Erectile Dysfunction: Peyronie’s Disease

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Peyronie’s disease is caused by scar tissue, called plaque, which forms along the length of the penis in the corpora cavernosa. This plaque is not visible, and depending on the severity of the condition, the plaque can cause the penis to bend, making sexual intercourse difficult and occasionally painful.

 

What Causes Peyronie’s Disease?

The cause of Peyronie’s disease is unclear. Many researchers believe the plaque of Peyronie’s disease can develop following trauma (hitting or bending) that causes localized bleeding inside the penis. The injury or trauma may not be noticeable. Other cases, which develop over time, may be genetically linked or inherited (passed on from parents to children through genes). The disorder could be caused by a combination of both factors.

In addition, a number of medications list Peyronie’s disease as a possible side effect. However, the chance of developing Peyronie’s disease from any of these drugs is very low and there is no absolute evidence that Peyronie’s disease is related to taking these drugs.

 

Who Gets Peyronie’s Disease?

One study found that Peyronie’s disease occurs in 1% of men, according to the National Institutes of Health. Although the disease occurs mostly in middle-aged men, younger and older men can get it. In some cases, men who are related tend to develop Peyronie’s disease, suggesting the disease may be genetically linked.

 

What Are the Symptoms of Peyronie’s Disease?

Symptoms may develop slowly or appear overnight. When the penis is soft, no problem can be seen. But, in severe cases, the hardened plaque (which is benign, or noncancerous) reduces flexibility, causing pain and forcing the penis to bend or arc during erection. In most cases, the pain decreases over time, but the bend in the penis can remain a problem. Occasionally, milder forms of the disease will resolve spontaneously without causing significant pain or permanent bending. Overall, Peyronie’s disease will resolve on its own between 5%-19% of the time.

Some men with Peyronie’s disease develop scar tissue elsewhere in the body, such as on the hand or foot.

 

How Is Peyronie’s Disease Diagnosed?

First, your doctor will talk to you and ask about any circumstances, such as injury, that may have occurred prior to symptoms appearing. Your doctor can feel the hardened tissue caused by the disease during an exam, although sometimes it is necessary to do the exam with the penis erect. In some cases where the doctor’s exam does not confirm Peyronie’s disease, or in cases where the condition develops rapidly, your doctor may perform a biopsy. A biopsy involves removing tissue from the affected area to be examined in a lab.

Can Peyronie’s Disease Be Treated?

Yes. But, since some people’s condition improves without treatment, doctors often suggest waiting one to two years or longer before attempting to correct it. Mild cases of the condition rarely require treatment. Also, the pain associated with Peyronie’s disease occurs only with an erection and is usually mild. If intercourse is satisfactory then no treatment may be needed.

What Treatments Are Available?

Possible treatments for Peyronie’s disease include surgery and medical treatment.

Medication

The FDA has approved the first drug for treating Peyronie’s disease, Xiaflex. It is believed to work by breaking down the scar tissue that causes the curvature.

Men get as many as four treatments, each of which is two injections of the drug. There’s also surgery to straighten the penis.

Side effects may include pain, bruising and swelling.

Surgery

The two most common surgeries used to treat Peyronie’s disease are:

  • Removal of the plaque followed by placement of a tissue patch.
  • Removal or altering the tissue from the side of the penis opposite the plaque, which counters the disease’s bending effect.

Unfortunately, the surgeries do not guarantee normal penis function. The first method can involve partial loss of erectile function, especially rigidity. The second method, known as the Nesbit procedure, causes a shortening of the erect penis.

Another surgery for Peyronie’s disease is penile prosthesis implantation. This treatment is reserved for men who have both Peyronie’s disease and significant erectile dysfunction (inability to obtain or maintain an erection suitable for intercourse).

Most types of surgery produce positive results. But because complications can occur, and because many of the complications associated with Peyronie’s disease (for example, shortening of the penis) cannot be corrected, most doctors prefer to perform surgery only on the small number of men with curvature so severe that it prevents sexual intercourse.

Vitamin Therapy
Some studies have shown that vitamin E improves Peyronie’s disease. Similar studies have been done on para-aminobenzoate, a substance related to B-complex vitamins, but the results have been inconclusive. Both of these substances theoretically decrease or inhibit the scar tissue (plaque) formation.

Other Options
Other approaches to treating Peyronie’s disease that have yet to be confirmed as effective include the injection of chemical agents directly into the plaque or radiation therapy. However, because radiation therapy can only relieve pain associated with Peyronie’s disease and pain frequently disappears without treatment, it is seldom performed.

Since the severity of the condition varies from person to person, talk to your doctor about what treatment strategy is right for you.

Pain Management
In the majority of men with penile pain due to Peyronie’s disease, the discomfort usually will resolve on its own as the penile injury heals and matures over time. This process may take as long as six to 18 months. In certain instances, the calcium channel blockers Calan or Isoptin may be effective in decreasing the pain related to Peyronie’s disease when injected directly into the penile scar or plaque.

What Is the Outlook for Peyronie’s Disease?

Peyronie’s disease may be a self-limiting condition. Pain usually disappears with time, plaque formation stops, and the erection deformity stabilizes. Most men with Peyronie’s disease are able to have sexual intercourse and mutual enjoyment with their partner.

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