DEAR DOCTOR K:
I have Peyronie’s disease. Are there any effective treatments for this condition?
Peyronie’s disease is, fortunately, relatively uncommon. About 5 percent of men in the United States may have it. The condition affects the penis. It causes inflammation and then scar tissue to form in the area of inflammation. The scar tissue accumulates and hardens, causing the penis to bend when it becomes erect, and potentially keeping it from becoming fully erect. This can make sexual intercourse difficult and painful. (I’ve put an illustration, below, showing the effect of Peyronie’s disease.)
Most men with a curved penis do not need any treatment. But if Peyronie’s disease causes pain or difficulty with sex, there are treatment options.
Treatment often involves a drug called pentoxifylline. It is taken by mouth. This drug acts on the immune system to quiet inflammation and formation of scar tissue. You would take this drug along with one of three other drugs: verapamil, interferon alpha-2b or collagenase. These drugs are injected directly into the scar tissue in the penis.
Other drugs or supplements, such as carnitine and vitamin E (sometimes with colchicine), may also be prescribed. They are taken by mouth. These therapies are not usually effective in men with moderate to severe curvature.
High-intensity ultrasound and radiation therapy have been tried, but there is no strong evidence that they are effective.
Peyronie’s sometimes improves gradually without treatment. If it doesn’t improve over the course of a year, and if it makes sexual intercourse difficult, corrective surgery is an option. In a typical procedure, the inflamed or scarred portion of tissue is removed from the penis. It is replaced with tissue taken from another part of the body (often the scrotum or forearm).
This surgery often works well. However, the penis may remain mildly curved. In addition, sexual function or shortening of the penis does not always improve following surgery. In some cases, surgery can cause erectile dysfunction. Surgeons sometimes implant a penile prosthesis during surgery. In some men, a prosthesis alone is enough to straighten the curvature and improve sexual function.
In December 2013, the FDA approved a new drug for Peyronie’s disease, Xiaflex (CCH). This drug is also used for treating a hand abnormality called Dupuytren’s contracture. This condition is like Peyronie’s, in that it causes scar tissue to form. In the hand, the scar tissue involves tendons and can prevent the fingers from straightening.
For Peyronie’s, Xiaflex is injected directly into the scar tissue in the penis. The medicine works by breaking down the thickened tissue. After the injection, tissues in the penis are stretched in order to straighten it. This drug does not run the risk of causing erectile dysfunction.
Since Peyronie’s disease can progressively worsen, injected drug treatments should begin as soon as the condition is causing bothersome symptoms. Given how disruptive this ailment can be, it’s good that we finally have some effective medical and surgical treatments.