FAQs Peyronie's Disease

Peyronie’s disease usually affects men over the age of 50, but a small number of teenagers also suffer from the disease. It is estimated that about 3-9% of men are affected by Peyronie’s disease, but the exact numbers are not known since some may be too embarrassed to bring the problem to their doctor.

The disease is also more frequent in people who have high blood pressure, diabetes mellitus, hyperlipidaemia, high colesterol, hypertension or other heart conditions. Peyronie’s disease can be a side effect of the anti-epileptic drug phenytoin. It is also more common in people who smoke or drink excessively.

The cause is still not known for sure but is thought that one-off or repeated damage to blood vessels cause blood to leak into areas of the penis which do not normally come into contact with blood, causing the body’s immune system to react. This results in scarring. Another theory is that it is caused by a defect in a person’s genetic make-up or that it is associated with low levels of the male hormone testosterone. There is also a rare, congenital form of the disease that affects a person from birth. Symptoms do not present however, until they reach sexual maturity.

People with Peyronie’s disease may suffer from:

• Painful erections – as well as areas of thickening along the shaft of the penis.
• Curved, angled or distorted shaft of the penis – most obvious when the penis is erect.

In most cases the two symptoms above will be enough evidence for your doctor to diagnose Peyronie’s disease. Occasionally they may advise you to undergo a duplex ultrasound scan to show the blood circulation of the penis.

The doctor will typically want to measure the curvature or distortion of the penis whilst it is erect, which can either be assessed by photographs you have taken at home or (more accurately) by using a vacuum pump or an injection into the shaft to stimulate an erection.

There are many non-surgical treatment options available for Peyronie’s disease but they have not proven to work for all patients. These include:

• Medication – oral and/or topical medication.
• Injections – medicine injected into the plaques, may improve pain, the size of the plaques and the amount of bend in the penis.
• Stretching – or external penile traction, which involves wearing a device which stretches the penis, with the aim of improving the length of the penis and reducing the deformity.
• Vacuum devices – these stretch the shaft by creating a vacuum around the penis.

Surgery is the only treatment guaranteed to have a beneficial effect on Peyronie’s disease. Surgery is only be offered to patients once the changes caused by the condition have settled down, which normally takes 12-18 months.

Surgery is not without risks and can include shortening of the penis and there is a chance the distortion may return. If your foreskin is already tight, you may require a circumcision as it may get even tighter after the operation. Some people report of feeling knots or stitches under the skin. You should carefully consider all these issues before consenting to surgery.

Possible surgery options include:

• Extracorporeal shock wave therapy – vibrations from sound waves are used to break down the tough fibrous plaques. Shock waves are delivered by a device outside the body.
• Nesbitt tuck procedure – removing some of the tissue from the side of the penis opposite the plaque. This straightens but shortens the penis.
• Cutting out plaque – sometimes combined with the insertion of a plastic rod (prosthesis) to counteract any shortening.
• Laser surgery – a carbon dioxide laser is used to thin the plaque.
• Plication – folding the normal tissue on itself rather than removing it completely.

If you have a mild version of the disease which does not cause much pain, if you are not sexually active, or have few or no difficulties with sexual intercourse, you may decide that you do not want treatment. About 13% of patients recover from their symptoms without treatment.