Peyronie's Disease

What is Peyronie's disease?

Peyronie's disease is a condition that causes a curved or bent penis. It’s caused by scar tissue called plaque that can form inside the penis. It's benign, meaning it isn't cancer, and while it's usually permanent once established, there are treatments to ease symptoms and stop it getting worse. It mainly affects men over 40, but it can happen at any adult age.

What are the symptoms of Peyronie's disease?

Symptoms can appear suddenly or develop gradually, and may include:

• a swelling or lump in the shaft of the penis
• curving or bending of the penis (usually when erect)
• painful erections, which can make sex difficult
• erectile dysfunction, or problems getting or keeping an erection
• other changes in shape, such as narrowing in the middle (sometimes called an hourglass shape) or shortening.

Penises vary a lot in shape, and a slight natural curve when erect doesn't necessarily mean you have Peyronie's disease. Get it checked if the curve is pronounced or your erections are painful.

Pain often lessens or settles over the first year or so, even though the curve itself usually remains. Some men also notice thicker, less flexible skin elsewhere on their body, such as their hands or feet, and Peyronie's disease is sometimes linked with a similar condition called Dupuytren's contracture, which affects the hands.

What are the causes of Peyronie's disease and who is at risk?

The exact cause isn't always known, but it's thought to usually follow small injuries to the penis e.g. during sex or sport, poor wound healing, and formation of scar tissue during healing.

You may not recall a specific injury, since many are too minor to notice at the time. In some men, an autoimmune condition, where the immune system mistakenly attacks the body's own tissue, is thought to play a role instead.

You're more likely to develop Peyronie's disease if you:

• have diabetes, particularly if you also have erectile dysfunction
• have high blood pressure, high cholesterol, or coronary heart disease, or thickened arteries (arteriosclerosis)
• have a connective tissue or autoimmune condition, such as Dupuytren’s contracture, plantar fasciitis, scleroderma, lupus, Sjögren’s syndrome or Behçet’s disease
• take certain medicines, such as beta blockers or antidepressants
• have had surgery for prostate cancer
• have a family history of Peyronie’s disease
• are older
• smoke or drink excess alcohol.

Does Peyronie's disease have different phases?

Peyronie’s disease typically develops in two phases.

The acute phase is when the plaque is actively forming, alongside inflammation. Your penis starts to curve during this time, and you may have pain, including pain without an erection as scarring develops. This phase can last up to about 18 months.

The chronic phase usually begins 12 to 18 months after symptoms first appear. The plaque and curve tend to stabilise and stop changing, and pain typically lessens or disappears, though erectile dysfunction can develop or worsen during this phase. Surgery, where needed, is generally only considered once the condition has reached this stable phase.

How is Peyronie's disease diagnosed?

If a GP thinks you might have Peyronie's disease, they'll ask about your symptoms and examine your penis. Because Peyronie's disease is linked with several cardiovascular conditions, they may also want to check your blood pressure, cholesterol and blood sugar.

Your GP may refer you to a urologist, a doctor specialising in urinary and sexual health problems.A urologist can usually feel the plaque whether your penis is erect or not, alongside asking about your medical and family history. If they need to examine you while erect, you may be given an injectable medicine to bring this on. You might also be asked to take photos at home to track how the curve changes over time.

How is Peyronie's disease treated?

If your symptoms are mild, you may not need treatment. Treatment is usually considered if you have pain, your symptoms are affecting your sex life, or they're affecting your confidence or mental wellbeing.

Devices

• Mechanical traction or vacuum devices, aim at gently stretching the curve – these need daily use over several months.
• Sound wave (shockwave) therapy directed at the plaque, mainly aimed at easing pain; evidence for this is still developing.

Medicines

• Injections directly into the plaque (intralesional injections), done in a clinic. Collagenase, which breaks down the substance that makes up the plaque, is approved for men with a curve greater than 30 degrees and is the best-studied option; verapamil and interferon-alpha 2b are also sometimes used
• Anti-inflammatory painkillers, if pain is a problem
• Medicines for erectile dysfunction, if this is also affecting you.
• There are currently no oral medicines proven to reduce the curve itself.

Surgical treatment

Surgery is usually only considered once your plaque and curve have stabilised in the chronic phase, and if the curve is preventing sex or your symptoms haven't improved.

It isn't usually possible to restore your penis exactly to how it was before it curved, and some men experience further shortening or numbness afterwards. The main approaches include:

• Grafting: Where the plaque is removed and replaced with a patch of tissue, which may help restore length as well as straighten the penis, though it carries a higher chance of numbness or erectile dysfunction afterwards
• Plication: Where a small piece of tissue is removed or pinched from the side opposite the curve to straighten it – this carries a lower risk of numbness or erectile dysfunction, but cannot restore lost length and may shorten the penis further
• A penile implant: Considered if you have both Peyronie’s disease and erectile dysfunction; this can sometimes straighten the penis on its own, or be combined with one of the other techniques.

When should I see a doctor?

See a GP if you have swelling or a hard lump on your penis, your penis curves when erect, or you have painful erections or difficulty getting or keeping one that's affecting your sex life. Don't feel embarrassed – this is a common problem that GPs are used to dealing with.

Get medical help straight away if you have severe penis pain, bleeding or you’re unable to urinate.