Curved Penis
Curved penis, also known as Peyronie’s disease, is a painful condition in which a man’s penis develops a curve—typically 45 degrees or greater–due to the accumulation of abnormal scar tissue or plaques inside the penis. Some experts suggest the condition develops when repeated mild trauma to the penis causes minor damage that accumulates over time. The trauma could be from sexual activity, sports injuries, or an accident. Damage causes scar tissue to develop, and the scars (lesions) decrease the ability of the penis to stretch and the organ leans toward the side of the scar. A curved penis can also develop in a small percentage of men who undergo radical prostatectomy. Other risk factors for a curved penis include diabetes, age, tobacco use, and presence of a connective tissue disease such as Dupuytren’s contracture, which is common in men with Peyronie’s disease.
According to the American Urological Association, up to 9% of men between the ages of 40 and 70 have some degree of a curved penis, although the number could be even higher because men are too embarrassed to report it. It is much less common in younger men. (American Urological Association)
A curved penis can cause a significant amount of pain and some penile shortening, as well as prevent men from having sex because of the angle of the penis and/or the pain. Men with this disease often experience much anxiety and distress related to the disorder. Treatment typically is reserved for men who are experiencing pain, are unable to engage in sexual activities because of the curvature, and the curvature is worsening. In about 5 to 12 percent of men the condition disappears without treatment. (Deveci)
Drug Treatments for a Curved Penis
Treatment options for a curved penis include use of oral drugs, a topical gel, and supplements, including tamoxifen, colchicines, potassium aminobenozoate, pentoxifylline, verapamil gel, and the natural supplements vitamin E, propionyl-L-carnitine, and omega-3 fatty acids. Thus far, none of these treatment options have yielded scientifically proven good results, except potassium aminobenozoate, which is now available as the prescription drug Potaba. (Kuehhas)
Potaba helps prevent the formation of fibrous tissue by increasing the supply of oxygen in tissues in the penis. You should take Potaba with food. Side effects of Potaba include nausea and loss of appetite, and failure to eat may result in symptoms of low blood sugar (e.g., increased hunger, elevated heartbeat, weakness, sweating, chills).
Another promising oral treatment is coenzyme Q10 (CoQ10). A total of 186 men with a curved penis were randomly assigned to take either 300 mg CoQ10 daily or placebo for 24 weeks. At the end of the study, the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and International Index of Erectile Dysfunction (IIEF-5) questionnaire results improved significantly in men who took CoQ10 but not in those taking placebo. More importantly, mean plaque size and mean penile curvature degree declined in the CoQ10 group while it increased in the placebo group. The curved penis progressed in 11 (13.6%) of men in the CoQ10 group compared with 46 (56.1%) in the placebo group. (Safarinejad)
A preliminary study reported in 2001 discovered that acetyl-L-carnitine provided some improvement in curvature and pain for men with a curved penis. However, no follow-up studies were ever done. (Biagiotti)
Verapamil gel has been introduced as a possible treatment for a curved penis. The makers of this calcium channel blocker treatment claim verapamil gel is absorbed into the skin and travels to the plaque, where it breaks it down and also interferes with its growth. However, little has been written about the effect of verapamil gel on a curved penis. One study published in 2007 in the Journal of Sexual Medicine reported that 94.4% of patients treated for 9 months with verapamil gel had an average percent improvement in curvature of 61.1% compared with 43.6% improvement at 3 months. Pain resolved in all patients at 9 months compared with 87.5% at 3 months. (Fitch)
In a survey of 236 practicing urologists, 70% said they preferred vitamin E as the first treatment of choice, with verapamil gel chosen by only 10%. (Shindel) An early (2002) study from Loyola University Medical Center reported that when verapamil gel was applied to the penile shaft of men who were scheduled to undergo penile prosthesis surgery for erectile dysfunction, only a small amount of the gel was absorbed and that the gel did not infiltrate the tunica albuginea. The authors concluded that “the use of transdermal verapamil for Peyronie’s disease has no scientific basis.” (Martin)
Use of penile injections also can reduce the curvature and pain, although multiple injections into the lesions are necessary over several months. The drugs used for injections include verapamil, collagenase, nicardipine, and interferon, all of which can disrupt the protein (collagen) that is key in the formation of the scar tissue. Not all of these drugs are equally effective, however.
Among the studies of penile injections are several that have used verapamil. One study of 156 men reported that about 60% of the patients reported a decrease in curvature and 71% said sexual function had increased. (Levine 2002) In another study, 94 men received an injection every two weeks for a total of six injections. At 5.2 months posttreatment, 18% of the men said curvature had improved, 60% reported stable curvature, and 22% said curvature had increased. (Bennett) Pain improved in all the patients.
Nicardipine is in the same drug class as verapamil, and studies indicate injections of this drug also are somewhat effective at reducing plaque size and improving both pain and penile curvature in some men. In one study, for example, 74 men were randomly assigned to take either nicardipine or placebo for a total of six injections given every two weeks. Plaque size was significantly reduced only in the nicardipine group, although penile curvature was significantly improved in both the nicardipine and placebo groups. (Soh)
Use of interferon has resulted in mixed results, with low rates of improvement and a high incidence of side effects. Collagenese injections, however, have been more promising. An early study showed 64% of men improved after 4 weeks of treatment (Gelbard), while a more recent study noted a statistically significant improvement in penile curvature and plaque size. (Jordan)
Xiaflex Experimental Drug Shows Promise in Trials for Treatment of Peyronie’s Disease
Nonsurgical and Surgery Treatments for a Curved Penis
A nonsurgical treatment approach that uses shockwaves has been controversial. Shockwaves are used to treat and break up kidney stones, so numerous studies have looked at how effective this approach could be in breaking up the plaque in the penis. Extracorporeal shock wave therapy (ESWT) for a curved penis has yielded mixed results. A study published in June 2010 reported on 157 patients who received an average of 3.5 ESWT treatments. One-third of the patients achieved significant reduction in curvature, while more than 90% of the men reported good reduction in pain and 6% had complete pain relief. No significant difference was seen in sexual function. (Busetto)
In a double-blind, placebo-controlled study one year prior, however, the results were not as promising. One hundred men were randomly assigned to either ESWT or placebo. At 12 weeks after treatment, mean plaque size and mean penile curvature degree had not changed in the ESWT group and showed a slight increase in the placebo group. By week 24, both mean plaque size and mean penile curvature were significantly higher in the placebo group compared with the ESWT group. This suggests ESWT may protect against disease progression.
Another nonsurgical option for treatment of a curved penis is penile traction. Only a few small studies have been conducted, and the results have been conflicting. Penile traction involves wearing a device with extender rods on the penis, whose purpose is to gradually straighten and extend the penile shaft. Men typically should wear the device for at least 2 hours per day, but more is recommended. Every few weeks, the rods are lengthened by a slight amount.
In one study, 10 men completed 6 months of penile traction therapy and reported improvements in both length (0.5 cm to 2.5 cm) and curvature (mean, 22 degree improvement). No side effects were reported, and the men were satisfied with the results and had an improvement on their IIEF scores. (Levine 2008) A subsequent study, however, also lasting 6 months, did not yield the same results. The 15 men in the study used the penile traction device for a mean of 5.5 hours daily but did not see a significant decrease in penile curvature, although there was some improvement in mean flaccid penile length (1.3 cm). (Gontero)
Surgery is an option for a curved penis if the curvature is severe or prevents sexual activity. Before surgery is performed, however, the curvature should be stable (not gotten any worse) for at least three months and other treatment options should have been explored, as there is no standard surgical procedure for treatment of a curved penis. Possible procedures include shortening one side of the tunica albuginea (the fibrous structure that plays a significant role in achieving an erection), lengthening one side with graft material, or implanting a penile prosthesis for men who have severe erectile dysfunction caused by a curved penis.
READ MORE AT THE “PEYRONIE’S HEALTH CENTER”
References
American Urological Association
Bennett NE et al. Intralesional verapamil prevents the progression of Peyronie’s disease. Urology 2007 Jun; 69(6): 1181-84
Biagiotti G, Cavallini G. Acetyl-L-carnitine vs tamoxifen in the oral therapy of Peyronie’s disease: a preliminary report. BJU Int 2001 Jul; 88(1): 63-67
Busetto GM. Extracorporeal shock wave therapy in the treatment of Peyronie’s disease: long-term results. Arch Ital Urol Androl 2010 Jun; 82(2): 128-33
Deveci S et al. Defining the clinical characteristics of Peyronie’s disease in young men. J Sex Med. 2007;4:485–490
Fitch WP et al. Topical verapamil HCl, topical trifluoperazine, and topical magnesium sulfate for the treatment of Peyronie’s disease–a placebo-controlled pilot study. J Sex Med 2007 Mar; 4(2): 477-84
Gelbard MK et al. The use of collagenase in the treatment of Peyronie’s disease. J Urol 1985; 134:280–83
Gontero P et al. Use of penile extender device in the treatment of penile curvature as a result of Peyronie’s disease. Results of a phase II prospective study. J Sex Med 2009; 6:558–66
Jordan GH. The use of intralesional clostridial collagenase injection therapy for Peyronie’s disease: a prospective, single-center, non-placebo-controlled study. J Sex Med 2008; 5:180–87.
Kuehhas FE. Peyronie’s disease: nonsurgical therapy options. Rev Urol 2011; 13(3): 139-46
Levine LA et al. Experience with intraplaque injection of verapamil for Peyronie’s disease. J Urol 2002 Aug; 168(2): 621-25
Levine LA, Newell M, Taylor FL. Penile traction therapy for treatment of Peyronie’s disease: a single-center pilot study. J Sex Med. 2008;5:1468–1473.
Martin DJ et al. Transdermal application of verapamil gel to the penile shaft fails to infiltrate the tunica albuginea. J Urol 2002 Dec; 168(6): 2483-85
Palmieri A et al. A first prospective, randomized, double-blind, placebo-controlled clinical trial evaluating extracorporeal shock wave therapy for the treatment of Peyronie’s disease. Eur Urol. 2009;56:363–369
Safarinejad MR. Safety and efficacy of coenzyme Q10 supplementation in early chronic Peyronie’s disease: a double-blind, placebo-controlled randomized study. Int J Impot Res 2010 Sep-Oct; 22(5): 298-309
Shindel AW et al. Urologist practice patterns in the management of Peyronie’s disease: a nationwide survey. J Sex Med 2008 Apr; 5(4): 954-64
Soh J et al. Nicardipine vs saline injection as treatment for Peyronie’s disease: a prospective, randomized, single-blind trial. J Sex Med 2010 Nov; 7()11): 3743-49
