Peyronie's Disease: This is Not a Rare Health Problem

Peyronie's disease (PD) is a little known connective tissue disorder of the deeper tissue of the penis that has no recognized cause or cure; even the cellular pathology is not completely understood. Three primary criteria of PD are needed to establish a diagnosis of Peyronie’s disease, even though universal concensus does not exist even on these: 1) presence of a palpable nodule of fibrous tissue (called a “scar” or plaque), primarily detected in the thin fibrous layers of deep tissue (tunica albuginea) of the penile shaft , 2) variable pain reactions during an erection caused by tissue stretching , and 3) curvature or bending of the erect penis not present before PD developed. Men with PD have a variable ability to develop an erection; for some it is totally unchanged while for others it can be a significant problem. As a result, some of these men can have difficulty with vaginal penetration due to abnormal curvature, or pain for either partner during insertion.

Few people know anything about Peyronie’s disease, so it is assumed to be a rare health problem. Actually, the opposite appears to be the truth of the matter and it is becoming evident that PD is a fairly common disorder that is simply not talked about.

Recent review of Peyronie’s disease

According to a report published in 1995 by the National Institutes of Health, Peyronie's disease occurs in about 1% of men. It is said to be most common between the ages of 45 and 60, but it also occurs in young and elderly men. Prevalence may be higher because of reluctance to seek medical attention for the condition and failure to report.

On one hand, some official government reportes state that Peyronie’s disease occurs in about one man out of 200 (or 0.50%) of the US population. If that is so, then approximately 1.4 million men have PD in the US. Yet, in another equally official study, Peyronie's disease is a “rare disease” as determined by the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH). Their calculations show it is found in fewer than 200,000 US males.

Peyronie’s disease was reported in several studies during the latter 1980s to be present in apporoximately 0.4% to 2.0% of US men. Now, based on additional investigation in the last several years, this number is increasing; perhaps this change is simply due to a greater openness about sexual subjects.

There is a strong tendency for men to exaggerate as well as withhold information about sexual matters. Yet when it comes to PD they are most shy and withdrawn. This is so because there is a great amount of humilation and shame associated with the loss of penile size and outright sexual dysfunction that occurs during hte course of this condition. Therefore, most data about Peyronie's diasese has shown itself unreliable.

This question has studied recently using much larger samples of men, over a wider age variance, and using more reliable and accurate survey methods to record the data collected:

· Schwarzer, et al, used a PD questionnaire sent to 8,000 men around Cologne, Germany. The response rate of men to this questionnaire quite high - more than 55%. Results indicated the frequency of Peyronie’s disease in this normal male group (mean age, 57.4 years) to be an astounding 3.2%, or much greater than previously reported. Of the men in the 30-39 year age group, 1.5% had small localized nodules of dense tissue suggestive of PD; in the 40-49 year age group this rate increased to 3.0%; in the 50-59 year of age group it increased to 4.0%. In those men older than 70 years the presence of tissue density or hardening increased to 6.5%. All these age groups surpassed expectations. Of 142 men with a confirmed diagnosis of Peyronie’s disease, 58 (40.8%) admitted they also had concurrent erectile dysfunction, a known consequence of this disease.
· Matkov, et al, found 30 (7%) of the 453 men in the Peyronie’s disease study group were less than 40 years of age. Characteristics of this younger group with confirmed PD included: (1) easily recalled and a well defined traumatic event (injury during intercourse) was the cause of the PD problem; (2) mild to extreme pain during an erection, presented as a major complaint; (3) younger men tend to have a malformation or curvature 10-20 degrees greater than men in hte older age group.
· Department of Urology, Loyola University Medical Center, Maywood, Illinois, conducted a study in which the prevalence of Peyronie's disease was determined in a group of men being screened for prostate cancer. In this study 534 men agve a complete medical history, and had a physical examination performed by a urologist, as well as completed a Sexual Health Inventory for Men (SHIM) questionnaire. Peyroie's disease would only be diagnosed only in the presence of a palpable penile nodular plaque. In this study, 48 of these men had such a palpable penile nodule detected on physical examination, creating a prevalence rate of 8.9%. The mean age of men with Peyronie's disease was 68.2 years compared to a mean of 61.8 years in men without Peyronie's disease. The conclusion of this study was that the prevalence of Peyronie's disease was greater than in most previously reported series.
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Conclusion

Recent studies and reviews of the current medical literature indicates Peyronie’s disease is more common within the male population than previously recognized, and is greatly more common in the older (65+ years) population than any other age group. The average age of onset for PD is 53 years of age. It is clearly not well known among the general population, both male and female, it is not even well-known in the medical community. The reasons for this disparity are sundry, primarily more to due to social and psychosexual reasons than medical reasons. This is a “rare” disease that is obviously more widespread than previousky measured.