Causes and Risk Factors of Peyronie’s Disease

Peyronie's disease the result of inflammation and scarring in the tissues of the penis, which leads to curvature of the penis. Scarring causes areas of the penis to become less flexible. During an erection, the penis curves towards the area that can't stretch. Depending on the location of the scarring, the penis may also become shorter.

Only a small fraction of cases of Peyronie's disease occur after there has been a clear, noticeable injury to the penis. The remaining cases are thought to be caused by small injuries and inflammation that has occurred over a long period of time. Because of this, the major risk factors for Peyronie's disease are injury, age, and health conditions associated with inflammation and scarring.

Peyronie's disease is first and foremost a wound-healing disorder. Its symptoms are the result of fibrous plaques, or scars, forming in the tunica albuginea. The tunica albuginea is the tissue that surrounds the erectile bodies of the penis.

Peyronie's disease is thought to occur in between 0.5 percent and 20 percent of men, depending on the population. It can happen in men of any age, but it is more common in older men. It is also more common in individuals suffering from one or more of the following health problems:

• Diabetes
• High blood pressure
• High cholesterol

Peyronie's is thought to be the result of injury to the penis. This injury can be severe and acute, for example, because of surgery on the penis or trauma during sex.

More often, the injuries that lead to Peyronie's are small, or even unnoticeable. Most, if not all, men experience some microtrauma during penetrative intercourse. However, only some men develop Peyronie's disease. This is likely because Peyronie's disease occurs in men where healing is impaired. If healing is successful, it doesn't lead to scarring.

Having sex with a penis that is not fully erect may predispose the penis to microtrauma. This may also explain why the incidence of Peyronie's disease increases with age. As people have more difficulty getting a firm erection, they experience more sub-acute injuries they need to heal.

A number of genetic associations have been proposed as contributing to the development of Peyronie's disease.

• A mutation of the wingless-type MMTV integration site family member 2 (WNT2) locus on chromosome 7, which is also associated with Dupuytren's contracture.
• Alterations in the expression of TGFbeta1, which seem to be associated with scarring and regulation of myofibroblasts. Myofibroblasts are associated with wound contracture and seem to be more difficult to eliminate for Peyronie's patients.
• Genes that affect how osteoblasts and macrophages are recruited to injuries have been implicated in the formation of Peyronie's disease, although those results are preliminary.
• Procollagenase IV mutations, affecting the way the body degrades collagen, may also play a role in Peyronie's.

Mouse studies also suggest that nitric oxide synthase may play a role in protecting the tissues of the penis from Peyronie's disease. Nitric oxide synthase may be particularly important in diabetic patients whose blood sugars run high.

You may have heard of nitric oxide synthase because medications for erectile dysfunction affect its production. This may be why these medications can sometimes be an effective treatment for Peyronie's disease.

High blood pressure, high cholesterol, and diabetes are all associated with both cardiovascular health and Peyronie's disease. So is the use of certain cardiovascular drugs, such as beta-blockers. This is thought to be because the particular vasculature of the penis, and damage to those blood vessels, is critical to the formation of plaques and scars. There is also some evidence that oxidative stress plays a role in Peyronie's disease as well as heart disease.

In addition to potentially playing a direct role in causing Peyronie's disease, cardiovascular disease also contributes significantly to one of its symptoms.

In other words, it's not the scarring that causes problems with getting and sustaining an erection; it is blood flow. This is another reason why Viagra and other erectile dysfunction drugs may be useful for Peyronie's patients.

There are a number of lifestyle risk factors for Peyronie's disease. Basically, these can be divided into two groups. The first group are risk factors that affect healing. These include:

• Smoking
• Alcohol abuse
• A history of unprotected sex leading to non-gonoccocal urethritis or exposure to another inflammatory STD

The other group of risk factors are those that affect the likelihood of penile trauma. These include:

• Rough sex or sex at angles that bend or stretch the penis.
• Starting penetration before the penis is fully erect
• Other activities that could damage the penis.

To a great extent, Peyronie's disease is not a condition you can avoid. You can maintain a healthy body, but inflammation and penile injury are not necessarily things you can control.

Fortunately, Peyronie's disease is often a relatively minor condition. Many individuals affected by it do not need any treatment. There is a range of treatments available for those who do.

If you are experiencing pain during erection, or noticing a new curve to your penis, talk to your doctor. If it is Peyronie's disease, sometimes early treatment can help.