All about Peyronie's disease (From A to Z)

Learn & understand the basics…

What causes Peyronie's disease?

Most experts are of the consensus that Peyronie's disease usually develops following a trauma or injury that causes bleeding inside the penis.  However, while this trauma may explain acute cases of Peyronie's disease, it does not explain why most cases develop slowly and progressively (chronic cases), or what causes the disease after no apparent traumatic event or accident.

What happens in Peyronie's disease?

Peyronie's disease is characterized by a plaque, or hard lump, that forms on the erection tissue of the penis. Fortunately, this plaque is benign (or non-cancerous) and often begins as an inflammation that may develop into a fibrous tissue. In most of the cases, when the disease heals within a year or so, the plaque does not progress beyond an initial inflammatory phase. However, when the disease lasts for years, the plaque often becomes a tough, fibrous tissue, and calcium deposits may form.

What are the signs & symptoms of Peyronie's disease?

While each individual may experience symptoms of Peyronie's disease differently, the most common symptoms of Peyronie's disease may include:

• Plaque: Which (if present on the top of the shaft) causes the penis to bend upward. Similarly, this plaque (if present on the underside of the penis) causes the penis to bend downward. 
• Shortening of penis: In cases where the plaque develops on both top and bottom, indentation and shortening of the penis may occur
• Pain, bending, and emotional distress can prohibit sexual intercourse
• Painful erections may occur. 

It should also be noted that the symptoms of Peyronie's disease may resemble other conditions or medical problems. Therefore, it is recommended to always consult your physician for a diagnosis.

How is Peyronie's disease diagnosed?

A diagnosis of Peyronie's disease is usually made with the help of a complete medical history and physical examination. For example, men visiting the doctor often seek medical attention for erections and difficulty with intercourse. This diagnosis is further confirmed by:

1-    Ultrasound examination of the penis: A diagnostic technique which uses high frequency sound waves to create an image of the internal organs.

2-    Color Doppler examination: A type of ultrasound that uses sound waves to measure the flow of blood through a blood vessel; waveforms of the blood flow are shown on the ultrasound screen (to evaluate erectile function, anatomy, and blood flow). 

How is Peyronie's disease treated?

In general, the goal of treatment is to keep the patient with Peyronie's disease sexually active. Providing education about the disease and its course is often included in the treatment plan. In some cases, treatment is not necessary, as Peyronie's disease often occurs in a mild form that heals without treatment in 6 to 15 months. Treatment may include:

Surgery: Surgery is often the last resort and is associated with high risk of complications, costs and side effects.

Vitamin E: Some clinical trials have reported improvements with oral vitamin E prescribed by a physician.

Drugs: In some cases, injections of various chemical agents into the plaques have been utilized in a small number of patients. However this mode of treatment does bear a strong potential for unwanted side effects.

Radiation therapy: With this treatment approach, radiation is aimed at the plaque to reduce pain, but does not affect the plaque itself; unwanted side effects or worsening of the disease may occur.

Use of extenders: For those who believe in the potency and effectiveness of alternative or natural treatment options, traction-based penis extenders (such as those of SizeGenetics) offer an attractive, safe and economical option with multiple benefits.

An expert review of alternative treatments of Peyronie's disease

Is natural the better?

As the surgical treatment of Peyronie’s disease is risky, expensive and is often considered as the last resort, more and more treatment modalities are being introduced.  Some of these include include vitamin E in tablet or cream form, potassium aminobenzoate (a chemical that belongs to the Vitamin B group and is used to break down hard, fibrous skin), and quite recently, the use of external penis stretchers.

Vitamin E: Antioxidants such as vitamin E prevent fibrosis. Early studies on the use of vitamin E in Peyronie’s disease reported a decrease in penile curvature in 78% of patients and a decrease in plaque size in 91%. Though the recent evidence does not support a strong role for vitamin E, the low toxicity and cheaper cost of the supplement encourages its use either alone or in combination with other treatment options in Peyronie’s disease.

Potassium para-aminobenzoate (POTABA): POTABA has long been suggested both by medical / alternative treatment experts as an effective therapy for the plaque, curvature, and pain produced by chronic Peyronie's disease. In a study done on 32 adult men who were treated for at least 3 months with POTABA on daily basis, symptom resolution was significantly seen. For example, improvement in penile discomfort / pain was seen in 8 of 18 patients, and decreased plaque size was found in 18 of 32 patients. Similarly, a significant improvement in penis angle (curvature) was seen in 18 patients while 8 patients reported complete correction of the curvature. However, even PTABA is not free of side effects and its efficacy still needs to be established in a vast majority of patients.

Traction-based extenders: Out of all these alternative options, penis stretchers (or extenders) have emerged as the most promising treatment option because of their high successful rate, long-lasting impact and safety. The most unique fact about the successful use of penis extenders in the treatment of Peyronie’s disease is that, unlike other natural / alternative methods of supplements, their use has been documented, established and recommended by several clinical trials and studies. In one of such study which was presented in the 2nd European Congress of Andrology (September 2002), the efficacy of mechanical penile stretching (PS) to reduce penile deformity during erection was tested. The study was done in Italy on ten patients affected by Peyronie's disease, apparently unchanged at least for the latest 3 months and with penile curvature during erection (PEC). Measurements were performed before and after daily home penile stretching application (at least four hours / day) for 3 to 6 months. As a result, penile curvature during erection was significantly and successfully decreased after 3 months. Also, the treatment was well tolerated (no severe complication and no patient drop outs occurred). The results suggested a promising use of penile stretchers in selected Peyronie's patients affected by penile curvature without erectile dysfunction.

While surgery is still an option, it is often associated with a high risk of complications, more costs and other problems.

Can medications cause Peyronie’s disease?

The dangers of drugs

One of the least common or rare risk factors associated with the development of Peyronie’s disease is long-term administration of certain drugs. These drugs can belong to a variety of different classes and are used to treat different disorders. However, the chance of developing Peyronie's disease from any of these medicines is very low and there is no absolute evidence that Peyronie's disease is directly related to taking these drugs. There role, however, is still considered important.

Which drugs may have a role in Peyronie’s disease?

A number of drugs list Peyronie's disease as a possible side effect. Most of these drugs belong to a class of blood pressure and heart medications called beta blockers. One beta blocker is an eye drop preparation used to treat glaucoma. Other drugs that may cause Peyronie's disease are interferon, used to treat multiple sclerosis, and phenytoin, an anti-seizure medicine. The chances of developing Peyronie's disease from any of these medicines are very low. Patients should check with their doctor before discontinuing any prescribed drug.

Major drugs that can cause Peyronie’s disease as a side effect

• Beta blockers
• Cerebyx
• Dilantin
• Dilantin Kapseals
• Glaucoma eye drop beta blocker
• Interferon
• Mesantoin
• Peganone
• Phenytek
• Phenytoin

How can drugs lead to Peyronie’s disease?

There have been various theories that attempt to explain how the prolong use of certain drugs or medications can lead to abnormal curvature of penis and Peyronie’s disease. Scientists believe one of such possibilities is that a particular medication or substance may be the real cause of the disease. Certain medications, chemicals, toxins or substances may possibly be underlying causes of Peyronie's disease. Side effects of medications or exposure to toxins, chemicals, or other substances may cause a symptom or condition. Hence, they become possible underlying causes of Peyronie's disease but are often misdiagnosed or overlooked as a cause.

Finally, it must be remembered that Peyronie’s disease (PD) does not develop overnight and is not an acute disease. Instead, it is a long-term, chronic disorder that develops progressively, over the period of time and can result from a number of causes such as injury / trauma, genetic history of PD, autoimmune factors and, very rarely, as a side effect of certain drugs as listed above.  If this is the case, proper consultation of a urologist or your physical is essential to know what drug is actually causing the problem.

Complications of Peyronie’s disease

What it could lead to?

First observed in a time as early as 1687, Peyronie’s disease was first described by a French surgeon François de la Peyronie in 1743 and, hence, was named after him.

Peyronie’s disease is one of the most bothersome penile / sex-related issues in men. Estimates of the prevalence of Peyronie’s disease range from less than 1 percent to 23 percent. A recent study in Germany found Peyronie’s disease in 3.2 percent of men between 30 and 80 years of age. Although the disease occurs mostly in middle age, younger and older men can also develop it. Similarly, statistics show that Peyronie’s disease is more common in white men with Northern European ancestry and is rarely found in African- American men and Asian men.

Complications of Peyronie’s disease

If left untreated, Peyronie’s disease can lead to a number of serious psychological and physiological complications in men such as:

Penile curvature / bending: A plaque on the topside of the shaft, which is most common, causes the penis to bend upward. Similarly, a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. At times, pain, bending, and emotional distress prohibit sexual intercourse. If not corrected or prevented early, this could lead to permanent deformity of the penis.

Hardened tissues on other parts of the body: About 30 percent of men with Peyronie’s disease develop hardened tissue on other parts of the body, such as the hand or foot. A common example is a condition known as Dupuytren’s contracture of the hand.

Urethral stricture: Urethral structure refers to the narrowing or obstruction of urethra (a long tube that carries your stored urine from urinary bladder to penis and, hence, expels it out of the body during urination). The most common cause of such stricture in Peyronie’s disease is the development of curvature or abnormal shape of the penis which causes a permanent twist / curve in the urethra itself.

Erectile dysfunction (impotence): Peyronie’s disease can easily lead to erectile dysfunction, the inability to achieve or sustain an erection firm or hard enough for intercourse. 

Psycho-social complications: Complications of Peyronie's disease also include inability to have sexual intercourse and embarrassment over the appearance of the penis. This can severely affect one’s sex life and sense of ego, leading to overall deterioration of relations between partners and unhappy social life.

All in all, Peyronie’s disease is a bothersome, serious penis-related disorder that could negatively affect your sexual, physical and social life in multiple ways. Therefore, it is best to seek early solution of the problem as soon as any of the signs or symptoms is discovered.

How to prevent Peyronie’s disease?

Is prevention possible at all?

As the old saying “prevention is better than cure” goes for many other health related disorders, same seems to be true for Peyronie’s disease as well. However, knowledge (you learn more, you prevent more) remains the single most important factor in prevention and early detection of Peyronie’s disease in men.

To better understand how to prevent Peyronie’s disease, it is essential to first learn how Peyronie’s disease develops.

Possible causes of Peyronie’s disease

Injury / trauma: Many researchers believe that the plaque of Peyronie’s disease develops following trauma, such as hitting or bending that causes localized bleeding inside the penis. Two chambers known as the corpora cavernosa run the length of the penis. A connecting tissue, called a septum, runs between the two chambers and attaches at the top and bottom of the tunica albuginea.  If the penis is bumped or bent, an area where the septum attaches to the tunica albuginea may stretch beyond a limit, injuring the tunica albuginea and rupturing small blood vessels. As a result of aging, diminished elasticity near the point of attachment of the septum might increase the chances of injury. In addition, the septum can also be damaged and form tough, fibrous tissue, called fibrosis. Hence, this inflammation over the period of time leads to formation of permanent plaque on your penis. This plaque, itself, then causes permanent bending or curvature of your penis.

Family (genetics): In some cases, Peyronie’s disease runs in families which suggest that genetic factors might make a man vulnerable to the disease.

Autoimmunity: Some researchers believe that Peyronie’s disease may be an autoimmune disorder i.e. it develops when your own body starts to develop antibodies against your own cells. However, this theory still needs to be confirmed by scientists.

Some natural tips to help prevent Peyronie’s disease

1- Do not sleep on your stomach

Although not medically proved yet, some sexologists and reproductive experts do ask adolescent to refrain from sleeping on stomach. The hypothesis is that sleeping on stomach has a “compression” effect on the blood vessels of the penis and it naturally results in a reduced blood to the spongy tissues of the penis. This eventually leads to the reduced growth of the tissue of the penis, often on one side and hence results in the formation of curvature or Peyronie’s disease.

2- Be careful during sex

As injury during intercourse is one of the most common causes of Peyronie’s disease, you should take special precaution while having sexual intercourse. Female being on top, for example, has been regarded as a common cause of several penis related injuries such as penile fractures. You should, therefore, should be very careful if you wish to perform sex in such positions.

3- Use Vitamin E supplements

Researchers have conducted small-scale studies in which men with Peyronie’s disease who were given vitamin E orally, reported improvements. However whether taking vitamin E supplements orally actually prevents the disease before it even develops is questionable and needs more research and studies to be confirmed.

4- Use traction based penis stretchers

If you are one of those penis health enthusiasts who want to increase their penis size (both in length & thickness) then there is good news for you. Using traction based penis stretching device, such as SizeGenetics extender, not only causes permanent enlargement of your penis but is also considered one of the easiest approaches to help prevent or correct abnormal curvature of your penis as seen in Peyronie’s disease. It involves stretching the side of the penis that has the scar tissue so that it matches the other side and results in longer, firmer and thicker erections and an overall sense of increased sexual confidence.

Top 5 myths of Peyronie’s disease (PD)

Fact versus fiction

Like many other health disorders and disease, there have been several myths, misconceptions and false assumptions associated with Peyronie’s disease (PD). The following article intends to highlight some of those common myths related with PD and will help you differentiate between fact and fiction.

Myth 1: PD is a disease of young age

Fact: Greater than 75% of patients with PD are between 45 and 65 years of age. Similarly, some people also believe that Peyronie’s disease only affects men over 50 years of age. In reality, however, studies show that up to 10% of patients may present at age 40 and below.

Myth 2: PD is a disease of no known cause

Fact:  While it is true that no single established cause can be considered as the sole factor responsible in all cases of PD, trauma / injury to the penis is considered as one of the most common causes of PD. Similarly, Peyronie’s disease has also been linked to other generalized conditions such as hypertension and diabetes. Also, it has been also found to be associated with Dupuytren’s disease (palmar aponeurosis), Ledderhose’s disease (plantar aponeurosis), Paget’s disease and knuckle pads. The disease also tends to run in some families, from fathers to the sons.

Myth 3: PD leads to cancer

Fact: The plaque developed in PD itself is benign, or noncancerous (or non-malignant).  It is not a tumor and cannot spread to adjacent body parts of tissues. Similarly, Peyronie’s disease is not contagious (cannot be transmitted to one person to another by any means) and is not known to be caused by any transmittable disease.

Myth 4: Surgery is the single best option that can completely cure all the cases of PD

Fact: Surgery is one of the riskiest, expensive and complex treatment options and is almost always implied as the last resort when other treatments do not work. In addition, even successful surgeries cannot guarantee that the disease will not recur in the future. Also, not all surgeries have shown 100% resolution of symptoms and signs in PD.

Myth 5: There is no link between Peyronie’s disease and erectile dysfunction

Fact: While both conditions can occur independently, PD is associated with erectile dysfunction (or male impotency) in majority of its cases. As a result of more recent research, the correlation between Peyronie’s disease and erectile dysfunction is much clearer than previously recognized. Published studies and trials have indicated that as much as 30% to 80% of men may have erectile dysfunction associated with Peyronie’s disease.

How to identify if you have a Peyronie’s disease?

Signs & symptoms at a glance…

History and background

Generally speaking, Peyronie’s disease refers to the presence of scar tissue in the penis. The condition is so called as it was first described by a French surgeon Francois Peyronie about 250 years ago. Today, according to the generally accepted estimates, Peyronie’s affects millions of men usually beginning in their 50’s. The plaque forms from a lifetime of small injuries or tears.  These injuries heal by forming exaggerated plaques, which result in the Peyronie’s disease.  Men who form abnormal scar tissue elsewhere in the body are more susceptible to develop a Peyronie’s plaque.

How Peyronie’s disease develops?

The scar tissue, or Peyronie’s Plaque, forms in the wall of the tissue that surrounds the corpus cavernosum. That is, a plaque forms in the “canvas” (tunica albuginea) that wraps the erectile tissues. This plaque is a flat plate of scar tissue that actually develops on the top or bottom side of the penis inside a thick membrane called the

Signs & symptoms of Peyronie’s disease

The severity, progression and resolution of various signs and symptoms of Peyronie’s disease are variable and vary from person to person.  Symptoms may develop slowly or appear overnight.

In a follow-up study of 97 men, 40% reported a worsening of their signs and symptoms over time. However, in 47%, the disease had stabilized after resolution of the inflammatory process, and, in 13%, symptoms had even disappeared spontaneously.

As mentioned above, in Peyronie’s disease, a plaque or hard lump forms in the tissue of the penis. However, it is not 100% confirmed that what actually causes the disease. Some experts believe that it could be some hidden trauma or injury but it is not always confirmed.  The plaque makes the penis less flexible, causing pain and making the penis bend when it is erect. For the same reason, many men with Peyronie’s disease have sexual problems because they cannot get or maintain a normal erection. Patients also usually have increasingly painful erection and deviation of the penis. Similarly, in many other cases, these plaques can also cause pain with erection and curvature of the penis.  

In many men, the pain decreases over time, but the bend in the penis may remain a problem, making sexual intercourse difficult. The sexual problems that result can disrupt a couple’s physical and emotional relationship and can lower a man’s self-esteem.

Does Peyronie’s disease cause erectile dysfunction?

Unfortunately, yes, as Peyronie’s disease will not only cause abnormal shape / curvature of your penis but will also prevent blood flow beyond the plaque resulting in erectile dysfunction.  Correcting the plaque will improve potency. 

Can the signs & symptoms resolve on their own?

If you don’t get any treatment at all, spontaneous improvement is very rare.  However, after one year, about 2/3rd of the men do not get any worse and remain stable.  However, on the other hand, 1/3rd of men may have worsening of the signs & symptoms, eventually leading to potential complications.

Based on the above discussion and clinical features, it can be concluded that Peyronie’s disease is, in fact, a serious issue that can lead to severe deformity, abnormal shape, erectile dysfunction and many other sexual health problems in men. It is, therefore, crucial to address the problem as early as possible. As surgery and medical drug treatment options for Peyronie’s disease are not free from side effects and risks, you can always choose another option.

Treating Peyronie’s disease with surgery…

Why and why not?

Peyronie’s disease (PD) affects 1 to 3% of the male population and is considered one of the frequent causes of shortening of penis, penile shape deformities and erectile dysfunction. The treatment of PD, to date, remains one of the greatest therapy challenges for doctors and sexual health care experts. While various treatment options like radiotherapy, medical drug treatment (both oral medicines and injections) are available, surgery is often used to correct the curvature and shape of the penis.

The following article gives you an outline of different surgical procedures used to treat PD and also highlights different pros and cons of surgical treatment of the same.

Types of surgery for Peyronie’s disease

According to surveys and studies, three surgical procedures for Peyronie’s disease have had some success.

1-    Removal / cutting: The first procedure involves removing or cutting of the plaque and attaching a patch of skin, vein, or material made from animal organs. This method may straighten the penis and restore some lost length from Peyronie’s disease. However, some patients may experience numbness of the penis and loss of erectile function.

2-    Plication: A second procedure, called plication, involves removing or pinching a piece of the tunica albuginea from the side of the penis opposite the plaque, which cancels out the bending effect. This method is less likely to cause numbness or erectile dysfunction, but it cannot restore length or girth of the penis.

3-    Implant: A third surgical option is to implant a device that increases rigidity of the penis. In some cases, an implant alone will straighten the penis adequately. If the implant alone does not straighten the penis, implantation is combined with one of the other two surgical procedures.

In short, most of the time, these types of surgery can produce positive results. But because complications can occur, and because many of the effects of Peyronie’s disease (for example, shortening of the penis) are not usually corrected by surgery, most doctors prefer to perform surgery only on the small number of men with curvature severe enough to prevent sexual intercourse. One should also not forget the high costs associated with hospitalization and post-surgery expenses. Also, some common complications associated with penis surgery include bleeding, infection, permanent shortening or disability of penis and post-operative (after the surgery) pain.

Penis stretchers or extenders, on the other hand, are now being considered as one of the alternatives for Peyronie’s disease. A typical external penis stretching device, like that of SizeGenetics, works by allowing the patient to stretch the flaccid penis for several hours a day. The level of traction can be adjusted by adding metal sections to the length of the splint. Over time, the stretching action appears to either elongate the plaque, or cause remodeling of the tissue that has been damaged or abnormally thickened as a result of Peyronie’s disease.

Peyronie’s disease - Care & cure

A review of various treatment options

History & background of Peyronie’s disease

Peyronie’s disease accounts for 0.3 to 0.7% of all urinary system related disorders and it occurs most often in the fourth to sixth decades of life, and occasionally in men less than 20 year old. A small number of men with Peyronie’s disease will get better without treatment but drug therapy or radiation are normally used. Most of the medical and surgical treatments, however, are designed to improve the symptoms of the disease rather than to cure it. The following article is a short review of all the major treatment options that are currently being used to treat or cure Peyronie’s disease.

Medical drug treatment

Medical drug treatment of Peyronie’s disease can be of two types:

Oral therapy: Oral medication therapy is only effective in the early, or the acute phase of Peyronie’s. Thus, within the first year of developing a plaque, drugs like PABA, vitamin E and colchicine are considered as effective first line treatments.  However, after one year with a plaque, oral medications are rarely helpful. 

Injection therapy: If the condition is not improved by oral drug treatment, doctors may prescribe intralesional injections with Verapamil, interferons or steroids.  The penis is anesthetized initially and then the medication is injected into several sites within the Peyronie’s Plaque.  Following a series of 6 injections spaced at least every other week, 2/3 of men have improvement in their curvature, and 80% have improved erections. Verapamil and interferon alpha-2b seem to diminish curvature of the penis. On the other hands, these drugs are not free of some serious side effects.  Steroids, such as cortisone, have frequently produced unwanted side effects, such as the atrophy or death of healthy tissues.

Surgery: If injections fail, surgical removal of the plaque and reconstruction can be performed.  While surgery is successful at correcting the curvature of penis, it rarely improves the erectile dysfunction and is also risky (because of high risk of associated complications) and costly (very expensive).

Extracorporeal Shock Wave Therapy

Extracorporeal shockwave therapy (ESWT) uses vibrations caused by sound waves to treat the affected tissue. The sound waves come from a device applied to the outside of the body that generates short bursts of sound, called ‘sonic pulses’. The plaques on the penis are targeted, normally using ultrasound as a guide. 

Radiotherapy

Radiation therapy, in which high-energy rays are aimed at the plaque, has also been used. Like some of the chemical treatments, radiation appears to reduce pain, but it has no effect on the plaque itself and can cause unwelcome side effects such as erectile dysfunction.

The key question in the treatment of Peyronie’s disease probably is can we prevent disease progression resulting in penile shortening and curvature without surgery? None of the currently available treatment modalities so far has so demonstrated this effect conclusively. Use of traction based extenders or penis stretchers (e.g. SizeGenetics), however, does offer an attractive, economical, safe and natural option that has been found to have a role in correcting and preventing the abnormal curvature of the penis in many men.