What can I do about Peyronie's - the bent penis disease?

Archive Page
This is archive material from the MHF's malehealth.co.uk website which is now part of this site in the section Male Health. This page remains on the site as site traffic suggests visitors find this page useful but it may not be up to date. It was last updated in 2008 and so does not conform to the NHS England Information Standard of which the MHF is a member. Up-to-date information on this topic can be found here: Peyronie's Disease FAQs.
 

Peyronie's Disease is a form of erectile dysfunction that can cause both physical and emotional scarring. Dr. Raj Persad explains the disease and the treatments available.

What is Peyronie's Disease?

Peyronie's Disease is caused by damage to penile tissue creating scar tissue known as plaque. The size and location of the plaque can cause the penis to bend upward or downward or be indented. The bending can happen gradually, starting with lumps and soreness that go on to develop into a hardened scar, or it can appear suddenly - almost overnight. (See image below from the BMJ.)

Although mostly found in middle-aged men, Peyronie's Disease can occur at any age. Estimates show that more than 80,000 men in the UK may have the disease.

What causes it?

It is hard to pin-point what actually causes the scar tissue to develop with many different theories having been put forward. While injury or trauma might explain some acute cases of Peyronie's Disease, it does not explain why most cases develop slowly and with no apparent traumatic event.

Some researchers theorise that Peyronie's Disease may be an autoimmune disorder. One study compared 66 patients with Peyronie's Disease with 20 controls of the same age. They found that 75.8% of patients with Peyronie's had at least one abnormal immunologic test, compared with only 10% in the control group.

This may explain why there are some recognised systemic disorders that are associated with the disease, such as:

  • Dupuytren's contracture, a condition of the hands and fingers, which can cause the affected fingers to bend towards the palm and won't allow patients to straighten fingers fully. (Peyronie's Disease is present in up to 20 per cent of patients with Dupuytren contracture.) 
  • Paget's disease, a chronic skeletal disorder that may result in enlarged or deformed bones in one or more regions of the skeleton.
How does the disease progress?

The development of Peyronie's Disease is not that well understood either. Symptoms have been known to improve or worsen over time; but it is usual for the sufferer to experience pain during an erection, making sexual intercourse very difficult. With the result that in addition to the physical scarring Peyronie's Disease can leave its emotional mark 

Without good communication and understanding in a relationship, Peyronie's Disease can cause huge amounts of distress. Even in a loving relationship it can disrupt a couple's physical and emotional relationship and lead to lowered self-esteem in the man.

What's the treatment?

Quick and accurate diagnosis is the fist step in effectively treating Peyronie's Disease. But, many men are reluctant to visit the doctor when they first notice an unusual curvature or pain in their erect penis. Occasionally their reluctance leads to self-misdiagnosis resulting in further anguish and distress by thinking they have cancer or a sexually transmitted disease.

However, in my experience, when intercourse becomes a struggle, men with Peyronie's Disease finally seek medical help - often as a result of their partner's encouragement.

Even after the diagnosis of Peyronie's Disease is confirmed, the course for healing can take many directions.

  • The early stage also known as the acute inflammatory stage of Peyronie's Disease lasts from approximately 6-18 months. The stage is characterised by painful and weak erections or difficult ejaculations caused by an inflammation, which can then develop into hardened scar tissue (plaque). Men may experience pain; varying degrees of penile curvature, shortening or indentation; and the formation of a lump of scar tissue.
  • The second phase, the chronic stage of Peyronie's Disease, is when a stable scar (plaque) forms and the deformity stabilises which may result in erectile dysfunction or loss of penile length. Many surgeons prefer to wait at least one year to surgically correct the curvature to help keep it from returning.

Doctors often first try a 'wait and watch' approach since Peyronie's Disease symptoms may improve on their own with no treatment necessary in correcting the curvature -  mostly within the first year.

There are also a number of non-surgical treatment options available including oral medications, injections, topical treatments shock wave and energy therapies, traction devices, and vacuum therapy. Other therapies are under investigation.

Remember that there is life after Peyronie's Disease; and that the day-to-day living with this disease should not be left to get the better of you. Having the right resources at hand, understanding the numerous options for treatment and discussing them with a physician are the first and effective steps in treating Peyronie's Disease. As a result, you can often stop the disease from turning into a crisis.

What about surgery?

Surgery is an option when non-surgical treatments are not working and may be the only effective treatment for severe cases. To minimise the reoccurrence of the disease physicians recommend that that the patient's disease be in a stable, inactive phase for at least six months.

Some men choose to receive an implanted device that increases rigidity of the penis. In some cases, an implant alone will straighten the penis adequately. In other cases, implantation is combined with a technique of incisions and grafting or 'plication' (pinching or folding the skin) if the implant alone does not straighten the penis.

A newer third method is grafting. This surgical method involves excision of some of the plaque followed by placement of a graft of either an autologous (human) tissue, synthetic material or a biologically designed material.

As Peyronie's Disease can vary extensively in how it affects each man, it is important to identify the best and most suitable course of action for each individual. The goal of treatment is to safeguard sexual function so in some cases all that is needed is education on the condition. Prompt and accurate diagnosis will not only lead to a quicker resolution of the problem but will give peace of mind.

Dr. Raj Persad is Consultant Urologist at United Bristol Healthcare NHS

 

Page created on September 30th, 2008