What is Peyronie’s Disease

Peyronie’s (pay-roe-NEEZ) disease is the growth of fibrous scar tissue within the penis that forms painful and curve erections. Penises range in size and shape, and possessing a curved erection isn’t necessarily a cause for attention or concern. But Peyronie’s disease triggers a significant bend or pain in some men.

This can hinder you from having sex or may make it challenging to develop or sustain an erection (erectile dysfunction). For many men, Peyronie’s disease also generates and anxiety and stress.

Peyronie’s disease occasionally subsides on its own. But in the majority cases, it will continue instability or worse. Treatment may be required if the curvature is critical enough that it impedes successful sexual intercourse.

Symptoms
Peyronie’s disease symptoms and signs might arise suddenly or increase gradually. The most typical signs and symptoms include:

Scar tissue. The scar tissue (plaques) linked with Peyronie’s disease can be felt beneath the skin of the penis as flat lumps or a band of solid tissue.
A visible curve of the penis. Your penis might be bent upward, downwards or bent to one side. In some instances, the erect penis might have contraction, indentations or an hourglass shape, with a tight, narrow band throughout the shaft.
Erection problems. Peyronie’s disease might cause difficulties getting or sustaining an erection (erectile dysfunction).
Compress of the penis. Your penis may grow shorter as a consequence of Peyronie’s disease.
Pain. You might have pain or discomfort in the penis, with or without an erection.
The curvature linked with Peyronie’s disease might progressively worsen. At some point, however, it stabilizes.

Pain throughout erections normally increases inside one to two years, but the scar tissue and curve often continue. In some cases, both the curvature and pain linked with Peyronie’s disease change external treatment.

When Should You See a Doctor
See your physician if pain or curvature of your penis inhibits you from having sex or triggers your anxiety.

Causes
Flaccid and erect penis
The cause of Peyronie’s disease isn’t completely understood, but some factors appear to be linked to its causation.

It’s considered Peyronie’s disease typically forms from repeated injury to the penis. For instance, the penis might be injured during an athletic activity, sex or as the consequence of an accident. However, in most cases, no particular trauma to the penis is remembered.

Throughout the restorative process, scar tissue develops in a disorderly fashion, which might then lead to a nodule that you can sense or progression of the curvature shape.

Each side of the penis encompasses a sponge-like tube (corpus cavernosum) that comprises many tiny blood vessels. Both of the corpora cavernosa is encased in a sheath of elastic tissue referred to as the tunica albuginea (TOO-nih-kuh al-BYOO-JIN-e-uh), which lengthen during an erection.

When you grow sexually aroused, blood flow to these chambers rises. As the chambers grow with blood, the penis swells unfold and harden into an erection.

In Peyronie’s disease, when the penis grows erect, the area with the scar tissue that does nor stretch, and the penis bends or becomes disfigured and possibly painful.

In some men, Peyronie’s disease comes on slowly and doesn’t seem to be related to an injury. Researchers are investigating whether Peyronie’s disease might be linked to an inherited trait or certain health conditions.

Risk factors
Minor injury to the penis does not always begin to Peyronie’s disease. Nevertheless, various factors can contribute to poor wound healing and scar tissue accumulation that might have a role in Peyronie’s disease. These include:

Heredity. If your father or sibling has Peyronie’s disease, you have an increased risk of the condition.
Connective tissue disorders. Men who have a linked/attached tissue disorder appear to have arisen risk of developing Peyronie’s disease. For instance, some men who have Peyronie’s disease also have a cord-like thickening across the palm that produces the fingers to pull inward (Dupuytren’s contracture).
Age. The predominance of Peyronie’s disease progresses with age, especially in men over 55.
Other factors — including certain health conditions, smoking and some types of prostate surgery — might be associated with Peyronie’s disease.

Complications
Complications of Peyronie’s disease might include:

Difficulty achieving or sustaining an erection (erectile dysfunction)
Failure to have sexual intercourse
Anxiety or stress about sexual abilities or the appearance of your penis
Stress on your bond with your sexual partner
Complexity fathering a child, because intercourse is challenging or impossible

Diagnosis
A physical exam is regularly effective to recognize the appearance of scar tissue in the penis and diagnose Peyronie’s disease. , other conditions cause similar signs and need to be ruled out.

Evaluate and test to diagnose Peyronie’s disease and understand precisely what’s triggering your symptoms might include the following:

Physical exam. Your physician will feel (palpate) your penis when it’s not erect, to distinguish the place and significance of scar tissue. He or she may also mark the length of your penis. If the condition continues to deteriorate, this initial determination helps decide whether the penis has shrunk in length.

Your physician might also request you to bring in photos of your erect penis taken at home. This can ascertain the degree of curvature, placement of scar tissue or other details that might assist distinguish the best treatment approach.

Other tests. Your physician might order an ultrasound or other tests to check your penis when it’s erect. Before getting images of your penis, you’ll likely undergo an injection immediately into the penis that causes it to become erect.

Ultrasound is the most regularly used test for penis deformities. Ultrasound tests utilize sound waves to create images of soft tissues. These tests can determine the presence of scar tissue, blood flow to the penis and any other irregularities.

Treatment
Your physician might recommend a wait-and-see (watchful waiting) approach if:

The curvature of your penis isn’t severe and is no longer worsening
You can still have erections and sex with no or mild pain
You have a good erectile function
If your symptoms are critical or are serious over time, your physician might prescribe medication or surgery.

Medication
Some oral medications have been tried to treat Peyronie’s disease, but they have not been shown to be effective consistently and are not as effective as surgery.

Pentoxifylline is an oral medicine used for Peyronie’s disease. When taken for several months, the medication may decrease the quantity of scar tissue, though exactly how it does so isn’t known.

In some cases, drugs injected straight into the penis might decrease curvature and pain linked with Peyronie’s disease. Based on the therapy, you might be given a local anesthetic to prevent pain during the injections.

If you have one of these approaches, you’ll likely undergo multiple injections over numerous months. Evidence on the effectiveness of penile injections is limited. These medicines may also be used in blending with oral drugs.

Medications include:

Collagenase. The only FDA-approved medication for Peyronie’s disease is collagenase clostridium histolyticum (Xiaflex). This medicine has been licensed for use in adult men with moderate to severe curvatures and a palpable nodule.

This treatment has been shown to improve curvature and bother associated with Peyronie’s disease. The treatment works by breaking down the buildup of collagen that causes penile curvature. Collagenase appears to be more powerful when used in conjunction with “modeling,” which is a forcible bending of the penis in the reverse direction of the bend.

  • Verapamil. This is a drug commonly used to treat high blood pressure. It appears to obstruct the creation of collagen, a protein that might be a key factor in the development of Peyronie’s disease scar tissue. The drug is well-tolerated and appears to reduce pain too.
    Interferon. This is a kind of protein that appears to disrupt the production of fibrous tissue and help break it down. One placebo-controlled trial showed recovery using this therapy over placebo.
    Surgery
    Illustration of Nesbit plication procedure
    Nesbit plication
    Your doctor might suggest surgery if the damage to your penis is severe, adequately troublesome, or prevents you from having sex. Surgery usually isn’t prescribed until you’ve had the disease for at least one year and the curvature of your penis stops growing and sustains for at least six months.

Common surgical methods include:

  • Suturing (plicating) the unaffected side. A variety of methods can be used to suture (plicate) the plentifuller side of the penis (the side without scar tissue). This happens in a straightening of the penis, although this is often restricted to less serious curvatures and might result in greater actual or observed penile shortening.
  • Nesbit plication is an instance of this type of procedure. In some cases, this type of surgery causes erectile dysfunction.
  • Incision or excision and grafting. With this type of surgery, the surgeon creates one or more cuts in the scar tissue, allowing the sheath to extend out and the penis to straighten. The surgeon might take off some of the scar tissue.
  • A piece of tissue (graft) is often sewn into place to cover the holes in the tunica albuginea. The graft might be tissue from your own body, human or animal tissue, or a synthetic material.

This procedure is used in instances of more-severe curvature or deformity, such as indentations. This procedure is linked to higher risks of worsening erectile function when compared to the plication procedures.

Penile implants. Surgically inserted penile implants substitute the spongy tissue that fills with blood while having an erection. The implants might be semirigid — manually bent down for the majority of the time and bent upward for sexual intercourse.

Another kind of implant is inflated with a pump implanted in the scrotum. Penile implants may be considered if you have both Peyronie’s disease and erectile dysfunction.

When the implants are placed, the doctor might present additional procedures to correct the curvature if needed.

The type of surgery used will be based on on your ailment. Your doctor will consider the area of scar tissue, the severity of your symptoms and other factors. If you’re uncircumcised, your doctor might suggest a circumcision during surgery.

Based on the kind of surgery you elect to have, you might be able to go back home from the hospital the same day or you might require staying overnight. Your surgeon will advise you on how long you should wait before going back to work — in most cases, a few days. After surgery for Peyronie’s disease, you’ll need to wait four to eight weeks before sexual activity.

Other treatments
A method known as iontophoresis uses an electric flow to administer a mixture of steroid and verapamil noninvasively within the skin. Available research has conferred conflicting results on penile curvature and erectile function.

Several nondrug therapies for Peyronie’s disease are being studied, but the evidence is restricted on how well they work and possible side effects. These involve using intense sound waves to split up scar tissue (shock wave therapy), devices to stretch the penis (penile traction therapy) and radiation therapy.

Coping and support
Peyronie’s disease can be a cause of significant anxiety and create stress for you and your sexual partner. To cope with Peyronie’s disease:

Talk to your partner about how the two of you can maintain sexual and physical intimacy.
Tell to your partner what Peyronie’s disease is and how it affects your ability to have sex.
Inform your partner how you feel about the appearance of your penis and your capacity to have sex..
Talk to a mental health provider who concentrates on family relations and sexual matters.
Let your partner know how you feel about the appearance of your penis and your ability to have sex.

Preparing for your appointment
If you have Peyronie’s disease symptoms, you’re inclined to begin by seeing your family doctor or general practitioner. You might be transferred to a specialist in male sexual disorders (urologist).

Preparing for your appointment will help you make the best use of your time. Make a list of the following information that helps your doctor understand what is going on.

Symptoms you’re encountering, including any that might seem irrelevant to Peyronie’s disease
Key health information, including any major importance or recent life changes
Medications that you’re using, including any vitamins or supplements
History of injury to the penis
Family history of Peyronie’s disease, if any

Questions to ask your Physicians
List questions for your doctor from most to least important in case time runs out. You might want to ask some of the following questions:

What treatment do you recommend?

Can you tell if symptoms are likely to worsen or improve?
What tests will I need?
Are there any booklets or other informative material that I can take home with me? What websites do you recommend?
In addition to the questions you’ve put together to ask your doctor, don’t pause to ask questions during your appointment.

What to expect from your physician
Your doctor may ask you some questions. Being ready to answer them might reserve time to go over any points you want to discuss further. Your doctor might ask:

Do your symptoms curb your ability to have sex?
Has the curvature of your penis become over time?
When did you first discern a curve in your penis or scar tissue beneath the skin of your penis?
Do you have pain during erections, and if so, has it gotten worse or improved over time?
Do you recall having an injury to your penis?
Your physician might also ask you to perform a survey, such as the International Index of Erectile Function, to help classify how the condition impairs your ability to have sex.