Peyronie’s disease causes

What is the cause of Peyronies disease?

The exact cause of Peyronie’s disease remains unknown almost 300 years after it was first described in detail by a French surgeon, François de la Peyronie in 1743.   However, it is safe to say that the dense fibrous plaque or scar that is central to the problem of Peyronie’s disease results from an interplay between two important factors:  trauma (injury) and genetic predisposition (passage of traits within a family).   Prescription drug reactions are also a possible factor in starting Peyronie’s disease, but this is a less common and less studied cause.

Clinically, I have noted that those men who have a strong genetic or ancestral tendency toward Peyronies disease often need only a small trauma to actually develop their problem.  And those men who have sustained a large trauma to the penis often do not have an apparent genetic predisposition, yet they still develop Peyronie’s disease anyway.  To say it another way, if a man has either a strong trauma or a strong family tendency, then he does not need much of the other factor to cause him to develop a Peyronie’s plaque.

Before this discussion goes on to cover several ways these possible factors work together to cause Peyronie’s disease, for a moment look at the information below, copied directly from the WebMD website (their slogan is    “Better information. Better health.”   So much for that!)  Their explanation for a Peyronie’s disease cause is:

“Peyronie’s disease is caused by scar tissue, called plaque, which forms along the length of the penis in the corpora cavernosa. This plaque is not visible, and depending on the severity of the condition, the plaque can cause the penis to bend, making sexual intercourse difficult and occasionally painful.”

When you read the statement that Peyronie’s disease is caused by scar tissue, do you not automatically wonder, “then what causes the scar tissue to form?”  They never discuss that.  This explanation is a good example of the confusing information and misinformation that is found on the internet and reason why people do not understand Peyronie’s disease as well as they should.  That description makes as much sense as, “A flooded basement is caused by water in the basement.”   Just as a homeowner would like to know how the water got into his basement to flood it, the man with Peyronie’s disease wants to know what caused the scar to form.

 

Peyronies disease cause #1:  Trauma

The most commonly discussed and widely accepted cause of Peyronie’s disease is trauma or injury.  The trauma can be in the form of minor injury that is repeated over time, or it can be major injury that occurs only once, or a combination of both.   The exact form of trauma can be compression (squeezing, tight clothing), stretching (as from a sudden and forceful bending), or blunt force (as from being hit during spots, work or auto accidents).  I had a conversation with a man whose Peyronie’s disease was caused by a drunken woman who severely and repeatedly bit him as she provided oral sex, while they were both drunk.

The classic mechanism of injury, that I am told about most often and is written about most often when this topic is explained, occurs during sexual intercourse with the woman on top.  In these cases, during heightened excitement she will increase her thrusting and pull back too far, causing her to lose the penis from inside her.  As she comes back down again she slams her body against her partner’s penis with force.  She rams or compresses  the top of the penis against her pubic area of groin, causing it to sharply bend or buckle under her.  Typically the man will experience variable pain (often excruciating) , depending on how severely and completely his penis is folded and compressed.  This type of sexual injury can be so severe as to cause what is termed a “penis fracture” in which the inner layers of the penile shaft are abruptly torn.

I have also learned that men who have either a large penis, or a sexual partner with a short vagina, or a combination of both, are also subject to sexual trauma by repeatedly hitting the cervix of her uterus with the head of his penis.  Over time this repeated low grade trauma can result in Peyronie’s disease.

Regardless of the exact details of trauma, the central idea is that if the injury is great enough to cause even a small amount of tissue damage that causes any bleeding within the penis, even micro-bleeding,  it can cause Peyronie’s disease.  This happens because the bleeding will be followed by a period of healing during which certain blood growth factors are trapped and concentrated in the area, eventually causing an abnormal amount of scar tissue (or plaque) to develop within the layer called the tunica albuginea.


Peyronie’s disease cause #2:  Genetics 

Human genetics is what determines those characteristics and traits we share with members of our family.  It is a large and complicated subject with a unique vocabulary that is not necessary to describe here.  For this reason I will avoid any boredom that might come from a technical discussion.  What is important to know is that Peyronie’s disease has long been known to “run in families,” and that is what genetics is all about.

Underscoring the importance of genetic predisposition as the cause of Peyronie’s disease, remember that a  considerable number of males who sustain significant penis injury will never develop Peyronie’s disease.   The opposite of this is also true.  There are a considerable number of men who do not recall ever sustaining penis injury, major or minor, and still develop Peyronie’s disease – of these men, many have a family history of Peyronie’s disease.  These situations support the proposal that certain inherited traits or genetic predisposition  may play a role in who is susceptible to developing Peyronies; it is like there genetic tendency for this problem is so acute that it does not take much to make it happen.

Several studies done over the last 4o years supports the genetic component of Peyronie’s disease, having demonstrated that those men with a close family member who has Peyronie’s disease will have a 42% higher risk of developing it than if they did not have a family member also with it.

Lastly, a significant percentage of those with Peyronie’s disease will also demonstrate a similar type of connective tissue disorder, called fibrosis,  in other parts of the body in which an excess of scar-like inelastic masses of collagen and fibrin will accumulate.   When this type of tissue develops in the penis it is called Peyronie’s disease; when it develops in the palms of the hands it is called Dupuytren’s contracture; and when it develops in the soles of the feet it is called Ledderhose disease.   Approximately one third of all men with Peyronie’s disease will also display fibrosis in the hands and feet, and will have other family members who also are similarly affected.

Peyronie’s disease cause #3:  Drugs

The list of possible medications or substances mentioned in medical research sources describing drugs as a possible cause or contributor to Peyronie’s disease is long.

No formal research exists to prove the medications listed below actually cause Peyronie’s disease, yet presumptive evidence and frequent patient complaints of strong association with these drugs supports these as possible causes.  However, the greatest effort of drug companies is to add new drugs to the market place, not investigate problems with existing drugs that might cause them to be removed from the market place.   There are huge numbers of law suits in the court system currently proposing to prove that these drugs caused Peyronie’s disease as a side effect.  At this time proof of this connection is lacking.

While the foot-dragging continues, the wary patient should review this list and discuss the possible option with his physician of replacement of these drugs as part of an overall strategy for Peyronie’s disease treatment.

1.  Calcium channel blockers – a group of blood pressure lowering drugs

2.  Beta-blockers  – another high blood pressure medication group. These are the most common medications in popular use that list Peyronie’s disease as a potential side effect.  Common beta-blockers are:

Acebutolol                  Alrenolol                     Atenolol
Betaxolol                     Bucindolol                  Carteolol
Carvedilol                   Celiprolol                     Esmolol
Labetalol                      Metoprolol                Nadolol
Nebivolol                     Penbutolol                 Pindolol
Propranolol                Sotalol                         Timolol

3.  Interferon – a prescription drug that is found in other drugs used to treat hepatitis, leukemia and multiple sclerosis.   Its manufacturer lists Peyronie’s disease as a possible side effect.

4.  Dilantin – an anti-seizure medication that may be a risk factor for the development of Peyronie’s disease.

 

5. PDE5 drug group (Viagra, Cialis, Levitra)– this is a group of inhibitor drugs that block an enzyme process of the smooth muscle cells lining blood vessels, increasing blood flow in the penis in response to sexual stimulation.   The maker of each of these three drugs advises that men with Peyronie’s disease should consult with their doctors due to possible adverse effects on the penis.6. Statin drugs – used to lower elevated blood cholesterol.  Statin drugs are recognized to cause many side effects affecting the soft tissue of the musculoskeletal system (muscles, tendons, ligaments), and for this reason would seem logical as a cause of Peyronie’s disease since PD is all about the soft tissue of the penis.  Many men report their Peyronie disease started with the prolonged use of a statin drug.   A few statin drugs by name:
Altocor                        Advicor                Cadnet
Compactin                 Crestor                  Lescol
Lipex                            Lipobay                 Livalo
Mevacor                     Pepitor                  Pitava
Pravachol                  Pravastatin          Vytorin
Zocor

7.  Propecia (finasteride)  – the FDA continues to monitor this baldness drug for several side effects it causes related to sexual dysfunction long after men stop taking the drug.  Peyronie’s disease has been mentioned as related to Propecia use.

8.  Proscar (finasteride) – also contains finasteride, used to treat symptoms of enlarged prostate, and is often mentioned as a cause of Peyronie’s disease.

 

All these possible causes, contributors or aggravaters of Peyronie’s disease must be considered and evaluated for each individual case.  Under the supervision and direction of your treating doctor each Peyronie cause should be dealt with by eliminating or minimizing exposure if this is determined appropriate for the individual.   Google for more information about Peyronie’s disease causes.