Some guys would rather avoid sex altogether than come clean about a sensitive medical issue that’s messing with their mojo. Peyronie’s disease, which causes abnormal penile curvature, is one of those problems.
Peyronie’s affects as many as one in 11 men, says the Association of Peyronie’s Disease Advocates. It mostly affects middle-aged males. But even guys in their 20s and 30s have been known to develop it.
If you look at Peyronie’s disease pictures, you’ll see the degree and direction of the bend—up, down, or sideways—can vary. Depending on its severity, it can certainly make intercourse challenging and even painful.
“Usually the man is fixated on the deformity and inability to perform,” says Laith Alzweri, MD, a urology and andrology fellow at Tulane University School of Medicine and Tulane Medical Center in New Orleans. “He lives in his own bubble.”
The thing is, he doesn’t have to live with it. There are effective medical and surgical therapies, and that’s where you come in. Encouraging your partner to see a urologist and explore possible treatment options can do wonders not only for your shared sex life but for his physical and emotional wellbeing.
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Peyronie’s disease causes
While experts don’t know exactly why some men develop it, they think Peyronie’s disease starts with some injury to the penis.
The male organ, like any part of the body, is vulnerable to trauma, whether it’s sustained in an accident or while playing sports or engaging in vigorous sexual activity. Any sudden or repeated force (or any number of minor injuries) to the penis may lead to swelling followed by the formation of scar tissue beneath the skin.
It’s the accumulation of this thickened scar tissue, called a plaque, that blocks blood flow during an erection, causing the penis to bend or become misshapen.
David Shin, MD, chief of the Center for Sexual Health and Fertility at Hackensack University Medical Center in New Jersey, says men usually don’t recall any specific event that may have led up to their disease. He suspects aggressive intercourse is a common cause. “Guys would remember sports injuries, especially in that area,” he says.
An injury down there doesn’t mean your guy is destined to develop Peyronie’s disease. His chances may hinge on certain risk factors. Age is a big one: The older he is, the greater the likelihood that he’ll develop Peyronie’s. Heredity is another: He’s at greater risk if his father or brother had it.
Having certain autoimmune diseases, like lupus or Sjogren’s syndrome, can increase the likelihood of developing Peyronie’s disease. So can having certain connective tissue disorders, such as Dupuytren’s contracture (a thickening and tightening of tissue of the palms and fingers) or plantar fasciitis (inflammation of a band of tissue at the bottom of the heel).
And, if your partner is a smoker or has diabetes or high blood pressure, the odds of developing Peyronie’s disease are greater for him than for an otherwise healthy man.
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Peyronie’s disease symptoms
Penises vary in length, girth, and shape. So what’s the difference between Peyronie’s disease and normal curvature? Well, an erect penis doesn’t have to be stick-straight to be considered normal. Having a slight curve is perfectly natural and may not interfere with intercourse.
Peyronie’s, by contrast, is an acquired disease causing curvature over time. Men may have painful erections in the early (acute) phase of the disease as scar tissue begins to form. Eventually, the inflammatory process settles down. But during this latter (chronic) phase, guys are often left with a hard plaque and a bend.
Men may not notice this gradual progression until “it just seems like all of a sudden, one day, it happened,” Dr. Shin explains. (In rare cases, a man may be born with a distinct curve. So-called congenital penile curvature may require corrective surgery. But this is not Peyronie’s.)
So what does Peyronie’s disease look and feel like? Here are the common signs and symptoms.
Pain with or without erections
Pain is a “defining symptom” of the acute (or active) stage of Peyronie’s disease, but it’s less common in the chronic phase, says the American Urological Association (AUA).
“With increasing awareness of the disease, we’re seeing more patients coming [for evaluation] in the acute phase brought in by pain,” Dr. Alzweri notes.
Scar tissue or hard lumps
Early in the disease process, a guy might find one or more flat lumps in his penis—often, but not always, on the top of the shaft.
It may feel “kind of like a hard nodule or knot” under the skin where the scar tissue has formed, as Dr. Shin describes it.
These plaques remain but typically don’t worsen in the chronic phase of Peyronie’s disease.
Bend to the penis
The amount of curvature can really vary—from 10 to 90 degrees, according to the AUA. Based on published studies, the average may be 30 degrees to almost 48 degrees.
Initially, there may be some curvature with full erection, “but not all the time,” Dr. Alzweri explains.
And that may be why some men are seemingly unaware of early changes leading to a chronic curve. Or maybe they avoid getting diagnosed because they’re “anxious or afraid,” he adds.
If it’s a mild case, symptoms sometimes disappear without causing permanent curvature, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
Other penile deformities
Peyronie’s disease can also cause narrowing or shortening of the penis. Some men’s penises become indented or take on a bottleneck or hourglass shape. The type of penile disfigurement may depend on the number and location of plaques.
Like curvature, some of these changes can make penetration difficult, according to the Sexual Medicine Society of North America.
Erection problems
If your partner has trouble getting or maintaining an erection, he may have Peyronie’s disease.
Studies suggest anywhere from 22% to 54% of men with Peyronie’s disease (and as many as 70% in one study) also have erectile dysfunction (ED), according to the International Society for Sexual Medicine.
But does Peyronie’s plaque cause ED? Or is ED a psychological consequence of Peyronie’s? Could underlying health conditions, like diabetes and heart disease, lead to ED? The exact role that Peyronie’s plays in ED remains unclear.
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Peyronie’s disease treatment
There’s no Peyronie’s disease cure, not yet anyway. But there are treatments that can reduce pain and restore function to his penis.
The first step is to see a urologist for an objective assessment of deformity, function, and patient expectations, among other factors.
“We sit down and say, ‘This is what you have. These are your options.’” Dr. Alzweri explains.
Medication
All sorts of oral medicines and nutritional supplements have been given to patients with Peyronie’s disease over the years. But there is scant evidence that they have any significant effect.
The AUA specifically advises clinicians they “should not offer oral therapy with vitamin E, tamoxifen, procarbazine, omega-3 fatty acids, or a combination of vitamin E with L-carnitine.”
Likewise, the International Society of Sexual Medicine finds “no benefit” with any oral therapy.
“Believe me, I would love to have these guys on these medications, but they just don’t work,” Dr. Shin asserts. “I don’t even offer it to patients.”
Dr. Alzweri says he doesn’t recommend oral options and won’t offer them “unless the patient insists on not doing any kind of better treatment.”
Injection therapy
Xiaflex (collagenase) is the first and only medication approved by the FDA specifically for the treatment of Peyronie’s disease. It requires multiple injections directly into the plaque over several weeks.
“What those injections do is break down the collagen, or plaque, which, in turn, helps improve blood flow to the penis,” Dr. Shin explains.
However, if a man has severe erectile dysfunction with severe curvature, “there’s no point in giving him Xiaflex,” Dr. Alzweri notes. “We may reduce the curvature, but he’s not going to be able to have erections.”
Other injectables under review to treat Peyronie’s disease include verapamil (a blood-pressure-lowering drug) and interferon (a protein that helps control scarring).
Dr. Shin says most guys opt for injection therapy because it’s less invasive than surgery: “If it works, it works well,” he says. “If it doesn’t, then you are left with surgery as a treatment option.”
Surgery
For some men, surgery may be the best bet for straightening the penis. The type of surgery may depend on factors such as the amount of curvature, the direction of the curve, and the patient’s expectations.
“The problem with most of the surgeries is that men may lose some penile length in the process,” Dr. Shin points out.
One option is to shorten the longer side of the penis, opposite the plaque, to straighten the shaft.
Another is to remove some of the plaque and fill the empty space with tissue from another part of the body.
A third option is to implant a prosthetic device, such as an inflatable pump. A prosthesis is usually used for men who also have erectile dysfunction, says Dr. Shin.
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Other non-surgical treatments
Until researchers have a better understanding of why scarring occurs and how to prevent it, the quest for new and improved Peyronie’s treatment options continues.
One therapy currently being explored for Peyronie’s disease is penile traction therapy. This involves wearing a device several hours a day to straighten the penis.
There’s also some thought that using a vacuum erection device to achieve an erection may be helpful in straightening the penis.