DEAR DOCTOR K:
A few months ago, I noticed that my penis had developed a bend in it. It hurts when I have sex, and it’s embarrassing. Is there a treatment?
What you describe sounds to me like Peyronie’s disease. This condition causes a curvature of the penis. It can also cause pain with erection, and it may interfere with sexual function. The pain often is more of a problem at the beginning of the condition than later. Even if the bend in the penis remains, the pain often resolves.
In Peyronie’s disease, inflammation and scar tissue form along the shaft of the penis. No one is certain why this occurs. It may be triggered by repeated mild trauma during sexual intercourse. In some men it goes away, but in most it doesn’t. However, when it remains, it doesn’t always interfere with sex or cause other symptoms. It just looks funny.
People with Peyronie’s disease may have genes that cause them to form scar tissue more readily. They are more likely than other people to also suffer from a condition called Dupuytren’s contracture, in which scar tissue builds up in the palms of the hands and soles of the feet.
You may feel the inflammation and scar tissue as a painful lump or area of unusual firmness. In many men, the scar tissue is not evenly distributed throughout the shaft of the penis. If it is more on one side, as it usually is, the scar tugs on the shaft, causing the penis to bend or shorten. This is because it prevents the penis from expanding normally. Men with Peyronie’s often have difficulty achieving a firm erection.
Treatment is available for cases that cause pain and interfere with sexual function. The best results have come from oral pentoxifylline and injections into the scar tissue with one of three drugs: verapamil, interferon alpha-2b and collagenase.
Pentoxifylline acts on the immune system to quiet inflammation and the associated formation of scar tissue. Other options include carnitine and vitamin E (sometimes with colchicine), taken by mouth. But 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 of their effectiveness.
Corrective surgery may be an option if your symptoms are very bothersome or disfiguring and persist for more than one year. In a typical procedure, the inflamed or scarred portion of tissue is removed from the penis and replaced with a graft taken from another part of the body.
This surgery often works well. However, mild curvature of the penis may remain. In addition, sexual function or shortening of the penis may not improve following surgery.
For this reason, surgeons sometimes implant a penile prosthesis during surgery. In some men, a prosthesis alone is enough to straighten the curvature and improve sexual function. If you decide to consider surgery, be sure to discuss all options with your doctor.