Understanding Peyronie’s Disease
What is Peyronie’s disease?
Peyronie's disease (PD) is a benign condition that causes a serious curve to your penis when erect. This is due to the formation of plaque or scar tissue on one side of the penis. The plaque can develop at any point along the penis and forms in the tunica albuginea. This plaque pulls on the surrounding tissue, leading it to cause the penis to curve, usually during an erection. This can lead to pain and erectile dysfunction.
PD occurs in 2 phases – Acute and Chronic
It is extremely important to distinguish the stage of PD you are in, as this will influence the choice of treatment and timing of potential surgery.
Acute Phase
- The plaque is developing
- Symptoms are dynamic and change over time
- Penis starts to curve
- Penis may hurt without an erection
- Erections may become painful when scarring develops
- Duration: up to 12-18 months
Chronic Phase
- The plaque is formed, 12-18 months after symptoms first start
- Symptoms have been unchanged or inactive for at least 3 months
- Penile curvature may stabilise and not get any worse, the plaque has calcified
- Pain in your penis may still be present but lessen
- Erectile dysfunction (ED) may develop or become worse
Causes
The definitive cause of PD is still unknown, but some popular theories suggest that a single traumatic event or repeated microtraumas can lead to an auto immune response leading to plaque formation in the fibres of the penis3. All men will experience some level of penile trauma during sex, however, only a few will develop PD. With that in mind, it suggests that other risk factors such as genetics, play a role in developing PD.
Injury to the penis
- These injuries can happen during sexual activity, athletic activity or an accident
- Injury could cause bleeding or swelling inside the elastic membrane
- When healed, scar tissue and plaque can form
Autoimmune disease
- An autoimmune disease can cause your immune system to attack the cells in the penis
- Leading to inflammation and a potential formation of scar tissue and plaque
- Some autoimmune diseases related to PD include:
- Dupuytren’s contracture
- Systemic lupus erythematosus
Physiological process of plaque development
Risk Factors
Genetic
Having a family history of PD
Age
Risk increases with age
Has additional disorders
Autoimmune disorders, diabetes, ED, hypertension, hyperlipidaemia
Lifestyle factors
Smoking, alcohol, low activity levels and unmanaged stress
Symptoms
Symptoms will vary between each individual and may develop at different paces. They can range in severity as well. Although, for many people’s pain will decrease over time, even if the curve in penis remains. A lump or plaque formation may not always be present, but a healthcare professional will be able to detect the plaque during a consultation.
Penile Curvature
A curve in the penis with or without an erection – can occur in different directions
Impact of PD
Peyronies disease can have big impacts on your physical, social and psychological life. Addressing your symptoms with treatment will have positive effects on those factors.
Diagnosis
Men with PD are generally referred to andrologists. They can diagnose PD based on medical/ family history and a clinical exam.
- Medical history is usually identified through questions
- The clinical exam should start with a focused genital assessment that is extended to the hands and feet to detect possible Dupuytren’s contracture or Ledderhose scarring of the plantar fascia
- A penile examination is performed to assess the presence of a palpable nodule or plaque
- An objective assessment of penile curvature with an erection is mandatory
either an injectable medicine will be used to cause an erection, or they will ask you to take a photo at home
- An objective assessment of penile curvature with an erection is mandatory
- Imaging tests are usually not needed but may be used to gain better insight on the plaque.
Diagnosis may involve identifying the stage of PD the individual is in – Acute or chronic
Current Treatment Options
The goal with treatment for PD is to reduce pain, achieve a straight or close-to-straight penis and maintain ability to have sexual intercourse.
Some people may not need treatment if you have:
- Small plaques
- Little or no curve in your penis
- No pain
- No problems with sexual intercourse
- No urinary problems
Your healthcare professional will recommend the best suited treatments to you based on:
- severity of symptoms
- how much your penis curves
- which phase of PD you are in
It is easier to treat PD in the acute phase and this is why it is extremely important to meet a specialist early.