What is Peyronie's Disease & Overview of Common Treatments

Like other conditions involving sexual and reproductive organs, Peyronie's Disease was not commonly discussed in the past. There were several stigmas attached to the condition, which prevented transparency on patient and professional spectrums. But now, that's a thing of the past as the modern world has emerging medical and scientific advancements supported by the minds of a progressive society. 

This opens up new doors for professionals and patients alike as more of them are open about their experiences, possible diagnoses, treatments, and more determined to seek treatment. According to statistics, approximately 4-13% of the male population suffer from this disease, with most patients belonging to the over-50 age group. While most people that develop the disease are older than 45, the disease still does affect those younger.

Let's find out more about what is Peyronie's Disease and the common treatment options that can be used to alleviate its effect on male virility and more:

Peyronie's Disease Explained?

Peyronie's Disease (PD) is a progressive and non-malignant disorder that causes the development of scar tissue  (plaque ) on the penis. This changes the form of the penis when erect, resulting in a curve or bend with a loss of length or girth. The location of the plaque varies from patient to patient, depending on the scar's location. The scar's location dictates the extremity of the bend/curve and its direction. In some cases, the curve might be completely absent. Instead, patients will notice an area of indentation or an "hourglass" appearance. The scar tissue is usually not rigid or hard, however, data shows that some men have calcium in the plaque tissue that can make it feel hard, like bones. 

The disease is broken up into 2 stages, acute and chronic/stable. We explain them better below:

• Acute phase

In this stage there is characteristically pain associated. This differentiates this stage from the stable/chronic stage where there is generally absence of pain.

• Chronic phase

In this phase, scar tissue stops forming, so the physical changes in the penis (curve, shape changes) do not worsen. Erectile dysfunction (ED) or issues achieving or maintaining an erection may develop at this stage. 

Most men suffer from pain in the acute phase of the condition when the penis is both erect and soft. Albeit pain may continue into the stable/chronic phase, it is characteristically reduced or absent. The intensity and duration of the pain vary depending on the person and the severity of the condition (amount of plaque formed). The presence of Peyronie's does not increase cancer risks or mean cancer is present. It also doesn't affect fertility.

The Peyronie's Curves and Bends

The penis essentially has 2 duties to perform—carry urine and sperm. Inside the penis, there are 3 tubes. The first is the urethra which carries urine from the bladder through the penis. The second is 2 tubes called the corpora cavernosa, which carry blood to the penis to form an erection. Peyronie's Disease doesn't affect the urethra but affects how an erection stands. Ideally, an erection is supposed to be straight, stiff, and hard for penetration. However, this is not possible with Peyronie's as the condition distorts an erection by affecting the shape, size, and direction of an erect penis.

Below we look at how plaque formation on the different parts of the penis will affect how an erection stands: 

• Plaque formation at the bottom: Downward bend

• Plaque formation at the top of the penis: Upwards curve

• Plaque formation on the side: Sideways lean (either left or right, depending on the side of the plaque)

In some cases,  plaque may form on both the top and bottom of the shaft. This causes neither a curve, bend, or lean, which can cause the penis to become shorter or dented. Scars can also form around the penis, narrowing it at certain points. 

What causes Peyronie's disease?

Multiple issues can cause this disease. Most research points to physical injury where an erect penis is injured or abnormally bent, causing damage to erectile tissue inside the penis. Penile injuries or pelvic trauma often happen during rough sex, masturbation, or other nonsexual physical activities like sports.

Injuries induce bleeding in the fibrous membrane of the penis (tunica albuginea). Over time, these micro-injuries to the penis lead to the development of scar tissue, which results in the characteristic curvature or bend seen in men with Peyronie's Disease. The disease also has some hereditary links. 

PubMed data shows that there is a  genetic contribution that predisposes men to develop Peyronie's, so in simple terms, if you have close family members with the disease, there is a high possibility that you would develop the condition as well. Men who have autoimmune conditions or certain connective tissue disorders are also more likely to develop Peyronie's 

Other risk factors that  may increase the likelihood of Peyronie's Disease development include:

• Diabetes and erectile dysfunction--Evidence shows a  high prevalence of Peyronie's among diabetic patients with ED. 

• Aging—As we age, the body becomes more susceptible to tissue damage, increasing the chances of developing Peyronies.

• Previous surgery or issues with wound healing —Those who've had surgery for prostate cancer in the past are at higher risk of developing the condition due to scar tissue that might develop post-surgery. Those suffering from slow healing can also develop scar tissue post-injury or surgery.

Signs and symptoms of Peyronie's Disease

The symptoms or signs of Peyronie's Disease are quite noticeable and start with the obvious curve or bend of the penis. The most common is the upward bend which occurs when plaques form on the dorsal side or top of the penis. However, not all penis curves and bends point to the disease. For example, those who've had a bend or curve from birth do not have Peyronie's. So it's important to acknowledge and look out for signs and symptoms. 

Let's look at them below: 

• Penis is shorter

• Lumps on the penis

• Erections are painful

• Loss of penis girth or thickness

• Bottle-necking—penis narrows and develops indentations in certain areas, taking on an hourglass-like shape. 

In addition to affecting the feel and shape of the penis, Peyronie's Disease can also hinder sexual capabilities, causing issues with performance. Erections may become softer and inconsistent, making it difficult to engage in penetrative sex. The extreme bend or curve of the penis can also make sex difficult or even impossible in some cases, which is a sign that the curve is linked to Peyronie's Disease. 

Peyronie's Disease Treatment Options Explained

Treatment options for Peyronie's are quite straightforward, which is great as having your sexual capabilities snuffed out by the disease is stressful enough. Similar to erectile dysfunction solutions, the treatments used to treat Peyronie's are divided into two categories, invasive and non-invasive. Also, in refractory cases or severe cases, surgical intervention may be warranted. Non-invasive options are typically recommended to those in the acute phase of the condition, while invasive options are recommended to those in the stable phase or for treatment failures. 

Below we expand on the different treatment options: 

Oral Medication (non-invasive):

• Pain Medications

Pain medication such as Ibuprofen and similar medications can assist with the pain and inflammation associated with the condition. 

• Tadalafil (Cialis)

This popular ED treatment improves blood flow to the penis, preventing scarring from worsening. Evidence from a study posted in The Journal of Urology states that daily tadalafil doses decrease pain, plaque size, and the degree of penile curvature linked to Peyronie's Disease. It also improves erectile function. 

• Pentoxifylline

Pentoxifylline is another medication that improves penile blood flow, but it isn't recommended for sensitive users as it may cause an upset stomach. A PubMed study confirms that this treatment is effective for long-term use in the first stage of Peyronie's Disease. 

• L-arginine

 L-arginine is part of natural supplementation. The agent is an amino acid that increases and improves blood flow. The efficacy of l-arginine for this function was confirmed in a study in Sage Journal. 

• Colchicine

Colchicine is an anti-inflammatory aid that can help reduce swelling. An extract from The International Urology and Nephrology states that colchicine is safe and effective in treating early-phase Peyronie's Disease. 

• Potassium amino-benzoate (Potaba)

This vitamin B-complex helps decrease plaque size, which minimizes scarring and its possible long-term effect. It does not correct the physical bend or curve of the penis. A study confirms that the treatment significantly protects penile curvature deterioration, stabilizing the disorder and preventing progression.

Some of these treatments still need more studies to be done to check or know their efficacy (most of these treatment recommendations are based on limited studies and evidence).

Injection Treatment (invasive):

• Collagenase injections (Xiaflex)

This treatment option is recommended for those with penis curvatures or bends at an angle that is more than 30 degrees but less than 90 degrees. Collagenase breaks down the plaque (scar tissue) to correct the curvature. The injections are administered in a series of two weekly shots for eight weeks. Evidence shows collagenase injections significantly improve penile curvature deformities and Peyronie's symptoms. The injections are also well tolerated, which confirms their safety.

• Interferon injections

This is a protein injection that helps control the swelling of the penis. It also prevents further scarring by slowing down the development of plaque. This prevents buildup and the worsening of the disease. Clinical evidence shows that interferon injection provided more than a 20% reduction in curvature in most men with the disease. 

• Verapamil injections

This is commonly known as an oral medication that helps control high blood pressure. However, it has shown promise in correcting symptoms of Peyronie's when injected. According to a PubMed study, Verapamil injections are a clinically effective option that provided noticeable results after being injected into Peyronie's plaques. The treatment helps with the pain and curvature and can improve sexual function and erections. It also has a low side effect rate which deems it clinically safe.

12 Sources

Nu Image Medical has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

https://healthcare.utah.edu/healthfeed/postings/2019/08/peyronies.php

https://pubmed.ncbi.nlm.nih.gov/24119147/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7108984/

https://www.nature.com/articles/3901518

https://pubmed.ncbi.nlm.nih.gov/12131321/ 

https://pubmed.ncbi.nlm.nih.gov/26144333/ 

https://pubmed.ncbi.nlm.nih.gov/25388099/

https://pubmed.ncbi.nlm.nih.gov/15774254/

https://link.springer.com/article/10.1023/B:UROL.0000020297.67752.b3

https://journals.sagepub.com/doi/full/10.1177/2631831818822018

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706125/

https://www.auajournals.org/doi/10.1097/01.JU.0000555753.36349.5d

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your physician about the risks and benefits of any treatment. Nu Image Medical may not offer the medications or services mentioned in this article.