Peyronie’s disease is a connective tissue disorder characterized by fibrous scar tissue (plaque) within the penis that causes curvature, deformity, pain, and often erectile dysfunction. It affects an estimated 3 to 9% of men, though true prevalence is likely higher due to significant underreporting.
Causes and Risk Factors
Peyronie’s disease most commonly results from repetitive microtrauma to the penis during sexual activity. In genetically predisposed individuals, the normal wound-healing response produces excessive collagen forming a hard, inelastic plaque. Risk factors include age over 40, family history, Dupuytren’s contracture, diabetes, and certain autoimmune conditions.
The Two Phases
The acute phase — typically lasting 6 to 18 months — involves active plaque formation, pain with erections, and progressive curvature change. The chronic phase begins when the plaque stabilizes: curvature stops progressing and pain generally resolves, but the deformity persists. Treatment strategy differs between these phases.
Treatment
In the acute phase, intralesional injections of collagenase clostridium histolyticum (Xiaflex — the only FDA-approved injectable treatment) work by breaking down the collagen in the plaque. Penile traction therapy limits deformity progression. In the chronic phase with stable deformity, surgical options offer the most definitive correction: plication procedures for mild curvature, plaque incision and grafting for more severe deformity, and penile prosthesis implantation when significant erectile dysfunction coexists — simultaneously treating both conditions.