Peyronie's disease is the development of abnormal scar tissue, or plaques, in tissues inside the penis. When a penis affected by Peyronie's (pa-ro-NEEZ) disease is erect, it's usually bent and may be painful.

Peyronie's disease may prevent a man from having sex, and men with Peyronie's disease often experience stress or anxiety related to this disorder.

Research about the effectiveness of nonsurgical treatments for Peyronie's disease is limited. Surgery to correct a curved or bent penis is usually recommended if the deformity is severe or prevents satisfactory sexual activity.

Peyronie's disease symptoms may appear suddenly or develop gradually. The most common signs and symptoms of Peyronie's disease include the following:

Deformed penis
When the penis is erect, it appears deformed. The penis may:

• Be bent, or curved, upward, the most common deformity
• Be bent down or to one side
• Have an "hourglass" appearance, with a tight, narrow band around the erect shaft
• Have a "hinge" effect, in which the penis appears erect but bends sharply downward at the base

The curvature or other deformity may gradually worsen over the first six to 18 months. At a certain point in time, the deformity will no longer worsen, but it will continue to recur with erections.

Pain
Pain most often occurs with an erection during the first six to 18 months after the onset of symptoms. However, pain associated with Peyronie's disease may occur in any of the following cases:

• During an erection
• Only during an orgasm
• When the penis is touched even when it's not erect (flaccid)

Scar tissue under the skin
The scar tissue, or plaques, associated with Peyronie's disease can be felt under the skin of the penis as flat lumps or a band of hard tissue.

Other symptoms
Other signs and symptoms include:

• Difficulty achieving or maintaining an erection (erectile dysfunction)
• Shortening of the penis

When to see a doctor
See your doctor if you have any symptoms during an erection that cause pain, prevent you from having sex or cause you anxiety. An accurate diagnosis is necessary to get appropriate treatment.

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Erect penis

The cause of Peyronie's disease isn't well understood, but it's generally considered the result of a wound that doesn't heal properly. The wound is most likely minor trauma to the penis during sexual activity. For example, the erect penis might be bent during sexual intercourse. A wound could also be the result of an accident or sports injury.

The role of wound healing
The penis contains two sponge-like, tube-shaped chambers (corpus cavernosa) with many tiny blood vessels. When a male becomes sexually aroused, nerve impulses increase blood flow to these chambers. An erection occurs when these chambers fill with blood, causing the penis to expand, straighten and stiffen.

The corpus cavernosa are encased in a sheath of elastic tissue called the tunica albuginea, which stretches during an erection. Injury to the penis can damage this elastic tissue. This damage can cause inflammation and damaged tissue. If an injury heals properly, there are generally no long-term problems.

In Peyronie's disease, problems in the normal wound-healing process result in permanent scar tissue. The section of the sheath with scar tissue is no longer flexible. Therefore, when the penis becomes erect, the region with the scar tissue doesn't stretch, and the penis bends or becomes disfigured.

Minor injury to the penis doesn't always lead to Peyronie's disease. There are a number of factors that can contribute to poor wound healing, and these factors may play a role in Peyronie's disease. These include:

• Heredity. If your father or brother has Peyronie's disease, you have an increased risk of the disorder.
• Connective tissue disorders. Men who have a connective tissue disorder appear to have a greater risk of developing Peyronie's disease. For example, a condition known as Dupuytren's contracture — a cord-like thickening across the palm that causes the fingers to pull inward — is common in men with Peyronie's disease.
• Age. The prevalence of Peyronie's disease increases with age. Age-related changes in tissues may cause them to be prone to injury, less likely to heal well, or both.

Other factors
Other factors associated with an increased risk of Peyronie's disease include:

• Diabetes
• Tobacco use
• History of pelvic injury

Complications of Peyronie's disease may include:

• Inability to have sex
• Difficulty achieving or maintaining an erection (erectile dysfunction)
• Anxiety or stress about sexual abilities or the appearance of your penis
• Stresses on the relationship with your sexual partner

If you have Peyronie's disease symptoms, you're likely to begin by seeing your family doctor or general practitioner. You may be referred to a specialist in male sexual and urinary tract disorders (urologist). Preparing for your appointment with your doctor or a urologist will help you make the best use of your time.

What you can do
Make a list ahead of time that you can share with your doctor. Your list should include:

• Symptoms you're experiencing, including any that may seem unrelated to problems with an erection
• Key personal information, including any major stresses or recent life changes
• Medications that you're taking, including any vitamins or supplements
• Family history of Peyronie's disease
• Questions to ask your doctor

List questions for your doctor from most important to least important in case time runs out. If you think you have signs or symptoms of Peyronie's disease, you may ask some of the following questions.

• What tests will I need to have?
• What treatment do you recommend?
• Can you tell if the condition is likely to worsen?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions you've prepared to ask your doctor, don't hesitate to ask questions during your appointment if you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first experience symptoms?
• Has the curvature of the penis — or other deformity — during an erection worsened over time?
• Do you continue to have pain when you have an erection?
• Do you recall any injury to the penis during sexual activity or any other injury to the penis?
• When your penis is flaccid (not erect), does it appear to be shorter than it used to be?
• Do your symptoms limit your ability to have sex?

Your doctor also may ask you to complete a survey, such as the International Index of Erectile Function, that may help him or her understand how the disorder affects your ability to engage in sexual activity.

Your doctor will conduct tests to diagnose the condition and understand the severity of your symptoms. These tests will include the following:

Physical exam
Your doctor will feel (palpate) your penis when it's flaccid (not erect) to identify the presence, exact location and amount of scar tissue. He or she may also measure the length of your penis. If the condition continues to worsen, this first measurement helps determine whether the penis has shortened.

Ultrasound
Your doctor will likely use an ultrasound device to examine the penis when it's erect. You will receive an injection directly into the penis that causes it to become erect. You'll be given a local anesthesia to lessen pain before the injection.

The ultrasound, which uses sound waves to produce images of soft tissues, can show the presence of plaques, blood flow to the penis and any abnormalities. Your doctor may use these images of the penis to measure the degree of curvature.

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Nesbit plication

Your doctor will likely not recommend treatment if all of the conditions apply to you:

• The curvature isn't severe and is no longer worsening
• You don't experience pain
• You can engage in satisfactory sexual activity

Oral medications
There's limited information on the effectiveness of drugs to treatment Peyronie's disease. A number of oral medications have been proposed and tested, but the use of these drugs isn't supported by reliable research.

Penile injections
Research on drugs injected directly into the plaques in the penis is somewhat limited. However, these treatments may reduce the curvature of the penis and pain associated with Peyronie's disease. If you have one of these treatments, you'll receive multiple injections over several months. You'll be given a local anesthetic to prevent pain during the injections.

Penile injections for Peyronie's disease may include one of the following drugs:

• Verapamil is a drug normally used to treat high blood pressure. It appears to disrupt the production of collagen, a protein in connective tissues that appears to be a key factor in the formation of Peyronie's disease scar tissue.
• Interferon is a protein that appears to disrupt the production and promote the breakdown of collagen.
• Collagenase is an enzyme that breaks down collagen and may eliminate some scar tissue.

Surgery
Your doctor may suggest surgery if the deformity of your penis is severe or prevents you from having sex. Surgery usually isn't performed until the condition is stabilized — until the curvature hasn't changed and your erections have been pain-free for at least six months.

Common surgical methods include:

• Shortening the unaffected side. A variety of procedures can be used to shorten the tunica albuginea on the side of the penis opposite the scar tissue. The shortened side of the sheath and the less elastic, scarred side of the sheath end up being about the same length when the penis is erect. This results in a relatively straight erection. These procedures usually shorten the overall length of the penis. It's generally used in men who have adequate penis length and a less severe curvature of the penis. A risk of this procedure is difficulty in achieving or maintaining an erection (erectile dysfunction).
• Lengthening the affected side. With these procedures, the surgeon makes several cuts in the scar tissue, allowing the sheath to stretch out and the penis to straighten. The surgeon may have to remove some of the scar tissue. A graft is sewn into place to cover the holes in the tunica albuginea. A graft may be tissue from your own body, human or animal tissue, or a synthetic material. This procedure is generally used if a man has a shorter penis, severe curvature or a complicated deformity. This procedure runs a greater risk of erectile dysfunction than does the shortening procedure.
• Penile implants. Penile implants are essentially artificial versions of the spongy, tube-like tissues in the penis (corpora cavernosa). The implants may be semirigid — manually bent down to appear flaccid or bent up for sexual intercourse. Other penile implants may be inflated with a pump implanted either in the groin or the scrotum. The inflated implants cause the penis to be erect. Penile implants are usually used if a man has both Peyronie's disease and erectile dysfunction. When the implants are put in place, the surgeon will likely make some incisions in the scar tissue to relieve tension on the tunica albuginea.

You'll likely go home from the hospital the same day as the surgery. You'll need to leave the dressing on your penis for 24 to 72 hours. Your surgeon will advise you on how long you should wait before having sex. You'll likely need to wait at least four to six weeks.

Peyronie's disease can be a source of significant anxiety and create stress between you and your sexual partner. The following suggestions may help you cope with Peyronie's disease:

• Explain to your partner what Peyronie's disease is and how it affects your ability to have sex.
• Let your partner know how you feel about the appearance of your penis and your ability to have sexual relations.
• Talk to your partner about how the two of you can maintain sexual and physical intimacy.
• Talk to a psychotherapist who specializes in family relations and sexual matters.