Penile Curvature and Peyronie’s Disease

Curvature becomes problematic when:

• It causes pain during erections

• It interferes with sexual intercourse

• It leads to psychological issues such as anxiety or depression

• It is associated with a palpable lump or plaque under the penile skin

Peyronie’s Disease (PD) is a connective tissue disorder characterized by the formation of fibrous scar tissue (plaque) within the tunica albuginea—the thick sheath surrounding the corpora cavernosa (erectile bodies) of the penis. This scar tissue limits flexibility and causes the penis to bend during erections.

Epidemiology

• Affects approximately 1 in 10 men, though the real incidence may be higher due to underreporting.

• Most common in men aged 40 to 70.

• Can occur at any age, including younger men (known as early-onset Peyronie’s disease).

1. Microtrauma or Injury

The most widely accepted cause of Peyronie’s disease is repeated microtrauma to the penis during sexual intercourse or physical activity. This trauma leads to localized bleeding and inflammation, triggering abnormal wound healing and scar tissue formation.

2. Genetic Predisposition

Some men may have a genetic susceptibility to abnormal scar tissue formation. Peyronie’s disease is sometimes found in families and is associated with other fibrotic conditions like Dupuytren’s contracture (a hand condition).

3. Autoimmune Reaction

Some experts believe Peyronie’s may involve an autoimmune process, where the body attacks its own tissue following injury.

4. Vascular Diseases

Men with conditions such as diabetes, high blood pressure, and atherosclerosis are at increased risk due to compromised blood flow and impaired healing.

5. Lifestyle Factors

• Smoking

• Excessive alcohol consumption

• Obesity

• Sedentary lifestyle

1. Acute Phase (0–12 months)

• Painful erections

• Noticeable curvature during erection

• Development of penile plaques (hard lumps)

• Shortening of the penis

• Erectile dysfunction (ED)

2. Chronic Phase (after 12 months)

• Pain usually subsides

• Curvature stabilizes

• Plaques become firm

• Erectile dysfunction may persist or worsen

Common Symptoms Include:

• Penile pain (especially during erection)

• Visible bend in the erect penis

• Lumps or hard areas under the skin

• Difficulty with sexual intercourse

• Psychological distress (depression, anxiety, relationship problems)

1. Patient History

The urologist will ask about:

• Duration and progression of symptoms

• Pain level during erections

• Erectile function

• History of penile trauma

• Impact on sexual activity

2. Physical Examination

• Palpation of penile shaft for plaques or lumps

• Assessment of curvature

• Measurement of penile length

3. Erection Induction and Imaging

To assess curvature and plaque location more accurately:

• Intracavernosal injection of a medication (e.g., prostaglandin E1) may be used to induce an erection.

• Penile ultrasound to measure plaque and evaluate blood flow.

4. Penile Duplex Doppler Ultrasound

Used to:

• Confirm plaque location and size

• Assess blood flow in the penile arteries

• Check for calcification within the plaque

Other causes of penile curvature and deformity must be ruled out:

• Congenital penile curvature (present from birth)

• Penile fracture (acute injury with hematoma)

• Penile cancer (rare, but serious)

• Lichen sclerosus (skin condition)

1. Observation (Watchful Waiting)

For mild cases without pain or erectile dysfunction:

• Monitoring the progression

• Lifestyle modification

• Managing psychological impact

2. Oral Medications

No oral therapy has been proven universally effective, but some may help in the early phase:

• Vitamin E: Antioxidant properties, limited benefit

• Potassium para-aminobenzoate (Potaba): Anti-inflammatory

• Colchicine: Reduces inflammation

• Pentoxifylline: May help reduce plaque calcification

• Tamoxifen: Anti-fibrotic effects

Note: Effectiveness of oral treatments is variable and often limited.

3. Intralesional Injections

Injections directly into the plaque are more effective than oral medications.

• Collagenase Clostridium Histolyticum (Xiaflex): FDA-approved; breaks down collagen in plaques

• Verapamil: Calcium channel blocker; reduces inflammation and plaque size

• Interferon-alpha 2b: Reduces fibroblast activity and plaque formation

4. Shockwave Therapy

Low-intensity extracorporeal shockwave therapy (LiESWT) is being studied for:

• Pain relief

• Possible plaque softening

Results are mixed, and this treatment is considered experimental.

5. Traction Devices

Penile traction therapy (PTT) involves wearing a device for several hours daily.

• Can reduce curvature

• May restore length

• Best when used in early stages or post-surgery

Surgery is considered when:

• Curvature is severe (>30 degrees)

• Erectile dysfunction persists

• Non-surgical options have failed

• The disease has stabilized (usually after 12 months)

1. Plication Procedures (e.g., Nesbit Procedure)

• Shortens the longer (non-affected) side of the penis

• Effective in mild to moderate curvature

• Results in penile shortening

2. Plaque Incision or Excision with Grafting

• For more severe curvatures

• Involves cutting or removing part of the plaque and replacing it with a graft

• Preserves length but carries risk of erectile dysfunction

3. Penile Prosthesis Implantation

• For men with severe Peyronie’s disease and ED

• Inflatable or malleable implants

• Can straighten the penis and restore rigidity

Peyronie’s disease and abnormal penile curvature are more common than many men realize. Though it can be a source of embarrassment or distress, effective treatments—both medical and surgical—are available. Early diagnosis, open communication with healthcare providers, and a tailored treatment plan can significantly improve both sexual function and quality of life.