About Peyronie’s Disease

Peyronie’s disease is a penile condition in which fibrous scar tissue, known as plaque, develops under the skin of the penis, causing abnormal curvature, pain, or erectile dysfunction. This non-cancerous disorder affects the tunica albuginea - a thick sheath surrounding the penile erectile chambers. 

As the plaque hardens, it restricts flexibility, resulting in bending during erection. While mild curvature may be harmless, severe cases can interfere with sexual function and cause psychological stress. Though the exact cause is unclear, Peyronie’s disease is often linked to trauma or repeated injury during intercourse, especially in genetically or metabolically susceptible men. If untreated, it may progress or stabilize but rarely resolves on its own.

Symptoms of Peyronie’s Disease

Men with Peyronie’s disease may experience a range of symptoms, which can vary in intensity depending on the stage of the condition:

• Penile Curvature: The most defining symptom—penis bends upward, downward, or sideways during erection
• Penile Pain: Discomfort or aching during erection or even when flaccid in early stages
• Erectile Dysfunction: Difficulty achieving or maintaining erections, often due to curvature or emotional stress
• Palpable Lump: A hard, fibrous nodule or plaque can often be felt under the penile skin
• Shortened Penis: Due to scar tissue contraction, the penis may appear smaller when erect
• Penile Deformities: Indentations, hourglass-like narrowing, or an irregular shape during erection
• Emotional Distress: Anxiety, embarrassment, and loss of sexual confidence

In the early (acute) phase, pain and evolving curvature dominate. Later, in the chronic phase, pain usually subsides, but the deformity becomes stable. Not all men require treatment; mild cases without functional interference may only need monitoring.

Peyronie’s Disease Causes

The exact origin of Peyronie’s disease is not always clear, but it is generally believed to arise from:

• Microtrauma: Repeated injury or bending of the penis during intercourse or physical activity can cause bleeding inside the tunica albuginea. Improper healing of this injury leads to plaque formation.
• Genetic Predisposition: Men with a family history of Peyronie’s disease or connective tissue disorders (e.g., Dupuytren’s contracture) have increased risk.
• Autoimmune Response: Some theories suggest the immune system may mistakenly attack the penile tissue, promoting scarring.
• Age-Related Factors: As men age, tissue elasticity reduces and healing becomes less efficient, making older men more prone to developing plaques.
• Certain Medical Conditions: Diabetes, high blood pressure, and metabolic syndrome may contribute to impaired wound healing and scarring.

This condition often begins gradually and may progress over 6 to 18 months without intervention.

Peyronie’s Disease Risk Factors

Several factors can increase a man’s susceptibility to Peyronie’s disease:

• Age Over 40: Though it can occur at any age, the condition is most common in middle-aged and older men
• Penile Trauma: Injury during intercourse or sports may trigger abnormal healing and scarring
• Genetics: Men with a family history of Peyronie’s or connective tissue diseases like Dupuytren’s contracture are at higher risk
• Erectile Dysfunction: The combination of ED and poor rigidity increases the chance of penile injury
• Health Conditions: Diabetes, smoking, obesity, and cardiovascular disease impair vascular health and tissue repair
• Prostate Surgery: Some men develop Peyronie’s following prostatectomy due to nerve or vascular changes

It’s important to note that not all penile curvature is caused by Peyronie’s disease; evaluation by a urologist is crucial.

Complications of Peyronie’s Disease

If left untreated, Peyronie’s disease may result in various functional and emotional complications:

• Severe Curvature: Can make penetration difficult or impossible
• Erectile Dysfunction: Worsening plaque and pain interfere with normal blood flow and confidence
• Penile Shortening: Permanent reduction in length from scar tissue contraction
• Emotional Impact: Depression, anxiety, and relationship issues are common, especially with untreated sexual dysfunction
• Penile Pain: Although pain often resolves, in some cases it persists or worsens
• Fracture Risk: Extreme deformity may increase vulnerability to penile fracture during intercourse

Early diagnosis and management can prevent these complications and restore normal sexual function and mental well-being.

Diagnosis of Peyronie’s Disease

A comprehensive evaluation is necessary to assess the severity and guide treatment:

• Medical History: Review of symptom onset, sexual function, prior trauma, and family history
• Physical Exam: Physician palpates the penis to identify plaque, curvature angle, and pain response
• Penile Ultrasound: High-resolution imaging identifies plaque characteristics, calcium deposits, and blood flow
• Erection-Induced Assessment: In-office injection may induce an erection to assess curvature and rigidity for accurate documentation
• Photographic Documentation: Patients may be asked to provide images of erect penis at home for review
• Questionnaires: Tools like the Peyronie’s Disease Questionnaire (PDQ) help evaluate sexual and psychological impact

Early-stage disease (acute phase) and late-stage disease (chronic phase) are managed differently, so determining the phase is essential.

Peyronie’s Disease Treatment

Not all Peyronie’s cases require immediate intervention. Mild, painless curvature without functional interference may be managed conservatively. When treatment is required, options include:

Medical Management

• Oral Medications: Limited effectiveness; options like pentoxifylline may reduce inflammation or plaque size in early stages
• Vitamin E & Antioxidants: Sometimes used to limit oxidative stress, though evidence is weak
• Intralesional Injections: Collagenase Clostridium Histolyticum (CCH, e.g., Xiaflex) is FDA-approved to break down scar tissue and improve curvature. Administered by a trained urologist over several sessions
• Verapamil/Interferon Injections: Alternatives for non-candidates of CCH; may reduce pain and plaque size
• Penile Traction Therapy: Devices worn daily stretch the penis, helping straighten curvature and preserve length

Peyronie’s Disease Surgical Management

Surgery is usually considered in stable (chronic) cases when deformity or dysfunction significantly impacts quality of life:

• Plication Surgery: Involves shortening the longer side of the penis to counter the bend; best for mild to moderate curvature without erectile issues
• Grafting Procedures: Surgeon removes plaque and inserts a graft to restore symmetry; suited for severe curvature with adequate erection quality
• Penile Prosthesis: For men with significant ED and Peyronie’s, inflatable implants can correct curvature and restore rigidity
• Nesbit Procedure: A type of plication surgery where tissue is removed to straighten the penis; may reduce length slightly

Each surgical method carries risks such as reduced length, numbness, or recurrence, so decisions are individualized.

All treatment options must be pursued under expert urological guidance.