all bothersome symptoms, but some treatments can help.
What happens if Peyronie’s Disease is left untreated?
Untreated Peyronie’s Disease can worsen symptoms, including a greater degree of curvature, a shorter penis, an inability to engage in enjoyable sexual activity, and/or erectile dysfunction.
Is it Peyronie’s Disease or normal curvature?
It is entirely normal for the penis to have curvature – it’s when that curvature is causing pain that you want to be concerned about. Peyronie’s Disease happens when scar tissue on the penis has formed plaque. Where there is scar tissue, the penis will bend in that direction due to it shortening that side of the penis – for example, if there is scar tissue on the top of the shaft, then the penis will have to bend upwards to compensate, causing a pull on the penis. This can become painful when having an erection, and in some cases, Peyronie’s Disease can even create an hourglass shape on the shaft.
Can Peyronie’s Disease Cause Infertility?
Peyronie’s Disease does not contribute to infertility and cannot cause it.
Can a Vasectomy Cause Peyronie’s Disease?
Peyronie’s Disease can be caused by minor trauma to the penis (i.e. bending during intercourse or sports accidents) and has also been recorded in men who haven’t endured any physical force – which researchers believe may be genetic or environmental. It is unknown if a vasectomy causes Peyronie’s Disease.
What is the best treatment for Peyronie’s Disease?
The best treatment for Peyronie’s Disease is individualised to the particular patient. Some men are managed conservatively, whilst others need careful reconstructive surgery.
When men with Peyronie’s Disease are managed carefully by an experienced urologist, the results are very good.
How do we cure Peyronie’s Disease?
The cure for Peyronie’s Disease is dependent on several factors, including severity and the presence of other symptoms. Some common treatments include medication, injection, electric current therapy, mechanical stretching or surgery.
How can we heal penile scar tissue?
Penile stretching has been known to relieve Peyronie’s through penile traction therapy or by massaging the area with a lubricant. Speak to your urologist to find a treatment that works for you.
For any questions on Peyronie’s Disease, treatment alternatives or pricing arrangements, please call our office on (02) 9477 7904 or fill out the contact form on this page.
Is Peyronie’s disease permanent?
So when men ask me is Peyronie’s disease permanent? The answer is ‘yes’. They generally will always have a palpable scar, but the ill effects such as the pain or the effect on erectile function may not be permanent.
Who is at risk of getting Peyronie’s disease?
It can happen in men who are frequently sexually active or in men who are not very sexually active. There are no particular risk factors for Peyronie’s disease, other than being a man and having a penis. Now for men listening to me talk about Peyronie’s disease, I want to emphasize its nothing you’ve done or haven’t done. It just happens. It’s not your fault. It does get inside a man’s head having a bent erection. Therefore, come forward, come and see me.
Why does Peyronie’s disease occur?
The frank answer is we don’t know.
What are the Non-Operative Options for Peyronie’s Disease?
Men with mild Peyronie’s disease do not need surgery, and they do not need treatment. If they have a lump in the penis, but good erections with a minimal deformity, no treatment is required.
Dr Katerlaris talks about the different forms of Peyronie’s disease and discusses the non-operative treatment options available for the disease and other treatment methods to avoid here:
References:
American Urological Association. (2015). Peyronie’s Disease. Peyronie’s disease guideline – american urological association. Retrieved May 23, 2022, from https://www.auanet.org/guidelines/guidelines/peyronies-disease-guideline
Babu, A., & Kayes, O. (2020). Recent advances in managing Peyronie’s disease. F1000Research, 9, 381. https://doi.org/10.12688/f1000research.20557.1
Bilgutay, A. N., & Pastuszak, A. W. (2015). Peyronie’s disease: A review of etiology, diagnosis, and management. Current Sexual Health Reports, 7(2), 117-131. https://doi.org/10.1007/s11930-015-0045-y
García-Gómez, B., García-Rojo, E., Alonso-Isa, M., Medina-Polo, J., Santos-Pérez de la Blanca, R., Justo-Quintas, J., Parnham, A., Rodríguez-Antolín, A., & Romero-Otero, J. (2020). Treatment of Peyronie’s disease with combination of clostridium histolyticum collagenase and penile traction therapy: A prospective, multicenter, single-arm study. International Journal of Impotence Research, 33(3), 325-331. https://doi.org/10.1038/s41443-020-0292-y
Hauck, E. W., & Weidner, W. (2007). Extracorporeal shockwave therapy in Peyronie’s disease. Peyronie’S Disease, 121-131. https://doi.org/10.1007/978-1-59745-161-1_11
Levine, L. (2013). The clinical and psychosocial impact of Peyronie’s disease. AJMC. Retrieved May 23, 2022, from https://www.ajmc.com/view/a449_13mar_peyronies_levine_s55
Martinez, D., Ercole, C. E., Hakky, T. S., Kramer, A., & Carrion, R. (2012). Peyronie’s disease: Still a surgical disease. Advances in Urology, 2012, 1-5. https://doi.org/10.1155/2012/206284
Miner, M. M., & Seftel, A. D. (2013). Peyronie’s disease: Epidemiology, diagnosis, and Management. Current Medical Research and Opinion, 30(1), 113-120. https://doi.org/10.1185/03007995.2013.842544
Randhawa, K., & Shukla, C. J. (2019). Non-invasive treatment in the management of Peyronie’s disease. Therapeutic Advances in Urology, 11, 175628721882367. https://doi.org/10.1177/1756287218823671