What is Peyronie’s Disease?

Peyronie’s disease has a long history dating back to the 18th century, when French surgeon Francois Gigot de La Peyronie wrote about it in 1743.1 But what exactly is it? Peyronie’s disease describes the development of a bend in a previously straight penis.1 Some experts estimate that as many as nine percent of men have it.2 It can be distressing and painful but luckily there are treatments that can help.

What Causes Peyronie’s Disease?

Despite being around for so long, experts don’t complete understand Peyronie’s disease. We know that it develops from the formation of scar tissue on the penis.1 This happens underneath the skin, so it doesn’t look like a normal scar. But some guys can feel it between their fingers as a little bump, called a plaque, under the skin. This little scar causes a lot of problems.When the penis gets hard in an erection, the scar tissue pulls the penis towards one side, bending in the direction of the scar.1 This bend causes a lot of trouble. It can make the penis shorter than before and it can be painful.3 It can also interfere with a man’s ability to have penetration with the penis.3 The worrying associated with this can lead to troublesome psychological effects.1,2It’s not known what causes the scarring.2 The main theory is that the penis gets bumped or hit and then instead of healing normally it ends up making an abnormal scar, causing the bend.2 Some people are more likely to have this abnormal scar formation happen. This includes people with diabetes, autoimmune disorders, or certain kinds of problems with the tendons of the hands or the feet.2

What happens to men with Peyronie’s disease?

Peyronie’s disease has two stages. The first is called the “active phase” and the second is called the “stable phase.” 3 The active phase is when the plaque is first forming.3During this time, the curve of the penis can worsen.3 This is when the disease is the most painful.3 This phase lasts about 12 months, after which the plaque stops changing and the curve becomes stable.3 The pain tends to improve around this time.3 For most men, the pain improves or even stops.

However, only about 4 to 13 percent of men with a bend will have it go away without treatment.1

Treatment Options

If you’ve noticed a new curve to your penis, with or without pain or a bump, talk to your doctor. For guys who have no pain and who are still able to have sex, they may not require any medication.4 That being said, changes in the penis can cause psychological problems.1 So talking to your doctor is still a good idea.

Otherwise, the main kinds of treatment are oral medication (pills), injectable therapy and surgery.1 Other types have treatment have also been tried. We’ll talk about each of the types of treatment and how well they work.

Oral Medications (pills)

A conventional treatment used for Peyronie’s disease is Vitamin E.1 The good thing about this medication is that it doesn’t cost very much and has few side effects.1 However, recent research indicates that it may not help with Peyronie’s disease at all.1

Newer treatments show promise. These include Co-enzyme Q10 (CoQ10) and pentoxifylline. Recent research shows that they may help improve the curve from Peyronie’s disease.1 But more research needs to be done and they do have side effects.1

Many other different types of medication have been studied to see if they work for Peyronie’s disease.1 This is partly because none of them seem to work all that well.1 These include omega-3, colchicine and tamoxifen.1 Erectile dysfunction drugs like Viagra have been studied but there isn’t enough evidence to recommend them.1

Injectable Therapy

This form of treatment involves medications that your doctor injects into the Peyronie’s plaque directly using a thin needle. This approach provides some benefits. Verapamil, interferon and collagenase are three types of injectable therapy that have been studied. Doctors are not sure yet of the benefits.5 Recent research on a new type of injectable therapy, called clostridium collagenase, has been more positive.5 It is now approved for treatment of Peyronie’s disease by the Food and Drug Administration (FDA), which regulates medications in the United States.4 Additional research is expected to come out in the next few years.5

Other Therapies

Another type of other therapy is the application of creams or gels to the penis. Although different creams and gels have been studied, none has convincingly worked to alleviate Peyronie’s disease.4 Other things that have been tried include radiation and shockwave ultrasound therapy. So far these treatments haven’t helped Peyronie’s disease to any great degree.1

Surgery

As nice as it would be for a pill or injection to fix Peyronie’s disease, the best treatment is still surgery to get rid of the bend on the penis, done under a general anesthetic.6 One approach is to straighten the penis by putting a stitch into the side opposite the plaque. This helps to balance out the bend. There are many different surgical techniques to do this, which, as a group, are called “tunical shortening procedures.” All seem to have more or less the same outcomes, which improve the bend.6 These are good options for a curve that isn’t too severe.6

Another approach is to cut out the plaque. This leaves a hole, so it needs to be filled with something called a graft. Typically, grafts are supplied by companies who make them especially for this kind of surgery.6 This kind of surgery should only be for men who have more severe deformity of the penis and who have hard erections before the surgery.6 This is because, compared to tunical shortening procedures, there is a higher rate of new erectile dysfunction after the surgery.6

Finally, for men who didn’t have hard erections before the surgery, or if the other options aren’t a good choice for them, they can have an inflatable penile prosthesis put in that produces an erection when a pump, hidden in the scrotum, is touched.6

Conclusion

Peyronie’s disease is complicated, can present itself differently for different men, and has a lot of treatment options. The most important message about Peyronie’s disease is, if you think you might have this problem and it’s bothering you, consult your doctor.

References

1. Schaeffer, A. J. & Burnett, A. L. Nonsurgical interventions for Peyronie disease: 2011 update. J. Androl. 33, 3–14 (2012).

2. Mulhall, J. P. et al. Subjective and objective analysis of the prevalence of Peyronie’s disease in a population of men presenting for prostate cancer screening. J. Urol. 171, 2350–2353 (2004).

3. Kadioglu, A., Küçükdurmaz, F. & Sanli, O. Current status of the surgical management of Peyronie’s disease. Nat. Rev. Urol. 8, 95–106 (2011).

4. Levine, L. A. in Book Chapter: Diagnosis and Management of Peyronie Disease, Campbell-Walsh Urology 31, 722–748.e6

5. Gelbard, M. et al. Phase 2b study of the clinical efficacy and safety of collagenase Clostridium histolyticum in patients with Peyronie disease. J. Urol. 187, 2268–2274 (2012).

6. Levine, L. A. & Larsen, S. M. Surgery for Peyronie’s disease. Asian J. Androl. 15, 27–34 (2013).