Peyronie’s disease is a problem of the penis, named after a French surgeon who described the condition in the 1700s. It is caused by scar tissue, or ‘plaque’ that forms in the wall of the penis, and can cause a curvature on erection, a lump in the penis, pain, shortening and sometimes erection problems.
Most men can still have sexual intercourse, but for some, it can be too painful and cause erectile dysfunction. Urologist Mr Rowland Rees talks to us about Peyronie’s disease and what can be done about it.
What causes it?
The exact cause of Peyronie’s disease is not known, but the theory is that it’s caused from microtrauma, whether from a minor injury, vigorous intercourse, bending the penis on penetration, pressure from the partner’s pubic bone or playing sport. Minor trauma to the penis can often feel like a penile fracture but without an actual fracture being present. There are also some background risk factors for Peyronie’s disease that can be either genetic or vascular. Vascular risk factors include having diabetes, high cholesterol, high blood pressure and high lipid count in the blood.
Who can get Peyronie’s disease?
Symptoms of Peyronie’s disease can be found in about one in 20 men over the age of 40, and in any man that’s sexually active, but the peak age tends to be in the mid-50’s. The exact reason as to why it peaks at this age is not entirely clear.
Post pubescent adolescents as young as 20 years of age can develop the condition but this is much rarer. Older men might not be aware that they even have the condition if they are very old and not sexually active. Usually, men that complain about Peyronie’s disease are those that are sexually active.
What are the symptoms?
The most common symptoms include:
- Scar tissue, which can be felt under the skin of the penis as flat lumps or hard tissue
- Pain on erection, or sometimes penile pain even without an erection
- Curvature of the penis on erection
- Difficulty with penetrative intercourse
Less common symptoms include:
- Alteration of the shape of the penis on erection
- Erectile dysfunction
- Shortening of the penis
Different symptoms can present at different phases of the disease. The first and most common symptom is pain. This occurs in the first phase that can be called the inflammatory stage or acute phase. This can last up to six months.
The second phase is called the chronic or stable phase, characterised by fibrosis or scarring. This is where the condition reaches a plateau and the curvature becomes stable. This usually happens a year after the onset of symptoms.
Can it effect sexual function?
Peyronie’s disease can affect sexual function in that it causes the penis to bend, making it difficult for a couple to achieve penetrative intercourse. If the penis is too curved, it can make sex painful not only for the man, but for their partner also. Curvature to the side and downwards tend to cause the most difficulty. In addition, there may be problems achieving or maintaining an erection (erectile dysfunction).
How is it diagnosed?
Peyronie’s disease is usually diagnosed clinically, taking into account a person’s medical history, along with a close physical examination. There are not too many tests involved, but occasionally an ultrasound scan may be used.
The physical exam is an examination of the genitals, feeling for lumps and examining the foreskin area. Assessment of the erection will also be required, and good-quality photographs are often sufficient. If not, an artificial erection may be required to examine the shape of the penis on erection. This involves injecting the penis with what’s called prostaglandin E1 to create an erection, which usually works within ten minutes or so.
Can it be treated?
In a proportion of cases, the penile curvature improves within six to 12 months. If there are erection difficulties, then medications such as sildenafil and vardenafil can improve blood flow to the penis, and strengthen the erection. Vitamin E can also be used to help the penile pain associated with Peyronie’s disease. There is very limited evidence for the use of medication for curvature, but Potaba Ò is sometimes used to try and limit the progression of the curvature. Some patients may not need or want treatment if they can tolerate the curvature.
There are mechanical therapies such as stretching the penis with a penile stretcher or vacuum erection device (VED). Although low-risk, their success is limited. There are also injectable treatments, such as collagenase which consists of an enzyme that breaks down collagen - the main constituent of scar tissue. This can allow the penis to stretch more and improves the curvature in around 50% of cases.
However, surgery remains the most effective treatment for severe curvature.
There are three main types of surgery:
- The Nesbit procedure: A relatively simple procedure that removes or shortens (Yachia procedure) the side opposite the bend (convex side) to restore symmetry to the erection: this carries a high success rate, and low re-operation and complication rate, and is suitable for most men with curvatures of less than 60 degrees.
- Grafting procedure: this procedure is more complex but may be required where the curvature is more severe (> 60 degrees). The shorter curved (concave) side of the penis is elongated using a graft to restore a symmetrical erection. Tissue (graft) can be tissue from the patient’s own body or synthetic material.
- Penile implant or prosthesis. If there is significant erectile dysfunction in conjunction with penile curvature or deformity then the best option to treat all elements of the problem may be a penile prosthesis. This is a fluid-filled system implanted inside the penis that straightens the erection and allows fully rigid erections on-demand, without the need for medication.
The type of treatment for Peyronie’s disease will depend on the severity of the symptoms and curvature, but also other factors such as general health. If you would like more information regarding Peyronie’s, get in touch with a specialist urologist such as Mr Rowland Rees to discuss your possible treatment options.