Peyronie’s Disease

An image of a carrot that looks like a penis with Peyronie's disease

Peyronie’s disease is a condition that can cause great distress for both the man and his partner. In this article we’ll review the symptoms, complications, causes, treatments and answer some common questions.

Luckily, many cases of Peyronie’s disease can be treated successfully to help the man restore his self-confidence and sex life.

Symptoms and complications

Peyronie’s disease is a condition in which scar tissue, or a plaque, develops under the skin in an area called the tunica albuginea. The tunica albuginea is a tough fibrous sheath that helps keep the penis stiff during an erection.

The plaque decreases the elasticity of the affected area of the penis and can cause the penis to curve, bend or even indent during an erection.

It is thought that the plaque is created in response to abnormal healing after repeated injury to the penis, although most men don’t remember an event that might have caused an injury.

The plaque can be felt under the skin as lumps or strips of hard tissue. The penis can curve upwards, downward or sideways. In some cases, there can be multiple plaques that can cause complex curvature and shortening of penile length.

There are also cases in which the plaque encircles the penis which creates a narrowing of the area or indentions. This can create a penis that is shaped in the form of an hourglass. The plaque can contain calcium and become as hard as a bone.

Peyronie’s disease can appear suddenly or develop gradually. Some cases are mild and only require observation while other cases are severe and can affect a man’s ability to have sex.

How much bend occurs in Peyronie’s disease?

Having a curved or bent penis itself is normal and does not necessarily mean you have Peyronie’s disease. A curve of 30-degrees or less of the penis that is stable and doesn’t cause pain can be normal. Mild Peyronie’s disease cases can begin with a curve of 10 degrees, and in severe cases can lead to a curve of up to 180 degrees.

There could be other reasons for a bent penis, such as congenital penile curvature which is present from birth and usually doesn’t require treatment.

Stages of Peyronie’s disease

Peyronie’s disease has two stages:

  1. Acute phase – this is the phase when the plaque forms. In this stage inflammation can accrue. It can take up to 18 months or two years for this phase to end. During this phase, the curvature and pain can get worse.
  2. Chronic phase – In this phase, the plaque has stopped growing and the symptoms stabilize. In most cases pain is improved or resolved in this stage. Erectile dysfunction can develop and get worse over time.

Complications

  • Pain – Peyronies disease usually causes penile pain in its initial phase (the acute phase). The pain can appear with or without an erection, but is more common during erection and intercourse. It is usually mild and doesn’t require treatment. After the disease stabilizes, pain usually improves or disappears. There can be cases of Peyronie’s disease without pain.
  • Erectile dysfunction – Up to half of the men will also experience erectile dysfunction. This can be because of psychological factors such as performance anxiety, or because of physical factors such as interference in blood flow. It is not clear if ED predisposes Peyronie’s disease of if it’s the other way round.
  • Trouble having sex – Some men experience troubles having sex because of the bent or curved penis or pain. Another problem is having a “flail” penis (floppy penis) where the part of the penis beyond the plaque does not become stiff, making penetration difficult. Some sex positions can be more suitable for a curved penis and might help.
  • Penile shortening – Some of the deformities can lead to penile shortening
  • Stress, anxiety and depression – Many men with Peyronie’s disease suffer from emotional problems. This study that 81% of men with Peyronie’s disease had emotional troubles.
  • Relationship issues – The same study also found that 54% of men with Peyronie’s disease had relationship problems
  • Infertility – Peyronie’s disease does not cause infertility, but if you can’t have sex because of it you will need to take other measures to father a child. It does not affect sperm or urine flow.

Does Peyronie’s disease get worse over time?

When Peyronie’s disease is left untreated, the majority of men will experience stabilization or worsening of the condition (curvature and penile shortening). It is estimated that only about 12-13% of men will see improvement without treatment. Pain on the other hand usually improves or disappears on its own.

Can Peyronie’s disease heal itself?

Peyronie’s disease is considered a permanent condition that typically does not go away on its own. Using the right treatments can improve the condition.

Peyronie’s disease pictures

We have gathered a few links that contains pictures of Peyronie’s disease:

  • Follow this link to see pictures of the difference between mild Peyornie’s disease, moderate Peyronie’s disease and severe Peyronie’s disease.
  • In this link you can see before and after pictures of surgery for Peyronie’s disease.
  • Here you can see an image of an hourglass shape penis caused by Peyronie’s disease

Peyronie’s disease and cancer

Peyronies disease does not cause cancer and is not related to cancer. 

Causes and risk factors

The exact cause of Peyronie’s disease is not completely understood. The main cause is considered to be an unnatural healing process after an injury or wound to the penis. This injury can be caused by rough sex or masturbation, physical activities, or any other traumatic blow to the genitals.

Since most men don’t remember an injury or trauma to the penis, it is believed that ongoing micro injuries to the penis can lead to this abnormal healing process.

There are two tubes in the penis called corpora cavernosa. They are wrapped inside the tunica albuginea – a tough fibrous sheath. These tubes fill with blood to make the penis hard during an erection. In men with Peyronie’s disease, a hard non-flexible plaque forms in the tunica albuginea, making the penis bend and curve during an erection.

An illustration of a penis with Peyronie's diseases

Risk factors

  • Connective tissue disorders – Connective tissue disorders, specifically Dupuytren’s contractures, have been linked to an increase in Peyronie’s disease cases.
  • Genetic – There is some evidence that genetics may play a role in Peyronie’s disease, but different studies show contradicting results.
  • Autoimmune disease – Some experts believe that autoimmune diseases (such as lupus) might put you at risk of Peyronie’s disease. But recent studies do not show a clear connection yet.
  • Diabetes – Peyronie’s disease is thought to be more common in men with both diabetes and erectile dysfunction, although further research is still needed to confirm this.
  • Age – Peyronie’s disease can happened at any age, but men in their 50s and 60s are at a higher risk.
  • Smoking – Some studies, such as this one have shown a connection between smoking tobacco and Peyronie’s disease although further research is still needed.
  • Prostate surgery – Studies have shown that there might be a link between prostate surgery and Peyronie’s disease.
  • High blood pressure – High blood pressure has been correlated with Peyronie’s disease although further research is still needed.
  • Medication side effects – Some medications list Peyronie’s disease as a side effect. These include certain beta blockers, Interferon and Dilantin. Contrary to popular belief, Viagra does not cause Peyronie’s disease.

How common is Peyronie’s disease?

Studies suggest that the prevalence of Peyronie’s disease can be as high as 9%. A 2016 study from the US showed an even higher prevalence of 11%.

Is Peyronie’s disease contagious?

No, Peyronie’s disease is not contagious

Peyronie’s disease diagnosis

Usually Peyronie’s disease is diagnosed using a simple physical exam. A urologist can detect the plaque with his hands.

Sometimes the penis will have to be erect for the plaque to be felt. If that’s the case an injection can be given to make the penis erect.

Another option is to take pictures at home and to send them to your urologist.

Your urologist will most likely ask you questions and examine your medical history.

In some cases, an ultrasound can help detect the plaque and assess if there is calcification around it. This can affect the choice of treatment.

Treatment

There are several treatment options for Peyronie’s disease. These include:

  • Drugs
  • Injections
  • Stretching exercises
  • Traction devices
  • Vacuum devices
  • Ultrasound
  • Shockwave
  • Radiation Therapy
  • Surgery

Some of these treatments are natural and can be done at home, while other procedures will have to be performed by a medical doctor.

It’s important to note that mild cases of Peyronie’s diseases do not require treatment. If after the condition has stabilized, there is no pain, and the curvature does not interrupt sex, then treatment is not necessary.

Drug and injections

The evidence for the use of oral medications and injections for Peyronie’s diseases is weak. Still, many urologists use them because of the low risk in the hopes of preventing a surgery later on.

There is more evidence to support the use of drugs in the acute phase rather than in the chronic phase. Injections are considered more effective than oral drugs.

Oral medications

  • Nonsteroidal anti-inflammatory (NSAIDs) – These can be used for pain relief in the acute phase of the disease. Ibuprofen (Advil) for example can help relive the pain generated by Peyronie’s disease in the acute (active) phase. They do not help with curvature or penile shortening.
  • Vitamin E – Vitamin E is currently not recommended for the treatment of Peyronie’s disease. While some studies have shown improvement, others have not. The official stance of the American Urological Association is to not use Vitamin E.
  • Vitamin D and Vitamin C– Vitamins C and D are also not helpful for Peyronie’s diseases. On the contrary, a recent study identified high levels of vitamin D as a risk factor for Peyronie’s disease
  • Potassium amino-benzoate – Amino benzoate is sometimes given to patients in the chronic stage to help with curvature and pain. A 2005 study found significant improvement in plaque size for patients who

took Potassium amino-benzoate four times a day for 12 months. Still, more research is needed to determine how effective this drug is as previous studies have been small.

  • Tamoxifen – Tamoxifen is a selective estrogen receptor which is mainly used for breast cancer. Some studies reported it can help Peyronie’s disease, but other studies showed no improvement for patients taking the drug.
  • Colchicine – Colchicine is a gout medication. A 2004controlled double blinded study showed that Colchicine is not more effective than a placebo in treating Peyronie’s disease.
  • acetyl-l-carnitine is a diet supplement used to prevent low blood levels of carnitine. This 2001 study showed significant improvement for patients taking carnitine, while this later 2007 study showed no improvement at all.
  • Tadalafil (Cialis) – Small studies (such as this one) reported that daily use of phosphodiesterase type 5 (PDE5) inhibitor drugs, like Cialis can treat Peyronie’s disease by reducing pain and penile curvature. Cialis can also help with erectile dysfunction that is occurs with Peronie’s disease.
  • Sildenafil (Viagra) – This 2014 study showed that Viagra help reduce plaque size and pain in men with Peyronie’s disease. Contrary to some popular belief, viagra doesn’t cause Peyronie’s disease. It is also ok to take viagra if you have Peyronie’s disease.           
  • Pentoxifylline – Pentoxifylline is a drug used to treat muscle pain in people with peripheral artery disease. Some studies have shown that it is effective in treating Peyronie’s disease but more research is needed. This is the most commonly recommended oral treatment.

Injections

Although injections are considered more effective than oral drugs, they have some commons side effects such as pain at the injection site and bruising/ecchymoses that need to be taken into account.

  • Collagenase clostridium hystolyticum (Xiaflex) – Xiaflex injections are used to treat Peyronie’s disease. This drug is injected into the plaque, and is followed by a stretching procedure, usually 1-3 days after the injection. Each treatment cycle includes two injections 1-3 days apart. You may have up to 4 treatments cycles, 6 weeks apart from one another. 2 large double blinded studies have shown that it is effective in treating Peyronie’s disease.
  • Verapamil – Verapamil is the most commonly used injection for Peyronie’s disease today. Several double blinded studies have shown its efficacy, although a recent review concluded that it is less effective in comparison to other injections such as interferon than initially considered. Its low cost and mild side effects still makes it a preferable choice for many urologists.
  • Interferon – Interferon is used to treat many diseases such as hepatitis B and C and lymphoma. Two [1][2] placebo control studies found modest improvement in penile curvature and pain, yet more research is needed.

Stretching exercises, traction devices and vacuum devices

Stretch therapy exercise involves gently stretching or pulling the non-erect penis taut. Traction devices are wearable devices that stretch the penis between two parallel bars for a period of time. A vacuum device is also a wearable device that uses suction to stretch the penis.

Stretch therapy can be done as a sole therapy, or alongside oral medications or injections.

Several different studies have shown that stretch therapy is effective in treating Peyronie’s disease, both in the acute and chronic phases. It can help both curvature and length restoration. Some of these studies used vacuum devices or traction devices while others used manual stretching exercises.

The optimal amount of daily practice and the length of treatment is still unknown. Usually a daily practice for several months is needed.  Most studies suggest that men should perform stretching for multiple hours daily.

Treatment in the acute stage is recommended and can sometimes prevent surgical interventions later on.

Other non-surgical treatments

A few other treatments that are being examined include ultrasound therapy, shockwave therapy and radiation therapy. Shockwave therapy has been shown to be effective for managing pain but equivocal for improving length or curvature. All of these still require further research. Most experts still do not recommend them as treatment alternatives.

Surgery

Surgery is usually recommended only for men who have severe curvature or other deformations that prevents them from having sex. Surgery remains the quickest and most effective option. Since it is invasive and has risks, most doctors prefer to use it as a last option.

Most experts will wait for the patient to enter the chronic stage, and then wait another six months to make sure the condition has stopped progressing before they perform the surgery.

There are three types of surgeries for Peyronie’s disease:

Penile plication (corporoplasty)

In this type of surgery, the surgeon “shortens” the side of the penis opposite to the scar tissue (plaque). The idea is that shortening the opposite side of the curvature will “pull” the penis away from the curvature, making it straight during an erection.

Penis shortening is a major concern for men regarding this type of surgery, although it is estimated to happen in only 20-40% of the cases.

This surgery is considered relatively safe and easy to perform. The success rate and satisfaction are considered high. It is recommended for men with mild to moderate penile curve, and little or no erectile dysfunction.

Plaque incision and grafting

This procedure is better for men who have no erectile dysfunction but have more severe penile curvature or deformity.

Since there is a risk of erectile dysfunction developing after surgery, it is important for the urologist to make sure the patient has excellent erectile function.

In this surgery, the surgeon incises the plaque, releasing the scar tissue so that the penis remains straight during an erection. The surgeon might also remove some of the plaque. The free space may then be filled with a graft. The graft can be made from the man’s own tissue or other biologic tissues.

This surgery is more technically difficult and also has more complications, and is therefore recommended only for men with severe Peyronie’s disease.

Satisfaction rates of this procedure have been reported to be around 55 to 100%, and patient satisfaction at 60 to 100%.

Penile prosthesis device

This surgery is recommended for men with severe Peyronie’s disease that are not suitable for grafting surgery because of a high risk of erectile dysfunction.

In this surgery, an inflatable pump is inserted into the penis. With the inflatable pump, the man can then have an erection by inflating the device using a pump hidden between the scrotum and the testicles.

In some cases, the surgeon might perform one of the two other surgeries to straighten the penis more if the implant does not straighten it enough.

This article reported that more than 80% of men and their partner said they are feeling somewhat or very satisfied with the outcome of the surgery.

Surgery side effects

Like most surgeries, all three Peyronie’s disease surgeries have risks and side effects. You should speak to your urologist about the risks and side effects before making a decision.

The penile plication surgery has a risk of penis shortening, and has a side effect of temporary sensation changes to the penis.

The plaque incision surgery has similar side effects and risks as the penile plication surgery but is has a much higher risk of erectile dysfunction.

The penile prosthesis surgery has the extra risks of device malfunctions and infections.

*This is not a complete list of all risks and side effects. Consult your healthcare provider before making a decision regarding surgery.

Are there natural treatments and home remedies?

There is a lot of false information about natural cures and home remedies for Peyronie’s disease. Here is a short overview of some of these treatments:

  • Homeopathic medicine for Peyronie’s disease – there is no homeopathic medicine that is proven to cure or help Peyronie’s disease. In fact, by modern evidence-based science homeopathy is considered not affective at all and should not be practiced.
  • Castor oil for peyronie’s disease – there are some that suggest that massaging the scar tissue with castor oil (or other essential oils) might help dissolve the fibrous collection. While stretching exercises, and perhaps massaging might help, there is nothing special about castor oil (or other oils) that we are aware of. Also these topical treatments cannot penetrate into the plaque just through massage.
  • Foods that help cure Peyronie’s disease – maintaining a healthy diet is important and can help prevent and improve erectile dysfunction. But there is no evidence that you can cure or improve Peyronie’s disease by changing your diet.
  • Ayurvedic treatment – Ayurveda is an alternative medicine system from India. It is considered a pseudoscience. This means that its claims have not yet been validated by scientific methods and evidence.
  • Herbal remedies – A 2010 study has shown that coenzyme Q10 might help erectile dysfunction and penile curvature in men with Peyronie’s disease. But there is insufficient evidence to prove that coenzyme Q10 supplements or other herbal remedies can cure or help Peyronie’s disease.

How long does it take to cure Peyronie’s disease?

Most treatment options will take several months to cure or improve Peyronie’s disease. Out of all treatments, surgery is the fastest option, but you would usually have to wait 6 months after you reached the chronic stage of the disease to have the operation.

How to prevent Peyronie’s disease?

Other than trying to make sure you don’t injure your penis during sex or other physical activity there isn’t much you can do to prevent Peyronie’s disease.

Medically reviewed by Oreoluwa Ogunyemi, MD.

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