To paraphrase a rather frantic patient I once saw “Doc I woke up one morning and out of nowhere I had a dogleg left!”

Peyronie’s Disease (PD) is an acquired, abnormal curvature of a man’s erect penis. It was first described by Francois Gigot de la Peyronie (1678-1747), who was kind of the OG of Urology. PD freaks a guy out, and rightfully so. It can be anything from a slight curve to a complete U-turn. Mild cases don’t impair sex much at all, and severe cases make sex impossible.

In order to understand how Peyronie’s Disease happens, we first how to understand what a normal erection is. A normal erection happens when the two corpora cavernosa (cylindrical spongy vascular structures which take up the majority of each side of penis) fill with blood. The outer casing of each corpus cavernosa is a stretchy fibrous lining called the tunica albuginea. When the corpora cavernosa fill with blood, the tunica albuginea stretch both in girth and length.

Peyronie’s Disease occurs when a fibrous, nodular plaque (scar) forms in a small segment of the tunica albuginea. The plaque is usually quite easy to feel. The scarred area cannot stretch like healthy tunica can. When the corpora fill with blood and the rest of the tunica stretches, the penis will curve at the point of the plaque. If the plaque is port side, the erection will curve to the left. If it is starboard side, it will curve right. If it is on the top, it will curve up. You get the picture.

Peyronie’s Disease is thought to occur due abnormal healing due to trauma. Some guys can actually recollect when the injury actually occurred. However, usually it is just the result of deposition of scar tissue from microscopic trauma and guys have no idea when it happened.

Unfortunately, there aren’t many good ones. Oral therapies including prescription meds and supplements are frequently used with results that are modest at best. Believe it or not, penile traction devices are often used to try to straighten that thing out, and do work. Sometimes, medicine can be injected into the plaque to soften it up and reduce curvature. Shockwave treatment has been used to attempt to break up the plaque, although it is not clear that it affects the curvature much.

Not gonna lie, Peyronie’s is a pain. And its common, affecting nearly 10% of men to some degree. Helping men deal with it is one thing we do at The Men’s Center.

Since we are on the subject of the tunica albuginea I will mention penile fracture. A penile fracture occurs when sudden bending of an erect penis causes a rupture (hole) of the tunica albuginea and all of the blood leaks out of the corpora cavernosa. It’s not good. Not good at all. I am going to write about penile fractures soon. Until then, just be careful out there.