Pictures Of A Bent Penis? Top Answer Update

Peyronie’s disease

Not what you are looking for? new search

What is Peyronie’s disease? Peyronie’s disease causes hard, flat plaques to form under the skin on the tissues of the penis. Plaque often begins as inflammation that can turn into scar tissue. It can cause pain and a sharp curve in the penis during erection.

What Causes Peyronie’s Disease? Some researchers believe that Peyronie’s disease develops after an injury that causes bleeding in the penis. This could explain cases of Peyronie’s developing rapidly. But it doesn’t explain why most cases develop slowly or what causes the disease after no clear injury. Most researchers believe that genetics or the environment could play a role. Men with certain connective tissue disorders and men who have a close family member with Peyronie’s disease are at higher risk. And certain health conditions, such as diabetes or tobacco use, can also contribute to their development. When the disease clears up in about a year, the plaque often doesn’t get worse. But as the disease persists for years, the plaque often becomes a tough, fibrous tissue, and calcium deposits can form. The plaque in Peyronie’s disease is not a cancer.

What Are the Symptoms of Peyronie’s Disease? The following are the most common symptoms of Peyronie’s disease: Changes in the appearance of an erection: Plaque on the top of the shaft causes the penis to bend upwards when erect. This is the most common disease. Plaque on the side causes the penis to bend to the side of the plaque. Plaque on the underside causes the penis to bend down during erection. Plaque on the top, bottom, or wrapping around the penis can cause deformity, nicking, and shortening of the penis.

Painful erections

Problems with sexual penetration Pain, bending and emotional stress can severely affect a man’s sex life. Peyronie’s disease symptoms can look like other conditions or health problems. Always speak to a doctor for a diagnosis.

How is Peyronie’s disease diagnosed? Your doctor will review your health and sex history. The provider will also perform a physical exam, during which the plaque can often be felt. Other tests may include: Ultrasound of the penis. This imaging test uses high-frequency sound waves to create images of the inside of the penis and check blood flow. To check how the penis looks during an erection, your doctor at the clinic may inject a drug into the penis to induce an erection.

How is Peyronie’s disease treated? The goal of treatment is to relieve pain and keep you sexually active. There is no cure. Education about the disease and its usual course is often part of the treatment plan. In some cases, treatment is not required. Peyronie’s disease often occurs in a mild form that heals on its own in 6 to 15 months. Treatment may include: Vitamin E. Small studies have reported improvements with oral (oral) intake of vitamin E. However, no major studies have been conducted to prove that this treatment works. Still, this is a simple, inexpensive treatment option.

Small studies have reported improvements with vitamin E taken orally. However, no major studies have been conducted to prove that this treatment works. Still, this is a simple, inexpensive treatment option. medication. Many oral medications have been tried, but none have been proven to work for all men. If your doctor wants to try a drug, make sure you understand what it is and what is known about it. Find out what side effects you should watch out for.

Many oral medications have been tried, but none have been proven to work for all men. If your doctor wants to try a drug, make sure you understand what it is and what is known about it. Find out what side effects you should watch out for. Shots (injections) of medication into the plaques. Injections of various drugs into the plaques have been attempted in a small number of men.

Injections of various drugs into the plaques have been attempted in a small number of men. Surgery. This can be used to correct plaque in severe cases. This also applies if the man experiences pain during an erection. Or when he can’t keep an erection long enough to have sex. In severe cases, you may need a penile implant to straighten the penis. Talk to your doctor about any questions or concerns you may have about this condition.

Living with Peyronie’s Disease Peyronie’s disease affects every man differently. It can be very frustrating and affect your confidence in sexual relationships. It’s not uncommon for men with Peyronie’s disease to experience depression or relationship problems. You and your partner should learn as much as possible about the disease

Key Points About Peyronie’s Disease Peyronie’s disease causes a hard, flat plaque to form under the skin on the tissues of the penis. It causes pain and a sharp curve in the penis during erection.

Some researchers believe that Peyronie’s disease develops after an injury that causes bleeding in the penis. But most cases develop slowly, after no clear injury.

Peyronie’s disease causes changes in the way an erection looks, pain when the penis is erect, and problems with sexual penetration.

A physical exam (during which the plaque can often be felt) may be enough to diagnose Peyronie’s disease.

The goal of treatment is to relieve pain and maintain sexual activity. In some cases, treatment is not required. Peyronie’s disease often occurs in a mild form that heals on its own in 6 to 15 months.

There is no cure for Peyronie’s disease. A variety of medications can be tried. Most are taken orally, but some are injected into plaque. In severe cases, surgery to remove plaque may be done.

Next Steps Tips to help you get the most out of a visit to your healthcare provider: Understand the reason for your visit and what you want to happen.

Before your visit, make a note of any questions you would like answered.

Bring someone to help you ask questions and remember what your provider tells you.

At the visit, write down the name of any new diagnosis and any new medications, treatments, or tests. Also, make a note of any new instructions your provider gives you.

Learn why a new medicine or treatment is being prescribed and how it will help you. Also find out about the side effects.

Ask if your condition can be treated in other ways.

Knowing why a test or procedure is recommended and what the results could mean.

Know what to expect if you are not taking the medicine or undergoing the test or procedure.

If you have a follow-up appointment, write down the date, time, and purpose of that visit.

Know how to contact your provider if you have any questions.

Medical Reviewer: Marc Greenstein MD

Medical Reviewer: Donna Freeborn PhD CNM FNP

Medical Reviewer: Raymond Kent Turley BSN MSN RN

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your doctor’s instructions.

The initial diagnosis of Peyronie’s disease may be based on self-reports of penile curvature and/or pain on erection. The healthcare provider may also ask questions about other symptoms or use a structured questionnaire designed for men who may have Peyronie’s disease. However, a physical exam is often required to determine the extent of the disease. Sometimes this just consists of the doctor examining the flaccid penis and checking to see if any plaques or scars can be felt. In other cases, this may require examination of the erect penis and/or diagnostic imaging.

Very good / Julie Bang

self control

People who fear they have Peyronie’s disease should ask themselves the same questions a healthcare provider would ask during an exam. Answering these questions can give an idea of ​​whether a diagnosis of Peyronie’s disease is likely and can help you prepare to speak to a healthcare provider about your condition. This is important because it can be difficult to talk about sexual health and sexual function with anyone, let alone an authority figure like a healthcare provider. So the more prepared you are, the easier it will be.

Peyronie’s Disease Physician Discussion Guide Get our printable guide to your next doctor appointment to help you ask the right questions. Download PDF Email Guide Send to yourself or a loved one. Register This physician discussion guide has been sent to {{form.email}}. There was a mistake. Please try again.

Questions to ask yourself if you suspect you may have Peyronie’s disease:

Do I have pain in my penis when I get an erection? Do I have trouble getting an erection that’s as firm as it used to be? Is my penis curved when I have an erection? Has this curve changed over time? Does my penis seem shorter than it used to be when erect? Does my penis look like it has a dimple or an hourglass shape when it’s erect? Have I noticed a new lump or bump in my penis? Do I have problems with penetrative sex because my penis bends or kinks?

Not everyone with Peyronie’s will have all of these symptoms. However, if you have one or more of these symptoms, it’s a good idea to speak to your GP or a urologist.

Not all cases of Peyronie’s disease require treatment. However, sometimes treating Peyronie’s disease early can help improve long-term function.

One thing to note: Having an erection that isn’t as firm as it used to be, or having trouble getting an erection, is not necessarily indicative of Peyronie’s disease. There are many causes of erectile dysfunction.

Laboratories and Tests

The initial diagnosis of Peyronie’s disease usually comes after your doctor has asked you a series of questions about your sexual history and sexual health. However, there are also several types of tests that may be indicated to diagnose Peyronie’s disease, determine its severity, and determine appropriate treatment. Testing can also be helpful in determining what treatment is appropriate when treatment is indicated.

palpation

The first test for Peyronie’s disease involves the healthcare provider palpating the flaccid penis. During this test, the doctor will palpate the penis for areas that appear nicked, hard, or otherwise different from the rest of the penis as a whole.

At this point, the healthcare provider may also measure the length of the stretched, flaccid penis. The ability to stretch the penis is also a measure of penile health.

Peyronie’s Disease Questionnaire (PDQ)

To test the extent of your Peyronie’s disease, your doctor may also use the Peyronie’s Disease Questionnaire (PDQ). The PDQ is a 15-item test that asks about psychological and physical symptoms that Peyronie’s disease can cause and how bothersome those symptoms are. It can be used both to determine the severity of the condition and to see how and if treatment is improving your ability to function.

measurement of curvature

This test is usually performed on the erect penis. In order for you to get an erection at the healthcare provider’s office, the healthcare provider usually injects drugs into your penis that cause an erection. At this point, the healthcare provider will measure the curve of your erection. Ideally, this is done with a so-called goniometer. But it can also be done manually.

blood tests

Some health care providers will use blood tests to determine testosterone levels in men suspected of having Peyronie’s disease, but this is somewhat controversial. There is no clear, well-established link between testosterone levels and Peyronie’s disease.

However, there is evidence that the inability to have a firm erection may increase the risk of Peyronie’s disease. This could also be related to testosterone levels, although low testosterone levels alone will not usually cause erectile dysfunction in the absence of other health issues.

imaging

Ultrasound is the main type of imaging used to diagnose Peyronie’s disease. Your health care provider will use ultrasound of your erect penis to look for problems with blood flow, which could indicate other problems that may affect erectile function. High-resolution ultrasound can also be used to identify the plaques and scars that are the hallmark of Peyronie’s disease.

Other imaging tests can also be used to identify plaques in the penis at various stages of formation.

X-rays can detect changes in the soft tissues of the penis

can detect changes in the soft tissues of the penis CT scans can identify plaques before they begin to calcify

can identify plaques before they have started to calcify MRI can detect early signs of Peyronie’s disease but is not usually used because of cost.

differential diagnoses

There are a few other conditions that can be confused with Peyronie’s disease

Sclerosing lymphangitis causes a superficial, rope-like lesion on the penis. It’s usually the result of extremely violent sex. This type of lesion usually resolves on its own after a period of abstinence

causes a superficial, rope-like lesion on the penis. It’s usually the result of extremely violent sex. This type of lesion usually goes away on its own after a period of abstinence. Trauma to the penis, such as a penile fracture, can share many of the same characteristics as Peyronie’s disease.

, like a penile fracture, can share many of the same characteristics as Peyronie’s disease. Erectile dysfunction can be confused with the early symptoms of Peyronie’s disease.

can be confused with the early symptoms of Peyronie’s disease. Cancer of the penis (either primary or metastatic from elsewhere) can present with some of the same symptoms as Peyronie’s disease, including pain with erection and penile curvature. However, this is extremely rare.

A word from Verywell

Going to your doctor and talking about your sexual health can be scary. People are often taught that sex is not something to talk about outside of the bedroom. However, learning to talk about it in the diagnostic room can be extremely important.

If you have concerns about discussing your sexual health symptoms with your doctor, write them down. If you find yourself uncomfortable talking about your symptoms, a written list can help you get the treatment you need. You’ll likely need to answer a few additional questions from your doctor, but writing down your symptoms can make it easier to start the conversation.

And remember, urologists are extremely experienced in penile health. The chances of you showing them something they’ve never seen before are pretty slim. And even if you do, their role isn’t to judge you. It is designed to help you feel better.

On this page:

What is Peyronie’s disease?

Peyronie’s disease is a condition in which scar tissue called plaque forms under the skin of the penis — the male organ used for urination and sex.

Plaque forms inside the penis, in the thick elastic membrane called the tunica albuginea. The tunica albuginea helps keep the penis erect during an erection. The plaque can develop anywhere along the penis.

As it develops, plaque pulls on surrounding tissues, causing the penis to curve or bend, usually during an erection. Curves in the penis can make erections painful and make intercourse painful, difficult, or impossible.

Cross-section of a penis showing the curvature caused by a plaque during erection.

The plaque that develops in Peyronie’s disease

caused by an injury to your penis or by an autoimmune disease

is not the same plaque that can develop in a person’s arteries

is benign – not cancerous and not a tumor

Peyronie’s disease has two phases.

acute phase

During the acute phase, plaque forms and this phase can last up to 18 months.1 During this phase

Inflammation can occur and plaque builds up on your penis.

Your penis begins to curve.

Your penis can hurt without an erection.

Erections can become painful as scars develop.

chronic phase

The chronic phase occurs after plaque has formed. Typically, the chronic phase begins 12 to 18 months after your symptoms first appear.1 During this phase

Plaque and penile curvature are allowed to stabilize and not worsen.

The pain in your penis may subside.

Erectile dysfunction (ED) may develop or worsen.

How common is Peyronie’s disease?

About 1 in every 100 men in the United States over the age of 18 has been diagnosed with Peyronie’s disease. However, based on studies of men who reported having symptoms of Peyronie’s disease, researchers estimate that the actual number of men who have Peyronie’s disease is more than 1 in 10.2,3

The likelihood of developing Peyronie’s disease increases with age.1 Men in their 20s and 30s are less likely to have Peyronie’s disease.1

Who is more likely to have Peyronie’s disease?

You may be at higher risk of developing Peyronie’s disease if you

engage in vigorous sexual or non-sexual activity that causes micro-injuries to the penis

have certain connective tissue and autoimmune diseases

have a family history of Peyronie’s disease

are older

Have diabetes and erectile dysfunction

have a history of treating prostate cancer with surgery

Vigorous sexual and non-sexual activity

Men whose sexual or non-sexual activities (e.g., sports) cause micro-injuries to the penis are more likely to develop Peyronie’s disease.

Connective tissue and autoimmune diseases

If you have certain connective tissue or autoimmune disorders, you may be at a higher risk of developing Peyronie’s disease.

Connective tissue is specialized tissue that supports, connects, or separates different types of tissues and organs in your body. Connective tissue diseases can affect your joints, muscles and skin. Some medical conditions associated with Peyronie’s disease include:

Dupuytren’s disease, also known as Dupuytren’s contracture. In this condition, the connective tissue in the palms shortens and thickens. This leads to permanent bending of the outer fingers. It’s not clear why men with Peyronie’s disease are more likely to develop Dupuytren’s disease.

Plantar fasciitis, an inflammation of the thick tissue on the sole of the foot that forms the arch of the foot.

Scleroderma, which is the abnormal growth of thick, hard patches of connective tissue. Scleroderma can also cause swelling or pain in muscles and joints.

In autoimmune diseases, the body’s immune system attacks the body’s own cells and organs. Autoimmune diseases associated with Peyronie’s disease include

systemic lupus erythematosus, which causes inflammation and damage to various body tissues, including joints, skin, kidneys, heart, lungs, blood vessels, and brain

Sjogren’s syndrome, which causes inflammation and damage to the glands that produce tears and saliva

Behçet’s disease, which causes inflammation of blood vessels

Family history of Peyronie’s disease

Medical experts believe that Peyronie’s disease can run in some families. For example, if your father or brother has Peyronie’s disease, you may be more likely to develop the disease.

aging

Your likelihood of developing Peyronie’s disease increases with age. Age-related changes in the tissues of the penis can make it more easily injured and less likely to heal well.

Diabetes with erectile dysfunction

Men with diabetes-associated ED are four to five times more likely to develop Peyronie’s disease than the general population.4

Prostate cancer treatment with surgery

Your chance of developing Peyronie’s disease increases after prostate cancer surgery. Medical experts believe this is related to ED developed after surgery for prostate cancer.5

What Are the Complications of Peyronie’s Disease?

Complications of Peyronie’s disease can include:

the inability to have sexual intercourse due to penile curvature

Ed

emotional stress, depression, or anxiety about sexual ability or the appearance of the penis

Stress in a relationship with a sexual partner

Difficulty conceiving a child because sexual intercourse is difficult

What Are the Signs and Symptoms of Peyronie’s Disease?

Signs and symptoms of Peyronie’s disease may include:

hard lumps on one or more sides of the penis

Pain during intercourse or during an erection

a curvature of the penis with or without an erection

Changes in penis shape such as narrowing or shortening

Ed

These can develop slowly or appear quickly and can be mild to severe. In many cases, the pain subsides over time, although the curvature in the penis may remain.1 Problems with sexual intercourse or ED can occur at both stages.

What Causes Peyronie’s Disease?

Medical experts don’t know the exact cause of Peyronie’s disease, but believe it could be the result

acute or chronic injury to the penis

autoimmune disease

Peyronie’s disease is not contagious and is not caused by any known communicable disease.

injury to the penis

Medical experts believe that hitting or bending the penis can injure the tissues inside. These injuries can occur during sex, during sports activities, or in an accident. It can happen once, an acute injury, or repeatedly over time, a chronic injury.

The injury can cause bleeding and swelling within the elastic membrane in the penis or tunica albuginea. As the injury heals, scar tissue may form and plaque may develop. The hard plaque pulls on the surrounding tissue, causing the penis to curve.

You may not be aware of micro-injuries to your penis when they occur. Researchers have found that many patients cannot remember a particular event just before symptoms started.1

autoimmune disease

Men with an autoimmune disease can develop Peyronie’s disease when the immune system attacks cells in the penis. This can lead to inflammation in the penis. Scar tissue can form and develop into plaque. For more information on autoimmune disorders associated with Peyronie’s disease, see Connective Tissue and Autoimmune Disorders.

How do healthcare professionals diagnose Peyronie’s disease?

Men with Peyronie’s disease are usually referred to a urologist — a doctor who specializes in sexual and urinary problems.

A urologist will diagnose Peyronie’s disease based on your medical and family history and a physical exam.

Imaging tests are not usually required to diagnose Peyronie’s disease but can be used to gather additional information about the plaque.

medical and family history

The urologist will ask you about your medical and family history. Some questions might be

When did your symptoms start?

Do you have pain during an erection or at other times?

Do you have erection problems or problems with sexual intercourse?

Does anyone in your family have Peyronie’s disease or other medical conditions?

Do you take any medications? If so, which ones are they?

Do you have any other medical problems or conditions?

To diagnose Peyronie’s disease, your doctor will ask about your medical and family history.

Physical examination

A urologist can usually feel plaques in the penis whether it is erect or not.

If the urologist needs to examine your penis during an erection, they will give you an injectable medication that will produce an erection. Your urologist may also ask you to take pictures of your erect penis at home to assess the curvature during your follow-up visits.

How do healthcare professionals treat Peyronie’s disease?

The goal of treatment is to relieve pain, achieve a straight or nearly straight penis, and restore and maintain the ability to have sexual intercourse.

Not all men with Peyronie’s disease need treatment. In very few cases, Peyronie’s disease goes away without treatment.1

Also, you may not need treatment if you have 6

small plaques

little or no curvature of your penis

no pain

no problems with intercourse

no urinary problems

If you need treatment, your urologist may recommend nonsurgical treatments or surgery, depending on the severity of your symptoms, how much your penis curves, and whether your Peyronie’s disease is in the acute or chronic phase.

Your urologist will discuss your treatment options with you and review possible side effects and results.

Along with treatment, your urologist may recommend lifestyle changes to reduce the risk of ED associated with Peyronie’s disease.

Non-surgical treatments

Non-surgical treatments include injections, oral medications, and medical therapies. They can be used when Peyronie’s disease is in the acute phase.

injections. In the acute phase, a drug can be injected directly into the plaques, which is called an intralesional injection. The injection site is often numbed before the injection. These treatments can be performed in the doctor’s office.

collagenase. Intralesional collagenase injections (Xiaflex) are currently the only FDA-approved treatment for Peyronie’s disease. Collagenase is an enzyme that helps break down the substances that make up plaques. Breaking down plaque reduces penile curvature and improves erectile function. This treatment is approved for men with a penile curvature greater than 30 degrees. 7

verapamil. Verapamil is used to treat high blood pressure and can reduce penile pain and curvature when injected into the plaque. 1

Interferon alpha 2b. Interferon is a protein made by white blood cells. Studies show it reduces pain, penile curvature and plaque size.7

Oral medication. There are currently no oral medicines that effectively treat penile curvature.7 However, potassium para-aminobenzoate is used to treat Dupuytren’s contracture and may reduce plaque size. It does not affect penile curvature.

If you experience pain, your urologist may suggest that you take nonsteroidal anti-inflammatory drugs (NSAIDs).

Non-drug medical therapies. Other medical therapies used to treat Peyronie’s disease are still being studied to see if they work.7 These therapies include

mechanical traction and vacuum devices – which aim to stretch or flex the penis to reduce curvature

Shockwave therapy – low-intensity focused electric shock waves directed at the plaque can be used to relieve pain1

surgery

A urologist may recommend surgery to remove plaque or flatten the penis during an erection. Surgery may be recommended for men with Peyronie’s disease

the symptoms have not improved

Erections or intercourse or both are painful

the curvature in the penis prevents sexual intercourse

Medical experts recommend that you do not undergo surgery until your plaque and penile curvature have stabilized.1

Several types of surgery treat Peyronie’s disease. Your urologist will examine the plaque on your penis and consider the best type of surgery for you. An ultrasound shows the exact location and size of the plaque.

Some men can develop complications after surgery, and sometimes surgery doesn’t correct some effects of Peyronie’s disease, such as: B. the shortening of the penis.

Grafting. In this surgery, your urologist removes the plaque and replaces it with a piece of tissue taken from another part of your body, such as your chest. B. skin or a vein from your leg. grown in a lab; or from organ donors.

This procedure can straighten the penis and restore some length lost due to Peyronie’s disease.

Some men may experience penile numbness and ED after the procedure.

Application. In plication surgery, your urologist removes or pinches a piece of the tunica albuginea from the opposite side of the penis from the plaque to straighten the penis.

This procedure is less likely to cause deafness or ED.

The plication cannot restore the length or girth of the penis, and the penis may become shorter.

device implantation. Penile implants can be considered when a man has both Peyronie’s disease and ED.

A urologist implants a device in the penis that can produce an erection. The device can help stretch the penis during an erection.

In some cases, the penis is sufficiently straightened by the implant alone. If the implant alone does not erect the penis, a urologist can combine the implantation with one of the other two surgeries.

Can I prevent Peyronie’s disease?

Researchers don’t know how to prevent Peyronie’s disease. At this point, it was established that diet and nutrition play no role in preventing Peyronie’s disease.1

Clinical studies on Peyronie’s disease

The NIDDK conducts and supports clinical trials in many diseases and conditions, including urological diseases. The studies aim to find new ways to prevent, detect or treat diseases and improve quality of life.

What are clinical trials for Peyronie’s disease?

Clinical trials — and other types of clinical trials — are part of medical research and involve people like you. When you volunteer to take part in a clinical trial, you help doctors and researchers learn more about diseases and improve healthcare for people in the future.

Researchers are studying many aspects of treating Peyronie’s disease, including the effectiveness of

various drugs

other types of non-surgical treatment

Find out if clinical trials are right for you.

What Peyronie’s disease clinical trials are recruiting for?

Visit www.ClinicalTrials.gov to view a filtered list of Peyronie’s disease clinical trials that are open and ongoing for recruitment. You can expand or narrow the list to include clinical trials from industry, universities, and individuals; However, the NIH does not review these studies and cannot guarantee their safety. Always talk to your doctor before participating in a clinical trial.

What have we learned from NIDDK-funded research on Peyronie’s disease?

The NIDDK has supported research projects to learn more about the formation of plaque and the role of genes.

references

Learn More Disclaimer If you have any medical questions or concerns, please consult your healthcare practitioner. Articles in the Health Guide are supported by peer-reviewed research and information sourced from medical societies and government agencies. However, they are not a substitute for professional medical advice, diagnosis or treatment.

Lots of great things come with age – like wisdom, experience, and discounts at the movies. But most people associate old age with the not-so-good things like wrinkles, health problems, and the end of sex life. However, the latter is a common mistake. Erectile dysfunction may become more common as men age, but it’s not just a natural part of aging.

The answer to the question “At what age does a man stop getting hard?” is simple: it doesn’t exist.

Some men in their 90s can still get erections with no problem, while many men in their 20s struggle with erectile dysfunction. There is no age limit for a healthy and enjoyable sex life. So if you suffer from ED, know that there are ways to help.

Receive $15 Off Your First Month Of ED Treatment When prescribed, have ED treatment delivered discreetly right to your door. Learn more

Erectile dysfunction by age

ED, or erectile dysfunction, occurs when you cannot get an erection sufficient for satisfactory sex. This can mean not being able to get an erection at all, or having erections that aren’t as firm or don’t last as long as you might like. Experts estimate that 30 million American men have experienced ED at some point (Nunes, 2012). ED can also affect your sex drive.

ED can occur at any age but is more common in older men. If a man is in his 40s, he has about a 40% chance of having experienced ED. This risk increases by about 10% with every decade of life—a 50% chance in his 50s, a 60% chance in his 60s, and so on (Ferrini, 2017).

So age is a risk factor for ED. But ED is not a natural part of aging that older men simply have to accept and learn to live with, and ED can occur at any age. It’s always worth checking with a healthcare provider, as ED can be a sign that something bigger is going on with your health.

Several health conditions can also increase your risk for ED, including:

Heart disease — The most common cause of ED in men over 50 is atherosclerosis, or hardening of the arteries, which leads to heart disease (Cleveland Clinic, n.d.). As men age, the linings of the arteries become less flexible. This means they don’t stretch as easily to get blood flowing where it needs to go (like the penis to create an erection). Plaque caused by high cholesterol can also build up in the arteries and restrict blood flow to the penis (Nunes, 2012).

—The most common cause of ED in men over 50 is atherosclerosis, or hardening of the arteries that leads to heart disease (Cleveland Clinic, n.d.). As men age, the linings of the arteries become less flexible. This means they don’t stretch as easily to get blood flowing where it needs to go (like the penis to create an erection). Plaque caused by high cholesterol can also build up in the arteries and restrict blood flow to the penis (Nunes, 2012). Hypertension – Also known as high blood pressure, hypertension means that blood is being pumped through the blood vessels more than it should, potentially damaging and narrowing the walls of the blood vessels. This condition can lead to heart disease and stroke (AHA, undated).

— Hypertension, also known as high blood pressure, means that blood is pumped through the blood vessels more than it should, potentially damaging and narrowing the walls of the blood vessels. This condition can lead to heart disease and stroke (AHA, undated). Diabetes – High blood sugar associated with diabetes can also damage the walls of blood vessels and impede blood flow (ADA, n.d.).

– High blood sugar associated with diabetes can also damage the walls of blood vessels and impede blood flow (ADA, n.d.). Stroke – A stroke can cause neurological damage that can contribute to ED (Koehn, 2019).

—A stroke can cause neurological damage that can contribute to ED (Koehn, 2019). Cancer – A variety of physical and psychological issues related to cancer symptoms, surgery, and treatment can contribute to ED (ACS, n.d.).

—A variety of physical and psychological issues related to cancer symptoms, surgery, and treatments can contribute to ED (ACS, n.d.). Anxiety and depression: ED is certainly not “all in your head” (nor is mental illness), but depression, anxiety disorders, and issues like relationship troubles and stage fright can all contribute to ED (Rajkumar, 2015).

Other lifestyle risk factors for ED

ED can also occur as a side effect of certain medications, including antidepressants. If you suffer from ED, be sure to tell a doctor about all medications you are taking. They may be able to adjust your dose or substitute another medication.

Other lifestyle factors that may contribute to ED include: being overweight or obese, not getting enough exercise, smoking or using tobacco products, drinking excessively (more than two alcoholic drinks per day), and using recreational drugs.

ED can also result from physical conditions where the body’s nerves are damaged or don’t work properly, such as nerve and spinal cord injuries and multiple sclerosis.

How to treat ED

The good news is that there are many ways to treat ED.

Regardless of your age, if you have ED, it’s a good idea to speak to a healthcare provider to identify underlying health conditions and find a treatment plan that’s right for you.

Peyronie’s disease (PD) is a condition that causes abnormal curvature of the penis. The curvature can be accompanied by pain in the penis. It can also be the cause of erectile dysfunction (ED). It has been estimated that 6% to 10% of men between the ages of 40 and 70 have Peyronie’s disease.

PD can often correct itself or be treated with injections that dissolve scar tissue from the penis. Surgical removal of scar tissue or correction with penile implant surgery can also be used.

Home remedies include supplements that can reduce scar tissue, stretching exercises, penile massage, and traction equipment. Early diagnosis of Peyronie’s disease is essential for the most effective treatment.

This article discusses the effectiveness of penile exercises for PD treatment and the specifics of each exercise.

John Fedele/Getty Images

Can Exercise Help a Curved Penis?

Some exercises have been found to help with Peyronie’s disease. Research shows that penile stretching in the form of penile traction therapy (PTT) helps to lengthen the penis and correct curvature in the acute phase of Parkinson’s disease. A gentle stretching exercise of the sleeve can help break down scar tissue and also relieve curvature issues.

There are two phases of Parkinson’s disease: the acute phase and the chronic phase. In the acute phase, plaque forms and curvature begins. This usually lasts five to seven months, but in rare cases it can last up to 18 months. As a rule, the chronic phase follows, which is characterized by stabilization of plaque formation and curvature. Your treatment will depend on what stage your Peyronie’s disease is in.

It is absolutely essential that you do the exercises correctly to avoid further damage to the penis. Talk to your doctor or urologist to make sure you’re using the equipment and exercises correctly at home.

penis modeling

Penis modeling is an option to treat a severe case of Peyronie’s disease. It is possible in conjunction with collagenase injections. It can also be done after surgical implantation of an inflatable penile prosthesis (IPP).

Penis modeling after IPP implantation

IPP implantation involves a surgical procedure in which a prosthesis is inserted into the penis. This approach is recommended for people in the chronic stages of PD who also have ED.

This surgical procedure can correct penile curvature and sexual dysfunction. While it is possible to resolve curvature issues with prosthetic implant placement alone, most people require additional straightening procedures during surgery, such as B. a penis modeling.

Once the IPP is implanted, the doctor bends the penis in the opposite direction of the curve. This maneuver can be repeated until the curvature is corrected.

Collagenase injections and penis modeling

An office-based penis modeling procedure is collagenase injection. Urologists give these injections directly into the plaque if it is palpable on examination. Studies have shown that this can help relieve Parkinson’s disease when used along with penis modeling in a doctor’s office and at home.

However, there is a chance that complications will arise. Urethral injury is possible during penis modeling. There are ways to avoid this complication, so overall penis modeling is a safe and effective way to treat Parkinson’s.

Bruising and pain in the penis are common in penis modeling.

stretching

milking

Milking, also known as jelqing, is a penile stretching exercise that involves massaging the penis to create micro-tears. Once these micro tears begin to heal, the penis can appear longer and thicker.

Research is lacking as to whether it is unsafe or effective. In general, it’s recommended to play it safe and skip this technique until more conclusive research is available.

massage

Massage could be a way to treat Peyronie’s disease. However, the research supporting this as an effective way to treat Parkinson’s is inconclusive.

Improper penis massage can also lead to further damage and worsening of Peyronie’s disease. Talk to your doctor before trying massage as a treatment for Peyronie’s disease.

Penile Traction Therapy (PTT)

Penile traction therapy (PTT) is an exercise that requires a device to be worn on the penis. It is intended for daily use over a period of time. The idea behind PTT is that it can help straighten or reduce curvature of the penis.

It should be noted that only limited data are available on the effectiveness of PTT in the treatment of Peyronie’s disease. It’s unclear if it helps straighten the penis and reverse the curvature. However, a growing body of research suggests it is a possible treatment to achieve these goals.

One study showed that penile traction therapy was likely helpful in lengthening the penis. However, this only applies to the acute phase. The role of PTT in chronic phase PD remains unclear. It should also be noted that this study evaluated PTT when administered prior to penile prosthesis insertion and after surgical correction of Parkinson’s disease.

vacuum erection devices

A vacuum erection device (VED) is another possible treatment option for Peyronie’s disease. Like PTT, it has limited data on its effectiveness, but evidence is mounting that it’s a viable option.

A VED, also known as a penis pump, is a device where the penis is inserted into a vacuum tube. The VED then stretches and pulls the penis through suction. The device is used for men with erectile dysfunction and can also be used to treat Parkinson’s disease.

As far as the research goes, a 2020 study showed that a vacuum erection device can help reduce penile curvature associated with Peyronie’s disease. The study had 53 participants, and 23 of those men were not using a VED.

All 20 participants using VED traction therapy showed significant improvement in curvature. Although the study is small, its results show that VEDs may be a promising treatment option.

A word from Verywell

While PD can sometimes go away on its own, many of those struggling with the condition need treatment. Everyone dealing with Parkinson’s will have a unique situation, and it’s best to consult your doctor to learn what treatment is best for you.

What stage your Peyronie’s disease is in will also determine what treatments may be most effective in reducing the curvature and other symptoms. Exercise has the potential to further damage the penis, so it’s best to do it under the guidance of your doctor.

access denied

Your access to the NCBI website at www.ncbi.nlm.nih.gov has been suspended due to possible misuse/abuse of your website. This is not an indication of a security issue such as a virus or attack. It could be something as simple as a script running away or learning how to make better use of e-utilities http://www.ncbi.nlm.nih.gov/books/NBK25497/ to work more efficiently so that your work this does not affect the ability of other researchers to also use our website. To restore access and understand how you can better interact with our site to avoid this in the future, ask your system administrator to contact [email protected].

The signs, causes, and treatment of Peyronie’s disease

Peyronie’s disease is a somewhat uncommon condition in men caused by scar tissue called plaque. This fibrous tissue builds up inside the penis and leads to unusual symptoms that can be worrisome. Peyronie’s disease causes not only discomfort but also deformity of the penis.

Signs of Peyronie’s disease can develop slowly or appear overnight. While the disease is generally more common in middle-aged men, both younger and older patients can develop symptoms.

If your partner is showing symptoms of Peyronie’s disease, encourage them to see a urologist to treat this condition. This blog will break down the signs of Peyronie’s disease, highlight the various causes, and next steps men can take to relieve the symptoms.

See also: How to Support Your Partner Through a Vasectomy

Signs of Peyronie’s disease

1. Deformity of the penis

Penile deformity is the main indicator of Peyronie’s disease. Because plaque is scar tissue, it cannot stretch like normal or healthy tissue. This leads to changes in the shape of the penis or a deformity of the penis.

Some changes can be drastic, causing irregular curvature or curvature of the penis where the plaque is located. The most common change in Peyronie’s is upward curvature of the penis. Alternatively, a downward or sideways curve is also possible. What’s more, men with multiple plaques can curve in more than one direction.

2. Scar tissue under the skin

Scar tissue is another obvious symptom that can be self-diagnosed. The plaque associated with Peyronie’s disease can be felt under the skin of the penis. Peyronie’s scar tissue feels similar to flat lumps or a band of hard tissue.

Also note that the tissue can change over time – it will feel soft at first and then become firmer as it develops. In addition, the plaque can appear anywhere along the shaft of the entire penis.

3. Penile pain

Your partner may experience penile pain, which is another prominent symptom in the early stages of Peyronie’s disease for many.

Although the pain usually occurs during an erection, it can also occur when the penis is flaccid. Penile pain is due to inflammation in the area where plaque is forming.

Pain, which occurs specifically during an erection, is caused by pressure on plaque as penile tissue expands. Luckily for most men, this pain and discomfort can be eliminated fairly quickly with the right treatment.

4. Shortening and narrowing

As a result of Peyronie’s disease, the penis can become shorter or narrower.

Shortening can occur with or without curvature when the plaque is deeper in the penis. It can also make itself felt with or without an erection.

In some cases, an erect penis can have a constricting effect or even indentations that create an hourglass-shaped appearance caused by a tight and narrow band around the shaft. The narrowing is often due to plaques present on opposite sides of the penis forcing the shape inward.

5. Erectile dysfunction

Peyronie’s disease can cause problems getting (or keeping) an erection for a variety of reasons.

Psychologically, men with Peyronie’s disease often feel depressed about their situation and fear sexual activity, which can lead to erectile dysfunction. Physically, penile curvature and other deformities can make sexual intercourse difficult and painful.

How to treat signs of Peyronie’s disease

It is not impossible for men with Peyronie’s disease to notice that the symptoms improve on their own without treatment. However, this doesn’t always happen, so it’s best to discuss treatment options with a doctor to properly manage this condition and prevent Peyronie’s disease from getting worse.

medication and physical therapy

Peyronie’s disease can be painful for many men and can result in uncomfortable sexual experiences for them and their partner. Pain management, whether through physical therapy or medication, can be helpful. A doctor can prescribe Xiaflex, a prescription drug for adult men who have uncomfortable symptoms of Peyronie’s disease that don’t go away on their own.

surgery

If Peyronie’s disease persists over time or symptoms worsen, surgery may be recommended.

Various surgical treatment options include transplants and implants. In transplantation, some of the scar tissue is removed and replaced with other healthy tissue from another part of the body. Penile implants could also be an option. Here the spongy tissue is placed in the erectile tissue to achieve normal erectile function. Be aware that these options could potentially increase the likelihood of erectile dysfunction, so surgery should be considered as a last resort if nothing else works for your partner.

Fortunately, there are several treatments for this condition, and some of them can be used in combination with others. It’s important to know that when signs of Peyronie’s disease are present, your partner is not alone and that treatments are available. Make an appointment with your doctor to discuss options.

A guide to men’s health

Men don’t always consider their health a top priority. Unfortunately, this can lead to all sorts of complications from the urological system, including Peyronie’s disease.

To encourage men to focus on their health, we created a resource that teaches them how to age gracefully. Our man-to-man guide to healthy aging explains what men at every stage of life should be doing to ensure their urological health is in check. Even if self-checks and doctor visits are not fun, they are necessary. Download a free copy of the guide and share it with someone you care about.

This content was originally published in August 2015 and updated in May 2020.

Standard treatment with potassium aminobenzoate is 12g daily divided into six doses of four 500mg tablets. The total number of tablets per day is 24 (720 tablets per month). Since a minimum of six to 12 months of treatment is recommended, patients need to take a large number of pills over the course of treatment to get any benefit. In a study of 21 patients with Peyronie’s disease treated with potassium aminobenzoate,13 the morphological deformity disappeared completely in 18 percent of the study participants and resolved in another 82 percent. Plaque completely resolved in 11 percent and reduced in another 67 percent, and pain disappeared in every patient.13 A retrospective review18 noted that no well-controlled, double-blind, prospective study with appropriate subjects was conducted to determine the efficacy of potassium aminobenzoate in the treatment of Peyronie’s disease. Because the rate of spontaneous resolution is high, results with potassium aminobenzoate may not be better than results with placebo.

See more See less

Oral medication

Drug therapy can help men who are severely affected by the disease in the acute phase. Most societal guidelines do not recommend oral medications because long-term studies have not shown convincing benefits.

Orally administered vitamin E

Vitamin E is an antioxidant popular for its mild side effects and low cost. Studies from 1948 show that taking vitamin E can shrink plaques and help straighten the penis. But most of these studies didn’t compare a group of people who took vitamin E with a group of people who didn’t (a control group). Some vitamin E studies that use a control group suggest that vitamin E works no better than placebo. (A placebo is a pill with no active ingredients—a “sugar pill.”)

potassium aminobenzoate

Small studies with placebo controls show that this vitamin B complex helps reduce plaque size, but not curve. Unfortunately, it is costly and patients have to take 24 pills a day for 3 to 6 months. It can also upset your stomach, so many men stop taking it.

tamoxifen

This nonsteroidal anti-estrogen drug has been used to treat desmoid tumors, which resemble the plaques found in Peyronie’s disease. There are few controlled studies of this drug and they have not shown that tamoxifen works better than placebo.

colchicine

Colchicine is a decongestant that has been shown to be mildly helpful in a few small studies with no controls. Many patients taking colchicine experience stomach problems and stop taking it. It has not been proven to work better than placebo.

carnitine

Carnitine is an antioxidant that reduces swelling to aid in wound healing. Studies without controls show some benefit. But a recent controlled study didn’t show it to work any better than a placebo.

penis injections

Injecting a drug directly into the plaque brings higher doses of the drug to the problem than taking a drug by mouth. Plaque injection is commonly used in men with early-stage Peyronie’s disease or in men who are unsure about undergoing surgery. The skin is often numbed before the injection to reduce pain.

verapamil injections

Verapamil is mainly used to treat high blood pressure. Some studies suggest that verapamil injection may work for penile pain and curvature. Verapamil appears to be a good and inexpensive option to treat Peyronie’s disease. More controlled studies are needed to prove how well it works.

interferon injections

Interferon is an endogenous protein that helps control swelling. It has been shown to help control scarring, perhaps by slowing the rate at which scar tissue builds up and by producing an enzyme that breaks down scar tissue. A large-scale trial of interferon injection for Peyronie’s disease showed that this treatment could help.

collagenase injections

Collagenase is made in the body and breaks down certain scar tissues. Studies have shown that injecting collagenase into plaques has helped cure Peyronie’s disease. This drug is now FDA approved in the US for the treatment of men with penile curvature greater than 30 degrees.

other treatments

Other ways to treat Peyronie’s disease are being studied. But there isn’t enough data on them yet to prove they work.

A few small studies have shown that stretching the penis daily for at least 6 months can help restore length and curvature.

Treatment of the penis with ultrasound, radiation, shock waves, heat and verapamil on the skin is also being studied. These are largely unproven and not recommended by experts in the field.

Surgery for Peyronie’s Disease

Surgery is reserved for men with more severe, disabling penile deformities that make it difficult to have sex. Most healthcare providers suggest postponing surgery until the plaque and curvature stop worsening and the patient has shown no deterioration for at least 9 to 12 months.

Before the surgery, your doctor may check the blood flow in the penis by injecting a drug that makes it stiff, and may also use ultrasound to examine the inside of the penis. These tests show what’s going on inside your penis (such as whether you also have ED) so your doctor can decide what type of surgery is best for you.

There are 3 basic ways to fix Peyronie’s disease through surgery:

causing the side of the penis opposite the plaque to become shorter

making the curved side of the penis longer

Inserting a prosthesis into the penis when the man has both Peyronie’s disease and erectile dysfunction

Surgery to shorten the side of the penis opposite the plaque/curve

This type of surgery can be performed either by cutting out small pieces of tissue on the outside of the curve and suturing them shut, or by folding the tissue and pulling it together with surgical thread. The surgery is safe in most cases, easy for the surgeon to perform, and carries a low risk of problems (such as bleeding or worsening ED). A disadvantage is that this type of surgery can shorten the penis. This surgery is better for men with mild or no ED, mild to moderate penile curvature, and a long penis.

Surgery to make the curved side of the penis longer

This type of surgery is used when penile curvature is severe, plaque has calcified, or the shaft has become very narrow. The surgeon cuts the plaque to relieve tension and may remove some of the plaque. The remaining space is then filled with a graft. In most cases, this surgery will not make the penis much shorter. But it is more difficult for the surgeon and there is a risk that it will make the ED worse. This surgery is often only recommended for cases of severe deformity in men who are able to get erections hard enough for sex.

penile prostheses

An inflatable pump or malleable silicone rods placed inside the penis are good options for men with Peyronie’s disease and moderate to severe ED. In most cases, this will straighten the penis and allow it to become stiff enough for sex. If the device does not straighten the penis sufficiently, the surgeon can straighten it further by modeling the plaque against the rigid prosthesis or by cutting the plaque and using a graft to cover the opening.

Background Peyronie’s disease is a relatively common condition in urological practice, but is still poorly recognized and understood in the broader medical community and the majority of the public. Identifying the condition and appropriate referral to an expert can significantly reduce the physical and psychological impact on patients.

Aim The aim of this article is to provide general practitioners with a concise and updated overview of Peyronie’s disease, with the aim of helping them to advise their patients appropriately.

Discussion Peyronie’s disease is an abnormal wound healing process that culminates in excessive scarring of the penis, which can cause pain, shortening, and curvature of the penis. It is often accompanied by erectile dysfunction and can lead to progressive and severe impairment of penetrative sexual intercourse. The course of the disease is divided into active inflammatory and chronically stable phases. Oral therapy is usually of limited effectiveness, while penile traction may only be beneficial in motivated patients. Recently, intralesional collagenase injections have been introduced as a non-surgical measure to reduce penile curvature. Surgery remains the most effective treatment for Peyronie’s disease and is considered the gold standard.

The development of a curved erection, usually for no apparent reason, is of great concern to men who develop Peyronie’s disease, and there is a reluctance to talk about it. François Gigot de La Peyronie first described the condition in 1743,1 but despite generations of research and treatment, Peyronie’s disease is still not fully understood and has proven resistant to a “cure.” No treatment can fully restore the penis to its pre-disease condition.

Etiology and clinical presentation

Up to 9% of men have evidence of Peyronie’s disease upon inquiry and examination, although the number of men with symptoms of Peyronie’s disease is far fewer.2,3 The peak incidence of Peyronie’s disease is around 55-60 years. and penile curvature is the most common manifestation, followed by the sensation of a lump in the penis. A painful erection is reported by more than half of patients with Peyronie’s disease.3,4 Only about 10% of patients with Peyronie’s disease,5 usually younger patients, report remembered penile trauma.

Peyronie’s disease is known to be associated with erectile dysfunction, and approximately 30% of patients with Peyronie’s disease also have diabetes.6 Peyronie’s disease is significantly associated with obesity,7 hypertension, hyperlipidemia,5 smoking, and pelvic surgery.6 This was the case. It has been found to affect 16% of patients after radical prostatectomy.8 An association with Dupuytren’s disease is also known.6 The increasing incidence of erectile dysfunction with age is probably related to the increasing prevalence Peyronie’s disease is associated with aging because the loss of “stiffness” or axial rigidity of the penis causes minor flexion injuries during normal sexual activity.

Peyronie’s disease can also cause significant emotional distress, partly as a result of the deformity and associated difficulties with sexual function, but often also because of the penile shortening that occurs in almost all patients. Up to 50% of patients with Peyronie’s disease can be diagnosed as clinically depressed.5

Peyronie’s disease is an abnormal wound healing disorder that occurs in genetically predisposed males with “trauma” to the structural layers of the penis (Figure 1).9 The abnormal healing results in a fibrous, inelastic scar that causes a palpable mass, or plaque, which, in an erection, causes a curvature, shortening, narrowing, or hinge effect. This happens because the affected part of the penis does not “stretch” during erection.10 In the early stages, there may also be an inflammatory component that causes pain.

Figure 1. Anatomy of Peyronie’s disease

Peyronie’s disease is a progressive process, with most men experiencing progression in the first few months after onset that may not be affected by early treatment.11 Peyronie’s disease is generally divided into two pathologic and clinical stages. The first phase is an acute inflammatory phase in which penile pain and curvature progression may occur, although pain typically resolves spontaneously within 12 months and curvature usually stabilizes with curvature stability for more than three months.

patient assessment

Diagnosis of Peyronie’s disease is readily made through a typical medical history and penile exam. Clinically important information includes:

Disease stage (i.e. active vs. chronic)

Curvature features (i.e. direction, degree)

Penis length and other related penile deformities (eg, hourglass deformity)

Presence of pre-existing or concomitant erectile dysfunction.

Short duration of disease (< 12 months), persistent penile pain, and persistent penile deformity changes are likely signs of the acute phase. Physical examination when flaccid often reveals a hardened area or obvious plaque on the penis, although patients may not be aware of it.12 However, assessment of a flaccid penis is inadequate in assessing Peyronie's disease deformity - the degree angulation is not fully appreciated and patients tend to overestimate the degree of angulation. Usually the direction of curvature corresponds to the location of the plaque. In two-thirds of patients, the plaque is on the dorsal surface of the penis. Lateral and ventral plaques are less common but are more likely to impair penetration. Multiple plaques located on opposite sides of the penis or plaques appearing in the septum can lead to penile shortening with a relatively straight penis.13 Studies on Peyronie's disease In general, the diagnosis of Peyronie's disease is based on clinical findings. When referred to a specialist, the urologist may perform duplex Doppler ultrasound combined with an intracavernous vasoactive agent. This allows the urologist to objectively measure the patient's penile perfusion parameters, penile curvature and other deformities, and plaque features (e.g., calcification). These parameters can help to derive treatment options.14 Magnetic resonance imaging (MRI) is indicated very rarely and should only be organized by a specialist. Non-surgical treatment of Peyronie's disease monitoring Patients should be cautioned that if the pain and curvature is minimal and sexual function is normal, or if the patient is not sexually active, medical or surgical intervention may not be warranted. Sometimes the patient seeks reassurance rather than intervention. oral therapy There is no oral remedy that will cure Peyronie's disease and most of the commonly used treatments that patients "get" off the internet or research on the internet have not been effective in proper clinical trials. If oral agents are to have any benefit they will probably need to be used very early in the disease course, but there is considerable doubt as to whether they offer any real benefit. Additionally, these oral agents are "off-label" when treating Peyronie's disease only. pentoxifylline Pentoxifylline is a nonspecific phosphodiesterase inhibitor that can increase penile nitric oxide levels and prevent or reverse calcification of Peyronie's patch.15 However, this drug is usually taken three times a day and has gastrointestinal side effects, which limits its use. Phosphodiesterase type 5 inhibitors Phosphodiesterase type 5 (PDE5) inhibitors available in Australia are sildenafil, tadalafil and vardenafil. Animal studies have shown that these drugs, designed to enhance erections, can reduce the ratio of collagen or smooth muscle to III-I collagen in Peyronie's disease-like plaque.16 In a retrospective controlled study, tadalafil (5th mg) administered in a statistically significant resolution of the septal scar in 69% of patients compared to 10% in the control group.17 Because erectile dysfunction is often co-existing in patients with Peyronie's disease, we usually recommend low-dose PDE5 inhibitors for the acute Stage Peyronie's disease, although we caution patients that the evidence supporting the use of these agents is scant solely for their "antibacterial" effects. intralesional injections Agents injected into the plaque hold more promise for improvement and are now widely studied and accepted as worthwhile treatments.18 Although used primarily in the chronic or stable phase of the disease, intralesional injections may play a role earlier in the process. collagenase The use of intralesional injections of collagenase along with physical modeling of the penis has been reported to result in a decrease in curvature.19 In two large prospective, randomized, double-blind, placebo-controlled studies, the overall response was a mean improvement of 37%. in curvature, compared to 17% (p<0.05) in the placebo arm.20 It is important to note that for a 60° curvature, a 37% improvement actually corresponds to a 22° improvement in curvature; this should be clearly communicated to the patient. Results may be unsatisfactory in patients with a calcified plaque, a high degree of curvature, or an associated hinge or hourglass deformity. Although collagenase was approved by the Therapeutic Goods Administration in Australia in 2016, it is not listed on the Pharmaceutical Benefits Scheme and is very costly. Multiple injections are required in multiple cycles, and between cycles, patients must undergo penile modeling exercises. Patients must be properly screened and informed prior to starting collagenase injections. Ideally, collagenase injections should only be given by a board-certified or general practitioner specializing in men's health. verapamil Verapamil has been found to affect the cellular activity of fibroblasts. Some studies have found that intralesional verapamil injection produces a significant reduction in penile curvature.21 However, verapamil is not an approved treatment for Peyronie's disease and has been used off-label. Other non-invasive therapy Low intensity shock wave therapy Low-intensity shockwave therapy has been found to have very little benefit in the treatment of Peyronie's disease.22 penis traction devices and vacuum pumps In several tissue models, including Dupuytren's scar, it has been found that the gradual stretching of tissue through tension leads to the formation of new connective tissue through cell proliferation.23 For patients who are highly motivated, a six-month trial of regular, daily use of a vacuum erection device or penile traction device can provide up to a 25% improvement in curvature.24 These devices are also used in conjunction with medical therapy and can help improve outcomes compared to medical therapy alone. Surgical Treatments of Peyronie's Disease Surgery remains the gold standard for correcting penile deformities. Surgery is indicated when the patient:25 stable illness minimal to no pain Difficulty or inability to have sex because of the deformity Desire for the fastest and most reliable result. Different authorities have different recommendations on the minimum time for stable disease before surgery. We believe an absolute minimum of three months of stable, pain-free illness is required prior to surgery. The goal of surgery is to correct the curvature to allow for a "functionally" straight erection. This corresponds to a curvature of <20°, which is usually sufficient to allow for satisfactory sexual intercourse. Some patients may require surgery for psychological or physical reasons, even for lesser curvatures. In the preoperative consultation it is very important to ensure that the patient understands this goal (ie a functionally straight erection) and that the penis cannot be restored to its previous state. Because some men have minor deformities that are not functionally significant, they need to fully understand the risks and realistic outcomes of surgery versus the minor deformity they may have, and in many cases, be dissuaded from surgery. There is general agreement that for men with sufficient preoperative erectile function and rigidity and with a curvature of < 60°, some type of procedure to shorten the "long" (convex) side of the curved penis, such as a tunic, albuginea fold (often referred to as Nesbit fold; Figure 2) is indicated. For patients with more severe deformity but still good preoperative rigidity, plaque incision or excision and grafting (lengthening of the “short” side; Figure 3) is recommended.26 For patients with poor erectile function or rigidity that cannot be improved pharmacologically , and where there is significant curvature, implantation of a penile prosthesis is recommended with or without additional procedures,27 even penile disassembly and reassembly techniques.28 Figure 2. Penis plication procedure Figure 3. Plaque incision and graft Conclusion The most important part of treating Peyronie's disease is setting reasonable expectations. Peyronie's disease is a clinical diagnosis and definitive treatment is reserved for the stable phase of the disease. Intralesional collagen is the only non-surgical treatment that has good evidence that it can provide modest improvement in penile curvature. Surgical correction of Peyronie's disease remains the only treatment that results in a functionally straight penis in the majority of patients. Changes and improvements in surgical techniques, complementary therapies, and the availability of better transplant materials have helped make Peyronie's disease surgery a viable and successful treatment option for carefully selected patients. Surgical therapy is beneficial for properly selected and advised patients and can significantly improve their quality of life. Important Practice Points Penile curvature, palpable lump in the penis and some discomfort are common features of Peyronie's disease; However, it should be noted that Peyronie's disease can have variable onset and this variability and unpredictability are hallmarks of this condition. There is often a history of erectile dysfunction, usually based on vascular risk factors, preceding the development of Peyronie's disease. Peyronie's disease is a wound healing disorder, the injury or trauma that triggers it is often subclinical, and symptoms usually develop and change over about 6 to 12 months before the onset of the chronic phase. Diagnosis of Peyronie's disease is largely based on history and examination, and specific investigation at the general medical level is usually not indicated. Referral to a specialist urologist should be considered when Peyronie's disease causes the patient sexual difficulty or anxiety, the curvature progresses, or the diagnosis is equivocal. The aim of the operation is to achieve a functionally straight erection. There is no treatment that can reverse Peyronie's disease and thereby return the penis to its pre-disease state. Surgical treatments for Peyronie's disease curvature remain the gold standard, but should only be performed in the stable or chronic phase, and patients must have realistic expectations of outcome. authors Christopher Love MBBS, FRACS (Urology), Urological and Prosthetic Surgeon, Men's Health Melbourne, Melbourne and Urology South, Moorabbin, Vic; Chief Urological Surgeon, Department of Urology, Monash Medical Center, Clayton, Vic; Bayside Urology, Melbourne, Vic [email protected] Darren J Katz MBBS, FRACS (Urology), Urologist and Prosthodontist, Men's Health Melbourne; and Urology Consultant, Western Health, Vic Eric Chung Eric Chung MBBS, FRACS (Urology), Associate Professor of Surgery and Consultant Urological Surgeon, Androrology Centre, Brisbane, Qld; University of Queensland, Department of Urology, Princess Alexandra Hospital, Brisbane, Qld Ohad Shoshany MD, Andrology and Sexual Health Fellow, Men's Health Melbourne and Western Health, Vic Competing interests: Dr. love, dr Katz and Dr. Chung are consulting advisors to Actelion, which manufactures medicines to treat Peyronie's disease, and have received personal honoraria from Actelion. Provenance and peer review: Commissioned, peer reviewed