What is Peyronie’s disease (also known as “curved penis disease”)?

A curved penis, also known as fibrous hardening of the penis (known as Peyronie’s disease), is the formation of fibrotic hardening tissue in the erectile component of the shaft of the penis.

It can affect a small or larger area of the fibrous sheath as well as the elastic tissue of the corpora cavernosa of the penis.

It primarily appears on the dorsal (top) surface of the penis, but in some cases, it can also appear on the lateral (side) or ventral (bottom) surfaces of these anatomical elements of the penile shaft.

This leads to a significant reduction in the ability of the penis to expand, as well as varying degrees of penile curvature during erection (commonly known as penile bending).

These changes, which essentially indicate scarring of the erectile tissue, can occur at any time in life during sexual activity.

Figure 1: Upward penile curvature. The fibrotic hardening lesion has infiltrated the fibrous sheath of the penis as well as part of the corpora cavernosa on the dorsal surface of the penile shaft. This topographic infiltration leads to the most common clinical form of the disease, which is dorsal (upward) penile curvature.

Figure 2: Penile curvature to the left or right. The fibrotic hardening lesion has infiltrated the fibrous sheath of the penis as well as part of the corpora cavernosa on the lateral surface of the penile shaft. This topographic infiltration leads to a less common clinical form of the disease, which is lateral (left or right) penile curvature.

Figure 3: Downward penile curvature. The fibrotic hardening lesion has infiltrated the fibrous sheath of the penis as well as part of the corpora cavernosa on the ventral surface of the penile shaft. This topographic infiltration leads to the rarest clinical form of the disease, which is ventral (downward) penile curvature.

What factors contribute to the problem of a curved penis?

Causes of Peyronie’s Disease & Pathogenesis

A. Multiple microtraumas

• Multiple or repeated microtraumas during sexual activity.
• These traumas affect the fibrous sheath of the penis and the cavernous tissue, gradually leading to scar formation.
• Continuous and successive injuries can disrupt the normal process of tissue repair and regeneration.
• This leads to an increased proliferation of collagen fibers in the walls of the penile chambers.

B. Severe trauma

• A severe trauma during intense sexual intercourse, which remained neglected.
• Various degrees of swelling and bruising are typically signs of injury to the erectile tissue, often accompanied by a sharp, transient pain that progressively results in localized pain of mild intensity hours later.
• Since in most cases the phenomenon is self-limiting, it gives the impression of a superficial injury, leading patients and even doctors to treat it superficially, providing only analgesic therapy.
• The lack of proper preventative treatment allows for the potential disturbance in the natural regeneration mechanism of penile tissue, leading to the formation of fibrotic/scarred non-functional penile tissue.

C. Age

• Many medical observations have shown an increased presence of “curved penis” up to 12% in individuals aged 40-50 years.
• Upon careful analysis, it becomes evident that in many cases, such minor injuries began to appear years before the patient became aware of them.
• Early symptoms usually included: slight penile deformity, pain during erection, or temporary erectile dysfunction.

D. Metabolic syndrome & diseases

• Diabetes, hyperlipidemia, hypertension, and smoking could lead to the formation of fibrous plaques due to microvascular disease and local disruption of the healing process.

E. Genetic predisposition

• We observe a family history of penile curvature/bending in approximately 3% of patients.
• There is also a co-occurrence of Peyronie’s Disease and Dupuytren’s Contracture in more than 17% of patients.
• Both diseases involve altered collagen breakdown and fibroblast differentiation.

F. Chronic prostatitis

Chronic inflammatory disease of the prostate contributes significantly to the development of penile curvature and erectile dysfunction through various mechanisms.

The most important of these are:

• Endothelial dysfunction.
• Reduction in eNOS expression and cGMP concentration in the cavernous tissue.
• Worsening of oxidative stress in the penile tissue.
• Inducing apoptosis of cells.
• Reducing the ratio of smooth muscle fibers to collagen fibers in the corpora cavernosa.

Although more research is needed to verify the link between prostatitis and Peyronie’s Disease, our clinical experience shows a statistically significant correlation/coexistence.

Important note
From my long-standing experience in diagnosing and treating all these conditions, such as:

• Chronic prostatitis
• Penile curvature
• Erectile dysfunction

a very high percentage of patients who present with fibrotic lesions in the penis, with or without erectile dysfunction, had chronic inflammatory changes in their prostate, despite the fact that most of these patients had not been previously diagnosed with chronic prostatitis.

Read also:

• How is Peyronie’s Disease treated without surgery?
• What is the surgical treatment for Peyronie’s Disease?
• What are the symptoms of Chronic Prostatitis?