Peyronie’s disease is an acquired condition, not a disorder a person is born with. It develops later in life and involves the formation of non-cancerous, fibrous scar tissue, known as plaque, within the penis. This plaque causes the penis to bend or curve during an erection, often leading to pain and difficulty with sexual activity. Penile curvature present from birth has a different cause and is a separate medical issue entirely.
Understanding the Difference Between Acquired and Congenital Curvature
The confusion often arises because there is a separate condition known as congenital penile curvature, or chordee, which is present from birth. Congenital curvature results from an abnormality in the structural development of the penis, typically involving a disproportionate length of tissue on one side. Chordee does not involve the formation of scar tissue or plaque and is usually noticed when the boy reaches puberty and begins having erections. Unlike Peyronie’s disease, congenital curvature is rarely associated with pain and the degree of the curve typically remains stable over time. Peyronie’s disease involves a progressive, pathological process that develops in adulthood, usually after age 40, and is characterized by the presence of a palpable, hard scar.
The Pathology of Peyronie’s Disease
Peyronie’s disease is characterized by the localized fibrosis of the tunica albuginea, the dense, elastic sheath surrounding the two erectile chambers (corpora cavernosa). This sheath normally stretches uniformly when the erectile tissue fills with blood, allowing the penis to straighten and stiffen. In Peyronie’s disease, a wound-healing disorder causes the formation of an inelastic plaque within this membrane. This plaque prevents the tunica albuginea from expanding on that side during an erection, pulling the penis toward the scar tissue and resulting in a bend or curvature. The disease progresses through two main phases: the acute phase, marked by inflammation, pain, and worsening curvature (lasting 6 to 18 months), and the chronic phase, where pain resolves and the scar tissue stabilizes, often becoming hard or calcified.
Identifying the Key Causes and Risk Factors
The exact cause of Peyronie’s disease is not fully understood, but the leading theory centers on repeated microtrauma to the penis, particularly during sexual activity. These minor injuries, which may not be consciously recalled, create micro-tears in the tunica albuginea. Instead of healing normally, a disordered wound-healing response is triggered, leading to the excessive deposition of fibrous tissue and the formation of the characteristic plaque.
Genetics play a role, suggested by the association with a family history of the disease. Peyronie’s disease frequently co-occurs with other fibroproliferative disorders, such as Dupuytren’s contracture (tissue thickening in the palm of the hand). Age is also a significant factor, with the condition becoming more prevalent in men between 45 and 70 years old, as tissue elasticity naturally decreases.
Underlying health conditions increase the risk of developing Peyronie’s disease by impairing tissue health and healing mechanisms. These include diabetes mellitus, which can cause microvascular damage, hypertension, and high cholesterol. Erectile dysfunction is also closely linked, as insufficient rigidity during intercourse potentially increases the likelihood of microtrauma, creating a cycle of injury and scarring.
Overview of Diagnosis and Treatment Options
Diagnosis of Peyronie’s disease begins with a physical examination, where a healthcare provider will feel the penis for the presence of the fibrous plaque. An examination of the erect penis, often induced in the clinic or photographed at home, is necessary to accurately assess the degree and direction of the curvature. Imaging, such as a penile ultrasound, may be used to confirm the presence of the plaque, check for calcification, and evaluate blood flow and erectile function.
Treatment options are tailored to the disease phase, focusing on non-surgical interventions during the acute, inflammatory stage. These may include oral medications, though their effectiveness at reducing curvature is uncertain, and penile traction therapy, which aims to minimize length loss and limit curvature progression. Intralesional injections of medication, such as collagenase, which helps break down the scar tissue, may also be administered directly into the plaque.
In the chronic phase, once the curvature has been stable for at least three to six months and pain has resolved, surgical correction becomes an option for men with severe deformity. Procedures may involve plication, which shortens the unaffected side of the penis with sutures to straighten the curve, or grafting, which involves removing the plaque and replacing the tissue. For men with both severe curvature and erectile dysfunction unresponsive to medication, a penile implant may be the most suitable surgical solution, addressing both issues simultaneously.