Risk Factors—Besides Trauma—That Can Throw Your Penis a Curve

As fully grown adults, men are generally past the dramatic physical alterations of adolescence.

Sure, guys may notice incremental bodily changes, such as waning energy, relentless flab accumulation or deteriorating eyesight. But the "What the hell is that?" phase of physical development is supposedly behind them.

Enter Peyronie's disease.

The effects of Peyronie's might be the closest adult men get to reexperiencing the uncertainty and low-level panic that can accompany changes during adolescence. That's because the condition involves the penis taking on a new shape: a curve, appearing either out of the blue or gradually, that might be painful or make an erection appear to be shorter.

For many men, seeing the trusty pal they've spent so many hundreds of hours getting to know over the years develop a whole new look can be more than a little disconcerting.

While one school of thought posits that Peyronie's can stem from a single traumatic incident, it can develop in other ways, too, and certain risk factors may determine who gets it.

Grading trauma on a curve

Peyronie's disease is thought to affect at least 10 percent of adult men, usually between 45 and 60 years old, although its frequency is believed to be underreported.

When it is documented, Peyronie's is frequently thought to have had an inciting incident, often when the man's partner is on top and a missed thrust brings their weight down on the end of the penis, causing it to "crack" inside.

These days, though, clinicians are pushing back against this "single trauma" narrative.

"A lot of theories don't necessarily indicate one event or one trauma, like a penile fracture," said Neel Parekh, M.D., whose Cleveland-area urology practice is affiliated with the Cleveland Clinic. "I'd say the leading theory is that over time, a series of micro-traumas to the penis—small bends in the penis from either manual stimulation or with certain sexual positions, particularly with the woman on top—leads to this plaque formation or scar tissue. It is a form of trauma, but it's not usually just one event patients can remember."

However, that doesn't mean Peyronie's shows up randomly. In fact, good evidence of a genetic component exists, supported by the link Peyronie's has to another connective tissue disorder called Dupuytren's disease, which affects the hands.

"Definitely [Peyronie's] tends to be associated with other medical conditions," Parekh said. "Dupuytren's disease, or Dupuytren's contracture, is when guys basically have scarring in their hand and their hand is unable to open completely. Almost 15 percent of guys that come to me with Peyronie's also have that diagnosis."

Further supporting the suggestion of a genetic component to Peyronie's is the much higher rate of incidence found in Caucasian men of European descent. It's rarely seen in men with an Asian or African background.

Peyronie's and ED

Another condition commonly seen in men who have Peyronie's is erectile dysfunction (ED). The question is, which came first, the ED or the Peyronie's?

Certainly, the prospect of operating with a suddenly curved, possibly painful and perhaps shorter penis could be enough to traumatize men into a less-than-ideal sexual response.

The order of events isn't always clear.

"It can go both ways," said William Brant, M.D., chief of urology at the Salt Lake City Veterans Affairs Medical Center. "A fully rigid, straight penis isn't really as subject to injury as one that is either curved or, worse, not quite rigid. The lack of tissue elasticity that goes with the Peyronie's may also cause or worsen ED."

Prostate cancer and Peyronie's

As if guys who have had their prostate gland removed aren't already facing enough challenges, a prostatectomy may also lead to the development of Peyronie's.

"Prostatectomy has also been shown to be a risk factor," Parekh said. "Probably that's due to the effect the surgery has on the erections, but I don't know that that's necessarily been elucidated."

A possible contributing factor is that the removal of the prostate gland leaves the man likely facing a minimum of a year or two of erectile problems. If the problems are not addressed, the result may be reduced blood flow as well as a lack of full rigidity, which could contribute to microtears and scar tissue buildup.

Other Peyronie's risk factors include:

• Age—it's less common in men younger than 30
• A family history of Peyronie's
• Diabetes

Bent but unbowed

At the end of the day, if the arc of your personal history bends toward, well, being bent, don't lose hope.

Once you get past the sometimes painful acute phase, which is the first six to 18 months of suffering from Peyronie's, you can easily live with the condition, as millions of other men do. Treatments are available to attempt to repair Peyronie's. But surgery isn't recommended unless the curvature is greater than 30 degrees, sex is impossible due to the curvature, or your penis remains extremely painful beyond the initial onset of the condition. You'll want to consult closely with your healthcare provider.

Be sure to get very clear information about what you can reasonably expect as a result of surgery or other treatments; it's highly unlikely you'll go back to exactly the way you were before.

It may be shocking at first to have a different-looking penis later in life, but always remember: Penis size, shape and curvature vary wildly.