Peyronie’s disease occurs when areas of hardened scar tissue called plaques form on the penis, making it less flexible. As a result, the penis curves or bends when erect. The degree of curvature varies from man to man. For some, the bend is slight and does not cause many problems. But for others, the curve is dramatic and intercourse becomes difficult or impossible.
Men with Peyronie’s disease may also find that their penis narrows or shortens. It may resemble an hourglass because the plaques form indentations.
Peyronie’s disease can also be quite painful.
When doctors are determining whether a man has Peyronie’s disease, they may consider the following:
- Medical history. Since Peyronie’s disease may be a wound-healing disorder, a doctor will want to know if there has been any injury to the penis. Such injury could occur through vigorous sex, playing sports, or surgery in the pelvic area. Doctors will also ask how the curvature affects sexual activity.
- Physical exam. Plaques are evaluated in a physical exam. If a man has Peyronie’s disease, a doctor can usually feel lumps in the penis. If the lumps are especially hard, the plaques may have already calcified. This means they have become inflexible. A doctor may also take measurements to determine the angle and degree of curvature. Length and girth may also be measured. Length measurements can be taken when the penis is fully stretched or erect. To induce an erection, a doctor may inject medication into the penis to form an erection. Since this erection may not be the same as one that develops in a natural setting, doctors may ask men or their partners to take a photograph of the erect penis at home. Recently, researchers evaluated a smartphone application that may allow men to take their own measurements at home. The application involves taking a photo, then using a touchscreen to show the points of the curve and the narrowed area. This method may be more convenient and private.
- Other tests. Ultrasound is an important tool throughout the Peyronie’s disease diagnosis and treatment process, as it allows doctors to measure plaque dimensions. If the patient has erectile problems in addition to suspected Peyronie’s disease, a duplex ultrasound can evaluate blood flow in and out of the penis. Biopsies and x-rays are possible, but less common, tests. MRIs provide good imaging, but are rarely used because they are not cost effective.
- Psychological assessment. Since Peyronie’s disease can interfere with sex and relationships, many men feel distress. Relationship problems can develop, especially if the couple is uncomfortable discussing the situation. Single men may be nervous about starting a new relationship and revealing their condition. It’s not unusual for men with Peyronie’s disease to feel depressed, anxious, and frustrated.
Feedback from partners is often helpful. Partners can explain the problems – both physical and psychological – from a different perspective and provide insight on how Peyronie’s disease affects the couple’s relationship.