Peyronie’s disease is a condition of abnormal curvature during an erection. It is characterized by a plaque, or hard lump, that forms within the capsule around the penis. The plaque, a flat plate of scar tissue, develops inside a thick membrane called the tunica albuginea, which envelopes the erectile tissues of the penis. The plaque begins as a localized inflammation and develops into a hardened scar. This plaque has no relationship to the plaque that can develop in arteries. The exact cause of Peyronie’s disease is unknown.
Cases of Peyronie’s disease range from mild to severe. Symptoms may develop slowly or appear overnight. For most men with a mild form of Peyronie’s, erections are not painful, and the bending does not interfere with sexual intercourse. In severe cases, the hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc toward the area of plaque during an erection. In many cases, the pain decreases over time, but the bend in the penis may remain a problem, making sexual intercourse difficult. The sexual problems that result can disrupt a couple’s physical and emotional relationship and can lower a man’s self-esteem.
The plaque itself is benign, or noncancerous. It is not a tumor. Peyronie’s disease is not contagious and is not known to be caused by any transmittable disease.
A plaque on the top side of the shaft, which is most common, causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. At times, pain, bending, and emotional distress prohibit sexual intercourse.
Estimates of the prevalence of Peyronie’s disease range from less than 1 percent to 23 percent.1 A recent study in Germany found Peyronie’s disease in 3.2 percent of men between 30 and 80 years of age.2 The exact cause of Peyronie’s disease is uncertain. It is speculated that it is related to weak connective tissue and mild trauma, that cannot usually be identified. Although the disease occurs mostly in middle age, younger and older men can develop it. About 30 percent of men with Peyronie’s disease develop plaques of scar tissue in other parts of the body, such as the hand or foot. A common example is a condition known as Dupuytren’s contracture of the hand. In some cases, Peyronie’s disease runs in families, which suggests that genetic factors might make a man vulnerable to the disease.
A French surgeon, François de la Peyronie, first described Peyronie’s disease in 1743. The problem was noted in print as early as 1687. Early writers classified it as a form of impotence, now called erectile dysfunction (ED). Peyronie’s disease can be associated with ED—the inability to achieve or sustain an erection firm enough for intercourse.
However, experts now recognize ED as only one factor associated with the disease — a factor that is not always present.
1 Wessells H, Joyce GF, Wise M, Wilt TJ. Erectile dysfunction and Peyronie’s disease. In: Litwin MS, Saigal CS, editors. Urologic Diseases in America. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: U.S. Government Printing Office, 2007; NIH Publication No. 07–5512:483–530.
2 Sommer F, Schwarzer U, Wassmer G, Bloch W, Braun M, Klotz T, Engelmann U. Epidemiology of Peyronie’s disease. International Journal of Impotence Research. 2002; 14:379–383.
- Genetic factors
- Curvature of the penis during erection (can be permanent)
- “lump” that can be felt in the erectile tissue of the penis
- Pain during erection (often decreases over time)
- Erectile dysfunction
Doctors can usually diagnose Peyronie’s disease based on a physical examination. The plaque can be felt when the penis is limp. Full evaluation, however, may require examination during erection to determine the severity of the deformity. The erection may be induced by injecting medicine into the penis or through self-stimulation. Some patients may eliminate the need to induce an erection in the doctor’s office by taking a digital or Polaroid picture at home. The examination may include an ultrasound scan of the penis to pinpoint the location(s) and calcification of the plaque. The ultrasound can also be used to evaluate blood flow into and out of the penis if there is a concern about erectile dysfunction.
Men with Peyronie’s disease usually seek medical attention because of painful erections, penile deformity, or difficulty with intercourse. Because the cause of Peyronie’s disease and its development are not well understood, doctors treat the disease empirically; that is, they prescribe and continue methods that seem to help. The goal of therapy is to restore and maintain the ability to have intercourse. For most men with mild disease, providing education and reassurance is often all that is required. For patients with more severe Peyronie’s treatment may be necessary.
Because the course of Peyronie’s disease is different in each patient and because most patients experience some improvement without treatment, medical experts suggest waiting 1 year or longer before having surgery. During that wait, anti-inflammatory medications such as ibuprofen or Co Q 10 may be helpful with the discomfort.
- Oral Medications — Researchers conducted small-scale studies in which men with Peyronie’s disease who were given vitamin E orally reported improvements. Yet, no controlled studies have established the effectiveness of vitamin E therapy. Similar inconclusive success has been attributed to aminobenzoate potassium (Potaba) and Co Q 10. Other oral medications that have been used include colchicine, tamoxifen, and pentoxifylline. Again, the benefit is questionable, and no controlled studies have been conducted on these medications.
- Penile Injections — For years researchers have tried injecting chemical agents such as verapamil, steroids, and interferon-alpha-2b directly into the plaques with variable, and usually disappointing, degrees of curvature improvement. Around 2015 the collagenase Xiaflex was approved by the FDA and has been used with better success to inject and dissolve Peyronie’s plaque.
- Radiation Therapy — Radiation therapy, in which high-energy rays are aimed at the plaque, has also been used. Like some of the chemical treatments, radiation appears to reduce pain, but it has no effect on the plaque itself and can cause unwelcome side effects such as erectile dysfunction.
- Traction Therapy — Traction therapy with a penile vacuum pump or penile traction device may be effective in reducing the curvature of the penis. Some form of traction therapy or modeling of the penis has been most effective when combined with Xiaflex injections.
Three surgical procedures for Peyronie’s disease have had some success. Most types of surgery produce positive results. But because complications can occur, and because many of the effects of Peyronie’s disease — for example, shortening of the penis — are not usually corrected by surgery, most doctors prefer to perform surgery only on the small number of men with curvature severe enough to prevent sexual intercourse.
One procedure involves removing or cutting of the plaque and attaching a graft of skin, vein, or material made from animal organs. This method may straighten the penis and restore some lost length from Peyronie’s disease. However, some patients may experience numbness of the penis and loss of erectile function.
A second procedure, called plication, involves removing or pinching a piece of the tunica albuginea from the side of the penis opposite the plaque, which cancels out the bending effect. This method is less likely to cause numbness or erectile dysfunction, but it shortens the penis.
A third surgical option is to implant a device that increases the rigidity of the penis. In some cases, an implant alone will straighten the penis adequately. If the implant alone does not straighten the penis, implantation is combined with one of the other two surgical procedures.