Erectile dysfunction (ED) can stem from multiple causal factors. Peyronie’s disease, or Peyronie disease, is also a common affliction, affecting up to 23% of the worldwide male population between the ages of 40 and 70 years.* In many cases, Peyronie’s disease leads to ED.
NEARLY 80% OF MEN WITH PEYRONIE’S DISEASE ALSO REPORT SOME DEGREE OF ERECTILE DYSFUNCTION (ED).
* While the actual numbers may be much higher (due to underreporting by patients and physicians), it is clear that Peyronie's disease is correlated with age. Although rarely seen in young men, Peyronie’s disease has been reported by men in their 30s.
What Is Peyronie's Disease?
Peyronie’s disease affects a man’s ability to have a normal erection. Fibrous scar tissue develops beneath the surface of the penis, leading to excessive curvature of the male organ. Initially, inflammation and swelling occur. Thereafter, a hard scar develops on the penis.
The scar tissue — also called a plaque — forms inside the tunica albuginea tissue (a thick, elastic membrane primarily made of collagen and elastin). This membrane envelops the corpora cavernosa: two cavernous bodies that house blood during an erection.
Commonly, the plaque resides on the top or bottom of the penis, causing the male organ to bend. As scar tissue builds, erections become painful and sexual intercourse difficult. Excessive curves in the penis may make sexual intercourse impossible.
The effects of Peyronie's Disease are devastating to a man’s sexual health and confidence - often causing pain for the individual with the disease and their partner. It is often connected to erectile dysfunction and may result in relationship tension with a significant other. While a curved erection alone isn’t a necessarily an issue, the associated pain and discomfort of a significant bend is characteristic of Peyronie's Disease and can be alleviated with treatment.
What Causes Peyronie's Disease?
The exact cause of Peyronie's Disease remains elusive.
That said, researchers largely believe Peyronie's Disease is caused by:
Acute penile injury
Chronic penile injury
Injury to the penis — whether a singular event or occurring repeatedly over time — may rupture blood vessels within the penis. Vigorous sexual or physical activity resulting in microscopic injuries is also linked to the condition. However, Peyronie’s Disease often occurs spontaneously, without a known trauma to the organ.
Following an injury, subsequent bleeding and swelling within the tissue of the tunica albuginea can occur. Swelling blocks blood flow and may form clots. These clots contain cells from the immune system. During the healing of the injury, these immune system cells release substances to form scar tissue. As the scar tissue builds, a plaque forms which reduces the overall elasticity and flexibility of the penis, producing organ curvature.
Men with autoimmune disease (and particularly connective tissue disorders) may have a higher chance of developing Peyronie’s disease. The patient’s own immune system may attack cells in the penis, resulting in inflammation and scarring. Dupuytren's disease, for example, (a cord-like thickening across the palm) is associated with 15% of men suffering from Peyronie's disease.
Other autoimmune and connective tissue disorders associated with Peyronie’s disease include:
Systemic lupus erythematosus
Family history and age also factor into the prevalence of Peyronie’s disease. For men with shared genetics, the likelihood of having the condition may increase among families. As one ages, the elasticity of tissue diminishes — which may further contribute to Peyronie's disease.
What Does Peyronie's Disease Look Like?
Signs of Peyronie’s disease vary from mild to severe. Symptoms may progress slowly or quickly.
Some indicators of Peyronie's disease include:
Plaque formation (felt through the skin as “hard lumps”) on the penis
Painful erections and/or sexual intercourse
Shrinkage or narrowing of the penis
Symptoms may dissipate without leaving permanent curvature of the penis. Often, however, the pain subsides while the curve remains. Researchers believe painful erections are due to active inflammation within the plaque, which abates over time.
Significant curvature may make sexual intercourse challenging. Additionally, the scar tissue associated with Peyronie’s disease can diminish the length and girth of your penis.
Peyronie’s Disease - Treatment Options
Treatment for Peyronie's Disease is considered more effective in the early stages of the condition. Roughly 20% of active patients may improve spontaneously, while 40% stabilize and another 40% progress further with the disease.
Medications for Peyronie’s Disease
Conventional ED treatments, such as oral ED medications, are not recommended for men who have Peyronie’s. Oral medications such as Viagra, Cialis and Levitra increase blood flow to the penis, but do not address the root cause and lessen the scar tissue causing Peyronie’s and are not recommended.
Medications for Peyronie's disease are designed to reduce the inflammation, plaque size, and curvature of the penis. These medications may be administered orally or through direct injection into the plaque within the penis. Topical (or transdermal) medication may also be applied.
Some naturally-occurring oral medications include vitamin E , CoQ10 and acetyl-L-carnitine. Others, such as colchicine, may treat an underlying autoimmune disorder causing Peyronie’s disease. However, a number of studies indicate that colchicine is no more effective than the placebo in treating Peyronie’s disease.
Potassium paraaminobenzoate (a.ka. Potaba), on the other, is shown to stabilize the condition and prevent any further progression of penile curvature. Unfortunately, a high degree of gastrointestinal discomfort also reduces the practicality of Potaba as a standard treatment.
On the injectable side, collagenase clostridium histolyticum is the only FDA-approved medication for Peyronie's disease. Known as Xiaflex, this enzymatic medication effectively dismantles collagen with the help of the gangrenous bacteria: clostridium histolyticum (found in soil and feces).
For those with penile curvature above 30 degrees, a series of Xiaflex injections are administered to break down excessive collagen build-up in the penis.
Verapamil may also be injected into penile plaques. Although not FDA-approved, this method has shown a 97% reduction in pain and a 56% decrease in penile curvature per an average of 2.5 injections.
This calcium channel blocker — thought to diminish collagen production — can double as a topical ointment for painless, non-invasive treatment. (Unfortunately, some studies show the administration via transdermal gel doesn’t garner promising results for Peyronie's disease.)
Calcium channel blockers demonstrably increase the activity of collagenase. Collagenase is the enzyme responsible for disassembling and remodeling excess collagen (seen in the plaques of Peyronie's disease). With the help of collagenase, an existing plaque can be reformed into healthy, flexible tissue — thereby restoring the proper functioning of the penile tissue.
While there are a number of medications that may be prescribed for Peyronie's disease, many produce deleterious side effects and insufficient results. Fortunately, there are other treatment options available. As in the case of medications, these options also vary in safety and efficacy.
Surgery for Peyronie's Disease
By and large, surgery is considered a last-resort treatment option for Peyronie's disease. Physicians recommend waiting at least a year after the onset of symptoms before considering surgical methods. Peyronie’s disease differs for each man, and surgery may not solve the issue.
For long-term cases, however, when symptoms have not improved and curvature doesn’t allow for sexual intercourse, surgery may be recommended. There are several surgical operations to treat Peyronie's disease. Keep in mind: Complications may result.
Grafting — The plaque is surgically removed and replaced with a patch of skin, vein or animal-organ material. As a result, the penis may straighten and length is restored.
Device Implantation — A device is implanted within the penis to straighten and produce an erection. Once implanted, the man must use the device in order to attain an erection.
Plication — A piece of the tunica albuginea is removed (or pinched) from the penis on the opposite side of the plaque. Thus straightening — and shortening — the male organ.
These procedures are completed in a hospital by a urologist. Adverse side effects may include numbness, erectile dysfunction, and other surgical complications. Depending on the severity of your condition, one surgery may be recommended over another.
Less invasive treatment methods, however, may offer you a greater degree of comfort and produce more desirable results. These non-surgical and non-pharmaceutical options can provide safe and effective treatment for your most sensitive external organ.
Peyronie's Disease Device
Peyronie's disease can be attended to through a variety of measures. Mechanical devices, such as vacuum erections devices (VED) and penile traction therapy (PTT), are therapeutic options to help straighten the excessive curvature of the penis.
The negative pressure of a VED enlarges small blood vessels within the penis and increases blood flow. When used regularly (twice a day for 10 minutes) over the course of several months, studies indicate satisfactory results for stabilizing or improving curvature of the penis.
Similarly, over the course of six months, PTT showed satisfactory results for men who wore penile extender rods for (at least) two hours each day. Unfortunately, those results were not repeated in subsequent studies. It is generally concluded that more research is needed on PTT.
Other techniques — such as iontophoresis — utilize a weak electrical current through a self-adhesive placed on the penile skin above the plaque. Iontophoresis is often used to deliver
medication, such as verapamil, for Peyronie's treatment. Interestingly, however, studies indicate the electrical current itself delivers a pronounced healing effect (rather than the medication).
Peyronie’s Disease - Our Recommended Treatment
When it comes to treating Peyronie’s Disease, you may find an overwhelming number of treatment options. Each therapy can come with significant drawbacks and discomfort.
As discussed, oral and injection medications have severe side effects (or may not work at all). Surgery is costly, painful, and leaves you with unalterable and undesirable changes. Right in the middle are alternative therapies. And, let’s face it - not all have the scientific backing we’d hope.
Of the differing treatments for Peyronie's disease, one treatment receives particularly notable and promising results from numerous medical studies. Low-intensity shockwave therapy — i.e. GAINSWave therapy — painlessly breaks down the plaque associated with Peyronie's disease.
In fact, these mild acoustic waves not only remove plaque in blood vessels but generate new blood vessels and penile tissue to improve sensitivity and blood flow. For those suffering from both Peyronie's disease and ED, low-intensity shockwave therapy is a two-for-one treatment. There is some limited but promising research for the use of Platelet Rich Plasma (PRP) treatment for Peyronie’s disease. Dr. Kass often combines PRP treatment with GAINSWave therapy for optimum results.
GAINSWave® has been shown to be an effective procedure to breakdown the scar tissue and reduce the curvature of the penis for someone suffering from typical Peyronie’s disease. Unlike oral ED medication, the mildly pulsating waves of GAINSWave can both reduce the scar tissue of Peyronie’s disease as well as increase blood flow to the penis.
Dr. Kass will discuss the realistic outcomes of any Peyronie’s disease treatment before proceeding. GAINSWave and PRP treatment allow most patients to see a 30% improvement in curvature. In addition, most patients do notice an improvement in erectile quality and a reduction in penile atrophy caused by Peyronie’s. Additionally, there is generally a resolution of pain associated with erections.