Peyronie's disease is a connective tissue disorder that causes flat scar tissue (a plaque) to form within the penis. Possibly triggered by injury, Peyronie's disease begins with localized inflammation that, over time, turns into a hard plaque. The condition can be painful and, depending on the location of the scar tissue, often causes the penis to bend either up or down during erections.
What Causes Peyronie's Disease?
The cause of Peyronie's is not fully understood, but it may result from damage to the penis. The penis has a sponge-like tube (corpus cavernosum) on each side that consists of small blood vessels. When a man is aroused, blood flows through the corpus cavernosa and causes the penis to stretch and stiffen. The corpus cavernosa are covered and protected by a thick sheath of tissue, called the tunica albuginea, that also expands during an erection. If the shaft of the penis is injured, usually through sexual activity, tiny blood vessels in the tunica albuginea can rupture and scar tissue can form.
Not all penile injuries result in Peyronie's disease, and not all cases of Peyronie's can be traced back to injury. An immune cell marker for the condition has been found, and this may indicate that heredity also plays a role.
Symptoms of Peyronie's Disease
Scar tissue, inflammation, and an arc to the penis are the most common indicators of Peyronie's disease. Other signs and symptoms can include:
- Problems achieving and maintaining an erection (erectile dysfunction)
- Shortening of the penis, which can occur if plaque develops on both the top and bottom of the penis
- Pain: As scar tissue grows and hardens, movement of the penile tissues is restricted and can cause the penis to bend during an erection, which can be painful in severe cases.
- Difficulty with penetration during sexual intercourse
Symptoms may develop slowly or suddenly. In mild cases, the inflammation may resolve without resulting in a permanent bend. In more severe instances, however, symptoms may lessen over time, but the erect penis may continue to bend, making sexual activity difficult and uncomfortable.
Incidence and Risk of Peyronie's Disease
Peyronie's disease affects anywhere from 1 to 23 percent of men between the ages of 40 to 70. Thirty percent of those with the condition also have hardened tissue on other body parts.
Beyond injury—which can occur while playing sports, engaging in sexual activity, or during surgery or radiation treatment on the prostate—various factors may increase a man's susceptibility to Peyronie's disease.
- Heredity: If a man's father or brother has Peyronie's disease, it is likely he will develop it as well.
- Connective tissue disorders: Men with these disorders are often at greater risk of developing the disease.
- Age: The tunica albuginea, which covers the corpus cavernosum tubes in the penis, is about 90 percent collagen and 5 percent elastin. A man loses collagen as he ages, something that can make tunica albuginea more vulnerable to injury.
Diagnosis of Peyronie's Disease
A physical exam is typically all it takes for a physician to diagnose the condition. The plaque can be detected in a flaccid penis but, in some cases, an erection may be necessary in order to determine the severity of the disease.
An ultrasound or x-ray can determine the location and extent of the plaque. And, if erectile dysfunction is one of the symptoms, the imaging test can also evaluate blood flow.
Treatment for Peyronie's Disease
Because research has not yet determined the root cause, many treatments for Peyronie's disease are experimental. Physicians may prescribe antibiotics or a variety of different therapies (including vitamin E), depending on the symptoms. Surgery is typically recommended for chronic cases.
References
Jordan GH, & McCammon KA. (2011). Surgery of the penis and urethra. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier. Chap 36.
Ralph DJ, & Minhas S. (2004). The management of Peyronie's disease. BJU International 93 (2): 208–15.
Levine, LA. (2003). Review of current nonsurgical management of Peyronie's disease. International Journal of Impotence Research 15 (Suppl 5): S113–20.
