How to Straighten the Peyronie's Curve Without Surgery
Despite nearly 500 years of documentation, researchers still know relatively little about Peyronie's disease, particularly the reason some men are more prone to its development than others.
The condition was first observed in 1561 by Italian researcher Gabriel Fallopius, the same man who identified and named fallopian tubes, and anatomist Andreas Vesalius, though they didn't provide much detail. About 200 years later, in 1743, Francois Gigot de la Peyronie produced the first full description of the condition and provided the condition its name.
Despite being somewhat common, affecting 1 in 100 men in the United States—some experts suggest this may be higher due to the number of men who don't see a doctor about the condition—Peyronie's disease remains a fairly obscure topic among the population at large.
How Peyronie's develops
"Well, first and foremost, it's not really a disease," said Gregory Bernstein, M.D., a urology specialist with VHC Health in Arlington, Virginia. "That's not really the best way to describe it. It's not a disease. It's really more of a deposition of scar and plaque that's formed along some of the tissues in the penis, and it's not indicative of any other underlying medical condition."
Bernstein mentioned that many patients who experience Peyronie's disease come to him in a panic, worried they've developed some horrible disease. He said explaining the condition to them almost always sets their mind at ease.
In truth, Peyronie's develops as a result of both trauma to a man's penis and the subsequent healing. The body responds to this trauma as it's supposed to: by developing scar tissue. For men with Peyronie's, this scar tissue results in hardened plaque in the tissue of the penis, which is far less malleable and, therefore, doesn't extend as much as the surrounding tissue, resulting in a curvature.
"People with Peyronie's often report curvature of the penis, narrowing of the penis, feeling a plaque/nodule in their penis, decreased length, pain with erections, difficulty assuming all sexual positions, erectile dysfunction and decreased confidence," said reconstructive urologist Paul Chung, M.D., who serves patients in Philadelphia and Cherry Hill, New Jersey.
When people hear the word "trauma," they generally assume a serious event must have occurred—a vehicular accident or excessive blunt force to the groin—but Chung said many men develop Peyronie's because of microtraumas to the penis. These include penetration with a weak erection, vigorous sex, pressure from a partner's pubic bone or "buckling," which can fracture the penis.
"Over time, that repetitive-injury, repetitive-repair [cycle] leads to scar tissue that forms, and scar tissue that becomes harder and more solid and calcifies," Bernstein said.
Nonsurgical treatments for Peyronie's
For many men experiencing severe Peyronie's symptoms, such as pain or difficulty engaging in intercourse, surgery is the clear path to recovery. However, not all men want to undergo surgery, and some men might not experience symptoms severe enough to warrant surgery in the first place.
Men with only slight curvature and pain, for example, might opt for traction therapy, a method in which a worn device stretches or bends the penis in the direction opposite the curvature. The device aids in helping scar tissue recycle into more normal tissue, decreasing the curvature and restoring length and erection hardness to the penis.
The caveat is men need to wear the device for several months, including while they are asleep, to achieve results. In addition to inconclusive, anecdotal evidence that these devices significantly improve the effects of Peyronie's, the success of this treatment is also reliant on the consistency with which men use it.
"I bet the compliance is pretty low, to be perfectly honest," Bernstein said, reiterating a lesson he's learned over the past 20 years of treating the condition: Not enough men go to their doctor about penile issues. It's not unrealistic to think they'd also be unlikely to follow up on using a traction device for hours each day.
"These therapies have varying success and different requirements for duration of treatment," said Chung, who identified two other commonly discussed nonsurgical treatment options for Peyronie's: injections and oral therapy.
Oral therapy for treating Peyronie's generally involves taking a series of agents, such as omega-3 fatty acids, vitamin E, tamoxifen, phosphodiesterase 5 (PDE5) inhibitors and pentoxifylline. However, the official guidelines set forth by the American Urological Association are strict regarding clinicians' recommendation of many of these agents in the treatment of Peyronie's, and research on their efficacy is limited to small sample sizes with results that are not easily reproduced.
The only other nonsurgical option for treating Peyronie's is through injections administered by urologists. Of these, the only option approved by the Food and Drug Administration is Xiaflex.
"[Xiaflex] has shown statistically, evidence-based, to have some improvement for men with Peyronie's plaque and functional curvature," Bernstein said "There is some definite improvement that we see with treatment with Xiaflex."
According to Bernstein, injections of Xiaflex, which is basically an enzyme injected into the plaque, are generally performed over the course of eight sessions. These injections, along with straightening and stretching exercises, have been shown to reduce curvature by 30 percent on average.
The goal of injection therapy and stretching isn't to completely straighten the penis, though. Rather, this method intends to decrease curvature enough to make the penis functional.
"The vast majority of men that have evidence or symptoms and signs of Peyronie's probably don't need any sort of intervention or treatment," Bernstein said. "The reason I say this is that although there might be a bend or a curve to the penis, if [a couple is] able to engage in satisfactory sexual activity, there's no pain or discomfort, and there are no difficulties with penetration, then we generally feel that treatment is worse than the actual process of what's going on with the scar tissue."
The pathophysiology of Peyronie's disease remains a relative mystery to most clinicians and researchers, and while nonsurgical treatment options exist, the literature on them suggests anecdotal evidence derived from limited samples. As it stands, the "gold standard" of treatment for severe or painful cases of Peyronie's disease is still surgery.
However, as more men talk about Peyronie's and contribute to researching it, the more the medical profession will understand its causes and treatments.
