What is Peyronie’s disease?

Peyronie’s disease is a disorder in which scar tissue, known as plaque, forms under the skin of the penis, the male organ used for urination and sexual intercourse.

Plaque builds up inside the penis, in the thick elastic membrane known as the tunica albuginea. The tunica albuginea helps keep the penis rigid during an erection. Plaque can develop anywhere on the penis.

As it develops, the plaque pulls on surrounding tissues, causing the penis to curve or bend, usually during an erection. Curves in the penis can make erections painful or intercourse painful, difficult, or impossible.

The plaque that develops in Peyronie’s disease:

  • is caused by an injury to the penis or an autoimmune disease
  • it is not the same plaque that can develop in the arteries
  • it is benign, that is, it is not cancerous or a tumor

Peyronie’s disease occurs in two phases.

Acute phase

During the acute phase, plaque forms; this phase can last up to 18 months. 1 During this phase:

  • Inflammation and plaque formation may occur in the penis.
  • The penis begins to curve.
  • The penis can hurt without an erection.
  • Erections may become painful when scars develop.

Chronic phase

The chronic phase occurs after plaque has formed. The chronic phase usually begins 12 to 18 months after symptoms appear. During this phase:

  • Plaque and curvature of the penis may stabilize and not worsen.
  • It could decrease the pain in the penis.
  • Erectile dysfunction may occur or worsen.

How common is Peyronie’s disease?

About 1 in 100 men in India over the age of 18 have been diagnosed with Peyronie’s disease. However, based on studies of men who reported having symptoms of Peyronie’s disease, researchers estimate that the true number of men who have Peyronie’s disease is more than 1 in 10.

The chance of developing Peyronie’s disease increases with age. It is less common for men between the ages of 20 and 30 to have Peyronie’s disease.

What are the complications of Peyronie’s disease?

Complications of Peyronie’s disease could include:

  • inability to have intercourse due to curvature of the penis
  • erectile dysfunction
  • emotional stress, depression, or anxiety about sexual abilities or the appearance of the penis
  • stress in a relationship with a sexual partner
  • problems fathering a child due to difficulty having sex

What are the signs and symptoms of Peyronie’s disease?

Signs and symptoms of Peyronie’s disease may include:

  • hard lumps on one or more sides of the penis
  • pain during intercourse or during an erection
  • curvature in the penis with or without an erection
  • changes in the shape of the penis, such as narrowing or shortening
  • erectile dysfunction

These may develop slowly or come on quickly and can be mild or severe. In many cases, the pain subsides over time, although the curvature in the penis may remain. Problems with intercourse or erectile dysfunction can occur during any phase.

What causes Peyronie’s disease?

Medical experts don’t know the exact cause of Peyronie’s disease, but believe it could be the result of:

  • an acute or chronic injury to the penis
  • an autoimmune disease

Peyronie’s disease is not contagious and is not caused by any known communicable disease.

Penis injury

Medical experts believe that hitting or bending the penis can injure internal tissues. These injuries can occur during sex, sports activity, or an accident. It can occur once (acute injury) or repeatedly over time (chronic injury).

The injury could cause bleeding and swelling within the elastic membrane of the penis (tunica albuginea). As the injury heals, scar tissue may form and a plaque may develop. The hard plaque pulls on the surrounding tissues and causes the penis to curve.

The person may not be aware of microinjuries to their penis when they occur. Researchers have found that many patients cannot recall a specific incident just before symptoms began.

Autoimmune disease

Men who have an autoimmune disease may develop Peyronie’s disease if the immune system attacks cells in the penis. This can cause swelling in the penis. Scar tissue may form and turn into plaque.

How do health care professionals diagnose Peyronie’s disease?

Men with Peyronie’s disease are often referred to a sexologist in Delhi, a doctor who specializes in sexual problems.

The sexologist diagnoses Peyronie’s disease based on medical and family history and a physical exam.

Imaging tests are not usually necessary to diagnose Peyronie’s disease, but may be used to gather additional information about the plaque.

Medical and family history

The sexologist will ask the patient about their medical and family history. Some questions might include:

  • When did the symptoms start?
  • Do you feel pain during an erection or at any other time?
  • Do you have problems with erection or with sexual intercourse?
  • Does anyone in your family have Peyronie’s disease or other medical conditions?
  • Are you taking any medication? If the answer is yes, which one?
  • Do you have other medical problems or conditions?

Physical exam

The sexologist can usually feel the plaques on the penis regardless of whether it is erect or not.

If the sexologist needs to examine the penis during an erection, they will give the patient an injectable medication that will cause an erection. The sexologist might also ask the patient to take photos of his erect penis at home to assess the curvature during follow-up visits.

How do health care professionals treat Peyronie’s disease?

The goal of treatment is to reduce pain, achieve a straight or nearly straight penis, and restore and maintain the ability to have sexual intercourse.

Not all men with Peyronie’s disease need treatment. In very few cases, Peyronie’s disease goes away without treatment.

In addition, the patient may not need treatment if:

  • has small plates
  • you have no curvature in your penis or the curvature is slight
  • has no pain
  • have no problems with sexual intercourse
  • no urinary problems

If the patient needs treatment, the sexologist may recommend non-surgical treatments or surgery, depending on the severity of the symptoms, the curvature of the penis, and whether Peyronie’s disease is in the acute or chronic phase.

The sexologist will discuss treatment options with the patient and review possible side effects and outcomes.

In addition to treatment, he or she might recommend lifestyle changes to reduce the risk of erectile dysfunction related to Peyronie’s disease.

Non-surgical treatments

Non-surgical treatments include injections, oral medications, and therapies. These could be used when Peyronie’s disease is in the acute phase.

  • Collagenase. Intralesional collagenase injections are currently the only FDA-approved treatment for Peyronie’s disease. Collagenase is an enzyme that helps break down the substances that make up plaque. By breaking down the plaques, the curvature of the penis is reduced and erectile function is improved. This treatment is approved for men with penises curved more than 30 degrees.
  • Verapamil. Verapamil is used to treat high blood pressure and may reduce pain and penile curvature when injected into plaque.
  • Interferon-alpha 2b. Interferon is a protein produced by blood cells. Studies show that it reduces pain, penile curvature, and plaque size.

Surgery

The sexologist might recommend surgery to remove plaque or help straighten the penis during an erection. Surgery may be recommended for men with Peyronie’s disease if:

  • symptoms have not improved
  • erections or intercourse, or both, are painful
  • the curvature of the penis prevents sexual intercourse

Medical experts recommend that the patient not undergo surgery until the plaque and penile curvature are stabilized.