Peyronie's Disease FAQs

What is Peyronie's Disease?

Peyronie’s disease is a condition where a hard fibrous lump/plaque forms after a period of inflammation within the lining of the erectile tissue of the penis called the tunica albuginea. The fibrous tissue prevents normal extensibility of the penile tissue, causing a change in shape of the penis. In most men, the lump builds up on one point within the tunica albuginea, and a curve will form at the point of the fibrous tissue and in that direction. In some cases though, the tissue can build up on two points, causing a shortening of the penis and an indentation, or if the scar tissue builds up around the girth of the penis, an hourglass shape can be formed.

What are the causes of Peyronie's Disease?

The exact cause of Peyronie’s Disease is not very well understood, but it is believed to be due to trauma, inflammation and genetic factors. It is mostly believed to be from trauma experienced during sexual activity where the erect or semi-erect penis is bent or buckled with force. This causes microvascular trauma (small scale trauma to small blood vessels), and thus an inflammatory response. Some men can recall a loud ‘crack’ during an injury, but most men with Peyronie’s Disease can’t recall an incident where this occurred, thus it is likely to be from repeated, small scale trauma events.

A co-morbidity that impedes healing such as an immune condition or diabetes may explain why some men recover well from a penile injury, and others go on to develop PD. 

Could the lump be cancerous?

It is unlikely the lump is cancerous if the symptoms you are experiencing are those of Peyronie’s disease. Penile cancer is very rare, and the symptoms of penile cancer are different. Symptoms of penile cancer usually start with bleeding and unusual discharge. Any lumps or changes should still be investigated by your GP though.

How common is Peyronie's Disease?

Up to about 1 in 10 men have Peyronie’s Disease. The risk of developing PD increases with age, and the peak incidence is between the ages of 55 & 60. It is unclear just how many men are affected by PD as there are many who don’t seek help from medical practitioners as their symptoms are mild, they don’t recognise the problem or are embarrassed and don’t feel they can talk to their doctor.

What are the symptoms of Peyronie's Disease?

There are two stages that occur with PD, an acute and chronic phase:

In the acute phase, there will be a period of inflammation and swelling, and the scar tissue is growing and forming. A curvature or other change in shape is starting to form during this phase. Pain, especially, is a large factor in the acute phase and is most strongly experienced with an erection, but may also be felt with a flaccid penis. The acute phase lasts from about 6-12 months.

After that is a chronic phase, where the scar has formed and growth ceases - the curve in the penis is at its most prominent. Pain usually eases in most cases, but some men experience ongoing pain. Sexual dysfunction and erectile problems may develop.

How does Peyronie’s disease affect sexual intercourse?

If symptoms and the degree of the curve are mild, the effect on a man’s ability to engage in sexual intercourse can be minimal. However, if the disease has progressed extensively, intercourse can be impossible due to problems getting an erection due to the plaque or due to the extent of the curve.

How is Peyronie’s disease treated?

Some men don’t need treatment for Peyronie’s disease. In many men, the curve is mild enough that it isn’t bothersome to the individual. In 60-70% of men, the fibrous plaque reduces in size over time, decreasing the severity of  the curve. Surgical intervention is the most  successful intervention for improving penile deformity due to Peyronie's. Spontaneous resolution usually occurs over a period of 6 to 15 months, so it is recommended to usually wait 1 to 2 years before undergoing surgical interventions. There are also some non-surgical interventions to trial either instead of surgery if it isn’t an option due to comorbidities or if men are unwilling to undergo surgery.

It is unlikely the lump is cancerous if the symptoms you are experiencing are those of Peyronie’s disease. Penile cancer is very rare, and the symptoms of penile cancer are different. Symptoms of penile cancer usually start with bleeding and unusual discharge. Any lumps or changes should still be investigated by your GP though.

What can be done for Peyronie's disease surgically?

Surgery is most indicated when the disease is in its later stage, and isn’t progressing or resolving, when pain is minimal, when the curvature of the penis is having an impact on sexual function, and when the impact is large enough to desire a fast and reliable result - typically surgery is performed when the condition is stable for at least 3 months.

The main goal of surgery is to correct the curve to the point where a functional erection can be achieved, which is a curve of <20 degrees - it is unlikely that the penis will return to its previous state. In fact, most penises have slight curvature anyway. 

There are two main surgical procedures to treat Peyronie’s: Plication, and excision and grafting

Plication involves making a tuck on the opposite side of the plaque on the penis. This is done by using stitches in the tunica albuginea to straighten the penis. The operation is quite simple with few side effects, but it does reduce the overall length of the penis.

Excision and grafting is a bit more complicated and involves removing the plaque from the penis, straightening it and putting a graft in its place. This procedure is more involved than plication and has a greater risk for side effects which depend on the size and location of the plaque. During the surgery, the nerves that supply the penis can be affected causing sensory numbness of the head of the penis (about 1 in 10), and erectile dysfunction (1 in 4).


Excision and Graft

What non surgical treatments are available?

There is some evidence to suggest vacuum therapy and penile traction therapy is helpful in reducing the curve in Peyronie’s disease. Gradual stretching of tissue has been found to result in formation of new connective tissue through cellular proliferation (increase in number of cells). With vacuum pump therapy, improvements of between 5 and 25 degrees in curvature have been possible over a three month period. These therapies require some dedication and consistency with the rehabilitation protocol to be successful. A Men’s Health physiotherapist can help guide you with what devices to use, for how long and how often to use them for rehab, and what intensity the exercises should be. A men’s health physio can also assist you in understanding more about Peyronie’s disease and what you should be expecting with treatment.

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