Understanding Peyronie’s Disease and its Impact on Men’s Health

Certain TV advertising tackles a once-little-known condition that can affect men in mid-life or beyond. It’s hard to miss. The public awareness, however, doesn’t mean Peyronie’s disease (PD) has become more common.

Peyronie’s disease affects 1 to 10% of men, with most of them being over 45 years of age, says Thomas Masterson, M.D., a urologist at the Desai Sethi Urology Institute at the University of Miami Health System. Until the U.S. Food and Drug Administration approved injectable medication, the condition was rarely discussed and certainly not featured on airwaves. That’s because few men want to consider — let alone talk about — a condition that affects the penis.

In Peyronie’s disease, men suffer from an abnormal curvature of the penis.

This is a result of scar tissue forming under the skin in what Dr. Masterson calls “the stretchy part” of the male organ. Though not fatal, it can cause abnormal curvature and painful erection, as well as make sexual intercourse difficult. It also shortens the penis. But it’s not just the physical symptoms that can affect a man. For many, the condition tends to have psychological consequences, too.

“There are few things worse than a single guy with Peryronie’s disease,” Dr. Masterson says. “It’s a lot about self-image. Dating is hard enough, but then they think, “Oh, great. Now I have to explain my disfigured penis to my partner.’ It’s embarrassing.”

Studies bear out his observations. Stressed out by the condition, some single men opt out of dating and sexual relationships. In fact, a 2016 review of the medical literature found that PD “can have a significant negative impact on mood and quality of life.”

More than 80% of men reported being distressed because of the condition, and about 50% of men reported depressive symptoms.

Relationships are also affected. Men are often too embarrassed to speak about the condition openly and are more likely to avoid intimacy with their partners. This, in turn, leads to” a significant impact on the sexual function and satisfaction of female sexual partners,” according to another study.

Understanding Peyronie’s disease — causes, symptoms, and effective treatment — can help alleviate some of the anxiety over the condition.

Experts believe that PD is usually a result of trauma to the penis. In some cases, the trauma can be as mild as the resistance to sexual penetration or bumping into a partner’s pubic bone. In others, it may have been as significant as a penile fracture. But most men don’t remember an injury and realize the beginning of PD only after the scar tissue has begun to accumulate, resulting in a bend in the penis or a painful erection.

“Everyone pretty much says, ‘I never had trauma to my penis,'” he adds. “They really don’t remember an injury.”

There also seems to be some connection between PD and inflammatory conditions, such as diabetes, but “right now it’s a loose association, not a cause and effect,” Dr. Masterson says.  In addition, some men appear to have a genetic predisposition to the condition.

PD has a spectrum of symptoms. “The curvature can range from very mild to fairly extreme, almost curving back to touch the stomach,” he says. “Some men report a little pain while others have more intense [pain]. Some men have no problem penetrating, and others can’t at all.”

Patients usually seek help because of the curvature or the pain. But many also visit because they are unable to maintain or have an erection. Erectile dysfunction may happen even before a patient notices any kind of curvature.

Peyronie’s disease is divided into two phases: active and stable.

During the active stage, the curvature is changing. About 12% of those of those cases resolve on their own. Most men with PD settle into the stable stage, however.

There’s good news: PD is highly treatable.

Dr. Masterson likes to offer his patients a range of options, from the least invasive to the most. Some mild cases, for example, may not require medical intervention. “If you have no pain and you’re OK with it and your partner is OK, too, you don’t have to do anything.” For light pain, Dr. Masterson might recommend over-the-counter nonsteroidal anti-inflammatory drugs

Many cases do require more aggressive intervention, such as traction therapy, which applies gentle but consistent pressure to limit curving. For the past decade or so, urologists’ go-to non-surgical treatment has been Xiaflex, an FDA-approved drug that is injected into the scar to break it down over weeks. It is indicated for men with curvature ranging from 30 to 90 degrees. (Dr. Masterson says there are other off-label injectables as well.)

For the more severe cases, surgery can be a last resort. A patient must have had stable symptoms, which is about six months after symptoms start. While this kind of intervention requires a six-week recovery time, it is highly effective for patients when other treatments have failed to produce results.

One word of caution: “Nothing is an overnight fix,” Dr. Masterson warns his patients. “You have to be patient. Surgery may be fastest, but the other treatments require months.”

Ana Veciana-Suarez is a regular contributor to the University of Miami Health System. She is an acclaimed author and journalist who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow her on Twitter: @AnaVeciana.

Tags: Desai Sethi Urology Institute, Dr. Thomas Masterson, Erectile dysfunction, Penile curvature, Peyronie’s treatment, Psychological impact of Peyronie’s