Peyronie’s disease is sometimes called “curved privates disease” or simply “curvature” because the scar tissue (or plaque) causes the privates to bend when aroused. However, many curved privates are simply normal variations of anatomy — and many patients with Peyronie’s disease don’t have curvature but experience other changes in aroused shape such as indentations or length loss.
Research shows that up to 10 percent of U.S. men may have signs or symptoms of Peyronie’s disease, though only about 1 percent seek treatment.
While many men may have some degree of curvature, it’s not always due to Peyronie’s disease. Keep reading to learn more about what this disease looks like, what causes it, and how to treat it.
Stages of Peyronie’s Disease
Peyronie’s disease occurs in two stages: the acute phase and the chronic phase.
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Acute phase. Plaques develop on the internal tough layer of skin during this phase, which can last as long as 18 months. You may develop painful arousals and notice a bend or curve in your privates. Your privates may also hurt when flaccid (soft).
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Chronic phase. At this point, plaques have developed, and your privates will have a noticeable bend or curve. You may feel less pain as the plaque stops growing. Some men develop ED (ED) during this stage.
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Symptoms of Peyronie’s Disease
The most apparent symptom of Peyronie’s disease is a deformity of the aroused privates, which can be a new curvature of the privates or a focal loss of aroused girth, which is referred to as an indentation or an hourglass deformity.
While those symptoms are only visible during an arousal, some men develop hardened, bone-like lumps due to plaque buildup.
Symptoms of Peyronie’s disease include:
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Curvature. If scar tissue forms on the top of your privates (most common), your privates will usually bend upwards. If it forms on the bottom or side, your privates will curve either downwards or to the side.
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Hourglass or bottleneck appearance. Around 65 percent of men with Peyronie’s disease experience a volume loss deformity which makes the privates appear like an hourglass or bottleneck.
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Hardened lumps on one or more sides of the privates. Scar tissue can feel like hard, flat lumps directly under the skin.
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Painful arousals. Pain occurs in about 20 to 70 percent of men with Peyronie’s disease during the acute phase.
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Shortening or narrowing of the privates. In severe cases, some men lose around 0.5-1.5 cm of length. Loss of length or girth could be the effect of the condition or surgery to correct it.
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Function issues. Research notes that up to 54 percent of men with Peyronie’s disease also report ED.
ED from Peyronie’s Disease
As we mentioned above, Peyronie’s disease can affect your intimate life and function. You may have painful arousals or find it difficult to get (or maintain) an arousal.
If left untreated, these changes (and the problems they bring to the bedroom) can eventually result in more physical discomfort, stress, depression, and a reduced quality of life.
In some cases, it may be challenging to treat ED when Peyronie’s disease is the cause. ED medications like sildenafil (generic Viagra®), vardenafil (Levitra®), tadalafil (Cialis®), and avanafil (Stendra®) are often effective, but there are cases when oral medications don’t work.
These medications, called Phosphodiesterase-5 inhibitors, or PDE5 inhibitors, increase blood flow to the corpora cavernosa (the spongy tissues within the privates).
But the scar tissue associated with Peyronie’s disease can impact how much your privates can expand and may also cause problems with maintaining the high pressures in the privates required for arousal, rendering these medications unhelpful for some men. (Learn more about ED.)
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What Causes Peyronie’s Disease?
The exact cause of Peyronie’s disease is still unknown, but physical injuries affecting the tissues are considered the most common.
Some research also suggests that connective tissue disorders or autoimmune diseases can cause Peyronie’s disease. Let’s take a closer look below.
Common causes of Peyronie’s disease include:
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Trauma
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Connective tissue disorders
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Autoimmune diseases
Trauma
Research shows that when an arousal is repeatedly injured, such as during vigorous intimacy, it can cause microvascular injuries to the tunica albuginea — a tough layer of connective tissue surrounding the corpora cavernosa. (Learn more about 12 Reasons for Losing an Arousal During Intimacy.)
This inflammation disrupts the elastic fibers in the privates, causing hardened plaques, or scar tissue, to form on the privates in genetically predisposed individuals.
A more significant injury linked to Peyronie’s disease is a fracture, in which blunt trauma to the privates causes the tunica albuginea to tear — usually during intimacy.
One 2023 study found that men with fractures were more likely to develop Peyronie’s disease and ED. If they were over 45, the onset of Peyronie’s disease was likely to occur within five years of the fracture.
Most experts believe that Peyronie’s disease results from microvascular trauma to the aroused or semi-aroused privates during intimate activity, though many patients can’t recall an incident or injury that would have led to the disease.
Connective Tissue Disorders
Your connective tissues bind together and protect other bodily tissues and organs, providing a structural framework for your body. Certain disorders that attack these tissues may contribute to Peyronie’s disease.
These tissue disorders include:
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Dupuytren’s contracture. This chronic condition causes the tissues under the skin of your palms and fingers to thicken and tighten, leading to permanently bent fingers. One study found that 22 percent of men with Peyronie’s disease also had Dupuytren’s contracture, which suggests that these patients may be strongly predisposed to develop abnormal scar tissue in parts of their bodies.
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Scleroderma. This disorder causes tissue thickening and hardening due to excess collagen production. It can affect the skin, tissues, blood vessels, and sometimes internal organs. Although its association with Peyronie’s disease is uncommon, some research cites it.
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Plantar fasciitis. This condition involves inflammation of the thick tissue on the bottom of the foot, which can result from foot injuries or spending too much time on your feet. It is also considered a potential contributor to Peyronie’s disease. But again, the connection is unclear.
Autoimmune Diseases
Autoimmune diseases occur when the immune system mistakenly attacks healthy tissues, cells, and organs.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), certain autoimmune diseases, like lupus and Sjögren’s syndrome, may be linked to Peyronie’s disease.
One 2015 study found that autoimmune diseases were strongly associated with Peyronie’s disease in men seeking help for intimacy dysfunction. The most commonly associated autoimmune disorders were psoriasis, psoriatic arthritis, and rheumatoid arthritis.
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Risk Factors for Peyronie’s Disease
There are many potential risk factors for Peyronie’s disease, including:
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Age
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Diabetes
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Family history
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Prostate cancer treatments
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Smoking
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Obesity
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ED
Age
Peyronie’s disease is thought to affect four out of 100 men between the ages of 40 and 70. Though it is rare in young men, it has been seen in men as young as 19, according to this population-based study, which found the mean age of diagnosis was 53 years old.
Diabetes
Diabetes, especially when it is poorly controlled, is thought to exaggerate the fibrotic process (thickening and scarring) in Peyronie’s disease. If you have diabetes, you’re also more likely to have severe Peyronie’s disease, according to this 2019 study.
The NIDDK also reports that men with ED linked to diabetes are four to five times more likely to develop Peyronie’s disease.
Family History
If your father or brother had Peyronie’s disease, there’s a chance you may develop it, too.
One 2022 study found that the risk of Peyronie’s disease was significantly higher in the immediate family members of men with the disease, including parents, siblings, and children.
But don’t forget the rest of your family tree. The risk was also higher in fifth-degree relatives, like second cousins.
Prostate Cancer Treatments
Some research indicates there may be a connection between prostate cancer treatments and Peyronie’s disease.
In one 2010 study of men experiencing post-prostatectomy problems, the rate of Peyronie’s disease was significantly higher than the rate in patients with intimacy dysfunction who did not undergo surgical treatment for prostate cancer.
Smoking
Smoking is one of the worst things you can do for your health. It’s linked to heart disease, cancer, lung diseases, type 2 diabetes, and, according to some research, Peyronie’s disease.
In one Italian study of 647 men aged 50 to 69, smokers were around four times more likely to develop Peyronie’s disease compared to non-smokers.
This took into account other potential contributing factors like age and medical history. But when the researchers looked at smoking alone, they found the ratio was actually seven times higher.
Obesity
One 2020 study suggested that obesity might be an independent risk factor for Peyronie’s disease.
The risk was even higher in men with diabetes and smokers — around 43 percent of subjects with Peyronie’s disease had diabetes, and 65 percent were current smokers or had a history of smoking.
ED
We mentioned earlier that ED commonly affects patients with Peyronie’s disease, but one study suggested that ED may actually be an independent risk factor for PD. The hypothesis is that having intimacy with semi-rigid privates may predispose to bending during intimacy, which could be a cause of trauma.
Complications
According to one 2023 study, calcification occurs in more than a third of Peyronie’s disease cases. In these cases, calcium deposits form within the Peyronie’s scar tissue, resulting in the transformation of plaque into a very hard, bone-like structure. This can be a major source of anxiety and depression in affected patients.
Regardless of whether or not Peyronie’s plaque becomes calcified, Peyronie’s disease can have a profoundly negative impact on affected men.
Studies have found that around 80 percent of men with Peyronie’s disease have psychological symptoms. Forty-eight to 62 percent struggle with depression (which increases the longer they have the disease), and 54 percent experience relationship problems as a result of the disease.
Though Peyronie’s disease doesn’t directly cause infertility, the condition can make it harder to conceive a child due to painful intimacy or ED. Some research also shows that having Peyronie’s disease may hinder the “completeness” of ejaculation, contributing to male factor infertility.
Men with Peyronie’s disease may also face a higher risk of developing urologic conditions like enlarged prostate, prostatitis, and lower urinary tract symptoms, as well as stomach cancer, testis cancer, and melanoma.
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How to Diagnose Peyronie’s Disease
Diagnosing Peyronie’s disease is a healthcare professional’s job, mostly because you won’t necessarily be able to tell the difference between normal and problematic curves yourself.
Men often have some degree of curvature, which means no aroused privates is 100 percent straight. That’s why it’s easy to mistake normal curvature for Peyronie’s disease — especially if you’re feeling self-conscious.
It’s worth speaking to a urologist, who can diagnose the condition based on your history and a physical exam. They’ll ask you questions to understand how your symptoms developed and check your privates for hard plaques and other common signs of Peyronie’s disease.
The hallmarks of Peyronie’s disease are noticeable changes to the shape of the aroused privates (not curvatures that have always been present), pain with arousal, and identifiable plaque on physical examination.
In some cases, a urologist might want to examine your aroused privates to assess the effects of Peyronie’s disease and to measure any resultant curvatures. This can be important when you’re considering serious treatments for Peyronie’s disease, such as surgery or collagenase injections (see below).
Evaluation of the aroused privates typically requires an intracavernosal-injection test, in which a urologist injects medication directly into the privates to induce an arousal. This is sometimes accompanied by ultrasonography, in which a urologist will measure blood flow during arousal and take images of any plaques to see if they are calcified.
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Peyronie’s Disease Treatments
Not all men require treatment for Peyronie’s disease. In fact, for most patients, the pain fades away over time without treatment. Curves are less likely to resolve on their own, although some younger men and those in the early stages of the disease (less than six months) may see some improvement without intervention.
Treatment should generally be saved for patients that are functionally impaired from the changes to the shape of their aroused privates, or for patients with profound psychological bother that is resulting in depression, anxiety, or avoidance of partnered intimacy.
As far as treatment options, the goal is usually to reduce symptoms rather than “cure” the disease. Your urologist will likely start with the less invasive options first, especially if you’re in the acute phase.
Treatment options for Peyronie’s disease include:
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Traction therapy
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Injections
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Oral medications and supplements
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Surgery
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Shockwave therapy
Traction Therapy
A traction device is designed to stretch the privates to counteract the effects of a Peyronie’s plaque on aroused shape.
In a 2023 review, researchers found this type of therapy was helpful in correcting curvature, but it did not improve arousedile function or lengthen the privates.
However, a high-quality individual study using a specific traction device concluded that traction therapy for six months can improve length, reduce curvature, and improve arousedile function in men with ED.
Injections
Injections aim to break up and dissolve plaques in the privates.
They include:
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Collagenase (Xiaflex®). The active ingredient in this medication is an enzyme that breaks down collagen forming within connective tissue. When injected into scar tissue, it can weaken the toughened collection of proteins and reduce curvature. Currently, Xiaflex is the only medication FDA-approved specifically for treating Peyronie’s disease.
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Interferon. This protein-based medication may help break down scar tissue that can develop in the privates. Studies show it can significantly improve curvature, plaque size, and pain, potentially even improving arousedile function.
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Verapamil. This calcium channel blocker is typically used to treat angina and high blood pressure. When used as an injectable drug for Peyronie’s disease, it has been shown in retrospective lower-quality medical studies to improve curvature, but it has not been proven effective in prospective, randomized clinical trials.
Oral Medications and Supplements
More research is needed on oral medications for treating Peyronie’s disease. Though several have been considered, most high-quality trials failed to show benefits for oral medications in men with Peyronie’s disease.
That said, if you don’t respond to other treatment options, your provider might suggest:
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Potassium para-aminobenzoate. This supplement may reduce the size of plaques due to its anti-inflammatory and anti-fibrotic properties, but it hasn’t been shown to treat curvature specifically.
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Oral vitamin E. Although one research study suggested vitamin E pills could help prevent the progression of Peyronie’s disease, the data is limited and most experts do not believe that vitamin E is effective.
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Tamoxifen. Typically used to treat breast cancer, tamoxifen has been shown to prevent the progression of Peyronie’s disease in vitro when combined with the ED medication tadalafil. The applicability of this laboratory-based study to patients with Peyronie’s disease is not clear, and tamoxifen is not standardly prescribed to treat PD.
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Colchicine. Limited research has shown that the anti-inflammatory drug colchicine may help stabilize Peyronie’s disease when combined with vitamin E in the early stages of the disease. The best candidates are men who have a curvature of less than 30° and no ED.
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Pentoxifylline. This vasodilator may also help stabilize Peyronie’s disease and reduce calcium buildup in plaques by improving blood flow to the privates. But, again, more research is needed.
Surgery
In severe cases, surgery may help remove plaque and/or reduce curvature.
Several possible types of surgery are available, including:
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Plaque incision or excision with grafting. Grafting involves removing the plaque from your privates and replacing it with a graft, which can be tissue taken from another part of your body or tissue from an organ donor. It is typically advised for curvatures over 60 degrees to help maintain length. The risk of ED after surgery is high with this option.
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Plication. Plication surgery involves shortening the side of the privates opposite the curvature with either permanent stitches or by removing a piece of the tunica albuginea. It has a high success rate and low risk of complications. Though effective, plication is usually recommended for curves less than 60 degrees because it can cause shortening of the privates.
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Implant. An implant, or prosthesis, is considered the treatment of choice in patients with Peyronie’s disease and severe ED. During this surgery, a hard or inflatable device is put into the arousal chambers of the privates that can cause an arousal and potentially straighten the privates.
Shockwave Therapy
Shockwave therapy uses low-intensity electroshock waves to reduce pain and break up plaques in the privates. Though it may help, shockwave therapy is a pricey option backed by only very limited research.
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Can You Prevent Peyronie’s Disease?
Researchers aren’t entirely sure if Peyronie’s disease can be prevented, but you can take steps to avoid trauma, which can lead to the disease.
Here are some tips to help prevent Peyronie’s disease:
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Use lubrication to avoid some forms of injury during intimacy
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Consider taking ED medication if your arousals are getting softer
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Quit smoking
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Lose weight or consider weight loss medications if you need more support
Treating Peyronie’s disease early is another important thing you can do to make sure it doesn’t get worse. If you’re noticing the first signs of Peyronie’s disease or you think you may have injured your privates, contact your healthcare provider right away to get the help you need.
This article originally appeared on Hims.com and was syndicated by MediaFeed.org.
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