Peyronie’s Disease

Peyronie’s disease is sometimes called “curved penis disease” or simply “penile curvature” because the scar tissue (or plaque) causes the penis to bend when erect.  However, many curved penises are simply normal variations of anatomy — and many patients with Peyronie’s disease don’t have curvature but experience other changes in erect penile shape such as indentations or length loss.

Research shows that up to 10 percent of U.S. men may have signs or symptoms of Peyronie’s disease, though only about 1 percent seek treatment. 

While many men may have some degree of penile curvature, it’s not always due to Peyronie’s disease. Keep reading to learn more about what this disease looks like, what causes it, and how to treat it. 

Stages of Peyronie’s Disease

Peyronie’s disease occurs in two stages: the acute phase and the chronic phase.

• Acute phase. Plaques develop on the internal tough layer of skin during this phase, which can last as long as 18 months. You may develop painful erections and notice a bend or curve in your penis. Your penis may also hurt when flaccid (soft). 

• Chronic phase. At this point, plaques have developed, and your penis will have a noticeable bend or curve. You may feel less pain as the plaque stops growing. Some men develop erectile dysfunction (ED) during this stage.

The most apparent symptom of Peyronie’s disease is a deformity of the erect penis, which can be a new curvature of the penis or a focal loss of erect penile girth, which is referred to as an indentation or an hourglass deformity.

While those symptoms are only visible during an erection, some men develop hardened, bone-like lumps due to plaque buildup.

Symptoms of Peyronie’s disease include:

• Penile curvature. If scar tissue forms on the top of your penile shaft (most common), your penis will usually bend upwards. If it forms on the bottom or side, your penis will curve either downwards or to the side.

• Hourglass or bottleneck appearance. Around 65 percent of men with Peyronie’s disease experience a volume loss deformity which makes the penis appear like an hourglass or bottleneck.

• Hardened lumps on one or more sides of the penis. Scar tissue can feel like hard, flat lumps directly under the skin.

• Penile pain and painful erections. Penile pain occurs in about 20 to 70 percent of men with Peyronie’s disease during the acute phase.

• Shortening or narrowing of the penis. In severe cases, some men lose around 0.5-1.5 cm of penile length. Loss of length or girth could be the effect of the condition or surgery to correct it.

• Sexual function issues. Research notes that up to 54 percent of men with Peyronie’s disease also report ED.

Erectile Dysfunction from Peyronie’s Disease

As we mentioned above, Peyronie’s disease can affect your sex life and erectile function. You may have painful erections or find it difficult to get (or maintain) an erection. 

If left untreated, these changes (and the problems they bring to the bedroom) can eventually result in more physical discomfort, stress, depression, and a reduced quality of life.

In some cases, it may be challenging to treat ED when Peyronie’s disease is the cause. Erectile dysfunction medications like sildenafil (generic Viagra Connect®), tadalafil (Cialis Together®), Vardenafil (Levitra®) and and avanafil (Stendra®) are often effective, but there are cases when oral medications don’t work.  

These medications, called Phosphodiesterase-5 inhibitors, or PDE5 inhibitors, increase blood flow to the corpora cavernosa (the spongy tissues within the penile shaft).

But the scar tissue associated with Peyronie’s disease can impact how much your penis can expand and may also cause problems with maintaining the high pressures in the penis required for erection, rendering these medications unhelpful for some men.

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The exact cause of Peyronie’s disease is still unknown, but physical injuries affecting the penile tissues are considered the most common. 

Some research also suggests that connective tissue disorders or autoimmune diseases can cause Peyronie’s disease. Let’s take a closer look below.

Common causes of Peyronie’s disease include:

• Penile trauma

• Connective tissue disorders

• Autoimmune diseases

Penile Trauma

Research shows that when an erect penis is repeatedly injured, such as during vigorous sex, it can cause microvascular injuries to the tunica albuginea — a tough layer of connective tissue surrounding the corpora cavernosa. 

This inflammation disrupts the elastic fibers in the penis, causing hardened plaques, or scar tissue, to form on the penile shaft in genetically predisposed individuals. 

A more significant injury linked to Peyronie’s disease is a penile fracture, in which blunt trauma to the penis causes the tunica albuginea to tear — usually during sex. 

One 2023 study found that men with penile fractures were more likely to develop Peyronie’s disease and erectile dysfunction. If they were over 45, the onset of Peyronie’s disease was likely to occur within five years of the fracture. 

Most experts believe that Peyronie’s disease results from microvascular trauma to the erect or semi-erect penis during sexual activity, though many patients can’t recall an incident or injury that would have led to the disease.

Connective Tissue Disorders

Your connective tissues bind together and protect other bodily tissues and organs, providing a structural framework for your body. Certain disorders that attack these tissues may contribute to Peyronie’s disease. 

These tissue disorders include:

• Dupuytren’s contracture. This chronic condition causes the tissues under the skin of your palms and fingers to thicken and tighten, leading to permanently bent fingers. One study found that 22 percent of men with Peyronie’s disease also had Dupuytren’s contracture, which suggests that these patients may be strongly predisposed to develop abnormal scar tissue in parts of their bodies.

• Scleroderma. This disorder causes tissue thickening and hardening due to excess collagen production. It can affect the skin, tissues, blood vessels, and sometimes internal organs. Although its association with Peyronie’s disease is uncommon, some research cites it.

• Plantar fasciitis. This condition involves inflammation of the thick tissue on the bottom of the foot, which can result from foot injuries or spending too much time on your feet. It is also considered a potential contributor to Peyronie’s disease. But again, the connection is unclear. 

Autoimmune Diseases

Autoimmune diseases occur when the immune system mistakenly attacks healthy tissues, cells, and organs. 

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), certain autoimmune diseases, like lupus and Sjögren’s syndrome, may be linked to Peyronie’s disease. 

One 2015 study found that autoimmune diseases were strongly associated with Peyronie’s disease in men seeking help for sexual dysfunction. The most commonly associated autoimmune disorders were psoriasis, psoriatic arthritis, and rheumatoid arthritis.

There are many potential risk factors for Peyronie’s disease, including:

• Age

• Diabetes

• Family history

• Prostate cancer treatments

• Smoking

• Obesity

• Erectile dysfunction

Age

Peyronie’s disease is thought to affect four out of 100 men between the ages of 40 and 70. Though it is rare in young men, it has been seen in men as young as 19, according to this population-based study, which found the mean age of diagnosis was 53 years old.   

Diabetes

Diabetes, especially when it is poorly controlled, is thought to exaggerate the fibrotic process (thickening and scarring) in Peyronie’s disease. If you have diabetes, you’re also more likely to have severe Peyronie’s disease, according to this 2019 study. 

The NIDDK also reports that men with ED linked to diabetes are four to five times more likely to develop Peyronie’s disease.

Family History

If your father or brother had Peyronie’s disease, there’s a chance you may develop it, too. 

One 2022 study found that the risk of Peyronie’s disease was significantly higher in the immediate family members of men with the disease, including parents, siblings, and children. 

But don’t forget the rest of your family tree. The risk was also higher in fifth-degree relatives, like second cousins.

Prostate Cancer Treatments

Some research indicates there may be a connection between prostate cancer treatments and Peyronie’s disease. 

In one 2010 study of men experiencing post-prostatectomy sexual problems, the rate of Peyronie’s disease was significantly higher than the rate in patients with sexual dysfunction who did not undergo surgical treatment for prostate cancer.  

Smoking

Smoking is one of the worst things you can do for your health. It’s linked to heart disease, cancer, lung diseases, type 2 diabetes, and, according to some research, Peyronie’s disease. 

In one Italian study of 647 men aged 50 to 69, smokers were around four times more likely to develop Peyronie’s disease compared to non-smokers. 

This took into account other potential contributing factors like age and medical history. But when the researchers looked at smoking alone, they found the ratio was actually seven times higher. 

Obesity

One 2020 study suggested that obesity might be an independent risk factor for Peyronie’s disease.  

The risk was even higher in men with diabetes and smokers — around 43 percent of subjects with Peyronie’s disease had diabetes, and 65 percent were current smokers or had a history of smoking.  

Erectile Dysfunction

We mentioned earlier that erectile dysfunction commonly affects patients with Peyronie’s disease, but one study suggested that ED may actually be an independent risk factor for PD.  The hypothesis is that having sex with a semi-rigid penis may predispose to penile bending during sex, which could be a cause of trauma.

Complications

According to one 2023 study, calcification occurs in more than a third of Peyronie’s disease cases. In these cases, calcium deposits form within the Peyronie’s scar tissue, resulting in the transformation of plaque into a very hard, bone-like structure.  This can be a major source of anxiety and depression in affected patients.

Regardless of whether or not Peyronie’s plaque becomes calcified, Peyronie’s disease can have a profoundly negative impact on affected men. 

Studies have found that around 80 percent of men with Peyronie’s disease have psychological symptoms. Forty-eight to 62 percent struggle with depression (which increases the longer they have the disease), and 54 percent experience relationship problems as a result of the disease.

Though Peyronie’s disease doesn’t directly cause infertility, the condition can make it harder to conceive a child due to painful sexual intercourse or ED. Some research also shows that having Peyronie’s disease may hinder the “completeness” of ejaculation, contributing to male factor infertility. Men with Peyronie’s disease may also face a higher risk of developing urologic conditions like enlarged prostate, prostatitis, and lower urinary tract symptoms, as well as stomach cancer, testis cancer, and melanoma.

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Diagnosing Peyronie’s disease is a healthcare professional’s job, mostly because you won’t necessarily be able to tell the difference between normal and problematic curves yourself.

Men often have some degree of curvature, which means no erect penis is 100 percent straight. That’s why it’s easy to mistake normal curvature for Peyronie’s disease — especially if you’re feeling self-conscious. 

It’s worth speaking to a urologist, who can diagnose the condition based on your history and a physical exam. They’ll ask you questions to understand how your symptoms developed and check your penis for hard plaques and other common signs of Peyronie’s disease. 

The hallmarks of Peyronie’s disease are noticeable changes to the shape of the erect penis (not curvatures that have always been present), pain with erection, and identifiable penile plaque on physical examination.

In some cases, a urologist might want to examine your erect penis to assess the effects of Peyronie’s disease and to measure any resultant curvatures. This can be important when you’re considering serious treatments for Peyronie’s disease, such as surgery or collagenase injections (see below). 

Evaluation of the erect penis typically requires an intracavernosal-injection test, in which a urologist injects medication directly into the penis to induce an erection.  This is sometimes accompanied by penile ultrasonography, in which a urologist will measure penile blood flow during erection and take images of any plaques to see if they are calcified.

Not all men require treatment for Peyronie’s disease. In fact, for most patients, the pain fades away over time without treatment. Curves are less likely to resolve on their own, although some younger men and those in the early stages of the disease (less than six months) may see some improvement without intervention. 

Treatment should generally be saved for patients that are functionally impaired from the changes to the shape of their erect penis, or for patients with profound psychological bother that is resulting in depression, anxiety, or avoidance of partnered sexual activity.  

As far as treatment options, the goal is usually to reduce symptoms rather than “cure” the disease. Your urologist will likely start with the less invasive options first, especially if you’re in the acute phase.

Treatment options for Peyronie’s disease include: 

• Penile traction therapy

• Penile injections

• Oral medications and supplements

• Surgery

• Shockwave therapy

Penile Traction Therapy

A penile traction device is designed to stretch the penis to counteract the effects of a Peyronie’s plaque on erect penile shape. 

In a 2023 review, researchers found this type of therapy was helpful in correcting penile curvature, but it did not improve erectile function or lengthen the penis.  

However, a high-quality individual study using a specific traction device concluded that penile traction therapy for six months can improve penile length, reduce curvature, and improve erectile function in men with ED.

Penile Injections

Penile injections aim to break up and dissolve plaques in the penis.

Oral Medications and Supplements

More research is needed on oral medications for treating Peyronie’s disease. Though several have been considered, most high-quality trials failed to show benefits for oral medications in men with Peyronie’s disease

That said, if you don’t respond to other treatment options, your provider might suggest:

• Potassium para-aminobenzoate. This supplement may reduce the size of plaques due to its anti-inflammatory and anti-fibrotic properties, but it hasn’t been shown to treat penile curvature specifically.

• Oral vitamin E. Although one research study suggested vitamin E pills could help prevent the progression of Peyronie’s disease, the data is limited and most experts do not believe that vitamin E is effective.

• Tamoxifen. Typically used to treat breast cancer, tamoxifen has been shown to prevent the progression of Peyronie’s disease in vitro when combined with the ED medication tadalafil. The applicability of this laboratory-based study to patients with Peyronie’s disease is not clear, and tamoxifen is not standardly prescribed to treat PD.

• Colchicine. Limited research has shown that the anti-inflammatory drug colchicine may help stabilize Peyronie’s disease when combined with vitamin E in the early stages of the disease. The best candidates are men who have a penile curvature of less than 30° and no erectile dysfunction. 

• Pentoxifylline. This vasodilator may also help stabilize Peyronie’s disease and reduce calcium buildup in plaques by improving blood flow to the penis. But, again, more research is needed. 

Surgery

In severe cases, surgery may help remove plaque and/or reduce penile curvature. 

Several possible types of surgery are available, including:

• Plaque incision or excision with grafting. Grafting involves removing the plaque from your penis and replacing it with a graft, which can be tissue taken from another part of your body or tissue from an organ donor. It is typically advised for curvatures over 60 degrees to help maintain penile length. The risk of ED after surgery is high with this option.

• Plication. Plication surgery involves shortening the side of the penis opposite the curvature with either permanent stitches or by removing a piece of the tunica albuginea. It has a high success rate and low risk of complications. Though effective, plication is usually recommended for curves less than 60 degrees because it can cause shortening of the penis.

• Penile implant. A penile implant, or penile prosthesis, is considered the treatment of choice in patients with Peyronie’s disease and severe ED. During this surgery, a hard or inflatable device is put into the erection chambers of the penis that can cause an erection and potentially straighten the penis.

Shockwave Therapy

Shockwave therapy uses low-intensity electroshock waves to reduce pain and break up plaques in the penis. Though it may help, shockwave therapy is a pricey option backed by only very limited research.

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Researchers aren’t entirely sure if Peyronie’s disease can be prevented, but you can take steps to avoid penile trauma, which can lead to the disease.

Here are some tips to help prevent Peyronie’s disease:

• Use lubrication to avoid some forms of injury during sex

• Consider taking ED medication if your erections are getting softer

• Quit smoking 

• Lose weight or consider weight loss medications if you need more support

Treating Peyronie’s disease early is another important thing you can do to make sure it doesn’t get worse. If you’re noticing the first signs of Peyronie’s disease or you think you may have injured your penis, contact your healthcare provider right away to get the help you need.