Peyronie Disease

Definition

Peyronies’s disease is a medical condition characterized by scarring in the soft tissue of the penis leading to abnormal bending of the penis with pain during erection and erectile dysfunction. About 10% of the adult male population suffers from some degree of Peyronie’s disease. The exact cause of Peyronie’s disease is not known, however, it is thought that healing process following minor injury during sexual intercourse may lead to formation of the scar tissue.

Elderly people and people having family history of Peyronie’s disease are at more risk of suffering from it. Treatment options include drugs like verapamil, interferon and in severe cases surgery is recommended to correct the abnormal bending. Many men do not seek any treatment for the condition unless it severely hampers sexual function or the pain is intolerable.

Symptoms

The symptoms of the Peyronie’s disease may appear gradually or suddenly. Common symptoms include :

  • Hard bend or flat lumpy structure of the scar tissue can be felt beneath the skin of the penis.
  • Penis shows upward, downward or sideways bending. In some cases the penis may have an hourglass appearance because of presence of narrowing in the middle of the length of the penile shaft due to a band of scar tissue.
  • Erectile dysfunction – difficulty in getting or maintaining an erection.
  • Shortening of the penis.
  • There may pain during erection, intercourse, during ejaculation or even on touching the erected penis. The pain may subside with time.

The symptoms of Peyronie’s disease may lead to number of complications like :

  • Inability to participate in sexual intercourse.
  • Anxiety, stress, depression, poor self-esteem or frustration.
  • Deterioration of relationship with sexual partner.
  • Secondary infertility may occur due to difficulty in performing sexual intercourse.

Causes

The exact cause of Peyronie’s disease is not fully understood. The most common explanation is that following minor injury to the penis, usually during intercourse and exercise, sports, the tiny blood vessels of the penis may rupture. Then during the subsequent healing process there is development of scar tissue in the soft tissue of the penis leading to abnormal curvature. Although not all the minor injuries to the penis will lead to Peyronie’s disease.

The penis contains tube-like structure known as corpora cavernosa, surrounding which there are tiny blood vessels. During erection the chamber of the corpora cavernosa is filled with blood supplied by those tiny vessels. The corpora cavernosa is in turn surrounded by flexible elastic tissue known as tunica albuginea which helps in erection of the penis. Any injury to the tunica albuginea usually heals without any scar tissue but in Peyronie’s disease the healing process leads to formation of scar tissue in the tunica albuginea leading to loss of its flexibility and painful bending of the penis during erection.

Risk factors

  • Family history of Peyronie’s disease.
  • Injury in elderly people are likely to heal with scar tissue thereby increasing the risk of Peyronie’s disease with progression of age.
  • Co-existent connective tissue disorder also increases the risk.
  • Smoking or prostate surgery may also increase the risk.

Treatment

Treatment may not be required in 12 to 13% of the patients as pain usually subsides but the disease progresses in 40 to 50% of the cases. Drugs like verapamil and interferons are prescribed to improve the condition with limited benefit. Surgery is advised in severe cases only when the disease stops progressing and the pain has subsided for at least last 6 months. Surgical options include shortening of the affected side, lengthening the unaffected side and inserting penile implants.

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