Penile fibrosis, more commonly known as Peyronie’s disease, is the formation of fibrous scar tissue, or plaque, inside the penis. This plaque is not the same as the plaque that can accumulate in blood vessels. This inelastic scar tissue develops within the tunica albuginea, the tissue surrounding the erectile bodies, and can interfere with normal function. The condition is not cancerous, cannot be transmitted to a partner, and its severity can range from minor to significant, affecting sexual function.
Identifying the Condition
The most direct sign of the condition is a palpable lump or a firm band of tissue under the skin of the penis. This plaque is composed of collagen and can harden, restricting the normal stretching of penile tissues during an erection. This leads to a noticeable bend or curve. The curvature can be directed upward, downward, or to one side.
Beyond the visible curvature, individuals may experience pain, which can occur with or without an erection. The physical changes can also lead to a shortening of the penis or a narrowing, sometimes described as an “hourglass” shape. These structural alterations may impede blood flow, contributing to difficulties in achieving or maintaining an erection, a condition known as erectile dysfunction.
Underlying Causes and Risk Factors
The condition is considered a type of wound-healing disorder. It is linked to penile trauma, which can be a single, distinct injury or repeated minor injuries that might occur during sexual activity. This trauma can trigger an abnormal healing response, leading to the disorganized buildup of scar tissue. Not every case is preceded by a known injury, as the condition can develop gradually without an obvious trigger.
Several factors increase the risk of developing this condition. A genetic predisposition is suggested by a family history of the disease. There is also a recognized association with other connective tissue disorders, such as Dupuytren’s contracture. Advancing age is another risk factor, with the condition most frequently observed in middle-aged men. Health issues like diabetes and high blood pressure are also contributing factors.
The Diagnostic Process
A diagnosis begins with a physical examination by a healthcare provider. The provider will feel the penis to locate and assess the size and texture of the plaque. This is coupled with a discussion of the patient’s medical and sexual history to understand the onset of symptoms.
To further evaluate the condition, imaging tests are often used. A penile ultrasound is a common diagnostic tool used to visualize the scar tissue within the penis. This procedure is performed after an erection is induced in the clinic, often through an injection. The ultrasound allows the clinician to see the plaque’s location and size and assess the degree of curvature.
Medical and Surgical Interventions
Treatment approaches are tailored to the individual’s symptoms and the stage of the disease. For some, particularly in the early phases, injectable medications are an option. Collagenase clostridium histolyticum is an enzyme injected directly into the plaque to break down the collagen that forms the scar tissue. Another non-surgical approach is penile traction therapy, which involves wearing a device that gently stretches the penis to help reduce the curve.
When the curvature is severe enough to interfere with sexual activity, surgical intervention may be recommended. One common procedure is penile plication, where the surgeon places stitches on the side of the penis opposite the plaque to straighten the shaft. This procedure may cause a slight shortening of the penis.
For more significant deformities, a surgeon might perform a plaque incision or excision with grafting. This involves cutting into the plaque to release tension or removing it and then covering the area with a graft. In cases with significant erectile dysfunction, implanting a penile prosthesis is a suitable option, as it provides rigidity and can straighten the penis. While some oral medications may be used, they have limited effectiveness in reducing plaques.
Disease Progression and Management
The condition unfolds in two distinct phases. The initial stage is the acute or active phase, which can last up to 18 months. This period is characterized by pain during erections, as the penile curvature and plaque are actively developing. During this phase, treatments are more conservative, aimed at managing pain and slowing the deformity’s progression.
Following the acute phase, the condition enters the chronic or stable phase. This stage is defined by the stabilization of the penile curvature and plaque size for at least three months, along with the resolution of pain. Corrective treatments, especially surgery, are reserved for this chronic phase to ensure the intervention is performed on a stable deformity. The physical changes can also have a psychological impact, leading to stress and anxiety.