Peyronie's Disease: A Not So Straightforward Disease

Peyronie's disease (PD), or induratio penis plastica, is a penile deformity that makes the penis curve during erection and can affect sexual activity as a result.

PD is a condition that has been known as far back as 1743, when it was named after surgeon Francios Gigot de La Peyronie. In those days, it was thought to be a venereal condition, or what we now term sexually transmitted disease. Of course, today we know that it is not at all infectious and is actually a wound-healing disorder.

How common is Peyronie's disease?

About 3 – 9% of adult males are thought to be affected, with the greatest number of sufferers being in their fifties. The prevalence of this disease may be somewhat higher as men may be reluctant to seek medical advice from their doctor, so it is likely to be under-reported.

What are the signs of Peyronie's disease?

If your penis curves when erected, you may have PD. The curvature tends to make the penis look shorter and can interfere with sexual activity, both of which are embarrassing issues for sufferers. You may also feel a lump along the penis associated with the curvature. In the initial stage of PD, also known as the acute phase, most if not all men experience painful erections. This phase typically lasts up to 6 months and the curvature can either worsen or stabilise.

What causes Peyronie's disease?

PD is a wound-healing disorder, meaning that the penis may have suffered an injury at some point before symptoms occurred. Some men recall some form of injury to the penis during sexual activity before the onset of the symptoms. It is a progressive disorder, meaning it can get worse over time.

Should you see a doctor if you think you have Peyronie's disease?

In most cases, if you have PD, it is unlikely that the condition will correct itself. Less than 15% of men with PD report a recovery without medical intervention. As a rule of thumb, 40% of men report curvatures that remain unchanged and approximately 45% of PD sufferers report that it continues to get worse.

Seek help with a urologist if you suffer from PD.  Bring some photos of your erect penis so that the doctor can see the type and stage of penile deformity. The urologist will usually ask for a penile Doppler ultrasound. Prior to the ultrasound, you will be given an injection to induce an artificial erection. The doctor will then measure the penile curvature and document this as a baseline prior to recommending any form of treatment. Your erectile function will then be assessed with the ultrasound.

What treatment can you expect?

Non-surgical therapies – There are several minimally invasive medical treatments for PD including stem cell treatment although the current literature only shows good evidence with the use of oral medication or intralesional therapy (treatment injected directly into the wound).

Surgery – If medical therapy fails, or if you want quick and long-lasting results, your doctor will advise you to go for surgery. If you do not have a problem getting or maintaining an erection and your curvature is not too severe, you will likely undergo a simple procedure called penile plication to correct the angle of curvature. There is a risk of penile shortening. If your curvature is more severe, your doctor will recommend incision of the plaque and use of a graft. This is a complicated procedure that carries a risk of erectile dysfunction. If you already suffer from erectile dysfunction along with PD, your surgeon will elect for the placement of an inflatable penile prosthesis. This will solve both the erectile dysfunction and the penile shortening.

To straighten out this private disease, talk to your doctor about your options.