What is Peyronie’s Disease?
Peyronie’s disease, also known as penile fibrosis, is a condition where a section of flat fibrous scar tissue, also known as a plaque, causes a bend or indentation in the penis. This can be accompanied by pain and erectile dysfunction.
While PD does occur in younger men, it most often develops between the ages of 50 to 70, and the incidence of the condition is probably higher that commonly believed. A survey of a large group of people showed that while the diagnosis of PD had been confirmed in 0.7% of them, probable cases were around 11%.
Common Treatments for Peyronie’s Disease
1. Penile Traction Therapy
A self-applied mechanical or vacuum device that stretches the penis is used over a period of time. Daily treatment may be as short as 30 minutes to as long as three to eight hours a day. This therapy is most effective when used early in the acute phase to minimize curvature and to prevent penile shortening.
A few small studies have found that a similar non-medical intervention of stretching is effective to help reduce the curvature and restore the length of the penis.
The treatment involves stretching the penis for 30 seconds at a time, three times a day. In the event of a spontaneous erection, the penis can be straightened lightly. This treatment needs to be done daily and continued for at least six months.
2. Oral Medication
There are a number of oral medications that might help during the acute phase, but to date none are supported by high-quality research. No oral medications are currently recommended by the American Urological Association for treating PD.
Based on observation or small unconfirmed studies, a few over-the-counter medicines or supplements are believed to help prevent PD from getting worse. These include:
- Vitamin E.
- Omega-3 fatty acid.
- Castor oil applied nightly to soften the plaque.
Injection treatment involves injecting a drug directly into the plaque to break it down. Compared to oral drugs, a higher dose of the medication can be safely brought directly to where it is needed.
Injections are most effective in the acute stages of PD, and the treatment usually involves a number of injections over a few months.
One of the drugs used for this treatment is collagenase (Xiaflex), and it is the only FDA-approved medication for PD. It is approved for use in people with a palpable nodule and moderate to severe curvatures.
Two further injectables are verapamil and inteferon. Both show promising results but need more research to confirm whether they are effective.
4. Shockwave Therapy
During shockwave therapy, low intensity electromagnetic impulses are delivered to the plaque. This may break up the fibrous tissue and has been successful in reducing pain. The treatment is relatively expensive and requires multiple sessions.
The use of sound waves to break up scar tissue is also currently being investigated.
Surgery has long been the standard treatment for severe penile deformity when the condition is concerning to the patient or prevents them from having sexual intercourse.
It is usually not done until the condition has stabilized for a few months, otherwise it might have to be repeated. The surgeon will decide which type of surgery is best, depending on the extent and location of the scar tissue and the symptoms.
Most often patients can go home on the same day, or an overnight stay might be necessary. Patients will need to stay off work for a few days and wait four to eight weeks before resuming sexual activity.
Here are the three main types of surgery.
This is used where curvatures are less severe. It involves cutting out or folding and sewing together tissue on the other side of the curvature.
Incision or Excision and Grafting
This is indicated where curvature and deformity are more severe and only when the person is still able to get an erection.
Cuts are made in the scar tissue to allow the sheath to stretch. Some of the scar tissue might be removed and sometimes tissue is grafted into the gaps created by the cuts. Compared to placation, this surgical procedure carries a higher risk that the condition might be worse after surgery.
Penile Prosthetic Device
A device is implanted into the spongy tissue that fills with blood during an erection. The device might be a semi-rigid silicone rod that is bent upward manually or with an inflatable pump.
Treatment for Peyronie’s Disease
While PD cannot be cured, early treatment may prevent the symptoms from worsening or, in some cases, it can even improve them. However, many people are embarrassed to consult their doctor, or they put up with the condition as just another part of aging.
Consult your doctor as soon as you experience symptoms to confirm the diagnosis and rule out other possible conditions. Your primary care physician might refer you to a urologist – a doctor who specializes in health problems related to the urinary tract.
The doctor will take a full history of the development of the condition, your signs and symptoms and its effects on your sexual functioning. The diagnosis can usually be confirmed with a physical examination. An ultrasound might be ordered to investigate the severity of the scar tissue and blood flow to the penis
When the PD is mild — with only some plaque, limited curvature and pain and no sexual dysfunction — treatment may not be necessary. You may be advised to report for regular checkups so the condition can be monitored.
The first line of treatments for PD includes non-invasive medical interventions and natural options, both of which are mostly only effective during the acute phase. Surgical options provide relief in severe cases but is usually only done once the condition has stabilized in the chronic phase.
What Causes Peyronie’s Disease?
PD is usually caused by injury to the penis, either during vigorous sex or injuries from sports or accidents. Often, though, the person has no recollection of a specific traumatic incident.
The reason why the scar tissue builds up to form the plaque is still unclear. Factors might include heredity and certain connective tissue or autoimmune disorders.
Furthermore, age-related physical changes might cause the tissue to be more easily injured and not heal as well. Other risk factors that have been identified include type 2 diabetes, smoking and substance abuse.
Signs and Symptoms of Peyronie’s Disease
The section of plaque on the penis can be felt under the skin as a nodule or a band of hard tissue. You can be reassured that this nodule is not cancerous.
The fibrous tissue cannot stretch like normal tissue. This is why it causes the penis to bend upward, downward or sideways, depending on the location of the plaque. Furthermore, there is often a shortening of the penis. Sometimes the fibrous tissue forms a band right around the penis causing a bottleneck indentation.
PD can appear rapidly or develop slowly over time and range from mild to severe. Significant curvature can cause pain, sometimes even without an erection. A frequent consequence can be erectile dysfunction — difficulty in getting or maintaining an erection.
Due to embarrassment and problems with sexual image and function, people with PD often become emotionally stressed, anxious and depressed. As a result, the relationship between partners can suffer as well.
The 2 Stages of Peyronie’s Disease
Peyronie’s disease has two phases that influence treatment options.
- Acute phase. The symptoms start, and changes in the curvature or length of the penis can cause pain during an erection. The condition usually progresses for 3 to 12 months.
- Chronic phase. The plaque stops growing and symptoms stabilize. There are no further changes, and the pain may also lessen or even resolve, although the scar tissue, penile curvature and shortening are likely to remain.
Getting Support for Peyronie’s Disease
There are numerous treatment options for Peyronie’s disease, and the sooner you visit your doctor the better your chances are of preventing more severe outcomes.
You should discuss your condition with your partner openly to avoid problems in your relationship. Furthermore, consult a therapist if you need help dealing with anxiety and depression because of the condition.
While it is still unknown exactly why the plaque develops, the risk does increase with age and certain medical conditions. This shows that healthy habits like a balanced diet, regular exercise and quitting smoking may help to prevent PD or limit progression.