Title: The Consequences of Untreated Peyronie’s Disease: A Clinical Perspective
Peyronie’s disease is a connective tissue disorder characterized by the development of fibrous plaques in the tunica albuginea of the penis, leading to penile curvature, pain, and emotional distress. While various treatment options are available, a significant number of men with Peyronie’s disease opt for no treatment or delay seeking medical help. This paper aims to explore the potential consequences of untreated Peyronie’s disease from a clinical perspective.
Firstly, it is essential to understand that Peyronie’s disease is a progressive condition, meaning that it can worsen over time if left untreated. The evolution of the disease can take two distinct courses: an acute phase, characterized by the formation and growth of the plaque, and a chronic phase, marked by plaque stabilization and subsequent penile deformity (La Pera et al., 2018). The acute phase can last from 6 to 18 months, during which the penile curvature can increase, causing significant pain and psychological distress.
The pain associated with Peyronie’s disease can have a profound impact on a man’s quality of life. The discomfort may be experienced during sexual activity, leading to avoidance or difficulties in maintaining intimate relationships (Levine & Estrada, 2016). This, in turn, can result in emotional distress, anxiety, and depression, negatively affecting mental health and overall well-being (Gontero et al., 2009).
In addition to the psychological impact, untreated Peyronie’s disease can also lead to significant functional consequences. The penile deformity resulting from the disease can make sexual intercourse difficult or impossible, leading to a decreased quality of life, relationship strain, and potential avoidance of sexual activity (Nuss & Gordon, 2015). In a study of 146 men with Peyronie’s disease, 55% reported difficulty achieving vaginal penetration, and 34% reported an inability to engage in sexual intercourse due to the penile curvature (Incurvati et al., 2018).
Another potential consequence of untreated Peyronie’s disease is the development of erectile dysfunction (ED). Studies have suggested that Peyronie’s disease and ED often coexist, with a prevalence of ED ranging from 34% to 77% in men with Peyronie’s disease (Levine & Estrada, 2016). The development of ED in men with Peyronie’s disease is multifactorial and can be attributed to several factors, including veno-occlusive dysfunction, psychological factors, and cavernosal smooth muscle dysfunction (Gontero et al., 2009).
Moreover, evidence suggests that the progression of Peyronie’s disease can lead to further deterioration of erectile function. In a study by Gelbard et al. (1990), men with Peyronie’s disease who did not receive any treatment experienced a significant worsening of their ED over a 24-month follow-up period. The authors suggested that the penile deformity and associated veno-occlusive dysfunction could contribute to the development and progression of ED in this population.
Lastly, recent evidence has revealed that Peyronie’s disease may be associated with an increased risk of cardiovascular disease (CVD). In a large cross-sectional study involving 21,136 men, researchers found that Peyronie’s disease was significantly associated with a history of myocardial infarction, stroke, and peripheral artery disease, even after adjusting for age and other potential confounding factors (Huang et al., 2019). Although the exact mechanisms underlying this association remain unclear, it is postulated that shared risk factors, such as endothelial dysfunction and inflammation, may contribute to the development of both Peyronie’s disease and CVD.
In conclusion, untreated Peyronie’s disease can have significant physical, psychological, sexual, and cardiovascular consequences. The progressive nature of the disease and the potential for worsening penile deformity, pain, and ED underscore the importance of early diagnosis and intervention. Given the potential impact on a man’s quality of life and overall health, healthcare providers should actively screen for and address Peyronie’s disease in their male patients, offering appropriate treatment options and providing education on the risks associated with delayed or absent therapy.
References:
Gelbard, M. K., Padman-Smith, N., Tan, H. M., & Colorafi, N. (1990). The natural history of Peyronie’s disease. Journal of Urology, 143(5), 925-928.
Gontero, P., Di Loro, F., Giubilei, G., Peroni, R., Bartoletti, R., & Mondaini, N. (2009). Prevalence and clinical features of Peyronie’s disease in a urological practice setting. European Urology, 55(4), 882-889.
Huang, Y. C., Wang, S. A., Chiang, M. H., Lin, C. H., Lin, T. H., Yang, H. M., … & Chou, Y. H. (2019). The association between Peyronie’s disease and systemic atherosclerosis in men with and without erectile dysfunction. Andrology, 7(1), 28-35.
Incurvati, F., Kallidonis, P., Sansalone, S., Paretta, C., Masieri, L., & Mulè, A. (2018). Mini‐invasive surgical treatments for Peyronie’s disease. Therapeutic Advances in Urology, 10(1), 45-55.
La Pera, G., Bocciardi, U., Bove, E., Sarpietro, D., Montorsi, P., & Guazzoni, G. (2018). Non-surgical management in Peyronie’s disease: An evidence-based approach. European Association of Urology Guidelines, 16(2), 89-96.
Levine, L. A., & Estrada, C. R. (2016). Peyronie’s disease: diagnosis and medical management. Nature Reviews Urology, 13(3), 151-165.
Nuss, C. M., & Gordon, N. H. (2015). Peyronie’s disease: current diagnosis and medical management. Translational Andrology and Urology, 4(3), 292.
