Q: I saw a late-night television ad for a condition where the penis is curved. What is it—and how is it treated?
A: The condition is Peyronie’s disease, which is characterized by an abnormally curved (or otherwise deformed) penis, most noticeable during erection. Named for the French physician in the court of King Louis XV who first reported it, Peyronie’s can cause pain as an early symptom and, as it progresses, can make sexual intercourse difficult or impossible.
The ad campaign, called “Ask About the Curve” with the tagline “Bent out of shape?,” comes from the manufacturer of Xiaflex (collagenase Clostridium histolyticum), the only drug approved by the FDA to treat the condition. (The drug is also used to treat Dupuytren’s disease, in which the affected fingers are flexed forward due to contractures in connective tissue.)
Unlike congenital penile curvature, which is present from birth, Peyronie’s is acquired later in life. Overall, an estimated 5 percent of men develop it, with rates ranging from 3 to 16 percent.
Typically, Peyronie’s develops in middle age, though it can also occur in young men, even teenagers, with curves ranging anywhere from 10 to 90 degrees. Of course, a small degree of curvature during erection is not unusual or abnormal. The problem is when the curvature increases over time, as happens in about half of affected men. In only about 12 percent of cases does the condition resolve on its own.
The cause of Peyronie’s is not fully clear, but it’s thought to have a genetic component and to be due to a problem in wound healing such that an injury to the penis—as may occur from intercourse or a sports accident, for example—leads to inflammation followed over time by the formation of fibrous or calcified scar tissue, referred to as plaque.
Though it may develop suddenly after a single significant trauma, it usually comes on gradually after repeated minor traumas as the plaque hardens over time. Sometimes, a knot or lump on the shaft can be felt. In some cases, the penis may become indented (and take on an hourglass shape) or become shrunken or shortened.
There are a variety of approaches to managing Peyronie’s, including watchful waiting, medication, and surgery, depending on how severe the condition is and how it’s affecting quality of life. If medication is indicated, some doctors recommend first trying pentoxifylline (an oral drug that has anti-inflammatory effects and also helps with blood flow), though evidence for its effectiveness (as well as for other oral drugs) is unconfirmed. The next step, for curvature of 30 degrees or more, could be to try Xiaflex, which is injected into the penis several times over weeks to break down the plaque. Other injectables are also available.
Other treatment options, which include ultrasound and shockwave therapy, have not been extensively studied. Mechanical traction was found to be safe and effective in a small study published in BJU International in October 2018. Botox injections are currently being investigated. A last resort is surgery (involving skin grafting or penile implants, for example), which has good results in most patients, according to the Association of Peyronie’s Disease Advocates. Several supplements are also touted to treat Peyronie’s, including omega-3s, vitamin E, and carnitine, but there’s no convincing evidence to support their use.
Bottom line: Peyronie’s disease—which is more common than once thought—can take its toll physically and psychologically. Men who have penile pain, progressive curvature, or lumps that can be felt under the skin of the penis should consult a urologist to get a diagnosis and discuss treatment options.
For more information and resources, go to the Association of Peyronie's Disease Advocates website.
This article first appeared in the UC Berkeley Wellness Letter.
Also see 6 Sex Injuries to Avoid.