Peyronie’s disease is a disorder in which the penis bends or curves because of plaque, or lumps, that have formed inside the penis. Depending on where the plaque is located, the penis will bend up, down, or to the side. In some cases, the plaque develops on both the top and bottom of the shaft, which can cause the penis to become “dented” and shorter.
What causes Peyronie’s disease?
The cause of Peyronie’s disease is not entirely clear. Many researchers believe the plaque of Peyronie’s disease can occur after the penis has been hit or bent, which causes bleeding inside the penis.
In addition, the elastic in the layer of the two erectile chambers (or cylinders) in the penis may become more brittle over time, which can also lead to an injury.
Many medications may cause Peyronie’s disease as a side effect, including:
- beta blockers, which are often prescribed for people with heart conditions or high blood pressure;
- interferon, which is used to treat multiple sclerosis; and
- Dilantin, an anti-seizure medicine.
Who gets Peyronie’s disease?
Peyronie’s disease occurs in about 10 percent of middle-aged men; however, younger and older men can also be affected. In some cases, men who are related tend to develop the disease, which means the disease may be inherited.
A man who has Peyronie’s disease may also have erectile dysfunction (impotence, or difficulty getting and keeping an erection). This may be because there is less blood flowing to the penis, or it can be caused by stress from having the disease. Erectile dysfunction may cause the penis to bend more during sexual intercourse.
What are the symptoms of Peyronie’s disease?
The problem cannot be seen while the penis is soft. Symptoms of Peyronie’s disease may develop slowly, or can appear overnight. In severe cases, the plaque makes the penis less flexible. This can cause pain and may force the penis to bend or curve during an erection.
The pain of Peyronie’s disease is usually mild, and is usually not treated. This pain may only occur with an 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 get better without causing great pain or permanent bending.
Approximately one in three men with Peyronie’s disease have some pain during intercourse. Peyronie’s disease may also make the erect penis shorter; this change may be permanent.
How is Peyronie’s disease diagnosed?
The doctor will ask the patient about anything that may have happened before the symptoms appeared, such as an injury. The doctor will feel the hardened tissue caused by the disease, although sometimes it is necessary to do the examination when the penis is erect.
In some cases, the doctor may perform a biopsy. A biopsy is the removal of cells or tissue for examination. The sample will be sent for testing and will be looked at under a microscope.
How is Peyronie’s disease treated?
Mild bending of the penis caused by Peyronie’s disease usually does not need to be treated. Since the condition improves on its own in some men, doctors often recommend waiting one year before having surgery.
Surgery may be helpful only in cases where there is severe bending of the penis that may keep a man from having sexual intercourse. There are two procedures for men who have Peyronie’s disease: plication and plaque removal. (When it is erect, the penis has a “long side” and a “short side” caused by the curvature.)
In a plication procedure, the doctor shortens the long side of the erect penis by operating on the opposite side from where the scar or plaque is located. The procedure straightens the penis and allows the man to keep an erection, but it does cause the erection to be a little shorter.
This procedure is done on an outpatient basis (the patient goes home the same day), and the doctor does not remove any skin. Plication is successful more than 90 percent of the time.
Plaque/scar tissue removal
In this procedure, the doctor removes plaque or scar tissue to allow the short side of the penis to expand and become straight. This procedure is usually done in men who have very severe bending of the erection.
After removing the plaque, the surgeon fills in the gap in the erectile chambers with a graft, which may be collected from somewhere else on the patient’s body, or obtained from a commercial source.
This procedure is successful in 75 percent of cases. It will help preserve the length of the erection, but the erection will not be as long as it was before the Peyronie’s disease.
There is a greater risk of side effects with this procedure, including:
- weak erection or erectile dysfunction that may require pills or a penile implant;
- a temporary change in sensation (feeling) in the penis; and,
- a longer recovery period after the operation.
Since Peyronie’s disease affects each man differently, you should talk to your doctor about the treatment that is right for you.
How can men prevent Peyronie’s disease?
Men may not realize that they can damage the penis during sexual intercourse. This can make it difficult or even impossible to have sex. To avoid this type of injury, there are a number of things a man and his partner can do.
As men age, their erections may be less rigid (firm), or there may be difficulty in maintaining firmness. Less rigid erections can be injured because regular thrusting during sexual intercourse may cause the penis to bend. The following suggestions can help:
- Doctors will usually prescribe oral medications (Viagra, Levitra, Cialis) when a man has erectile dysfunction and sexual intercourse is either difficult or impossible. The first step in avoiding penile injuries is to begin to use one of these agents as soon as erections begin to become less rigid.
- The woman should make sure that the vagina is lubricated (moist). If it is not, the woman should use an over-the-counter vaginal lubricant.
- If the penis slips out of the vagina during sexual intercourse, the man or his partner should use their hand to guide it back in.
- Sexual intercourse with the partner on top should be avoided or used with caution because this position may increase the chances of the penis bending.
- Regardless of the position, the man’s thrusting movements during sexual intercourse should be straight in and out. He should avoid movements that might bend or twist the penis.
- Sexual intercourse should be avoided when the man is tired or has had too much alcohol to drink, as erections may be less reliable on these occasions