Peyronie’s disease is a condition involving the formation of fibrous scar tissue, known as plaque, beneath the skin of the penis. This plaque development leads to physical changes, most notably during an erection. The condition arises from scar tissue forming in the tunica albuginea, a fibrous sheath that surrounds the erectile tissues. This internal scarring can cause concern and uncertainty, and it can also have an impact on emotional well-being.
Visual Manifestations of Peyronie’s Disease
The most recognized sign of Peyronie’s disease is a noticeable bend or curvature of the penis, which is most apparent during an erection. The direction of the bend depends on the location of the plaque. A plaque on the top (dorsal side) of the shaft will cause an upward curve, while a plaque on the underside (ventral side) results in a downward bend. If plaques form on the sides, a sideways curvature will occur.
In addition to curvature, the penis may develop an indentation or a narrowing in the shaft, creating what is sometimes described as an “hourglass” or “bottle-necking” appearance. A palpable lump or a firm band can often be felt under the skin of the penis where the plaque has formed. This scar tissue can sometimes accumulate calcium deposits and become hard.
Another visual change that can occur is a loss of penile length. This shortening is a consequence of the internal scarring, which can prevent it from stretching to its full erect length.
The Underlying Cause of the Physical Changes
The physical deformities seen in Peyronie’s disease are a direct result of changes within the penis’s internal structure. The corpora cavernosa, two spongy columns of tissue, fill with blood to create an erection. These columns are encased in a flexible sheath called the tunica albuginea. In Peyronie’s disease, plaques of fibrous scar tissue form within this normally elastic sheath.
During an erection, as the corpora cavernosa expand, the tunica albuginea is meant to stretch evenly. However, the scar tissue from Peyronie’s disease is rigid and does not stretch. This inelasticity forces the penis to bend or deform around the tethering point created by the plaque. The location and shape of the plaque determine the specific nature of the deformity.
The trigger for this scarring process is often linked to minor injury or repetitive trauma to the penis, perhaps during sexual activity. This trauma is thought to initiate an abnormal wound healing response, leading to the excessive formation of scar tissue. There may also be a genetic predisposition, as the condition is sometimes associated with other connective tissue disorders.
Associated Symptoms and Diagnosis
Peyronie’s disease has two distinct phases, each with its own set of symptoms. The initial, or acute phase, is when the plaque is actively forming. This stage can last from five to eighteen months and is often accompanied by pain, both with and without an erection. As the scar tissue develops, the penile curvature may progressively worsen.
Once the plaque stabilizes, the condition enters the chronic phase. In this later stage, the pain experienced during erections often subsides or resolves completely. However, the penile curvature and any shortening remain. Erectile dysfunction can be another symptom, developing in either phase due to pain, the deformity itself, or changes in blood flow.
A diagnosis is made through a physical examination by a healthcare provider, who will feel the penis to locate the hard plaque. To evaluate the curvature, the doctor might ask the patient to provide photos of the erect penis. In some cases, a penile duplex ultrasound may be used to get a clearer image of the plaque, evaluate blood flow, and measure the curvature after an injection is used to induce an erection.
Medical and Surgical Interventions
Treatment for Peyronie’s disease is tailored to the individual and depends on the phase of the condition, the severity of symptoms, and how it affects sexual function. For men in the chronic phase with stable disease, several interventions are available. Non-surgical options are often considered first and include intralesional injections directly into the plaque. The most common of these is collagenase clostridium histolyticum, an enzyme that helps break down the collagen forming the plaque. Penile traction therapy, which involves wearing a device to gently stretch the penis over time, may also be recommended to help reduce curvature.
When the deformity is severe and prevents satisfactory intercourse, surgery may be the most effective option. One common surgical procedure is tunical plication, where the surgeon places stitches on the side of the penis opposite the plaque to straighten the shaft. Another approach is plaque incision or excision and grafting, which involves cutting the plaque to release tension and then covering the area with a graft of tissue.
For men who have both Peyronie’s disease and significant erectile dysfunction, the placement of a penile prosthesis, or implant, may be recommended. This device provides the rigidity needed for an erection, and the surgeon can perform additional maneuvers during the implantation surgery to straighten the penis. The choice of treatment is a decision made between the patient and their doctor.