Peyronie’s Disease Treatment

Peyronie's Disease: Overview

Peyronie's disease is a benign (non-cancerous) condition in which fibrous scar tissue (called plaque) forms on the penis that causes an increase in its curvature leading to painful erections. Significant pain or bend can be a cause of concern, as it prevents you from having sexual intercourse or getting/maintaining an erection (a condition known as erectile dysfunction). 

This disease rarely gets cured on its own and mostly remains as is or worsens. However, early medical intervention will prevent it from getting worse and improve symptoms such as pain, curvature, and penile shortening.

Causes Of Peyronie's Disease

The exact cause of Peyronie's disease is unknown. Several factors are said to be at play.

It can result from recurrent injury to the penis (damage caused either during sex, athletic activity or due to an accident). The body attempts to heal the wound which results in disorganized scar tissue formation that can be felt by the patient as a nodule or is seen as a curve.

• Each side of the penis consists of a tube (corpus cavernosum) consisting of several small blood vessels and the tube is encased within a sheath of elastic tissue called the tunica albuginea (that stretches during erection).
• During sexual arousal, blood flow increases in the tubes/cylinders, causing an erection.
• In Peyronie's disease, when the patient's penis becomes erect, the scar tissue doesn't allow the stretching. As a result, the penis becomes deformed and painful. 

In some cases, Peyronie's disease may not be associated with any injury. Further research is on to find the link between the disease, heredity, and certain health conditions.

Risk Factors For Peyronie's Disease

Minor injury to the penis accompanied by various factors can lead to poor wound healing and scar tissue build-up, which may contribute to Peyronie's disease. 

These factors include:

• Heredity: If someone in your family has this condition, you may be at risk.
• Connective Tissue Disorders: Those who have some connective tissue disorders may be at risk for Peyronie's disease, for example, those with Dupuytren’s contracture.
• Age: This condition may occur at all ages but is more likely in older men, especially in their 50s and 60s. A small amount of curvature in younger men is normal, often not related to Peyronie’s disease; it is known as congenital penile curvature.
• Some health conditions, smoking, and certain types of prostate surgery: Might also be linked to Peyronie's disease.

Moreover, diabetes with erectile dysfunction and engagement in vigorous sexual/nonsexual activities causing micro-injuries to the penis also count as risk factors for this condition.

Symptoms of Peyronie's Disease

The symptoms of Peyronie's disease can vary in severity and may include:

• A flat lump or hard tissue under the skin of the penis that can be felt.
• Excessive curvature of the penis downward/upward/ bent to one side.
• Erectile dysfunction or difficulty getting or maintaining an erection.
• Shortened or narrowed penis due to the scar tissue.
• Penile pain with or without an erection. The pain can range from mild to severe.
• Other penile deformities like indentations, narrowing, or an hourglass-like appearance of an erect penis.

The symptoms may worsen with time. However, the condition stabilizes after 3 to 12 months. Also, pain during erections generally improves in a year or two, but other symptoms often remain. In some men, though rare, both pain and curvature associated with Peyronie’s disease improve without any treatment.

Complications Of Peyronie's Disease

• Difficulty getting an erection (erectile dysfunction).
• Difficulty with sexual intercourse resulting from the curvature.
• Anxiety and stress (about sexual abilities, penis appearance, and relationship with a partner).
• Painful or uncomfortable erections due to the curvature.
• Difficulty fathering a child as sexual intercourse becomes difficult/impossible.
• Penile shortening, leading to functional problems.

Peyronie's Disease Diagnosis

The doctor often requires only a physical examination to identify the scar tissue in the penis and diagnose the disease. Rarely do other conditions produce such symptoms.

Physical Examination: The doctor feels the penis (when it isn’t erect) to know the amount and location of scar tissue. S/he may measure the penis length, which later helps judge if the length has reduced or not. Photos of an erect penis may also help identify the degree of curvature, scar tissue locations, and more details to help determine the best treatment. 

Other Tests: Ultrasound, the most common test for penis abnormalities, or other tests (in an erect penis) may be prescribed. An injection is given directly into the penis to make it erect. An ultrasound test uses sound waves and produces images of soft tissues to display blood flow, the presence of scar tissue, and other abnormalities.  In some cases, the healthcare provider may order blood tests or imaging studies, such as an MRI, to rule out other conditions that can cause similar symptoms.

Peyronie's Disease Treatment

There are several treatment options available for Peyronie's disease, depending on the severity of the condition and the symptoms you are experiencing. 

There are two phases of the condition based on the symptoms:

• Acute phase: This marks the early phase of the disease with symptoms like pain and curvature, lasting for two to four weeks, or even up to a year or more.
• Chronic phase: This phase is marked by stabilizing symptoms, no pain, and no changes in curvature. It occurs 3-12 months after the onset of symptoms.

Now, in the acute phase, penile traction therapy might be recommended. It minimizes the curve and prevents loss of length. While injection and medical therapies are optional during this phase, surgery is only recommended when the symptoms are severe. The following are the various treatment options for Peyronie's disease.

Medications: Oral medicines haven’t proven as effective as surgery. It’s been found that sometimes drugs injected directly into the penis may reduce pain and curve/curvature. Multiple injections might be given over several months. Injection medications might be used in combination with traction therapies or oral drugs.

Traction Therapy: A mechanical device is used for a specified time to improve penile length, deformity, and curvature. Penile traction therapy is the only treatment that has shown improvement in penile length. It is recommended in the early phase, but might also be used in the chronic phase when combined with other treatments or post-surgery for better outcomes. 

Surgery: In case of severe deformity and inability to have sex, surgery might be suggested. Surgery is recommended after 9-12 months of the condition, once the curve stops increasing and stabilizes for at least 3-6 months. Three of the common surgical approaches are suturing (plicating) of the unaffected side, penile implants, and incision or excision and grafting. 

Iontophoresis: This is another treatment technique that is effective for Peyronie’s disease which uses an electric current, is under investigation along with several nondrug treatments (such as radiation therapy).  

It is important to discuss the available treatment options with your healthcare provider to determine the best course of action for your specific situation. In some cases, a combination of treatments may be recommended for the best outcomes.

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