Acquired penile curvature, or Peyronie's disease, is a surprisingly common disorder. Some estimates indicate that at least 1% of men are affected. The most frequent symptom of onset is dull penile discomfort or pain often associated with intercourse. This typically continues for a month or two at which point a penile curvature is noted. Usually the curvature progresses over a six-month period before becoming stable. Pain from the inflammation of Peyronie's disease always resolves, but may be present for two to three months. Careful examination of the corporal bodies on the side to which the penis curves often reveals a firm nodule or plaque. This plaque is actually a dense fibrotic scar that replaces the normal elastic corporal tissue. The scar does not expand during penile erection resulting in penile curvature toward the side of the scar. Usually a mild degree of curvature is of little significance. In some patients, however, the curvature may progress to the point where intercourse is difficult or impossible. The direction of curvature is important in predicting whether Peyronie's disease will cause problems for an individual. Dorsal curvatures (toward the stomach) of 40 degrees or less usually do not require surgery. Curvatures greater than 40 degrees can produce significant penile discomfort during intercourse. When curvature reaches 50 degrees or more, vaginal penetration may be difficult or impossible. We have seen penile curvature greater than 90 degrees on many occasions. Lateral and ventral (downward) curvature can be more problematic than upward curvature. Curvature of 30 degrees in those directions may make intercourse difficult or impossible.
The oral medications, Potaba and Vitamin E have been used in the early stages of inflammation to decrease the progression of scarring. There is very little evidence to support efficacy claims of these medications, however. We often do not prescribe Potaba due to the shortage of data supporting efficacy and the growing amount of data questioning whether the medication is better than a placebo. Once the plaque is established and curvature stable, oral medication clearly will not decrease the curvature. The main decision at that point is whether the curvature sufficiently interferes with intercourse to elect surgery. Surgical correction is usually effective, however, certain side effects are possible. Success rates for individual cases vary depending on the extent of scar tissue, the degree and direction of curvature, and the type of repair chosen. During your office visit Dr. Douglas F. Milam will discuss with you the options applicable to your individual situation.