Peyronie’s Disease Overview and Statistics
Peyronie’s Disease is also known as: curved penis, penile curvature, PD, indurato penis plastica, fibrous sclerosis of the penis, chronic cavernositis, fibrous cavernositis, fibrous plaques of the penis, penile fibrosis, penile induration, penile fibromatosis, penile shaft thickening, painful erection, Van Buren’s disease
Overview of Peyronie’s disease
Peyronie’s (pa-ro-NEEZ) disease is named after Francois Gigot de la Peyronie, a famed French physician and surgeon who cared for many royalty of his era, including Peter the Great.
Peyronie’s disease, named after famed 18th century French surgeon, Francois Gigot de la Peyronie
Peyronie was the personal physician to French King Louis XV, and achieved great wealth and popularity. He described, in 1743, the cases of three men with “rosary beads of scar tissue to cause an upward curvature of the penis during erection.” Apparently his notoriety caused his name to be forever connected to this mysterious problem, although it was well known long before this and was described earlier. In 1587, Guilio Cesare Aranzi, a famed Italian anatomist from Bologna, in his book “Tumores Praeter Naturam,” gave a very accurate description of the problem when he wrote that it was “palpable like a bean in the flaccid penis, causing a deformity similar to a ram horn during erection”.
Peyronie’s disease basics
Peyronie’s disease (PD) can be considered an exaggeration of the wound healing process. It is characterized by the presence of one or more benign (non-cancerous) fibrous plaques or scars along the shaft of the penis usually on the upper or lower side, as well as painful erections and shortening. These Peyronie’s plaques or scars are flat and irregular; usually there is only one scar, but multiple scars do occur.
As you read the next few paragraphs, pay attention to the wide variation and range of findings and complaints that are used to attempt to define PD. It is rather unique in medicine to have such great variation and assortment of possibilities in a medical condition, such as you will read here about PD. This is the crux of the problem in dealing with PD, from both the patient’s and doctor’s perspective.
Cases of PD range from mild to severe; some cases are so mild as to be detected only on autopsy, while others are so severe that surgery is necessary to reduce painful distortion. The size of the scar or fibrous plaque may range from a few millimeters or may encompass the entire shaft of the penis. Associated pain, hardened scar formation and/or distortion may develop slowly or appear overnight in PD. In severe cases, the inelastic plaque reduces flexibility of the underlying tissue, causing pain and forcing the penis to bend or arc during erection. Angulation of the erect penis from 10°- 45° is not uncommon, and can be greater; deformities can advance to the degree they are described as “J,” “cane handle” and “corkscrew.” Distortion or angulation of the non-erect penis is rare. Without treatment the pain often decreases over a variable period of time, usually after 6-12 months. In a small percentage of cases with a milder form of the disease, inflammation may resolve without causing significant pain or permanent bending. Sexual difficulty and impotency also range from mild to severe, but at any level can disrupt a couple’s physical and emotional relationship, and lead to despondency and lowered self-esteem in the man.(1)
Soon after penile trauma an inflammatory reaction can occur, often first drawing attention to the problem because of pain associated with erection. Usual experience is that a man will tolerate distortion of the penis and avoid medical investigation, but will promptly seek assistance if pain develops. Over a period of time that is variable from man to man, the inflammation progresses and a dense nodule or band of scar tissue will develop. Often the process heals without treatment after the initial 12 months after the scar forms. These nodules of scar tissue can impede full expansion of the penis during erection resulting in various degrees and patterns of distortion. Depending on the number, size and location of the scar nodules within the penile tissue, the penis can be slightly to severely distorted during erection, or not at all. In cases of severe injury the scar formation can be extensive, becoming progressively more obvious with greater curvature during erection. In some extreme cases, the scars may create a bottle-neck, collar-like, or hourglass-like appearance in the erect penis. The presence of scar tissue in the normally expansive penile tissue may cause the penis to be limp or soft beyond the location of the nodule, leading to inability to have sexual intercourse. At the extreme of distortion an erect penis afflicted by PD may be so distorted (“J” or “corkscrew”) making intercourse impossible or at least extremely painful for both partners.
Peyronie’s disease statistics
- Many surveys have been performed over recent years, with each giving a different statistical overview of PD. Perhaps no one will ever know the actual depth and breadth of this problem due to the tendency of men for both reluctance and braggadocio in this area. Data presented here is fairly representative of the majority opinion in the various categories.
- Primarily affects men between 45 and 60 years of age, although an age range of 18 to 80 years has been reported (2), with an average age at onset of 53.
- In a survey of 4,432 men, with a mean age of 57: 3.2% had only plaque, and 1% had plaque, pain and angulation. Symptoms included 84% with angulation, 46% painful erection, 40% with erectile dysfunction (ED).(3)
- Almost all affected are Caucasians, most common in northern Europeans or Scandinavian descent. Much less common to rare in men of African heritage; rare to unknown in men of Asian heritage. When found in African heritage males, often associated with preexisting diabetes mellitus.
- 30 percent of men with PD develop fibrosis (hardened cells) in other elastic tissues of the body, such as on the hand (Dupuytren’s contracture) or foot (Ledderhose’s disease), which suggests genetic vulnerability.(1) However, only 1 to 2% of individuals with Dupuytren’s contracture ever develop curvature of the penis.(4)
- Estimated to affect 0.4 to 3.5% of adult male patients worldwide.(5-7)
- Estimated 85 percent of men when diagnosed with Peyronie’s disease are told to “try” vitamin E as a non-drug therapy, but are not given guidance or instruction how to do so effectively or correctly; as a result all these men take vitamin E incorrectly, and fail to see improvement. This occurs not because of the failure of vitamin E to help in the recovery of Peyronie’s disease, but because it was used incorrectly.
- Approximately one-third of patients with chronic late-stage disease have such disabling curvature and pain that surgical correction is performed.(2)
Peyronie’s disease remains one of the most perplexing and difficult to treat diseases in urology; it has been called “the doctor’s nightmare”. It is a complex problem that is much more common than people realize. Most everything about it is variable and unique to the man who has it. It is said that the single constant factor from one case of PD to another is that it changes so much. When you read about Peyronie’s treatment do not expect to find too many things that are like your case, except the scar – even the presence of pain and penile curvature can be quite variable.
1. NIH Publication No. 04-3902, December 2003
2. Am Fam Physician 1999;60:549-54
3. Boston University Institute of Sexual Medicine “Treating Peyronie’s Disease” – 11/29/03
4. U.S. National Library of Medicine, National Institute of Health Updated by: Young Kang, M.D., Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY. – 5-25-02
5. Carson C, Jordan G, Gelbard M: Peyronie’s disease: new concepts in etiology, diagnosis and treatment. Contemp Urol, 11: 44, 1999.
6. Lindsay MB, Schain DM, Grambsch P, Benson RC, Beard CM, Kurland LT: The incidence of Peyronie’s disease in Rochester, Minnesota, 1950 through 1984. J Urol, 146: 1007-1009, 1991.
7. Schwarzer U, Klotz T, Braun M, Wassmer G, Englemann U: Prevalence of Peyronie’s disease: results of an 8,000 men survey. J Urol, 163: 167, 2000.