DRHOOK- Get bent! Peyronie's disease no laughing matter

the handsome doctor John Hong

Crooked teeth, crooked painting on the wall, Enron executives. There are many crooked things in life. I had crooked teeth most of my life until I got braces at the age of 36. I wear my retainer every single dingle night to keep them straight– the only thing straight about me. 

 What happens with a crooked penis?

 Peyronie's (rhymes with macaroni) disease causes an erect penis to– well, bend. What's the big deal? Imagine a police officer directing traffic. You know how he holds his arm out with the hand up at 90 degrees? Ok, imagine making love to that.

 In Peyronie's disease, scar tissue or plaque builds up in the penis, usually in the tunica albuginea— an elastic sheath that covers the erectile tissue chambers. Because the sheath can't stretch well, the erection bends– usually upwards, although it can go side-to-side or straight down. 

 Needless to say, this can be quite painful, making arousal as much fun as a vice grip. Beside the pain, the psychological and emotional distress can be devastating. Peyronie's isn't like the Leaning Tower of Pisa, but more like a right-angle ruler. 

Most penises curve or point to some degree, but Peyronie's creates a significant bend. Also, a man with Peyronie's worries about his sexual partner. So needless to say the pain of an erection combined with the psychological distress can be a real downer.

 We don't know what causes Peyronie's. For most men, it's probably from trauma to the penis that has led to scarring of the tunica albuginea. Believe it or not, a man can fracture his erect penis, in particular during sex, causing permanent damage. (Sorry, dudes, for this visual.) But also sports injuries or a kick in the groin can create scar tissue. Folks with hand contractures are more at risk of Peyronie's. Diabetics, smokers, and men with pelvic trauma history are at increased risk of Peyronie's. 

 Genetics seems to play a role because men with a father or brother with Peyronie's are more at risk. (Though honestly, I don't know any father or brother who's going to mention this to relatives. "Son, my erect penis gets a weird bend– ") And as I have seen in my own practice, older men tend to be the ones affected by Peyronie's. 

 To make things worse: Peyronie's is like osteoporosis of the spine. It shrinks it. Men can lose a large percentage of penis size from scarring. 

 As much as I hate pharmaceutical ads, the Erectile Dysfunction discussions have made it easier for men to talk to their doctors about Peyronie's. Often the scar tissue/plaque can be felt on the back or side of the penis, even when flaccid. After an injection of prostaglandins to cause an erection, an ultrasound can confirm the scar tissue of Peyronie's. 

 The first 6-18 months are the worst because that's when the Peyronie's matures and the pain becomes most severe. But then it tends to level off. ED medications like Cialis and Levitra are used to keep the erections going and stretch the scarred tissue. Colchicine, a gout medication, is used as well as Vitamin E. Verapamil penile injections might help break up the scarred tissue, as well as interferon and collagenase, although results aren't that great. Surgery is a last resort, but I have yet to see anyone go through that.

 This might seem like a bent topic to you, but it does affect quite a few men. A good urologist might be able to help unfortunates with Peyronie's.


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.