Men's Health

Peyronie's Disease - Symptoms, Diagnosis and Treatment

Fact Checked

Peyronie’s disease, or PD for short, is a chronic disease named after the French surgeon François Gigot de la Peyronie.

Last Updated: 05/03/2022

Written by

James Lang

Medically Reviewed by

Dr. Paul Thompson

In this comprehensive guide, you will learn everything you need to know about Peyronie’s disease, including its underlying mechanism, causes, risk factors, symptoms, treatments, and more.

Peyronie's disease is a condition in which the penis bends or there is penile curvature in one or more directions. It is the result of a scar tissue buildup in the erectile tissues of the penis. This condition is often referred to as "Peyronie's disease." 

Peyronie's disease is a progressive condition that can cause penile pain, penile curvature, pain during sexual intercourse, erectile dysfunction and other sexual and urinary problems. It is most common in men who have had multiple sexual partners and/or have had a history of smoking, alcohol, and drug abuse. Peyronie's disease can be treated, but it is not curable.

What is Peyronie's disease?

Peyronie Disease is the condition where scar tissue forms beneath the skin of the penis in the corpora cavernosa, the organ used to irrigate the penis’ blood. The plaque builds within a thin elastic layer known as a "tunica albuginea" inside the penis. Tunica albuginea becomes stiff after blood flows in making the penis erect. This plaque can be positioned anywhere in your pelvis area from pelvic trauma. The plaque reaches the surrounding tissue when the erection occurs, causing the penis to curve. 

A curved penis causes painful erections and can make sexual intercourse painful, hard, or impossible.

Peyronie's disease and erectile dysfunction

Peyronie's illness may make it difficult to acquire or keep an erection (erectile dysfunction). However, men frequently experience erectile dysfunction prior to the onset of Peyronie's disease symptoms.

What is Erectile Dysfunction?

Erectile dysfunction can be one of the symptoms of peyronie’s disease or another medical or psychological problem. It can lead to stress, relational difficulty, and low self-esteem.

The major symptom is a man's inability to obtain or maintain a hard adequate erection for sexual intercourse.

Patients with erectile dysfunction should be assessed for any underlying medical or psychological disorders. Medication and assistance equipment, such as pumps, can be recommended if treating the underlying issues does not help.

Peyronie's Disease Symptoms

A man can develop Peyronie’s disease suddenly or slowly. The primary symptom is severe curvature of the penis. Other symptoms include: Flat scar tissue on the shaft, a curve to one side of the penis, penile shortening may become worsening as a result. Generally, the acute phase of the disease can stabilize in 1-3 months, if not more leading to the chronic phase. 

Pain during erection usually improves over time, but sometimes scar tissue shortening of penile muscles or curvatures associated with Peyronie’s disease remain. Despite the lack of treatment for this illness, the curvatures and pain associated with Peyronie Disease generally can be improved with various medical therapies.

Symptoms associated with developing Peyronie's disease include:

  • Scar tissue is a kind of connective tissue. The fiberous scar tissue linked with Peyronie's disease, known as plaque but there is more than one plaque in the body. Peyronie’s disease is distinct from plaque that can form in blood vessels, can be felt under the skin of the penis as flat lumps or a ring of hardened tissue over normal tissue.

  • A substantial bend to the side of the penis. Men with Peyronie’s disease may have a spot where the penis curves forward or downward, or it may bow to one side.

  • Erectile function issues: Peyronie's illness may make it difficult to obtain or sustain an erection (erectile dysfunction) or cause soft erections. However, erectile dysfunction is frequently reported by males prior to the onset of Peyronie's disease symptoms.

  • Penis shortening: Peyronie's illness may cause penile shortening, or stated another way, your penis to get shorter.

  • Pain. Penile pain can occur with or without an erection but often causes painful erections.

  • Other penile deformities: In some men with Peyronie's disease, the erect penis may exhibit constriction, indentations, or even an hourglass-like look, with a tight, thin band around the shaft.

What causes Peyronie's disease?

Peyronie's disease is one of many certain connective tissue disorders that is most likely triggered by a small penile injury or penile trauma. 

This sort of injury is most commonly caused by forceful intercourse (for example, bending the penis during penetration or pressure from a partner's pubic bone), although it can also be caused by sports or other incidents. Injury to the tunica albuginea may result in the formation of scar tissue in the cells (fibrosis). This scar tissue then hardens to produce the Peyronie's disease plaque. Peyronie's disease is caused by a flaw in the way the body heals wounds, often on the top or side of the penis.

Injury to the penis causing scar tissue

Medical professionals say the penis is damaged by hitting the penis. This can also be caused by sports and accidents. 

Occasionally, acute injuries can be experienced, and repeatedly over time chronic injuries occur. 

The injury might cause blood clots inside the elastic membrane of the penis - tunica albuginea. If injuries heal, they can cause scars to form, causing the formation of plaque. This hard plaque forces against the surrounding tissue which causes a curve in the penis to form. Occasionally, men with Peyronie’s disease may have micro-infections in his penis. 

Researchers say it was not easy to recall a particular incident before symptoms began. 

Autoimmune disorders

Peyronie’s disease may develop in men who have autoimmune disorders if their immune systems attack their penile tissue. It may cause inflammation of the penis, especially in the acute phase. Scars can form into plaque. More information regarding the autoimmune diseases and connectivities of Peyronie can be found on the American Urilogical Association website.

A connective tissue disorder

Peyronie's disease is a penile connective tissue illness similar to Dupuytren's contracture of the hand. It is distinguished by bent erections, penile discomfort during erections, and palpable penile plaque.

Risk factors

Sometimes minor penis injuries are not necessarily the cause of Peyronie's disease, there are other genetic or environmental reasons as well. However, different factors may be contributing factors to poor wound healing; these factors could also play an important role in causing Peyronie’s disease. Other factors, such as smoking and prostate surgery, can also be linked with Peyronie’s disease.

  • Heredity: You are more likely to get Peyronie's disease if a family member has the disorder.

  • Disorders of the connective tissue: Certain connective tissue abnormalities appear to put men at a higher risk of getting Peyronie's disease. A number of men with Peyronie's disease, for example, also have a cordlike thickening across the palm, causing the fingers to pull inward (Dupuytren's contracture).

  • Age: Peyronie's disease can affect males of any age, although its frequency rises with age, notably in men in their 50s and 60s. Curvature in younger men is more usually caused by congenital penile curvature rather than Peyronie's disease. In younger males, a modest bit of curvature is typical and not cause for concern.

How common is Peyronie's disease?

About one in 100 Americans over 18 are diagnosed with Peyronie's disease. According to studies on the prevalence of men with Parkinson's disease, the average male who had the disease was over one in ten. The likelihood of Peyronie's disease increases as we get older. The prevalence of Peyronie’s is low for men under 30 years old.

How do doctors diagnose Peyronie's disease?

Most patients need a urologic specialist specializing in sexual and urinary health issues to have Peyronie’s disease diagnosed properly. The urologist can diagnose Peyronie's disease using your history of health and family history, as well as a physical exam. An imaging test is no longer necessary in order to identify Peyronie's disease, but it can serve to collect additional details about the plaque.

Lab testing

Your healthcare professional will generally diagnose Peyronie's disease after asking you about your sexual history and health. However, there are various tests that may be used to diagnose Peyronie's, assess severity, and determine therapy options. If therapy is necessary, tests can assist determine which treatment is best.

Palpation

Looking at the flaccid penis is the first sign of Peyronie's illness. Palpation is used to detect indented, hard, or otherwise dissimilar parts of the penis from penis stress or other damage. Since the acute phase can develop slowly, Peyronie's disease may not be immediately apparent if caught early.

The healthcare professional may also measure the stretched, flaccid penis at this time. Stretching the penis is also a sign of penile health.

Questionnaire for Peyronie's (PDQ)

Your doctor may use the Peyronie's Illness Questionnaire to assess your disease (PDQ). The PDQ is a 15-item exam that assesses the severity of psychological and physical symptoms associated with Peyronie's disease. It may be used to assess illness severity as well as therapeutic efficacy.

Curvature measurement

The erect penis is generally tested. In order to help you to achieve an erection in the doctor's office, the doctor frequently injects your penis with erectile dysfunction medicine. He will now measure your erection's curvature. A goniometer is ideal for this. It may be done manually too.

Tests of the Blood

In some cases of Peyronie's disease, doctors utilize testosterone blood testing to diagnose males. The link between testosterone and Peyronie's disease is not well-established.

Inability to get an erection may raise the chance of Peyronie's. Erectile dysfunction is frequently caused by other health issues, such as low testosterone levels.

Ultrasound

To diagnose Peyronie's disease, an ultrasound is commonly employed. They utilize ultrasonography on the erect penis to detect blood flow difficulties that may indicate additional erectile concerns. High-resolution ultrasonography can also detect Peyronie's disease plaques and scarring.

In certain cases, other imaging techniques can detect plaques in the penis at various stages of production.

Other testing methods

X-Rays 

An X-ray can detect changes in the penis' soft tissue.

CT scans 

CT scans can detect plaques that haven't calcified yet.

MRI

An MRI is used on occasion to help detect Peyronie’s disease. However, due to high costs, MRI is rarely employed.

Treating Peyronie’s disease

If you have very little penile curvature, no discomfort, and no sex issues, you may not need to treat Peyronie’s disease at all. Some instances of Peyronie's disease resolve on their own. Consult with your healthcare practitioner or family physicians to determine which alternatives are best for you.

There is no treatment for Peyronie's disease, however there are always ways to ameliorate the alterations in the penis. There are several treatments available, including stretch therapy (traction therapy), medicines, and even surgery.

Surgery

Surgery has been demonstrated to be the most effective therapy for Peyronie's disease in terms of treating penis curvature. However, it is normally only suggested in extreme situations for individuals who have curvature for more than 12 months and have not responded to nonsurgical treatments.

What can I do without medicine or surgery for Peyronie's?

Traction therapy

This therapy involves stretching the penis and sometimes even bending the penis opposite of the direction of the curvature. This promotes the regeneration of scar tissue, which improves curvature, length, and even the hardness of erections.

The traction therapy device must be used every day for months to demonstrate results with this healing process. Many guys sleep with it. This therapy has had no long-term negative effects. Men may need to buy the device themselves, although insurance companies frequently compensate them. However, most devices are not FDA-approved for traction, but according to the Journal of Sexual Medicine, some devices can be effective.

Penis pumps

Many doctors utilize vacuum erection devices to treat men with Peyronie's disease. However, the FDA made a non-binding statement that using a penile pump may worsen pre-existing problems including Peyronie's disease. The FDA released this advice statement on December 28, 2004. Several clinical trials have been conducted to investigate the use of a penis pump to treat Peyronie's disease.

The British Journal of Urology published a study titled "The role of vacuum pump therapy to mechanically straighten the penis in Peyronie's disease" that concluded vacuum therapy can improve or stabilize the curvature of Peyronie's Disease, that it is safe to use in all stages of the disease, and that it may reduce the number of patients who require surgery.

Penile injections

The sole FDA-approved pharmacological treatment for Peyronie’s disease is collagenase clostridium injections. The drug's enzyme decreases plaque, which improves penile curvature. Two injectable procedures are part of the collagenase clostridium therapy cycle. Your second injection will be administered one to three days after your initial injection session.

Other injection treatments include:

Injections of IFN: Interferon helps reduce edema and scarring. It generates an enzyme that delays the formation of scar tissue.

Verapamil shots: This medicine is used to treat high blood pressure, but it also helps with penile discomfort and curvature when injected into Peyronie's plaque.

What drugs treat Peyronie's?

Medication can be administered orally or injected into the penis. Oral drugs are less effective than injections. Injections directly into the scar tissue can help break down the scar and improve penis curvature. Medications might be utilized in the acute period or for men debating surgery. No medication produces a straight penis.

There is no 100% effective oral medicine for Peyronie's disease. These oral medicines may help:

NSAIDs. Ibuprofen and other anti-inflammatory drugs may help relieve discomfort

Vitamin E: oral Vitamin E will aid to shrink the plaques and straighten the bent penis. (Cialis®) Daily tadalafil enhances penile blood flow and may slow scarring.

Pentoxifylline. Although it increases blood flow, it might produce nausea.

L-arginine. Blood flow can be improved with L-arginine.

Colchicine. Colchicine reduces edema.

Aminobenzoate (Potaba). These vitamins may help decrease plaque size but not the penis curvature.

Vitamin B is rumored to also be beneficial, but there is little evidence to back it up.

Li-ESWT

Extracorporeal shockwave therapy for refractory penile discomfort and plaque size reduction may be effective in the medical management of Peyronie's disease. However, penile discomfort usually disappears on its own over time, and shockwave therapy in the doctors office can be expensive for individuals. Thankfully, due to modern technology, home treatments are now available and are very promising

Penile prosthesis

To improve the stiffness, girth, and straighten the penis in patients with Peyronie's disease and erectile dysfunction, an inflated penile prosthesis surgery or, a penile implant is implanted.

When to see a doctor

Consult your doctor as soon as you discover signs or symptoms of Peyronie's disease. Early therapy provides you the best chance of improving — or preventing — the problem from worsening. If you've had the disease for a while, consult a doctor if the discomfort, curvature, length, or other abnormalities affect you or your spouse.