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Peyronie’s disease

Peyronie’s disease

Peyronie's disease is a condition in which painful, hard plaques form underneath the skin of the penis leading to penile curvature. This plaque is dense and can usually be felt through the penile skin. This plaque is not a tumor but it may lead to serious problems such as curved and/or painful erections. If you have pain and penile curvature characteristic of Peyronie's disease, the following information may help you understand your condition.

What are the symptoms of Peyronie's disease?

The plaques of Peyronie's disease most commonly develop on the upper side of the penis. Plaques reduce the elasticity of the tunica albuginea and may cause the penis to bend upwards during an erection. Although Peyronie's plaques are most commonly located on the top of the penis, they may also occur on the bottom or side of the penis, causing a downward or sideways bend, respectively. Some men have more than one plaque, which may cause complex curvatures.

In some men an extensive plaque that goes circumferentially all the way around the penis may develop. These plaques typically do not cause curvature but may cause a "wasting" or "bottleneck" deformity of the penis. In other severe cases, the plaque may accumulate calcium and become very hard, almost like a bone. In addition to penile curvature, many patients also report shrinkage or shortening of their penis.

Since there is great variability in this condition, men with Peyronie's disease may complain of a variety of symptoms. Penile curvature, lumps in the penis, painful erections, soft erections, and difficulty with penile penetration due to curvature are common concerns that bring men with Peyronie's disease to see their doctors.

Peyronie's disease can be a serious quality-of-life issue. Studies have shown that over 75% of men with Peyronie's disease have stress related to the condition. Unfortunately, many men with Peyronie's disease are embarrassed about the condition and choose to suffer in silence rather than speaking with their health care provider about it.

How common is Peyronie's disease?

It is estimated that Peyronie's disease can be found in up to 1% to 23% of men between the ages of 40 and 70. The condition is rare in young men but has been reported in men in their 30s. The actual prevalence of Peyronie's disease is difficult to ascertain since patient embarrassment prevent them from bring up the issue to their physicians.

What causes Peyronie's disease?

Peyronie's disease is in essence a derangement of normal wound healing. Because it is related to normal wound healing, Peyronie's disease is a very dynamic process early on but over time, the inflammatory changes may decrease. In fact, this disease is usually divided into two distinct stages. The first phase is the acute phase; this portion of the disease persists for six to eighteen months and is usually characterized by pain, worsening penile curvature, and formation of penile plaques. The second phase is the chronic phase where the deformity remains in a stable state. As in the first stage the deformity may interfere with sexual activity and there may be associated erectile dysfunction. Pain with erection has typically resolved during this phase.

How is Peyronie's disease diagnosed?

A physical examination by an experienced physician is usually sufficient to diagnose Peyronie's disease. The hard plaques can usually be felt with or without erection. It may be necessary to induce an erection in the clinic for proper evaluation of the penile curvature; this is usually done by direct injection of a medication that causes penile erection. Pictures of the erect penis may also be useful in the evaluation of penile curvature. In some cases an ultrasound or x-ray examination of the penis is used to characterize the plaque and check for the presence of calcification.

For commonly asked questions, please see answers provided by Dr. Ramasamy 

For more information, please visit Dr. Ramasamy's YouTube channel.

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