Peyronie's disease is a condition that causes the penis to become bent or curved during an erection. The condition may cause pain and make sexual intercourse difficult. It does not appear to cause difficulty urinating.
Patients with Peyronie's disease develop a layer of hard, fibrous scar tissue (called plaque) on one or more sides of the penis. The plaque may look like a hard lump on the penis. When the penis becomes erect, the plaque pulls the affected area off at an angle, causing a curved penis.
Many acute cases of Peyronie's disease have been linked to penile injuries. However, the cause of many cases of Peyronie's disease is poorly understood. Researchers have suggested that factors, such as autoimmune disorders, medications, genetics, or vitamin E deficiencies, may also play a role in the development of the disorder.
Peyronie's disease has been reported in males who are 30-80 years old. It is most common in men who are 40-60 years old. Peyronie's disease is estimated to affect 0.39-0.3% of males in the United States.
In some cases, Peyronie's disease may improve without any treatment. If the condition does not improve on its own, patients typically receive oral medications. However, oral treatment is only effective during the first 12 to 18 months because this is when plaque is still forming. If medication is ineffective, surgery may be recommended.
General: Researchers are still learning about the causes of Peyronie's disease. Penile injuries appear to cause most cases of sudden Peyronie's disease, while the causes of cases that develop slowly are poorly understood. Factors, such as autoimmune disorders, genetics, medications, and vitamin E deficiencies, have been associated with Peyronie's disease.
Penile injuries: Patients who suffer from penile injuries that heal abnormally may develop Peyronie's disease. Penile injuries may occur when the penis is abnormally bent or bumped. For instance, penile injuries may occur during rough or vigorous sex that results in forcefully bending an erect penis. They may also occur during activities such as contact sports. Sometimes, a penile injury causes small tears to develop in the tissue or small blood vessels to break resulting in bleeding inside the penis. If this injury heals abnormally, thick and hard scar tissue (called plaque) may develop under the skin of the penis. If the patient suffers repetitive trauma, the plaque may develop tough fibrous tissue (called fibrosis) or calcium deposits (called calcification) and result in deformity.
Autoimmune disorder: There is some evidence to suggest that Peyronie's disease may be caused by an autoimmune disorder. An autoimmune disorder occurs when the body's immune system, which normally fights against disease and infection, attacks the patient's own body. It has been suggested that this abnormal immune response may cause plaque to build up in the penis.
Genetics: Peyronie's disease may be caused by an inherited mutated gene that regulates the growth fibrous connective tissue proteins called collagen. This mutation may cause excessive tissue to grow in several areas of the body, including the penis.
Medications: Peyronie's disease is a rare, but possible, side effect of some medications, especially beta-blockers, which are commonly taken to regulate blood pressure.
Vitamin E deficiency: Vitamin E deficiency has also been linked to Peyronie's disease.
SIGNS AND SYMPTOMS
Peyronie's disease may develop suddenly or gradually. Common symptoms include painful erection, a bend or curve in the penis when it is erect, a lump of hard tissue on one or more sides of the penis, difficulty achieving an erection (called erectile dysfunction or ED), and shortening of the penis.
The penis will bend upward if scar tissue develops on the top of the penis. The penis will bend downward if scar tissue develops on the underside of the penis. Although less common, scar tissue may develop on the sides of the penis. When this occurs, the penis has an indentation that causes it to have a bottleneck shape. In some cases, the penis may bend to the side.
Peyronie's disease can be diagnosed after a physical examination. The thick, hard scar tissue, called plaque, may be felt in the penis, even without an erection. In some cases, the doctor may inject saline into the penis in order to cause an erection. This allows the healthcare provider to see the abnormal curvature of the penis.
Sexual quality of life: Peyronie's disease may make sexual intercourse difficult. Patients may have difficulty achieving erection and/or experience pain in their penises. Patients with Peyronie's disease are encouraged to visit their doctors to determine the best possible treatment options. In addition to medical treatments, a doctor may recommend psychotherapy or couples therapy.
General: In some cases, pain and erectile dysfunction (ED) associated with Peyronie's disease may improve without any treatment. Therefore, a doctor may wait nine to 12 months to see if the condition goes away on its own before recommending any sort of treatment. If the condition does not worsen, and the patient is not bothered by the symptoms, a doctor might recommend no treatment. This is because some treatments may increase a patient's risk of developing erectile dysfunction (ED).
The first line of treatment is generally oral medications. However, oral treatment is only effective during the first 12 to 18 months because this is when plaque is still forming. If medication is ineffective, surgery may be recommended.
Colchicine: A mediation called colchicine may be used to treat Peyronie's disease. This drug stops collagen from growing and may help reduce symptoms of the disease. Side effects of this medication commonly include digestive problems, such as diarrhea.
Potassium aminobenzoate (Potaba©): A medication called potassium aminobenzoate (Potaba©) has also been used to treat Peyronie's disease. This drug helps increase the oxygen supply in tissues, which may help prevent fibrous tissues from forming in the penis. However, the effectiveness of this treatment is unclear. In addition, patients must take up to 24 tablets a day. Side effects commonly include digestive problems.
Vitamin E: Vitamin E supplements have also been used to treat Peyronie's disease, despite limited research on its effectiveness. This is because some cases of Peyronie's disease have been linked to vitamin E deficiencies. Patients should only take vitamin E under the strict supervision of their doctors because high doses may be unsafe.
Intralesional injections: A doctor may inject medications, such as calcium channel blockers (such as verapamil), collagenase, or interferons, into the plaque in the penis. The goal of this therapy is to break down the scar tissue and, therefore, reduce symptoms of the disorder, including pain, ED, and curvature of the penis. Patients receive several injections over the course of several months. The effectiveness of these treatments varies among patients. Researchers are trying to determine what type of intralesional injection offers the most benefit.
Radiation therapy: Radiation therapy, which involves using high-energy waves, has been used to reduce pain caused by Peyronie's disease. Radiation therapy is performed at hospitals. Although this treatment has been shown to alleviate pain, it does not decrease the plaque in the penis. It may also cause many side effects, including fatigue, erectile dysfunction (ED), and decreased testosterone levels.
A surgical procedure called nesbit plication may be performed if all other treatments are unsuccessful. The patient's penis is injected with saline in order to cause an erection. Then, tissue on the unaffected side of the penis is shortened. As a result, the penis will no longer bend when erect. However, this procedure may shorten the penis. This procedure is performed in patients who have large penises that have curves that are less than 45 degrees.
Saphenous vein graft:
A surgical procedure that involves a saphenous vein graft may be performed if all other treatment options fail. During the procedure, several incisions are made in the hard scar tissue, which allows the penis to become straight. The cut tissue is then covered with a grafted vein. This procedure is usually performed in patients who have small penises that have curves that are greater than 45 degrees or an hourglass-shaped curve.
Penile prosthesis: Patients with Peyronie's disease who have erectile dysfunction (ED) may receive penile prostheses. This surgical procedure involves implanting a device to straighten out the penis. The device may either be solid or inflatable. Men who have a solid implant have semi-rigid penises all the time. This type of device helps increase the rigidity of the penis when it is erect. Individuals who have an inflatable implant use a pump to inflate the device and cause an erection.
Counseling: Peyronie's disease may affect the patient's sexual quality of life. Counseling may help patients handle their feelings and concerns about Peyronie's disease. It may also help patients learn how to communicate their feelings to their partners.
Unclear or conflicting scientific evidence:
L-carnitine: The human body produces L-carnitine in the liver, kidney, and brain. Early evidence suggests that oral supplements of L-carnitine may help treat Peyronie's disease. However, additional research is needed before a firm conclusion can be made.
Avoid if allergic to L-carnitine. Use cautiously with peripheral vascular disease, high blood pressure, alcohol-induced liver cirrhosis, or diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
Para-aminobenzoic acid (PABA): Para-aminobenzoic acid (PABA) is a naturally occurring non-protein amino acid. Several studies suggest that PABA supplements may help reduce symptoms of Peyronie's disease. However, a firm conclusion cannot be made until additional studies are performed.
Avoid if allergic to PABA or its derivatives. Avoid if taking sulfonamides. Use cautiously with kidney disease, diabetes, low blood sugar levels, bleeding disorders, or if taking blood thinners. Stop taking PABA if rash, nausea, or decreased appetite occurs. Avoid oral use in children and pregnant or breastfeeding women. Other forms of PABA are not recommended if pregnant or breastfeeding, due to a lack of safety data. It is recommended that individuals have their liver function and blood sugar levels monitored while taking PABA.
Traditional or theoretical uses lacking sufficient evidence:
Bromelain: Classified as an herb, bromelain is a digestive enzyme that comes from the stem and the fruit of the pineapple plant. Although it has been suggested that bromelain may help treat Peyronie's disease, scientific evidence is currently lacking in this area. A firm conclusion cannot be reached at this time.
Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or other members of the Bromeliaceae
family. Avoid with liver disease, kidney disease, or bleeding disorders. Use cautiously with bleeding disorders, stomach ulcers, high blood pressure, or acute genitourinary tract inflammation. Use cautiously before dental or surgical procedures or while driving or operating machinery. Use cautiously in children younger than two years of age. Avoid if pregnant or breastfeeding, due to a lack of safety evidence.
Physical therapy: The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury. A variety of techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used during physical therapy sessions. Physical therapy has been proposed as a possible treatment for Peyronie's disease. However, studies have not been performed to determine if this treatment is safe and effective. Research is warranted in this area.
Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. However, physical therapy may aggravate some pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature, although causality is unclear. Erectile dysfunction has also been reported. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
Vitamin E: Vitamin E exists in eight different forms ("isomers"): alpha, beta, gamma, and delta tocopherol; and alpha, beta, gamma, and delta tocotrienol. Alpha-tocopherol is the most active form in humans. Until scientific studies are performed, it remains unknown if vitamin E is a safe and effective treatment for Peyronie's disease.
Avoid if allergic to vitamin E. For short periods of time, and in the recommended doses, vitamin E supplementation is generally considered safe. Avoid doses higher than 1,000 milligrams a day. Avoid with Retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders.
There is currently no known method of prevention for Peyronie's disease. It is possible that the problem may be caused by trauma to the penis after being hit or bent abnormally when erect or during sexual intercourse. Avoiding such injuries may help prevent the development of Peyronie's disease. However, since some cases of Peyronie's disease are not caused by injuries, people may still develop the disorder.
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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