Penile Curvature and Peyronie’s Disease
If a man notices that his penis has a bend when erect, this may be “normal”, in that very few penises are completely straight, or could be due to a mis-match in the length of the cylinders in the penis, present since birth (congenital chordee), or could be a condition that has occurred later in life, like Peyronie’s disease.
When penile curvature is causing physical or psychological problems, it should be assessed and treatment offered.
Peyronie’s disease was described by a French surgeon, Francois Gigot de la Peyronie (pictured), in 1743, but descriptions of it can be found in historical medical documents hundreds of years before that.
It is a condition where the patient experiences penile curvature, indentation, a lump that can be felt in the penis, and often loss of penile length (with or without pain) upon erection. These deformities of the penis can appear in men of all ages but is most commonly present in men over 50. Erectile dysfunction, of some degree, is also found to occur in up to 90% of men with Peyronie’s disease.
The cause of Peyronie’s disease is not well understood, but there is probably a genetic predisposition to it in most men who develop the condition. In most cases, the disease is a result of inflammation and plaque (or scar) formation after repeated minor (and unrecognised) trauma to the penis; most commonly occurring during sexual intercourse. Generally, this is not obvious “trauma” but more likely minor bending of the penis during normal sexual activity leading to “fraying” and damage to the fibrous support beams in the penis.
The deformity of the penis is due to plaque formation that is, in fact, a thick inelastic scar. Scar tissue does not stretch; so thick inelastic scar can create curvature of the penis upwards, downwards, or sideways when the rest of the penis fills with blood during an erection.
Peyronie’s disease can result in bends or curvature, indentation, narrowing, or loss of length all of which can interfere with the ability to engage in sexual activity and penetration
Peyronie’s disease can also be associated with a reduction in rigidity, or hardness of erections.
Correction of the curvature only, via surgery, usually will not lead to correction of erectile dysfunction.
If a patient also has erectile dysfunction as well as Peyronie’s disease, treatment options exist that will correct both problems, such as penile implant surgery.
This condition has been recognised to affect a man’s psyche markedly, including causing depression and anxiety disorders. Appropriate diagnosis and treatment requires the help of an experienced medical professional
WHAT ARE THE TREATMENT OPTIONS?
The goal of therapy is to maintain or regain sexual function by straightening the penis, to what is called “functionally” straight.
Treatment should be individualised based on a number of factors including, but not limited to, the degree of penile curvature, severity of penile shortening, the presence of penile narrowing, and whether erectile dysfunction is present.
There are a number of interventions available including:
- Oral medications (variable benefit)
- Verapamil or collagenase (Xiaflex) injections into the plaque
- Mechanical penile traction and stretching with vacuum devices or external penile extenders
- Surgical penile straightening and reconstruction with or without grafting
- Placement of penile implant or prosthesis with straightening
- Penile dis-assembly surgery with length restoration and penile implant placement.
Dr. Love is one of the most experienced Australian doctors in treating Peyronie’s disease, performing all the surgical techniques available, and using Xiaflex injection therapy.