Curvature of the Penis (Peyronie's Disease)
What Is It?
Peyronie's disease is a curve in the penis.
Many men have a slight curve in the penis. As long as there is no pain or problem with sexual performance, men with a slightly curved penis should not be concerned. They do not need to see a doctor.
However, some men develop a more serious bend in the penis. This bend interferes with sexual function or causes pain.
This occasionally happens after the penis is injured. Injury may occur during intercourse or from a motor vehicle or industrial accident. Most cases, however, are the result of a poorly understood process known as Peyronie's disease.
In Peyronie's disease, inflammation and scar tissue form along the shaft of the penis. No one is certain why this problem occurs. It may be triggered by repeated mild trauma during sexual intercourse.
You may feel the inflammation and scar tissue as a painful lump or area of unusual firmness. In many men, the scar tissue causes the penis to bend or shorten. This is because it prevents the penis from expanding normally.
Men with Peyronie's often have difficulty achieving a firm erection. But it is unclear whether this occurs first or is caused by the scar tissue.
Most men with the problem are between the ages of 45 and 60. The disease runs in families.
In one-third of men, Peyronie's is associated with the formation of scar tissue in other parts of the body. These include the palms of the hands, the soles of the feet and the eardrums.
Sometimes, a serious curvature of the penis is seen in boys at or shortly after birth. This is not Peyronie's disease. Most of these cases are thought to be caused by abnormal development in the womb. They may be associated with other abnormalities of the penis.
About half of men with Peyronie's disease will first notice pain during intercourse. Symptoms may appear suddenly, or may develop slowly over time. Often the penis will feel firm or lumpy at the painful site.
Other men with Peyronie's will notice a painless curve of the penis that can occur suddenly or get worse over time. The penis may curve up, down or to either side. Severe changes in the shape of the penis may prevent the man from having intercourse.
If the penis has been injured by sudden trauma, most men will be able to recall the event. Often there will be a sensation or sound of a "snap" followed by loss of erection and the appearance of a bruise. Part of the penis will remain painful for a time. But usually the area will heal over time. However, scar tissue may form and cause a new curvature. This problem is different from Peyronie's. It rarely results in difficulties with erections or shortening of the penis.
Your doctor will ask you about your symptoms. He will examine your penis, looking for tender, firm areas of scar tissue. Usually, this is all that is needed to diagnose the problem.
If your doctor needs more information, he or she may order an X-ray to look for calcium deposits in scar tissue. Your doctor may ask you to bring in photographs of your erect penis to better determine the extent of the damage.
Men who are considering surgery may be asked to undergo special testing of sexual function. This will help determine the best method of repairing the problem.
A curve in the penis that is present since birth or is caused by scarring from an injury will not go away unless it is corrected with surgery.
How long Peyronie's disease lasts is difficult to predict. In more than a third of men, there is gradual improvement over 12 to 18 months without any specific treatment. In others, the scarring is permanent or worsens over time.
There is no way to prevent Peyronie's disease.
However, middle-aged men who engage in more vigorous or frequent intercourse appear more likely to develop Peyronie's.
Most men with curvature of the penis do not need any treatment. This is true regardless of the cause.
Men with Peyronie's disease who experience pain or difficulty with intercourse sometimes are offered medical treatment. The ones that have shown the best results are oral pentoxifylline and injections into the scar tissue with one of three drugs:
Other oral therapies include carnitine and vitamin E (sometimes with colchicine). But they men with moderate to severe curvature show little improvement with these agents.
High intensity Ultrasound and radiation therapy are other potential treatments.
Corrective surgery may be offered to men with more bothersome or disfiguring symptoms that persist for more than one year. It's important to make sure that the disease is not active at the time of surgery. So, surgery should be delayed for at least three months after the condition is clearly stable.
In a typical procedure, the inflamed or scarred portion of tissue is removed from the penis. It is replaced with a graft taken from another part of the body (often the scrotum or forearm).
This surgery often works well. However, mild curvature of the penis may remain. In addition, sexual function or shortening of the penis may not improve following surgery.
For this reason, surgeons sometimes implant a penile prosthesis during surgery. In some men, a prosthesis alone is enough to straighten the curvature and improve sexual function. Men who are considering surgery should be sure to discuss all the options with their physicians.
When to Call a Professional
Call your doctor if:
- You notice new curvature of your penis.
- You experience pain during intercourse.
- You develop difficulties with erections.
- You notice a firm or painful lump on your penis.
Some men with Peyronie's disease improve without treatment. Other men have mild symptoms that can be tolerated. Because they do not interfere with sexual activity, these men may choose not to seek treatment.
Only a minority of men eventually will require surgery.
Peyronie's disease does not develop into cancer or other serious conditions.
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