Peyronie's Disease

As the channel for semen and urine, the penis serves two important functions in men. But a disease described as early as the mid-18th century by a French physician, Francois Gigot de la Peyronie, which causes hardened patches on the penile shaft, can severely impact a man's sexual performance. If you have pain and penile curvature characteristic of Peyronie's disease, the following information should help you understand your condition.

What happens under normal conditions?

The penis is a cylindrical organ consisting of three chambers: paired corpora cavernosa that are surrounded by a protective tunica albuginea; a dense, elastic membrane or sheath under the skin; and the corpus spongiosum, a singular channel, located centrally beneath and surrounded by a thinner connective tissue sheath. It contains the urethra, the narrow tube that carries urine and semen out of the body.

These three chambers are made up of highly specialized, sponge-like erectile tissue filled with thousands of venous cavities, spaces that remain relatively empty of blood when the penis is soft. But during erection, blood fills the cavities, causing the corpora cavernosa to balloon and push against the tunica albuginea. While the penis hardens and stretches, the skin remains loose and elastic to accommodate the changes.

What is Peyronie's disease?

Peyronie's disease (also known as fibrous cavernositis) is an acquired inflammatory condition of the penis. It is the formation of a plaque or hardened scar tissue beneath the skin of the penis. This scarring is non-cancerous, but often leads to painful erection and curvature of the erect penis (a "crooked penis").

What are the symptoms of Peyronie's disease?

This scarring, or plaque, typically develops on the upper side of the penis (dorsum). It reduces the elasticity of the tunica albuginea in that area and, as a result, causes the penis to bend upward during an erection. Although Peyronie's plaque is most commonly located on the top of the penis, it may occur on the underside or on the lateral side of the penis, causing a downward or lateral bend. Some patients may even develop a plaque that goes all the way around the penis, causing a "waisting" or "bottleneck" deformity of the penile shaft. The majority of patients complain of generalized shrinkage or shortening of their penis.

Painful erections and difficulty with intercourse usually lead men with Peyronie's disease to seek medical help. Since there is great variability in this condition, sufferers may complain of any combination of symptoms: Penile curvature, obvious penile plaques, painful erection and diminished ability to achieve an erection.

Any of those physical deformities make Peyronie's disease a quality-of-life issue. Not surprising, it is linked to erectile dysfunction in 20 to 40 percent of sufferers. While studies have shown that 77 percent of men demonstrate significant psychological effects, the numbers, medical researchers believe, are under reported. Instead, many men affected with this truly devastating condition suffer in silence.

How frequently does Peyronie's disease occur?

Peyronie's disease affects a reported one to 3.7 percent (about one to four in 100) of males between ages 40 and 70, even though severe cases have been reported in younger men. Medical researchers believe the actual prevalence may be higher due to patient embarrassment and limited reporting by physicians. Since the introduction of sildenafil citrate, an oral therapy for impotence, doctors have reported increased incidence of Peyronie's cases. With more men being treated successfully for erectile dysfunction in the future, an increasing number of cases presenting to urologists are anticipated.

What causes Peyronie's disease?

Ever since Francois Gigot de la Peyronie, personal physician to King Louis XV, first reported penile curvature in 1743, scientists have been mystified by the causes of this well-recognized disorder. Yet medical researchers have speculated on a variety of factors that might be at work.

Most experts believe that acute or short-term cases of Peyronie's disease are likely the consequence of a minor penile trauma, sometimes caused by sports injuries, but more often by vigorous sexual activity (e.g., the penis accidentally being jammed into a mattress). In injuring the tunica albuginea, that trauma triggers a cascade of inflammatory and cellular events resulting in the abnormal fibrosis (excess fibrous tissue), plaque and calcifications characteristic of this disease.

Such trauma, however, may not account for those Peyronie's cases that begin slowly and become so severe that they require surgery. Researchers believe genetics or relationship with other connective tissue disorders may play a role. Studies already suggest that if you have a relative with Peyronie's disease you have a greater risk of developing it yourself.

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How is Peyronie's disease diagnosed?

A physical examination is sufficient to diagnose curvature of the penis. The hard plaques can be felt with or without erection. It may be necessary to use injectable medications to induce an erection for proper evaluation of the penile curvature. The patient may also provide pictures of the erect penis for evaluation by the physician. Ultrasound of the penis may demonstrate the lesions in the penis but is not always necessary.

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