What is Peyronie's Disease?
My penis is now curved, what is going on?????
I feel for you and all my patients with this. This is more than likely what is called Peyronie’s disease. And it stinks cuz it really makes having sex or even the thought of having sex difficult and anxiety provoking.
Good news though, there are treatments for Peyronie’s disease and I’ll walk you through it. Peyronie’s disease is due to a hard lump, or plaque, that is on the lining of the penis where an erection forms. This plaque affects the shape of the penis during an erection causing it to curve. You may also notice that your erection is not as strong and your penis may even be shorter when you have an erection. All of these are signs and symptoms of Peyronie’s disease.
Why did this happen?
Usually there is no great reason to explain why this happened.
Sometimes patients will remember one bad sexual encounter when they think they hurt or injured the penis but oftentimes patients won’t give me any obvious reason for why this occurred. For Peyronie’s disease, the going theory is that over the course of your life, through sex and/or masterbation, the penis healed funny due to this ‘microtrauma‘ and a plaque formed on the lining of the penis the helps with erection formation.
It’s not that you are having sex wrong, it’s just that for whatever reason your body formed this plaque that is now tethering the penis during an erection.
My penis hurts with an erection, is that normal?
This is typical for Peyronie’s disease. Thankfully this always gets better over time, however, sometimes this can take a year to resolve. This is during what is called the ‘acute phase’ of Peyronie’s disease
Will the curve get better?
Usually not. Typically the curve will stay about the same. Less frequently, the curve will improve and likewise, less frequently, it will get worse. I tell most of my patient’s with Peyronie’s Disease that what you see is what you got. Meaning, if there is a curve but you are able to penetrate, then leave it alone because the treatment isn’t worth it. On the other hand, if the curve is significant then we should consider treatment because it likely isn’t going to get much better.
Is there a pill to make this go away?
No. Sometimes your urologist will give you a medication called pentoxifylline. This medication can help people who have penile pain associated with Peyronie’s disease. Sometimes you will be given ED meds like Cialis to help with the erection quality and rarely with the curvature.
The other thing your urologist will check is your testosterone. This is because there is a relationship found with testosterone and Peyronie’s Disease and for those with low testosterone, there can be a benefit with testosterone replacement on the treatment outcome.
So, does anything work?
There are both surgical and non-surgical ways to fix this.
The only FDA approved non-surgical treatment is Xiaflex (collagenase clostridium histolyticum). Again, you might be prescribed some other medications (likely due to insurance reasons) but technically Xiaflex is the only approved treatment that doesn’t require a surgery.
For surgical intervention, there are multiple different ways to manage and I will review that below.
What is Xiaflex and how is it given?
Xiaflex is an enzyme that is injected into the plaque itself. This treatment involves up to four cycles. Let’s walk through one cycle.
Treatment #1: injection of Xiaflex into the plaque
Treatment #2: about 2-3 days later, Xiaflex is injected into the plaque again
Treatment #3: about 2-3 days after that, you will stretch the penis daily and bend the penis opposite an erection to help ‘model’ the plaque.
This process is repeated every six weeks for up to four cycles. I have a whole section on Xiaflex in the ‘urology medications’ section.
For all things Xiaflex and understanding the nitty gritty details with this treatment, click over here. Here is a link for full prescribing information on Xiaflex as well.
Who is a good candidate for this?
This indication for Xiaflex is a patient who has difficulty with penetration.
There should be greater than 30 degrees of curvature. This can be assessed either through pictures or your urologist will induce an erection in the office and take formal measurements. Lastly, the plaque should not be on the under side (ventral) part of the penis because this will be too close to the urethra.
Now this medication is really expensive and not all insurances cover it. There are other non-FDA approved injection treatments.
I will sometimes treat people with technically a blood pressure medication called verapamil. This too is given via an injection into the Peyronie’s plaque however the protocol for this is slightly different in that the injection is done every 2 weeks for six total treatments. The results aren’t as good as Xiaflex but I have had some success with this as well.
What do I experience during treatment?
During the injection, you will notice penile discomfort, bruising and swelling. The amount of this really varies. For some patients, it’s not too bad. For others, it’s a LOT. This is usually pronounced for a week but that really varies between injection to injection.
I tell people that your penis will look like you have been in a bar fight and lost. You gotta remember, we are trying to break down a hard plaque. So the Xiaflex medicine has to be strong enough to do that which is why there is some collateral damage along the way.
One important point to note, the major risk associated with treatment is something called a penile fracture. This is where that lining on the penis which helps with erection formation tears or rips and may require surgery to fix. This is why you have to avoid sex for a month while getting the injections. Like I tell all my patients, you gotta earn your reward with this treatment, no free lunch here.
What about surgery, what options are there?
There are three surgical options for Peyronies disease. Let’s walk through them…
- Penile plication: This is surgery where the urologist will place stitches to bend the penis in the opposite direction of your curve. This has the advantage of less risk of erectile dysfunction after surgery. The disadvantage is that this works best when the curvature is not too pronounced and can lead to shortening of the penis.
- Plaque excision and grafting: If the bend is more severe, then another option is to remove the plaque and place a patch. This can work for a patient with large curvature and is not associated with penile shortening. The major risk with this intervention is that it can lead to erectile dysfunction.
- Inflatable penile prosthesis: the penis pump. For those with ED and curvature, this can be a great option. It can not only treat the ED but it can also help fix the curvature as well. The satisfaction rates with surgery are pretty high and it can be a great choice for the right patient.
Dr. Jafri's Wrap up
So this is a quick overview of why your penis is curved and what can be done to fix it. As time goes on, we are realizing that Peyronie’s disease is WAY more common than we first realized. Don’t be embarrassed. Don’t stress out. If you have this and it’s bothering you, make the appointment. The treatments aren’t easy but they can really really work and make a difference in your sex life.
Remember, we focus treatment on people who are having difficulty having sex. If you notice a curve, but you aren’t having any issues with penetration we will likely not offer treatment at that time and wait to see if things get worse. If you are having issues with penetration, then Xiaflex can potentially be a great treatment to help reduce the bend and help improve your sexual performance.