***Trost Commentary and Key Take-Home Points***
This was a study that we did of men who we treated for PD while at Mayo Clinic. We basically asked all men to complete a questionnaire that included a question as to whether or not the condition caused their partner pain. We then compared differences between men who answered yes or no to this question to try to look for patterns. Overall, the key take home points were that men with more severe curvature and those with specific directions (down / side ways for men with female partners) were more likely to respond yes. In my experience, the exact angle of curvature where people start getting affected tends to be around 50-55 degrees when bending upward (dorsal) or 30-40 degrees when to the side or down.
Peyronie’s disease is a disorder caused by fibrous plaques forming in the shaft of the penis, leading to curvature, pain, deformity, shortening and erectile dysfunction. Up to 20% of men in certain populations will experience Peyronie’s disease and while the pain usually resolves on its own, treatment is often needed to correct the other issues such as curvature and deformity.
Amid the physical symptoms, men with Peyronie’s disease also can experience emotional and relationship distress, due to the inability to engage in intercourse or the pain it causes. Nearly half of all Peyronie’s patients report depressive symptoms and relationship difficulties, and many have high levels of anxiety, less sexual confidence and fear of not being able to satisfy their partners.
As there is very limited data on how Peyronie’s disease affects the partners of men who experience it, this study aims to characterize those patients whose Peyronie’s symptoms cause their partners pain during intercourse.
From March 2014 to June 2016, new patients were given a 74-item questionnaire asking about their penile curvature, including details about relationship duration, frequency of intercourse, erections and the bother it caused. The response to one question defined the study population, “Does the curvature cause your partner any pain during penetrative intercourse?” This was followed by a physical exam to determine treatment options for each patient.
Of all the new patients with Peyronie’s disease, 322 (16%) of them reported that their curvature caused their partner pain during intercourse. These men were more likely to be smokers, have difficulties with sleep, report higher subjective erectile strength, consider surgery as a treatment option, higher penile buckling during intercourse and negative impacts on relationship.
Discussion and Conclusion
This study showed that greater curvature was more likely to cause the partner pain. The direction of the curvature also showed differences in partner pain, with ventral curvatures causing particular problems with vaginal intercourse. Ventral curvature is a downward-curving penis, while the vaginal canal curves upward, making penetration difficult based on the angles.
Results from the psychological questions clearly show how Peyronie’s disease negatively affects men with feelings of embarrassment, shame, depression, inadequacy, and lower masculinity. These often lead to avoidance of physical intimacy and fear of causing their partner pain. Additionally, prior studies have shown that female partners of men with Peyronie’s disease have lower sexual function and satisfaction. This has also shown to affect men’s choice in treatment, as many prefer more invasive surgery than conservative methods. Clearly, the impact of Peyronie’s disease on the patient’s partner should be a consideration in the management of the disease.
Meng Y, Yang DY, Hebert KM, Savage JB, Alom M, Kohler TS, Trost L. What about the partner? —factors associated with patient-perceived partner dyspareunia in men with Peyronie’s disease. Transl Androl Urol 2018;7(6):935-940. doi: 10.21037/tau.2018.07.20