By Parminder Sethi, MD
Peyronie’s Disease, commonly understood as the abnormal curvature of an erect penis, may affect as many as one in every 12 men, however the causes of the condition remain enigmatic. While men with the disease are able to continue sexual relations, many report sexual gratification coupled with pain. Peyronie’s can be physically and psychologically distressing, and men often withdraw from their partners.
Peyronie’s Disease is the result of scarring from fibrous plaques in the soft tissue of the penis, and causes abnormal curvature, erectile dysfunction, painful sexual intercourse and shortening or loss of penile girth.
Inelasticity is caused by the plaque – in what is otherwise the normal stretchy outer layer of connective tissue in the penis – which restricts the expansion of the affected area during erection.
The restricted tissue results in curvature or incomplete rigidity of the erect penis. Over time, it may also cause chronic inflammation and hardened lesions that sometimes create indentations or divots.
Men with Peyronie’s Disease may accept their condition as either non-problematic or be too embarrassed to discuss their ailment. It is for this reason that studies regarding the prevalence of the disease are scant.
One German study found that the prevalence of Peyronie’s for the male population of greater Cologne was 3.2 percent. Upon physical examination, American urologists in a second study reported that 8.9 percent of men in had a palpable penile plaque.
While there is a large discrepancy in the prevalence of Peyronie’s Disease, experts agree that the occurrence of penile plaque and decreased quality or condition of the erection increases over time. The disease is most commonly found in Caucasian men, 40 years and older.
Though the first references to Peyronie’s Disease were recorded more than 250 years ago – the disease would later become synonymous with the work of the surgeon to Louis XV of France, Francois Gigot de la Peyronie – the etiology remains a mystery. It is widely thought that the condition is caused by physical trauma that is typically sustained during sexual intercourse, with consequent healing and scar formation.
Some researchers have noted a strong association between presence of the disease in men with diabetes and autoimmune disorders. Additionally, it is found in roughly 30 percent of men with fibrotic connective tissue disorders such as Dupuytren’s contracture and carpal tunnel. Peyronie’s Disease is also listed as a possible side effect of some beta blocker medications.
Peyronie’s appears to run in families, leading researches to believe that some men may be genetically predisposed to the disease.
Patients often discover that they have Peyronie’s Disease only after seeking medical help for erectile dysfunction or painful erections. In other cases, men may discover palpable penile plaque, leading them to seek the advice of an urologist. An ultrasound is the surest method of discovering the disease.
If left untreated, it is estimated that 50 percent of patients will see their condition worsen, while 20 percent will see their condition improve or experience complete resolution within the first year.
From surgical intervention to less invasive techniques such as injections into the scar tissue (plaques), there are varying techniques for correction of Peyronie’s Disease. Depending upon the severity of the correction needed, many urologists are looking towards new agents (such as Coenzyme, Collagenase and potassium para-aminobenzoate) to target the inflammation, however further study is needed to assess the effectiveness of these emerging treatments.