Peyronies disease causes remain somewhat of a puzzle for researchers. However, they have named some possible causes, including trauma, prostate cancer treatment, genetic and other lifestyle issues such as diabetes and erectile dysfunction. Perhaps the most popular theory is that the plaque associated with Peyronie’s disease develops after the penis is subjected to some type of trauma.
The trauma may be a recurring event, such as riding a bicycle or horse on a regular basis, or an acute injury, such as getting hit with a hockey puck in the penis or accidentally bending the penis during sexual intercourse.
A type of mild trauma that can recur over years is likely among all sexually active men who experience some amount of wear and tear on the structures involved in achieving an erection. It is possible that over time, some men are more likely than others to lose elasticity in their connective tissue and/or build up plaque, making them more susceptible to developing Peyronies disease and this being one of the main Peyronies disease causes.
Whether the trauma occurs once or recurs over time, the injury can result in localized bleeding inside the penis and affect the structures that surround the erectile tissue. Those structures include the two chambers (corpora cavernosa) that run the length of the penis and the septum, which is the connecting tissue that runs between the corpora cavernosa and attaches at the top and bottom of the tunica albuginea, the membrane that surrounds the corpora cavernosa.
If the penis is injured, part of the septum where it attaches to the tunica albuginea may stretch excessively and damage the tunica albuginea. This damage can include rupturing of small or even microscopic blood vessels, which in turn triggers the release of substances (cytokines) that cause inflammation between the many layers of the tunica albuginea. Over time, the inflammatory cells may release substances that cause fibrosis and affect elasticity. Eventually this process results in accumulation of plaque, excessive scar tissue, and deformity of the penis (bending or curvature).
Although trauma is one of the possible Peyronies disease causes, it does not explain why many men develop the condition slowly and without any precipitating traumatic event. Trauma also does not explain why Peyronies disease resolves by itself in some cases.
Several studies have examined other Peyronies disease causes, and a compilation of the results of three of these studies yields the following list of risk factors.However, experts are unclear about how these factors contribute to the condition (Agrawal 2008; Bjekic 2006; Casabe 2011):
- Genetic predisposition associated with a family history of Dupuytren contracture. About 30% of men with Peyronie’s disease also have Dupuytren contracture.
- Minor trauma to the blood supply of the penis, either accidental or inadvertent from a medical procedure such as transurethral resection of the prostate (TURP) or cystoscopy.
- Smoking
- Alcohol consumption
- Gout, which affects connective tissue healing
- Systemic vascular diseases such as diabetes, hypertension, and high cholesterol
- Use of propranolol
- History of nongonococcal urethritis
- Evidence of systemic arterial impairment
- Presence of erectile dysfunction
- Coital trauma (severe pain or “cracking” during sexual intercourse)
Several research teams have examined the physical and biochemical changes in men with Peyronies disease and uncovered some differences between men with the condition and men without it. One group discovered that men with Peyronies disease have more type III collagen than type I collagen in their tunica albuginea, while another found elevated type III collagen in the adjacent penile tissue. (Luangkhot 1992; Chiang 1992)
The importance of this difference in type of collagen is not yet clear. Yet another team found men with Peyronies disease have greater production of a substance involved in scar formation, which may be responsible for the increase in the accumulation of collagen seen in Peyronies disease. (El-Sakka 1997)
To conclude the list of Peyronies disease causes, some experts have suggested it is an autoimmune disorder, while others have associated it with a deficiency of vitamin E or high levels of serotonin. Clearly much is still unknown about what causes Peyronies disease, and this uncertainty has an effect on the treatment options available.
References
Agrawal V et al. Systemic vascular endothelial dysfunction in Peyronies disease causes. J Sex Med Nov 2008; 5(11):2688-93.
Bjekic MD et al. Risk factors for Peyronie’s disease: a case-control study. BJU Int Mar 2006; 97(3):570-74.
Casabé A et al. Risk factors of Peyronies disease causes. What does our clinical experience show? J Sex Med Feb 2011; 8(2):518-23.
Chiang PH et al. Study of the changes in collagen of the tunica albuginea in venogenic impotence and Peyronie’s disease. Eur Urol 1992; 21(1):48-51.
El-Sakka AI et al. Peyronie’s disease is associated with an increase in transforming growth factor-beta protein expression. J Urol Oct 1997; 158(4):1391-94
Luangkhot R et al. Collagen alterations in the corpus cavernosum of men with sexual dysfunction. J Urol Aug 1992; 148(2 Pt 1):467-71.