Matthew Wosnitzer, MD, is board-certified in urology. He is an attending physician at Yale New Haven Health System, Northeast Medical Group and teaches at the Frank Netter School of Medicine.
Peyronie’s disease is a condition in which fibrous scar tissues called plaques form beneath the skin of the penis, causing curved and often painful erections which can make sexual intercourse difficult or impossible. Peyronie’s disease plaque is different from plaque that builds up in blood vessels.
The cause of Peyronie's disease is not well understood, but causes are thought to include having underlying conditions such as high cholesterol and diabetes, erectile dysfunction, and injury (microtrauma) to the penis. It may affect 6% of men between ages of 40 and 70 years, possibly more men since likely underreported.
If the scarring affects the blood vessels that supply the corpus cavernosum (the two spongy tubes in the penis that enable erections), erectile dysfunction may develop.
Symptoms of Peyronie’s disease can improve on their own without treatment. Moreover, not all men with Peyronie's disease will develop pain or sexual dysfunction, even when the curvature of the penis is significantly altered.
In about 13% of cases, Peyronie’s disease goes away with no treatment; in others, it can be permanent. Not all men experience symptoms that are significant enough to cause problems with sexual activity. When treatment is necessary, it may involve medication (injections into penile plaque; traction, and/or surgery (such as plication, excision/incision and grafting).
Peyronie’s disease is primarily caused by a problem with wound healing in the penis. As such, trauma to the penis is thought to be a significant cause. Injury can result from vigorous intercourse, an accident, or a sports injury. Risk factors include underlying health conditions such as high cholesterol, diabetes, erectile dysfunction, and conditions associated with inflammation and scarring.
Peyronie’s disease is characterized by a bend or curvature in the penis when erect. Depending on where plaques occur, bends or curves can bend upward or downward, with left or right deviation possible as well. If plaques form all around the penis, an “hourglass” shape can occur. Shortening of the penis is also possible. There can be pain associated with penile plaque.
Disorders characterized by a contraction of the body tissue that connects, supports, binds, and separates organs and tissues. Peyronie’s disease involves contraction of connective tissue; other examples of connective tissue disorders include rheumatoid arthritis and scleroderma.
The inability to get an erection or maintain one that is firm enough or lasts long enough to give a man a satisfying sexual experience. Erectile dysfunction (ED) is thought to affect 43% of men at one time or another. Risk factors include being older, certain health conditions (including Peyronie’s disease), medications, and smoking.
A technique in which an electric current administers a combination of verapamil and a steroid noninvasively through the skin to break up scar tissue. Thus far, studies on the effectiveness of iontophoresis for Peyronie’s disease have been conflicting.
Tissue that is formed by collagen in response to an injury. In Peyronie’s disease, scarring causes areas of the penis to become less flexible. As a result, the penis curves toward the area of the penis that can’t stretch.
A technique used to straighten the curvature of the penis in a man with Peyronie’s disease. This can be done manually. Alternatively, a mechanical device is applied around the penis and kept in place for anywhere from 30 minutes to several hours per day. In some cases, traction therapy has been found to be more effective with combined with medical injection therapy.
A non-surgical treatment for Peyronie’s disease in which enzymes from the bacteria Clostridium collagenase histolyticum (brand name Xiaflex) are injected into the penis in order to break down plaques. While a few other medications have been used off-label for this purpose, Xiaflex is the only FDA-approved therapy and currently the most effective injection for treatment of Peyronie’s.
Russo GI, Milenkovic U. Clinical Efficacy of Injection and Mechanical Therapy for Peyronie's Disease: A Systematic Review of the Literature. Eur Urol. 2018 Dec;74(6):767-781. doi:10.1016/j.eururo.2018.07.005
Johns Hopkins Medicine. Peyronie’s Disease.
Mayo Clinic. Peyronie’s disease. Diagnosis and Treatment.
Alom M, Sharma KL, Toussi A, et al. Efficacy of Combined Collagenase Clostridium histolyticum and RestoreX Penile Traction Therapy in Men with Peyronie's Disease. J Sex Med. 2019 Jun;16(6):891-900. doi: 10.1016/j.jsxm.2019.03.007.
Russo GI, Milenkovic U, Hellstrom W, et al. Clinical Efficacy of Injection and Mechanical Therapy for Peyronie's Disease: A Systematic Review of the Literature. Eur Urol. 2018 Dec;74(6):767-781. doi: 10.1016/j.eururo.2018.07.005.
Urology Care Foundation. What Is Peyronie’s Disease?