Peyronie’s Disease

Not all curved erections or penile bumps are caused by Peyronie’s disease. It is important for men to discuss their condition with their healthcare provider.

When a man has a curved erection, he might have a condition called Peyronie’s disease. Peyronie's is a condition in which a man's erections are curved and may be painful.

Like most patients with sexual health problems, men with Peyronie’s disease may be reluctant to seek help and instead expect their physician to initiate the conversation. But, if a man has a curved erection or thinks he might have symptoms of Peyronie’s, the best thing to do is talk about it with a healthcare provider.

It is important to remember that urologists are trained to help patients with all types of problems that affect the penis—including Peyronie’s.

Read on to learn more about Peyronie’s disease.

Questions about Peyronie’s Disease

 

History of PD

Peyronie’s disease was first described by French physician Francois de la Peyronie (1678-1747) in 1741, who reported the first series of patients with “rosary beads of scar tissue” causing curvature of the penis. Peyronie was the personal physician to King Louis XV of France.

 

 

What is Peyronie’s disease?

Not all curved erections or penile bumps are caused by Peyronie’s disease. It is important for men to discuss their condition with their healthcare provider.

Peyronie’s disease is a condition in which a man’s erection curves and may feel painful. It may begin as a bump on the penis. The bump is scar tissue, and it’s known as Peyronie’s plaque. Some men are aware of the Peyronie’s plaque, which can feel like a small bump directly under the skin of the penis. A Peyronie’s plaque itself is benign, or noncancerous. It is not a tumor, but only a healthcare professional can make a proper diagnosis.

A Peyronie's plaque is not elastic. During an erection, the penis can’t expand in the area where the Peyronie’s plaque is located. As a result, the erection becomes curved.

It might be difficult to talk about a curved erection, but it is important to discuss this symptom with a healthcare provider.

 

 

What does Peyronie’s disease look like?

Not all curved erections or penile bumps are caused by Peyronie’s disease. It is important for men to discuss their condition with their healthcare provider.

The main feature of Peyronie’s disease is the curved penis caused by a Peyronie’s plaque (lump). The location of the plaque may determine the type of curvature deformity that occurs. The most common type of curvature deformity is “dorsal” – in other words, an upward bend caused by plaques on the dorsal (top) side of the erect penis.

In addition to the Peyronie’s plaque and curved penis, many men initially experience painful erections. Further, the plaque may cause changes to the length or circumference of the penis while erect. Other physical symptoms are penile folding or collapsing during intercourse, and erectile dysfunction.

 

 

Is Peyronie’s disease common? Who has it?

It is estimated that about 5% of men have Peyronie’s disease, which is more than previously thought —and the rate may be even higher.

The condition is found in men of all ages, but is most common among men ages 40 to 60. At least 65,000 men are projected to be diagnosed with Peyronie’s annually, and it’s believed that many more remain undiagnosed because they are embarrassed to seek help for their condition.

 

 

How does a man get Peyronie’s disease?

The cause of Peyronie’s is not clear, but healthcare providers believe that in some men injury to the penis (possibly during sex) results in abnormal scarring. The scar tissue that forms is not stretchy, so it causes the erection to curve and possibly feel painful. Genetic factors may also play a role in the development of Peyronie’s.

 

 

Other than physical symptoms, how might a man be affected by Peyronie’s disease?

Not all curved erections or penile bumps are caused by Peyronie’s disease. It is important for men to discuss their condition with their healthcare provider.

For men with Peyronie’s disease, the impact goes beyond the physical symptoms and may include sexual, psychological, and social effects. Because in Peyronie’s, the erection curves and even hurts, intercourse can become difficult and even impossible for some men. Others can become self-conscious about the appearance and limitations of their erections, causing them to avoid sex.

For some men, the problem is more than just sexual. Peyronie’s can be embarrassing to talk about – even with a partner. This can lead to relationship difficulties.

Keep in mind, Peyronie’s bothers men in different ways. For example, in one study of 92 men with Peyronie’s, 48% had clinical depression.

 

 

Peyronie’s disease can significantly impact men in many different and meaningful ways…

Physically

curvature deformity; pain; indentation; hourglass narrowing; penile shortening; compromised penile rigidity

Sexually

erectile dysfunction; performance anxiety; inability to have or difficulty in having intercourse

Psychologically

depression, lowered self-esteem, embarrassment, anger, fear of rejection; diminished self-worth; self-loathing; fear of shame or humiliation

Socially

difficulties with relationships; isolation; avoidance of intimacy

 

 

 

Can Peyronie’s disease get worse over time?

In the beginning stages of Peyronie’s, men have curved erections that may also be painful. With time, the pain usually goes away. But it’s most likely that the curve will remain.

There are two phases of Peyronie’s disease:

  • The acute phase, which lasts up to a year, is a time when men can experience painful erections. In addition, the acute phase is characterized by an increase in plaque size, penile curvature, and pain.
  • The chronic phase, which follows the acute phase, is characterized by minimal or no pain and stable penile curvature deformity. While pain usually subsides, other characteristics of the disease remain throughout the chronic phase.

If a man has a curved erection or thinks he might have Peyronie’s, the best thing to do is talk about it with a healthcare provider.

 

 

Does Peyronie’s disease last forever?

For some men, Peyronie’s disease may go away on its own – this is called “spontaneous resolution.” However, just as it is unclear how many men have Peyronie’s disease, it is unclear how often spontaneous resolution occurs. One study in 2001 suggested that “spontaneous resolution” was a rare occurrence.

In a 1990 study, among 97 patients with Peyronie’s disease, 13% experienced a resolution of their symptoms. They further noted that 40% of respondents perceived that their disease had progressed, and 48% considered that their condition had remained unchanged at follow up.

 

 

Is Peyronie’s disease the same thing as erectile dysfunction?

Erectile dysfunction (ED) may be a symptom of Peyronie’s disease, but it is not the cause of Peyronie’s disease. And not all men with Peyronie’s disease have ED. A man may experience one condition and not the other.

There is an increased occurrence of ED in patients with Peyronie’s disease. In fact, studies of patients with Peyronie’s disease have reported that between 30% and 80% of them may have ED.

What remains unclear is whether this is due to psychological or physiological factors. It might be that the effects of Peyronie’s disease (curvature deformity and pain) cause distress or performance anxiety that interferes with the ability to have or maintain an erection. Or it could be that the change in fibrotic tissue affects normal blood flow during erection.

Either way, when a man expresses concern about ED it’s important to consider the possibility of Peyronie’s disease.

 

 

How should a man initiate the conversation about Peyronie’s disease with his healthcare provider?

A man with a curved penis may find it hard to start a conversation with his physician. But seeing a healthcare provider, such as a urologist, is an important step to take. A man should feel free to ask the urologist whatever questions come to mind using whatever words are most comfortable. First, it is important for a man to find out from a healthcare professional whether or not he has Peyronie’s disease.

If he does have it, and he is concerned about how it is affecting him, here are some questions to get started:

  • Why do I have a curved penis?
  • What causes a curved penis?
  • What can I do about the pain I have?
  • Will this problem go away on its own?
  • Is it normal to feel the way I do about this?
  • How can I make sex more comfortable?

 

 

 

How does a healthcare provider evaluate for Peyronie’s disease?

A thorough evaluation for Peyronie’s disease is essential so that the healthcare provider can fully understand the man’s condition and make an accurate diagnosis. Currently there is not one universally accepted standardized evaluation for Peyronie’s disease, but during an initial evaluation, the patient might participate in:

  • a physical exam
  • imaging analysis
  • an interview

Physical exam: A healthcare provider might measure the degree of curvature of an erect penis. The healthcare provider may also look for the number and position of plaques on the penis and the degree of plaque calcification (hardening).

Imaging analysis: Penile ultrasound has gained widespread acceptance as a valuable tool for the diagnosis of Peyronie’s disease in recent years.

Patient interview: During the interview, a healthcare provider may ask questions about the degree of curvature of an erect penis, the onset and duration of symptoms, presenting signs and symptoms, and the presence or absence of pain. Patients should also plan to tell their healthcare provider about personal or family medical history of Dupuytren’s contracture and Lederhose disease as well as risk factors for erectile dysfunction including hypertension, dyslipidemia, tobacco use, and diabetes.

 

 

What kinds of questions will a healthcare provider ask?

Since each man’s experience with Peyronie’s disease is unique, the healthcare provider might ask a number of questions to better understand the individual’s condition. Some questions might include:

  • When did this problem start?
  • Do you have any bumps on your penis?
  • Do you have a palpable plaque (a bump you can feel on your penis)?
  • Do you have a curved erection?
  • How severe is the curvature (how much does your erection bend)?
  • Are your erections painful?
  • Does this interfere with sex?
  • On a scale of 1 to 10, what kind of impact is this having on your day-to-day well-being?
  • How else does this bother you?

A healthcare provider might ask more than just basic physical questions to better understand how Peyronie’s disease is affecting a man’s life. Some questions he or she might ask are:

  • On a scale of 1 to 10, what kind of impact is this having on your relationship with your partner?
  • Do you find you’re thinking about this when you should be focusing on other matters?
  • What kind of impact is this having on your day-to-day well-being?
  • Do you find it easy to talk to your partner about what’s happening physically?
  • How easy is it to talk to your partner about Peyronie’s disease?
  • How is this affecting your social life?

 

 

 

What role can partners play in recognizing the signs and symptoms of Peyronie’s disease and encouraging men to speak with a healthcare provider?

It is important to keep in mind that Peyronie’s disease and some of its related symptoms may be very difficult for men to speak about openly. If you recognize any of the signs and symptoms of Peyronie’s disease (see What does Peyronie’s disease look like? and Other than physical symptoms, how might a man be affected by Peyronie’s disease? sections above) in your partner offer him support and understanding and encourage him to visit his healthcare provider to see if he may have Peyronie’s disease.

Keep in mind that Peyronie’s disease, in addition to impacting a man physically, may lead to sexual, psychological and social issues. If he is comfortable with the idea of seeing a healthcare provider, offer to go along with him to visit his healthcare provider or offer support by doing research on the condition (see our For More Information section.)

 

 

This information was developed by Auxilium Pharmaceuticals, Inc. in collaboration with MHN.

 

For more information: