The Peyronie's Curve May Send Mental Health Spiraling
Today, we know much about how the mind and body are connected. Physical illnesses can be caused by, or elicit, a mental illness, and vice versa. One such condition is Peyronie's disease, a buildup of fibrous scar tissue in the penis that causes curved, sometimes painful, erections. It's a physical condition, yes, but it can also directly cause depression in men.
Estimates indicate more than 1 in 10 men in the United States have Peyronie's, but the disease is considered underreported. While penises come in different shapes and sizes, men with a curved penis might not be able to have penetrative sex easily or maintain an erection.
These men are also more likely to suffer from depression, because the disorder directly affects their sex life and body image. About 50 percent of men with Peyronie's disease also suffer from depressive symptoms, and as many as 80 percent report distress related to the condition, according to a 2016 study published in the journal Translational Andrology and Urology.
Unlike some other penile conditions, such as chordee, a person isn't born with Peyronie's disease. It typically develops over time due to repeated microtears during vigorous sex or after a sports injury or other trauma to the penis, though this latter explanation is not universally accepted by medical organizations.
These tears cause scar tissue, called plaque, to form in the penis and lead to a curved erection. However, not everyone who has an accident or injury to their penis develops Peyronie's. In fact, many researchers believe the disease has genetic or environmental components.
How can Peyronie's cause depression?
More than 50 percent of men report that Peyronie's negatively impacts their relationship, according to the aforementioned 2016 study. Men in the study described themselves as "abnormal" and felt shame and stigmatization.
"In addition to depression, men can have relationship issues, body image concerns, issues with sexual performance and a feeling of isolation," said Rena Malik, M.D., a urologist based in the Baltimore area, adding that because of perceived stigma, men don't typically speak to their partners or healthcare professionals about Peyronie's, which in turn causes isolation.
Men who have Peyronie's seem to struggle with depression after the disease becomes a regular part of their life. Malik suggested their feelings don't change based on how long they've had Peyronie's, which indicates most men don't actually get used to the condition.
Unfortunately, Peyronie's won't dissipate on its own. Penile shortening and curved erections can remain or worsen over time.
Do urologists screen Peyronie's patients for depression?
All men with Peyronie's should be screened for mental and emotional concerns and referred to a mental health provider with expertise in sexual and relationship issues, Malik said.
However, this doesn't always happen.
"Men's mental health is an often-ignored topic. Men are often taught by society that the essence of masculinity is to be tough and tough it out," said Jordan Luskin, M.D., a urologist with the Palm Beach Health Network Physician Group and Good Samaritan Medical Center in West Palm Beach, Florida. "Men don't often seek help for medical problems at large, let alone for mental health issues."
Doctors don't typically refer patients with Peyronie's to a therapist, at least not right away, because they try to fix the source of the depression first. However, speaking to a therapist should be discussed, especially if treatment doesn't work as planned.
Sex therapists in particular can help patients continue to have a healthy sex life—talk therapy and cognitive behavioral therapy are two arrows in their quiver—which can decrease their depression and help them restore a positive body image.
It's important for people with Peyronie's to seek emotional support—and for people in their life to provide it. Penile deformity is a sensitive, taboo topic, but it doesn't have to be. Medical professionals, especially men's health specialists, won't judge or even view the condition as "abnormal," so men should feel comfortable opening up to them. It may take time to normalize Peyronie's disease with a larger audience, but the years-long TV ad campaign has helped, so the stigma is decreasing.
Men with Peyronie's face tremendous uncertainty, because they don't know if treatment can help or if they'll have to live the rest of their life with a sexual deformity. Patients should seek a urologist who works with a psychologist and cares as much about their mental health as their physical health.
Peyronie's disease treatment
People with the disease may explore treatment such as surgery, noninvasive shock wave therapy to remove the plaque causing the penile curve, or Xiaflex, the only prescription medication for Peyronie's approved by the Food and Drug Administration. Other treatments include penile implants, penile traction therapy and verapamil medication.
Unfortunately, none of these treatments are guaranteed. The sooner you undergo treatment, however, the better your chances of improving the symptoms.
If you have Peyronie's disease, consult your doctor to find the ideal treatment based on the severity of your condition. It's equally imperative to ask them for a referral to a therapist if you're also suffering from depression or other mental health disorder.
"We can hope to improve on the stigma by letting patients know, through articles like these and through our interactions with them in the office, that it is OK to reach out," Luskin said.