Cause of Peyronie Disease

depressed man, hands folded — Peyronie Disease

Peyronie’s disease, a condition of
uncertain cause, is characterized by a plaque, or hard lump, that forms on the
penis. The plaque develops on the upper or lower side of the penis in layers
containing erectile tissue. It begins as a localized inflammation and can
develop into a hardened scar.

Cases of Peyronie’s disease range from mild
to severe. Symptoms may develop slowly or appear overnight. In severe cases, the
hardened plaque reduces flexibility, causing pain and forcing the penis to bend
or arc during erection. In many cases, the pain decreases over time, but the
bend in the penis may remain a problem, making sexual intercourse difficult. The
sexual problems that result can disrupt a couple’s physical and emotional
relationship and lead to lowered self-esteem in the man. In a small percentage
of patients with the milder form of the disease, inflammation may resolve
without causing significant pain or permanent bending.

The plaque itself is benign, or
noncancerous. A plaque on the top of the shaft (most common) causes the penis to
bend upward; a plaque on the underside causes it to bend downward. In some
cases, the plaque develops on both top and bottom, leading to indentation and
shortening of the penis. At times, pain, bending, and emotional distress
prohibit sexual intercourse.

One study found Peyronie’s disease in 1
percent of men. Although the disease occurs mostly in middle age, younger and
older men can develop it. About 30 percent of men with Peyronie’s disease
develop fibrosis (hardened cells) in other elastic tissues of the body, such as
on the hand or foot. A common example is a condition known as Dupuytren’s
contracture of the hand. In some cases, men who are related by blood tend to
develop Peyronie’s disease, which suggests that genetic factors might make a man
vulnerable to the disease.

Men with Peyronie’s disease usually seek
medical attention because of painful erections and difficulty with intercourse.
Since the cause of the disease and its development are not well understood,
doctors treat the disease empirically; that is, they prescribe and continue
methods that seem to help. The goal of therapy is to keep the Peyronie’s patient
sexually active. Providing education about the disease and its course often is
all that is required. No strong evidence shows that any treatment other than
surgery is effective. Experts usually recommend surgery only in long-term cases
in which the disease is stabilized and the deformity prevents
intercourse.

A French surgeon, François de la Peyronie,
first described Peyronie’s disease in 1743. The problem was noted in print as
early as 1687. Early writers classified it as a form of impotence, now called
erectile dysfunction (ED). Peyronie’s disease can be associated with ED;
however, experts now recognize ED as only one factor associated with the
disease—a factor that is not always present.

Course of the Disease

Many researchers believe the plaque of
Peyronie’s disease develops following trauma (hitting or bending) that causes
localized bleeding inside the penis. Two chambers known as the corpora
cavernosa run the length of the penis. The inner-surface membrane of the
chambers is a sheath of elastic fibers. A connecting tissue, called a septum,
runs between the two chambers and attaches at the top and
bottom.

If the penis is abnormally bumped or bent,
an area where the septum attaches to the elastic fibers may stretch beyond a
limit, injuring the lining of the erectile chamber and, for example, rupturing
small blood vessels. As a result of aging, diminished elasticity near the point
of attachment of the septum might increase the chances of
injury.

The damaged area might heal slowly or
abnormally for two reasons: repeated trauma and a minimal amount of blood flow
in the sheath-like fibers. In cases that heal within about a year, the plaque
does not advance beyond an initial inflammatory phase. In cases that persist for
years, the plaque undergoes fibrosis, or formation of tough fibrous tissue, and
even calcification, or formation of calcium deposits.

While trauma might explain acute cases of
Peyronie’s disease, it does not explain why most cases develop slowly and with
no apparent traumatic event. It also does not explain why some cases disappear
quickly or why similar conditions such as Dupuytren’s contracture do not seem to
result from severe trauma.

Some researchers theorize that Peyronie’s
disease may be an autoimmune disorder.

Diagnosis and Evaluation

Doctors can usually diagnose Peyronie’s
disease based on a physical examination. The plaque is visible and palpable
whether the penis is flaccid or erect. Full evaluation, however, may require
examination during erection to determine the severity of the curvature. The
erection may be induced by injecting medicine into the penis or through
self-stimulation. Some patients may eliminate the need to induce an erection in
the doctor’s office by taking a digital or Polaroid picture in the home. The
examination may include an ultrasound scan of the penis to pinpoint the location
and extent of the plaque and evaluate blood flow throughout the
penis

Treatment

Because the course of Peyronie’s disease is
different in each patient and because some patients experience improvement
without treatment, medical experts suggest waiting 1 to 2 years or longer before
attempting to correct it surgically. During that wait, patients often are
willing to undergo treatments whose effectiveness has not been
proven.