Does your penis bend during an erection?
You're not alone.

John

John discovered that he had Peyronie’s disease in his late fifties. For him it seemed that the curvature appeared out of the blue. Here is John’s story.

“Painful, uncomfortable, not looking forward to sex.”

When did you start to notice symptoms of Peyronie’s disease?

- The first time I noticed Peyronies in myself was in my late fifties. It seemed to me at the time that it happened overnight, that one minute I had a normal erect penis and then almost out the blue – suddenly – I had what turned out to be a 65-degree bend.

How did it affect you?

- The penis was pointing almost straight at my navel, and was bent more or less halfway along this length. That's not how my penis was supposed to look. Psychologically it's very dismaying to suddenly experience this thing. A man's erect penis is a pretty fundamental part of his self-concept, I discovered. And when it wasn't the way it ought to be, in the actual fact to have an erection was uncomfortable bordering on painful. Also, just the appearance of it. I didn't like the way it looked. I didn't like the way I felt. It was undermining in quite a profound way. Particularly because I was in a relatively new relationship and sex was a pretty important part of that.

How would you describe Peyronie’s disease?

Horrible, painful, uncomfortable, not looking forward to sex, not looking forward to sexual stimulation. That's a really weird thing, that's a really weird position to be in. It's totally counter to the way a human being is supposed to function. I didn't want to be sexually aroused, what about that? It's not fun.

What advice can you give to somebody who suspects Peyronie’s disease?

- The most important advice I can give somebody who discovers they have Peyronies is to find somebody to talk to who knows about it. There are an awful lot of people who don't. I encountered several of them before I found somebody that did understand it, that did know what treatments were available. I was told by my GP that there was no cure, no solution apart from surgery and to go home and get on with my life. I didn't. I consulted Dr. Google, did a little bit more research and then eventually found someone who did understand and did know what the options were.

About Peyronie's Disease

WHY DOES THE PENIS BECOME BENT?

No man’s penis is entirely straight when erect, that's the way it's shaped. It may bend slightly upward, downward, to the left or to the right. It varies from man to man and does not usually affect one’s sex life, mood or self-esteem. With Peyronie’s disease, however, the curvature is so disabling that sexual intercourse can be both difficult and painful.[1]

LET'S GET THE FACTS STRAIGHT

The bending is caused by a build-up of collagen in the penis. Collagen is one of the proteins used in the body as a structural material, along with bone, but unlike bone it is flexible.

Nobody knows why collagen is deposited in the penis like this - it might be a genetic condition, or it could be caused by scar tissue formation. The lump - or "plaque" - of collagen cannot expand when the penis becomes erect, and this causes the penis to bend.

- More common than you think
It is estimated that around 3-7 % of men have Peyronie’s disease, but it may be even higher than that.[2,3] Peyronie's disease is probably a lot more common than anybody thinks, especially amongst older men. For obvious reasons it is not the kind of subject that people talk about.

THERE IS HELP

Peyronie’s disease can be treated by both surgical and non surgical treatments. The latter include everything from food supplements to medicines injected directly into the plaque in the penis. However, treatments for Peyronie's disease are as variable in effect as they are plentiful. [4,5]

  1. NHS website http://www.nhs.uk/chq/Pages/875.aspx?CategoryID=61&SubCategoryID=61
  2. Bella AJ, et al. J Sex Med. 2007;4:1527-1538.
  3. Smith CJ, et al. BJU Int. 2005;95:729-732.
  4. Sherer MD et al. (2015) Expert Opinion on Pharmacotherapy, 16:9, 1299-1311.
  5. Culley C. Carson, Laurence A. Levine BJU Int 2014; 113: 704–713.

Peyronie’s disease is named after a French surgeon who described it in the 18th century. It is caused by the development of collagen plaque, or scar tissue, on the shaft of the penis. The scar tissue, known as a Peyronie’s plaque, is not visible but can cause the penis to curve when erect. The penis can curve in various directions including upward, downward or to the side, depending on the location of the plaque.[1]

Who can get Peyronie’s disease?
What causes Peyronie's disease is still unknown, many different factors have been suggested. One widely believed theory is that ordinary sexual intercourse can cause what is known as "micro-trauma" inside the penis. This "micro-trauma" cannot be felt, or seen, because it causes no pain and leaves no bruising. When this microscopic injury heals, scar tissue in the form of a collagen plaque is deposited in certain susceptible men, and this causes Peyronie's disease to develop.

Peyronie’s disease mostly affects men between 40–60 years of age, although it can occur at any age. It is not likely to go away on its own and may get worse over time. Treatment may not be necessary if the bend caused by PD is stable, and is not severe enough to interfere with that person's usual ability to enjoy sexual activity.[2]

Symptoms
Peyronie’s disease signs and symptoms might appear suddenly or develop gradually. The most common signs and symptoms are penile curvature, scar tissue felt under the skin, erectile problems, shortening of the penis due to the curvature and penile pain. The penile curvature deformity might gradually worsen over time. Peyronie's disease is usually divided into two stages: the acute phase and the chronic phase.

- Acute (active) phase. Starts with an acute inflammatory phase that generally lasts for 6 to 18 months. During this phase, pain may arise during erections. Progression in plaque size and curvature deformity is also common.[3]

- Chronic (stable) phase. In the chronic phase the pain may improve, the plaque size and curvature deformity is stable.

Psychological symptoms
The problem with Peyronie’s disease is not only physical – it also has a major psychological impact. In a study with men with Peyronie's disease, 77 % said that they were affected psychologically. This had to do with worries about erection appearance and performance, decreased self-esteem and relationship difficulties. In another study, almost half of men with Peyronie's disease were classified as being depressed. [4,5]

  1. NHS website http://www.nhs.uk/chq/Pages/875.aspx?CategoryID=61&SubCategoryID=61
  2. Tran VQ, et al. Adv Urol. 2008;263450;1-4.
  3. Bekos A, et al. Eur Urol. 2008;53:644-650.
  4. Nelson CJ, et al. J Sex Med. 2008;5:1985-1990.
  5. Rosen R et al. J Sex Med. 2008;5:1977-1984.

It is natural to feel reluctant to discuss problems concerning your penis, even with your doctor. To get to the right diagnosis and treatment as swiftly as possible, it is important that you prepare yourself for your appointment with a doctor.
- Explain the symptoms as thoroughly as possible: when they started, how long you’ve had them and how they appear – and how they affect you.
- If you have a curvature of your penis, try to take a picture of it while erect and show it to your doctor. This will make it easier to confirm or rule out Peyronie’s disease.

If you think you've got Peyronie’s disease, you’ve probably scanned the web and found countless treatment options already. Here we will list some, and go through each treatment based on the latest scientific evidence.

Treatment of Peyronie’s disease ranges from minimally disabling treatments to surgical intervention. There are treatments available that can help to reduce the curvature of the penis and go some way to restoring normal function.

Which treatment is right for me?
Finding the right treatment just for you is a matter of discussion with your doctor and largely depends on the severity of the curvature, which stage it’s in and how much it affects your life.

Non-surgical treatment options[1]

Intralesional injection therapy
An intralesional treatment means injecting a medical substance directly into a body part that is affected by a disease (lesion) – in the case of Peyronie’s disease that means, the collagen plaque that is causing the penis to bend. Depending on the degree and severity of the curvature, intralesional treatments can be used to reduce the curvature of the penis. Many of the intralesional treatments that are being used for Peyronie’s disease are already being used for other illnesses, however, only one is approved in the EU and US specifically for the treatment of Peyronie's disease. Talk to your doctor to find out more.

Oral treatments
Several oral treatments are said to help against Peyronie’s disease. However, most of them are not supported by treatment guidelines for routine use in patients with Peyronie’s disease. This has to do with their lack of scientifically proven clinical effect.

Traction therapy
This may be done using a stretching device, or by use of a vacuum pump of the kind normally supplied for certain kinds of erectile dysfunction. As with the oral treatments, there are no good-quality studies that prove the benefit of this treatment. However, it may be possible that traction or vacuum therapy could be beneficial, especially when used along with other treatments.[2]

  1. Sherer MD et al. (2015) Expert Opinion on Pharmacotherapy, 16:9, 1299-1311.
  2. Jordan GH, Carson CC, Lipshultz LI. BJU Int 2014;114:16–24.

Surgery

Surgery has been used for many years for the treatment of Peyronie's disease. It is only used on men with Peyronie's disease that is in a stable phase with a disabling deformity, in other words when the curvature not getting worse, and is hindering sexual intercourse and a normally functioning life.

What type of surgery is it?
The goal of the surgery is to straighten out the curvature, preserve or restore the ability to have erections and the same time not affect the length and girth of the penis. Although, it’s important to remember that surgery won’t change the penis back to exactly how it looked and felt before Peyronie's disease was present. The type of surgery that is performed is dependent on where the Peyronie’s plaque is located, degree of curvature, how much the erectile function is impaired, what the patient prefers and also the surgeon’s experience. Since Peyronie’s disease is a condition that varies in presentation from man to man, no single surgical intervention can be used on all Peyronie's disease cases.

The different surgical procedures for Peyronie’s disease are called:

  • Tunical shortening
  • Tunical lengthening
  • Penile prosthesis implantation

Tunical shortening
This is suitable for patients with normal penile length and a curvature of less than 60 degrees. Tunical shortening means that the penis is physically straightened by the surgeon by operating on the side opposite to the plaque. Tunical shortening, such as the Nesbit procedure, is the most commonly performed surgery for Peyronie's disease.

Tunical lengthening
Suitable for patients with a more complex curvature deformity exceeding 60 degrees, large plaques and short length of the penis. Tunical lengthening is a form of reconstructive surgery that means cutting or completely removing the plaque in the penis. The space where the plaque was located is then filled with a graft.

Penile prosthesis implantation
In very severe cases, especially where the patient also has erectile dysfunction, the surgeon may offer to implant a prosthesis at the same time as straightening out the bend in the penis.

  1. Culley C. Carson, Laurence A. Levine BJU Int 2014; 113: 704–713.

Many men with Peyronie’s disease are anxious about the appearance of their penis. Some men might feel worried about not being able to satisfy their partner, or perhaps they might have anxieties about being unable to father a child due to difficulties in having sexual intercourse. The loss of intimacy and the relationship problems due to Peyronie’s disease can strongly affect your psychological well-being. [1,2] That is why it is important to be open about these feelings, however difficult it might be.

Talk, involve, resolve

- Explain to your partner what Peyronie’s disease is and be as thorough as possible. Explain to your partner that this is not an infectious disease, and cannot be "caught".
- Involve your partner in how your condition makes you feel, physically, emotionally and sexually.
- Try to resolve the problem together. It’s a good idea to involve your partner in every step of the process of getting help, from finding different techniques for having sex to going to doctor's appointments.

  1. Ryan CA. Peyronie’s Disease from a Partner’s Perspective. 27 Jun 2012. Read more (PDF)
  2. Rosen R, et al. J Sex Med. 2008;5:1977-1984.

The contents of this video express the doctor’s own views of Peyronie’s disease and do not necessarily express Sobi’s views

Questions & Answers

Peyronie’s disease can give a variety of symptoms, most notably including: penile curvature, but also lumps in the penis, painful erections, and difficulty with penile penetration.

Although not completely clear, there is some evidence suggesting that Peyronie's may be hereditary.

A urologist with experience of diagnosing and treating Peyronie’s disease.

Surgery is still the most widely used successful treatment. However, new therapies are being developed all the time, and European and USA guidelines, published by the professional groups of urological surgeons, also mention injections, traction therapy, and oral medicines. Discuss your condition with your doctor to decide which treatment would be best for you.

Peyronie’s disease most commonly develops in men aged 40–60, but it can occur in men both older and younger than this age range.

First, to really know if you have it, a urologist must perform an examination. The best course of action is to seek professional help and proper treatment.