Vanderbilt Urology Clinic

When treatments are needed, they include surgery, radiation or androgen deprivation therapy. This phase involves pain of the flaccid penis, and pain with erection or intercourse. 1 percent versus 5. Treatments for erectile dysfunction, “He said he’d been struggling, he’d been freaking out, and he’d gone from using Viagra when he was a bit blasted, to taking it all the time. Some sources of grafts used for Peyronie's disease are a vein from your leg (saphenous vein) or skin from behind your ear (temporalis fascia). Approximately a third of men in the European Male Aging Study demonstrated low testosterone, suggesting that hypogonadism is overrepresented among men with ED.

The plaques make the tunica albuginea less flexible and may cause the penis to bend upwards when it stiffens. Deformity of the penis is the most frequent finding associated with Peyronie's disease. Some selection bias could have been introduced by non-differential misclassification; which would tend to bias measures of association toward the null hypothesis. The condition mostly affects men over 40, although it can happen at any age. General health problems such as diabetes and high cholesterol are thought to contribute to Peyronie’s, although this is not always the case. Recent data on the treatment appeared online in February and will be published in the July print issue of the Journal of Urology.

When curvature reaches 50 degrees or more, vaginal penetration may not be possible.

Implantation of penile prosthesis remains an important option for men with ED if medical treatment fails or is inappropriate. Acquired premature ejaculation. This combination of increased bending of the penis during intercourse as a result of aging or erectile dysfunction, in association with the less elastic tunica layer is felt to potentially cause small cracks or injuries that in some people lead to exaggerated scarring and fibrosis of the area. According to one study, Peyronie’s disease is most commonly seen as men enter their 40s and 50s. If a male fertility issue is detected (50 percent of the time it’s related to the man), a reproductive urologist is the right doctor to see. Researchers are investigating whether Peyronie's disease might be linked to an inherited trait or certain health conditions. Drug therapy may help men who are badly affected by the disease during the acute phase. Once the penis' curvature is stable (not getting any more curved), oral medication will not change it.

Partners may have pain due to severe curvature of the penis during the erection. Food and Drug Administration for the treatment of Peyronie's is Xiaflex (collagenase clostridium histolyticum). As a result, the penis straightens out, “but then there is a defect, as there is no covering to the erectile tissue where the plaque was removed or incisions were made,” Dr. Men who have certain connective tissue disorders appear to have an increased risk of developing Peyronie's disease. Collagenase is made in the body and breaks down certain tissues. If the device doesn't straighten the penis enough, the surgeon may straighten it more by modeling the plaque against the stiff prosthesis or by cutting the plaque and using a graft to cover the opening. A number of common sexual and reproductive health conditions can develop at any age.

Surgically inserted penile implants replace the spongy tissue that fills with blood during an erection. The 2020 American Urological Association Guidelines for the treatment of Erectile Dysfunction recommend a complete history and physical and lifestyle modifications followed by a shared-decision-making approach for the existing medical treatments (Figure 1). Peyronie's Disease is an inflammatory, benign condition that may cause a curvature, deformity or shortening of the erect penis. It is important to keep in mind that Peyronie's Disease always causes a loss in penis size. Although this technique is effective in improving the angulation, it does so at the cost of penile shortening. Injections of Xiaflex are performed in the office twice a week, every six weeks. A prolonged inflammatory response will result in the remodelling of connective tissue into a fibrotic plaque.

  • In severe cases, Peyronie’s disease can be treated with surgery.
  • The most common symptom of penile curvature is discomfort or pain in the penis during sex.

What are the different types (and causes) of ED?

This may have existed before the onset of penile curvature due to vascular disease or diabetes among other things, or it can be caused by stress from having the disease. The diuretic may be withdrawn, but a trial of oral ED therapy can be initiated during the observation period while the patient is waiting to see if any spontaneous improvement in ED occurs after drug withdrawal. One option is to have a prosthesis (something to make the penis firm) put in the penis. Heredity and certain connective tissue disorders like Dupuytren’s contractures increase the risk of developing Peyronie’s. Sensation, orgasm, ejaculation, and urination are unaffected.

It can also replace missing tissue on your body with donor tissue or a laboratory-made replacement.

Peyronie's Disease

Peyronie’s disease is a condition in which fibrous scar tissues, called plaques, form beneath the skin of the penis, causing curved and often painful erections. In some cases, a specific physical or mechanical limitation may be the reason for why a man cannot have sexual intercourse. My penis length was 6 inches before the onset 20 years ago. Adhd symptoms in children? Patient medical or sexual history . However, only a very small number of people with Dupuytren contracture develop curvature of the penis. “I think Xiaflex is a great breakthrough in terms of options,” said Honig. The condition is thought to affect about 6 out of 100 men between ages 40 and 70, according to the Urology Care Foundation (UCF).

Aminobenzoate potassium is a prescription medicine.

How common is Peyronie’s disease?

12 The most commonly used instrument is the International Index of Erectile Function, a 15-item questionnaire that has been validated in many populations and is considered the gold standard to evaluate patients for ED. By activating your account, you will create a login and password. The size, shape, location, and consistency of the plaque all impact the shape of the erection. Members, “All that shit happened in the span of 48 hours,” he posted. 2 percent reduction. It a portable, non-invasive device that utilizes high-frequency sound waves to generate still and real-time images of underlying tissues. 0005 for all), with pain during intercourse having the greatest impact (maximum likelihood estimation ± standard error =.

Because erectile dysfunction is caused by a complex set of psychosocial, neurologic, and vascular factors, a specific cause in a patient may remain ambiguous. But a recent controlled study didn't show it to work better than placebo. The underlying cause of Peyronie’s is unclear, but is suspected to be penile trauma—perhaps associated with excessive bending and buckling from sexual intercourse—that activates an abnormal scarring process. With the exception of penile shortening, (which is not perceptible in most men) they are all rare. Do you have morning or evening erections and, if so, what is the quality of these erections?

Stretching Devices for Peyronie's Disease

The curvature of the penis is due to the fact that scar tissue does not stretch as well as normal tissue. In this pre-analysis form, you can put all your complaints so that I can answer you and guide you on the best procedure for healing. Some men may experience numbness of the penis and ED after the procedure. In addition to causing all of the above symptoms, it can also make him feel frustrated both at work and at home. These psychological issues can lead to erection problems. At this point, no further improvement of the condition will occur. Like some of the chemical treatments, radiation appears to reduce pain, yet it has no effect on the plaque itself and can cause some unwelcome side effects. Learn more about Peyronie's disease from the U.

While most men will continue to be able to have sexual relations, they are likely to experience some degree of erectile dysfunction.

During the procedure, some of the scar tissue may be removed. References, augmentation therapy with mirtazapine seems to decrease the sexual side effects of SSRIs [82, 83], supporting that SSRI-induced sexual dysfunction may be mediated by 5-HT 2C -receptors. Men with Peyronie's and diabetes were more likely to have severe curvature, defined as over 60 degrees (27. )In the initial evaluation of ED, sophisticated laboratory testing is rarely necessary.

Tools & Resources

The psychological effects of Peyronie’s disease can be a significant influence on male sexual behavior. Encourage him to have a sperm check sooner if you’ve been trying for six months and you’re approaching 35, or if something in his medical history suggests he could have male-factor fertility issues such as: Although there have been recent advances in reparative surgeries. Furthermore, many men with Peyronie’s OR erectile dysfunction – especially those who men who also have diabetes – may experience a loss of elasticity along the entire penis. Men who are taking medications that contain nitrates, such as nitroglycerin, should NOT use these medications. An enlarged or swollen prostate, also called benign prostatic hyperplasia (BPH), is a very common condition in men. Besides treatment, your urologist may recommend lifestyle changes to reduce the risk of ED associated with Peyronie’s disease.

Many men with Peyronie’s may also notice a significant loss of length of the erection.


What scientists do know is that around 10 percent of men will be affected by the disorder, most commonly when they are in their 50s. Patients at high cardiovascular risk should not be treated for ED until their cardiac condition is stabilize. During your office visit, the doctor will discuss with you the options appropriate for your situation. Sometimes, the erect penis may become very narrow at a certain point. It’s completely normal to have some amount of curvature in your penis — no erect penis is 100 percent even and symmetrical. Conners is on the Executive Committee of the Sexual Medicine Society of North America, the primary organization supporting research and establishing national standards to the treatment of Peyronie’s disease. If your symptoms are severe or are worsening over time, your doctor might recommend medication or surgery. Scar tissue may form and develop into plaque.

Two types of implants are used to treat ED, including:

Verapamil (Calan, Verelan, Verelan PM, Isoptin, Isoptin SR, Covera-HS [a medication usually used for high blood pressure treatment]) appears to disrupt the production of a protein involved in the formation of Peyronie's disease lesions. What is Peyronie's disease? 5 One of the more common reasons for seeking treatment involves discomfort of the patient's partner during intercourse, which is associated with penile curvature. Collagenase clostridium hystolyticum is an enzyme that causes the breakdown of connective tissue. Are you having any difficulties with sexual desire, arousal, ejaculation, or orgasm? In this procedure, the Peyronie’s plaque is incised and replaced with a graft.

Colchicine is an anti-inflammatory drug used in gout that has proven slightly useful in treating Peyronie's. Carson notes that men often worry that they have cancer of the penis when they see these skin changes, which may feel like small knots or nodules. Dose-adjustment is recommended in patients with hepatic failure and with co-administration of drugs also metabolized by the cytochrome p450 enzymes. This can include a nerve block anaesthetic to reduce pain.

The prevalence of complete ED increased from 5% at age 40 to 15% at age 70.

Risk Factors for Male Pattern Baldness

Most doctors believe Peyronie's disease is caused by repetitive trauma to the penis or, in some cases, genetic factors that cause a scar or plaque to develop, which restricts the elasticity of this area of the penis during erection. Peyronie's disease is a connective tissue disorder of the penis that can be likened to arthritis. Even so, surgery should only be considered if the deformity is severe and the condition interferes with your ability to have sex. Finally, making some changes to your lifestyle can potentially improve the effects of Peyronie’s disease. Complications from the use of a vacuum constriction device are relatively minor. According to Dr. • The plaques may impair blood flow into the penis.

Your urologist will discuss your treatment options with you and review possible side effects and outcomes. This an outpatient procedure with a recovery time of less than one week. To date, there has been little evidence of a familial link to the Peyronie's disease. In plication surgery, your urologist will remove or pinch a piece of the tunica albuginea from the side of the penis opposite the plaque to help straighten the penis. Men enter the stable phase of Peyronie’s if the curvature of the erect penis hasn’t changed for three to six months and there is also no pain from inflammation.


Side effects of treatment can include urinary incontinence and impotence, which is why doctors often take a “wait and watch” approach when a man is diagnosed with prostate cancer and delay treatment until it’s warranted. This procedure is generally used in cases of more-severe curvature or deformity, such as indentations. Experts estimate Peyronie's disease, a connective tissue disorder, affects at least 5% of men. Many people ask why most of the cases of Peyronie's disease are linked to erectile dysfunction. The acute phase, which often causes painful erections, lasts for six to 18 months, during which plaque forms and deformity of the erect penis worsens. Honig’s recent research includes studies on oral testosterone, novel treatments of erectile dysfunction and the effect of high blood pressure medications on male fertility.

The removal or pinching of tissue from the side of the penis opposite the plaque, which can cancel out the curvature, is known as the Nesbit procedure. People who are prone to forming scar tissue—such as those who experience Dupuytren’s contracture, a similar condition in the fingers, or Ledderhose disease, a similar condition in the feet—are also more likely to get Peyronie’s. Peyronie's disease can be embarrassing and frustrating, but it's important to address it. Your penis starts to curve.

In most cases, the acute formation of plaque will ease over time without treatment.

How do health care professionals diagnose Peyronie’s disease?

Risk factors for ED include diabetes mellitus, increasing age, dyslipidemia, hypertension, and use of antihypertensive and psychotropic medications. Many patients with Peyronie's disease suffer psychological trauma, may experience difficulty with sexual intercourse, and may also suffer from erectile dysfunction. Alprostadil can be delivered to the erectile tissue either via an intraurethral suppository that is massaged and then absorbed across the corpus spongiosum of the urethra to the corpora cavernosa, or directly injected into the corpora cavernosa. Here’s how Peyronie’s manifests:

The principal finding in men with Peyronie's disease is the deposition of scar tissue in the tunica albuginea.

Alternative therapies, including intracorporeal injection and intraurethral suppositories of prostaglandins should be administered selectively. However, some primary care practitioners may recommend vacuum constriction devices. Statistics show American men are less likely than women to see a doctor for regular checkups. Surgical treatment for Peyronie’s disease is generally reserved for patients with severe curvature or deformity, for men who do not respond to or do not wish to undergo intralesional therapy, and for men with both Peyronie’s and erectile dysfunction.

The most popular theory today is that Peyronie's disease is induced by trauma.

Read More About Erectile Dysfunction

Reports of penile curvatures exist from ancient times, but the disorder was first described in detail by De La Peyronie, a French physician in the 17th century. It is this population who will benefit most from treatment. Inability to delay ejaculation on all or nearly all vaginal penetrations; and, negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.

Testosterone replacement therapy may improve energy, mood, and bone density, increase muscle mass and weight, and heighten sexual interest in older men who may have deficient levels of testosterone. With the penile prosthetic, the tissue of the erectile bodies is replaced by a plastic “water balloon” that fills with saline (salt water) to create an erection. The chronic phase occurs after the plaque has formed. This way, your doctor can see where the plaque is and assess blood flow to your penis, notes the Mayo Clinic. These medical treatments should NOT be used by women or children. This length discrepancy causes curvature,” Dr. Erectile dysfunction is defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance.

Can I prevent Peyronie’s disease?

” Only rarely does the problem correct itself without treatment. The chronic phase typically occurs up to 18 months after initial onset and is characterized by resolution of pain and inflammation, stabilization of the curvature and deformity, and possible erectile dysfunction. When the plaque is large enough, it causes painful curvature of the penis that may prevent intercourse. Psychological and emotional issues are also common, especially if the man is unable to have intercourse. Flaccid and erect penis Open pop-up dialog box Close Flaccid and erect penis Flaccid and erect penis The penis contains two cylindrical, spongelike structures (corpora cavernosa). Incision or excision and grafting.

Peyronie’s disease is the growth of fibrous plaque, a form of scar tissue, inside the tissue of the penis. Early in the development of Peyronie’s the plaque or scar-like tissue can be tender, both at rest and with sexual activity. Erectile dysfunction can cause strain on a couple.

Scar tissue does not stretch like the normal tunica, and may lead to curvature during erection toward the side of the most prominent scarring. His wife finally convinced him to see his primary care physician, who referred him to an urologist. The good news is that ED can usually be treated safely and effectively. Hormonal abnormalities, such as increased prolactin (a hormone produced by the anterior pituitary gland), steroid abuse by bodybuilders, too much or too little thyroid hormone, and hormones administered for prostate cancer may cause ED. What is XIAFLEX® ? Erectile dysfunction or disorder (ED) is the inability to develop and maintain an erection for satisfactory sexual intercourse or activity.

  • Semi-rigid Penile Prosthesis.
  • The condition is caused by scar tissue that develops in the shaft of the penis, often as a result of injury during sexual intercourse or other traumatic injuries to the penis.
  • Carson explains that no oral medicines have yet been approved for use in Peyronie's disease, but some men are given pentoxifylline, a drug that's typically prescribed to improve blood flow in people with other circulation issues.
  • Some self-administered measures may be useful in the primary care setting to screen for and evaluate the degree of ED.
  • This medicine has been approved for use in adult men with moderate to severe curvatures and a palpable nodule.
  • Other ways to treat Peyronie's disease are being studied.
  • Regular use of these devices can help to a minor degree with length lost during Peyronie’s disease or as a result of global contraction of the erectile bodies.

Potential Etiologies

In some patients, however, the curvature may get in the way of sexual activity. It is worth noting that a large number of males who experience a penis injury do not go on to develop Peyronie’s disease. Once an erection is achieved, a constriction band is applied to the base of the penis to maintain the erection. Feeling embarrassed about sexual health problems may prevent many men from seeking the medical attention they need, which can delay diagnosis and treatment of more serious underlying conditions.

Diagnosis of Erectile Dysfunction

Peyronie’s disease is an acquired inflammatory condition of the penis where a plaque develops under the skin of the penis leading to penile curvature, painful erections, and erectile dysfunction. These plaques most often don’t cause curving but may cause the shaft of the penis to narrow like the neck of a bottle (sometimes called “bottle-necking” or “waisting”). These injuries can happen during sex, athletic activity, or an accident. Most health care providers suggest putting off surgery until the plaque and curving have stopped getting worse, and the patient has been pain-free for at least 9 to 12 months.

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Eid shows a patient that has had his Peyronie's disease corrected with a penile implant. In the setting of Peyronie’s disease and ED it is always preferable to simply place a penile implant. Vacuum constriction devices provide acceptable alternative therapy for patients who do not qualify for medical treatment. Of the drugs used for depression, tricyclic antidepressants may be associated with erectile problems and other drugs may be substituted to prevent this complication. Vitamin E supplementation has been studied for decades, and some success has been reported in older trials but those successes have not been reliably repeated in larger, newer studies. Men with Peyronie’s disease are usually referred to a urologist—a doctor who specializes in sexual and urinary problems. How frequently do you have intercourse currently, and how frequent was it in the past? Genetics may also play a part.

Even if you've had the condition for some time, treatment may help improve bothersome symptoms, such as pain, curvature and penile shortening. Steroids, such as cortisone, have produced unwanted side effects such as atrophy of healthy tissues. About 30 percent of men with Peyronie's disease develop fibrosis in other elastic tissues of the body, such as on the hand or foot, including Dupuytren's contracture of the hand.