What is Peyronie’s disease?
Peyronie’s disease is a disorder affecting the penis that can cause a lump within the shaft of the penis and pain in the shaft of the penis. Abnormal angulation of the erect penis (“bent” penis) can also be seen.
Typically, a man would first notice a tender lump in the penis, which might later be followed by bending of the penis when erect, sometimes at very odd angles. The flaccid penis is not usually deformed. It is important to remember that a degree of upward (towards the head) angulation of the erect penis is quite normal and not a feature of Peyronie’s disease.
Noticing a lump in the penis can be a frightening experience. Men are often concerned that they have developed a cancer. Cancer within the penile shaft is very rare indeed, whilst Peyronie’s disease is by far the most common cause of such lumps. If you find a lump, it is important to seek prompt medical advice, but you should not be too fearful that a serious cause will be found.
What causes Peyronie’s disease?
The penis is basically three cylinders, covered by several sheaths of tissue and, finally, by skin. A pair of corpora cavernosa form the erectile tissue that becomes engorged with blood during erection, acting like the inner tube of a tyre. They are surrounded by the tunica albuginea, a tough, inelastic, fibrous sheath, which might be compared with the tyre itself. When the penis becomes erect, the inner tubes (corpora cavernosa) inflate, filling the space within the tyre (tunica albugenia), making it more rigid.
In Peyronie’s disease, tough, fibrous plaques spontaneously appear within the tunica albugenia, and are felt as tender lumps. When the penis becomes erect, it inflates unevenly and tends to bend around the plaque, causing the characteristic deformed appearance of Peyronie’s disease.
Experts are not certain why some men get Peyronie’s disease and others do not. Several factors might be involved, including:
- Genetics: Occasionally the disease has a tendency to run in certain families (inherited or genetic predisposition), but this is not common.
- Injury: Peyronie’s disease is more common after injury to the penis, such as penile fracture or forceful bending of the erect penis. It also occurs more frequently in men that give injections into the penis for the treatment of erectile dysfunction (impotence).
- Circulatory disorders: More men with Peyronie’s disease seem to be affected by high blood pressure and hardening of the arteries (atherosclerosis), so these conditions might possibly be involved in its development.
- Diabetes: This is more common in men with Peyronie’s disease, so might also be involved in its development.
What are the symptoms of Peyronie’s disease?
Peyronie’s disease occurs at any time from adolescence onwards, but most commonly in men aged 40-60 years.
The disease causes very variable degrees of deformity and inconvenience. Some men are barely troubled by it, while others find sexual intercourse physically impossible. Many men will not require treatment, but all should seek prompt medical advice.
The symptoms are:
- A lump within the shaft of the penis: This can slowly develop over several months and frequently takes 12-18 months to reach its full extent.
- Pain in the shaft of the penis: Two-thirds of men with Peyronie’s disease will experience pain in the penis. In most cases, it will gradually settle down and disappear without treatment in a few months.
- Abnormal angulations of the erect penis (“bent” penis): During the 12-18 months that the plaque or lump is developing, the deformity of the erect penis can change – 30-40% get worse, 10-20% get better and 50% remain the same.
- Some men will develop varying degrees of erectile dysfunction (impotence) as a consequence of Peyronie’s disease. This can vary from a complete inability to attain and/or maintain an erection adequate for satisfactory sexual experience to a slight reduction in penile rigidity. Some men report a tendency for the penis to buckle around the lump during sex. The frequency of this problem has been reported as 4-80%, although experience suggests that the true rate is towards the lower end of this range.
How is Peyronie’s disease diagnosed?
Peyronie’s disease is diagnosed on the basis of the history (how the problem has developed, as you describe it to your doctor) and examination (what the doctor can see and feel).
Some men with Peyronie’s disease have Dupuytren’s contracture, a claw-like deformity in which the little finger, the ring finger and sometimes other fingers bend over towards the palm of the hand.
No special investigations are needed and biopsy (surgically removing a piece of the lump for examination under a microscope) is only needed for rapidly enlarging lumps that are not developing in the usual manner. Ultrasound scanning can be used to assess the exact size and position of the lump, but is rarely necessary.
Although extremely rare, sarcoma of the penis (a form of cancer) can present in a similar way. Your doctor will consider this if the lump enlarges very rapidly or develops in an unusual manner.
How is Peyronie’s disease treated?
If you think that you might have Peyronie’s disease, you should seek medical advice as soon as is convenient, usually within a few days. You should consult your doctor. The doctor will want to hear how the problem has developed and how it affects you, and to examine you.
If the problem has been present for a long time, is not changing, and is not causing you much trouble, the doctor might recommend no treatment and simply ask you to return if the condition starts to worsen.
If the problem has been present for a long time and is causing you sexual difficulties (such as impotence, difficulty with penetration, or pain during sex for either partner), they may refer you to a urologist. You might need surgical treatment to correct the deformity. It is unwise to seek surgical treatment solely for cosmetic reasons.
If the problem has recently developed, particularly if the lump is continuing to develop or is painful, the doctor may consider offering drug treatment themselves or refer you to a urologist, genito-urinary physician, or other specialist for advice.
There is nothing you can do to prevent the development of Peyronie’s disease after it has appeared. However, avoiding penile trauma might prevent it. Men who are injecting into the penis to treat erectile dysfunction might reduce their risk of developing Peyronie’s disease by careful injection technique and by varying the site of injections. This advice is usually given when patients are first taught to use injections.
Your doctor should be able to reassure you that you do not have cancer. Drug treatment is a controversial area, as only limited evidence of the effectiveness of drug treatment exists. However, such treatment is worth considering in men with early or active Peyronie’s disease, that is when the lump is expanding or is painful. The aim is to reduce pain, lump size and the eventual deformity. Drugs that have been tried include: Vitamin E and potassium aminobenzoate, Tamoxifen and Verapamil. Extracorporeal shockwave therapy and surgery may also be option.
What types of surgery are available for Peyronie’s disease?
Because the development of Peyronie’s disease varies so much between individuals, a wise strategy is to adopt a conservative approach to treatment and avoid early surgical intervention. Surgery should be done only to correct penile deformity in men with stable Peyronie’s disease that has been present for at least a year and has not changed whatsoever for at least three months. It is essential that the disease has stabilised and become inactive before surgery is attempted, otherwise the condition can continue to progress after the operation has been performed.
The indications for surgery is an unacceptable difficulty with penetration during sex. Pain during sex for either partner that is a consequence of the penile deformity. Unacceptable cosmetic appearance of the erect penis is not a good reason to have surgery unless it is causing severe and intractable psychological distress.
Success of surgery is usually measured by the correction of deformity but there are no guarantees that the penis will be perfectly straight after surgery. In addition, some men will develop erectile dysfunction or even numbness of the penis following surgery, so it is not a treatment to contemplate without considerable caution.
What is the prognosis for men with Peyronie’s disease?
Peyronie’s disease runs a very variable course. Many men with Peyronie’s disease will not require or desire treatment, and will enjoy very satisfactory sex with their rather unusually shaped penis. Men who have had Peyronie’s disease are more likely to have a further episode in the future than the general population. Nothing is proven to prevent a recurrence.