Peyronie’s Disease: The Complete Guide

Take-home points

• Peyronie's Disease is characterised by an abnormal curvature of the penis, often accompanied by pain and erectile dysfunction, and primarily affects men aged over 30.
  
• The condition progresses through two stages: the acute phase involving pain and curvature development, and the chronic phase marked by stabilisation of symptoms and potential erectile dysfunction.
  
• Diagnosis typically involves a physical examination, symptom assessment, and imaging tests, with treatment options ranging from non-invasive therapies and medications to surgical interventions in severe cases.
  
• Consultation with a urologist is crucial for managing Peyronie's Disease, and adopting safe sexual practices and maintaining overall health can help in prevention and mitigation.

What is Peyronie’s Disease?

Peyronie's Disease is a condition often misunderstood and overlooked by many men. As we know, penises come in all different sizes. The shape of the penis, however, shouldn’t be anything other than straight. For some men with Peyronie's Disease, this may not be the case.

Characterised by the formation of scar tissue and collagen beneath the penile skin, Peyronie's Disease is a connective tissue disorder which leads to an unnatural curvature of the penis. However, this curvature is more than just a slight bend; it's a noticeable deviation that can make sexual intercourse difficult or even painful.¹ 

While a minor curve during erection can be typical, any curvature when flaccid is unusual. Many men dismiss this condition as simply having a "different" penis, often due to a lack of pain or awareness. However, as intercourse becomes increasingly uncomfortable, the reality of Peyronie's Disease becomes apparent, yet many are reluctant to seek treatment because of the stigma and shame associated with the condition.²

Signs and symptoms of Peyronie’s Disease

If you're experiencing changes in the shape or function of your penis, it could be a sign of Peyronie's Disease. This condition is often progressive, meaning that it occurs over time. One key symptom to be aware of is an abnormal curvature of your penis, especially if it's greater than 30 degrees.³ Such a significant bend can notably impact your sexual activity, possibly leading to discomfort or even making sexual intercourse difficult or unfeasible.¹ 

Other symptoms of Peyronie's Disease can include:⁴

• Difference in shape and size
• A palpable lump may form within the penile tissue
• Experiencing pain during erections or discomfort during sexual intercourse (dyspareunia)
• Erectile dysfunction (ED)
• Initially, a small, localised ache or discomfort might be felt in the penis, often where a lump subsequently forms
• Uncomfortable, painful, or less firm than usual erections
• In some cases, there may be more than one area of plaque formation.

It’s important to note that Peyronie's Disease is not just a cosmetic concern, but a medical condition that warrants attention from a certified healthcare professional. If you experience any of the symptoms noted above, we advise you to seek medical advice at your earliest convenience.

What does Peyronie’s Disease look like? 

Scar tissue isn’t often as flexible as normal tissue. Most cases of Peyronie's Disease involve a scar on the penis that causes it to curve when erect. The nature of this bend depends on the scar's location: if it's on the top, the penis curves upwards (most common); if on the bottom, it bends downwards; and if on the side, the penis may curve sideways.⁵ In some men, the scar can develop on both the top and the bottom of the penis shaft, causing it to ‘shorten’, and it can encircle the shaft, causing indentations of sorts. 

How common is Peyronie’s Disease? 

Classical studies and more recent figures suggest that Peyronie's Disease affects around 13.1–22% of men, mostly those aged between 40–70.⁶

Causes and risk factors for Peyronie’s Disease

While the exact causes of Peyronie's Disease are still unclear, scientists have attributed it to a few factors related to disordered wound healing and scarring.⁷ These include but are not limited to:

• Age: As we’ve clarified, Peyronie's Disease is more prevalent in older men. The ageing process could affect tissue elasticity and healing capacity, potentially leading to the development of Peyronie's Disease.⁷
  
• Sexual or Physical Trauma: Injury to the penis during sexual activity, sports, or accidents can cause internal tissue damage. Such trauma, whether a single acute injury or repeated over time (chronic), can lead to internal bleeding and swelling, particularly in the tunica albuginea, the elastic membrane of the penis. Healing from these injuries might result in scar tissue and plaque formation, causing the penis to curve.⁷
  
• Genes: A family history of Peyronie's Disease may put you at greater risk for developing the condition.⁷
  
• Connective Tissue Disorders: Certain diseases affecting the connective tissues could be linked to the development of Peyronie's Disease.⁴
  
• Autoimmune Conditions: In autoimmune diseases, the body’s immune system may mistakenly attack healthy cells in the penis, leading to inflammation and scar tissue formation.⁴
  
• Lifestyle: Conditions such as hypertension, smoking, and obesity are thought to contribute to the risk of developing peyronie's disease. These factors may affect blood flow and tissue health, increasing the likelihood of penile injury and impaired healing.⁶
  

The stages of Peyronie's Disease 

Peyronie’s Disease is typically divided into two distinct phases: the acute (active) phase and the chronic (stable) phase. Each stage is characterised by specific features and symptoms:⁷ 

• Acute Stage: The acute phase of Peyronie's Disease typically lasts for 18 to 24 months and is characterised by a series of distinct symptoms. While your erectile function may be affected, the main symptoms that happen at this stage are associated with pain around the penis. You may also start to notice a slight curvature to the penis, as well as the formation of a nodule or lumps.⁷
  
• Chronic Stage:  This stable phase is characterised by a plaque which you can feel (sometimes hard) and a distinct curvature of the penis. You’ll notice that the pain won’t be as noticeable as it was during the acute phase, but your erectile function may be more greatly affected, leading to ED.⁷ 

Diagnosing Peyronie’s Disease

Diagnosing Peyronie's Disease typically starts with a discussion about your symptoms with your healthcare provider. You might be asked about the curvature of your penis and any pain experienced during erections.⁷  

Your healthcare provider may also perform various physical examinations to ascertain the extent of the disease. This might involve them palpating the flaccid penis to detect plaques or scars. In some cases, an examination of the erect penis or diagnostic imaging may be required.⁷  Additional tests like imaging (such as ultrasound) curvature testing can help determine the severity of the condition and guide the appropriate treatment approach.⁷  The type of diagnostic tool used to determine the severity of your condition should be decided upon during your consultation.

If you are concerned that you may have Peyronie's Disease, you should ask yourself the same questions which a healthcare provider would typically ask. By answering these truthfully, you should be able to gauge a better idea as to whether you need to be seen by a doctor. These questions include:

• Are you finding it difficult to maintain a firm erection?
• Do you feel pain in your penis when erect?
• Does your penis curve when erect? If so, have you noticed this curve change?
• Have you noticed a reduction in the length of your penis when erect?
• Does your penis shape resemble an hourglass?
• Have you noticed any new lumps or bumps on your penis?
• Do you find sexual intercourse difficult due to the curvature of your penis?

See the Peyronie's Disease questionnaire (PDQ) scale here, a resource that evaluates the severity and physical and psychosexual issues of Peyronie's Disease symptoms.

Treating Peyronie’s Disease: Is there a cure?

In some cases, Peyronie's Disease is not limiting, therefore requiring no intervention. For many people, however, treatment is needed to manage symptoms, redact the curvature, and reinstate a sex life. Treating Peyronie's Disease early in the acute stage can stop or even revert the curvature without the need for surgery.⁸ It’s therefore important for you to seek treatment as soon as you notice a difference in your penile function.

Treatment for Peyronie's Disease often includes:

• Non-invasive techniques: Certain non-invasive treatment methods such as therapeutic continuous ultrasound and shockwave therapy can be used to help break down plaque and reduce inflammation.⁹
• Oral Medications: Oral medications, like tamoxifen and Carnitine, are used to reduce plaque size.¹⁰
• Injections: Penile injections, including Collagenase or Interferon, aim to decrease penile pain and curvature.¹⁰
• Traction Therapy: This involves stretching the penis using a self-applied mechanical device for at least 30 minutes daily, which helps reduce curvature and length loss.¹¹
• Surgery: More severe cases of Peyronie's Disease warrant invasive therapy. This can include grafting, plication, and the use of penile implants.¹²

Remember, pain isn’t normal, particularly if you experience pain during sexual intercourse. If, however, that is the case, then consulting with a healthcare professional for an appropriate treatment plan is essential.

Your next step to mend the bend

Peyronie’s Disease is a urological problem that can be diagnosed and treated by a urologist. A urologist is a doctor who specialises in the kidneys, urinary tract, and male reproductive systems. When spotted early, treatment for Peyronie's Disease can halt disease progression and ensure you continue to lead a satisfactory sex life. The bottom line? Do as the doctors do, ask yourself the necessary questions, and take the first step in mending the bend.

References

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4. Penile curvature (peyronie’s disease). National Institute of Diabetes and Digestive and Kidney Diseases. 2022.
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