Does your penis bend during an erection?
You're not alone.

About Peyronie's Disease

WHY DOES THE PENIS BECOME BENT?

No man’s penis is entirely straight when erect, that is the way it is shaped. It may bend slightly upward, downward, to the left or to the right. It varies from man to man and does not usually affect one’s sex life, mood or self-esteem. With Peyronie’s disease, however, the curvature is so invasive that sexual intercourse can be both difficult and painful.[1]

LET'S GET THE FACTS STRAIGHT

The bending results from a build up of connective tissue in the penis – made of collagen – which normally helps build our hair and fingernails. This tiny lump of tissue presses on the penis causing it to bend.

- More common than you think
Some health problems are difficult to talk about and deal with, especially when they affect our “private parts”. It is estimated that around 3-7 % of men have Peyronie’s

disease, but it may be even higher than that.[2,3] This makes Peyronie's disease a common and at the same time not so commonly discussed health problem among men.

THERE IS HELP

Peyronie’s disease can be treated by both surgery and non-surgical treatments. The latter include everything from food supplements to injections directly into the plaque. However, treatments for PD are as variable in effect as they are plentiful.[4,5]

  1. NHS website http://www.nhs.uk/chq/Pages/875.aspx?CategoryID=61&SubCategoryID=61
  2. Bella AJ, et al. J Sex Med. 2007;4:1527-1538.
  3. Smith CJ, et al. BJU Int. 2005;95:729-732.
  4. Sherer MD et al. (2015) Expert Opinion on Pharmacotherapy, 16:9, 1299-1311.
  5. Culley C. Carson, Laurence A. Levine BJU Int 2014; 113: 704–713.

Peyronie’s disease is named after a French surgeon who described it in the 18th century. It is caused by the development of collagen plaque, or scar tissue, on the shaft of the penis. The scar tissue, known as a Peyronie’s plaque, is not visible but can cause the penis to curve when erect. The penis can curve in various directions including upward, downward or to the side, depending on the location of the plaque.[1]

Who can get Peyronie’s disease?
What causes Peyronie's disease is still unknown, many different factors have been suggested. The most common explanation is that trauma, which may happen during intercourse, causes a small bleeding inside the penis. When the wound is healing, scar tissue (collagen plaque) is formed. Some men may be predisposed to develop excessive amount of scar tissue, and are therefore likely to develop Peyronie's disease.

Peyronie’s disease mostly affects men between 40–60 years of age, although it can occur at any age. It is not likely to go away on its own and may get worse over time. However, treatment may not be necessary if the condition does not affect the sexual function or significantly impairs quality of life. In a minority of cases, the condition improves without treatment.[2]

Symptoms
Peyronie’s disease signs and symptoms might appear suddenly or develop gradually. The most common signs and symptoms are penile curvature, scar tissue felt under the skin, erectile problems, shortening of the penis due to the curvature and penile pain. The penile curvature deformity might gradually worsen over time. However, at some point, it stabilizes in the majority of men. Peyronie's disease is usually divided into two stages: the acute phase and the chronic phase.

- Acute (active) phase. Starts with an acute inflammatory phase that generally lasts for 6 to 18 months. During this phase, pain may arise during erections and spontaneous resolution can occur. Progression in plaque size and curvature deformity is also common.[3]

- Chronic (stable) phase. In the chronic phase the pain is almost not felt or has completely gone, the plaque size and curvature deformity is stable and spontaneous resolution is not expected.

Psychological symptoms
The problem with Peyronie’s disease is not only physical – it also sticks in your head – as most men find it hard to adjust to having a bent penis. In a study with men with Peyronie's disease, 77 % said that they were affected psychologically. This had to do with worries about erection appearance and performance, decreased self-esteem and relationship difficulties. In another study, almost half of men with Peyronie's disease were classified as being depressed. [4,5]

  1. NHS website http://www.nhs.uk/chq/Pages/875.aspx?CategoryID=61&SubCategoryID=61
  2. Tran VQ, et al. Adv Urol. 2008;263450;1-4.
  3. Bekos A, et al. Eur Urol. 2008;53:644-650.
  4. Nelson CJ, et al. J Sex Med. 2008;5:1985-1990.
  5. Rosen R et al. J Sex Med. 2008;5:1977-1984.

It is natural to feel reluctant to discuss problems concerning your penis, even with your doctor. However, there are numerous doctors out there who have helped many men with Peyronie’s disease, you won’t be an exception. To get to the right diagnosis and treatment as swiftly as possible, it is important that you prepare yourself for your appointment with a doctor.
- Explain the symptoms as thoroughly as possible: when they started, how long you’ve had them and how they appear – and how they affect you.
- If you have a curvature of your penis, try to take a picture of it and show it to your doctor. This will make it easier to confirm or rule out Peyronie’s disease.

If you suspect having Peyronie’s disease, you’ve probably scanned the web and found countless treatment options already. Here we will list some, and go through each treatment based on the latest scientific evidence.

Treatment of Peyronie’s disease ranges from minimally invasive treatments to surgical intervention. Currently, there is no cure for PD, but there are treatments available that can help reduce the curvature of the penis and reduce the pain.

Which treatment is right for me?
Finding the right treatment just for you is a matter of discussion with your doctor and largely depends on the severity of the curvature, which stage it’s in and how much it affects your life.

Non-surgical treatment options[1]

Intralesional injection therapy
Put simply, an intralesional treatment means injecting a medical substance directly into a body part that is affected by a disease (lesion) – in the case of Peyronie’s disease, the collagen plaque that is causing the penis to bend. Depending on the degree and severity of the curvature, intralesional treatments can be used to reduce the pain and decrease the curvature of the penis. Many of the intralesional treatments that are being used for Peyronie’s disease are already being used for other illnesses, however, only one is approved in the EU and US specifically for the treatment of Peyronie's disease. Talk to your doctor to find out more.

Oral treatments
Several oral treatments are said to help against Peyronie’s disease, from food supplements such as vitamins and omega-3 to many oral prescription medicines. However, most of them are not supported by treatment guidelines for routine use in patients with Peyronie’s disease. This has to do with their lack of scientifically proven clinical effect as a monotherapy, i.e. a treatment that is used alone without combination of other medications. Further studies on oral therapies might shed some light on whether they can play a role in combination therapy for PD.

Traction therapy
This is intended to work by stretching the plaque mechanically using a stretching device that is worn several hours per day. Although penile stretching is said to have possible effects on curvature, both in studies and guidelines, no larger evaluation has been done comparing it to placebo. Traction therapy is therefore not recommended as an evidence-based treatment.[2]

  1. Sherer MD et al. (2015) Expert Opinion on Pharmacotherapy, 16:9, 1299-1311.
  2. Jordan GH, Carson CC, Lipshultz LI. BJU Int 2014;114:16–24.

Surgery

Surgery has been used for many years for the treatment of Peyronie's disease. It is mainly used on men with PD that is in a stable phase with a disabling deformity, in other words when the curvature is hindering sexual intercourse and a normally functioning life. Surgery is also performed on men with PD who also have erectile dysfunction.

What type of surgery is it?
The goal of the surgery is to straighten out the curvature, preserve or restore the ability to have erections and the same time not affect the length and girth of the penis. Although, it’s important to remember that surgery won’t change the penis back to exactly how it looked and felt before PD was present. Which type of surgery that is performed is dependent on where the Peyronie’s plaque is located, degree of curvature, how much the erectile function is impaired, what the patient prefers and also the surgeon’s experience. Since Peyronie’s disease is a condition that varies in presentation from man to man, no single surgical intervention can be used on all PD-cases.

PD-surgery means working with the tunica albuginea
The tunica albuginea is the layer of connective tissue that surrounds the cavernous body of the penis, the sponge-like tissue inside the penis that is filled with blood to create an erection.

The different surgical procedures for Peyronie’s disease are:

  • Tunical shortening
  • Tunical lengthening
  • Penile prosthesis implantation

Tunical shortening
This is suitable for patients with adequate penile length and a curvature of less than 60 degrees. Tunical shortening roughly means that the tunica albuginea is altered on one side of the penis, the side opposite to the plaque, so it matches the shorter side. The penis is thereby straightened out. Tunical shortening, such as the Nesbit procedure, is the most commonly performed surgery for PD.

Tunical lengthening
Suitable for patients with a more complex curvature deformity exceeding 60 degrees, large plaques and short length of the penis. Tunical lengthening is a form of reconstructive surgery that means cutting or completely removing the plaque in the penis. The space where the plaque was located is then filled with a graft, tissue that is reassigned from the patient’s own body. Specially processed animal tissue can also be used.

Penile prosthesis implantation
The use of a penile prosthesis is often reserved for patients with PD who also have a severe erectile dysfunction that is non-responsive to medication. There are different types of implants available, both malleable (shapable) and inflatable devices.

  1. Culley C. Carson, Laurence A. Levine BJU Int 2014; 113: 704–713.

Many men with Peyronie’s disease are anxious about the appearance of their penis, for obvious reasons. Some might feel worried about not being able to satisfy their partner or even fathering a child, due to difficulties having intercourse. The loss of intimacy and the relationship problems due to Peyronie’s disease can strongly affect one’s psychological well-being.[1,2] That is why it is important to be open about these feelings, however difficult it might be. Here are some tips/guidelines for talking to your partner about Peyronie’s disease.

Talk, involve, resolve

- Explain to your partner what Peyronie’s disease is and be as thorough as possible. Preconceptions about different diseases are bound to create confusion and unnecessary misunderstandings.
- Involve your partner in how your condition makes you feel, physically, emotionally and sexually.
- Try to resolve the problem together. It’s a good idea to involve your partner in every step of the process of getting help, from finding different techniques for having sex to going to doctor's appointments.

  1. Ryan CA. Peyronie’s Disease from a Partner’s Perspective. 27 Jun 2012. Read more (PDF)
  2. Rosen R, et al. J Sex Med. 2008;5:1977-1984.

The contents of this video express the doctor’s own views of Peyronie’s disease and do not necessarily express Sobi’s views

Questions & Answers

Peyronie’s disease can give a variety of symptoms, including: penile curvature, lumps in the penis, painful erections, and difficulty with penile penetration.

Although not completely clear, there is some evidence suggesting that Peyronie's may be hereditary.

A urologist with experience of diagnosing and treating Peyronie’s disease.

For a long time, surgery has been the only treatment option. Today, several less invasive treatments are available which target the plaque directly. Of these, one is approved by American and European pharmaceutical authorities for the treatment of Peyronie’s disease.

Peyronie’s disease most commonly develops in men aged 40–60, but it occurs at both lower and higher ages.

First, to really know if you have it, an urologist must perform an examination. Secondly, Peyronie’s disease is self-resolving only in a minority of cases. The best course of action is to seek professional help and proper treatment.