Psychological and Psychosocial Distress
Limited data available consistently demonstrate negative effects of PD on psychological and psychosocial factors. Anxiety, depression, low self-worth and relationship discord have been associated with PD. The intensity of distress experienced does not necessarily correlate with the degree of penile curvature; that is, patients may show high distress in the presence of minimal penile curvature and vice versa. Common psychological concerns of patients with PD include appearance, physical/sexual attractiveness, self-image, sexual functioning and performance, PD-related pain and discomfort during intercourse, mood disturbances, general emotional distress, low self-esteem, feelings of isolation and social stigmatisation.
A high prevalence of emotional (81% of patients) and relationship (54% of patients) problems have been reported among PD patients. Emotional problems [odds ratio (OR), 6.9; confidence interval (CI) 3.0–15.9] and ability to have intercourse (OR 0.4; CI 0.2–0.7) were significant and independent predictors of relationship problems. In addition, relationship difficulties (OR 8.0; CI 3.3–19.7) and loss of penile length (OR 2.7; CI 1.2–6.2) are independent predictors of emotional problems. In addition, using the PD-specific patient-reported outcome questionnaire, a positive correlation was found between penile curvature and subjective bother of PD symptoms (r = 0.22).
The majority of men do not appear to adjust psychologically to their diagnosis of PD. Among men with disease lasting from 3 months to 8 years, 77% reported negative psychological effects because of PD. Overall, the psychological effects improved over the course of disease in 23% of the patients, worsened in 27% and remained unchanged in 28%. Among men whose PD lasted a mean of 1 year, clinically meaningful depression was found in 48% of patients, which remained consistent over time.
Studies suggest that early identification and treatment of PD may be associated with improvements in psychological distress. In particular, patients who receive timely information and reassurance about the disease and its treatment options, particularly interventions that address sexual functioning and penile shortening, may be more likely to experience less distress and an improved quality of life. Further support of the effect of PD treatment on patient distress is demonstrated by the significant improvement in patient-reported level of PD symptom bother among those receiving treatment with collagenase clostridium histolyticum (CCH) compared with placebo.