How to Navigate the Active Phase of Peyronie’s Disease: The First 12 Months

A diagnosis of Peyronie’s disease can be traumatic. Characterized by the development of fibrous scar tissue within the penis and often a painful bending during erection, the condition can lead to significant sexual and psychological effects.

“Many men have never heard of Peyronie’s disease before they develop it, so the diagnosis often comes as a shock,” says Travis Green, MD, an assistant professor and a urologist at McGovern Medical School at UTHealth Houston. “Seeing a new curvature, feeling a lump, or experiencing pain during erections can be alarming and deeply distressing.”

As with most medical conditions, it’s crucial to take action in the first 12 months or so to get the disease under control before it becomes more difficult to treat.

“It’s essentially a small contraption you put over your penis to pull it,” says Zachary Glaser, MD, a urologist at Rush University Medical Center in Chicago. “Although it’s an odd concept, many of these devices are lightweight and discreet, so they can be worn under your pants at home, work, or walking down the street, and no one will know.”

There’s a “use it or lose it” concept at work with these tools, as benefits disappear if you do not use them consistently as directed. Michael Eisenberg, MD, a professor of urology at Stanford Medicine in Palo Alto, California, cautions that results depend on your commitment.

“A man has to invest time on a regular basis to see improvement, which can take several months,” he says. “Discomfort is also a downside to be aware of.”

Dr. Green says that vacuum erection devices may help maintain penile tissue health. Although these commonly treat erectile dysfunction, there is less research available for its use with Peyronie's.

Depending on the severity of your condition and your preference, a urologist may suggest treatments such as medications, supplements, and injections.

Injections

Your doctor may suggest certain medications injected directly into your penis, depending on your disease severity. The idea may make some men squirm, Green says.

“That’s why we talk a lot about the procedure with the patient,” he says. “We use an incredibly small needle. And every time I've done it, that gentleman will tell me, ‘Wow, I thought this was going to be a lot worse,’ and they tend to tolerate it just fine.”

• collagenase (Xiaflex) This is the only medication approved by the U.S. Food and Drug Administration (FDA) to treat Peyronie’s, and it is recommended for penile curves greater than 30 degrees. It is injected into the scar tissue over several months according to a protocol. The medication uses enzymes to break down collagen that drives scar formation. Although it is often used during the stable phase of the disease, it can reduce curvature and pain in the acute phase.

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• verapamil (Isoptin) Often prescribed to treat high blood pressure, it may ease Peyronie’s symptoms. But evidence is mixed, Green says.
• interferon This protein helps reduce swelling and scarring, releasing an enzyme that may help break down scar tissue.

Oral Treatments

• Colchicine The FDA has approved colchicine (Colcrys, Mitgare) to treat gout. An anti-inflammatory medication, it can reduce pain and limit plaque but may have side effects.

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• Tamoxifen Typically used to treat breast cancer, the anti-estrogen drug tamoxifen (Nolvadex, Soltamox) could ease pain and slow plaque progression.

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• Phosphodiesterase Type 5 (PDE5) Inhibitors Research has suggested that medications for erectile dysfunction such as sildenafil (Viagra) and tadalafil (Cialis) may shorten pain duration during the active phase of Peyronie’s.

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• Pentoxifylline This drug improves blood flow in tiny blood vessels. It lowers the amount of the body’s collagen, a type of protein that helps scars form.

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• Potassium Aminobenzoate A form of vitamin B, potassium aminobenzoate (Potaba) can address scarring.

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• L-Arginine Your body produces this amino acid naturally, and your doctor may recommend taking it as a supplement to improve blood flow.

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Lifestyle changes may improve penile blood flow and help the function of the penis in the active phase of Peyronie’s, Dr. Eisenberg says. These include:

• Get regular exercise.
• Follow a healthy diet.
• Quit smoking.
• Maintainin a healthy weight.

“Seeing a mental health professional, including sexual therapists, can be very useful for some men,” Eisenberg says.

In addition to a sex therapist, a psychiatrist may help you with your body image and emotional health.

When you first suspect that you might have Peyronie’s, urologists advise that you seek a doctor’s advice as soon as possible.

“Remember, there are many treatment options,” Dr. Glaser says. “The key is to stay on top of things and make it to the chronic stage, when the disease is more stable and easier to treat.”

• Early treatment leads to the best outcomes with Peyronie’s disease, especially in the first 12 months, when symptoms often are the worst.
• Treatment options may include traction devices to straighten curvature and to make scar tissue more flexible, as well as oral and injected medications.
• Lifestyle changes such as getting more exercise, eating healthier, and maintaining your weight may ease some symptoms.
• Talk to your doctor if symptoms worsen, and recognize that mental health assistance can help you navigate emotional and body-image issues.