When a Curve Isn't Just a Curve, Is It Peyronie’s?

For a condition that affects 5 to 10 percent of men, Peyronie’s disease is surprisingly little known.

Peyronie’s occurs when scar tissue or a growth of fibrous plaque builds up on one side of the shaft of the penis, or on top or underneath, and causes a distinct new bend when the organ is erect. In some cases, the plaque can grow to encircle the entire shaft, resulting in an hourglass-shaped penis. In others, the growth can cause the penis to bend sharply up or down—as severely as 90 degrees on rare occasions.

Peyronie’s has two stages: acute, where the man experiences painful erections and a change in penile curvature (the pain is treated with nonsteroidal drugs such as Advil during this phase); and chronic, where the pain has usually subsided and curvature is the only issue.

The disorder, named after the 18th-century French doctor who first studied it extensively, can lead to discomfort and even severe pain during sex. Sometimes this pain can be so acute it results in difficulty maintaining an erection.

Who is most likely to get Peyronie’s?

Researchers believe the most common cause of Peyronie’s disease is trauma, either during sex or some other type of physical activity. Some 200,000 men per year are diagnosed with Peyronie’s in America, and a large majority are believed to have developed it after sustaining an injury during vigorous sexual activity.

Any of the following can put you at higher risk for Peyronie’s:

• Vigorous physical activity, especially sex, that causes micro-injuries to the penis
• Autoimmune disorders
• Connective tissue disorders
• A family history of Peyronie’s
• Diabetes
• Erectile dysfunction (ED)
• A history of prostate cancer treatment
• Advanced age

Peyronie’s & low testosterone

Numerous studies suggest an association, though no direct causal link, between low testosterone (low-T) and Peyronie’s. One study showed that within a group of 121 patients with Peyronie’s disease, as many as 74 percent also had low-T.

Furthermore, the study’s authors also showed a correlation between low-T and the degree of penis curvature of men with Peyronie’s. Additional research supports this connection, with another study suggesting low-T may exacerbate the symptoms of Peyronie’s.

Treatment for Peyronie’s

While there’s no cure for Peyronie’s, treatments are available. The type of treatment depends on how much the symptoms affect the man, and it’s important to establish realistic expectations for the disease's outcome.

Most doctors prefer to take a "watch and wait" approach for men who aren’t facing severe symptoms of Peyronie’s. If the degree of penile curvature is 30 degrees or less, many urologists and general practitioners feel it is best not to intervene. That’s because the most effective option is a series of injections, directly into the penis, of a drug called clostridium hystolyticum (Xiaflex), which aids in breaking down collagen.

In addition, patients receiving Xiaflex injections are told to stretch their penis daily for 30 seconds at a time, and to straighten their penis for 30 seconds when they experience a spontaneous erection unrelated to sex. The use of injection therapy depends on the degree of curvature, with the usual recommendation of 30-90 degrees meeting the criteria for injections.

Other potential treatments being studied include:

• Verapamil taken orally or by injection (typically used to treat high blood pressure)
• Penis stretching using penile traction therapy
• Penile vacuum devices

Invasive treatment options include surgery. One surgery either lengthens the affected side or shortens the unaffected side. Another involves the placement of penile implants. Surgery is only considered for men who are in the chronic phase of Peyronie’s and have severe sexual dysfunction or severe curvature.

If you are experiencing pain, discomfort or anxiety about the onset of Peyronie’s disease, be sure to speak with your partner about it, as well as your physician.