Peyronie’s disease is a condition caused by scarring that forms within the penis, just under the surface of the skin. The hardened scar tissues (known as plaques) pulls together in such a way that it causes the penis to bend or curve abnormally. They also make the penis less flexible and may also shorten it.
Sexual intercourse can be difficult for men with Peyronie’s disease, especially if the curve is severe. Men may also experience pain and have problems with erections.
We do not know what exactly causes Peyronie’s disease, but many experts believe that the scarring is developed as a result of abnormal wound healing.
Why does scarring develop in the penis? You may have injured your erect penis through rough, vigorous sex, or a hard knock in the groin during contact sport or from a nasty prank (which is not funny when you cause direct trauma to the crotch) and not even be aware of it.
Your body proceeds to heal the injury in the way it knows how and unfortunately, sometimes this process is not perfect and an excessive amount of scar tissue is formed instead. Over time, your body tries to break down and remodel this scar tissue to gradually reduce its size.
In Peyronie’s disease, this process malfunctions. The plaques are hard and inflexible and cause the penis to lose its elasticity in the spot where the scarring is and causes the penis to bend. Sometimes, the curvature is severe enough to make any form of penetration – vaginal, oral or anal – difficult.
Development of Peyronie’s disease
Peyronie’s disease develops across 2 phases:
Active Phase
The Active Phase lasts for about 1-2 years. During this period, the abnormal wound healing process progresses and the penis continues to slowly bend across this time. This phase of Peyronie’s disease causes pain and discomfort over the penis.
Chronic Phase
This phase usually occurs when the pain subsides and the curvature of the penis doesn’t worsen any further and the disease stabilises.
How is Peyronie’s disease treated?
For severe cases, surgery is required. Tunica Albuginea Plication involves stitching tissue on the opposite side of the affected area to even out the curvature. More severe cases are treated with a plaque incision and grafting procedure, which involves cutting out the plaques and filling it with tissue from another part you body.
Surgery can only be done once the Peyronie’s disease has stabilised and the abnormal curvature is at its peak and not worsening further – meaning the disease is in its chronic phase.
Fortunately, most men do not require surgery, as the abnormal penile curvature is often not severe.
What are some non-surgical treatments for Peyronie’s disease?
Men who are in the active phase of Peyronie’s disease may opt for nonsurgical treatments such as the following:
1. Vacuum Erection Device
A vacuum erection device is a cylinder that is attached to a pump. When activated, the device creates a vacuum that forces blood into the penis. Once an erection is formed, a constriction ring is placed at the base of the penis to maintain the straightened erection for the desired duration.
2. Traction Device
This is a special device that is worn for 6-9 hours a day to lengthen and straighten the penis.
3. Extracorporeal Shockwave Therapy (ESWT)
The low intensity extracorporeal shockwave treatment works on the basis of powerful acoustic waves.
When these waves are directed into the plaque, they can exert a mechanical effect that breaks the plaque down. The focused shock waves also help to promote blood flow to the area where the plaque is, which support the growth of special cells in the blood called macrophages that lyse or “eat” through the plaque.
ESWT is best for treating the pain associated with Peyronie’s disease during the acute or even in the stable phase of the disease.
Commonly 4-6 sessions are required to appropriately manage this pain.
Many doctors have had personal experiences with improvement in the curvature of the penis when ESWT is used to correct the bend of the penis. More scientific evidence however is required before this can be considered as an alternative first line recommendation.
4. Platelet Rich Plasma Therapy (PRP)
PRP is the special golden extract rich in growth factors that is obtained when a sample of your blood is spun down in specialised tubes in a centrifuge. This rich extract of the blood, which we call platelet rich plasma, is then injected into the scar or painful area.
The injections help to reduce inflammation and promote tissue healing. Athletes sometimes have PRP to speed up the healing of sports injuries. PRP is now also used to treat other male sexual health issues like erectile dysfunction.
This new and novel strategy has promising data from studies that PRP can reduce the plaque size by 50%, improve the curve of the penis by 50% and reduce pain from Peyronie’s disease by 80%.