Peyronie's Disease (Curved Penis) (cont.)

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A plaque on the topside of the shaft, which is most common, causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. At times, pain, bending, and emotional distress prohibit sexual intercourse.

Estimates of the prevalence of Peyronie's disease range from less than 1 percent to 23 percent.¹ A recent study in Germany found Peyronie's disease in 3.2 percent of men between 30 and 80 years of age.² Although the disease occurs mostly in middle age, younger and older men can develop it. About 30 percent of men with Peyronie's disease develop hardened tissue on other parts of the body, such as the hand or foot. A common example is a condition known as Dupuytren's contracture of the hand. In some cases, Peyronie's disease runs in families, which suggests that genetic factors might make a man vulnerable to the disease.

A French surgeon, Francois de la Peyronie, first described Peyronie's disease in 1743. The problem was noted in print as early as 1687. Early writers classified it as a form of impotence, now called erectile dysfunction (ED). Peyronie's disease can be associated with ED-the inability to achieve or sustain an erection firm enough for intercourse. However, experts now recognize ED as only one factor associated with the disease-a factor that is not always present.

Many researchers believe the plaque of Peyronie's disease develops following trauma, such as hitting or bending, that causes localized bleeding inside the penis. Two chambers known as the corpora cavernosa run the length of the penis. A connecting tissue, called a septum, runs between the two chambers and attaches at the top and bottom of the tunica albuginea.

If the penis is bumped or bent, an area where the septum attaches to the tunica albuginea may stretch beyond a limit, injuring the tunica albuginea and rupturing small blood vessels. As a result of aging, diminished elasticity near the point of attachment of the septum might increase the chances of injury. In addition, the septum can also be damaged and form tough, fibrous tissue, called fibrosis.

The tunica albuginea has many layers, and little blood flows through those layers. Therefore, the inflammation can be trapped between the layers for many months. During that time, the inflammatory cells may release substances that cause excessive fibrosis and reduce elasticity. This chronic process eventually forms a plaque with excessive amounts of scar tissue and causes calcification, loss of elasticity in spots, and penile deformity.

While trauma might explain some cases of Peyronie's disease, it does not explain why most cases develop slowly and with no apparent traumatic event. It also does not explain why some cases resolve or why similar conditions such as Dupuytren's contracture do not seem to result from severe trauma.

Some researchers theorize that Peyronie's disease may be an autoimmune disorder.

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