What Is Peyronie's Disease?
Peyronie's (pronounced pay-ruh-neez) disease is a medical condition where your penis is abnormally bent or curved when you have an erection. And you may also have some pain. Most men and people assigned male at birth naturally have some curve in their penis, so you don't have it just because your penis is a bit curved.
Peyronie's disease is caused by a buildup of scar tissue inside your penis. Scar tissue isn't as flexible as your skin, so it doesn't expand when you get an erection. This causes your penis to curve or bend up, down, or to the side, depending on where the scar tissue is. You may also lose length and girth during an erection.
It's difficult to know how common it is because many people with it are embarrassed and won't talk to their doctor about it. But the best estimate is that about 10% of men and people assigned male at birth have Peyronie's disease. It can make sexual intercourse difficult, painful, or impossible for you. In some cases, the scar tissue may expand into the tissues that help you achieve an erection, leading to erectile dysfunction.
Several treatments are available, including medicine, ultrasound, radiation therapy, and surgery. Read on to learn more about the symptoms and treatment options for Peyronie's disease.
Peyronie's Disease Phases
Acute phase
During this phase, you start to develop scar tissue in your penis. You may notice that your penis is more curved, and you may have pain, with or without an erection. This phase generally lasts about 5-7 months, but it may last up to 18 months.
Chronic phase
This usually starts 12-18 months after you first notice symptoms. You may notice that the curve in your penis stabilizes or stops getting worse. Your pain may lessen, as well. But you may develop erectile dysfunction, or it may get worse if you already had it before.
Peyronie's Disease Causes
You have two types of tissue in your penis that allow you to achieve an erection. One type of tissue is called the corpora cavernosa. Your corpora cavernosa is composed of two chambers that run along the length of your penis under your skin. When you're aroused, your corpora cavernosa fills with blood, which makes your penis harder, longer, and bigger around.
The second type of tissue is called the tunica albuginea. This is a fibrous sheath of tissue that helps keep your corpora cavernosa filled with blood so your penis stays stiff during an erection. You get Peyronie's disease when scar tissue (medically called a plaque) builds up in your tunica albuginea. This plaque can build up anywhere along the length of your penis, and it may form in multiple places. When you get an erection, the plaque can't expand, so it pulls on the tissue surrounding it. This makes your penis bend or curve away from the spot with the plaque.
Doctors don't know exactly why some people develop this scar tissue. Some experts think that it may start after you get an injury, even a microscopic one, in your penis. You may not even notice the injury at the time. For instance, you may hit or bend your penis while you have sex or play sports or when you have an accident. In fact, many people who develop Peyronie's disease can't recall a specific injury that led to their condition.
But even a small injury can cause bleeding and swelling inside your tunica albuginea tissue. As your body heals, you may develop some scar tissue that starts a cycle of chronic inflammation (swelling and damage). This leads to a buildup of scar tissue over time.
Peyronie's Disease Risk Factors
Anyone with a penis can develop Peyronie's disease. But some factors that can make it more likely include:
Age
Peyronie's disease is more common in older people. It's most common in men and people assigned male at birth who are aged 50-59. Average age at the time symptoms start is about 55. It may be that changes that happen in your tissues as you get older can make you more likely to get it.
People younger than 50 who develop it tend to have have higher average blood sugar levels over the past 2-3 months than younger people without it. And they tend to develop more plaques.
Autoimmune conditions
You may have a higher risk of developing Peyronie's disease if you have the following autoimmune conditions:
- Systemic lupus erythematosus. This can cause inflammation and damage to your blood vessels, joints, skin, brain, heart, lungs, and kidneys.
- Sjögren's syndrome. This can cause inflammation and damage to your salivary glands and tear ducts.
- Beçhet's disease. This causes inflammation in your blood vessels.
Connective tissue disorders
Your connective tissue supports and connects your different body organs and tissues. Connective tissue disorders affect your muscles, skin, and joints. The following connective tissue disorders may increase your risk of developing Peyronie's disease:
- Dupuytren contracture (also called Dupuytren's disease). This causes the connective tissue in your hands to shorten and thicken. It can cause your fingers to permanently bend down.
- Plantar fasciitis. This causes inflammation in the connective tissue on the bottom of your foot.
- Scleroderma. This causes thickening of your connective tissues, which can cause swelling and pain in your muscles and joints.
Family history
Peyronie's disease runs in some people's families. If you have a family member, like your dad or your brother, with Peyronie's disease, you may have a higher chance of developing it. About 4% of people with a family history of Peyronie's disease are likely to develop it.
Diabetes
People with diabetes are more likely to develop erectile dysfunction. People with erectile dysfunction because of diabetes are about four to five times more likely to develop Peyronie's disease than other people. Getting your blood sugar under control can improve your symptoms.
Hypogonadism
Hypogonadism is when your sex glands don't make enough hormones. In men and people assigned male at birth with hypogonadism, your testes don't make enough testosterone. Having low levels of testosterone can interfere with your ability to heal, which may increase your chance of developing Peyronie's disease.
Activities that can cause penis injuries
Having an injury to your genitals may increase your chance of developing Peyronie's disease. Some activities and medical procedures that may increase your chance of getting injured include:
Peyronie's Disease Symptoms
Your signs and symptoms may include:
- Hard lumps on one or more sides of your penis
- A curve in your penis, with or without an erection
- Sometimes, if you have plaques in a couple of places, you may have an indentation that makes your penis look like an hourglass
- Pain when you have an erection or during sex
- Narrowing or shortening of your penis
- Inability to achieve or maintain an erection (erectile dysfunction)
These signs and symptoms may develop over time or may start quickly. Your pain may decrease over time, but your penis will likely remain curved.
Peyronie's Disease Diagnosis
Your doctor will likely start by asking about your medical and family history and symptoms.
Your doctor may need to examine your penis both when it's soft and erect. In this case, your doctor can inject a vasoactive substance into your penis that will cause an erection. Consider bringing photos in from home, but they will still need to examine you in the office.
They usually won't need other testing, such as blood tests or imaging, to diagnose you. Your doctor may use ultrasound to understand where the scar is in your penis, check if some of your scar has calcium deposits, and see how blood flows in your penis.
Your doctor will likely do some lab tests to see if you have an underlying condition that may be causing it. If they suspect Peyronie's disease, they'll likely refer you to a urologist, who is a doctor specializing in conditions that affect your penis and urinary system.
Can Peyronie's Disease Be Treated?
You may or may not need treatment, depending on what your symptoms are and how they're affecting your life. For instance, you may not need treatment if you:
- Have small plaques
- Have little or no curve to your penis
- Have no pain
- Have no problems with sex
- Have no problems peeing
Very rarely, Peyronie's disease may go away on its own without treatment.
But if you need treatment, there are several options available, including medications, medical therapies, and surgical therapies. Your urologist will explain your options and help you pick the right one for you and your life.
You can also make some lifestyle changes that may reduce your risk of developing erectile dysfunction secondary to Peyronie's disease.
Peyronie's Disease Treatments
The goal of treatment is to:
- Reduce your pain
- Straighten your penis as much as possible
- Restore and maintain your ability to have sex
Your doctor will help you choose from the following treatment options:
Medications
Medicines may work best when Peyronie's disease is in the acute phase. There are several medicines that your doctor can inject into the plaque, including:
- Collagenase (Xiaflex). This is an FDA-approved medicine to treat Peyronie's disease with more than 30 degrees of curvature. It's a special protein called an enzyme that helps break down the scar tissue in your plaque. This will help ease your symptoms.
- Interferon-alpha 2b. This is a protein that your white blood cells make that helps reduce swelling. It can slow down the buildup of scar tissue and help your body make an enzyme to break down your scar tissue.
- Verapamil (Isoptin). This is a medicine used to treat high blood pressure. It can help reduce the pain and curve in your penis.
They can also try oral medications, such as:
- Carnitine: It's an antioxidant medicine that reduces swelling and promotes healing. Studies so far have mixed results; some show benefit and others show it doesn't work better than a placebo.
- Colchicine (Colcrys): It's a medicine that can help reduce swelling. This is another medicine that has been studied, but it may work about the same as a placebo. One of the challenges with this medicine is that it can be hard on your stomach.
- Pentoxifylline (Pentopak): It is a medicine that improves blood flow. It can help improve blood flow to your penis which may ease your symptoms.
- Potassium para-aminobenzoate (Potaba): It is typically used for Dupuytren's contracture. This is a vitamin B complex that probably won't correct the curve in your penis, but it can reduce the size of your plaque. The challenge with this medicine is that you'll need to take 24 pills per day for 3-6 months, and it's expensive.
- Tadalafil (Cialis): It is a medicine used to treat erectile dysfunction. This can improve the blood flow in your penis and keep the scarring from getting worse.
- Tamoxifen: It is an anti-estrogen medicine that's used to treat some types of tumors, such as breast cancer. Studies have been done using this for Peyronie's disease, but it may not work better than a placebo (also known as a sugar pill).
Extracorporeal shockwave therapy (ESWT)
This is a technique that uses focused, low-intensity electroshock waves to help break down the scar tissue. It may help ease your pain.
Vacuum pump or traction therapy
Another medical therapy uses a vacuum device or traction device to stretch your penis or bend it in the opposite direction of your curve. This can help break down your scar tissue to correct the curve in your penis, make your penis longer, and increase the hardness of your erection. One of the benefits is that there are few side effects. One of the challenges is that it may take months of treatment to notice any improvement.
Radiation therapy
One of the treatments researchers are studying is radiation therapy. Radiation therapy may help relieve pain associated with Peyronie's disease. But in some cases, this can make your scar tissue worse. Because of this risk, this isn't often used anymore. Also, other methods can usually relieve your pain better.
Surgery
Your doctor won't usually recommend surgery unless your penis is so curved that it's difficult or impossible for you to have sexual intercourse. They will usually wait until you're in the chronic phase and haven't had any pain for 6-12 months before suggesting surgical correction.
The most common procedures include:
- Surgery to shorten the side of your penis on the opposite side as your plaque (called penile plication or tunica shortening)
- Surgery to lengthen the side of your penis on the same side as your plaque (called tunica lengthening).
- Insertion of a prosthetic device
Supplements
Studies suggest that taking vitamin E supplements may reduce the size of plaques in your penis and straighten the curve. The benefit here is that it's relatively inexpensive and easy to try. However, it may not work better than a placebo.
L-arginine is an amino acid that can help improve blood flow. It's available as an over-the-counter supplement.
Peyronie's Disease Pain Management
Your doctor may also suggest you take nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen, to ease your pain. Using a hot water bottle or heating pad may also help ease your pain.
Living With Peyronie's Disease
Peyronie's disease can be stressful. You may feel anxious, depressed, and embarrassed to talk about it. This can negatively impact your relationships with your partners. It can be helpful to understand that your symptoms probably aren't permanent, and treatments can help ease your symptoms.
Here are some ways you can help yourself:
- Communicate with your sex partners. Be open with them and honest about what your condition is and how you feel about it. Be open to hearing how they feel about it, and work together with them to come up with a management plan that works for all of you.
- Talk with a sex therapist. A certified sex therapist can help you work through your mental and physical challenges. Consider having your partners go with you to the therapist so that you can work through it together.
- Talk with a psychotherapist. Talk therapy can also help you work through the mental and emotional challenges you have when you're managing a medical condition.
Takeaways
Peyronie's disease is a medical condition where your penis is abnormally bent or curved when you have an erection, and you may also have some pain. It is caused by a buildup of scar tissue inside your penis. Since scar tissue isn't as flexible as your skin, it doesn't expand, causing your penis to curve or bend. It can make sexual intercourse challenging, painful, or impossible for you and may progress to erectile dysfunction. It can be stressful, but treatments are available to help ease your symptoms.
Peyronie's Disease FAQs
What happens if Peyronie's disease is left untreated?
In some cases, Peyronie's disease may go away on its own even without treatment. In most cases, it stabilizes, so the curvature doesn't get worse, and your pain improves. If you're not having a lot of pain or trouble having sex, it may be OK to avoid or delay treatment. But talk with your doctor about it so you understand what to expect in your situation.
Does Peyronie's disease affect my fertility?
No, Peyronie's disease doesn't negatively affect your ability to have a biological child. It can make sexual intercourse more challenging, but your sperm is unaffected.
Is Peyronie's disease permanent?
Generally, yes. Peyronie's disease is permanent. Some mild cases may go away on their own, but more serious cases are likely permanent. Treatment can help you manage your symptoms.
What can I do to prevent Peyronie's disease?
Since experts aren't exactly sure what causes Peyronie's disease, it's difficult to offer suggestions about how to prevent it. Studies have been done to see if improving your diet and nutrition levels can help prevent it. But so far, they haven't shown that this has any effect. Probably, the best way to prevent it is to prevent injuries to your groin. Wear protection when you're playing sports and take care not to bend your penis when you're having sex.