Straight talk about Peyronie's disease
The condition can make intercourse painful.
- Reviewed by Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
While erectile dysfunction (ED) remains the top sexual issue for older men, another condition that can affect their sex life is Peyronie's disease, a disorder marked by significant curvature of the penis.
Peyronie's disease, named after French surgeon François Gigot de la Peyronie, who first described the condition in 1743, affects about 3% to 10% of men. It usually strikes between ages 45 and 60, but also can occur in men older than 60.
It's not clear what causes Peyronie's. The leading theory relates to repeated trauma or an injury to the penis during sex. "Research has found that men who engage in more vigorous or frequent intercourse appear more likely to develop Peyronie's," says Dr. Martin Kathrins, a urologist with Harvard-affiliated Brigham and Women's Hospital.
The inflammation from trauma is thought to cause scar tissue (also referred to as plaque) to form in the corpora cavernosa, the spongy erectile tissue in the penis. Over time, this plaque builds up and prevents the penis from expanding normally, causing it to curve upward or bend to one side. (It's rare for the penis to curve downward.)
Watch the curve
Many men's erections have a curvature ranging from about 10° to 20°, which is not bothersome. In Peyronie's, however, the bend can reach 90° or even more. "The curvature or bending can make erections painful, prevent men from having intercourse, or make sex painful for the man and his partner," says Dr. Kathrins.
About half of men with Peyronie's first notice pain during intercourse. Often the penis feels firm or lumpy at the painful site. The curvature then gradually follows. Peyronie's shortens the penis, and many men also experience ED. However, the condition doesn't cause problems with urination. It's also unclear if it's related to prostate cancer. "However, men who've had surgery for prostate removal tend to be at a higher risk for Peyronie's," says Dr. Kathrins. The condition also runs in families and is sometimes associated with scar tissue formation in other parts of the body, like the palms and the soles of the feet.
Two phases
Peyronie's has two phases: active and passive. The active phase involves the initial plaque formation and can last from three months to a year. "This is when men first notice pain during erections and changes in the penis's shape and curvature," says Dr. Kathrins.
In the passive phase, the plaque has set, so the curvature in the penis doesn't get worse. The pain is usually gone by this time, but it can occur with erections or come and go. The passive phase also is when ED happens.
If you notice pain during intercourse or changes in your penis's appearance, see your doctor. He or she will ask you about your symptoms and examine your penis, looking for tender, firm areas of scar tissue. Usually, this is all that is needed to diagnose the problem. Your doctor may also order an ultrasound to look for calcium deposits in scar tissue.
Treatment options
There is no cure for Peyronie's, and the condition usually does not improve on its own, but in mild cases, men can maintain a regular sex life.
If the curvature is severe, making erections or intercourse painful, some treatments may help. For example, traction therapy uses a device to stretch the penis. This encourages the scar tissue to be recycled into more normal tissue and can reduce curvature and restore length.
One FDA-approved traction device often recommended is RestoreX. The device is worn three times daily, for five to 10 minutes each time for the first few days and then for 15 minutes at a time for a week. After that, it is worn twice daily for 30 minutes at a time until the curvature has improved enough for sex.
Another possible option is a vacuum constriction device. This draws blood into the shaft of the penis and may slow curvature progression.
Other treatments include medication and surgery. The most common Peyronie's drug is pentoxifylline, which is taken orally to treat poor blood circulation. Some research has shown it provides modest improvement.
Another choice is the enzyme collagenase clostridium histolyticum (Xiaflex). Injected into the penis, the drug helps to gradually break down plaque. Injections are given in three or four treatment cycles. Each cycle consists of two injections given a few days apart, followed by a six-week rest period. Another injectable drug is verapamil, which also works to break down plaque. Treatment consists of six injections given at two-week intervals.
If devices or drugs produce no improvement, the final option is surgery to correct the curvature. "Surgery should be reserved for men with significant pain or sexual impairment, and it should never be undertaken until Peyronie's has entered the passive phase and the disease has stabilized," says Dr. Kathrins. While surgery often works well, some curvature may remain.
Image: © Andres Barrionuevo Lopez/Getty Images
About the Author
Matthew Solan, Executive Editor, Harvard Men's Health Watch
About the Reviewer
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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