If someone has Peyronie’s disease, the penis typically curves towards the scar during an erection. The curvature can be, but is not always, painful.
Even if the curvature itself doesn’t cause pain, it can make sexual penetration uncomfortable or, in severe cases, impossible.
Xiaflex is a medication approved by the U.S. Food and Drug Administration (FDA) for Peyronie’s disease, but it’s not available, nor the right treatment, for every person with the condition.
In certain cases, surgery can be a more appropriate option for treating Peyronie’s disease.
Before Surgery
Peyronie’s disease does not always require surgery. Early signs of Peyronie’s disease may resolve on their own or never become severe enough to warrant surgical correction.
Surgery for Peyronie’s disease is generally only recommended if:
The curvature of the penis has been stable for at least three to six monthsSymptoms have been present for at least a year
For people who enjoy penetrative sex, surgery may be recommended if the degree of penile curvature makes penetrative intercourse difficult.
A healthcare provider will need to perform physical examinations both when the penis is flaccid, to identify penile plaque, indentation, or other abnormalities, and when it is erect to measure curvature degree and direction.
A person may not be able to get an erection for the exam. Medication can be used to cause an artificial erection, which allows the healthcare provider to observe the extent of penile curvature as well as the nature and location of any scarred areas.
Plication
Plication is the least-invasive form of surgery for Peyronie’s disease. In this procedure, stitches are placed on the penis opposite the areas of scarring.
The goal is to shorten the penis on the far side of the curve, allowing it to be pulled straight. Essentially, the penis is shortened the same amount on both sides—once by scarring and once by plication.
Plication is generally only recommended if the curvature of the penis is less than 60 degrees.
Plication is usually done as an outpatient procedure. It can be performed under sedation or general anesthesia. A local anesthetic is also used to numb the area and prevent pain.
After surgery, a person can usually recover at home. Before discharge, they will be taught how to change their dressings, which they will need to do for five days after the procedure. Most people can return to work within a day or two of surgery.
Plication has some limitations. For example, it cannot be used to treat hourglass deformities or indentations.
Other potential issues with plication include:
Decreased sensation in the penis Persistent pain after surgery Bumps or lumps in the penis Less-rigid erections Indentations in the penis will remain The penis can become curved again
Excision and Grafting
An excision and grafting procedure (also called incision and grafting, or just grafting) can also be used to treat Peyronie’s disease. The procedure is typically used when the penile curvature is greater than 60 to 70 degrees.
During the procedure, the scarred area of tissue is cut out of the penis and replaced with a tissue graft. The type of tissue used for the graft depends on several factors, including the surgeon performing the procedure.
Surgical grafting is a much more invasive treatment than plication. The procedure takes longer and usually requires general anesthesia or an epidural.
An incision and grafting procedure is more invasive and may require multiple incisions depending on the type of graft. An overnight hospital stay is usually required, and the recovery period is longer.
Compared to plication, people who have had surgical grafting will need to wait longer to return to work or resume engaging in sexual intercourse.
During recovery, penile stretching and massage may be recommended to restore shape and length. A person may also be instructed to use a penile traction device.
The risks of excision and grafting, such as nerve damage and impotence, are higher than with plication. However, unlike plication, grafting procedures can be used when the penis is indented or the penis is at risk for bending around a destabilized area (such as a hinge).
Penile Implant
Plication and grafting are generally best for people who are still able to get an erection (even if medication or a vacuum pump is required).
However, if someone with Peyronie’s disease is unable to get an erection (even with assistance), a penile implant may be the only option.
Penile implants are inflatable cylinders (balloons) placed inside the penis and controlled by a pump in the scrotum.
If someone has Peyronie’s disease, the implant is sometimes enough to straighten the penis. However, placing an implant is often combined with additional manual modeling or surgery, which can be either plication or grafting.
As with grafting, penile implant surgery is usually done under general anesthesia or with an epidural. Patients can expect to stay in the hospital overnight.
The surgery involves incising the corpora cavernosa of the penis in order to place penile prosthesis cylinders. The procedure affects much more tissue than grafting alone, so the recovery period is generally longer.
After getting a penile implant, it may take one to several weeks before someone is ready to return to work.
Once an implant is placed, it must be used in order to get an erection. There is also a risk of implant failure.
The device may need to be replaced, especially in younger people and those who are more sexually active. Implants can also lead to ongoing issues with curvature and, as with plication, may shorten the length of the penis.
A Word From Verywell
A curved penis doesn’t always require medical treatment. A slight curve to the penis (less than 20 degrees) may have little to no impact on sexual function. However, if the curvature impairs sexual function for someone who enjoys penetrative sex, surgery may be needed.
If you have Peyronie’s disease, it’s important to find a healthcare provider who understands the condition and with whom you can comfortably discuss your sexual health.
After discussing your symptoms with your healthcare provider, they can help you understand the risks and benefits of each treatment option for Peyronie’s disease.
