Peyronie's Disease may cause the penis to have a slight bend or hourglass shape. ©Xiaflex

According to Johns Hopkins Medicine, even though there is not much public awareness, Peyronie’s disease is quite common and may affect up to one out of eleven men. The reason this disease is getting attention now is a new injectable medication that is the first medication approved by the Food and Drug Administration (FDA) to treat Peyronie’s.

See Xiaflex’s “Bent Carrot” commercial.

Peyronie’s’ Disease Symptoms: What Does Peyronie’s Disease Look Like?

Peyronie’s disease is caused by a thick scar – called a plaque – that forms under the skin of the penis. To get an erection, the penis has two tubes that fill with blood, called corpora cavernosa. To keep the blood inside, the corpora cavernosa are encased in an elastic sheath called the tunica albuginea. The scar forms on the tunica albuginea, so when the penis fills with blood it is unable to form a normal looking erection.

Think of blowing up a balloon that has lost its elasticity in one area. Depending where the plaque forms, the penis can have a slight bend, a more severe bend, or even an hourglass type narrowing. The most common deformity is a penis that bends upward during an erection.

Other Symptoms of Peyronie’s Disease

Peyronie’s disease has three main symptoms. One is the deformed penis. Another symptom is pain, especially during an erection. The third is a plaque that can be felt under the skin of the penis.

Symptoms of the disease come in two phases. The first is the active phase. During this phase the plaque is forming and growing. It can be felt and it causes pain along with deformity. The symptoms may get gradually worse, and a man may be unable to get or maintain an erection. If the bend is 30 degrees or more, sexual intercourse may be impossible. Many men have symptoms of anxiety and depression during this phase which can last from three to 12 months or longer.

Eventually the plaque stops growing and the pain gets less, although the deformity usually remains. This is called the chronic phase. Stress, anxiety, and the inability to have sexual intercourse may also continue. This disease can start at any age but is most common in men between the ages of 50 and 60.

What Causes Peyronie’s Disease?

Peyronie’s disease was first described by the French physician Francois de la Peyronie in 1743, but the cause is still a mystery. The plaque is a type of scar tissue that is made up mostly of a protein called collagen. One cause may be an injury to the penis from blunt trauma during an accident or contact sport. Why the injury heals with an abnormal plaque is not known. The penis can also be injured during vigorous sexual intercourse or it may be a very gradual type of injury that builds up over time. This sometimes happens when men with weak erections have sex. In all these cases, the plaque seems to be an abnormal type of scarring.

However, most men with Peyronie’s disease have no history of trauma. The collagen protein that forms the plaque – which can get as hard as bone – is the building block of body tissues called connective tissue. These tissues give the body shape and structure. Peyronie’s may be a connective tissue disease caused by genetic changes in collagen cells. Support for this theory is that the condition tends to run in families, and many men with this condition have other connective tissue diseases like Dupuytren’s contracture (scarring in the palm of the hand) and plantar fasciitis (scarring in the arch of the foot).

Is Peyronie’s Disease Permanent or Can Peyronie’s Disease Heal Itself?

There is no cure for Peyronie’s disease, but in some cases, it can heal itself and go away. According to Johns Hopkins, about 20 percent of men will have the deformity gradually correct itself. For other men the deformity is permanent without treatment. Some men have only minimal deformity and good sexual function. In those men, treatment may not be necessary. The doctors who treat Peyronie’s disease are urological surgeons, called urologists.

Because the extent of the deformity can’t be determined until the acute phase has stopped, most urologists do not start treatment or consider surgery during this phase. Treatment during the acute phase may include pain management and erectile dysfunction medication. The new medication approved by the FDA is called collagenase, because when it is injected into the plaque it breaks down the collagen. It is approved for men with a bend of at least 30 degrees. The brand name for this drug is Xiaflex.

According to the American Urological Association, these injections can be started in the chromic phase for men who don’t want surgery. Other than surgery, injection therapy is the only approved treatment. No oral medications have been effective, and other treatments need more study. These include stretching the penis (called penile traction), applying heat, using medications applied to the penis (topical therapy), and shock wave therapy.

Surgery for Peyronie’s Disease

After waiting at least one year, surgery may be recommended for men who have not responded to injection therapy. There are three surgical options. Plication surgery straightens the penis with sutures. Incision and graft surgery removes the plaque and replaces it with a graft. Penile implant surgery may be the best choice for men who have a more severe bend, or erectile dysfunction. Surgery is often successful, and penile implant prosthesis is most successful, says Johns Hopkins.

There is no one-size-fits-all treatment for Peyronie’s disease, but the disease can be managed for most men. Fifty percent of men with this condition suffer from depression, so emotional support is also important. For men who develop symptoms of Peyronie’s, a primary care provider is a good place to start. Most men will be referred to a urologist for diagnosis and treatment. A urologist who specializes in sexual health is the best bet for a surgical option.