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Peyronie’s Disease

Peyronie’s disease is a noncancerous condition characterised by the formation of fibrous scar tissue on the penis, leading to curved and often painful erections. While it’s common for penises to vary in shape and size, and a slight curve is not typically a cause for concern, Peyronie’s disease can cause a significant bend or pain in some men. This curvature can hinder sexual activity and may result in difficulty achieving or maintaining an erection, known as erectile dysfunction.

The condition can also lead to stress, anxiety, and concerns about penile shortening. Peyronie’s disease rarely resolves on its own, and in many cases, may persist or even worsen over time.

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Causes of Peyronie's Disease

Repeated Injury: The primary cause of Peyronie’s disease is believed to be repeated injury to the penis. This can occur during sexual activity, athletic activities, or due to accidents. However, in many cases, individuals do not recall a specific trauma to the penis.

Scar Tissue Formation: After an injury to the penis, scar tissue forms in a disorganised manner. This can lead to the formation of a nodule or the development of curvature in the penis. The scar tissue associated with Peyronie’s disease is called plaque, which is different from the plaque that can build up in blood vessels. This plaque can be felt under the skin of the penis as flat lumps or a band of hard tissue.

Penis Structure: The penis contains two sponge-like structures called corpora cavernosa. During sexual arousal, blood flow increases to these structures, causing the penis to erect. In Peyronie’s disease, the scar tissue prevents certain parts of the penis from stretching, leading to a bend or deformity in the penis when erect.

Genetic Factors: Some men may have a genetic predisposition to Peyronie’s disease. If a family member has the condition, there is an increased risk of developing it.

Connective Tissue Disorders: Men with certain connective tissue disorders may have a higher risk of developing Peyronie’s disease. For instance, some men with Peyronie’s disease also have Dupuytren’s contracture, a condition where there’s a cordlike thickening across the palm causing the fingers to pull inward.

Age: While Peyronie’s disease can occur in men of any age, its prevalence increases with age, especially in men in their 50s and 60s. Curvature in younger men is often due to congenital penile curvature rather than Peyronie’s disease.

Other Factors: Other potential factors that might be linked to Peyronie’s disease include certain health conditions, smoking, and some types of prostate surgery.

Symptoms of Peyronie’s Disease

Hard Lumps: One of the primary symptoms of Peyronie’s Disease is the formation of hard lumps or plaques on one or more sides of the penis. These plaques are essentially scar tissues that develop under the skin of the penis.

Pain: Men with Peyronie’s Disease may experience pain during sexual intercourse or even during an erection. This pain can be mild to severe and may decrease over time.

Penile Curvature: The presence of plaques can cause the penis to curve or bend, especially during an erection. The degree of curvature can vary, and in some cases, it can be significant enough to make sexual intercourse difficult or impossible.

Changes in Penis Shape: Apart from curvature, Peyronie’s Disease can also lead to other changes in the shape of the penis. This includes narrowing, indentations, or even shortening of the penis.

Erectile Dysfunction (ED): Some men with Peyronie’s Disease may also experience difficulties in achieving or maintaining an erection, commonly referred to as erectile dysfunction.

Diagnosis of Peyronie’s Disease

The diagnosis of Peyronie’s Disease typically involves a combination of medical history, physical examination, and, in some cases, imaging tests:

Medical and Family History: A urologist will begin by asking about the patient’s medical and family history. Questions may revolve around the onset of symptoms, any pain experienced, problems with sexual intercourse, family history of Peyronie’s Disease, and other related medical conditions.

Physical Examination: A physical exam helps in diagnosing Peyronie’s Disease. A urologist can usually feel the plaques in the penis, whether it’s erect or flaccid. If required, the patient might be given an injectable medicine to induce an erection for a more detailed examination. In some cases, patients may also be asked to provide photographs of their erect penis to evaluate the curvature during follow-up visits.

Imaging Tests: While imaging tests are not always necessary for the diagnosis of Peyronie’s Disease, they can provide additional information about the plaque’s location and size. An ultrasound, in particular, can offer a detailed view of the plaque and its exact location within the penis.

Treatment Options for Peyronie’s Disease

Observation

If the condition is not causing significant pain or hindrance in sexual activity, the doctor might recommend a wait-and-see approach. Some cases of Peyronie’s Disease improve without treatment.
Pros: No side effects or complications from interventions.
Cons: The condition might progress or not improve.

Non-surgical Treatments

Medications:
While no drug is approved by all health agencies for the treatment of Peyronie’s Disease, some medications have been studied for this purpose. These include oral medications like Potassium para-aminobenzoate (Potaba), pentoxifylline, and colchicine, and injections like Collagenase clostridium histolyticum (Xiaflex), verapamil, and interferon.
Pros: Less invasive than surgery.
Cons: Not always effective, potential side effects from medications.

Shock Wave Therapy:
This involves directing sound waves at the plaque to break it down.
Pros: Non-invasive procedure.
Cons: Might not be effective for everyone.

Penile Traction Therapy:
Devices that stretch the penis can be used to reduce curvature and restore some length.
Pros: Non-invasive and can restore some penile length.
Cons: Needs to be used for several hours a day for a few months to be effective.

Surgical Treatments

Shortening the unaffected side (Nesbit procedure):
This involves removing or pinching a piece of the tunica albuginea from the side of the penis opposite the plaque.
Pros: Effective in correcting penile curvature.
Cons: Can lead to a slight shortening of the penis.

Lengthening the affected side:
This involves incising or removing the plaque and attaching a patch of graft material.
Pros: Can correct significant curvatures.
Cons: Potential for erectile dysfunction.

Penile implants:
For men with Peyronie’s Disease and erectile dysfunction, penile implants might be an option.
Pros: Effective in correcting penile curvature and restoring erectile function.
Cons: Invasive procedure with potential complications.

Conclusion

Peyronie’s disease, while not life-threatening, can significantly impact an individual’s quality of life. Understanding the condition, its causes, symptoms, and available treatments is important for those affected. Early diagnosis and intervention can help manage the condition and improve the quality of life for many men.

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Dr Lee Fang Jann image

Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders

He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).

  • Bachelor of Medicine and Bachelor of Surgery (Singapore)
  • Membership of The Royal College of Surgeons (Edin)
  • Master of Medicine (Surgery) (Singapore)
  • Fellowship of the Academy of Medicine (Urology)
  • Clinical fellowship at Oxford Transplant Centre in the UK
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Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.

Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.

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    Frequently Asked Questions

    What is the prevalence of Peyronie’s Disease in the general population?
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    Peyronie’s Disease affects a certain percentage of the male population, though the exact prevalence can vary. Many cases go unreported due to embarrassment or lack of awareness.

    Are there any lifestyle changes that can help manage or prevent Peyronie’s Disease?
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    While the exact cause of Peyronie’s Disease is not fully understood, avoiding penile injuries and maintaining good overall health can potentially reduce the risk. Regular check-ups and early medical intervention upon noticing symptoms can also be beneficial.

    Can Peyronie’s Disease affect fertility?
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    Peyronie’s Disease primarily affects the structure of the penis and does not directly impact fertility. However, if the condition leads to erectile dysfunction or pain during intercourse, it might indirectly affect a man’s ability to conceive.

    Can Peyronie’s Disease recur after treatment?
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    While treatments for Peyronie’s Disease can be effective, there’s a possibility of recurrence in some cases. Regular follow-ups with a urologist helps monitor the condition and address any potential recurrence.

    Is Peyronie’s Disease associated with any other medical conditions?
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    Peyronie’s Disease can be associated with certain connective tissue disorders. Some men with Peyronie’s Disease also have conditions like Dupuytren’s contracture. However, more research is needed to understand these associations fully.