Peyronie’s disease (pronounced: pay-row-knees) is a disease that affects the male penis. It is considered a connective tissue disorder that affects an estimated 10-12 percent of men. Scar tissue, also known as fibrous plaques, develops along one side of the shaft of the penis. Commonly the penis is bent rather than straight when erect. However, when present, this scar tissue can cause the penis to take on a curved shape. Sometimes the curve is extreme.
In addition to curvature, the condition can also cause general pain, erectile dysfunction, pain with intercourse, and a decrease in penile size. The disease can range from extremely mild to markedly severe.
Peyronie’s disease can occur at any time, but it most commonly appears in middle-aged men and is more common in older men. When present, the severity of Peyronie’s disease becomes more pronounced over time.
Signs and symptoms
A mild curvature of the penis is considered normal and termed “benign congenital curvature.” When the condition is present, cord-like scar tissue can cause both penile curvature and depression or dents in the penile shaft, although a curved penis is the most commonly reported manifestation of the disease.
Many men with significant disease report discomfort and pain with intercourse. Men with mild disease may not experience uncomfortable sex. About 10-20 percent of men with Peyronie’s disease will also develop connective tissue conditions that affect the hands and feet.
The exact cause of Peyronie’s disease is not clearly understood. Many doctors believe Peyronie’s disease may be a combination of both genes and trauma. Theories suggest it is the result of some traumatic event or repeated minor trauma to the penis from sexual encounters or physical activity. Oddly, most men with Peyronie’s disease don’t report any history or memory of injury to the penis.
It does seem to occur more commonly among family members, so there may indeed be a genetic basis to the disease. Some medications may list Peyronie’s as a side effect, but there is no medical proof that drugs cause Peyronie’s disease.
A urologist can diagnose the condition. In most cases, a hard fibrous plaque or cord can be felt along one side of the penile shaft. The urologist may also order an ultrasound imaging study to confirm the diagnosis.
Sometimes the determination can only be made when the penis is erect. In those cases, a medicine can be given at the doctor’s office to cause an erection and enable the diagnosis. In rare cases, a biopsy of affected tissue may be required to solidify the diagnosis.
It is estimated that about 10 percent of cases will improve on their own, without any treatment. About 50 percent of cases will worsen over time, and the rest of the cases will appear and remain unchanged.
Treatment of Peyronie’s disease is both challenging and controversial, and is usually reserved for symptomatic cases. Because a small percentage of cases resolve spontaneously, patients with mild Peyronie’s disease may elect to observe the condition without intervention.
Many doctors, in mild to moderate cases, will recommend just observation for one or two years before engaging in treatment. If Peyronie’s disease does not affect sexual performance or produce pain with intercourse, treatment may not be required, at all.
If Peyronie’s disease is causing pain, oral medications such as vitamin E supplementation have reportedly been effective in some, but certainly not a majority, of cases. It appears that earlier studies reporting the effectiveness of vitamin E have not been able to be replicated recently. Reports of B vitamins and closely related medications indicate that these might also be beneficial.
There is a medication that is now FDA-approved to treat Peyronie’s disease. It is an enzyme named collagenase clostridium histiolyticum that is injected into the penis and works by breaking down the scar tissue or fibrous cords that cause Peyronie’s disease.
Some medications that function as non-steroidal anti-inflammatory medications (like pentoxifylline, verapamil and others) have also been used with success. These anti-inflammatory medications appear to be not as effective in treating longstanding disease.
There are penile devices that can straighten and stretch the penis to improve the condition. The results are mixed, but because it is safe and cost-effective, this treatment may be worth trying. Unfortunately, experts are not in agreement about how much, how often, and for what time period penile stretching is optimal for disease treatment. At this point, this option appears to be more trial and error than any unique or specific plan.
Surgery is indicated when Peyronie’s disease prevents sexual intercourse. The plaque itself can be surgically excised, or the area opposite the affected area can be removed. This surgical procedure, called the “Nesbitt” procedure, was developed by and named for a famous urologic surgeon.
The Nesbitt procedure is used as a last-hope treatment for extreme cases when nothing else works. The Nesbitt surgery is a complicated procedure that requires both extreme experience and skill and causes a shortening of the penis. In cases where erectile dysfunction is present, a prosthesis may be surgically implanted.
Many surgeries can be helpful. However, the risk of causing a side effect that can’t be corrected causes surgeons to recommend surgical correction infrequently.
Peyronie’s disease can be psychologically devastating. Affected persons can have low self-esteem. Often patients develop symptoms of depression and avoid social or sexual partners. In these cases, appropriate counseling from experienced therapists can make a significant difference.
Peyronie’s disease is a common, but little-discussed disease. It can have severe mental and physical effects in those suffering from it and affected by it, and can completely ruin the sexual component of a relationship.
The good news is that Peyronie’s disease is being discussed more and there is an FDA-approved treatment for the condition. If you or a loved one may be suffering from symptomatic Peyronie’s disease, help may be as close as your doctor’s office.
Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations, and president of the Minnesota Association of Black Physicians.