View source for Peyronie's disease

{{Short description|Abnormal growth of scar tissue within the penis}}
{{Infobox medical condition
| name = Peyronie's disease
| synonyms = Peyronie disease, induratio penis plastica (IPP),<ref name="Fitz2">{{cite book |author1=Freedberg, Irwin M. |author2=Fitzpatrick, Thomas B. |title=Fitzpatrick's dermatology in general medicine |publisher=McGraw-Hill, Medical Pub. Division |location=New York |year=2003 |page=990 |isbn=978-0-07-138076-8 |edition=6th}}</ref> chronic inflammation of the tunica albuginea (CITA)
| image = Curved and bent penis due to peyronies disease 6.jpg
| caption = Abnormal curvature of the penis associated with Peyronie's disease
| pronounce = {{IPAc-en|p|eɪ|r|oʊ|ˈ|n|iː}}
| field = [[Urology]]
| symptoms = 
| complications = 
| onset = 
| duration = 
| types = 
| causes = Unknown<ref name=NIH2014/>
| risks = 
| diagnosis = 
| differential = 
| prevention = 
| treatment = 
| medication = 
| prognosis = 
| frequency = ~10% of men<ref name=NIH2014/>
| deaths = 
| named after = [[François Gigot de la Peyronie]]
}}

'''Peyronie's disease''' ('''PD''') is a benign, acquired penile [[connective tissue disease]] characterized by the occurrence of fibrotic plaques within the [[Tunica albuginea (penis)|tunica albuginea]] — the dense elastic covering of the [[Corpora cavernosa of penis|corpora cavernosa]]. The plaques cause abnormal curvature, [[pain]], penile deformities (e.g., narrowing or indentation), and usually [[erectile dysfunction]], particularly during [[erection]]. The condition typically leads to significant sexual and psychological effects, including difficulty with penetration and lowered self-esteem or evasiveness. Peyronie's disease is most often seen in middle-aged and older men with a median age of onset between 55 and 60 years, however it is also common in younger individuals and adolescents.

While the [[etiology]] of Peyronie's disease is still uncertain, the leading hypothesis is that it arises from dysregulated [[wound healing]] in response to [[Chronic condition|chronic]] [[microtrauma]] of the erect penis. This triggers a [[Biochemical cascade|cascade]] of profibrotic [[Molecular pathway|molecular pathways]] — most notably [[overexpression]] of [[Transforming growth factor beta 1|transforming growth factor-beta 1]] (TGF-β1) — that end in fibroblast [[Wound healing#Proliferative phase|proliferation]], myofibroblast [[Wound healing#Maturation and remodeling|differentiation]], and overproduction of [[type I collagen]]. [[Genetic predisposition]] is supported by [[Family aggregation|family clustering]] and [[Genetic linkage|linkage]] with systemic fibrosing disorders such as [[Dupuytren's contracture]]. Risk factors include age, [[penile injury]], [[Diabetes|diabetes mellitus]], and [[cigarette smoking]].

The [[prevalence]] of Peyronie's disease has been projected at 1% to 20% among the general population of men increasing with age and [[comorbidities]] such as erectile dysfunction (ED) or [[connective tissue disease]]. While Peyronie's disease is neither [[Infection|infectious]] nor [[Malignancy|malignant]], it can have disastrous implications on [[sexual health]] and [[quality of life]]. It is diagnosed mainly on the clinical presentation supplemented by [[penile ultrasonography]] if necessary. Treatment depends on the phase and severity of the disease with conservative measures (e.g., oral therapy, traction, intralesional injection) in the milder and stable forms to surgical intervention for the advanced or stable ones. The condition is named for French surgeon [[François Gigot de la Peyronie]], who in 1743 described the condition.<ref name="NIH2014" /><ref>{{cite journal |last1=Levine |first1=Laurence A |year=2010 |title=Peyronie's disease and erectile dysfunction: Current understanding and future direction |journal=Indian Journal of Urology |volume=22 |issue=3 |pages=246–50 |doi=10.4103/0970-1591.27633|doi-access=free }}</ref><!-- Epidemiology -->

It is estimated to affect 1–20% of men.<ref name=NIH2014>{{cite web|title=Penile Curvature (Peyronie's Disease)|url=https://www.niddk.nih.gov/health-information/urologic-diseases/penile-curvature-peyronies-disease|website=National Institute of Diabetes and Digestive and Kidney Diseases|access-date=25 October 2017|date=July 2014}}</ref><ref name=":4">{{Citation |last1=Sandean |first1=Darren P. |title=Peyronie Disease |date=2025 |work=StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK560628/ |access-date=2025-10-08 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32809463 |last2=Leslie |first2=Stephen W. |last3=Lotfollahzadeh |first3=Saran}}</ref><ref name=":9">{{Cite journal |last1=Moghalu |first1=O. |last2=Pastuszak |first2=A. |last3=Hotaling |first3=J. |last4=Das |first4=R. |last5=Campbell |first5=A. |last6=Horns |first6=J. |date=2021-03-01 |title=060 Regional Differences in The Incidence and Prevalence of Peyronie's Disease in The United States - Results from a Claims and Encounters Database |url=https://www.sciencedirect.com/science/article/pii/S1743609521000333 |journal=The Journal of Sexual Medicine |series=21st Annual Fall Scientific Meeting of SMSNA |volume=18 |issue=3, Supplement 1 |pages=S32–S33 |doi=10.1016/j.jsxm.2021.01.030 |issn=1743-6095|url-access=subscription }}</ref> The condition becomes more common with age.<ref name=NIH2014/><ref>{{Cite journal |last1=DiBenedetti |first1=Dana Britt |last2=Nguyen |first2=Dat |last3=Zografos |first3=Laurie |last4=Ziemiecki |first4=Ryan |last5=Zhou |first5=Xiaolei |date=2011 |title=A Population-Based Study of Peyronie′s Disease: Prevalence and Treatment Patterns in the United States |journal=Advances in Urology |language=en |volume=2011 |issue=1 |article-number=282503 |doi=10.1155/2011/282503 |doi-access=free |issn=1687-6377 |pmc=3202120 |pmid=22110491}}</ref><ref name=":10">{{Cite journal |last1=Di Maida |first1=Fabrizio |last2=Cito |first2=Gianmartin |last3=Lambertini |first3=Luca |last4=Valastro |first4=Francesca |last5=Morelli |first5=Girolamo |last6=Mari |first6=Andrea |last7=Carini |first7=Marco |last8=Minervini |first8=Andrea |last9=Cocci |first9=Andrea |date=2021-07-01 |title=The Natural History of Peyronie's Disease |journal=The World Journal of Men's Health |language=English |volume=39 |issue=3 |pages=399–405 |doi=10.5534/wjmh.200065 |issn=2287-4208 |pmc=8255406 |pmid=32648381}}</ref>

==Signs and symptoms==
[[File:Peyronie's disease.jpg|thumb|Example of [[Human penis|penis]] deformation from side]]
The most frequent [[Signs and symptoms|sign]] of Peyronie's disease is penile curvature acquired on erection. The location and extent of curvature vary with the location and extent of the fibrous plaque of the tunica albuginea. Curvature is the most frequent complaint, but some men complain of penile shortening, penile narrowing (hourglass deformity), or indentations. Palpable plaques can be seen along the shaft, most commonly on the dorsum. Pain with erection is common during the initial, inflammatory phase but usually resolves during the chronic phase with resolution of swelling. Erectile dysfunction is estimated to affect 30–70% of men with Peyronie's disease, either due to decreased rigidity secondary to anatomic changes or [[Psychogenic disease|psychogenic]] causes like [[Distress (medicine)|distress]] and [[sexual performance anxiety]]. Peyronie's disease can substantially impair sexual function and quality of life, leading to [[Depression (mood)|depression]], [[Relationship quality|relationship]] difficulties, and low [[self-esteem]].<ref>{{Cite journal |last1=Smith |first1=R. J. |last2=Bryant |first2=R. G. |date=1975-10-27 |title=Metal substitutions incarbonic anhydrase: a halide ion probe study |journal=Biochemical and Biophysical Research Communications |volume=66 |issue=4 |pages=1281–1286 |doi=10.1016/0006-291x(75)90498-2 |issn=0006-291X |pmid=3 |bibcode=1975BBRC...66.1281S }}</ref><ref name="pmid23153101" /><ref name="pmid14690485">{{cite journal |last1=Ralph |first1=D. J. |last2=Minhas |first2=S. |date=January 2004 |title=The management of Peyronie's disease |journal=[[British Journal of Urology International]] |volume=93 |issue=2 |pages=208–15 |doi=10.1111/j.1464-410X.2004.04587.x |pmid=14690485 |s2cid=38211880 |doi-access=free}}</ref>

===Psychosocial===
Peyronie's disease can also have [[Psychological stress|psychological]] effects. While most men will continue to be able to have [[sexual relations]], they are likely to experience some degree of erectile dysfunction. It is not uncommon to exhibit [[Depression (mood)|depression]] or withdrawal from their [[Sexual partner|sexual partners]].<ref name="pmid23153101">{{cite journal |vauthors=Nelson CJ, Mulhall JP |title=Psychological impact of Peyronie's disease: a review |journal=[[The Journal of Sexual Medicine]] |volume=10 |issue=3 |pages=653–60 |date=March 2013 |pmid=23153101 |doi=10.1111/j.1743-6109.2012.02999.x}}</ref>  In one study, 81% of men diagnosed with Peyronie's disease reported emotional difficulties. 48% reported clinically meaningful depression. Of those, 26% experienced moderate depression, while 21% experienced severe depression. 54% reported relationship problems due to Peyronie's disease.<ref name=":5">{{Cite journal |last1=Nelson |first1=Christian J. |last2=Mulhall |first2=John P. |date=2013-03-01 |title=Psychological Impact of Peyronie's Disease: A Review |url=https://www.sciencedirect.com/science/article/pii/S1743609515302939 |journal=The Journal of Sexual Medicine |volume=10 |issue=3 |pages=653–660 |doi=10.1111/j.1743-6109.2012.02999.x |pmid=23153101 |issn=1743-6095|url-access=subscription }}</ref> Peyronie's disease can cause patients to feel [[Social isolation|socially isolated]] and [[Social stigma|stigmatized]]. Physicians may be unaware of the psychological effects suffered by patients and their partners. Many men with Peyronie's disease avoid [[Intimate relationship|intimacy]] and isolate themselves as they cope with anger, depression, fear of rejection, and decreased [[Self-esteem|self‐worth]].<ref name=":5" />

==== Body dysmorphic disorder ====
{{Main|Body dysmorphic disorder|Penile dysmorphic disorder}}
Men may also suffer from body dysmorphic disorder (BDD), and specifically penile dysmorphic disorder (PDD).<ref name=":3">{{Cite journal |last=Hartzell |first=Rose |date=2014-12-01 |title=Psychosexual Symptoms and Treatment of Peyronie's Disease Within a Collaborative Care Model |journal=Sexual Medicine |language=en |volume=2 |issue=4 |pages=168–177 |doi=10.1002/sm2.45 |pmid=25548648 |issn=2050-1161 |pmc=4272248}}</ref><ref name=":6">{{Cite journal |last=Mansfield |first=Abigail K. |date=2020-01-01 |title=Genital manifestations of body dysmorphic disorder in men: a review |url=https://www.sciencedirect.com/science/article/pii/S001502821932597X |journal=Fertility and Sterility |volume=113 |issue=1 |pages=16–20 |doi=10.1016/j.fertnstert.2019.11.028 |pmid=32033717 |issn=0015-0282|url-access=subscription }}</ref><ref name=":7" /> In one study, 54% of men with Peyronie's disease overestimated their degree of penile curvature, with 44% of men overestimating their degree of penile curvature by more than 20°.<ref name=":3" /><ref name=":2">{{Cite journal |last1=Bacal |first1=Vanessa |last2=Rumohr |first2=John |last3=Sturm |first3=Renea |last4=Lipshultz |first4=Larry I. |last5=Schumacher |first5=Michael |last6=Grober |first6=Ethan D. |date=2009-03-01 |title=Correlation of Degree of Penile Curvature between Patient Estimates and Objective Measures among Men with Peyronie's Disease |url=https://academic.oup.com/jsm/article-abstract/6/3/862/6834467?redirectedFrom=fulltext |journal=The Journal of Sexual Medicine |language=en |volume=6 |issue=3 |pages=862–865 |doi=10.1111/j.1743-6109.2008.01158.x |pmid=19284472 |issn=1743-6109 |archive-url=http://web.archive.org/web/20240512104911/https://academic.oup.com/jsm/article-abstract/6/3/862/6834467?redirectedFrom=fulltext |archive-date=2024-05-12|url-access=subscription }}</ref> Only 20% of men accurately estimated their degree of curvature within 5°.<ref name=":2" />

[[Body dysmorphic disorder]] (BDD) is a condition defined by an overwhelming preoccupation with a perceived flaw in one's physical appearance. Its importance is disproportionately magnified in the mind of the individual. Ruminations concerning this perceived defect become pervasive and intrusive, consuming substantial mental bandwidth for extended periods each day. This excessive preoccupation induces severe emotional distress and also disrupts daily functioning and activities. The [[DSM-5]] places BDD within the [[obsessive–compulsive spectrum]], distinguishing it from disorders such as [[anorexia nervosa]].<ref name=":6" /><ref>{{Cite journal |last1=Bjornsson |first1=Andri S. |last2=Didie |first2=Elizabeth R. |last3=Phillips |first3=Katharine A. |date=2010-06-30 |title=Body dysmorphic disorder |journal=Dialogues in Clinical Neuroscience |volume=12 |issue=2 |pages=221–232 |doi=10.31887/DCNS.2010.12.2/abjornsson |pmid=20623926 |pmc=3181960 }}</ref>

[[Penile dysmorphic disorder]] (PDD) is a manifestation of body dysmorphic disorder where the main area of fixation is the [[Human penis|penis]]. Individuals with penile dysmorphic disorder typically develop heightened [[Anxiety disorder|anxiety]], [[shame]], and [[Contentment|dissatisfaction]] about their penis. This distorted perception may interfere with daily functioning and relationships. Although penile dysmorphic disorder is not formally classified as a distinct diagnosis, it has become more prominent in clinical studies and discussions around [[Body image|male body image]].<ref name=":7">{{Cite journal |last1=Veale |first1=David |last2=Miles |first2=Sarah |last3=Read |first3=Julie |last4=Troglia |first4=Andrea |last5=Carmona |first5=Lina |last6=Fiorito |first6=Chiara |last7=Wells |first7=Hannah |last8=Wylie |first8=Kevan |last9=Muir |first9=Gordon |date=2015-11-01 |title=Penile Dysmorphic Disorder: Development of a Screening Scale |journal=Archives of Sexual Behavior |language=en |volume=44 |issue=8 |pages=2311–2321 |doi=10.1007/s10508-015-0484-6 |pmid=25731908 |issn=1573-2800 |url=https://kclpure.kcl.ac.uk/portal/en/publications/4dc1a320-1d1f-47ab-9205-8c26fe5169b9 }}</ref><ref>{{Citation |last1=Yianni |first1=James |title=Penile Dysmorphic Disorder (PDD) |date=2022 |work=Textbook of Rare Sexual Medicine Conditions |pages=19–35 |editor-last=Reisman |editor-first=Yacov  |place=Cham |publisher=Springer International Publishing |language=en |doi=10.1007/978-3-030-98263-8_3 |isbn=978-3-030-98263-8 |last2=Veale |first2=David |editor2-last=Lowenstein |editor2-first=Lior |editor3-last=Tripodi |editor3-first=Francesca}}</ref>

== Causes and risk factors ==
The [[etiology]] of Peyronie's disease is [[Multifactorial disease|multifactorial]]. The most widely held hypothesis is that recurrent [[microtrauma]] to the erect penis (e.g., during [[Sexual intercourse|intercourse]]) leads to localized [[inflammation]] and abnormal [[wound healing]] in genetically predisposed men. This pathway initiates a cascade of pro-inflammatory and pro-fibrotic [[cytokine]]s such as [[transforming growth factor beta 1]] (TGF-β1), resulting in abnormal [[collagen]] deposition and plaque formation. [[Risk factor|Risk factors]] include advancing age, penile trauma, [[diabetes mellitus]], [[Dupuytren's contracture]], and [[tobacco smoking]]. [[Familial aggregation]] and [[Genetic linkage|linkage]] with other [[Fibrosis|fibrosing disorders]] suggest a [[Genetic disorder|genetic]] basis. Peyronie's disease is seen most frequently in men over 40 years of age, with a prevalence in the general male population estimated at between 1% and 20%, and with higher prevalence in those with erectile dysfunction.<ref name=":4" /><ref name="pmid14690485" /><ref>{{cite journal |last1=Abern |first1=Michael R. |last2=Levine |first2=Laurence A. |title=Peyronie's disease: evaluation and review of nonsurgical therapy |journal=The Scientific World Journal |date=2009 |volume=27 |issue=9 |pages=665–675 |doi=10.1100/tsw.2009.92 |pmid=19649505 |pmc=5823162 |doi-access=free }}</ref>

== Pathophysiology ==
Peyronie's disease develops in two phases: the acute ([[Inflammation|inflammatory]]) and chronic ([[Fibrosis|fibrotic]]) phase. During the acute phase, microtrauma induces damage to the [[endothelium]], fibrin deposition, and immigration of [[immune cells]] into the [[Tunica albuginea (penis)|tunica albuginea]]. [[Fibroblast]] proliferation and [[myofibroblast]] differentiation are promoted by [[cytokine]]s like [[transforming growth factor beta 1]] (TGF-β1), [[platelet-derived growth factor]] (PDGF), and [[reactive oxygen species]] (ROS). [[Myofibroblast]]s overexpress [[type I collagen]] and [[extracellular matrix proteins]], leading to plaque formation. In the chronic presentation, inflammation is reduced, but the fibrotic plaque is preserved, and partial [[calcification]] occurs in most cases. This causes structural deformity of the penile tissue and inelasticity that impedes normal growth during an erection. Intense calcification and fibrosis impair normal [[hemodynamics]] and penile elasticity of the penis, which usually causes venous leakage and erectile failure.<ref name=":10" /><ref>{{Cite journal |last1=Şahin |first1=Mehmet Fatih |last2=Doğan |first2=Çağrı |last3=Akgül |first3=Murat |last4=Yazıcı |first4=Cenk Murat |last5=Şeramet |first5=Serkan |last6=Dayısoylu |first6=Hulusi Sıtkı |date=2024-05-17 |title=Bibliometric analysis of most cited Peyronie's disease and its management publications |journal=Frontiers in Surgery |volume=11 |article-number=1336391 |doi=10.3389/fsurg.2024.1336391 |doi-access=free |issn=2296-875X |pmc=11140013 |pmid=38826812}}</ref>

==Diagnosis==
[[File:Peyronie's Disease Ultrasound.jpg|thumb|This ultrasound depicts cross sections of the penis at different locations in a patient with Peyronie's disease.  The top image shows normal anatomy whereas the bottom image shows scar tissue on the [[tunica albuginea (penis)]]. The scar tissue is localized and responsible for the hallmark deformities of Peyronie's disease (curvature and narrowing).]]
Peyronie's disease [[diagnosis]] is mostly [[Clinical diagnosis|clinical]]. [[Medical history|Patient history]] and [[physical examination]] are crucial. The most prominent features are acquired penile curvature, palpable plaques, [[erectile dysfunction]], and pain during erections. [[Penile ultrasonography]] is the imaging method of choice for plaque location, measurement, and confirmation of [[calcification]]. [[Doppler ultrasonography|Doppler ultrasound]] can be utilized to assess [[Vascular function curve|vascular function]], which is useful in the evaluation of associated erectile dysfunction. Imaging also helps to differentiate Peyronie's disease from congenital penile curvature, [[penile fracture]], or [[neoplastic disease]]. [[Magnetic resonance imaging|MRI]] can be employed in severe ones, although it is generally not required.<ref>{{cite journal |vauthors=Amin Z, Patel U, Friedman EP, Vale JA, Kirby R, Lees WR |title=Colour Doppler and duplex ultrasound assessment of Peyronie's disease in impotent men |journal=The British Journal of Radiology |volume=66 |issue=785 |pages=398–402 |date=May 1993  |pmid=8319059 |doi=10.1259/0007-1285-66-785-398}}</ref>
[[File:Bent penis erected.jpg|thumb|Bent [[Human penis|penis]] due Peyronie's disease]]

===Ultrasonography===
On [[penile ultrasonography]], the typical appearance is [[hyperechoic]] focal thickening of the tunica albuginea. Due to associated calcifications, the imaging of patients with Peyronie's disease shows acoustic shadowing, as illustrated in figures below. Less common findings, attributed to earlier stages of the disease (still mild [[fibrosis]]), are hypoechoic lesions with focal thickening of the paracavernous tissues, echoic focal thickening of the tunica without posterior acoustic shadowing, retractile [[Isochoic wave|isoechoic]] lesions with posterior attenuation of the beam, and focal loss of the continuity of the tunica albuginea.<ref>{{Cite journal |last=McCauley |first=John F. |last2=Dean |first2=Robert C. |date=2020-02-01 |title=Diagnostic utility of penile ultrasound in Peyronie’s disease |url=https://doi.org/10.1007/s00345-019-02928-y |journal=World Journal of Urology |language=en |volume=38 |issue=2 |pages=263–268 |doi=10.1007/s00345-019-02928-y |issn=1433-8726|url-access=subscription }}</ref>

In the [[Doppler ultrasonography|doppler]] study, increased flow around the plaques can suggest inflammatory activity and the absence of flow can suggest disease stability. Ultrasound is useful for the identification of lesions and to determine their relationship with the [[neurovascular bundle]]. Individuals with Peyronie's disease can present with erectile dysfunction, often related to venous leakage, due to insufficient drainage at the site of the plaque. Although plaques are more common on the dorsum of the penis, they can also be seen on the ventral face, lateral face, or septum.<ref name="FernandesSouza2018">Originally copied from:<br />{{cite journal|last1=Fernandes|first1=Maitê Aline Vieira|last2=Souza|first2=Luis Ronan Marquez Ferreira de|last3=Cartafina|first3=Luciano Pousa|title=Ultrasound evaluation of the penis|journal=Radiologia Brasileira|volume=51|issue=4|year=2018|pages=257–261|issn=1678-7099|doi=10.1590/0100-3984.2016.0152|pmid=30202130|pmc=6124582}}<br />[[Creative Commons|CC-BY]] license</ref>

<gallery mode="packed" heights="200">
File:Ultrasonography of orpus cavernosum calcification.jpg|Transverse [[ultrasound]] of the penis, in a ventral view, in the middle portion of the penis. Note the echoic image with posterior acoustic shadowing, corresponding to [[calcification]] (arrow), in the left corpus cavernosum.<ref name="FernandesSouza2018"/> 
</gallery>

== Management and treatment ==
Peyronie's disease treatment is based on stage of disease, degree of curvature, loss of function, and patient choice. [[Conservative management]] in the acute phase has the aim of reducing [[inflammation]] and disease extension.<ref>{{Cite journal |last1=Reddy |first1=Amit G. |last2=Dai |first2=Michelle C. |last3=Song |first3=Jeffrey J. |last4=Pierce |first4=Hudson M. |last5=Patel |first5=Sagar R. |last6=Lipshultz |first6=Larry I. |date=2023-02-02 |title=Peyronie's Disease: An Outcomes-Based Guide to Non-Surgical and Novel Treatment Modalities |journal=Research and Reports in Urology |language=English |volume=15 |pages=55–67 |doi=10.2147/RRU.S278796 |doi-access=free |pmc=9901485 |pmid=36756281}}</ref>

=== Oral therapy ===
[[File:Pentoxifylline Structure V.1.svg|thumb|The chemical structure of [[pentoxifylline]], an [[Oral Medications|oral medication]] for Peyronie's disease.]]
Treatment can be with oral therapy such as [[pentoxifylline]] (an anti-fibrotic [[phosphodiesterase inhibitor]]). Pentoxifylline lowers inflammation by blocking [[transforming growth factor beta 1]] (TGF-β1), which interferes with the production of [[collagen type I]].<ref name=":4" /><ref>{{Cite journal |last1=Shindel |first1=Alan W. |last2=Lin |first2=Guiting |last3=Ning |first3=Hongxiu |last4=Banie |first4=Lia |last5=Huang |first5=Yun-Ching |last6=Liu |first6=Gang |last7=Lin |first7=Ching-Shwun |last8=Lue |first8=Tom F. |date=June 2010 |title=Pentoxifylline attenuates transforming growth factor-β1-stimulated collagen deposition and elastogenesis in human tunica albuginea-derived fibroblasts part 1: impact on extracellular matrix |journal=The Journal of Sexual Medicine |volume=7 |issue=6 |pages=2077–2085 |doi=10.1111/j.1743-6109.2010.01790.x |issn=1743-6109 |pmc=3543151 |pmid=20367772}}</ref><ref>{{Cite journal |last1=Paulis |first1=Gianni |last2=Paulis |first2=Andrea |date=2025-02-12 |title=Oxidative Mechanism of Peyronie's Disease and Effectiveness of Pentoxifylline in the Therapeutic Management: A Narrative Review |journal=Antioxidants |language=en |volume=14 |issue=2 |pages=208 |doi=10.3390/antiox14020208 |pmid=40002394 |doi-access=free |issn=2076-3921 |pmc=11851550 }}</ref>

[[Pain management]] in the active phase of the disease can be provided by [[Nonsteroidal anti-inflammatory drug|non-steroidal anti-inflammatory drugs]] (NSAID).<ref>{{Cite web |title=EAU Guidelines on Sexual and Reproductive Health - Uroweb |url=https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/penile-curvature |access-date=2025-10-11 |website=uroweb.org |language=en}}</ref> One of the main [[Signs and symptoms|symptoms]] of active Peyronie's disease is [[pain]] with or without [[erection]]. Pain is often distressing to patients and may compromise [[sexual function]]. [[Pain level]] should be periodically checked to measure treatment efficacy.<ref name=":4" /><ref name=":0">{{Cite web |title=Peyronie's Disease Guideline - American Urological Association |url=https://www.auanet.org/guidelines-and-quality/guidelines/peyronies-disease-guideline |access-date=2025-10-05 |website=www.auanet.org}}</ref><ref name=":1">{{Cite journal |last1=Chung |first1=Eric |last2=Gillman |first2=Michael |last3=Tuckey |first3=John |last4=La Bianca |first4=Shane |last5=Love |first5=Chris |date=2020 |title=A clinical pathway for the management of Peyronie's disease: integrating clinical guidelines from the International Society of Sexual Medicine, American Urological Association and European Urological Association |url=https://onlinelibrary.wiley.com/doi/abs/10.1111/bju.15057 |journal=BJU International |language=en |volume=126 |issue=S1 |pages=12–17 |doi=10.1111/bju.15057 |issn=1464-410X |pmid=32542884}}</ref>

Not recommended oral therapies include [[Acetylcarnitine|Acetyl-L-carnitine]] and [[vitamin E]] .<ref name=":0" /><ref name=":1" />

=== Traction therapy ===
[[File:Peyronie’s before & after comparison & traction treatment.jpg|thumb|Before (left) and after (middle) onset of Peyronie's disease, causing an indentation near the base on the right side and a decrease in length of 1.3 cm (½ inch). At right, treatment for Peyronie's disease using a [[Penis extender|traction device]].<ref>{{Cite journal |last=Ziegelmann |first=Matthew |last2=Savage |first2=Josh |last3=Toussi |first3=Amir |last4=Alom |first4=Manaf |last5=Yang |first5=David |last6=Kohler |first6=Tobias |last7=Trost |first7=Landon |date=September 2019 |title=Outcomes of a Novel Penile Traction Device in Men with Peyronie’s Disease: A Randomized, Single-Blind, Controlled Trial |url=https://www.auajournals.org/doi/10.1097/JU.0000000000000245 |journal=The Journal of Urology |language=EN |doi=10.1097/JU.0000000000000245|url-access=subscription }}</ref>]]Mechanical treatments in the form of [[penile traction therapy]] (PTT) and [[Penis vacuum|vacuum erection devices]] (VED) are used to correct the curvature due to plaque and preserve length.

=== Intralesional injections ===
Intralesional [[Injection (medicine)|injection]] therapy is part of non-surgical therapy, particularly for stable disease.<ref>{{Cite journal |last1=Khooblall |first1=Prajit |last2=Bole |first2=Raevti |last3=Lundy |first3=Scott D. |last4=Bajic |first4=Petar |date=2023-06-21 |title=Expanded Utilization of Intralesional Therapies for Treatment of Peyronie's Disease |journal=Research and Reports in Urology |language=English |volume=15 |pages=205–216 |doi=10.2147/RRU.S386340 |doi-access=free |pmc=10290860 |pmid=37366388}}</ref><ref>{{Cite journal |last=Trost, L. W., Gur, S., & Hellstrom, W. J. |title=Pharmacological management of Peyronie's disease. |journal=Drugs |date=2007 |volume=67 |issue=4 |pages=527–545|doi=10.2165/00003495-200767040-00004 |pmid=17352513 }}</ref> [[Verapamil]] and [[interferon alfa-2b]] have intermediate efficacy. [[Collagenase clostridium histolyticum|Collagenase Clostridium histolyticum]] (CCH),<ref>{{Cite journal |last1=Phillips |first1=Drew |last2=Chan |first2=Justin Y.H. |last3=Flannigan |first3=Ryan |date=May 2020 |title=Evaluating collagenase Clostridium histolyticum administration protocols in the treatment of Peyronie's disease |url=https://journals.lww.com/10.1097/MOU.0000000000000760 |journal=Current Opinion in Urology |language=en |volume=30 |issue=3 |pages=328–333 |doi=10.1097/MOU.0000000000000760 |pmid=32235277 |issn=0963-0643|url-access=subscription }}</ref> an enzymatic drug approved by the US [[Food and Drug Administration]] (FDA), targets plaque [[collagen]] and repairs in moderate disease. It is administered in a series of treatment cycles with attendant penile modeling and elongation. Potential side effects include corporal rupture ([[penile fracture]]) or other serious penile injury.<ref>{{Cite web |date=June 1, 2018 |title=label |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/125338s109lbl.pdf |access-date=October 13, 2025 |website=U.S. [[Food and Drug Administration]] (FDA)}}</ref>

=== Surgery ===
[[Surgery|Surgical therapy]] is reserved for fixed patients with severe curvature, or failed medical therapy.<ref>{{Cite journal |last1=Osmonov |first1=Daniar |last2=Ragheb |first2=Ahmed |last3=Ward |first3=Sam |last4=Blecher |first4=Gideon |last5=Falcone |first5=Marco |last6=Soave |first6=Armin |last7=Dahlem |first7=Roland |last8=van Renterghem |first8=Koenraad |last9=Christopher |first9=Nim |last10=Hatzichristodoulou |first10=Georgios |last11=Preto |first11=Mirko |last12=Garaffa |first12=Giulio |last13=Albersen |first13=Maarten |last14=Bettocchi |first14=Carlo |last15=Corona |first15=Giovanni |date=2022-02-01 |title=ESSM Position Statement on Surgical Treatment of Peyronie's Disease |journal=Sexual Medicine |language=en |volume=10 |issue=1 |article-number=100459 |doi=10.1016/j.esxm.2021.100459 |issn=2050-1161 |pmc=8847818 |pmid=34823053}}</ref><ref>{{Cite journal |last1=Kadıoğlu |first1=Ateş |last2=Gürcan |first2=Mehmet |last3=Rakhmonovich |first3=Abdurakhmonov Farkod |last4=Dursun |first4=Murat |date=2024-04-30 |title=Surgical management of complex curvature in Peyronie's disease |journal=World Journal of Urology |language=en |volume=42 |issue=1 |page=276 |doi=10.1007/s00345-024-04936-z |issn=1433-8726 |pmc=11061042 |pmid=38689034}}</ref> Operations include penile plication (shortening the concave portion of the penis), plaque incision or [[Excision (surgery)|excision]] with grafting (lengthening the convex portion of the penis), and [[Penile implant|penile prosthesis]] implantation in concomitant [[erectile dysfunction]]. Reasonable levels of satisfaction after surgery are present, especially with appropriate preoperative counseling.

== Epidemiology ==
Peyronie's disease is estimated to affect 1–20% of men.<ref name=NIH2014/><ref name=":4" /><ref name=":9" /> The condition becomes more common with age.<ref name=NIH2014/> The median age at onset of disease is 55–60 years although many cases have been recorded in adolescence and early 20's.<ref name="pmid14690485"/><ref>{{Cite journal |last1=Tal |first1=Raanan |last2=Hall |first2=Matthew S. |last3=Alex |first3=Byron |last4=Choi |first4=Judy |last5=Mulhall |first5=John P. |date=2012-01-01 |title=Peyronie's Disease in Teenagers |url=https://www.sciencedirect.com/science/article/pii/S1743609515337486 |journal=The Journal of Sexual Medicine |volume=9 |issue=1 |pages=302–308 |doi=10.1111/j.1743-6109.2011.02502.x |pmid=21981606 |issn=1743-6095|url-access=subscription }}</ref>

The overall prevalence of Peyronie's disease is about 1–20% in men.<ref name="NIH2014" /><ref name=":4" /><ref name=":9" /> Rates range from 3.2% in a community-based survey of 4,432 men (mean age of sample 57.4) to 16% among 488 men undergoing evaluation for erectile dysfunction (mean age 52.8).<ref name="ReferenceA">{{cite journal | doi=10.1097/01.ju.0000127744.18878.f1 | title=Subjective and Objective Analysis of the Prevalence of Peyronie's Disease in a Population of Men Presenting for Prostate Cancer Screening | date=2004 | last1=Mulhall | first1=John P. | last2=Creech | first2=Steven D. | last3=Boorjian | first3=Stephen A. | last4=Ghaly | first4=SAM | last5=Kim | first5=Edward D. | last6=Moty | first6=Ayham | last7=Davis | first7=Rodney | last8=Hellstrom | first8=Wayne | journal=Journal of Urology | volume=171 | issue=6 Part 1 | pages=2350–2353 | pmid=15126819 }}</ref><ref>{{cite journal | doi=10.1038/sj.ijir.3901247 | title=Incidentally diagnosed Peyronie's disease in men presenting with erectile dysfuntion | date=2004 | last1=Kadioglu | first1=A. | last2=Oktar | first2=T. | last3=Kandirali | first3=E. | last4=Kendirci | first4=M. | last5=Sanli | first5=O. | last6=Ozsoy | first6=C. | journal=International Journal of Impotence Research | volume=16 | issue=6 | pages=540–543 | pmid=15116064 }}</ref> The prevalence of Peyronie's disease among the 4,432 men in the community based study who responded by self report positively for palpable plaque, newly occurring angulation or curvature and painful erection was 1.5% between the ages of 30 and 39, 3% between 40 and 49, 3% between 50 and 59, 4% between 60 and 69, and 6.5% over age 70.

In 534 men undergoing routine [[Prostate cancer screening|prostate screening]] for cancer detection (without a specific urologic complaint), the prevalence of Peyronie's disease was 8.9%.<ref name="ReferenceA"/> In this study, the mean age of those with Peyronie's disease was 68.2 years compared with 61.8 years of those without Peyronie's disease. Accurately determining the prevalence of Peyronie's disease is difficult due to the embarrassment many patients feel about the condition. The actual prevalence is likely much higher than reported.<ref name=":4" /><ref>{{Cite journal |last1=Perimenis |first1=P. |last2=Athanasopoulos |first2=A. |last3=Gyftopoulos |first3=K. |last4=Katsenis |first4=G. |last5=Barbalias |first5=G. |date=2001 |title=Peyronie's disease: epidemiology and clinical presentation of 134 cases |journal=International Urology and Nephrology |volume=32 |issue=4 |pages=691–694 |doi=10.1023/a:1014485204205 |issn=0301-1623 |pmid=11989566}}</ref><ref>{{Cite journal |last1=Pozzi |first1=Edoardo |last2=Capogrosso |first2=Paolo |last3=Boeri |first3=Luca |last4=Cazzaniga |first4=Walter |last5=Matloob |first5=Rayan |last6=Ventimiglia |first6=Eugenio |last7=Oreggia |first7=Davide |last8=Schifano |first8=Nicolò |last9=Candela |first9=Luigi |last10=Abbate |first10=Costantino |last11=Montorsi |first11=Francesco |last12=Salonia |first12=Andrea |date=September 2021 |title=Trends in reported male sexual dysfunction over the past decade: an evolving landscape |journal=International Journal of Impotence Research |volume=33 |issue=6 |pages=596–602 |doi=10.1038/s41443-020-0324-7 |issn=1476-5489 |pmid=32612274}}</ref>

=== Penile curves in the general population ===
{{Main|Erection#Direction}}{{See also|Human penis#Erection angle}}
In a survey of the general population, it was found that although many erect penises point upwards, it is common and normal for the erect penis to point nearly vertically upwards or horizontally straight forward or even nearly vertically downwards, all depending on the tension of the suspensory ligament that holds it in position. 37% of healthy men have a penile curve. With 22.2% of men having upwards curvature and 14.8% of men having downwards curvature.<ref name=":8">{{Cite journal |last=Sparling |first=J. |date=1997 |title=Penile erections: shape, angle, and length |journal=Journal of Sex & Marital Therapy |volume=23 |issue=3 |pages=195–207 |doi=10.1080/00926239708403924 |issn=0092-623X |pmid=9292834}}</ref><ref>{{Cite journal |last1=Chung |first1=Eric |last2=Gillman |first2=Michael |last3=Rushton |first3=Derren |last4=Love |first4=Chris |last5=Katz |first5=Darren |date=November 2018 |title=Prevalence of penile curvature: a population-based cross-sectional study in metropolitan and rural cities in Australia |journal=BJU International |volume=122 Suppl 5 |pages=42–49 |doi=10.1111/bju.14605 |issn=1464-410X |pmid=30387224}}</ref>
{| class="wikitable"
|+Occurrence of erection angles<ref name=":8" />
!Angle (°)
!Percent of population
|-
|0–30
|4.9
|-
|30–60
|29.6
|-
|60–85
|30.9
|-
|85–95
|9.9
|-
|95–120
|19.8
|-
|120–180
|4.9
|}

==History==
The condition was first described in 1561 in correspondence between [[Andreas Vesalius]] and [[Gabriele Falloppio]] and separately by Gabriele Falloppio.<ref>{{cite journal |vauthors=Dunsmuir WD, Kirby RS|author-link2=Roger Kirby |title=Francois de LaPeyronie (1978-1747): the man and the disease he described |journal=Br J Urol |volume=78 |issue=4 |pages=613–22 |date=October 1996 |pmid=8944520 |doi=10.1046/j.1464-410x.1996.14120.x }}</ref><ref>{{Cite book|url=http://archive.org/details/2235026R.nlm.nih.gov|title=Gabrielis Falloppii medici Mutinensis Observationes anatomicae ad Petrum Mannam medicum Cremonensem|last=Falloppio|first=Gabriele|date=1561|publisher=Venetiis : Apud Marcum Antonium Vlmum|others=U.S. National Library of Medicine}}</ref> The condition is named after [[François Gigot de la Peyronie]], who described it in 1743.<ref>{{WhoNamedIt|synd|3345|Peyronie's disease}}</ref> Peyronie was the personal physician of [[Louis XV|King Louis XV]] and cofounder of the Académie Royale de Chirurgie, which was later included in the French [[Académie nationale de médecine]].<ref name=":4" /><ref>{{Cite journal |last1=Musitelli |first1=Sergio |last2=Bossi |first2=Maurizio |last3=Jallous |first3=Hussein |date=July 2008 |title=A brief historical survey of "Peyronie's disease" |journal=The Journal of Sexual Medicine |volume=5 |issue=7 |pages=1737–1746 |doi=10.1111/j.1743-6109.2007.00692.x |issn=1743-6109 |pmid=18179461}}</ref>

== See also ==

* [[Body dysmorphic disorder]]
* [[Penile dysmorphic disorder]]

==References==
{{Reflist}}

== External links ==
{{Commons category}}
* [https://www.ncbi.nlm.nih.gov/books/NBK560628/ Peyronie Disease - StatPearls]

{{Medical resources
| ICD10           = {{ICD10|N|48|6|n|40}}
| ICD9            = {{ICD9|607.85}}
| ICDO            = 
| OMIM            = 171000
| OMIM_mult       = 
| MedlinePlus     = 001278
| eMedicineSubj   = derm
| eMedicineTopic  = 851
| DiseasesDB      = 29308
| MeshID          = D010411
| SNOMED CT       = 1335005
}}
{{Male diseases of the pelvis and genitals}}
{{Authority control}}

{{DEFAULTSORT:Peyronie's Disease}}
[[Category:Dermal and subcutaneous growths]]
[[Category:Diseases named after discoverers]]
[[Category:Penis disorders]]
[[Category:Sexual health]]