Symptoms and causes

Penile Incurvation

Symptoms of penile incurvation

Peyronie's disease may produce one or more of the following symptoms:

• Pain. Pain in the penis affects about half of the men who have Peyronie's disease. It is not usually an intense pain. It may initially appear after intercourse or with erection, and later sometimes even without erection. The pain may last for a year, and then disappear. One of the problems that pain can cause is the appearance of erectile dysfunction during the active phase of the disease. As far as possible we have to try to rule out the presence of organic erectile dysfunction, since the prognosis of the disease is much worse. In 5% of men the pain may become chronic and last longer than the typical one-year duration of the acute phase.
• Penile incurvation. Approximately half of the men with Peyronie's disease may have a twisted penis. The curve evolves during the active phase of the disease, to stabilize in the stable phase. In most cases, penile curvature is usually not very severe, although this is not always the case. Most men with Peyronie's will not have a curve or, if they do, it will be very mild. Only a minority of curves are very intense and worsen - or even hinder - penetration.
• Erectile dysfunction. Many men experience erectile dysfunction during the activity phase, partly due to pain and partly due to inflammation and alterations produced by plaque. We can also encounter erectile problems of psychological cause, caused by changes in the shape and function of the penis, which often have a significant impact on the man who suffers from them. If erection problems persist after the resolution of the active phase, Peyronie's disease has a worse prognosis: in this situation it is common that prosthetic surgery is necessary to achieve greater rigidity of the penis, in addition to correcting the incurvation if it exists.
• Penile shortening. This is a symptom that is not very common but erodes the confidence and self-image of the men who suffer from it. Many men explain that the penis shortens relative to the curve, although in some cases the shortening is not accompanied by incurvation. On average, many men report that Peyronie's disease shortens the penis by about 2 cm, although as mentioned above this is highly variable.
• Hourglass deformity. This is the narrowing of the penis at a certain point, as if it were strangled. It is undoubtedly the worst sequela of Peyronie's disease, since it often leads to other symptoms, such as erectile dysfunction. If it is very intense, it can lead to an increased risk of penile fracture.

Causes of Penile Incurvation

There are studies that link Peyronie's disease to the presence of certain genes. Men with Peyronie's disease are more likely to have other cases of Peyronie's disease or fibrosis of the palm of the hand (Dupuytren's disease), of the sole of the foot (Ledderhorse's disease) or retroperitoneal fibrosis in their family.

Currently, aside from genetics, the only sufficiently robust risk factor that has been linked to Peyronie's is diabetes mellitus. Although the reason why the two diseases are related, it does seem clear that men with higher blood sugar levels are more at risk for penile fibrosis.

Some men explain that Peyronie's disease appeared after a "cracking" sensation or trauma to the erect penis. This is not a link that explains all cases, but it certainly seems that significant trauma to the erect penis can trigger penile incurvation.

However, in a study published by our group, we observed that the probability of having Peyronie's disease after penile fracture - the maximum degree of penile injury - was approximately 5%, which is exactly the same number of people with penile incurvation in the general population. This data seems to suggest that trauma could initiate the disease, although only in men who are predisposed to it.

On the other hand, some studies point to a certain relationship between lower testosterone levels and a potential increased risk of developing Peyronie's disease. This relationship has not been reliably established, so at present we could not consider hypogonadism as a risk factor for developing penile incurvation.