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Peyronie disease is a condition in which scar tissue develops in the deep tissues under the skin of the penis. This scar tissue causes the penis to curve, which is most noticeable during an erection. The condition can cause pain and difficulty with penetration during sex, which can lead to anxiety and stress.
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What Is Peyronie Disease?
Peyronie disease (PD) is a condition in which fibrous scar tissue known as plaque develops in the deep tissues under the skin of the penis. This build-up of scar tissue causes the penis to curve, which is most noticeable during an erection.
Normal tissue will stretch with an erection, but scar tissue stays tight. A penis affected by PD may curve or narrow at the shaft, creating an hourglass shape.
PD can cause pain and difficulty with penetration during sex, which can lead to anxiety and stress.
It is not associated with penile cancer.
How common is Peyronie disease?
Peyronie disease affects about 6% of men, most commonly between the ages of 40 and 70.
What causes Peyronie disease?
Doctors don't have a definitive explanation for why PD occurs.
However, possible causes of Peyronie disease include:
- Injury —Whether from sports, trauma, or even sex, that leads to scar tissue.
- Genetics — If your father had Peyronie disease, you may be more likely to develop it yourself.
Peyronie disease isn't a life-threatening condition, nor does it increase your risk of cancer or other illnesses. Although doctors don't fully understand the causes of PD, there are treatments available to improve the symptoms.
Peyronie disease risk factors
Risk factors for Peyronie disease include:
- Autoimmune disorders.
- Connective tissue disorders, including Dupuytren’s contracture, scleroderma, and plantar fasciitis.
- Cystoscopy.
- Diabetes — Especially with diabetes-related erectile dysfunction.
- Family history of Peyronie disease.
- Fibromatous lesions in their partner's genital tract.
- Heavy alcohol use.
- Heavy smoking.
- Lipoma — A benign fat-cell tumor that grows under the skin.
- History of genital or perineal injury.
- Hypogonadism – Low production of hormones.
- Hypertension — High blood pressure.
- Obesity or high body mass index (BMI).
- Use of the beta blocker propranolol for another health issue.
- Rough sexual or nonsexual activities that cause penis micro-injuries.
- Surgical intervention on their partner's genital tract.
- Transurethral prostatectomy – Prostate removal surgery.
Men with Peyronie disease also have an increased risk of developing other health problems, including:
- Benign prostatic hyperplasia.
- Lower urinary tract symptoms.
- Prostatitis.
- Keloids.
Complications of Peyronie disease
If left untreated, the fibrous scar tissue that builds up can cause the penis to curve. In time, this curvature can cause other issues.
Physical issues include:
- Inability to get or hold an erection (erectile dysfunction or ED).
- Inability to have penetrative intercourse.
- Loss of penis length.
- Painful erections and intercourse.
Although PD does not necessarily affect a person’s fertility, achieving a pregnancy without assisted reproduction may be difficult.
About 80% of men report mental health complications of Peyronie disease in addition to physical symptoms.
Psychological complications may include:
- Anxiety or depression over sexual performance.
- Fear of intimacy.
- Lower quality of life.
- Self-esteem issues over appearance.
- Sexual dissatisfaction or frustration.
- Stress on intimate relationships.
What Are the Signs and Symptoms of Peyronie Disease?
A curved penis during an erection is the most common symptom of the condition, but you may notice other symptoms as well. In some cases, you may be able to feel the scar tissue beneath the skin.
Other symptoms include:
- A lump or thickening along the shaft, even when the penis is soft.
- Difficulty with penetration during sex.
- Erectile dysfunction – Inability to achieve an erection.
- Pain mostly during an erection when the scar tissue remains tight.
- Tenderness at the site of the scar tissue buildup.
Symptoms may develop slowly over time, and they may even go away on their own.
When should I see a doctor about my Peyronie disease symptoms?
If you're experiencing pain or trouble having sex, talk to your doctor about treatment options. Early treatment can help keep the condition from getting worse.
If you’ve had PD for some time, get a checkup if you have any changes in pain, curvature, or length, or if changes bother you or your partner.
How Do You Diagnose Peyronie Disease?
Diagnosing Peyronie disease begins with a physical exam and medical history. Your doctor will ask about your symptoms and family history, and will likely do a physical exam.
They may inject a drug into the penis to make it erect, allowing the doctor to see where the scar tissue has built up.
Your doctor may also order imaging tests, such as:
- An ultrasound or x-ray – Shows what's happening under the skin.
- Doppler flow study – Measures blood flow within the penis with ultrasound.
Imaging tests also help your doctor make a diagnosis by excluding other possible causes of your symptoms.
How Do You Treat Peyronie Disease?
Peyronie disease isn't curable, but doctors have developed a range of treatment options to reduce the symptoms and help your penis function normally.
What treatment looks like will depend on your situation. If the condition is mild and doesn't interfere with sex or cause pain, your doctor may recommend that you simply monitor the condition and avoid taking any action unless it gets worse.
Nonsurgical treatments for PD
Medication
For mild to moderate cases of PD, your doctor may recommend taking medication that targets the buildup of collagen and tissue to help reduce pain and correct the curve.
These medications may be delivered through an injection into the penis or taken orally:
- Collagenase — Delivered by injection to break down collagen causing the curve.
- Interferon — Injection that breaks down scar tissue causing the curve.
- Pentoxifylline — Oral medication combines vitamin E and colchicine or carnitine to reduce scar tissue.
- Verapamil — Injection that blocks further production of collagen to prevent the curve from worsening.
Noninvasive treatments for PD
- Extracorporeal shockwave therapy (EST) — Ultrasound therapy that can relieve pain but does not treat scar tissue buildup or penis curvature.
- Penile traction therapy — Involves applying traction to the penis for 30 to 90 minutes a day to help reduce the curvature.
- Vacuum pump — Devices may relieve pain and curvature, but do not fix erectile dysfunction (ED).
Surgical treatments for PD
If you have a severe curvature that causes pain and interferes with your daily life, your doctor may recommend surgery.
Because Peyronie disease can worsen over time, it's best to wait until there's been no change to your condition for at least six months before you undergo surgery. Be sure to discuss the risks and benefits of each procedure in detail with your doctor.
Surgical options include:
- Plication — The surgeon removes the scar tissue and stitches the skin together on the opposite sides of the shaft. This surgery can cause the penis to look shorter. This procedure has low risks.
- Incision and grafting — The surgeon cuts the scar tissue, which allows the penis to straighten. Then they make a graft – either from your own tissue, donor tissue, or synthetic material – to cover the cuts. In some cases, the procedure has a risk of making erectile dysfunction worse.
- Penile implant or prosthesis — Your doctor may recommend this option if you have ED and severe PD. This surgery involves placing a penile implant.
Some procedures will allow you to go home the same day, while others may require a short hospital stay. Your doctor will base your options and recovery time on the severity of your condition. Most men can return to work within a few days of surgery, but you will likely need to avoid sex for about two months.
