Men with Peyronie’s disease (PD) typically present with complaints of penile deformity, but some patients also report suffering from pain and erectile dysfunction (ED). “There is a common misconception that penile pain is common in men with PD, but the reality is that only about 40% of those with the disease experience pain,” says John P. Mulhall, MD, MSc, FECSM. “In most cases, penile pain in PD resolves within 12 months. However, if the pain doesn’t resolve, further action is needed to evaluate the situation.”


A Stressful Experience

PD can be especially stressful, restrictive, and difficult for those with debilitating pain. Studies suggest that penile pain in men with PD can have a broad impact on psychosocial well-being, with data showing that these men report more psychological distress, depressive symptoms, and sexual dysfunction and lower self-esteem when compared with those without PD. However, few studies have been published on the prevalence, natural history, or predictors of penile pain in this population.

To address this research gap, Dr. Mulhall and colleagues examined potential factors associated with more penile pain and how pain impacted psychosocial factors. The study, published in Sexual Medicine, included 431 men with PD and used several validated questionnaires, including the Peyronie’s Disease Questionnaire (PDQ), the Self-Esteem and Relationship Questionnaire (SEAR), and the Center for Epidemiologic Studies Depression Scale Questionnaire (CES-D). The PDQ evaluates symptoms and psychological effects in patients with PD who had vaginal intercourse within the last 3 months to assess psychological and physical symptoms, penile pain, and bother, whereas SEAR evaluates psychosocial variables in men with ED and CES-D measures depressive symptoms.


Uncommon, But Impactful

“Our results showed that penile pain was reported by only about one-third of men with PD, so it was relatively uncommon,” says Dr. Mulhall. “For those who experienced pain, nearly two-thirds had painful erections, but just 7% had pain only when in a flaccid state.” About 20% of men in the study reported having pain in both the acute and stable stages of PD.

In adjusted logistic regression analyses, the study team found that advanced age was the most significant factor associated with penile pain, with older patients having less penile pain compared with younger patients (Table). Of note, the degree, direction, and location of penile curvature were not identified as predictors of penile pain in the study population.


An Important Psychosocial Impact

Study participants with penile pain had no significant differences in the average CES-D and SEAR scores when compared with men with no penile pain. However, PDQ scores for the physical/psychological symptom domain and the bother domain were significantly higher among men with penile pain. In addition, men with penile pain had a higher rate of clinically significant bother scores than men without penile pain (52% vs 35).

“About one-third of patients with PD who experienced pain had depression, which can lead to avoidance of sex or lower sex drive, among other consequences,” Dr. Mulhall says. “However, depression may not necessarily be related to the pain that these men experience. For most men with PD, pain isn’t a driver for treatment, depression, or emotional consequences. Instead, these patients tend to care more about the appearance of their penis and have concerns about the uncertainty of their condition.”


Proactively Think About Pain

In light of the findings, Dr. Muhall says greater attention should be given to the presence of pain, as well as its nature and magnitude, so patients are appropriately referred to specialist care when needed. “It’s important to conduct more research on the overall impact of penile pain in this patient population, including sexual function, self-esteem, and depression,” he says. “In addition, data are needed on potential treatments for debilitating pain in PD, such as shock wave therapy and injectable options, to optimize care for men with Peyronie’s disease.”