Curvature of the Penis (Peyronie's Disease)

What is curvature of the penis (Peyronie's disease)?

Peyronie's disease is a condition in which there is a prominent curve in the penis.

Many men have a slight curve in the penis. As long as there is no pain or problem with sexual performance, men with a slightly curved penis should not be concerned. They do not need to see a doctor.

However, some men develop a more serious bend in the penis. This bend interferes with sexual function or causes pain.

This occasionally happens after the penis is injured. Injury may occur during sexual intercourse or from trauma such as a motor vehicle or industrial accident. Most cases, however, are the result of a poorly understood process known as Peyronie's disease.

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In Peyronie's disease, inflammation and scar tissue form along the shaft of the penis. No one is certain why this problem occurs.

You may feel the inflammation and scar tissue as a painful lump or area of unusual firmness. In many men, the scar tissue causes the penis to bend or shorten. This is because it prevents the penis from expanding normally.

Men with Peyronie's disease often have difficulty achieving a firm erection. But it is unclear whether this occurs first or is caused by the scar tissue.

Most men with the problem are at least 45 years old. The disease can run in families.

In 10% to 20% of men with Peyronie's disease, there is scarring in other parts of the body, especially the hands, feet, and eardrum.

Sometimes, a serious curvature of the penis is seen in boys at or shortly after birth. This is not Peyronie's disease. Most of these cases are thought to be caused by abnormal development in the womb. They may be associated with other abnormalities of the penis.

Symptoms of Peyronie's disease

About half of men with Peyronie's disease will first notice pain during intercourse. Symptoms may appear suddenly or may develop slowly over time. Often the penis will feel firm or lumpy at the painful site.

Other men with Peyronie's disease will notice a painless curve of the penis that can occur suddenly or get worse over time. The penis may curve up, down, or to either side. Severe changes in the shape of the penis may prevent the man from having intercourse.

Peyronie's disease is distinct from a single injury that occurs during sex, when there may be a sensation or sound of a "snap" followed by loss of erection and the appearance of a bruise. Part of the penis may remain painful for a while, but usually the area will heal over time even if scar tissue forms. This problem is different from Peyronie's in that it rarely leads to difficulties with erections or shortening of the penis.

Diagnosing Peyronie's disease

Your doctor will ask you about your symptoms. He will examine your penis, looking for tender, firm areas of scar tissue. Usually, this is all that is needed to diagnose the problem.

If your doctor needs more information, he or she may order an x-ray, ultrasound, or CT scan to look for calcium deposits in scar tissue. Your doctor may ask you to bring in photographs of your erect penis to better determine the extent of the damage.

Expected duration of Peyronie's disease

How long Peyronie's disease lasts is difficult to predict. In more than a third of men, there is gradual improvement over 12 to 18 months without any specific treatment. In others, the scarring is permanent or worsens over time.

Preventing Peyronie's disease

There is no known way to prevent Peyronie's disease.

Treating Peyronie's disease

Most men with curvature of the penis do not need any treatment. This is true regardless of the cause.

Men with Peyronie's disease who experience pain or difficulty with intercourse may be offered treatment with oral pentoxifylline first. Alternatively, the doctor may suggest penile injections with collagenase or verapamil.

Corrective surgery may be offered to men with more bothersome or disfiguring symptoms that persist for more than one year. It's important to make sure that the disease has been stable for three to six months prior to surgery; successful surgery is less likely if performed at a time when the disease is getting worse.

In a typical procedure, the inflamed or scarred portion of tissue is removed from the penis and the curve is corrected by a series of sutures (stitches). Sometimes a graft is inserted into the space where the scar tissue was removed.

This surgery often works well. However, mild curvature of the penis may remain. In addition, sexual function or shortening of the penis may not improve following surgery.

For this reason, surgeons sometimes implant a penile prosthesis during surgery. In some men, a prosthesis alone is enough to straighten the curvature and improve sexual function. Men who are considering surgery should be sure to discuss all the options with their physicians.

When to call a professional

Call your doctor if

you notice new curvature of your penis
you experience pain during intercourse
you develop difficulties with erections
you notice a firm or painful lump on your penis.

Prognosis

Some men with Peyronie's disease improve without treatment. Other men have mild symptoms that can be tolerated. If the condition does not interfere with sexual activity or cause significant pain, many men may choose not to seek treatment.

Only a minority of men eventually will require surgery.

Peyronie's disease does not develop into cancer or other serious conditions.