Bent Out of Shape: What is Peyronie’s Disease

Peyronie's disease is a condition that affects the penis, causing it to develop a noticeable bend or curvature. It is caused by the build-up of scar tissue in the erectile tissue of the penis, which can make it difficult to achieve or maintain an erection, and can cause pain or discomfort during sexual activity. Peyronie's disease can affect men of any age, but it is most commonly seen in middle-aged men.

Peyronie's disease, with formation of a fibrous plaque and penis deviation. Image Credit: Ellepigrafica / Shutterstock

Up to 9% of men will have evidence of Peyronie’s disease if asked and examined, although the number of men presenting with symptoms of Peyronie’s disease are far fewer. The peak incidence of Peyronie’s disease is around 55–60 years of age, and penile curvature is the most common presentation, followed by feeling a nodule in the penis. Painful erection is reported by over half of the patients with Peyronie’s disease. A history of remembered penile trauma is reported by only about 10% of patients with Peyronie’s disease, generally younger patients.

CAUSES
The exact cause of Peyronie's disease is unknown, but it is believed to be related to injury or trauma to the penis, such as during sexual activity or as a result of a medical procedure. In some cases, genetics may also play a role. Peyronie's disease can be a progressive condition, which means that it may worsen over time, causing more severe symptoms.

Peyronie’s disease can also cause significant emotional stress, in part as a result of the deformity and associated difficulties with sexual function, but often also because of the penile shortening that occurs in almost all patients.

DIAGNOSIS
Diagnosis of Peyronie’s disease is readily made by a typical history and penile examination. Clinically important information includes:

·      stage of the disease (ie active versus chronic)

·      curvature features (ie direction, degree)

·      penile length and other associated penile deformities (eg hourglass deformity)

·      presence of pre-existing or co-existing erectile dysfunction.

TREATMENTS
There are several treatment options available for Peyronie's disease, depending on the severity of the condition and the individual's specific needs. In mild cases, where the curvature is not significant and does not cause any pain or discomfort, no treatment may be necessary.

For more severe cases, where the curvature is more pronounced or causes pain during sexual activity, there are several treatment options available. One common treatment is the use of medication which can help to break down the scar tissue in the penis and reduce the curvature. Another option is the use of penile traction devices, which are designed to stretch the penis and help to straighten out the curvature over time. This can be a slow and gradual process, but can be effective in some cases.

In some cases, surgery may be necessary to correct the curvature of the penis. This may involve removing the scar tissue or inserting a penile implant to help straighten out the penis and restore normal function.

Traction Device for treatment of Peyronie’s Disease: Image credit: 1.Valenzuela R, Ziegelmann M, Tokar S, Hillelsohn J. The use of penile traction therapy in the management of Peyronie’s disease: current evidence and future prospects. Therapeutic Advances in Urology. 2019;11.

Overall, Peyronie's disease can be a challenging condition to manage, but with the right treatment approach, many men are able to achieve good outcomes and restore normal sexual function. If you are experiencing symptoms of Peyronie's disease, it is important to talk to your doctor to discuss your options and find the best treatment plan for your specific needs.