Peyronie's Disease: Symptoms, Causes, and Treatments
Peyronie’s disease is the growth of fibrous plaques, a type of flat scar tissue, under the skin of the penis.
These plaques, which form in the tunica albuginea, can change the shape of the penis, resulting in a noticeable curve, or bend, when the penis is erect.
More than 10 percent of men are estimated to be affected by Peyronie’s disease, although the severity of the disorder can vary from one person to another.
Peyronie’s disease usually becomes more prevalent with age, with older men more likely to be affected than younger men.
According to one study, Peyronie’s disease is most commonly seen as men enter their 40s and 50s. In comparison, only 8.2 percent of men under 40 years of age are affected by Peyronie’s disease.
Peyronie’s disease has a variety of effects. First, the curvature of the penis can affect both the physical and psychological side of sex, from making the physical act of sex uncomfortable to a loss of confidence or increase in anxiety symptoms during sexual intercourse.
The psychological effects of Peyronie’s disease can be a significant influence on male sexual behavior. Research shows that many men affected by Peyronie’s disease show some level of concern about their sexual activity, confidence and physical appearance.
What Causes Peyronie’s Disease?
Right now, researchers aren’t aware of the precise cause of Peyronie’s disease. However, the most current research indicates that it’s likely caused by physical injuries that affect the erectile tissue inside your penis.
These injuries, which can happen during sex or physical activity, can cause internal bleeding to develop within the fibrous membrane of your penis, called the tunica albuginea.
Over time, this process can result in the development of scar tissue, which causes the curvature or bend of the penis that’s present in men with Peyronie’s disease.
Some experts also believe that Peyronie’s disease could potentially be caused by autoimmune diseases, which cause the human immune system to attack cells and tissue such as the tunica albuginea.
Several risk factors may increase your likelihood of developing Peyronie’s disease, including the following:
Having vigorous or intense sex. This can cause micro-injuries to your penis that may lead to the development of scar tissue.
Engaging in nonsexual activities that injure your penis. For example, certain sports may also cause penile pain and micro-injuries that lead to scar tissue formation.
Have diabetes and erectile dysfunction. Research suggests that diabetes could affect the fibrotic process and lead to Peyronie’s disease.
Are older. As we briefly mentioned above, Peyronie’s disease is more common in men who are 50 years of age or older.
Have a family history of Peyronie’s disease. You may be more likely to develop this disease if your other family members are affected.
Have undergone surgery for prostate cancer. Some surgical procedures for prostate cancer, such as radical prostatectomy, may increase your risk of developing Peyronie’s disease.
Symptoms of Peyronie’s Disease
The most common symptom of Peyronie’s disease is the development of plaques on the dorsal side, or top, of your penis. These may cause your penis to bend upwards when it’s erect.
About 70 percent of men with Peyronie’s disease have dorsal plaques that result in an upward curved penis. However, plaques can also develop elsewhere on your penis, causing a range of different symptoms:
Bends or curves in your penis. When plaques develop on the side of the penis, they may cause your penis to curve to the left or right.
"Bottle-necking.” In some cases, your penis may narrow and develop indentations in certain areas, taking on an hourglass-like shape. This occurs when plaques form all the way around your penis. It’s often referred to as “bottle-necking” or “waisting.”
Lumps in your penis. When plaques develop in certain areas of your penis, they may result in firm lumps. Over time, the plaques caused by Peyronie’s disease can become very hard and bone-like in feel due to calcium buildup.
In addition to affecting the shape and feel of your penis, Peyronie’s disease may cause sexual performance issues.
Some men with Peyronie’s disease develop softer erections and other erectile function issues, while others might find it difficult to have sex due to the changes that can occur in their penis’s shape and curvature.
Because of its effects on sexual performance and enjoyment, Peyronie’s disease is a common cause of stress, depression and reduced quality of life.
While the plaques caused by Peyronie’s disease can cause discomfort and affect your sexual health and performance, they’re benign and not a sign of cancer or tumors.
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Peyronie’s Disease Diagnosis
It’s completely normal to have some amount of curvature in your penis — no erect penis is 100 percent straight or symmetrical.
Because of this, it’s quite common for men to mistake normal congenital penis curvature for the symptoms of Peyronie’s disease.
However, if you have a noticeable bend in your erection, it’s worth speaking to your healthcare provider or scheduling an appointment with a urologist to talk about the possibility of Peyronie’s disease.
Most of the time, Peyronie’s disease can be diagnosed with a physical exam. Your healthcare provider may need to look at your penis for hard plaques or other common signs of Peyronie’s disease.
To help your healthcare provider check for penile curvature, you may need to use medication to make your penis erect.
For a more accurate diagnosis, your healthcare provider may use dynamic ultrasound imaging to view plaques, blood flow and calcium buildup in your penis.
Stages of Peyronie’s Disease
Peyronie’s disease occurs in stages, which are often referred to as the acute phase and chronic phase. During each phase, you’ll typically experience different symptoms:
Acute phase. During this phase, plaques will develop on the fibrous membrane of your penis. You may develop uncomfortable or painful erections and notice that your penis is starting to bend or curve. This phase can continue for up to 18 months.
Chronic phase. During this phase, plaques have developed in your penis and a bend or curve is clearly identifiable. Since the plaque is no longer actively growing, you may not experience pain or discomfort when your penis is erect.
This phase usually begins 12 to 18 months after you first notice symptoms of Peyronie’s disease. Some men with chronic Peyronie’s disease experience erectile dysfunction.
Peyronie’s Disease and Erectile Dysfunction
Sometimes, Peyronie’s disease can make it difficult to develop or keep an erection. It can also contribute to issues such as stress and anxiety -- two common psychological causes of erectile dysfunction for men.
Because of this, erectile dysfunction is particularly common among men who have Peyronie’s disease. In fact, research published in the journal Urology notes that more than 54 percent of men diagnosed with Peyronie’s disease also report experiencing ED.
Erectile dysfunction medications such as sildenafil (the active ingredient in Viagra®), tadalafil (Cialis®), vardenafil (Levitra®) and avanafil (Stendra®) typically aren’t effective as treatments for Peyronie’s disease.
However, they’re often used to improve erections and sexual function in men with Peyronie’s disease who also have ED.
These drugs work by increasing blood flow to the corpora cavernosa -- the two chambers of soft, sponge-like erectile tissue inside your penis.
This improvement in blood flow can make it easier to develop and maintain an erection when you’re sexually stimulated.
You can read more about the specific benefits of each ED medication in our guide to the most common medications for erectile dysfunction.
Because Peyronie’s disease is considered a physical abnormality of the penis, it’s important to talk to your healthcare provider before you consider using any type of medication to treat ED.
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Current Treatments for Peyronie’s Disease
Peyronie’s disease doesn’t always need to be permanent. From surgical procedures to lifestyle changes and medications, a range of options can treat Peyronie’s disease or lower the severity of your symptoms.
Injections For Peyronie’s Disease
One of the most widely used treatments is Clostridium histolyticum, which is sold in the United States as Xiaflex®.
Collagenase Clostridium histolyticum, the enzyme produced by Clostridium histolyticum, is an enzyme that causes the breakdown of collagen that forms connective tissue.
When injected into scar tissue, clostridium histolyticum (or Xiaflex) can weaken the scar tissue and, in combination with stretching exercise, reduce the penile curvature caused by Peyronie’s disease.
Right now, Xiaflex is the only FDA-approved medication designed specifically for the treatment of Peyronie’s disease.
In addition to Clostridium histolyticum, several other injectable medications are used to break down plaques and treat Peyronie’s disease. These include:
Interferon. This protein-based medication is used to control swelling and may help to break down scar tissue that can develop in the penis.
Verapamil. This medication, which is typically used to treat angina and hypertension (high blood pressure) may help to reduce penile curvature and discomfort. More controlled studies are needed.
Your healthcare provider may recommend performing Peyronie’s disease exercises, or penile traction therapy (PTT), while using these medications.
Oral Medications & Supplements For Peyronie’s Disease
Several different oral medications and supplements have been studied as potential treatments for Peyronie’s disease, although research on their effectiveness is mixed.
Because of this, oral medications typically aren’t used as first-line treatments for Peyronie’s disease.
Oral medications and supplements that have been studied as treatment options for Peyronie’s disease include:
Potassium aminobenzoate. Some small-scale studies have found that this medication, which is a form of vitamin B, may help to reduce the size of plaques that often develop in the penis. However, potassium aminobenzoate doesn’t treat penile curvature. Treatment with potassium aminobenzoate usually lasts for three to six months and often involves patients taking up to 24 tablets per day.
Oral vitamin E. Research has found that vitamin E may help to shrink the plaques that can develop from Peyronie’s disease. It may also help to reduce the severity of penile curvature. However, some studies have found that oral vitamin E is no more effective at improving Peyronie’s disease symptoms than a non-therapeutic placebo.
Other medications. Several other medications, including carnitine, colchicine and the anti-estrogen medication tamoxifen, have been studied as potential oral treatments for Peyronie’s disease.
Although research into these medications is ongoing, most high quality studies have not shown a significant difference in effects when compared to placebo treatments.
Peyronie’s Disease Surgery
In severe cases, Peyronie’s disease can be treated via surgery to remove plaque and/or reduce penile curvature.
One of the more common forms of surgery for Peyronie’s disease, a procedure that's referred to as Nesbit’s procedure, has a high success rate and is often used for cases that can’t be treated with medication.
In some cases, surgery for Peyronie’s disease may involve placing a penile prosthesis, or penile implant, made from flexible silicone inside the penis to treat erectile dysfunction.
Your healthcare provider may suggest surgery if nonsurgical treatments for Peyronie’s disease, such as those listed above, haven’t produced improvements.
Other Treatment Options For Peyronie’s Disease
Several other treatments for Peyronie’s disease are currently undergoing clinical trials, although at the time of publication none are currently approved by the FDA.
Finally, making certain changes to your lifestyle may potentially reduce the effects of Peyronie’s disease and improve your sexual performance.
Quitting smoking, reducing your consumption of alcohol and increasing the amount of exercise you engage in can all reduce your risk of experiencing Peyronie’s disease-related ED.
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Peyronie’s Disease and Next Steps
Peyronie’s disease is relatively common, with researchers estimating that about one in every 10 men is affected to some degree.
Currently, the only FDA-approved medication for Peyronie’s disease is Clostridium histolyticum, which is available as Xiaflex.
Other treatments, such as oral medications or surgery, may also help to reduce penile curvature and treat issues such as pain and discomfort but are not typically used as first line therapies.
Finally, ED meds may help to improve your erections and sexual function if you have ED that’s caused by Peyronie’s disease.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment or medication.
