Peyronie’s Disease and Penile Curvature

This is a condition you are born with that typically becomes more noticeable after puberty. Depending on the direction of curvature, it is caused by mismatched growth patterns or differences in length of the internal penile structures.

Most commonly, the penis curves downward (ventral curvature) due to a shorter underside of the shaft. Less commonly, curvature may be sideways (lateral) or upward (dorsal), depending on which structures develop unevenly.

Peyronie’s disease is an inflammatory condition that leads to abnormal wound healing, resulting in the formation of fibrotic plaques within the tunica albuginea, the tough, elastic sheath that surrounds the erectile cylinders of the penis (corpora cavernosa).

The tunica albuginea plays a crucial role in trapping blood during an erection, allowing the penis to become firm and maintain rigidity. When scarring develops in the tunica albuginea, it loses its natural elasticity. This means that when the rest of the penis fills with blood and expands during an erection, the scarred area does not stretch as it should. Instead, it creates resistance, pulling the penis toward the plaque and leading to curvature, indentation, or shortening. The direction of the bend depends on where the scar tissue is located, resulting in an upward, downward, or sideways curvature.

There is a strong genetic link between Peyronie’s disease and other fibrotic conditions, such as Dupuytren’s contracture (thickened, tight bands in the hand causing fingers to curl) and Ledderhose disease (fibrotic nodules in the soles of the feet). While Peyronie’s disease most commonly develops between the ages of 50 and 60, it can also occur in men under 40.

The disease typically progresses through two distinct phases: The first is the active phase, where you might experience painful erections and feel a lump or plaque under the skin of the penis. During this stage, the penis may start to curve, although this doesn’t happen in every case. Some men experience penile shortening or narrowing. The second stage is the chronic phase, where the plaques become harder and may calcify. At this point, the disease stabilises, any pain typically resolves and the curvature or deformity stabilises and does not continue to worsen at that location.

Atypical Peyronie’s disease is likely under reported. While many specialists consider Peyronie’s a condition affecting only the tunica albuginea (the fibrous sheath where plaques can be felt), the reality is more complex, it can impact the entire penile structure. Unlike classic Peyronie’s disease, which presents with palpable plaques and penile curvature, atypical Peyronie’s disease may involve scarring deep within the spongy erectile tissue of the corpora cavernosa and the septum that separates the erectile cylinders.These internal changes are often only detectable through ultrasound, meaning many men with this condition may be misdiagnosed with primary erectile dysfunction rather than a structural penile disorder. The key distinguishing feature of atypical Peyronie’s disease is a rapid loss of penile length and girth, often occurring without noticeable curvature or angulation, alongside progressive erectile dysfunction. Recognising this condition with early ultrasound investigation is essential, as its progression can lead to significant functional and psychological impacts. Expert evaluation with a dedicated penile ultrasound service is crucial for accurate diagnosis of subtle findings.

Peyronie’s-like disease refers to the formation of scar tissue in the penis due to causes unrelated to classic Peyronie’s disease. While it may present with similar symptoms, such as penile curvature, shortening, or deformity, its underlying mechanism is different. This condition can develop after penile surgery, trauma, or repetitive microtrauma, particularly in men with deteriorating erectile function. Normally, regular erections oxygenate the penile tissue, maintaining its health and elasticity. However, when erectile function declines, even minor wear and tear during sex or the repeated use of penile injections can lead to collagen deposition and scarring, resulting in deformities that mimic Peyronie’s disease. Unlike true Peyronie’s disease, which is an multifocal inflammatory condition with active and stable phases, Peyronie’s-like disease is primarily a defective healing response due to impaired penile blood flow. This is likely the type of Peyronie’s disease after prostate cancer treatment or pelvic surgery. Identifying and addressing vascular health issues is crucial for managing this condition effectively.