What Are the Options for Treating Peyronie’s Disease in Iraq?

What Are the Options for Treating Peyronie’s Disease in Iraq?

Peyronie’s disease can be stressful for many men because it affects both the shape of the penis and confidence during sexual activity. The condition usually develops when scar tissue, called a plaque, forms inside the penile tissue. During erection, this plaque does not stretch like normal tissue, which can lead to curvature, pain, shortening, narrowing, or difficulty with penetration.

In Iraq, treatment options for Peyronie’s disease depend mainly on three things: the stage of the disease, the degree of curvature, and whether the patient also has erectile dysfunction.

There is no single treatment that fits every patient. Some men only need monitoring and pain control, while others may need traction therapy, injections, corrective surgery, or penile implant surgery if Peyronie’s disease is associated with severe erectile dysfunction.

What Is Peyronie’s Disease?

Peyronie’s disease is a benign, non-cancerous condition caused by fibrous scar tissue inside the penis. This scar tissue can make the penis bend during erection. It may also cause pain, a palpable hard plaque, narrowing, an hourglass shape, shortening, or erectile dysfunction.

Dr. Anas M. Hasan’s Arabic guide explains that Peyronie’s disease is not a malignant tumor and does not turn into cancer. It is usually related to abnormal healing inside the tunica albuginea, the elastic layer surrounding the erectile bodies of the penis. When one area becomes stiff and less elastic, the penis bends toward that side during erection.

Why Treatment Depends on the Stage of the Disease

The first step in choosing the correct treatment is identifying whether the disease is in the active phase or the stable phase.

Active Phase

The active phase is the early stage of Peyronie’s disease. It may last several months and is usually associated with:

• Penile pain.

• A curvature that is still changing.

• New plaque formation.

• Anxiety because the shape is not stable yet.

During this stage, surgery is usually avoided because the curvature may continue to change. Treatment is often focused on pain control, monitoring, preventing progression, and preserving function.

Dr. Anas’s Arabic article explains that the active phase may last around 6 to 18 months and is usually managed with conservative or non-surgical options while waiting for the condition to stabilize.

Stable Phase

The stable phase begins when pain improves and the curvature stops worsening. At this stage, the doctor can evaluate whether the curvature prevents intercourse and whether surgery is needed.

The European Association of Urology recommends surgery only when Peyronie’s disease is stable and sexual intercourse is compromised by the deformity.

Option 1: Observation and Follow-Up

Not every man with Peyronie’s disease needs immediate treatment.

Observation may be suitable when:

• The curvature is mild.

• Sexual intercourse is still possible.

• Pain is limited or improving.

• There is no significant erectile dysfunction.

• The condition is still changing and not yet stable.

In these cases, the doctor may monitor the curvature, pain, erectile function, and plaque changes over time.

Observation does not mean ignoring the condition. It means the case is being followed medically before choosing a more invasive treatment.

Option 2: Pain Control During the Active Phase

Pain is more common in the early phase of Peyronie’s disease. In many men, pain improves as the disease becomes stable.

Treatment during this stage may include pain-relief medication when appropriate, avoiding activities that worsen penile trauma, and follow-up with a urologist to monitor whether the curvature is increasing.

Pain treatment alone does not usually correct the curvature. Its role is to improve comfort while the disease is still active.

Option 3: Penile Traction Therapy

Penile traction therapy uses a medical stretching device applied to the penis for a prescribed period. The goal is to apply controlled, gentle tension to the tissue.

Traction may help some patients by:

• Reducing curvature.

• Preserving penile length.

• Supporting treatment during early or stable disease.

• Helping as part of a combined treatment plan.

The EAU guideline states that penile traction devices and vacuum devices may be offered to reduce penile deformity or as part of multimodal therapy, although outcome data is limited.

Traction therapy requires commitment. It is not a one-time treatment, and patients should only use medically appropriate devices under guidance.

Option 4: Intralesional Injections

Intralesional injections are injections given directly into the Peyronie’s plaque. The goal is to reduce plaque stiffness and improve curvature.

Possible injection options mentioned in international guidelines include:

• Collagenase clostridium histolyticum.

• Interferon.

• Verapamil.

Collagenase is the best-known option internationally. The American Urological Association states that clinicians may administer intralesional collagenase with penile modeling in patients with stable Peyronie’s disease, curvature greater than 30 degrees and less than 90 degrees, and intact erectile function.

However, injection treatment is not suitable for every patient. It depends on:

• Whether the disease is stable.

• The degree and direction of curvature.

• Plaque characteristics.

• Erectile function.

• Availability of the medication.

• Cost and treatment protocol.

• Doctor experience.

Patients should also be informed about possible side effects such as bruising, swelling, pain, and rare but serious complications. The AUA guideline specifically recommends counseling patients about adverse events before collagenase treatment.

Option 5: Oral Medications

Many patients ask whether Peyronie’s disease can be treated with tablets alone.

The realistic answer is that oral medications have limited evidence for correcting significant penile curvature. They may be used in selected cases for symptoms or as part of a broader plan, but they should not be presented as a guaranteed cure for deformity.

Dr. Anas’s Arabic article also notes that many oral medications have been tried historically, but modern evidence shows limited effectiveness in significantly reducing curvature.

This is important for patients in Iraq because many men delay proper evaluation while trying supplements, creams, or unproven treatments. Delaying care may allow the deformity to become more severe.

Option 6: Plication Surgery

Plication is a surgical option used to straighten the penis by placing stitches on the longer side opposite the curvature.

It is often considered when:

• The disease is stable.

• The curvature prevents intercourse.

• Erectile function is good.

• The curvature is mild to moderate.

• Penile length is adequate.

The advantage of plication is that it is generally less complex than grafting. The main downside is that it may cause some shortening, because the longer side is tightened to match the shorter side.

Dr. Anas’s Arabic Peyronie’s article describes plication as effective and safe, but notes that it may cause slight shortening and is usually more suitable for mild to moderate curvature with good penile length.

Option 7: Incision or Excision With Grafting

Grafting surgery is usually reserved for more complex Peyronie’s cases.

It may be considered when the patient has:

• Severe curvature.

• Complex deformity.

• Hourglass narrowing.

• Significant indentation.

• Good erectile function.

• Concern about preserving length.

In this operation, the surgeon releases or removes the scarred area and places a graft to cover the defect. The advantage is that it may better preserve length in selected cases. The downside is that it is more complex and may carry a higher risk of postoperative erectile dysfunction.

Dr. Anas’s article explains that incision or excision with grafting is used for more complex cases such as severe curvature or hourglass deformity, but it may carry a higher risk of erectile dysfunction after surgery.

Option 8: Penile Implant Surgery

Penile implant surgery is usually considered when Peyronie’s disease is combined with severe erectile dysfunction that does not respond to medication or other treatments.

In these cases, the problem is not only curvature. The patient also cannot achieve or maintain a firm erection suitable for intercourse. A penile implant can address erection rigidity and allow the surgeon to correct curvature during the same operation when needed.

The AUA guideline states that clinicians may perform adjunctive procedures such as modeling, plication, or incision/grafting when significant deformity remains after penile prosthesis insertion. It also states that inflatable penile prosthesis should be used for patients undergoing prosthetic surgery for Peyronie’s disease.

The EAU guideline also recommends penile prosthesis implantation, with or without additional straightening procedures, in Peyronie’s disease patients with erectile dysfunction that does not respond to medication.

Dr. Anas’s Arabic article describes penile implant surgery as the final and most appropriate solution for patients who have Peyronie’s disease with severe erectile dysfunction that has not responded to other treatments.

How Does the Doctor Choose the Right Treatment?

The best treatment is chosen after proper evaluation, not by the name of the disease alone.

The doctor usually considers:

• Degree of curvature.

• Direction of curvature.

• Whether penetration is possible.

• Presence of pain.

• Whether the disease is active or stable.

• Erectile function.

• Penile length.

• Presence of hourglass deformity.

• Plaque location and calcification.

• Previous treatments.

• Patient expectations.

This is why measuring the curvature correctly is important. Dr. Anas’s article on curvature measurement explains that accurate measurement helps determine whether the patient needs observation, non-surgical treatment, injections, or surgery. It also explains the importance of taking clinical photos from different angles or using in-clinic duplex ultrasound when needed.

When Should You See a Doctor?

You should see a urologist or andrology specialist if you notice:

• New penile curvature.

• Pain during erection.

• A hard plaque or lump under the skin.

• Difficulty with penetration.

• Worsening curvature.

• Hourglass narrowing.

• Loss of penile length.

• Erectile dysfunction.

• Psychological distress or avoidance of intimacy.

Dr. Anas’s article on measuring Peyronie’s curvature warns that waiting out of embarrassment is one of the biggest mistakes, especially when pain, worsening curvature, difficulty with intercourse, erectile dysfunction, hourglass deformity, or psychological distress are present.

Peyronie’s Disease Treatment in Iraq

In Iraq, patients with Peyronie’s disease should look for a urologist or andrology surgeon who can offer a full treatment pathway, not only one option.

A complete Peyronie’s disease evaluation may include:

• Medical and sexual history.

• Physical examination.

• Curvature measurement.

• Assessment of erectile function.

• Review of photos taken during erection.

• Penile duplex ultrasound in selected cases.

• Discussion of non-surgical and surgical options.

Dr. Anas M. Hasan evaluates Peyronie’s disease, penile curvature, erectile dysfunction, and cases that may require penile implant surgery. Treatment may include monitoring, traction therapy, injection options when suitable, corrective surgery, or penile implant surgery for patients who also have severe erectile dysfunction.

Which Treatment Is Best?

There is no single “best” treatment for all Peyronie’s disease patients.

A simple way to understand treatment selection is:

• Mild curvature with no sexual difficulty: observation may be enough.

• Active phase with pain: conservative treatment and follow-up may be recommended.

• Stable curvature with good erections: injections, traction, plication, or grafting may be considered depending on severity.

• Severe curvature with good erections: grafting or plication may be considered depending on the case.

• Peyronie’s disease with severe erectile dysfunction: penile implant surgery may be the strongest option.

The goal is not always to make the penis perfectly straight. The goal is to achieve a functionally straight penis that allows comfortable intercourse and restores confidence.

Frequently Asked Questions

Can Peyronie’s disease go away on its own?

In some men, pain may improve over time, but significant curvature often does not fully disappear. A medical evaluation is recommended when curvature affects intercourse, worsens, or is associated with erectile dysfunction.

Is Peyronie’s disease cancer?

No. Peyronie’s disease is benign and is not penile cancer. It is caused by fibrous scar tissue inside the penis.

Can tablets cure Peyronie’s disease?

Tablets alone usually have limited evidence for correcting significant curvature. They may be used in selected cases, but patients should not rely on unproven oral treatments as a guaranteed cure.

When is surgery needed?

Surgery is usually considered when the disease is stable and the deformity prevents or significantly affects sexual intercourse. The EAU recommends surgery only when Peyronie’s disease is stable and intercourse is compromised.

What is the best treatment if Peyronie’s disease comes with erectile dysfunction?

If erectile dysfunction is severe and does not respond to medication, penile implant surgery may be the most effective option because it restores rigidity and allows correction of curvature during the same operation.

Can Peyronie’s disease be treated in Iraq?

Yes. Treatment options in Iraq may include evaluation, observation, traction therapy, injection therapy when appropriate, corrective surgery, and penile implant surgery for advanced cases with erectile dysfunction.

Is traction therapy useful?

Penile traction therapy may be offered to reduce deformity or as part of a combined treatment plan, but results vary and evidence is limited.

Can Peyronie’s disease cause erectile dysfunction?

Yes. Peyronie’s disease may be associated with difficulty achieving or maintaining erections. Dr. Anas’s article notes that erectile dysfunction may occur with Peyronie’s disease and may even appear before other symptoms in some patients.

This article is for educational purposes only and does not replace a medical consultation. Treatment decisions should be made after examination and evaluation by a qualified urologist or andrology specialist.