Topic Overview

What is Peyronie’s disease?

Peyronie’s disease is an abnormal curvature of the penis caused by scar tissue in the erectile tissue. Because the scar tissue prevents straightening of the penis, the curvature is most obvious during an erection. The curvature may be so severe that it prevents penetration during intercourse.

Peyronie’s disease usually affects men who are 50 and older.

What causes Peyronie’s disease?

Although the exact cause of Peyronie’s disease is unknown, some experts believe the scarring is caused by injury to the penis from accidents, sports, or vigorous sex. During sexual intercourse, the penis can be injured by being bent during penetration or by pressure from a partner’s pubic bone.

Experts also wonder if this disease involves a problem with wound-healing.

Peyronie’s disease is not caused by cancer and does not increase the risk of cancer. It is not caused by sexually transmitted infections (STIs).

What are the symptoms?

Symptoms of Peyronie’s disease may develop slowly or suddenly. Common symptoms include:

• A lump or thickening along the shaft of the penis that is most noticeable when the penis is soft (flaccid).
• A bent or curved appearance of the penis that is most noticeable when the penis is erect.
• A painful erection. Some men do not have pain with an erection but have tenderness when the lump along the side of the penis is touched.
• An inability to keep an erection.
• An inability to achieve penetration during intercourse.

What are the stages of Peyronie’s disease?

Peyronie’s disease is usually divided into two stages:

• The acute phase. The most common symptoms of this phase are painful erections and a change in the curve of the penis.
• The chronic phase. The curve of the penis may be the only symptom of this phase. Pain, if present during the acute phase, usually gets better or goes away completely.

How is Peyronie’s disease diagnosed?

Peyronie’s disease is usually diagnosed using a medical history and physical exam. Your doctor will ask you questions about when you first noticed your symptoms and whether the symptoms were gradual or sudden. This will help determine which stage of Peyronie’s disease you are experiencing.

Because symptoms of Peyronie’s disease are usually most noticeable when the penis is erect, your doctor may inject a drug into your penis to make it erect. This will help your doctor see where the erectile tissue is scarred. Other tests that may be ordered include:

• An X-ray or ultrasound, to produce a picture of the structures within the penis.
• Doppler flow studies, which use sound waves to monitor blood-flow patterns.

How is it treated?

Peyronie’s disease rarely gets better on its own. For men who have a slight curve that isn’t getting worse and who have good erectile function, treatment usually is not needed. But if pain is a problem, or if the curve is getting worse and interfering with your sexual activity, then getting treatment may help. And early treatment during the acute phase may also work better than waiting until you’re in the chronic phase.

If your doctor is a primary care doctor, he or she may refer you to a urologist.

Most men are able to remain sexually active. Counseling can help couples maintain an active sexual life.

Medicines may help treat pain and reduce how much the penis curves. They include:

• NSAIDS such as ibuprofen (Advil) or naproxen (Aleve) for pain.
• Pentoxifylline, a combination of vitamin E and colchicine, or carnitine to reduce scarring. These are oral medicines (pills).
• Collagenase, interferon, and verapamil to reduce scarring. These are given as shots into the scar tissue.

There is not much evidence from studies showing how well any of these medicines work to heal the scarring and reduce the curve.

Surgery is only considered for men who have severe pain, a severely curved penis, or sexual dysfunction related to Peyronie’s disease. Surgical options include removing the scar tissue or shortening the unaffected side of the penis (plication). In some cases, use of a penile prosthesis may be used to help keep an erection during intercourse.