Peyronie’s plaque

What is a Peyronie’s plaque?

The infamous Peyronie’s plaque is the central problem of Peyronie’s disease.  It is a knot of fibrous tissue that is an over-reaction of the healing response that occurs after injury to the tunica albuginea layer of the penis.  It is not at all like the plaque made of cholesterol that clogs blood vessels  in and around the heart and other important organs.   This same Peyronie’s plaque, sometimes called a Peyronie’s scar, is  also not exactly like the scar that develops on the surface of your body as a result of an old injury or surgery.

Both terms are not very accurate, but they are used because foreign fibrous tissue cells are found in all three: blood vessels, scars that develop on the skin surface after a cut, as well as within the tunica albuginea layer of tissue after the penis has been injured.

The Peyronie’s plaque is of variable size, thickness and surface features.   When it is thick, rounded and dense it is usually easy to locate.  But when it is very small, very thin, and very soft, it is difficult for even a doctor to locate.  Even when a Peyronies plaque cannot be immediately discovered, its presence must be assumed if the penis shaft displays a newly developed bend, curve, dent, hourglass or bottleneck deformity, or if the penis has lost size of length or girth (circumference).   Both the distortion and reduced sized are a result of the Peyronie’s plaque that contracts and prevents expansion of the elastic tissue of the penis. 

Bottleneck and bent penis caused by Peyronie’s plaque

Even the unusual problem of partial erectile dysfunction that is common to Peyronie’s disease  is caused by the notorious Peyronie’s plaque.   This unusual phenomenon can cause the erection to be distorted.  It occurs because a portion of the penis is expanded and rigid with an erection at the same that another (large or small) portion of the penis is flaccid.  This occurs when the Peyronie’s plaque prevents a portion of the penile veins from closing and they therefore cannot create the characteristic hydraulic pressure that is required to develop the enlargement and rigidity that is characteristic of an erection. In these cases the penis will develop a full erection only in isolated and discrete areas, while adjacent areas remain small and soft  in isolated and discrete areas.  This phenomenon results in the penis appearing as though it has one or more dents or hinges along the shaft, or as a bottleneck or hourglass deformity.  Lastly, this ability of the Peyronie’s plaque to prevent closure of the penis veins that should trap blood to create the turgid hydraulic pressure state of the erection can be so widespread and total that a man can experience impotence because of the mechanical impediment to the blood vessels.   In these cases the Peyronie’s scar or plaque will case total erectile dysfunction.

Cellular make up of the plaque  

A developing Peyronie’s plaque appears as an exaggerated healing response to either repeated micro-trauma or a single macro-trauma of the small blood vessels of the tunica albuginea. While there is undeniable evidence that genetic factors and drug factors also participate in the start of Peyronie’s disease, trauma of some type usually is considered to be the most likely initiating cause of the Peyronies plaque or scar.

On the cellular level the developing Peyronie’s plaque initially consists mostly of fibrin threads deposited in a massive network throughout the injured area of the tunica albuginea layer below the surface of the penis. Peyronie’s plaques, or scars, later combine the dense threads of fibrin connective tissue with a smaller amount of reduced and fragmented elastic connective tissue fibers, plus a very large proportion of type III collagen material, a type of collagen that happens to be specially inclined to excessive scar development.  In about one-third of chronic cases of Peyronie’s disease, calcification of the plaque can occur over time.

The curved penis of Peyronie’s disease is created because the mass of dense fibrous plaque material does not stretch as easily or as fully as healthy normal tissue of the penis.  The healthy and normal tunica albuginea layer is composed of elastin fibers and collagen, while the plaque tissue of  Peyronie’s disease is primarily made of collagen.  This significant difference between the cellular composition, and the difference in their ability to stretch and elongate, of these two types of tissue is what causes a curved penis to develop during erection.

Peyronie’s plaque can be difficult to find sometimes

In some men the Peyronies plaque is easily found on manual examination, in others it is found with difficulty, and in some men the Peyronies plaque is never located with any confidence.  It can be aggravating for someone to have a nasty penis distortion but still be unable to locate the Peyronie’s plaque that is causing it.

To locate the offensive fibrous material a light and inquisitive touch is most essential, along with the confidence to know what enough normal tissue feels like so the abnormal and irregular tissue is identified. To discover the Peyronie’s plaque material  it is necessary to use a gentle touch; do not be heavy-handed, or press down into the deeper layers, because what you are looking for is located just below the surface of the skin.

Make peace with the Peyronie’s plaque; do not hate it and do not hate yourself.  Do your best to determine how it might be possible to assist your body to remove it as happens in about of men who develop Peyronie’s disease.