Bottom Line: Here’s what works—and what doesn’t…
What if there were a disease that caused a man’s penis to shrink and bend…and it led to painful erections that could make sex impossible?
Sadly, for up to 10% of men ages 40 to 70, this nightmare—a condition called Peyronie’s disease—is a reality. If you haven’t heard of it, that’s because many men who are affected never talk about it or seek help.
Even though a host of treatments for this disease have been recommended over the years, few have offered much relief. Now there are new and better options available, so it’s time for men with Peyronie’s to finally seek help.
What you need to know…
Peyronie’s disease was first described by a French surgeon named Francois Gigot de la Peyronie in 1743. While the cause has long been a mystery, over the years, some medical experts have blamed Peyronie’s on vigorous or acrobatic sex that injures the penis and causes scar tissue. However, many men who develop Peyronie’s have no history of injury.
Now researchers believe there is a genetic cause. Peyronie’s is related to other diseases that cause thickening of connective tissue such as Dupuytren’s contracture, a hand deformity that makes it difficult or impossible to straighten one or more fingers.
Peyronie’s sneaks up on men, starting as a hard lump (called a plaque) that forms under the skin in the shaft of the penis. Most of the time, the plaque is on top of the shaft.
The disease occurs in two phases. During the acute phase, the lump is painful and gets progressively bigger and harder. The plaque may cause the penis to shrink or to bend. The resulting change in the shape of the penis is typically noticeable only during erections, which can be very painful. In some cases, it becomes impossible to have an erection hard enough or straight enough for sexual intercourse. The acute phase typically lasts from as few as three months to as many as 18 months.
During the chronic phase, the plaque stops growing. Pain with an erection stops, but the deformity is permanent without treatment. Other symptoms are anxiety and depression, reported by more than 70% of affected men. Intercourse is still possible except when there’s severe deformity. Ejaculation is not affected. But for many men who have erectile dysfunction (ED) with Peyronie’s, it’s the psychological trauma that causes ED, not the disease.
For years, men were told to use a topical cream that was rubbed into the area of the plaque and absorbed through the skin. Today, we know that topical treatments are not effective for Peyronie’s.
Many oral treatments have been used that don’t work or may be too hard to take. Vitamin E…a vitamin B antioxidant called Potaba…the cancer drug tamoxifen (Soltamox)…and the amino acid derivative supplement carnitine have been shown to be no better than a placebo. The drawbacks of these treatments are numerous. For example, Potaba requires 24 pills a day for three to six months. The gout medication colchicine (Colcrys) is sometimes helpful to reduce pain, but it has no impact on penile deformity and can cause severe upset stomach.
Injecting the penis with interferon, a protein used to treat hepatitis and some cancers, is an effective treatment that may slow the rate of plaque growth, but it makes men feel like they have a bad case of the flu.
Vacuum devices have also been tried, but there is no evidence that they help.
The best treatment for Peyronie’s involves shared decision-making between doctor and patient. The goal is to find treatment with the least risk that will get a man’s penis hard enough and straight enough for sex. It does not need to be perfect. Men who notice symptoms of Peyronie’s, such as those described earlier, should be sure to discuss them with their doctor. Effective treatment options include…
• Oral medication. One oral drug that may help during the acute phase is pentoxifylline (Pentoxil), which is typically used to improve blood circulation. Studies show about a 40% chance of improvement after six months with low risk for side effects.
Other oral drugs to try during the acute phase include ED drugs, such as sildenafil (Viagra) or vardenafil (Levitra), and pain medicine, usually nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Motrin) or naproxen (Aleve). These drugs help control symptoms, such as ED and pain, that often occur during the acute phase.
• Penile injection with verapamil (Verelan)—a drug typically prescribed for high blood pressure or chest pain—has been used to treat Peyronie’s for years. Studies show that it slows plaque progression during the acute phase. You need injections every two weeks for up to six months. Your doctor will numb your penis first with lidocaine. The treatment has only minor side effects, such as penile bruising and temporary nausea.
None of the treatments described above are approved to treat Peyronie’s. They are used “off label,” meaning that they are FDA-approved for other uses. Off-label treatments are sometimes covered by insurers. Check with your insurance provider.
Latest treatment options include…
• Collagenase clostridium histolyticum (Xiaflex) is the first drug to receive FDA approval for the treatment of Peyronie’s disease. It improves the condition by breaking down connective tissue. Studies show, on average, a 34% improvement in penile curvature when eight injections are given over 32 weeks. There is some risk of bruising or swelling and, in rare cases, risk of rupturing one of the erection chambers of the penis, which could require urgent surgical repair. This treatment is approved only for chronic disease in men with at least a 30-degree curvature deformity.
• RestoreX, a new painless traction device, may also be worth a try. When men used the device 30 to 90 minutes a day for three months, 77% experienced about a 30% reduction in curvature and 94% achieved increased length of 1.6 cm, according to research published in The Journal of Urology.
Many men get adequate relief from the treatments described above. If not, there are relatively safe and effective surgical options.
• Plication surgery involves simply straightening the penis by placing sutures or using other reconstructive techniques to shorten the side of the penis opposite the plaque. It is considered a “preferred and reliable technique,” according to research published in Translational Andrology and Urology. The downside of penile plication is that it shortens the penis by 1 cm to 2 cm in most cases.
• Grafting surgery involves excising the penile plaque and inserting a graft into the penis to lengthen the affected side. While this sounds preferable to most men at first, grafting surgery involves risks for penile sensory loss and ED that can be very impairing. It is generally reserved for patients with excellent erectile function and moderate-to-severe penile deformities.
• Penile implant is appropriate for men who have both Peyronie’s and severe ED. This procedure, which involves the placement of an inflatable penile prosthesis, is considered the gold standard for men with both conditions, notes a study in Current Urology Reports.
Peyronie’s disease can be a major quality-of-life issue, not only for men but also for their sexual partners. It helps to get your partner involved in treatment decisions and discuss other ways to maintain intimacy while treatment is under way.
Also: Don’t ignore the psychological aspects. Working with a mental health counselor for psychological support or seeking couples therapy can be a key element of treatment.
Finding the right specialist is also important. Ideally, look for a urologist with subspecialty training in sexual health. Ask your doctor for a referral, or to find this type of specialist near you, consult the website of the Sexual Medicine Society of North America.
