Frequently Asked Questions On Peyronie’s Disease

Peyronie’s disease is a condition where scar tissue causes the penis to curve or lose length or girth. In some cases, it can cause pain and prevent the man from having sex.

There are surgical and nonsurgical treatments that can manage it and it doesn’t cause any harm to the rest of the body.

The information below is intended to provide responses to many of the common questions men have about Peyronie’s disease when they contact Pollock Clinics for information or assessment.

About Peyronie’s Disease

What is Peyronie's disease?

Peyronie’s is a disease where scar tissue in your penis causes it to bend, curve or lose length or girth. You may be able to feel the scar tissue (plaque) through the skin or you may have pain in a specific part of your penis as the scar tissue forms. During an erection, your penis can bend up, down, or to the side depending on the location of the scar. Some men with this condition don’t have a curve, but might have an area of indentation or “hourglass” appearance.

Most men don’t have perfectly straight erections. Just because there is a little curve in your penis, that doesn’t mean you have Peyronie’s disease. Men who have had a curvature their whole lives do not have Peyronie’s disease.

In most cases, the scar forms on the top of the penis, causing it to curve upwards when it becomes erect. Your penis will bend downward if the scar is on the bottom, and sideways if the scar is on the side. In some cases, the scar develops on both the top and bottom of the shaft, which can cause the penis to become “dented” or shorter. Sometimes the scar will go all the way around the penis, making it narrow like the neck of a bottle or the center of an hourglass. About one in three men with this condition may have calcium in the scar tissue that can make it feel like bone.

Is Peyronie’s dangerous?

Peyronie;s is not life-threatening and cannot lead to a serious illness. It may, however, lead to erectile dysfunction which means that it is not possible to get or maintain an erection if left untreated.

Could I have something else?

Depending on the type of lumps on the penis, it could be genital warts or genital herpes which are both superficial and visible, and sexually transmitted. Sores can also be a sign of syphilis. In Peyronie’s disease, the nodule is under the skin and does not present as a sore or blister.

Is Peyronie’s disease painful?

Peyronie’s disease can be painful. This is most common in the early phase of the disease. However, pain may continue with erections even in the later, chronic phase. The severity of it varies depending on the person.

Does Peyronie’s disease make the penis smaller?

Peyronie’s disease can shorten your penis. Treatments for Peyronie’s disease can attempt to restore length.

Does Peyronie’s disease cause erectile dysfunction (ED)?

Peyronie’s disease can cause erectile dysfunction by interfering with the normal blood trapping valves that are important for getting or maintaining an erection.

Is Peyronie’s disease contagious?

No. Peyronie’s is not contagious or caused by any other disease.
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Will Peyronie’s disease keep me from having sex?

You can have sex, but it might be painful or difficult for you or your partner. The greater the curve, the more difficult it is to have sex. Some men with Peyronie’s disease may suffer from erectile dysfunction, which is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Not all men with Peyronie’s disease suffer from erectile dysfunction, but many do, either temporarily or permanently. Most men with Peyronie’s disease do find some ways to keep intimacy alive in their relationships.

Could it be penile cancer?

Cancer of the penis is quite rare, but lumps on the penis should be examined by a doctor, so that cancer can be ruled out.

Can a relatively young man have Peyronie’s?

Yes if you are displaying the symptoms you could. Although Peyronie’s disease is more common in older men it does happen to younger men too. If you have symptoms, make an appointment for an evaluation.

What are the stages of Peyronie’s disease?

Peyronie’s disease has two stages: acute and chronic.

Acute phase: This stage lasts between six and 12 months. During this period the scar forms under the skin of your penis, causing a curvature or other change in its shape. You may feel pain when your penis is erect or when it is soft.

Chronic phase: The scar has stopped growing in this phase, so the curvature in the penis doesn’t get worse. The pain will usually be gone by this time, but sometimes it can continue, especially with erections. Also, erectile dysfunction (ED) or problems getting or keeping the penis hard may develop.

How common is Peyronie’s disease?

Experts estimate that about 6% to 10% of men between ages 40 and 70 have Peyronie’s disease. It’s been observed in other ages, but it’s less common. There’s a theory that the actual number may be higher since some men choose not to talk about the disease with their healthcare provider, and others may not be bothered enough to seek medical care. If you have concerns about your sexual health, be sure to report your symptoms to a healthcare provider.

Causes & Transmission

Peyronie’s disease is likely caused by minor injury to the penis. This type of damage is most often caused by vigorous sex (such as bending the penis during penetration or pressure from a partner’s pubic bone), though it can also be caused by sports or other accidents.
It cannot be passed on through physical or intimate contact. It is possible that it can be passed on genetically from father to son, but there is no evidence for this.

Several risk factors might increase your chances of getting Peyronie’s disease:

Age. Peyronie’s disease is more likely to happen as you get older. It occurs in about 10-15% of middle-aged men.

Genetics. If you have a close relative (brother or father, for example) with the disease, you’re at a higher risk.

Connective tissue disorders. Those with a connective tissue disorder are at a greater risk. Examples of those disorders include Dupuytren’s disease, plantar fasciitis and scleroderma.

Erectile dysfunction. Men who have diabetes-associated erectile dysfunction (ED) (impotence/difficulty getting and keeping an erection) are four to five times more likely to develop Peyronie’s disease. Sometimes erectile dysfunction can be caused by having Peyronie’s.

Prostate cancer. Men who have had surgery for prostate cancer are at an increased risk.
Autoimmune disorders. If you have an autoimmune disorder like lupus, you’re more likely to get Peyronie’s disease.

Generally the cause is thought to be some damage to the penis, either during sex or masturbation. For some people this heals up normally, but in other people there is a genetic predisposition to scar tissue forming. This scar tissue gathers up on one side of your penis, making it curved
While low testosterone itself cannot cause Peyronie’s disease (PD), hormone levels can affect penile rigidity, which can cause injury to the penis during sexual intercourse. Low testosterone levels can impact a man’s ability to maintain an erection firm enough for sex.
There is no evidence to suggest that what you eat or drink affects Peyronie’s disease.

It is recommended to go to the doctor for a diagnosis. It is normal to feel embarrassed but doctors are used to dealing with problems such as this. The sooner you get diagnosed, the sooner you can get treatment. Most professionals recommend starting some form of Peyronie’s treatment during the acute phase and ideally within 6 months of noticing the first symptoms.

It is estimated that Peyronie’s disease improves or resolves without any treatment in only 5 – 15% of cases.

What are the Treatment Options?

There are a number of treatment options. Some work well for some men but not for others. Starting a non-surgical treatment as soon as possible is a good idea, as well as combining several treatments.

The sooner you start your treatment, the more options you have and the better results you are likely to get. The aim of most treatments is to stop the disease progressing further, maintain or improve sexual function, relieve any penile pain and to straighten the bend as much as possible.

Many modalities have been tested in Peyronie’s disease and have found to be effective. These include intralesional therapies (penile injections), oral therapies, topical therapies, penile traction devices, low-intensity acoustic shockwave, and surgical procedures.

Treatments offered through Pollock Clinics include:

Low Intensity Shock Wave Therapy (LiSWT) has been shown to be an effective treatment modality for relieving the pain associated with Peyronie’s disease as well as vasculogenic erectile dysfunction.

The actual mechanism of LiSWT for Peyronie’s disease is not fully understood. However, electron microscopy studies have demonstrated actual histological changes within the Peyronie’s plaque following LiSWT.

Additional studies also reported an improvement in penile curvature by more than 15° in 33% of men who received LiSWT with a corresponding decrease in penile plaque hardness in 60%. LiSWT is believed to reduce the pain associated with Peyronie’s disease and to improve the quality of erection by promoting the generation of new and stronger blood vessels at the level of the penile shaft.

The Canadian Urological Association 2018 guideline states that “contemporary guidelines have clearly demarcated ESWT’s role in Peyronie’s disease management and the Committee concurs with this approach, supporting ESWT for potential penile pain improvement.”

Verapamil gel, a topical version of the drug, has also been effective in eliminating pain upon erection, decreasing the size of plaque, decreasing curvature, and improving erection quality in patients with Peyronie’s disease.

It is a prescription compounded medication that is applied directly to the skin. Verapamil belongs to the class of medications known as calcium channel blockers. The gel has been designed to carry the verapamil through the skin and deliver it to the Peyronie’s plaque. The proprietary formula allows for minimal absorption into the blood, while maximizing the concentration of verapamil in the plaque and surrounding tissue.

Trimix is an injectable prescription medication used to treat erectile dysfunction. The active ingredients in the three-drug mixture are alprostadil, papaverine, and phentolamine. Trimix causes an increase in blood flow to the penis, and in some men may help to potentiate other treatment modalities offered.

Oral medications that may be useful in the treatment of Peyronie’s disease include:

Pentoxifylline

Pentoxifylline belongs to a group of drugs which improve peripheral blood flow and thus enhance peripheral tissue oxygenation. This medication also has strong antioxidant, anti-inflammatory effects. Additionally, Pentoxifylline has fibrinogen-reducing properties which can help decrease the Peyronie’s plaque and prevent advancement when in the acute stage. It can be taken orally, and also may be administered as an intralesional injection.

Coenzyme Q10

Coenzyme Q10 is an antioxidant and anti-inflammatory medicine. Coenzyme Q10 supplementation may lead the decrease of plaque volume and penile curvature and improved erectile function in patients with early chronic Peyronie’s disease.

PDE-5 Inhibitors (i.e. Cialis)

PDE-5 inhibitors, often prescribed for erectile dysfunction, are sometimes beneficial for patients in the early stages of Peyronie’s disease. In a study of Peyronie’s’ patients the drug was associated with decreased pain on erection and degree of penile curvature, and improved erectile function.

Vitamin E

The proposed action of vitamin E for Peyronie’s is through its ability to scavenge free radicals. Many clinicians consider this inexpensive, virtually side effect-free drug a reasonable treatment to offer patients awaiting stabilization of disease.

PRP Shots

Platelet rich plasma injection is a simple and near painless procedure which uses platelet rich plasma (PRP) drawn from your own blood.

Platelets possess a variety of growth factors and substances with reparative and healing properties. There is promising scientific data that shows the potential ability and safety of PRP therapy in improving the health and functioning of erectile tissue and potentially mitigating Peyronie’s disease.

Pentoxifylline

Pentoxifylline belongs to a group of drugs which improve peripheral blood flow and thus enhance peripheral tissue oxygenation. It can be used as an intralesional injection, as well as in oral form.

This medication also has strong antioxidant, anti-inflammatory effects. Additionally, Pentoxifylline has fibrinogen-reducing properties which can help decrease the Peyronie’s plaque and prevent advancement when in the acute stage.

Xiaflex

Xiaflex is injected into the plaque in your penis which may help break down the plaque that is causing your erect penis to curve. This may help the erection to be straighter and may enable you to feel less bothered by your Peyronie’s disease. The active substance is collagenase clostridium histolyticum and is naturally produced by a bacterium named Clostridium histolyticum.

Interferon

Interferon injections appear to disrupt the production of fibrous tissue and help break it down. It also has been shown to reduce penile pain in men with Peyronie’s disease.

Penile vacuum therapy and penile traction techniques may provide some benefit to treatment in combination with above therapies. These techniques are thought to stretch and lengthen the shortened Peyronie’s plaques leading to re-organization of the scar fibres. We may employ the Restorex Traction Device and/or a vacuum erection device (VED).

For men that are not candidates for other forms of therapy and are both psychologically and functionally bothered by their Peyronie’s Disease, surgery may be an option. This may include different techniques depending upon the nature of the curve, deformity, and baseline erectile function. The doctor will discuss these if they are appropriate but generally include:

  • Penile plication – shortening the ‘long side of the penis’ opposite the curve.
  • Penile plaque excision and grafting – the scar tissue is cut and stretched, and a graft is sewn in place.
  • Penile implant device that replaces the erectile tissue and helps to straighten the penis (typically reserved for men with significant curvature and erectile dysfunction).

Patients should do everything they can to improve their vascular and aerobic health.  Exercise is very important as is good diet, maintaining a healthy.

Lifestyle changes may allow a man to achieve an erection more easily, allowing him to continue having sex, even when he has Peyronie’s disease. Some of the potential lifestyle changes a man can try include:

  • Quitting smoking
  • Exercising regularly
  • Reducing the consumption of alcohol
  • Eliminating the use of illegal drugs

A man may also want to undergo counselling to help with stress, anxiety, or depression. Understand that these lifestyle changes may not affect Peyronie’s disease. Changes of this kind are intended to improve the ability to have sexual intercourse without worrying about ED symptoms.