What Every Man Should Know About Peyronie’s Disease
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Noticing a bend in your penis can be, to put it mildly, unsettling—especially because you might feel like you’re the only guy it’s ever happened to. “This isn’t the kind of thing you get a beer and talk to your buddies about,” says Frederick Taylor, MD, a men’s health specialist and urologist with Central Ohio Urology Group.
But Peyronie's disease, with its hallmark penile curvature, is more common than you think—approximately one in 100 men will experience a change in the appearance of his penis in his lifetime. Some experts believe that number might be higher than reported, as not all men with the condition are being diagnosed with Peyronie’s disease. Here’s what you need to know about the condition and why it’s crucial to see a doctor when you first notice something’s not normal down there.
How to Know You Have Peyronie’s Disease
If your penis starts looking or working differently, that could be a sign of the condition. “You’ll notice one of a few changes in the appearance of your erect penis,” says Dr. Taylor. “It could be a curvature in any direction—upwards toward the ceiling is most common, but any direction is possible—or a narrowing or hourglass effect.”
These changes don’t just impact the look of your penis. They also affect the way it functions, making it harder to have sexual intercourse; you might also have pain with an erection. Your doctor can make the diagnosis after taking a look at your penis and performing an ultrasound, which reveals blood flow and any scar tissue inside it.
What Causes the Condition
“It’s called a disease, but it’s really not one,” says Stanton Honig, MD, professor of clinical urology at Yale School of Medicine. “Peyronie’s disease is actually an injury.” Maybe you got hit by a ball playing sports, or a dog jumped on you unexpectedly, or maybe you were having sex and your penis slipped out and accidentally hit your partner’s pubic bone. “About one in five men can recall a specific injury, but most of the time they don’t remember anything in particular,” says Dr. Honig.
In the vast majority of cases, normal sexual activity is to blame. “Every time you have an erection or intercourse, you create microscopic traumas to the tissues in the penis,” says Dr. Taylor. “It’s no different from bumping your knee on your coffee table.”
Normally, your body repairs those microtraumas without you even realizing it, but in some cases, the healing goes awry, and scar tissue is left behind. That scar tissue, also called plaque, doesn’t behave the same as normal healthy tissue. “As a result, your penis can’t stretch and fill with blood the way it normally does,” explains Dr. Taylor. The resulting condition is Peyronie’s disease.
What Puts You At Risk for Peyronie’s Disease
Peyronie’s disease can affect anyone, but there are a few conditions that can increase the likelihood it may happen to you. Around 11 percent of men with Peyronie’s disease have either type 1 or type 2 diabetes, suggesting a strong link between these conditions. There’s also a disorder called Dupuytren’s disease, which impacts the way your fingers bend. Men who hav that are more likely to develop Peyronie’s disease. “We think the molecular mechanisms are exactly the same in both diseases, even though they show up in two very different parts of the body,” says Dr. Taylor.
Other Conditions Linked to Peyronie’s Disease
Having Peyronie’s disease can put you at risk for additional health issues, both mental and physical. Nearly half of men living with Peyronie’s disease need to be evaluated for depression, according to a study published in The Journal of Sexual Medicine that looks at the impact of the condition on men. “There is almost always an emotional component to dealing with Peyronie’s disease,” says Dr. Taylor. “Any change in the penis is going to cause a lot of anxiety and depression and could potentially negatively impact a man’s relationship with his partner.”
You might also experience erectile dysfunction as a side effect of Peyronie’s. “This can be related to the anxiety you feel, because your penis has changed and you worry about how it will function, which makes it harder to have an erection,” says Dr. Honig.
Top Treatments for Peyronie’s Disease
When you see your penis starting to change, it’s natural to want to take action right away, but your doctor might have other ideas. “We don’t typically do any major treatment until things stabilize, because we don’t want to treat the penis and then have it get worse again,” says Dr. Honig. “Usually that process takes about a year from when the penis was injured.” During that phase, your doctor might suggest an over-the-counter pain reliever or an erectile disorder medicine to help with symptoms.
Once your penis has stabilized, it’s time to decide which treatment path to take—if any. “There are different ends of the spectrum,” says Dr. Honig. “If you can still get an erection and you just have a little curvature that doesn’t bother you too much, your doctor may just let you be.” In that case, you’ll want to keep an eye on it. “Eighty-five percent of the time, the curvature remains unchanged from this point, 5 percent of the time it gets a little worse, and 10 percent of the time it actually gets a little better,” says Dr. Taylor. “I have patients come back six months after they see me to check, and from then it’s just annual visits or as needed.”
If your Peyronie’s disease is more severe, impacting intercourse or causing depression, it’s time to treat it. At that point, here are your options:
Injectable medications: For men with moderate Peyronie’s disease, the first treatment approach may be a series of collagenase injections to break down the tissue or plaque. “This can result in a 20-degree improvement in the curvature,” says Dr. Taylor. “So it’s a reasonable place to start but might not be the best option if you have a more severe curve.” The thought of injecting medications into your penis may make you wince, but it’s the only way to get the medication into the scar tissue where it’s needed to break down the plaque. If you fit the profile, “it’s a good treatment,” says Dr. Honig. “Around 70 percent of men will have improvement.”
Plication: In this surgical procedure, your doctor will put stitches on the opposite side of the curve to straighten things out. “If the penis curves to the right, we put stitches on the left to bend it back,” says Dr. Honig. “The results of surgery are very good, but the penis can end up a little shorter.”
Grafting: For more extreme curvatures, your doctor can open up your penis, remove the scar tissue causing the curvature, then sew some graft tissue in there. “The graft tissue can hold the blood during an erection, creating normal function,” says Dr. Taylor.
Penile Implant: “We perform this for men who have Peyronie’s disease as well as erectile dysfunction, because the penile implant will fix both problems,” says Dr. Taylor. This more complicated surgery involves inserting an implantable penis pump, which both straightens the penis out and creates an erection.
With multiple options to choose from, you’re going to want to see a specialist. “The most important thing is to find a doctor who is familiar with Peyronie’s disease,” says Dr. Honig, who recommends looking at the provider’s listing on the website for the Sexual Medicine Society of North America (SMSNA). “You want a doctor who is aware of all the treatment options, so that you get the best care.”
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