Peyronie’s disease (also known as indurations plastica penis) is an acquired inflammatory condition of the penis. The principle manifestation of Peyronie’s disease is the formation of a plaque (a segment of flat scar tissue) within the tunica albuginea of the penis. This plaque can usually be felt through the penile skin. This plaque is not a tumor but it may lead to serious problems such as curved and/or painful erections
The name “Peyronie’s Disease” is derived from the physician Francois Gigot de la Peyronie, personal physician to King Louis XV of France. De la Peyronie wrote an authoritative description of the disorder in 1743 and his name has been associated with the condition since that time.
Peyronie’s Disease Signs & Symptoms
The plaques of Peyronie’s disease most commonly develop on the upper (dorsal) side of the penis. Plaques reduce the elasticity of the tunica albuginea and may cause the penis to bend upwards during the process of erection. Although Peyronie’s plaques are most commonly located on the top of the penis, they may also occur on the bottom (ventral) or side (lateral) of the penis, causing a downward or sideways bend, respectively. Some men have more than one plaque, which may cause complex curvatures.
In some men an extensive plaque that goes all the way around the penis may develop. These plaques typically do not cause curvature but may cause a “waisting” or “bottleneck” deformity of the penile shaft. In other severe cases, the plaque may accumulate calcium and become very hard, almost like a bone. In addition to penile curvature, many patients also report shrinkage or shortening of their penis.
Since there is great variability in this condition, men with Peyronie’s disease may complain of a variety of symptoms. Penile curvature, lumps in the penis, painful erections, soft erections, and difficulty with penile penetration due to curvature are common concerns that bring men with Peyronie’s disease to see their doctors.
Peyronie’s disease can be a serious quality-of-life issue. Studies have shown that over 75% of men with Peyronie’s disease have stress related to the condition. Unfortunately, many men with Peyronie’s disease are embarrassed about the condition and choose to suffer in silence rather than speaking with their health care provider about it.
Recent demographic surveys have reported that Peyronie’s disease can be found in up to 9% of men between the ages of 40 and 70. The condition is rare in young men but has been reported in men in their 30s. The actual prevalence of Peyronie’s disease may be much higher than 9% due to patient embarrassment and limited reporting by physicians.
Interestingly, more Peyronie’s disease cases have been reported in recent years. This is likely due to the availability within the last decade of highly effective oral medications for the treatment of erectile dysfunction (ED). With more men seeking treatment for erectile problems, many cases of Peyronie’s disease that would have gone undiagnosed in the past have come to the attention of the medical establishment. It is likely that the number of men being treated for erectile dysfunction will continue to increase in the future. For this reason, the number of men presenting with Peyronie’s disease will likely continue to increase in the future.
Peyronie’s Disease Causes
Scientists have been mystified by the cause of Peyronie’s disease since before it was characterized by Francois Gigot de la Peyronie. Although the process by which Peyronie’s disease occurs is still not entirely understood, much progress in our understanding of the disorder has been made in recent years.
Most experts believe that Peyronie’s disease is likely the consequence of a minor penile trauma. The most common source of this type of penile trauma is thought to be vigorous sexual activity (e.g., bending of the penis during penetration, pressure from a partner’s pubic bone, etc.) although injuries from sports or accidents may also play a role. Injury to the tunica albuginea may trigger a cascade of inflammatory and cellular events resulting in a process called fibrosis, a medical term for formation of excessive scar tissue. This abnormal scar tissue in turn forms the plaque of Peyronie’s disease.
Not all men who suffer occasional mild trauma to the penis develop Peyronie’s disease. For this reason, most researchers believe that there must be genetic or environmental factors that contribute to the formation of Peyronie’s disease plaques. Men with certain connective tissue disorders (such as Dupuytren’s contractures or tympanosclerosis) and men who have a close relative with Peyronie’s disease have a greater risk of developing the condition. Certain health conditions such as diabetes, tobacco use, or a history of pelvic trauma may also lead to abnormal wound healing and may contribute to the development of Peyronie’s disease.
Peyronie’s disease is in essence a derangement of normal wound healing. Because it is related to normal wound healing, Peyronie’s disease is a very dynamic process early on but over time, the inflammatory changes may decrease. In fact, this disease is usually divided into two distinct stages. The first phase is the acute phase; this portion of the disease persists for six to 18 months and is usually characterized by pain, worsening penile curvature and formation of penile plaques. The second phase is the chronic phase where the deformity remains in a stable state. As in the first stage the deformity may interfere with sexual activity and there may be associated erectile dysfunction. Pain with erection has typically resolved during this phase.
Peyronie’s Disease Diagnosis
A physical examination by an experienced physician is usually sufficient to diagnose Peyronie’s disease. The hard plaques can usually be felt with or without erection. It may be necessary to induce an erection in the clinic for proper evaluation of the penile curvature; this is usually done by direct injection of a medication that causes penile erection. Pictures of the erect penis may also be useful in the evaluation of penile curvature. In some cases an ultrasound or x-ray examination of the penis is used to characterize the plaque and check for the presence of calcification.
Peyronie’s Disease Treatment
In about 13% of cases, Peyronie’s disease goes away without treatment. Many physicians recommend conservative (non-surgical) treatment for at least the first 12 months after symptoms present.
Men with small plaques, minimal penile curvature, no pain, and satisfactory sexual function do not require treatment. Men with active phase disease who do have one or more of the above problems may benefit from medical therapy. Unfortunately, very few well designed clinical trials of medications for Peyronie’s disease have been performed and therefore the true effectiveness of many of these treatments is unclear.