Keep Them Coming: A left hook from Peyronie’s Disease

Kristen Thomas // Photo by Nicole Bissey

The human penis is as varied and unique as our fingerprints. Some are long, some are thin, some have a big head, and some are curved. While a curved penis is considered nothing abnormal medically, a penis-owner may have negative thoughts about their own member not being straight, but it is totally normal.

When is a curved dick a medical issue rather than an aesthetic difference? Peyronie’s disease is when scar tissue has created an intense curve, usually upward or to one side, that causes pain. Peyronie’s disease (PD) can cause a loss of length, girth, and erection strength. It can make sexual intercourse incredibly painful, sometimes impossible.

Pain during sex, alone or partnered, is never normal, no matter what kind of genitals you possess. If pain has begun to interfere with pleasure, and not in a kinky way, you’re encouraged to seek medical advice.

The cause of PD is not known. In literature, blogs, and interviews, most doctors seem to skirt around saying there is a definitive answer, but they will generally point to two factors: inflammation or trauma. There’s a correlation between PD and conditions like low testosterone and autoimmune disorders. However, trauma, or repeated microtraumas to the tunica albuginea, the portion of the shaft responsible for maintaining your erection, seems to be the cause for people with underlying conditions (Paulis et. al, 2015).

Gee, repetitive trauma…what could that be from? Perhaps masturbation? That’s a very repetitive motion, and if you’re always using the same hand or giving your cock the Death Grip treatment, there could be microtrauma to the same location of the shaft over and over, leading to scar tissue, AKA plaque. Repeated rough sex, or a sex injury, can also be the culprit.

Peyronie’s Disease isn’t a rare occurrence. Around 20% of penises have curvature of the shaft, and up to 1 in 100 men have PD, according to a 2018 Australian survey. “One in six men reported an adverse impact of penile curvature in their lives, complaining of penile pain or discomfort when they had an erection, while 26% of men were bothered by the appearance of their penis and 20% were bothered when they tried to have sexual intercourse,” this survey says.

Most patients being treated for PD are in their 50s. Men over 60 have more sexual dysfunction associated with their PD, whereas men under 60 have more psychological distress about their curvature. Increasingly, younger men are being seen by urologists for this condition. A retrospective study by Paulis et. al found PD patients under 40 have a few things in common, such as more frequency, greater progression of the curvature, more pain, and significantly higher angle of curvature. Younger men are clearly in need of some conversations around Peyronie’s Disease. Earlier interventions can make a difference!

Unfortunately, this is a condition that men often wait a long time to be seen for because of fear or stigma. The majority of men will do “almost anything to avoid going to the doctor” (Cleveland Clinic, 2022). With any condition, genital or sexual function-related, there’s an added layer of potential embarrassment at the idea of going to a urologist and saying, “My dick isn’t the same,” and then dropping your drawers for them. Stigma means some men would rather try a wait-and-see method, hoping their symptoms will dissipate on their own. There is also a fundamental lack of awareness of this condition that prevents treatment.

While there is no cure, meaning a 30% curvature will not go back to zero, with treatment, patients can see improvement. A typical treatment plan takes time. Your urologist will want to see if your symptoms stabilize or worsen for around a year.

The first FDA-approved treatment came in 2015 with an injectable called Xiaflex. This shot breaks up the plaque in the penis. Anti-inflammatory NSAID pain relievers like ibuprofen or naproxen sodium may also be recommended. Surgery is a last resort and involves removing the scar tissue if the condition has become severely painful and is interfering with quality of life.

Some people turn to traction devices and penis pumps to help their PD symptoms. While pump companies are required by law to say they don’t treat or cure any conditions, it stands to reason that if habits like the Death Grip or prolonged masturbation may be the culprit, traction or pumps can help stretch the plaque, making the curve less pronounced. However, in some cases, a device could also make things worse, so consult a doctor before you use a pump or traction device, even if it’s awkward to discuss.

The advent of the little blue pill, Viagra, made it easier to discuss erections, but with around 18% of men experiencing acute or chronic PD in their lifetime, and with Peyronie’s on the rise in the under-40 age group, it’s important to start having more conversations about penile health with younger men. And these conversations need to be about more than erection strength.

If you have concerns about your penis curvature, pain during sex, or think your penis is changing in length or girth, or your dick is taking on an hour-glass shape, talk to both a provider and your partner. While medical intervention is an important aspect of your treatment plan, so is working with your long-term partner (if you have one).

Explain to them what PD is and how it’s affecting your perception of yourself and your sexual function. If certain positions or speeds exacerbate pain, please communicate your need to avoid positions. Don’t suffer or pretend it doesn’t hurt just because it’s your or your partner’s favorite position. Use this as an opportunity to have new experiences together. Nuance and communication are both important for maintaining a long-term sexual connection! Again, while there is no cure, Peyronie’s Disease is not the end of your sex life.

But speaking of endings, my time writing for The Pitch has come to a close. This will be my very last column. I have loved hitting ‘send’ to my editor for the last four years! Thank you to every one of the readers who let me know you laughed, learned something new, or had an honest conversation inspired by my column. You can still get my advice via the Keep Them Coming Podcast. Thank you to every single guest who offered their expertise and time. Thank you to The Pitch for giving me a chance to write professionally. It’s been a real dream come true! Wishing you all my best, XOXO Kristen