Peyronie's disease. It might be an uncomfortable topic to talk about, but we're discussing it because it's literally uncomfortable.

"While the cause of Peyronie's disease isn't completely clear, the result is — a painful, curved erection that often leads to discomfort during sex, as well as stress and anxiety about sex. It's one of the most underdiagnosed sexual issues that men face, but Peyronie's disease is worth discussing since it typically doesn't go away on its own," says Dr. Nathan Starke, urologist specializing in men's health at Houston Methodist.

Most importantly, Dr. Starke points out that there are treatments available that can prevent it from getting worse — and even improve symptoms in almost all cases.

What is Peyronie's disease?

"Peyronie's disease is the term for scar tissue formation involving the erection chambers underneath the skin of the penis, which ultimately affects the process of forming an erection," says Dr. Starke. "As blood flows to the penis during an erection, any scar tissue that's present interferes with how it hardens. This can cause a bend or another shape that can be frustrating and even painful," explains Dr. Starke.

The symptoms of Peyronie's disease include:

• A buildup of scar tissue under the skin of the penis, which can feel like a hard, flat nodule
• Severe bending of the penis, either upward, downward or towards one side, especially with an erection
• Problems forming or maintaining an erection
• Experiencing painful erections
• Shrinkage or shortening of the penis or other changes, such as narrowing or a bottleneck shape
  
  

"It's important to note that penises vary in shape and size. Having a curved penis or noticing shrinkage doesn't mean you have Peyronie's disease, but if you notice either in combination with one or more of the symptoms above, it's time to speak to a men's health urologic specialist," adds Dr. Starke.

Why does Peyronie's disease occur?

As mentioned, the exact cause of Peyronie's disease is unknown, but a few risk factors have been identified, including:

• Experiencing trauma or repeated injury to the penis, such as during sexual activity or an accident
• Increasing age, since minor injuries may be slower to heal in older men
• Having Dupuytren's contracture, a connective tissue disorder of the hands
  
  

There's also evidence that some men may have a genetic predisposition to developing Peyronie's disease. If another man in your family has this condition, you may have a higher risk of developing it yourself — but it's not a guarantee.

"In most cases, it's thought that Peyronie's disease is caused by repetitive microtrauma to the penis over time, but often a man doesn't recall any specific instance of an injury occurring," says Dr. Starke.

How is Peyronie's disease treated?

Understandably, the most important question you have is: Will Peyronie's disease go away?

"In some cases, the bending and pain associated with Peyronie's disease can improve on its own — but not always. This is typically a disease that, untreated, remains the same or might even get worse over time," says Dr. Starke. "The good news, though, is that there are treatment options available. The earlier you seek treatment, the likelier you are to see improvement in your symptoms. Treatment can also help prevent your condition from progressing."

Peyronie's disease treatment options include:

• Penile traction therapy – a device worn anywhere between 30 minutes to several hours a day that can improve curvature and correct deformity — when used in the early phase of this condition
• Injectable medications – there is only one FDA-approved medication for Peyronie's treatment, called Xiaflex (collagenase clostridium histolyticum), which is delivered in a series of injections in the office over a period of months. The collagenase breaks down the scar tissue, helping to improve pain and reduce curvature
• Surgery – various procedures are available, and represent the "gold standard" of Peyronie's treatment. However, which procedure(s) are preferred varies depending on the individual man's situation
• Watchful waiting – your doctor may recommend using a wait-and-see approach to help determine which treatment option will be most effective for your specific symptoms and condition, particularly in the later phases of this condition
  
  

The most effective treatment plan for Peyronie's disease varies depending on whether you are earlier or later in the disease course. Your doctor will help you understand which options are available and likely to provide you the most benefit.

And you probably have one final question: Who treats Peyronie's disease?

"Even if your symptoms of Peyronie's disease seem manageable for the time being, it's important to see a urologist specializing in men's health," adds Dr. Starke. "Over time, this condition can result in more than just a painful erection. For instance, it can impact your self-esteem, cause stress in your relationship and even impact your ability to father a child. A doctor who specializes in both urology and men's health can help you find the most effective, advanced treatment option that's right for you. And, remember, the sooner you start treatment, the better," adds Dr. Starke.

Next Steps:

• Learn about Houston Methodist's Men's Health Center, which offers comprehensive, confidential care for men who have Peyronie's disease.