Make it Straight! How to Treat Peyronie’s Disease?

Peyronie’s disease is a condition that affects the penis, usually causing painful erections, lumps in the penis, and a bend in the erection.

Although it can be progressive, it is not a malignant (cancerous) condition and it is not life-threatening.

What causes Peyronie’s disease?

The cause is not known for certain. A likely explanation is that it is an unusual reaction to injury to the penis, although most men with Peyronie’s do not recall having a specific injury. However the penis is subjected to varying degrees of stress and strain during penetrative sexual activity, and these relatively small injuries may result in some men developing the disease.

Who gets Peyronie’s disease?

The disease affects approximately one man in every hundred, perhaps even more. It is more common in older men, but all ages can be affected. There is an association between Peyronie’s disease and the hand condition Duypetren’s contracture, which causes one or more fingers to bend into the palm. About one in ten men with Duypetren’s contracture have Peyronie’s. However, no-one knows why some men get Peyronie’s disease and others don’t; it appears to be a matter of chance.

What happens in the disease?

Not every case of Peyronie’s disease is the same, but men usually first complain of painful erections or a bend in the erection, or both. Sometimes they notice lumps in the shaft of the penis, although these lumps may not be obvious initially. The symptoms may come on suddenly or slowly.

The symptoms usually get worse over a few months, but then stop progressing. The time course is very variable, but in most cases, the disease stops progressing after 6 to 18 months. In a few unfortunate cases, the disease continues to progress relentlessly, but this is rare.

When the disease stops progressing, the erections cease to be painful. The lumps in the penis may become harder and more obvious, and the bend in the erection stops getting worse. Sometimes the bend actually improves, although unfortunately, this is unusual.

What causes the bend?

The penis is made up for the most part of two big bundles of blood channels (or sinusoids) called the corpora cavernosa, or more simply known as the erectile tissue. These run along the whole length of the penis and on the inside have the appearance of a very fine honeycomb. At rest, when the penis is flaccid, they are empty. When a man gets an erection, large amounts of blood flow into the erectile tissue, filling the blood channels which increases the penile size and gives the penis its rigidity.

In Peyronie’s disease, the fibrous lumps block part of the erectile tissue, preventing the affected area from expanding. The rest of the penis is free to expand, so the erection becomes bent, with the lump at the apex of the bend.

More often than not the lumps are on the top surface of the penis, so the bend is usually in an upwards direction, towards the stomach; but it may be sideways or downwards.

Does Peyronie’s disease cause impotence?

Impotence is the lack of rigid erections, or the inability to maintain a rigid erection. Men with Peyronie’s disease are perhaps more likely to have less rigid erections although the association is not completely clear cut.

Impotence and Peyronie’s disease are both conditions that are more common in older men, so any associated impotence may be simply part of the aging process. Additionally, impotence may be psychological, particularly if the erection is painful, or if intercourse is difficult or impossible because of the bend.

Sometimes, however, the amount of fibrosis in the penis is so great that no blood can get past the fibrotic area to the tip of the penis. In these cases, the base of the penis may be rigid, but the tip is floppy.

How is Peyronie’s disease treated?

Once the disease has stopped progressing, it is perfectly possible to straighten the erection, should that be necessary.

Non-surgical treatments

Over the years a multitude of drugs has been tried in an attempt to cure Peyronie’s disease, or at least minimize the amount of deformity the disease causes. The most popular is Vitamin E, which is readily available from chemists and health food shops, and some prescription drugs are reported as being helpful but none has been proved to be of definite benefit in clinical trials.

ESWT (Extracorporeal Shock Wave Treatment)

ESWT or shock wave therapy has gained some popularity in recent years. The technology used is the same as is used to shatter kidney stones (lithotripsy). Multiple shock waves are fired at the lumps within the penis, breaking them up. Three treatments are usually given over a period of a few weeks. ESWT seems to be most beneficial to men who have a lot of pain with their erections.

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