What Is Peyronie's Disease?
Peyronie’s disease (PD) is a common issue that occurs in many men as they get older. The disease causes a condition that men describe as bent penis or curved penis.
Experts believe Peyronie’s disease is caused by an abnormal healing process when an injury occurs in a man’s penis. This abnormal healing creates plaque or swelling of the tough covering of the erectile portion of the penis. Usually, the disease starts with swelling, and plaque occurs over time.
Approximately three and a half percent to nine percent of men have Peyronie’s disease, depending on age.*
Some men experience pain with erections, which causes problems with having sex and can result in stress and anxiety.
Peyronie's Disease Symptoms
Common symptoms of PD, which are visible during an erection, include:
- A curve or bend in the penis,
- Narrowing of the penis (also referred to as “hour-glassing”),
- Erectile difficulties or dysfunction, and/or
- Painful erections or pain during sex.
Find a Men's Health Doctor
Peyronie's Disease Treatment
University of Utah Health providers offer surgical and non-surgical treatment for PD to improve quality of life for men with this condition.
Peyronie’s Disease Medications
Medication is most effective in the early stages of PD. These medications focus on reducing inflammation and the development of plaque. Our providers use these sparingly, as other medical options can be more effective and there is little data to support long term use of these oral agents.
The medications can include:
- Pentoxifylline (Trental),
- Daily Phosphodiesterase 5 inhibitors (i.e. sildenafil, tadalafil),
- L-arginine, and
- Vitamin E.
Penile Traction Therapy
Penile traction therapy can also be an effective Peyronie’s disease treatment. Many men do their traction therapy as a Peyronie’s disease home treatment, as prescribed. This therapy focuses on stretching the penis over time to straighten it.
Traction therapy devices can be worn comfortably under your clothes for long periods of time, making this treatment easy to do on your own after our providers help you decide which device is best for you.
Injections are a more common Peyronie’s disease medical treatment. Providers will inject your penis with lidocaine to numb it before we inject medications.
After the injection, your provider will wrap your penis in a pressure bandage to prevent swelling and bruising. You can remove the bandage three hours after your procedure.
Expect some bruising following the injection appointment. Also note you shouldn’t engage in sexual activity for 24 hours after your injection.
Verapamil, a calcium channel inhibitor, is typically used for blood pressure control, but it also stops the progression of plaque formation for men with PD. Injecting verapamil directly into the affected area can soften the tissue and reduce pain, especially early on.
Verapamil injections are usually prescribed with medication to help with pain and to aid in penile modeling.
Initially, most patients start with a series of six Verapamil injections every two weeks. Your provider will assess your progress to decide if you need further treatment.
Xiaflex injections are the only FDA-approved medical therapy for PD. The enzyme in the drug reduces the plaque, improving penile curvature.
Xiaflex treatment cycles include two injection procedures. You’ll receive your second injection one to three days after your first injection appointment.
You will also do some penile modeling with a penile traction device at home one to three days after each injection round.
Patients can undergo a maximum of four Xiaflex treatment cycles. Typically, you’ll need to perform modeling therapy for two hours daily for about six weeks after your cycle.
Penile Modeling Frequency
Your provider will prescribe you a penile traction device for penile modeling and give you instructions about how you should use it at home.
We suggest two types of at-home penile modeling therapies: one is for stretching your penis and the other is for straightening your penis.
Penis-stretching should be done three times per day with a non-erect penis, unless you’re using a traction device, which replaces this activity. Penis straightening should only be done if you experience a spontaneous erection and should only be done once per day.
Do not attempt penis straightening if you do not experience a spontaneous erection.
At-Home Penile Modeling
- Grasp your penis by the tip and stretch it out.
- Using the target plaque as a bending point, bend your penis in the opposite direction of the plaque and your curve.
- Hold this stretch for 30 seconds, then release.
- Rest for 30 seconds, then repeat this exercise twice more for a total of three times.
- This exercise can be performed daily for five to six weeks in addition to traction therapy.
Penile modeling does carry a risk of penile fracture or other serious injury. It’s normal to experience bruising and/or swelling and mild-to-moderate pain that can be relieved by taking over-the-counter pain medications as directed.
Contact your provider or go to the nearest emergency department if you experience any of the following symptoms. These symptoms may mean you have a penile fracture, which could require surgery:
- A popping sound or sensation in your erect penis,
- Sudden loss of the ability to maintain an erection,
- Difficulty urinating or blood in your urine, and/or
- Severe pain in your penis.
Peyronie's Disease Surgery
Your provider may suggest surgery to correct the curve in your penis, depending on your situation or goals. Typically, providers suggest surgical procedures if medical treatments haven’t given you the results you want.
During penile plication, a doctor places stitches directly into your penile tissue to correct the bend in the penis. Although this popular treatment permanently corrects the curvature, it does not correct notches, waists, any length or width loss associated with PD, or other deformities.
You can go home following this procedure and you should be able to return to work after one day of recovery. You can resume sexual activity after five weeks.
In penile grafting, surgeons remove the plaque and replace it with a graft of synthetic or biological material during this procedure. Penile grafting corrects the curve in the penis and can also correct other deformities and reclaim some of the length/width loss associated with PD.
You’ll need to stay overnight in the hospital after your penile grafting procedure and you should be able to return to work within two to three days. Sexual activity can resume after eight weeks.
We may recommend penile implants or a prosthesis if you have also experienced erectile dysfunction (ED) or if you who develop ED after a grafting procedure.
Implants are ideal for those patients because both PD and ED are corrected at the same time. Penile implants are usually covered by insurance, including Medicare.
This table lists three surgical PD treatment options offered at University of Utah Health. Each surgery gives the patient different treatment options to choose from.
If you would like to make an appointment with one of our specialists, please call our office at 801-587-1454