What Is Peyronie’s Disease?

Peyronie’s disease is a noncancerous condition that affects the penis. It is characterized by fibrous scar tissue, known as plaque, forming under the skin. The plaque forms inside a thick, elastic membrane in the penis, known as the tunica albuginea. This tube keeps the penis stiff during an erection.

When plaque forms in the tunica albuginea, it pulls on the surrounding tissues and causes the penis to unnaturally curve. This usually happens during an erection. The curve in the penis leads to pain and can make sexual intercourse painful or impossible.

Peyronie’s disease is believed to be caused by an injury (or repeated microtrauma) to the penis that leads to the formation of scar tissue. Most men who experience this condition require treatment with injections or surgery. This article will provide an overview of Peyronie’s disease, including the most common symptoms, how it is diagnosed, and treatment options. 

Phases of Peyronie’s Disease 

There are two phases of Peyronie’s disease, acute and chronic, and they are treated differently. 

Acute Phase

During the acute phase, plaque forms under the skin of the penis. This phase can last for up to 18 months and involves scar tissue forming and causing worsening symptoms over time. Symptoms during the acute phase include:

• Inflammation
• Penile curvature
• Painful erections
• Penile pain

Chronic Phase

The chronic phase of Peyronie’s disease usually begins around 12 to 18 months after the first symptoms appear. During the chronic phase, the scar tissue usually stops forming. Symptoms may slightly improve and include:

• Penile curvature stabilizes
• Slightly less pain
• Erectile dysfunction

Peyronie’s Disease Symptoms

Symptoms may develop quickly or slowly over time. As Peyronie’s disease enters the chronic phase, the pain may improve, but the curve to the penis usually stays. Common signs and symptoms of Peyronie’s disease include:

• A curve in the penis
• Shortening of the penis 
• Hard lumps that can be felt under the skin
• Painful sex and erections
• Erectile dysfunction

Causes

Peyronie’s disease is believed to be caused by an injury to the penis that then leads to scar tissue formation. Peyronie’s disease is not contagious and cannot be passed during sex. 

An injury to the penis can lead to bleeding and swelling inside the albuginea. As the injury heals, scar tissue may develop. The scar tissue, known as plaque, then begins to pull on the surrounding tissues, leading to a curve. 

Risk Factors

Autoimmune diseases can also affect one’s risk of experiencing Peyronie’s disease. It is possible for an autoimmune disease to cause the immune system to attack the cells in the penis. This leads to inflammation and scar tissue formation. 

Possible risk factors for Peyronie’s disease include:

• Injuries to the penis: Injuries caused by sexual activity or accidental trauma to the penis can cause micro-injuries that lead to scar tissue formation. 
• Connective tissue disorder: Connective tissue disorders that affect the specialized tissue in joints, muscles, or skin could affect your risk of Peyronie’s disease. Men with Dupuytren’s disease (abnormal thickening of the skin on the palm of your hand), plantar fasciitis (inflammation of the thick band of tissue running along the arch of your foot), or scleroderma (group of rare disease-causing hardening of the skin and connective tissues) may have an increased risk of developing Peyronie’s disease. 
• Autoimmune disorder: Autoimmune disorders that have been linked to Peyronie’s disease include systemic lupus erythematosus (causing widespread inflammation), Sjogren’s syndrome (causing dry eyes and dry mouth) and Behcet’s disease (causing blood vessel inflammation). 
• Family history: If Peyronie’s disease tends to run in your family, you are at an increased risk of developing it. 
• Older age: The chance of experiencing Peyronie’s disease goes up with age. This may be related to the age-related changes that take place in the tissues of the penis over time. 
• Erectile dysfunction caused by diabetes: It is estimated that men with erectile dysfunction related to diabetes have a 4 to 5 times higher risk of developing Peyronie’s disease than men without these conditions. 
• History of surgery for prostate cancer: It is possible to experience erectile dysfunction after prostate cancer surgery. This may be why this surgery seems to increase the risk of Peyronie’s disease. 

Diagnosing Peyronie's Disease

A urologist is usually the healthcare provider to diagnose Peyronie’s disease. Urologists are doctors who specialize in urinary and sexual problems. The diagnosis is often made with a detailed history and physical. Other diagnostic tests are usually not needed.

Rarely, your doctor may recommend an imaging test to visualize the plaque, such as an ultrasound test. Ultrasounds use sound waves to produce images and can show scar tissue formation.

During the physical exam, the physician will palpate your penis to feel for hard lumps under the skin. A urologist is usually able to feel the plaque during a physical exam. Your doctor may need to examine your penis when it is erect as well. This will help to determine where the plaque is and how curved the penis has become. 

Treatment

The goal of Peyronie’s disease treatment is to straighten the penis and relieve any pain. Occasionally, Peyronie’s disease goes away on its own. If you have mild symptoms such as no pain and a small curve, you may not require treatment. 

However, most of the time it requires medical treatment. Treatment options for Peyronie’s disease include injections, medical therapies, and surgery. 

Injections

Injections are often used to treat the acute phase of Peyronie’s disease. Known as intralesional injections, this treatment can be injected directly into the plaques. Injection treatments are usually performed in the physician’s office, and the skin is numbed beforehand. Medications used include:

• Collagenase: Xiaflex (collagenase clostridium histolyticum) is the only FDA-approved medication to treat Peyronie’s disease. It contains an enzyme from a bacterium that helps to break down plaque. This leads to improved erectile dysfunction and lessening of the penile curve. 
• Verelan (verapamil): Verelan is a blood pressure medication that can break up plaque and improve symptoms of Peyronie’s disease. 
• Interferon-alpha 2b: Interferon is a protein that is naturally made by the white blood cells in the body. When injected into plaque, it helps to decrease the size of the plaque and improve other symptoms. 

Medical Therapies 

There are some medical therapies still being investigated for the treatment of Peyronie’s disease. These therapies include mechanical traction, vacuum devices, and shockwave therapy. 

Surgery 

Surgery may be recommended during the chronic phase of Peyronie’s disease to remove plaque and straighten the penis. Surgery is usually only considered once plaque formation and penis curving have stabilized and typically after attempt at medical therapy. 

Discuss your surgical options with your doctor if you have been dealing with Peyronie’s disease for several months with no improvement in your symptoms. Surgical options include:

• Grafting: During a grafting procedure, the surgeon removes the plaque and replaces it with tissue taken from another area of the body. This can help to straighten the penis and add length if the penis has shortened. However, there is risk of possible erectile dysfunction.
• Plication: Plication involves the surgeon removing or pinching an area of the tunica albuginea from the opposite side of the plaque. This can help to straighten the penis but will not add length. 
• Device implantation: If you have been experiencing both Peyronie’s disease and erectile dysfunction, your doctor may recommend device implantation. During this procedure, the surgeon implants a device in the penis to straighten it during an erection. This is sometimes performed along with one of the other two surgeries. 

Prognosis

Peyronie’s disease is a relatively common condition and can be treated. If left untreated, complications can occur. Possible complications include:

• Erectile dysfunction
• Inability to engage in sexual activity
• Depression
• Anxiety
• Stress in the relationship with a sexual partner
• Fertility problems 

Coping

Peyronie’s disease is an uncomfortable condition that can significantly affect your quality of life. Treatment may take time, so finding ways to cope is essential. 

Mental Health

It’s estimated that more than 75% of men with Peyronie’s disease report feeling stressed or depressed because of their symptoms. Consider meeting with a psychologist or certified sex therapist to learn new coping skills. 

If your symptoms have affected your relationship with your partner, talk with them about your concerns and consider going to therapy together. 

Sexual Activity

If you have been unable to engage in sex with your partner, talk with your doctor. There are steps you can take to help both of you enjoy sex again. If you have experienced erectile dysfunction, ask your doctor about an oral medication such as Viagra (sildenafil) or Cialis (tadalafil) to help. Consider using an over-the-counter lubricant if needed as well. Be mindful of avoiding any bending or twisting movements that could further bend the penis. 

Summary

Peyronie’s disease is a noncancerous condition that affects the penis. It causes scar tissue, known as plaque, to form under the skin and leads to curving of the penis and painful erections. Peyronie’s disease is usually diagnosed with a detailed history and physical. It is believed to be caused by injury to the penis. Treatment options include injections, medical therapies, and surgery. 

A Word From Verywell

Peyronie’s disease is a painful and frustrating condition that can affect your relationships and quality of life. If you have been struggling with symptoms, know that you are not alone. It may be helpful to remember that Peyronie’s disease is treatable. Talk with your healthcare provider as soon as you develop symptoms, and consider meeting with a therapist for support.