Peyronie’s disease as a multifactorial disease: the combined effect of fibrosis, inflammation, and psychoemotional disorders on treatment outcome

Abstract

Peyronie’s disease is a chronic fibro-inflammatory disorder of the tunica albuginea characterized by penile deformity, pain, erectile dysfunction, and reduced quality of life. In addition to biological mechanisms, psychological factors play a significant but often underestimated role in clinical outcomes. Aim. To analyze the multifactorial nature of Peyronie’s disease and to justify the integration of psychogenic erectile dysfunction assessment into clinical management algorithms. A narrative review of publications indexed in international and Russian databases (PubMed/MEDLINE, Web of Science, Scopus, Google Scholar, eLIBRARY.RU) was performed. Studies addressing the pathogenesis of Peyronie’s disease, psychosocial aspects, and psychometric assessment tools were included. Chronic inflammation, TGF-β-driven fibrosis (TGF-β – transforming growth factor β), and dysregulation of extracellular matrix remodeling were identified as key pathogenic mechanisms. Psychological disturbances, including depression and sexual performance anxiety, are highly prevalent and contribute to a self-reinforcing cycle with erectile dysfunction. The analysis revealed insufficient integration of mental health assessment into clinical practice. The use of psychometric tools, including the Index of Psychogenic Erectile Dysfunction, is justified for patient stratification and optimization of treatment strategies. Peyronie’s disease should be considered a multifactorial condition requiring a biopsychosocial approach. Incorporation of psychogenic erectile dysfunction assessment using validated tools, including Psychogenic Erectile Dysfunction, may improve treatment outcomes and support personalized management.