Fact Sheets

Peyronie's Disease

Peyronie's disease is a localised area of abnormal scar tissue or fibrosis that appears as a plaque or nodule in the penis. These plaques occur in about 1% of men over 50 years of age. A plaque when mature is painless and often associated with curvature of the erection. Most plaques occur on the top of the penis. Patients present with pain, a lump in the penis, a curvature of the erection or erectile dysfunction.

Peyronie's disease has two distinct phases. The acute phase lasts 12-18 months and may be associated with pain during erection. Nodules form and a curvature may slowly develop. The chronic phase involves thickening of the scar tissue and the absence of pain. The curvature may improve, stay the same or deteriorate. The presence of calcification indicates a poorer outcome.

These plaques arise from mild trauma associated with mechanical strain of the erect penis during intercourse. This effect is commonly seen with the partner in the superior position. The exaggerated localised scarring response may be genetic (HLAB27) and associated with scarring in the hands. Penile injection therapy may also predispose to this scarring.

Erection problems may occur in 20% of men with Peyronie's disease. This may arise from a performance anxiety due to the pain and visible bend or due a physical cause when penile blood vessels are affected by the plaque.

No treatment is required with minimal deformity, no pain and no discomfort. When the plaque presents as a painful lump, the pain can be improved by oral medication using colchicines tablets (an anti-inflammatory used for the treatment of gout). Vitamin E can be taken orally and applied to the skin of the penis. It can be applied by squeezing the liquid out of the oral capsules and rubbing that directly onto the penile skin. Various chemicals can be injected into the plaque such as cortisone, verapamil and interferon.

Three surgical procedures are available to straighten the penis if the bend in the erection interferes with penetrative intercourse. However, surgery will not improve the rigidity of the erection if there is already a pre-existing problem with the rigidity. Surgery is only considered if the Peyronie's has been present for 12 months and stable for 3 months.

The first operation is a plication operation (Nesbitt procedure). It may cause slight shortening of the erection. The second operation involves incision and graft and is more complex and has slower recovery but has less effect on penile length. The third operation is the insertion of a penile implant when other options fail.