Peyronie’s disease is condition where a band of scar tissue (called a plaque) forms in the penis, causing a pronounced bend or curve in the penis when it is erect.
The scar tissue may prevent the normal expansion of the penis during an erection, which can affect the size and shape of the erect penis. Peyronie’s disease can affect a man’s sex life because erections can be painful, and some men have difficulty getting or maintaining an erection.
Peyronie’s disease is most common in Australian men aged between 45 and 60 years.
Although it’s normal for an erect penis to be curved slightly, a man with Peyronie’s disease will have an abnormal amount of curvature of the penis when he has an erection, which may make it difficult for him to have sex.
Symptoms vary, but can include:
- curvature of the penis (the penis can bend sideways, upwards or downwards);
- a lump or band of hard scar tissue on the penis (usually felt under the skin on the upper or lower side of the penis);
- shortening or narrowing of the penis;
- an abnormally shaped penis, such as a hourglass-shaped penis (resulting from a band of scar tissue around middle of the shaft);
- pain in the penis;
- painful erections;
- erectile dysfunction – difficulty getting or maintaining an erection; and
- inability for the penis to become erect past the area of scar tissue.
These symptoms may appear suddenly or develop slowly over a long period of time. The curvature can gradually become more pronounced.
If Peyronie’s disease is affecting your sex life, it is common to have feelings of stress or anxiety.
What causes Peyronie’s disease?
The exact cause of Peyronie’s disease is not clear. It is thought that Peyronie’s disease may be due to repeated injury, for example, if the penis is damaged during sex, or if a man has had an injury to the groin area. Many men with Peyronie’s disease do not recall being injured.
A problem with the immune system that leads to an abnormal healing response to minor injuries, resulting in scarring, may also contribute to the development of a penile plaque.
It’s also possible that the scar tissue may form because of an autoimmune disease, where the body’s normal defence mechanism — the immune system — turns on the body itself.
There are some factors that are known to increase the risk of Peyronie’s disease, including the following.
- Peyronie's disease is sometimes associated with a condition called Dupytren's contracture, where a similar fibrous band occurs in the palm of the hand. It has also been associated with other connective tissue diseases.
- A family history of Peyronie’s disease.
- Increasing age.
Tests and diagnosis
Your doctor will ask about your symptoms and perform a physical examination.
Your doctor may refer you to a urologist – a doctor who specialises in problems with the urinary tract and male reproductive organs. Your urologist may recommend a test called an intracavernosal injection test, where an injection is given into the penis to cause an erection, in order to examine the degree of curvature and whether there are any other problems.
Your doctor may also perform an ultrasound scan of the penis that shows the extent of the scar tissue and blood flow within the penis. An injection into the penis that causes an erection may be given before the test.
Treatments for Peyronie's disease
Treatment for Peyronie’s disease will depend on your symptoms, their severity, and whether the condition is getting worse, has stabilised or is improving. The aim of treatment is to treat pain and maximise sexual function.
Peyronie’s disease can sometimes resolve over time without treatment. If your symptoms are mild and not affecting your sex life, you may not need treatment and your doctor may recommend monitoring your condition.
Treatment with medicines or surgery may be recommended for men with symptoms that are severe or not improving.
Pain relievers such as non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended for the treatment of pain in the penis.
Injecting penile plaques with certain medicines can help reduce the curvature of the penis and may improve pain.
An injection of a medicine called collagenase clostridium histolyticum (brand name Xiaflex) may be recommended for some men with stable Peyronie’s disease. This medicine is injected into the scar tissue (plaque) in the penis, and may help to break down the plaque and reduce curvature. Several injections are usually given, followed by gentle exercises to help stretch and straighten the penis.
Side effects can include mild pain, bruising, and swelling of the penis. After this treatment there is also a risk of having a penile fracture during an erection. Symptoms of a penile fracture (which requires immediate medical attention) include: a popping sound or sensation in the penis; sudden, severe pain or swelling of the penis; bruising of the penis; sudden loss of erection; difficulty urinating; or blood in the urine.
There are several surgical procedures that can be used in the treatment of Peyronie’s disease. The type of surgery recommended will depend on your symptoms and the location of the penile plaque(s).
- Plication surgery is performed on the opposite side of the penis from the affected side. It involves making a tuck in the lining of the penis (using stitches) to try to even out the curve. Possible risks of this surgery include penile shortening and erectile dysfunction.
- Incision/excision of the plaque and grafting. This involves cutting the plaque, and sometimes also removing the scar tissue and grafting healthy tissue to the affected area. Erectile dysfunction is the major risk associated with this type of surgery. Numbness of the penis can also occur.
- Penile implants may be considered in men with Peyronie’s disease and erectile dysfunction. It involves the insertion of a prosthesis to help straighten the penis and make it firm enough to have sex.
Because the condition can improve on its own, doctors recommend waiting at least one year before considering surgical treatments. Also, surgery is usually only an option once the curvature is stable (no longer increasing).
If Peyronie’s disease is affecting your sex life or your relationship, it can help to talk about it with your partner. Talk to your doctor if you have feelings of stress or anxiety.
Your doctor may recommend you see a psychologist, counsellor or family therapist to help deal with problems with anxiety or relationship problems.
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4. American Urological Association. Diagnosis and treatment of Peyronie’s disease: AUA guideline (2015). https://www.auanet.org/education/guidelines/peyronies-disease.cfm (accessed Jul 2016).