How Peyronie's disease affects the penis

DR MAXWELL ADEYEMI

Peyronie’s is a disease where scar tissue in the penis causes it to bend, curve or lose length or girth. You may be able to feel the scar tissue (plaque) through the skin or you may have pain in a specific part of your penis as the scar tissue forms.

During an erection your penis can bend up, down, or to the side depending on the location of the scar. Some men with this condition don’t have a curve, but might have an area of indentation or “hourglass” appearance.

In most cases, the scar forms on the top of the penis, causing it to curve upwards when it becomes erect. The penis will bend downward if the scar is on the bottom, and sideways if the scar is on the side. In some cases, the scar develops on both the top and bottom of the shaft, which can cause the penis to become “dented” or shorter. Sometimes the scar will go all the way around the penis, making it narrow like the neck of a bottle or the centre of an hourglass.

Peyronie’s disease has two stages – acute and chronic.

Acute phase: This stage lasts between six and 12 months, during which time the scar forms under the skin of the penis, causing a curvature or other change in its shape. This may cause pain when the penis is erect or soft.

Chronic phase: The scar has stopped growing in this phase, so the curvature in the penis doesn’t get worse. The pain will usually be gone by this time, but sometimes it can continue, especially with erections.

Risk factors

There are a number of factors that may increase your chances of getting Peyronie’s disease:

Age: Peyronie’s disease is more likely to happen as you get older. It occurs in about ten-15 per cent of middle-aged men.

Genetics: You’re at higher risk if you have a close relative with the disease.

Connective tissue disorders: Those with a connective tissue disorder such as Dupuytren's disease, plantar fasciitis and scleroderma are at a greater risk.

Erectile dysfunction: Men who have diabetes-associated erectile dysfunction are four to five times more likely to develop Peyronie’s disease. Sometimes erectile dysfunction can be caused by having Peyronie’s.

Prostate cancer: Men who have had surgery for prostate cancer are at an increased risk.

Autoimmune disorders: If you have an autoimmune disorder like lupus, you’re more likely to get Peyronie’s disease.

Causes

The cause of Peyronie’s disease is not always clear. Some researchers believe the scar occurs after the erect penis has been injured or abnormally bent, typically during sexual intercourse. However, 80 per cent of men don’t remember a specific event that led to the changes in their penis. These changes probably happen due to small unrecognised injuries that happen during regular sexual relations.

Not all men who have injuries end up with Peyronie’s disease, so it is likely that there are genetic or environmental reasons. There are also health issues that have been linked to Peyronie’s disease and it is unclear if they cause it or if they happen alongside it. They include high blood sugar, pelvic trauma, problems with wound healing, using tobacco products, autoimmune diseases such as lupus, Sjogren’s syndrome and Bechet’s disease.

A man with Peyronie’s disease may notice that this condition also affects their mental health. Changes in the penis can cause body image issues, anxiety or even depression. It can cause strain in a relationship and in other aspects of life.

Management and treatment

If you have very little penis curvature with no pain and no problems with sex, you may not need to be treated at all. Some cases of Peyronie’s disease go away without treatment. There is no cure for Peyronie’s disease, but there are always ways that the changes in the penis can be improved, including stretch therapy (traction), medications and even surgeries.

Traction therapy uses a device to stretch the penis and sometimes even bend the penis in the opposite direction of the curvature. This encourages the scar tissue to be recycled into more normal tissue and can improve curvature, restore length lost due to Peyronie’s disease, and even improve the hardness of erections.

Medications can be used in the acute phase, or in men who aren’t sure if they want surgery. Oral medications that may help include:

Pain medications such as ibuprofen and similar medications may help with the pain and reduce inflammation.

Tadalafil (Cialis) in daily doses improves blood flow in the penis and may prevent the scarring from worsening.

Pentoxifylline improves blood flow but may cause upset stomach.

L-arginine is an amino acid that can improve blood flow.

Colchicine is an anti-swelling agent.

Potassium amino-benzoate is a vitamin B complex that may help reduce plaque size, but not necessarily the curve of the penis.

Injections:

Collagenase injections are prescribed for men with penises that have curvatures of more than 30 degrees but less than 90 degrees. It breaks down scar tissue to improve curvature.

Interferon injections contain a protein that helps control swelling and scarring, it slows down the rate of scar tissue buildup by making an enzyme.

Verapamil can be taken orally to treat high blood pressure, but when injected into Peyronie’s plaque, helps with penile pain and curvature.

Surgery is only performed on men whose Peyronie’s disease makes it hard to have sex. This is done when the scar and curvature have stopped worsening and there has been no pain for around six to 12 months.