Peyronie's disease, a condition causing an abnormal curvature of the penis due to the buildup of fibrous scar tissue, affects an estimated one in ten men, according to Dr. Petar Bajic, a urologist at the Cleveland Clinic. Despite its prevalence, the condition is significantly underdiagnosed, with research suggesting as few as one in 100 affected men receive a formal diagnosis. Many men remain silent about the issue due to shame or embarrassment, often delaying seeking medical help.
The disease develops when the body forms fibrous plaques within the shaft of the penis. These plaques do not stretch, leading to bending or curvature when the penis becomes erect because the affected area cannot expand as readily as the surrounding tissue. This can result in pain during erections, difficulty with sexual intercourse, and a noticeable change in penile shape. In some instances, Peyronie's disease can also lead to a permanent reduction in penile length or narrowing.
The condition is often triggered by minor injuries to the penis, which may occur during sexual activity and go unnoticed. In a typical healing response, the body would repair such injuries smoothly. However, in individuals prone to Peyronie's disease, excessive scar tissue forms instead of smooth repair. While the exact reason why some men develop this condition and others do not is not fully understood, factors such as age, genetics, diabetes, and smoking are believed to play a role in how the body heals.
While a slight curve in an erect penis can be normal, Peyronie's disease is typically addressed when it causes significant distress, pain, or impacts sexual function. Dr. Bajic notes that many patients are in their 40s and 50s, but the condition can affect men of all adult ages. If the condition has remained unchanged for over six months, it is considered stable and unlikely to progress further.
Many men resort to unproven online remedies, such as Vitamin E supplements or applying weights to the penis, which Dr. Bajic states are ineffective. He emphasizes that treatment approaches vary depending on whether the disease is in its active or stable phase.
Treatment Phases
For men in the active phase, typically the first 12 to 18 months when curvature is still developing, treatment focuses on stabilizing the condition and preventing further worsening. This may involve a daily low dose of tadalafil, an erectile dysfunction medication believed to help slow disease progression and manage pain by relaxing blood vessels. Traction therapy, involving a device that gently stretches the penis for about an hour daily, is also prescribed. This controlled tension can help remodel the scar tissue, making it less restrictive and potentially reducing curvature and further shortening.
In the stable phase, when the penile angle has remained consistent for at least three months, more direct treatments can be offered. These include collagenase injections, an enzyme that breaks down plaques, typically administered over several appointments combined with daily traction therapy. Many patients experience significant improvements, with some seeing over 60% reduction in curvature.
Surgical options are also available for the stable phase. These include penile implants, often recommended for men with concurrent erectile dysfunction. Other surgical procedures aim to straighten the penis by shortening the longer side or lengthening the scarred side using grafts. While surgery can result in a straighter penis, Dr. Bajic notes that patients who undergo injection therapy often report higher satisfaction due to the less invasive nature and fewer potential complications, such as loss of sensation or further erectile dysfunction.
Dr. Bajic encourages men experiencing symptoms of Peyronie's disease to seek medical advice without shame, as effective treatments are available and often covered by health insurance, including Medicare and Medicaid. He recounts a case of a patient successfully treated with collagenase injections and traction therapy, leading to significant improvement in penile angle and sexual function.