Peyronie's Disease

Peyronie's disease is a medical condition in which fibrous scar tissue grows within the penis resulting in curved and painful erections.

Since the shape and size of men's penis vary, having a curved erection is common and isn’t a serious concern.

However, it can cause a severe pain or considerable bend. This may refrain a man from having sexual intercourse or cause erectile dysfunction (inability to develop or maintain erect penis).

It could be the source of stress and anxiety in many men.

In most of the cases of Peyronie's disease, the condition remains stable or worsens while in minority of the cases the condition improves on its own.

The treatment is needed if the disease cause significant bend and prevents successful sexual intercourse. 

The symptoms of Peyronie's disease are either seen abruptly or progressively.

The signs and symptoms are:

• Scar tissue that can be felt under the skin of penis as a band of hard tissue
• Considerable bending of penis to upward, downward or to one side
• Erectile dysfunction
• Penile pain (may be experienced with or without erection)
• Shorter penis size

In most of the cases, the penile pain subsides within few years but scar tissue and curvature are often persistent.

The condition may improve or stabilize without treatment in few instances.

When to see a Doctor?

Immediately seek medical advice if you experience penile pain or significant curving of penis that prevents you from having sexual intercourse or results in anxiety.

The exact cause of Peyronie's disease has not been understood entirely.

Peyronie's disease is believed to occur due to involvement of number of factors which generally result in repeated injury to the penis (penile damage during sex, athletic activity or consequences of an accident).

The healing process after repeated injury causes normal tissue to be replaced by scar tissue in disordered way that leads to formation of nodules or growth of curved penis.

Tunica albuginea (sheath of an elastic tissue) encloses corpus cavernosum (sponge-like tube) which contains numerous blood vessels. During erection, tunica albuginea stretches and blood flow to corpus cavernosum increases.

Increase in blood flow causes penis to stretch and be erect.

In Peyronie's disease, area with fibrous tissue doesn’t expand resulting in curved penis and severe penile pain. In few instances the disease progresses slowly and seems to be unrelated to injury.

The investigation usually begins with physical examination of penis which is adequate enough to diagnose Peyronie's disease.

If you have any signs and symptoms that worry you, make an appointment with your doctor. Depending upon your condition, you may be referred to urologist (specialist in genitourinary system).

Physical exam

Your doctor will palpate your penis when it is not erect to spot the location and amount of scar tissues. The length of penis might be measured in order to determine whether the length has shortened as the condition worsens. To determine the extent of bending and location of scar tissue, you may be asked to bring photos of your erect penis taken at home.

Imaging tests

You might be suggested an ultrasound to examine your penis. Your penis is made erect after you receive an injection directly into penis. Ultrasound guidance is mostly used to test for penis abnormalities that can show the fibrous tissue and amount of blood flow to penis.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

• List out all the symptoms.
• Write down your key medical information.
• Write down the names of all your medications, vitamins or supplements.

Make a list of the questions to ask your doctor.

Some typical question can be:

• Do I need to perform any tests?
• Which treatment do you recommend?
• Will the symptoms worsen or improve?
• What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

• When did you start becoming aware of scar tissue or curvature in your penis?
• Has the curvature worsened?
• Do you experience penile pain during erection?
• Has it got worse or improved over time?
• Have you had any circumstances that could cause injury to penis?
• Do the symptoms prevent you from having sex?

If Peyronie's disease is not worsening and you can have sexual intercourse without pain the doctor may suggest no treatment at all.

Medication or surgery is recommended only if the symptoms worsens or get severe over time.

Medication

Medication is given with an aim to minimize the scar formation, penile pain and bending of penis.

The drug approved by FDA (Food and Drug Administration) is collagenase clostridium histolyticum which is used when the lump from scars in penis cause penile curvature of at least 30 degrees during erection.

The medication works by breaking down collagen responsible for bending of penis. The medication is directly injected into the lump of scars followed by penile modeling (exercises to gently extend and straighten the penis).

It is essential to discuss the probable side effect of the medication with your doctor. Some off-label use medicines that have been used in treatment of Peyronie's disease are pentoxifylline (oral drug), verapamil (injections or topical gels) and interferon (injection).

Surgery

Surgery is recommended if the penile curvature keeps on increasing or deformity of penis is severe or prevents you from having sexual intercourse.

The surgical methods are:

• Suturing or plicating of the unaffected side: Plicating the side of penis without fibrous tissue can straighten the penis. It may cause shortened penis or erectile dysfunction in some cases.
• Incision or excision and grafting: It may result in worsened erectile dysfunction as compared to placating. This procedure is followed for severe penile curvature. The surgeon crafts one or more cuts in scar tissue of tunica albunigea, occasionally removing few of the scar tissue, that allows the elastic sheath to extend and penis to straighten. The surgeon may stitch graft to cover up the hole in tunica albuginea.
• Penile implants: The spongy tissues within the penis are replaced by penile implants by surgical procedure. Since implants are semi-rigid, it needs to be bent downward or upward manually. Penile implants are considered for those who are suffering from both Peyronie's disease and erectile dysfunction.

The type of surgery is dictated the location of scar tissue and the severity of symptoms.

Other treatments

Iontophoresis is a technique where combinations of drug (verapamil and dexamethasone) are delivered with the use of weak electrical current through the skin without the need of invasion.

Non drug treatment: These are still being investigated and the evidence for their efficacy is still inadequate. Some of these are shock wave therapy (use of intensive sound waves to break down the scar tissue), penile traction therapy (devices that stretch peins) and vacuum devices.

Lifestyle modifications are necessary in order to cope with Peyronie's disease.

Since Peyronie's disease can create anxiety and stress between you and your sexual partner it is essential to explain your partner about this disease.

Explain your partner about how it feels about the appearance of your penis and your ability to have sexual intercourse.

Discuss with your partner about how to maintain the intimacy between the two of you.

Seek advice from mental health provider who specializes in family relation and sexual matter

There are several risks and complications associated with Peyronie's disease.

Risks

• Heredity: You are at an increased risk of developing the condition if you have family history of Peyronie's disease.
• Connective Tissue Disorders: Men with connective tissue disorder have higher risk of the condition.
• Peyronie's disease co-exists with Dupuytren's contracture (a cord-like thickening across the palm that causes the fingers to pull inward).
• Age: Older men are at higher risk. Increase in age can cause tissues to be injured more easily and heal slowly. 
• Other factors: Smoking, prostate surgery might be linked to Peyronie's disease.

Complications

• Inability to have sexual intercourse
• Erectile dysfunction 
• Anxiety or stress about sexual abilities or the appearance of your penis
• Stresses on the relationship with your sexual partner