Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

The relationship between penile deformity, age, psychological bother, and erectile dysfunction in a sample of men with Peyronie’s Disease (PD)

Abstract

The aim of the present study was to investigate which PD specific factors (e.g., degree of penile curvature, levels of pain) cause most distress and to further explore whether there are specific subgroups of patients that report particularly high levels of psychological distress. Data were available for N = 119 men with a clinical diagnosis of PD presenting at a private Uro-Andrology in Germany. The strongest complaint of men with PD was being bothered by the look of the penis as opposed to being distressed by the pain (3.48 vs. 2.11). 75.4% reported having significantly less intercourse due to PD and for 61.4% this was very bothersome. Plaque size correlated positively with the level of symptom bother (r = 0.73, p < 0.05). Furthermore, men with a stronger curvature reported more concerns regarding size and form of the penis (r = 0.18, p < 0.05), more overall sexual dissatisfaction (r = −0.38, p < 0.001), and more PD related psychological and physiological symptoms (r = 0.58, p < 0.001). 44.4% of patients had a concurrent ED. Highest level of symptom bother was reported by men with a a strong curvature and a comorbid ED. Clinicians should pay special attention to patients presenting with extreme penile deformity and impaired sexual functioning, as they show the highest levels of psychological distress. Here, additional psychosexual support might be necessary.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Pryor JP, Ralph DJ. Clinical presentations of Peyronie’s disease. Int J Impot Res. 2002;14:414–7.

    Article  PubMed  CAS  Google Scholar 

  2. Sommer F, Schwarzer U, Wassmer G, Bloch W, Braun M, Klotz T, Engelmann U. Epidemiology of Peyronie’s disease. Int J Impot Res. 2002;14:379–83.

    Article  PubMed  CAS  Google Scholar 

  3. Schwarzer U, Sommer F, Klotz T, Braun M, Reifenrath B, Engelmann U. The prevalence of Peyronie’s disease: results of a large survey. BJU Int. 2001;88:727–30.

    Article  PubMed  CAS  Google Scholar 

  4. Lindsay MB, Schain DM, Grambsch P, Benson RC, Beard CM, Kurland LT. The incidence of Peyronie’s disease in Rochester, Minnesota, 1950 through 1984. J Urol. 1991;146:1007–9.

    Article  PubMed  CAS  Google Scholar 

  5. Bjekic MD, Vlajinac HD, Sipetic SB, Marinkovic JM. Risk factors for Peyronie’s disease: a case-control study. BJU Int. 2006;97:570–4.

    Article  PubMed  Google Scholar 

  6. Herati AS, Pastuszak AW. The genetic basis of Peyronie’s disease: a review. Sex Med Rev. 2016;4:85–94.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Moreno SA, Morgentaler A. Testosterone deficiency and Peyronie’s disease: pilot data suggesting a significant relationship. J Sex Med. 2009;6:1729–35.

    Article  PubMed  CAS  Google Scholar 

  8. Davila HH, Magee TR, Zuniga FI, Rajfer J, Gonzalez-Cadavid NF. Peyronie’s disease associated with increase in plasminogen activator inhibitor in fibrotic plaque. Urol. 2005;65:645–8.

    Article  PubMed  Google Scholar 

  9. Mulhall JP. Expanding the paradigm for plaque development in Peyronie’s disease. Int J Impot Res. 2003;5(suppl 5):S93–102.

    Article  Google Scholar 

  10. Iacono F, Prezioso D, Ruffo A, Illiano E, Romis L, Di Lauro G, Romeo G, Amato B. Testosterone deficiency causes penile fibrosis and organic erectile dysfunction in aging men. Evaluating association among Age, TDS and ED. BMC Surg. 2012;12(Suppl 1):S24.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Smith JF, Walsh TJ, Conti SL, Turek P, Lue T. Risk factors for emotional and relationship problems in Peyronie’s disease. J Sex Med. 2008;5:2179–84.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Nelson CJ, Diblasio C, Kendirci M, Hellstrom W, Guhring P, Mulhall JP. The chronology of depression and distress in men with Peyronie’s disease. J Sex Med. 2008;5:1985–90.

    Article  PubMed  Google Scholar 

  13. Rosen R, Catania J, Lue T, Althof S, Henne J, Hellstrom W, Levine L. Impact of Peyronie’s disease on sexual and psychosocial functioning: Qualitative findings in patients and controls. J Sex Med. 2008;5:1977–84.

    Article  PubMed  Google Scholar 

  14. Hartzell R. Psychosexual symptoms and treatment of Peyronie’s disease within a collaborative care model. Sex Med. 2014;2:168–77.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mulhall JP, Schiff J, Guhring P. An analysis of the natural history of Peyronie’s disease. J Urol. 2006;175:2115–8. discussion 2118

    Article  PubMed  Google Scholar 

  16. Bella AJ, Perelman MA, Brant WO, Lue TF. Peyronie’s disease (CME). J Sex Med. 2007;4:1527–38.

    Article  PubMed  CAS  Google Scholar 

  17. El-Sakka AI. Prevalence of Peyronie’s disease among patients with erectile dysfunction. Eur Urol. 2006;49:564–9.

    Article  PubMed  Google Scholar 

  18. Hellstrom WJ, Feldman R, Rosen RC, Smith T, Kaufman G, Tursi J. Bother and distress associated with Peyronie’s disease: validation of the Peyronie’s disease questionnaire. J Urol. 2013;190:627–34.

    Article  PubMed  Google Scholar 

  19. Coyne KS, Currie BM, Thompson CL, Smith TM. Responsiveness of the Peyronie’s Disease Questionnaire (PDQ). J Sex Med. 2015;12:1072–9.

    Article  PubMed  Google Scholar 

  20. Giraldi A, Rellini A, Pfaus JG, Bitzer J, Laan E, Jannini EA, Fugl-Meyer AR. Questionnaires for assessment of female sexual dysfunction: a review and proposal for a standardized screener. J Sex Med. 2011;8:2681–706.

    Article  PubMed  Google Scholar 

  21. Hatzichristou D, Rosen RC, Denogatis LR, Low WY, Sadovsky R, Symonds T. Recommendations for the clinical evaluation of men and women with sexual dysfunction. J Sex Med. 2010;7:337–48.

    Article  PubMed  Google Scholar 

  22. Fugl-Meyer KS, Nilsson M, Hylander B, Lehtihet M. Sexual function and testosterone level in men with conseratively treated chronic kidney disease. Am J Mens Health. 2017;11:1069–76.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Rosen RC, et al. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urol. 1997;49:822–30.

    Article  PubMed  CAS  Google Scholar 

  24. Cappelleri JC, et al. Some developments on the International Index of Erectile Function (IIEF). Drug Info. 1999;33:179–90.

    Article  Google Scholar 

  25. Wiltink J, Hauck EW, Phädayanon M, Weidner W, Beutel ME. Validation of the German version of the International Index of Erectile Function (IIEF) in patientswith erectile dysfunction, Peyronie’s disease and controls. Int J Impot Res. 2003;15:192–7.

    Article  PubMed  CAS  Google Scholar 

  26. Heinemann LAJ, Zimmermann T, Vermeulen A, Thiel C, Hummel W. A new ‘aging males’ symptoms’ rating scale. Aging Male. 1999;2:105–14.

    Article  Google Scholar 

  27. Daig I, Heinemann LA, Kim S, Leungwattanakij S, Badia X, et al. The Aging Males’ Symptoms (AMS) scale: review of its methodological characteristics. Health Qual Life Outcomes. 2003;1:77.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Heinemann L, Saad F, Zimmermann T, Novak A, Myon E, Badia X, Potthoff P, T’Sjoen G, Pöllänen P, Goncharow NP, Kim S, Giroudet C. The Aging Males’ Symptoms (AMS) scale: update and compilation of international versions. Health Qual Life Outcomes. 2003;1:15.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Silberstein LR, Mishkind ME, Striegel-Moore RH, Timko C, Rodin J. Men and their bodies: a comparison of homosexual and heterosexual men. Psychosom Med. 1989;51:337–46.

    Article  PubMed  CAS  Google Scholar 

  30. Veale D, Miles S, Read J, Troglia A, Wylie K, Muir G. Sexual functioning and behavior of men with body dysmorphic disorder concerning penis size compared with men anxious about penis size and with controls: a cohort study. Sex Med. 2015;3:147–55.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Herbenick D, Schick V, Reece M, Sanders SA, Fortenberry JD. The development and validation of the male genital self-image scale: results from a nationally representative probability sample of men in the United States. J Sex Med. 2013;10:1516–25.

    Article  PubMed  Google Scholar 

  32. Althof SE, Cappelleri JC, Shpilsky A, Stecher V, Diuguid C, Sweeney M, et al. Treatment responsiveness of the Self-Esteem And Relationship questionnaire in erectile dysfunction. Urol. 2003;61:888–92.

    Article  PubMed  Google Scholar 

  33. Lawrance K-A, Byers ES. Sexual satisfaction in long-term heterosexual relationships: the interpersonal exchange model of sexual satisfaction. Pers Rel. 1995;2:267–85.

    Article  Google Scholar 

  34. Rosen R, Catania J, Lue T, Althof S, Henne J, Hellstrom W, Levine L. Impact of Peyronie’s disease on sexual and psycho- social functioning: qualitative findings in patients and con- trols. J Sex Med. 2008;5:1977–84.

    Article  PubMed  Google Scholar 

  35. Wylie KR, Eardley I. Penile size and the “small penis syndrome”. BJU Int. 2007;99:1449–55.

    Article  PubMed  Google Scholar 

  36. Bacal V, Rumohr J, Sturm R, Lipshultz LI, Schumacher M, Grober ED. Correlation of degree of penile curvature between patient estimates and objective measures among men with Peyronie’s disease. J Sex Med. 2009;6:862–5.

    Article  PubMed  Google Scholar 

  37. El-Sakka AI. Prevalence of Peyronie´s disease among patients with erectile dysfunction. Eur Urol. 2006;49:564–9.

    Article  PubMed  Google Scholar 

  38. Paulis G, Romano G, Paulis A. Prevalence, psychological impact and risk factors of erectile dysfunction in patients with Peyronie´s disease: a retrospective analysis of 309 cases. Res Rep Urol. 2016;8:95–103.

    PubMed  PubMed Central  Google Scholar 

  39. Serefoglu EC, Smith TM, Kaufman GJ, Liu G, Yafi FA, Hellstrom WJG. Factors associated with erectile dysfunction and the Peyronie’s disease questionnaire in patients with Peyronie disease. Urology. 2017;107:155–60.

    Article  PubMed  Google Scholar 

  40. Chung E, De YL, Brock GB. Penile duplex ultrasonography in men with Peyronie’s disease: is it veno-occlusive dysfunction or poor cavernosal arterial inflow that contributes to erectile dysfunction? J Sex Med. 2011;8:3446–51.

    Article  PubMed  Google Scholar 

  41. Cavallini G, Biagiotti G, Lo Giudice C. Association between Peyronie disease and low serum testosterone levels: detection and therapeutic considerations. J Androl. 2012;33:381–8.

    Article  PubMed  CAS  Google Scholar 

  42. Sturm R, Rumohr J, Lipshultz L, Mohamed O, Khera M. Increased incidence of hypogonadism in patients with a novel diagnosis of peyronie’s disease as compared to organic erectile dysfunction. J Urol. 2009;181:278–9.

    Article  Google Scholar 

  43. Shenoy-Bhangle A, Perez-Johnston R, Singh A. Penile imaging. Radiol Clin North Am. 2012;50:1167–81.

    Article  PubMed  Google Scholar 

Download references

Funding

This study received no external funding.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrea Burri.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Burri, A., Porst, H. The relationship between penile deformity, age, psychological bother, and erectile dysfunction in a sample of men with Peyronie’s Disease (PD). Int J Impot Res 30, 171–178 (2018). https://doi.org/10.1038/s41443-018-0029-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-018-0029-3

This article is cited by

Search

Quick links