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Despite spending most of its time hidden away, the penis can be a sensitive area for men and not just during stimulation. There’s plenty of research that shows men have insecurities about their penis which can lead to low self-esteem and even sexual issues.

During an individual's lifetime, the appearance of their penis can undergo changes. Some of which may be deemed undesirable, due to unrealistic societal standards as a result of things like social media and pornography. Examples of penile changes can include a reduction in size, or change in shape (for example increased curvature).

Peyronie’s disease (PD) is a condition that can cause the penile changes mentioned above. The disease often causes alterations to the penis's appearance and may even affect sexual function. This article explores Peyronie’s disease, its symptoms, and the treatments available.

What is Peyronie’s disease?

Peyronie’s disease is a condition in which scar tissue (known as plaque) develops on the penis. Although penises vary in shape and size naturally, Peyronie’s disease can lead to noticeable curvature of the penis, reduction in size, and painful erections.

People who have Peyronie’s disease may find that their sex life becomes damaged.

This can be due to a decrease in sexual function or the development of mental health conditions such as depression. Due to painful erections, men may struggle to stay erect and find it too painful to participate in sex. People may also develop erectile dysfunction (ED) as a result of PD. Alternatively, given the possible curvature of the penis, individuals may find themselves becoming self-conscious and avoiding sexual activity.

How Common is Peyronie’s Disease?

In contrast to some of the more common sexual disorders in men (such as ED or premature ejaculation) Peyronie’s disease is less well known. However, despite the condition being previously considered rare, it’s said that Peyronie’s disease can now be found in up to 13% of men.

Stages of Peyronie’s Disease

There are two main stages of Peyronie’s disease; the acute and chronic phases. According to a review of Peyronie’s disease, the difference between the two phases are as follows:

  • Acute  Phase

    The initial 6-18 months sees deformity of the penis advancing. Pain may be present in an erect and/or flaccid state. Treatment is not recommended at this point.
  • Chronic Phase

    This phase is in effect when the symptoms have not progressed for 3-6 months. The changes to the penis have now stabilized and there has been a reduction in pain. Treatment is appropriate in this phase.

What Causes Peyronie’s Disease

The exact causes of Peyronie’s disease are not yet fully understood. However, it’s thought that there are some specific risk factors for the development of PD. These can range anywhere from physical damage to genetics. We’ve detailed some of the potential causes of Peyronie’s disease below:

 Potential Causes of Peyronie's Disease

 

Diagram about the Potential Causes Peyronie’s Disease

 

Trauma (Penile Injury)

With the male reproductive system being external, reproductive organs such as the penis and testicles can be susceptible to physical damage. Injuries can easily occur as a result of impact faced in contact sports, workplace accidents, or even during sexual activity. Although some claims that penile trauma coincides with Peyronie’s disease are speculative, studies have shown significantly higher rates of penile trauma in patients with Peyronie’s disease when compared to control groups.

Autoimmune Disease

Autoimmune disease (AD) occurs when the body fails to tell the difference between its own cells and foreign cells, leading it to attack itself. To make matters worse for individuals with AD, the disease may also predispose them to Peyronie’s disease. An analysis consisting of 1,140 men found that 148 of the men (13%) had Peyronie’s disease. Out of these men, 14 of them (9%) had comorbid autoimmune disease, with the rate of AD significantly lower in patients who did not have PD.

Family History

The possible genetic cause of PD divides opinion. A review of existing literature of PD’s relationship with genetics was carried out in 2020. The first link mentioned dates back to 1979, a hypothesis based on HLA-B group antigens and a potential link to PD. The review mentions three pedigrees of families with three generations of father-son transmissions of PD. Furthermore, reports of twins with PD whose father and son had signs of PD were noted. However, the review concluded that PD's link to genetics is highly controversial, and questions about the relationship between them still exist.

    Risk factors for developing Peyronie’s disease

    A number of the risk factors which could lead to individuals developing PD have been explored in the table below.

    RISK FACTORS

    NOTES

    Age

    Although PD can develop at any age, the average age of men who develop the disease is 50-55 years old.

    Genetics

    Albeit a controversial topic, genetics may be a risk factor for PD development. With previous instances of PD being inherited (see ‘family history’ under causes).

    Connective tissue disorders

    Individuals with certain connective tissue disorders may be at higher risk of developing PD. An example is the known link between Dupuytren’s disease and PD.

    Erectile dysfunction

    A study consisting of 317 patients seeking help for PD found erectile dysfunction to be an independent risk factor for the development of PD.

    Autoimmune disorders

    AD has been found to have a higher prevalence (see autoimmune disease section) in patients with PD when compared to individuals who do not have PD.

    Trauma (Penile injury)

     Research supports a link between penile trauma and PD. With studies showing a higher occurrence of penile trauma in PD patients.

    Lifestyle (smoking, alcohol, diabetes)

    Smoking and alcohol consumption are both linked to the development of PD as referenced later in the article (see ‘lifestyle changes’ under non-surgical treatments). Patients with diabetes are also said to have a 7% higher incidence of PD.

    Symptoms of Peyronie’s disease

    Being familiar with the symptoms of PD may be helpful for recognizing its development. This section details the main symptoms of Peyronie’s disease.

    SYMPTOMS

    DESCRIPTION

    Curvature and Penile Shortening

    One of the most damaging symptoms to male self-esteem is perhaps PDs ability to change the penis's appearance. Peyronie’s disease can cause drastic curvature of the penis as well as a loss of length.

    Plaques / Lumps in the Penis

    Scar tissue known as plaque forms in the penis which can lead to it becoming curved. Individuals may also be able to feel a build-up of lumps on their penis when they touch it.

    Painful Erections

    Another damaging symptom of Peyronie’s disease is pain while erect. The pain may prevent individuals from being able to maintain a sufficient erection.

    Pain during sexual intercourse

    Given the painful erections associated with PD, some individuals may find sexual intercourse highly painful. This can prevent them from being able to have enjoyable intercourse and lead to a damaged sex life for both partners.  

    Erectile Dysfunction

    The pain caused by Peyronie’s disease during erections may lead to erectile problems. Individuals with PD may also develop erectile dysfunction.  

      Treatment for Peyronie’s disease

      Although a number of treatments are available for Peyronie’s disease, never take matters into your own hands.

      The first step you should take for treating the disease is to get a professional consultation from a doctor.

      They will be able to advise the best course of action for your situation and recommend an appropriate treatment. We’ve highlighted some of the possible treatments for Peyronie’s disease below.

      Non-surgical treatments

      Non-surgical treatments are considered one of the less aggressive ways of dealing with Peyronie’s disease. Some of the most common non-surgical treatments for PD have been listed below.

      Oral Medication

      An oral medicine may be an effective treatment for PD, with Collagenase Clostridium histolyticum (CCH) used for treating curving of the penis. A study found that CCH in combination with vacuum therapy was able to improve penile curvature compared to baseline figures.

      Lifestyle changes

      The development of PD might not always be down to bad luck. It seems that lifestyle habits may increase an individual’s chances of developing the disease. A study found a link between smoking and the development of PD in men aged between 50 and 69. Another case study consisting of 82 patients made reference to smoking playing a role in the development of PD as well as alcohol consumption.

      Creams

      Verapamil hydrochloride gel is applied topically and appears to be an effective, non-intrusive method of treating PD. A study assessed the use of 15% verapamil gel with bidaily applications for treating PD. It found that out of fifty-seven patients treated for 9 months, 94.4% experienced curvature improvement, the average plaque change was 84.7% and the pain was resolved for 100% of patients.

      Penile traction

      Traction therapy involves the use of a device to stretch the penis, helping to turn scar tissue into regular tissue to reduce the effects of PD. A study consisting of 110 men explored the effectiveness of using a traction device (RestoreX) for 30 to 90 minutes each day. The study reported that 77% of men experienced improved curvature and 94% had increased length. It also noted improvements in erectile function for men with ED.


      Penis pumps


      Vacuum therapy has proven to be an efficient way of treating Peyronie's disease. A study was carried out to assess the success of vacuum therapy in straightening penile curvature. 31 patients with PD used a vacuum device twice a day for 12 weeks. 21 patients noticed a reduction in their curvature angle, while three had worse curvature and seven noticed no change.

      Vitamin E

      Vitamin E may help to reduce the effects of PD. Research explored the effectiveness of vitamin E for PD treatment. It split 70 patients into two groups (A and B), adding vitamin E to an existing list of treatments for patients in group A. After 6 months they found group A patients had better plaque reduction, a greater improvement in penile curvature, and improved erectile function compared to patients in group B.

      Invasive therapies and surgery

      Invasive treatments such as surgery may be turned to when some of the milder treatments for PD don’t make an impact. Some of the most common invasive treatments for PD have been listed below.

      Penile injections

      Although verapamil injections are considered an effective non-surgical treatment, they can still seem daunting. A 46-man study found that 97% of patients noticed pain reduction after a mean of 2.5 injections. After the therapy (fortnightly injections administered 12 times) 76% noticed a decrease in penile curvature (although 9.5% noticed an increase and 14.5% remained unchanged).

      Iontophoresis

      Iontophoresis involves using electrical currents to deliver medication (such as verapamil) into the affected part of the penis. Research has shown it can be an effective treatment with few side effects. The study in question had 100 PD patients on 3 weekly courses of iontophoresis and found a 96% rate of pain reduction, 53% reduced plaque, and 44% improvement in sexual function.

      Extracorporeal shockwave treatment

      Extracorporeal shockwave therapy (ESWT) is another option for treating Peyronie’s disease by delivering energy to damaged areas of the penis. A meta-analysis of ESWT and PD found that it appears effective in treating penile pain and sexual function. Another study on ESWT consisting of 42 people found that 81% of patients had improvement in angulation. 84% of patients had full or near full pain relief post-treatment.

      Surgery

      Surgery for PD may be considered after some of the less intrusive methods have been exhausted. Surgery can be a complicated option as the possible side effects of the procedures can include penile numbness and erectile dysfunction. There are several options for surgery to address PD, we’ve highlighted these in the table below.

      TYPE OF SURGERY

      DESCRIPTION

      NOTES

      Plication

      Surgery is carried out on the side of the penis with no plaque. Known as a shortening procedure because penile length is determined by the shorter side.

      Change in erection length is more likely in this procedure compared to grafting. It may result in loss of shaft length. Considered a method with a high rate of success and low rate of complication.

      Grafting

      Additional tissue known as grafts get added to the plaque or scar tissue which is cut. Suited to individuals with severe curvature.

      This surgery aims to maintain penile length, but comes with a higher risk of ED and is the preferred treatment for individuals with penile curving of >60° (if erectile rigidity is satisfactory prior to operation).

      Prosthesis implant

      This involves implanting a device into the penis, allowing individuals to achieve an erection at their command. This makes it effective for treating sexual issues.

      Penile prosthesis is considered a great option (highly satisfying for patients) for individuals who have erectile dysfunction issues in combination with their PD. A good option for restoring sexual function.

      FAQ’s

      Can Peyronie’s disease affect fertility?

      Peyronie’s disease should not affect fertility at all. If an individual is trying to conceive, they may struggle to have sex due to the pain caused by PD. However, the disease does not affect sperm count or quality.

      Is Peyronie’s disease a permanent condition?

      Although Peyronie’s disease may not go away by itself, there are options for treating the condition. There are a variety of surgical and non-surgical treatments available. Some successful treatments for the pain, curvature and reduced sexual function caused by PD include creams, traction therapy, penis pumps, and a number of surgery options (plication, grafting, and prosthesis implants).

      Can Peyronie’s disease be prevented or avoided?

      Peyronie’s disease can’t be prevented. This is because certain risk factors such as penile trauma or autoimmune disease may be unavoidable. However, according to the previous research cited in this article, smoking and alcohol may be risk factors for PD. Avoiding these behaviors might reduce your chances of developing the disease.

      Is Peyronie’s disease an STD?

      Peyronie’s disease is not a sexually transmitted disease. However, it’s thought that PD may develop after trauma to the penis. It may be possible that the penis becomes damaged and PD develops as a result of vigorous sex.

      What are the common complications of Peyronie’s disease?

      Some of the complications of Peyronie’s disease can include pain during erections, penile curvature, loss of penile length, and the inability to maintain an erection. These factors could lead to a damaged sex life and self-esteem issues. Potential complications of Peyronie’s disease surgery also include penile numbness and ED.

      Summary

      Peyronie’s disease is caused by scar tissue (or plaque) developing in the penis. This can lead the penis to become curved, painful, and even lose length. The two stages of Peyronie’s disease are acute (when the condition is developing) and chronic (when symptoms have settled). The exact causes of Peyronie’s disease are unknown but there are strong links to the disease developing as a result of penile trauma, autoimmune disease, and genetics.

      Peyronie’s disease can be treated and a number of options are available which include non-invasive treatments such as creams or therapy.

      In more severe cases surgery may be required however, surgery comes with a risk of complications such as ED and penile numbing. Although this article is intended to be informative it cannot be considered a substitute for medical advice. For any health-related concerns, be sure to consult a medical professional.

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