Man's health

Peyronie’s disease


Peyronie's Disease: Symptoms, Causes, Treatments

Peyronie’s disease is a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis. Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa, causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening. A v ariety of treatments have been used, but none have been especially effective.

Peyronie’s disease is penisproblem caused by scar tissue, called plaque, that forms inside the penis. It can result in a bent, rather than straight, erect penis.

Most men with Peyronie’s diseasecan still have sex. But for some, it can be painful and cause erectile dysfunction.

Depending on the symptoms, you may opt for observation, medical or surgical treatments.

It is estimated to affect ~10% of men. The condition becomes more common with age. Peyronie’s disease sometimes goes away on its own. But in most cases, it will remain stable or worsen. Treatment might be needed if the curvature is severe enough that it prevents successful sexual intercourse.

Highlights

  1. Peyronie’s disease is a form of erectile dysfunction that causes a bend in the penis that can make an erection quite painful.
  2. The condition may develop after trauma to the penis, such as bending or hitting. This can cause bleeding and subsequent scar tissue buildup.
  3. This scar tissue can generally be felt through the skin. Plaque normally forms on the upper side of the penis, but may also occur on the bottom or side.

Erectile dysfunction (ED) is a condition in which a man has difficulty getting or maintaining an erection. It can cause problems in the bedroom for men of all ages. One rare form of ED, called Peyronie’s disease, results in a bend in the penis that can make an erection painful.

While a curved erection doesn’t always indicate a problem, men who have Peyronie’s disease may have trouble having sex. This often causes anxiety and discomfort. Keep reading to understand more about Peyronie’s disease.

Causes of Peyronie’s Disease

Doctors don’t know exactly why Peyronie’s disease happens. However, research suggests that the condition may develop after trauma to the penis, such as bending or hitting. This can cause bleeding and subsequent scar tissue buildup.

It’s thought Peyronie’s disease generally results from repeated injury to the penis. For example, the penis might be damaged during sex, athletic activity or as the result of an accident. However, most often, no specific trauma to the penis is recalled.

During the healing process, scar tissue forms in a disorganized manner, which might then lead to a nodule that you can feel or development of curvature.

Symptoms

Peyronie’s disease signs and symptoms might appear suddenly or develop gradually. The most common signs and symptoms include:

  • Scar tissue. The scar tissue (plaques) associated with Peyronie’s disease can be felt under the skin of the penis as flat lumps or a band of hard tissue.
  • A significant bend to the penis. Your penis might be curved upward, downward or bent to one side. In some cases, the erect penis might have narrowing, indentations or an hourglass appearance, with a tight, narrow band around the shaft.
  • Erection problems. Peyronie’s disease might cause problems getting or maintaining an erection (erectile dysfunction).
  • Shortening of the penis. Your penis might become shorter as a result of Peyronie’s disease.
  • Pain. You might have penile pain, with or without an erection.

The curvature associated with Peyronie’s disease might gradually worsen. At some point, however, it typically stabilizes.

The disease may cause pain; hardened, big, cord-like lesions (scar tissue known as “plaques”); or abnormal curvature of the penis when erect due to chronic inflammation of the tunica albuginea (CITA). Although the popular conception of Peyronie’s disease is that it always involves curvature of the penis, the scar tissue sometimes causes divots or indentations rather than curvature. The condition may also make sexual intercourse painful and/or difficult, though it is unclear whether some men report satisfactory or unsatisfactory intercourse in spite of the disorder. It can affect men of any race and age. The disorder is confined to the penis, although a substantial number of men with Peyronie’s exhibit concurrent connective tissue disorders in the hand, and to a lesser degree, in the feet. About 30 percent of men with Peyronie’s disease develop fibrosis in other elastic tissues of the body, such as on the hand or foot, including Dupuytren’s contracture of the hand. An increased incidence in genetically related males suggests a genetic component.

Pain during erections usually improves within one to two years, but the scar tissue and curvature often remain. In some cases, both the curvature and pain associated with Peyronie’s disease improve without treatment.

Peyronie’s Disease in Young Men

Peyronie’s disease is most common in middle-aged men, but may occur in men as young as 20. Research shows 8 to 10 percent of men with Peyronie’s disease are under the age of 40.

Most young men with Peyronie’s present with symptoms such as painful erection. They often require medical intervention due to acute disease. Less than 21 percent of patients researched had a history of erectile dysfunction.

Treatment for Peyronie’s Disease

Without treatment, about 12–13% of patients will spontaneously improve over time, 40–50% will get worse and the rest will be relatively stable. This is based on a survey of 97 men and therefore based on the subjective impression of the patients. No objective long-term natural history via continual evaluation of patients has been recorded to date.

Nonsurgical Options

Iontophoresis, a technique that uses a weak electrical current to deliver medication through the skin, is another treatment option for Peyronie’s disease.

Nondrug treatments are being investigated, such as:

  • shock wave therapy to break up scar tissue
  • penile traction therapy to stretch the penis
  • vacuum devices

Patients being treated with Xiaflex may benefit from gentle penile exercises. For six weeks after treatment, you should do two activities:

  • Stretch the penis when not erect, three times daily for 30 seconds per stretch.
  • Straighten the penis when experiencing a spontaneous erection unrelated to sexual activity for 30 seconds, once daily.

Drug therapy may help men who are badly affected by the disease during the acute phase. There haven’t been enough studies to tell exactly how well these drugs work, though.

Oral vitamin E

Vitamin E is an antioxidant that’s popular because of its mild side effects and low cost. Studies show that taking vitamin E may make plaques smaller and help straighten the penis. But most of these studies did not compare a group of people using vitamin E to a group of people who did not (a control group). A few studies of vitamin E that used a control group suggest that vitamin E doesn’t work better than placebo. (A placebo is a pill with no drugs in it – a “sugar pill.”)

Potassium amino-benzoate (“Potaba”)

Small studies with placebo controls show that this vitamin B-complex helps reduce plaque size, but not the curve. Unfortunately, it is costly and patients need to take 24 pills per day for 3 to 6 months. It also can upset your stomach, so many men stop taking it.

Tamoxifen

This non-steroidal, anti-estrogen drug has been used to treat desmoid tumors, which are like the plaques in Peyronie’s disease. There are only a few controlled studies of this drug and they haven’t shown that tamoxifen works better than placebo.

Colchicine

Colchicine is an anti-swelling agent that has been shown to be slightly helpful in a few small studies without controls. Many patients taking colchicine get stomach problems and stop taking the drug. It hasn’t been proven to work better than placebo.

Carnitine

Carnitine is an antioxidant drug that lowers swelling to help wounds heal. Studies without controls show some benefit. But a recent controlled study didn’t show it to work better than placebo.

Penile Injections

Injecting a drug right into the plaque brings higher doses of the drug to the problem than when a drug is taken by mouth. Plaque injection is often used for men with acute phase disease who aren’t sure they want to have surgery. The skin is often numbed before the shot to reduce pain.

Verapamil injections

Verapamil is mostly used to treat high blood pressure. Some studies suggest that verapamil injection also works for penile pain and curving. Verapamil appears to be a good, low-cost option for Peyronie’s disease. More controlled studies are needed to prove how well it works.

Interferon injections

Interferon is a protein made in the body that helps control swelling. It has been shown to help control scarring, perhaps by slowing down the rate that scar tissue builds and by making an enzyme that breaks down the scar tissue.
A large-scale test of interferon injection for Peyronie’s disease showed that this treatment can help. But more studies are needed.

Collagenase injections

Collagenase is made in the body and breaks down certain tissues. Studies have shown that injecting collagenase into plaques helped fix Peyronie’s disease. This drug (Xiaflex®) is now approved in the U.S. for treatment of men with penises curving more than 30 degrees.

Lifestyle Changes

Lifestyle changes may reduce the risk of ED related to Peyronie’s disease. These include:

  • quitting smoking
  • reducing alcohol consumption
  • stopping use of illegal drugs
  • exercising regularly

Surgery

Surgery is the last course of action in the case of severe penis deformity. According to the NKUDC, you should wait at least a year before turning to surgery for Peyronie’s disease. Surgical solutions include:

  • shortening the unaffected side
  • lengthening the scar tissue side
  • penile implants

Lengthening runs a greater risk of erectile dysfunction. Shortening the unaffected side is used when curvature is less severe. One type of shortening is a procedure called the Nesbit plication. In this procedure, doctors remove or cinch excess tissue on the longer side. This creates a straighter, shorter penis.

Other Options

Other ways to treat Peyronie’s disease that are unproven include injecting chemicals directly into the plaque and radiation therapy. But because radiation therapy can only relieve pain associated with Peyronie’s disease and pain often stops without treatment, it’s rarely done.

Risk factors

Minor injury to the penis doesn’t always lead to Peyronie’s disease. However, various factors can contribute to poor wound healing and scar tissue buildup that might play a role in Peyronie’s disease. These include:

  • Heredity. If your father or brother has Peyronie’s disease, you have an increased risk of the condition.
  • Connective tissue disorders. Men who have a connective tissue disorder appear to have an increased risk of developing Peyronie’s disease. For example, a number of men who have Peyronie’s disease also have a cord-like thickening across the palm that causes the fingers to pull inward (Dupuytren’s contracture).
  • Age. The prevalence of Peyronie’s disease increases with age, especially in men over 55.

Other factors — including certain health conditions, smoking and some types of prostate surgery — might be linked to Peyronie’s disease.

Counseling

Peyronie’s disease can be a physically and psychologically devastating disease. While most men will continue to be able to have sexual relations, they are likely to experience some degree of deformity and erectile dysfunction in the wake of the disease process. It is not uncommon for men afflicted with Peyronie’s disease to exhibit depression or withdrawal from their sexual partners.

Reviewed by the QSota Medical Advisory Board