Impact of Peyronie's Disease on Sexual and Psychosocial Functioning: Qualitative Findings in Patients and Controls

Abstract

Introduction There are no validated scales for assessing the psychosocial impact of Peyronie's disease (PD), which affects approximately 5–10% of men over age 50. Aim To develop a psychometrically valid outcome measure for assessing psychosocial and sexual consequences of PD. To conduct a qualitative study of men with PD and age-matched controls, and design a new patient-reported outcome measure of PD. Methods An expert advisory panel identified relevant topics and conceptual areas to be addressed based on clinical experience and literature reviews. A conceptual model was developed to serve as a discussion guide for qualitative interviews with geographically and ethnically diverse PD subjects and controls. Interviews were conducted in a focus-group format by a trained interviewer and were recorded and transcribed for qualitative analysis according to grounded theory concepts. Main Outcome Measure Focus-group interviews. Results Focus-group interviews were conducted with 64 men (28 PD patients, 36 controls) in 13 separate focus groups over a 3-month period. Blinded analysis of the interview transcripts identified four core domains: (i) physical appearance and self-image; (ii) sexual function and performance; (iii) PD-related pain and discomfort; and (iv) social stigmatization and isolation. Based on feedback from participants and experts, a new outcome questionnaire was developed to assess core domain responses in a structured, self-report format. Conclusion This qualitative study helped to refine and broaden the focus of the conceptual model for further assessment. It also confirmed that PD has a major impact on sexual and psychological function in these patients.

Surgery for Peyronie's disease

“…Although curvature is the hallmark symptom of disease, shortening can be the most psychologically devastating, occurring in 70% of patients and ranging from 1 to 10 cm. 2,3 Determining whether there is a family history of PD or other fibrotic disorders such as Dupuytren's is also useful as it does appear to occur more frequently among males in the same family and through generations.…”

“…Although diminished rigidity may be associated with several underlying medical conditions such as diabetes, smoking and peripheral vascular disease, it may also be psychogenic in nature given the devastating psychological effects that PD has on the affected individual. 2,13 Questions regarding sexual dysfunction should include ejaculation, orgasm, and change in sensation.…”

“…1 The perceived loss of length and girth is often more disturbing than the curvature itself, all of which can lead to moderate to severe depressive symptoms, emotional, and relationship problems. 2,3 Despite a myriad of treatment options, PD remains a considerable therapeutic dilemma due to several factors including an incomplete understanding of its etiopathophysiology and the relative paucity of randomized, placebo-controlled trials. A general explanation of this disorder, which has gained acceptance, is that PD is a disorder in which genetically susceptible individuals experience a localized response to endogenous factors such as tumor growth factor-b, which are released in response to microtrauma.…”

Factors Associated With Erectile Dysfunction and the Peyronie's Disease Questionnaire in Patients With Peyronie Disease

“…2,8 Although pain typically resolves over time, 1 penile curvature or deformity persists and may impact patients' psychological health, relationships with their sexual partners, and emotional well-being. 9,10 For example, a singlecenter, cross-sectional study demonstrated that more than half of patients with PD experienced relationship problems because of the condition, and 81% reported emotional problems. 9 Furthermore, an observational study of 92 men with PD demonstrated that almost half (48%) indicated that they were depressed and that the depression had not resolved over time.…”

“…Factors underlying this connection remain unknown, 13 but both conditions have been associated with increased age, 2,14-16 comorbid disorders (eg, diabetes, 2,8,16 cardiovascular events, 17,18 radical prostatectomy 19,20 ), psychological symptoms, [9][10][11]15,21,22 and altered blood flow. 13 In addition, ED has been associated with depression, 22 which, similar to PD, may influence a patient's assessment of physical and psychological functioning.…”