Rounding the Bend: It’s Time to Talk about Peyronie’s
It’s a well-known phenomenon that many patients dislike going to the doctor, and will wait until a problem becomes nearly intolerable to finally seek treatment.
We’re not trying to point fingers here, but men are notoriously bad about this. In fact, a recent online survey conducted earlier this spring by a research group called The Harris Poll found that two thirds of men surveyed thought they were healthier than most other men. That’s the healthcare equivalent of saying “65% of drivers think they are above average drivers” (a statistical impossibility).
It’s one of the reasons that we put so much thought into how to make our clinic at Men’s Health Boston a friendly space for men. Because feeling comfortable discussing sensitive topics like erectile dysfunction, low libido, and cardiology concerns is absolutely critical to receiving the care you need – and deserve.
One of the most common ways we see this play out is for patients suffering from Peyronie’s Disease. When we asked our resident MHB Peyronie’s expert, Peter Veneziano, PA-C, what he wishes more people knew, here’s what he had to say:
“A lot of guys don’t seek treatment. But Peyronie’s Disease is a legitimate medical condition. There are treatments available. And things can get better.”
So in this month’s blog post, we wanted to tackle all aspects of this condition: what it is, how it can be treated, and why seeking medical care can make a major difference in your health and quality of life.
Read on to learn more, and to discover if an evaluation might be right for you.
Is having a curved penis normal, and how is Peyronie’s Disease different?
Having a slight bend in your erection is completely normal, and no cause for distress. This is particularly true if you have no issues with sexual performance.
In contrast, two of the biggest telltale signs that something might be off is if you start to experience abnormal pain (whether erect or otherwise), or difficulty achieving or maintaining an erection.
Peyronie’s Disease (PD) differs from basic penile curvature in both the degree of the bend, and the potential complications during sex. In PD, scar tissue develops in the tunica albuginea, a fibrous sheath of tissue surrounding the erectile chambers in the penis that expand when blood flows in. As this scar tissue develops, it can build a fibrous band that pulls back on the shaft of the penis, causing a “drawbridge-like” effect that creates the characteristic “bent” look.
While both the degree and direction of the curvature can vary patient-to-patient based on the location and size of the scar tissue, a bend of greater than 30 degrees is often accompanied by difficulty with having sexual intercourse. In some cases, this fibrous band of scar tissue instead creates a ring around the shaft of the penis, compressing the tissue and causing it to develop more of an “hourglass” appearance.
The most common symptoms that lead men to seek a check-up at our MHB clinic are an abnormal degree of curvature in the penis and painful erections. However, several other typical signs also exist:
- For some men, the penis can appear shorter, due to a loss of length associated with the bend.
- In many cases, scar tissue can be felt as a firm lump underneath the skin of the shaft.
It’s important to note that these symptoms can develop slowly over time, or onset can be very quick, seemingly occurring overnight. In addition to the sexual pain and frustration a lot of Peyronie’s patients experience, it can take a major toll on their mental health and relationships. If you experience one or more of the symptoms mentioned above, getting a comprehensive evaluation could greatly benefit you.
What causes Peyronie’s disease to develop?
Peyronie’s is thought to result from rogue healing mechanisms following traumatic injury to the penile tissue during sexual intercourse, although it’s also possible during other high impact activities, such as contact sports.
Interestingly, research shows that when patients are interviewed about specific incidents that might have caused the initial injury, the majority cannot identify one. This has led some researchers to hypothesize that repeated small injuries (dubbed “microtraumas”) healing abnormally over time may better account for the widespread incidence of Peyronie’s, which is estimated to impact between 6-10% of men over the age of 40.
Progression of the disease occurs in two phases, including an initial acute phase followed by a sustained chronic phase. During the acute phase, the fibrous plaque is actively under development, with excess collagen, and in some cases calcium, being deposited onto the scar tissue. This phase is often accompanied by painful erections due to inflammation and fluid pressure which irritates the nerves, development of characteristic “lumps”, and changes in penile shape. It’s estimated to last around 6-12 months for most men, during which time symptoms progressively worsen.
At some point though, the plaque appears to stabilize and stop growing, characteristic of a shift into the chronic phase. Pain often resolves on its own during this time, but erectile dysfunction can develop if the scar tissue interferes with the normal operations necessary to trap excess blood flow in the penis to achieve an erection.
Are certain people more at-risk for Peyronie’s Disease?
Aside from age (over 40 years old), there does seem to be a genetic component, meaning that if you have a close family member who has been diagnosed, you might be at increased risk. Certain autoimmune disorders, such as Lupus, or connective tissue disorders including plantar fasciitis, scleroderma, and Dupuytren’s disease can increase your chances of developing the scar tissue plaques. In addition, PD is more commonly developed in men who undergo surgery to remove a cancerous prostate, known as a radical prostatectomy.
Beyond this, a number of associations between Peyronie’s and metabolic dysfunction exist that are not currently well understood.
Will Peyronie’s Disease go away on its own?
Generally, true Peyronie’s Disease does not resolve on its own. The vast majority of cases require treatment to alleviate symptoms.
What are the treatments for Peyronie’s Disease?
The first step is scheduling an initial consultation with one of our sexual health experts. They will discuss the symptoms you’ve been experiencing, and conduct a physical exam.
From there, we often arrange for a penile vasculature study, which involves medically inducing an erection to assess the direction and degree of curvature, and potentially using ultrasound to identify the location of penile plaques.
Once a full assessment is complete, you and your provider will decide on the best course of
action for your situation.
- In some cases, no immediate treatment is necessary, depending on the degree of the curvature and whether or not there are signs and symptoms of dysfunction.
- In such cases, early assessment is highly beneficial, as you and your provider can actively monitor your situation and move quickly to resolve any symptoms that develop in the future.
- Medications exist which can help dissolve the scar tissue.
- One such option is Xiaflex, a form of injectable collagenase (an enzyme that breaks down fibrous collagen bands).
- Typical treatment with Xiaflex includes 2 injections within a single week, followed by 6 weeks of monitoring. During this phase, at-home manipulation of the scar tissue helps to further break down the plaque.
- This cycle is repeated 4 times total, before a re-evaluation to assess the results.
- For severe cases, surgical options exist which can return the penis to a functional state.
I think I need to get checked out. How can I schedule a consultation?
Living in the shadow of sexual pain and frustration can take a toll on your mental and physical health. If you or someone you know are suffering from painful erections or penile dysfunction, we’re here to help. For more information on our industry-leading care at Men’s Health Boston, click here. For a clinical evaluation, call our office or request an appointment with one of our expert practitioners today.