Cause of Peyronie’s Disease
Although the cause of Peyronie’s disease (PD) is still unknown almost 375 years after Peyronie first wrote about the condition, it is now generally agreed there are multi-factorial issues that contribute to this problem. While the cause is unknown, this does not mean there is no cause and it does not mean there is no effective Peyronie’s disease treatment even though the medical profession does not acknowledge the ability of the body to repair this problem 50% of the time. . An undetermined cause is only a reminder of the complexity of this condition, and that more needs to be done to unravel its many mysteries.
As a general statement, all authors and clinicians maintain that the single most likely factor causing PD is direct or indirect trauma. More than 75% of men with PD are between 45 and 65 years of age, when the collagen of the penis is less elastic and more susceptible to injury.(1) This ties in neatly with injury as the primary causation. Of those men who recall an event of penile trauma, it is often reported to be something like an invasive examination procedure, blunt trauma or a bend-injury during intercourse, at the site of subsequent plaque formation. While the evidence for trauma to the penis as the total or partial cause of PD is strong, clinicians admit that many times no injury can be recalled prior to the onset of the condition. This then leads to speculation about the minor nature of injury, one so small – even a bump – as to be easily forgotten, that can start the problem.
While significant trauma might explain the sudden onset of PD, it does not explain why most cases develop slowly and with absolutely no memory of trauma, even minor. Further, trauma does not explain why some cases of PD disappear rather quickly, or why similar conditions such as Dupuytren’s contracture of the hand do not start after trauma.(1-4)
Genetic predisposition is a possible cause of PD, because it is fairly common for men with PD to also have health problems from a particular list of conditions. The most common condition found in association with PD is Dupuytren’s contracture. This is a similar problem of excess dense tissue formation in which a cord-like hardening develops across the palm of the hand, usually at the 4th and 5th digit. In fact, up to 47% of men with PD also had another condition associated with loss of soft tissue elasticity, such as Dupuytren’s contracture or Ledderhose’s disease (fibrosis of soft tissue on the bottom of the foot). Other less common conditions and situations that occur with PD are diabetes, tympanosclerosis, Paget’s disease, hypertension and gout.(9,10) Studies of Peyronie’s patients have even implicated an autoimmune component.(11,12) This gives support to the theory that men with genetic predisposition to these conditions respond to mechanical injury and micro-hemorrhage of the tunica albuginea with an unusually excessive wound healing reaction.(1, 3-15) Thus, men with these particular conditions could possess a genetic background that causes excess scar development and predisposes to development of Peyronie’s plaques.
Medication is also related to occurrence of Peyronie’s disease, although not as a significant factor since the type of drugs implicated were not known or used in the time of Peyronie when the condition already existed. The drugs suggested as a possible cause belong to a class of blood pressure and heart medications called beta blockers. These drugs are also used to treat glaucoma, multiple sclerosis and seizures. Developing PD as a side effect of these drugs is rare. Check with your doctor before discontinuing any prescribed drug.(16)
Along with the reduced soft tissue elasticity that is associated with the aging process, there is another factor that could contribute to PD that does not seem to appear in the medical literature. That factor is reduced blood circulation in the older male, including the penis. If about 75% of the men with PD are between 45-65 years of age, these men could also have reduced blood flow and poor oxygen supply to the penis as well as other parts of the body. If you recall from the pathology section of this website, you learned that “lack of oxygen would therefore increase collagen (scar) formation.” So if oxygen is critical in keeping scar development in check, and oxygen is carried by the blood, then anything that increases blood flow and oxygen to the penis can decrease scar development of PD, and maybe even cause elimination of existing scar tissue in the latter phase. Keep this in mind as we discuss treatment ideas in other sections, and how it nicely ties a few treatment ideas together.
There is a direct, safe and effective technique for manual penis stretching that has been researched and developed by PDI. For details, click on stretching curved penis.
1. Devine CJ Jr, Somers KD, Jordan SG, Schlossberg SM. Proposal: trauma as the cause of the Peyronie’s lesion. J Urol 1997;157:285-90.
2. NIH Publication No. 04-3902 – December 2003
3. Van de Water L. Mechanisms by which fibrin and fibronectin appear in healing wounds: implications for Peyronie’s disease. J Urol 1997;157:306-10.
4. Jarow JP, Lowe FC. Penile trauma: an etiologic factor in Peyronie’s disease and erectile dysfunction. J Urol 1997;158:1388-90.
5. Desanctis PN, Furey CA Jr. Steroid injection therapy for Peyronie’s disease: a 10-year summary and review of 38 cases. J Urol 1967;97:114-6.
6. Somers KD, Dawson DM. Fibrin deposition in Peyronie’s disease plaque. J Urol 1997;157:311-5.
7. Rodriques CI, Njo KH, Karim AB. Results of radiotherapy and vitamin E in the treatment of Peyronie’s disease. Int J Radiat Oncol Biol Phys 1995;31:571-6.
8. Morales A, Bruce AW. The treatment of Peyronie’s disease with parathyroid hormone. J Urol 1975;114:901-2.
9. Carrieri MP, Serraino D, Palmiotto F, Nucci G, Sasso F: A case-control study on risk factors for Peyronie’s disease. J Clin Epidemiol, 51: 511-515, 1998.
10. Nyberg LM Jr., Bias WB, Hochberg MC, Walsh PC: Identification of an inherited form of Peyronie’s disease with autosomal dominant inheritance and association with Dupuytren’s contracture and histocompatibility B7 cross-reacting antigens. J Urol, 128: 48-51, 1982.
11. Schiavino D, Sasso F, Nucera E, Alcini E, Gulino G, Milani A, Patriarca G: Immunologic findings in Peyronie’s disease: a controlled study. Urology, 50: 764-768, 1997.
12. Stewart S, Malto M, Sandberg L, Colburn KK: Increased serum levels of anti-elastin antibodies in patients with Peyronie’s disease. J Urol, 152: 105-106, 1994.
13. Devine CJ Jr., Somers KD, Jordan SG, Schlossberg SM: Proposal: trauma as the cause of the Peyronie’s lesion. J Urol, 157: 285-290, 1997.
14. Devine CJ Jr., Horton CE: Peyronie’s disease. Clin Plast Surg, 15: 405-409, 1988.
15. Diegelmann RF: Cellular and biochemical aspects of normal and abnormal wound healing: an overview. J Urol, 157: 298-302, 1997.
16. 1998-2004 Mayo Foundation for Medical Education and Research (MFMER).