Peyronies

Treatment options for Peyronies Disease
What is Peyronie’s Disease?
Peyronie’s disease is a condition where scar tissue (called plaques) develops inside the penis, leading to curvature, pain, or sometimes even erectile dysfunction. It’s not just about appearance; the curvature can make sexual activity difficult or even painful.
The exact cause isn’t always clear, but it’s often linked to repeated injury to the penis during sex, sports, or accidents. Some men might also have a genetic predisposition to developing this condition.
Your plaque shape and distribution can affect the shape change in the penis
1. Hour glassing = often superficial plaques in one or both sides causing an indent
2. Single small or multiple small plaques in different locations = often does not affect shape but may cause pain or asynchronous filling
3. Long thicker continuous plaque = larger curvature
Conservative (Non-Surgical) Treatments
One pain has settled ultrasound treatment can be intorduced early
- Therapeutic Ultrasound : limited evidence but good clinical outcomes seen at our clinic for hour glassing or small plaques
- Shock wave therapy : Low-intensity shockwaves may help reduce pain and improve blood flow, regain length and decrease curvature
- Penile Pumps with or without penile rings: whilst often not changing the plaque itself these tools can often straighten the penis enough for penetrative intimcay
- Oral Medications: PDE5's - viagra, cialis, levitra, stendra and other medication like potassium para-aminobenzoate (Potaba) and vitamin E have been used, but results are mixed
- Injection Therapy: Collagenase clostridium histolyticum (Xiaflex) is an FDA- approved injectable treatment that can break down the scar tissue
- Traction Devices: Penis traction therapy involves using a device to gently stretch the penis over time, helping reduce curvature over time - used for 30-90 min with restoreX and up to 6-8 hours with more traditional penile traction devises
Surgical Management
When Peyronie’s disease has stabilized (usually after 12 months) and the curvature
significantly affects sexual function, surgery might be recommended. The three main
surgical options are:
- Plication Surgery: The shorter side of the penis is stitched to match the length of the curved side
- Plaque Incision/Excision with Grafting: The plaque is cut or removed, and a graft is used to cover the area
- Penile Prosthesis: For men with severe erectile dysfunction, an implant can help restore both function and straightness
Treatments for Peyronies Disease
Type 1 and 2 (Hour glassing and small plaques);
1. Baseline measurements of the plaques or hour glassing;
- Radiological studies
- String and tape measures
- Serial photography
2. Four weeks of physiotherapy 2 x per week including
- Therapeutic ultrasound
- Pump therapy where relevant
- Penile rings where relevant
- Demonstration and explanation of home massage wand stretching with vit E cream
- Release of any tension banding along inguinal ligament (lower abdomen) and to into the base of the penis if relevant
- Pelvic floor muscle assessment and optimisation if relevant (downtraining for tight muscles and strengthening for weakness)

Type 3: Large plaques
We normally refer on to our urological colleagues for the larger plaques and for shock wave therapy trial as we do not find our conservate therapies are useful for the larger plaques
Final Thoughts
While Peyronie’s disease can feel isolating, it’s important to know that there is a building interest discussion and research into better management pathways for this condition.
At Pelvic Health Melbourne we are passionate about being informed and offering all the evidence and advise around the best treatment options for you. We will talk about ways to be intimate with your disease and discuss options for you. We offer Ultrasound therapy for hourglassing and small plaques and demonstrate how to massage the plaques and refer you onto a local provider for shock wave therapy if you would like to persue this option.
Come in and see one of our experienced clinicians for a consultation and discussion about your how your peyronies disease is affecting you.
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