Key Takeaways
- Peyronie’s disease involves the formation of scar tissue, or plaque, in the penis, leading to curved and often painful erections, which can impact sexual function and cause distress.
- While there’s no definitive cure, treatment options range from medications like Xiaflex injections to nonsurgical methods such as penile traction therapy, and in severe cases, surgical interventions.
- Although the exact cause isn’t known, Peyronie’s disease is thought to arise from penile trauma, with certain factors like connective tissue disorders and older age increasing the risk.
A rare form of erectile dysfunction (ED), Peyronie’s disease results in a bend in the penis that can make an erection painful. There are two phases of Peyronie’s disease, which include:
- This is an acute phase, during which plaque forms and the penis starts to curve. People may experience pain with and without an erection.
- This is a chronic phase, beginning
12 to 18 months after the first symptoms start. In this phase, once the plaque has formed, pain may improve, though people may develop or experience worsening ED.
While a curved erection doesn’t always indicate a problem, people who have Peyronie’s disease may have trouble having sex. This often causes anxiety and discomfort.
Keep reading to learn and understand more about Peyronie’s disease.
The main indicator of Peyronie’s disease is the formation of flat scar tissue called plaque. This scar tissue can generally be felt through the skin.
Plaque normally forms on the top side of the penis, but it may also occur on the bottom or side. Sometimes plaque goes all the way around the penis, causing a “waisting” or “bottleneck” atypical formation. Plaque may gather calcium and become very hard.
Symptoms of Peyronie’s disease may include:
- scar tissue on the penis that may feel like hard lumps
- painful erections
- soft erections
- severe curvature
- shrinkage or shortening of the penis
- changes in penis shape
- erectile dysfunction
Scar tissue on a certain part of the penis reduces elasticity in that area. Plaque on the top of the penis may cause it to bend upward during an erection. Plaque on the side may cause curvature toward that side. More than one plaque can cause complex curvatures.
Curvature may make sexual penetration more difficult. Scar tissue may cause shrinkage or shortening of the penis.
If you think you have Peyronie’s disease, the first step is seeing a primary care doctor. Your appointment may include:
- reviewing your medical history
- reviewing your family history
- having a physical exam that may involve measuring the penis
- having an ultrasound to reveal the location of scar tissue
By measuring the penis, a doctor can identify the location and amount of scar tissue. This also helps determine whether your penis has shortened.
A doctor may also refer you to a urologist.
There’s no cure for Peyronie’s disease, but treatment may help reduce symptoms. In rare cases, it may also go away on its own. Though it may be tempting to request medication right away, many doctors prefer the “watchful waiting” approach if symptoms are not severe.
Medication
A doctor may recommend medications or even surgery if you’re experiencing more pain or penis curvature over time.
Nonsteroidal anti-inflammatory drugs (NSAIDS) are typically the first-line treatment recommendation for pain.
Doctors
Intralesional injectables are typically the main, ongoing treatment for the condition. They involve a series of penile injections that break down collagen buildup.
The American Urology Association (AUA) guidelines recommend the following injectable treatments for Peyronie’s disease:
- Xiaflex (active ingredient collagenase clostridium hystolyticum), approved by the Food and Drug Administration (FDA) for people whose penis curves more than
30 degrees during erection - injectable verapamil, which is usually used to treat high blood pressure, may reduce pain and curvature
- interferon injections, which help break down fibrous tissue
It’s important to note that sometimes oral medications, such as tadalafil, sildenafil, or pentoxifylline, are prescribed.
Nonsurgical options
Researchers are investigating nondrug treatments, such as:
- penile traction therapy to stretch the penis, such as RestoreX
- shockwave therapy to break up scar tissue
- vacuum devices
People receiving Xiaflex treatment may benefit from gentle penile exercises. For 6 weeks after treatment, doctors may recommend the following two activities:
- Stretch the penis when not erect three times daily for 30 seconds per stretch.
- Straighten the penis when experiencing a spontaneous erection unrelated to sexual activity for 30 seconds once daily.
Lifestyle changes
Some lifestyle changes may reduce the risk of ED related to Peyronie’s disease. These include:
- quitting smoking if you smoke
- reducing alcohol consumption if you consume alcohol
- stopping drug misuse
- exercising regularly
- avoiding activities that can cause trauma or microtrauma to the penis
Surgery
Surgery is the last course of action for severe penis deformity. According to the
- removing the plaque
- shortening the unaffected side
- lengthening the scar tissue side
- penile implants
Lengthening runs a greater risk of ED. Shortening the unaffected side is used when curvature is less severe.
One type of shortening is a procedure called the Nesbit plication. In this procedure, doctors remove or cinch excess tissue on the longer side. This creates a straighter, shorter penis.
Natural remedies
More evidence is still needed about natural remedies for Peyronie’s disease. The American Urological Association stresses that the current evidence is insufficient to recommend their use.
AUA guidelines and
- sports injuries
- vigorous sex
- micro-injuries that occur over time
This can cause bleeding and subsequent scar tissue buildup.
While injury may cause the condition in some cases, the
Some people may be
- people with connective tissue disorders, such as Dupuytren’s contracture, which is a thickening in the hand that makes your fingers pull inward
- people with autoimmune disorders such as systemic lupus erythematosus, Sjögren disease, and Behcet disease
- people with family members who have Peyronie’s disease
- people who are older, as tissue changes lead to increased injury and slower healing as people get older
- people with diabetes-associated ED
- people who have surgery for prostate cancer
Complications may result from Peyronie’s disease and can include:
- emotional stress, depression, or anxiety
- ED
- inability to have sex or difficulty during sexual intercourse
- inability to conceive a child due to an inability to engage in intercourse
You can seek support from your healthcare team, which may include your doctor and a mental health professional, to help you better understand and manage these complex issues.
Can I prevent Peyronie’s disease?
Currently, there is no definitive way to prevent Peyronie’s disease. However, you may be able to reduce some of your risk factors, which can include avoiding trauma to the penis and quitting smoking if you smoke.
Are there clinical trials for Peyronie’s disease?
Clinical trials for Peyronie’s disease may involve new medications or new combinations of treatments. It’s best to talk with a doctor about whether a clinical trial is right for you and to learn more about open clinical trials for Peyronie’s disease.
Does Peyronie’s disease go away?
Rarely, Peyronie’s disease may go away without treatment. Doctors may recommend “watchful waiting” for mild cases to see if pain resolves after the acute phase.
What happens if Peyronie’s is left untreated?
Rarely, Peyronie’s disease may go away on its own. Pain may resolve after the acute phase. But if the curvature is severe or you experience severe or lasting pain, a doctor may be able to prescribe treatment and recommend ways to help prevent complications, such as stress and difficulty having sex.
Research is underway to help scientists better understand what causes Peyronie’s disease. Researchers are investigating the process by which the condition develops with the goal of creating an effective therapy to help people manage it.
As research continues, it’s important to work with your healthcare team to understand, monitor, and manage your condition.