Peyronie’s Disease

Peyronie’s disease is a condition that changes the shape of the penis, often causing it to bend or curve when erect. This happens because of scar tissue, called plaque, that builds up under the skin.

A slight curve in the penis can be normal. However, Peyronie’s disease can lead to pain, trouble getting or keeping an erection, and difficulty with sexual activity.

This condition is fairly common in men, especially those between the ages of 40 and 70, but it can occur at any age after puberty.

It may begin suddenly or progress slowly over time.

Peyronie’s disease occurs when fibrous scar tissue develops in the tunica albuginea. This is a thick layer of tissue surrounding the chambers that fill with blood during an erection. Since this scar tissue doesn’t stretch like healthy tissue does, it causes the penis to bend or curve during an erection.

It typically develops in two phases:

Acute phase

The acute phase can last around 12 to 18 months. During this time, the scar tissue is still forming, and the shape of the penis may continue to change. You might notice:

• Increasing curvature
• Pain with or without an erection
• Firm lumps under the skin

Chronic phase

Once the condition stabilizes, the chronic phase begins. Curvature usually stops progressing, and pain may subside. Structural changes in the penis, such as shortening, indentation, or bending, often remain.

The exact cause isn’t always clear, but it’s commonly linked to injury or repeated minor trauma to the penis. If the tissue doesn’t heal properly, scar tissue can form in a disorganized way, leading to the symptoms of the condition.

Risk factors that may increase the chance of developing Peyronie’s disease include:

• Age: it is more common in men over 40
• Family history of Peyronie’s disease
• Connective tissue disorders like Dupuytren’s contracture
• Diabetes
• Previous prostate surgery or radiation
• Smoking or vascular disease

These factors may make tissues more prone to inflammation, scarring, or poor healing.

Symptoms of Peyronie’s disease may develop slowly or appear more suddenly, and they can include:

• A noticeable bend or curve in the penis during erection
• Lumps or hard areas under the skin
• Narrowing or indentation of the shaft
• Pain during erections or sexual activity
• Erectile dysfunction (ED)
• Shortening of the penis
• Difficulty with penetration or sexual performance

Peyronie’s disease is diagnosed based on a physical exam and symptom history.

Your doctor may feel firm plaques under the skin of the penis. If needed, an ultrasound can help assess the size and location of the scar tissue and evaluate blood flow to the penis.

Early diagnosis and treatment of Peyronie’s disease are important.

During the initial phase, the condition is still changing. Medical intervention may help slow its progression or reduce pain. Addressing it early also gives you more options for managing symptoms before the scar tissue becomes stable and harder to treat.

Non-Surgical Treatment Options

Treatment during the acute phase focuses on relieving pain, preserving function, and minimizing curve progression. Common non-surgical options include:

Penile traction therapy

Traction involves wearing a mechanical device that gently stretches the penis for extended periods daily. Over time, it may help reduce curvature, improve length, and soften plaque formations. It is most effective when used consistently for several months.

Injection therapy

Medications can be injected directly into the scar tissue, including:

• Collagenase clostridium histolyticum, which is the only FDA-approved injectable treatment. It works by breaking down the buildup of collagen in the plaque.
• Verapamil and interferon, which are used off-label, and may help reduce plaque size or soften the tissue.

Vacuum erection devices (VEDs)

VEDs are noninvasive tools that use negative pressure to draw blood into the penis, helping to create an erection. A constriction ring is then used to maintain it. VEDs are safe, noninvasive options to support erection quality and potentially preserve penile structure in Peyronie’s disease. This is especially true when they are used early and regularly. Their benefit for curvature correction is limited, but they’re often part of a broader treatment plan.

Surgical Options for More Advanced Cases

If symptoms persist into the chronic phase and non-surgical therapies don’t work, surgery may be recommended. This is especially true if curvature is severe or interferes with sexual activity.

• Plication surgery involves placing sutures on the opposite side of the curvature to straighten the penis. It is best suited for men with good erectile function and less severe curvature. Some shortening of the penis may occur.
• Plaque incision with grafting involves making small cuts in the scar tissue and placing a graft to restore length and straighten the penis. It is typically used for more complex curvatures or indentations.
• Penile implants or a penile prosthesis may be used for men who also have ED. The implants can help restore erectile firmness and straighten the penis in the process. Inflatable implants are the most common and allow control over the timing and rigidity of erections.

Getting checked early gives you more treatment options and can help you avoid surgery later on. You should see a urologist if you experience:

• A new or worsening curve in the penis
• Painful erections
• A lump or band under the skin
• Difficulty with intercourse
• Loss of length or changes in appearance

1. Can Peyronie’s disease cause urinary problems?

While it primarily affects the erect penis, some men with severe curvature or indentation may notice changes in the direction or strength of their urine stream. This is uncommon but should be evaluated by a urologist if it occurs.

2. Is there a connection between Peyronie’s disease and low testosterone?

There is no direct relationship, but men with Peyronie’s disease may also have low testosterone levels. For this reason, testing hormone levels may be appropriate during evaluation.

All of our providers treat Peyronie’s Disease.