If you think you have Peyronie’s disease (PD) – the sometimes painful condition that causes the penis to bend or appear smaller – your doctor will need a detailed medical history and will perform an exam. While not life-threatening, PD requires a doctor who can expertly diagnose, treat, and counsel you about the disorder. This is usually a urologist, a specialist in diseases of sexual organs and the urinary tract.
Your first PD visit should take longer than a routine doctor’s visit, anywhere from 30 to 45 minutes. Your doctor will ask multiple questions. It’s more helpful to both of you if you’re prepared to answer them as well as you can.
Questions to Expect From Your Doctor
When did the curve in your penis first appear? Has it worsened or stayed the same?
How your Peyronie’s disease is treated depends on the phase it’s in. Early in the disease – the acute phase – your PD is usually continuing to progress as scar tissue forms within your penis. This can cause the bend in your penis to become larger. Your doctor may ask whether your penis has developed an hourglass shape, decreased in length or thickness, or if it feels less hard when erect. The acute phase can last from a few weeks up to a year or more.
Scar tissue stops forming in the chronic phase of PD, and the curving, length, and other issues typically stabilize – usually several months to a year after your symptoms started. In this phase, you may develop problems having an erection (erectile dysfunction, or ED) or your ED may get worse. If your doctor recommends it, surgery should only be performed in the chronic phase of Peyronie’s disease – when your disease is stable – to avoid the need for more surgery.
Most penises don’t appear perfectly straight. A slight bend in your penis that you’ve had since birth isn’t a sign of PD.
Do you have pain with or without erections? Has the pain stayed the same, gotten worse, or improved?
Pain is typically present in the acute phase of PD. As plaque forms in your penis, it can cause inflammation and pain. During this phase, your penis may hurt both when it’s flaccid (not erect) and erect. Your erections may become more painful over time as the scarring within your penis increases. In most cases, the pain that appears with PD is mild enough for an over-the-counter pain reliever. Tell your doctor if that’s not the case. This pain usually improves or goes away in the chronic phase of PD, with one study showing improved pain in a majority of patients within a year of diagnosis, with almost 90% pain-free at 18 months.
Your doctor may ask about your partner as well. During sex, PD may cause pain for your partner, particularly as the curve in your penis increases.
Do you have problems getting or keeping an erection? Do your symptoms affect sex?
Because Peyronie’s disease affects not only sexual health but emotional health as well, you should be open with your doctor about the impact of PD on your sex life. PD may make it difficult for you to have or maintain an erection by impacting blood flow to your penis. What’s more, your penis is more likely to bend during sex if it’s not as hard, which can lead to more injury and pain. The type of erection problem you have can determine the course of treatment your doctor recommends. To see how severe your curve is, your doctor may ask you to bring photos of your erect penis to your first or follow-up visits. Ask your partner to take the photos if you find it hard to get a good image of the affected area.
During your physical examination for PD, your doctor will most likely start by feeling and stretching your penis gently, trying not to cause any pain but to uncover the location and nature of the problem. You may also get a shot into your penis, through a very small needle, of a drug that helps mimic an erection. This also allows your doctor to see what areas are affected and take a baseline measurement of your penis length. You also may have an ultrasound procedure that measures blood flow to your penis and uncovers any scarring or other abnormalities in your penis tissue.
Have you had an injury to your penis?
You may not remember injuring your penis or believe it’s not important to tell your doctor, but it is. You may have hit or bent it during sex, playing sports, or by accident. A one-time injury or a seemingly minor repeat injury to the penis over time can cause Peyronie’s disease.
What other medical conditions do you have? Do you have a family member with Peyronie’s disease or a similar condition?
Peyronie’s disease does appear to run in some families. If you have a father or sibling with the disease, your chances of having it increase.
Your doctor will ask you about certain similar diseases, so-called scarring disorders that affect the connective tissue – the material that supports skin, muscles, and joints. Autoimmune disorders, in which the immune system attacks various areas of the body – including the penis – also increase your risk of PD, whether you have one or more of these diseases or a close relative does. Some of these conditions include:
- Dupuytren’s contracture, in which connective tissue in the palms of your hands contracts and thickens, causing fingers to contract
- Scleroderma, hardening and thickening of the connective tissue of muscles and joints
- Plantar fasciitis, inflammation of connective tissue on the bottom of the foot
- Autoimmune disorders that cause damage and inflammation in various parts of the body such as lupus (joints, skin and organs), Sjögren’s syndrome (tear ducts and salivary glands) and Behcet’s disease (blood vessels)
Diabetes-caused erectile dysfunction is associated with four to five times the risk of PD. And although PD does not develop into or cause cancer, it is possible to get it after prostate cancer surgery. Your doctor will also ask you about any prescription or over-the-counter medicines you take.
Difficulties with wound healing and tobacco use also have been linked to PD. While it’s unclear whether they are a direct cause, you might be asked about these too.
Has the condition affected your mood or outlook?
The frustration, anxiety, and even depression surrounding Peyronie’s disease shouldn’t be ignored by your doctor or you. More than three-quarters of PD patients have reported depression and worry due to their condition. Your doctor may prescribe medicine or refer you to counseling to treat your anxiety and mood. If you have a partner, consider including them in discussions with your doctor about how PD affects your sex life and relationship. Talk openly to your partner about your condition and how it impacts you both and, if possible, seek counseling together.
You will, of course, have questions for your doctor too. As you prepare for your visit, remember that your sexual health is as important as any other aspect of your health. Seek treatment early, and don’t let embarrassment or fear keep you from discussing exactly how Peyronie’s disease impacts your physical, sexual, and emotional well-being.
Show Sources
Photo Credit: Pornpak Khunatorn / Getty Images
SOURCES:
American Urological Association: “Peyronie’s Disease (2015).”
Association of Peyronie’s Disease Advocates: “Working with Your Doctor.”
Cleveland Clinic: “Peyronie’s Disease.”
National Institute of Diabetes and Digestive Kidney Diseases: “Penile Curvature (Peyronie’s Disease).”
National Library of Medicine: “Peyronie’s Disease: A Review of Etiology, Diagnosis, and Management.”
