1100 Queensborough Blvd Unit 102, Mt Pleasant, SC 29464

Peyronie’s Disease

A Peyronie’s Disease Q&A with Dr. Denny Kubinski, board-certified urologist

What is Peyronie’s Disease?

Peyronie’s Disease (PD) is curvature of the erect penis caused by scar or fibrosis of the tunica albuginea of the penile corpora cavernosa. It was first described by French surgeon Francois Gigot de la Peyronie, who identified the disease in the year 1743. It occurs in about 10% of men.

Why does curvature happen?

When a normal erection occurs, the two corpora cavernosa of the penis fill with blood. The outer casings of the two corpora, called the tunica albuginea, are elastic and stretch uniformly in length and girth, causing a straight, rigid erection. PD occurs when a short segment of the tunica albuginea develops a fibrotic, calcified scar, called a Peyronie’s plaque. The plaque does not stretch along with the rest of the tunica. Therefore as the corpora fill with blood and the rest of the tunica stretches, the penis will curve in the direction of the plaque. Think about blowing up a long balloon but pinching one side of it. It will curve to the side you are pinching because the opposite side is stretching. PD also causes shortening of the erect penis. Occasionally, it will also cause narrowing of the erection at the site of the plaque, called hourglassing. In many the deformity appears almost overnight, resulting in a real “WTF” moment. Guys are usually pretty proud of their penises, so this can be really distressing.

What causes the Peyronie’s plaque?

Some men will note a traumatic bending of the erection during sex prior to developing Peyronie’s Disease. However, most men do not note any trauma, but just a spontaneous and sudden development of curvature. Many will just wake up with a curved morning erection. This can obviously really freak a guy out. In this case, the plaque is thought to be caused by repeated microtrauma, which results in sudden formation of a scar from abnormal healing. The penis gets put through a lot over time.

Are there any other symptoms?

Yes. Usually men will note pain with erections, sometimes even when flaccid. This is generally limited to what is called the “active phase” of PD which usually resolves in about 6-12 months.

What happens if Peyronie’s Disease is not treated at all?

Untreated Peyronie’s can stabilize over time or continue to get worse. In some cases it actually completely resolves with no treatment. There are certain health risk factors that can help predict chances of outcome (smoking, cardiovascular disease, obesity, diabetes to name a few), but in general it is fairly unpredictable.

When do we treat Peyronie’s Disease?

In many cases PD is mild and does not impair sexual activity. Sometimes the prudent approach for mild disease is to leave it alone, as treatment have both expense and risk. However, if PD negatively affects the experience of sex for either the man or his partner, treatment is indicated.

What are the treatment options for Peyronie’s Disease?

The only FDA approved treatment for Peyronie’s Disease is a series of injections into the plaque with a medicine called Xiaflex. Xiaflex is a collagenase (breaks down scar). It definitely can help with PD. However, Xiaflex is quite expensive and requires work to get approved by insurance. Furthermore, it is never covered by insurance if the initial curvature is less than 30 degrees. Additionally, there is an increased risk of penile fracture after Xiaflex. Primarily due to the cost and insurance hurdles, we do not do currently offer Xiaflex.

There are a number of other effective treatments for PD, however. Unfortunately, there are no oral therapies that have good data to support use, and no oral therapies that are part of the American Urological Association (AUA)  guidelines for treatment of PD. However, there are a couple that we sometimes incorporate into a treatment plan because they are inexpensive and add very little risk. These may include Vitamin E and Acetyl-L-Carnitine.

Peyronie’s Disease treatments at The Men’s Center

At The Men’s Center, we take very individualized approaches to PD. Treatment choice depends on degree of curvature, effects on intercourse, and how much ED is also present. We offer each of the following as either standalone treatments or in combination.

We offer the Restorex penile traction device, invented by at Mayo Clinic by Dr. Landon Trost. In 2019, Dr. Trost published a paper in The Journal of Sexual Medicine which demonstrated that Restorex improved curvature and penile length in men with PD, and that Restorex is one of the most cost-effective approaches for PD. Restorex has also been shown to help regain penile length that is lost after radical prostatectomy. We have Restorex devices at The Men’s Center available for purchase at a competitive price. (You can find more information about Restorex here.)

Injection of verapamil directly into the plaque has also been shown to improve penile curvature. Verapamil is FDA approved for treatment of high blood pressure, but is commonly used off-label for treatment of Peyronie’s Disease and is included in the AUA guidelines. Verapamil can decrease collagen production and increase collagenase activity, reducing plaque density. Verapamil is much less expensive than Xiaflex. A course of verapamil injections consists of 6 treatments (some studies use 12) two weeks apart.

Low-intensity shockwave treatment using focused-linear shockwave is an effective treatment for erectile dysfunction (ED) caused by vascular disease (the most common cause of ED). It has been studied as a treatment for PD as well. Studies have shown that shockwave improves pain caused by Peyronie’s Disease. There is no data yet to support the claim that shockwave improves PD curvature, however. That being said, because ED is a risk factor for Peyronie’s Disease and many men with PD complain of ED, shockwave is a reasonable adjunct to Restorex and verapamil for PD treatment.  

We also often include an oral ED medication such as tadalafil (Cialis) for our men with ED and PD.

Peyronie’s Disease is a bothersome problem for many men. It can be difficult to treat for some. But there is hope.