Peyronie’s Disease (Penile Curvature)
Peyronie’s Disease, penile curvature with erections, was named after the French surgeon Francois Gigot De La Peyronie who described the condition in 1743. Peyronie’s Disease is a significant sexual health issue where scar tissue (called plaque) forms under the skin of the penis and often leads to curved erections that can be painful. The plaque that builds up in Peyronie’s Disease (PD) is not the same as plaque that can build in a person’s arteries leading to a heart attack or stroke. Peyronie’s Disease if fairly common, affecting up to 10% of men between the ages of 40 and 70 years old. In fact, up to 10% of men with PD are ages 40 or younger. The number of cases of PD is likely higher than reported because many men are too embarrassed to seek medical attention. Some men fear that the PD plaque is some type of cancer and do not want to be evaluated and find out bad news. Peyronie’s disease is often associated with erectile dysfunction but can also be found in men with good rigidity but a curved penis that interferes with sexual intercourse.
Common signs of PD include the following: a curved or bent penis with erections; hard lumps on the top or side(s) of the penis; painful erections; soft erections and difficulty with intercourse because of a curved penis that is painful for the man and/or his partner. While men can best feel the penis plaque in the flaccid or non-erect state, the actual curvature happens with an erection. The penis in PD can curve up, down, sideways or any combination. Some men with PD will develop an indentation (narrowing in circumference or waist) that occurs on one or both sides at the base of the penis. This indentation causes a floppy, unstable penis that makes intercourse difficult. Peyronie’s Disease can be associated with ED or can be present in men with a good erection but a bent penis causing difficulty with intercourse.
The etiology behind PD is not fully understood. Sometimes you will find a history of penile trauma from vigorous intercourse or external causes that trigger the onset of PD. Certain connective tissue and autoimmune problems, like Dupytren’s contracture, can be associated with increased risk of PD and there is also a familial history component. Peyronie’s Disease usually occurs in two phases, namely, the acute (active) phase and the chronic (stable) phase. The acute phase occurs first and can last up to 18 months. This acute phase is often characterized by pain with erections, plaque formation and worsening of penile curvature. Penile pain can occur with and without an erection in the acute phase. The chronic phase begins at 12 to 18 months after the first symptoms of PD occur. The main signs of PD in the chronic phase are a palpable penile plaque and curvature with erections. By this time the plaque and curvature are not likely to worsen but also does not get better.
There are medical and surgical options for treating Peyronie’s disease (PD). Our seasoned team, directed by Dr. Kevin Billups and Lead Physician Assistant Ken Mitchell, focus on the medical management of PD. Dr. Billups and Ken Mitchell each have over 25 years experience with treating PD. We start with a full evaluation, which includes a Doppler Ultrasound and a thorough physical exam, to look at the plaque and overall penile blood flow. Your PD treatment plan will be designed to fit your personal situation.
Men who have smaller plaques, less curvature, and no pain during intercourse may not need medical treatment—just an evaluation and reassurance. For those with more severe PD, the most common non-surgical treatment is injecting medication, known as collagenase (Xiaflex), directly in the penis plaque. If we find that you’d benefit from surgical therapy, we can refer you to the right specialist. At The Billups Center, we work closely with local Urologists who specialize in PD surgery. Our goal is to help you achieve the best possible outcome when treating you for Peyronie’s disease, to help you return to a satisfying sex life.