Peyronie’s Disease
Peyronie's disease typically affects men that are 40 years of age and older, and is often a source of anxiety and concern. It can result in penile curvature, painful erections, deformity, loss of length or girth of the penis, and erectile dysfunction. We know how to help. The specialists at the Men's Health Program are experienced in the diagnosis and treatment of Peyronie's disease.
Peyronie's disease is characterized by a plaque, or hard lump, that forms on the erection tissue of the penis. The plaque often begins as an inflammation that may develop into a fibrous tissue.
Trauma, or physical injury, to the penis is one of the most common causes of PD and can affect a man at any age. Damage can result during regular sexual intercourse if the penis bends or is struck severely, which leads to the formation of a hard lump or plaque on the erection tissue. Such lumps, while non-cancerous, are responsible for decreasing normal elasticity and changes in the appearance of the penis.
Some individuals are genetically predisposed to PD. Having a family member with PD or other connective tissue disorder might indicate risk for the disease.
Symptoms and Diagnosis
The plaque that forms on the erection tissue of the penis often begins as an inflammation that may develop into a lump. Generally, when the disease heals within a year or so, the condition does not advance beyond inflammation.
However, when it lasts for years, the plaque often becomes tough, fibrous tissue, and calcium deposits may form. Each man will experience symptoms differently, but the most common of them include:
- Plaque on the top of the shaft that causes the penis to bend upward.
- Plaque on the underside causing the penis to bend downward.
- Indentation and shortening of the penis, when plaque develops on both top and bottom.
- Pain, bending and painful erections.
- Associated emotional distress that restricts sexual intercourse.
- Erectile dysfunction, the inability to maintain an erection sufficient for sex.
A diagnosis of Peyronie's disease is usually made when men seek medical attention for painful erections and difficulty with intercourse. A complete medical history and physical examination is usually sufficient. If your doctor needs to understand exactly what's causing your symptoms, diagnostic procedures may include:
- Ultrasound examination of the penis. Ultrasound is the most commonly used test for penis abnormalities. Sound waves are used to produce images of soft tissues that may show the presence of scar tissue, blood flow to the penis and any other abnormalities.
- Color Doppler examination. This type of ultrasound uses sound waves to measure the flow of blood through a blood vessel; waveforms of the blood flow are shown on the ultrasound screen (to evaluate erectile function, anatomy and blood flow).
Treatment
While there’s no known cure, in general, the goal of treatment is to keep men with Peyronie's disease sexually active and reduce associated pain. Providing education about the disease and its course is often included in the treatment plan. The degree of curvature, location of scar tissue, sexual disability or other details will help your doctor identify the best treatment approach, which varies by individual. Options include:
Active Surveillance
- The curvature of your penis isn't severe and is no longer worsening.
- You can still have sex without pain.
- Pain during erection is mild.
- You have good erectile function.
Medication
One medication — collagenase Clostridium histolyticum (Xiaflex) — has been approved by the Food and Drug Administration for the treatment of Peyronie's disease in men with a curvature of the penis of at least 30 degrees during erection.
The treatment works by breaking down the buildup of collagen that causes penile curvature. It involves a series of in-office injections, directly into the penile lump, as well as penile modeling — brief exercises to gently stretch and straighten the penis.
Surgery
Most experts recommend against surgery during the early inflammatory phase of Peyronie's disease. If the deformity of your penis is long-lasting and severe, or prevents you from having sex, surgery may be an option; although, it usually isn't recommended until the curvature of your penis stops increasing. Methods include:
- Plication (making tucks or folds). A variety of procedures can be used on the longer side of the penis (the side without scar tissue) to gather and sew the tissue so that it straightens the penis; although, it might result in actual or perceived penile shortening. In some cases plication can cause erectile dysfunction.
- Incision or excision and grafting. The surgeon makes one or more cuts in the scar tissue, sometimes removing some of that tissue, allowing the sheath to stretch out and the penis to straighten. The surgeon may sew in a piece of tissue (graft) to cover the spots over which tissue was removed. This procedure is linked to greater risks of worsening erectile function compared with plication procedures.
- Penile implants. Surgically inserted penile implants replace the spongy tissue that fills with blood during an erection. Penile implants might be considered if you have both Peyronie's disease and erectile dysfunction.