Peyronie’s disease

Peyronie’s disease is a condition where the penis develops fibrous scar tissue (plaque) within the deeper layers below the skin. Men can notice a lump, curvature of their erection, loss of penile length, pain and erectile dysfunction (although not necessarily all of these signs). 

The exact cause of Peyronie’s disease is not fully understood, but it’s believed to involve a combination of genetic, environmental, and lifestyle factors. Occasionally men may be able to pin point an incident or episode of pain during intercourse or masturbation. But most men will have no recollection of an event.

It can be hugely psychologically upsetting and shocking, particularly as most men have never heard of this condition. Pippa Sangster has a wealth of experience in the topic to both manage and treat the change in the penis but also to offer psychological support and empathy.

Symptoms:The condition is split into 2 phases: the acute and the chronic phases. The acute phase is a timeline of ongoing change and potentially pain. It can last from 6 to 18 months. When men have moved into the chronic phase, the disease is stable and should indicate no further change will occur.

Curvature: The most common symptom is the development of curvature or bending of the penis during erections. The curvature can vary in severity and direction. It can be very mild or significant enough to make sexual intercourse impossible.

Pain: Some men with Peyronie’s disease may experience pain during erections, particularly at the site of the plaque. This tends to be a temporary symptom within the acute phase.

Erectile Dysfunction: The presence of plaque can interfere with normal blood flow in the penis, leading to difficulty achieving or maintaining an erection. The psychological worry can also affect men significantly in regards to obtaining and sustaining erections.

Prevalence: The prevalence of Peyronie’s disease is estimated to affect 10% of of adult men. It’s more common in middle-aged and older men, although it can occur at any age.

Treatment:

Medications: Oral medications such as pentoxifylline, colchicine, and vitamin E may be prescribed to help reduce plaque formation and alleviate symptoms. However, their effectiveness varies, and there is little evidence based medicine to support their use.

Injection Therapy: Injections of medications such as verapamil or collagenase directly into the plaque may help soften the scar tissue and reduce curvature. Collagenase (Ziapex) was discontinued within the UK.

Penile Traction Devices: These devices are worn on the penis to apply gentle stretching forces over time.

Shockwave Therapy: Extracorporeal shockwave therapy (ESWT) involves using low-intensity shockwaves with the aim of causing mechanical stress , thereby inducing new blood vessel formation and thus improving blood flow. The hope is to help with remodelling the plaque and improve blood flow in the penis. There are limited good randomised controlled trials and those that are available show positive effects with pain but limited curvature improvements.

Surgery: Surgical intervention may be considered in severe where penetration becomes impossible. Surgical options include plaque incision or excision (Lue procedure), penile plication (shortening the longer side of the penis to correct curvature), or penile implants.

Counselling: Counselling may be beneficial, particularly for men experiencing emotional distress or relationship issues related to Peyronie’s disease.