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Understanding ED: Peyronie’s Disease

Peyronie’s Disease

Highlights

  1. Peyronie’s disease is a form of erectile dysfunction that causes a bend in the penis that can make an erection quite painful.
  2. The condition may develop after trauma to the penis, such as bending or hitting. This can cause bleeding and subsequent scar tissue buildup.
  3. This scar tissue can generally be felt through the skin. Plaque normally forms on the upper side of the penis, but may also occur on the bottom or side.

Erectile dysfunction (ED) is a condition in which a man has difficulty getting or maintaining an erection. It can cause problems in the bedroom for men of all ages. One rare form of ED, called Peyronie’s disease, results in a bend in the penis that can make an erection painful. 

While a curved erection doesn’t always indicate a problem, men who have Peyronie’s disease may have trouble having sex. This often causes anxiety and discomfort. Keep reading to understand more about Peyronie’s disease.

Causes of Peyronie’s Disease

Causes

According to the Mayo Clinic, the cause of Peyronie’s disease is largely unknown. However, research suggests that the condition may develop after trauma to the penis, such as bending or hitting. This can cause bleeding and subsequent scar tissue buildup.

While injury may be the cause of the condition in some cases, the National Kidney and Urologic Diseases Clearinghouse (NKUDC) notes that often the condition arises without a traumatic event. 

Risk Factors of Peyronie’s Disease

Risk Factors

Genetics and age appear to play a role in Peyronie’s disease. Tissue changes lead to easier injury and slower healing as men get older. This puts them at greater risk for developing the condition.

Men with a connective tissue disorder called Dupuytren’s contracture have a higher chance of developing Peyronie’s disease. Dupuytren’s contracture is a thickening in the hand that makes your fingers pull inward.

Symptoms of Peyronie’s Disease

Symptoms

The main symptom of Peyronie’s disease is the formation of flat scar tissue called plaque. This scar tissue can generally be felt through the skin. Plaque normally forms on the upper side of the penis, but may also occur on the bottom or side. 

Sometimes plaque goes all the way around the penis, causing a "waisting" or "bottleneck" deformity. Plaque may gather calcium and become very hard. Scar tissue might cause painful erections, soft erections, or severe curvature.

Scar tissue on a certain part of the penis reduces elasticity in that area. Plaque on the top of the penis may cause it to bend upward during an erection. Plaque on the side may cause curvature toward that side. More than one plaque can cause complex curvatures.

Curvature may make sexual penetration more difficult. Scar tissue may cause shrinkage or shortening of the penis.

Tests and Diagnosis

Diagnosis

If you think you have Peyronie’s disease, the first step is to visit your primary doctor. A physical exam helps your doctor determine if you have the condition. This exam may involve taking an initial measurement of your penis.

By measuring the penis, your doctor can identify the location and amount of scar tissue. This also helps determine whether your penis has shortened. Your doctor may also suggest an ultrasound or X-rays to reveal the presence of scar tissue, and she may refer you to a urologist.

Treatment for Peyronie’s Disease

Treatment

There is no cure for Peyronie’s disease, but it is treatable and may go away on its own. Though it may be tempting to request medicine right away, many doctors prefer the “watchful waiting” approach if your symptoms aren’t severe.

Medication

Your doctor may recommend medications — often drugs injected into the penis — or even surgery if you’re experiencing more pain or penis curvature over time. Only one medication, clostridium hystolyticum (Xiaflex), is approved by the Food and Drug Administration (FDA) to treat the condition. It’s approved for use in men whose penis curves more than 30 degrees during erection. The treatment involves a series of penile injections that break down the buildup of collagen.

Two other types of medicines that may be prescribed are:

  • oral verapamil (usually used to treat high blood pressure)
  • interferon injections (helps break down fibrous tissue)

Nonsurgical Options

Iontophoresis, a technique that uses a weak electrical current to deliver medication through the skin, is another treatment option for Peyronie’s disease.

Nondrug treatments are being investigated, such as:

  • shock wave therapy to break up scar tissue
  • penile traction therapy to stretch the penis
  • vacuum devices

Patients being treated with Xiaflex may benefit from gentle penile exercises. For six weeks after treatment, you should do two activities:

  • Stretch the penis when not erect, three times daily for 30 seconds per stretch.
  • Straighten the penis when experiencing a spontaneous erection unrelated to sexual activity for 30 seconds, once daily.

Lifestyle Changes

Lifestyle changes may reduce the risk of ED related to Peyronie’s disease. These include:

  • quitting smoking
  • reducing alcohol consumption
  • stopping use of illegal drugs
  • exercising regularly

Surgery

Surgery is the last course of action in the case of severe penis deformity. According to the NKUDC, you should wait at least a year before turning to surgery for Peyronie’s disease. Surgical solutions include:

  • shortening the unaffected side
  • lengthening the scar tissue side
  • penile implants

Lengthening runs a greater risk of erectile dysfunction. Shortening the unaffected side is used when curvature is less severe. One type of shortening is a procedure called the Nesbit plication. In this procedure, doctors remove or cinch excess tissue on the longer side. This creates a straighter, shorter penis.

Natural Remedies

home treatment

Most natural remedies for Peyronie’s disease are not well-studied, and based on anecdotal evidence. A couple remedies have been studied and show promise.

A 2001 study published in BJU International concluded that acetyl-l-carnitine “is significantly more effective and safe than tamoxifen in treating acute and early chronic Peyronie’s disease.” No follow-up study has been published.

Results of a 2010 study published in International Journal of Impotence Research found that coenzyme Q10 supplements improves erectile function. They also reduced penile curvature in patients with early chronic Peyronie’s disease. More study is needed.

According to an article published in Reviews in Urology, vitamin E has been extensively studied for treating Peyronie’s disease. Recent studies show no improvement in patients treated with vitamin E compared to placebo.

Peyronie’s Disease in Young Men

men

Peyronie’s disease is most common in middle-aged men, but may occur in men as young as 20. Research shows 8 to 10 percent of men with Peyronie’s disease are under the age of 40.

Most young men with Peyronie’s present with symptoms such as painful erection. They often require medical intervention due to acute disease. Less than 21 percent of patients researched had a history of erectile dysfunction.

Complications

Complications

In addition to the anxiety or stress the condition may cause you — and perhaps your partner — other complications may arise. Difficulty achieving or keeping an erection makes it tough to have sexual intercourse.

If intercourse isn’t possible, you may be unable to father a child. Seek support from your healthcare team, which may include your doctor and a psychological counselor, to help you face these complex issues.

Talking to Your Partner

teens

This type of anxiety may lead to problems with your sexual partner.

Take steps to nip stress in the bud. Talk to your partner about Peyronie’s disease and how it may affect your performance in bed. If necessary, enlist the support of your doctor or a therapist to help you cope. 

Outlook

Outlook

Research is underway to help scientists better understand what causes Peyronie’s disease. Researchers hope their investigation into the process will lead them to an effective therapy to help men with Peyronie’s disease.

In the meantime, do what you can to understand the condition and take necessary steps to improve your quality of life — both in and outside of the bedroom.

You asked, we answered

  • Are there any severe symptoms of Peyronie’s disease that would require immediate medical attention?
  • Thank you for the great question. There are basically TWO concerning symptoms, for which you should seek immediate medical attention: pain, and priapism. Any case of Peyronie’s disease (or suspected Peyronie’s) that is accompanied by pain (whether with or without erection), warrants an immediate visit to the doctor’s office or urgent care center (or ER). The second symptom that warrants immediate medical evaluation is priapism — which is defined as an unwanted penile erection that persists. If the priapism persists for more than 30 minutes, especially if accompanied by pain, please make arrangements to get immediate medical attention. 

    - Steve Kim, MD

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