Peyronie's Disease Question and Answer Panel

Find answers to commonly asked questions and some that aren't so common.

The Experts

Gerald Brock, MD; urology professor; london, ontario

Gerald Brock, MD

Dr. Brock is professor for the Department of Surgery, Division of Urology, at St. Joseph's Health Centre in London, Ontario, and runs the center's erectile dysfunction clinic.

Rafael Carrion, MD; associate professor of urology; tampa, florida

Rafael Carrion, MD

Dr. Carrion is an associate professor of urology at the University of South Florida and practices at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida.

Culley C. Carson III, MD; chief of urology; UNC-chapel hill

Culley C. Carson III, MD

Dr. Carson is the Rhodes Distinguished Professor at the University of North Carolina School of Medicine and the chief of urology for University of North Carolina Hospitals in Chapel Hill, North Carolina.

Read Dr. Culley Carson's archived transcript. »

Martin Gelbard, MD; clinical faculty; UCLA school of medicine

Martin Gelbard, MD

Dr. Gelbard is on the clinical faculty at the UCLA School of Medicine and practices at Providence Saint Joseph Medical Center in Burbank, California.

Gerald H. Jordan, MD; urology professor; eastern virginia medical school

Gerald H. Jordan, MD

Dr. Jordan has been certified by FACS and FAAP and is a professor in the Department of Urology at Eastern Virginia Medical School. He is also the director of the Devine Center for Genitourinary Reconstructive Surgery at Sentara Norfolk General Hospital in Norfolk, Virginia.

L. Dean Knoll, MD; center for urological treatment; nashville, tennessee

L. Dean Knoll, MD

Dr. Knoll is a surgeon at the Center for Urological Treatment and Research in Nashville, Tennessee.

Second Opinions

Read how two physicians answer the same question, allowing you to get an additional opinion in one place.

1. What is the prevalence of Peyronie's disease?

Dr. Knoll: The prevalence of Peyronie's disease is estimated between 5 and 10 percent. It has been reported in the past to be lower, but we are seeing more patients with Peyronie's disease today.

Dr. Brock: In my practice I see men with Peyronie's disease all the time. Current studies say probably around 7% of men have some degree of penile scarring, but … significant Peyronie's disease, where it really affects the shape of the penis and the function of the penis, is probably something around 3 of every 100 men.

2. Is there a specific age group affected by Peyronie's disease?

Dr. Knoll: The majority of patients who present with Peyronie's disease are generally between 40 and 60 years of age, however we see patients who are younger as well as older.

Dr. Jordan: It's a disease of 45 to 65, but the average age is in the mid fifties, 52 to 53.

3. What causes Peyronie's disease?

Dr. Carson: Peyronie's disease is generally caused by trauma, injury to the penis. And that injury can be of a variety of different kinds. Most often it's a sexual injury—injury during sexual intercourse. But it can be a Foley catheter placement. It can be injury during recovery from a radical prostatectomy, or a variety of other kinds of trauma.

Dr. Gelbard: Peyronie's can be caused by trauma to an erect penis during intercourse, but most patients do not have a discrete history of trauma. It can be related to genetic factors such as Dupuytren's contractures in the hand, and it can also be a genetic and a familial pattern.

4. Does medical therapy improve Peyronie's disease?

Dr. Carson: Some patients improve with medical therapy, with special oral medications, but the question is, “is that improvement a placebo effect or is it actually a medical effect?” And a number of different pills and oral preparations have been used, but no evidence-based medicine shows that they are better than placebo.

Dr. Jordan: Peyronie's disease is a disease of phases, and in those phases, oftentimes, as the disease goes to maturity, you will see improvement from the inflammatory phase. Whether it is medical therapy that accomplished that is the problem. The studies haven't been done.

5. When should you abandon medical therapy in favor of surgical intervention?

Dr. Gelbard: Surgical intervention is generally not considered until patients have had a problem with Peyronie's for a year or more, particularly when they've had no results with medical therapy and are having sexual problems due to the amount of deformity they have.

Dr. Carrion: Once the plaque has been stable for a period of time and there is no clear efficacy with some of the conservative approaches, we then begin to counsel our patients concerning the surgical management.

6. How soon after Peyronie's repair surgery do patients resume sexual relations?

Dr. Jordan: We're relatively conservative at the center, and we ask our patients to refrain from intercourse for about 10 to 12 weeks. We don't state an exact date purposefully because we don't want them to go home and mark their calendar and then have a night that they immediately fail.

Dr. Carrion: In my practice, we counsel our patients to wait typically an average of 6 weeks from the date of surgery to engage in sexual activity.

7. Will patients have erectile dysfunction as a result of this Peyronie's repair surgery?

Dr. Carrion: Properly selected patients that have good erectile function preoperatively should maintain erectile function postoperatively.

Dr. Carson: Any procedure on the penis can cause erectile dysfunction. We try every way we can to select patients who have good erections before surgery, but there is a significant number of patients that have erectile dysfunction following the surgery. The causes of that can be a variety of things, but yes, any surgical procedure on the penis can cause erectile dysfunction.

8. Does the partner play a role in the decision-making process of the repair procedure?

Dr. Brock: You know, sex is a team sport; and at the end of the day, when we're looking at men and women and satisfaction with any intervention, a really active, engaged partner is absolutely essential for success. Both in understanding what's going to happen to him as he recovers, and also long term, accepting what's going to happen in terms of their sexual and intimate relationship.

Dr. Gelbard: That depends on the patient, but I think in most cases they should. Particularly in my practice I would want to have a conference with both the patient and the partner if, for instance, the patient has been through medical therapy and has progressed to the point where they are considering surgery. I think at that point it is important to discuss with the partner.

9. At what stage of the process do you involve the partner?

Dr. Brock: I ask that the partner come in for the first visit, and for all subsequent visits, and that happens probably in about a quarter of my own patient practice. I think that those guys typically do better.

Dr. Knoll: The sooner I can get the partner's involvement, understanding even the preoperative assessment that's required, I feel it's easier for them to understand the progression of what potential treatment options are available for that patient.

10. Is surgery a permanent solution?

Dr. Jordan: Surgical treatment is felt to be a permanent solution. Certainly the patient can re-injure his penis. But the combination of the original injury and the surgery for that injury, in some ways, is protective against future injury. Also, patients are quite careful with their sexual activities after surgery; because they've had surgery and they understand that there is some morbidity associated with it.

Dr. Carson: Surgery for Peyronie's disease is usually a permanent solution. There are some patients that need a second or revised plaque incision or excision and grafting, if their graft contracts. Its less than 3% of the patients in my own practice. Occasionally patients will have enough erectile dysfunction with their initial straightening surgery that they'll need a penile implant, but [for] the vast majority of patients, more than 95%, one surgical procedure is sufficient.



The physicians appearing in the menshealthpd.com videos have been compensated by Cook Medical for their participation.

For clinical publications and research about Peyronie's disease, visit the for Physicians page. »