Penile fibrosis consists of rigid scars that can cause curvature and affect male sexual performance.
Penile fibrosis is a pathological condition characterized by the excessive formation of fibrous tissue.
But why is it so important? During the erection process, the smooth muscle tissue of the corpora cavernosa relaxes, allowing blood to flow into the organ. Without the tunica albuginea, a fibrous and elastic layer that surrounds the corpora cavernosa and helps “trap” the blood, the erection cannot be maintained. This is when erectile dysfunction may arise.
Penile fibrosis can develop for several reasons, but the diagnosis should only be made by urologists. Therefore, if you notice anything unusual in this regard, seek medical help as soon as possible. Early diagnosis makes it possible to properly assess the condition and guide follow-up and treatment options when necessary.
The fibrous tissue we are referring to is mainly composed of collagen. It is what gives the penis its normal “elasticity,” which helps during erection.
What is penile fibrosis?
Penile fibrosis is the accumulation of fibrous tissue in the tunica albuginea. Because excess fibrous tissue reduces the expansion capacity of the tunica albuginea, deformities usually become visible only when the penis is erect.
An analogy that helps explain what penile fibrosis does to the penis is to imagine a balloon with a piece of adhesive tape attached to its surface. When inflated, the taped area does not expand and becomes deformed.
A penis with fibrosis may become curved, and the degree of curvature can vary.
In fact, this is what determines whether a man’s sex life will be affected or not. In severe cases of penile fibrosis, a curved penis may make penetration during intercourse difficult or even impossible.
What causes penile fibrosis?
Penile fibrosis may develop after an injury or trauma to the penis, such as falls, sports-related accidents, more vigorous sexual activity, and even masturbation.
However, penile fibrosis may also be associated with other conditions, such as:
- Peyronie’s disease;
- Diabetes;
- High blood pressure;
- High cholesterol;
- Excessive force on the penis while sleeping face down;
- Lack of lubrication;
- Pelvic surgeries, such as prostate removal surgery.
Some specialists believe that repeated mechanical factors, such as compression or improper positioning of the penis during erections, may be associated with microtrauma.
This happens because if the penis is positioned to the side and an erection occurs, the compression caused by very tight underwear may increase the risk of microinjuries.
Another factor that may contribute to the formation of penile fibrosis is tucking the penis to the side. If a man has an erection and forces it to remain sideways, this may also lead to scar formation inside the penis.
4 types of penile fibrosis
The main types of penile fibrosis are:
| Type of Fibrosis | Characteristics |
| Superficial fibrosis | Affects the tunica albuginea of the penis, causing upward, sideways, and/or downward curvature. |
| Deep fibrosis | Located in the corpora cavernosa, it prevents their expansion, leading to loss of axial rigidity and making penetration difficult. In general, this type of fibrosis is responsible for penile narrowing. |
| Localized fibrosis | It may form at a single point on the penis, such as the base, middle, or tip, resulting in curvature or narrowing. |
| Diffuse fibrosis (2+ points) | It occurs when fibrosis develops in multiple regions, leading to several deformities, such as two or more curvatures and/or areas of narrowing. |
| Multiple calcifications | They may occur in several parts of the penis and may be located on the top, sides, or tip of the organ. |
In addition, penile fibrosis can be divided into superficial and internal fibrosis. Superficial fibrosis is responsible for penile curvature because it affects the elastic tissue, reducing one side.
There is also internal penile fibrosis. In addition to penile curvature, it has an even more significant consequence for sexual activity: impaired blood circulation inside the penis, which limits blood flow and directly interferes with erectile capacity and the patient’s sexual performance.
It is important to emphasize that any sign of penile fibrosis should be evaluated by a urologist and, when necessary, treated.
How to identify penile fibrosis?
It is possible to perform a penile palpation self-exam with the penis either erect or flaccid. However, consulting a urologist is the most appropriate option when symptoms are more noticeable.
| Type of self-exam | How to perform it and what to look for |
| Flaccid penis | Pull the penis by the glans and palpate it along its entire length (sides, top, and underside). The goal is to identify thicker areas of tissue at the base of the penis. |
| Erect penis | Assess whether there is curvature or narrowing in the area where the fibrosis has developed. |
During palpation, any change in the organ should be observed, especially lumps.
It is important to point out that only 70% of cases in which the penis has fibrosis can be identified through palpation. In 30% of cases, there is only loss of elasticity, and scar tissue cannot be detected through self-examination.
Pain during erection may also indicate that something is wrong and requires medical attention.
Therefore, if you notice any of these signs, seek a urologist as soon as possible.
Common symptoms of penile fibrosis
Knowing the symptoms of penile fibrosis can help the patient seek medical evaluation if they notice changes. The main ones are:
- Difficulty getting or maintaining an erection;
- Pain during erection or sexual activity;
- Curvature or deformity of the penis when erect.
Does penile fibrosis hurt?
Yes. Depending on the degree, it may cause pain.
It is important to note that pain intensity may vary. Some men may feel mild discomfort, while others may experience sharp pain.
Penile fibrosis may result in penile pain for several reasons:
- During erection: fibrous tissue does not expand like normal penile tissue, which may cause pain when the penis becomes erect.
- Due to deformity: the curvature or deformity of the penis, which may accompany fibrosis, may also lead to discomfort or pain during sexual activity.
- In the scar tissue: scar tissue formation may be sensitive or painful to the touch.
Pain should not be ignored, and consulting a urologist is the best way to understand the causes and obtain an appropriate diagnosis and treatment.
I have penile fibrosis, now what?
Many patients are able to maintain a satisfying sex life after medical evaluation and treatment recommended by a physician.
When visiting a urologist, an induced erection test will be performed to assess penile blood flow and the type and stage of the existing fibrosis.
If the penile fibrosis is mild and does not cause deformity severe enough to interfere with getting or maintaining an erection, the condition may be treated with medications to help prevent worsening and further consequences.
However, if the fibrosis has extended, caused a significant deformity in the penis, or interferes with erection, in some cases medical treatment may not provide a satisfactory response.
What treatment options are available for penile fibrosis?
There are different therapeutic approaches that may be considered depending on each case. In addition, seeking medical guidance at the first signs may help prevent the condition from progressing. This reduces the likelihood of requiring more complex treatments later on.
Therefore, the best treatment for penile fibrosis depends on the stage of the condition. See below:
Mild penile fibrosis
Mild penile fibrosis does not cause severe penile deformities or serious degrees of erectile dysfunction. Therefore, non-surgical treatment with a combination of colchicine and vitamin E may be considered to help slow the progression of existing fibrosis and delay the formation of new scars.
Drug treatment for penile fibrosis may also include intracavernosal Verapamil injections.
In the study “Intralesional verapamil for the treatment of Peyronie’s disease,” the authors reviewed the published literature and found that most men reported a reduction in penile fibrosis sequelae, such as less pain, partial reversal of curvature, and improved sexual function.
Another option is Xiaflex injections (still unavailable in Brazil). According to the study “Xiaflex for the treatment of Peyronie’s disease,” injections of this medication are safe and effective as a first-line treatment for Peyronie’s disease.
Related: Learn about 3 types of ointment for Peyronie’s disease and the effectiveness of each one
Severe penile fibrosis
When penile fibrosis progresses or becomes calcified, the necessary treatment for the condition may be penile fibrosis surgery.
As the fibrotic plaque worsens, penile deformity becomes more pronounced, potentially reaching 90 degrees, and erection becomes increasingly challenging.
To treat this type of case, the surgical procedure may aim to correct the curvature and restore penile anatomy within the limits allowed by the structure of the organ.
In addition to treating fibrosis, surgery may involve placing a penile prosthesis of the largest possible size and girth, while respecting penile anatomy after restoration of dimensions.
Penile implant surgery is indicated to provide enough rigidity for sexual intercourse and is one of the alternatives used in cases of erectile dysfunction associated with fibrosis.
Is it possible to have a normal sex life even with penile fibrosis?
Yes. With proper treatment and/or surgery recommended by a urologist, it may be possible to maintain a healthy and active sex life.
However, it is necessary to assess whether the fibrosis is localized and whether the deformity caused by it does not interfere with penile rigidity or cause frequent slippage during penetration.
It is also important for the patient to take care of sexual health so that penile fibrosis does not worsen and lead to more serious problems, such as narrowing and marked curvature, or further penile injury that may cause additional fibrosis.
If the condition does not compromise penile function, the patient may continue life without the need for drug treatment or surgery.
Take active care of your health with Dr. Paulo Egydio
Penile fibrosis is a complex condition that requires attention and appropriate treatment to avoid serious complications.
There are currently different therapeutic options that may be considered according to medical evaluation, and early intervention may help prevent penile fibrosis from progressing to more advanced stages.
If you have any of the symptoms mentioned above, it is time to seek a specialist to pursue a healthy and safe sex life. Specialized follow-up is essential for the proper management of each case.
Request your pre-assessment with Dr. Paulo Egydio, a urologist specialized in penile curvature, and receive personalized instructions by email within 24 hours.
Investing in penile health means investing in quality of life and sexual health.
