What Causes Peyronie’s Disease?
What is Peyronie’s disease?
Peyronie’s disease (PD) is a connective tissue disorder affecting the tunica albuginea and is characterized by penile curvature resulting from fibrosis and plaque deposits. PD can not only cause physical pain, but it can also cause psychological and psychosexual issues. PD affects between 0.4 to 20+% of the male population (depending on how PD is defined and the population studied).
Are there any known causes of PD?
The most commonly described cause of PD is due to repeated penile microtrauma. The trauma is thought to occur during penetrative sex due to a lack of penile rigidity causing delamination of the tunica albuginea of the penile corpora cavernosa. Scarring occurs as healing takes place, and this plaque buildup leads to the shortening of the penis and penile curvature. While this is the most commonly cited cause of PD, there are several other factors to be considered.
Diabetes Mellitus is a risk factor that can lead to PD. In an article written by Simone Gianazza and colleagues, the authors reported that, “due to autonomic neuropathy, cavernosal arteriosclerosis, smooth muscle collagenization, and endothelial dysfunction, diabetes can be considered one of the pivotal factors in the development of PD and resistance to the medical treatment” (Gianazza, S., et al., 2022, pg. 5). They also mention that diabetes is one of the most common comorbidities observed in people with PD. Other common risk factors of PD include hypertension, alcohol abuse, and smoking.
In addition to risk factors, genetics may play a role in the development of PD. This is evidenced by the higher rate of certain conditions, such as Dupuytren’s contracture in men with PD. In a study done by Kristina L. Allen-Brady and colleagues, they studied 307 genealogical records of men diagnosed with PD and included their 1st through 5th-degree relatives. The authors found that approximately 0.12% of the studied population had PD, suggesting that genetic factors likely accounted for at least some of the cases observed and confirming that PD is a heritable condition.
Finally, another contributing factor of PD is erectile dysfunction (ED). We know that ED and PD are connected; however, in many cases we do not know which one comes first. Insufficient rigidity due to ED (or other factors) during penetrative sex can lead to damage of the tunica albuginea, which can then lead to PD. Likewise, the increased scarring, pain, narrowing, and curvature of the penis can contribute to ED. Therefore, although it is difficult to know if one condition is more likely to cause the other, it is clear that the two conditions are commonly associated.
Overall, Peyronie’s disease can have a significant impact on a man and his partner’s life. While we do not know the exact cause of PD, several factors are commonly associated, including diabetes, hypertension, alcohol abuse, smoking, Dupuytren’s contracture, erectile dysfunction and genetics. The good news is that men who find themselves with PD have treatment options to help improve their quality of life. Several of the most popular and promising treatment options include collagenase clostridium histolyticum (CCH) injections, penile traction, and surgery. (See our previous blog post for more information on the cost-effectiveness and more information on these treatments.)
References
1. Montague, D.K. (2021). Peyronie disease and erectile dysfunction: A potential new paradigm. Cleve Clin J of Med, 88(12), 661-663. DOI: 10.3949/ccjm.88a.21027
https://pubmed.ncbi.nlm.nih.gov/34857603/
2. Zandoná, P.C.E., Teixeira, N.P., Oliveira, H.E., and Garcia, J.H.S. (2022). The use of polyglycolic acid polymer graft in Peyronie’s disease – preliminary outcomes. Arch Ital Urol Androl, 94(1), 87-90. DOI: 10.4081/aiua.2022.1.87
https://pubmed.ncbi.nlm.nih.gov/35352532/
3. García-Gómez, B., Martínez-Salamanca, J.I., Sarquella-Geli, J., Justo-Quintas, J., García-Rojo, E., Fernández-Pascual, E., Ruíz-Castañé, E., and Romero-Otero, J. (2022). Peyronie’s Disease Questionnaire (PDQ): Spanish translation and validation. Int J Impot Res, 34(5), 501-504. DOI: 10.1038/s41443-021-00460-5
https://pubmed.ncbi.nlm.nih.gov/34282285/
4. Hegarty, P.K., Sullivan, D.O., Hegarty, P.A., and Zafirakis, H. (2022). Multiple plaque incisions with or without grafting for Peyronie’s disease. BJUI Compass, 3(3), 220-225. DOI: 10.1002/bco2.130
https://pubmed.ncbi.nlm.nih.gov/35492223/
5. Gianazza, S., Belladelli F., Leni, R., Masci, F., Rossi, P., Gianesini, G., Maggio, P., Zaffuto, E., Salonia, A., Carcano, G., Dehò, F., and Capogrosso, P. (2022). Peyronie’s disease development and management in diabetic men. Andrology, Online ahead of print, 1-7. DOI: 10.1111/andr.13224
https://pubmed.ncbi.nlm.nih.gov/35771713/
6. Allen-Brady, K.L., Christensen, M.B., Sandberg, A.D., Pastuszak, A.W. (2022). Significant familial clustering of Peyronie’s disease in close and distant relatives. Andrology, Online ahead of print, Abstract. DOI: 10.1111/andr.13223