Causes of Peyronie's Disease and Diagnosis
Why does Peyronie's disease develop – and how is it reliably diagnosed? This page explains the biological mechanism behind the condition, which risk factors are known, and how a thorough diagnosis is carried out at UGRS.
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How Does Peyronie's Disease Develop? – The Biological Mechanism
According to current understanding, Peyronie's disease is a wound-healing disorder affecting the tunica albuginea – the elastic sheath surrounding the erectile tissue of the penis.
Normally, minor injuries or strain in this tissue heal without lasting consequences. In Peyronie's disease, this healing process runs differently: excessive scar formation occurs. The resulting scar tissue – known as a plaque – is significantly less elastic than healthy tissue.
Why this faulty healing process occurs in some men and not in others is still not fully understood. It is thought that several factors interact – genetic predisposition, mechanical strain, and possibly inflammatory processes within the tissue.
Known Risk Factors
Genetic Predisposition
There is clear evidence that Peyronie's disease clusters within families. Men whose fathers or brothers are also affected have an increased risk. Whether an individual carries a genetic predisposition cannot be reliably determined in advance.
Association with Dupuytren's Contracture
There is a well-documented association between Peyronie's disease and Dupuytren's contracture – a condition of the palm in which connective tissue shortens and permanently pulls the fingers into a bent position. Both conditions are based on a similar mechanism of excessive scar formation. Men with Dupuytren's contracture have a significantly increased risk of Peyronie's disease.
Microtrauma
Repeated minor injuries to the tunica albuginea – for example through certain sexual practices, intense physical activity, or sport – can act as a trigger. In most cases, a single event is not enough; it is rather the repeated interplay of strain and faulty wound healing.
Pelvic Surgery
Certain surgical procedures – particularly radical prostatectomy – are associated with an increased risk of Peyronie's disease. The exact mechanism has not been conclusively established; it is thought that surgery on neighboring structures may affect the connective tissue in the penile area.
Metabolic Disorders
Diabetes mellitus and other metabolic disorders that affect blood flow or tissue repair are also associated with an increased risk of Peyronie's disease.
No Identifiable Trigger
In a substantial proportion of patients, no clear risk factor or trigger can be identified. This is not the exception but common – and should not cause feelings of guilt. The condition does not arise from any particular behavior or decision.
How Diagnosis of Peyronie's Disease Works
A thorough diagnosis is the foundation of every treatment decision. The diagnostic process at UGRS always begins with a detailed conversation – before any examination takes place.
Step 1: The Medical History Interview
During this conversation, we discuss together:
- When the first changes appeared
- How the symptoms have developed – better, worse, or stable?
- Whether and what kind of pain is present
- Whether erectile problems are present, and to what extent
- How much the condition affects sexual life and general well-being
- Relevant pre-existing conditions and previous procedures
This conversation is not only medically necessary – for many patients, it is also an initial relief. Many speak openly for the first time about symptoms that have accompanied them for a long time.
Step 2: Physical Examination
In many cases, plaques can already be felt during the physical examination. The location, size, and consistency of the hardened areas provide important clues about the extent of the condition. In addition, we ask for photographs of the erection, which the patient can take beforehand – a simple but valuable diagnostic tool for assessing the curvature.
Step 3: Ultrasound Examination
Ultrasound examination of the penis is the most important supplementary diagnostic procedure. It makes plaques visible, shows their precise location and extent, and provides information that cannot be detected by palpation alone. Calcified plaques are particularly well visualized on ultrasound.
Step 4: Additional Diagnostics When Needed
Depending on the individual situation, further examinations may be useful:
- Doppler ultrasound to assess penile blood flow – important when erectile problems are also present
- MRI in selected cases – for example with unclear findings or complex deformities
- Diagnostic workup for erectile dysfunction – if an erectile disorder is present alongside Peyronie's disease, this influences the treatment decision
Not every patient needs all of these examinations. What is appropriate always depends on the individual situation.
What Diagnosis Can Show – and What It Cannot
A good diagnosis answers three key questions: What is present? How advanced is the condition? And which treatment options should be considered?
What it cannot do: reliably predict how the condition will progress without treatment. The course of Peyronie's disease is individual – and cannot be read from findings alone.
That is why diagnosis is not an endpoint but a starting point. It gives you the foundation to discuss the right next steps together with an experienced physician.
Frequently Asked Questions About Causes and Diagnosis
Not in the strict sense. The condition arises from an interplay of genetic predisposition and external influences. No particular behavior causes Peyronie's disease – even though microtrauma is discussed as a contributing trigger. Feelings of guilt are not warranted.
A complete diagnosis requires an in-person examination. However, the initial conversation can also take place by phone or video consultation, to get an initial assessment and discuss the next steps.
The medical history interview, examination, and ultrasound diagnostics can be carried out in a single appointment. This typically takes about one to two hours, depending on the individual situation and the examinations required. We recommend that patients have preliminary examinations carried out by their local physician. At least these preliminary examinations are then usually covered by statutory or, in the case of basic policies, private health insurance – supporting patients along the way.
Many physicians in private practice, clinics, and university hospitals refer their patients to us. This is not strictly necessary. However, a precisely completed referral, together with the results of high-quality preliminary examinations, is welcome and supports your treatment. Please note: a referral does not mean that your health insurance will cover the cost of the surgery.
Schedule a Consultation
If you have noticed changes or are looking for a diagnosis, we are your point of contact – open, discreet, and with no obligation.
The first step isn't surgery – it's clarity.
Updated on July 31, 2026
