Peyronie’s Disease

Peyronie’s disease is a condition that causes abnormal penile curvature when erect. This happens when scar tissue, also known as plaque, builds up in the tunica albuginea — a stretchable layer surrounding the erectile tissue in the penis. The plaque build-up restricts the ability of the penis to stretch normally during erections, causing the penis to bend when erect.

Stages of Peyronie’s Disease
Peyronie’s disease is categorised into two stages: Acute and Chronic. In the acute stage, there is ongoing scar tissue formation beneath the skin, and this is when pain and discomfort are more likely to be felt during erections. During this phase, the curvature continues to form and worsen as the plaque grows in size.

Peyronie’s disease enters the chronic stage when the symptoms stabilise. In the chronic phase, the plaque stops growing and the penis doesn’t bend further. In some cases, pain may continue into the chronic stage.

Causes of Peyronie’s Disease
The exact cause of Peyronie’s disease is not completely known. However, it is known that trauma, such as penile fracture or repeated micro trauma to the penis during vigorous sex, may contribute to it. It is also thought that patients with erectile dysfunction may be more prone to Peyronie’s disease due to stress on the penis from buckling when attempting intercourse without being fully rigid.

While Peyronie’s disease can occur at any age, the condition is also more common in men aged 50 and above.

How Do I Know if I Have Peyronie’s Disease?
Many men have a natural bend in their penis, and a curve under 30 degrees is generally not a cause for concern. A greater curve exceeding 30 degrees, however, may be an indication of Peyronie’s disease.

Here are some signs of Peyronie’s disease to look out for:

• Discomfort or pain during erections
• Penile curve greater than 30 degrees
• Hard lumps that can be felt underneath the skin of the penis, usually in the same side of the direction of your penis curve.
• Difficulty engaging in penetrative sex or with specific sex positions
• Sexual intercourse that is painful for you or your partner
• A decrease in penis length when erect, due to fibrous scar tissue that restricts the penis from stretching normally.
• Loss of penile girth — scar tissue can cause indentations or narrowing of the penis shaft. In some cases, indentations can occur on both sides of the penis, resulting in what is called an ‘hourglass deformity’

Why Does Peyronie’s Disease Cause Curvature in Different Directions?
Penile curvature caused by Peyronie’s disease can differ from person to person. Factors that affect the direction and extent of the curvature include the plaque size, layers involved, and location of the plaque. A scar on the left of the penis, for example, will usually result a corresponding curve to the left, while a scar at the bottom of the penis tunica would result in a downward curvature.

An upward curvature is the most common for men with Peyronie’s disease, occurring when the scar is situated at the top of the tunical lining. In some patients, however, curvature may be absent. Instead, there may be indentations on the penis or an ‘hourglass’ appearance due to indentations on opposite sides of the penis.

Surgery
Surgery is known to be the most definitive treatment for treating Peyronie’s disease. Main surgical methods include plication, excision, grafting, or implanting a penile prosthesis. However, surgery is usually recommended only in severe cases due to the invasiveness of the procedure and the risk of impotence (3-5%) and nerve injury/permanent penile numbness after surgery (5-7%). In general, surgery should be avoided in the acute stage of Peyronie’s, as the risk of recurrence and ongoing progression of penile deformity might affect the optimal outcome of the procedure. Instead, conservative treatment options such as oral medications, topical treatments, and therapies should be considered.

Injectable Treatment
Injection treatment for Peyronie’s disease involves injecting enzymes such as collagenase clostridium histolyticum directly into the plaque that is causing the penile bend. This helps break down the scar tissue. Injectable treatment can be administered when there is a palpable plaque and requires up to 4 treatment cycles of 2 injections per cycle, depending on the severity of your condition. Common side effects of collagenase clostridium histolyticum treatment include pain, bruising, and bleeding under the skin at the injection site. In some cases, lower back pain may occur. These are temporary side effects that lasts from a few days to several weeks.

Penile Traction Therapy (PTT)
Penile traction therapy (PTT) is a treatment option that can be used in both the acute and chronic phases of Peyronie’s disease. The treatment involves wearing a traction device on the penis to stretch it in the opposite direction of the curve. The device is worn daily during the course of treatment, over a period of months.

Extracorporeal Shockwave Therapy (ESWT)
Shockwave therapy is a safe and non-invasive treatment for Peyronie’s disease. During treatment, gentle shockwaves are targeted at the hardened lumps in the penis to break down the fibrous scar tissue that is causing abnormal penile curvature. The treatment is especially beneficial for patients with painful Peyronie’s, offering rapid and sustained pain relief. Unlike surgery or injectable treatments, shockwave therapy has no downtime and risks of complications.

Peyronie’s disease is an entirely treatable condition and can be corrected by surgical or non-surgical treatment options. Early diagnosis and intervention are recommended for better treatment outcomes and to prevent progression or worsening discomfort. Peyronie’s disease is more responsive to non-surgical treatments in its early stages. As the condition progresses, the plaques become denser and more calcified, making it less responsive to non-surgical treatments. Cases with higher grades of calcification are more likely to require surgery.

If you notice any troubling changes, it is advised to consult a doctor promptly. At Veritas, our goal is to help you regain confidence without discomfort or invasive procedures. If you face troubling issues with Peyronie’s disease, reach out to us to learn more.