Peyronie’s Disease: Understanding, Causes, and Management

Introduction

Peyronie’s disease is a connective tissue disorder of the penis characterized by the development of fibrous scar tissue, known as plaques, within the tunica albuginea — the thick sheath surrounding the corpora cavernosa. This condition results in penile curvature, pain during erections, and, in severe cases, erectile dysfunction. Though often underreported due to embarrassment, Peyronie’s disease affects an estimated 5–10% of men, primarily between the ages of 40 and 70. It significantly impacts sexual health, self-esteem, and quality of life.

Pathophysiology and Causes

The exact cause of Peyronie’s disease remains unclear, but the prevailing theory suggests that it results from repeated microtrauma to the penis during sexual intercourse or physical activity. In most men, such minor injuries heal normally. However, in those predisposed to Peyronie’s disease, abnormal wound healing occurs — fibroblasts produce excessive collagen, forming dense fibrous plaques rather than normal elastic tissue.

Genetic factors may also play a role; studies show associations with Dupuytren’s contracture (a similar condition affecting the hand). Additionally, oxidative stress and inflammation are thought to contribute to abnormal scar formation. The disease often manifests in two phases:

1. Acute phase (first 6–18 months): Characterized by pain, inflammation, and progressive curvature.

2. Chronic phase: The plaque stabilizes, pain typically subsides, and curvature becomes fixed.

Clinical Manifestations

The hallmark symptom of Peyronie’s disease is penile curvature during erection, which may bend upward, downward, or to the side. Other common symptoms include:

• Palpable hard plaques under the penile skin.

• Pain during erection or sexual activity.

• Shortening or narrowing (“hourglass deformity”) of the penis.

• Difficulty with penetration and erectile dysfunction.

The degree of curvature varies widely, from mild cosmetic deformities to severe bends that make intercourse impossible. The psychological burden can be profound, leading to anxiety, depression, and relationship difficulties.

Diagnosis

Diagnosis primarily relies on clinical evaluation. A urologist performs a physical examination to detect plaques and assess curvature, often using photographic evidence or induced erection for measurement. Ultrasound imaging may be used to evaluate plaque size, location, and calcification. In rare cases, other imaging studies like MRI are utilized for complex presentations.

Treatment Options

Management depends on the stage and severity of the disease, as well as the patient’s symptoms and preferences.

1. Non-Surgical Treatments:

   • Oral medications: Agents like vitamin E, colchicine, pentoxifylline, or potassium para-aminobenzoate (Potaba) have been tried, but results are inconsistent.

   • Intralesional injections: Collagenase clostridium histolyticum (Xiaflex) is FDA-approved and helps break down plaque collagen, reducing curvature in many cases.

   • Shockwave therapy and traction devices: Used to reduce pain and improve length or curvature.

   • Lifestyle modifications: Smoking cessation and management of comorbidities like diabetes and hypertension may help prevent progression.

2. Surgical Treatments:
   Reserved for patients with stable disease (typically after 12 months) and severe deformities affecting intercourse. Options include:

   • Plication procedures (shortening the longer side).

   • Plaque incision or excision with grafting (to restore length).

   • Penile prosthesis implantation (for those with severe erectile dysfunction).

Psychological and Emotional Impact

Beyond physical deformity, Peyronie’s disease can have a major psychological toll. Feelings of inadequacy, embarrassment, and sexual anxiety are common. Partner distress also occurs, emphasizing the need for psychological counseling and couple’s therapy as part of comprehensive management.

Conclusion

Peyronie’s disease is a complex condition affecting both physical and emotional well-being. Although its exact cause remains elusive, advances in diagnosis and treatment — particularly with injectable collagenase and refined surgical techniques — offer hope for effective management. Early recognition, open communication with healthcare providers, and a holistic approach encompassing both medical and psychological care are essential to improving outcomes for men with this challenging disorder.