What is Peyronie’s Disease?

Peyronie’s disease is a condition in which scar tissue (plaque) forms inside the penis, causing it to bend or curve during erection. This curvature can lead to painful erections and difficulty with sexual intercourse. The exact cause of Peyronie’s disease is not always clear, but it is often associated with trauma or injury to the penis, whether due to vigorous sexual activity or accidents. Over time, the scar tissue can develop in the form of plaques that affect the natural shape of the penis.

Symptoms of Peyronie’s Disease

• Penile curvature – The most prominent symptom is a noticeable bend or curve in the penis during an erection, which can be to one side or up or down.
• Painful erections – Pain during erection, which can be either mild or severe, is common, especially during the acute phase of the disease.
• Palpable lumps or plaques – Hard lumps or areas of thickened tissue may be felt along the shaft of the penis.
• Erectile dysfunction (ED) – Some individuals may experience difficulty achieving or maintaining an erection due to the changes in the penis' structure and blood flow.
• Shortening of the penis – As the disease progresses, the penis may become shorter due to the scar tissue affecting its ability to expand fully during an erection.

What Causes Peyronie’s Disease?

While the precise cause is often unknown, several factors are believed to contribute to the development of Peyronie’s disease, including:

• Trauma or injury – A direct injury to the penis or repetitive trauma can cause the formation of scar tissue.
• Genetics – Some individuals may be genetically predisposed to developing Peyronie’s disease, as it can run in families.
• Age – The condition is more common in men over the age of 40, although it can affect men of all ages.
• Connective tissue disorders – Certain conditions, such as Dupuytren’s contracture (a hand condition), have been linked to a higher risk of developing Peyronie’s disease.
• Vascular conditions – Conditions like diabetes or high blood pressure, which affect blood vessels, may increase the risk of Peyronie’s disease.

Treatment Options for Peyronie’s Disease

The treatment for Peyronie’s disease depends on the severity of the symptoms, the degree of curvature, and the impact on sexual function. Treatment may include:

1. Medications
   • Oral medications – Oral treatments, such as potassium aminobenzoate (Potaba), can help reduce plaque size and prevent further curvature.
   • Intralesional injections – Enzyme injections (e.g., Xiaflex) can break down the collagen in the plaques, potentially reducing curvature and improving symptoms.
   • Verapamil – This drug, typically used to treat high blood pressure, may also help prevent the formation of scar tissue when injected directly into the plaque.
2. Shockwave Therapy
   Low-intensity shockwave therapy is sometimes used to treat Peyronie’s disease. It may help break down the plaque and improve blood flow to the affected area, though the evidence for its effectiveness is still being researched.

3. Penile implants – In cases where Peyronie’s disease causes erectile dysfunction that does not respond to other treatments, a penile implant may be inserted to restore function and appearance.

1. Lifestyle Modifications
   • Management of underlying conditions – Managing conditions like diabetes, high blood pressure, or cholesterol may help improve overall blood flow and reduce complications.
   • Avoiding further trauma – Avoiding further injury to the penis through careful sexual practices or activities can help prevent worsening of the disease.

When is Surgery Needed?

Surgery is typically recommended for patients who have significant curvature (greater than 60 degrees), severe erectile dysfunction, or when other treatments have been unsuccessful.