Peyronie's Disease: Understanding Penile Curvature
A comprehensive guide to Peyronie's disease, a condition causing penile curvature and potential erectile dysfunction due to scar tissue formation.
What is Peyronie's Disease?
Peyronie's disease is a connective tissue disorder that causes fibrous scar tissue (plaque) to develop inside the penis. This plaque causes the penis to curve or bend during erections, which can make sexual intercourse difficult or impossible and may cause erectile dysfunction.
Men affected worldwide
Average age of onset
Also have erectile dysfunction
Signs and Symptoms
Physical Symptoms
- • Penile curvature: Bending during erection (upward, downward, or sideways)
- • Palpable plaque: Hard lumps or bands under the skin
- • Penile shortening: Reduction in length or girth
- • Indentation: Narrowing or "hourglass" shape
- • Erectile dysfunction: Difficulty achieving or maintaining erections
Pain and Discomfort
- • Penile pain: During erection or at rest (acute phase)
- • Painful intercourse: For both partners
- • Tenderness: When touching the plaque area
- • Discomfort: During physical activity
- • Psychological distress: Anxiety, depression, relationship issues
Phases of Peyronie's Disease
Acute Phase (Inflammatory)
Characteristics:
- • Duration: 6-18 months
- • Active inflammation and pain
- • Progressive curvature development
- • Plaque formation and growth
- • Possible penile shortening
Treatment Focus:
- • Pain management
- • Anti-inflammatory medications
- • Prevent further curvature
- • Oral medications
- • Topical treatments
Chronic Phase (Stable)
Characteristics:
- • Pain typically resolves
- • Stable curvature (no progression)
- • Plaque may calcify
- • Erectile function may worsen
- • Psychological impact continues
Treatment Options:
- • Injection therapy
- • Surgical correction
- • Penile traction devices
- • Shock wave therapy
- • ED medications if needed
Causes and Risk Factors
Potential Causes
- • Penile trauma: Injury during sexual activity
- • Genetic factors: Family history of connective tissue disorders
- • Autoimmune response: Body's immune system attacks penile tissue
- • Aging: Changes in collagen and elastin
- • Repeated microtrauma: Minor injuries over time
Risk Factors
- • Age: More common after age 40
- • Dupuytren's contracture: Hand connective tissue disorder
- • Diabetes: Increased risk of connective tissue problems
- • Smoking: Affects blood flow and healing
- • Certain medications: Beta-blockers, anti-seizure drugs
Diagnosis
Physical Examination
Palpation:
- • Feel for plaque or scar tissue
- • Assess plaque size and location
- • Check for calcification
- • Evaluate penile sensation
Measurement:
- • Penile length assessment
- • Curvature angle measurement
- • Girth evaluation
- • Photography for documentation
Imaging Studies
Ultrasound
Visualizes plaque location, size, and calcification. Can assess blood flow.
MRI
Detailed imaging of penile anatomy and plaque characteristics.
X-ray
May show calcified plaques but not routinely used.
Treatment Options
Oral Medications
First-line Options:
- • Pentoxifylline: Improves blood flow, reduces inflammation
- • Vitamin E: Antioxidant properties (limited evidence)
- • L-Carnitine: May reduce pain and curvature
- • Colchicine: Anti-inflammatory effects
Effectiveness:
- • Limited scientific evidence
- • May help with pain in acute phase
- • Minimal impact on curvature
- • Generally well-tolerated
Injection Therapy
Xiaflex (Collagenase):
- • FDA-approved for Peyronie's disease
- • Breaks down collagen in plaque
- • Series of injections over months
- • 20-30% reduction in curvature
- • Most effective treatment option
Other Injections:
- • Verapamil: Calcium channel blocker
- • Interferon: Anti-inflammatory protein
- • Steroids: Reduce inflammation
- • Hyaluronidase: Breaks down scar tissue
Surgical Options
Plication
- • Shortens longer side
- • Preserves erectile function
- • May cause shortening
- • Outpatient procedure
Plaque Excision
- • Removes scar tissue
- • Grafting may be needed
- • Risk of ED
- • For severe curvature
Penile Implant
- • For ED + curvature
- • Corrects both problems
- • Permanent solution
- • High satisfaction rates
Non-Surgical Treatments
Penile Traction Therapy
Mechanical stretching device worn for several hours daily to gradually straighten the penis.
- • Duration: 6-8 hours daily for 6 months
- • Benefits: May reduce curvature and increase length
- • Evidence: Some studies show modest improvement
- • Compliance: Requires dedication and consistency
Shock Wave Therapy
Low-intensity extracorporeal shock wave therapy to break down scar tissue.
- • Sessions: Multiple treatments over weeks
- • Mechanism: Breaks down fibrous tissue
- • Evidence: Limited but promising results
- • Side effects: Minimal, well-tolerated
Living with Peyronie's Disease
While Peyronie's disease can be challenging, many men successfully manage the condition and maintain satisfying sexual relationships with proper treatment and support.
Medical Management
- • Regular urologist visits
- • Monitor disease progression
- • Adjust treatment as needed
Psychological Support
- • Counseling or therapy
- • Support groups
- • Partner communication
Lifestyle Adaptations
- • Sexual position modifications
- • Use of ED medications if needed
- • Stress management techniques