Peyronie's Disease: Causes and Treatment Options
Peyronie’s Disease is an inflammatory condition of the penis that causes penile curvature and an uncomfortable or painful erection that can dramatically interfere with one’s sexual health. It’s not uncommon, with more than 120,000 cases per year in the USA (only a small fraction of cases are actually treated.) Although it can manifest at any age, it most commonly occurs in 50-60 year olds.
What causes Peyronie’s Disease?
Essentially, Peyronie’s Disease is caused by scar tissue in a bad location, which sabotages the ability to obtain a straight and rigid erection. It causes fibrous, inelastic “plaques” of the sheath surrounding the erectile chambers within the penis, resulting in deformities of the penis during erections. It can also cause a hard lump or lumps, shortening, curvature and bending, narrowing, and/or a visual indentation of the penis described as an hourglass deformity. These deformities lead result in painful, less rigid erections that can dramatically interfere with one’s sexual and psychological health.
The underlying cause of Peyronie’s is unclear, but is suspected to be penile trauma—perhaps associated with excessive bending and buckling from sexual intercourse—that activates an abnormal scarring process. The acute phase is characterized by painful erections and an evolving scar, curvature and deformity. The chronic phase typically occurs up to 18 months after initial onset and is characterized by resolution of pain and inflammation, stabilization of the curvature and deformity, and possible erectile dysfunction.
What are the side effects of Peyronie’s Disease?
Penile pain, curvature, and poor expansion of the erectile cylinders contribute to difficulty in having a functional and anatomically correct rigid erection suitable for intercourse. The curvature can range from a very minor, barely noticeable deviation to a deformity that requires “acrobatics” to achieve vaginal penetration, to an erection that is so angulated that intercourse is impossible. The angulation can occur in any direction and sometimes involves more than one angle, depending on the number, location and extent of the scarring. Although the scarring is physical, it often has psychological ramifications, causing anxiety and depression.
Peyronie’s regresses in about 15% of men, progresses in 40% of untreated men, and remains stable in 45% of men. Many men become very self-conscious about the appearance of their penis and the limitations it causes, and they may avoid sex entirely.
What are the treatment options for Peyronie’s Disease?
Treatment options include:
- Oral medications
- Topical agents
- Injections into the scar tissue
- Shock wave therapy
- Surgery
Upon initial diagnosis, most men are started on oral Vitamin E, 400 IU daily, as this has the potential to soften the scar tissue causing the plaque. Many of the treatments listed above are not particularly effective because scar tissue is a challenging problem.
If there is an unsatisfactory response to conservative treatment options, a penile implant may be appropriate. This can manage the dual problems of erectile dysfunction and penile angulation. If erections are adequate, but angulation precludes intercourse, options include procedures that attempt to counteract the curvature by doing a nip and tuck opposite the plaque in an effort to make expansion more symmetrical. Although this technique is effective in improving the angulation, it does so at the cost of penile shortening. Other more complex procedures involve incising or removing the scar tissue and using grafting material to replace the tissue defect.