What is Peyronie's disease?
Peyronie's disease is a problem affecting the penis.
It is caused by damage to the penile tissue creating a scarring under the skin, known as a plaque. Depending upon the size and location of the plaque, it can cause the penis to bend upwards, downwards or become indented.
Although the name Peyronie’s disease is not widely known, the condition is fairly common, affecting approximately three per cent of men. It can occur at any age but most often affects men in their 40’s and 50’s.
What causes Peyronie's disease?
The penis consists of three cylinders (tubes), covered by several sheaths (covers) of tissue and, finally, by skin.
Along the length of each side of the penis are cylindrical (tubular) structures like sponge called the corpora cavernosa. These form the erectile tissue that becomes engorged (filled) with blood during erection. They are surrounded by the tunica albuginea, a tough, inelastic (non stretchy), fibrous sheath.
When the penis becomes erect, the corpora cavernosa (spongy tubes) swell, filling the space within the tunica albuginea (non stretchy cover), making it more rigid (hard).
In Peyronie's disease, hard, fibrous plaques appear within the tunica albuginea. They feel like lumps and can be tender. When the penis becomes erect, it swells unevenly and tends to bend around the plaque, causing the curved appearance of Peyronie's disease.
One in three men with Peyronie’s have pain or penile bending when erect as their main symptom.
Symptoms of Peyronie’s disease
Symptoms of Peyronie's disease may appear suddenly or may develop gradually. The most common signs and symptoms include:
- Scar tissue. The scar tissue (plaques) associated with Peyronie's disease can be felt under the skin of the penis as flat lumps or a band of hard tissue. It can slowly develop over several months and frequently takes 12 to 18 months to reach its full extent.
- A significant bend to the penis. Your penis may be curved upward, downward or bent to one side. In some cases, the erect penis has an "hourglass" appearance, with a tight, narrow band around the shaft. During the 12 to 18 months that the plaque or lump is developing, the deformity of the erect penis can change. 30 to 40 per cent get worse, 10 to 20 per cent get better and 50 per cent remain the same.
- Erection problems. Peyronie's disease may cause problems getting or maintaining an erection (erectile dysfunction).
- Shortening of the penis. Your penis may become shorter as a result of Peyronie's disease.
- Pain. You may have pain during an erection, only during an orgasm or any time your penis is touched. In most cases, it will gradually settle down and disappear without treatment in a few months.
You may not have all of these symptoms. What often happens is a man will first notice a tender lump in the penis, which might later develop bending of the penis when erect, sometimes at very odd angles. The flaccid (soft, non-erect) penis is not usually bent.
If you are having any symptoms you are concerned about it is advisable to see your GP.
Noticing a lump in the penis can be a frightening experience. Men are often concerned that they have developed cancer.
Cancer within the penis is very rare, while Peyronie's disease is the most common cause of lumps. If you find a lump, it is important to see your doctor as soon as possible for assessment.
What causes Peyronies disease?
Doctors are not certain why some men get Peyronie's disease and others don’t. However some of the causes might be:
- Genetics: occasionally the disease can run in the family (inherited or genetic predisposition), but this is not common.
- Injury: Peyronie's disease is more common after injury (damage) to the penis, such as penile fracture or forceful bending of the erect penis. It also occurs more frequently in men that give injections into the penis for the treatment of erectile dysfunction (ED).
- Circulatory problems: men with Peyronie's disease often seem to be affected by hypertension (high blood pressure) and atherosclerosis (hardening of the arteries) so these conditions may be involved in its development.
- Diabetes: this is more common in men with Peyronie's disease. As a result diabetes might also be involved in its development.
How is Peyronie's disease diagnosed?
Peyronie's disease is diagnosed on the basis of the history (how the problem has developed, as you describe it to your doctor) and examination (what the doctor can see and feel).
Between 10 and 25 per cent of men with Peyronie's disease have Dupuytren's contracture, a deformity in which the little finger, the ring finger and, sometimes, other fingers bend over towards the palm of the hand.
No special investigations (tests) are needed and biopsy (removing a piece of the lump for examination under a microscope) is only needed for lumps that are growing quickly and are not developing in the usual manner. Ultrasound scanning can be used to assess the exact size and position of the lump but is not often needed.
If the problem has been there for a long time, is not changing, and is not causing you much trouble, the doctor might recommend no treatment and simply ask you to return if the condition starts to get worse.
If the problem has been there for a long time and is causing you sexual difficulties such as erectile dysfunction, difficulty with penetration (entering your partner) or pain during sex for either partner, your doctor may refer you to see a urologist (doctor who specialises in bladder, kidneys and genitals). You might need surgical treatment (an operation) to correct the problem.
If the problem has recently developed, especially if the lump is continuing to develop or is painful, the doctor may consider offering drug treatment themselves or refer you to a Urologist or other specialist for advice.
There is nothing you can do to prevent Peyronie's disease getting worse after it has appeared. However, avoiding penile trauma (damage) might prevent it. Men who are injecting into the penis to treat erectile dysfunction can lower their risk of developing Peyronie's disease by careful injection technique and by changing the position of injections. This advice is usually given when patients are first taught to use injections by their nurse or doctor. If you are using injections and are unsure, ask your doctor or nurse.
Vacuum erection device/ vacuum therapy
More research is needed into this treatment; however, a recent study conducted by Dr David Ralph (Peyronie’s specialist doctor, Harley Street, London) showed that a short course of VED therapy can be useful to men suffering from Peyronie's disease.
The study found that for some men use of a vacuum erection device (VED) can be helpful in the treatment of Peyronie's disease, though, as with other treatment options, it can take quite some time for results to show. VED improves the blood flow to the penis, while also stretching out the scar tissue/penile plaque that is present. This is not only useful for those trying to avoid surgery (by reducing curvature) but also those hoping to reduce curvature to ensure that less length is lost if they do go for a surgical option at a later date.
Many men with peyronie's disease struggle to maintain (keep) an erection, and this may worsen their condition. Regular penile exercise using a vacuum pump may help some men avoid Erectile Dysfunction.
Vacuum therapy is the most successful treatment of ED. See our ED webpage for more information.
There is limited evidence (proof) of the success of drug treatments. However, drug treatment is worth considering in men with early or active Peyronie's disease (when the lump is getting bigger or is painful). The aim is to reduce pain, lump size and the eventual deformity (bending).
- Vitamin E and potassium aminobenzoate: these drugs have been shown to improve pain in 30 to 60 per cent of affected men but do not seem to affect lump size or deformity (bending) of the erect penis.
- Tamoxifen: one study showed that tamoxifen (e.g. Nolvadex D) not only improved pain in about 80 per cent of affected men but reduced lump size and deformity (bending) in about 30 per cent of men. The study was in men with early disease and soft plaques. There is currently no evidence in men with long-established disease. Tamoxifen is usually used in the treatment of breast cancer. Although not licensed (not yet approved) for use in Peyronie's disease, some specialists will recommend it.
- Steroid injections: several studies have looked at injecting steroids into Peyronie's plaques in an attempt to reduce pain, deformity and lump size but the results have been very disappointing.
- Verapamil injections: one study in a very small group of men has shown that repeated injections of verapamil into the Peyronie's plaque improved pain, deformity and lump size. Given that penile injection is a potential cause of Peyronie's disease, more evidence from larger, long-term studies must be gathered before this can be recommended as a treatment.
Extracorporeal shockwave therapy
Studies in the UK and Germany have shown that extracorporeal (outside the body) shockwaves directed at Peyronie's plaques can reduce penile deformity (bending) in established, stable disease (Peyronies disease that has been there for a long time and is not getting any worse).
This technique has been used to smash kidney and gallstones for many years, and might avoid the need for surgery in established Peyronie's disease. Treatment is given over several sessions on an outpatient basis. This technique is still being tested and is not yet widely available.
Surgery is only done to correct penile deformity (bending) in men with stable Peyronie's disease (Peyronies disease that has been present for a long time and is not getting any worse).
It is essential that the disease has stabilised and become inactive (stopped getting worse) before surgery is tried, otherwise the condition can continue to progress (get worse) after the operation has been performed.
You may need surgery if:
- You are unable to penetrate your partner during sex
- You or your partner are experiencing pain during sex that is caused by the penile deformity (bending).
Success of surgery is usually measured by the correction of deformity but there are no guarantees that the penis will be perfectly straight after surgery. Unfortunately, some men will develop erectile dysfunction or even numbness of the penis following surgery, so it is important to think about all these factors before going ahead.
Types of surgery
Plaque excision and grafting
This is where the surgeon cuts out the plaque from the tunica albuginea and fills the defect with a skin graft from the abdominal wall. However, results from this procedure are disappointing, with success rates from studies reported between 20 and 70 per cent. Also between 16 and 70 per cent of men suffer erectile dysfunction after this type of surgery.
Plaque incision and grafting
This is where the surgeon cuts through the plaque, either with a scalpel or laser, and then fills the defect with a graft (a piece of living tissue surgically removed from one part of the body and placed in another).
This procedure has the advantage of protecting the tunica and keeping penile length. Although results from studies seem better than for plaque excision, the research only looked at a very small number of men and more investigation is needed to confirm its safety and success.
- Plication of the corpora: plication of the corpus cavernosum (stitching a small tuck into the corpus) on the opposite side to the plaque may improve deformity (bending) but will make the erect penis shorter. Success rates of 50 to 60 per cent have been reported with this technique.
- Nesbit's operation: this operation involves taking out a section (piece) of corpus cavernosum on the opposite side to the plaque, then suturing (stitching) the edges together. This corrects the deformity (bending) but, again, will make the erect penis shorter. Success rates of up to 80 per cent have been reported with this technique.
In both of these operations, circumcision (removal of the foreskin) will also normally be performed, as foreskin problems frequently follow these operations in uncircumcised men.
Sex and Peyronies disease
Sex is an important part of a close and happy relationship for most couples whether in younger or later life. A disappointing or unfulfilling sex life can often damage a relationship, leaving either partner feeling lonely and insecure.
It is important that throughout your treatment and recovery you talk to your partner about how you feel. Trying different sexual positions may help you to continue to have sexual intercourse. However, there are many ways of having an intimate relationship if you are unable to have penetrative sex. Physical contact through kissing and cuddling can help couples to feel close to one another.
Some men will develop varying degrees of erectile dysfunction (ED) as a consequence of Peyronie's disease. ED is the inability to get and/or keep an erection adequate (good enough) for satisfactory sexual intercourse.
ED can be treated successfully in up to 95% of all men. Don’t suffer in silence. Speak to your GP or nurse as soon as possible. The sooner you start treatment for ED the more likely it is to work!
For more information, see our ED webpage.
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