What is Peyronie's disease?
It is caused by fibrous scar tissue (fibrous plaques) developing under the penis' skin.
According to the NIH, 1-23 percent of men aged 40-70 are affected.
It is common for a man's penis to curve slightly; this is considered normal. However, if the curve causes pain, or if the bend is severe, then it is a problem. Peyronie's disease can undermine a man's ability to have sex, and can also cause erectile dysfunction.
However, a considerable number of adult males who have Peyronie's disease have satisfactory sex lives.
Symptoms of Peyronie's disease
Peyronie's disease can cause psychological distress, but treatment is available.
Signs and symptoms of Peyronie's disease may either emerge gradually over time or appear abruptly. The primary symptom is a considerable curvature of the penis - the penis bends, either sideways, downward, or upward, depending on where the plaques are.
Sometimes, the erect penis may become very narrow at a certain point. In some individuals, the bend slowly becomes more pronounced, for others, it slowly improves and, for others still, the curve stays the same. Other symptoms include:
- Plaques - scar tissue which is felt under the skin of the penis. It feels like a band of hard tissue. For some, it may feel like flattened lumps.
- Erectile dysfunction - men with Peyronie's disease may have difficulties in either getting or maintaining an erection.
- Penis length - Peyronie's disease can eventually result in a shortening of the penis.
- Pain - patients may experience pain when they have an erection, and/or during orgasm. However, in the majority of cases, this gradually goes away after a few months (without any treatment).
Causes of Peyronie's disease
The causes of Peyronie's disease are not fully understood.
Most likely, it is the result of damage to small blood vessels, which may have occurred during sex, a sporting event, a blow, or a vehicle accident. Cells might become trapped where the injury took place during the healing process, resulting in scar tissue.
The penis contains two sponge-like tubes on both sides, each one called the corpus cavernosum. These tubes are full of capillaries (tiny blood vessels). When a male is sexually excited, the capillaries become engorged with blood, resulting in an erection.
The corpus cavernosum sits in an elastic tissue casing - the tunica albuginea. This casing becomes stretched when the penis is erect. If the penis is injured, the tissue of this elastic casing can become damaged. Proper healing will result in no noticeable consequences.
However, if there is permanent scar tissue, there is a chance the patient may develop Peyronie's disease, because that part of the casing can no longer stretch properly; when the penis becomes erect, the scarred part that cannot stretch pulls at the penis, bending it.
It is worth noting that a large number of males who experience a penis injury do not go on to develop Peyronie's disease.
Wound healing may be affected by several factors which could increase the risk of Peyronie's disease:
- Heredity - individuals with close relatives who have Peyronie's disease are more likely to develop it themselves.
- Connective tissue disorder - for instance, Dupuytren's contracture, a thickening and tightening of tissues in the hand, causing the fingers to pull inward.
- Age - older people are more likely to scar as they heal.
Because some cases of Peyronie's disease occur without injury, researchers believe there may be an immune system disorder that causes it in some cases.
Treatment options for Peyronie's disease
The doctor will ask the patient questions about symptoms, how long they have been there, and how they developed over time (sudden or gradual). The patient will also undergo a physical examination.
If the patient's curvature is not getting worse, there is no pain or pain is very slight, and symptoms do not interfere with sex, the doctor will probably recommend watchful waiting - a wait-and-see approach. In general, the individual will be asked to observe changes for at least 12 months before considering a surgical intervention.
In more serious cases, the patient may be prescribed medication or advised to have surgery.
Clostridium hystolyticum (Xiaflex) - this is the only FDA approved drug for use in Peyronie's disease. It is recommended for individuals whose penis bends at an angle of 30 degrees or more when erect.
Penile injections - curvature may be reduced with injections straight into the penis. Treatment may go on for several months. Interferon helps break down fibrous tissue and reduce its production. Verapamil, a hypertension therapy medication, stimulates the activity of collagenase, which plays a role in the formation of scar tissue and wound healing.
However, only small studies have been done on penile injections. Urologists are concerned that the injections themselves - perforating the skin - might cause lesions that might encourage plaque growth.
Vitamin E and potassium aminobenzoate - these medications might reduce pain, but typically have no significant impact on pre-existing abnormal curvature.
Collagenase - an enzyme that reduces the size of plaques, and sometimes gets rid of them altogether.
Other compounds currently being investigated for the treatment of Peyronie's disease include acetyl-l-carnitine and coenzyme Q10.
Some individuals with Peyronie's disease have found relief with:
- Iontopheresis - uses a weak electrical signal to transfer medication through the skin
- Shock wave therapy - breaks up scar tissue
- Penile traction therapy - helps stretch the penis
- Vacuum devices
Certain lifestyle changes can help reduce symptoms:
- Reduce alcohol intake
- Do not smoke tobacco
- Avoid illegal drugs
- Exercise frequently
If the curvature is severe and prevents the patient from having sex, the urologist may recommend surgery. Most experts say the patient must have had no pain for several months for surgical interventions to be considered; also, the curvature must have stopped getting worse.
Shortening one side of the penis
The unaffected side of the penis, the side without plaques, can be shortened; this stops the bending during an erection. This procedure shortens the length of the penis. This procedure may be considered if the curvature is not too severe (less shortening required), and the man's penis is long enough.
Lengthening one side of the penis
The scar tissue is cut in several places, allowing the sheath to stretch again. If the sheath stretches adequately, the man's erect penis will be straight. During the procedure, some of the scar tissue may be removed. Some tissue is grafted over parts that are taken out. This procedure is more commonly recommended for patients with a shorter penis, or more severe curvature. However, lengthening the side has a higher risk of causing impotence than shortening.
The spongy tissue that becomes engorged with blood during sexual arousal and produces an erection can have implants surgically inserted. There are two types of implants: Permanent ones, and those that inflate with a pump action in the scrotum.
The permanent implants will give the man a semi-rigid penis, which is erect enough for sexual intercourse, while the pump-activated one will provide a better erection. Some of the scar tissue may be removed to reduce curvature.
Complications from Peyronie's disease
The main complication is the inability to have sexual intercourse because of pain, erectile dysfunction, or both. The patient may also experience severe anxiety and stress, which can further exacerbate erectile function problems.
Anyone with a curvature of the penis that is causing them discomfort or distress should speak with a doctor. Treatment options are available.