Why Does Peyronie's Disease Develop? Risk Factors and Early Signs

Peyronie's disease is an acquired condition in which fibrous tissue building up in the elastic sheath surrounding the erectile tissue (the tunica albuginea) causes curvature, shortening or deformity during an erection. Unlike congenital penile curvature, it appears at a particular point in life and changes over time.

Patients most often begin by asking “why did this happen”. The question is not driven only by curiosity; understanding the cause also makes it easier to grasp how the condition will progress and at what stage treatment comes into consideration. This article covers the mechanism behind Peyronie's disease, who it affects more often, which signs stand out early on and how the first phase is approached.

How does Peyronie's disease develop?

The tunica albuginea, which surrounds the erectile tissue of the penis, is an elastic sheath that stretches during an erection and withstands pressure. According to the most widely accepted view today, Peyronie's disease begins when the healing process following small injuries to this sheath proceeds differently from normal.

Under normal conditions a minor injury heals without leaving a mark. In some people, however, an excessive amount of connective tissue is produced during this repair process and hardened tissue (a plaque) forms over time. Because this plaque loses its elasticity, that part of the penis cannot lengthen as much as the rest during an erection; curvature towards the side of the plaque is the result.

This mechanism also explains why the condition follows a different course in different people: what matters is not only the injury itself but how a person heals. Of two men experiencing the same strain, one may develop the condition while the other does not.

Can a specific cause be identified?

Some patients recall a strain during intercourse, a sudden pain or a specific event. Others describe no trauma at all; the condition may have begun quietly. Both situations are ordinary and neither changes the diagnosis.

Not remembering a specific event therefore does not mean the cause cannot be found or that the diagnosis is uncertain. In Peyronie's disease the diagnosis is made from the history and examination findings; assessment of the curvature during an erection and, where needed, imaging support this evaluation.

Who is affected more often?

Peyronie's disease can occur at any age, but its frequency increases in certain situations. The prominent risk factors are:

• Age: More common in middle and later life; the reduction in tissue elasticity plays a part in this association.
• Diabetes: May increase risk by affecting tissue healing and vascular health.
• Erectile dysfunction: Where adequate rigidity is not achieved, the likelihood of strain during intercourse may increase.
• A connective tissue tendency: Conditions such as Dupuytren's contracture, which involves similar hardening in the palm, may indicate a comparable healing tendency.
• A similar condition in the family: A familial tendency has been described in some patients.
• The period after prostate surgery: Changes in erection quality during this period may be an indirect factor.
• Smoking and vascular risk factors: May adversely affect tissue healing.

The presence of these factors does not mean the condition will certainly develop; they merely indicate where it is seen more often. Equally, it can occur in people with no risk factors at all.

What are the early signs?

Peyronie's disease usually does not begin dramatically. The findings that most often draw attention early on are:

• Pain during an erection: A typical finding of the early phase in particular, which tends to diminish over time.
• Palpable hardness: A small area of hardness or irregularity felt in the shaft, most often on the upper surface.
• A change in shape beginning: Slight curvature, indentation or narrowing at a particular point during an erection.
• A sense of shortening: One side of the tissue being unable to lengthen sufficiently because of the plaque.
• Weakening of erections: In some patients an erection problem accompanies the curvature.

When mild, these findings can easily be overlooked. Assessment in the early phase matters, however, both so that the course of the condition can be monitored and so that unnecessary anxiety is avoided.

What course does the condition follow?

Peyronie's disease is assessed in two phases. In the active (early) phase the curvature continues to change and pain is often present. In the stable phase the pain settles and the curvature takes its final form.

This distinction determines the timing of the treatment decision: surgical correction is planned once the condition has entered its stable phase. In the active phase, monitoring and, where appropriate, non-surgical approaches come to the fore.

A question patients often ask is whether the condition resolves on its own. In some men the curvature remains mild and does not markedly affect their sexual life; in others it increases over time. Making a firm prediction about the course in the early phase is therefore not appropriate; regular monitoring shows which direction the condition is taking.

What is done in the early phase?

The basic approach in the active phase is to monitor the course of the condition and manage the patient's symptoms. The following topics are generally addressed during this period:

• Regular monitoring: Assessing the course of curvature and pain at set intervals.
• Addressing accompanying conditions: Managing erectile dysfunction, blood sugar control and smoking.
• Non-surgical approaches: Applications that may be considered in selected cases and where expectations need to be discussed realistically.
• Information: A clear explanation of how the condition progresses and why the surgical decision is deferred.

Deferring surgical correction during this period is not intended to keep the patient from treatment; it is the preferred approach because a correction carried out before the curvature takes its final form may prove inadequate or excessive.

Is Peyronie's disease a serious condition?

Peyronie's disease is not a condition associated with cancer, and palpable hardness in the penis is not regarded as a sign of a malignant disease in this sense. It can, however, markedly affect quality of life through its sexual and psychological impact.

Anxiety, avoidance behaviour and difficulty within a relationship are seen in a significant proportion of patients. Discussing these effects during consultations is part of the treatment process; an approach focusing only on the degree of curvature can miss the difficulty the patient actually experiences.

Peyronie's disease arises from a difference in wound healing within the elastic sheath surrounding the penis, and its course varies between individuals. Pain and palpable hardness stand out in the early phase; the basic approach at this stage is monitoring and managing accompanying conditions. Assoc. Prof. Dr. Zülfü Sertkaya practises in urology and andrology in Istanbul; assessment and monitoring in Peyronie's disease are carried out with individual planning and confidentiality.

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