Condition: Peyronie’s Disease
Brief Overview: Peyronie’s disease is a connective tissue disorder of the penis characterized by the development of fibrous scar tissue (plaques) within the tunica albuginea. This causes abnormal curvature, indentation, or shortening of the penis during erection, which can lead to pain, difficulty with sexual intercourse, and psychological distress. The condition may stabilize or worsen over time and has both acute (active) and chronic (stable) phases.
Stages of Peyronie’s Disease (from Urology Care Foundation):
- Acute Phase: The acute phase usually lasts for 5 to 7 months but can last up to 18 months in rare cases. During this time, the plaques form in the penis, the bending/curving of the penis gets worse and you may feel pain when your penis gets hard.
- Chronic Phase: The chronic phase is when the plaque stops growing and the penis doesn't bend any further. If there was pain with erection during the acute phase, it often will have ended by this time.
Prevalence: According to Urology Care Foundation, “Peyronie’s disease is thought to happen in about 4 out of 100 men between the ages of 40 and 70.”
Etiology:
- Injury to the penis (vigorous intercourse, sports, trauma, etc.)
- Injury to the tunica albuginea that leads to excessive scar tissue formation
Risk Factors:
- Family history
- Increasing age
- Dupuytren's contracture
- Genital/perineal injuries
- Radical prostatectomy
- Plantar fascial contractures
Commonly Associated Conditions:
- Dupuytren's contractures
- Vascular disease
- Erectile dysfunction
- Depression, anxiety, relationship difficulty/distress
- Diabetes
Common Medications:
- NSAIDs
- Pentoxifylline
- Intralesional injections of collagenase clostridium histolyticum or verapamil
Common Labs, Imaging, and Tests:
- Physical exam
- Ultrasound may be indicated
Common Symptoms:
- Penile pain
- Penile nodules/plaques
- Penile indentation, curvature, or deformity
- Penile shortening during erection
- Sexual dysfunction, sexual discomfort
Common Treatments:
- Typically managed by urology
- Sometimes no treatment is needed
- Intralesional injections of collagenase clostridium histolyticum
- Intralesional verapamil
- Penile traction therapy
- Management of erectile dysfunction, if present
- Surgical intervention may be indicated
Physical Findings:
- Palpable, firm plaque along dorsal or lateral aspect of penis.
- Penile curvature during erection.
- Possible shortening or indentation deformity.
Potential Complications and Contraindications:
- Increased risk of depression, relationship difficulties, lowered self-esteem, and body image issues
- Progressive curvature leading to sexual dysfunction
General Health and Lifestyle Guidance:
- Encourage open communication with partners to reduce psychological stress.
- Avoid vigorous sexual activity during active phase to prevent worsening injury.
- Quit smoking and work with your healthcare provider(s) to manage any chronic health conditions (diabetes, hypertension).
- Consistent follow-up with urology to monitor curvature and treatment response.
- Supportive counseling or therapy for sexual or emotional distress.
- Promote healthy circulation and tissue health through regular exercise (as approved by healthcare provider) and balanced nutrition.
Suggested Questions to Ask Patients:
- When did you first notice penile curvature or pain?
- Has the curvature worsened or stabilized over time?
- Are erections painful or difficult to maintain?
- Does the curvature prevent sexual activity?
- Have you noticed any palpable lumps or hard areas on the shaft?
- Are you currently being treated for erectile dysfunction or diabetes?
- Has this condition affected your confidence or relationships?
- Are you interested in exploring treatment options (medications, traction, or surgery)?
Suggested Talking Points:
- Peyronie’s disease is a common, treatable condition that develops from scar tissue in the penis.
- Many men experience improvement or stabilization with medications or nonsurgical treatments.
- Early intervention during the active phase can prevent worsening curvature.
- Treatment focuses on reducing curvature, improving function, and maintaining quality of life.
- Emotional and relationship support are important—this condition is medical, not psychological.
- Surgery may be an option if curvature prevents sexual function once the disease is stable.
- Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.
Sources:
- https://www.uptodate.com/contents/peyronies-disease-diagnosis-and-medical-management?search=peyronie%20disease&source=search_result&selectedTitle=1~18&usage_type=default&display_rank=1
- https://www.niddk.nih.gov/health-information/urologic-diseases/penile-curvature-peyronies-disease#common
- https://www.urologyhealth.org/urology-a-z/p/peyronies-disease
- https://www.nhs.uk/conditions/peyronies-disease/