Peyronie’s disease is a benign condition in which firm scar tissue – a plaque – forms in the elastic sheath of the penis. During an erection the plaque does not stretch, so the penis bends, becomes shorter or develops an indentation. Approximate figures suggest it affects a few men in every hundred, most often between the ages of 45 and 65.
Many men put off seeing a doctor, but an early consultation relieves the pain and helps choose the right moment for treatment. Dr Penev sees patients with curvature of the penis in Plovdiv and Karlovo.
What Peyronie’s disease is
In the sheath around the erectile bodies (corpora cavernosa), which normally stretches evenly during an erection, collagen builds up in one spot and forms a hard, inelastic plaque – most often on the upper side, which is why the curvature is usually upwards.
The disease has two phases. The active (inflammatory) phase lasts roughly six to eighteen months: the plaque forms, erections are painful and the curvature changes. The stable phase begins when the pain settles and the deformity stops changing; improvement on its own is rare.
Symptoms
- a hard lump (“nodule”) under the skin, easiest to feel when the penis is soft;
- pain during erection, sometimes also at rest, typical of the active phase;
- curvature during erection upwards, sideways or downwards, which changes over months;
- a narrowing (“hourglass” shape) or an indentation on one side;
- shortening of the penis, an unstable or weakening erection.
The disease itself is not an emergency. However, a sudden “crack” with sharp pain during intercourse, loss of the erection and swelling or bruising are signs of a penile fracture, which needs surgery within the first few hours – do not wait for an appointment; go to an emergency department or call 112 (the European emergency number).
Causes and risk factors
Most probably, repeated micro-injuries during intercourse cause small bleeds in the sheath, which in predisposed men heal with excessive scar tissue. The risk is higher over the age of 40, with a family history and other fibrotic diseases (for example Dupuytren’s contracture, which bends the fingers), diabetes, high blood pressure, smoking, unstable erections and pelvic surgery.
Diagnosis
Dr Penev will ask you about when the symptoms began, the pain and any changes in the curvature. During the urology consultation the plaque can be felt as a well-defined hard area, and the length of the penis is measured. Photos of the erect penis taken at home from above and from the side are standard practice and show the deformity precisely.
An ultrasound scan shows the size of the plaque and whether there are calcifications (calcium deposits), which are typical of a stable process. Before surgery and when there is also erectile dysfunction, blood flow is assessed with a Doppler scan. Other causes of curvature are also ruled out, for example a short frenulum.
Treatment
Medicines do not remove the plaque, but the pain can be controlled and the deformity corrected; the approach depends on the phase.
In the active phase surgery is not performed – the result would not last. The pain usually responds to ordinary anti-inflammatory painkillers and settles with time, and the condition is reviewed periodically. Tablets aimed at the plaque itself lack convincing evidence; in individual cases, injecting a medicine into the plaque, shock wave therapy for the pain, or daily stretching (traction) are discussed.
In the stable phase – at least three months without change and about a year from the start – surgery is discussed only if the curvature makes intercourse impossible or very difficult. With moderate curvature and good erections, the sheath is tightened on the outer (convex) side of the bend (plication), at the cost of slight shortening; with severe curvature, the plaque is cut and a graft is inserted, which preserves length but carries a higher risk to erections. When there is also erectile dysfunction that does not respond to medicines, a penile prosthesis straightens the penis and provides erections.
The operations are performed in hospital – Dr Penev discusses the method and what to expect with you and refers you to the Department of Urology at Kaspela University Hospital (UMBAL Kaspela), Plovdiv, where he is part of the team, or to a specialised centre.
When to see a urologist
Book a consultation if you can feel a lump on your penis, have had painful erections for more than a few weeks, notice new or increasing curvature, or find intercourse difficult. An initial consultation with Dr Penev is €50.
Prevention
There is no sure way to prevent it, but the risk of micro-injuries is reduced by using enough lubricant and taking care when the erection is not full, treating erectile dysfunction, controlling diabetes and stopping smoking.
Curvature of the penis is not an easy subject, but there is a suitable approach for every phase. Book an appointment with Dr Penev in Plovdiv or Karlovo for an accurate assessment and a calm conversation about your options.
Frequently asked questions
Is Peyronie's disease contagious and can it turn into cancer?
No. The plaque is scar tissue, not an infection or a tumour – it is not passed on through sex and does not turn into a malignant disease. Even so, any lump on the penis should be examined by a urologist so that an accurate diagnosis can be made.
Can I have sex with Peyronie's disease?
Yes, when intercourse is not painful and the curvature allows it – sex does not make the disease worse, as long as you avoid sudden movements and positions in which the penis bends sharply. If you have pain during the active phase, it is sensible to spare the penis for a while.
My curvature has been there since my teens – is it Peyronie's disease?
Most probably not. Congenital curvature is present from the very first erections, is not linked to a plaque or pain and does not change over the years. It is corrected surgically only if it interferes with your sex life, and an examination tells the two conditions apart.
Do vitamin E and food supplements help?
According to current guidelines, vitamin E and most supplements have no proven effect on the plaque or the curvature. In usual doses they are not harmful, but they should not replace an examination or delay treatment.
Are erection tablets harmful if I have Peyronie's disease?
No, when they are prescribed by a doctor. In some patients they are even helpful, because a firm erection makes intercourse easier and reduces the risk of new micro-injuries. Dr Penev will judge whether they are suitable for you based on your general health and the medicines you take.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.