ON THIS PAGE: Visiting a Doctor Criteria for Treatment

Peyronie's Disease is characterized by a hard bump of plaque on the penis and often penile curvature. The plaque develops on the upper or lower side of the penis in layers containing erectile tissue. It begins as a localized inflammation and can develop into a hardened scar.

Cases can range from mild to severe. Symptoms may develop slowly or happen overnight. In severe cases, the hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection. In many cases, pain decreases over time, but the bend in the penis may remain a problem, making sexual intercourse difficult. The sexual problems that result can disrupt a couple's physical and emotional relationship and lead to lowered self-esteem in the man. In a small percentage of patients with the milder form of the disease, inflammation may resolve without causing significant pain or permanent bending.

Visiting a Doctor A first appointment will typically be between 45 and 60 minutes.

• History: Your physician will first take a history. He will particularly focus on whether you have had any history of penile trauma. He will also ask for any other medical conditions you may have that may make you more likely to have developed this problem. He will need to know when the curvature began to develop. He will also ask you to quantify the curvature. It may also be very useful to take a Polaroid picture both from the side and from the top while erect as possible, important visual information about the amount of curvature you have developed. You will also need to explain how much, if any, the rigidity of your erections has been altered.
• Physical Examination: Your physician will then do a focused physical examination on the penis and testes. Specifically, your doctor will look for evidence of scar tissue on the penis. You may even be able to feel this yourself by squeezing your penis gently through your fingers along its length and seeing if there are any hard nodules. The physician will also check the sensation of your penis with a biothesiometer (a test that measures how intense vibrations need to be for you to sense them).
• Laboratory Testing: Your physician will usually check your hormone levels by taking blood from your arm.
• Treatment: Your physician will usually begin conservative treatment if you have presented within six months of developing a curvature. The natural history of this curvature is that one third of them will resolve on their own, one third will stay constant, and one third of them will progress. The curvature needs to be stable for six months before a final treatment can be determined. Also, any pain that you may have with erections (pain often accompanies the development of a curvature) must be stabilized before you begin treatment.

Treatment may include Potaba, a member of the vitamin B complex family. Your physician may also start you on vitamin E and/or vitamin E oil. Some physicians are currently using more experimental techniques. These may include injecting the plaque with certain substances, taking oral colchicine, or attempting to keep the penis straight by using a vacuum erection device to create erections.

• Definitive Treatment: Once the curvature has stabilized for six months and there is no pain in the penis or with erections, the determination of treatment can begin. This will be determined by two factors. First, the physician will assess the amount of curvature. Many men are born with a small amount of curvature that causes no problem. Even a fair amount of curvature may allow successful intercourse without discomfort to either partner. Thus, the presence of a curvature does not necessarily mean that an operation is warranted. Some men do have significant curvature that makes penetration without discomfort to one or both partners challenging. This would be a curvature that needs treatment.

Second, the degree of erectile dysfunction the patient has that is distinct from the curvature must be assessed. Many men have preexisting moderate amounts of erectile dysfunction. The scar tissue that causes the curvature may cause a worsening of erectile dysfunction. There is no point in straightening out the penis if the surgery will not result in rigid erections that are adequate for penetration. Thus, the erectile dysfunction and whether or not it can be treated (separately from the problem of the curvature) must also be assessed.

Once these two parameters have been assessed adequately, a decision about treatment can be made.

Back to top Criteria for Treatment Curvature
Is successful intercourse without pain possible with this degree of curvature?

YES – No treatment necessary.
NO – Treatment dependent on erectile function.

Erectile Function
Can adequate rigidity be obtained and maintained?

YES – No treatment necessary
NO – Treat like all patients with erectile dysfunction.

If there is reasonable erectile function (adequate rigidity obtained and maintained) as well as a curvature that is not significant enough to prevent comfortable intercourse, then only conservative treatment is necessary.

If there is a significant curvature, that makes intercourse uncomfortable, but there is adequate erectile function, then surgery may be considered to correct the curvature of the penis.

If there is significant erectile dysfunction, but a curvature, that is not significant enough to prevent intercourse, then the patient will be treated like all patients with erectile dysfunction.

If there is significant erectile dysfunction as well as significant curvature, the patient can consider an implantation of a penile prosthesis and straightening at the same time.

The evaluation of penile curvature (Peyronie's Disease) is a very sophisticated one. Deciding on the appropriate treatment can involve difficult decisions. Once a plan of treatment is determined, there is a significant amount of expertise required to perform the various surgeries involved in correcting the curvature. It is truly advisable to see a specialist when facing these decisions.

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