General: In some cases, pain and erectile dysfunction (ED) associated with Peyronie's disease may improve without any treatment. Therefore, a doctor may wait nine to 12 months to see if the condition goes away on its own before recommending any sort of treatment. If the condition does not worsen, and the patient is not bothered by the symptoms, a doctor might recommend no treatment. This is because some treatments may increase a patient's risk of developing erectile dysfunction (ED).
The first line of treatment is generally oral medications. However, oral treatment is only effective during the first 12 to 18 months because this is when plaque is still forming. If medication is ineffective, surgery may be recommended.
Colchicine: A mediation called colchicine may be used to treat Peyronie's disease. This drug stops collagen from growing and may help reduce symptoms of the disease. Side effects of this medication commonly include digestive problems, such as diarrhea.
Potassium aminobenzoate (Potaba®): A medication called potassium aminobenzoate (Potaba®) has also been used to treat Peyronie's disease. This drug helps increase the oxygen supply in tissues, which may help prevent fibrous tissues from forming in the penis. However, the effectiveness of this treatment is unclear. In addition, patients must take up to 24 tablets a day. Side effects commonly include digestive problems.
Vitamin E: Vitamin E supplements have also been used to treat Peyronie's disease, despite limited research on its effectiveness. This is because some cases of Peyronie's disease have been linked to vitamin E deficiencies. Patients should only take vitamin E under the strict supervision of their doctors because high doses may be unsafe.
Intralesional injections: A doctor may inject medications, such as calcium channel blockers (such as verapamil), collagenase, or interferons, into the plaque in the penis. The goal of this therapy is to break down the scar tissue and, therefore, reduce symptoms of the disorder, including pain, ED, and curvature of the penis. Patients receive several injections over the course of several months. The effectiveness of these treatments varies among patients. Researchers are trying to determine what type of intralesional injection offers the most benefit.
Radiation therapy: Radiation therapy, which involves using high-energy waves, has been used to reduce pain caused by Peyronie's disease. Radiation therapy is performed at hospitals. Although this treatment has been shown to alleviate pain, it does not decrease the plaque in the penis. It may also cause many side effects, including fatigue, erectile dysfunction (ED), and decreased testosterone levels.
A surgical procedure called nesbit plication may be performed if all other treatments are unsuccessful. The patient's penis is injected with saline in order to cause an erection. Then, tissue on the unaffected side of the penis is shortened. As a result, the penis will no longer bend when erect. However, this procedure may shorten the penis. This procedure is performed in patients who have large penises that have curves that are less than 45 degrees.
Saphenous vein graft:
A surgical procedure that involves a saphenous vein graft may be performed if all other treatment options fail. During the procedure, several incisions are made in the hard scar tissue, which allows the penis to become straight. The cut tissue is then covered with a grafted vein. This procedure is usually performed in patients who have small penises that have curves that are greater than 45 degrees or an hourglass-shaped curve.
Penile prosthesis: Patients with Peyronie's disease who have erectile dysfunction (ED) may receive penile prostheses. This surgical procedure involves implanting a device to straighten out the penis. The device may either be solid or inflatable. Men who have a solid implant have semi-rigid penises all the time. This type of device helps increase the rigidity of the penis when it is erect. Individuals who have an inflatable implant use a pump to inflate the device and cause an erection.
Counseling: Peyronie's disease may affect the patient's sexual quality of life. Counseling may help patients handle their feelings and concerns about Peyronie's disease. It may also help patients learn how to communicate their feelings to their partners.
Unclear or conflicting scientific evidence
L-carnitine: The human body produces L-carnitine in the liver, kidney, and brain. Early evidence suggests that oral supplements of L-carnitine may help treat Peyronie's disease. However, additional research is needed before a firm conclusion can be made.
Avoid if allergic to L-carnitine. Use cautiously with peripheral vascular disease, high blood pressure, alcohol-induced liver cirrhosis, or diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
Para-aminobenzoic acid (PABA): Para-aminobenzoic acid (PABA) is a naturally occurring non-protein amino acid. Several studies suggest that PABA supplements may help reduce symptoms of Peyronie's disease. However, a firm conclusion cannot be made until additional studies are performed.
Avoid if allergic to PABA or its derivatives. Avoid if taking sulfonamides. Use cautiously with kidney disease, diabetes, low blood sugar levels, bleeding disorders, or if taking blood thinners. Stop taking PABA if rash, nausea, or decreased appetite occurs. Avoid oral use in children and pregnant or breastfeeding women. Other forms of PABA are not recommended if pregnant or breastfeeding, due to a lack of safety data. It is recommended that individuals have their liver function and blood sugar levels monitored while taking PABA.
Traditional or theoretical uses lacking sufficient evidence
Bromelain: Classified as an herb, bromelain is a digestive enzyme that comes from the stem and the fruit of the pineapple plant. Although it has been suggested that bromelain may help treat Peyronie's disease, scientific evidence is currently lacking in this area. A firm conclusion cannot be reached at this time.
Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or other members of the Bromeliaceaefamily. Avoid with liver disease, kidney disease, or bleeding disorders. Use cautiously with bleeding disorders, stomach ulcers, high blood pressure, or acute genitourinary tract inflammation. Use cautiously before dental or surgical procedures or while driving or operating machinery. Use cautiously in children younger than two years of age. Avoid if pregnant or breastfeeding, due to a lack of safety evidence.
Physical therapy: The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury. A variety of techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used during physical therapy sessions. Physical therapy has been proposed as a possible treatment for Peyronie's disease. However, studies have not been performed to determine if this treatment is safe and effective. Research is warranted in this area.
Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. However, physical therapy may aggravate some pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature, although causality is unclear. Erectile dysfunction has also been reported. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
Vitamin E: Vitamin E exists in eight different forms ("isomers"): alpha, beta, gamma, and delta tocopherol; and alpha, beta, gamma, and delta tocotrienol. Alpha-tocopherol is the most active form in humans. Until scientific studies are performed, it remains unknown if vitamin E is a safe and effective treatment for Peyronie's disease.
Avoid if allergic to vitamin E. For short periods of time, and in the recommended doses, vitamin E supplementation is generally considered safe. Avoid doses higher than 1,000 milligrams a day. Avoid with Retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders.
There is currently no known method of prevention for Peyronie's disease. It is possible that the problem may be caused by trauma to the penis after being hit or bent abnormally when erect or during sexual intercourse. Avoiding such injuries may help prevent the development of Peyronie's disease. However, since some cases of Peyronie's disease are not caused by injuries, people may still develop the disorder.